title: Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak.
abstract: OBJECTIVE
  To compare the efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine with the commercially available influenza hemagglutinin-subunit vaccine in preventing influenza in older adults living in a nursing home.
  
  
  METHODS
  A prospective, randomized, double-blind vaccine trial with 5 months of follow-up after vaccination.
  
  
  METHODS
  Fourteen Wisconsin nursing homes.
  
  
  METHODS
  Nursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy.
  
  
  METHODS
  Participants received, by intramuscular injection, 0.5 mL of a trivalent influenza vaccine containing 15 micrograms each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mL of an influenza vaccine containing the same antigens conjugated to diphtheria toxoid (HA-D).
  
  
  METHODS
  Blood was obtained pre- and 1 month post-vaccination to assess for any vaccine-induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained.
  
  
  RESULTS
  204 participants received HA and 204 received HA-D. Both groups had similar baseline antibody levels to all influenza antigens. HA-D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA-D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87-like and A/Victoria/7/87-like), fewer HA-D (29/195) than HA (43/204) recipients had laboratory-confirmed infection (P = 0.053), and, of these, fewer HA-D-treated subjects had lower respiratory tract involvement (5/29 HA-D and 17/43 HA) (P = 0.022).
  
  
  CONCLUSIONS
  HA-D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HA-D's ability to stimulate and recruit antigen-presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.
authors.affiliation: Department of Medicine, University of Wisconsin-Madison.
authors.forename: S
authors.initials: S
authors.lastname: Gravenstein
authors.forename: P
authors.initials: P
authors.lastname: Drinka
authors.forename: E H
authors.initials: EH
authors.lastname: Duthie
authors.forename: B A
authors.initials: BA
authors.lastname: Miller
authors.forename: C S
authors.initials: CS
authors.lastname: Brown
authors.forename: M
authors.initials: M
authors.lastname: Hensley
authors.forename: R
authors.initials: R
authors.lastname: Circo
authors.forename: E
authors.initials: E
authors.lastname: Langer
authors.forename: W B
authors.initials: WB
authors.lastname: Ershler
mesh_terms: D000368:Aged; D000917:Antibody Formation; D003428:Cross Infection / Q000517:prevention & control*; D004168:Diphtheria Toxoid / Q000008:administration & dosage* / Q000276:immunology; D004196:Disease Outbreaks; D004311:Double-Blind Method; D005260:Female; D019267:Hemagglutinin Glycoproteins, Influenza Virus; D006389:Hemagglutinins, Viral / Q000276:immunology*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control*; D008213:Lymphocyte Activation; D008297:Male; D009735:Nursing Homes; D011446:Prospective Studies; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000276:immunology
chemical_list: D004168:Diphtheria Toxoid; D019267:Hemagglutinin Glycoproteins, Influenza Virus; D006389:Hemagglutinins, Viral; D007252:Influenza Vaccines; D018074:Vaccines, Conjugate