Assessment of temporally-related acute respiratory illness following influenza vaccination

• Published in: Vaccine Vol. 36; no. 15; pp. 1958 - 1964
• Main Authors: Rikin, Sharon, Jia, Haomiao, Vargas, Celibell Y., Castellanos de Belliard, Yaritza, Reed, Carrie, LaRussa, Philip, Larson, Elaine L., Saiman, Lisa, Stockwell, Melissa S.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 05.04.2018; Elsevier Limited
• Subjects: Acute respiratory illness; Adolescent; Adult; Adults; Ambulatory care; Asthma; Belief; Child; Child, Preschool; Children; Decision making; Disease control; Female; Fever; Health hazards; Households; Humans; Illnesses; Infant; Infections; Influenza; Influenza vaccine; Influenza Vaccines - administration & dosage; Influenza Vaccines - adverse effects; Influenza Vaccines - immunology; Influenza, Human - complications; Influenza, Human - prevention & control; Laboratories; Male; Medical research; Middle Aged; Misperceptions; Pathogens; Pediatrics; Perception; Primary care; Proportional Hazards Models; Public Health Surveillance; Registries; Respiratory diseases; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - etiology; Risk Assessment; Seasons; Short message service; Spatio-Temporal Analysis; Surveillance; Vaccination; Vaccination - adverse effects; Vaccines; Viruses; Young Adult; France; New York; United States > US; Belief; MoSAIC; NYP; Influenza; ARI; Misperceptions; Acute respiratory illness; CIR; Influenza vaccine
• ISSN: 0264-410X; 1873-2518
• DOI: 10.1016/j.vaccine.2018.02.105

•We investigated risk of acute respiratory illness post-influenza vaccination.•Post-vaccination risk of non-influenza respiratory pathogen was higher in children.•Patient perceptions of illness following influenza vaccination may be supported.•Assessments of potential mechanisms for findings are needed. A barrier to influenza vaccination is the misperception that the inactivated vaccine can cause influenza. Previous studies have investigated the risk of acute respiratory illness (ARI) after influenza vaccination with conflicting results. We assessed whether there is an increased rate of laboratory-confirmed ARI in post-influenza vaccination periods. We conducted a cohort sub-analysis of children and adults in the MoSAIC community surveillance study from 2013 to 2016. Influenza vaccination was confirmed through city or hospital registries. Cases of ARI were ascertained by twice-weekly text messages to household to identify members with ARI symptoms. Nasal swabs were obtained from ill participants and analyzed for respiratory pathogens using multiplex PCR. The primary outcome measure was the hazard ratio of laboratory-confirmed ARI in individuals post-vaccination compared to other time periods during three influenza seasons. Of the 999 participants, 68.8% were children, 30.2% were adults. Each study season, approximately half received influenza vaccine and one third experienced ≥1 ARI. The hazard of influenza in individuals during the 14-day post-vaccination period was similar to unvaccinated individuals during the same period (HR 0.96, 95% CI [0.60, 1.52]). The hazard of non-influenza respiratory pathogens was higher during the same period (HR 1.65, 95% CI [1.14, 2.38]); when stratified by age the hazard remained higher for children (HR 1·71, 95% CI [1.16, 2.53]) but not for adults (HR 0.88, 95% CI [0.21, 3.69]). Among children there was an increase in the hazard of ARI caused by non-influenza respiratory pathogens post-influenza vaccination compared to unvaccinated children during the same period. Potential mechanisms for this association warrant further investigation. Future research could investigate whether medical decision-making surrounding influenza vaccination may be improved by acknowledging patient experiences, counseling regarding different types of ARI, and correcting the misperception that all ARI occurring after vaccination are caused by influenza.