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- Title
Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children.
- Authors
Olson, Samantha M; Newhams, Margaret M; Halasa, Natasha B; Feldstein, Leora R; Novak, Tanya; Weiss, Scott L; Coates, Bria M; Schuster, Jennifer E; Schwarz, Adam J; Maddux, Aline B; Hall, Mark W; Nofziger, Ryan A; Flori, Heidi R; Gertz, Shira J; Kong, Michele; Sanders, Ronald C; Irby, Katherine; Hume, Janet R; Cullimore, Melissa L; Shein, Steven L
- Abstract
Background Predominance of 2 antigenically drifted influenza viruses during the 2019–2020 season offered an opportunity to assess vaccine effectiveness against life-threatening pediatric influenza disease from vaccine-mismatched viruses in the United States. Methods We enrolled children aged <18 years admitted to the intensive care unit with acute respiratory infection across 17 hospitals. Respiratory specimens were tested using reverse-transcription polymerase chain reaction for influenza viruses and sequenced. Using a test-negative design, we estimated vaccine effectiveness comparing odds of vaccination in test-positive case patients vs test-negative controls, stratifying by age, virus type, and severity. Life-threating influenza included death or invasive mechanical ventilation, vasopressors, cardiopulmonary resuscitation, dialysis, or extracorporeal membrane oxygenation. Results We enrolled 159 critically ill influenza case-patients (70% ≤8 years; 51% A/H1N1pdm09 and 25% B-Victoria viruses) and 132 controls (69% were aged ≤8 years). Among 56 sequenced A/H1N1pdm09 viruses, 29 (52%) were vaccine-mismatched (A/H1N1pdm09/5A+156K) and 23 (41%) were vaccine-matched (A/H1N1pdm09/5A+187A,189E). Among sequenced B-lineage viruses, majority (30 of 31) were vaccine-mismatched. Effectiveness against critical influenza was 63% (95% confidence interval [CI], 38% to 78%) and similar by age. Effectiveness was 75% (95% CI, 49% to 88%) against life-threatening influenza vs 57% (95% CI, 24% to 76%) against non-life-threating influenza. Effectiveness was 78% (95% CI, 41% to 92%) against matched A(H1N1)pdm09 viruses, 47% (95% CI, –21% to 77%) against mismatched A(H1N1)pdm09 viruses, and 75% (95% CI, 37% to 90%) against mismatched B-Victoria viruses. Conclusions During a season when vaccine-mismatched influenza viruses predominated, vaccination was associated with a reduced risk of critical and life-threatening influenza illness in children.
- Subjects
UNITED States; INFLUENZA treatment; INFLUENZA vaccines; DRUG efficacy; REVERSE transcriptase polymerase chain reaction; CONFIDENCE intervals; TREATMENT effectiveness; DESCRIPTIVE statistics; DATA analysis software; LOGISTIC regression analysis; CHILDREN
- Publication
Clinical Infectious Diseases, 2022, Vol 75, Issue 2, p230
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciab931