1). In many comparisons, the difference between LAIV and placebo recipients was statistically significant. In study 3, responses were observed after a single dose but the differences compared to placebo recipients were more apparent after receipt of 2 doses of vaccine. Among subjects receiving only 1 dose of vaccine in year 1, a

greater difference versus placebo was observed at GW786034 molecular weight the second versus first sample collection (approximately 2 months versus 1 month postvaccination). When the percentage of subjects with a ≥4-fold increase was evaluated, a similar pattern was observed, although response rates were lower. For LAIV and placebo recipients respectively, response rates were 26–39% versus 12–30% for A/H1N1, 33–48% versus 20–27% for A/H3N2, and 46–59% versus 14–38% for B. When subjects were stratified by baseline

serostatus, similar IgA responses were observed among seronegative and seropositive subjects. Postvaccination GMFRs for strain-specific IgA ratios among LAIV recipients after 2 doses of vaccine in year 1 ranged from 1.4 to 6.2, compared to 0.5–2.0 among placebo recipients (Table 1). In year 2, GMFRs ranged from 1.2 to 4.6 among LAIV recipients and 0.8–2.2 among placebo recipients (Table 1). Postvaccination GMFRs in absolute strain-specific IgA, uncorrected for total IgA, trended higher than postvaccination Selleck Adriamycin GMFRs in strain-specific IgA ratios. Among LAIV and placebo recipients, total IgA increased from prevaccination to postvaccination by 1.0- to 2.4-fold in year 1 and 0.7- to 1.2-fold in year 2 (Table 2). Year 1 of study 3 was responsible for the greatest observed responses for LAIV and placebo recipients and 4 of the 5 statistically significant GMFRs. Because of the observed increases in total IgA from prevaccination to postvaccination in both placebo and vaccine recipients in year 1 of study 3, subject-level data by site were reviewed. In study 3, but not in studies 1 and 2, the total IgA content in year 1 prevaccination samples was lower among the initial subjects enrolled

at sites and higher among subjects enrolled subsequently; because linear regression analysis controlling for site showed that total IgA content in prevaccination samples increased significantly over calendar time in study 3 (P = 0.002). Across studies, data for both HAI and IgA responses following receipt of 2 doses was available for 392 LAIV recipients and 213 placebo recipients in year 1. Four-fold increases in HAI antibody titer for A/H1N1 were observed for 61% of LAIV recipients compared to 13% of placebo recipients (P < 0.001); for A/H3N2 and B, responses were 74% versus 16% (P < 0.001) and 76% versus 12% (P < 0.001) for LAIV versus placebo recipients, respectively. Among LAIV recipients, IgA responses were more frequently seen among subjects with an HAI response. Across studies, IgA responses to A/H1N1 were observed among 48% of subjects with a 4-fold HAI response, compared to 33% of those without a 4-fold HAI response (P < 0.001).