In this episode, I’ll discuss the effect of high-dose versus standard-dose influenza vaccines on hospitalization outcomes and mortality in older adults.
The effects of high-dose vs standard-dose influenza vaccine in patients over 65 is uncertain. A group of authors published in The Lancet a systematic review and meta-analysis to compare the effects of high-dose inactivated influenza vaccine (HD-IIV) versus those of standard-dose inactivated influenza vaccine (SD-IIV) for hospitalization and mortality outcomes in patients over 65 years of age.
The authors found 14 different randomized controlled trials representing over half a million patients that met their criteria for comparing high-dose vs standard-dose influenza vaccine in patients over 65. Prespecified primary outcomes were hospitalization for influenza or pneumonia, hospitalization for influenza, hospitalization for pneumonia, hospitalization for laboratory-confirmed influenza, hospitalization for cardiorespiratory disease, all-cause hospitalization, and all-cause mortality; serious adverse events (SAEs) were the secondary outcome.
Compared with standard dose, high dose vaccination significantly reduced hospitalization with a relative risk ratio of 0.61 in favor of high dose. This translated into 4 fewer hospitalizations per 10,000 patients vaccinated with high-dose vaccine. Results were similar with hospitalization for lab-confirmed influenza with a RR of 0.68 and 4 fewer hospitalizations per 10,000.
However other outcomes had a stronger effect with high dose vaccination – per 10,000 patients vaccinated with high dose there were 15 fewer hospitalizations for cardiorespiratory disease, and 29 fewer all-cause hospitalizations.
Effects on mortality were not significant between the groups and neither was hospitalization for pneumonia alone, influenza or pneumonia combined, or serious adverse events.
The authors concluded:
HD-IIV could be considered as a strategy to reduce hospitalisation burden in adults 65 years or older; however, the evidence does not support routine preferential use across all older adults irrespective of context. Absolute benefits were modest on average, and the value of HD-IIV is likely to depend on baseline risk, health-care context, and implementation considerations.
Modest is probably the best way the authors could have characterized the findings of this research. Choosing the high dose vaccine might make more sense in a patient with an elevated risk of hospitalization, but further trials would be needed before claiming this strategy was ready for routine implimentation.
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