Trivalent and quadrivalent influenza vaccination effectiveness in Australia and South Africa: results from a modelling study

Influenza Other Respir Viruses. 2016 Jul;10(4):324-32. doi: 10.1111/irv.12367. Epub 2016 Feb 8.


Background: A modelling study was conducted to determine the effectiveness of trivalent (TIV) and quadrivalent (QIV) vaccination in South Africa and Australia.

Objectives: This study aimed to determine the potential benefits of alternative vaccination strategies which may depend on community-specific demographic and health characteristics.

Methods: Two influenza A and two influenza B strains were simulated using individual-based simulation models representing specific communities in South Africa and Australia over 11 years. Scenarios using TIV or QIV, with alternative prioritisation strategies and vaccine coverage levels, were evaluated using a country-specific health outcomes process.

Results: In South Africa, approximately 18% fewer deaths and hospitalisations would be expected to result from the use of QIV compared to TIV over the 11 modelled years (P = 0·031). In Australia, only 2% (P = 0·30) fewer deaths and hospitalisations would result. Vaccinating 2%, 5%, 15% or 20% of the population with TIV using a strategy of prioritising vulnerable age groups, including HIV-positive individuals, resulted in reductions in hospitalisations and mortality of at least 7%, 18%, 57% and 66%, respectively, in both communities.

Conclusions: The degree to which QIV can reduce health burden compared to TIV is strongly dependent on the number of years in which the influenza B lineage in the TIV matches the circulating B lineages. Assuming a moderate level of B cross-strain protection, TIV may be as effective as QIV. The choice of vaccination prioritisation has a greater impact than the QIV/TIV choice, with strategies targeting those most responsible for transmission being most effective.

Keywords: Influenza vaccination; quadrivalent influenza vaccine; seasonal influenza.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Viral / immunology
  • Australia
  • Cross Protection
  • Female
  • Humans
  • Influenza A virus / genetics
  • Influenza A virus / immunology*
  • Influenza B virus / genetics
  • Influenza B virus / immunology*
  • Influenza Vaccines / administration & dosage*
  • Influenza Vaccines / immunology
  • Influenza, Human / immunology
  • Influenza, Human / prevention & control*
  • Influenza, Human / virology
  • Male
  • Models, Theoretical
  • South Africa
  • Vaccination


  • Antibodies, Viral
  • Influenza Vaccines