Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States

Aaron M. Frutos; Ashley M. Price; Elizabeth Harker; Emily L. Reeves; Haris M. Ahmad; Vel Murugan; Emily T. Martin; Stacey House; Elie A. Saade; Richard K. Zimmerman; Manjusha Gaglani; Karen J. Wernli; Emmanuel B. Walter; Marian G. Michaels; Mary A. Staat; Geoffrey A. Weinberg; Rangaraj Selvarangan; Julie A. Boom; Eileen J. Klein; Natasha B. Halasa; Adit A. Ginde; Kevin W. Gibbs; Yuwei Zhu; Wesley H. Self; Sara Y. Tartof; Nicola P. Klein; Kristin Dascomb; Malini B. Desilva; Zachary A. Weber; Duck Hye Yang; Sarah W. Ball; Diya Surie; Jennifer Decuir; Fatimah S. Dawood; Heidi L. Moline; Ariana P. Toepfer; Benjamin R. Clopper; Ruth Link-Gelles; Amanda B. Payne; Jessie R. Chung; Brendan Flannery; Nathaniel M. Lewis; Samantha M. Olson; Katherine Adams; Mark W. Tenforde; Shikha Garg; Lisa A. Grohskopf; Carrie Reed; Sascha Ellington; Adam S. Lauring; Julie Arndorfer; Daniel Bride; Ithan D. Peltan; Nicholas M. Mohr; David N. Hager; Matthew Prekker; Amira Mohamed; Nicholas Johnson; Jay Steingrub; Akram Khan; Laurence W. Busse; Abhijit Duggal; Jennifer G. Wilson; Nida Qadir; Christopher Mallow; Jennie H. Kwon; Matthew C. Exline; Nathan I. Shapiro; Cristie Columbus; Ivana A. Vaughan; Jarrod M. Mosier; Basmah Safdar; Estelle S. Harris; James D. Chappell; Laura S. Stewart; Sydney A. Swan; Pedro A. Piedra; Leila C. Sahni; Janet A. Englund; Danielle M. Zerr; Robert W. Hickey; John V. Williams; Chelsea Rohlfs; Elizabeth P. Schlaudecker; Dinah Dosdos; Mary E. Moffatt; Jennifer E. Schuster; Kirsten Weltmer; Peter G. Szilagyi; Tara Curley; Jamie Mills; Kiran Faryar; Robert A. Salata; Krissy Moehling Geffel; Mary Patricia Nowalk; Kempapura Murthy; Spencer Rose; Michael E. Smith; Brianna Wickersham; Brian D. Williamson; Natalie A.B. Bontrager; Olivia L. Williams; Joanna L. Kramer; Lora Nordstrom; Arnold S. Monto; Ivana A. Vaughn; Monica Dickerson; Callie McLean; Emma K. Noble; Caitlin Ray; Kelsey Sumner; Inih Essien; Linda Fletcher; Phillip Heaton; Sheryl Kane; Charlene McEvoy; Sunita Thapa; Gabriela Vazquez-Benitez; Cassandra Bezi; Richard Contreras; Bruno J. Lewin; Parag Mahale; Rudy Patrick; Lei Qian; Emily Rayens; Iris Anne C. Reyes; Denison S. Ryan; S. Bianca Salas; Lina S. Sy; Meiyu Yeh; Xi Zeng; Bruce Fireman; Kristin Goddard; John Hansen; Karen B. Jacobson; Julius Timbol; Ousseny Zerbo; Margaret Dunne; Yan Zhuang

doi:10.15585/mmwr.mm7308a3

Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States

Aaron M. Frutos, Ashley M. Price, Elizabeth Harker, Emily L. Reeves, Haris M. Ahmad, Vel Murugan, Emily T. Martin, Stacey House, Elie A. Saade, Richard K. Zimmerman, Manjusha Gaglani, Karen J. Wernli, Emmanuel B. Walter, Marian G. Michaels, Mary A. Staat, Geoffrey A. Weinberg, Rangaraj Selvarangan, Julie A. Boom, Eileen J. Klein, Natasha B. HalasaAdit A. Ginde, Kevin W. Gibbs, Yuwei Zhu, Wesley H. Self, Sara Y. Tartof, Nicola P. Klein, Kristin Dascomb, Malini B. Desilva, Zachary A. Weber, Duck Hye Yang, Sarah W. Ball, Diya Surie, Jennifer Decuir, Fatimah S. Dawood, Heidi L. Moline, Ariana P. Toepfer, Benjamin R. Clopper, Ruth Link-Gelles, Amanda B. Payne, Jessie R. Chung, Brendan Flannery, Nathaniel M. Lewis, Samantha M. Olson, Katherine Adams, Mark W. Tenforde, Shikha Garg, Lisa A. Grohskopf, Carrie Reed, Sascha Ellington, Adam S. Lauring, Julie Arndorfer, Daniel Bride, Ithan D. Peltan, Nicholas M. Mohr, David N. Hager, Matthew Prekker, Amira Mohamed, Nicholas Johnson, Jay Steingrub, Akram Khan, Laurence W. Busse, Abhijit Duggal, Jennifer G. Wilson, Nida Qadir, Christopher Mallow, Jennie H. Kwon, Matthew C. Exline, Nathan I. Shapiro, Cristie Columbus, Ivana A. Vaughan, Jarrod M. Mosier, Basmah Safdar, Estelle S. Harris, James D. Chappell, Laura S. Stewart, Sydney A. Swan, Pedro A. Piedra, Leila C. Sahni, Janet A. Englund, Danielle M. Zerr, Robert W. Hickey, John V. Williams, Chelsea Rohlfs, Elizabeth P. Schlaudecker, Dinah Dosdos, Mary E. Moffatt, Jennifer E. Schuster, Kirsten Weltmer, Peter G. Szilagyi, Tara Curley, Jamie Mills, Kiran Faryar, Robert A. Salata, Krissy Moehling Geffel, Mary Patricia Nowalk, Kempapura Murthy, Spencer Rose, Michael E. Smith, Brianna Wickersham, Brian D. Williamson, Natalie A.B. Bontrager, Olivia L. Williams, Joanna L. Kramer, Lora Nordstrom, Arnold S. Monto, Ivana A. Vaughn, Monica Dickerson, Callie McLean, Emma K. Noble, Caitlin Ray, Kelsey Sumner, Inih Essien, Linda Fletcher, Phillip Heaton, Sheryl Kane, Charlene McEvoy, Sunita Thapa, Gabriela Vazquez-Benitez, Cassandra Bezi, Richard Contreras, Bruno J. Lewin, Parag Mahale, Rudy Patrick, Lei Qian, Emily Rayens, Iris Anne C. Reyes, Denison S. Ryan, S. Bianca Salas, Lina S. Sy, Meiyu Yeh, Xi Zeng, Bruce Fireman, Kristin Goddard, John Hansen, Karen B. Jacobson, Julius Timbol, Ousseny Zerbo, Margaret Dunne, Yan Zhuang

Pulmonary and Critical Care Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

In the United States, annual influenza vaccination is rec¬ommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023- 24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory ill¬ness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associ¬ated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.

Original language	English (US)
Pages (from-to)	168-174
Number of pages	7
Journal	Morbidity and Mortality Weekly Report
Volume	73
Issue number	8
DOIs	https://doi.org/10.15585/mmwr.mm7308a3
State	Published - Feb 29 2024

ASJC Scopus subject areas

Epidemiology
Health(social science)
Health, Toxicology and Mutagenesis
Health Information Management

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10.15585/mmwr.mm7308a3

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Frutos, A. M., Price, A. M., Harker, E., Reeves, E. L., Ahmad, H. M., Murugan, V., Martin, E. T., House, S., Saade, E. A., Zimmerman, R. K., Gaglani, M., Wernli, K. J., Walter, E. B., Michaels, M. G., Staat, M. A., Weinberg, G. A., Selvarangan, R., Boom, J. A., Klein, E. J., ... Zhuang, Y. (2024). Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States. Morbidity and Mortality Weekly Report, 73(8), 168-174. https://doi.org/10.15585/mmwr.mm7308a3

Frutos, AM, Price, AM, Harker, E, Reeves, EL, Ahmad, HM, Murugan, V, Martin, ET, House, S, Saade, EA, Zimmerman, RK, Gaglani, M, Wernli, KJ, Walter, EB, Michaels, MG, Staat, MA, Weinberg, GA, Selvarangan, R, Boom, JA, Klein, EJ, Halasa, NB, Ginde, AA, Gibbs, KW, Zhu, Y, Self, WH, Tartof, SY, Klein, NP, Dascomb, K, Desilva, MB, Weber, ZA, Yang, DH, Ball, SW, Surie, D, Decuir, J, Dawood, FS, Moline, HL, Toepfer, AP, Clopper, BR, Link-Gelles, R, Payne, AB, Chung, JR, Flannery, B, Lewis, NM, Olson, SM, Adams, K, Tenforde, MW, Garg, S, Grohskopf, LA, Reed, C, Ellington, S, Lauring, AS, Arndorfer, J, Bride, D, Peltan, ID, Mohr, NM, Hager, DN, Prekker, M, Mohamed, A, Johnson, N, Steingrub, J, Khan, A, Busse, LW, Duggal, A, Wilson, JG, Qadir, N, Mallow, C, Kwon, JH, Exline, MC, Shapiro, NI, Columbus, C, Vaughan, IA, Mosier, JM, Safdar, B, Harris, ES, Chappell, JD, Stewart, LS, Swan, SA, Piedra, PA, Sahni, LC, Englund, JA, Zerr, DM, Hickey, RW, Williams, JV, Rohlfs, C, Schlaudecker, EP, Dosdos, D, Moffatt, ME, Schuster, JE, Weltmer, K, Szilagyi, PG, Curley, T, Mills, J, Faryar, K, Salata, RA, Geffel, KM, Nowalk, MP, Murthy, K, Rose, S, Smith, ME, Wickersham, B, Williamson, BD, Bontrager, NAB, Williams, OL, Kramer, JL, Nordstrom, L, Monto, AS, Vaughn, IA, Dickerson, M, McLean, C, Noble, EK, Ray, C, Sumner, K, Essien, I, Fletcher, L, Heaton, P, Kane, S, McEvoy, C, Thapa, S, Vazquez-Benitez, G, Bezi, C, Contreras, R, Lewin, BJ, Mahale, P, Patrick, R, Qian, L, Rayens, E, Reyes, IAC, Ryan, DS, Salas, SB, Sy, LS, Yeh, M, Zeng, X, Fireman, B, Goddard, K, Hansen, J, Jacobson, KB, Timbol, J, Zerbo, O, Dunne, M & Zhuang, Y 2024, 'Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States', Morbidity and Mortality Weekly Report, vol. 73, no. 8, pp. 168-174. https://doi.org/10.15585/mmwr.mm7308a3

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title = "Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States",

abstract = "In the United States, annual influenza vaccination is rec¬ommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023- 24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory ill¬ness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associ¬ated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.",

author = "Frutos, {Aaron M.} and Price, {Ashley M.} and Elizabeth Harker and Reeves, {Emily L.} and Ahmad, {Haris M.} and Vel Murugan and Martin, {Emily T.} and Stacey House and Saade, {Elie A.} and Zimmerman, {Richard K.} and Manjusha Gaglani and Wernli, {Karen J.} and Walter, {Emmanuel B.} and Michaels, {Marian G.} and Staat, {Mary A.} and Weinberg, {Geoffrey A.} and Rangaraj Selvarangan and Boom, {Julie A.} and Klein, {Eileen J.} and Halasa, {Natasha B.} and Ginde, {Adit A.} and Gibbs, {Kevin W.} and Yuwei Zhu and Self, {Wesley H.} and Tartof, {Sara Y.} and Klein, {Nicola P.} and Kristin Dascomb and Desilva, {Malini B.} and Weber, {Zachary A.} and Yang, {Duck Hye} and Ball, {Sarah W.} and Diya Surie and Jennifer Decuir and Dawood, {Fatimah S.} and Moline, {Heidi L.} and Toepfer, {Ariana P.} and Clopper, {Benjamin R.} and Ruth Link-Gelles and Payne, {Amanda B.} and Chung, {Jessie R.} and Brendan Flannery and Lewis, {Nathaniel M.} and Olson, {Samantha M.} and Katherine Adams and Tenforde, {Mark W.} and Shikha Garg and Grohskopf, {Lisa A.} and Carrie Reed and Sascha Ellington and Lauring, {Adam S.} and Julie Arndorfer and Daniel Bride and Peltan, {Ithan D.} and Mohr, {Nicholas M.} and Hager, {David N.} and Matthew Prekker and Amira Mohamed and Nicholas Johnson and Jay Steingrub and Akram Khan and Busse, {Laurence W.} and Abhijit Duggal and Wilson, {Jennifer G.} and Nida Qadir and Christopher Mallow and Kwon, {Jennie H.} and Exline, {Matthew C.} and Shapiro, {Nathan I.} and Cristie Columbus and Vaughan, {Ivana A.} and Mosier, {Jarrod M.} and Basmah Safdar and Harris, {Estelle S.} and Chappell, {James D.} and Stewart, {Laura S.} and Swan, {Sydney A.} and Piedra, {Pedro A.} and Sahni, {Leila C.} and Englund, {Janet A.} and Zerr, {Danielle M.} and Hickey, {Robert W.} and Williams, {John V.} and Chelsea Rohlfs and Schlaudecker, {Elizabeth P.} and Dinah Dosdos and Moffatt, {Mary E.} and Schuster, {Jennifer E.} and Kirsten Weltmer and Szilagyi, {Peter G.} and Tara Curley and Jamie Mills and Kiran Faryar and Salata, {Robert A.} and Geffel, {Krissy Moehling} and Nowalk, {Mary Patricia} and Kempapura Murthy and Spencer Rose and Smith, {Michael E.} and Brianna Wickersham and Williamson, {Brian D.} and Bontrager, {Natalie A.B.} and Williams, {Olivia L.} and Kramer, {Joanna L.} and Lora Nordstrom and Monto, {Arnold S.} and Vaughn, {Ivana A.} and Monica Dickerson and Callie McLean and Noble, {Emma K.} and Caitlin Ray and Kelsey Sumner and Inih Essien and Linda Fletcher and Phillip Heaton and Sheryl Kane and Charlene McEvoy and Sunita Thapa and Gabriela Vazquez-Benitez and Cassandra Bezi and Richard Contreras and Lewin, {Bruno J.} and Parag Mahale and Rudy Patrick and Lei Qian and Emily Rayens and Reyes, {Iris Anne C.} and Ryan, {Denison S.} and Salas, {S. Bianca} and Sy, {Lina S.} and Meiyu Yeh and Xi Zeng and Bruce Fireman and Kristin Goddard and John Hansen and Jacobson, {Karen B.} and Julius Timbol and Ousseny Zerbo and Margaret Dunne and Yan Zhuang",

year = "2024",

month = feb,

day = "29",

doi = "10.15585/mmwr.mm7308a3",

language = "English (US)",

volume = "73",

pages = "168--174",

journal = "Morbidity and Mortality Weekly Report",

issn = "0149-2195",

publisher = "Department of Health and Human Services",

number = "8",

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TY - JOUR

T1 - Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States

AU - Frutos, Aaron M.

AU - Price, Ashley M.

AU - Harker, Elizabeth

AU - Reeves, Emily L.

AU - Ahmad, Haris M.

AU - Murugan, Vel

AU - Martin, Emily T.

AU - House, Stacey

AU - Saade, Elie A.

AU - Zimmerman, Richard K.

AU - Gaglani, Manjusha

AU - Wernli, Karen J.

AU - Walter, Emmanuel B.

AU - Michaels, Marian G.

AU - Staat, Mary A.

AU - Weinberg, Geoffrey A.

AU - Selvarangan, Rangaraj

AU - Boom, Julie A.

AU - Klein, Eileen J.

AU - Halasa, Natasha B.

AU - Ginde, Adit A.

AU - Gibbs, Kevin W.

AU - Zhu, Yuwei

AU - Self, Wesley H.

AU - Tartof, Sara Y.

AU - Klein, Nicola P.

AU - Dascomb, Kristin

AU - Desilva, Malini B.

AU - Weber, Zachary A.

AU - Yang, Duck Hye

AU - Ball, Sarah W.

AU - Surie, Diya

AU - Decuir, Jennifer

AU - Dawood, Fatimah S.

AU - Moline, Heidi L.

AU - Toepfer, Ariana P.

AU - Clopper, Benjamin R.

AU - Link-Gelles, Ruth

AU - Payne, Amanda B.

AU - Chung, Jessie R.

AU - Flannery, Brendan

AU - Lewis, Nathaniel M.

AU - Olson, Samantha M.

AU - Adams, Katherine

AU - Tenforde, Mark W.

AU - Garg, Shikha

AU - Grohskopf, Lisa A.

AU - Reed, Carrie

AU - Ellington, Sascha

AU - Lauring, Adam S.

AU - Arndorfer, Julie

AU - Bride, Daniel

AU - Peltan, Ithan D.

AU - Mohr, Nicholas M.

AU - Hager, David N.

AU - Prekker, Matthew

AU - Mohamed, Amira

AU - Johnson, Nicholas

AU - Steingrub, Jay

AU - Khan, Akram

AU - Busse, Laurence W.

AU - Duggal, Abhijit

AU - Wilson, Jennifer G.

AU - Qadir, Nida

AU - Mallow, Christopher

AU - Kwon, Jennie H.

AU - Exline, Matthew C.

AU - Shapiro, Nathan I.

AU - Columbus, Cristie

AU - Vaughan, Ivana A.

AU - Mosier, Jarrod M.

AU - Safdar, Basmah

AU - Harris, Estelle S.

AU - Chappell, James D.

AU - Stewart, Laura S.

AU - Swan, Sydney A.

AU - Piedra, Pedro A.

AU - Sahni, Leila C.

AU - Englund, Janet A.

AU - Zerr, Danielle M.

AU - Hickey, Robert W.

AU - Williams, John V.

AU - Rohlfs, Chelsea

AU - Schlaudecker, Elizabeth P.

AU - Dosdos, Dinah

AU - Moffatt, Mary E.

AU - Schuster, Jennifer E.

AU - Weltmer, Kirsten

AU - Szilagyi, Peter G.

AU - Curley, Tara

AU - Mills, Jamie

AU - Faryar, Kiran

AU - Salata, Robert A.

AU - Geffel, Krissy Moehling

AU - Nowalk, Mary Patricia

AU - Murthy, Kempapura

AU - Rose, Spencer

AU - Smith, Michael E.

AU - Wickersham, Brianna

AU - Williamson, Brian D.

AU - Bontrager, Natalie A.B.

AU - Williams, Olivia L.

AU - Kramer, Joanna L.

AU - Nordstrom, Lora

AU - Monto, Arnold S.

AU - Vaughn, Ivana A.

AU - Dickerson, Monica

AU - McLean, Callie

AU - Noble, Emma K.

AU - Ray, Caitlin

AU - Sumner, Kelsey

AU - Essien, Inih

AU - Fletcher, Linda

AU - Heaton, Phillip

AU - Kane, Sheryl

AU - McEvoy, Charlene

AU - Thapa, Sunita

AU - Vazquez-Benitez, Gabriela

AU - Bezi, Cassandra

AU - Contreras, Richard

AU - Lewin, Bruno J.

AU - Mahale, Parag

AU - Patrick, Rudy

AU - Qian, Lei

AU - Rayens, Emily

AU - Reyes, Iris Anne C.

AU - Ryan, Denison S.

AU - Salas, S. Bianca

AU - Sy, Lina S.

AU - Yeh, Meiyu

AU - Zeng, Xi

AU - Fireman, Bruce

AU - Goddard, Kristin

AU - Hansen, John

AU - Jacobson, Karen B.

AU - Timbol, Julius

AU - Zerbo, Ousseny

AU - Dunne, Margaret

AU - Zhuang, Yan

PY - 2024/2/29

Y1 - 2024/2/29

N2 - In the United States, annual influenza vaccination is rec¬ommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023- 24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory ill¬ness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associ¬ated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.

AB - In the United States, annual influenza vaccination is rec¬ommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023- 24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory ill¬ness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associ¬ated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.

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U2 - 10.15585/mmwr.mm7308a3

DO - 10.15585/mmwr.mm7308a3

M3 - Article

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AN - SCOPUS:85186311889

SN - 0149-2195

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EP - 174

JO - Morbidity and Mortality Weekly Report

JF - Morbidity and Mortality Weekly Report

IS - 8

ER -

Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States

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