Table 1.

Comparative studies on the immunogenicity, safety and effectiveness of cell culture vaccine versus egg-derived vaccine.

Author	Objective	Population	Results/conclusion
Ambrozatis14, Vaccine 2009	Tolerability and immunogenicity	n = 1,200 (18–60 years)	Local reaction 27–31% CCIV vs 25% TIV Systemic reaction: overall CCIV 24–26% vs. TIV 23% Immune responses were similar for CCIV vs. TIV
Bart21, Human Vaccine & Immunotherapeutics 2016	Immunogenicity and safety	N = 2,680	Overall antibody responses were similar in cQIV and TIV At day 22, the GMT and the percentage of subjects with seroconversion for unmatched B strains were higher in QIV than TIV.
Frey56, Clinical Infectious Diseases 2010	Immunogenicity, efficacy and safety	n = 11,404 (18–49 years)	Baseline seroprotection rates, seroconversion rates, and antihemagglutinin GMT did not differ between CCIV and TIV. The overall vaccine efficacy was 83.8% (one-sided 97.5% CI lower limit, 61.0%) for the CCIV and 78.4% (one-sided 97.5% CI lower limit, 52.1%) for the TIV group. An A/H1N1 virus was isolated from 56 of 60 cases, including 43 in the placebo group, five in the CCIV group (vaccine efficacy, 88.2%), and 8 in the TIV group (vaccine efficacy, 80.3%). Three cases were caused by vaccine-like H3N2 strains and only one by a vaccine-like B strain. The percentage of study participants reporting solicited reactions was similar in each group.
Szymczakiewich57, Journal of Infectious Diseases 2009	Immunogenicity and safety	18–60 years, n = 1,300; elderly persons > or = 61 years, n = 1,354	The immunogenicity of CCIV was non-inferior to that of the conventional vaccine for all three vaccine strains in both age groups, regardless of underlying health status. Both vaccines fulfilled European Union registration criteria and were well tolerated, with similar incidences of solicited local and systemic reactions in both age groups; the only significant difference was an increased frequency of mild or moderate pain with CCIV than the conventional vaccine among adult (22% vs 17%; P < .05) and elderly (9% vs 5%; P < .001) vaccines.
Hartvickson59, International Journal of Infectious Disease 2015	Immunogenicity and safety	N = 2,333	cQIV met the non-inferiority criteria against all four vaccine strains and demonstrated superiority for both influenza B strains Similar percentages of subjects experienced solicited and unsolicited adverse events (AEs) across all groups
Barta60, Human Vaccine& Immunotherapeutics 2016	Immunogenicity and safety	N = 2,680	QIV non-inferiority criteria for all vaccine strains and demonstrated superiority for both influenza B strains Between 48–52% subjects experienced≥one solicited AE. Serius AE were reported < 1%
Izureta65, Journal of Infectious Diseases 2018	Relative vaccine effectiveness (RVE)	>13 million beneficiaries	Relative vaccine effectiveness for cell-cultured vaccine relative to egg-based quadrivalent vaccine was 10%
Szymczakiewich66, Human Vaccine& Immunotherapeutics 2012	Immunogenicity and safety	n = 2,609	The safety profile of both vaccines was similar, no serious adverse events related to either vaccine occurred. Mild or moderate pain was the most commonly reported reaction. Reactogenicity was slightly higher in elderly subjects receiving CCIV/TIV concomitantly with PV [46% vs 37%; p = non-significant]. Both vaccines met CHMP licensure criteria for adults and elderly subjects. With concomitant CCIV and PV, all three CHMP criteria were met for A/H1N1 and A/H3N2, whereas the B strain only met seroprotection and GMR criteria.