High-risk Medical Conditions Research Articles

Coronavirus disease 2019 vaccine hesitancy among children's hospital staff: A single-center survey.

Among 4448/7012 (63.4%) children's hospital clinical and non-clinical staff who responded to an electronic survey, COVID-19 vaccine hesitancy was identified among 18.9% and more prevalent among those who identify as female, Black, and/or Hispanic/Latinx; non-clinical staff; and those with high-risk medical conditions and lower concern for severe COVID-19. We identified specific concerns and communication preferences to guide development of targeted vaccine education and advocacy strategies.

Systematic Review of Safety and Efficacy of COVID-19 Vaccines in Patients With Kidney Disease

Systematic Review of Safety and Efficacy of COVID-19 Vaccines in Patients With Kidney Disease

The advisory Committee on Immunization practices' updated interim recommendation for allocation of COVID-19 vaccine-United states, December 2020.

This month’s MMWR selection is a link to the updated recommendations from the Advisory Committee on Immunization Practices regarding the allocation of COVID‐19 vaccine.

Association of Bacteremia with Vaccination Status in Children Aged 2 to 36 Months

To determine the association between bacteremia and vaccination status in children aged 2-36months presenting to a pediatric emergency department. Retrospective cohort study of children aged 2-36months with blood cultures obtained in the pediatric emergency department between January 2013 and December 2017. The exposure of interest was immunization status, defined as number of Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae vaccinations, and the main outcome positive blood culture. Subjects with high-risk medical conditions were excluded. Of 5534 encounters, 4742 met inclusion criteria. The incidence of bacteremia was 1.5%. The incidence of contaminated blood culture was 5.0%. The relative risk of bacteremia was 0.79 (95% CI 0.39-1.59) for unvaccinated and 1.20 (95% CI 0.52-2.75) for undervaccinated children relative to those who had received age-appropriate vaccines. Five children were found to have S pneumoniae bacteremia and 1 child had Hib bacteremia; all of these subjects had at least 3 sets of vaccinations. No vaccine preventable pathogens were isolated from blood cultures of unvaccinated children. We found no S pneumoniae or Hib in children 2-6months of age who were not fully vaccinated due to age (95% CI 0-0.13%) and the contamination rate in this group was high compared with children 7-36months (6.6% vs 3.7%). Bacteremia in young children is an uncommon event. Contaminated blood cultures were more common than pathogens. Bacteremia from S pneumoniae or Hib is uncommon and, in this cohort, was independent of vaccine status.

The Advisory Committee on Immunization Practices' Updated Interim Recommendation for Allocation of COVID-19 Vaccine - United States, December 2020.

The first vaccines for prevention of coronavirus disease 2019 (COVID-19) in the United States were authorized for emergency use by the Food and Drug Administration (FDA) (1) and recommended by the Advisory Committee on Immunization Practices (ACIP) in December 2020.* However, demand for COVID-19 vaccines is expected to exceed supply during the first months of the national COVID-19 vaccination program. ACIP advises CDC on population groups and circumstances for vaccine use.† On December 1, ACIP recommended that 1) health care personnel§ and 2) residents of long-term care facilities¶ be offered COVID-19 vaccination first, in Phase 1a of the vaccination program (2). On December 20, 2020, ACIP recommended that in Phase 1b, vaccine should be offered to persons aged ≥75 years and frontline essential workers (non-health care workers), and that in Phase 1c, persons aged 65-74 years, persons aged 16-64 years with high-risk medical conditions, and essential workers not recommended for vaccination in Phase 1b should be offered vaccine.** These recommendations for phased allocation provide guidance for federal, state, and local jurisdictions while vaccine supply is limited. In its deliberations, ACIP considered scientific evidence regarding COVID-19 epidemiology, ethical principles, and vaccination program implementation considerations. ACIP's recommendations for COVID-19 vaccine allocation are interim and might be updated based on changes in conditions of FDA Emergency Use Authorization, FDA authorization for new COVID-19 vaccines, changes in vaccine supply, or changes in COVID-19 epidemiology.

1500. Population-based incidence, health care resource utilization and cost among children < 5 years of age hospitalized with RSV, Utah

BackgroundRespiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) worldwide. Accurate data are critical to inform the rationale for RSV vaccine and immunoprophylaxis development. We evaluated the burden of laboratory-confirmed RSV from hospitalized children.MethodsDuring the 2019-2020 RSV season, we prospectively identified children < 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton hospitals in Salt Lake City, Utah. Outcomes included Salt Lake county RSV hospitalization rates, adjusted for market share, health care resource utilization including intensive care unit (ICU) stays, mechanical ventilation, length of stay (LOS), and total hospital costs.ResultsA total of 284 children had laboratory-confirmed RSV LRTI hospitalizations during the 2019-2020 RSV season: 106 (37%) < 6 months of age; 67 (24%) had high-risk medical conditions (HMC); 70 (25%) children had an ICU stay; 18 (6%) required mechanical ventilation; 132 (46%) received antibiotics and median hospital LOS of 2.3 days (IQR 1.6- 3.6). Population-based incidence rates of RSV hospitalization were 4.6/1000 (range 0.7/1000 to 17/1000). The highest rates were in children < 6 months, and rates decreased with increasing age. The mean hospital cost was $12,974.6 (standard deviation: $19869.7), with a total for the cohort was $3.7 million; 42% was accounted for by children < 6 months. Median age of children with HMC’s were significantly older (18.7 mon vs. 12.7 mon; p=0.001) than healthy, but comparable mean hospital cost ($14208.5 vs. 12593.2) and median hospital LOS (2.4 vs. 2.3).ConclusionHospitalized RSV LRTI among children < 5 years remains significant, and is associated with substantial HCRU, antibiotic use and morbidity. Nationwide, the mean hospital costs may total $1.1 billion. Our data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization.DisclosuresKrow Ampofo, MBChB, Merck (Grant/Research Support) Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck & Co Inc, (Employee)

Estimating the Proportion of Antibiotics Attributable to Common Paediatric Respiratory Viruses: An Example Leveraging Unique Population-Based Prescribing and Laboratory Data

IntroductionInappropriate antibiotic prescribing, such as that for viral illness, is common in primary care. This is of growing interest given concerns around antimicrobial resistance and harms associated with unnecessary treatment; however, current data limitations have hindered population-based estimates of the proportion of community-prescribed antibiotics attributable to common respiratory viruses.&#x0D; Objectives and ApproachTo estimate the proportion of antibiotics prescribed in primary care to young children attributable to common respiratory viruses, including respiratory syncytial virus (RSV), influenza, human metapneumovirus (HuMPV) and parainfluenza. We leveraged two unique sources of comprehensive, linked population-based administrative data on dispensed antibiotic prescriptions and laboratory tests for respiratory viruses for all Scottish children (&lt;5 years). We fit time series negative binomial models to predict weekly antibiotic prescribing rates from positive viral tests rates for the period April 1, 2009 through Dec 27, 2017. Using linked demographic and hospitalization data, we stratified our analysis by age, presence of high-risk chronic medical conditions, and antibiotic class.&#x0D; ResultsWe included data on over 6 million antibiotic prescriptions among nearly 800,000 children. An estimated 6.9% (95% CI: 5.6,8.3), 2.4% (1.7,3.1), and 2.3% (0.8,3.9) of prescribed antibiotics were attributable to RSV, influenza and HuMPV, respectively. RSV was consistently associated with the highest proportion of antibiotics prescribed across all analyses but particularly among children without chronic conditions [4.30% (3.19, 5.41)] and for amoxicillin [8.10% (6.43, 9.76)] and macrolide prescriptions [7.65% (6.14, 9.16)].&#x0D; Conclusion / ImplicationsNearly 14% of antibiotics prescribed to Scottish children in this study were attributable to common viral pathogens such as RSV for which antibiotics are not recommended. This highlights clear targets for antibiotic stewardship programs and suggests antibiotic prescribing could be reduced once an RSV vaccine is introduced.

Meningococcal Disease and Related Vaccinations: Knowledge, Attitudes, and Practices among Healthcare Workers Who Provide Care to Patients with Underlying High-Risk Medical Conditions.

This cross-sectional study assessed knowledge, attitudes, and practices regarding meningococcal disease and related vaccinations among healthcare workers (HCWs) who provided care to patients with underlying high-risk medical conditions. A total of 411 HCWs returned the survey. Only 35% of the respondents had a good knowledge about the incidence and lethality of meningococcal disease, the most frequent serogroups in Italy and the diseases or conditions that expose patients to a high-risk of severe complications caused by meningococcal disease. Vaccination against meningococcal disease was perceived to be highly effective by 38.4% of participants, very safe by 36.2%, and 82% agreed or strongly agreed that HCWs should promote adherence to recommended vaccinations even in hesitant patients. Moreover, 34.1% recommended meningococcal vaccinations to all eligible patients and the results of the multivariate analysis showed that older HCWs, who work in pediatric/neonatal wards, have good knowledge about meningococcal vaccinations, have a favourable attitude towards vaccinations, and do not need additional information about meningococcal vaccinations, were more likely to recommend meningococcal vaccinations to all eligible patients. Interventions aimed at the enhancement of knowledge and awareness of HCWs who provide care to these patients on the benefits of meningococcal vaccinations are warranted.

Aryl Hydrocarbon Receptor Role in Co-Ordinating SARS-CoV-2 Entry and Symptomatology: Linking Cytotoxicity Changes in COVID-19 and Cancers; Modulation by Racial Discrimination Stress.

There is an under-recognized role of the aryl hydrocarbon receptor (AhR) in co-ordinating the entry and pathophysiology of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) that underpins the COVID-19 pandemic. The rise in pro-inflammatory cytokines during the ‘cytokine storm’ induce indoleamine 2,3-dioxygenase (IDO), leading to an increase in kynurenine that activates the AhR, thereby heightening the initial pro-inflammatory cytokine phase and suppressing the endogenous anti-viral response. Such AhR-driven changes underpin the heightened severity and fatality associated with pre-existent high-risk medical conditions, such as type II diabetes, as well as to how racial discrimination stress contributes to the raised severity/fatality in people from the Black Asian and Minority Ethnic (BAME) communities. The AhR is pivotal in modulating mitochondrial metabolism and co-ordinating specialized, pro-resolving mediators (SPMs), the melatonergic pathways, acetyl-coenzyme A, and the cyclooxygenase (COX) 2-prostaglandin (PG) E2 pathway that underpin ‘exhaustion’ in the endogenous anti-viral cells, paralleling similar metabolic suppression in cytolytic immune cells that is evident across all cancers. The pro-inflammatory cytokine induced gut permeability/dysbiosis and suppression of pineal melatonin are aspects of the wider pathophysiological underpinnings regulated by the AhR. This has a number of prophylactic and treatment implications for SARS-CoV-2 infection and cancers and future research directions that better investigate the biological underpinnings of social processes and how these may drive health disparities.

The aging veteran population: Promoting awareness to influence best practices

The older adult population is the most rapidly growing population in the United States. It is projected that by 2035, the population of adults older than 65 years is expected to be greater than the population of children. The projected number of Veterans age 60 and older is about 11 million. Along with common age-related complex and high-risk chronic medical conditions, care of older adult Veteran requires a holistic approach that focuses on the culture, and subcultures, and unique health care needs resultant of military service. Veterans’ health care is often multifocal and complex, requiring an integrated, collaborative, and comprehensive model of care that better facilitates meeting health goals to the degree most realistic and attainable for each older adult Veteran. This highlights the need to promote awareness and provide educational opportunities for engaging in best practices that meet the unique needs of the aging Veteran population.

Influenza vaccine effectiveness among outpatients in the US Influenza Vaccine Effectiveness Network by study site 2011-2016.

BackgroundInfluenza vaccination is recommended for all US residents aged ≥6 months. Vaccine effectiveness (VE) varies by age, circulating influenza strains, and the presence of high‐risk medical conditions. We examined site‐specific VE in the US Influenza VE Network, which evaluates annual influenza VE at ambulatory clinics in geographically diverse sites.MethodsAnalyses were conducted on 27 180 outpatients ≥6 months old presenting with an acute respiratory infection (ARI) with cough of ≤7‐day duration during the 2011‐2016 influenza seasons. A test‐negative design was used with vaccination status defined as receipt of ≥1 dose of any influenza vaccine according to medical records, registries, and/or self‐report. Influenza infection was determined by reverse‐transcription polymerase chain reaction. VE estimates were calculated using odds ratios from multivariable logistic regression models adjusted for age, sex, race/ethnicity, time from illness onset to enrollment, high‐risk conditions, calendar time, and vaccination status‐site interaction.ResultsFor all sites combined, VE was statistically significant every season against all influenza and against the predominant circulating strains (VE = 19%‐50%) Few differences among four sites in the US Flu VE Network were evident in five seasons. However, in 2015‐16, overall VE in one site was 24% (95% CI = −4%‐44%), while VE in two other sites was significantly higher (61%, 95% CI = 49%‐71%; P = .002, and 53%, 95% CI = 33,67; P = .034).ConclusionWith few exceptions, site‐specific VE estimates aligned with each other and overall VE estimates. Observed VE may reflect inherent differences in community characteristics of the sites and highlights the importance of diverse settings for studying influenza vaccine effectiveness.

Review of Evidence for Using Chest X-Rays for Active Tuberculosis Screening in Long-Term Care in Canada.

Background: People living in long-term care facilities (LTCF) are at high risk to develop active tuberculosis primarily as a result of reactivation of a latent TB infection, or endemic transmission between residents. Current national guidelines in Canada are to use a posterior-anterior and lateral chest X-ray to screen for TB for those over 65 years old, upon admission to a LTCF.Objective: To assess the available evidence for cost benefits of universal chest X-ray screening for new LTCF residents.Methodology: We conducted a search for all articles published until September 2018, in PubMed and WorlCat databases, in English, using a combination of key words: chest X-ray, chest radiography or CXR, long-term care, elderly, screening, and tuberculosis. We also reviewed publicly available guidelines for screening new residents to LTCF from across Canada. We report on a qualitative synthesis of the evidence in the documents retrieved.Results: The final review yielded four cost-effectiveness studies (2 of 4 conducted in countries with low incidence), one systematic review, one recommendation/editorial, and one cohort study. We found that in a tuberculosis low-incidence country the CXR cost per identified case was $672,298 CAD. Enacting a more targeted screening program, perhaps one that tests only those who previously had TB, or other high-risk medical conditions may enhance the cost-effectiveness.Recommendations: We suggest reviewing the screening policy for active TB in people entering LTCF, which is based on a CXR. The results indicate that a targeted search for active TB in people with symptoms or other high-risk medical conditions may be more cost-effective.

2731. Does Last Season’s Influenza Vaccination Affect Current Season’s Vaccine Effectiveness in Young Children?

BackgroundWe evaluated influenza VE over two consecutive years vs. the current season against influenza illness during two H3N2-predominant seasons in children receiving care at emergency/urgent care (ED/UC) facilities in metropolitan Colorado.MethodsWe conducted a test-negative case–control analysis of 1478 children aged 6 months to 8 years enrolled at Children’s Hospital Colorado ED/UC with influenza like illness during the 2016–2017 and 2017–2018 influenza seasons. The primary outcome was PCR-confirmed influenza and vaccination status was confirmed using electronic medical record and parental interviews. Vaccination status was defined as completely vaccinated (all doses of influenza vaccine according to child’s age); partially or not vaccinated children were defined as unvaccinated. Multivariable logistic regression models adjusted for high-risk medical condition, age, race and insurance status were used to calculate odds ratios (OR) and 95% confidence intervals. Vaccine effectiveness was calculated as (1 − OR) × 100.ResultsOf the 1224 (82.8%) children enrolled in the study with known vaccination status for both seasons, 361 (29%) tested positive for influenza. Overall, VE against influenza was 49% (95% CI, 33–61%) after adjusting for other covariates in the model. VE did not differ significantly between those vaccinated in both seasons and those vaccinated in only the current season (VE 69%, 95% CI 41–115) (Table 1).ConclusionOur estimates of influenza VE for two predominantly H3N2-influenza seasons in Colorado are comparable to the CDC -VE for children 6 months to 8 years. VE against ED or UC-attended influenza illness in children did not vary significantly by prior seasons’ vaccination status. Disclosures All authors: No reported disclosures.

The Use of Risk Enhancing Factors to Personalize ASCVD Risk Assessment: Evidence and Recommendations from the 2018 AHA/ACC Multi-society Cholesterol Guidelines.

In 2018, the AHA/ACC multi-society Cholesterol Guidelines introduced the novel concept of risk-enhancing factors to be used as a supplement to the pooled cohort risk equations to personalize atherosclerotic cardiovascular disease risk assessment in primary prevention. In this review, we discuss the rationale and evidence behind each of the risk- enhancing factors to help clinicians perform a more personalized cardiovascular risk assessment. The risk-enhancing factors are high-risk features that may guide the use of lipid-lowering therapy particularly in intermediate and select borderline risk patients. For the purpose of this review, these factors are divided into 5 categories: (i) race and genetics, (ii) conditions specific to women (iii) lipid related risk, (iv) concurrent high-risk medical conditions, and (v) biomarkers. The addition of the risk-enhancing factors to the pooled cohort equations provides a more individualized and comprehensive approach to cardiovascular disease risk assessment.

Spectrum of Influenza B Viral Infection in Indian Children: A Tertiary Centre Experience

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: Influenza viral infection in children can range from subclinical illness to multi system involvement. The morbidity associated with influenza B viral infection is often overlooked. India being the second most populous country, accounts for 20% of global childhood deaths from respiratory infections. There is paucity of data on the clinical features and complications of influenza B viral infections in children from the Indian subcontinent. Our objective was to study the clinical profile, seasonality, complications and outcome associated with Influenza B viral infection in children &lt; 18 years of age.&#x0D; Material and Methods: We conducted a retrospective observational study at a tertiary care hospital in South India. Children less than 18 years of age admitted to our paediatric unit were included in the study. We reviewed the case sheets of 56 patients who tested positive for influenza B virus during the study period and recorded their clinical and laboratory data. Throat swab obtained from cases were tested by RT-PCR. The illness was classified as upper respiratory tract infection, pneumonia and severe pneumonia. Outcome measures analysed were- mortality, need for oxygen supplementation or assisted ventilation, duration of oxygen support, duration of ICU/ hospital stay and time for defervescence following initiation of oseltamivir therapy.&#x0D; Results: The mean age of the study population was 6.98 years. Majority of the affected children were &gt; 5 years of age in the school going category with a male to female ratio of 3:2. The diagnosis based on clinical and radiological findings included upper respiratory tract infection (URTI) in 44 (78.5%) cases followed by pneumonia in 11(19.6%) and severe pneumonia in one (1.7%) child. The peak incidence was in the month of March. Malnutrition was the most common risk factor affecting 22 (39.3%) cases followed by history of asthma in eight (14.3%). Three children required oxygen supplementation at admission. The median duration of hospital stay was seven days. The median duration for defervescence following initiation of oseltamivir therapy was 24 hours. Mortality was recorded in one infant who died of acute respiratory distress syndrome.&#x0D; Conclusions: Influenza B virus should be screened in all children having underlying high risk medical condition, presenting with pneumonia or upper respiratory tract infection. Oseltamivir therapy should be initiated early in the management of influenza B viral infections to prevent complications.&#x0D; &#x0D; &#x0D; &#x0D;

820: “You can't get pregnant:” Contraceptive counseling by non-gynecologic specialties

Unintended pregnancies can be life-threatening for women with complex medical conditions, yet MFMs typically do not meet the patient until after conception. We sought to better understand the contraceptive counseling provided by non-gynecologic specialists who care for medically complex women. Providers across 10 non-gynecologic specialties at a single tertiary center in 2016-2017 completed an anonymous survey. The survey assessed provider demographics, counseling rates, and comfort with counseling about contraception and pregnancy risks. We then performed a retrospective cohort study to evaluate the extent of contraceptive counseling women with 20 high-risk comorbidities received. We selected comorbidities that are frequently encountered (e.g. diabetes, hypertension), associated with high morbidity (e.g. pulmonary hypertension), or put a woman at high risk of exposure to teratogenic medications (e.g. acne, lupus). We compared comorbidities using low-, moderate-, and high-maternal morbidity classifications. We considered teratogenic medications to be those previously classified as FDA category X. Of 200 providers approached, 158 responded (79%). Of respondents, 77% felt that it was the responsibility of all providers (primary care, gynecologist, and specialist) to counsel the patient about the risks of pregnancy; 60% felt that these same providers were responsible for counseling about contraceptive options. Over 40% of respondents reported providing contraceptive counseling "always” or "most of the time,” and over 35% reported offering contraception "always” or "most of the time.” Additionally, 40% of respondents reported counseling women about the risks of pregnancy; however, contraception was documented for only 36% of all women and recommended to ≤5% of women with high-risk medical conditions or taking a teratogenic medication. The risks of pregnancy or medication were rarely documented. While non-gynecologic specialists feel that contraceptive counseling is their responsibility, they do not routinely document counseling nor refer them to a gynecologist. OB and MFMs must provide more outreach to subspecialists who care for these women to help prevent unintended pregnancies in women at high risk of perinatal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

995. Effectiveness of Influenza Vaccine for Prevention of Influenza-Associated Hospitalizations Among High-Risk Adults in the United States, 2015–2016

BackgroundIndividuals with cardiopulmonary and other chronic conditions are at increased risk for severe complications of influenza. Few studies have examined influenza vaccine effectiveness (VE) in high-risk groups. We evaluated VE against influenza-associated hospitalization among adults with specific high-risk conditions.MethodsAdults hospitalized with acute respiratory illness (ARI) during the 2015–2016 influenza season were enrolled at eight hospitals participating in the US Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) study. Respiratory specimens were tested for influenza by reverse transcription PCR. Measures of illness severity, underlying health status, and vaccination were obtained from medical records and enrollment interviews. The presence of high-risk conditions was determined from clinical codes assigned to prior year medical encounters. We estimated VE using a test-negative design as (1 − adjusted odds ratio), comparing odds of PCR-confirmed influenza among vaccinated patients vs. unvaccinated controls. Multivariate logistic regression was adjusted for age, sex, and other factors, stratifying by chronic conditions.ResultsOf 1,467 adults hospitalized with ARI, 236 (16%) had PCR-confirmed influenza; 180 (78%) were A(H1N1)pdm09. In all, 1,358 (93%) had ≥1 high-risk medical condition, and 1,026 (70%) had ≥3 conditions. Cardiovascular (n = 835), metabolic (including diabetes) (n = 773) and lung conditions (n = 692) were most common (figure). Patients with ≥1 high-risk conditions were more likely to be vaccinated (70%) vs. patients not at high risk (31%, P < 0.001). Among all patients, VE against any influenza-associated hospitalization was 50% (95% CI: 31–63). VE was similarly high among patients with neurologic (VE = 64%, 95% CI: 26–83), metabolic (VE = 55%, 95% CI: 30–71), and cardiovascular (VE = 53%, 95% CI: 27–69) conditions, though lower for patients with immunosuppression and malignancy (VE = 20%, 95% CI: −42–54).ConclusionVaccination significantly reduced risk of influenza hospitalization among adults with the most prevalent high-risk cardiovascular, metabolic, and lung conditions. Results support the benefit of vaccinating adults with existing specific chronic conditions. Disclosures H. K. Talbot, sanofi pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none.

988. Effectiveness of Seasonal Influenza Vaccines Against Influenza A(H3N2) Illness Among Children Aged &amp;lt;18 Years, US Flu VE Network, 2010–2018

BackgroundInterim estimates of 2017–2018 influenza vaccine effectiveness (VE) against influenza A(H3N2)-related illness in the United States indicated better protection among young children than among older children and adolescents. We examined VE against influenza A(H3N2) illness during five A(H3N2)-predominant seasons from 2010–2011 through 2016–2017 to investigate differences between VE among younger vs. older children.MethodsWe analyzed data from 11,736 outpatients aged <18 years with medically attended acute respiratory illnesses enrolled at US Flu VE Network study sites during five influenza A(H3N2)-predominant seasons. Respiratory specimens from all enrollees were tested for influenza viruses using reverse transcription PCR. Children with documented receipt of the recommended number of doses of current season inactivated influenza vaccine at least 14 days before illness onset were considered fully vaccinated; partially vaccinated children and those who received live attenuated influenza vaccine were excluded. Vaccine effectiveness was estimated as 100 × (1 – adjusted odds ratio) from multivariable logistic regression adjusting for study site, age, sex, presence of high-risk medical conditions, and days from illness onset to enrollment comparing odds of vaccination among A(H3N2)-positive cases vs. influenza-negative controls.ResultsA total of 1,854 influenza A(H3N2) cases and 9,882 influenza-negative controls were included; 494 (28%) influenza A(H3N2) cases and 3,637 (41%) controls were fully vaccinated before illness onset. VE ranged from 26% (95% confidence interval [CI], −17% to 53%) to 60% (38%–75%) among children aged 6 months–4 years and from 9% (−16% to 29%) to 66% (37%–82%) among 5–17 year olds (figure). During 2012–2013 and 2014–2015, A(H3N2) VE estimates were significantly higher among younger compared with older children (P < 0.05); in other seasons before 2017–2018, A(H3N2) VE estimates were similar among younger and older children.ConclusionHigher VE against A(H3N2) viruses in younger vs. older children in some seasons suggests immunologic differences in response to vaccine components. Overall, inactivated influenza vaccine provided moderate protection against A(H3N2)-related illness among children.Disclosures M. L. Jackson, sanofi pasteur: Grant Investigator, Research support. L. A. Jackson, Novartis: Grant Investigator, Research support. R. K. Zimmerman, sanofi pasteur: Grant Investigator, Research support. Pfizer: Grant Investigator, Research support. Merck: Grant Investigator, Research support. M. P. Nowalk, Merck: Grant Investigator, Research support. Pfizer: Grant Investigator, Research support. M. R. Griffin, MedImmune: Grant Investigator, Research support. H. K. Talbot, sanofi pasteur: Investigator, Research grant. Gilead: Investigator, Research grant. MedImmune: Investigator, Research grant. Vaxinnate: Safety Board, none. Seqirus: Safety Board, none. J. J. Treanor, Novartis: Board Member and Consultant, Consulting fee.

Influenza vaccine effectiveness among patients with high-risk medical conditions in the United States, 2012–2016

BackgroundAnnual influenza vaccination has been recommended for persons with high-risk conditions since the 1960s. However, few estimates of influenza vaccine effectiveness (VE) for persons with high-risk conditions are available. MethodsData from the U.S. Influenza Vaccine Effectiveness Network from 2012 to 2016 were analyzed to compare VE of standard-dose inactivated vaccines against medically-attended influenza among patients aged ≥6 months with and without high-risk medical conditions. Patients with acute respiratory illness were tested for influenza by RT-PCR. Presence of high-risk conditions and vaccination status were obtained from medical records. VE by influenza virus type/subtype and age group was calculated for patients with and without high-risk conditions using the test-negative design. Interaction terms were used to test for differences in VE by high-risk conditions. ResultsOverall, 9643 (38%) of 25,369 patients enrolled during four influenza seasons had high-risk conditions; 2213 (23%) tested positive for influenza infection. For all ages, VE against any influenza was lower among patients with high-risk conditions (41%, 95% CI: 35–47%) than those without (48%, 95% CI: 43–52%; P-for-interaction = 0.02). For children aged <18 years, VE against any influenza was 51% (95% CI: 39–61%) and 52% (95% CI: 39–61%) among those with and without high-risk conditions, respectively (P-for-interaction = 0.54). For adults aged ≥18 years, VE against any influenza was 38% (95% CI: 30–45%) and 44% (95% CI: 38–50%) among those with and without high-risk conditions, respectively (P-for-interaction = 0.21). For both children aged <18 and adults aged ≥18 years, VEs against illness related to influenza A(H3N2), A(H1N1)pdm09, and influenza B virus infection were similar among those with and without high-risk conditions. ConclusionsInfluenza vaccination provided protection against medically-attended influenza among patients with high-risk conditions, at levels approaching those observed among patients without high-risk conditions. Results from our analysis support recommendations of annual vaccination for patients with high-risk conditions.

Assessment of motor development using movement assessment battery for children 2nd edition in preschool children with high risk medical and surgical conditions

Assessment of motor development using movement assessment battery for children 2nd edition in preschool children with high risk medical and surgical conditions