Efficacy and effectiveness of high-dose versus standard-dose influenza vaccination for older adults: a systematic review and meta-analysis

  title={Efficacy and effectiveness of high-dose versus standard-dose influenza vaccination for older adults: a systematic review and meta-analysis},
  author={Jason K H Lee and Gary K L Lam and Thomas Shin and Jiyeon Kim and Anish Krishnan and David P. Greenberg and Ayman Chit},
  journal={Expert Review of Vaccines},
  pages={435 - 443}
ABSTRACT Background: Influenza is responsible for a significant disease burden annually, especially in older adults. This study reviews the relative vaccine efficacy or effectiveness (rVE) of high-dose inactivated trivalent influenza vaccine (HD-IIV3) compared to standard-dose influenza vaccines (SD-IIV3) in adults ≥65 against influenza-associated outcomes to inform evidence-based decision-making to shift clinical practice and standard of care in this population. Methods: A systematic review… 

Systematic review of the efficacy, effectiveness and safety of high-dose seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age.

From limited data, HD-IIV were found to be more effective in the prevention of laboratory-confirmed influenza, for a range of proxy outcome measures, and associated with more adverse events.

Relative and absolute effectiveness of high-dose and standard-dose influenza vaccine against influenza-related hospitalization among older adults - United States, 2015-2017.

During two U.S. influenza seasons, vaccine effectiveness was low to moderate for prevention of influenza hospitalization among adults aged ≥65 years.

Immunogenicity of high-dose trivalent inactivated influenza vaccine: a systematic review and meta-analysis

High-dose trivalent, inactivated, split-virus influenza vaccine (IIV3-HD) has been available in the US since 2009 and is consistently more immunogenic than IIV3-SD in adults aged ≥ 65 years, and appears more Immunogenic in immunocompromised individuals.

Cost-effectiveness of high dose versus adjuvanted trivalent influenza vaccines in England and Wales

Use of HD TIV over aTIV could increase clinical benefits and reduce the public health and economic burden of influenza, and was consistent across the secondary analysis and deterministic sensitivity analyses.

Evaluating the Relative Vaccine Effectiveness of Adjuvanted Trivalent Influenza Vaccine Compared to High-Dose Trivalent and Other Egg-Based Influenza Vaccines among Older Adults in the US during the 2017–2018 Influenza Season

Adjusted analyses demonstrated a significant benefit of aTIV against influenza- and respiratory-related events compared to the other egg-based vaccines.

An economic assessment of high-dose influenza vaccine: Estimating the vaccine-preventable burden of disease in the United States using real-world data

The causal interpretation of rate-change methods is discussed, a novel approach to test its sensitivity to violations of underlying assumptions is proposed and it is concluded that HD-IIV3 is associated with less hospitalizations compared to SD-I IV3 and aIIV2.

Comparing the Clinical and Economic Outcomes Associated with Adjuvanted versus High-Dose Trivalent Influenza Vaccine among Adults Aged ≥ 65 Years in the US during the 2019–20 Influenza Season—A Retrospective Cohort Analysis

The adjusted clinical and economic outcomes evaluated in this study were comparable between aIIV3 and HD-Iiv3e during the 2019–2020 influenza season.



Efficacy of high-dose versus standard-dose influenza vaccine in older adults.

Among persons 65 years of age or older, IIV3-HD induced significantly higher antibody responses and provided better protection against laboratory-confirmed influenza illness than did IIV3-SD.

Comparative effectiveness of high-dose versus standard-dose influenza vaccination in community-dwelling veterans.

High-dose (HD) trivalent inactivated vaccine was not found to be more effective than SD vaccine in protecting against hospitalization for influenza or pneumonia; however, a protective effect in the oldest subgroup of patients was found.

Relative Vaccine Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among Veterans Health Administration Patients

In protecting senior VHA patients against influenza- or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.

Efficacy of Recombinant Influenza Vaccine in Adults 50 Years of Age or Older

RIV4 provided better protection than standard‐dose IIV4 against confirmed influenza‐like illness among older adults and satisfied prespecified criteria for the primary noninferiority analysis and an exploratory superiority analysis.

A Double-Blind, Randomized Trial of High-Dose vs Standard-Dose Influenza Vaccine in Adult Solid-Organ Transplant Recipients

H vaccine demonstrated significantly better immunogenicity than SD vaccine in adult transplant recipients and may be the preferred influenza vaccine for this population.