Patterns of Influenza Vaccination and Vaccine Effectiveness Among Young US Children Who Receive Outpatient Care for Acute Respiratory Tract Illness
- PMID: 32364599
- PMCID: PMC7199168
- DOI: 10.1001/jamapediatrics.2020.0372
Patterns of Influenza Vaccination and Vaccine Effectiveness Among Young US Children Who Receive Outpatient Care for Acute Respiratory Tract Illness
Abstract
Importance: The burden of influenza among young children is high, and influenza vaccination is the primary strategy to prevent the virus and its complications. Less is known about differences in clinical protection following 1 vs 2 doses of initial influenza vaccination.
Objectives: To describe patterns of influenza vaccination among young children who receive outpatient care for acute respiratory tract illness in the US and compare vaccine effectiveness (VE) against medically attended laboratory-confirmed influenza by number of influenza vaccine doses received.
Design: This test-negative case-control study was conducted in outpatient clinics, including emergency departments, at 5 sites of the US Influenza Vaccine Effectiveness Network during the 2014-2015 through 2017-2018 influenza seasons. The present study was performed from November 5, 2014, to April 12, 2018, during periods of local influenza circulation. Children aged 6 months to 8 years with an acute respiratory tract illness with cough who presented for outpatient care within 7 days of illness onset were included. All children were tested using real-time, reverse-transcriptase polymerase chain reaction for influenza for research purposes.
Exposures: Vaccination in the enrollment season with either 1 or 2 doses of inactivated influenza vaccine as documented from electronic medical records, including state immunization information systems.
Main outcomes and measures: Medically attended acute respiratory tract infection with real-time, reverse-transcriptase polymerase chain reaction testing for influenza.
Results: Of 7533 children, 3480 children (46%) were girls, 4687 children (62%) were non-Hispanic white, and 4871 children (65%) were younger than 5 years. A total of 3912 children (52%) were unvaccinated in the enrollment season, 2924 children (39%) were fully vaccinated, and 697 children (9%) were partially vaccinated. Adjusted VE against any influenza was 51% (95% CI, 44%-57%) among fully vaccinated children and 41% (95% CI, 25%-54%) among partially vaccinated children. Among 1519 vaccine-naive children aged 6 months to 2 years, the VE of 2 doses in the enrollment season was 53% (95% CI, 28%-70%), and the VE of 1 dose was 23% (95% CI, -11% to 47%); those who received 2 doses were less likely to test positive for influenza compared with children who received only 1 dose (adjusted odds ratio, 0.57; 95% CI, 0.35-0.93).
Conclusions and relevance: Consistent with US influenza vaccine policy, receipt of the recommended number of doses resulted in higher VE than partial vaccination in 4 influenza seasons. Efforts to improve 2-dose coverage for previously unvaccinated children may reduce the burden of influenza in this population.
Conflict of interest statement
Comment in
-
The Clinical Importance of a Second Dose of Influenza Vaccination in Young Children.JAMA Pediatr. 2020 Jul 1;174(7):643-644. doi: 10.1001/jamapediatrics.2020.0377. JAMA Pediatr. 2020. PMID: 32364577 No abstract available.
Similar articles
-
Influenza Vaccine Effectiveness for Fully and Partially Vaccinated Children 6 Months to 8 Years Old During 2011-2012 and 2012-2013: The Importance of Two Priming Doses.Pediatr Infect Dis J. 2016 Mar;35(3):299-308. doi: 10.1097/INF.0000000000001006. Pediatr Infect Dis J. 2016. PMID: 26658375 Free PMC article.
-
Association of Prior Vaccination With Influenza Vaccine Effectiveness in Children Receiving Live Attenuated or Inactivated Vaccine.JAMA Netw Open. 2018 Oct 5;1(6):e183742. doi: 10.1001/jamanetworkopen.2018.3742. JAMA Netw Open. 2018. PMID: 30646262 Free PMC article.
-
Effectiveness of Live Attenuated vs Inactivated Influenza Vaccines in Children During the 2012-2013 Through 2015-2016 Influenza Seasons in Alberta, Canada: A Canadian Immunization Research Network (CIRN) Study.JAMA Pediatr. 2018 Sep 1;172(9):e181514. doi: 10.1001/jamapediatrics.2018.1514. Epub 2018 Sep 4. JAMA Pediatr. 2018. PMID: 29971427 Free PMC article.
-
Systematic Review and Meta-analysis of Indirect Protection Afforded by Vaccinating Children Against Seasonal Influenza: Implications for Policy.Clin Infect Dis. 2017 Sep 1;65(5):719-728. doi: 10.1093/cid/cix420. Clin Infect Dis. 2017. PMID: 28475770 Review.
-
Influenza Vaccine Effectiveness: New Insights and Challenges.Cold Spring Harb Perspect Med. 2021 Jun 1;11(6):a038315. doi: 10.1101/cshperspect.a038315. Cold Spring Harb Perspect Med. 2021. PMID: 31988202 Free PMC article. Review.
Cited by
-
Vaccine Effectiveness Against Pediatric Influenza-A-Associated Urgent Care, Emergency Department, and Hospital Encounters During the 2022-2023 Season: VISION Network.Clin Infect Dis. 2024 Mar 20;78(3):746-755. doi: 10.1093/cid/ciad704. Clin Infect Dis. 2024. PMID: 37972288 Free PMC article.
-
Influenza Vaccine Effectiveness Among Children: 2011-2020.Pediatrics. 2023 Apr 1;151(4):e2022059922. doi: 10.1542/peds.2022-059922. Pediatrics. 2023. PMID: 36960655 Free PMC article.
-
Epipharyngeal Abrasive Therapy Down-regulates the Expression of Cav1.2: A Key Molecule in Influenza Virus Entry.In Vivo. 2022 Sep-Oct;36(5):2357-2364. doi: 10.21873/invivo.12967. In Vivo. 2022. PMID: 36099101 Free PMC article.
-
Text Message Reminders for the Second Dose of Influenza Vaccine for Children: An RCT.Pediatrics. 2022 Sep 1;150(3):e2022056967. doi: 10.1542/peds.2022-056967. Pediatrics. 2022. PMID: 35965283 Free PMC article. Clinical Trial.
-
Influenza Vaccination Effectiveness in Paediatric 'Healthy' Patients: A Population-Based Study in Italy.Vaccines (Basel). 2022 Apr 10;10(4):582. doi: 10.3390/vaccines10040582. Vaccines (Basel). 2022. PMID: 35455331 Free PMC article.
References
-
- Centers for Disease Control and Prevention Past seasons estimated influenza disease burden: 2018. Updated January 9, 2020. Accessed July 3, 2019. https://www.cdc.gov/flu/about/burden/past-seasons.html
-
- Grohskopf LA, Sokolow LZ, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2018-19 influenza season. MMWR Recomm Rep. 2018;67(3):1-20. doi:10.15585/mmwr.rr6703a1 - DOI - PMC - PubMed
Publication types
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous