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Grohskopf LA, Ferdinands JM, Blanton LH, Broder KR, Loehr J. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024-25 Influenza Season. MMWR Recomm Rep 2024; 73:1-25. [PMID: 39197095 DOI: 10.15585/mmwr.rr7305a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2024] Open
Abstract
This report updates the 2023-24 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2022;72[No. RR-2]:1-24). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. Trivalent inactivated influenza vaccines (IIV3s), trivalent recombinant influenza vaccine (RIV3), and trivalent live attenuated influenza vaccine (LAIV3) are expected to be available. All persons should receive an age-appropriate influenza vaccine (i.e., one approved for their age), with the exception that solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens may receive either high-dose inactivated influenza vaccine (HD-IIV3) or adjuvanted inactivated influenza vaccine (aIIV3) as acceptable options (without a preference over other age-appropriate IIV3s or RIV3). Except for vaccination for adults aged ≥65 years, ACIP makes no preferential recommendation for a specific vaccine when more than one licensed and recommended vaccine is available. ACIP recommends that adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: trivalent high-dose inactivated influenza vaccine (HD-IIV3), trivalent recombinant influenza vaccine (RIV3), or trivalent adjuvanted inactivated influenza vaccine (aIIV3). If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be used.Primary updates to this report include the following two topics: the composition of 2024-25 U.S. seasonal influenza vaccines and updated recommendations for vaccination of adult solid organ transplant recipients. First, following a period of no confirmed detections of wild-type influenza B/Yamagata lineage viruses in global surveillance since March 2020, 2024-25 U.S. influenza vaccines will not include an influenza B/Yamagata component. All influenza vaccines available in the United States during the 2024-25 season will be trivalent vaccines containing hemagglutinin derived from 1) an influenza A/Victoria/4897/2022 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/67/2022 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines); 2) an influenza A/Thailand/8/2022 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Massachusetts/18/2022 (H3N2)-like virus (for cell culture-based and recombinant vaccines); and 3) an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus. Second, recommendations for vaccination of adult solid organ transplant recipients have been updated to include HD-IIV3 and aIIV3 as acceptable options for solid organ transplant recipients aged 18 through 64 years who are receiving immunosuppressive medication regimens (without a preference over other age-appropriate IIV3s or RIV3).This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2024-25 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/acip-recs/hcp/vaccine-specific/flu.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines. Updates and other information are available from CDC's influenza website (https://www.cdc.gov/flu). Vaccination and health care providers should check this site periodically for additional information.
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Burgaya-Subirana S, Balaguer M, Miró Catalina Q, Sola L, Ruiz-Comellas A. Influenza Vaccination Coverage in Children: How Has COVID-19 Influenced It? A Review of Five Seasons (2018-2023) in Central Catalonia, Spain. Vaccines (Basel) 2024; 12:925. [PMID: 39204048 PMCID: PMC11358914 DOI: 10.3390/vaccines12080925] [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: 07/12/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
Influenza vaccination is the main method of preventing influenza. Vaccination is recommended for certain individuals with diseases that could cause complications in the case of flu infection. The objective of this retrospective observational study was to examine influenza vaccination coverage in patients with risk factors, to describe the characteristics of those vaccinated and to study the influence of COVID-19. The study population was children under 14 years old with risk factors between 2018/19 and 2022/23 in Central Catalonia, sourced through the electronic database of the Catalan Institute of Health. The association of influenza vaccination data with sociodemographic data and risk factors was performed by bivariate and multivariate analysis. A total of 13,137 children were studied. Of those, 4623 had received the influenza vaccine in at least one season. The average influenza vaccination rate was 28.8%. The statistically significant factors associated with vaccination were age and having certain risk factors: asthma, diabetes, haemoglobinopathies and clotting disorders. In all seasons, the immigrant population was vaccinated more than the native population p < 0.05, except for the COVID-19 season (2020/21), where no differences were observed. Of those vaccinated, 7.1% had been vaccinated for 5 consecutive years. Influenza vaccination coverage in the paediatric age group was low. Vaccination promotion measures must be implemented. COVID-19 meant an increase in vaccination of the native population to the same level as that of the immigrant population.
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Affiliation(s)
- Sílvia Burgaya-Subirana
- Pediatrics Department, EAP Manlleu, Institut Català de la Salut, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, C/Castellot, 17, 08560 Manlleu, Barcelona, Spain;
- Faculty of Medicine, Universitat de Vic-Universitat Central de Catalunya, Cta/Roda, 70, 08500 Vic, Barcelona, Spain;
| | - Mònica Balaguer
- Faculty of Medicine, Universitat de Vic-Universitat Central de Catalunya, Cta/Roda, 70, 08500 Vic, Barcelona, Spain;
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Queralt Miró Catalina
- Research Department, Institut Català de la Salut, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, C/Pica d’Estats, 13-15, 08272 Sant Fruitós de Bages, Barcelona, Spain
| | - Laia Sola
- Research Department, Institut Català de la Salut, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, C/Pica d’Estats, 13-15, 08272 Sant Fruitós de Bages, Barcelona, Spain
| | - Anna Ruiz-Comellas
- Faculty of Medicine, Universitat de Vic-Universitat Central de Catalunya, Cta/Roda, 70, 08500 Vic, Barcelona, Spain;
- Research Department, Institut Català de la Salut, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, C/Pica d’Estats, 13-15, 08272 Sant Fruitós de Bages, Barcelona, Spain
- Medicine Department, EAP Sant Joan de Vilatorrada, Institut Català de la Salut, Gerència d’Atenció Primària i a la Comunitat de la Catalunya Central, Avinguda del Torrent del Canigó, 0, 08250 Sant Joan de Vilatorrada, Catalonia, Spain
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Howa AC, Zhu Y, Wyatt D, Markus T, Chappell JD, Halasa N, Trabue CH, Olson SM, Ferdinands J, Garg S, Schaffner W, Grijalva CG, Talbot HK. Estimating the Burden of Influenza Hospitalizations Across Multiple Seasons Using Capture-Recapture. J Infect Dis 2024; 229:1823-1829. [PMID: 37768170 PMCID: PMC11175696 DOI: 10.1093/infdis/jiad417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Influenza remains an important cause of hospitalizations in the United States. Estimating the number of influenza hospitalizations is vital for public health decision making. Combining existing surveillance systems through capture-recapture methods allows for more comprehensive burden estimations. METHODS Data from independent surveillance systems were combined using capture-recapture methods to estimate influenza hospitalization rates for children and adults in Middle Tennessee during consecutive influenza seasons from 2016-2017 through 2019-2020. The Emerging Infections Program (EIP) identified cases through surveillance of laboratory results for hospitalized children and adults. The Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) and New Vaccine Surveillance Network (NVSN) recruited hospitalized patients with respiratory symptoms or fever. Population-based influenza rates and the proportion of cases detected by each surveillance system were calculated. RESULTS Estimated overall influenza hospitalization rates ranged from 23 influenza-related hospitalizations per 10 000 persons in 2016-2017 to 40 per 10 000 persons in 2017-2018. Adults aged ≥65 years had the highest hospitalization rates across seasons and experienced a rate of 170 hospitalizations per 10 000 persons during the 2017-2018 season. EIP consistently identified a higher proportion of influenza cases for adults and children compared with HAIVEN and NVSN, respectively. CONCLUSIONS Current surveillance systems underestimate the influenza burden. Capture-recapture provides an alternative approach to use data from independent surveillance systems and complement population-based burden estimates.
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Affiliation(s)
- Amanda C Howa
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dayna Wyatt
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tiffanie Markus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James D Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher H Trabue
- Department of Medicine, University of Tennessee College of Medicine, Nashville, Tennessee, USA
| | - Samantha M Olson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jill Ferdinands
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William Schaffner
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - H Keipp Talbot
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Sairuk R, Nishino K, Inthaphatha S, Hamajima N, Yamamoto E. Comparison of the influenza vaccination coverage among high-risk people between the online registration system and walk-in service system in Bangkok, Thailand. NAGOYA JOURNAL OF MEDICAL SCIENCE 2024; 86:252-261. [PMID: 38962419 PMCID: PMC11219236 DOI: 10.18999/nagjms.86.2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/28/2023] [Indexed: 07/05/2024]
Abstract
Until recently, the Thai national program of seasonal influenza vaccination for high-risk people has been using a walk-in service system. However, in 2020, an online registration system was introduced in Bangkok to improve vaccine coverage. This study aimed to compare the coverage of influenza vaccination between the walk-in service and online registration systems. The study participants included 374,710 Thai individuals who obtained an influenza vaccination from the national program in the Bangkok health region in 2018 (n = 162,214) and in 2020 (n = 212,496). The registration systems that were examined were the walk-in service system in 2018 and the online registration system in 2020. The characteristics of vaccine recipients and the vaccine coverage in each risk group and health facility level were compared between the two systems. Coverage comparison in Bangkok between the years 2018 and 2020 showed an increase in coverage, particularly among individuals who had an influenza vaccination at health facilities of the primary level and in the elderly and obesity groups. The coverage among children was lowest among all high-risk groups. To improve coverage in Thailand, the online registration system should be introduced in all regions. Additionally, information about influenza vaccination for children should be disseminated to parents using handbooks or by word-of-mouth from healthcare workers.
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Affiliation(s)
- Ranai Sairuk
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- National Health Security Office, Bangkok, Thailand
| | - Kimihiro Nishino
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Worsham CM, Bray CF, Jena AB. Optimal timing of influenza vaccination in young children: population based cohort study. BMJ 2024; 384:e077076. [PMID: 38383038 PMCID: PMC10879981 DOI: 10.1136/bmj-2023-077076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE To assess optimal timing of influenza vaccination in young children. DESIGN Population based cohort study. SETTING United States. PARTICIPANTS Commercially insured children aged 2-5 years who were vaccinated against influenza during 2011-18. MAIN OUTCOME MEASURE Rates of diagnosis of influenza among children who were vaccinated against influenza, by birth month. RESULTS Overall, 819 223 children aged 2-5 received influenza vaccination. Children vaccinated in November and December were least likely to have a diagnosis of influenza, a finding that may be confounded by unmeasured factors that influence the timing of vaccination and risk of influenza. Vaccination commonly occurred on days of preventive care visits and during birth months. Children born in October were disproportionately vaccinated in October and were, on average, vaccinated later than children born in August and earlier than those born in December. Children born in October had the lowest rate of influenza diagnosis (for example, 2.7% (6016/224 540) versus 3.0% (6462/212 622) for those born in August; adjusted odds ratio 0.88, 95% confidence interval 0.85 to 0.92). CONCLUSIONS In a quasi-experimental analysis of young children vaccinated against influenza, birth month was associated with the timing of vaccination through its influence on the timing of preventive care visits. Children born in October were most likely to be vaccinated in October and least likely to have a diagnosis of influenza, consistent with recommendations promoting October vaccination.
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Affiliation(s)
- Christopher M Worsham
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Charles F Bray
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- National Bureau of Economic Research, Cambridge, MA, USA
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Antoon JW, Sarker J, Abdelaziz A, Lien PW, Williams DJ, Lee TA, Grijalva CG. Trends in Outpatient Influenza Antiviral Use Among Children and Adolescents in the United States. Pediatrics 2023; 152:e2023061960. [PMID: 37953658 PMCID: PMC10681853 DOI: 10.1542/peds.2023-061960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Influenza antivirals improve outcomes in children with duration of symptoms <2 days and those at high risk for influenza complications. Real-world prescribing of influenza antivirals in the pediatric population is unknown. METHODS We performed a cross-sectional study of outpatient and emergency department prescription claims in individuals <18 years of age included in the IBM Marketscan Commercial Claims and Encounters Database between July 1, 2010 and June 30, 2019. Influenza antiviral use was defined as any dispensing of oseltamivir, baloxavir, or zanamivir. The primary outcome was the rate of antiviral dispensing per 1000 enrolled children. Secondary outcomes included antiviral dispensing per 1000 influenza diagnoses and inflation-adjusted costs of antiviral agents. Outcomes were calculated and stratified by age, acute versus prophylactic treatment, influenza season, and geographic region. RESULTS The analysis included 1 416 764 unique antiviral dispensings between 2010 and 2019. Oseltamivir was the most frequently prescribed antiviral (99.8%). Dispensing rates ranged from 4.4 to 48.6 per 1000 enrolled children. Treatment rates were highest among older children (12-17 years of age), during the 2017 to 2018 influenza season, and in the East South Central region. Guideline-concordant antiviral use among young children (<2 years of age) at a high risk of influenza complications was low (<40%). The inflation-adjusted cost for prescriptions was $208 458 979, and the median cost ranged from $111 to $151. CONCLUSIONS There is wide variability and underuse associated with influenza antiviral use in children. These findings reveal opportunities for improvement in the prevention and treatment of influenza in children.
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Affiliation(s)
| | - Jyotirmoy Sarker
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | - Abdullah Abdelaziz
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | - Pei-Wen Lien
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | | | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | - Carlos G. Grijalva
- Health Policy and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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Teoh Z, Conrey S, McNeal M, Burrell A, Burke RM, Mattison C, McMorrow M, Payne DC, Morrow AL, Staat MA. Burden of Respiratory Viruses in Children Less Than 2 Years Old in a Community-based Longitudinal US Birth Cohort. Clin Infect Dis 2023; 77:901-909. [PMID: 37157868 PMCID: PMC10838707 DOI: 10.1093/cid/ciad289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Respiratory viral infections are a major cause of morbidity and hospitalization in young children. Nevertheless, the population burden of respiratory viral infections, especially asymptomatic cases, is not known due to the lack of prospective community-based cohort studies with intensive monitoring. METHODS To address this gap, we enacted the PREVAIL cohort, a Centers for Disease Control and Prevention-sponsored birth cohort in Cincinnati, Ohio, where children were followed from 0 to 2 years of age. Weekly text surveys were administered to record acute respiratory illnesses (ARIs), which were defined as the presence of cough or fever (≥38°C). Weekly midturbinate nasal swabs were collected and tested using the Luminex Respiratory Pathogen Panel, which detected 16 viral pathogens. Viral infection was defined as ≥1 positive tests from the same virus or viral subtype ≤30 days of a previous positive test. Maternal report and medical chart abstractions identified healthcare utilization. RESULTS From 4/2017 to 7/2020, 245 mother-infant pairs were recruited and followed. From the 13 781 nasal swabs tested, a total of 2211 viral infections were detected, of which 821 (37%) were symptomatic. Children experienced 9.4 respiratory viral infections/child-year; half were rhinovirus/enterovirus. Viral ARI incidence was 3.3 episodes/child-year. Emergency department visits or hospitalization occurred with only 15% of respiratory syncytial virus infections, 10% of influenza infections, and only 4% of all viral infections. Regardless of pathogen, most infections were asymptomatic or mild. CONCLUSIONS Respiratory viral infections are common in children 0-2 years. Most viral infections are asymptomatic or non-medically attended, underscoring the importance of community-based cohort studies.
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Affiliation(s)
- Zheyi Teoh
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shannon Conrey
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica McNeal
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison Burrell
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rachel M Burke
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Meredith McMorrow
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ardythe L Morrow
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mary Allen Staat
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season. MMWR Recomm Rep 2023; 72:1-25. [PMCID: PMC10468199 DOI: 10.15585/mmwr.rr7202a1] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
This report updates the 2022–23 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States ( MMWR Recomm Rep 2022;71[No. RR-1]:1–28). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. All seasonal influenza vaccines expected to be available in the United States for the 2023–24 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. Inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. For most persons who need only 1 dose of influenza vaccine for the season, vaccination should ideally be offered during September or October. However, vaccination should continue after October and throughout the season as long as influenza viruses are circulating and unexpired vaccine is available. Influenza vaccines might be available as early as July or August, but for most adults (particularly adults aged ≥65 years) and for pregnant persons in the first or second trimester, vaccination during July and August should be avoided unless there is concern that vaccination later in the season might not be possible. Certain children aged 6 months through 8 years need 2 doses; these children should receive the first dose as soon as possible after vaccine is available, including during July and August. Vaccination during July and August can be considered for children of any age who need only 1 dose for the season and for pregnant persons who are in the third trimester during these months if vaccine is available ACIP recommends that all persons aged ≥6 months who do not have contraindications receive a licensed and age-appropriate seasonal influenza vaccine. With the exception of vaccination for adults aged ≥65 years, ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. ACIP recommends that adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be used Primary updates to this report include the following two topics: 1) the composition of 2023–24 U.S. seasonal influenza vaccines and 2) updated recommendations regarding influenza vaccination of persons with egg allergy. First, the composition of 2023–24 U.S. influenza vaccines includes an update to the influenza A(H1N1)pdm09 component. U.S.-licensed influenza vaccines will contain HA derived from 1) an influenza A/Victoria/4897/2022 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/67/2022 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines); 2) an influenza A/Darwin/9/2021 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Darwin/6/2021 (H3N2)-like virus (for cell culture-based and recombinant vaccines); 3) an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus; and 4) an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Second, ACIP recommends that all persons aged ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used. It is no longer recommended that persons who have had an allergic reaction to egg involving symptoms other than urticaria should be vaccinated in an inpatient or outpatient medical setting supervised by a health care provider who is able to recognize and manage severe allergic reactions if an egg-based vaccine is used. Egg allergy alone necessitates no additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine, regardless of severity of previous reaction to egg. All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2023–24 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html . These recommendations apply to U.S.-licensed influenza vaccines used according to Food and Drug Administration–licensed indications. Updates and other information are available from CDC’s influenza website ( https://www.cdc.gov/flu ). Vaccination and health care providers should check this site periodically for additional information.
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Orrico-Sánchez A, Valls-Arévalo Á, Garcés-Sánchez M, Álvarez Aldeán J, Ortiz de Lejarazu Leonardo R. Efficacy and effectiveness of influenza vaccination in healthy children. A review of current evidence. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:396-406. [PMID: 36681572 DOI: 10.1016/j.eimce.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/08/2022] [Indexed: 01/21/2023]
Abstract
Influenza is common in healthy children and adolescents and is associated with a high rate of hospitalization in this group, especially for those <5 years. Although the WHO has recommended vaccination in children under 5 years of age since 2012, it is really implemented in few countries today. The aim of this paper was to review the available evidence on the efficacy/effectiveness of influenza vaccination in healthy children <18 years of age through a non-systematic search of studies conducted between 2010 and 2020. Despite the high variability in results due to differences in design, vaccine type and season included in the 41 selected studies, statistically significant studies show efficacy values for the influenza vaccine of between 25.6% and 74.2%, and effectiveness from 26% to 78.8%. Although a systematic review would be necessary to corroborate the evidence, this review suggests that paediatric vaccination is generally an effective measure for preventing influenza in healthy children in line with international organisms' recommendations.
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Affiliation(s)
- Alejandro Orrico-Sánchez
- Área de Investigación en vacunas, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO) - Salud Pública, Valencia, Spain
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Haddadin Z, Spieker AJ, Amarin JZ, Hall M, Thurm C, Danziger-Isakov L, Godown J, Halasa NB, Dulek DE. Incidence of and risk factors for influenza-associated hospital encounters in pediatric solid organ transplant recipients. Am J Transplant 2023; 23:659-665. [PMID: 36758752 DOI: 10.1016/j.ajt.2023.01.024] [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: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
Few studies have defined the incidence of and risk factors for influenza infection in pediatric solid organ transplant (SOT) recipients. We used a linkage between the Pediatric Health Information System and the Scientific Registry of Transplant Recipients databases to identify posttransplant influenza-associated hospital encounters (IAHEs) in pediatric SOT recipients of single-organ transplants. Among 7997 unique pediatric SOT recipients transplanted between January 01, 2006, and January 06, 2016, estimated 1- and 3-year posttransplant cumulative incidence rates of IAHEs were 2.7% (95% CI, 2.4%-3.1%) and 7.4% (95% CI, 6.8%-8.0%), respectively. One- and 3-year cumulative incidence rates of severe IAHEs were 0.3% (95% CI, 0.2%-0.5%) and 0.9% (95% CI, 0.7%-1.2%), respectively. Multivariable analysis showed that the organ type (adjusted subdistribution hazard ratio [aSHR]-kidney: reference, liver: 0.64 [95% CI, 0.49-0.84], and heart: 0.72 [95% CI, 0.57-0.93]), race/ethnicity (aSHR-non-Hispanic White: reference, non-Hispanic Black: 1.63 [95% CI, 1.29-2.07], Hispanic 1.57 [95% CI, 1.27-1.94]), and increasing age at transplant (aSHR, 0.93 [95% CI, 0.91-0.94]) were significantly associated with IAHE occurrence. Heart transplant recipients had a near statistically significant increase in hazard for severe IAHE (aSHR 1.96 [0.92-3.49]). Our findings may help guide future influenza prevention efforts and facilitate intervention impact assessment measurement in pediatric SOT recipients.
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Affiliation(s)
- Zaid Haddadin
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin Z Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | | | - Lara Danziger-Isakov
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Justin Godown
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Dulek
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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11
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Lebron CN, Agosto Y, Nair R, Mathew MS, Natale R, Messiah SE. Health status of childcare center providers in a COVID-19 hotspot. Work 2023; 76:1311-1316. [PMID: 37393483 DOI: 10.3233/wor-230111] [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] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Childcare center providers in Miami-Dade County, Florida a COVID-19 hotspot, are made up almost entirely of ethnic minority women. This is a critical frontline staff that is now encountering the triple threat of respiratory illnesses from respiratory syncytial virus (RSV), influenza viruses (or the seasonal flu), and COVID-19. OBJECTIVE To examine sociodemographic characteristics, anthropometrics, and health behaviors that were collected from a sample of CCC teachers in Miami Dade County, a COVID-19 hotspot. METHODS Cross-sectional data were used from Healthy Caregivers, Healthy Children (HC2), a randomized controlled intervention trial (#NCT02697565) for healthy weight maintenance among children 2-to-5 years old, conducted in 24 subsidized childcare centers in MDC in 2015-2018. Prevalence was determined by frequency or mean/standard deviation of each variable. Chi-squared analyses were performed to test for differences in BMI categories. RESULTS In this sample of childcare center providers (n = 255), the majority (61%) had an elevated body mass index. Positive health behaviors such as regular exercise and eating fruits and vegetables were only reported in about a third of the sample. CONCLUSION It is vital that we encourage the uptake of regular vaccination schedules as a means to protect our community, especially the critical frontline workers that have been caring for our young children.
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Affiliation(s)
- Cynthia N Lebron
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Yaray Agosto
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Rohit Nair
- Health Science Center at Houston, University of Texas School of Public Health, Dallas Regional Campus, Dallas, TX, USA
| | - M Sunil Mathew
- Health Science Center at Houston, University of Texas School of Public Health, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas, University of Texas Health Science Center, Dallas, TX, USA
| | - Ruby Natale
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sarah E Messiah
- Health Science Center at Houston, University of Texas School of Public Health, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas, University of Texas Health Science Center, Dallas, TX, USA
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12
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Regan AK, Fiddian-Green A. Protecting pregnant people & infants against influenza: A landscape review of influenza vaccine hesitancy during pregnancy and strategies for vaccine promotion. Hum Vaccin Immunother 2022; 18:2156229. [PMID: 36535646 PMCID: PMC10019833 DOI: 10.1080/21645515.2022.2156229] [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: 10/05/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Before COVID-19, influenza vaccines were the most widely recommended vaccine during pregnancy worldwide. In response to immunization during pregnancy, maternal antibodies offer protection against potentially life-threatening disease in both pregnant people and their infants up to six months of age. Despite this, influenza vaccine hesitancy is common, with few countries reporting immunization rates in pregnant people above 50%. In this review, we highlight individual, institutional, and social factors associated with influenza vaccine hesitancy during pregnancy. In addition, we present an overview of the evidence evaluating interventions to address influenza vaccine hesitancy during pregnancy. While some studies have indicated promising results, no single intervention has consistently effectively increased influenza vaccine uptake during pregnancy. Using a social-ecological model of health framework, future strategies addressing multiple levels of vaccine hesitancy will be needed to realize the potential health benefits of prenatal immunization programs.
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Affiliation(s)
- Annette K. Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Alice Fiddian-Green
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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13
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Continuing Medical Education Improves Physician Communication Skills and Increases Likelihood of Pediatric Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-II. Vaccines (Basel) 2022; 11:vaccines11010017. [PMID: 36679861 PMCID: PMC9861912 DOI: 10.3390/vaccines11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/12/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
This study evaluated the impact of a continuing medical education (CME) program that emphasized actionable information, motivation to act, and skills to strengthen physician recommendations for seasonal influenza vaccination in children 6 through 23 months of age for whom influenza immunization rates are suboptimal. Physicians were randomly assigned to an accredited CME program or to no CME. Participants completed pre- and post-study questionnaires. Influenza immunization rates were compared between groups. A total of 33 physicians in the CME group and 35 in the control group documented 292 and 322 healthy baby visits, respectively. Significantly more parents immunized their children against influenza after interacting with CME-trained physicians than those with no CME training (52.9% vs. 40.7%; p = 0.007). The odds ratio for vaccination after visits with CME-trained physicians was 1.52 (95% confidence interval 1.09 to 2.12; p = 0.014), which was unaffected by the socioeconomic status of parents. Parents who discussed influenza vaccination with CME-trained physicians were 20% more likely to choose an approved but publicly unfunded adjuvanted pediatric influenza vaccine. The percentages of physicians reporting the highest levels of knowledge, ability, and confidence doubled or tripled after the CME intervention. Significantly more parents immunized very young children after interacting with physicians who had undergone CME training.
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14
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Fisher WA, Gilca V, Murti M, Orth A, Garfield H, Roumeliotis P, Rampakakis E, Brown V, Yaremko J, Van Buynder P, Boikos C, Mansi JA. Parental Attitudes and Perceptions of Support after Brief Clinician Intervention Predict Intentions to Accept the Adjuvanted Seasonal Influenza Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-I. Vaccines (Basel) 2022; 10:1957. [PMID: 36423052 PMCID: PMC9698621 DOI: 10.3390/vaccines10111957] [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: 09/07/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 08/29/2023] Open
Abstract
Adjuvanted trivalent influenza vaccine (aTIV) provides enhanced protection against seasonal influenza in children compared with nonadjuvanted trivalent influenza vaccine (TIV). This prospective cohort study assessed parental attitudes, beliefs, and intentions to vaccinate their infants aged 6-23 months with aTIV. Parents were surveyed before and after routine healthy baby visits, and post clinician interaction results were analyzed using multivariable logistic regression. Physicians at 15 community practice clinics and nurses at 3 public health clinics participated; 207 parents were surveyed. After clinician consultation, most parents considered immunization with aTIV to be safe (72.9%), effective (69.6%), and important (69.0%); most perceived support for vaccination from significant others (62.8%) and clinicians (81.6%); and 66.6% intended to vaccinate their infant with aTIV. Parental attitudes toward vaccinating their infant with aTIV were strongly correlated with perceptions of vaccine safety, efficacy, and importance, and these represented the strongest influence on intentions to vaccinate (odds ratio (OR) 79.25; 95% confidence interval (CI) 6.05-1037.50). Parental intentions were further influenced by perceived strength of clinician recommendation (OR 4.55, 95% CI 1.38-15.06) and social support for vaccination (OR 3.46, 95% CI 0.50-24.13). These findings may inform clinician approaches to parental education to ensure optimal seasonal pediatric influenza vaccination.
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Affiliation(s)
- William A. Fisher
- Department of Psychology, Department of Obstetrics and Gynaecology, Western University, London, ON N6A 3K7, Canada
| | - Vladimir Gilca
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Institut Nationale de Sante Publique du Québec and Université Laval, Québec City, QC G1V 5B3, Canada
| | - Michelle Murti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Alison Orth
- Fraser Health Authority, Vancouver, BC V3T 0H1, Canada
| | - Hartley Garfield
- The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | | | | | - Vivien Brown
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - John Yaremko
- The Montreal Children’s Hospital, Montreal, QC H4A 3J1, Canada
- Department of Pediatrics, McGill University, Montreal, QC H3A 0G4, Canada
| | - Paul Van Buynder
- School of Medicine, Griffith University, University of Western Australia, Perth, WA 6009, Australia
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Clinicians Are Not Able to Infer Parental Intentions to Vaccinate Infants with a Seasonal Influenza Vaccine, and Perhaps They Should Not Try: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-IV. Vaccines (Basel) 2022; 10:vaccines10111955. [PMID: 36423050 PMCID: PMC9697433 DOI: 10.3390/vaccines10111955] [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: 09/07/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
This prospective cohort survey evaluated the concordance of clinicians’ perceptions of parental intentions and parents’ actual intentions to vaccinate their infants against influenza. During a routine healthy baby visit, clinicians provided parents with information about influenza, children’s vulnerability to influenza, and nonadjuvanted and adjuvanted trivalent influenza vaccines (TIV and aTIV, respectively). Before and after the clinician−parent interaction, parents were surveyed about their attitudes, their perceptions of support from significant others, and the intention to vaccinate their infant with aTIV. Clinicians were asked about their perception of parents’ intentions to choose aTIV for their children. These assessments included 24 clinicians at 15 community practices and nine public health clinics, and 207 parents. The correlation coefficients of the clinicians’ assessment of parents’ intention to vaccinate were 0.483 (p < 0.001) if the vaccine was presented as free of cost, 0.266 (p < 0.001) if the cost was $25, and 0.146 (p = 0.036) if the cost was $50, accounting for 23%, 7%, and 2% of the variance in parental intentions, respectively. The clinicians were poor at predicting parental intentions to immunize, particularly when cost was involved. Information on vaccine options and influenza infection should be provided for every eligible patient to allow parents to determine if the vaccine is appropriate for their child.
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16
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Banerjee D, Hassan F, Avadhanula V, Piedra PA, Boom J, Sahni LC, Weinberg GA, Lindstrom S, Rha B, Harrison CJ, Selvarangan R. Comparative analysis of three multiplex platforms for the detection of respiratory viral pathogens. J Clin Virol 2022; 156:105274. [PMID: 36099751 DOI: 10.1016/j.jcv.2022.105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Acute viral respiratory infections are a major health burden in children worldwide. In recent years, rapid and sensitive multiplex nucleic acid amplification tests (NAATs) have replaced conventional methods for routine virus detection in the clinical laboratory. OBJECTIVE/STUDY DESIGN We compared BioFire® FilmArray® Respiratory Panel (FilmArray V1.7), Luminex NxTag® Respiratory Pathogen Panel (NxTag RPP) and Applied Biosystems TaqMan Array Card (TAC) for the detection of eight viruses in pediatric respiratory specimens. Results from the three platforms were analyzed with a single-plex real-time RT-PCR (rRT-PCR) assay for each virus. RESULTS Of the 170/210 single-plex virus-positive samples, FilmArray detected a virus in 166 (97.6%), TAC in 163 (95.8%) and NxTag RPP in 160 (94.1%) samples. The Positive Percent Agreement (PPA) of FilmArray, NxTag RPP and TAC was highest for influenza B (100%, 100% and 95.2% respectively) and lowest for seasonal coronaviruses on both FilmArray (90.2%) and NxTag RPP (81.8%), and for parainfluenza viruses 1- 4 on TAC (84%). The Negative Percent Agreement (NPA) was lowest for rhinovirus/enterovirus (92.9%, 96.7% and 97.3%) on FilmArray, NxTag RPP and TAC respectively. NPA for all three platforms was highest (100%) for both parainfluenza viruses 1- 4 and influenza A and B, and 100% for human metapneumovirus with TAC as well. CONCLUSION All three multiplex platforms displayed high overall agreement (>90%) and high NPA (>90%), while PPA was pathogen dependent and varied among platforms; high PPA (>90%) was observed for FilmArray for all eight viruses, TAC for six viruses and NxTag RPP for 4 viruses.
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Affiliation(s)
- Dithi Banerjee
- Children's Mercy Hospital, Kansas City, MO, United States of America
| | - Ferdaus Hassan
- Children's Mercy Hospital, Kansas City, MO, United States of America
| | - Vasanthi Avadhanula
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States of America
| | - Pedro A Piedra
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States of America; Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States of America
| | - Julie Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States of America; Texas Children's Hospital, Immunization Project, Baylor College of Medicine, Houston, TX, United States of America
| | - Leila C Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States of America; Texas Children's Hospital, Immunization Project, Baylor College of Medicine, Houston, TX, United States of America
| | - Geoffrey A Weinberg
- University of Rochester School of Medicine & Dentistry, Rochester, NY, United States of America
| | - Stephen Lindstrom
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Brian Rha
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Perez A, Lively JY, Curns A, Weinberg GA, Halasa NB, Staat MA, Szilagyi PG, Stewart LS, McNeal MM, Clopper B, Zhou Y, Whitaker BL, LeMasters E, Harker E, Englund JA, Klein EJ, Selvarangan R, Harrison CJ, Boom JA, Sahni LC, Michaels MG, Williams JV, Langley GE, Gerber SI, Campbell A, Hall AJ, Rha B, McMorrow M. Respiratory Virus Surveillance Among Children with Acute Respiratory Illnesses - New Vaccine Surveillance Network, United States, 2016-2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1253-1259. [PMID: 36201373 PMCID: PMC9541034 DOI: 10.15585/mmwr.mm7140a1] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The New Vaccine Surveillance Network (NVSN) is a prospective, active, population-based surveillance platform that enrolls children with acute respiratory illnesses (ARIs) at seven pediatric medical centers. ARIs are caused by respiratory viruses including influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and most recently SARS-CoV-2 (the virus that causes COVID-19), which result in morbidity among infants and young children (1-6). NVSN estimates the incidence of pathogen-specific pediatric ARIs and collects clinical data (e.g., underlying medical conditions and vaccination status) to assess risk factors for severe disease and calculate influenza and COVID-19 vaccine effectiveness. Current NVSN inpatient (i.e., hospital) surveillance began in 2015, expanded to emergency departments (EDs) in 2016, and to outpatient clinics in 2018. This report describes demographic characteristics of enrolled children who received care in these settings, and yearly circulation of influenza, RSV, HMPV, HPIV1-3, adenovirus, human rhinovirus and enterovirus (RV/EV),* and SARS-CoV-2 during December 2016-August 2021. Among 90,085 eligible infants, children, and adolescents (children) aged <18 years† with ARI, 51,441 (57%) were enrolled, nearly 75% of whom were aged <5 years; 43% were hospitalized. Infants aged <1 year accounted for the largest proportion (38%) of those hospitalized. The most common pathogens detected were RV/EV and RSV. Before the emergence of SARS-CoV-2, detected respiratory viruses followed previously described seasonal trends, with annual peaks of influenza and RSV in late fall and winter (7,8). After the emergence of SARS-CoV-2 and implementation of associated pandemic nonpharmaceutical interventions and community mitigation measures, many respiratory viruses circulated at lower-than-expected levels during April 2020-May 2021. Beginning in summer 2021, NVSN detected higher than anticipated enrollment of hospitalized children as well as atypical interseasonal circulation of RSV. Further analyses of NVSN data and continued surveillance are vital in highlighting risk factors for severe disease and health disparities, measuring the effectiveness of vaccines and monoclonal antibody-based prophylactics, and guiding policies to protect young children from pathogens such as SARS-CoV-2, influenza, and RSV.
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Regragui Z, Bimouhen A, El Falaki F, Ihazmad H, Benkerroum S, Triki S, Cherkaoui I, Mahraoui C, Filali-Maltouf A, Medraoui L, Oumzil H. Influenza-associated severe acute respiratory infections among children under five years old in Morocco, September 2017 to March 2019. LE INFEZIONI IN MEDICINA 2022; 30:446-453. [PMID: 36148170 PMCID: PMC9448308 DOI: 10.53854/liim-3003-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/02/2022] [Indexed: 06/16/2023]
Abstract
The main aim of this research is to investigate the trend of influenza infection among children under 5 years with severe acute respiratory infections (SARI) as well as those who suffer from a high burden of disease. This research is based on a survey conducted from September 2017 to March 2019. During this period nasopharyngeal swabs were collected in a group of 942 children under 5 years with SARI, admitted in pediatric services of 8 sentinel hospitals. The virological surveillance of influenza was carried out at the National influenza Center, located in the National Institute of Hygiene, using a Reverse transcription polymerase chain reaction (qRt-PCR) monoplex assay developed by the Centers for Disease Control and Prevention (CDC; Atlanta, GA). The median age of participants was 11 months, and 40% of them were female. A total of 112 samples were reported positive yielding a frequency of 11.88% (112/942). Among all the influenza confirmed cases, 68.75% (77/112), 15.17% (17/112), 16.04% (18/112) were subtyped as influenza AH1N1pdm09, AH3N2 and influenza B respectively. Meanwhile, the proportion of patients admitted at the intensive care unit was 5,35% (6/112). Out of which 83.33% (5/6) were AH1N1pdm09 and it was reported that just 1.78% (2/112) of the positive cases were vaccinated. The study confirms that influenza affects greatly children with SARI. Thus, the need for influenza vaccines is highly recommended for children under 5 years. Moreover, our findings highlight that influenza virus is not the only cause of SARI among this group of children. Accordingly, special attention should be paid to the non-flu respiratory viruses.
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Affiliation(s)
- Zakia Regragui
- National Influenza Center, Virology Department, National Institute of Hygiene, RABAT, Morocco
- Equipe de Microbiologie et Biologie Moléculaire (EMBM), Biology Department, Mohamed V University of RABAT, Morocco
| | - Abderrahman Bimouhen
- National Influenza Center, Virology Department, National Institute of Hygiene, RABAT, Morocco
| | - Fatima El Falaki
- National Influenza Center, Virology Department, National Institute of Hygiene, RABAT, Morocco
| | - Hassan Ihazmad
- National Influenza Center, Virology Department, National Institute of Hygiene, RABAT, Morocco
| | - Samira Benkerroum
- National Influenza Center, Virology Department, National Institute of Hygiene, RABAT, Morocco
| | - Soumia Triki
- World Health Organization, Country Office. Rabat, Morocco
| | - Imad Cherkaoui
- Directorate of Epidemiology and Disease Control, Ministry of Health, Rabat, Morocco
| | - Chafiq Mahraoui
- Hôpital d’Enfants, Centre Hospitalier Universitaire, Rabat, Morocco
| | - Abdelkarim Filali-Maltouf
- Equipe de Microbiologie et Biologie Moléculaire (EMBM), Biology Department, Mohamed V University of RABAT, Morocco
| | - Leila Medraoui
- Equipe de Microbiologie et Biologie Moléculaire (EMBM), Biology Department, Mohamed V University of RABAT, Morocco
| | - Hicham Oumzil
- National Influenza Center, Virology Department, National Institute of Hygiene, RABAT, Morocco
- Pedagogy and Research Unit of Microbiology, and Genomic Center of Human Pathologies, School of Medicine and Pharmacy, Mohammed V University in Rabat, Morocco
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Grohskopf LA, Blanton LH, Ferdinands JM, Chung JR, Broder KR, Talbot HK, Morgan RL, Fry AM. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2022-23 Influenza Season. MMWR Recomm Rep 2022; 71:1-28. [PMID: 36006864 PMCID: PMC9429824 DOI: 10.15585/mmwr.rr7101a1] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This report updates the 2021–22 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2021;70[No. RR-5]:1–24). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used.With the exception of vaccination for adults aged ≥65 years, ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. All seasonal influenza vaccines expected to be available in the United States for the 2022–23 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. Inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. Trivalent influenza vaccines are no longer available, but data that involve these vaccines are included for reference. Influenza vaccines might be available as early as July or August, but for most persons who need only 1 dose of influenza vaccine for the season, vaccination should ideally be offered during September or October. However, vaccination should continue after October and throughout the season as long as influenza viruses are circulating and unexpired vaccine is available. For most adults (particularly adults aged ≥65 years) and for pregnant persons in the first or second trimester, vaccination during July and August should be avoided unless there is concern that vaccination later in the season might not be possible. Certain children aged 6 months through 8 years need 2 doses; these children should receive the first dose as soon as possible after vaccine is available, including during July and August. Vaccination during July and August can be considered for children of any age who need only 1 dose for the season and for pregnant persons who are in the third trimester if vaccine is available during those months Updates described in this report reflect discussions during public meetings of ACIP that were held on October 20, 2021; January 12, 2022; February 23, 2022; and June 22, 2022. Primary updates to this report include the following three topics: 1) the composition of 2022–23 U.S. seasonal influenza vaccines; 2) updates to the description of influenza vaccines expected to be available for the 2022–23 season, including one influenza vaccine labeling change that occurred after the publication of the 2021–22 ACIP influenza recommendations; and 3) updates to the recommendations concerning vaccination of adults aged ≥65 years. First, the composition of 2022–23 U.S. influenza vaccines includes updates to the influenza A(H3N2) and influenza B/Victoria lineage components. U.S.-licensed influenza vaccines will contain HA derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture–based or recombinant vaccines); an influenza A/Darwin/9/2021 (H3N2)-like virus (for egg-based vaccines) or an influenza A/Darwin/6/2021 (H3N2)-like virus (for cell culture–based or recombinant vaccines); an influenza B/Austria/1359417/2021 (Victoria lineage)-like virus; and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Second, the approved age indication for the cell culture–based inactivated influenza vaccine, Flucelvax Quadrivalent (ccIIV4), was changed in October 2021 from ≥2 years to ≥6 months. Third, recommendations for vaccination of adults aged ≥65 years have been modified. ACIP recommends that adults aged ≥65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4). If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be used This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2022–23 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used according to Food and Drug Administration–licensed indications. Updates and other information are available from CDC’s influenza website (https://www.cdc.gov/flu). Vaccination and health care providers should check this site periodically for additional information.
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Kanecki K, Lewtak K, Goryński P, Tyszko P, Bogdan M, Rząd M, Nitsch-Osuch A. Hospitalization of Children Aged <5 Years Due to Influenza: Study Based on the National Hospitalization Registry. CHILDREN (BASEL, SWITZERLAND) 2022; 9:930. [PMID: 35883914 PMCID: PMC9321516 DOI: 10.3390/children9070930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022]
Abstract
Background: Influenza constitutes a significant health care burden that can be related to an increased morbidity and mortality. The aim of the study is to show up-to-date information on influenza hospitalization cases in Poland in children aged <5 years. Methods: The data used in the study were hospitalization records from 2015−2019, which had been gathered in a Nationwide General Hospital Morbidity Study and made available by the National Institute of Public Health. Results: 8565 records of patients with influenza were subject to analysis. The mean and median age of the patients were 2.2 and 2.1 years, respectively. Influenza hospitalization incidence was estimated at 90 per 100,000 person-years (PY) in children aged <5 years. The number of hospitalization cases was significantly higher in patients living in urban regions than in those living in rural regions (97 vs. 77 per 100,000 PY; p < 0.001). The age of patients living in urban regions was significantly lower than the age of patients living in rural regions (2.2 vs. 2.3 years; p < 0.001). A statistically significant increase in hospitalization was observed. Conclusions: The reported increasing trend in hospitalizations indicates the need to take focused measures. Presented data may be useful in comparative analyses in a European context.
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Affiliation(s)
- Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland; (K.K.); (P.T.); (M.B.); (M.R.); (A.N.-O.)
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland; (K.K.); (P.T.); (M.B.); (M.R.); (A.N.-O.)
| | - Paweł Goryński
- National Institute of Public Health NIH—National Research Institute, 24 Chocimska Street, 00-791 Warsaw, Poland;
| | - Piotr Tyszko
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland; (K.K.); (P.T.); (M.B.); (M.R.); (A.N.-O.)
- Institute of Rural Health in Lublin, 2 Jaczewskiego Street, 20-090 Lublin, Poland
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland; (K.K.); (P.T.); (M.B.); (M.R.); (A.N.-O.)
| | - Michał Rząd
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland; (K.K.); (P.T.); (M.B.); (M.R.); (A.N.-O.)
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland; (K.K.); (P.T.); (M.B.); (M.R.); (A.N.-O.)
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21
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Salazar RA, Field SS. Factors Influencing Frequency of Pediatric Clinically Distinguishable Influenza: A 2 Season Case-Control Study. Clin Med Insights Pediatr 2022; 16:11795565221084159. [PMID: 35355882 PMCID: PMC8958712 DOI: 10.1177/11795565221084159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Little is known about the individual differences in susceptibility to, or lifetime frequency of clinically distinguishable influenza in children. Methods: Rapid enzyme linked immunoassay-confirmed influenza pediatric cases (n = 96) in season 1 (2017-2018) were compared to age-matched (mean 7.7 years) controls (n = 171) with no evidence of influenza in season 1. The 2 cohorts were again studied in season 2 (2018-2019) for influenza outcomes and influences. Medical records, questionnaires, and interviews were used to determine past influenza disease and vaccine histories. Results: After season 2, known lifetime influenza illnesses per year of age averaged 22.6% in cases and 5.6% in controls, with 62% of controls still having never experienced known influenza. Having had prior influenza was marginally significant as a risk for season 1 influenza in cases versus controls (P = .055), yet a significant risk factor in controls for season 2 (P = .018). Influenza vaccine rates were significantly higher in controls than in cases for season 1, with a greater female vaccine benefit. Lack of previous influenza had greater calculated effectiveness (52%) than vaccination (17%-26%) in escaping season 2 influenza. Lifetime rates of vaccination did not correlate with lifetime rates of known influenza in either cohort. Conclusions: Lifetime clinically distinguishable influenza rates varied among children, with many escaping it for years even without being immunized against it. Findings of less than expected clinical influenza, no correlation between vaccination frequency and disease frequency, sex differences, and an association between past clinical influenza and current risk, point to innate differences in individual influenza experiences.
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Affiliation(s)
- Ryan A Salazar
- University of Alabama at Birmingham School of Medicine (Medical Student), Huntsville, AL, USA
| | - Scott S Field
- Department of Pediatrics, University of Alabama at Birmingham, Huntsville Campus (Adjunct Faculty), Huntsville, AL, USA
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22
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Efficacy and effectiveness of influenza vaccination in healthy children. A review of current evidence. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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23
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Hamdan L, Probst V, Haddadin Z, Rahman H, Spieker AJ, Vandekar S, Stewart LS, Williams JV, Boom JA, Munoz F, Englund JA, Selvarangan R, Staat MA, Weinberg GA, Azimi PH, Klein EJ, McNeal M, Sahni LC, Singer MN, Szilagyi PG, Harrison CJ, Patel M, Campbell AP, Halasa NB. Influenza clinical testing and oseltamivir treatment in hospitalized children with acute respiratory illness, 2015-2016. Influenza Other Respir Viruses 2022; 16:289-297. [PMID: 34704375 PMCID: PMC8818823 DOI: 10.1111/irv.12927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Antiviral treatment is recommended for all hospitalized children with suspected or confirmed influenza, regardless of their risk profile. Few data exist on adherence to these recommendations, so we sought to determine factors associated with influenza testing and antiviral treatment in children. METHODS Hospitalized children <18 years of age with acute respiratory illness (ARI) were enrolled through active surveillance at pediatric medical centers in seven cities between 11/1/2015 and 6/30/2016; clinical information was obtained from parent interview and chart review. We used generalized linear mixed-effects models to identify factors associated with influenza testing and antiviral treatment. RESULTS Of the 2299 hospitalized children with ARI enrolled during one influenza season, 51% (n = 1183) were tested clinically for influenza. Clinicians provided antiviral treatment for 61 of 117 (52%) patients with a positive influenza test versus 66 of 1066 (6%) with a negative or unknown test result. In multivariable analyses, factors associated with testing included neuromuscular disease (aOR = 5.35, 95% CI [3.58-8.01]), immunocompromised status (aOR = 2.88, 95% CI [1.66-5.01]), age (aOR = 0.93, 95% CI [0.91-0.96]), private only versus public only insurance (aOR = 0.78, 95% CI [0.63-0.98]), and chronic lung disease (aOR = 0.64, 95% CI [0.51-0.81]). Factors associated with antiviral treatment included neuromuscular disease (aOR = 1.86, 95% CI [1.04, 3.31]), immunocompromised state (aOR = 2.63, 95% CI [1.38, 4.99]), duration of illness (aOR = 0.92, 95% CI [0.84, 0.99]), and chronic lung disease (aOR = 0.60, 95% CI [0.38, 0.95]). CONCLUSION Approximately half of children hospitalized with influenza during the 2015-2016 influenza season were treated with antivirals. Because antiviral treatment for influenza is associated with better health outcomes, further studies of subsequent seasons would help evaluate current use of antivirals among children and better understand barriers for treatment.
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Affiliation(s)
- Lubna Hamdan
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Varvara Probst
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zaid Haddadin
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Herdi Rahman
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Andrew J. Spieker
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Simon Vandekar
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Laura S. Stewart
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - John V. Williams
- Pediatric Infectious Diseases, Institute for Infection, Inflammation, and Immunity in Children, University of Pittsburgh School of MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Julie A. Boom
- Primary Care Practice at Palm Center, Immunization Project, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Flor Munoz
- Pediatrics and Molecular Virology and Microbiology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Janet A. Englund
- Department of Pediatrics, Division of Infectious DiseasesSeattle Children's HospitalSeattleWashingtonUSA
| | | | - Mary A. Staat
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Geoffrey A. Weinberg
- Pediatric Infectious DiseasesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Parvin H. Azimi
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Eileen J. Klein
- Department of Pediatrics, Division of Emergency MedicineSeattle Children's HospitalSeattleWashingtonUSA
| | - Monica McNeal
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Leila C. Sahni
- Department of Pediatrics, Section of Hematology‐Oncology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Monica N. Singer
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Peter G. Szilagyi
- Department of PediatricsUniversity of California at Los Angeles Mattel Children's HospitalLos AngelesCaliforniaUSA
| | | | - Manish Patel
- National Center for Immunization and Respiratory Diseases, Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Angela P. Campbell
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Natasha B. Halasa
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
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24
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Esposito S, Nauta J, Lapini G, Montomoli E, van de Witte S. Efficacy and safety of a quadrivalent influenza vaccine in children aged 6–35 months: A global, multiseasonal, controlled, randomized Phase III study. Vaccine 2022; 40:2626-2634. [DOI: 10.1016/j.vaccine.2022.02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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25
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Kim DK, McGeer A, Uleryk E, Coleman BL. Burden of severe illness associated with laboratory confirmed influenza in adults aged 50-64 years: A rapid review. Influenza Other Respir Viruses 2022; 16:632-642. [PMID: 35044096 PMCID: PMC9178069 DOI: 10.1111/irv.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND While the high burden of illness caused by seasonal influenza in children and the elderly is well recognize, less is known about the burden in adults 50-64 years of age. The lack of data for this age group is a key challenge in evaluating the cost-effectiveness of immunization programs. We aimed to assess influenza-associated hospitalization and mortality rates and case fatality rates for hospitalized cases among adults aged 50-64 years. METHODS This rapid review was conducted according to the PRISMA; we searched MEDLINE, EMBASE, Cochrane, Web of Science, and grey literature for articles and reports published since 2010. Studies reporting rates of hospitalization and/or mortality associated with laboratory-confirmed influenza among adults 50-64 or 45-64 years of age for the 2010-11 through 2019-20 seasons were included. RESULTS Twenty studies from 13 countries were reviewed. Reported rates of hospitalization associated with laboratory-confirmed influenza were 5.7 to 112.8 per 100,000. Rates tended to be higher in the 2015-2019 compared with the 2010-2014 seasons and were higher in studies reporting data from high-income versus low and middle-income countries. Mortality rates were reported in only one study, with rates ranging from 0.8 to 3.5 per 100,000 in four different seasons. The case fatality rate among those hospitalized with influenza, as reported by population-based studies, ranged from 1.3% to 5.6%. CONCLUSIONS Seasonal influenza imposes a significant burden of morbidity on adults 50-64 years of age but with high heterogeneity across seasons and geographic regions. Ongoing surveillance is required to improve estimates of burden to better inform influenza vaccination and other public health policies.
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Affiliation(s)
- Dong Kyu Kim
- Infectious Disease Epidemiology Research Unit, Sinai Health, Toronto, ON, Canada
| | - Allison McGeer
- Infectious Disease Epidemiology Research Unit, Sinai Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Brenda L Coleman
- Infectious Disease Epidemiology Research Unit, Sinai Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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26
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Bøås H, Bekkevold T, Havdal LB, Kran AMB, Rojahn AE, Størdal K, Debes S, Døllner H, Nordbø SA, Barstad B, Haarr E, Vázquez Fernández L, Nakstad B, Leegaard TM, Hungnes O, Flem E. The burden of hospital-attended influenza in Norwegian children. Front Pediatr 2022; 10:963274. [PMID: 36160779 PMCID: PMC9491848 DOI: 10.3389/fped.2022.963274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Norwegian health authorities do not recommend universal pediatric vaccination against seasonal influenza. We aimed to estimate the incidence of influenza by age and underlying medical conditions in hospitalized Norwegian children aged <18 years. METHODS Active surveillance for influenza in children <18 years was implemented in five hospitals during 2015-18. Children with respiratory symptoms and/or fever were prospectively enrolled and tested for influenza. Surveillance data were linked to health registry data to estimate the national burden of influenza in hospitals. RESULTS In 309 (10%) out of 3,010 hospital contacts, the child tested positive for influenza, corresponding to an average incidence of 0.96 hospital-attended influenza cases per 1,000 children <18 years of age. Children <1 year of age (3.8 per 1,000 children) and children with underlying medical conditions (17 per 1,000 children with bronchopulmonary dysplasia) had the highest average incidence. Among <1 year old children, 3% tested positive for influenza, compared to 25% for children aged 6-17. Few children were vaccinated against influenza. CONCLUSIONS Children <1 year of age and children with underlying medical conditions had a higher incidence of influenza requiring hospital treatment compared to the general population. Effective interventions against seasonal influenza for children in Norway should be considered.
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Affiliation(s)
- Håkon Bøås
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Lise Beier Havdal
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Nordbyhagen, Norway
| | - Anne-Marte Bakken Kran
- Norwegian Institute of Public Health, Oslo, Norway.,Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | | | - Ketil Størdal
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway.,Department of Pediatrics, Østfold Hospital, Grålum, Norway.,Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sara Debes
- Department of Medical Microbiology, Østfold Hospital, Grålum, Norway
| | - Henrik Døllner
- Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein Arne Nordbø
- Department of Medical Microbiology, St. Olavs University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Barstad
- Department of Paediatric and Adolescent Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Elisebet Haarr
- Department of Medical Microbiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Britt Nakstad
- Department of Paediatric and Adolescent Medicine, Akershus University Hospital, Nordbyhagen, Norway.,Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Truls Michael Leegaard
- Department of Microbiology and Infection Control, Akershus University Hospital, Nordbyhagen, Norway.,Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Hungnes
- Norwegian Institute of Public Health, Oslo, Norway
| | - Elmira Flem
- Norwegian Institute of Public Health, Oslo, Norway
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Tillard C, Chazard E, Faure K, Bartolo S, Martinot A, Dubos F. Burden of influenza disease in children under 2 years of age hospitalized between 2011 and 2020 in France. J Infect 2021; 84:145-150. [PMID: 34785266 DOI: 10.1016/j.jinf.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although influenza viruses cause significant morbidity and mortality worldwide, the impact of these infections on children in France and in other European countries has not been extensively characterized. The primary objective of the present study was to describe the burden of influenza disease on hospitalized children under 2 years of age in France, using data from the national hospital discharge summary database (Programme de Médicalisation des Systèmes d'Information, PMSI). METHODS In a retrospective study of hospital admissions for influenza among children under the age of 2 in France, we extracted and analyzed hospital administrative data from the PMSI database (from January 1, 2011, to December 31, 2020). RESULTS From 2011 to 2020, 28,507 children under the age of 2 were admitted to hospital with a primary or secondary diagnosis of influenza infection. The hospital admission rate was 205 per 100,000 for children under the age of 2, 276 per 100,000 for children under the age of 12 months, and 135 per 100,000 for children aged between 12 and 23 months. Children under 6 months of age were the most affected (45.4%). An underlying condition was identified for 9.4% of the children, and 2.2% of the children were admitted to the intensive care unit. The death rate was 0.12 per 100,000 for children under 2, 0.11 per 100,000 for children under 12 months, and 0.16 per 100,000 for children aged between 12 and 23 months. CONCLUSIONS In France, the burden of influenza disease is significant in children under the age of 2.
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Affiliation(s)
- Célia Tillard
- CHU Lille, Urgences Pédiatriques & Maladies Infectieuses, Avenue Emile Laisne, Lille F-59000, France; University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Emmanuel Chazard
- University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Karine Faure
- University of Lille, CHU Lille, Service des Maladies Infectieuses et Tropicales, Lille F-59000, France
| | - Stéphanie Bartolo
- University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France; Douai Hospital, Gynecology-Obstetric Unit, Douai F-59507, France
| | - Alain Martinot
- CHU Lille, Urgences Pédiatriques & Maladies Infectieuses, Avenue Emile Laisne, Lille F-59000, France; University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - François Dubos
- CHU Lille, Urgences Pédiatriques & Maladies Infectieuses, Avenue Emile Laisne, Lille F-59000, France; University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France.
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Grohskopf LA, Alyanak E, Ferdinands JM, Broder KR, Blanton LH, Talbot HK, Fry AM. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021-22 Influenza Season. MMWR Recomm Rep 2021; 70:1-28. [PMID: 34448800 PMCID: PMC8407757 DOI: 10.15585/mmwr.rr7005a1] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This report updates the 2020-21 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2020;69[No. RR-8]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. During the 2021-22 influenza season, the following types of vaccines are expected to be available: inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4).The 2021-22 influenza season is expected to coincide with continued circulation of SARS-CoV-2, the virus that causes COVID-19. Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient visits, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html. Recommendations for the use of COVID-19 vaccines are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html, and additional clinical guidance is available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.Updates described in this report reflect discussions during public meetings of ACIP that were held on October 28, 2020; February 25, 2021; and June 24, 2021. Primary updates to this report include the following six items. First, all seasonal influenza vaccines available in the United States for the 2021-22 season are expected to be quadrivalent. Second, the composition of 2021-22 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components. U.S.-licensed influenza vaccines will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines), an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Third, the approved age indication for the cell culture-based inactivated influenza vaccine, Flucelvax Quadrivalent (ccIIV4), has been expanded from ages ≥4 years to ages ≥2 years. Fourth, discussion of administration of influenza vaccines with other vaccines includes considerations for coadministration of influenza vaccines and COVID-19 vaccines. Providers should also consult current ACIP COVID-19 vaccine recommendations and CDC guidance concerning coadministration of these vaccines with influenza vaccines. Vaccines that are given at the same time should be administered in separate anatomic sites. Fifth, guidance concerning timing of influenza vaccination now states that vaccination soon after vaccine becomes available can be considered for pregnant women in the third trimester. As previously recommended, children who need 2 doses (children aged 6 months through 8 years who have never received influenza vaccine or who have not previously received a lifetime total of ≥2 doses) should receive their first dose as soon as possible after vaccine becomes available to allow the second dose (which must be administered ≥4 weeks later) to be received by the end of October. For nonpregnant adults, vaccination in July and August should be avoided unless there is concern that later vaccination might not be possible. Sixth, contraindications and precautions to the use of ccIIV4 and RIV4 have been modified, specifically with regard to persons with a history of severe allergic reaction (e.g., anaphylaxis) to an influenza vaccine. A history of a severe allergic reaction to a previous dose of any egg-based IIV, LAIV, or RIV of any valency is a precaution to use of ccIIV4. A history of a severe allergic reaction to a previous dose of any egg-based IIV, ccIIV, or LAIV of any valency is a precaution to use of RIV4. Use of ccIIV4 and RIV4 in such instances should occur in an inpatient or outpatient medical setting under supervision of a provider who can recognize and manage a severe allergic reaction; providers can also consider consulting with an allergist to help identify the vaccine component responsible for the reaction. For ccIIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency or any component of ccIIV4 is a contraindication to future use of ccIIV4. For RIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency or any component of RIV4 is a contraindication to future use of RIV4. This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2021-22 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used according to Food and Drug Administration-licensed indications. Updates and other information are available from CDC's influenza website (https://www.cdc.gov/flu); vaccination and health care providers should check this site periodically for additional information.
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29
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Influenza Vaccination in Psoriatic Patients-Epidemiology and Patient Perceptions: A German Multicenter Study (Vac-Pso). Vaccines (Basel) 2021; 9:vaccines9080843. [PMID: 34451968 PMCID: PMC8402561 DOI: 10.3390/vaccines9080843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/10/2023] Open
Abstract
The risk of developing severe complications from an influenza virus infection is increased in patients with chronic inflammatory diseases such as psoriasis (PsO) and atopic dermatitis (AD). However, low influenza vaccination rates have been reported. The aim of this study was to determine vaccination rates in PsO compared to AD patients and explore patient perceptions of vaccination. A multicenter cross-sectional study was performed in 327 and 98 adult patients with PsO and AD, respectively. Data on vaccination, patient and disease characteristics, comorbidity, and patient perceptions was collected with a questionnaire. Medical records and vaccination certificates were reviewed. A total of 49.8% of PsO and 32.7% of AD patients were vaccinated at some point, while in season 2018/2019, 30.9% and 13.3% received an influenza vaccination, respectively. There were 96.6% and 77.6% of PsO and AD patients who had an indication for influenza vaccination due to age, immunosuppressive therapy, comorbidity, occupation, and/or pregnancy. Multivariate regression analysis revealed higher age (p < 0.001) and a history of bronchitis (p = 0.023) as significant predictors of influenza vaccination in PsO patients. Considering that most patients had an indication for influenza vaccination, the rate of vaccinated patients was inadequately low.
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Clinical characteristics of influenza with or without Streptococcus pneumoniae co-infection in children. J Formos Med Assoc 2021; 121:950-957. [PMID: 34332830 DOI: 10.1016/j.jfma.2021.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/27/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/PURPOSE Influenza is frequently complicated with bacterial co-infection. This study aimed to disclose the significance of Streptococcus pneumoniae co-infection in children with influenza. METHODS We retrospectively reviewed medical records of pediatric patients hospitalized for influenza with or without pneumococcal co-infection at the National Taiwan University Hospital from 2007 to 2019. Clinical characteristics and outcomes were compared between patients with and without S. pneumoniae co-infection. RESULTS There were 558 children hospitalized for influenza: 494 had influenza alone whereas 64 had S. pneumoniae co-infection. Patients with S. pneumoniae co-infection had older ages, lower SpO2, higher C-Reactive Protein (CRP), lower serum sodium, lower platelet counts, more chest radiograph findings of patch and consolidation on admission, longer hospitalization, more intensive care, longer intensive care unit (ICU) stay, more mechanical ventilation, more inotropes/vasopressors use, more surgical interventions including video-assisted thoracoscopic surgery (VATS) and extracorporeal membrane oxygenation (ECMO), and higher case-fatality rate. CONCLUSION Compared to influenza alone, patients with S. pneumoniae co-infection had more morbidities and mortalities. Pneumococcal co-infection is considered when influenza patients have lower SpO2, lower platelet counts, higher CRP, lower serum sodium, and more radiographic patches and consolidations on admission.
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Guillari A, Polito F, Pucciarelli G, Serra N, Gargiulo G, Esposito MR, Botti S, Rea T, Simeone S. Influenza vaccination and healthcare workers: barriers and predisposing factors. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021004. [PMID: 33855983 PMCID: PMC8138807 DOI: 10.23750/abm.v92is2.11106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/04/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Influenza is a disease that affects a large part of the world's population annually, with major health, social and economic impacts. Active immunisation practices have always been recommended to counter influenza, especially for people at risk. The recommendations of major health agencies strongly advise influenza vaccination for all healthcare workers, mostly for those in contact with at-risk or immunocompromised individuals. Yet, the influenza vaccination coverage among healthcare workers remains rather low worldwide. This review explore barriers and the facilitators of health care professional toward influenza's vaccination. METHODS Narrative review consulting the databases: PubMed, CINAHL by combining keywords health care worker, flu, influenza, vaccination, barrier, resistence, hesitangy, between November 2019 and February 2020 Results. From the 1031 records initially, twenty-two primary studies were included in this narrative review. Our results show that the identified facilitators are: desire for self-protection, protection for loved ones and community. Instead, the barriers to vaccination identified are: fear of contracting influenza from the vaccination itself; not considering themselves at risk; to believing believe that their immune system is capable of managing a trivial disease; disease considered trivial, laziness; false beliefs. DISCUSSION AND CONCLUSION Adherence rate on influenza vaccination among health professionals is quite low. The interventions that make it "complex and traceable" flu vaccination refusal increase adherence to this type of vaccination. The results show that current vaccination campaigns do not increase the rate of adherence by healthcare workers. Identifying the predisposing factors and barriers to such vaccination can help to create, develop and test targeted educational programmes.
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Affiliation(s)
- Assunta Guillari
- Department of Hygiene, University of Naples Federico II, Naples (Italy).
| | - Francesco Polito
- Department of Hygiene, University of Naples Federico II, Naples (Italy).
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome (Italy).
| | - Nicola Serra
- Department of Hygiene, University of Naples Federico II, Naples (Italy).
| | | | | | | | - Teresa Rea
- Department of Hygiene, University of Naples Federico II, Naples (Italy).
| | - Silvio Simeone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome (Italy).
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Lafond KE, Porter RM, Whaley MJ, Suizan Z, Ran Z, Aleem MA, Thapa B, Sar B, Proschle VS, Peng Z, Feng L, Coulibaly D, Nkwembe E, Olmedo A, Ampofo W, Saha S, Chadha M, Mangiri A, Setiawaty V, Ali SS, Chaves SS, Otorbaeva D, Keosavanh O, Saleh M, Ho A, Alexander B, Oumzil H, Baral KP, Huang QS, Adebayo AA, Al-Abaidani I, von Horoch M, Cohen C, Tempia S, Mmbaga V, Chittaganpitch M, Casal M, Dang DA, Couto P, Nair H, Bresee JS, Olsen SJ, Azziz-Baumgartner E, Nuorti JP, Widdowson MA. Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis. PLoS Med 2021; 18:e1003550. [PMID: 33647033 PMCID: PMC7959367 DOI: 10.1371/journal.pmed.1003550] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 03/15/2021] [Accepted: 01/27/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. METHODS AND FINDINGS We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000-5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000-44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265-612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. CONCLUSIONS In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.
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Affiliation(s)
- Kathryn E. Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- * E-mail: (KEL); (MAW)
| | - Rachael M. Porter
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa J. Whaley
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zhou Suizan
- Influenza Division, US Centers for Disease Control and Prevention, Beijing, China
| | - Zhang Ran
- Influenza Division, US Centers for Disease Control and Prevention, Beijing, China
| | - Mohammad Abdul Aleem
- Program for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Binay Thapa
- Royal Centre for Disease Control, Thimphu, Bhutan
| | - Borann Sar
- Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | | | - Zhibin Peng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Luzhao Feng
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | | | - Edith Nkwembe
- Institut National de Recherches Biomédicales, Kinshasa, République Démocratique du Congo
| | | | - William Ampofo
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control and Prevention, New Delhi, India
| | | | - Amalya Mangiri
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | - Vivi Setiawaty
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | - Sandra S. Chaves
- Influenza Division, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Dinagul Otorbaeva
- Department of State Sanitary Epidemiological Surveillance, Bishkek, Kyrgyzstan
| | - Onechanh Keosavanh
- National Center for Laboratory and Epidemiology, Vientiane, Lao People’s Democratic Republic
| | - Majd Saleh
- Epidemiological Surveillance Program, Lebanese Ministry of Public Health, Beirut, Lebanon
| | - Antonia Ho
- MRC–University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
- Malawi–Liverpool–Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Hicham Oumzil
- Virology Department, Institut National d’Hygiène, Rabat, Morocco
- Faculty of Medicine, Microbiology RPU, Mohammed V University, Rabat, Morocco
| | | | - Q. Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Adedeji A. Adebayo
- Nigeria Centre for Disease Control, Federal Ministry of Health, Abuja, Nigeria
| | - Idris Al-Abaidani
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Marta von Horoch
- Ministerio de Salud Publica y Bienestar Social, Asunción, Paraguay
| | - Cheryl Cohen
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- MassGenics, Duluth, Georgia, United States of America
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Malinee Chittaganpitch
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Mariana Casal
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Paula Couto
- Pan American Health Organization, Washington, District of Columbia, United States of America
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joseph S. Bresee
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sonja J. Olsen
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - J. Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marc-Alain Widdowson
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail: (KEL); (MAW)
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Safety and immunogenicity of high doses of quadrivalent influenza vaccine in children 6 months through <18 years of age: A randomized controlled phase II dose-finding trial. Vaccine 2021; 39:1572-1582. [PMID: 33610374 DOI: 10.1016/j.vaccine.2021.02.014] [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] [Received: 10/13/2020] [Accepted: 02/06/2021] [Indexed: 11/23/2022]
Abstract
Quadrivalent high-dose inactivated influenza vaccine (Fluzone® High-Dose Quadrivalent, IIV4-HD) was licensed in the USA in 2019 for adults ≥ 65 years of age. This Phase II study examined safety and immunogenicity of 3 dose formulations of IIV4-HD in healthy children. In a randomized, modified double-blind, active-controlled trial in the USA and Canada, 661 children aged 6 months through < 18 years received 1 or 2 doses intramuscularly of standard-dose quadrivalent influenza vaccine (IIV4-SD; 15 µg HA/strain), IIV4-HD at 3 dose levels (30, 45, and 60 µg HA/strain), or adjuvanted trivalent influenza vaccine (aIIV3, 7.5 µg HA/strain). Rates of unsolicited AEs were similar irrespective of dose. No treatment-related serious adverse events or deaths were reported. Reactogenicity was slightly higher for IIV4-HD than IIV4-SD, although most solicited reactions were grade 1 or 2. Hemagglutination inhibition (HAI) and seroneutralization antibody titers were measured 28-35 days after each dose. Geometric mean HAI titers increased with increasing hemagglutinin dose, especially in children 6 months through < 3 years. For IIV4-HD 60 µg, in participants 6 months through < 18 years of age, the geometric mean titer ratio (95% confidence interval) versus IIV4-SD was 1.35 (0.94, 1.94) for A/H1N1, 2.51 (1.77, 3.55) for A/H3N2, 1.60 (1.17, 2.18) for B/Victoria, and 1.51 (1.13, 2.03) for B/Yamagata. The GMT ratio (95% confidence interval) for IIV4-HD 60 µg versus IIV4-SD was highest for participants 6 months through < 3 years of age: 4.24 (2.05, 8.76) for A/H1N1, 3.14 (1.53, 6.44) for A/H3N2, 2.04 (1.10, 3.77) for B/Victoria, and 1.92 (1.08, 3.41) for B/Yamagata; similarly, seroneutralization antibody GMT ratio was highest in these participants: 170 (84.6, 340) for A/H1N1, 7.13 (4.90, 10.4) for A/H3N2, 35.8 (22.1, 58.1) for B/Victoria, and 22.7 (14.7, 35.0) for B/Yamagata. This study showed that IIV4-HD (60 µg HA/strain) provides improved immunogenicity without affecting vaccine safety in children.
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de Boer PT, Nagy L, Dolk FCK, Wilschut JC, Pitman R, Postma MJ. Cost-Effectiveness of Pediatric Influenza Vaccination in The Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:19-31. [PMID: 33431149 DOI: 10.1016/j.jval.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study evaluates the cost-effectiveness of extending the Dutch influenza vaccination program for elderly and medical high-risk groups to include pediatric influenza vaccination, taking indirect protection into account. METHODS An age-structured dynamic transmission model was used that was calibrated to influenza-associated GP visits over 4 seasons (2010-2011 to 2013-2014). The clinical and economic impact of different pediatric vaccination strategies were compared over 20 years, varying the targeted age range, the vaccine type for children or elderly and high-risk groups. Outcome measures include averted symptomatic infections and deaths, societal costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Costs and QALYs were discounted at 4% and 1.5% annually. RESULTS At an assumed coverage of 50%, adding pediatric vaccination for 2- to 17-year-olds with quadrivalent live-attenuated vaccine to the current vaccination program for elderly and medical high-groups with quadrivalent inactivated vaccine was estimated to avert, on average, 401 820 symptomatic cases and 72 deaths per year. Approximately half of averted symptomatic cases and 99% of averted deaths were prevented in other age groups than 2- to 17-year-olds due to herd immunity. The cumulative discounted 20-year economic impact was 35 068 QALYs gained and €1687 million saved, that is, the intervention was cost-saving. This vaccination strategy had the highest probability of being the most cost-effective strategy considered, dominating pediatric strategies targeting 2- to 6-year-olds or 2- to 12-year-olds or strategies with trivalent inactivated vaccine. CONCLUSION Modeling indicates that introducing pediatric influenza vaccination in The Netherlands is cost-saving, reducing the influenza-related disease burden substantially.
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Affiliation(s)
- Pieter T de Boer
- Unit of PharmacoTherapy, -Epidemiology, and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Lisa Nagy
- Unit of PharmacoTherapy, -Epidemiology, and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | - Jan C Wilschut
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Richard Pitman
- ICON Health Economics and Epidemiology, Oxfordshire, United Kingdom
| | - Maarten J Postma
- Unit of PharmacoTherapy, -Epidemiology, and -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands; Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands; Department of Economics, Econometrics, and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Vesikari T, Ramsey K, Pitisuttithum P, Capeding R, Heijnen E, Sawlwin D, Oberyé J, Zhang B, Smolenov I. Repeated exposure to an MF-59 adjuvanted quadrivalent subunit influenza vaccine (aQIV) in children: Results of two revaccination studies. Vaccine 2020; 38:8224-8231. [PMID: 33139136 DOI: 10.1016/j.vaccine.2020.10.036] [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: 06/07/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pediatric adjuvanted seasonal influenza vaccines induce higher immune responses and have the potential to confer better protection against influenza among young vaccine-naïve children. Limited data describe benefits and risks of repeated administration of adjuvanted influenza vaccines in children. Two revaccination studies assess the safety and immunogenicity of repeated exposure to an MF59-adjuvanted quadrivalent influenza vaccine (aQIV; Fluad®) compared to routine non-adjuvanted quadrivalent influenza vaccine (QIV). METHODS Children previously enrolled in the parent study, who received vaccination with aQIV or nonadjuvanted influenza vaccine (TIV or QIV), were recruited in Season 1 (n = 607) or Season 2 (n = 1601) of the extension trials. Season 1 participants remained in their original randomization groups (aQIV-aQIV or TIV-QIV); Season 2 subjects were re-randomized to either vaccine, resulting in four groups (aQIV-aQIV, aQIV-QIV, QIV-aQIV, or QIV-QIV). All subjects received a single-dose vaccination. Blood samples were taken for immunogenicity assessment prior to vaccination and 21 and 180 days after vaccination. Reactogenicity (Days 1-7) and safety were assessed in all subjects. RESULTS Hemagglutination inhibition (HI) geometric mean titer (GMT) ratios demonstrated superiority of aQIV revaccination over QIV revaccination for all strains in Season 1 and for A/H1N1, B/Yamagata, and B/Victoria in Season 2. Higher HI titers against heterologous influenza strains were observed after aQIV vaccination during both seasons. Mild to moderate severity and short duration reactogenicity was more common in the aQIV than QIV groups, but the overall safety profiles were similar to the parent study. CONCLUSION The safety and immunogenicity results from this study demonstrate benefit of aQIV for both priming and revaccination of children aged 12 months to 7 years.
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Affiliation(s)
| | - K Ramsey
- Jordan Ridge Kids & Teens, West Jordan, USA
| | - P Pitisuttithum
- Mahidol University, Department of Clinical Tropical Medicine, Bangkok, Thailand
| | - R Capeding
- Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Esther Heijnen
- Janssen Vaccines & Prevention B.V., Leiden, the Netherlands
| | | | - Janine Oberyé
- Seqirus Netherlands BV, Clinical Science and Strategy, Amsterdam, The Netherlands
| | - Bin Zhang
- Seqirus Inc, Clinical Science and Strategy, Cambridge, USA
| | - Igor Smolenov
- Seqirus Inc, Clinical Science and Strategy, Cambridge, USA
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Segaloff HE, Leventer-Roberts M, Riesel D, Malosh RE, Feldman BS, Shemer-Avni Y, Key C, Monto AS, Martin ET, Katz MA. Influenza Vaccine Effectiveness Against Hospitalization in Fully and Partially Vaccinated Children in Israel: 2015-2016, 2016-2017, and 2017-2018. Clin Infect Dis 2020; 69:2153-2161. [PMID: 30753347 DOI: 10.1093/cid/ciz125] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) varies by season, circulating influenza strain, age, and geographic location. There have been few studies of influenza VE among hospitalized children, particularly in Europe and the Middle East. METHODS We estimated VE against influenza hospitalization among children aged 6 months to 8 years at Clalit Health Services hospitals in Israel in the 2015-2016, 2016-2017, and 2017-2018 influenza seasons, using the test-negative design. Estimates were computed for full and partial vaccination. RESULTS We included 326 influenza-positive case patients and 2821 influenza-negative controls (140 case patients and 971 controls from 2015-2016, 36 case patients and 1069 controls from 2016-2017, and 150 case patients and 781 controls from 2017-2018). Over all seasons, VE was 53.9% for full vaccination (95% confidence interval [CI], 38.6%-68.3%), and 25.6% for partial vaccination (-3% to 47%). In 2015-2016, most viruses were influenza A(H1N1) and vaccine lineage-mismatched influenza B/Victoria; the VE for fully vaccinated children was statistically significant for influenza A (80.7%; 95% CI, 40.3%-96.1%) but not B (23.0%; -38.5% to 59.4%). During 2016-2017, influenza A(H3N2) predominated, and VE was (70.8%; 95% CI, 17.4%-92.4%). In 2017-2018, influenza A(H3N2), H1N1 and lineage-mismatched influenza B/Yamagata cocirculated; VE was statistically significant for influenza B (63.0%; 95% CI, 24.2%-83.7%) but not influenza A (46.3%; -7.2% to 75.3%). CONCLUSIONS Influenza vaccine was effective in preventing hospitalizations among fully vaccinated Israeli children over 3 influenza seasons, but not among partially vaccinated children. There was cross-lineage protection in a season where the vaccine contained B/Victoria and the circulating strain was B/Yamagata, but not in a season with the opposite vaccine-circulating strain distribution.
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Affiliation(s)
| | | | - Dan Riesel
- Clalit Health Services, Clalit Research Institute, Tel Aviv
| | - Ryan E Malosh
- University of Michigan School of Public Health, Ann Arbor
| | | | | | - Calanit Key
- Clalit Community Division, Clalit Health Services, Tel Aviv
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor
| | - Mark A Katz
- University of Michigan School of Public Health, Ann Arbor.,Clalit Health Services, Clalit Research Institute, Tel Aviv.,Ben Gurion University, Beer Sheva, Israel
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Grohskopf LA, Alyanak E, Broder KR, Blanton LH, Fry AM, Jernigan DB, Atmar RL. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2020-21 Influenza Season. MMWR Recomm Rep 2020; 69:1-24. [PMID: 32820746 PMCID: PMC7439976 DOI: 10.15585/mmwr.rr6908a1] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This report updates the 2019–20 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2019;68[No. RR-3]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. Most influenza vaccines available for the 2020–21 season will be quadrivalent, with the exception of MF59-adjuvanted IIV, which is expected to be available in both quadrivalent and trivalent formulations. Updates to the recommendations described in this report reflect discussions during public meetings of ACIP held on October 23, 2019; February 26, 2020; and June 24, 2020. Primary updates to this report include the following two items. First, the composition of 2020–21 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. Second, recent licensures of two new influenza vaccines, Fluzone High-Dose Quadrivalent and Fluad Quadrivalent, are discussed. Both new vaccines are licensed for persons aged ≥65 years. Additional changes include updated discussion of contraindications and precautions to influenza vaccination and the accompanying Table, updated discussion concerning use of LAIV4 in the setting of influenza antiviral medication use, and updated recommendations concerning vaccination of persons with egg allergy who receive either cell culture–based IIV4 (ccIIV4) or RIV4. The 2020–21 influenza season will coincide with the continued or recurrent circulation of SARS-CoV-2 (the novel coronavirus associated with coronavirus disease 2019 [COVID-19]). Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient illnesses, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html. This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2020–21 season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used within Food and Drug Administration (FDA)–licensed indications. Updates and other information are available from CDC’s influenza website (https://www.cdc.gov/flu). Vaccination and health care providers should check this site periodically for additional information.
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Jacob R, White B, McCaskill ME. Does location of rapid influenza diagnostic testing influence treatment time and ancillary testing in a paediatric emergency department? Emerg Med Australas 2020; 33:88-93. [PMID: 32808485 DOI: 10.1111/1742-6723.13591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Influenza causes a significant burden of disease. Our aim was to assess whether location of rapid influenza diagnostic testing (RIDT) for patients with influenza-like illness (ILI) has an impact on ED treatment time or ancillary testing. METHODS This was a retrospective observational study in a tertiary paediatric ED during 2017 influenza season. All patients with ILI were included. Some had RIDT performed (ED bedside or at the laboratory). Primary outcome measure was the correlation of RIDT location to treatment time compared to patients with ILI with no RIDT. Secondary outcome measures were the correlation of RIDT location to ancillary testing and treatment with antibiotics. RESULTS A total of 1451 patients with ILI were included. Eighty patients for whom RIDT was performed at the laboratory had a shorter treatment time in the ED when compared to the 215 patients for whom RIDT was performed bedside (2.8 and 3.4 h, respectively; P < 0.0001). However, treatment time was not statistically different when sub-analysed for admitted and discharged patients separately. Overall, patients with ILI and no RIDT had the shortest treatment time in the ED (1.7 h). There was no difference in ancillary testing and treatment with antibiotics between ILI patients for whom RIDT was performed bedside or at the laboratory regardless of admission. CONCLUSION Location of RIDT may not have a significant impact on treatment time, ancillary testing and treatment with antibiotics. When RIDT was not performed, patients had the shortest treatment time.
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Affiliation(s)
- Ron Jacob
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Paediatric Emergency Department, Ha'Emek Medical Centre, Afula, Israel
| | - Brent White
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Mary E McCaskill
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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39
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de St Maurice A, Edwards K. Rethinking Flu Vaccine Messaging. Pediatrics 2020; 146:peds.2020-1770. [PMID: 32540984 DOI: 10.1542/peds.2020-1770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Kathryn Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
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40
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Kovacevic P, Matijasevic J, Dragic S, Zlojutro B, Gavrilovic S, Jandric M, Andrijevic A, Kovacevic T, Carapic V, Travar M, Preradovic L, Momcicevic D. Characteristics and outcomes of critically ill patients with influenza A (H1N1) in the Western Balkans during the 2019 post-pandemic season. Indian J Med Microbiol 2020; 38:415-420. [PMID: 33154256 DOI: 10.4103/ijmm.ijmm_20_169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background This study looked at the characteristics and outcomes of critically ill patients with confirmed influenza A (H1N1) pdm09 infection in the Western Balkans in the post-pandemic period. Materials and Methods This retrospective observational study of medical records and associated data collected during the post-pandemic period included all mechanically ventilated adult patients of two university-affiliated hospitals of the Western Balkans between 1 January and 31 March 2019 who had influenza A (H1N1) pdm09 infection confirmed by real-time reverse transcriptase-polymerase chain reaction from nasopharyngeal swab specimens and respiratory secretions. Results The study included 89 patients, 49 males (55.1%), aged 56.09 ± 12.64 years. The median time from shift from hospital time to intensive care unit was 1 day (range: 1-2). In the post-pandemic period, cases observed in this study were found to have the following comorbidities: cardiovascular diseases in 44 (49.4%) patients and diabetes in 21 (23.6%) patients. Thirty-one patients (34.8%) in this study were obese. All 89 patients (100%) experienced some degree of acute respiratory distress syndrome, and 39 (44%) had multiorgan failure. Eighty-three patients (93%) were intubated and mechanically ventilated, 6 (7%) received non-invasive mechanical ventilation, 12 (13%) were treated with vvECMO and 36 (40%) received renal replacement therapy. Vasoactive support was needed by 56 (63%) patients. The median duration of mechanical ventilation was 9 (6-15.5) days. The hospital mortality rate was 44%. Conclusion Critically ill patients with confirmed influenza A (H1N1) pdm09 infection in the post-pandemic season were older, required vasoactive drugs more often, and there was a trend of higher survival compared to H1N1 infection patients in the previous pandemic seasons.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska; Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina, Novi Sad, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Srdjan Gavrilovic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Ana Andrijevic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Tijana Kovacevic
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina; Department of Pharmacy, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Vladimir Carapic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Maja Travar
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina; Department of Microbiology, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Ljubisa Preradovic
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina, Novi Sad, Serbia
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
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Abstract
BACKGROUND Influenza A viruses are conventionally thought to cause more severe illnesses than B viruses, but few studies with long observation periods have compared the clinical severity of A and B infections in hospitalized children. METHODS We analyzed the clinical presentation, outcomes and management of all children <16 years of age admitted to Turku University Hospital, Finland, with virologically confirmed influenza A or B infection during the 14-year period of 1 July 2004 to 30 June 2018. All comparisons between influenza A and B were performed both within predefined age groups (0-2, 3-9 and 10-15 years) and in all age groups combined. RESULTS Among 391 children hospitalized with influenza A or B infection, influenza A was diagnosed in 279 (71.4%) and influenza B in 112 (28.6%) children. Overall, there were no significant differences in any clinical features or outcomes, management, treatment at intensive care unit or length of stay between children with influenza A and B, whether analyzed by age group or among all children. As indicators of the most severe clinical presentations, blood cultures were obtained from 101 (36.2%) children with influenza A and 39 (34.8%) with influenza B (P = 0.80), and lumbar puncture was performed to 16 (5.7%) children with influenza A and 11 (9.8%) children with influenza B (P = 0.15). CONCLUSIONS The clinical severity of influenza A and B infections is similar in children. For optimal protection against severe influenza illnesses, the use of quadrivalent vaccines containing both lineages of B viruses seems warranted in children.
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42
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Affiliation(s)
- Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, UR Golisano Children's Hospital, Rochester, New York, USA
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43
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Weinberg GA. Nontraditional Uses of Live Attenuated Influenza Vaccine: School-Located Influenza Vaccination. J Pediatric Infect Dis Soc 2020; 9:S19-S23. [PMID: 32191311 DOI: 10.1093/jpids/piaa007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Immunization against influenza continues to be the best method of preventing influenza infection in children, and additionally, indirectly helping to lower disease in adults, given the role of children as "spreaders" of influenza to the community at large. An increasing evidence base exists for the use of school-located influenza vaccination (SLIV) programs to increase the influenza vaccination rates among children. Live, attenuated influenza vaccine (LAIV) has unique characteristics that make it useful for SLIV programs, including ease of immunization without needles, faster delivery, and in many (but not all) years, good vaccine effectiveness. Reviewed herein are results of selected published trials as well as guidance on planning a successful SLIV program.
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Affiliation(s)
- Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, University of Rochester Golisano Children's Hospital, Rochester, New York, USA
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44
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Kitt E, Drew RJ, Cunney R, Beekmann SE, Polgreen P, Butler K, Zaoutis T, Coffin SE. Diagnosis and Management of Pediatric Influenza in the Era of Rapid Diagnostics. J Pediatric Infect Dis Soc 2020; 9:51-55. [PMID: 30476135 DOI: 10.1093/jpids/piy118] [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: 03/19/2018] [Accepted: 10/24/2018] [Indexed: 01/29/2023]
Abstract
Influenza is a significant cause of childhood morbidity and death; it contributes to up to 16% of hospitalizations for respiratory illnesses worldwide. Novel rapid viral diagnostic tests, including molecular diagnostic tests, have the potential to significantly affect both time to diagnosis and selection of optimal anti-infective therapy. However, little is known about current treatment algorithms used in US hospitals. In this study, for hospitalized children in the United States, we aimed to define the current approaches to influenza diagnosis and treatment and to explore reasons for their potential variation. In this study, we aimed to define the current approaches to pediatric influenza diagnosis and treatment in US hospitals, and to explore reasons for their potential variation. Our results suggest a rise in the availability and use of rapid molecular diagnostic testing in addition to continued variability in anti-infective management, particularly with regard to antiviral use.
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Affiliation(s)
- Eimear Kitt
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Richard J Drew
- Temple Street Children's University Hospital, Dublin, Ireland.,Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin
| | - Robert Cunney
- Temple Street Children's University Hospital, Dublin, Ireland
| | - Susan E Beekmann
- Emerging Infections Network, University of Iowa Carver College of Medicine, Iowa City
| | - Philip Polgreen
- Emerging Infections Network, University of Iowa Carver College of Medicine, Iowa City
| | - Karina Butler
- Temple Street Children's University Hospital, Dublin, Ireland.,School' of Medicine, University College Dublin, Ireland
| | - Theoklis Zaoutis
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan E Coffin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Children's Hospital of Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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45
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Nekrasova E, Stockwell MS, Localio R, Shults J, Wynn C, Shone LP, Berrigan L, Kolff C, Griffith M, Johnson A, Torres A, Opel DJ, Fiks AG. Vaccine hesitancy and influenza beliefs among parents of children requiring a second dose of influenza vaccine in a season: An American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) study. Hum Vaccin Immunother 2020; 16:1070-1077. [PMID: 32017643 DOI: 10.1080/21645515.2019.1707006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
To receive adequate protection against influenza, some children 6 months through 8 y old need two doses of influenza vaccine in a given season. Currently, only half of those receiving the first dose receive a second. Our objective was to assess vaccine hesitancy and influenza disease and vaccine knowledge, attitudes, and beliefs among caregivers of children who received the first of their two needed doses. As part of a national-randomized control trial of second dose text-message influenza vaccine reminders (2017-2018 season), a telephone survey collected caregiver and index child demographic information. Each child had received the first of two needed influenza vaccine doses. Caregivers completed a measure of general vaccine hesitancy - the five-question Parent Attitudes About Childhood Vaccines Survey Tool (PACV-5) - and questions about influenza infection and vaccine. We assessed associations between participant demographic characteristics, vaccine hesitancy, and influenza beliefs and calculated the standardized proportion of caregivers endorsing each outcome using logistic regression. Analyses included responses from 256 participants from 36 primary care practices in 24 states. Some caregivers (11.7%) reported moderate/high vaccine hesitancy and many had misperceptions about influenza disease and vaccine. In multivariable models, no single variable was consistently associated with inaccurate knowledge, attitudes, and beliefs. These results demonstrate that caregivers whose children received the first dose of influenza vaccine may still be vaccine hesitant and have inaccurate influenza beliefs. Pediatricians should consider broadly addressing inaccurate beliefs and promoting vaccination even after caregivers agree to the first dose.
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Affiliation(s)
- Ekaterina Nekrasova
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melissa S Stockwell
- Department of Pediatrics, Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Russell Localio
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Justine Shults
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Chelsea Wynn
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Laura P Shone
- Department of Research, American Academy of Pediatrics, Itasca, IL, USA
| | - Lindsay Berrigan
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chelsea Kolff
- Department of Pediatrics, Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Miranda Griffith
- Department of Research, American Academy of Pediatrics, Itasca, IL, USA
| | - Andrew Johnson
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alessandra Torres
- Department of Research, American Academy of Pediatrics, Itasca, IL, USA
| | - Douglas J Opel
- University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Alexander G Fiks
- Department of Pediatrics, Center for Pediatric Clinical Effectiveness & PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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46
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The effectiveness of influenza vaccination in pregnancy in relation to child health outcomes: Systematic review and meta-analysis. Vaccine 2020; 38:1601-1613. [PMID: 31932138 DOI: 10.1016/j.vaccine.2019.12.056] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the effectiveness of influenza vaccination during pregnancy on child health outcomes. DESIGN Systematic review/meta-analysis. DATA SOURCES Clinical Trials.gov, Cochrane Library, EMBASE, Medline, Medline in process, PubMed and Web of Science, from 1st January 1996 to 29th June 2018. An updated Medline search was performed 30th June 2018 to 31st October 2019. METHODS Randomised controlled trials (RCTs) and observational studies reporting health outcomes of infants and children born to women who received inactivated influenza vaccine during pregnancy. The primary outcome was infant laboratory confirmed influenza (LCI). Secondary outcomes included influenza-like illness (ILI), other respiratory illnesses, primary care, clinic visit or hospitalisations due to influenza illness and long-term respiratory childhood outcomes. RESULTS 19 studies were included; 15 observational studies and 4 primary RCTs with an additional 3 papers reporting secondary outcomes of these RCTs. In a random effects meta-analysis of 2 RCTs including 5742 participants, maternal influenza vaccination was associated with an overall reduction of LCI in infants of 34% (95% confidence interval 15-50%). However, there was no effect of maternal influenza vaccination on ILI in infants ≤6 months old. Two RCTs were excluded from the meta-analysis for the outcome of LCI in infants (different controls used). Both of these studies showed a protective effect for infants from LCI, with a vaccine efficacy of up to 70%. Overall observational studies showed an inverse (protective) association between maternal influenza vaccination and infant LCI, hospitalisation and clinic visits due to LCI or ILI in infants and other respiratory illness in infants ≤6 months old. CONCLUSIONS This systematic review supports maternal influenza vaccination as a strategy to reduce LCI and influenza-related hospitalisations in young infants. Communicating these benefits to pregnant women may support their decision to accept influenza vaccination in pregnancy and increase vaccine coverage in pregnant women. REGISTRATION PROSPERO CRD42018102776.
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Collins JP, Campbell AP, Openo K, Farley MM, Cummings CN, Kirley PD, Herlihy R, Yousey-Hindes K, Monroe ML, Ladisky M, Lynfield R, Baumbach J, Spina N, Bennett N, Billing L, Thomas A, Schaffner W, Price A, Garg S, Anderson EJ. Clinical Features and Outcomes of Immunocompromised Children Hospitalized With Laboratory-Confirmed Influenza in the United States, 2011-2015. J Pediatric Infect Dis Soc 2019; 8:539-549. [PMID: 30358877 DOI: 10.1093/jpids/piy101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Existing data on the clinical features and outcomes of immunocompromised children with influenza are limited. METHODS Data from the 2011-2012 through 2014-2015 influenza seasons were collected as part of the Centers for Disease Control and Prevention (CDC) Influenza Hospitalization Surveillance Network (FluSurv-NET). We compared clinical features and outcomes between immunocompromised and nonimmunocompromised children (<18 years old) hospitalized with laboratory-confirmed community-acquired influenza. Immunocompromised children were defined as those for whom ≥1 of the following applies: human immunodeficiency virus/acquired immunodeficiency syndrome, cancer, stem cell or solid organ transplantation, nonsteroidal immunosuppressive therapy, immunoglobulin deficiency, complement deficiency, asplenia, and/or another rare condition. The primary outcomes were intensive care admission, duration of hospitalization, and in-hospital death. RESULTS Among 5262 hospitalized children, 242 (4.6%) were immunocompromised; receipt of nonsteroidal immunosuppressive therapy (60%), cancer (39%), and solid organ transplantation (14%) were most common. Immunocompromised children were older than the nonimmunocompromised children (median, 8.8 vs 2.8 years, respectively; P < .001), more likely to have another comorbidity (58% vs 49%, respectively; P = .007), and more likely to have received an influenza vaccination (58% vs 39%, respectively; P < .001) and early antiviral treatment (35% vs 27%, respectively; P = .013). In multivariable analyses, immunocompromised children were less likely to receive intensive care (adjusted odds ratio [95% confidence interval], 0.31 [0.20-0.49]) and had a slightly longer duration of hospitalization (adjusted hazard ratio of hospital discharge [95% confidence interval], 0.89 [0.80-0.99]). Death was uncommon in both groups. CONCLUSIONS Immunocompromised children hospitalized with influenza received intensive care less frequently but had a longer hospitalization duration than nonimmunocompromised children. Vaccination and early antiviral use could be improved substantially. Data are needed to determine whether immunocompromised children are more commonly admitted with milder influenza severity than are nonimmunocompromised children.
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Affiliation(s)
- Jennifer P Collins
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Angela P Campbell
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kyle Openo
- Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | | | | | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver
| | | | - Maya L Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore
| | - Macey Ladisky
- Michigan Department of Health and Human Services, Lansing
| | | | | | | | | | | | | | | | - Andrea Price
- Salt Lake Valley Health Department, Salt Lake City, Utah
| | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
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Goldstein E, Finelli L, O’Halloran A, Liu P, Karaca Z, Steiner CA, Viboud C, Lipsitch M. Hospitalizations Associated with Respiratory Syncytial Virus and Influenza in Children, Including Children Diagnosed with Asthma. Epidemiology 2019; 30:918-926. [PMID: 31469696 PMCID: PMC6768705 DOI: 10.1097/ede.0000000000001092] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is uncertainty about the burden of hospitalization associated with respiratory syncytial virus (RSV) and influenza in children, including those with underlying medical conditions. METHODS We applied previously developed methodology to Health Care Cost and Utilization Project hospitalization data and additional data related to asthma diagnosis/previous history in hospitalized children to estimate RSV and influenza-associated hospitalization rates in different subpopulations of US children between 2003 and 2010. RESULTS The estimated average annual rates (per 100,000 children) of RSV-associated hospitalization with a respiratory cause (ICD-9 codes 460-519) present anywhere in the discharge diagnosis were 2,381 (95% CI(2252,2515)) in children <1 year of age; 710.6 (609.1, 809.2) (1 y old); 395 (327.7, 462.4) (2 y old); 211.3 (154.6, 266.8) (3 y old); 111.1 (62.4, 160.1) (4 y old); 72.3 (29.3, 116.4) (5-6 y of age); 35.6 (9.9,62.2) (7-11 y of age); and 39 (17.5, 60.6) (12-17 y of age). The corresponding rates of influenza-associated hospitalization were lower, ranging from 181 (142.5, 220.3) in <1 year old to 17.9 (11.7, 24.2) in 12-17 years of age. The relative risks for RSV-related hospitalization associated with a prior diagnosis of asthma in age groups <5 y ranged between 3.1 (2.1, 4.7) (<1 y old) and 6.7 (4.2, 11.8) (2 y old; the corresponding risks for influenza-related hospitalization ranged from 2.8 (2.1, 4) (<1y old) to 4.9 (3.8, 6.4) (3 y old). CONCLUSION RSV-associated hospitalization rates in young children are high and decline rapidly with age. There are additional risks for both RSV and influenza hospitalization associated with a prior diagnosis of asthma, with the rates of RSV-related hospitalization in the youngest children diagnosed with asthma being particularly high.
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Affiliation(s)
- Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | | | - Alissa O’Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, US CDC, Atlanta, GA 30329 USA
| | - Patrick Liu
- Yale School of Medicine, New Haven, CT 06510 USA
| | - Zeynal Karaca
- Agency for HealthCare Research and Quality, U.S. Department of Health & Human Services, Rockville, MD 20850 USA
| | - Claudia A. Steiner
- Agency for HealthCare Research and Quality, U.S. Department of Health & Human Services, Rockville, MD 20850 USA (work performed in that capacity; currently works at Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80231 USA)
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
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49
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Brillo E, Tosto V, Giardina I, Buonomo E. Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization: an overview. J Matern Fetal Neonatal Med 2019; 34:3415-3444. [PMID: 31645152 DOI: 10.1080/14767058.2019.1680633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Maternal tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunization for women during pregnancy (the so-called "maternal immunization") has been introduced in several countries, and recently also in Italy, to protect mother and fetus during pregnancy, infant in his first months of life and mother during postpartum period. However, very low vaccination coverage rates have been reached due to several variables. METHODS A literature search was conducted on PubMed and Embase, including any experimental or observational studies, to assesses existing evidence on the effectiveness, efficacy, safety and optimal timing of administration of Tdap and influenza immunization in pregnancy for mothers and their infants. The search was finalized in August 2019. RESULTS Reviewing the literature, we identified only a few studies that, among several maternal and infant outcomes, found sporadic significant associations with maternal influenza immunization and even less with Tdap immunization. Moreover, most of the authors of these studies explained these findings as a result of residual confounding effect. The effectiveness of maternal influenza immunization is more complicated to prove than the effectiveness of Tdap immunization because of several reasons. Not all nations recommend and offer vaccines in the same weeks of pregnancy and this one manifests the complexity in defining the best timing for Tdap or influenza immunization. CONCLUSIONS The safety of maternal Tdap or influenza immunization is supported by the evidence so far, however, regular surveillance should be maintained, especially with regard to the influenza vaccine that changes in formulation each year. There is a need to optimize the timing of vaccination in pregnancy and to have a national system of detection of maternal immunization in each country.
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Affiliation(s)
- Eleonora Brillo
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Valentina Tosto
- Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Irene Giardina
- Center for Research in Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy.,Department of Obstetrics and Gynecology, University Hospital of Perugia, Perugia, Italy
| | - Ersilia Buonomo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
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50
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Chong CY, Yung CF, Gan C, Thio ST, Tan NWH, Tee NWS, Lin C, Lin RTP, Thoon KC. The burden and clinical manifestation of hospitalized influenza among different pediatric age-groups in the tropics. Influenza Other Respir Viruses 2019; 14:46-54. [PMID: 31608598 PMCID: PMC6928028 DOI: 10.1111/irv.12692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction In tropical Singapore, influenza occurs all year‐round. This study of influenza‐confirmed hospitalized pediatric patients compared clinical characteristics and complications by age‐group and differences between influenza A and B. Methods This was a retrospective study of pediatric inpatients from January 2013 to December 2014. Patients were grouped into: <6 months, 6 months to <5 years, 5‐ to <10‐year and ≥10 years. Complications were classified into neurologic, pulmonary, and other. We also calculated the incidence of hospitalized influenza cases per 100 000 age‐related population. Results There were a total of 1272 patients with a median age of 37 months. The highest hospitalization rates were in the <6 months age‐group. Majority (75.2%) had no comorbidity; 25.6% had complications: neurologic 11.9%, pulmonary 9.6%, other 4.1%. Patients with other complications were older, male, and had the highest influenza B rates and the longest length of stay. Influenza A comprised 76.9% of cases and had higher complication rates especially neurologic, compared to influenza B. Influenza B patients were older and were more likely to develop other complications. The 6‐month to <5‐year‐age‐group had the highest complication rate (30.6%), especially neurologic. However, ≥10 years old had the highest other complications, ICU/ high‐dependency admissions and influenza B Victoria rates. Conclusions Infants <6 months had the highest hospitalization rates for influenza. The 6‐month to <5‐year‐age‐group had the highest complication rate especially neurologic. Influenza A patients were younger, had higher seizure rates and complications compared to influenza B.
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Affiliation(s)
- Chia-Yin Chong
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Chee-Fu Yung
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Cherie Gan
- Singhealth Residency Programme, Singapore General Hospital, Singapore
| | - Szu-Tien Thio
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Natalie Woon-Hui Tan
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nancy Wen-Sim Tee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore
| | - Cui Lin
- National Public Health Laboratory, Ministry of Health, Singapore
| | - Raymond Tze-Pin Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore.,National Public Health Laboratory, Ministry of Health, Singapore
| | - Koh-Cheng Thoon
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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