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Effectiveness of intranasal live attenuated influenza vaccine against all-cause acute otitis media in children.
Pediatr Infect Dis J 2013; 32(6):669-74PI

Abstract

BACKGROUND

Acute otitis media (AOM) is a frequent complication of influenza in children, and influenza vaccination helps protect against influenza-associated AOM. A live attenuated influenza vaccine (LAIV) approved for eligible children aged ≥2 years for the prevention of influenza also effectively reduces influenza-associated AOM. However, the annual effectiveness of LAIV against all-cause AOM is unknown.

METHODS

AOM rates in children aged 6-83 months from 6 randomized, placebo-controlled trials and 2 randomized, inactivated influenza vaccine-controlled trials were pooled and analyzed. To enable comparison with studies of AOM prevention by pneumococcal conjugate vaccines, 12-month effectiveness was calculated assuming that LAIV had no effect outside of influenza seasons.

RESULTS

During influenza seasons, LAIV efficacy compared with placebo against all-cause AOM in children aged 6-71 months (N = 9497) was 12.4% (95% confidence interval [CI]: 2.0%, 21.6%) in year 1. In year 2, the efficacy in children aged 18-83 months (N = 4142) was 6.2% (95% CI: -12.4%, 21.7%). Compared with inactivated influenza vaccine, the efficacy of LAIV in children aged 6-71 months (N = 9901) against febrile all-cause AOM was 9.7% (95% CI: -2.1%, 20.1%). The estimated 12-month effectiveness of LAIV compared with placebo against all-cause AOM was 7.5% (95% CI: -2.4%, 16.2%).

CONCLUSIONS

LAIV reduced the incidence of all-cause AOM compared with placebo in children. The estimated 12-month effectiveness of LAIV was comparable with 7-valent pneumococcal conjugate vaccine. The effects of the vaccines will overlap somewhat; however, because pneumococcal conjugate vaccines only prevent a fraction of all pneumococcal AOM and influenza-associated AOM can be caused by other pathogens, LAIV could further reduce the incidence of AOM in children.

Authors+Show Affiliations

Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland. terho.heikkinen@utu.fiNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23271441

Citation

Heikkinen, Terho, et al. "Effectiveness of Intranasal Live Attenuated Influenza Vaccine Against All-cause Acute Otitis Media in Children." The Pediatric Infectious Disease Journal, vol. 32, no. 6, 2013, pp. 669-74.
Heikkinen T, Block SL, Toback SL, et al. Effectiveness of intranasal live attenuated influenza vaccine against all-cause acute otitis media in children. Pediatr Infect Dis J. 2013;32(6):669-74.
Heikkinen, T., Block, S. L., Toback, S. L., Wu, X., & Ambrose, C. S. (2013). Effectiveness of intranasal live attenuated influenza vaccine against all-cause acute otitis media in children. The Pediatric Infectious Disease Journal, 32(6), pp. 669-74. doi:10.1097/INF.0b013e3182840fe7.
Heikkinen T, et al. Effectiveness of Intranasal Live Attenuated Influenza Vaccine Against All-cause Acute Otitis Media in Children. Pediatr Infect Dis J. 2013;32(6):669-74. PubMed PMID: 23271441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of intranasal live attenuated influenza vaccine against all-cause acute otitis media in children. AU - Heikkinen,Terho, AU - Block,Stan L, AU - Toback,Seth L, AU - Wu,Xionghua, AU - Ambrose,Christopher S, PY - 2012/12/29/entrez PY - 2012/12/29/pubmed PY - 2014/2/7/medline SP - 669 EP - 74 JF - The Pediatric infectious disease journal JO - Pediatr. Infect. Dis. J. VL - 32 IS - 6 N2 - BACKGROUND: Acute otitis media (AOM) is a frequent complication of influenza in children, and influenza vaccination helps protect against influenza-associated AOM. A live attenuated influenza vaccine (LAIV) approved for eligible children aged ≥2 years for the prevention of influenza also effectively reduces influenza-associated AOM. However, the annual effectiveness of LAIV against all-cause AOM is unknown. METHODS: AOM rates in children aged 6-83 months from 6 randomized, placebo-controlled trials and 2 randomized, inactivated influenza vaccine-controlled trials were pooled and analyzed. To enable comparison with studies of AOM prevention by pneumococcal conjugate vaccines, 12-month effectiveness was calculated assuming that LAIV had no effect outside of influenza seasons. RESULTS: During influenza seasons, LAIV efficacy compared with placebo against all-cause AOM in children aged 6-71 months (N = 9497) was 12.4% (95% confidence interval [CI]: 2.0%, 21.6%) in year 1. In year 2, the efficacy in children aged 18-83 months (N = 4142) was 6.2% (95% CI: -12.4%, 21.7%). Compared with inactivated influenza vaccine, the efficacy of LAIV in children aged 6-71 months (N = 9901) against febrile all-cause AOM was 9.7% (95% CI: -2.1%, 20.1%). The estimated 12-month effectiveness of LAIV compared with placebo against all-cause AOM was 7.5% (95% CI: -2.4%, 16.2%). CONCLUSIONS: LAIV reduced the incidence of all-cause AOM compared with placebo in children. The estimated 12-month effectiveness of LAIV was comparable with 7-valent pneumococcal conjugate vaccine. The effects of the vaccines will overlap somewhat; however, because pneumococcal conjugate vaccines only prevent a fraction of all pneumococcal AOM and influenza-associated AOM can be caused by other pathogens, LAIV could further reduce the incidence of AOM in children. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/23271441/Effectiveness_of_intranasal_live_attenuated_influenza_vaccine_against_all_cause_acute_otitis_media_in_children_ L2 - http://dx.doi.org/10.1097/INF.0b013e3182840fe7 DB - PRIME DP - Unbound Medicine ER -