Comparison of the immunogenicity and safety of a split-virion, inactivated, trivalent influenza vaccine (Fluzone®) administered by intradermal and intramuscular route in healthy adults

Abstract: The aim of the study was to determine whether reduced doses of trivalent inactivated influenza vaccine (TIV) administered by the intradermal (ID) route generated similar immune responses to standard TIV given intramuscularly (IM) with comparable safety profiles. Recent changes in immunization recommendations have increased the number of people for whom influenza vaccination is recommended. Thus, given this increased need and intermittent vaccine shortages, means to rapidly expand the vaccine supply are needed. Previously healthy subjects 18–64 years of age were randomly assigned to one of four TIV vaccine groups: standard 15μg HA/strain TIV IM, either 9μg or 6μg HA/strain of TIV ID given using a new microinjection system (BD Soluvia™ Microinjection System 1 [1] BD Soluvia™ is the trademark of BD micro-injection system, Becton Dickinson (BD), BD Medical Pharmaceutical Systems. ), or 3μg HA/strain of TIV ID given by Mantoux technique. All vaccines contained A/New Caledonia (H1N1), A/Wyoming (H3N2) and B/Jiangsu strains of influenza. Sera were obtained 21 days after vaccination and hemagglutination inhibition (HAI) assays were performed and geometric mean titers (GMT) were compared among the groups. Participants were queried immediately following vaccination regarding injection pain and quality of the experience. Local and systemic reactions were collected for 7 days following vaccination and compared. Ten study sites enrolled 1592 subjects stratified by age; 18–49 years [N =814] and 50–64 years [N =778]. Among all subjects, for each of the three vaccine strains, the GMTs at 21 days post-vaccination for both the 9μg and the 6μg doses of each strain given ID were non inferior to GMTs generated after standard 15μg doses/strain IM. However, for the 3μg ID dose, only the A/Wyoming antigen produced a GMT that was non-inferior to the standard IM dose. Additionally, in the subgroup of subjects 50–64 years of age, the 6μg dose given ID induced GMTs that were inferior to the standard IM TIV for the A/H1N1 and B strains. No ID dose produced a GMT superior to that seen after standard IM TIV. Local erythema and swelling were significantly more common in the ID groups but the reactions were mild to moderate and short-lived. No significant safety issues related to intradermal administration were identified. Participants given TIV ID provided favorable responses to questions about their experiences with ID administration. In conclusion, for the aggregated cohorts of adults 18–64 years of age, reduced doses (6μg and 9μg) of TIV delivered ID using a novel microinjection system stimulated comparable HAI antibody responses to standard TIV given IM. The reduced 3μg dose administered ID by needle and syringe, as well as the 6μg ID for subjects aged 50–64 years of age generated poorer immune responses as compared to the 15μg IM dose. [Copyright &y& Elsevier]