Efficacy of live attenuated and inactivated influenza vaccines among children in rural India: A 2-year, randomized, triple-blind, placebo-controlled trial release_do527u2q4jahlgh3i52tp3v7vy

by Anand Krishnan, Lalit Dar, Siddhartha Saha, venkatesh vinayak narayan, Rakesh Kumar, Dr Ramesh Kumar, RITVIK, Shivram Dhakad, Reshmi Chokker, Avinash Choudekar, Giridara Gopal Parameswaran, Aashish Choudhary (+6 others)

Published in PLoS Medicine by Public Library of Science (PLoS).

Volume 18, Issue 4 e1003609 (2021)

Abstract

<jats:sec id="sec001"> <jats:title>Background</jats:title> Influenza is a cause of febrile acute respiratory infection (FARI) in India; however, few influenza vaccine trials have been conducted in India. We assessed absolute and relative efficacy of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) among children aged 2 to 10 years in rural India through a randomized, triple-blind, placebo-controlled trial conducted over 2 years. </jats:sec> <jats:sec id="sec002"> <jats:title>Methods and findings</jats:title> In June 2015, children were randomly allocated to LAIV, IIV, intranasal placebo, or inactivated polio vaccine (IPV) in a 2:2:1:1 ratio. In June 2016, vaccination was repeated per original allocation. Overall, 3,041 children received LAIV (<jats:italic>n</jats:italic> = 1,015), IIV (<jats:italic>n</jats:italic> = 1,010), nasal placebo (<jats:italic>n</jats:italic> = 507), or IPV (<jats:italic>n</jats:italic> = 509). Mean age of children was 6.5 years with 20% aged 9 to 10 years. Through weekly home visits, nasal and throat swabs were collected from children with FARI and tested for influenza virus by polymerase chain reaction. The primary outcome was laboratory-confirmed influenza-associated FARI; vaccine efficacy (VE) was calculated using modified intention-to-treat (mITT) analysis by Cox proportional hazards model (PH) for each year. In Year 1, VE was 40.0% (95% confidence interval (CI) 25.2 to 51.9) for LAIV and 59.0% (95% CI 47.8 to 67.9) for IIV compared with controls; relative efficacy of LAIV compared with IIV was −46.2% (95% CI −88.9 to −13.1). In Year 2, VE was 51.9% (95% CI 42.0 to 60.1) for LAIV and 49.9% (95% CI 39.2 to 58.7) for IIV; relative efficacy of LAIV compared with IIV was 4.2% (95% CI −19.9 to 23.5). No serious adverse vaccine-attributable events were reported. Study limitations include differing dosage requirements for children between nasal and injectable vaccines (single dose of LAIV versus 2 doses of IIV) in Year 1 and the fact that immunogenicity studies were not conducted. </jats:sec> <jats:sec id="sec003"> <jats:title>Conclusions</jats:title> In this study, we found that LAIV and IIV vaccines were safe and moderately efficacious against influenza virus infection among Indian children. </jats:sec> <jats:sec id="sec004"> <jats:title>Trial registration</jats:title> <jats:bold>Clinical Trials Registry of India <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=10921&amp;EncHid=&amp;modid=&amp;compid=%27,%2710921det%27" xlink:type="simple">CTRI/2015/06/005902</jats:ext-link></jats:bold>. </jats:sec>
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