Leora R Feldstein1, Constance Ogokeh1,2, Brian Rha3, Geoffrey A Weinberg4, Mary A Staat5, Rangaraj Selvarangan6, Natasha B Halasa7, Janet A Englund8,9, Julie A Boom10,11, Parvin H Azimi12, Peter G Szilagyi4,13, Monica McNeal5, Christopher J Harrison14, John V Williams15, Eileen J Klein8,9, Leila C Sahni11, Monica N Singer12, Joana Y Lively3,16, Daniel C Payne3, Alicia M Fry1, Manish Patel1, Angela P Campbell1. 1. Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 2. Oak Ridge Institute for Science and Education Fellowship Program, Oak Ridge, Tennessee, USA. 3. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 4. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. 5. Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 6. Department of Pathology and Laboratory Medicine, University of Missouri-Kansas City, Children's Mercy Hospital, Kansas City, Missouri, USA. 7. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 8. Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, USA. 9. Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA. 10. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. 11. Texas Children's Hospital, Houston, Texas, USA. 12. Department of Infectious Diseases, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA. 13. Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA. 14. Department of Infectious Diseases, University of Missouri-Kansas City, Children's Mercy Hospital, Kansas City, Missouri, USA. 15. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 16. IHRC, Atlanta, Georgia, USA.
Abstract
BACKGROUND: Annual United States (US) estimates of influenza vaccine effectiveness (VE) in children typically measure protection against outpatient medically attended influenza illness, with limited data evaluating VE against influenza hospitalizations. We estimated VE for preventing laboratory-confirmed influenza hospitalization among US children. METHODS: We included children aged 6 months-17 years with acute respiratory illness enrolled in the New Vaccine Surveillance Network during the 2015-2016 influenza season. Documented influenza vaccination status was obtained from state immunization information systems, the electronic medical record, and/or provider records. Midturbinate nasal and throat swabs were tested for influenza using molecular assays. We estimated VE as 100% × (1 - odds ratio), comparing the odds of vaccination among subjects testing influenza positive with subjects testing negative, using multivariable logistic regression. RESULTS: Of 1653 participants, 36 of 707 (5%) of those fully vaccinated, 18 of 226 (8%) of those partially vaccinated, and 85 of 720 (12%) of unvaccinated children tested positive for influenza. Of those vaccinated, almost 90% were documented to have received inactivated vaccine. The majority (81%) of influenza cases were in children ≤ 8 years of age. Of the 139 influenza-positive cases, 42% were A(H1N1)pdm09, 42% were B viruses, and 14% were A(H3N2). Overall, adjusted VE for fully vaccinated children was 56% (95% confidence interval [CI], 34%-71%) against any influenza-associated hospitalization, 68% (95% CI, 36%-84%) for A(H1N1)pdm09, and 44% (95% CI, -1% to 69%) for B viruses. CONCLUSIONS: These findings demonstrate the importance of annual influenza vaccination in prevention of severe influenza disease and of reducing the number of children who remain unvaccinated or partially vaccinated against influenza. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2020.
BACKGROUND: Annual United States (US) estimates of influenza vaccine effectiveness (VE) in children typically measure protection against outpatient medically attended influenza illness, with limited data evaluating VE against influenza hospitalizations. We estimated VE for preventing laboratory-confirmed influenza hospitalization among US children. METHODS: We included children aged 6 months-17 years with acute respiratory illness enrolled in the New Vaccine Surveillance Network during the 2015-2016 influenza season. Documented influenza vaccination status was obtained from state immunization information systems, the electronic medical record, and/or provider records. Midturbinate nasal and throat swabs were tested for influenza using molecular assays. We estimated VE as 100% × (1 - odds ratio), comparing the odds of vaccination among subjects testing influenza positive with subjects testing negative, using multivariable logistic regression. RESULTS: Of 1653 participants, 36 of 707 (5%) of those fully vaccinated, 18 of 226 (8%) of those partially vaccinated, and 85 of 720 (12%) of unvaccinated children tested positive for influenza. Of those vaccinated, almost 90% were documented to have received inactivated vaccine. The majority (81%) of influenza cases were in children ≤ 8 years of age. Of the 139 influenza-positive cases, 42% were A(H1N1)pdm09, 42% were B viruses, and 14% were A(H3N2). Overall, adjusted VE for fully vaccinated children was 56% (95% confidence interval [CI], 34%-71%) against any influenza-associated hospitalization, 68% (95% CI, 36%-84%) for A(H1N1)pdm09, and 44% (95% CI, -1% to 69%) for B viruses. CONCLUSIONS: These findings demonstrate the importance of annual influenza vaccination in prevention of severe influenza disease and of reducing the number of children who remain unvaccinated or partially vaccinated against influenza. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2020.
Entities:
Keywords:
hospitalization; influenza; pediatric; test-negative study design; vaccine effectiveness
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