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Abstract: TH-PO904

High Dose and Quadrivalent Influenza Vaccine Safety and Efficacy in Dialysis Patients: Interim 2016-17 Flu Season Analysis

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Manley, Harold J., Dialysis Clinic Inc, Albany, New York, United States
  • Lacson, Eduardo K., Dialysis Clinic Inc, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States
  • Meyer, Klemens B., Tufts Medical Center, Boston, Massachusetts, United States
Background

Dialysis patients have high morbidity and mortality risk from influenza. During the 2016-17 flu season, Dialysis Clinic, Inc. administered Quadrivalent (Quad) and High Dose (High) flu vaccines. We compared safety and efficacy associated with each vaccine type.

Methods

All patients administered vaccine in clinic between 8/1/2016 and 12/31/2016 were followed thru 3/13/2017. Safety signal events were death, hospitalization, urgent care/ED visit or practitioner visit within 3 days of vaccination. Efficacy measures were death, hospitalization, and urgent care/ED visits ≥14 days post dose. Cox models were constructed for the entire population and within age subgroups (<65, ≥65 yrs old).

Results

There were 9393 patients vaccinated, 3646 (39%) with Quad and 5747 (61%) with High. Older patients were more likely to receive High flu vaccine (p<0.001). Hemodialysis was principal modality (90.2%). Safety signals were insignificant between vaccine type except for practitioner visit (1.6% v 0.5% in Quad and High patients, respectively (p<0.001). Vaccine hazard ratio (95% CI) and p-values regarding long term outcomes are shown in table. Kaplan-Meir survival curve for hospitalization is shown in figure.

Conclusion

Interim 2016-17 flu season analysis demonstrated that dialysis patients tolerated High and Quad vaccines similarly. High was associated with fewer hospitalizations in patients overall and ≥65 yrs old. High vaccine use also trended towards fewer hospitalizations in patients < 65 yrs old. No differences were noted in mortality rates. Dialysis providers should consider High flu vaccine in patients ≥65 yrs old.

OutcomeAge <65 groupAge≥ 65 groupOverall
HR (95% CI)P valueHR (95% CI)P valueHR (95% CI)P value
HOSP0.93 (0.82, 1.06)0.300.83 (0.73, 0.95)0.010.90 (0.82, 0.98)0.02
Death0.98 (0.73, 1.31)0.871.06 (0.82, 1.37)0.641.04 (0.86, 1.25)0.69
HOSP + Death0.95 (0.83, 1.07)0.370.86 (0.77, 0.97)0.020.92 (0.84, 1.00)0.06

HOSP = hospitalization