Influenza in Infants Born to Women Vaccinated During Pregnancy

Shakib, Julie H.; Korgenski, Kent; Presson, Angela P.; Sheng, Xiaoming; Varner, Michael W.; Pavia, Andrew T.; Byington, Carrie L.

doi:10.1542/peds.2015-2360

Cited by 74 publications

(69 citation statements)

References 24 publications

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“…14 Studies have shown that maternal influenza vaccination can prevent influenza in infants; therefore, pregnant women should receive influenza vaccination to protect their infants. 15,16 The age-group 6 month to <5 years was the largest cohort (54%) with the second-highest hospitalization rate and the highest complication rate (30.6%) especially neurologic, similar to another study. 17 In other studies, the age-group 6-35 months or the lowest agegroups had the highest incidence of complications.…”

Section: Discussionsupporting

confidence: 83%

“…11,16 20,24 In two published studies, encephalitis, encephalopathy, and febrile seizures constituted 0.6%-4.4% of influenza admissions, whereas these constituted 10.3% of our admissions. 16,20 In a study of influenza vaccine uptake, only 51% and 46% of physicians recognized epilepsy and intellectual disability as high-risk conditions. 25 Physicians should routinely offer influenza vaccination to patients with a prior seizure disorder, neurologic conditions or developmental delay.…”

Section: Discussionmentioning

confidence: 87%

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The burden and clinical manifestation of hospitalized influenza among different pediatric age‐groups in the tropics

Chong

Yung

Gan

et al. 2019

Influenza Resp Viruses

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IntroductionIn tropical Singapore, influenza occurs all year‐round. This study of influenza‐confirmed hospitalized pediatric patients compared clinical characteristics and complications by age‐group and differences between influenza A and B.MethodsThis was a retrospective study of pediatric inpatients from January 2013 to December 2014. Patients were grouped into: <6 months, 6 months to <5 years, 5‐ to <10‐year and ≥10 years. Complications were classified into neurologic, pulmonary, and other. We also calculated the incidence of hospitalized influenza cases per 100 000 age‐related population.ResultsThere were a total of 1272 patients with a median age of 37 months. The highest hospitalization rates were in the <6 months age‐group. Majority (75.2%) had no comorbidity; 25.6% had complications: neurologic 11.9%, pulmonary 9.6%, other 4.1%. Patients with other complications were older, male, and had the highest influenza B rates and the longest length of stay. Influenza A comprised 76.9% of cases and had higher complication rates especially neurologic, compared to influenza B. Influenza B patients were older and were more likely to develop other complications. The 6‐month to <5‐year‐age‐group had the highest complication rate (30.6%), especially neurologic. However, ≥10 years old had the highest other complications, ICU/ high‐dependency admissions and influenza B Victoria rates.ConclusionsInfants <6 months had the highest hospitalization rates for influenza. The 6‐month to <5‐year‐age‐group had the highest complication rate especially neurologic. Influenza A patients were younger, had higher seizure rates and complications compared to influenza B.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 87%

The burden and clinical manifestation of hospitalized influenza among different pediatric age‐groups in the tropics

Chong

Yung

Gan

et al. 2019

Influenza Resp Viruses

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“…Instead, the preferred strategy for preventing influenza in this age group is through the vaccination of pregnant women. Although clinical trials and observational studies have both reported a protective effect of maternal influenza vaccination on infections in babies aged <6 months [5][6][7], this appears to be limited to the first 8 weeks of life [8].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for admission to hospital with laboratory-confirmed influenza in young children: birth cohort study

et al. 2017

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We determined risk factors for influenza hospital admission in children aged <2 years to guide the design of paediatric vaccination programmes.We linked all singleton live births in Scotland from 2007 to 2015 to hospital administrative data and influenza laboratory reports. Cox proportional hazard models were used to identify birth and family risk factors for influenza admissions.There were 1115 influenza admissions among 424 048 children. 85.1% of admitted children were born at term and were not in a high-risk group. Presence of an older sibling was strongly associated with increased risk of influenza admission, particularly for children aged <6 months: hazard ratio for second- first-born child was 2.02 (95% CI 1.52-2.69). Maternal age<30 years and birth during autumn (age <6 months) or spring (age 6-23 months) were also associated with admission risk.Targeting vaccination programmes to high-risk children will not prevent the vast majority of influenza admissions. Parents of children aged <2 years should be advised that vaccination of older siblings will protect younger children against influenza infection. As evidence of the impact of the universal influenza vaccine programme emerges, there may be a need to reconsider universal influenza vaccination in children aged 6 months to 2 years in the UK.

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“…Importantly, that study was the only RCT designed a priori with a (co-)primary outcome of low birthweight, and therefore the only trial powered to detect a difference in birthweight between the 2 groups. In addition to data from clinical trials, results from multiple recent observational studies have also demonstrated a consistent beneficial impact of maternal influenza immunization on a variety of fetal and infant outcomes (21–24). …”

mentioning

confidence: 97%

Maternal Influenza Immunization and Adverse Birth Outcomes: Using Data and Practice to Inform Theory and Research Design

Phadke

Steinhoff²,

Omer

et al. 2016

Am. J. Epidemiol.

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Maternal influenza immunization can reduce influenza-attributable morbidity and mortality among pregnant women and infants who are too young to be vaccinated. Data from empirical studies also support the hypothesis that immunization can protect the fetus against adverse outcomes if the mother is exposed to influenza. In their theoretical analysis in the Journal, Hutcheon et al. (Am J Epidemiol. 2016;184(3):227–232) critiqued the existing evidence of the fetal benefits of maternal influenza immunization by calculating the sample sizes needed to demonstrate hypothetical reductions in risk and concluded that the benefits observed in empirical studies are likely implausible. However, in their analysis, they did not take into account multiple fundamental characteristics of influenza epidemiology, including the time-variable effects of influenza illness and vaccination during pregnancy, or well-known differences in disease epidemiology between seasons, populations, and geographic regions. Although these and other factors might affect the magnitude of fetal benefit conferred by maternal influenza immunization, studies in which investigators have accounted for influenza circulation have demonstrated a consistent protective effect against a variety of adverse birth outcomes; those studies include the only randomized controlled trial designed a priori and adequately powered to do so. Only a comprehensive and nuanced assessment of the evidence base will allow for effective translation of these data into a global immunization policy.

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Influenza in Infants Born to Women Vaccinated During Pregnancy

Abstract: BACKGROUND: Infants <6 months old with influenza are at risk for adverse outcomes. Our objective was to compare influenza outcomes in infants <6 months old born to women who did and did not report influenza vaccine during pregnancy.

Cited by 74 publications

References 24 publications

The burden and clinical manifestation of hospitalized influenza among different pediatric age‐groups in the tropics

The burden and clinical manifestation of hospitalized influenza among different pediatric age‐groups in the tropics

Risk factors for admission to hospital with laboratory-confirmed influenza in young children: birth cohort study

Maternal Influenza Immunization and Adverse Birth Outcomes: Using Data and Practice to Inform Theory and Research Design

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