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Regan AK, Moore HC, Binks MJ, McHugh L, Blyth CC, Pereira G, Lust K, Sarna M, Andrews R, Foo D, Effler PV, Lambert S, Van Buynder P. Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis. Pediatrics 2023; 152:e2023062664. [PMID: 37807881 PMCID: PMC10598625 DOI: 10.1542/peds.2023-062664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Following the introduction of jurisdictional maternal pertussis vaccination programs in Australia, we estimated maternal vaccine effectiveness (VE) and whether maternal pertussis vaccination modified the effectiveness of the first 3 primary doses of pertussis-containing vaccines. METHODS We conducted a population-based cohort study of 279 418 mother-infant pairs using probabilistic linkage of administrative health records in 3 Australian jurisdictions. Infants were maternally vaccinated if their mother had a documented pertussis vaccination ≥14 days before birth. Jurisdictional immunization records were used to identify receipt of the first 3 infant doses of pertussis-containing vaccines. Infant pertussis infections were identified using notifiable disease records. VE was estimated using Cox proportional hazard models. RESULTS Pertussis was administered during 51.7% (n = 144 429/279 418) of pregnancies, predominantly at 28-31 weeks' gestation. VE of maternal pertussis vaccination declined from 70.4% (95% confidence interval [CI], 50.5-82.3) among infants <2 months old to 43.3% (95% CI, 6.8-65.6) among infants 7-8 months old and was not significant after 8 months of age. Although we observed slightly lower VE point estimates for the third dose of infant pertussis vaccine among maternally vaccinated compared with unvaccinated infants (76.5% vs 92.9%, P = .002), we did not observe higher rates of pertussis infection (hazard ratio, 0.70; 95% CI, 0.61-3.39). CONCLUSIONS Pertussis vaccination near 28 weeks' gestation was associated with lower risk of infection among infants through 8 months of age. Although there was some evidence of lower effectiveness of infant vaccination among maternally vaccinated infants, this did not appear to translate to greater risk of disease.
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Affiliation(s)
- Annette K. Regan
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Hannah C. Moore
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
| | - Michael J. Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lisa McHugh
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases
- Division of Pediatrics, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gavin Pereira
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Karin Lust
- Women’s and Newborn Services, Royal Brisbane Women’s Hospital, Brisbane, Queensland, Australia
| | - Mohinder Sarna
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
| | - Ross Andrews
- Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia
| | - Damien Foo
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases
- Yale School of Environment, Yale University, New Haven, Connecticut
| | - Paul V. Effler
- Department of Health Western Australia, Communicable Disease Control Directorate, Perth, Western Australia, Australia
| | - Stephen Lambert
- Communicable Disease Control Branch, Queensland Health, Brisbane, Queensland, Australia
- National Centre for Immunization Research and Surveillance, Westmead, New South Wales, Australia
| | - Paul Van Buynder
- School of Medicine, Griffith University, Southport, Queensland, Australia
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Association between maternal influenza vaccination and neurodevelopmental disorders in childhood: a longitudinal, population-based linked cohort study. Arch Dis Child 2023; 108:647-653. [PMID: 37001967 PMCID: PMC10423464 DOI: 10.1136/archdischild-2022-324269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/02/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To assess the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and the risk of a diagnosis of a neurodevelopmental disorder in early childhood. DESIGN Retrospective cohort study. SETTING Population-based birth registry linked with health administrative databases in Western Australia (WA). PARTICIPANTS Singleton, liveborn children born between 1 April 2012 and 1 July 2016 in WA. EXPOSURE Receipt of seasonal IIV during pregnancy obtained from a state-wide antenatal vaccination database. MAIN OUTCOME MEASURES Clinical diagnosis of a neurodevelopmental disorder was recorded from hospital inpatient and emergency department records. We used Cox proportional hazard regression, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio (HR) of neurodevelopmental disorders associated with in utero exposure to seasonal IIV. RESULTS The study included 140 514 children of whom, 15 663 (11.2%) were exposed to seasonal IIV in utero. The prevalence of neurodevelopmental disorders was 5.4%, including mental or behavioural (0.4%), neurological (5.1%), seizure (2.2%) and sleep disorders (2.7%). Maternal IIV was not associated with increased risk of neurodevelopmental disorders (HR 1.00; 95% CI 0.91 to 1.08). Children exposed in the first trimester had a lower risk of seizure disorders (adjusted HR [aHR] 0.73; 95% CI 0.54 to 0.998), and preterm children exposed any time during pregnancy had a lower risk of sleep disorders (aHR 0.63; 95% CI 0.41 to 0.98). CONCLUSIONS We did not observe increased risk of neurodevelopmental disorders following in utero exposure to seasonal IIV. Although we observed some evidence for lower risk of seizure and sleep disorders, additional studies are required to confirm.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- eNable Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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Daley MF, Reifler LM, Shoup JA, Glanz JM, Naleway AL, Jackson ML, Hambidge SJ, McLean H, Kharbanda EO, Klein NP, Lewin BJ, Weintraub ES, McNeil MM, Razzaghi H, Singleton JA. Influenza Vaccination Among Pregnant Women: Self-report Compared With Vaccination Data From Electronic Health Records, 2018-2020 Influenza Seasons. Public Health Rep 2023; 138:456-466. [PMID: 35674233 PMCID: PMC10240889 DOI: 10.1177/00333549221099932] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Having accurate influenza vaccination coverage estimates can guide public health activities. The objectives of this study were to (1) validate the accuracy of electronic health record (EHR)-based influenza vaccination data among pregnant women compared with survey self-report and (2) assess whether survey respondents differed from survey nonrespondents by demographic characteristics and EHR-based vaccination status. METHODS This study was conducted in the Vaccine Safety Datalink, a network of 8 large medical care organizations in the United States. Using EHR data, we identified all women pregnant during the 2018-2019 or 2019-2020 influenza seasons. Surveys were conducted among samples of women who did and did not appear vaccinated for influenza according to EHR data. Separate surveys were conducted after each influenza season, and respondents reported their influenza vaccination status. Analyses accounted for the stratified design, sampling probability, and response probability. RESULTS The survey response rate was 50.5% (630 of 1247) for 2018-2019 and 41.2% (721 of 1748) for 2019-2020. In multivariable analyses combining both survey years, non-Hispanic Black pregnant women had 3.80 (95% CI, 2.13-6.74) times the adjusted odds of survey nonresponse; odds of nonresponse were also higher for Hispanic pregnant women and women who had not received (per EHR data) influenza vaccine during current or prior influenza seasons. The sensitivity, specificity, and positive predictive value of EHR documentation of influenza vaccination compared with self-report were ≥92% for both survey years combined. The negative predictive value of EHR-based influenza vaccine status was 80.5% (95% CI, 76.7%-84.0%). CONCLUSIONS EHR-based influenza vaccination data among pregnant women were generally concordant with self-report. New data sources and novel approaches to mitigating nonresponse bias may be needed to enhance influenza vaccination surveillance efforts.
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Affiliation(s)
- Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Liza M. Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Michael L. Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Simon J. Hambidge
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of General Pediatrics, Denver Health and Hospitals, Denver, CO, USA
| | - Huong McLean
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | | | | | - Bruno J. Lewin
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Eric S. Weintraub
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael M. McNeil
- Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilda Razzaghi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James A. Singleton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Sarna M, Pereira GF, Foo D, Baynam GS, Regan AK. The risk of major structural birth defects associated with seasonal influenza vaccination during pregnancy: A population-based cohort study. Birth Defects Res 2022; 114:1244-1256. [PMID: 35678518 PMCID: PMC9796878 DOI: 10.1002/bdr2.2049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/08/2022] [Accepted: 04/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Seasonal inactivated influenza vaccine (IIV) is routinely recommended during pregnancy to protect both mothers and infants from complications following influenza infection. While previous studies have evaluated the risk of major structural birth defects in infants associated with prenatal administration of monovalent pandemic IIV, fewer studies have evaluated the risk associated with prenatal seasonal IIV. METHODS We conducted a population-based cohort study of 125,866 singleton births between 2012 and 2016 in Western Australia. Birth registrations were linked to the state's registers for congenital anomalies and a state prenatal vaccination database. We estimated prevalence ratios (PR) of any major structural birth defect and defects by organ system. Vaccinated pregnancies were defined as those with a record of IIV in the first trimester. Inverse probability treatment weighting factored for baseline probability for vaccination. A Bonferroni correction was applied to account for multiple comparisons. RESULTS About 3.9% of births had a major structural birth defect. Seasonal IIV exposure during the first trimester was not associated with diagnosis of any major structural birth defect diagnosed within 1 month of birth (PR 0.98, 95% CI: 0.77, 1.28) or within 6 years of life (PR 1.02, 95% CI: 0.78, 1.35). We identified no increased risk in specific birth defects associated with seasonal IIV. CONCLUSION Based on registry data for up to 6 years of follow-up, results suggest there is no association between maternal influenza vaccination and risk of major structural birth defects. These results support the safety of seasonal IIV administration during pregnancy.
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Affiliation(s)
- Mohinder Sarna
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Gavin F. Pereira
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia,Centre for Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Damien Foo
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Gareth S. Baynam
- King Edward Memorial Hospital, Western Australian Department of HealthSubiacoWestern AustraliaAustralia,Faculty of Health and Medical Sciences, Division of PediatricsThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Annette K. Regan
- Curtin School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia,Wesfarmers Centre of Vaccines & Infectious DiseasesTelethon Kids InstitutePerthWestern AustraliaAustralia,School of Nursing and Health ProfessionsUniversity of San FranciscoSan FranciscoCaliforniaUSA
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Maternal influenza vaccination and child mortality: Longitudinal, population-based linked cohort study. Vaccine 2022; 40:3732-3736. [PMID: 35606236 DOI: 10.1016/j.vaccine.2022.05.030] [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: 04/05/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Influenza vaccination is recommended to protect mothers and their infants from influenza. Few studies have evaluated the association between maternal influenza vaccination and child mortality. We aimed to evaluate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and mortality among young children. This longitudinal, population-based cohort study included 191,247 maternal-child pairs in Western Australia between April 2012 and December 2017. Maternal vaccine information was obtained from a state-wide antenatal vaccination database. Mortality was defined as a record of a death registration. We used Cox proportional hazard models, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio of child mortality associated with in utero exposure to seasonal IIV. This study found no association between in utero exposure to seasonal IIV and mortality through age five years.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States; Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Prenatal influenza vaccination and allergic and autoimmune diseases in childhood: A longitudinal, population-based linked cohort study. PLoS Med 2022; 19:e1003963. [PMID: 35381006 PMCID: PMC9017895 DOI: 10.1371/journal.pmed.1003963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/19/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies have evaluated the effect of maternal influenza vaccination on the development of allergic and autoimmune diseases in children beyond 6 months of age. We aimed to investigate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and subsequent diagnosis of allergic and autoimmune diseases. METHODS AND FINDINGS This longitudinal, population-based linked cohort study included 124,760 singleton, live-born children from 106,206 mothers in Western Australia (WA) born between April 2012 and July 2016, with up to 5 years of follow-up from birth. In our study cohort, 64,169 (51.4%) were male, 6,566 (5.3%) were Aboriginal and/or Torres Strait Islander children, and the mean age at the end of follow-up was 3.0 (standard deviation, 1.3) years. The exposure was receipt of seasonal IIV during pregnancy. The outcomes were diagnosis of an allergic or autoimmune disease, including asthma and anaphylaxis, identified from hospital and/or emergency department (ED) records. Inverse probability of treatment weights (IPTWs) accounted for baseline probability of vaccination by maternal age, Aboriginal and/or Torres Strait Islander status, socioeconomic status, body mass index, parity, medical conditions, pregnancy complications, prenatal smoking, and prenatal care. The models additionally adjusted for the Aboriginal and/or Torres Strait Islander status of the child. There were 14,396 (11.5%) maternally vaccinated children; 913 (6.3%) maternally vaccinated and 7,655 (6.9%) maternally unvaccinated children had a diagnosis of allergic or autoimmune disease, respectively. Overall, maternal influenza vaccination was not associated with diagnosis of an allergic or autoimmune disease (adjusted hazard ratio [aHR], 1.02; 95% confidence interval [CI], 0.95 to 1.09). In trimester-specific analyses, we identified a negative association between third trimester influenza vaccination and the diagnosis of asthma (n = 40; aHR, 0.70; 95% CI, 0.50 to 0.97) and anaphylaxis (n = 36; aHR, 0.67; 95% CI, 0.47 to 0.95).We did not capture outcomes diagnosed in a primary care setting; therefore, our findings are only generalizable to more severe events requiring hospitalization or presentation to the ED. Due to small cell sizes (i.e., <5), estimates could not be determined for all outcomes after stratification. CONCLUSIONS In this study, we observed no association between in utero exposure to influenza vaccine and diagnosis of allergic or autoimmune diseases. Although we identified a negative association of asthma and anaphylaxis diagnosis when seasonal IIV was administered later in pregnancy, additional studies are needed to confirm this. Overall, our findings support the safety of seasonal inactivated influenza vaccine during pregnancy in relation to allergic and autoimmune diseases in early childhood and support the continuation of current global maternal vaccine programs and policies.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C. Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K. Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States of America
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Longitudinal, population-based cohort study of prenatal influenza vaccination and influenza infection in childhood. Vaccine 2022; 40:656-665. [PMID: 35000794 DOI: 10.1016/j.vaccine.2021.11.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza vaccination is recommended to protect mothers and their infants from influenza infection. Few studies have evaluated the health impacts of in utero exposure to influenza vaccine among children more than six months of age. METHODS We used probabilistically linked administrative health records to establish a mother-child cohort to evaluate the risk of influenza and acute respiratory infections associated with maternal influenza vaccination. Outcomes were laboratory-confirmed influenza (LCI) and hospitalization for influenza or acute respiratory infection (ARI). Adjusted hazard ratios (aHRs) accounted for child's Aboriginal status and were weighted by the inverse-probability of treatment. RESULTS 14,396 (11.5%) children were born to vaccinated mothers. Maternally vaccinated infants aged < 6 months had lower risk of LCI (aHR: 0.33; 95% CI: 0.13, 0.85), influenza-associated hospitalization (aHR: 0.39; 95% CI: 0.16, 0.94) and ARI-associated hospitalization (aHR: 0.85; 95% CI: 0.77, 0.94) compared to maternally unvaccinated infants. With the exception of an increased risk of LCI among children aged 6 months to < 2 years old following first trimester vaccination (aHR: 2.28; 95% CI: 1.41, 3.69), there were no other differences in the risk of LCI, influenza-associated hospitalization or ARI-associated hospitalization among children aged > 6 months. CONCLUSION Study results show that maternal influenza vaccination is effective in preventing influenza in the first six months and had no impact on respiratory infections after two years of age.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia; Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia; School of Nursing and Health Professions, University of San Francisco, San Francisco, California, United States; Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
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Speake HA, Pereira G, Regan AK. Risk of adverse maternal and foetal outcomes associated with inactivated influenza vaccination in first trimester of pregnancy. Paediatr Perinat Epidemiol 2021; 35:196-205. [PMID: 33155331 DOI: 10.1111/ppe.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In many countries, influenza vaccination is routinely recommended during any stage of pregnancy, yet uptake remains low, particularly in the first trimester. This is thought to be due to maternal concerns regarding vaccine safety. OBJECTIVE To evaluate the safety of influenza vaccination in the first trimester of pregnancy. METHODS In a 4-year retrospective cohort study using probabilistic record linkage of administrative health data, we established a population-based cohort of 2391 women vaccinated in first trimester and 68 447 never vaccinated women with a date of conception between 2012 and 2015 in Western Australia. We estimated the relative risk (RR) of perinatal health outcomes among first trimester vaccinated women as compared to never vaccinated women using log-binomial logistic regression following a propensity score matched (PSM) analyses (2391 vaccinated women matched with 9564 never vaccinated women). RESULTS First trimester vaccination was not associated with increased risk of stillbirth (RR 1.18, 95% confidence interval [CI] 0.64, 2.19), small for gestational age (RR 0.96, 95% CI 0.83, 1.11) or preeclampsia (RR 0.97, 95% CI 0.74, 1.28). The risk of spontaneous birth at 32-36 weeks was higher in first trimester vaccinated women compared with never vaccinated women (RR 1.40, 95% CI 1.11, 1.77). Vaccination was associated with a 10-19% increase in the risk of gestational diabetes (RR 1.18, 95% CI 0.94, 1.49), premature rupture of membranes (RR 1.10, 95% CI 0.82, 1.48), and threatened preterm labour (RR 1.19, 95% CI 0.90, 1.59). CONCLUSIONS With exception to spontaneous preterm birth, findings suggest that first trimester vaccination is not associated with adverse maternal and foetal outcomes. Results can be used to support patient and provider-level vaccine decision making during first trimester.
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Affiliation(s)
- Hollie A Speake
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia.,School of Public Health, Curtin University, Perth, WA, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, WA, Australia.,Telethon Kids Institute, Nedlands, WA, Australia.,Centre for Fertility and Health, Norwegian Public Health Institute, Oslo, Norway
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, WA, Australia.,School of Public Health, Texas A&M University, College Station, TX, USA.,UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Age-specific vaccination coverage estimates for influenza, human papillomavirus and measles containing vaccines from seven population-based healthcare databases from four EU countries – The ADVANCE project. Vaccine 2020; 38:3243-3254. [DOI: 10.1016/j.vaccine.2020.02.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 11/18/2022]
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Regan A, Effler PV, Thomson C, Mak DB. Potential use of Western Australia’s mandatory Midwives Notification System for routinely monitoring antenatal vaccine coverage. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background
Despite the maternal and infant health benefits of antenatal vaccines and availability of government-funded vaccination programs, Australia does not have a national system for routinely monitoring antenatal vaccination coverage. We evaluated the potential use of Western Australia’s mandatory Midwives Notification System (MNS) as a tool for routinely monitoring antenatal vaccination coverage.
Methods
Two hundred and sixty-eight women who gave birth to a live infant between August and October 2016 participated in a telephone survey of vaccines received in their most recent pregnancy. For women who reported receiving influenza and/or pertussis vaccine and whose vaccination status was documented by their vaccine provider, MNS vaccination data were compared with the vaccine provider’s record as the ‘gold standard.’ For women who reported receiving no vaccines, MNS vaccination data were compared with self-reported information.
Results
Influenza and pertussis vaccination status was complete (i.e. documented as either vaccinated or not vaccinated) for 66% and 63% of women, respectively. Sensitivity of MNS influenza vaccination data was 65.7% (95% CI 56.0-74.2%) and specificity was 53.0% (95% CI 42.4-63.4%). Sensitivity of MNS pertussis vaccination data was 62.5% (95% CI 53.3-70.9%) and specificity was 40.4% (95% CI 27.6-54.7%). There was no difference between vaccinated and unvaccinated women in the proportion of MNS records with missing or unknown vaccination information. When considering only MNS records with complete vaccination information, the sensitivity of the MNS influenza vaccination field was 91.8% (95% CI 83.0-96.9%) and the sensitivity of the MNS pertussis vaccination field was 88.0% (95% CI 76.7-95.5%).
Conclusion
Due to the high proportion of records with missing or unknown vaccination status, we observed low sensitivity and specificity of antenatal vaccination data in the MNS. However, given we did not observe differential ascertainment by vaccination status, MNS records with complete information may be reliable data source for routinely monitoring antenatal vaccine coverage.
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Affiliation(s)
- Annette Regan
- 1-School of Public Health, Curtin University 2-Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute 3-School of Public Health, Texas A&M University
| | - Paul V Effler
- 1-Communicable Disease Control Directorate, Department of Health Western Australia 2- School of Pathology and Laboratory Medicine, University of Western Australia
| | - Chloe Thomson
- 1-Communicable Disease Control Directorate, Department of Health Western Australia 2-School of Population and Global Health, University of Western Australia
| | - Donna B Mak
- 1-Communicable Disease Control Directorate, Department of Health Western Australia 2- School of Medicine, University of Notre Dame
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11
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Naleway AL, Ball S, Kwong JC, Wyant BE, Katz MA, Regan AK, Russell ML, Klein NP, Chung H, Simmonds KA, Azziz-Baumgartner E, Feldman BS, Levy A, Fell DB, Drews SJ, Garg S, Effler P, Barda N, Irving SA, Shifflett P, Jackson ML, Thompson MG. Estimating Vaccine Effectiveness Against Hospitalized Influenza During Pregnancy: Multicountry Protocol for a Retrospective Cohort Study. JMIR Res Protoc 2019; 8:e11333. [PMID: 30664495 PMCID: PMC6360380 DOI: 10.2196/11333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023] Open
Abstract
Background Although pregnant women are believed to have elevated risks of severe influenza infection and are targeted for influenza vaccination, no study to date has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy, primarily because this outcome poses many methodological challenges. Objective The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) was formed in 2016 as an international collaboration with the Centers for Disease Control and Prevention; Abt Associates; and study sites in Australia, Canada, Israel, and the United States. The primary goal of this collaboration is to estimate IVE in preventing acute respiratory or febrile illness (ARFI) hospitalizations associated with laboratory-confirmed influenza virus infection during pregnancy. Secondary aims include (1) describing the incidence, clinical course, and severity of influenza-associated ARFI hospitalization during pregnancy; (2) comparing the characteristics of ARFI-hospitalized pregnant women who were tested for influenza with those who were not tested; (3) describing influenza vaccination coverage in pregnant women; and (4) comparing birth outcomes among women with laboratory-confirmed influenza-associated hospitalization versus other noninfluenza ARFI hospitalizations. Methods For an initial assessment of IVE, sites identified a retrospective cohort of pregnant women aged from 18 to 50 years whose pregnancies overlapped with local influenza seasons from 2010 to 2016. Pregnancies were defined as those that ended in a live birth or stillbirth of at least 20 weeks gestation. The analytic sample for the primary IVE analysis was restricted to pregnant women who were hospitalized for ARFI during site-specific influenza seasons and clinically tested for influenza virus infection using real-time reverse transcription polymerase chain reaction. Results We identified approximately 2 million women whose pregnancies overlapped with influenza seasons; 550,344 had at least one hospitalization during this time. After restricting to women who were hospitalized for ARFI and tested for influenza, the IVE analytic sample included 1005 women. Conclusions In addition to addressing the primary question about the effectiveness of influenza vaccination, PREVENT data will address other important knowledge gaps including understanding the incidence, clinical course, and severity of influenza-related hospitalizations during pregnancy. The data infrastructure and international partnerships created for these analyses may be useful and informative for future influenza studies. International Registered Report Identifier (IRRID) DERR1-10.2196/11333
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Affiliation(s)
- Allison L Naleway
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR, United States
| | - Sarah Ball
- Abt Associates, Inc, Cambridge, MA, United States
| | | | | | - Mark A Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, Australia
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | | | | | | | - Becca S Feldman
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Avram Levy
- PathWest Laboratory Medicine Western Australia, Perth, Australia
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Steven J Drews
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul Effler
- Western Australia Department of Health, Perth, Australia
| | - Noam Barda
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Stephanie A Irving
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR, United States
| | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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12
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Association of influenza vaccination during pregnancy with birth outcomes in Nicaragua. Vaccine 2017; 35:3056-3063. [PMID: 28465095 PMCID: PMC5439533 DOI: 10.1016/j.vaccine.2017.04.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 01/12/2023]
Abstract
Background: Studies have shown that influenza vaccination during pregnancy reduces the risk of influenza disease in pregnant women and their offspring. Some have proposed that maternal vaccination may also have beneficial effects on birth outcomes. In 2014, we conducted an observational study to test this hypothesis using data from two large hospitals in Managua, Nicaragua. Methods: We conducted a retrospective cohort study to evaluate associations between influenza vaccination and birth outcomes. We carried out interviews and reviewed medical records post-partum to collect data on demographics, influenza vaccination during pregnancy, birth outcomes and other risk factors associated with adverse neonatal outcomes. We used influenza surveillance data to adjust for timing of influenza circulation. We assessed self-reports of influenza vaccination status by further reviewing medical records of those who self-reported but did not have readily available evidence of vaccination status. We performed multiple logistic regression (MLR) and propensity score matching (PSM). Results: A total of 3268 women were included in the final analysis. Of these, 55% had received influenza vaccination in 2014. Overall, we did not observe statistically significant associations between influenza vaccination and birth outcomes after adjusting for risk factors, with either MLR or PSM. With PSM, after adjusting for risk factors, we observed protective associations between influenza vaccination in the second and third trimester and preterm birth (aOR: 0.87; 95% confidence interval (CI): 0.75–0.99 and aOR: 0.66; 95% CI: 0.45–0.96, respectively) and between influenza vaccination in the second trimester and low birth weight (aOR: 0.80; 95% CI: 0.64–0.97). Conclusions: We found evidence to support an association between influenza vaccination and birth outcomes by trimester of receipt with data from an urban population in Nicaragua. The study had significant selection and recall biases. Prospective studies are needed to minimize these biases.
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13
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Effect of Maternal Influenza Vaccination on Hospitalization for Respiratory Infections in Newborns: A Retrospective Cohort Study. Pediatr Infect Dis J 2016; 35:1097-103. [PMID: 27314823 DOI: 10.1097/inf.0000000000001258] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants are at increased risk of hospitalization for influenza. Although vaccinating women during pregnancy has been shown to reduce the incidence of influenza infection among newborns, population-based data are limited. METHODS A population-based cohort of 31,028 mothers and singleton infants were included in the analysis. Hospitalizations with a principal diagnosis or additional diagnoses consistent with severe respiratory illness occurring during the 2012 and 2013 southern hemisphere influenza seasons were identified using a state-wide hospital discharge database. Newborns were defined as "maternally vaccinated" if the mother received influenza vaccine ≥14 days before delivery. Cox regression models were used to estimate adjusted hazard ratios for hospitalization. RESULTS A total of 3169 infants were maternally vaccinated and 27,859 were unvaccinated; 732 hospitalizations were identified, 528 (69%) of which were for bronchiolitis. There were 21.9 hospitalizations per 100,000 person days among maternally vaccinated infants and 30.2 hospitalizations per 100,000 person days among unvaccinated infants. Maternally vaccinated infants were 25% less likely to be hospitalized for an acute respiratory illness during influenza season compared with unvaccinated infants (adjusted hazard ratio: 0.75, 95% confidence interval: 0.56-0.99, P = 0.04). Vaccinations administered in the third trimester were associated with a 33% reduction in the risk of newborn hospitalization (adjusted hazard ratio: 0.67, 95% confidence interval: 0.47-0.95, P = 0.03). No such reduction was identified for vaccinations administered earlier in pregnancy. CONCLUSIONS Maternal influenza vaccination was associated with a reduction in the incidence of hospital admission for acute respiratory illness among infants <6 months of age. These data suggest that vaccination during third trimester may provide optimal benefit to the newborn.
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14
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Regan AK, Klerk ND, Moore HC, Omer SB, Shellam G, Effler PV. Effectiveness of seasonal trivalent influenza vaccination against hospital-attended acute respiratory infections in pregnant women: A retrospective cohort study. Vaccine 2016; 34:3649-56. [PMID: 27216758 DOI: 10.1016/j.vaccine.2016.05.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/06/2016] [Accepted: 05/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pregnant women are at risk of serious influenza infection. Although previous studies indicate maternal influenza vaccination can prevent hospitalisation in young infants, there is limited evidence of the effect in mothers. METHODS A cohort of 34,701 pregnant women delivering between 1 April 2012 and 31 December 2013 was created using birth records. Principal diagnosis codes from hospital emergency department (ED) and inpatient records were used to identify episodes of acute respiratory illness (ARI) during the 2012 and 2013 southern hemisphere influenza seasons. Cox regression models were used to calculate adjusted hazard ratios (aHRs) by maternal vaccination status, controlling for Indigenous status, socioeconomic level, medical conditions, and week of delivery. RESULTS 3,007 (8.7%) women received a seasonal influenza vaccine during pregnancy. Vaccinated women were less likely to visit an ED during pregnancy for an ARI (9.7 visits per 10,000 person-days vs. 35.5 visits per 10,000 person-days; aHR: 0.19, 95% CI: 0.05-0.68). Vaccinated women were also less likely to be hospitalised with an ARI compared to unvaccinated women (16.2 hospitalisations per 10,000 person-days vs. 34.0 hospitalisations per 10,000 person-days; aHR: 0.35, 95% CI: 0.13-0.97). CONCLUSIONS Influenza vaccination during pregnancy was associated with significantly fewer hospital attendances for ARI in pregnant women.
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Affiliation(s)
- Annette K Regan
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, 6009, Australia; Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA, 6008, Australia.
| | - Nicholas de Klerk
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, Western Australia, 6008, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, Western Australia, 6008, Australia
| | - Saad B Omer
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, United States
| | - Geoffrey Shellam
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, 6009, Australia
| | - Paul V Effler
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, 6009, Australia; Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA, 6008, Australia
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15
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Regan AK, Moore HC, de Klerk N, Omer SB, Shellam G, Mak DB, Effler PV. Seasonal Trivalent Influenza Vaccination During Pregnancy and the Incidence of Stillbirth: Population-Based Retrospective Cohort Study. Clin Infect Dis 2016; 62:1221-7. [DOI: 10.1093/cid/ciw082] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/05/2016] [Indexed: 12/16/2022] Open
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