1 Efficacy (Effectiveness) of Pneumococcal Conjugate Vaccine in Infants by Maternal Influenza Vaccination Public
van Santen, Katharina (2012)
Abstract
Abstract
Efficacy (Effectiveness) of Pneumococcal Conjugate Vaccine in
Infants by Maternal Influenza Vaccination
BACKGROUND: Influenza virus can predispose patients to
secondary pneumococcal infections,
potentially resulting in increased otitis media or other
pneumococcal-related outcomes. Children
are at greatest risk for pneumococcal infection in the first year
of life. However, they are not
considered fully protected
adminstered at 6 months of age, and there
is currently no influenza vaccine licensed for infants under 6
months of age. Maternal influenza
vaccination during pregnancy can protect infants from respiratory
diease during this time of
increased susceptibility.
METHODS: We conducted a retrospective cohort study of 5,525
mother-infant pairs enrolled in
an MCO, with infants born during the influenza season. Exposure was
assessed for receipt of
maternal influenza vaccine, infant pneumococcal vaccine (PCV7), and
the combination of
vaccines. Outcomes of interest were acute otitis media (AOM) and
medically attended acute
respiratory infection (MAARI) in the first year of life. We
estimated the incidence of illness,
incidence rate ratios, and vaccine effectiveness based off of the
ratio of incidence rate ratios
between the pre-influenza circulation period and the period of at
least local influenza circulation.
RESULTS: Initial AOM and MAARI rate estimates were higher in
infants born during pre-
influenza circulation periods, compared to periods of influenza
circulation, and were higher
among infants who received any combination of vaccines compared to
those who received no
vaccine in both periods. When controlling for period of birth using
the ratio of ratios method,
lower rates of AOM and MAARI were observed for infants with any
vaccine exposure, compared
to infants who received neither vaccine. Relative to infants who
were exposed to neither vaccine,
the effectiveness of combined pneumococcal vaccination and maternal
influenza vaccination was
35.7% (95% confidence interval [CI]: -3.3, 60) and 13.9% (95% CI:
-24.7, 40.6) for infants who
received only PCV7.
CONCLUSIONS: The combination of maternal influenza
vaccination and infant pneumococcal
vaccination seems to confer more protection from acute otitis media
infections in the first year of
life than infant pneumococcal infection alone.
Table of Contents
Table of Contents
Background
........................................................................................................................
1
Global and U.S. Burden of Pneumococcal Diseases
.......................................................1
Pneumococcal Conjugate Vaccine
...................................................................................2
Maternal Influenza Vaccination and Pneumococcal Conjugate Vaccine
.......................5
Bangladesh Study
.............................................................................................................7
Manuscript..........................................................................................................................
8
Introduction
......................................................................................................................8
Methods
............................................................................................................................9
Results
............................................................................................................................12
Discussion
......................................................................................................................14
Tables and Figures
...........................................................................................................
16
Figure 1: Cohort creation from births during periods of
pre-influenza circulation or influenza
circulation from October 1, 2002 to December 31, 2009
......................................................17
Table 1: Cohort births during pre-influenza activity periods and
periods of at last local
influenza activity, shown for each influenza season including H1N1
births. N=5,525 ............18
Table 2: Maternal influenza vaccination coverage, infant PCV
vaccination coverage,
acute otitis media coverage, and medically attended acute
respiratory infection
(MAARI) coverage for outcomes after 2 months of age by influenza
season. H1N1
births included. N=5,525
................................................................................................19
Table 3: Cohort births during pre-influenza activity periods and
periods of at last local
influenza activity, shown for each influenza season including H1N1
births. N=5,525 ............20
Table 4: Adjusted IRRs, ratio of IRRs (R-IRR) and vaccine
effectiveness for pre-
influenza circulation period births and births during the period of
influenza circulation
from Oct. 1, 2002-Dec. 31, 2009.
.................................................................................21
References
.........................................................................................................................
22
Supplementary Tables
.....................................................................................................
27
Public Health Implications
..............................................................................................
29
Kaiser Permanente GA IRB Approval
..............................................................................
30
About this Master's Thesis
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