ArticleVaccine2020
Relative effectiveness of high dose versus standard dose influenza vaccines in older adult outpatients over four seasons, 2015-16 to 2018-19.
Article in Vaccine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Relative Efficacy, Effectiveness and Safety of Newer and/or Enhanced Seasonal Influenza Vaccines for the Prevention of Laboratory-Confirmed Influenza in Individuals Aged 18 years and Over: Update of a Systematic Review.Reviews in medical virology · 2025Pooled it
- Absolute and Relative Effectiveness of Cell Culture-Based and Egg-Based Quadrivalent Inactivated Influenza (Flu) Vaccine Products From the 2014-2015 to 2018-2019 Seasons, US Flu VE Network.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Observational
- The Evolution of Annual Immunization Recommendations Against Influenza in Italy: The Path to Precision Vaccination.Vaccines · 2025Review
- ERS International Congress 2023: highlights from the Respiratory Infections Assembly.ERJ open research · 2024Article
- High-Dose Influenza Vaccine Is Associated With Reduced Mortality Among Older Adults With Breakthrough Influenza Even When There Is Poor Vaccine-Strain Match.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- The role of vaccination in COPD: influenza, SARS-CoV-2, pneumococcus, pertussis, RSV and varicella zoster virus.European respiratory review : an official journal of the European Respiratory Society · 2023Article
- High-dose influenza vaccine in older adults by age and seasonal characteristics: Systematic review and meta-analysis update.Vaccine: X · 2023Article
- How aging impacts vaccine efficacy: known molecular and cellular mechanisms and future directions.Trends in molecular medicine · 2022Review
- Methods to account for measured and unmeasured confounders in influenza relative vaccine effectiveness studies: A brief review of the literature.Influenza and other respiratory viruses · 2022Review
- Relative effectiveness of influenza vaccines in elderly persons in the United States, 2012/2013-2017/2018 seasons.NPJ vaccines · 2021Article
- Achieving Influenza Vaccine Uptake Target in Canada via a Pharmacy-Led Telephone Discussion during the 2019-2020 Season.Vaccines · 2021Article
Corrections and comments
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Authors and funding
18 authors at 7 institutions in 2 countries.
Funding
Abstract
backgroundNew influenza vaccine formulations are designed to improve vaccine effectiveness and protect those most vulnerable to infection. High dose trivalent inactivated influenza vaccine (HD-IIV3), licensed for ages ≥65 years, produces greater antibody responses and efficacy in clinical trials, but post-licensure vaccine effectiveness (VE) compared to standard dose (SD-IIV3/4) vaccine remains an open question.
methodsUsing a test-negative, case control design and propensity analyses to adjust for confounding, US Influenza VE Network data from the 2015-2016 through 2018-2019 seasons were analyzed to determine relative VE (rVE) between HD-IIV3 and SD-IIV3/4 among outpatients ≥65 years old presenting with acute respiratory illness. Influenza vaccination status was derived from electronic medical records and immunization registries.
resultsAmong 3861 enrollees, 2993 (78%) were vaccinated; 1573 (53%) received HD-IIV3 and 1420 (47%) received SD-IIV3/4. HD-IIV3 recipients differed from SD-IIV3/4 recipients by race, previous vaccination, number of outpatient visits in the previous year and timing of vaccination, and were balanced in the propensity model except the timing of vaccination. Compared with no vaccination, significant protection against any influenza A was observed from both HD-IIV3 (VE = 29%; 95%CI = 10%, 44%) and SD-IIV3/4 (VE = 24%; 95%CI = 5%, 39%); rVE = 18% (95%CI = 0%, 33%, SD as referent). When stratified by virus type, against A/H1N1, HD-IIV3 VE was 30% (95%CI = -7%, 54%), SD-IIV3/4 VE was 40% (95%CI = 10%, 61%), and rVE = -32%; (95%CI = -94%, 11%); Against A/H3N2, HD-IIV3 VE was 31% (95%CI = 9%, 47%), SD-IIV3/4 VE was 19% (95%CI = -5%, 37%), and rVE = 27%; (95% CI = 9%, 42%).
conclusionsAmong adults ≥65 years of age, recipients of standard and high dose influenza vaccines differed significantly in their characteristics. After adjusting for these differences, high dose vaccine offered more protection against A/H3N2 and borderline significant protection against all influenza A requiring outpatient care during the 2015-2018 influenza seasons.
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Registered trials
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