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Marika K Iwane,
Sandra S Chaves,
Peter G Szilagyi,
Kathryn M Edwards,
Caroline B Hall,
Mary A Staat,
Cedric J Brown,
Marie R Griffin,
Geoffrey A Weinberg, Katherine A Poehling,
Mila M Prill,
John V Williams,
Carolyn B Bridges
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ABSTRACT: Few US studies have assessed racial disparities in viral respiratory hospitalizations among children. This study enrolled black and white children under 5 years of age who were hospitalized for acute respiratory illness (ARI) in 3 US counties during October-May 2002-2009. Population-based rates of hospitalization were calculated by race for ARI and laboratory-confirmed influenza and respiratory syncytial virus (RSV), using US Census denominators. Relative rates of hospitalization between racial groups were estimated. Of 1,415 hospitalized black children and 1,824 hospitalized white children with ARI enrolled in the study, 108 (8%) black children and 111 (6%) white children had influenza and 230 (19%) black children and 441 (29%) white children had RSV. Hospitalization rates were higher among black children than among white children for ARI (relative rate (RR) = 1.7, 95% confidence interval (CI): 1.6, 1.8) and influenza (RR = 2.1, 95% CI: 1.6, 2.9). For RSV, rates were similar among black and white children under age 12 months but higher for black children aged 12 months or more (for ages 12-23 months, RR = 1.7, 95% CI: 1.1, 2.5; for ages 24-59 months, RR = 2.2, 95% CI: 1.3, 3.6). Black children versus white children were significantly more likely to have public insurance or no insurance (85% vs. 43%) and a history of asthma/wheezing (28% vs. 18%) but not more severe illness. The observed racial disparities require further study.
American journal of epidemiology 02/2013; · 5.59 Impact Factor
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Katherine A Poehling,
Kathryn M Edwards,
Marie R Griffin,
Peter G Szilagyi,
Mary A Staat,
Marika K Iwane,
Beverly M Snively,
Cynthia K Suerken,
Caroline B Hall,
Geoffrey A Weinberg,
Sandra S Chaves,
Yuwei Zhu,
Monica M McNeal,
Carolyn B Bridges
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ABSTRACT: OBJECTIVE:To characterize the health care burden of influenza from 2004 through 2009, years when influenza vaccine recommendations were expanded to all children aged ≥6 months.METHODS:Population-based surveillance for laboratory-confirmed influenza was performed among children aged <5 years presenting with fever and/or acute respiratory illness to inpatient and outpatient settings during 5 influenza seasons in 3 US counties. Enrolled children had nasal/throat swabs tested for influenza by reverse transcriptase-polymerase chain reaction and their medical records reviewed. Rates of influenza hospitalizations per 1000 population and proportions of outpatients (emergency department and clinic) with influenza were computed.RESULTS:The study population comprised 2970, 2698, and 2920 children from inpatient, emergency department, and clinic settings, respectively. The single-season influenza hospitalization rates were 0.4 to 1.0 per 1000 children aged <5 years and highest for infants <6 months. The proportion of outpatient children with influenza ranged from 10% to 25% annually. Among children hospitalized with influenza, 58% had physician-ordered influenza testing, 35% had discharge diagnoses of influenza, and 2% received antiviral medication. Among outpatients with influenza, 7% were tested for influenza, 7% were diagnosed with influenza, and <1% had antiviral treatment. Throughout the 5 study seasons, <45% of influenza-negative children ≥6 months were fully vaccinated against influenza.CONCLUSIONS:Despite expanded vaccination recommendations, many children are insufficiently vaccinated, and substantial influenza burden remains. Antiviral use was low. Future studies need to evaluate trends in use of vaccine and antiviral agents and their impact on disease burden and identify strategies to prevent influenza in young infants.
PEDIATRICS 01/2013; · 4.47 Impact Factor
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ABSTRACT: We evaluated the limits of detection of 3 rapid influenza diagnostic tests-BD Veritor(TM) System for Flu A+B, Binax NOW® Influenza A+B, and QuickVue® Influenza-for influenza strains circulating in 2010-2012. Limits of detection varied by influenza strain, with Veritor(TM) Flu A+B test showing the lowest limit of detection for all strains.
Diagnostic microbiology and infectious disease 12/2012; · 2.45 Impact Factor
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ABSTRACT: We estimated the potential impact of parental Tdap immunization before delivery, at delivery and at the 2-week newborn visit on U.S. infant pertussis hospitalizations. We used published data for pertussis hospitalization rates among U.S. infants aged 0-4 months, the Tdap vaccine efficacy in adults, and the proportion of infants with pertussis <6 months of age in which either parent was the source (16-40% from mothers and 16-20% from fathers). Immunizing parents before pregnancy or ≥ 2 weeks prior to delivery should reduce pertussis hospitalizations among infants 0-4 months by 2694-9314 if both parents are vaccinated, and by 1347-6909 if only mothers are vaccinated. Greater reductions in pertussis hospitalizations would be achieved if parents are immunized ≥ 2 weeks prior to delivery than after delivery or the 2-week newborn visit. Although immunizing parents prior to pregnancy or delivery is best, immunizing parents in the postpartum period should provide protection to that newborn and to infants of subsequent pregnancies.
Vaccine 06/2012; 30(37):5527-32. · 3.77 Impact Factor
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ABSTRACT: Studies have documented direct medical costs of influenza-related illness in young children, however little is known about the out-of-pocket and indirect costs (e.g., missed work time) incurred by caregivers of children with medically attended influenza.
To determine the indirect, out-of-pocket (OOP), and direct medical costs of laboratory-confirmed medically attended influenza illness among young children.
Using a population-based surveillance network, we evaluated a representative group of children aged <5 years with laboratory-confirmed, medically attended influenza during the 2003-2004 season. Children hospitalized or seen in emergency department (ED) or outpatient settings in surveillance counties with laboratory-confirmed influenza were identified and data were collected from medical records, accounting databases, and follow-up interviews with caregivers. Outcome measures included work time missed, OOP expenses (e.g., over-the-counter medicines, travel expenses), and direct medical costs. Costs were estimated (in 2009 US Dollars) and comparisons were made among children with and without high risk conditions for influenza-related complications.
Data were obtained from 67 inpatients, 121 ED patients and 92 outpatients with laboratory-confirmed influenza. Caregivers of hospitalized children missed an average of 73 work hours (estimated cost $1456); caregivers of children seen in the ED and outpatient clinics missed 19 ($383) and 11 work hours ($222), respectively. Average OOP expenses were $178, $125 and $52 for inpatients, ED-patients and outpatients, respectively. OOP and indirect costs were similar between those with and without high risk conditions (p>0.10). Medical costs totaled $3990 for inpatients and $730 for ED-patients.
Out-of-pocket and indirect costs of laboratory-confirmed and medically attended influenza in young children are substantial and support the benefits of vaccination.
Vaccine 04/2012; 30(28):4175-81. · 3.77 Impact Factor
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ABSTRACT: We estimated the potential impact of administering the first dose of rotavirus vaccine at 6 weeks (42 days of life) instead of 2 months of age, which is permissible for all U.S. vaccines recommended at 2 months of age, on rotavirus hospitalization rates. We used published data for hospitalization rates, vaccine coverage, and vaccine efficacy after one dose and assumed a two-week delay in seroconversion after vaccine administration in the United States. Administering the first dose of rotavirus vaccine at 6 weeks instead of 8 weeks of age should have prevented 1110, 1660, and 2210 rotavirus hospitalizations among U.S. infants <3 months of age in 2006 when the vaccine was first introduced. This estimated benefit represents a 2-4% reduction in rotavirus hospitalizations among children <5 years of age.
Vaccine 02/2012; 30(17):2738-41. · 3.77 Impact Factor
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ABSTRACT: To estimate the impact of missed opportunities on influenza vaccination coverage among 6- through 23-month-old children who sought medical care during the 2004-2005 influenza season.
Retrospective cohort study.
Fifty-two primary care practice sites located in Rochester, New York, Nashville, Tennessee, and Cincinnati, Ohio.
Children 6 through 23 months of age. METHODS/OUTCOME MEASURE: Charts were reviewed and data collected on influenza vaccinations, type of health care visit (well child or other), and presence of illness symptoms. Missed opportunity was defined as a practice visit by an eligible child during influenza season, when vaccine was available, but during which the child did not receive an influenza vaccination. Vaccine was assumed to be available between the first and last dates influenza vaccination was recorded at that practice. Each child was classified as fully vaccinated, partially vaccinated, or unvaccinated.
Data were analyzed for 1724 children, 6 through 23 months of age. Most children (62.0%) had at least 1 missed opportunity during this period. Among children with any missed opportunities, 12.8% were fully and 29.8% were partially vaccinated. Overall, 33.6% of the missed opportunities occurred during well child visits and 66.4% during other types of visits; 75% occurred when no other vaccines were given. Eliminating all missed opportunities would have increased full vaccination coverage from 30.3% to 49.9%.
Missed opportunities for influenza vaccination are frequent. Reducing missed opportunities could significantly increase influenza vaccination rates and should be a goal in each practice.
Journal of public health management and practice: JPHMP 11/2011; 17(6):560-4. · 0.96 Impact Factor
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Mary Allen Staat,
Marie R Griffin,
Stephanie Donauer,
Kathryn M Edwards,
Peter G Szilagyi,
Geoffrey A Weinberg,
Caroline B Hall,
Mila M Prill,
Sandra S Chaves,
Carolyn B Bridges, Katherine A Poehling,
Gerry Fairbrother
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ABSTRACT: To estimate the effectiveness of influenza vaccine against medical care visits for laboratory-confirmed influenza in young children we conducted a matched case-control study in children with acute respiratory illness or fever from 2005-2007. Influenza vaccine effectiveness (VE) was calculated using cases with laboratory-confirmed influenza and controls who tested negative for influenza. The effectiveness of influenza vaccine in fully vaccinated children 6-59 months of age was 56% (95% CI: 25%-74%); a significant VE was not found for partial vaccination.
Vaccine 09/2011; 29(48):9005-11. · 3.77 Impact Factor
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Katherine A Poehling,
Peter G Szilagyi,
Mary A Staat,
Beverly M Snively,
Daniel C Payne,
Carolyn B Bridges,
Susan Y Chu,
Laney S Light,
Mila M Prill,
Lyn Finelli,
Marie R Griffin,
Kathryn M Edwards
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ABSTRACT: We sought to determine whether maternal vaccination during pregnancy was associated with a reduced risk of laboratory-confirmed influenza hospitalizations in infants <6 months old. Active population-based, laboratory-confirmed influenza surveillance was conducted in children hospitalized with fever and/or respiratory symptoms in 3 US counties from November through April during the 2002 through 2009 influenza seasons. The exposure, influenza vaccination during pregnancy, and the outcome, positive/negative influenza testing among their hospitalized infants, were compared using logistic regression analyses. Among 1510 hospitalized infants <6 months old, 151 (10%) had laboratory-confirmed influenza and 294 (19%) mothers reported receiving influenza vaccine during pregnancy. Eighteen (12%) mothers of influenza-positive infants and 276 (20%) mothers of influenza-negative infants were vaccinated (unadjusted odds ratio, 0.53; 95% confidence interval, 0.32-0.88 and adjusted odds ratio, 0.52; 95% confidence interval, 0.30-0.91). Infants of vaccinated mothers were 45-48% less likely to have influenza hospitalizations than infants of unvaccinated mothers. Our results support the current influenza vaccination recommendation for pregnant women.
American journal of obstetrics and gynecology 06/2011; 204(6 Suppl 1):S141-8. · 3.28 Impact Factor
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Katherine A Poehling,
Gerry Fairbrother,
Yuwei Zhu,
Stephanie Donauer,
Sandra Ambrose,
Kathryn M Edwards,
Mary Allen Staat,
Mila M Prill,
Lyn Finelli,
Norma J Allred,
Barbara Bardenheier,
Peter G Szilagyi
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ABSTRACT: The objective of this study was to determine both practice and child characteristics and practice strategies associated with receipt of influenza vaccine in young children during the 2004-2005 influenza season, the first season for the universal influenza vaccination recommendation for all children who are aged 6 to 23 months.
Clinical and demographic data from randomly selected children who were aged 6 to 23 months were obtained by chart review from a community-based cohort study in 3 US counties. The proportion of children who were vaccinated by April 5, 2005, in each practice was obtained. For assessment of practice characteristics and strategies, sampled practices received a self-administered practice survey. Practice and child characteristics that predicted complete influenza vaccination were determined by using multinomial logistic regression.
Forty-six (88%) of 52 sampled practices completed the survey and permitted chart reviews. Of 2384 children who were aged 6 to 23 months and were studied, 27% were completely vaccinated. The proportion of children who were completely vaccinated varied widely among practices (0%-71%). Most (87%) practices implemented ≥1 vaccination strategy. Complete influenza vaccination was associated with 3 practice characteristics: suburban location, lower patient volume, and vaccination strategies of evening/weekend vaccine clinics; with child characteristics of younger age, existing high-risk conditions, ≥6 well visits to the practice by 3 years of age, and any practice visit from October through January.
Modifiable factors that were associated with increased influenza vaccination coverage included October to January practice visits and evening/weekend vaccine clinics.
PEDIATRICS 10/2010; 126(4):665-73. · 4.47 Impact Factor
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ABSTRACT: To define the utility of using routine diagnostic methods to detect influenza in older, hospitalized adults.
Descriptive study.
One academic hospital and 1 community hospital during the 2006-2007 and 2007-2008 influenza seasons. Participants. Hospitalized adults 50 years of age or older.
Adults who were 50 years of age or older and hospitalized with symptoms of respiratory illness were enrolled and tested for influenza by use of reverse-transcriptase polymerase chain reaction (RT-PCR). Using RT-PCR as the gold standard, we assessed the performances of rapid antigen tests and conventional influenza culture and the diagnostic use of the clinical definition of influenza-like illness.
Influenza was detected by use of RT-PCR in 26 (11%) of 228 patients enrolled in our study. The sensitivity of the rapid antigen test performed at bedside by research staff members was 19.2% (95% confidence interval, 8.51%-37.9%); the sensitivity of conventional influenza culture was 34.6% (95% confidence interval, 19.4%-53.8%). The ability to detect influenza with both the rapid antigen test and culture was associated with patients with a higher viral load (P=.002 and P=.001, respectively). The ability to diagnose influenza by use of the clinical definition of influenza-like illness had a higher sensitivity (80.8%) but lacked specificity (40.6%).
Because rapid antigen testing and viral culture have poor sensitivity (19.2% and 34.6%, respectively), neither testing method is sufficient to use to determine what type of isolation procedures to implement in a hospital setting.
Infection Control and Hospital Epidemiology 07/2010; 31(7):683-8. · 3.67 Impact Factor
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ABSTRACT: The cause of historically higher rates of invasive pneumococcal disease among blacks than whites has remained unknown. We tested the hypothesis that sickle cell trait or hemoglobin C trait is an independent risk factor for invasive pneumococcal disease.
Eligible children were born in Tennessee (1996-2003), had a newborn screen, enrolled in TennCare aged <1 year, and resided in a Tennessee county with laboratory-confirmed, pneumococcal surveillance. Race/ethnicity was ascertained from birth certificates. Children were followed through 2005 until loss of enrollment, pneumococcal disease episode, fifth birthday, or death. We calculated incidence rates by race/ethnicity and hemoglobin type before and after pneumococcal conjugate vaccine (PCV7) introduction. Poisson regression analyses compared invasive pneumococcal disease rates among blacks with sickle cell trait or hemoglobin C trait with whites and blacks with normal hemoglobin, controlling for age, gender, time (pre-PCV7, transition year, or post-PCV7) and high-risk conditions (eg, heart disease).
Over 10 years, 415 invasive pneumococcal disease episodes occurred during 451,594 observed child-years. Before PCV7 introduction, disease rates/100,000 child-years were 2941 for blacks with sickle cell disease, 258 for blacks with sickle cell trait or hemoglobin C trait and 188, 172, and 125 for blacks, whites, and Hispanics with normal hemoglobin. Post-PCV7, rates declined for all groups. Blacks with sickle cell trait or hemoglobin C trait had 77% (95% CI = 22-155) and 42% (95% CI = 1-100) higher rates than whites and blacks with normal hemoglobin.
Black children with sickle cell trait or hemoglobin C trait have an increased risk of invasive pneumococcal disease.
Epidemiology (Cambridge, Mass.) 03/2010; 21(3):340-6. · 5.51 Impact Factor
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ABSTRACT: Outpatient burden of laboratory-confirmed influenza among children in Knox and Davidson Counties was compared in 2006-2007 when only Knox County had a school-based influenza vaccine campaign. Of 1016 eligible children seeking outpatient care, 87% were enrolled and 20% were influenza-positive. Estimated influenza vaccination coverage was similar in Knox and Davidson for preschool-age children (36% versus 33%) but higher in Knox County for school-age children (44% versus 12%). Influenza detection was higher among Knox than Davidson County preschool-age children (18% versus 10%) but similar among school-age children (28% versus 27%). These data are consistent with a direct effect of the campaign in school-age children.
Vaccine 06/2009; 27(20):2695-700. · 3.77 Impact Factor
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ABSTRACT: To estimate the potential effect of the acceleration of administration of the first dose of pneumococcal conjugate vaccine from 2 months to 6 weeks of age.
Prediction model using data from a retrospective cohort study.
Published data from 8 states that participated in Active Bacterial Core Surveillance of the Emerging Infections Program Network for pneumococcus before pneumococcal conjugate vaccine introduction (July 1, 1997- June 30, 2000).
A total of 759 739 live births under surveillance. Intervention Estimating the potential benefit of administration of the first dose of the pneumococcal conjugate vaccine at 6 weeks of age instead of 2 months of age.
Estimation of reduction in the rate of invasive pneumococcal disease in infants 61 to 90 days of age.
The estimated direct effect of the acceleration of administration of the first dose of pneumococcal conjugate vaccine from 2 months to 6 weeks of age when this vaccine was first introduced could have reduced the burden of invasive pneumococcal disease in infants 61 to 90 days of age by 39.9%, 56.0%, and 72.1% for respective vaccine efficacies of 50%, 70%, and 90%. This translates into preventing an estimated 73, 103, and 133 cases of invasive pneumococcal disease per year among approximately 4 112 052 live births in the United States.
The acceleration of administration of the pneumococcal conjugate vaccine from 2 months to 6 weeks of age could reduce the burden of invasive pneumococcal disease among infants. This observation may be important when a new conjugate vaccine becomes available, particularly among populations with prevalent invasive pneumococcal disease from a serotype included in the new vaccine.
Archives of pediatrics & adolescent medicine 06/2009; 163(5):422-5. · 3.73 Impact Factor
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ABSTRACT: The extent to which immunizing school children reduce the burden of influenza in adults is controversial. We enrolled a systematic sample of adults > or = 50 years hospitalized with respiratory symptoms in two counties, one with and one without a school-based immunization program. We tested all subjects for influenza by polymerase chain reaction. Hospitalizations per 1000 adults aged > or = 50 years were 1.28 (95% CI 0.59, 2.04) in the intervention county and 1.53 (95% CI 0.71, 2.34) in the control county. These rates did not differ significantly except in the subgroup aged 50 -- 64 years where rates in the intervention county were significantly lower.
Vaccine 04/2009; 27(13):1923-7. · 3.77 Impact Factor
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Caroline Breese Hall,
Geoffrey A Weinberg,
Marika K Iwane,
Aaron K Blumkin,
Kathryn M Edwards,
Mary A Staat,
Peggy Auinger,
Marie R Griffin, Katherine A Poehling,
Dean Erdman,
Carlos G Grijalva,
Yuwei Zhu,
Peter Szilagyi
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ABSTRACT: The primary role of respiratory syncytial virus (RSV) in causing infant hospitalizations is well recognized, but the total burden of RSV infection among young children remains poorly defined.
We conducted prospective, population-based surveillance of acute respiratory infections among children under 5 years of age in three U.S. counties. We enrolled hospitalized children from 2000 through 2004 and children presenting as outpatients in emergency departments and pediatric offices from 2002 through 2004. RSV was detected by culture and reverse-transcriptase polymerase chain reaction. Clinical information was obtained from parents and medical records. We calculated population-based rates of hospitalization associated with RSV infection and estimated the rates of RSV-associated outpatient visits.
Among 5067 children enrolled in the study, 919 (18%) had RSV infections. Overall, RSV was associated with 20% of hospitalizations, 18% of emergency department visits, and 15% of office visits for acute respiratory infections from November through April. Average annual hospitalization rates were 17 per 1000 children under 6 months of age and 3 per 1000 children under 5 years of age. Most of the children had no coexisting illnesses. Only prematurity and a young age were independent risk factors for hospitalization. Estimated rates of RSV-associated office visits among children under 5 years of age were three times those in emergency departments. Outpatients had moderately severe RSV-associated illness, but few of the illnesses (3%) were diagnosed as being caused by RSV.
RSV infection is associated with substantial morbidity in U.S. children in both inpatient and outpatient settings. Most children with RSV infection were previously healthy, suggesting that control strategies targeting only high-risk children will have a limited effect on the total disease burden of RSV infection.
New England Journal of Medicine 03/2009; 360(6):588-98. · 53.30 Impact Factor
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ABSTRACT: To determine the population-based inpatient disease burden of parainfluenza virus in children <5 years of age.
The New Vaccine Surveillance Network (NVSN) enrolled children <5 years of age who were hospitalized with febrile or acute respiratory illnesses. Surveillance hospitals admitted >95% of all hospitalized children from each county. Combined nasal turbinate/throat swabs were tested for parainfluenza virus (PIV), respiratory syncytial virus, and influenza virus with culture and reverse-transcription-polymerase chain reaction. Both parental interviews and medical chart reviews were conducted. Age-specific population-based hospitalization rates were calculated.
From October 2000 through September 2004, 2798 children were enrolled. A total of 191 PIVs were identified from 189 children (6.8% of enrolled: 73 PIV type 1, 23 PIV type 2, and 95 PIV type 3), compared with 521 respiratory syncytial viruses and 159 influenza viruses. Mean PIV hospitalization rates were 3.01, 1.73, 1.53, 0.39, and 1.02 per 1000 children per year for ages 0 to 5 months, 6 to 11 months, 12 to 23 months, 24 to 59 months, and 0 to 59 months, respectively.
PIV accounted for 6.8% of all hospitalizations for fever, acute respiratory illnesses, or both in children <5 years of age. The pediatric PIV inpatient burden is substantial and highlights the need to find an effective vaccine candidate.
The Journal of pediatrics 01/2009; 154(5):694-9. · 4.02 Impact Factor
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Katherine W Eisenberg,
Peter G Szilagyi,
Gerry Fairbrother,
Marie R Griffin,
Mary Staat,
Laura P Shone,
Geoffrey A Weinberg,
Caroline B Hall, Katherine A Poehling,
Kathryn M Edwards,
Geraldine Lofthus,
Susan G Fisher,
Carolyn B Bridges,
Marika K Iwane
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ABSTRACT: The goal was to estimate the effectiveness of influenza vaccination against laboratory-confirmed influenza during the 2003-2004 and 2004-2005 influenza seasons in children 6 to 59 months of age.
We conducted a case-control study with children with medically attended, acute respiratory infections who received care in an inpatient, emergency department, or outpatient clinic setting during 2 consecutive influenza seasons. All children residing in Monroe County, New York, Davidson County, Tennessee, or Hamilton County, Ohio, were enrolled prospectively at the time of acute illness and had nasal/throat swabs tested for influenza with cultures and/or polymerase chain reaction assays. Children with laboratory-confirmed influenza were case subjects and children who tested negative for influenza were control subjects. Child vaccination records from the parent and the child's physician were used to determine and to validate influenza vaccination status. Influenza vaccine effectiveness was calculated as (1 - adjusted odds ratio) x 100.
We enrolled 288 case subjects and 744 control subjects during the 2003-2004 season and 197 case subjects and 1305 control subjects during the 2004-2005 season. Six percent and 19% of all study children were fully vaccinated according to immunization guidelines in the respective seasons. Full vaccination was associated with significantly fewer influenza-related inpatient, emergency department, or outpatient clinic visits in 2004-2005 (vaccine effectiveness: 57%) but not in 2003-2004 (vaccine effectiveness: 44%). Partial vaccination was not effective in either season.
Receipt of all recommended doses of influenza vaccine was associated with halving of laboratory-confirmed influenza-related medical visits among children 6 to 59 months of age in 1 of 2 study years, despite suboptimal matches between the vaccine and circulating influenza strains in both years.
PEDIATRICS 12/2008; 122(5):911-9. · 4.47 Impact Factor
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ABSTRACT: This study estimates the potential impact, on rates of pertussis infections, hospitalizations, and deaths among infants in the United States, of administering the first dose of diphtheria and tetanus toxoids and acellular pertussis vaccine at 6 weeks rather than 2 months of age.
We used existing data to estimate current US rates of pertussis infections, hospitalizations, and deaths according to age and infant population in 2004. We then estimated the potential impact of accelerating the administration of the first dose of diphtheria and tetanus toxoids and acellular pertussis vaccine from 2 months to 6 weeks of age, an alternative schedule consistent with current vaccination guidelines. We used Poisson distribution analysis to determine 95% confidence intervals for projected rates of pertussis disease.
Acceleration of administration of the first dose of diphtheria and tetanus toxoids and acellular pertussis vaccine from 2 months to 6 weeks of age is expected to prevent 1236 cases of pertussis, 898 hospitalizations, and 7 deaths attributable to pertussis per year in the United States. These decreases represent 9% reduction in cases, 9% reduction in hospitalizations, and 6% reduction in deaths attributable to pertussis among infants <3 months of age. Acceleration of the second and third doses by 2 weeks is expected to prevent an additional 923 cases, 520 hospitalizations, and 2 deaths attributable to pertussis each year.
Acceleration of administration of diphtheria and tetanus toxoids and acellular pertussis vaccine from 2 months to 6 weeks should reduce the burden of pertussis among young infants.
PEDIATRICS 11/2008; 122(5):1021-6. · 4.47 Impact Factor
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Peter G Szilagyi,
Gerry Fairbrother,
Marie R Griffin,
Richard W Hornung,
Stephanie Donauer,
Ardythe Morrow,
Mekibib Altaye,
Yuwei Zhu,
Sandra Ambrose,
Kathryn M Edwards, Katherine A Poehling,
Geraldine Lofthus,
Michol Holloway,
Lyn Finelli,
Marika Iwane,
Mary Allen Staat
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ABSTRACT: To measure vaccine effectiveness (VE) in preventing influenza-related health care visits among children aged 6 to 59 months during 2 consecutive influenza seasons.
Case-cohort study estimating effectiveness of inactivated influenza vaccine in preventing inpatient/outpatient visits (emergency department [ED] and outpatient clinic). We compared vaccination status of laboratory-confirmed influenza cases with a cluster sample of children from a random sample of practices in 3 counties (subcohort) during the 2003-2004 and 2004-2005 seasons.
Counties encompassing Rochester, New York, Nashville, Tennessee, and Cincinnati, Ohio.
Children aged 6 to 59 months seen in inpatient/ED or outpatient clinic settings for acute respiratory illnesses and community-based subcohort comparison. Main Exposure Influenza vaccination.
Influenza vaccination status of cases vs subcohort using time-dependent Cox proportional hazards models to estimate VE in preventing inpatient/ED and outpatient visits.
During the 2003-2004 and 2004-2005 seasons, 165 and 80 inpatient/ED and 74 and 95 outpatient influenza cases were enrolled, while more than 4500 inpatient/ED and more than 600 outpatient subcohorts were evaluated, respectively. In bivariate analyses, cases had lower vaccination rates than subcohorts. However, significant influenza VE could not be demonstrated for any season, age, or setting after adjusting for county, sex, insurance, chronic conditions recommended for influenza vaccination, and timing of influenza vaccination (VE estimates ranged from 7%-52% across settings and seasons for fully vaccinated 6- to 59-month-olds).
In 2 seasons with suboptimal antigenic match between vaccines and circulating strains, we could not demonstrate VE in preventing influenza-related inpatient/ED or outpatient visits in children younger than 5 years. Further study is needed during years with good vaccine match.
Archives of pediatrics & adolescent medicine 11/2008; 162(10):943-51. · 3.73 Impact Factor
