Influenza vaccine effectiveness and disease burden in children and adolescents with sickle cell disease: 2012-2017

Carol M. Kao, Kristina Lai, John M. McAteer, Mohnd Elmontser, Elizabeth M. Quincer, Marianne E.M. Yee, Ashley Tippet, Robert C. Jerris, Peter A. Lane, Evan J. Anderson, Nitya Bakshi, Inci Yildirim

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3 Scopus citations


Background: Data are limited on the burden of influenza and seasonal influenza vaccine effectiveness (VE) in children with sickle cell disease (SCD). Methods: We used a prospectively collected clinical registry of SCD patients 6 months to 21 years of age to determine the influenza cases per 100 patient-years, vaccination rates, and a test-negative case-control study design to estimate influenza VE against medically attended laboratory-confirmed influenza infection. Influenza-positive cases were randomly matched to test-negative controls on age and influenza season in 1:1 ratio. We used adjusted logistic regression models to compare odds ratio (OR) of vaccination in cases to controls. We calculated VE as [100% × (1 − adjusted OR)] and computed 95% confidence intervals (CIs) around the estimate. Results: There were 1037 children with SCD who were tested for influenza, 307 children (29.6%) had at least one influenza infection (338 infections, incidence rate 3.7 per 100 person-years; 95% CI, 3.4-4.1) and 56.2% of those tested received annual influenza vaccine. Overall VE pooled over five seasons was 22.3% (95% CI, −7.3% to 43.7%). Adjusted VE estimates ranged from 39.7% (95% CI, −70.1% to 78.6%) in 2015/2016 to −5.9% (95% CI, −88.4% to 40.4%) in the 2016/17 seasons. Influenza VE varied by age and was highest in children 1-5 years of age (66.6%; 95% CI, 30.3-84.0). Adjusted VE against acute chest syndrome during influenza infection was 39.4% (95% CI, −113.0 to 82.8%). Conclusions: Influenza VE in patients with SCD varies by season and age. Multicenter prospective studies are needed to better establish and monitor influenza VE among children with SCD.

Original languageEnglish
Article numbere28358
JournalPediatric Blood and Cancer
Issue number8
StatePublished - Aug 1 2020


  • influenza
  • sickle cell disease
  • test-negative
  • vaccine effectiveness


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