Samantha M Olson1, Margaret M Newhams2, Natasha B Halasa3, Leora R Feldstein1, Tanya Novak2,4, Scott L Weiss5, Bria M Coates6, Jennifer E Schuster7, Adam J Schwarz8, Aline B Maddux9, Mark W Hall10, Ryan A Nofziger11, Heidi R Flori12, Shira J Gertz13, Michele Kong14, Ronald C Sanders15, Katherine Irby15, Janet R Hume16, Melissa L Cullimore17, Steven L Shein18, Neal J Thomas19, Laura S Stewart3, John R Barnes1, Manish M Patel1, Adrienne G Randolph2,4,20. 1. Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 2. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. 3. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 4. Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA. 5. Division of Critical Care, Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 6. Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. 7. Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA. 8. Department of Pediatrics, Children's Hospital of Orange County, Orange, California, USA. 9. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA. 10. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA. 11. Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, USA. 12. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan, USA. 13. Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey, USA. 14. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA. 15. Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas, USA. 16. Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA. 17. Division of Pediatric Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA. 18. Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA. 19. Department of Pediatrics, Penn State Hershey Children's Hospital, Penn State University College of Medicine, Hershey, Pennsylvania, USA. 20. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Predominance of 2 antigenically drifted influenza viruses during the 2019-2020 season offered an opportunity to assess vaccine effectiveness against life-threatening pediatric influenza disease from vaccine-mismatched viruses in the United States. METHODS: We enrolled children aged <18 years admitted to the intensive care unit with acute respiratory infection across 17 hospitals. Respiratory specimens were tested using reverse-transcription polymerase chain reaction for influenza viruses and sequenced. Using a test-negative design, we estimated vaccine effectiveness comparing odds of vaccination in test-positive case patients vs test-negative controls, stratifying by age, virus type, and severity. Life-threating influenza included death or invasive mechanical ventilation, vasopressors, cardiopulmonary resuscitation, dialysis, or extracorporeal membrane oxygenation. RESULTS: We enrolled 159 critically ill influenza case-patients (70% ≤8 years; 51% A/H1N1pdm09 and 25% B-Victoria viruses) and 132 controls (69% were aged ≤8 years). Among 56 sequenced A/H1N1pdm09 viruses, 29 (52%) were vaccine-mismatched (A/H1N1pdm09/5A+156K) and 23 (41%) were vaccine-matched (A/H1N1pdm09/5A+187A,189E). Among sequenced B-lineage viruses, majority (30 of 31) were vaccine-mismatched. Effectiveness against critical influenza was 63% (95% confidence interval [CI], 38% to 78%) and similar by age. Effectiveness was 75% (95% CI, 49% to 88%) against life-threatening influenza vs 57% (95% CI, 24% to 76%) against non-life-threating influenza. Effectiveness was 78% (95% CI, 41% to 92%) against matched A(H1N1)pdm09 viruses, 47% (95% CI, -21% to 77%) against mismatched A(H1N1)pdm09 viruses, and 75% (95% CI, 37% to 90%) against mismatched B-Victoria viruses. CONCLUSIONS: During a season when vaccine-mismatched influenza viruses predominated, vaccination was associated with a reduced risk of critical and life-threatening influenza illness in children. Published by Oxford University Press for the Infectious Diseases Society of America 2022.
BACKGROUND: Predominance of 2 antigenically drifted influenza viruses during the 2019-2020 season offered an opportunity to assess vaccine effectiveness against life-threatening pediatric influenza disease from vaccine-mismatched viruses in the United States. METHODS: We enrolled children aged <18 years admitted to the intensive care unit with acute respiratory infection across 17 hospitals. Respiratory specimens were tested using reverse-transcription polymerase chain reaction for influenza viruses and sequenced. Using a test-negative design, we estimated vaccine effectiveness comparing odds of vaccination in test-positive case patients vs test-negative controls, stratifying by age, virus type, and severity. Life-threating influenza included death or invasive mechanical ventilation, vasopressors, cardiopulmonary resuscitation, dialysis, or extracorporeal membrane oxygenation. RESULTS: We enrolled 159 critically ill influenza case-patients (70% ≤8 years; 51% A/H1N1pdm09 and 25% B-Victoria viruses) and 132 controls (69% were aged ≤8 years). Among 56 sequenced A/H1N1pdm09 viruses, 29 (52%) were vaccine-mismatched (A/H1N1pdm09/5A+156K) and 23 (41%) were vaccine-matched (A/H1N1pdm09/5A+187A,189E). Among sequenced B-lineage viruses, majority (30 of 31) were vaccine-mismatched. Effectiveness against critical influenza was 63% (95% confidence interval [CI], 38% to 78%) and similar by age. Effectiveness was 75% (95% CI, 49% to 88%) against life-threatening influenza vs 57% (95% CI, 24% to 76%) against non-life-threating influenza. Effectiveness was 78% (95% CI, 41% to 92%) against matched A(H1N1)pdm09 viruses, 47% (95% CI, -21% to 77%) against mismatched A(H1N1)pdm09 viruses, and 75% (95% CI, 37% to 90%) against mismatched B-Victoria viruses. CONCLUSIONS: During a season when vaccine-mismatched influenza viruses predominated, vaccination was associated with a reduced risk of critical and life-threatening influenza illness in children. Published by Oxford University Press for the Infectious Diseases Society of America 2022.
Entities:
Keywords:
case control; influenza; pediatrics; severity; vaccination
Authors: Natasha B Halasa; Samantha M Olson; Mary A Staat; Margaret M Newhams; Ashley M Price; Pia S Pannaraj; Julie A Boom; Leila C Sahni; Kathleen Chiotos; Melissa A Cameron; Katherine E Bline; Charlotte V Hobbs; Aline B Maddux; Bria M Coates; Kelly N Michelson; Sabrina M Heidemann; Katherine Irby; Ryan A Nofziger; Elizabeth H Mack; Laura Smallcomb; Stephanie P Schwartz; Tracie C Walker; Shira J Gertz; Jennifer E Schuster; Satoshi Kamidani; Keiko M Tarquinio; Samina S Bhumbra; Mia Maamari; Janet R Hume; Hillary Crandall; Emily R Levy; Matt S Zinter; Tamara T Bradford; Heidi R Flori; Melissa L Cullimore; Michele Kong; Natalie Z Cvijanovich; Suzanne M Gilboa; Kara N Polen; Angela P Campbell; Adrienne G Randolph; Manish M Patel Journal: N Engl J Med Date: 2022-06-22 Impact factor: 176.079
Authors: Natasha B Halasa; Andrew J Spieker; Cameron C Young; Samantha M Olson; Margaret M Newhams; Justin Z Amarin; Kristin L Moffitt; Mari M Nakamura; Emily R Levy; Vijaya L Soma; Rana Talj; Scott L Weiss; Julie C Fitzgerald; Elizabeth H Mack; Aline B Maddux; Jennifer E Schuster; Bria M Coates; Mark W Hall; Stephanie P Schwartz; Adam J Schwarz; Michele Kong; Philip C Spinella; Laura L Loftis; Gwenn E McLaughlin; Charlotte V Hobbs; Courtney M Rowan; Melania M Bembea; Ryan A Nofziger; Christopher J Babbitt; Cindy Bowens; Heidi R Flori; Shira J Gertz; Matt S Zinter; John S Giuliano; Janet R Hume; Natalie Z Cvijanovich; Aalok R Singh; Hillary A Crandall; Neal J Thomas; Melissa L Cullimore; Manish M Patel; Adrienne G Randolph Journal: Clin Infect Dis Date: 2022-06-19 Impact factor: 20.999
Authors: Jessie R Chung; Sara S Kim; Rebecca J Kondor; Catherine Smith; Alicia P Budd; Sara Y Tartof; Ana Florea; H Keipp Talbot; Carlos G Grijalva; Karen J Wernli; C Hallie Phillips; Arnold S Monto; Emily T Martin; Edward A Belongia; Huong Q McLean; Manjusha Gaglani; Michael Reis; Krissy Moehling Geffel; Mary Patricia Nowalk; Juliana DaSilva; Lisa M Keong; Thomas J Stark; John R Barnes; David E Wentworth; Lynnette Brammer; Erin Burns; Alicia M Fry; Manish M Patel; Brendan Flannery Journal: MMWR Morb Mortal Wkly Rep Date: 2022-03-11 Impact factor: 17.586