Yinong Young-Xu1,2, Robertus Van Aalst1, Salaheddin M Mahmud3,4, Kenneth J Rothman5,6, Julia Thornton Snider7, Daniel Westreich8, Vincent Mor9,10, Stefan Gravenstein10,11,12,13, Jason K H Lee14,15, Edward W Thommes16,17, Michael D Decker16,18, Ayman Chit14,16. 1. Clinical Epidemiology Program, Veterans Affairs Medical Center, White River Junction, Vermont. 2. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. 3. Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Canada. 4. George & Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Canada. 5. RTI Health Solutions, Research Triangle Institute, Research Triangle Park, North Carolina. 6. Department of Epidemiology, Boston University School of Public Health, Massachusetts. 7. Precision Health Economics, Oakland, California. 8. Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, North Carolina. 9. Health Services, Policy, and Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island. 10. Veterans Administration Medical Center, Providence, Rhode Island. 11. Center for Geriatrics and Palliative Care, University Hospitals Cleveland Medical Center and Case Western Reserve University, Ohio. 12. Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island. 13. Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island. 14. Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada. 15. Sanofi Pasteur, Toronto, Ontario, Canada. 16. Sanofi Pasteur, Swiftwater, Pennslyvania. 17. Department of Mathematics & Statistics, University of Guelph, Ontario, Canada. 18. Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennesse.
Abstract
Background: We examined whether a high-dose inactivated influenza vaccine was more efficacious in preventing hospitalizations than a standard-dose vaccine in the Veterans Health Administration (VHA) senior population. Methods: This study estimated the relative vaccine effectiveness (rVE) of high dose versus standard dose using a retrospective cohort of VHA patients 65 years of age or older in the 2015-2016 influenza season. To adjust for measured confounders, we matched each high-dose recipient with up to 4 standard-dose recipients vaccinated at the same location within a 2-week period and having 2 or more pre-existing medical comorbidities. We used the previous event rate ratio method (PERR), a type of difference-in-differences analysis, to adjust for unmeasured confounders. Results: We evaluated 104965 standard-dose and 125776 high-dose recipients; matching decreased the population to 49091 standard-dose and 24682 high-dose recipients. The matched, PERR-adjusted rVE was 25% (95% confidence interval [CI], 2%-43%) against influenza- or pneumonia-associated hospitalization, 7% (95% CI, -2% to 14%) against all-cause hospitalization, 14% (95% CI, -8% to 32%) against influenza- or pneumonia-associated outpatient visit, 5% (95% CI, 2%-8%) against all-cause outpatient visit, and 38% (95% CI, -5% to 65%) against laboratory-confirmed influenza. Conclusions: In protecting senior VHA patients against influenza- or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.
Background: We examined whether a high-dose inactivated influenza vaccine was more efficacious in preventing hospitalizations than a standard-dose vaccine in the Veterans Health Administration (VHA) senior population. Methods: This study estimated the relative vaccine effectiveness (rVE) of high dose versus standard dose using a retrospective cohort of VHA patients 65 years of age or older in the 2015-2016 influenza season. To adjust for measured confounders, we matched each high-dose recipient with up to 4 standard-dose recipients vaccinated at the same location within a 2-week period and having 2 or more pre-existing medical comorbidities. We used the previous event rate ratio method (PERR), a type of difference-in-differences analysis, to adjust for unmeasured confounders. Results: We evaluated 104965 standard-dose and 125776 high-dose recipients; matching decreased the population to 49091 standard-dose and 24682 high-dose recipients. The matched, PERR-adjusted rVE was 25% (95% confidence interval [CI], 2%-43%) against influenza- or pneumonia-associated hospitalization, 7% (95% CI, -2% to 14%) against all-cause hospitalization, 14% (95% CI, -8% to 32%) against influenza- or pneumonia-associated outpatient visit, 5% (95% CI, 2%-8%) against all-cause outpatient visit, and 38% (95% CI, -5% to 65%) against laboratory-confirmed influenza. Conclusions: In protecting senior VHA patients against influenza- or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.
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