Effectiveness of Trivalent and Quadrivalent Inactivated Vaccines Against Influenza B in the United States, 2011–2012 to 2016–2017

Abstract

Background Since 2013, quadrivalent influenza vaccines containing 2 B viruses gradually replaced trivalent vaccines in the United States. We compared the vaccine effectiveness of quadrivalent to trivalent inactivated vaccines (IIV4 to IIV3, respectively) against illness due to influenza B during the transition, when IIV4 use increased rapidly. Methods The US Influenza Vaccine Effectiveness (Flu VE) Network analyzed 25 019 of 42 600 outpatients aged ≥6 months who enrolled within 7 days of illness onset during 6 seasons from 2011–2012. Upper respiratory specimens were tested for the influenza virus type and B lineage. Using logistic regression, we estimated IIV4 or IIV3 effectiveness by comparing the odds of an influenza B infection overall and the odds of B lineage among vaccinated versus unvaccinated participants. Over 4 seasons from 2013–2014, we compared the relative odds of an influenza B infection among IIV4 versus IIV3 recipients. Results Trivalent vaccines included the predominantly circulating B lineage in 4 of 6 seasons. During 4 influenza seasons when both IIV4 and IIV3 were widely used, the overall effectiveness against any influenza B was 53% (95% confidence interval [CI], 45–59) for IIV4 versus 45% (95% CI, 34–54) for IIV3. IIV4 was more effective than IIV3 against the B lineage not included in IIV3, but comparative effectiveness against illnesses related to any influenza B favored neither vaccine valency. Conclusions The uptake of quadrivalent inactivated influenza vaccines was not associated with increased protection against any influenza B illness, despite the higher effectiveness of quadrivalent vaccines against the added B virus lineage. Public health impact and cost-benefit analyses are needed globally.

Lineage-specific protection and immune imprinting shape the age distributions of influenza B cases

“…The same studies of strains from the late 1980s, 2000s and 2010s show that exposure to B/Victoria induces antibodies that inhibit hemagglutination by B/Yamagata, suggesting B/Victoria might protect against B/Yamagata even if this protection does not strongly affect the age distributions of cases. In contrast to the asymmetric cross-lineage protection suggested by these serological observations, cross-lineage protection in both directions has been observed in some vaccine efficacy studies but not in others, with unexplained variation across seasons and age groups (Belshe et al, 2010; Tricco et al, 2013; Ohmit et al, 2014; McLean et al, 2015; Skowronski et al, 2019; Drori et al, 2020; Gaglani et al, 2020). Longitudinal studies of infection and vaccination might reveal if cross-lineage protection differs between infection and vaccination or varies with age (e.g., via increased bias toward conserved epitopes in adults; Nachbagauer et al, 2016; Sun et al, 2019) or vaccine type (inactivated or live attenuated).…”

Interim estimates of 2019/20 vaccine effectiveness during early-season co-circulation of influenza A and B viruses, Canada, February 2020

“…Notwithstanding that vaccine mismatch, we found substantial VE of 69% overall and 77% in children. As previously highlighted, influenza B immuno-epidemiology is complex with cohort effects and cross-lineage interactions that may also play a role in vaccine protection [18,19,[22][23][24].…”

Natural immunity to influenza A and B among Saudi blood donors in Al Madinah Al Munawarah, Saudi Arabia

“…23,24 Typically, B-Victoria infects naive children/adolescents, whereas B-Yamagata infects both children and adults. [25][26][27] The influenza vaccine is seasonal and is recommended to be administered in KSA from September-March, which corresponds to the seasonality of Influenza in KSA. Influenza B virus has been shown to contribute considerably to winter respiratory disease, causing seasonal epidemics every 2 to 4 years.…”