Immunogenicity of influenza vaccine in elderly people: a systematic review and meta-analysis of randomized controlled trials, and its association with real-world effectiveness

Figures & data

Table 1. Summary of study characteristics

Study (year), Ref. [Publication dates]	Type of study	Total numberof subjects randomized/vaccinated(N)	Vaccine strains in QIV	Vaccine strains in TIV	Country	Vaccine manufacturer	Ethnicity(%)
Greenberg^Citation10 [2013]	open-label phase II	590	A/Brisbane/59/2007[H1N1]	TIV-Vic: A/Brisbane/59/2007[H1N1]	United States	Sanofi Pasteur Swiftwater, PA, USA	White (88.8) Asian (0.35) others (10.85)
			A/Uruguay/716/2007 [H3N2]	A/Uruguay/716/2007 [H3N2]
			B/Brisbane/60/2008[B/Vic]	B/Brisbane/60/2008[B/Vic]
			B/Florida/04/2006[B/Yam]	TIV-Yam: A/Brisbane/59/2007[H1N1]
				A/Uruguay/716/2007 [H3N2]
				B/Florida/04/2006[B/Yam]
Pépin^Citation12 [2013]	double-blind for QIV group open-label for TIV/Yam group phase III	1,565	A/California/07/2009[H1N1]	TIV-Vic: A/California/07/2009[H1N1]	France Germany	Sanofi Pasteur	White (98.7) Asian (0.5) others (0.8)
			A/Victoria/210/2009 [H3N2]	A/Victoria/210/2009 [H3N2]
			B/Brisbane/60/2008[B/Vic]	B/Brisbane/60/2008[B/Vic]
			B/Florida/04/2006[B/Yam]	TIV-Yam: A/California/07/2009[H1N1]
				A/Victoria/210/2009 [H3N2]
				B/Florida/04/2006[B/Yam]
Wang^Citation15 [2017]	double-blind Phase III	1,832	A/California/7/2009[H1N1]	TIV-Vic: A/California/7/2009[H1N1]	Lianyungang City from China	QIV: Jiangsu GDK Biotechnology Co., Ltd, China TIV:Changsheng Biology Science & Technology Co. Ltd, China	White (0) Asian (100) others (0)
			A/Switzerland/9715293/2013[H3N2]	A/Switzerland/9715293/2013[H3N2]
			B/Brisbane/60/2008[B/Vic]	B/Brisbane/60/2008[B/Vic]
			B/Phuket/3073/2013[B/Yam]	TIV-Yam: A/California/7/2009[H1N1]
				A/Switzerland/9715293/2013[H3N2]
				B/Phuket/3073/2013[B/Yam]
Sesay^Citation13 [2018]	double-blinded for QIV group and TIV/Yam single-blinded for TIV/Vic phase III	2,225	A/California/7/2009[H1N1]	TIV-Vic: A/California/7/2009[H1N1]	France, Germany Poland	Sanofi Pasteur, Lyon, France	White (99.14) Asian (NA) others (0.86)
			A/Texas/50/2012 [H3N2]	A/Texas/50/2012 [H3N2]
			B/Brisbane/60/2008[B/Vic]	B/Brisbane/60/2008[B/Vic]
			B/Massachusetts/2/2012[B/Yam]	TIVYam: A/California/7/2009[H1N1]
				A/Texas/50/2012 [H3N2]
				B/Massachusetts/2/2012[B/Yam]
Witte^Citation13 [2018]	double-blind Phase III	1,980	A/California/7/2009[H1N1]	TIV/Vic: A/California/7/2009[H1N1]	Belgium Germany Hungary Latvia Lithuania	Abbott Biologicals B.V	White(99.5) Asian(0.2) Others(0.3)
			A/Texas/50/2012[H3N2]	A/Texas/50/2012[H3N2]
			B/Brisbane/60/2008[B/Vic]	B/Brisbane/60/2008[B/Vic]
			B/Massachusetts/2/2012[B/Yam]	TIV/Yam: A/California/7/2009[H1N1]
				A/Texas/50/2012[H3N2]
				B/Massachusetts/2/2012[B/Yam]
Sharma [2018]	single blind phase II/III	350	A/California/7/2009/[H1N1]	TIV-Yam:	Indian	QIV: M/s Cadila Healthcare Limited, India TIV: Sanofi Pasteur India Private Limited	White(0) Asian(100) Others(0)
			A/Switzerland/9715293/2013[H3N2]	A/California/7/2009/[H1N1]
			B/Brisbane/60/2008[B/Vic]	A/Switzerland/9715293/2013[H3N2]
			B/Phuket/3073/2013[B/Yam]	B/Phuket/3073/2013[B/Yam]

QIV: quadrivalent influenza vaccine; TIV: trivalent influenza vaccine; All the QIV and TIV were standard-dose

NA: Not available

White: Caucasian and Hispanic were included.

Figure 1. The risk of bias summary for each included study

Figure 2. (a) The seroprotection rate (SPR) of older vs. younger adults for the four virus strains after vaccination (SPR was defined as the percentage of participants with a HAI titer of ≥40). (b) The seroconversion rate (SCR) of older vs. younger adults for the four strains after vaccination (SCR was defined as the percentage of those with either a pre-vaccination HAI titer of <10 and a post-vaccination HAI titer of ≥40, or a pre-vaccination HAI titer of ≥10 and a ≥ fourfold increase in HAI titer after vaccination)

Figure 2. (Continued)

Figure 3. Comparison of seroprotection rates (SPRs) across virus types and subtypes after influenza vaccine vaccination (SPR was defined as the percentage of participants with a HAI titer of ≥4

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