NDLI: Association of Prior Vaccination With Influenza Vaccine Effectiveness in Children Receiving Live Attenuated or Inactivated Vaccine

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Association of Prior Vaccination With Influenza Vaccine Effectiveness in Children Receiving Live Attenuated or Inactivated Vaccine

Content Provider	JAMA Network
Author	McLean, Huong Q. Caspard, Herve Griffin, Marie R. Gaglani, Manjusha Peters, Timothy R. Poehling, Katherine A. Ambrose, Christopher S. Belongia, Edward A.
Copyright Year	2018
Abstract	Importance: Some studies have reported negative effects of prior-season influenza vaccination. Prior-season influenza vaccination effects on vaccine effectiveness ( VE) in children are not well understood. Objective: To assess the association of prior-season influenza vaccination with subsequent VE in children aged 2 to 17 years. Design, Setting, and Participants: This multiseason, test-negative case-control study was conducted in outpatient clinics at 4 US sites among children aged 2 to 17 years with a medically attended febrile acute respiratory illness. Participants were recruited during the 2013-2014, 2014-2015, and 2015-2016 seasons when influenza circulated locally. Cases were children with influenza confirmed by reverse-transcription polymerase chain reaction. Test-negative control individuals were children with negative test results for influenza. Exposures: Vaccination history, including influenza vaccine type received in the enrollment season (live attenuated influenza vaccine [ LAIV], inactivated influenza vaccine [ IIV], or no vaccine) and season before enrollment ( LAIV, IIV, or no vaccine), determined from medical records and immunization registries. Main Outcomes and Measures: LAIV and IIV effectiveness by influenza type and subtype (influenza A[ H1N1]pdm09, influenza A[ H3N2], or influenza B), estimated as 100 × (1 − odds ratio) in a logistic regression model with adjustment for potential confounders. Prior season vaccination associations were assessed with an interaction term. Results: Of 3369 children (1749 [52%] male; median age, 6.6 years [range, 2-17 years]) included in the analysis, 772 (23%) had a positive test result for influenza and 1674 (50%) were vaccinated in the enrollment season. Among LAIV recipients, VE against influenza A( H3N2) was higher among children vaccinated in both the enrollment and 1 prior season (50.3% [95% CI, 17.0% to 70.2%]) than among those without 1 prior season vaccination (−82.4% [95% CI, −267.5% to 9.5%], interaction: P < .001). The effectiveness of LAIV against influenza A( H1N1)pdm09 was not associated with prior season vaccination among those with prior season vaccination (47.5% [95% CI, 11.4% to 68.9%]) and among those without prior season vaccination (7.8% [95% CI, −101.9% to 57.9%]) (interaction: P = .37). Prior season vaccination was not associated with effectiveness of IIV against influenza A( H3N2) (38.7% [95% CI, 6.8% to 59.6%] among those with prior-season vaccination and 23.2% [95% CI, −38.3% to 57.4%] among those without prior-season vaccination, interaction: P = .16) or with effectiveness of IIV against influenza A[ H1N1]pdm09 (72.4% [95% CI, 56.0% to 82.7%] among those with prior season vaccination and 67.5% [95% CI, 32.1% to 84.4%] among those without prior season vaccination, interaction: P = .93). Residual protection from prior season vaccination only (no vaccination in the enrollment season) was observed for influenza B ( LAIV: 60.0% [95% CI, 36.8% to 74.7%]; IIV: 60.0% [36.9% to 74.6%]). Similar results were observed in analyses that included repeated vaccination in 2 and 3 prior seasons. Conclusions and Relevance: Influenza VE varied by influenza type and subtype and vaccine type, but prior-season vaccination was not associated with reduced VE. These findings support current recommendations for annual influenza vaccination of children.
Ending Page	e183742
Starting Page	e183742
File Format	PDF HTM / HTML
ISSN	25743805
DOI	10.1001/jamanetworkopen.2018.3742
Issue Number	6
Journal	JAMA Network Open
Volume Number	1
Language	English
Publisher	American Medical Association
Publisher Date	2018-10-05
Access Restriction	Open
Subject Keyword	influenza vaccines vaccination vaccines trivalent live attenuated influenza vaccine swine influenza influenzavirus a influenza swine-origin influenza virus h1n1 subtype influenza a virus influenzavirus b attenuation Infectious Diseases
Content Type	Text
Resource Type	Article
Subject	Medicine

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