Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children

被引：29

作者：

Olson, Samantha M. ^{[1
]}

Newhams, Margaret M. ^{[2
]}

Halasa, Natasha B. ^{[3
]}

Feldstein, Leora R. ^{[1
]}

Novak, Tanya ^{[2
,4
]}

Weiss, Scott L. ^{[5
]}

Coates, Bria M. ^{[6
]}

Schuster, Jennifer E. ^{[7
]}

Schwarz, Adam J. ^{[8
]}

Maddux, Aline B. ^{[9
,10
]}

Hall, Mark W. ^{[11
]}

Nofziger, Ryan A. ^{[12
]}

Flori, Heidi R. ^{[13
,14
]}

Gertz, Shira J. ^{[15
]}

Kong, Michele ^{[16
]}

Sanders, Ronald C., Jr. ^{[17
]}

Irby, Katherine ^{[17
]}

Hume, Janet R. ^{[18
]}

Cullimore, Melissa L. ^{[19
]}

Shein, Steven L. ^{[20
]}

Thomas, Neal J. ^{[21
]}

Stewart, Laura S. ^{[3
]}

Barnes, John R. ^{[1
]}

Patel, Manish M. ^{[1
]}

Randolph, Adrienne G. ^{[2
,4
,22
]}

机构：

[1] Centers Dis Control & Prevent, Influenza Div, Natl Ctr Immunizat & Resp Dis, Atlanta, GA USA

[2] Boston Childrens Hosp, Dept Anesthesiol Crit Care & Pain Med, Boston, MA USA

[3] Vanderbilt Univ, Div Pediat Infect Dis, Dept Pediat, Med Ctr, Nashville, TN USA

[4] Harvard Med Sch, Dept Anesthesia, Boston, MA USA

[5] Univ Penn, Div Crit Care, Dept Anesthesiol & Crit Care, Perelman Sch Med, Philadelphia, PA USA

[6] Northwestern Univ, Ann & Robert H Lurie Childrens Hosp Chicago, Div Crit Care Med, Dept Pediat,Feinberg Sch Med, Chicago, IL USA

[7] Childrens Mercy Kansas City, Div Pediat Infect Dis, Dept Pediat, Kansas City, MO USA

[8] Childrens Hosp Orange Cty, Dept Pediat, Orange, CA USA

[9] Univ Colorado, Dept Pediat, Sect Crit Care Med, Sch Med, Aurora, CO USA

[10] Childrens Hosp Colorado, Aurora, CO USA

[11] Nationwide Childrens Hosp, Dept Pediat, Div Crit Care Med, Columbus, OH USA

[12] Akron Childrens Hosp, Dept Pediat, Div Crit Care Med, Akron, OH USA

[13] Mott Childrens Hosp, Dept Pediat, Div Pediat Crit Care Med, Ann Arbor, MI USA

[14] Univ Michigan, Ann Arbor, MI USA

[15] St Barnabas Hosp, Dept Pediat, Div Pediat Crit Care, Livingston, NJ USA

[16] Univ Alabama Birmingham, Dept Pediat, Div Pediat Crit Care Med, Birmingham, AL USA

[17] Arkansas Childrens Hosp, Dept Pediat, Sect Pediat Crit Care, Little Rock, AR USA

[18] Univ Minnesota, Mason Childrens Hosp, Div Pediat Crit Care, Minneapolis, MN USA

[19] Univ Nebraska Med Ctr, Dept Pediat, Div Pediat Crit Care, Omaha, NE USA

[20] Rainbow Babies & Childrens Hosp, Div Pediat Crit Care Med, Cleveland, OH USA

[21] Penn State Univ, Penn State Hershey Childrens Hosp, Coll Med, Dept Pediat, Hershey, PA USA

[22] Harvard Med Sch, Dept Pediat, Boston, MA USA

来源：

CLINICAL INFECTIOUS DISEASES | 2022年 / 75卷 / 02期

关键词：

influenza; pediatrics; vaccination; severity; case control; SEASONAL INFLUENZA; UNITED-STATES; PREVENTION; RECOMMENDATIONS; INFECTIONS;

D O I：

10.1093/cid/ciab931

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background Predominance of 2 antigenically drifted influenza viruses during the 2019-2020 season offered an opportunity to assess vaccine effectiveness against life-threatening pediatric influenza disease from vaccine-mismatched viruses in the United States. Methods We enrolled children aged <18 years admitted to the intensive care unit with acute respiratory infection across 17 hospitals. Respiratory specimens were tested using reverse-transcription polymerase chain reaction for influenza viruses and sequenced. Using a test-negative design, we estimated vaccine effectiveness comparing odds of vaccination in test-positive case patients vs test-negative controls, stratifying by age, virus type, and severity. Life-threating influenza included death or invasive mechanical ventilation, vasopressors, cardiopulmonary resuscitation, dialysis, or extracorporeal membrane oxygenation. Results We enrolled 159 critically ill influenza case-patients (70% <= 8 years; 51% A/H1N1pdm09 and 25% B-Victoria viruses) and 132 controls (69% were aged <= 8 years). Among 56 sequenced A/H1N1pdm09 viruses, 29 (52%) were vaccine-mismatched (A/H1N1pdm09/5A+156K) and 23 (41%) were vaccine-matched (A/H1N1pdm09/5A+187A,189E). Among sequenced B-lineage viruses, majority (30 of 31) were vaccine-mismatched. Effectiveness against critical influenza was 63% (95% confidence interval [CI], 38% to 78%) and similar by age. Effectiveness was 75% (95% CI, 49% to 88%) against life-threatening influenza vs 57% (95% CI, 24% to 76%) against non-life-threating influenza. Effectiveness was 78% (95% CI, 41% to 92%) against matched A(H1N1)pdm09 viruses, 47% (95% CI, -21% to 77%) against mismatched A(H1N1)pdm09 viruses, and 75% (95% CI, 37% to 90%) against mismatched B-Victoria viruses. Conclusions During a season when vaccine-mismatched influenza viruses predominated, vaccination was associated with a reduced risk of critical and life-threatening influenza illness in children. In the largest study of its kind, vaccination averted most critical (63%) and life-threatening (75%) influenza among children aged <18 years. This reduction was impressive because vaccine components were mismatched to the 2 predominant circulating influenza strains during this season.

引用

页码：230 / 238

页数：9

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