Association of Prior Vaccination With Influenza Vaccine Effectiveness in Children Receiving Live Attenuated or Inactivated Vaccine | Infectious Diseases | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Protection against the flu
    Frederick Rivara, MD, MPH | University of Washington
    Nice to see this study showing that prior vaccination did not affect risk of vaccine failure in prevention of flu. But there are still too many kids who are not vaccinated against this illness. Any new ideas of how to increase immunization rates?
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Original Investigation
    Infectious Diseases
    October 26, 2018

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

    Author Affiliations
    • 1Marshfield Clinic Research Institute, Marshfield, Wisconsin
    • 2AstraZeneca, Gaithersburg, Maryland
    • 3Vanderbilt University Medical Center, Nashville, Tennessee
    • 4Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine, Temple
    • 5Wake Forest School of Medicine, Winston-Salem, North Carolina
    JAMA Netw Open. 2018;1(6):e183742. doi:10.1001/jamanetworkopen.2018.3742
    Key Points español 中文 (chinese)

    Question  Is prior-season vaccination associated with vaccine effectiveness by type in children aged 2 to 17 years?

    Findings  In this multiseason, test-negative case-control study, live attenuated influenza vaccine effectiveness was higher in children vaccinated in both the enrollment and prior season compared with those vaccinated only in the enrollment season. Prior-season vaccination was not associated with either inactivated or live attenuated vaccine effectiveness against influenza A(H1N1)pdm09, although there was evidence of residual protection with prior-season vaccination only against influenza B.

    Meaning  Prior-season vaccination history was not associated with reduced vaccine effectiveness in children, supporting current recommendations for annual influenza vaccination of children.


    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.