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TOPLINE:

Recombinant quadrivalent influenza vaccine (RIV4) and standard egg-based quadrivalent inactivated IV (IIV4) show comparable effectiveness in reducing influenza-related hospitalization among older adult nursing home residents studied across two influenza seasons (2019-2020 and 2020-2021).

METHODOLOGY:

• Researchers conducted a pragmatic cluster randomized trial to assess the effectiveness of RIV4 vs IIV4 among nursing home residents in the United States, who resided in the facility for 100 or more days before the start of influenza season.
• Overall, 144,565 person observations (mean age, 77.4 years; 63% women) across 1078 nursing homes from two influenza seasons, 2019-2020 and 2020-2021, were included.
• Nursing homes were cluster-randomized to vaccinate all their residents with either RIV4 or IIV4, and the resident-level hospitalization outcomes were evaluated using Medicare claims data.
• The primary outcome was respiratory-related hospitalization; the secondary outcomes included death and hospitalization due to any cause.
• Additional outcomes included pneumonia alone and hospitalizations due to pneumonia, influenza, major adverse cardiovascular events, and COVID-19.

TAKEAWAY:

• Respiratory-related hospitalizations were comparable between RIV4 (1.9%) and IIV4 (2.0%) groups (hazard ratio [HR], 1.01; 95% CI, 0.62-2.17).
• Pneumonia- and influenza-related hospitalization rates were also similar between the two groups (HR, 0.98; 95% CI, 0.41-2.47).
• For both vaccines, hospitalization outcomes and death, overall, and by season and subgroups (sex, race, and comorbidities) remained similar.

IN PRACTICE:

“On the basis of the current evidence, recombinant influenza vaccine remains a reasonable first-line choice, but these study findings do not suggest superiority for the nursing home population,” the authors wrote.

SOURCE:

This study was led by Kevin W. McConeghy, PharmD, MS, PhD, Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island. It was published online on January 02, 2025, in JAMA Network Open.

LIMITATIONS:

The COVID-19 pandemic significantly affected this study’s conclusions by restricting influenza activity during the study period. Poor vaccine match with circulating strains further complicated the assessment of vaccine effectiveness. The trial design also had limitations in controlling for individual-level adherence to the assigned vaccines.

DISCLOSURES:

This study was supported by a grant from Sanofi-Pasteur. Few authors reported receiving grants and personal fees from various pharmaceutical organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.