Intradermal Trivalent Influenza Vaccination in Nursing Home Older Adults

Abstract

The recent report on “Intradermal Trivalent Influenza Vaccination in Nursing Home Older Adults” is very interesting. 1 Chan TC, Hung IF, Chan KH, et al. Immunogenicity and safety of intradermal trivalent influenza vaccination in nursing home older adults: A randomized controlled trial [published online ahead of print June 21, 2014]. J Am Med Dir Assoc. pii: S1525-8610(14)00285–0. Google Scholar Chan et al 1 Chan TC, Hung IF, Chan KH, et al. Immunogenicity and safety of intradermal trivalent influenza vaccination in nursing home older adults: A randomized controlled trial [published online ahead of print June 21, 2014]. J Am Med Dir Assoc. pii: S1525-8610(14)00285–0. Google Scholar concluded that “ID vaccination is noninferior, and even superior in some parts of immunogenicity assessment, to IM vaccination without compromising safety in nursing home older adults.” In fact, there are many considerations on the present study. First, it must be noted that “the immune response appears to partially depend on the delivery device and route of injection.” 2 Levin Y. Kochba E. Kenney R. Clinical evaluation of a novel microneedle device for intradermal delivery of an influenza vaccine: Are all delivery methods the same?. Vaccine. 2014; 32: 4249-4252 Crossref PubMed Scopus (54) Google Scholar The technique and injection device must be well selected to get the most appropriate immune response. 2 Levin Y. Kochba E. Kenney R. Clinical evaluation of a novel microneedle device for intradermal delivery of an influenza vaccine: Are all delivery methods the same?. Vaccine. 2014; 32: 4249-4252 Crossref PubMed Scopus (54) Google Scholar , 3 Van Damme P. Oosterhuis-Kafeja F. Van der Wielen M. et al. Safety and efficacy of a novel microneedle device for dose sparing intradermal influenza vaccination in healthy adults. Vaccine. 2009; 27: 454-459 Crossref PubMed Scopus (276) Google Scholar The basic pitfall in medical practice is the incorrect intradermal administration technique. In addition, to get the best immunogenicity, a specific device for intradermal administration is required for successful intradermal delivery. 2 Levin Y. Kochba E. Kenney R. Clinical evaluation of a novel microneedle device for intradermal delivery of an influenza vaccine: Are all delivery methods the same?. Vaccine. 2014; 32: 4249-4252 Crossref PubMed Scopus (54) Google Scholar Second, although the intradermal influenza vaccination is considered safe, a higher rate of local adverse effects (such as pain and erythema) is reported in some settings. 4 Hoon Han S. Hee Woo J. Weber F. et al. Immunogenicity and safety of Intanza(®)/IDflu(®) intradermal influenza vaccine in South Korean adults: A multicenter, randomized trial. Hum Vaccin Immunother. 2013; 9: 1971-1977 Crossref PubMed Scopus (12) Google Scholar , 5 Esposito S. Daleno C. Picciolli I. et al. Immunogenicity and safety of intradermal influenza vaccine in children. Vaccine. 2011; 29: 7606-7610 Crossref PubMed Scopus (18) Google Scholar Response to Comments on “Immunogenicity and Safety of Intradermal Trivalent Influenza Vaccination in Nursing Home Older Adults: A Randomized Controlled Trial”Journal of the American Medical Directors AssociationVol. 15Issue 10PreviewWe thank Professor Wiwanitkit for his important comments, to which we agreed. First, although intradermal (ID) vaccination may induce noninferior or even superior immunogenicity, it may be more difficult to deliver without a specific device. The technique also requires extra training when compared with intramuscular (IM) vaccination1 and the injection technique improves with experience. Incorrect administration affects the induced immunogenicity.2 Development of various ID vaccination devices makes ID vaccination less technically demanding. Full-Text PDF