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Recombinant influenza vaccine yields higher A(H1N1) and A(H3N2) titers in adults with severe obesityRecombinant flu vaccine shows stronger immune response in people with obesity

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Key Takeaway
Note that RIV elicited higher A(H1N1) and A(H3N2) titers in adults with severe obesity compared to egg-based vaccines.

This randomized clinical trial enrolled 206 adults with severe obesity (BMI ≥35 kg/m2) across 15 centers in France to compare a recombinant influenza vaccine (RIV) against an egg-based standard-dose influenza vaccine (SD).

The primary outcome was the ratio of geometric mean hemagglutinin-inhibition (HAI) titers (RIV/SD) for 4 influenza strains at 28 days post-vaccination. Results showed RIV had a higher ratio for A/H1N1 (1.6; 95% CI, 1.1-2.3) and A/H3N2 (2.0; 95% CI, 1.3-3.2). The ratio for B/Yamagata was 1.3 (95% CI, 1.0-1.8), while the ratio for B/Victoria was 0.9 (95% CI, 0.6-1.3), indicating no significant difference for that strain.

Reactogenicity and safety profiles were similar between the RIV and SD groups. No significant difference in GMT titers was observed at Day 180. A limitation of the study is its open-label design. While RIV elicited stronger short-term humoral immune responses than the egg-based vaccine, these titers are surrogate measures of immunity and do not directly measure clinical infection rates.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in data regarding specific vaccine types for the obese population. While prior coverage noted higher post-pandemic vaccine effectiveness against A(H3N2) and B strains across multiple age groups, this study specifically evaluates the humoral immune response of recombinant versus egg-based vaccines in adults with severe obesity (BMI ≥35 kg/m2).

Living with severe obesity can sometimes make it harder for the body to build a strong defense against common illnesses like the flu. Researchers recently looked at how two different types of flu shots work for people with a BMI of 35 or higher. They compared a recombinant influenza vaccine to the standard egg-based vaccine.

The study, which included 206 adults across 15 centers in France, found that the recombinant vaccine produced a stronger immune response for three out of four flu strains. Specifically, it showed higher levels of antibodies for the A/H1N1, A/H3N2, and B/Yamagata strains compared to the egg-based version. For the B/Victoria strain, the two vaccines performed about the same.

While the results are promising for building a stronger immune response, it is important to remember that the study measured antibody levels, not actual infection rates. The researchers also noted that both vaccines were well-tolerated by the participants. Because the study was open-label, some factors could influence the results, but the data suggests the recombinant option provides a stronger initial defense for those with severe obesity.

What this means for you:
A recombinant flu vaccine shows a stronger immune response than egg-based vaccines for people with severe obesity.

Common questions

Is the recombinant flu vaccine safe for people with obesity?

Yes, the study found that the safety and tolerability of the recombinant vaccine were similar to the standard egg-based vaccine. No serious adverse events were reported during the trial, and both vaccines were well-tolerated by the participants.

How does the recombinant vaccine compare to the standard egg-based vaccine?

The recombinant vaccine showed a stronger immune response for three strains: A/H1N1, A/H3N2, and B/Yamagata. For the B/Victoria strain, there was no significant difference between the two types of vaccines.

Does this mean the recombinant vaccine prevents more infections?

The study measured antibody levels, which are a way to measure how the immune system reacts, rather than actual infection rates. While it showed a stronger immune response, it did not directly measure how many people got sick.

Study Details

Study typeRct
Sample sizen = 206
EvidenceLevel 2
Follow-up6.0 mo
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Individuals with severe obesity are at increased risk of severe influenza and may have impaired immune responses to vaccination. Recombinant influenza vaccine (RIV) may provide enhanced protection compared with egg-based standard-dose influenza vaccine (SD), but data in this high-risk population are limited. METHODS: The AP-HP FLUO trial (NCT05409612) was an open-label, randomized clinical trial conducted in 15 centers in France (November 2022-March 2023) with 6 months of follow-up. Adults with BMI ≥35 kg/m2 were randomized 1:1 to receive RIV or SD, using minimization by center, age (<50 vs ≥50 years), and BMI (<40 vs ≥40 kg/m2). The primary outcome was the ratio (RIV/SD) of geometric mean hemagglutinin-inhibition (HAI) titers (GMTs) for 4 influenza strains 28 days after vaccination. Safety and reactogenicity were also assessed. RESULTS: A total of 206 participants were included (104 RIV, 102 SD). Median age was 50 years, 60.2% were women, and median BMI was 41.0 kg/m2. At Day 28, GMT ratios favored RIV for A/H1N1 (1.6; 95% CI, 1.1-2.3), A/H3N2 (2.0; 95% CI, 1.3-3.2), and B/Yamagata (1.3; 95% CI, 1.0-1.8), but not for B/Victoria (0.9; 95% CI, 0.6-1.3). The effect did not vary significantly across the different age and BMI groups. By Day 180, titers did not differ significantly. Reactogenicity and safety profiles were similar between groups. CONCLUSIONS: In adults with severe obesity, RIV elicited stronger short-term humoral immune responses than an egg-based standard-dose vaccine, suggesting potential additional benefit for influenza prevention in this vulnerable population.
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