{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T17:50:24Z","timestamp":1767635424109,"version":"3.48.0"},"reference-count":52,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T00:00:00Z","timestamp":1767484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health of the Russian Federation government contract","award":["125020401358-1"],"award-info":[{"award-number":["125020401358-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Patients with end-stage renal disease (ESRD) on hemodialysis are at increased risk for severe influenza, and underlying immune dysfunction may limit vaccine-induced protection. Methods: This observational open-label study evaluated immune responses in 93 hemodialysis patients vaccinated with seasonal inactivated influenza vaccine (IIV) during the 2019\u20132020 (n = 22) and 2023\u20132024 (n = 71) seasons. Immune responses were comprehensively assessed using hemagglutination inhibition and microneutralization assays to measure antibody levels, together with flow cytometry analysis of key immune cell populations, including plasmablasts, T-follicular helper cells (Tfh), and effector memory T cells (Tem). Results: During the 2019\u20132020 season, antibody responses in hemodialysis patients were comparable to those in healthy volunteers in both younger (18\u201360 years) and older (over 60) age groups. By day 7 post-vaccination, there was a pronounced increase in activated Tfh1 cells, coinciding with a surge in plasmablasts and a rise in antigen-specific B cells. This was accompanied by a T-cell response mediated by IFN\u03b3-producing and polyfunctional CD4+ Tem cells. In the 2023\u20132024 season, revaccination was associated with higher baseline antibody levels but did not alter subsequent response kinetics to A\/H1N1pdm, A\/H3N2, and B\/Yamagata antigens. In contrast, responses to B\/Victoria were higher in revaccinated patients throughout the entire observation period. Conclusions: Our findings confirm that standard-dose IIV vaccination is beneficial for hemodialysis patients, inducing robust and adequate humoral and T-cell immune responses.<\/jats:p>","DOI":"10.3390\/vaccines14010063","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T13:35:47Z","timestamp":1767620147000},"page":"63","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influenza Vaccine Immunogenicity in Hemodialysis Patients"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3685-7068","authenticated-orcid":false,"given":"Anna-Polina","family":"Shurygina","sequence":"first","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7560-398X","authenticated-orcid":false,"given":"Ekaterina","family":"Romanovskaya-Romanko","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9146-0816","authenticated-orcid":false,"given":"Vera","family":"Krivitskaya","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-9896","authenticated-orcid":false,"given":"Mariia","family":"Sergeeva","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8394-102X","authenticated-orcid":false,"given":"Janna","family":"Buzitskaya","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7750-9652","authenticated-orcid":false,"given":"Kirill","family":"Vasilyev","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7550-5519","authenticated-orcid":false,"given":"Marina","family":"Shuklina","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6945-4711","authenticated-orcid":false,"given":"Konstantin","family":"Vishnevskii","sequence":"additional","affiliation":[{"name":"St. Petersburg State Budgetary Healthcare Institution \u201cCity Hospital No. 15\u201d, 198205 St. Petersburg, Russia"},{"name":"Dialysis Department, North-Western State Medical University Named After I. I. Mechnikov, 191015 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Smotrov","family":"Dmitry","sequence":"additional","affiliation":[{"name":"St. Petersburg State Budgetary Healthcare Institution \u201cCity Hospital No. 15\u201d, 198205 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tutin","family":"Aleksey","sequence":"additional","affiliation":[{"name":"Kupchino Outpatient Dialysis Center, 192102 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3643-7354","authenticated-orcid":false,"given":"Dmitry","family":"Lioznov","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2127-3820","authenticated-orcid":false,"given":"Marina","family":"Stukova","sequence":"additional","affiliation":[{"name":"Smorodintsev Research Institute of Influenza, Ministry of Health of the Russian Federation, 197022 St. Petersburg, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of Chronic Kidney Disease: An Update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int. Suppl."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1053\/j.ackd.2018.10.002","article-title":"Vaccination in Chronic Kidney Disease","volume":"26","author":"Reddy","year":"2019","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1378\/chest.120.6.1883","article-title":"Pulmonary Infectious Mortality Among Patients with End-Stage Renal Disease","volume":"120","author":"Sarnak","year":"2001","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s40620-017-0407-9","article-title":"Influenza and the Patient with End-Stage Renal Disease","volume":"31","author":"Bowman","year":"2018","journal-title":"J. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1053\/j.ackd.2006.04.004","article-title":"Infectious Complications in Chronic Kidney Disease","volume":"13","author":"Naqvi","year":"2006","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1053\/j.jrn.2011.10.020","article-title":"Effect of Uremia on Structure and Function of Immune System","volume":"22","author":"Vaziri","year":"2012","journal-title":"J. Ren. Nutr."},{"key":"ref_7","first-page":"1013","article-title":"Effectiveness of Influenza Vaccine in Patients on Hemodialysis\u2014A Review","volume":"19","author":"Gwiazda","year":"2013","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S206","DOI":"10.1046\/j.1523-1755.2001.59780206.x","article-title":"Molecular Aspects of T- and B-Cell Function in Uremia","volume":"78","author":"Girndt","year":"2001","journal-title":"Kidney Int. Suppl."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cohen, G. (2020). Immune Dysfunction in Uremia 2020. Toxins, 12.","DOI":"10.3390\/toxins12070439"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Losappio, V., Franzin, R., Infante, B., Godeas, G., Gesualdo, L., Fersini, A., Castellano, G., and Stallone, G. (2020). Molecular Mechanisms of Premature Aging in Hemodialysis: The Complex Interplay Between Innate and Adaptive Immune Dysfunction. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21103422"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"465","DOI":"10.3858\/emm.2012.44.8.053","article-title":"B Cell-Associated Immune Profiles in Patients with End-Stage Renal Disease (ESRD)","volume":"44","author":"Kim","year":"2012","journal-title":"Exp. Mol. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4110\/in.2017.17.3.152","article-title":"Dendritic Cell Dysfunction in Patients with End-Stage Renal Disease","volume":"17","author":"Kim","year":"2017","journal-title":"Immune Netw."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, Y., and Gao, L. (2022). Inflammation and Cardiovascular Disease Associated with Hemodialysis for End-Stage Renal Disease. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.800950"},{"key":"ref_14","first-page":"169","article-title":"Telomere Shortening and Ageing of the Immune System","volume":"59","author":"Kaszubowska","year":"2008","journal-title":"J. Physiol. Pharmacol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Remschmidt, C., Wichmann, O., and Harder, T. (2014). Influenza Vaccination in Patients with End-Stage Renal Disease: Systematic Review and Assessment of Quality of Evidence Related to Vaccine Efficacy, Effectiveness, and Safety. BMC Med., 12.","DOI":"10.1186\/s12916-014-0244-9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2147\/IJNRD.S231142","article-title":"Current Knowledge of Vaccinations in Chronic Kidney Disease Patients","volume":"13","author":"Haddiya","year":"2020","journal-title":"Int. J. Nephrol. Renovasc. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wang, I.-K., Lin, C.-L., Lin, P.-C., Liang, C.-C., Liu, Y.-L., Chang, C.-T., Yen, T.-H., Morisky, D.E., Huang, C.-C., and Sung, F.-C. (2013). Effectiveness of Influenza Vaccination in Patients with End-Stage Renal Disease Receiving Hemodialysis: A Population-Based Study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0058317"},{"key":"ref_18","first-page":"290","article-title":"Influenza Vaccination Reduces Hospitalization for Heart Failure in Elderly Patients with Chronic Kidney Disease: A Population-Based Cohort Study","volume":"32","author":"Fang","year":"2016","journal-title":"Acta Cardiol. Sin."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e2588","DOI":"10.1097\/MD.0000000000002588","article-title":"Influenza Vaccination Is Associated with Lower Risk of Acute Coronary Syndrome in Elderly Patients with Chronic Kidney Disease","volume":"95","author":"Chen","year":"2016","journal-title":"Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4847","DOI":"10.1038\/s41598-021-84285-8","article-title":"Influenza Vaccination Reduces Incidence of Peripheral Arterial Occlusive Disease in Elderly Patients with Chronic Kidney Disease","volume":"11","author":"Hu","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2868","DOI":"10.1097\/MD.0000000000002868","article-title":"Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: A Population-Based Cohort Study","volume":"95","author":"Liu","year":"2016","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1053\/j.ajkd.2019.06.014","article-title":"Practical Guide to Vaccination in All Stages of CKD, Including Patients Treated by Dialysis or Kidney Transplantation","volume":"75","author":"Krueger","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ramsay, L.C., Buchan, S.A., Stirling, R.G., Cowling, B.J., Feng, S., Kwong, J.C., and Warshawsky, B.F. (2019). The Impact of Repeated Vaccination on Influenza Vaccine Effectiveness: A Systematic Review and Meta-Analysis. BMC Med., 17.","DOI":"10.1186\/s12916-018-1239-8"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3338","DOI":"10.1038\/s41467-019-11296-5","article-title":"Repeat Vaccination Reduces Antibody Affinity Maturation Across Different Influenza Vaccine Platforms in Humans","volume":"10","author":"Khurana","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Tarasov, M., Shanko, A., Kordyukova, L., and Katlinski, A. (2020). Characterization of Inactivated Influenza Vaccines Used in the Russian National Immunization Program. Vaccines, 8.","DOI":"10.3390\/vaccines8030488"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Shanko, A., Shuklina, M., Kovaleva, A., Zabrodskaya, Y., Vidyaeva, I., Shaldzhyan, A., Fadeev, A., Korotkov, A., Zaitceva, M., and Stepanova, L. (2020). Comparative Immunological Study in Mice of Inactivated Influenza Vaccines Used in the Russian Immunization Program. Vaccines, 8.","DOI":"10.3390\/vaccines8040756"},{"key":"ref_27","unstructured":"(2017). Study of Population Immunity to Influenza in the Population of the Russian Federation (Approved by the Chief State Sanitary Doctor of the Russian Federation on 27 October 2017) (Standard No. MU 3.1.3490-17)."},{"key":"ref_28","unstructured":"Robert, G., Cox, N., and Scott, K. (2002). WHO Manual on Animal Influenza Diagnosis and Surveillance, World Health Organization."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100845","DOI":"10.1016\/j.xpro.2021.100845","article-title":"Isolation of Polymorphonuclear Neutrophils and Monocytes from a Single Sample of Human Peripheral Blood","volume":"2","author":"Cui","year":"2021","journal-title":"STAR Protoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/978-1-4939-8567-8_19","article-title":"Detection and Quantification of Influenza A\/H1N1 Virus-Specific Memory B Cells in Human PBMCs Using ELISpot Assay","volume":"1808","author":"Haralambieva","year":"2018","journal-title":"Methods Mol Biol."},{"key":"ref_31","first-page":"4","article-title":"Adequacy of Hemodialysis. Classical Approach","volume":"3","author":"Zemchenkov","year":"2001","journal-title":"Nephrol. Dial."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Sergeeva, M.V., Romanovskaya-Romanko, E.A., Krivitskaya, V.Z., Kudar, P.A., Petkova, N.N., Kudria, K.S., Lioznov, D.A., Stukova, M.A., and Desheva, Y.A. (2023). Longitudinal Analysis of Neuraminidase and Hemagglutinin Antibodies to Influenza A Viruses after Immunization with Seasonal Inactivated Influenza Vaccines. Vaccines, 11.","DOI":"10.20944\/preprints202309.1919.v1"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2990","DOI":"10.1080\/21645515.2018.1498435","article-title":"Cytokine Production in Whole-Blood Cultures Following Immunization with an Influenza Vaccine","volume":"14","author":"Nakayama","year":"2018","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Puspitasari, M., Sattwika, P.D., Rahari, D.S., Wijaya, W., Hidayat, A.R.P., Kertia, N., Purwanto, B., and Thobari, J.A. (2023). Outcomes of Vaccinations against Respiratory Diseases in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0281160"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1053\/j.ajkd.2019.09.008","article-title":"Effectiveness of Influenza Vaccination Among Older Adults Across Kidney Function: Pooled Analysis of 2005\u20132006 Through 2014\u20132015 Influenza Seasons","volume":"75","author":"Ishigami","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5825","DOI":"10.1016\/j.vaccine.2019.08.016","article-title":"Safety and Immunogenicity of High-Dose Quadrivalent Influenza Vaccine in Adults \u226565 years of Age: A Phase 3 Randomized Clinical Trial","volume":"37","author":"Chang","year":"2019","journal-title":"Vaccine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6087","DOI":"10.1016\/j.vaccine.2018.08.079","article-title":"High-Dose Influenza Vaccine Use among Patients Receiving Hemodialysis in the United States, 2010\u20132013","volume":"36","author":"McGrath","year":"2018","journal-title":"Vaccine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1053\/j.ajkd.2019.05.018","article-title":"Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccine Among Patients Receiving Maintenance Hemodialysis","volume":"75","author":"Butler","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1080\/21645515.2016.1201623","article-title":"Effect of a Booster Dose of Influenza Vaccine in Patients with Hemodialysis, Peritoneal Dialysis and Renal Transplant Recipients: A Systematic Literature Review and Meta-Analysis","volume":"12","author":"Liao","year":"2016","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s41100-021-00378-0","article-title":"Survival and Predictive Factors in Dialysis Patients with COVID-19 in Japan: A Nationwide Cohort Study","volume":"7","author":"Kikuchi","year":"2021","journal-title":"Ren. Replace. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Hu, R., Yin, J., He, T., Zhu, Y., Li, Y., Gao, J., Ye, X., Hu, L., and Li, Y. (2024). Impact of COVID-19 Vaccination on Mortality and Clinical Outcomes in Hemodialysis Patients. Vaccines, 12.","DOI":"10.3390\/vaccines12070799"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Davidovic, T., Schimpf, J., Abbassi-Nik, A., Stockinger, R., Sprenger-M\u00e4hr, H., Lhotta, K., and Zitt, E. (2022). Humoral and Cellular Immune Response After a 3-Dose Heterologous SARS-CoV-2 Vaccination Using the MRNA-BNT162b2 and Viral Vector Ad26COVS1 Vaccine in Hemodialysis Patients. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.907615"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.kint.2022.01.022","article-title":"COVID-19 in Dialysis: Clinical Impact, Immune Response, Prevention, and Treatment","volume":"101","year":"2022","journal-title":"Kidney Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1093\/ckj\/sfab206","article-title":"Diminished and Waning Immunity to COVID-19 Vaccination Among Hemodialysis Patients in Israel: The Case for a Third Vaccine Dose","volume":"15","author":"Peres","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1093\/qjmed\/hcab171","article-title":"COVID-19 Vaccination and Dialysis Patients: Why the Variable Response","volume":"114","author":"Yen","year":"2021","journal-title":"QJM"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1159\/000529767","article-title":"Examination of the Effect of Switching Dialysis Membranes on the Immune Response to Influenza Virus Vaccination in Hemodialysis Patients","volume":"52","author":"Tomo","year":"2023","journal-title":"Blood Purif."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1053\/j.ajkd.2008.11.032","article-title":"Immunogenicity of a Standard Trivalent Influenza Vaccine in Patients on Long-Term Hemodialysis: An Open-Label Trial","volume":"54","author":"Peetermans","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Pleros, C., Adamidis, K., Kantartzi, K., Griveas, I., Baltsavia, I., Moustakas, A., Kalliaropoulos, A., Fraggedaki, E., Petra, C., and Damianakis, N. (2023). Dialysis Patients Respond Adequately to Influenza Vaccination Irrespective of Dialysis Modality and Chronic Inflammation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12196205"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1159\/000443416","article-title":"Previous Vaccination and Age Are More Important Predictors of Immune Response to Influenza Vaccine than Inflammation and Iron Status in Dialysis Patients","volume":"41","author":"Eiselt","year":"2016","journal-title":"Kidney Blood Press. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"14001","DOI":"10.1073\/pnas.96.24.14001","article-title":"Variable Efficacy of Repeated Annual Influenza Vaccination","volume":"96","author":"Smith","year":"1999","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1093\/cid\/ciw176","article-title":"A Perfect Storm: Impact of Genomic Variation and Serial Vaccination on Low Influenza Vaccine Effectiveness During the 2014\u20132015 Season","volume":"63","author":"Skowronski","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1093\/infdis\/jix074","article-title":"Serial Vaccination and the Antigenic Distance Hypothesis: Effects on Influenza Vaccine Effectiveness During A(H3N2) Epidemics in Canada, 2010\u20132011 to 2014\u20132015","volume":"215","author":"Skowronski","year":"2017","journal-title":"J. Infect. Dis."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/1\/63\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T13:55:54Z","timestamp":1767621354000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/1\/63"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,4]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["vaccines14010063"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14010063","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,4]]}}}