Developmental Biology - Flu Virus|
Children Under 5 at High Risk for Flu Complications
Full flu vaccination among children cuts hospitalization in half...
Fully vaccinating children reduces their risk of hospitalization with influenza by 54%. This information is according to research from the University of Michigan, the Clalit Research Institute, and Ben-Gurion University in Israel.
The study, published by Oxford University Press in the December 2019 issue of their journal Clinical Infectious Disease, is one of the few studies worldwide that has tested the effectiveness of childhood vaccination against influenza and risk of hospitalization due to influenza complications.
In Israel, as in the United States, government guidelines recommend that children 8 or younger who have never been vaccinated, or who have only gotten one dose of flu vaccine previously, should receive two doses of vaccine.
Data shows that children vaccinated according to government guidelines are much better protected from influenza than those who only receive one vaccine.
"Over half of our study population had underlying conditions that may put them at high risk for severe influenza-related complications, so preventing influenza in this group is critically important. Our results also showed that the vaccine was effective in three different seasons with different circulating viruses, reinforcing the importance of getting an influenza vaccine every year no matter what virus is circulating."
Hannah Segaloff PhD, Research Fellow, University of Michigan School of Public Health and lead author of the study.
The retrospective study used data from Clalit health Services, the largest health fund in Israel, to review the vaccination data of 3,746 hospitalizations of children 6 months to 8 years old at six hospitals in Israel. They were tested for influenza over three winter seasons 2015-16, 2016-17 and 2017-18.
Not only do the findings reveal that the flu vaccine reduced hospitalizations associated with the flu by 54%, but show giving two vaccine doses to children up to age 8 — who have never been vaccinated or only received one dose previously — is more effective than administering one dose in accordance with the Israel Ministry of Health's recommendations.
"Young children are at high risk of hospitalization due to influenza complications. Children with underlying illnesses such as asthma and heart disease have an even greater risk of getting the complications. It is important to prevent influenza infections in these populations."
Mark Katz PhD, Senior Researcher, Clalit Research Institute research arm of Clalit Health Services, Adjunct Associate Clinical Professor, BGU School of Public Health and Medical School for International Health; and study co-author.
The findings support health organizations' recommendations, including the Israel Ministry of Health, to vaccinate children against influenza every year, preferably before the onset of winter or early childhood. Children under 5 are defined as having a high risk of influenza complications.
"This study mirrors a previous study we conducted at Clalit Institute where we found that flu vaccine reduces 40% risk of hospitalizations in pregnant women. It reaffirms that vaccination is the most effective way to prevent both the flu and hospitalization. We hope parents will be made aware of these facts and make an informed decision about the importance of vaccinating their children."
Ran Balicer, Director, Clalit Research Institute; Professor, Ben Gurion University School of Public Health, Beer Sheva, Israel.
The researchers hope that this study and additional research will increase vaccination rates among the general public and especially children.
Influenza vaccine effectiveness (VE) varies by season, circulating influenza strain, age, and geographic location. There have been few studies of influenza VE among hospitalized children, particularly in Europe and the Middle East.
We estimated VE against influenza hospitalization among children aged 6 months to 8 years at Clalit Health Services hospitals in Israel in the 2015–2016, 2016–2017, and 2017–2018 influenza seasons, using the test-negative design. Estimates were computed for full and partial vaccination.
We included 326 influenza-positive case patients and 2821 influenza-negative controls (140 case patients and 971 controls from 2015–2016, 36 case patients and 1069 controls from 2016–2017, and 150 case patients and 781 controls from 2017–2018). Over all seasons, VE was 53.9% for full vaccination (95% confidence interval [CI], 38.6%–68.3%), and 25.6% for partial vaccination (-3% to 47%). In 2015–2016, most viruses were influenza A(H1N1) and vaccine lineage–mismatched influenza B/Victoria; the VE for fully vaccinated children was statistically significant for influenza A (80.7%; 95% CI, 40.3%–96.1%) but not B (23.0%; -38.5% to 59.4%). During 2016–2017, influenza A(H3N2) predominated, and VE was (70.8%; 95% CI, 17.4%–92.4%). In 2017–2018, influenza A(H3N2), H1N1 and lineage-mismatched influenza B/Yamagata cocirculated; VE was statistically significant for influenza B (63.0%; 95% CI, 24.2%–83.7%) but not influenza A (46.3%; -7.2% to 75.3%).
Influenza vaccine was effective in preventing hospitalizations among fully vaccinated Israeli children over 3 influenza seasons, but not among partially vaccinated children. There was cross-lineage protection in a season where the vaccine contained B/Victoria and the circulating strain was B/Yamagata, but not in a season with the opposite vaccine-circulating strain distribution.
Hannah E Segaloff, Maya Leventer-Roberts, Dan Riesel, Ryan E Malosh, Becca S Feldman, Yonat Shemer-Avni, Calanit Key, Arnold S Monto, Emily T Martin and Mark A Katz.
The authors are indebted to Matthew Camilleri for unwavering technical and administrative support. Thanks also goes to Julia Camilleri for assistance with experiments. We are also very grateful to Aaron Voigt, Magalie Lecourtois, Jane Wu, Brian McCabe, and Fabian Feiguin for fly stocks. This work was supported by the University of Malta Research Fund to RJC, and the Malta Council for Science & Technology Internationalisation Partnership Award to RJC. RC was supported by the Erasmus+ programme of the EU. ML was supported by an Endeavour Scholarship (Malta), part-financed by the EU – European Social Fund under Operational Programme II – Cohesion Policy 2014–2020, “Investing in human capital to create more opportunities and promote the well-being of society”. RMB was supported by a Bjorn Formosa Scholarship for Advanced Research into ALS/MND funded by the non-profit organisation, ALS Malta Foundation, facilitated by the Research Trust (RIDT) of the University of Malta.
Study co-authors are Rebecca Cacciottolo, Joanna Ciantar, Maia Lanfranco, Rebecca Borg and Prof Neville Vassallo from the University of Malta, and Dr Remy Bordonne from the Institut de Genetique Moleculaire de Montpellier (CNRS/Universite de Montpellier). Research in Dr. Cauchi's laboratory is founded by the Malta Council for Science & Technology, an Endeavour Scholarship (part-financed by the European Social Fund), ALS Malta Foundation and the University of Malta's Research Trust (RIDT).
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