Impact of Repeated Prior Influenza Vaccination on Serum Hemagglutinin Inhibition Antibody Response to B/Victoria/Brisbane/60/2008-like virus in 2010-11 Inactivated Influenza Vaccine and Prior Seasonal Victoria and Yamagata Influenza B Lineage Components among Healthcare Personnel Open Access

Reich, Jeremy (2017)

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Introduction: Seasonal influenza B is an important contributor to the overall burden of influenza during each season. There is recent evidence of lower vaccine effectiveness (VE) against influenza A for those vaccinated in prior seasons. However, this relationship has not yet been investigated for influenza B.

Methods: Hemagglutination inhibition antibody (HI) assays were collected preseason and ~30 days post-vaccination from a prospective healthcare personnel (HCP) cohort. Eligible participants had confirmed medical and vaccination records for four years and received the 2010-11 trivalent inactivated influenza vaccine (IIV3) containing B/Brisbane/60/2008-like virus (B/Victoria). Preseason and post-vaccination geometric mean titers (GMTs), geometric mean ratio (GMR), and fold-change were assessed for B/Brisbane/60/2008 (B/Victoria), B/Florida/4/2006 (B/Yamagata), and B/Malaysia/2506/2004 (B/Victoria) response adjusted for age, sex, race, education, household size and hospital care responsibilities.

Results: All three viruses had post-vaccination fold change results inversely associated with the number of prior vaccinations and only B/Florida experienced a significant, direct, association for preseason GMT. B/Brisbane and B/Malaysia experienced a significant increase in adjusted GMR among those with no prior vaccinations (GMR = 1.61 and 1.42, respectively) compared to having received at least one prior vaccination. B/Florida exhibited a similar increase in adjusted GMR for no prior vaccinations (GMR = 1.18) and was significantly higher than HCP that received 2-4 prior vaccinations.

Conclusions: Our findings suggest that a single prior IIV3 vaccination reduces immune response and cross-reactivity of influenza B virus with non-significant differences between one and four prior vaccination responses. Ultimately, more research into specific B vaccine component response and cross-reactivity to other B viruses may be needed to optimize immunogenicity and vaccine effectiveness among HCP and other repeated vaccinees.

Table of Contents

Table of Contents

Chapter I: Background and Literature Review.. 1

Introduction. 1

Burden of Disease. 1

Epidemiology. 4

Immunization Practice. 5

Chapter II: Manuscript 8

Title, Authors, Abstract 8

Introduction. 10

Methods. 10

Results. 14

Discussion. 18

References. 22

Tables. 31

Figures. 35

Chapter III: Extended Discussion. 38

Public Health Implications. 38

Possible Future Directions. 39

Appendices. 41

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