tetano
Editor, Senior Moderator
Clin Infect Dis
. 2022 Jan 13;ciab931.
doi: 10.1093/cid/ciab931. Online ahead of print.
Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children
Samantha M Olson[SUP] 1 [/SUP], Margaret M Newhams[SUP] 2 [/SUP], Natasha B Halasa[SUP] 3 [/SUP], Leora R Feldstein[SUP] 1 [/SUP], Tanya Novak[SUP] 2 4 [/SUP], Scott L Weiss[SUP] 5 [/SUP], Bria M Coates[SUP] 6 [/SUP], Jennifer E Schuster[SUP] 7 [/SUP], Adam J Schwarz[SUP] 8 [/SUP], Aline B Maddux[SUP] 9 [/SUP], Mark W Hall[SUP] 10 [/SUP], Ryan A Nofziger[SUP] 11 [/SUP], Heidi R Flori[SUP] 12 [/SUP], Shira J Gertz[SUP] 13 [/SUP], Michele Kong[SUP] 14 [/SUP], Ronald C Sanders[SUP] 15 [/SUP], Katherine Irby[SUP] 15 [/SUP], Janet R Hume[SUP] 16 [/SUP], Melissa L Cullimore[SUP] 17 [/SUP], Steven L Shein[SUP] 18 [/SUP], Neal J Thomas[SUP] 19 [/SUP], Laura S Stewart[SUP] 3 [/SUP], John R Barnes[SUP] 1 [/SUP], Manish M Patel[SUP] 1 [/SUP], Adrienne G Randolph[SUP] 2 4 20 [/SUP], Pediatric Intensive Care Influenza Investigators
Collaborators, Affiliations
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.
Keywords: case control; influenza; pediatrics; severity; vaccination.
. 2022 Jan 13;ciab931.
doi: 10.1093/cid/ciab931. Online ahead of print.
Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children
Samantha M Olson[SUP] 1 [/SUP], Margaret M Newhams[SUP] 2 [/SUP], Natasha B Halasa[SUP] 3 [/SUP], Leora R Feldstein[SUP] 1 [/SUP], Tanya Novak[SUP] 2 4 [/SUP], Scott L Weiss[SUP] 5 [/SUP], Bria M Coates[SUP] 6 [/SUP], Jennifer E Schuster[SUP] 7 [/SUP], Adam J Schwarz[SUP] 8 [/SUP], Aline B Maddux[SUP] 9 [/SUP], Mark W Hall[SUP] 10 [/SUP], Ryan A Nofziger[SUP] 11 [/SUP], Heidi R Flori[SUP] 12 [/SUP], Shira J Gertz[SUP] 13 [/SUP], Michele Kong[SUP] 14 [/SUP], Ronald C Sanders[SUP] 15 [/SUP], Katherine Irby[SUP] 15 [/SUP], Janet R Hume[SUP] 16 [/SUP], Melissa L Cullimore[SUP] 17 [/SUP], Steven L Shein[SUP] 18 [/SUP], Neal J Thomas[SUP] 19 [/SUP], Laura S Stewart[SUP] 3 [/SUP], John R Barnes[SUP] 1 [/SUP], Manish M Patel[SUP] 1 [/SUP], Adrienne G Randolph[SUP] 2 4 20 [/SUP], Pediatric Intensive Care Influenza Investigators
Collaborators, Affiliations
- PMID: 35024795
- DOI: 10.1093/cid/ciab931
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.
Keywords: case control; influenza; pediatrics; severity; vaccination.