Abstract

BackgroundInfluenza vaccines contain Influenza A and B antigens and are adjusted annually to match the characteristics of circulating viruses. In Germany, Influenza B viruses belonged to the B/Yamagata lineage, but since 2001, the antigenically distinct B/Victoria lineage has been co-circulating. Trivalent influenza vaccines (TIV) contain antigens of the two A subtypes A(H3N2) and A(H1N1), yet of only one B lineage, resulting in frequent vaccine mismatches. Since 2012, the WHO has been recommending vaccine strains from both B lineages, paving the way for quadrivalent influenza vaccines (QIV).MethodsUsing an individual-based simulation tool, we simulate the concomitant transmission of four influenza strains, and compare the effects of TIV and QIV on the infection incidence. Individuals are connected in a dynamically evolving age-dependent contact network based on the POLYMOD matrix; their age-distribution reproduces German demographic data and predictions. The model considers maternal protection, boosting of existing immunity, loss of immunity, and cross-immunizing events between the B lineages. Calibration to the observed annual infection incidence of 10.6% among young adults yielded a basic reproduction number of 1.575. Vaccinations are performed annually in October and November, whereby coverage depends on the vaccinees’ age, their risk status and previous vaccination status. New drift variants are introduced at random time points, leading to a sudden loss of protective immunity for part of the population and occasionally to reduced vaccine efficacy. Simulations run for 50 years, the first 30 of which are used for initialization. During the final 20 years, individuals receive TIV or QIV, using a mirrored simulation approach.ResultsUsing QIV, the mean annual infection incidence can be reduced from 8,943,000 to 8,548,000, i.e. by 395,000 infections, preventing 11.2% of all Influenza B infections which still occur with TIV (95% CI: 10.7-11.8%). Using a lower B lineage cross protection than the baseline 60%, the number of Influenza B infections increases and the number additionally prevented by QIV can be 5.5 times as high.ConclusionsVaccination with TIV substantially reduces the Influenza incidence compared to no vaccination. Depending on the assumed degree of B lineage cross protection, QIV further reduces Influenza B incidence by 11-33%.

Highlights

  • Influenza vaccines contain Influenza A and B antigens and are adjusted annually to match the characteristics of circulating viruses

  • We have developed the simulation tool 4Flu to compare the effect of trivalent and quadrivalent vaccination on the incidence of influenza infection in Germany. 4Flu is based on an individual-based stochastic model, which allows for the independent and simultaneous transmission of the four influenza variants A(H1N1), A(H3N2), B/Vic and B/Yam

  • The composition of Trivalent influenza vaccines (TIV) during the evaluation period of our simulations is determined at random, our finding that in 53% of seasons, the B lineage not contained in TIV causes more infections than the B lineage which is contained in the vaccine is practically identical to findings from the US [11]

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Summary

Introduction

Influenza vaccines contain Influenza A and B antigens and are adjusted annually to match the characteristics of circulating viruses. The two Influenza B lineages are antigenically distinct [1,2,3]; genome sequence analysis revealed that they substantially differ as to the gene encoding the surface hemagglutinin [1,2] and that they continue to diverge [4,5]. Viruses of both B lineages co-circulate together with the Influenza A viruses A(H3N2) and A(H1N1) [6]. Influenza B infections cause severe disease in all age groups [7] and their clinical symptoms and outcomes are similar to those of Influenza A infections [8]

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