Safety and effectiveness of dose-sparing strategies for seasonal influenza vaccine

Antony, Jesmin

doi:10.1101/2020.07.31.20163717

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…The NACI Influenza Working Group reviewed and approved the protocol. The search strategies were developed in consultation with an experienced librarian based on pre-defined population, intervention, control, outcomes, study design and timeframe, and the following research questions (( 1 , 2 )): What is the safety and effectiveness of using fractional dosing strategies to deliver IM seasonal influenza vaccines? ; and What is the safety and effectiveness of using fractional dosing strategies to deliver seasonal influenza vaccine by ID administration?…”

Section: Methodsmentioning

confidence: 99%

Summary of the National Advisory Committee on Immunization (NACI) Statement—Recommendations on Fractional Influenza Vaccine Dosing in the Event of a Shortage: Pandemic preparedness

Sinilaite¹,

Doyon-Plourde²,

Harrison³

et al. 2023

CCDR

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Background At the commencement of a pandemic, it is important to consider the impact of respiratory infections on the health system and the possibility of vaccine shortages due to increased demand. In the event of an influenza vaccine shortage, a strategy for administration of fractional influenza vaccine doses might be considered. This article reviews the available evidence for efficacy, effectiveness, immunogenicity and safety of fractional influenza vaccine dosing, and summarizes the National Advisory Committee on Immunization (NACI) recommendations on fractional dosing strategies by public health programs in Canada. Methods Two rapid literature reviews were undertaken to evaluate the efficacy, effectiveness, immunogenicity and safety of fractional influenza vaccine dosing via the intramuscular or intradermal route. The NACI evidence-based process was used to assess the quality of eligible studies, summarize and analyze the findings, and apply an ethics, equity, feasibility and acceptability lens to develop recommendations. Results There was limited evidence for the effectiveness of fractional influenza vaccine dosing. Fractional dosing studies were primarily conducted in healthy individuals, mainly young children and infants, with no underlying chronic conditions. There was fair evidence for immunogenicity and safety. Feasibility issues were identified with intradermal use in particular. Conclusion NACI recommended that, in the event of a significant population-level shortage of influenza vaccine, a full-dose influenza vaccine should continue to be used, and existing vaccine supply should be prioritized for those considered to be at high risk or capable of transmitting to those at high risk of influenza-related complications or hospitalizations. NACI recommended against the use of fractional doses of influenza vaccine in any population.

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Section: Methodsmentioning

confidence: 99%

Summary of the National Advisory Committee on Immunization (NACI) Statement—Recommendations on Fractional Influenza Vaccine Dosing in the Event of a Shortage: Pandemic preparedness

Sinilaite¹,

Doyon-Plourde²,

Harrison³

et al. 2023

CCDR

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“…Alternative dosing has also been considered for seasonal influenza (Antony et al, 2020;Pan-American Health Organization, 2009). Existing evidence from clinical trials suggests that alternative doses of some vaccines could yield high immune responses, comparable to those for standard doses of the same vaccines, and greater than those for some other, already approved vaccines.…”

Section: Evidence On Efficacy Under Dose-stretchingmentioning

confidence: 99%

Could Vaccine Dose Stretching Reduce COVID-19 Deaths?

Więcek

Ahuja

Kremer

et al. 2021

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We argue that alternative COVID-19 vaccine dosing regimens could potentially dramatically accelerate global COVID-19 vaccination and reduce mortality, and that the costs of testing these regimens are dwarfed by their potential benefits. We first use the high correlation between neutralizing antibody response and efficacy against disease (Khoury et. al. 2021) to show that half or even quarter doses of some vaccines generate immune responses associated with high vaccine efficacy. We then use an SEIR model to estimate that under these efficacy levels, doubling or quadrupling the rate of vaccination by using fractional doses would dramatically reduce infections and mortality. Since the correlation between immune response and efficacy may not be fully predictive of efficacy with fractional doses, we then use the SEIR model to show that fractional dosing would substantially reduce infections and mortality over a wide range of plausible efficacy levels. Further immunogenicity studies for a range of vaccine and dose combinations could deliver outcomes in weeks and could be conducted with a few hundred healthy volunteers. National regulatory authorities could also decide to test efficacy of fractional dosing in the context of vaccination campaigns based on existing immune response data, as some did for delayed second doses. If efficacy turned out to be high, the approach could be implemented broadly, while if it turned out to be low, downside risk could be limited by administering full doses to those who had received fractional doses. The SEIR model also suggests that delaying second vaccine doses will likely have substantial mortality benefits for multiple, but not all, vaccine-variant combinations, underscoring the importance of ongoing surveillance. Finally, we find that for countries choosing between approved but lower efficacy vaccines available immediately and waiting for mRNA vaccines, using immediately available vaccines typically reduces mortality.

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