Vaccine Effectiveness Against Pediatric Influenza Hospitalizations and Emergency Visits

Campbell, Angela P; Ogokeh, Constance; Lively, Joana Y; Staat, Mary Allen; Selvarangan, Rangaraj; Halasa, Natasha; Englund, Janet A.; Boom, Julie A.; Weinberg, Geoffrey A.; Williams, John V.; McNeal, Monica; Harrison, Christopher J.; Stewart, Laura S; Klein, Eileen J.; Sahni, Leila C; Szilâgyi, Peter G.; Michaels, Marian G.; Hickey, Robert W.; Moffat, Mary E.; Pahud, Barbara; Schuster, Jennifer E; Weddle, Gina; Rha, Brian; Fry, Alicia M.; Patel, Manish

doi:10.1542/peds.2020-1368

Cited by 26 publications

(20 citation statements)

References 46 publications

(59 reference statements)

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“…Provisional data were obtained from the New Vaccine Surveillance Network (NVSN), a prospective, population-based ARI surveillance platform funded by the Centers for Disease Control and Prevention (CDC). 18,19…”

Section: Methodsmentioning

confidence: 99%

“…Children under 18 years were eligible for enrollment if they resided within a site's surveillance area and visited the ED or were admitted to the hospital within 48 hours of enrollment with ≥1 of the following symptoms: fever, cough, earache, nasal congestion, runny nose, sore throat, posttussive vomiting, wheezing, shortness of breath/rapid or shallow breathing, apnea, apparent lifethreatening event, brief resolved unexplained event, or myalgias; and duration of illness <14 days. 18 Children were excluded if they had a known non-respiratory cause for their illness, chemotherapy-associated fever and neutropenia, been transferred from another hospital after an admission of >48 hours, were admitted <5 days after a previous hospitalization, were never discharged home after birth, or had previous enrollment in the study <14 days before current enrollment. Of note, three sites restricted ED enrollment primarily to children under five years…”

Section: Study Populationmentioning

confidence: 99%

“…Diagnostic assay methods varied by site and included Luminex NxTAG Respiratory Pathogen Panel (Cincinnati and Kansas City), BioFire FilmArray Respiratory Panel (Seattle), Applied Biosystems TaqMan Array Microfluidic Card (Rochester), and in-house real-time reverse transcription-polymerase chain reaction assays (Houston, Pittsburgh, and Nashville). 18 All sites conducted CDC-sponsored proficiency testing to ensure the validity and consistency of respiratory viral detections at each site. 18,19…”

Section: Data and Specimen Collectionmentioning

confidence: 99%

“…18 All sites conducted CDC-sponsored proficiency testing to ensure the validity and consistency of respiratory viral detections at each site. 18,19…”

Section: Data and Specimen Collectionmentioning

confidence: 99%

“…For example, respiratory syncytial virus (RSV) and influenza are among the most common causes of ARI in children, both associated with increased disease severity, and generally peak in winter and early-spring months each year. [14][15][16][17][18] Therefore, this study aimed to (1) assess the frequency of ARI in children, including those due to RSV and influenza, in both the ED and inpatient settings, before and during the pandemic within a US multicenter active surveillance network, and (2) whether the proportions of such ARIs testing positive for RSV and influenza during the COVID-19 mitigation period in 2020 were lower than in prior seasons.…”

Section: Introductionmentioning

confidence: 99%

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Acute Respiratory Illnesses in Children in the SARS-CoV-2 Pandemic: Prospective Multicenter Study

et al. 2021

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This is a prepublication version of an article that has undergone peer review and been accepted for publication but is not the final version of record. This paper may be cited using the DOI and date of access. This paper may contain information that has errors in facts, figures, and statements, and will be corrected in the final published version. The journal is providing an early version of this article to expedite access to this information. The American Academy of Pediatrics, the editors, and authors are not responsible for inaccurate information and data described in this version.

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Section: Methodsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Data and Specimen Collectionmentioning

confidence: 99%

“…18 All sites conducted CDC-sponsored proficiency testing to ensure the validity and consistency of respiratory viral detections at each site. 18,19…”

Section: Data and Specimen Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute Respiratory Illnesses in Children in the SARS-CoV-2 Pandemic: Prospective Multicenter Study

et al. 2021

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Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US

et al. 2023

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ImportanceRhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting.ObjectiveTo quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals.Design, Setting, and ParticipantsThis cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought medical care for fever and/or respiratory symptoms at 7 EDs or hospitals within NVSN across the US between December 2016 and February 2021. Persons younger than 18 years were enrolled in NVSN, and respiratory specimens were collected and tested for multiple viruses.Main Outcomes and MeasuresProportion of patients in whom rhinovirus and/or enterovirus, or another virus, was detected by calendar month and by prepandemic (December 1, 2016, to March 11, 2020) or pandemic (March 12, 2020, to February 28, 2021) periods. Month-specific adjusted odds ratios (aORs) for rhinovirus and/or enterovirus–positive test results (among all tested) by setting (ED or inpatient) and age group (&lt;2, 2-4, or 5-17 years) were calculated, comparing each month during the pandemic to equivalent months of previous years.ResultsOf the 38 198 children and adolescents who were enrolled and tested, 11 303 (29.6%; mean [SD] age, 2.8 [3.7] years; 6733 boys [59.6%]) had rhinovirus and/or enterovirus–positive test results. In prepandemic and pandemic periods, rhinoviruses and/or enteroviruses were detected in 29.4% (9795 of 33 317) and 30.9% (1508 of 4881) of all patients who were enrolled and tested and in 42.2% (9795 of 23 236) and 73.0% (1508 of 2066) of those with test positivity for any virus, respectively. Rhinoviruses and/or enteroviruses were the most frequently detected viruses in both periods and all age groups in the ED and inpatient setting. From April to September 2020 (pandemic period), rhinoviruses and/or enteroviruses were detectable at similar or lower odds than in prepandemic years, with aORs ranging from 0.08 (95% CI, 0.04-0.19) to 0.76 (95% CI, 0.55-1.05) in the ED and 0.04 (95% CI, 0.01-0.11) to 0.71 (95% CI, 0.47-1.07) in the inpatient setting. However, unlike some other viruses, rhinoviruses and/or enteroviruses soon returned to prepandemic levels and from October 2020 to February 2021 were detected at similar or higher odds than in prepandemic months in both settings, with aORs ranging from 1.47 (95% CI, 1.12-1.93) to 3.01 (95% CI, 2.30-3.94) in the ED and 1.36 (95% CI, 1.03-1.79) to 2.44 (95% CI, 1.78-3.34) in the inpatient setting, and in all age groups. Compared with prepandemic years, during the pandemic, rhinoviruses and/or enteroviruses were detected in patients who were slightly older, although most (74.5% [1124 of 1508]) were younger than 5 years.Conclusions and RelevanceResults of this study show that rhinoviruses and/or enteroviruses persisted and were the most common respiratory virus group detected across all pediatric age groups and in both ED and inpatient settings. Rhinoviruses and/or enteroviruses remain a leading factor in ARI health care burden, and active ARI surveillance in children and adolescents remains critical for defining the health care burden of respiratory viruses.

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Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children

Antoon,

Stopczynski,

Amarin

et al. 2024

JAMA Netw Open

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ImportanceStudies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown.ObjectiveTo determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings.Design, Setting, and ParticipantsChildren younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 US pediatric medical centers affiliated with the Centers for Disease Control and Prevention–sponsored New Vaccine Surveillance Network from December 1, 2016, to March 31, 2020, were included in this cohort study. Nasal and/or throat swabs were collected for research molecular testing for influenza, regardless of clinical testing. Data, including ICD-10 discharge diagnoses and clinical testing for influenza, were obtained through medical record review. Data analysis was performed in August 2023.Main Outcomes and MeasuresThe accuracy of ICD-10–coded discharge diagnoses was characterized using molecular clinical or research laboratory test results as reference. Measures included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Estimates were stratified by setting (ED vs inpatient) and age (0-1, 2-4, and 5-17 years).ResultsA total of 16 867 children in the ED (median [IQR] age, 2.0 [0.0-4.0] years; 9304 boys [55.2%]) and 17 060 inpatients (median [IQR] age, 1.0 [0.0-4.0] years; 9798 boys [57.4%]) were included. In the ED, ICD-10 influenza diagnoses were highly specific (98.0%; 95% CI, 97.8%-98.3%), with high PPV (88.6%; 95% CI, 88.0%-89.2%) and high NPV (85.9%; 95% CI, 85.3%-86.6%), but sensitivity was lower (48.6%; 95% CI, 47.6%-49.5%). Among inpatients, specificity was 98.2% (95% CI, 98.0%-98.5%), PPV was 82.8% (95% CI, 82.1%-83.5%), sensitivity was 70.7% (95% CI, 69.8%-71.5%), and NPV was 96.5% (95% CI, 96.2%-96.9%). Accuracy of ICD-10 diagnoses varied by patient age, influenza season definition, time between disease onset and testing, and clinical setting.Conclusions and RelevanceIn this large cohort study, influenza ICD-10 discharge diagnoses were highly specific but moderately sensitive in identifying laboratory-confirmed influenza; the accuracy of influenza diagnoses varied by clinical and epidemiological factors. In the ED and inpatient settings, an ICD-10 diagnosis likely represents a true-positive influenza case.

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Vaccine Effectiveness Against Pediatric Influenza Hospitalizations and Emergency Visits

Cited by 26 publications

References 46 publications

Acute Respiratory Illnesses in Children in the SARS-CoV-2 Pandemic: Prospective Multicenter Study

Acute Respiratory Illnesses in Children in the SARS-CoV-2 Pandemic: Prospective Multicenter Study

Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US

Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children

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