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Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness
BACKGROUND: Children with comorbidities are at greater risk of severe influenza outcomes compared with healthy children. In Australia, influenza vaccination was funded for those with comorbidities from 2010 and all children aged <5 years from 2018. Influenza vaccine coverage remains inadequate in...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818821/ https://www.ncbi.nlm.nih.gov/pubmed/34787369 http://dx.doi.org/10.1111/irv.12939 |
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author | Norman, Daniel A. Cheng, Allen C. Macartney, Kristine K. Moore, Hannah C. Danchin, Margie Seale, Holly McRae, Jocelynne Clark, Julia E. Marshall, Helen S. Buttery, Jim Francis, Joshua R. Crawford, Nigel W. Blyth, Christopher C. |
author_facet | Norman, Daniel A. Cheng, Allen C. Macartney, Kristine K. Moore, Hannah C. Danchin, Margie Seale, Holly McRae, Jocelynne Clark, Julia E. Marshall, Helen S. Buttery, Jim Francis, Joshua R. Crawford, Nigel W. Blyth, Christopher C. |
author_sort | Norman, Daniel A. |
collection | PubMed |
description | BACKGROUND: Children with comorbidities are at greater risk of severe influenza outcomes compared with healthy children. In Australia, influenza vaccination was funded for those with comorbidities from 2010 and all children aged <5 years from 2018. Influenza vaccine coverage remains inadequate in children with and without comorbidities. METHODS: Children ≤16 years admitted with acute respiratory illness and tested for influenza at sentinel hospitals were evaluated (2010–2019). Multivariable regression was used to identify predictors of severe outcomes. Vaccine effectiveness was estimated using the modified incidence density test‐negative design. RESULTS: Overall, 6057 influenza‐confirmed hospitalized cases and 3974 test‐negative controls were included. Influenza A was the predominant type (68.7%). Comorbidities were present in 40.8% of cases. Children with comorbidities were at increased odds of ICU admission, respiratory support, longer hospitalizations, and mortality. Specific comorbidities including neurological and cardiac conditions increasingly predisposed children to severe outcomes. Influenza vaccine coverage in influenza negative children with and without comorbidities was low (33.5% and 17.9%, respectively). Coverage improved following introduction of universal influenza vaccine programs for children <5 years. Similar vaccine effectiveness was demonstrated in children with (55% [95% confidence interval (CI): 45; 63%]) and without comorbidities (57% [(95%CI: 44; 67%]). CONCLUSIONS: Comorbidities were present in 40.8% of influenza‐confirmed admissions and were associated with more severe outcomes. Children with comorbidities were more likely experience severe influenza with ICU admission, mechanical ventilation, and in‐hospital morality. Despite demonstrated vaccine effectiveness in those with and without comorbidities, vaccine coverage was suboptimal. Interventions to increase vaccination are expected to reduce severe influenza outcomes. |
format | Online Article Text |
id | pubmed-8818821 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-88188212022-03-01 Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness Norman, Daniel A. Cheng, Allen C. Macartney, Kristine K. Moore, Hannah C. Danchin, Margie Seale, Holly McRae, Jocelynne Clark, Julia E. Marshall, Helen S. Buttery, Jim Francis, Joshua R. Crawford, Nigel W. Blyth, Christopher C. Influenza Other Respir Viruses Original Articles BACKGROUND: Children with comorbidities are at greater risk of severe influenza outcomes compared with healthy children. In Australia, influenza vaccination was funded for those with comorbidities from 2010 and all children aged <5 years from 2018. Influenza vaccine coverage remains inadequate in children with and without comorbidities. METHODS: Children ≤16 years admitted with acute respiratory illness and tested for influenza at sentinel hospitals were evaluated (2010–2019). Multivariable regression was used to identify predictors of severe outcomes. Vaccine effectiveness was estimated using the modified incidence density test‐negative design. RESULTS: Overall, 6057 influenza‐confirmed hospitalized cases and 3974 test‐negative controls were included. Influenza A was the predominant type (68.7%). Comorbidities were present in 40.8% of cases. Children with comorbidities were at increased odds of ICU admission, respiratory support, longer hospitalizations, and mortality. Specific comorbidities including neurological and cardiac conditions increasingly predisposed children to severe outcomes. Influenza vaccine coverage in influenza negative children with and without comorbidities was low (33.5% and 17.9%, respectively). Coverage improved following introduction of universal influenza vaccine programs for children <5 years. Similar vaccine effectiveness was demonstrated in children with (55% [95% confidence interval (CI): 45; 63%]) and without comorbidities (57% [(95%CI: 44; 67%]). CONCLUSIONS: Comorbidities were present in 40.8% of influenza‐confirmed admissions and were associated with more severe outcomes. Children with comorbidities were more likely experience severe influenza with ICU admission, mechanical ventilation, and in‐hospital morality. Despite demonstrated vaccine effectiveness in those with and without comorbidities, vaccine coverage was suboptimal. Interventions to increase vaccination are expected to reduce severe influenza outcomes. John Wiley and Sons Inc. 2021-11-16 2022-03 /pmc/articles/PMC8818821/ /pubmed/34787369 http://dx.doi.org/10.1111/irv.12939 Text en © 2021 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Norman, Daniel A. Cheng, Allen C. Macartney, Kristine K. Moore, Hannah C. Danchin, Margie Seale, Holly McRae, Jocelynne Clark, Julia E. Marshall, Helen S. Buttery, Jim Francis, Joshua R. Crawford, Nigel W. Blyth, Christopher C. Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness |
title | Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness |
title_full | Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness |
title_fullStr | Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness |
title_full_unstemmed | Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness |
title_short | Influenza hospitalizations in Australian children 2010–2019: The impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness |
title_sort | influenza hospitalizations in australian children 2010–2019: the impact of medical comorbidities on outcomes, vaccine coverage, and effectiveness |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818821/ https://www.ncbi.nlm.nih.gov/pubmed/34787369 http://dx.doi.org/10.1111/irv.12939 |
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