John J. Treanor, MD; H. Reid Mattison, MD; Ghinwa Dumyati, MD; Amos Yinnon, MD; Shirley Erb, RN; Diane O'Brien, RN; Raphael Dolin, MD; Robert F. Betts, MD
▪ Objective: To evaluate the efficacy of adding intranasal live attenuated cold-adapted influenza A vaccine to inactivated influenza vaccine to prevent influenza A in elderly residents of long-term-care institutions.
▪ Design: Randomized, double-blind, placebo-controlled study conducted over 3 years.
▪ Setting: Three large nursing homes.
▪ Participants: A total of 523 residents of nursing homes (mean age, 84.2 years).
▪ Interventions: All participants received trivalent inactivated influenza vaccine parenterally and were randomly assigned to receive either live attenuated influenza A (H3N2) virus vaccine or placebo intranasally.
▪ Measurements: Laboratory-documented influenza A was defined as a respiratory illness plus isolation of influenza A virus from nasal secretions, significant serologic response, or both. Participants were considered to have been exposed to influenza A if they resided in an institution in which cases of influenza A were documented. Outbreak-associated illnesses were defined as those occurring between the first and last isolation of influenza virus from within the institution, ± 3 days.
▪ Results: Participants who received intranasal vaccine and were subsequently exposed to influenza A had significantly lower rates of laboratory-documented influenza A (9 of 162 vaccine recipients compared with 24 of 169 placebo recipients; vaccine protective efficacy, 60.6%; 95% Cl, 18% to 82%), outbreak-associated respiratory illnesses (13 of 162 vaccine recipients compared with 34 of 169 placebo recipients; vaccine protective efficacy, 56.8%; Cl 23% to 76%), and outbreakassociated influenza-like illnesses (6 of 162 vaccine recipients compared with 18 of 169 placebo recipients; vaccine protective efficacy, 65.0%; Cl 17% to 86%).
▪ Conclusions: Intranasal immunization with live attenuated influenza A virus vaccine provided additional protection against influenza A when added to parenteral trivalent inactivated influenza vaccine among elderly nursing home residents.
Treanor JJ, Mattison HR, Dumyati G, Yinnon A, Erb S, O'Brien D, et al. Protective Efficacy of Combined Live Intranasal and Inactivated Influenza A Virus Vaccines in the Elderly. Ann Intern Med. ;117:625–633. doi: 10.7326/0003-4819-117-8-625
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Published: Ann Intern Med. 1992;117(8):625-633.
Geriatric Medicine, Infectious Disease, Influenza, Prevention/Screening, Vaccines/Immunization.
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