Constance E Ogokeh1,2, Angela P Campbell1, Leora R Feldstein1, Geoffrey A Weinberg3, Mary A Staat4, Monica M McNeal4, Rangaraj Selvarangan5, Natasha B Halasa6, Janet A Englund7,8, Julie A Boom9,10, Parvin H Azimi11, Peter G Szilagyi3,12, Christopher J Harrison13, John V Williams14, Eileen J Klein7,8, Laura S Stewart6, Leila C Sahni9,10, Monica N Singer11, Joana Y Lively15,16, Daniel C Payne15, Manish Patel1. 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. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. 4. Department of Pediatrics, University of Cincinnati College of Medicine, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. 5. Department of Pathology and Laboratory Medicine, University of Missouri-Kansas City, Children's Mercy Hospital, Kansas City, Missouri, USA. 6. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 7. Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, USA. 8. Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA. 9. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. 10. Texas Children's Hospital, Houston, Texas, USA. 11. Department of Infectious Diseases, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA. 12. Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, California, USA. 13. Department of Pediatrics, University of Missouri-Kansas City; Division of Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri, USA. 14. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 15. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 16. IHRC Inc, Atlanta, Georgia, USA.
Abstract
BACKGROUND: Parent-reported influenza vaccination history may be valuable clinically and in influenza vaccine effectiveness (VE) studies. Few studies have assessed the validity of parental report among hospitalized children. METHODS: Parents of 2597 hospitalized children 6 months-17 years old were interviewed from November 1, 2015 to June 30, 2016, regarding their child's sociodemographic and influenza vaccination history. Parent-reported 2015-2016 influenza vaccination history was compared with documented vaccination records (considered the gold standard for analysis) obtained from medical records, immunization information systems, and providers. Multivariable logistic regression analyses were conducted to determine potential factors associated with discordance between the 2 sources of vaccination history. Using a test-negative design, we estimated VE using vaccination history obtained through parental report and documented records. RESULTS: According to parental report, 1718 (66%) children received the 2015-2016 influenza vaccine, and of those, 1432 (83%) had documentation of vaccine receipt. Percent agreement was 87%, with a sensitivity of 96% (95% confidence interval [CI], 95%-97%) and a specificity of 74% (95% CI, 72%-77%). In the multivariable logistic regression, study site and child's age 5-8 years were significant predictors of discordance. Adjusted VE among children who received ≥1 dose of the 2015-2016 influenza vaccine per parental report was 61% (95% CI, 43%-74%), whereas VE using documented records was 55% (95% CI, 33%-69%). CONCLUSIONS: Parental report of influenza vaccination was sensitive but not as specific compared with documented records. However, VE against influenza-associated hospitalizations using either source of vaccination history did not differ substantially. Parental report is valuable for timely influenza VE studies. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2020.
BACKGROUND: Parent-reported influenza vaccination history may be valuable clinically and in influenza vaccine effectiveness (VE) studies. Few studies have assessed the validity of parental report among hospitalized children. METHODS: Parents of 2597 hospitalized children 6 months-17 years old were interviewed from November 1, 2015 to June 30, 2016, regarding their child's sociodemographic and influenza vaccination history. Parent-reported 2015-2016 influenza vaccination history was compared with documented vaccination records (considered the gold standard for analysis) obtained from medical records, immunization information systems, and providers. Multivariable logistic regression analyses were conducted to determine potential factors associated with discordance between the 2 sources of vaccination history. Using a test-negative design, we estimated VE using vaccination history obtained through parental report and documented records. RESULTS: According to parental report, 1718 (66%) children received the 2015-2016 influenza vaccine, and of those, 1432 (83%) had documentation of vaccine receipt. Percent agreement was 87%, with a sensitivity of 96% (95% confidence interval [CI], 95%-97%) and a specificity of 74% (95% CI, 72%-77%). In the multivariable logistic regression, study site and child's age 5-8 years were significant predictors of discordance. Adjusted VE among children who received ≥1 dose of the 2015-2016 influenza vaccine per parental report was 61% (95% CI, 43%-74%), whereas VE using documented records was 55% (95% CI, 33%-69%). CONCLUSIONS: Parental report of influenza vaccination was sensitive but not as specific compared with documented records. However, VE against influenza-associated hospitalizations using either source of vaccination history did not differ substantially. Parental report is valuable for timely influenza VE studies. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2020.
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