Effectiveness of High-Dose Influenza Vaccination on Hospitalizations of Older Adults in US Nursing Homes: Results. from a Cluster-Randomized Controlled Trial
Bibliographic record
Abstract
Background. Response to influenza (flu) vaccine declines with age, reducing clinical effectiveness. Our primary objective was to determine whether a more immunogenic Fluzone high-dose vaccine (HD), compared with a Fluzone standard-dose vaccine (SD) could reduce hospitalizations among nursing home (NH) residents. Methods. In this pragmatic, comparative effectiveness, cluster-randomized trial, enrolled NHs were randomized to administer either HD or SD vaccine to long-stay residents for the 2013-2014 season. Facilities were also allocated to free vaccine for staff or usual procedure in a 2 × 2 factorial design. Data were collected from CMS under data-use agreements and from enrolled facilities. All analyses were by Intent-To-Treat. We analyzed hospitalization incidence using marginal Poisson regression accounting for clustering of residents within facilities, and adjusting for a priori facility and resident covariates. We analyzed secondary outcomes (mortality, activities of daily living) using Cox proportional hazards and logistic regression. Results. We randomized 823 facilities with 53,008 long-stay residents; facility and resident characteristics were similar between arms. Flu A/H1N1 was the dominant flu strain during the study period. Incidence of hospitalization was significantly lower in HD than SD facilities for all-causes (adjusted RR = 0.951, 95% CI 0.907–.996, P = 0.0347) and respiratory conditions (ARR = 0.883, CI 0.787–0.989, P = 0.032) and lower but NS so for pneumonia and influenza. Conclusion. High-dose flu vaccine reduces risk of all-cause hospitalization and hospitalization for respiratory conditions in long-term care residents in an A/H1N1 dominant season. Registration. NCT01815268 Funding. Sanofi Pasteur Disclosures. S. Gravenstein, Sanofi: Consultant, Grant Investigator, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research support and Speaker honorarium H. E. Davidson, Sanofi: Grant Investigator, Grant recipient and Research support J. Ogarek, Sanofi: analyst, Research support L. Han, Sanofi: Investigator, Grant recipient, Research grant and Research support R. Dahal, Sanofi: analyst, Research support P. Gozalo, Sanofi: Grant Investigator, Research support V. Mor, Sanofi: Grant Investigator, Research grant and Research support
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".