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We investigated sex as a potential modifier of influenza vaccine effectiveness (VE) between 2010-2011 and 2016-2017 in Canada. Overall VE was 49% (95% confidence interval [CI], 43% to 55%) for females and 38% (95% CI, 28% to 46%) for males (absolute difference [AD], 11%;  = .03). Sex differences were greatest for influenza A(H3N2) (AD, 17%;  = .07) and B(Victoria) (AD, 20%;  = .08) compared with A(H1N1)pdm09 (AD, 10%;  = .19) or B(Yamagata) (AD, -3%;  = .68). They were also more pronounced in older adults ≥50 years (AD, 19%;  = .03) compared with those <20 years (AD, 4%;  = .74) or 20-49 years (AD, -1%;  = .90) but with variation by subtype/lineage. More definitive investigations of VE by sex and age are warranted to elucidate these potential interactions.

Should Sex Be Considered an Effect Modifier in the Evaluation of Influenza Vaccine Effectiveness?