Published online June 22, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. e587-e595 (doi:10.1542/10.1542/peds.2006-1878)

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ARTICLE

Vaccine Effectiveness Against Medically Attended, Laboratory-Confirmed Influenza Among Children Aged 6 to 59 Months, 2003–2004

Carrie M. Shuler, DVM, MPH^a,b, Martha Iwamoto, MD, MPH^a, Carolyn Buxton Bridges, MD^c, Mona Marin, MD^a, Ruth Neeman, RN, BSN^b, Paul Gargiullo, PhD^c, Terrace A. Yoder, MD^d, Harry L. Keyserling, MD^e and Pauline D. Terebuh, MD, MPH^b

^a Epidemic Intelligence Service
^c Centers for Disease Control and Prevention, Atlanta, Georgia
^b Notifiable Diseases Section, Division of Public Health, Georgia Department of Human Resources, Atlanta, Georgia
^d Children’s Medical Group, Atlanta, Georgia
^e School of Medicine, Emory University, Atlanta, Georgia

OBJECTIVES. Influenza is a leading cause of illness among children. Studies rarely have measured influenza vaccine effectiveness among young children, particularly when antigenic match between vaccine and circulating viruses is suboptimal. We assessed vaccine effectiveness against medically attended, laboratory-confirmed influenza for children who were aged 6 to 59 months during the 2003–2004 influenza season.

METHODS. In a case-control study that was conducted in a single pediatric practice, case patients who were aged 6 to 59 months and had laboratory-confirmed influenza were age matched 1:2 to eligible control subjects. Vaccination status was ascertained as of the date of the case patient’s symptom onset. Conditional logistic regression was used to calculate vaccine effectiveness, adjusting for underlying medical conditions and health care usage.

RESULTS. We identified 290 influenza case patients who were seen for medical care from November 1, 2003, to January 31, 2004. Vaccine effectiveness among fully vaccinated children, compared with unvaccinated children, was 49%. Partially vaccinated children who were aged 6 to 23 months had no significant reduction in influenza (vaccine effectiveness: –70%), but partially vaccinated children who were aged 24 to 59 months had a significant (65%) reduction in influenza, compared with unvaccinated children.

CONCLUSIONS. Full vaccination provided measurable protection against laboratory-confirmed influenza among children who were aged 6 to 59 months during a season with suboptimal vaccine match. No vaccine effectiveness was identified with partial vaccination among children who were aged 6 to 23 months, affirming that children need to be fully vaccinated to obtain protective effects. These results strengthen the evidence of the vaccine’s ability to reduce substantially the burden of disease in this age group.

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Key Words: influenza • children • vaccine effectiveness

Abbreviations: ACIP—Advisory Committee on Immunization Practices • VE—vaccine effectiveness • ILI—influenza-like illness • RAD—reactive airway disease • OR—odds ratio • aOR—adjusted odds ratio • CI—confidence interval • P&I—pneumonia and influenza

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Accepted Sep 26, 2006.

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