title: Comparison of the immunogenicity and safety of a split-virion, inactivated, trivalent influenza vaccine (Fluzone®) administered by intradermal and intramuscular route in healthy adults.
abstract: The aim of the study was to determine whether reduced doses of trivalent inactivated influenza vaccine (TIV) administered by the intradermal (ID) route generated similar immune responses to standard TIV given intramuscularly (IM) with comparable safety profiles. Recent changes in immunization recommendations have increased the number of people for whom influenza vaccination is recommended. Thus, given this increased need and intermittent vaccine shortages, means to rapidly expand the vaccine supply are needed. Previously healthy subjects 18-64 years of age were randomly assigned to one of four TIV vaccine groups: standard 15 μg HA/strain TIV IM, either 9 μg or 6 μg HA/strain of TIV ID given using a new microinjection system (BD Soluvia™ Microinjection System), or 3 μg HA/strain of TIV ID given by Mantoux technique. All vaccines contained A/New Caledonia (H1N1), A/Wyoming (H3N2) and B/Jiangsu strains of influenza. Sera were obtained 21 days after vaccination and hemagglutination inhibition (HAI) assays were performed and geometric mean titers (GMT) were compared among the groups. Participants were queried immediately following vaccination regarding injection pain and quality of the experience. Local and systemic reactions were collected for 7 days following vaccination and compared. Ten study sites enrolled 1592 subjects stratified by age; 18-49 years [N=814] and 50-64 years [N=778]. Among all subjects, for each of the three vaccine strains, the GMTs at 21 days post-vaccination for both the 9 μg and the 6 μg doses of each strain given ID were non inferior to GMTs generated after standard 15 μg doses/strain IM. However, for the 3 μg ID dose, only the A/Wyoming antigen produced a GMT that was non-inferior to the standard IM dose. Additionally, in the subgroup of subjects 50-64 years of age, the 6μg dose given ID induced GMTs that were inferior to the standard IM TIV for the A/H1N1 and B strains. No ID dose produced a GMT superior to that seen after standard IM TIV. Local erythema and swelling were significantly more common in the ID groups but the reactions were mild to moderate and short-lived. No significant safety issues related to intradermal administration were identified. Participants given TIV ID provided favorable responses to questions about their experiences with ID administration. In conclusion, for the aggregated cohorts of adults 18-64 years of age, reduced doses (6 μg and 9 μg) of TIV delivered ID using a novel microinjection system stimulated comparable HAI antibody responses to standard TIV given IM. The reduced 3 μg dose administered ID by needle and syringe, as well as the 6 μg ID for subjects aged 50-64 years of age generated poorer immune responses as compared to the 15 μg IM dose.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. robert.frenck@cchmc.org
authors.forename: Robert W
authors.initials: RW
authors.lastname: Frenck
authors.forename: Robert
authors.initials: R
authors.lastname: Belshe
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Brady
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Winokur
authors.forename: James D
authors.initials: JD
authors.lastname: Campbell
authors.forename: John
authors.initials: J
authors.lastname: Treanor
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hay
authors.forename: Cornelia L
authors.initials: CL
authors.lastname: Dekker
authors.forename: Emmanuel B
authors.initials: EB
authors.lastname: Walter
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Cate
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.forename: Heather
authors.initials: H
authors.lastname: Hill
authors.forename: Mark
authors.initials: M
authors.lastname: Wolff
authors.forename: Tom
authors.initials: T
authors.lastname: Leduc
authors.forename: Nadia
authors.initials: N
authors.lastname: Tornieporth
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D000917:Antibody Formation; D005260:Female; D006385:Hemagglutination Inhibition Tests; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000276:immunology*; D053122:Influenza A Virus, H3N2 Subtype / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D007251:Influenza, Human / Q000276:immunology / Q000517:prevention & control; D007271:Injections, Intradermal; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D014611:Vaccination
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines