1 Efficacy (Effectiveness) of Pneumococcal Conjugate Vaccine in Infants by Maternal Influenza Vaccination 公开

van Santen, Katharina (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/8c97kq54h?locale=zh
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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

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