The effectiveness of influenza vaccination in preventing hospitalisation in children in Western Australia |
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| Institution: | 1. School of Paediatrics and Child Health, University of Western Australia, Perth, Australia;2. Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia;3. Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children, Perth, Australia;4. Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia;5. Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;6. Communicable Disease Control Directorate, WA Department of Health, Perth, Australia;7. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia;8. Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine WA, Perth, Australia;9. Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia;10. Australian National University, Canberra, Australia;11. National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, University of Sydney, Sydney, Australia;12. Children''s Hospital Westmead, University of Sydney, Sydney, Australia;13. Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Australia;1. National Centre for Immunisation Research and Surveillance (NCIRS), The Children''s Hospital at Westmead, and the Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, NSW, Australia;2. Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia;3. King Abdullah Medical City, Makkah, Saudi Arabia;4. Al Maha Children Unit, Hamad Medical Corporation, Doha, Qatar;5. Ministry of Health, and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia;6. Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, University of Sydney, Sydney, Australia;1. School of Paediatrics and Child Health, University of Western Australia, Subiaco, WA, Australia;2. Princess Margaret Hospital for Children, Subiaco, WA, Australia;3. Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, WA, Australia;4. PathWest Laboratory Medicine WA, Nedlands, WA, Australia;5. Communicable Disease Control Directorate, Department of Health, Perth, WA, Australia;6. Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC, Australia;7. Australian National University, Canberra, ACT, Australia;8. School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia;1. PathWest Laboratory Medicine, Perth, WA, Australia;2. WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, VIC, Australia;3. University of Melbourne, Melbourne, VIC, Australia;4. Department of Health (Western Australia), Perth, WA, Australia;1. Instituto de Salud Pública de Navarra, IdiSNA–Navarra Institute for Health Research, Pamplona, Spain;2. CIBER Epidemiología y Salud Pública (CIBERESP), Spain;3. Complejo Hospitalario de Navarra, IdiSNA–Navarra Institute for Health Research, Pamplona, Spain;4. Clínica Universidad de Navarra, IdiSNA–Navarra Institute for Health Research, Pamplona, Spain;5. Centro Nacional de Microbiología (WHO National Influenza Centre–Madrid), Instituto de Salud Carlos III, Majadahonda, Spain;1. Victorian Infectious Diseases Reference Laboratory, The Doherty Institute, Melbourne, Victoria, Australia;2. National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia;3. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia;4. PathWest Laboratory Medicine WA, Perth, Western Australia, Australia;5. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia;6. Discipline of General Practice, University of Adelaide, Adelaide, South Australia, Australia;7. World Health Organization Collaborating Centre for Reference and Research on Influenza, The Doherty Institute, Melbourne, Victoria, Australia;8. Communicable Disease Control Directorate, Western Australia Department of Health, Perth, Western Australia, Australia;9. Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA |
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| Abstract: | BackgroundThere is increasing evidence demonstrating influenza vaccine effectiveness (VE) in the prevention of influenza in children, including the very young. Data demonstrating the effectiveness against severe disease, including hospitalisation, are limited. We aimed to determine the VE of the southern hemisphere trivalent inactivated influenza vaccine (TIV) in preventing laboratory-confirmed influenza-associated hospitalisation in children.Patients and MethodsLaboratory records were used to identify children with confirmed influenza hospitalised (i.e., cases) during a 5 year period (2008, 2010–2013) at the only tertiary paediatric facility in Western Australia. Cases and time, age and ward matched controls were retrospectively reviewed to determine risk factors, vaccination status and outcome. Adjusted odds ratios and VE estimates were derived using conditional logistic regression models.ResultsThree hundred and eighty five cases were identified (Influenza A, 64.9%; Influenza B, 35.1%). Influenza-like illness and pneumonia were the most frequent presentation (74.5% and 23.9%, respectively). The median length of stay was 2 days (Interquartile range 1–4 days). Twenty children (5.2%) required admission to the intensive care unit. Vaccine uptake in cases and controls was low (4.9% and 8.5%, respectively). Three hundred and six case-control pairs were included in the VE analysis, of which 19 pairs were informative with discrepant vaccination status. VE (fully vaccinated vs. unvaccinated) was estimated to be 62.3% (95% CI: ?6.6%, 86.7%).ConclusionIn this study, the point estimate for the effectiveness of TIV in preventing influenza-associated hospitalisation in children was similar to that reported for emergency or outpatient attended, laboratory-confirmed influenza, yet confidence intervals were wide. Vaccine uptake remains low. Studies, enroling larger numbers of children, ideally with higher vaccine uptake, are needed to provide additional evidence on TIV protection against influenza hospitalisation in children. |
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