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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease

Eric I. Benchimol, Steven Hawken, Jeffrey C. Kwong and Kumanan Wilson
Pediatrics June 2013, 131 (6) e1811-e1820; DOI: https://doi.org/10.1542/peds.2012-3567
Eric I. Benchimol
aCHEO IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;
bDepartments of Pediatrics,
cEpidemiology and Community Medicine, and
dInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
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Steven Hawken
dInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
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Jeffrey C. Kwong
dInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
eDepartment of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and
fPublic Health Ontario, Toronto, Ontario, Canada;
gUniversity Health Network, Toronto, Ontario, Canada
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Kumanan Wilson
cEpidemiology and Community Medicine, and
dInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
hMedicine, University of Ottawa, Ottawa, Ontario, Canada;
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Abstract

OBJECTIVE: Influenza immunization is recommended for children with IBD, however safety concerns may limit uptake. This study assessed whether immunization was associated with adverse events in IBD patients using a population-based database of children with IBD.

METHODS: All children <19 years diagnosed with IBD in Ontario, Canada between 1999–2009 were identified using health administrative data, and matched to non-IBD controls. Self-controlled case series (SCCS) analyses determined health services event rates (outpatient visits, hospitalizations and emergency visits) in any 2-week risk period to 180 days post-immunization compared to a no-risk control period. Relative incidence (RI) was calculated for overall and IBD-related events and rates were compared between IBD cases and controls using relative incidence ratios (RIR).

RESULTS: A total of 4916 IBD patients were matched to 21 686 controls. IBD patients were more likely to have received immunization than controls (25.3% vs 13.2%, P < .001). No increased event rates existed in IBD cases during risk periods (pooled RI 0.95, 95% CI 0.84–1.07), including hospitalizations and emergency visits. There was a slightly higher event rate in IBD cases versus controls for days 3–14 (RIR 1.60, 95% CI 1.05–2.44, P = .03). IBD-related visit rates were lower in risk periods compared to control period (pooled RI 0.81, 95% CI 0.68–0.96).

CONCLUSIONS: There was no increase in health services use in the post-vaccine risk period in IBD patients, and there was evidence for a protective effect of influenza immunization against IBD-related health services use. Influenza immunization is safe in children with IBD and should be encouraged to improve poor coverage rates.

  • epidemiology
  • health administrative data
  • inflammatory bowel diseases
  • influenza vaccines
  • pediatrics
  • seasonal influenza
  • vaccine safety
  • Abbreviations:
    CD —
    Crohn’s disease
    CI —
    confidence intervals
    ED —
    emergency department
    IBD —
    inflammatory bowel disease
    OCCC —
    Ontario Crohn’s and Colitis Cohort
    OHIP —
    Ontario Health Insurance Plan
    SCCS —
    self-controlled case series
    RI —
    relative incidence
    RIR —
    relative incidence ratio
    UC —
    ulcerative colitis
    • Accepted February 22, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 6
    1 Jun 2013
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    Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease
    Eric I. Benchimol, Steven Hawken, Jeffrey C. Kwong, Kumanan Wilson
    Pediatrics Jun 2013, 131 (6) e1811-e1820; DOI: 10.1542/peds.2012-3567

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    Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease
    Eric I. Benchimol, Steven Hawken, Jeffrey C. Kwong, Kumanan Wilson
    Pediatrics Jun 2013, 131 (6) e1811-e1820; DOI: 10.1542/peds.2012-3567
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