Estimation of the efficacy of live, attenuated influenza vaccine from a two-year, multi-center vaccine trial: implications for influenza epidemic control

The authors provide an analysis of data From a two-year (1996-1998), multic enter (ten US cities), double-blinded, placebo-controlled influenza vaccine trial in children. The vaccine was the trivalent cold-adapted influenza va ccine. Estimates are made of the vaccine efficacy for susceptibility to cul ture-confirmed influenza (VES) while taking inter-center variability in the risk of infection into account. Our overall estimate of VES against influe nza is 0.92 (95% confidence interval (CI) 0.89-0.94). In addition, for the second year, although the vaccine contained antigen for A/Wuhan-like (H3N2) , the estimated VES for epidemic variant A/Sydney-like (H3N2) was 0.89 (95% CI 0.81-0.94). Thus, the vaccine showed a high degree of protection agains t a variant not closely matched to the vaccine antigen. With regard to natu ral immunity, an influenza a infection in the first year reduces the estima ted risk of an influenza A infection in the second year by a factor of 0.88 (95% CI 0.21-0.98). When comparing year 1 to year 2,there is a negative co rrelation of -0.50 in the center-specific attack rates in the placebo group s, This is consistent with the theory that natural immunity provides overal l community protection to children. The authors argue that mass vaccination of 70% of the children with the cold-adapted influenza vaccine could provi de substantial protection to the community at large. (C) 2000 Elsevier Scie nce Ltd. All rights reserved.