1
|
Cole J, Cąpała-Szczurko I, Roseti S, Chen C, Caveney S, Aksyuk AA, Streicher K, Ponnarambil S, Colice G. Effect of Tezepelumab on the Humoral Immune Response to Seasonal Quadrivalent Influenza Vaccination in Patients with Moderate to Severe Asthma: The Phase 3b VECTOR Study. Pulm Ther 2024; 10:53-67. [PMID: 38064153 PMCID: PMC10881940 DOI: 10.1007/s41030-023-00245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/06/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Annual influenza vaccinations are recommended for adolescents and adults with moderate to severe asthma. This study investigated the effect of tezepelumab, a human monoclonal antibody that blocks the activity of thymic stromal lymphopoietin, on the humoral immune response to the quadrivalent seasonal influenza vaccine in patients with moderate to severe asthma. METHODS VECTOR was a phase 3b, randomized, multicenter, double-blind, parallel-group, placebo-controlled study. Adolescents (aged 12-17 years) and young adults (aged 18-21 years) with moderate to severe asthma were enrolled across 15 centers in the USA. Patients received tezepelumab 210 mg or placebo subcutaneously at weeks 0, 4, 8, and 12, and a single dose of inactivated quadrivalent seasonal influenza vaccine at week 12 before receiving study treatment. Immediately before vaccination and at 4 weeks postvaccination (week 16), strain-specific antibody responses were assessed for four influenza antigens by hemagglutination inhibition (HAI) and microneutralization (MN) assays. Safety was assessed. RESULTS Seventy patients were randomized to tezepelumab (n = 35) or placebo (n = 35). There were no meaningful differences in HAI or MN antibody responses between treatment groups at week 16. HAI assay geometric mean fold rises (GMFRs) for influenza strains were 1.76-7.34 for tezepelumab and 1.46-4.75 for placebo. MN assay GMFRs were 4.00-14.56 for tezepelumab and 3.56-10.62 for placebo. In the HAI assay, a fourfold or larger rise in antibody titer from weeks 12 to 16 occurred in 15.2-78.8% and 15.2-51.5% of tezepelumab and placebo recipients, respectively, and 97.0-100% of patients in both treatment groups achieved an antibody titer of at least 40 at week 16. No unexpected safety findings occurred. CONCLUSION There was no observed suppression of the humoral immune response after influenza vaccination in adolescents and young adults with moderate to severe asthma treated with tezepelumab. Therefore, the influenza vaccine can be administered to this patient population during tezepelumab treatment. CLINICALTRIALS GOV IDENTIFIER NCT05062759.
Collapse
Affiliation(s)
| | - Iwona Cąpała-Szczurko
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Warsaw, Poland
| | - Stephanie Roseti
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Claudia Chen
- Biometrics, Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Scott Caveney
- Global Development, Inflammation, R&D, Amgen, Thousand Oaks, CA, USA
| | - Anastasia A Aksyuk
- Translational Medicine, Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Katie Streicher
- Translational Medicine, Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Sandhia Ponnarambil
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK.
- AstraZeneca BioPharmaceuticals R&D, 136 Hills Road, Cambridge, CB2 8PA, UK.
| | - Gene Colice
- Late-Stage Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| |
Collapse
|
2
|
Khojasteh-Kaffash S, Parhizkar Roudsari P, Ghaffari Jolfayi A, Samieefar N, Rezaei N. Pediatric asthma exacerbation and COVID-19 pandemic: Impacts, challenges, and future considerations. J Asthma 2024; 61:81-91. [PMID: 37610180 DOI: 10.1080/02770903.2023.2251062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Asthma, a common disease among children and adolescents, poses a great health risk when ignored; therefore, a thorough follow-up to prevent exacerbations is emphasized. The aim of the present study is to investigate asthma exacerbation in children during the Coronavirus disease 2019 (COVID-19) era. DATA SOURCES This narrative review has been done by searching the PubMed and Embase databases using Asthma, COVID-19, Pandemic, and Symptom flare up as keywords. STUDY SELECTIONS Studies related to asthma exacerbation in COVID-19 pandemic were included. RESULTS Based on studies, controlled or mild to moderate asthma has not been considered a risk factor for COVID-19 severity and has not affected hospitalization, intensive care unit (ICU) admission, and mortality. Surprisingly, emergent and non-emergent visits and asthmatic attacks decreased during the pandemic. The three main reasons for decreased incidence and exacerbation of asthma episodes in the COVID-19 era included reduced exposure to environmental allergens, increasing the acceptance of treatment by pediatrics and caregivers, and decreased risk of other respiratory viral infections. Based on the available studies, COVID-19 vaccination had no serious side effects, except in cases of uncontrolled severe asthma, and can be injected in these children. Also, there was no conclusive evidence of asthma exacerbation after the injection of COVID-19 vaccines. CONCLUSION Further studies are recommended to follow the pattern of asthma in the post-pandemic situation and to become prepared for similar future conditions.
Collapse
Affiliation(s)
- Soroush Khojasteh-Kaffash
- Student Research Committee, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peyvand Parhizkar Roudsari
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ghaffari Jolfayi
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Cardiovascular Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Noosha Samieefar
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- USERN Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Science, Tehran, Iran
| |
Collapse
|
3
|
Fainardi V, Caffarelli C, Deolmi M, Zambelli G, Palazzolo E, Scavone S, Bergamini BM, Bertelli L, Biserna L, Bottau P, Corinaldesi E, De Paulis N, Di Palmo E, Dondi A, Gallucci M, Guidi B, Lombardi F, Magistrali MS, Marastoni E, Pastorelli S, Piccorossi A, Poloni M, Tagliati S, Vaienti F, Gregori G, Sacchetti R, Antodaro F, Bergomi A, Reggiani L, De Fanti A, Marchetti F, Grandinetti R, Mussi N, Ricci G, Esposito S. Maintenance Therapy for Children and Adolescents with Asthma: Guidelines and Recommendations from the Emilia-Romagna Asthma (ERA) Study Group. J Clin Med 2023; 12:5467. [PMID: 37685533 PMCID: PMC10487522 DOI: 10.3390/jcm12175467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Asthma is the most frequent chronic disease of childhood, affecting up to 20% of children worldwide. The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment. This project aims to summarize the most recent evidence regarding maintenance therapy for asthma in children and adolescents. A multidisciplinary panel of experts was asked clinical questions regarding the treatment of children and adolescents with asthma. Overall, 10 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results showed that the choice of medication depends on the severity of the child's asthma, phenotype, age, preference, and individual factors. In addition to medications, the identification of comorbidities and modifiable factors is crucial to obtaining good control. Asthma in children is heterogeneous, and its evolution varies over time. Since most recommendations for asthma management in childhood are extrapolated from clinical studies performed in adults, more clinical trials specifically designed for young children should be conducted.
Collapse
Affiliation(s)
- Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Michela Deolmi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Giulia Zambelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Elisabetta Palazzolo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Sara Scavone
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Barbara Maria Bergamini
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Luca Bertelli
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Loretta Biserna
- Paediatrics and Neonatology Unit, Ravenna Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 48121 Ravenna, Italy; (L.B.); (F.M.)
| | - Paolo Bottau
- Paediatrics Unit, Imola Hospital, 40026 Imola, Italy;
| | | | - Nicoletta De Paulis
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.)
| | - Emanuela Di Palmo
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Arianna Dondi
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Marcella Gallucci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Battista Guidi
- Hospital and Territorial Paediatrics Unit, 41026 Pavullo, Italy;
| | | | - Maria Sole Magistrali
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.)
| | - Elisabetta Marastoni
- Paediatrics Unit, Santa Maria Nuova Hospital, Azienda Unità Sanitaria Locale (AUSL)-Scientific Institute for Research and Healthcare (IRCCS) of Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.F.)
| | | | - Alessandra Piccorossi
- Paediatrics and Paediatric Intensive Care Unit, Cesena Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47521 Cesena, Italy
| | - Maurizio Poloni
- Paediatrics Unit, Rimini Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47921 Rimini, Italy;
| | | | - Francesca Vaienti
- Paediatrics Unit, G.B. Morgagni Pierantoni Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 47121 Forlì, Italy;
| | - Giuseppe Gregori
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Piacenza, 29121 Piacenza, Italy; (G.G.); (R.S.)
| | - Roberto Sacchetti
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Piacenza, 29121 Piacenza, Italy; (G.G.); (R.S.)
| | - Francesco Antodaro
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Modena, 41125 Modena, Italy; (F.A.)
| | - Andrea Bergomi
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Modena, 41125 Modena, Italy; (F.A.)
| | - Lamberto Reggiani
- Primary Care Pediatricians, Azienda Unità Sanitaria Locale (AUSL) Imola, 40026 Imola, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, Azienda Unità Sanitaria Locale (AUSL)-Scientific Institute for Research and Healthcare (IRCCS) of Reggio Emilia, 42123 Reggio Emilia, Italy (A.D.F.)
| | - Federico Marchetti
- Paediatrics and Neonatology Unit, Ravenna Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, 48121 Ravenna, Italy; (L.B.); (F.M.)
| | - Roberto Grandinetti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Nicole Mussi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| | - Giampaolo Ricci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (L.B.); (E.D.P.); (A.D.); (M.G.); (G.R.)
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (V.F.); (C.C.); (M.D.); (G.Z.); (E.P.); (S.S.); (R.G.); (N.M.)
| |
Collapse
|
4
|
Khan S, Ouaalaya EH, Chauveau AD, Scherer E, Reboux G, Millon L, Deschildre A, Marguet C, Dufourg MN, Charles MA, Raherison Semjen C. Whispers of change in preschool asthma phenotypes: Findings in the French ELFE cohort. Respir Med 2023; 215:107263. [PMID: 37224890 DOI: 10.1016/j.rmed.2023.107263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/26/2023]
Abstract
RATIONALE Early life asthma phenotyping remains an unmet need in pediatric asthma. In France, severe pediatric asthma phenotyping has been done extensively; however, phenotypes in the general population remain underexplored. Based on the course and severity of respiratory/allergic symptoms, we aimed to identify and characterize early life wheeze profiles and asthma phenotypes in the general population. METHODS ELFE is a general population based birth cohort; which recruited 18,329 newborns in 2011, from 320 maternity units nationwide. Data was collected using parental responses to modified versions of ISAAC questionnaire on eczema, rhinitis, food allergy, cough, wheezing, dyspnoea and sleep disturbance due to wheezing at 3 time points: post-natal (2 months), infancy (age 1) and pre-school (age 5). We built a supervised trajectory for wheeze profiles and an unsupervised approach was used for asthma phenotypes. Chi squared (χ2) test or fisher's exact test was used as appropriate (p < 0.05). RESULTS Wheeze profiles and asthma phenotypes were ascertained at age 5. Supervised wheeze trajectory of 9161 children resulted in 4 wheeze profiles: Persistent (0.8%), Transient (12.1%), Incident wheezers at age 5 (13.3%) and Non wheezers (73.9%). While 9517 children in unsupervised clusters displayed 4 distinct asthma phenotypes: Mildly symptomatic (70%), Post-natal bronchiolitis with persistent rhinitis (10.2%), Severe early asthma (16.9%) and Early persistent atopy with late onset severe wheeze (2.9%). CONCLUSION We successfully determined early life wheeze profiles and asthma phenotypes in the general population of France.
Collapse
Affiliation(s)
- Sadia Khan
- Bordeaux University, INSERM, Bordeaux Population Health Research Center, Team: EPICENE, UMR1219, Bordeaux, France.
| | - El Hassane Ouaalaya
- High Institute of Nursing Professions and Health Techniques, ISPITS, Agadir, Morocco
| | | | | | | | - Laurence Millon
- Parasitology-Mycology Department, University Hospital of Besançon, Chrono-Environnement UMR 6249 CNRS, University of Bourgogne Franche-Comté, 25000, Besançon, France
| | | | | | | | | | - Chantal Raherison Semjen
- Bordeaux University, INSERM, Bordeaux Population Health Research Center, Team: EPICENE, UMR1219, Bordeaux, France
| |
Collapse
|
5
|
Lai LY, Arshad F, Areia C, Alshammari TM, Alghoul H, Casajust P, Li X, Dawoud D, Nyberg F, Pratt N, Hripcsak G, Suchard MA, Prieto-Alhambra D, Ryan P, Schuemie MJ. Current Approaches to Vaccine Safety Using Observational Data: A Rationale for the EUMAEUS (Evaluating Use of Methods for Adverse Events Under Surveillance-for Vaccines) Study Design. Front Pharmacol 2022; 13:837632. [PMID: 35392566 PMCID: PMC8980923 DOI: 10.3389/fphar.2022.837632] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 12/28/2022] Open
Abstract
Post-marketing vaccine safety surveillance aims to detect adverse events following immunization in a population. Whether certain methods of surveillance are more precise and unbiased in generating safety signals is unclear. Here, we synthesized information from existing literature to provide an overview of the strengths, weaknesses, and clinical applications of epidemiologic and analytical methods used in vaccine monitoring, focusing on cohort, case-control and self-controlled designs. These designs are proposed to be evaluated in the EUMAEUS (Evaluating Use of Methods for Adverse Event Under Surveillance-for vaccines) study because of their widespread use and potential utility. Over the past decades, there have been an increasing number of epidemiological study designs used for vaccine safety surveillance. While traditional cohort and case-control study designs remain widely used, newer, novel designs such as the self-controlled case series and self-controlled risk intervals have been developed. Each study design comes with its strengths and limitations, and the most appropriate study design will depend on availability of resources, access to records, number and distribution of cases, and availability of population coverage data. Several assumptions have to be made while using the various study designs, and while the goal is to mitigate any biases, violations of these assumptions are often still present to varying degrees. In our review, we discussed some of the potential biases (i.e., selection bias, misclassification bias and confounding bias), and ways to mitigate them. While the types of epidemiological study designs are well established, a comprehensive comparison of the analytical aspects (including method evaluation and performance metrics) of these study designs are relatively less well studied. We summarized the literature, reporting on two simulation studies, which compared the detection time, empirical power, error rate and risk estimate bias across the above-mentioned study designs. While these simulation studies provided insights on the analytic performance of each of the study designs, its applicability to real-world data remains unclear. To bridge that gap, we provided the rationale of the EUMAEUS study, with a brief description of the study design; and how the use of real-world multi-database networks can provide insights into better methods evaluation and vaccine safety surveillance.
Collapse
Affiliation(s)
- Lana Yh Lai
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, United Kingdom
| | - Faaizah Arshad
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Carlos Areia
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Thamir M Alshammari
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Paula Casajust
- Real-World Evidence, Trial Form Support, Barcelona, Spain
| | - Xintong Li
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Dalia Dawoud
- Faculty of Pharmacy, Cairo University, Giza, Egypt
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicole Pratt
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Marc A Suchard
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Dani Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom.,Health Data Sciences, Medical Informatics, Erasmus Medical Center University, Rotterdam, Netherlands
| | - Patrick Ryan
- Department of Biomedical Informatics, Columbia University, New York, NY, United States.,Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States
| | - Martijn J Schuemie
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States.,Observational Health Data Analytics, Janssen R&D, Titusville, NJ, United States
| |
Collapse
|
6
|
Nie X, Xu L, Bai Y, Liu Z, Liu Z, Farrington P, Zhan S. Self-controlled case series design in vaccine safety: a systematic review. Expert Rev Vaccines 2021; 21:313-324. [PMID: 34937500 DOI: 10.1080/14760584.2022.2020108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND : An increasing number of vaccine safety studies using the self-controlled case-series (SCCS) design have been conducted in the last decade. However, there has been no comprehensive evaluation of the methodology and reporting quality of these observational studies. The purpose of this paper is to document the methodological features of studies that focused on vaccine safety using the SCCS design, and to evaluate the reporting quality of these studies to suggest future improvements on appropriate design and transparent reporting. METHODS : Databases including Medline, Embase, Web of Science, Scopus and Chinese databases were searched from inception to May 31, 2021. All observational studies regarding vaccine safety using a SCCS design were selected. Information regarding methodological elements were extracted. In addition, reporting quality was assessed using the REporting of studies Conducted using Observational Routinely collected health Data statement for PharmacoEpidemiology (RECORD-PE). RESULTS : Of the 105 studies identified, administrative databases were the main data source for vaccination records and adverse events following immunization (AEFI). 28 articles (27%) used multiple designs to verify the association, and the results obtained with the SCCS design were robust. The top three AEFI studied were intussusception, Guillain-Barré syndrome, and convulsions. Only 21 studies (20%) reported the approach for case validation by chart review. The healthy vaccinee effect was considered by 51studies (49%), with 16 of them (31%) using extended SCCS models to alleviate this effect. Overall, the reporting quality of included studies could be improved. CONCLUSIONS : This study systematically reviewed the methodology of studies regarding vaccine safety using a SCCS design and critically assessed their respective reporting quality. Case validation, the validity of assumptions for standard SCCS, and quality of reporting should be given more importance in future research projects.
Collapse
Affiliation(s)
- Xiaolu Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.,Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Lu Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Yi Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Zuoxiang Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Zhike Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Paddy Farrington
- School of Mathematics and Statistics, The Open University, Milton Keynes MK7 6AA, UK
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.,Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
| |
Collapse
|
7
|
Andreoni M, Sticchi L, Nozza S, Sarmati L, Gori A, Tavio M. Recommendations of the Italian society for infectious and tropical diseases (SIMIT) for adult vaccinations. Hum Vaccin Immunother 2021; 17:4265-4282. [PMID: 34524945 PMCID: PMC8828129 DOI: 10.1080/21645515.2021.1971473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 12/14/2022] Open
Abstract
Vaccination prevents 2-3 million deaths worldwide every year. Nevertheless, vaccine-preventable diseases (VPDs) still cause a considerable number of deaths especially in subjects belonging to "risk groups." These are represented by older adults, immunocompromised individuals and all subjects with underlying chronic medical conditions (cardiovascular, pulmonary, renal and liver chronic diseases, diabetes, immunodeficiency disorders). They have a weaker immune system and, if infected, are more likely to develop severe complications of their condition or of the preventable-infectious disease. This document summarizes the recommendations for vaccination of the main Global Institutional Organizations and analyses the risks of comorbidities associated with infectious disease and the benefits of vaccination for each specific group. The document provides a clear, practical and authoritative guide to adult vaccination.
Collapse
Affiliation(s)
- Massimo Andreoni
- UOC Infectious diseases Tor Vergata Polyclinic, University Hospital Viale, Rome, Italy
| | - Laura Sticchi
- Hygiene Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Silvia Nozza
- Medical Director, San Raffaele Hospital, Milan, Italy
| | - Loredana Sarmati
- UOC Infectious diseases Tor Vergata Polyclinic, University Hospital Viale, Rome, Italy
| | - Andrea Gori
- UOC Infectious Diseases, Irccs Ca’Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
| | - Marcello Tavio
- UOC Division of Emerging Infectious Diseases and Immunosuppressed, AOU Ospedali Riuniti of Ancona, Ancona, Italy
| | - Society for Infectious and Tropical Diseases (SIMIT)
- UOC Infectious diseases Tor Vergata Polyclinic, University Hospital Viale, Rome, Italy
- Hygiene Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Medical Director, San Raffaele Hospital, Milan, Italy
- UOC Infectious Diseases, Irccs Ca’Granda Foundation, Maggiore Policlinico Hospital, Milan, Italy
- UOC Division of Emerging Infectious Diseases and Immunosuppressed, AOU Ospedali Riuniti of Ancona, Ancona, Italy
| |
Collapse
|
8
|
Hou A, Silverberg JI. Increasing rates of influenza vaccination were associated with lower asthma prevalence in United States children. Allergy 2021; 76:2273-2275. [PMID: 33624361 DOI: 10.1111/all.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alexander Hou
- Department of Dermatology Feinberg School of Medicine Northwestern University Chicago Illinois USA
| | - Jonathan I. Silverberg
- Department of Dermatology George Washington University School of Medicine Washington District of Columbia USA
| |
Collapse
|
9
|
Wautlet AJ, Patel PD, Chavez P, Codispoti CD. Influenza epidemics: The role of allergists-immunologists. Ann Allergy Asthma Immunol 2020; 126:350-356. [PMID: 33259922 DOI: 10.1016/j.anai.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To review influenza epidemics and pandemics for practicing allergists-immunologists. DATA SOURCES English-language articles published in PubMed from 1990 to present with relevance to allergic disorders and articles cited by or similar to these articles. STUDY SELECTIONS A total of 472 articles were identified from PubMed. Two independent reviewers appraised the titles for relevance. RESULTS A total of 212 relevant articles were selected. Additional articles and government websites increased the number to 295 relevant citations. CONCLUSION Influenza epidemics and pandemics have recurred throughout history. Patients with asthma and immunodeficiency are at an increased risk. Nonpharmaceutical interventions, vaccination, and neuraminidase inhibitors are key strategies for the prevention and treatment of influenza epidemics/pandemics. Allergists play a vital role in protecting high-risk groups and increasing influenza vaccination coverage.
Collapse
Affiliation(s)
- Arnaud J Wautlet
- Departments of Internal Medicine and Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Payal D Patel
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Patricia Chavez
- Library of Rush University Medical Center, Chicago, Illinois
| | - Christopher D Codispoti
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
| |
Collapse
|
10
|
McLean HQ, Hanson KE, Foster AD, Olson SC, Kemble SK, Belongia EA. Serious outcomes of medically attended, laboratory-confirmed influenza illness among school-aged children with and without asthma, 2007-2018. Influenza Other Respir Viruses 2020; 14:173-181. [PMID: 31944583 PMCID: PMC7040974 DOI: 10.1111/irv.12710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/27/2022] Open
Abstract
Background Asthma was associated with influenza hospitalizations in children during the 2009 pandemic, but it is unclear if asthma is associated with serious illness during seasonal epidemics. Little is known regarding the effect of vaccination on influenza severity in children with asthma. Methods Children aged 5‐17 years in a community cohort presenting with acute respiratory illness were prospectively enrolled and tested for influenza from 2007‐08 through 2017‐18 (excluding the 2009‐10 pandemic season). Data from the electronic health record were extracted to determine asthma status and serious outcomes associated with influenza infection. A serious outcome was defined as hospitalization, emergency department visit, and/or pneumonia diagnosis within 30 days of symptom onset. Multivariable logistic regression models were used to assess asthma status and effect of vaccination on odds of a serious outcome. Results One thousand seven hundred and sixty four medically‐attended influenza infections among school‐aged children were included. Asthma was confirmed in 287 (16%) children. A serious influenza‐associated outcome occurred in 104 (6%) children. The odds of a serious outcome did not differ between those with confirmed asthma and those without asthma [adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): (0.77‐2.35), P = .3]. The effect of vaccination on serious outcomes was not modified by asthma status [aOR for children without asthma: 0.55 (95% CI: 0.28‐1.07), children with asthma: 1.39 (95% CI: 0.53‐3.69); interaction P‐value = .12]. Conclusions Asthma was not a risk factor for serious illness among children with influenza. Additional studies are needed to better understand the role of influenza vaccination in preventing serious outcomes among children with asthma.
Collapse
Affiliation(s)
- Huong Q McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Kayla E Hanson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Allison D Foster
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Scott C Olson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | | | - Edward A Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| |
Collapse
|
11
|
Liu K, Li S, Qian ZM, Dharmage SC, Bloom MS, Heinrich J, Jalaludin B, Markevych I, Morawska L, Knibbs LD, Hinyard L, Xian H, Liu S, Lin S, Leskinen A, Komppula M, Jalava P, Roponen M, Hu LW, Zeng XW, Hu W, Chen G, Yang BY, Guo Y, Dong GH. Benefits of influenza vaccination on the associations between ambient air pollution and allergic respiratory diseases in children and adolescents: New insights from the Seven Northeastern Cities study in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 256:113434. [PMID: 31672350 DOI: 10.1016/j.envpol.2019.113434] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Little information exists on interaction effects between air pollution and influenza vaccination on allergic respiratory diseases. We conducted a large population-based study to evaluate the interaction effects between influenza vaccination and long-term exposure to ambient air pollution on allergic respiratory diseases in children and adolescents. METHODS A cross-sectional study was investigated during 2012-2013 in 94 schools from Seven Northeastern Cities (SNEC) in China. Questionnaires surveys were obtained from 56 137 children and adolescents aged 2-17 years. Influenza vaccination was defined as receipt of the influenza vaccine. We estimated air pollutants exposure [nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters ≤1 μm (PM1), ≤2.5 μm (PM2.5) and ≤10 μm (PM10)] using machine learning methods. We employed two-level generalized linear mix effects model to examine interactive effects between influenza vaccination and air pollution exposure on allergic respiratory diseases (asthma, asthma-related symptoms and allergic rhinitis), after controlling for important covariates. RESULTS We found statistically significant interactions between influenza vaccination and air pollutants on allergic respiratory diseases and related symptoms (doctor-diagnosed asthma, current wheeze, wheeze, persistent phlegm and allergic rhinitis). The adjusted ORs for doctor-diagnosed asthma, current wheeze and allergic rhinitis among the unvaccinated group per interquartile range (IQR) increase in PM1 and PM2.5 were significantly higher than the corresponding ORs among the vaccinated group [For PM1, doctor-diagnosed asthma: OR: 1.89 (95%CI: 1.57-2.27) vs 1.65 (95%CI: 1.36-2.00); current wheeze: OR: 1.50 (95%CI: 1.22-1.85) vs 1.10 (95%CI: 0.89-1.37); allergic rhinitis: OR: 1.38 (95%CI: 1.15-1.66) vs 1.21 (95%CI: 1.00-1.46). For PM2.5, doctor-diagnosed asthma: OR: 1.81 (95%CI: 1.52-2.14) vs 1.57 (95%CI: 1.32-1.88); current wheeze: OR: 1.46 (95%CI: 1.21-1.76) vs 1.11 (95%CI: 0.91-1.35); allergic rhinitis: OR: 1.35 (95%CI: 1.14-1.60) vs 1.19 (95%CI: 1.00-1.42)]. The similar patterns were observed for wheeze and persistent phlegm. The corresponding p values for interactions were less than 0.05, respectively. We assessed the risks of PM1-related and PM2.5-related current wheeze were decreased by 26.67% (95%CI: 1.04%-45.66%) and 23.97% (95%CI: 0.21%-42.08%) respectively, which was attributable to influenza vaccination (both p for efficiency <0.05). CONCLUSIONS Influenza vaccination may play an important role in mitigating the detrimental effects of long-term exposure to ambient air pollution on childhood allergic respiratory diseases. Policy targeted at increasing influenza vaccination may yield co-benefits in terms of reduced allergic respiratory diseases.
Collapse
Affiliation(s)
- Kangkang Liu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Zhengmin Min Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, 63104, USA
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, 3052, Australia
| | - Michael S Bloom
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China; Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich, 80336, Germany
| | - Bin Jalaludin
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW, 2052, Australia
| | - Iana Markevych
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany; Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Munich, Ludwig-Maximilians-University of Munich, Munich, 80336, Germany; Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich, 80336, Germany
| | - Lidia Morawska
- International Laboratory for Air Quality & Health (ILAQH), Science and Engineering Faculty, Institute of Health Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, 4059, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Leslie Hinyard
- Center for Health Outcomes Research, Saint Louis University, Saint Louis, 63104, USA
| | - Hong Xian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, 63104, USA
| | - Shan Liu
- NHC Key Laboratory of Food Safety Risk Assessment, China National Center for Food Safety Risk Assessment, Beijing, 100021, China
| | - Shao Lin
- Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, 12144, USA
| | - Ari Leskinen
- Finnish Meteorological Institute, Kuopio, 70211, Finland; Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, 70211, Finland
| | - Mika Komppula
- Finnish Meteorological Institute, Kuopio, 70211, Finland
| | - Pasi Jalava
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, 70211, Finland
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, 70211, Finland
| | - Li-Wen Hu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao-Wen Zeng
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia
| | - Gongbo Chen
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, 430000, China
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| |
Collapse
|
12
|
Trinh P, Jung TH, Keene D, Demmer RT, Perzanowski M, Lovasi G. Temporal and spatial associations between influenza and asthma hospitalisations in New York City from 2002 to 2012: a longitudinal ecological study. BMJ Open 2018; 8:e020362. [PMID: 30269061 PMCID: PMC6169763 DOI: 10.1136/bmjopen-2017-020362] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/10/2018] [Accepted: 08/02/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To determine whether asthma hospitalisations of children and adults in the five boroughs of New York City are correlated with influenza hospitalisations temporally and spatially. DESIGN A longitudinal ecological study. INCLUSION CRITERIA We reviewed the Statewide Planning and Research Cooperative System's records of hospitalisations in Manhattan, Bronx, Queens, Brooklyn and Staten Island from 2002 to 2012. All hospitalisations with a primary diagnosis of either asthma or influenza were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. METHODS A time-series regression analysis was performed using aggregate monthly counts of influenza hospitalisations as predictors of asthma hospitalisations. Time-series regression models were also applied to different age groups and boroughs to examine the magnitude of influenza and asthma correlations across strata. The per cent excess risk was also calculated across age groups and boroughs. RESULTS Time-series analysis of the overall population revealed a significant positive correlation between influenza and asthma hospitalisations (p=0.011). When stratifying by age, there was a significant positive correlation between asthma and influenza hospitalisations for individuals 18 and older (p<0.01), and no significant correlation found for age groups younger than 18. Percentages of excess risk of influenza-related asthma hospitalisations also increased with increasing age with adults 18-44, 45-64 and 65+ having excess risk percentages of 2.9%, 3.4% and 4%, respectively. Time-series analysis by location revealed positive significant correlations between asthma and influenza hospitalisations in Brooklyn (p=0.03) and Manhattan (p<0.01). Manhattan and Brooklyn had a 2.5% and 1.6%, respectively, percentage of excess risk of influenza-related asthma hospitalisations. CONCLUSION Influenza and asthma hospitalisations are significantly associated at the population level among adults. These associations vary by age and geographical location. Influenza prevention strategies targeting adult populations, particularly individuals living in Manhattan and Brooklyn, have the potential for meaningful reduction of influenza-related asthma hospitalisations.
Collapse
Affiliation(s)
- Pauline Trinh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Tae Hyun Jung
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Danya Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Ryan T Demmer
- Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Columbia University, New York City, New York, USA
| | - Gina Lovasi
- Department of Epidemiology, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
13
|
Schwarze J, Openshaw P, Jha A, Giacco SR, Firinu D, Tsilochristou O, Roberts G, Selby A, Akdis C, Agache I, Custovic A, Heffler E, Pinna G, Khaitov M, Nikonova A, Papadopoulos N, Akhlaq A, Nurmatov U, Renz H, Sheikh A, Skevaki C. Influenza burden, prevention, and treatment in asthma-A scoping review by the EAACI Influenza in asthma task force. Allergy 2018; 73:1151-1181. [PMID: 29105786 DOI: 10.1111/all.13333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma. The strongest evidence of an association was seen in studies of children. Countries in the European Union currently recommend influenza vaccination of adults with asthma; however, coverage varied between regions. Coverage was lower among children with asthma. Limited data suggest that good seroprotection and seroconversion can be achieved in both children and adults with asthma and that vaccination confers a degree of protection against influenza illness and asthma-related morbidity to children with asthma. There were insufficient data to determine efficacy in adults. Overall, influenza vaccines appeared to be safe for people with asthma. We identify knowledge gaps and make recommendations on future research needs in relation to influenza in patients with asthma.
Collapse
Affiliation(s)
- J. Schwarze
- Centre for Inflammation Research The Queens Medical Research Institute University of Edinburgh Edinburgh UK
| | - P. Openshaw
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - A. Jha
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - S. R. Giacco
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | - D. Firinu
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | | | - G. Roberts
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - A. Selby
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | - I. Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - A. Custovic
- Department of Paediatrics Imperial College London London UK
| | - E. Heffler
- Personalized Medicine Asthma and Allergy Clinic Department of Biomedical Sciences Humanitas University Milan Italy
| | - G. Pinna
- Department of Medical Microbiology National Kapodistrian University of Athens Athens Greece
| | - M. Khaitov
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - A. Nikonova
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - N. Papadopoulos
- Division of Infection, Inflammation & Respiratory Medicine The University of Manchester Manchester UK
- Allergy Department 2nd Paediatric Clinic National Kapodistrian University of Athens Athens Greece
| | - A. Akhlaq
- Department of Health and Hospital Management Institute of Business Management Korangi Creek Karachi 75190 Pakistan
| | - U. Nurmatov
- Division of Population Medicine School of Medicine Cardiff University the National Centre for Population Health and Wellbeing Research Wales UK
| | - H. Renz
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
| | - A. Sheikh
- Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - C. Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
| |
Collapse
|
14
|
Guibas GV, Tsolia M, Christodoulou I, Stripeli F, Sakkou Z, Papadopoulos NG. Distinction between rhinovirus-induced acute asthma and asthma-augmented influenza infection. Clin Exp Allergy 2018; 48:536-543. [PMID: 29473978 DOI: 10.1111/cea.13124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rhinovirus (RV) is an established trigger of asthma attacks, whereas such a link is less consistent for influenza virus (IFV). OBJECTIVE In the context of precision medicine, we hypothesized that IFV infection may cause a condition essentially different from RV, and we investigated this by evaluating clinical characteristics of RV/IFV-positive and -negative children with respiratory symptoms and/or fever. METHODS One thousand two hundred and seven children, 6 months to 13 years old, hospitalized for flu-like illness were recruited in this cross-sectional study. Collected information included demographics, medical history, symptoms/physical findings/diagnosis at presentation and treatment. Nasal secretions were PCR-tested for IFV/RV. Associations were evaluated with adjusted logistic regression models. RESULTS Rhinovirus positivity was associated with an asthma-like presentation, including increased wheeze/effort of breathing/diagnosis of acute asthma, and decreased fever/vomiting. Conversely, IFV+ children presented with less wheeze/effort of breathing/diagnosis of acute asthma, while they were more frequently febrile. In those with previous asthma history, both viruses induced wheeze; however, IFV was uniquely associated with a more generalised and severe presentation including fever, rales, intercostal muscle retractions and lymphadenopathy. These symptoms were not seen in RV+ asthmatics, who had fewer systemic signs and more cough. CONCLUSIONS AND CLINICAL RELEVANCE In children with respiratory symptoms and/or fever, RV but not IFV is associated with wheeze and an asthma-like presentation. In those with an asthma history, IFV causes more generalised and severe disease that may be better described as "asthma-augmented influenza" rather than an "asthma attack." Differences in the acute conditions caused by these viruses should be considered in the design of epidemiological studies.
Collapse
Affiliation(s)
- G V Guibas
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,Paediatric Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Tsolia
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | | | - F Stripeli
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | - Z Sakkou
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | - N G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,Paediatric Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,2nd Paediatric Clinic, University of Athens, Athens, Greece
| |
Collapse
|
15
|
Hardelid P, Ghebremichael-Weldeselassie Y, Whitaker H, Rait G, Gilbert R, Petersen I. Effectiveness of live attenuated influenza vaccine in preventing amoxicillin prescribing in preschool children: a self-controlled case series study. J Antimicrob Chemother 2018; 73:779-786. [PMID: 29228207 DOI: 10.1093/jac/dkx463] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/07/2017] [Indexed: 05/02/2024] Open
Abstract
Objectives To determine the effectiveness of live attenuated influenza vaccine (LAIV) in reducing amoxicillin prescribing in preschool children in primary care. Patients and methods We used The Health Improvement Network (THIN), a large primary care database from the United Kingdom. We included children aged 2 to 4 years old at the start of either the 2013/14 or the 2014/15 winter season, with at least one amoxicillin prescription between September and May, irrespective of LAIV vaccination status. We used the self-controlled case series method to estimate influenza vaccine effectiveness (VE). Results The total study sample included 33 137 children from 378 general practices during the two winter seasons. Of these children, 43.4% with at least one amoxicillin prescription had been vaccinated. The rate of amoxicillin prescribing was significantly reduced during periods of influenza vaccine immunity. The associated VE for amoxicillin prescribing was 12.8% (95% CI 6.9%, 18.3%) in 2013/14 and 14.5% (9.6%, 19.2%) in 2014/15. Given a VE of 14.5%, we estimated that amoxicillin prescribing could have been reduced by 5.6% if LAIV uptake in children aged 2-4 years increased to 50% in the 2014/15 winter season. Conclusions Influenza vaccination of young children may contribute to a reduction in the prescribing of amoxicillin, one of the most commonly prescribed antibiotics in primary care. Further studies are required to confirm the size of the effect.
Collapse
Affiliation(s)
- Pia Hardelid
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | | | - Heather Whitaker
- Statistics Group, Department of Mathematics and Statistics, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - Ruth Gilbert
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
- Department of Clinical Epidemiology, Aarhus University, Olof Palmes Allé 43-45, DK 8200 Aarhus N, Denmark
| |
Collapse
|
16
|
Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev 2018; 2:CD004879. [PMID: 29388195 PMCID: PMC6491174 DOI: 10.1002/14651858.cd004879.pub5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The consequences of influenza in children and adults are mainly absenteeism from school and work. However, the risk of complications is greatest in children and people over 65 years of age. This is an update of a review published in 2011. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions. OBJECTIVES To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in healthy children. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 12), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (1966 to 31 December 2016), Embase (1974 to 31 December 2016), WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017), and ClinicalTrials.gov (1 July 2017). SELECTION CRITERIA Randomised controlled trials comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy children under 16 years. Previous versions of this review included 19 cohort and 11 case-control studies. We are no longer updating the searches for these study designs but have retained the observational studies for historical purposes. DATA COLLECTION AND ANALYSIS Review authors independently assessed risk of bias and extracted data. We used GRADE to rate the certainty of evidence for the key outcomes of influenza, influenza-like illness (ILI), complications (hospitalisation, ear infection), and adverse events. Due to variation in control group risks for influenza and ILI, absolute effects are reported as the median control group risk, and numbers needed to vaccinate (NNVs) are reported accordingly. For other outcomes aggregate control group risks are used. MAIN RESULTS We included 41 clinical trials (> 200,000 children). Most of the studies were conducted in children over the age of two and compared live attenuated or inactivated vaccines with placebo or no vaccine. Studies were conducted over single influenza seasons in the USA, Western Europe, Russia, and Bangladesh between 1984 and 2013. Restricting analyses to studies at low risk of bias showed that influenza and otitis media were the only outcomes where the impact of bias was negligible. Variability in study design and reporting impeded meta-analysis of harms outcomes.Live attenuated vaccinesCompared with placebo or do nothing, live attenuated influenza vaccines probably reduce the risk of influenza infection in children aged 3 to 16 years from 18% to 4% (risk ratio (RR) 0.22, 95% confidence interval (CI) 0.11 to 0.41; 7718 children; moderate-certainty evidence), and they may reduce ILI by a smaller degree, from 17% to 12% (RR 0.69, 95% CI 0.60 to 0.80; 124,606 children; low-certainty evidence). Seven children would need to be vaccinated to prevent one case of influenza, and 20 children would need to be vaccinated to prevent one child experiencing an ILI. Acute otitis media is probably similar following vaccine or placebo during seasonal influenza, but this result comes from a single study with particularly high rates of acute otitis media (RR 0.98, 95% CI 0.95 to 1.01; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. Vaccinating children may lead to fewer parents taking time off work, although the CI includes no effect (RR 0.69, 95% CI 0.46 to 1.03; low-certainty evidence). Data on the most serious consequences of influenza complications leading to hospitalisation were not available. Data from four studies measuring fever following vaccination varied considerably, from 0.16% to 15% in children who had live vaccines, while in the placebo groups the proportions ranged from 0.71% to 22% (very low-certainty evidence). Data on nausea were not reported.Inactivated vaccinesCompared with placebo or no vaccination, inactivated vaccines reduce the risk of influenza in children aged 2 to 16 years from 30% to 11% (RR 0.36, 95% CI 0.28 to 0.48; 1628 children; high-certainty evidence), and they probably reduce ILI from 28% to 20% (RR 0.72, 95% CI 0.65 to 0.79; 19,044 children; moderate-certainty evidence). Five children would need to be vaccinated to prevent one case of influenza, and 12 children would need to be vaccinated to avoid one case of ILI. The risk of otitis media is probably similar between vaccinated children and unvaccinated children (31% versus 27%), although the CI does not exclude a meaningful increase in otitis media following vaccination (RR 1.15, 95% CI 0.95 to 1.40; 884 participants; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. We identified no data on parental working time lost, hospitalisation, fever, or nausea.We found limited evidence on secondary cases, requirement for treatment of lower respiratory tract disease, and drug prescriptions. One brand of monovalent pandemic vaccine was associated with a sudden loss of muscle tone triggered by the experience of an intense emotion (cataplexy) and a sleep disorder (narcolepsy) in children. Evidence of serious harms (such as febrile fits) was sparse. AUTHORS' CONCLUSIONS In children aged between 3 and 16 years, live influenza vaccines probably reduce influenza (moderate-certainty evidence) and may reduce ILI (low-certainty evidence) over a single influenza season. In this population inactivated vaccines also reduce influenza (high-certainty evidence) and may reduce ILI (low-certainty evidence). For both vaccine types, the absolute reduction in influenza and ILI varied considerably across the study populations, making it difficult to predict how these findings translate to different settings. We found very few randomised controlled trials in children under two years of age. Adverse event data were not well described in the available studies. Standardised approaches to the definition, ascertainment, and reporting of adverse events are needed. Identification of all global cases of potential harms is beyond the scope of this review.
Collapse
Affiliation(s)
- Tom Jefferson
- University of OxfordCentre for Evidence Based MedicineOxfordUKOX2 6GG
| | - Alessandro Rivetti
- ASL CN2 Alba BraDipartimento di Prevenzione ‐ S.Pre.S.A.LVia Vida 10AlbaPiemonteItaly12051
| | - Carlo Di Pietrantonj
- Local Health Unit Alessandria‐ ASL ALRegional Epidemiology Unit SeREMIVia Venezia 6AlessandriaAlessandriaItaly15121
| | - Vittorio Demicheli
- Azienda Sanitaria Locale ASL ALServizio Regionale di Riferimento per l'Epidemiologia, SSEpi‐SeREMIVia Venezia 6AlessandriaPiemonteItaly15121
| | | |
Collapse
|
17
|
|
18
|
Grohskopf LA, Sokolow LZ, Broder KR, Olsen SJ, Karron RA, Jernigan DB, Bresee JS. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep 2016; 65:1-54. [PMID: 27560619 DOI: 10.15585/mmwr.rr6505a1] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This report updates the 2015-16 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines (Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season. MMWR Morb Mortal Wkly Rep 2015;64:818-25). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For the 2016-17 influenza season, inactivated influenza vaccines (IIVs) will be available in both trivalent (IIV3) and quadrivalent (IIV4) formulations. Recombinant influenza vaccine (RIV) will be available in a trivalent formulation (RIV3). In light of concerns regarding low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013-14 and 2015-16 seasons, for the 2016-17 season, ACIP makes the interim recommendation that live attenuated influenza vaccine (LAIV4) should not be used. Vaccine virus strains included in the 2016-17 U.S. trivalent influenza vaccines will be an A/California/7/2009 (H1N1)-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent vaccines will include an additional influenza B virus strain, a B/Phuket/3073/2013-like virus (Yamagata lineage).Recommendations for use of different vaccine types and specific populations are discussed. A licensed, age-appropriate vaccine should be used. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is otherwise appropriate. This information is intended for vaccination providers, immunization program personnel, and public health personnel. Information in this report reflects discussions during public meetings of ACIP held on October 21, 2015; February 24, 2016; and June 22, 2016. These recommendations apply to all licensed influenza vaccines used within Food and Drug Administration-licensed indications, including those licensed after the publication date of this report. Updates and other information are available at CDC's influenza website (http://www.cdc.gov/flu). Vaccination and health care providers should check CDC's influenza website periodically for additional information.
Collapse
Affiliation(s)
- Lisa A Grohskopf
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
| | | | | | | | | | | | | |
Collapse
|
19
|
Special Considerations for Infants and Young Children. PEDIATRIC ALLERGY: PRINCIPLES AND PRACTICE 2016. [PMCID: PMC7271152 DOI: 10.1016/b978-0-323-29875-9.00032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
20
|
|
21
|
A systematic review of validated methods to capture acute bronchospasm using administrative or claims data. Vaccine 2014; 31 Suppl 10:K12-20. [PMID: 24331069 DOI: 10.1016/j.vaccine.2013.06.091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 06/08/2013] [Accepted: 06/21/2013] [Indexed: 11/23/2022]
Abstract
PURPOSE To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify acute bronchospasm in administrative and claims databases. METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to bronchospasm, wheeze and acute asthma. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics. RESULTS Our searches identified 677 citations of which 38 met our inclusion criteria. In these 38 studies, the most commonly used ICD-9 code was 493.x. Only 3 studies reported any validation methods for the identification of bronchospasm, wheeze or acute asthma in administrative and claims databases; all were among pediatric populations and only 2 offered any validation statistics. Some of the outcome definitions utilized were heterogeneous and included other disease based diagnoses, such as bronchiolitis and pneumonia, which are typically of an infectious etiology. One study offered the validation of algorithms utilizing Emergency Department triage chief complaint codes to diagnose acute asthma exacerbations with ICD-9 786.07 (wheezing) revealing the highest sensitivity (56%), specificity (97%), PPV (93.5%) and NPV (76%). CONCLUSIONS There is a paucity of studies reporting rigorous methods to validate algorithms for the identification of bronchospasm in administrative data. The scant validated data available are limited in their generalizability to broad-based populations.
Collapse
|
22
|
Vernacchio L, Francis ME, Epstein DM, Santangelo J, Trudell EK, Reynolds ME, Risko W. Effectiveness of an asthma quality improvement program designed for maintenance of certification. Pediatrics 2014; 134:e242-8. [PMID: 24935994 DOI: 10.1542/peds.2013-2643] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Pediatricians are required to perform quality improvement for board recertification. We developed an asthma project within the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, designed to meet recertification requirements and improve asthma care. METHODS The program was based on the learning collaborative model. We developed practice-based registries of children 5 to 17 years of age with persistent asthma and helped physicians improve processes of asthma care through education, data feedback, and sharing of best practices. RESULTS Fifty-six physicians participated in 3 cohorts; 594 patients were included in the project. In all cohorts, improvements occurred in the use of asthma action plans (62.4%-76.8% cohort 1, 50.6%-88.4% cohort 2, 53.0%-79.6% cohort 3) and Asthma Control Tests (4.6%-55.2% cohort 1, 9.0%-67.8% cohort 2, 15.2%-61.4% cohort 3). Less consistent improvements were observed in seasonal influenza vaccines, controller medications, and asthma follow-up visits. The proportion of patients experiencing ≥1 asthma exacerbation within the year declined in all 3 cohorts (37.8%-19.9%, P = .0002 cohort 1; 27.8%-20.7%, P = .1 cohort 2; 36.6%-26.9%, P = .1 cohort 3). For each cohort, asthma exacerbations declined to a greater extent than those of a comparison group. CONCLUSIONS This asthma quality improvement project designed for maintenance of certification improved processes of care among patients with persistent asthma. The learning collaborative approach may be a useful model for other board-recertification quality improvement projects but requires a substantial investment of organizational time and staff.
Collapse
Affiliation(s)
- Louis Vernacchio
- Pediatric Physicians' Organization at Children's, Brookline, Massachusetts;Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; andDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mary E Francis
- Pediatric Physicians' Organization at Children's, Brookline, Massachusetts
| | - Daniel M Epstein
- Pediatric Physicians' Organization at Children's, Brookline, Massachusetts;Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; andDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jean Santangelo
- Pediatric Physicians' Organization at Children's, Brookline, Massachusetts
| | - Emily K Trudell
- Pediatric Physicians' Organization at Children's, Brookline, Massachusetts
| | - Meghan E Reynolds
- Pediatric Physicians' Organization at Children's, Brookline, Massachusetts
| | - Wanessa Risko
- Pediatric Physicians' Organization at Children's, Brookline, Massachusetts;Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; andDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
23
|
Greenhawt MJ. Influenza vaccination in asthmatic patients. J Allergy Clin Immunol 2014; 133:1233-4. [PMID: 24679474 DOI: 10.1016/j.jaci.2014.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/03/2014] [Accepted: 02/11/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Matthew J Greenhawt
- University of Michigan Food Allergy Center, Division of Allergy and Clinical Immunology, University of Michigan Health System, Ann Arbor, Mich.
| |
Collapse
|
24
|
Yáñez A, Cho SH, Soriano JB, Rosenwasser LJ, Rodrigo GJ, Rabe KF, Peters S, Niimi A, Ledford DK, Katial R, Fabbri LM, Celedón JC, Canonica GW, Busse P, Boulet LP, Baena-Cagnani CE, Hamid Q, Bachert C, Pawankar R, Holgate ST. Asthma in the elderly: what we know and what we have yet to know. World Allergy Organ J 2014; 7:8. [PMID: 25152804 PMCID: PMC4137434 DOI: 10.1186/1939-4551-7-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/02/2014] [Indexed: 02/07/2023] Open
Abstract
In the past, asthma was considered mainly as a childhood disease. However, asthma is an important cause of morbidity and mortality in the elderly nowadays. In addition, the burden of asthma is more significant in the elderly than in their younger counterparts, particularly with regard to mortality, hospitalization, medical costs or health-related quality of life. Nevertheless, asthma in the elderly is still been underdiagnosed and undertreated. Therefore, it is an imperative task to recognize our current challenges and to set future directions. This project aims to review the current literature and identify unmet needs in the fields of research and practice for asthma in the elderly. This will enable us to find new research directions, propose new therapeutic strategies, and ultimately improve outcomes for elderly people with asthma. There are data to suggest that asthma in older adults is phenotypically different from young patients, with potential impact on the diagnosis, assessment and management in this population. The diagnosis of AIE in older populations relies on the same clinical findings and diagnostic tests used in younger populations, but the interpretation of the clinical data is more difficult. The challenge today is to encourage new research in AIE but to use the existing knowledge we have to make the diagnosis of AIE, educate the patient, develop a therapeutic approach to control the disease, and ultimately provide a better quality of life to our elderly patients.
Collapse
Affiliation(s)
- Anahí Yáñez
- Investigaciones en Alergia y Enfermedades Respiratorias- InAER, Buenos Aires, Argentina
| | - Sang-Hoen Cho
- Department of Internal Medicine, Hanyang University Hospital, Seoul, South Korea
| | - Joan B Soriano
- Programa de Epidemiologia e Investigacion Clinica, Fundación Caubet-CIMERA, Illes Balears, Spain
| | - Lanny J Rosenwasser
- Children's Mercy Hospital, University of Missouri - Kansas City School of Medicine, Kansas City, Missoui, United States of America
| | - Gustavo J Rodrigo
- Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - Klaus F Rabe
- Krankenhaus Lungen Clinic, Grosshansdorf, Germany
| | - Stephen Peters
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Akio Niimi
- Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, Kyoto, Japan
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Medicine, Morsani University of South Florida College of Medicine, James A Haley Veterans Hospital, Tampa, Florida, United States of America
| | - Rohit Katial
- Division of Allergy and Immunology, National Jewish Health, Denver, Colorado, United States of America
| | - Leonardo M Fabbri
- Department of Oncology, Haematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of UPMC, Pittsburgh, Pennsylvania, United States of America
| | | | - Paula Busse
- Division of Clinical Immunology, Department of Medicine, Mount Sinai School of Medicine, New York, New York, United States of America
| | - Louis-Phillippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, (Quebec Heart and Lung Institute, Laval University), Quebéc, Canada
| | - Carlos E Baena-Cagnani
- Centre for Research in Respiratory Medicine, Catholic University of Córdoba, Córdoba, Argentina
| | - Qutayba Hamid
- Meakins-Christie Laboratories, McGill University, Quebéc, Canada
| | - Claus Bachert
- Upper Airways Research Laboratory (URL), Clinics ENT-Department, University Hospital Ghent, Ghent, Belgium
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Stephen T Holgate
- Faculty of Medicine Clinical and Experimental Sciences, University of Southampton, Hampshire, United Kingdom
| |
Collapse
|
25
|
Asciak R, Balzan M, Buttigieg J. Predictors of seasonal influenza vaccination in chronic asthma. Multidiscip Respir Med 2013; 8:68. [PMID: 24143918 PMCID: PMC3875888 DOI: 10.1186/2049-6958-8-68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guidelines advise annual influenza vaccination in chronic asthma. The aim of this study was to determine uptake of the influenza vaccine in a group of patients (n = 146) with moderate to severe chronic asthma and establish the main predictors of vaccination. METHOD Patients attending a hospital asthma clinic were asked to complete a questionnaire in February 2012 (n = 146). These same patients were contacted a year later via telephone (n = 109 responded), and they were asked to complete the same questionnaire. RESULTS Vaccination rate was 50.3% in winter 2011/12, and 57.8% in 2012/13. Using binary logistic regression, the predictors for vaccination in 2012 were patient advice (Odds ratio [OR] 15.37 p = 0.001), female gender (OR 2.75, p = 0.028), past side effects (OR 0.21, p = 0.001) and comorbidity (OR 0.39, p = 0.013). Stepwise regression resulted in age as predictor (T value = 3.99, p = 0.001). On analyzing the responses from the second questionnaire at one year after attendance to asthma clinic, predictors changed to compliance to medication (OR 9.52, p= 0.001) and previous exacerbations (OR 4.19, p = 0.026). Out of the 56 patients vaccinated in 2011/12, 33 reported asthma exacerbations before 2012, and 29 reported asthma exacerbations after receiving the influenza vaccine. Out of the 46 unvaccinated patients in 2012, 27 had asthma exacerbations before 2012 and 19 patients had exacerbations in 2013. Patients vaccinated in 2011/12 needed 0.59 courses of steroid/patient/year, and 1.23 visits for nebulizer/patient/year while non-vaccinated patients needed 0.18 courses of steroids/patient/year (p = 0.048), and 0.65 visits for nebulized/patient/year (p = 0.012). Patients' subjective statements broadly confirmed the predictors. 16/69 (23.1%) received the vaccine in winter 2012/13 despite reporting previous side effects. CONCLUSIONS Advice to patient, female gender and patients' age predicted vaccination, while past side effects to the influenza vaccine, and presence of comorbidities predicted non vaccination. Symptomatic asthma patients are more likely to be vaccinated. One year after the first contact, treatment compliance and previous asthma exacerbations gained statistical significance as predictors of vaccination.
Collapse
Affiliation(s)
- Rachelle Asciak
- Department of Medicine, Mater Dei Hospital, 211, Street Margaret Street Tal Qroqq, Msida MSD 2090, Malta
| | - Martin Balzan
- Department of Medicine, Mater Dei Hospital, 211, Street Margaret Street Tal Qroqq, Msida MSD 2090, Malta
| | - Jesmar Buttigieg
- Department of Medicine, Mater Dei Hospital, 211, Street Margaret Street Tal Qroqq, Msida MSD 2090, Malta
| |
Collapse
|
26
|
Obuchi M, Adachi Y, Takizawa T, Sata T. Influenza A(H1N1)pdm09 virus and asthma. Front Microbiol 2013; 4:307. [PMID: 24133489 PMCID: PMC3796256 DOI: 10.3389/fmicb.2013.00307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/24/2013] [Indexed: 12/03/2022] Open
Abstract
Respiratory viral infection is a major cause of asthma exacerbations in both children and adults. Among the respiratory viruses, influenza virus is a particularly important pathogen due to its enormous morbidity and mortality in annual epidemics. The swine-origin influenza A virus, designated as A(H1N1)pdm09, emerged in the spring of 2009 and caused the first influenza pandemic in the 21st century. With the emergence of the novel A(H1N1)pdm09 virus, numerous epidemiologic studies detected asthma as a frequent comorbid condition in patients infected with this virus. Here we review recent reports regarding asthma in patients infected with influenza A(H1N1)pdm09 virus, and we discuss the utility of influenza vaccines and antivirals.
Collapse
Affiliation(s)
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of ToyamaToyama, Japan
| | | | - Tetsutaro Sata
- Department of Virology, Toyama Institute of HealthToyama, Japan
| |
Collapse
|
27
|
Greene SK, Rett MD, Vellozzi C, Li L, Kulldorff M, Marcy SM, Daley MF, Belongia EA, Baxter R, Fireman BH, Jackson ML, Omer SB, Nordin JD, Jin R, Weintraub ES, Vijayadeva V, Lee GM. Guillain-Barré Syndrome, Influenza Vaccination, and Antecedent Respiratory and Gastrointestinal Infections: A Case-Centered Analysis in the Vaccine Safety Datalink, 2009-2011. PLoS One 2013; 8:e67185. [PMID: 23840621 PMCID: PMC3694016 DOI: 10.1371/journal.pone.0067185] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/14/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Guillain-Barré Syndrome (GBS) can be triggered by gastrointestinal or respiratory infections, including influenza. During the 2009 influenza A (H1N1) pandemic in the United States, monovalent inactivated influenza vaccine (MIV) availability coincided with high rates of wildtype influenza infections. Several prior studies suggested an elevated GBS risk following MIV, but adjustment for antecedent infection was limited. METHODS We identified patients enrolled in health plans participating in the Vaccine Safety Datalink and diagnosed with GBS from July 2009 through June 2011. Medical records of GBS cases with 2009-10 MIV, 2010-11 trivalent inactivated influenza vaccine (TIV), and/or a medically-attended respiratory or gastrointestinal infection in the 1 through 141 days prior to GBS diagnosis were reviewed and classified according to Brighton Collaboration criteria for diagnostic certainty. Using a case-centered design, logistic regression models adjusted for patient-level time-varying sources of confounding, including seasonal vaccinations and infections in GBS cases and population-level controls. RESULTS Eighteen confirmed GBS cases received vaccination in the 6 weeks preceding onset, among 1.27 million 2009-10 MIV recipients and 2.80 million 2010-11 TIV recipients. Forty-four confirmed GBS cases had infection in the 6 weeks preceding onset, among 3.77 million patients diagnosed with medically-attended infection. The observed-versus-expected odds that 2009-10 MIV/2010-11 TIV was received in the 6 weeks preceding GBS onset was odds ratio = 1.54, 95% confidence interval (CI), 0.59-3.99; risk difference = 0.93 per million doses, 95% CI, -0.71-5.16. The association between GBS and medically-attended infection was: odds ratio = 7.73, 95% CI, 3.60-16.61; risk difference = 11.62 per million infected patients, 95% CI, 4.49-26.94. These findings were consistent in sensitivity analyses using alternative infection definitions and risk intervals for prior vaccination shorter than 6 weeks. CONCLUSIONS After adjusting for antecedent infections, we found no evidence for an elevated GBS risk following 2009-10 MIV/2010-11 TIV influenza vaccines. However, the association between GBS and antecedent infection was strongly elevated.
Collapse
Affiliation(s)
- Sharon K. Greene
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Melisa D. Rett
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Claudia Vellozzi
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lingling Li
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Martin Kulldorff
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - S. Michael Marcy
- Kaiser Permanente Southern California, Pasadena, California, United States of America
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States of America
- Department of Pediatrics, University of Colorado, Aurora, Colorado, United States of America
| | - Edward A. Belongia
- Marshfield Clinic Research Foundation, Marshfield, Wisconsin, United States of America
| | - Roger Baxter
- Kaiser Permanente Vaccine Study Center, Oakland, California, United States of America
| | - Bruce H. Fireman
- Kaiser Permanente Vaccine Study Center, Oakland, California, United States of America
| | - Michael L. Jackson
- Group Health Research Institute, Seattle, Washington, United States of America
| | - Saad B. Omer
- Center for Health Research-Southeast, Kaiser Permanente Georgia, Atlanta, Georgia, United States of America
| | - James D. Nordin
- HealthPartners Research Foundation, Minneapolis, Minnesota, United States of America
| | - Robert Jin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
| | - Eric S. Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vinutha Vijayadeva
- Center for Health Research-Hawaii, Kaiser Permanente Hawaii, Honolulu, Hawaii, United States of America
| | - Grace M. Lee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America
- Division of Infectious Diseases and Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
28
|
Patria MF, Tagliabue C, Longhi B, Esposito S. Influenza vaccination in children at high risk of respiratory disease. THERAPEUTIC ADVANCES IN VACCINES 2013; 1:21-31. [PMID: 24757513 PMCID: PMC3967668 DOI: 10.1177/2051013613480770] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Chronic respiratory diseases (CRDs) are a heterogeneous group of diseases that can affect the pediatric population and health authorities throughout the world recommend influenza vaccination because of the significant risk of influenza-related complications. However, despite this recommendation, vaccine coverage is generally unsatisfactory. The aim of this review is to analyze the impact of influenza on children at high risk of respiratory disease, and the immunogenicity, safety and efficacy of influenza vaccination in such children. The results show that there is a significant risk of influenza-related complications in preterm neonates and infants, in whom influenza vaccines are immunogenic and safe (although their efficacy has not been specifically studied). There are conflicting data concerning the effect of influenza infection on asthma morbidity in children, and whether or not influenza vaccination helps to prevent asthma exacerbations. Recent data provide no evidence that influenza is more frequent in patients with cystic fibrosis than in healthy subjects, or that it is responsible for increased lower respiratory tract morbidity. The lack of any clear correlate of protection suggests that future studies should also consider the efficacy of the different influenza vaccines and not only evaluate them in terms of immunogenicity. Furthermore, there is a need for clinical studies to assess the effectiveness of the available vaccines in patients with other rare CRDs and other chronic underlying diseases with possibly severe respiratory involvement. It is also important to determine whether children with recurrent respiratory tract infections should be included in the list of those for whom influenza vaccination is recommended. In the meantime, given the increasing evidence of the burden of influenza on the population as a whole and the benefits associated with vaccination, annual influenza vaccinations should be recommended for all children at high risk of respiratory disease and the members of their households.
Collapse
Affiliation(s)
- Maria Francesca Patria
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Tagliabue
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Benedetta Longhi
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milano, Italy
| |
Collapse
|
29
|
|
30
|
Vernacchio L, Trudell EK, Muto JM. Correlation of care process measures with childhood asthma exacerbations. Pediatrics 2013; 131:e136-43. [PMID: 23209109 DOI: 10.1542/peds.2012-1144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to define processes of pediatric asthma care identifiable through administrative data that correlate with asthma exacerbations for use in quality improvement. METHODS Commercially insured children aged 5 to 17 years from the Pediatric Physicians' Organization at Children's, an independent practice association affiliated with Boston Children's Hospital, with persistent asthma in 2008, 2009, or 2010 were identified. The correlations of various process measures with asthma exacerbations, defined as hospitalizations or emergency department visits for asthma or outpatient visits for asthma with an oral steroid prescription, were analyzed by using logistic regression. RESULTS Significant correlations were found between filling 0 vs ≥ 1 controller medications in all years (relative risk [RR] 3.35, 2.11, and 2.71 in 2008, 2009, and 2010, respectively) although only 4% of subjects overall filled no controller medications. The asthma medication ratio (controller prescriptions divided by total asthma prescriptions) was also associated with exacerbations, with the lowest 2 quartiles having a lower risk compared with the highest in all years (RR 2.27, 2.45, and 2.39 for the lowest; RR 2.10, 2.02, and 2.65 for the second quartile in 2008, 2009, and 2010, respectively). CONCLUSIONS Filling 0 vs ≥ 1 controllers and the asthma medication ratio correlated with asthma exacerbations. Although both might serve as quality improvement metrics for pediatric asthma, we favor the asthma medication ratio because it applies to a broader range of children with asthma and better reflects the recommended clinical approach for children with persistent asthma.
Collapse
Affiliation(s)
- Louis Vernacchio
- The Pediatric Physicians' Organization at Children's, Brookline, MA 02445, USA.
| | | | | |
Collapse
|
31
|
Patria MF, Tenconi R, Esposito S. Efficacy and safety of influenza vaccination in children with asthma. Expert Rev Vaccines 2012; 11:461-8. [PMID: 22551031 DOI: 10.1586/erv.12.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The mean global prevalence of asthma among children is approximately 12%, making it the most common chronic disease in children. Influenza infection has been associated with complications such as exacerbations of wheezing and asthma, increased airway hyper-reactivity and hospitalization. Although influenza vaccination is recommended for asthmatic patients by all health authorities, vaccination coverage remains significantly lower than expected and is lowest of all in children. Compliance is affected by the uncertainty of parents and physicians concerning the clinical risk of influenza in asthmatic subjects, the benefits of influenza vaccination in preventing asthma exacerbations and the safety of immunization. The aim of this review is to analyze the rationale for using influenza vaccine, discuss the relationship between influenza and the severity of asthmatic episodes and document the efficacy and safety of influenza vaccination in the pediatric asthmatic population.
Collapse
Affiliation(s)
- Maria Francesca Patria
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | |
Collapse
|
32
|
Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V, Ferroni E. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev 2012; 2012:CD004879. [PMID: 22895945 PMCID: PMC6478137 DOI: 10.1002/14651858.cd004879.pub4] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The consequences of influenza in children and adults are mainly absenteeism from school and work. However, the risk of complications is greatest in children and people over 65 years of age. OBJECTIVES To appraise all comparative studies evaluating the effects of influenza vaccines in healthy children, assess vaccine efficacy (prevention of confirmed influenza) and effectiveness (prevention of influenza-like illness (ILI)) and document adverse events associated with influenza vaccines. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3) which includes the Acute Respiratory Infections Group's Specialised Register, OLD MEDLINE (1950 to 1965), MEDLINE (1966 to November 2011), EMBASE (1974 to November 2011), Biological Abstracts (1969 to September 2007), and Science Citation Index (1974 to September 2007). SELECTION CRITERIA Randomised controlled trials (RCTs), cohort and case-control studies of any influenza vaccine in healthy children under 16 years of age. DATA COLLECTION AND ANALYSIS Four review authors independently assessed trial quality and extracted data. MAIN RESULTS We included 75 studies with about 300,000 observations. We included 17 RCTs, 19 cohort studies and 11 case-control studies in the analysis of vaccine efficacy and effectiveness. Evidence from RCTs shows that six children under the age of six need to be vaccinated with live attenuated vaccine to prevent one case of influenza (infection and symptoms). We could find no usable data for those aged two years or younger.Inactivated vaccines in children aged two years or younger are not significantly more efficacious than placebo. Twenty-eight children over the age of six need to be vaccinated to prevent one case of influenza (infection and symptoms). Eight need to be vaccinated to prevent one case of influenza-like-illness (ILI). We could find no evidence of effect on secondary cases, lower respiratory tract disease, drug prescriptions, otitis media and its consequences and socioeconomic impact. We found weak single-study evidence of effect on school absenteeism by children and caring parents from work. Variability in study design and presentation of data was such that a meta-analysis of safety outcome data was not feasible. Extensive evidence of reporting bias of safety outcomes from trials of live attenuated influenza vaccines (LAIVs) impeded meaningful analysis. One specific brand of monovalent pandemic vaccine is associated with cataplexy and narcolepsy in children and there is sparse evidence of serious harms (such as febrile convulsions) in specific situations. AUTHORS' CONCLUSIONS Influenza vaccines are efficacious in preventing cases of influenza in children older than two years of age, but little evidence is available for children younger than two years of age. There was a difference between vaccine efficacy and effectiveness, partly due to differing datasets, settings and viral circulation patterns. No safety comparisons could be carried out, emphasising the need for standardisation of methods and presentation of vaccine safety data in future studies. In specific cases, influenza vaccines were associated with serious harms such as narcolepsy and febrile convulsions. It was surprising to find only one study of inactivated vaccine in children under two years, given current recommendations to vaccinate healthy children from six months of age in the USA, Canada, parts of Europe and Australia. If immunisation in children is to be recommended as a public health policy, large-scale studies assessing important outcomes, and directly comparing vaccine types are urgently required. The degree of scrutiny needed to identify all global cases of potential harms is beyond the resources of this review. This review includes trials funded by industry. An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry-funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favourable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in the light of this finding.
Collapse
|
33
|
Hambidge SJ, Ross C, Glanz J, McClure D, Daley MF, Xu S, Shoup JA, Narwaney K, Baggs J, Weintraub E. Trivalent inactivated influenza vaccine is not associated with sickle cell crises in children. Pediatrics 2012; 129:e54-9. [PMID: 22157132 DOI: 10.1542/peds.2011-1294] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with sickle cell disease are considered at high risk for complications from influenza infection and are recommended to receive annual influenza vaccination. However, data on the safety of influenza vaccination in children with sickle cell anemia are sparse. METHODS Using a retrospective cohort of children aged 6 months to 17 years in 8 managed care organizations that comprise the Vaccine Safety Datalink and who had a diagnosis of sickle cell anemia from 1999 to 2006, we conducted matched case-control and self-controlled case series studies to examine the association of trivalent inactivated influenza vaccination with hospitalization for sickle cell crisis in the 2 weeks after vaccination. RESULTS From an original pool of 1085 pediatric subjects with a diagnosis of sickle cell anemia, we identified 179 children with at least 1 sickle cell crisis during any influenza season (October 1-March 31). In the matched case-control study (matching on age category, gender, Vaccine Safety Datalink site, and season), the odds ratio of hospitalization for a crisis in vaccinated compared with unvaccinated children was not significant: 1.3 (95% confidence interval 0.8-2.2). In the self-controlled case series study of hospitalized cases, the incident rate ratio for hospitalization with sickle cell crisis in the 2 weeks after trivalent inactivated influenza vaccination was also not significant: 1.2 (95% confidence interval 0.75-1.95). CONCLUSION This large cohort study did not find an association of influenza vaccination and hospitalization for sickle cell crises in children with sickle cell anemia.
Collapse
Affiliation(s)
- Simon J Hambidge
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Jackson DJ, Sykes A, Mallia P, Johnston SL. Asthma exacerbations: origin, effect, and prevention. J Allergy Clin Immunol 2011; 128:1165-74. [PMID: 22133317 PMCID: PMC7172902 DOI: 10.1016/j.jaci.2011.10.024] [Citation(s) in RCA: 235] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/21/2011] [Accepted: 10/24/2011] [Indexed: 11/26/2022]
Abstract
Asthma is the most common chronic respiratory disease, affecting up to 10% of adults and 30% of children in the Western world. Despite advances in asthma management, acute exacerbations continue to occur and impose considerable morbidity on patients and constitute a major burden on health care resources. Respiratory tract viruses have emerged as the most frequent triggers for exacerbations in both children and adults; however, the mechanisms underlying these remain poorly understood. More recently, it has become increasingly clear that interactions might exist between viruses and other triggers, increasing the likelihood of an exacerbation. In this article we begin with an overview of the health, economic, and social burden that exacerbations of asthma carry with them. This is followed by a review of the pathogenesis of asthma exacerbations, highlighting the various triggers responsible and multiple interactions that exist between them. The final section first addresses what preventative measures are currently available for asthma exacerbations and subsequently examines which of the new treatments in development might lessen the burden of exacerbations in the future.
Collapse
Affiliation(s)
- David J Jackson
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | | | | | | |
Collapse
|
35
|
Use of the self-controlled case-series method in vaccine safety studies: review and recommendations for best practice. Epidemiol Infect 2011; 139:1805-17. [DOI: 10.1017/s0950268811001531] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYThe self-controlled case-series method was originally developed to investigate potential associations between vaccines and adverse events, and is now commonly used for this purpose. This study reviews applications of the method to vaccine safety investigations in the period 1995–2010. In total, 40 studies were reviewed. The application of the self-controlled case-series method in these studies is critically examined, with particular reference to the definition of observation and risk periods, control of confounders, assumptions and potential biases, methodological and presentation issues, power and sample size, and software. Comparisons with other study designs undertaken in the papers reviewed are also highlighted. Some recommendations are presented, with the emphasis on promoting good practice.
Collapse
|
36
|
Dulek DE, Peebles RS. Viruses and asthma. Biochim Biophys Acta Gen Subj 2011; 1810:1080-90. [PMID: 21291960 PMCID: PMC3130828 DOI: 10.1016/j.bbagen.2011.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 01/19/2023]
Abstract
Background Viral respiratory infection has long been known to influence the occurrence of asthma exacerbations. Over the last 20 years much effort has been put into clarifying the role that viral respiratory infections play in the eventual development of asthma. Scope of review In this review we give a general background of the role of viruses in the processes of asthma exacerbation and asthma induction. We review recent additions to the literature in the last 3 years with particular focus on clinical and epidemiologic investigations of influenza, rhinovirus, bocavirus, respiratory syncytial virus, and metapneumovirus. Major conclusions The development of asthma emerges from a complex interaction of genetic predisposition and environmental factors with viral infection likely playing a significant role in the effect of environment on asthma inception. This article is part of a Special Issue entitled: Biochemistry of Asthma. General significance Further understanding of the role that viruses play in asthma exacerbation and inception will contribute to decreased asthma morbidity in the future. This article is part of a Special Issue entitled: Biochemistry of Asthma.
Collapse
Affiliation(s)
- Daniel E Dulek
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232-2650, USA.
| | | |
Collapse
|
37
|
Abstract
Vaccines play a major role in preventing potentially life-threatening diseases. More attention is now focused on the adult population, particularly as they age, as a reservoir for vaccine-preventable diseases. Adults with comorbid conditions such as asthma and chronic obstructive pulmonary disease (COPD) are considered to be at higher risk for invasive diseases, many of which are preventable through routine vaccination. This article reviews the pertinent literature for the use of vaccines in the management of adult patients with asthma and COPD.
Collapse
Affiliation(s)
- R Pesek
- Division of Allergy and Immunology, University of South Florida College of Medicine, James A. Haley Veteran's Hospital, Tampa, FL 33612, USA.
| | | |
Collapse
|
38
|
Clark AT, Skypala I, Leech SC, Ewan PW, Dugué P, Brathwaite N, Huber PAJ, Nasser SM. British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy. Clin Exp Allergy 2010; 40:1116-29. [PMID: 20649608 DOI: 10.1111/j.1365-2222.2010.03557.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This guideline advises on the management of patients with egg allergy. Most commonly, egg allergy presents in infancy, with a prevalence of approximately 2% in children and 0.1% in adults. A clear clinical history and the detection of egg white-specific IgE (by skin prick test or serum assay) will confirm the diagnosis in most cases. Egg avoidance advice is the cornerstone of management. Egg allergy often resolves and re-introduction can be achieved at home if reactions have been mild and there is no asthma. Patients with a history of severe reactions or asthma should have reintroduction guided by a specialist. All children with egg allergy should receive measles, mumps and rubella (MMR) vaccination. Influenza and yellow fever vaccines should only be considered in egg-allergic patients under the guidance of an allergy specialist. This guideline was prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and is intended for allergists and others with a special interest in allergy. The recommendations are evidence-based but where evidence was lacking consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, diagnosis, treatment, prognosis and co-morbid associations.
Collapse
Affiliation(s)
- A T Clark
- Allergy Department, Cambridge University NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Trogdon JG, Nurmagambetov TA, Thompson HF. The economic implications of influenza vaccination for adults with asthma. Am J Prev Med 2010; 39:403-10. [PMID: 20965377 DOI: 10.1016/j.amepre.2010.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 03/19/2010] [Accepted: 07/15/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Influenza vaccination is recommended for adults with asthma. PURPOSE This study estimates the effect of influenza vaccination on utilization of medical services and expenditures for acute and chronic respiratory conditions (ACRC) among adults with asthma. METHODS The sample was adults aged ≥18 years self-reporting asthma in the 2003 through 2006 Medical Expenditure Panel Survey (MEPS), covering four complete influenza seasons. The dependent variables were indicators for any ACRC claims within service category and ACRC expenditures. The main independent variable was an indicator of influenza vaccination. To control for selection bias in the observational data, a nonlinear instrumental variables approach was used. The instruments were indicators for influenza in the first year of MEPS and vaccination in the year prior to MEPS. Data were analyzed in 2009. RESULTS Adults with asthma vaccinated for influenza were 4.4 percentage points less likely to have an inpatient stay due to ACRC (95% CI = -10.8, -1.0). Influenza vaccination was associated with a $492 decrease (95% CI = -$1591, -$56) in annual ACRC nonprescription expenditures, a $224 increase (95% CI = $70, $360) in annual ACRC prescription expenditures, and a nonsignificant $216 decrease (95% CI = -$854, $248) in overall annual ACRC expenditures. CONCLUSIONS Although there was no evidence that vaccination reduced overall ACRC expenditures, the study suggests that efforts to increase the percentage of adults with asthma who are vaccinated may bring substantial benefits in terms of reducing the prevalence and costs of hospitalization although raising prescription medication costs, possibly through improvement in compliance.
Collapse
Affiliation(s)
- Justin G Trogdon
- Public Health Economics Program, RTI International, Research Triangle Park, North Carolina, USA.
| | | | | |
Collapse
|
40
|
Esposito S, Azzari C, Bartolozzi G, Fara GM, Giovanetti F, Giudice ML, Galeone C, Atti MCD. Knowledge of vaccination of allergic children among Italian primary care pediatricians, hospital pediatricians and pediatric residents. Vaccine 2010; 28:7569-75. [DOI: 10.1016/j.vaccine.2010.07.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
|
41
|
Underestimation of influenza viral infection in childhood asthma exacerbations. J Pediatr 2010; 157:505-6. [PMID: 20542291 DOI: 10.1016/j.jpeds.2010.04.067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 03/31/2010] [Accepted: 04/28/2010] [Indexed: 11/21/2022]
Abstract
Bocavirus was found in 11.6% of hospitalized children and 13% of ambulatory patients with exacerbations of asthma, and respiratory syncytial virus was found in 13.5% and 17.7%, respectively. In addition, influenza A virus was detected in 2.6% of hospitalized children and 14.1% (P<.001) of ambulatory-treated patients. Thus, the influenza burden in asthma may be underestimated.
Collapse
|
42
|
Rottem M. Asthma prevalence and exacerbations in children: is there an association with childhood vaccination? Expert Rev Clin Immunol 2010; 4:687-94. [PMID: 20477118 DOI: 10.1586/1744666x.4.6.687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infections and vaccinations may have a potential role in the normal maturation of the immune system, in the development and balance of regulatory pathways, and in the development and exacerbations of asthma. Asthma exacerbations often result from respiratory viral infections, and, while vaccination towards common viral infections may reduce the occurrence of such exacerbations, there has been concern that vaccinations can increase the risk of asthma. Current studies show that childhood vaccines, including inactivated influenza vaccine, are generally safe. However, there is some concern regarding possible exacerbations in infants or children with frequent wheezing or persistent asthma who are given live-attenuated influenza vaccination. Although severe allergic adverse events attributable to vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, such as egg protein or gelatin. The risks of not vaccinating children far outweigh the risks of allergy and asthma exacerbations. Therefore, childhood vaccination should remain an essential part of child health programs and should not be withheld, even from children with asthma or those predisposed to allergy.
Collapse
|
43
|
Chung EY, Huang L, Schneider L. Safety of influenza vaccine administration in egg-allergic patients. Pediatrics 2010; 125:e1024-30. [PMID: 20368312 DOI: 10.1542/peds.2009-2512] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Current guidelines recommend that egg-allergic patients receive an influenza vaccine skin test before the influenza vaccine. This study evaluated the safety of bypassing the skin test and administering graded doses of influenza vaccine to egg-allergic children. METHODS We conducted a retrospective chart-review study of egg-allergic patients aged 6 months to 18 years who received the vaccine skin test and/or a 2-dose graded influenza vaccine. Between influenza seasons 2002-2003 and 2006-2007, egg-allergic patients underwent a vaccine skin test before influenza vaccine administration. Starting in 2006-2007, the skin test was removed from our protocol and egg-allergic patients received the influenza vaccine in 2 graded doses. All vaccinated patients were observed for adverse reactions. RESULTS Two hundred sixty-one egg-allergic patients were evaluated for influenza vaccine administration, and 171 went on to receive the vaccine. Of the 56 patients who received the skin test before the influenza vaccine, 95% (exact 95% confidence interval [CI]: 85.1-98.9) tolerated the vaccine without a serious adverse reaction. This rate was unchanged after the vaccine skin test was removed from the protocol. Of the 115 patients who received the vaccine without a preceding skin test, 97% (exact 95% CI: 91.3-99.0) tolerated the vaccine without serious adverse reaction. The tolerance rate ratio was 1.01 (95% CI: 0.97-1.06). CONCLUSION The results of our study suggest that egg-allergic patients without anaphylaxis to egg may safely receive the influenza vaccine in a 2-dose, graded fashion without a vaccine skin test.
Collapse
Affiliation(s)
- Erica Y Chung
- Department of Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | | | | |
Collapse
|
44
|
Abstract
Influenza is an important contributor to population and individual morbidity and mortality. The current influenza pandemic with novel H1N1 has highlighted the need for health care professionals to better understand the processes involved in creating influenza vaccines, both for pandemic as well as for seasonal influenza. This review presents an overview of influenza-related topics to help meet this need and includes a discussion of the burden of disease, virology, epidemiology, viral surveillance, and vaccine strain selection. We then present an overview of influenza vaccine-related topics, including vaccine production, vaccine efficacy and effectiveness, influenza vaccine misperceptions, and populations that are recommended to receive vaccination. English-language articles in PubMed published between January 1, 1970, and October 7, 2009, were searched using key words human influenza, influenza vaccines, influenza A, and influenza B.
Collapse
Affiliation(s)
| | | | - Gregory A. Poland
- Individual reprints of this article are not available. Address correspondence to Gregory A. Poland, MD, Mayo Vaccine Research Group, Mayo Clinic, 200 First St SW, Rochester MN, 55905 ()
| |
Collapse
|
45
|
Ortiz JR, Neuzil KM, Victor JC, Wald A, Aitken ML, Goss CH. Influenza-associated cystic fibrosis pulmonary exacerbations. Chest 2009; 137:852-60. [PMID: 19965953 DOI: 10.1378/chest.09-1374] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although cystic fibrosis (CF) is the most common inherited respiratory disease, the burden of influenza among individuals with CF is not well characterized. METHODS We used the CF Foundation Patient Registry to determine the relationship between pulmonary exacerbation incidence rate and influenza virus season from July 2003 through June 2007. The outcome of interest, pulmonary exacerbation, was defined as treatment of a respiratory illness with IV antibiotics. Each influenza season was defined as all months during which >/= 15% of laboratory tests for influenza virus were positive in the US influenza virologic surveillance system. We calculated incidence rates of pulmonary exacerbation during the influenza and summertime seasons as well as relative rates with 95% CIs. A multivariate regression model adjusted for demographic and clinical predictors. RESULTS In 2003, the patient cohort size was 21,506 patients, and 7,727 patients experienced at least one pulmonary exacerbation. The overall pulmonary exacerbation incidence rate in the influenza season was 595.0 per 10,000 person-months compared with a summertime baseline of 549.6 per 10,000 person-months. The incidence rate ratio was 1.08 (95% CI: 1.06, 1.10). Multivariate analysis did not change our estimate of risk (adjusted odds ratio: 1.07; 95% CI: 1.05, 1.10). An estimated annual excess of 147.6 per 10,000 person-months or an excess 2.1% of total exacerbations occur during the influenza season. CONCLUSION Our data demonstrate a substantial contribution of the influenza season to CF morbidity. Further studies to determine any causal link between influenza infection and CF pulmonary exacerbations are necessary.
Collapse
Affiliation(s)
- Justin R Ortiz
- Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Box 356522, 1959 NE Pacific St, Seattle, WA 98195-6522, USA.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW To describe what is currently known about the role of virus vaccines in the pathogenesis of asthma and atopy and summarize their role in the prevention of morbidity due to childhood asthma. RECENT FINDINGS The development of virus vaccines and their incorporation into infant and childhood immunization programmes over the last few decades of the twentieth century have been accompanied by a striking concomitant rise in the incidence of asthma and atopy. However, a causal relationship is not supported by the majority of observational studies. The role of childhood immunization against respiratory viruses in the reduction of morbidity from asthma is another important public health issue. Recent findings suggest that influenza is not strongly associated with exacerbations of asthma in children, despite recommendations that this group should be immunized against it. SUMMARY Current evidence suggests that virus vaccination is well tolerated and does not lead to an increased incidence of asthma or atopy in children receiving vaccines. Debate continues regarding the place of respiratory virus vaccination in the therapeutic armamentarium for children with asthma. In the case of influenza, there appears to be an absence of harm, but benefit seems to be limited to younger children.
Collapse
|
47
|
Ong BA, Forester J, Fallot A. Does influenza vaccination improve pediatric asthma outcomes? J Asthma 2009; 46:477-80. [PMID: 19544168 DOI: 10.1080/02770900902795538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Controversy exists regarding the effectiveness of influenza vaccination in preventing influenza-related asthma exacerbations in the pediatric population. While yearly influenza immunization is widely recommended for children with asthma, there is currently little evidence to support this practice. Several studies have demonstrated no measurable benefit in asthma outcomes. This study sought to determine whether influenza vaccination status is associated with indicators of asthma morbidity within the military pediatric population. METHODS A survey was conducted of patients 3 to 18 years of age with a diagnosis of asthma enrolled in the pediatric clinics of Brooke Army Medical Center, Fort Sam Houston, Texas, and Wilford Hall Medical Center, Lackland Air Force Base, Texas. Management practices and outcomes for 80 children were evaluated. Data were analyzed using the statistical package SPSS version 12 (SPSS Inc., Chicago). Univariate analyses were performed to identify associations between influenza vaccination, selected demographic variables and asthma exacerbation defined by oral steroid prescription, hospital visits, and unscheduled clinic or emergency department visits for asthma symptoms. Logistic regression analyses were conducted to detect possible confounding variables. RESULTS In the univariate analyses, current influenza vaccination status was associated with a significant reduction of oral steroid use in the 12 months before the survey. This relationship was appreciated to a lesser extent with emergency department or unscheduled clinic visits in the last 12 months. No significant differences were found regarding the distribution of influenza vaccination status across selected demographic variables. In the multivariate analyses, current influenza vaccination status was independently associated with significantly decreased odds of using oral steroids in the previous 12 months. There was no evidence of confounding or effect modification. CONCLUSIONS This study suggests influenza vaccination is associated with fewer asthma exacerbations. After controlling for several potential confounding variables, administration of influenza vaccine was associated with a protective effect against indicators of asthma exacerbations. Our results indicate that children with asthma in the military beneficiary population may benefit from annual influenza vaccination.
Collapse
Affiliation(s)
- Bruce A Ong
- Department of Aviation Medicine, Hunter Army Airfield, Building 1257, North Lightning Road, Savannah, GA 31419, USA.
| | | | | |
Collapse
|
48
|
The Role of Influenza Vaccination in Asthmatic Children. ALLERGY FRONTIERS: THERAPY AND PREVENTION 2009. [PMCID: PMC7122049 DOI: 10.1007/978-4-431-99362-9_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Asthma is the most occurring chronic disease in children. Asthma related genes and environmental factors play a role in the etiology. Nowadays, asthma is regarded as a chronic inflammatory disease of the airways instead of solely a reversible airway obstruction. Asthma is often diagnosed on specific symptoms such as chest tightness, wheezing, dyspnea, and coughing. It is likely that, rather than a single disease entity, asthma consists of related, partially overlapping syndromes. The first symptoms often are experienced before the age of 5. Children with the highest risk have a family history of atopy and/or asthma. Viral infections with symptoms of wheezing acquired in the first year of life may be associated with the risk of developing asthma later on [1]. However, making the diagnosis with a reasonable certainty that is supported by spirometry is only possible from the age of 6 onward. More than 50% of children with a period of wheezing earlier on in life are not diagnosed as having asthma at the age of 6 [2]. The use of rescue and anti-inflammatory medication has largely altered the prospects of asthma patients and has improved their quality of life. Thus, nowadays, most asthma patients lead a normal life without restrictions. Disease control achieved by the asthmatics is an important predictor of the likelihood of complications of the disease [3]. However, asthma exacerbations neither respond to inhaled steroids nor can they substantially be prevented in this way [4, 5]. Only the use of oral corticos-teroids seems to be unmistakably effective in case of exacerbations [6, 7].
Collapse
|
49
|
Martin E. Improving influenza vaccination rates for pediatric asthmatics by use of an asthma educational tool and a patient electronic care system. Clin Pediatr (Phila) 2008; 47:588-92. [PMID: 18441318 DOI: 10.1177/0009922808314902] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A prescription-sized asthma educational tool (AET) was used to identify, assess, and educate pediatric asthma patients during a 2-year period. A Patient Electronic Care System (PECS) was used to register these patients over 2 influenza vaccination seasons to determine whether influenza vaccination rates could be improved among these pediatric asthmatics by use of the asthma educational tool. During this study, influenza vaccination rates among all asthmatics increased over 450% from 2003 to 2004 influenza season compared with 2006 to 2007 influenza season (13.1%-59.4%). The mild persistent to severe persistent asthmatics subgroup in this pool of patients also improved their influenza vaccination rates over 250% from the 2003 to 2004 influenza season to the 2006 to 2007 influenza season (36.6%-91.7%). All the results were statistically significant to 95% confidence levels.
Collapse
Affiliation(s)
- Elmer Martin
- Health Point Family Care Inc, Dixie Pike Health Center, Covington, Kentucky 41011, USA.
| |
Collapse
|
50
|
Jefferson T, Rivetti A, Harnden A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev 2008:CD004879. [PMID: 18425905 DOI: 10.1002/14651858.cd004879.pub3] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The consequences of influenza in children and adults are mainly absenteeism from school and work. However, the risk of complications is greatest in children and people over 65 years old. OBJECTIVES To appraise all comparative studies evaluating the effects of influenza vaccines in healthy children; assess vaccine efficacy (prevention of confirmed influenza) and effectiveness (prevention of influenza-like illness) and document adverse events associated with influenza vaccines. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, issue 3); OLD MEDLINE (1950 to 1965); MEDLINE (1966 to September 2007); EMBASE (1974 to September 2007); Biological Abstracts (1969 to September 2007); and Science Citation Index (1974 to September 2007). SELECTION CRITERIA Randomised controlled trials (RCTs), cohort and case-control studies of any influenza vaccine in healthy children under 16 years of age. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS Fifty-one studies with 294,159 observations were included. Sixteen RCTs and 18 cohort studies were included in the analysis of vaccine efficacy and effectiveness. From RCTs, live vaccines showed an efficacy of 82% (95% confidence interval (CI) 71% to 89%) and an effectiveness of 33% (95% CI 28% to 38%) in children older than two compared with placebo or no intervention. Inactivated vaccines had a lower efficacy of 59% (95% CI 41% to 71%) than live vaccines but similar effectiveness: 36% (95% CI 24% to 46%). In children under two, the efficacy of inactivated vaccine was similar to placebo. Variability in study design and presentation of data was such that a meta-analysis of safety outcome data was not feasible. Extensive evidence of reporting bias of safety outcomes from trials of live attenuated vaccines impeded meaningful analysis. AUTHORS' CONCLUSIONS Influenza vaccines are efficacious in children older than two but little evidence is available for children under two. There was a marked difference between vaccine efficacy and effectiveness. No safety comparisons could be carried out, emphasizing the need for standardisation of methods and presentation of vaccine safety data in future studies. It was surprising to find only one study of inactivated vaccine in children under two years, given current recommendations to vaccinate healthy children from six months old in the USA and Canada. If immunisation in children is to be recommended as a public health policy, large-scale studies assessing important outcomes and directly comparing vaccine types are urgently required.
Collapse
Affiliation(s)
- Tom Jefferson
- Vaccines Field, Cochrane Collaboration, Via Adige 28a, Anguillara Sabazia, Roma, Italy, 00061
| | | | | | | | | |
Collapse
|