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Tillard C, Chazard E, Faure K, Bartolo S, Martinot A, Dubos F. Burden of influenza disease in children under 2 years of age hospitalized between 2011 and 2020 in France. J Infect 2021; 84:145-150. [PMID: 34785266 DOI: 10.1016/j.jinf.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although influenza viruses cause significant morbidity and mortality worldwide, the impact of these infections on children in France and in other European countries has not been extensively characterized. The primary objective of the present study was to describe the burden of influenza disease on hospitalized children under 2 years of age in France, using data from the national hospital discharge summary database (Programme de Médicalisation des Systèmes d'Information, PMSI). METHODS In a retrospective study of hospital admissions for influenza among children under the age of 2 in France, we extracted and analyzed hospital administrative data from the PMSI database (from January 1, 2011, to December 31, 2020). RESULTS From 2011 to 2020, 28,507 children under the age of 2 were admitted to hospital with a primary or secondary diagnosis of influenza infection. The hospital admission rate was 205 per 100,000 for children under the age of 2, 276 per 100,000 for children under the age of 12 months, and 135 per 100,000 for children aged between 12 and 23 months. Children under 6 months of age were the most affected (45.4%). An underlying condition was identified for 9.4% of the children, and 2.2% of the children were admitted to the intensive care unit. The death rate was 0.12 per 100,000 for children under 2, 0.11 per 100,000 for children under 12 months, and 0.16 per 100,000 for children aged between 12 and 23 months. CONCLUSIONS In France, the burden of influenza disease is significant in children under the age of 2.
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Affiliation(s)
- Célia Tillard
- CHU Lille, Urgences Pédiatriques & Maladies Infectieuses, Avenue Emile Laisne, Lille F-59000, France; University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Emmanuel Chazard
- University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Karine Faure
- University of Lille, CHU Lille, Service des Maladies Infectieuses et Tropicales, Lille F-59000, France
| | - Stéphanie Bartolo
- University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France; Douai Hospital, Gynecology-Obstetric Unit, Douai F-59507, France
| | - Alain Martinot
- CHU Lille, Urgences Pédiatriques & Maladies Infectieuses, Avenue Emile Laisne, Lille F-59000, France; University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - François Dubos
- CHU Lille, Urgences Pédiatriques & Maladies Infectieuses, Avenue Emile Laisne, Lille F-59000, France; University of Lille, CHU Lille, ULR 2694-METRICS, Évaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France.
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Kohlmaier B, Svendova V, Walcher T, Pilch H, Krenn L, Kurz H, Zwiauer K, Zenz W. A severe influenza season in Austria and its impact on the paediatric population: mortality and hospital admission rates, november 2017 - march 2018. BMC Public Health 2020; 20:178. [PMID: 32019542 PMCID: PMC7001220 DOI: 10.1186/s12889-020-8239-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/20/2020] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In Austria paediatric influenza-associated hospitalisations and deaths have never been systematically monitored. We examined the influenza season 2017/18 in terms of hospitalisation and mortality in the Austrian paediatric population and put the results into perspective of the available data from the last 15 years. METHODS Cases of influenza-associated hospitalisations and deaths for season 2017/18 in children below 18 years were retrospectively collected from 12 and 33 Austrian hospitals, respectively. Hospitalisation and mortality rates for the whole Austrian paediatric population were estimated, adjusting for the population in each catchment area. Two Austrian databases were queried for hospitalisations and deaths associated with influenza during 2002-2016. Rough estimate of the vaccination coverage was calculated from a survey on 100 inpatients. RESULTS Influenza-related paediatric hospitalisation rate in season 2017/18 was estimated as 128 (CI: 122-135) per 100,000 children, much higher than the national average of 40 per 100,000 over the years 2002-2016. There were nine reported influenza-associated deaths among children, resulting in mortality rate of 0.67 (CI: 0.32-1.21) per 100,000 children. CONCLUSIONS Reported influenza-associated hospitalisations and fatalities demonstrate a high burden of influenza in the Austrian paediatric population corresponding with very low vaccination coverage.
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Affiliation(s)
- Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Vendula Svendova
- Department of General Paediatrics, Medical University of Graz, Graz, Austria.,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Thomas Walcher
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Heidemarie Pilch
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Larissa Krenn
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Kurz
- Department of Paediatrics and Adolescent Medicine, Social Medical Center East - Danube Hospital (SMZ-Ost), Vienna, Austria
| | - Karl Zwiauer
- Department of Paediatrics and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria.
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Yu J, Zhang X, Shan W, Gao J, Hua J, Tian J, Ding Y, Zhang J, Chen L, Song Y, Zhou S, Iuliano AD, Greene CM, Zhang T, Zhao G. Influenza-associated Hospitalization in Children Younger Than 5 Years of Age in Suzhou, China, 2011-2016. Pediatr Infect Dis J 2019; 38:445-52. [PMID: 30153228 DOI: 10.1097/INF.0000000000002178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studying the burden and risk factors associated with severe illness from influenza infection in young children in eastern China will contribute to future cost-effectiveness analyses of local influenza vaccine programs. METHODS We conducted prospective, severe acute respiratory infection (SARI) surveillance at Suzhou University-Affiliated Children's Hospital to estimate influenza-associated hospitalizations in Suzhou University-Affiliated Children's Hospital by month in children younger than 5 years of age from October 2011 to September 2016. SARI was defined as fever (measured axillary temperature ≥ 38°C) and cough or sore throat or inflamed/red pharynx in the 7 days preceding hospitalization. We combined SARI surveillance data with healthcare utilization survey data to estimate and characterize the burden of influenza-associated SARI hospitalizations in Suzhou within this age group in the 5-year period. RESULTS Of the 36,313 SARI cases identified, 2,297 from respiratory wards were systematically sampled; of these, 259 (11%) were influenza positive. Estimated annual influenza-associated SARI hospitalization rates per 1,000 children younger than 5 years of age ranged from 4 (95% confidence interval [CI], 2-5) in the 2012-2013 season to 16 (95% CI, 14-19) in the 2011-2012 season. The predominant viruses were A/H3N2 (59%) in 2011-12, both A/H1N1pdm09 (42%) and B (46%) in 2012-13, A/H3N2 (71%) in 2013-14, A/H3N2 (55%) in 2014-15 and both A/H1N1pdm09 (50%) and B (50%) in 2015-16. The age-specific influenza-associated SARI hospitalization rates for the 5-year period were 11 (95% CI, 8-15) per 1,000 children 0-5 months of age; 8 (95% CI, 7-10) per 1,000 children 6-23 months of age and 5 (95% CI, 4-5) per 1,000 children 24-59 months of age, respectively. CONCLUSIONS From 2011 to 2016, influenza-associated SARI hospitalization rates in children aged younger than 5 years of age in Suzhou, China, were high, particularly among children 0-5 months of age. Higher hospitalization rates were observed in years where the predominant circulating virus was influenza A/H3N2. Immunization for children > 6 months, and maternal and caregiver immunization for those < 6 months, could reduce influenza-associated hospitalizations in young children in Suzhou.
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Arístegui Fernández J, González Pérez-Yarza E, Mellado Peña MJ, Rodrigo Gonzalo de Liria C, Hernández Sampelayo T, García García JJ, Ruiz Contreras J, Moreno Pérez D, Garrote Llanos E, Ramos Amador JT, Cilla Eguiluz CG, Méndez Hernández M, Aristegui J, Garrote E, Larrauri A, Pérez-Yarza E, Cilla G, Unsain M, Contreras JR, García-Ochoa E, Gordillo J, Sampelayo TH, Rodríguez R, González F, Mellado M, Calvo C, Méndez A, Bustamante J, Salas D, Lacasta C, Ramos J, Illán M, Mendez M, Barjuan M, García J, Urraca S, Caballero M, Launes C, Rodrigo C, Fàbregas A, Esmel R, Antón A, Moreno D, Valdivielso A, Piñero P, Carazo B. Hospitalizaciones infantiles asociadas a infección por virus de la gripe en 6 ciudades de España (2014-2016). An Pediatr (Barc) 2019; 90:86-93. [DOI: 10.1016/j.anpedi.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
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Arístegui Fernández J, González Pérez-yarza E, Mellado Peña MJ, Rodrigo Gonzalo de Liria C, Hernández Sampelayo T, García García JJ, Ruiz Contreras J, Moreno Pérez D, Garrote Llanos E, Ramos Amador JT, Cilla Eguiluz CG, Méndez Hernández M, Aristegui J, Garrote E, Larrauri A, Pérez-yarza E, Cilla G, Unsain M, Contreras JR, García-ochoa E, Gordillo J, Sampelayo TH, Rodríguez R, González F, Mellado M, Calvo C, Méndez A, Bustamante J, Salas D, Lacasta C, Ramos J, Illán M, Mendez M, Barjuan M, García J, Urraca S, Caballero M, Launes C, Rodrigo C, Fàbregas A, Esmel R, Antón A, Moreno D, Valdivielso A, Piñero P, Carazo B. Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014–2016). Anales de Pediatría (English Edition) 2019; 90:86-93. [DOI: 10.1016/j.anpede.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVES The aim of this systematic review was to assess incidence rates of laboratory-confirmed influenza (LCI) outcomes among infants under 6 months of age. DESIGN Systematic literature search and review of indexed studies in PubMed, EMBASE, the Cochrane Library and CINAHL Plus from inception to 19 April 2017. SETTING Population-based estimates from community or hospital settings. PARTICIPANTS Infants under 6 months of age. PRIMARY AND SECONDARY OUTCOME MEASURES LCI illness in ambulatory care settings, LCI hospitalisation, LCI intensive care unit admission and LCI death. Only studies with population-based incidence data were included. RESULTS We identified 27 primary studies, 11 of which were from the USA, four were from other non-US high-income settings and the remaining were from lower-middle-income or upper-middle-income countries. Most studies (n=23) assessed incidence of LCI hospitalisation, but meta-analysis to pool study-specific rates was not possible due to high statistical and methodological heterogeneity. Among US studies, the reported incidence of LCI hospitalisation ranged from 9.3 to 91.2 per 10 000 infants under 6 months for seasonal influenza, while the only US-based estimate for pandemic H1N1 influenza was 20.2 per 10 000 infants. Reported rates for LCI hospitalisation for seasonal influenza from other countries ranged from 6.2 to 73.0 per 10 000 infants under 6 months, with the exception of one study with an estimated rate of 250 per 10 000 infants. No events were reported in five of the nine studies that evaluated LCI death among infants under 6 months. CONCLUSION Our review of published studies found limited data on LCI outcomes for infants under 6 months, particularly from non-US settings. Globally representative and reliable incidence data are necessary to fully evaluate influenza disease burden and the potential impact of maternal influenza immunisation programme on morbidity and mortality in young infants.
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Affiliation(s)
- Deshayne B Fell
- University of Ottawa and Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Jeanene Johnson
- Independent Epidemiology Consultant, Los Gatos, California, USA
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Katz
- Medical School for International Health and Department of Health Systems Management, Ben Gurion University in the Negev, Beersheba, Israel
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Kathleen M Neuzil
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Justin R Ortiz
- Initiative for Vaccine Research, WHO, Geneva, Switzerland
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
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Fell DB, Azziz-Baumgartner E, Baker MG, Batra M, Beauté J, Beutels P, Bhat N, Bhutta ZA, Cohen C, De Mucio B, Gessner BD, Gravett MG, Katz MA, Knight M, Lee VJ, Loeb M, Luteijn JM, Marshall H, Nair H, Pottie K, Salam RA, Savitz DA, Serruya SJ, Skidmore B, Ortiz JR; WHO taskforce to evaluate influenza data to inform vaccine impact and economic modelling. Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group. Vaccine 2017; 35:5738-50. [PMID: 28867508 DOI: 10.1016/j.vaccine.2017.08.037] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 12/05/2022]
Abstract
From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses challenges for robust estimation of the potential impact of maternal influenza immunization programs.
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Abstract
INTRODUCTION The identification of factors that can predispose to the development of severe influenza is essential to enable the implementation of optimal prevention and control measures for vulnerable populations. AREAS COVERED Unfortunately, data in the pediatric age group remain difficult to interpret. However, epidemiological data seem to suggest that the most severe influenza cases, those who are hospitalized, those who are admitted to the intensive care unit, and those who died, occur in children in the first 2 years of life and in school age patients. Expert commentary: Immaturity of the immune system, and in particular of the mechanisms that usually recognize influenza viruses and activate cytokine and chemokine responses to reduce viral replication, might explain the high hospitalization rate observed in the youngest patients. Some underlying chronic conditions favour the development of the severe cases, sometime leading to death, although both admission to the intensive care unit and death can occur in otherwise healthy subjects.
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Affiliation(s)
- Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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Homaira N, Luby SP, Hossain K, Islam K, Ahmed M, Rahman M, Rahman Z, Paul RC, Bhuiyan MU, Brooks WA, Sohel BM, Banik KC, Widdowson MA, Willby M, Rahman M, Bresee J, Ramirez KS, Azziz-Baumgartner E. Respiratory Viruses Associated Hospitalization among Children Aged <5 Years in Bangladesh: 2010-2014. PLoS One 2016; 11:e0147982. [PMID: 26840782 PMCID: PMC4739641 DOI: 10.1371/journal.pone.0147982] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 01/11/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We combined hospital-based surveillance and health utilization survey data to estimate the incidence of respiratory viral infections associated hospitalization among children aged < 5 years in Bangladesh. METHODS Surveillance physicians collected respiratory specimens from children aged <5 years hospitalized with respiratory illness and residing in the primary hospital catchment areas. We tested respiratory specimens for respiratory syncytial virus, parainfluenza viruses, human metapneumovirus, influenza, adenovirus and rhinoviruses using rRT-PCR. During 2013, we conducted a health utilization survey in the primary catchment areas of the hospitals to determine the proportion of all hospitalizations for respiratory illness among children aged <5 years at the surveillance hospitals during the preceding 12 months. We estimated the respiratory virus-specific incidence of hospitalization by dividing the estimated number of hospitalized children with a laboratory confirmed infection with a respiratory virus by the population aged <5 years of the catchment areas and adjusted for the proportion of children who were hospitalized at the surveillance hospitals. RESULTS We estimated that the annual incidence per 1000 children (95% CI) of all cause associated respiratory hospitalization was 11.5 (10-12). The incidences per 1000 children (95% CI) per year for respiratory syncytial virus, parainfluenza, adenovirus, human metapneumovirus and influenza infections were 3(2-3), 0.5(0.4-0.8), 0.4 (0.3-0.6), 0.4 (0.3-0.6), and 0.4 (0.3-0.6) respectively. The incidences per 1000 children (95%CI) of rhinovirus-associated infections among hospitalized children were 5 (3-7), 2 (1-3), 1 (0.6-2), and 3 (2-4) in 2010, 2011, 2012 and 2013, respectively. CONCLUSION Our data suggest that respiratory viruses are associated with a substantial burden of hospitalization in children aged <5 years in Bangladesh.
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Affiliation(s)
- Nusrat Homaira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P. Luby
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Kamal Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kariul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Makhdum Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Repon C. Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mejbah Uddin Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - W. Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Bloomberg School of Public, Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Badrul Munir Sohel
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kajal Chandra Banik
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marc-Alain Widdowson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Melisa Willby
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, (IEDCR), Dhaka, Bangladesh
| | - Joseph Bresee
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Katharine-Sturm Ramirez
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Abstract
Despite ample evidence for the great burden that annual influenza epidemics place on children and society in general, few European countries currently recommend influenza vaccination of healthy children of any age. The most frequently cited reasons for reluctance to extend general vaccine recommendations to children include the view that influenza is a mild illness of limited clinical importance, lack of country-specific data on disease burden, uncertainty about the efficacy and safety of influenza vaccines in children and inadequate evidence of cost-effectiveness of vaccinating children. In recent years, several clinical studies have provided new and important information that help address many of these areas of question and concern. In light of this newly available scientific evidence, influenza vaccine recommendations for children should be properly reevaluated in all European countries. Furthermore, to allow for variation in costs and patterns of healthcare delivery between different countries, cost-effectiveness analyses of influenza vaccination of healthy children should be performed in each country or region. Finally, increased efforts should be made to educate both healthcare professionals and the great public about recent findings and advances in the field of pediatric influenza.
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Abstract
Influenza is a viral disease of the upper respiratory tract, which is manifested in seasonal epidemic waves associated with excess morbidity and mortality. Although efforts at prevention have traditionally been focused on the elderly, interest is growing on the specific features of influenza disease in children and the opportunities for prevention in this age group. Owing to recent improvements in surveillance schemes and diagnostic tools it has been realized that young children experience a burden of morbidity due to influenza as high or higher than the elderly and that children possibly act as a source of influenza infection and determinants of the intensity and the spread of influenza in the community, and as a result, the proposition that children should be preferentially targeted for influenza vaccination is gaining acceptance in many industrialized countries. Traditional seasonal inactivated influenza vaccines have performed poorly in the very young and the live-attenuated influenza vaccines, which are highly efficacious in this age group, have been associated with a poor safety profile in those less than 2 years of age. MF59™-adjuvanted influenza vaccines that were traditionally used in the elderly show a very promising safety and efficacy profile in the pediatric population that could overcome the limitations of the other currently available influenza vaccines for use in this age group.
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Affiliation(s)
- Joan Puig-Barberà
- Centro Superior de Investigación en Salud Pública, Centre for Public Health Research, Area of Vaccines Research, Avda Cataluña, 21, 46020 Valencia, Spain.
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Banzhoff A, Stoddard JJ. Effective influenza vaccines for children: a critical unmet medical need and a public health priority. Hum Vaccin Immunother 2012; 8:398-402. [PMID: 22327501 PMCID: PMC3426083 DOI: 10.4161/hv.18561] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Seasonal influenza causes clinical illness and hospitalization in all age groups; however, conventional inactivated vaccines have only limited efficacy in young children. MF59(®), an oil-in-water emulsion adjuvant, has been used since the 1990s to enhance the immunogenicity of influenza vaccines in the elderly, a population with waning immune function due to immunosenescence. Clinical trials now provide information to support a favorable immunogenicity and safety profile of MF59-adjuvanted influenza vaccine in young children. Published data indicate that Fluad(®), a trivalent seasonal influenza vaccine with MF59, was immunogenic and well tolerated in young children, with a benefit/risk ratio that supports routine clinical use. A recent clinical trial also shows that Fluad provides high efficacy against PCR-confirmed influenza. Based on the results of clinical studies in children, the use of MF59-adjuvanted vaccine offers the potential to enhance efficacy and make vaccination a viable prevention and control strategy in this population.
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Abstract
Influenza viruses continue to cause disease of varying severity among humans. People with underlying disease and the elderly are at increased risk of developing severe disease after infection with an influenza virus. As effective and safe vaccines are available, the WHO has recommended vaccinating these groups against influenza annually. In addition to this recommendation, public health authorities of a number of countries have recently recommended vaccinating all healthy children aged 6-59 months against influenza. Here, we review the currently available data concerning the burden of disease in children, the economical impact of implementing universal vaccination of children, the efficacy of currently available influenza virus vaccines, the theoretical concerns regarding preventing immunity otherwise induced by infections with seasonal influenza viruses, and finally, how to address these concerns.
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Affiliation(s)
- Pieter L A Fraaij
- Department of Virology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Nair H, Brooks WA, Katz M, Roca A, Berkley JA, Madhi SA, Simmerman JM, Gordon A, Sato M, Howie S, Krishnan A, Ope M, Lindblade KA, Carosone-Link P, Lucero M, Ochieng W, Kamimoto L, Dueger E, Bhat N, Vong S, Theodoratou E, Chittaganpitch M, Chimah O, Balmaseda A, Buchy P, Harris E, Evans V, Katayose M, Gaur B, O'Callaghan-Gordo C, Goswami D, Arvelo W, Venter M, Briese T, Tokarz R, Widdowson MA, Mounts AW, Breiman RF, Feikin DR, Klugman KP, Olsen SJ, Gessner BD, Wright PF, Rudan I, Broor S, Simões EAF, Campbell H. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet 2011; 378:1917-30. [PMID: 22078723 DOI: 10.1016/s0140-6736(11)61051-9] [Citation(s) in RCA: 662] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associated with influenza in children younger than 5 years. METHODS We estimated the incidence of influenza episodes, influenza-associated acute lower respiratory infections (ALRI), and influenza-associated severe ALRI in children younger than 5 years, stratified by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies. We applied these incidence estimates to global population estimates for 2008 to calculate estimates for that year. We estimated possible bounds for influenza-associated ALRI mortality by combining incidence estimates with case fatality ratios from hospital-based reports and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality. FINDINGS We identified 43 suitable studies, with data for around 8 million children. We estimated that, in 2008, 90 million (95% CI 49-162 million) new cases of influenza (data from nine studies), 20 million (13-32 million) cases of influenza-associated ALRI (13% of all cases of paediatric ALRI; data from six studies), and 1 million (1-2 million) cases of influenza-associated severe ALRI (7% of cases of all severe paediatric ALRI; data from 39 studies) occurred worldwide in children younger than 5 years. We estimated there were 28,000-111,500 deaths in children younger than 5 years attributable to influenza-associated ALRI in 2008, with 99% of these deaths occurring in developing countries. Incidence and mortality varied substantially from year to year in any one setting. INTERPRETATION Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available. FUNDING WHO; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK.
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Abstract
During the past decade, accumulating data on the impact of influenza virus-related disease in children have become available. In this review, we summarize and discuss these data. We conclude that mortality due to influenza in children is relatively limited. But, in contrast, influenza-related hospitalizations occur frequently. The bulk of the influenza-related disease burden is experienced in the outpatient setting. This results in sometimes very high consultation rates, frequent complications, and substantial parental work absenteeism.
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Moral L, Marco N, Toral T, Fuentes MJ, Fuentes L, Lillo L. Burden of severe 2009 pandemic influenza A (H1N1) infection in children in Southeast Spain. Enferm Infecc Microbiol Clin 2011; 29:497-501. [PMID: 21514011 DOI: 10.1016/j.eimc.2011.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/11/2011] [Accepted: 01/13/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Most of the published studies on patients admitted with 2009 pandemic influenza are not population based. We have compiled the clinical information regarding all children admitted with 2009 pandemic influenza A (H1N1) infection during the season 2009-2010 in our defined population, in order to have an unbiased view of the most severe side of the clinical spectrum of the infection and to quantify its burden. METHODS Children <15 years-old admitted to any of 3 hospitals in South-East Spain with 2009 pandemic influenza A (H1N1) detected by means of reverse transcriptase polymerase chain reaction. High quality data were extracted from clinical records specially designed for the pandemic. RESULTS Eighty two children fulfilled the inclusion criteria. The hospitalization rate was 68 per 100,000 children <15 years-old; in those <5 years-old the rate was of 131 and in <1 year-old, 234 per 100,000. An estimated 0.7% of the children who suffered from pandemic influenza were admitted (1.7% in <5 years-old). Intensive care was required for 5% of the hospitalized patients living in the study area. Mortality was roughly estimated about 1 per 100,000 children <15 years-old and was associated with the presence of very severe comorbidities or co-infections. Only 20% of the admitted children were ≥ 5 years-old and without risk factors. The disease followed a generally benign course despite the modest use of oseltamivir (49% of the patients). CONCLUSIONS Clinical and epidemiological data are very similar to those observed in other places and in interpandemic seasons with a high influenza activity.
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Affiliation(s)
- Luis Moral
- Department of Pediatrics, Hospital General Universitario, Alicante, Spain.
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18
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Silvennoinen H, Peltola V, Vainionpää R, Ruuskanen O, Heikkinen T. Incidence of influenza-related hospitalizations in different age groups of children in Finland: a 16-year study. Pediatr Infect Dis J 2011; 30:e24-8. [PMID: 21298851 DOI: 10.1097/inf.0b013e3181fe37c8] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND children are frequently hospitalized with influenza-associated illnesses. Few virologically confirmed population-based studies of pediatric hospitalizations performed during several consecutive seasons are vailable. METHODS this 16-year retrospective study consisted of all children ≤ 16 years of age who were treated for virologically confirmed influenza at the Department of Pediatrics, Turku University Hospital, Finland, between July 1, 1988 and June 30, 2004. Calculation of the population-based rates of hospitalization in different age cohorts was based on children (n = 69,068) who lived within the 38 municipalities whose acute pediatric care was provided solely by Turku University Hospital. RESULTS during the study period, 401 children were hospitalized with virologically confirmed influenza. The average annual incidences of influenza-related hospitalizations were highest among children <6 months (276 [95% confidence interval, 220–336] per 100,000) and 6 to 11 months (173 [95% confidence interval, 129–220] per 100,000) of age. For both influenza A and B, the rates of hospitalization were highest among children younger than 1 year of age. Influenza A accounted for 82% and influenza B for 18% of all hospitalizations. A total of 40 (10.0%) children received treatment at the intensive care unit. Of all 401 children with confirmed influenza infection, only 216 (53.9%) had a discharge International Classification of Diseases code related to influenza. CONCLUSIONS the high incidence of influenza-associated hospitalization among infants less than 6 months of age underscores the need to find effective ways to prevent influenza in this age group, in which influenza vaccines are not currently licensed for use.
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Sam IC, Abdul-Murad A, Karunakaran R, Rampal S, Chan YF, Nathan AM, Ariffin H. Clinical features of Malaysian children hospitalized with community-acquired seasonal influenza. Int J Infect Dis 2010; 14 Suppl 3:e36-40. [DOI: 10.1016/j.ijid.2009.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 09/15/2009] [Accepted: 10/27/2009] [Indexed: 10/19/2022] Open
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21
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Lopez-de-Andres A, Hernández-Barrera V, Carrasco-Garrido P, Gil-de-Miguel A, Jiménez-García R. Influenza vaccination coverage among Spanish children, 2006. Public Health 2009; 123:465-9. [PMID: 19535118 DOI: 10.1016/j.puhe.2009.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 04/14/2009] [Accepted: 05/15/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Traditionally, influenza is not considered to be a serious disease in healthy children. However, for vulnerable populations, such as young children and those with chronic medical conditions, influenza can lead to serious complications and even death. This study aimed to assess vaccination coverage among Spanish children under 16 years of age in 2006, and to describe the factors associated with vaccination. STUDY DESIGN Cross-sectional survey. METHODS In total, 8851 records of children included in the Spanish National Health Survey for 2006 were analysed. The reply ('yes' or 'no') to the question: 'Did you have a flu shot in the latest campaign?' was used as a dependent variable. Influenza vaccine coverage was calculated as the percentage of individuals aged 6 months to 16 years whose parents reported that they had been vaccinated against influenza in the most recent campaign. The influence of sociodemographic variables on vaccination and the presence of associated chronic diseases (asthma and/or diabetes) were also analysed. RESULTS Vaccination coverage among Spanish children in 2006 was 6.82%: 19.43% in children with associated conditions (asthma and/or diabetes), and 5.81% in healthy children. The only factor significantly associated with influenza vaccination in children with associated conditions was household income; children with a lower household monthly income were more likely to have been vaccinated against influenza than children with a higher household monthly income (odds ratio 1.96). In children for whom vaccination is not indicated, the probability of being vaccinated against influenza was greater in those whose parents were not university graduates. CONCLUSION Influenza vaccination coverage in Spanish children is low. Socio-economic inequalities continue to be a factor at the time of vaccination.
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Affiliation(s)
- Ana Lopez-de-Andres
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda de Atenas s/n, Alcorcón 28922 Madrid, Spain.
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Bernaola Iturbe E, Giménez Sánchez F, Baca Cots M, De Juan Martín F, Diez Domingo J, Garcés Sánchez M, Gómez-Campderá A, Martinón-Torres F, Picazo J, Pineda Solás V. Calendario vacunal de la Asociación Española de Pediatría: Recomendaciones 2009. An Pediatr (Barc) 2009; 70:72-82. [DOI: 10.1016/j.anpedi.2008.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 10/08/2008] [Indexed: 10/20/2022] Open
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Cilla G, Oñate E, Perez-yarza EG, Montes M, Vicente D, Perez-trallero E. Hospitalization rates for human metapneumovirus infection among 0- to 3-year-olds in Gipuzkoa (Basque Country), Spain. Epidemiol Infect 2009; 137:66-72. [DOI: 10.1017/s0950268808000666] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYNumerous studies have been published on human metapneumovirus (HMPV) infection, but few have been population based. The main aim of this study was to estimate the incidence rate of hospitalization for community-acquired HMPV infection in infants and children aged <3 years. Between July 2004 and June 2007, 796 episodes (742 patients) of community-acquired acute respiratory infection were hospitalized. HMPV was detected in 90 episodes (11·3%). Fifty-nine episodes occurred in infants aged <1 year. The mean length of hospital stay was 6·2 days (range 2–31 days). Thirteen children required admission to the intensive care unit. Viral co-infections were detected in 46 episodes (51·1%). The incidence rate of hospitalization per 1000 inhabitants was 2·6 (95% CI 2·1–3·2), lower than that for respiratory syncytial virus, but higher than that observed for the influenza and parainfluenza viruses. HMPV is a major respiratory pathogen that leads to a high hospitalization rate.
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Bernaola Iturbe E, Giménez Sánchez F, Baca Cots M, de Juan Martín F, Díez Domingo J, Garcés Sánchez M, Gómez-Campderá A, Martinón Torres F, Picazo J, Pineda Solás V. Calendario vacunal de la Asociación Española de Pediatría: recomendaciones 2008. An Pediatr (Barc) 2008; 68:63-9. [DOI: 10.1157/13114474] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Lewis EN, Griffin MR, Szilagyi PG, Zhu Y, Edwards KM, Poehling KA. Childhood influenza: number needed to vaccinate to prevent 1 hospitalization or outpatient visit. Pediatrics 2007; 120:467-72. [PMID: 17766517 DOI: 10.1542/peds.2007-0167] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The goal was to assess the potential benefits of the influenza vaccine recommendations for children 6 to 59 months of age by estimating the number of children needed to be vaccinated to prevent 1 hospitalization or 1 outpatient visit attributable to influenza. METHODS The influenza burden was obtained from published studies in which rates for children 6 to 23 months and 24 to 59 months of age could be ascertained. We assumed a range of influenza vaccine efficacies of 25% to 75%, consistent with the literature. We estimated the number of children who needed to be vaccinated to prevent 1 influenza-attributable hospitalization or 1 outpatient visit for each age group. RESULTS As both vaccine efficacy and severity of the influenza season increased, the number of children who needed to be vaccinated to prevent 1 hospitalization or 1 outpatient visit decreased. The numbers of children who needed to be vaccinated to prevent 1 hospitalization in a year with 50% vaccine efficacy ranged from 1031 to 3050 for children 6 to 23 months of age and from 4255 to 6897 for children 24 to 59 months of age. For every 12 to 42 children 6 to 59 months of age vaccinated in a year with 50% vaccine efficacy, we estimated that 1 influenza-attributable outpatient visit would be prevented. CONCLUSIONS With 1 outpatient visit being prevented through vaccination of <50 children, influenza vaccination can reduce influenza-attributable medical visits in children significantly, even in years with modest vaccine efficacy.
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Lenglet AD, Hernando V, Rodrigo P, Larrauri A, Donado JD, de Mateo S. Impact of flu on hospital admissions during 4 flu seasons in Spain, 2000-2004. BMC Public Health 2007; 7:197. [PMID: 17686175 DOI: 10.1186/1471-2458-7-197] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 08/08/2007] [Indexed: 11/23/2022] Open
Abstract
Background Seasonal flu epidemics in the European region cause high numbers of cases and deaths. Flu-associated mortality has been estimated but morbidity studies are necessary to understand the burden of disease in the population. Our objective was to estimate the excess hospital admissions in Spain of diseases associated with influenza during four epidemic influenza periods (2000 – 2004). Methods Hospital discharge registers containing pneumonia, chronic bronchitis, heart failure and flu from all public hospitals in Spain were reviewed for the years 2000 to 2004. Epidemic periods were defined by data from the Sentinel Surveillance System. Excess hospitalisations were calculated as the difference between the average number of weekly hospitalisations/100,000 in epidemic and non-epidemic periods. Flu epidemics were defined for seasons 2001/2002, 2002/2003, 2003/2004. Results A(H3N2) was the dominant circulating serotype in 2001/2002 and 2003/2004. Negligible excess hospitalisations were observed during the 2002/2003 epidemic where A(H1N1) was circulating. During 2000/2001, flu activity remained below threshold levels and therefore no epidemic period was defined. In two epidemic periods studied a delay between the peak of the influenza epidemic and the peak of hospitalisations was observed. During flu epidemics with A(H3N2), excess hospitalisations were higher in men and in persons <5 and >64 years higher than 10 per 100,000. Pneumonia accounted for 70% of all flu associated hospitalisations followed by chronic bronchitis. No excess flu-specific hospitalisations were recorded during all seasons. Conclusion Flu epidemics have an impact on hospital morbidity in Spain. Further studies that include other variables, such as temperature and humidity, are necessary and will deepen our understanding of the role of each factor during flu epidemics and their relation with morbidity.
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Bernaola Iturbe E, Giménez Sánchez F, Baca Cots M, de Juan Martín F, Díez Domingo J, Garcés Sánchez M, Gómez-Campderá A, Martinón-Torres F, Picazo JJ, Pineda Solás V. [Vaccination schedule of the Spanish Association of Pediatrics: recommendations 2007]. An Pediatr (Barc) 2007; 66:62-9. [PMID: 17266854 DOI: 10.1016/s1695-4033(07)70295-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The Vaccine Advisory Committee of the Spanish Association of Pediatrics provides information on the new developments in vaccines that have taken place in 2006 and recommends certain modifications to the Immunization Schedule for 2007. To ensure early protection, the measles-mumps-rubella (MMR) vaccine booster dose should be administered when children start school (3-4 years). Based on existing scientific evidence, the importance of universal heptavalent conjugate pneumococcal vaccination, as occurs in most similar European countries and in the autonomous community of Madrid in Spain, is confirmed. The safety and efficacy of rotavirus and human papilloma virus vaccines, as well as their use in our environment, is discussed and the role of pediatricians in their implementation is stressed. The recommended immunization schedule for children and adolescents starting vaccination late is also discussed.
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Affiliation(s)
- E Bernaola Iturbe
- Comité Asesor de Vacunas de la Asociación Española de Pediatría, Pamplona, Spain.
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Pineda Solas A, Bernaola Iturbe E, Martinón-Torres F, Baca Cots M, de Juan Martín F, Gómez Campderá JA, Díaz Domingo J, Garcés Sánchez M, Giménez Sánchez F, Picazo J. [Recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics: influenza vaccination campaign 2006-2007]. An Pediatr (Barc) 2007; 65:252-5. [PMID: 16956504 DOI: 10.1157/13092162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The recommendations of the Spanish Association of Pediatrics on influenza vaccination in the pediatric age group for the 2006-2007 season are presented. Influenza has special characteristics in children due to the high morbidity it carries. Moreover, children constitute the most frequent source of transmission. The risk factors supporting influenza vaccination in children and the need for immunization in persons living with high-risk children are discussed. The advisability of extending vaccination in health workers, and specifically to pediatricians and medical personnel in contact with sick children is stressed. The composition of the vaccine for the 2006-2007 seasons, the schedules and dosages in children depending on age, and the contraindications to vaccination are specified. Finally, the premises required to recommend universal vaccination in young children in Spain as a strategy to reduce morbidity due to this epidemic in children and adults are discussed.
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Affiliation(s)
- A Pineda Solas
- Comité Asesor de Vacunas de la Asociación Española de Pediatría. Pamplona. España
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Abstract
Based on the evidence available, the Vaccines Advisory Committee (VAC) of the Spanish Association of Pediatrics reports and comments on the new developments in vaccines that have taken place in 2005 and recommends some modifications to the vaccination schedule for 2006. In agreement with changes in the product monographs for the meningococcal C vaccine, the VAC recommends two doses for the three commercially available preparations with a booster dose in the second year of life. The European Medicines Evaluation Agency (EMEA) has temporarily suspended the sale of the Hexavac vaccine due to doubts about its long-term protection against hepatitis B. The VAC continues to support the use of these combined vaccines. Currently only Infranrix Hexa is available in Spain. The recommendation of vaccinating adolescents with a booster dose of pertussis vaccine via the administration of an acellular preparation of low antigenic load together with the adult diphtheria and tetanus vaccine remains valid. Vaccination against chickenpox in susceptible children aged more than 12 months old continues to be recommended. There is wide coverage for the 7-valent pneumococcal conjugate vaccine in many areas of Spain. In view of the studies published, the VAC reiterates the need for universal immunization by introducing this vaccine in the official vaccination schedule. Finally, other vaccines not included in this schedule are discussed, with special mention of the advisability of influenza vaccination in children, according to the recommendations of the VAC available at the beginning of each season on the web site of the Spanish Association of Pediatrics www.aeped.es; www. vacunasaep.org.
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30
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Abstract
Commentary on the paper by Beard et al (see page 20)
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Affiliation(s)
- J S Nguyen-Van-Tam
- Health Protection Agency Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK.
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