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Influenza Vaccine Effectiveness for Fully and Partially Vaccinated Children 6 Months to 8 Years Old During 2011-2012 and 2012-2013: The Importance of Two Priming Doses.

ABSTRACT: Few studies have examined the effectiveness of full versus partial vaccination with inactivated trivalent influenza vaccines (IIV3) as defined by the US CDC Advisory Committee on Immunization Practices.Respiratory swabs were collected from outpatients aged 6 months to 8 years with acute cough for ?7 days in clinics in 5 states during the 2011-2012 and 2012-2013 influenza seasons. Influenza was confirmed by real-time reverse transcription polymerase chain reaction assay. Receipt of current season IIV3 and up to 4 prior vaccinations was documented from medical records and immunization registries. Using a test-negative design, vaccine effectiveness (VE) was estimated adjusting for age, race/ethnicity, medical conditions, study site and month of enrollment.We did not observe higher VE for children fully versus partially vaccinated with IIV3, as defined by US Advisory Committee on Immunization Practice, although our sample of partially vaccinated children was relatively small. However, among children aged 2-8 years in both seasons and against A(H3N2) and B influenza illness separately, VE point estimates were consistently higher for children who had received 2 doses in the same prior season compared with those without (VE range of 58%-80% vs. 33%-44%, respectively). Across seasons, the odds of A(H3N2) illness despite IIV3 vaccination were 2.4-fold (95% confidence interval: 1.4-4.3) higher among children who had not received 2 doses in the same prior season. We also noted residual protection among unvaccinated children who were vaccinated the previous season (VE range = 36%-40% across outcomes).Vaccination with IIV3 may provide preventive benefit in subsequent seasons, including possible residual protection if vaccination is missed. Two vaccine doses in the same season may be more effective than alternative priming strategies.

SUBMITTER: Thompson MG

PROVIDER: S-EPMC5218633 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Influenza Vaccine Effectiveness for Fully and Partially Vaccinated Children 6 Months to 8 Years Old During 2011-2012 and 2012-2013: The Importance of Two Priming Doses.

Thompson Mark G MG Clippard Jessie J Petrie Joshua G JG Jackson Michael L ML McLean Huong Q HQ Gaglani Manjusha M Reis Evelyn C EC Flannery Brendan B Monto Arnold S AS Jackson Lisa L Belongia Edward A EA Murthy Kempapura K Zimmerman Richard K RK Thaker Swathi S Fry Alicia M AM

The Pediatric infectious disease journal 20160301 3

<h4>Background</h4>Few studies have examined the effectiveness of full versus partial vaccination with inactivated trivalent influenza vaccines (IIV3) as defined by the US CDC Advisory Committee on Immunization Practices.<h4>Methods</h4>Respiratory swabs were collected from outpatients aged 6 months to 8 years with acute cough for ≤7 days in clinics in 5 states during the 2011-2012 and 2012-2013 influenza seasons. Influenza was confirmed by real-time reverse transcription polymerase chain reacti ...[more]

PMID: 26658375

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Project description:BackgroundThe pathogenesis of acute measles encephalitis (AME) is poorly understood. Treatment with immune-modulators is based on theories that post-infectious autoimmune responses cause demyelination. The clinical course and immunological parameters of AME were examined during an outbreak in Vietnam.Methods and findingsFifteen measles IgM-positive patients with confusion or Glasgow Coma Scale (GCS) score below 13, and thirteen with uncomplicated measles were enrolled from 2008-2010. Standardized clinical exams were performed and blood collected for lymphocyte and measles- and auto-antibody analysis. The median age of AME patients was 21 years, similar to controls. Eleven reported receiving measles vaccination when aged one year. Confusion developed a median of 4 days after rash. Six patients had GCS <8 and four required mechanical ventilation. CSF showed pleocytosis (64%) and proteinorrhachia (71%) but measles virus RNA was not detected. MRI revealed bilateral lesions in the cerebellum and brain stem in some patients. Most received dexamethasone +/- IVIG within 4 days of admission but symptoms persisted for ?3 weeks in five. The concentration of voltage gated calcium channel-complex-reactive antibodies was 900 pM in one patient, and declined to 609 pM ? 3 months later. Measles-reactive IgG antibody avidity was high in AME patients born after vaccine coverage exceeded 50% (? 25 years earlier). AME patients had low CD4 (218/µl, p?=?0.029) and CD8 (200/µl, p?=?0.012) T-cell counts compared to controls.ConclusionYoung adults presenting with AME in Vietnam reported a history of one prior measles immunization, and those aged <25 years had high measles-reactive IgG avidity indicative of prior vaccination. This suggests that one-dose measles immunization is not sufficient to prevent AME in young adults and reinforces the importance of maintaining high coverage with a two-dose measles immunization schedule. Treatment with corticosteroids and IVIG is common practice, and should be assessed in randomized clinical trials.

Dataset Information

Influenza Vaccine Effectiveness for Fully and Partially Vaccinated Children 6 Months to 8 Years Old During 2011-2012 and 2012-2013: The Importance of Two Priming Doses.

Publications

Influenza Vaccine Effectiveness for Fully and Partially Vaccinated Children 6 Months to 8 Years Old During 2011-2012 and 2012-2013: The Importance of Two Priming Doses.

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