Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children

Author:

Olson Samantha M1ORCID,Newhams Margaret M2,Halasa Natasha B3,Feldstein Leora R1,Novak Tanya24,Weiss Scott L5,Coates Bria M6,Schuster Jennifer E7,Schwarz Adam J8,Maddux Aline B9,Hall Mark W10,Nofziger Ryan A11,Flori Heidi R12,Gertz Shira J13,Kong Michele14,Sanders Ronald C15,Irby Katherine15,Hume Janet R16,Cullimore Melissa L17,Shein Steven L18,Thomas Neal J19,Stewart Laura S3,Barnes John R1,Patel Manish M1,Randolph Adrienne G2420,Michele Kong21,Murdock Meghan22,Sanders Ronald C23,Irby Katherine23,Hefley Glenda23,Schwarz Adam J24,Flores Cathy24,Vargas-Shiraishi Ofelia24,Maddux Aline B25,Mourani Peter M25,Van Kevin A25,Coates Bria M26,Shukla Avani26,Chavez Jairo26,Randolph Adrienne G27,Newhams Margaret M27,Novak Tanya27,Chen Sabrina R27,Jung Emily27,Flori Heidi R28,Dahmer Mary K28,Jayachandran Chaandini28,Hume Janet R29,Goertzen Lexie29,Faanes Brittany29,Schuster Jennifer E30,Bledsoe Megan C30,Clark Shannon E30,Cullimore Melissa L31,Wellman Rachel L31,Gertz Shira J32,Nofziger Ryan A33,Twinem Nicole33,Shein Steven L34,Lansell Amanda N34,Rasal Rajashri34,Hall Mark W35,Flowers Maggie35,Steele Lisa35,Weiss Scott L36,Bush Jenny L36,Burnett Ryan H36,Thomas Neal J37,Spear Debra37,Halasa Natasha B38,Stewart Laura S38,Lynch Tricia L38,Olson Samantha M38,Patel Manish M38,Feldstein Leora R38,Barnes John R38,Le Shoshona38,DaSilva Juliana38,Keong Lisa38,Stark Thomas38,Kondor Rebecca Garten38,Michael Wu38,

Affiliation:

1. Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

2. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA

3. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA

4. Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA

5. Division of Critical Care, Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA

6. Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA

7. Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri, USA

8. Department of Pediatrics, Children’s Hospital of Orange County, Orange, California, USA

9. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital  Colorado, Aurora, Colorado, USA

10. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA

11. Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio, USA

12. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children’s Hospital and University of Michigan, Ann Arbor, Michigan, USA

13. Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey, USA

14. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA

15. Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas, USA

16. Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota, USA

17. Division of Pediatric Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA

18. Division of Pediatric Critical Care Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA

19. Department of Pediatrics, Penn State Hershey Children’s Hospital, Penn State University College of Medicine, Hershey, Pennsylvania, USA

20. Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

21. Alabama: Children’s of Alabama, Birmingham

22. Arkansas: Arkansas Children’s Hospital, Little Rock

23. California: Children’s Hospital of Orange County, Orange County

24. Colorado: Children’s Hospital Colorado, Aurora

25. Illinois: Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago

26. Massachusetts: Boston Children’s Hospital, Boston

27. Michigan: University of Michigan CS Mott Children’s Hospital, Ann Arbor

28. Minnesota: University of Minnesota Masonic Children’s Hospital, Minneapolis

29. Missouri: Children’s Mercy Hospital, Kansas City

30. Nebraska: Children’s Hospital & Medical Center, Omaha

31. New Jersey: St. Barnabas Medical Center, Livingston

32. Ohio: Akron Children’s Hospital, Akron

33. University Hospitals Rainbow Babies and Children’s Hospital, Cleveland

34. Nationwide Children’s Hospital, Columbus

35. Pennsylvania: Children’s Hospital of Philadelphia, Philadelphia

36. Penn State Children’s Hospital, Hershey

37. Tennessee: Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville

38. Centers for Disease Control and Prevention (CDC)

Abstract

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.

Funder

Centers for Disease Control and Prevention

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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