title: Influenza Vaccine Effectiveness and Uptake in Children at Risk of Severe Disease.
abstract: BACKGROUND
  Data demonstrating the effectiveness of inactivated trivalent influenza vaccine (TIV) for children at increased risk of severe disease are limited. Our objective was to determine the effectiveness of TIV in children with risk factors for severe disease and to compare vaccine uptake, parental attitudes and prescriber recommendations in children with and without risk factors for severe disease.
  
  
  METHODS
  Children aged 6-59 months presenting for emergency care (2008 to 2014) with an influenza-like illness were eligible. Influenza polymerase chain reaction/culture was performed on nasopharyngeal samples. Vaccination status was confirmed via the national register and/or vaccine providers. The test-negative design was used to estimate vaccine effectiveness (VE). Risk factors, parental attitudes and prescriber recommendations were assessed by parental questionnaire.
  
  
  RESULTS
  Two thousand seven hundred twenty-three children were recruited. Risk factors for severe disease included comorbid medical conditions (11.6%), preterm birth (13.0%) and indigeneity (5.0%). Influenza was identified in 546 (20.1%) participants. Overall VE (2008 and 2010 to 2014) was 70.0% (95% confidence interval: 47.7 to 82.9); VE for children with medical comorbidities, children born preterm and children <2 years were 82.5% (14.6 to 96.4), 79.2% (10.9 to 95.1) and 84.7% (49.6 to 95.3), respectively. After adverse events in 2010, the number of children fully vaccinated with TIV declined significantly. This included children with and without risk factors for severe disease. Attitudes were similar in parents of children with and without risk factors for severe disease.
  
  
  CONCLUSIONS
  VE for TIV in young children with and without risk factors for severe disease was ≥70%. Despite this, participation in the preschool influenza vaccination program remains low with parents and prescribers unconvinced of the benefits and safety of TIV.
authors.affiliation: From the *School of Paediatrics and Child Health, University of Western Australia; †Department of Infectious Diseases, Princess Margaret Hospital for Children; ‡Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia; §Department of Microbiology, PathWest Laboratory Medicine WA, Princess Margaret Hospital for Children; ¶Department of Health, Communicable Disease Control Directorate, Perth, Western Australia, Australia; ‖Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia; **Australian National University, Canberra, Australia; ††School of Pathology and Laboratory Medicine, University of Western Australia; ‡‡Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine WA; §§Emergency Department, Princess Margaret Hospital for Children; ¶¶School of Primary, Aboriginal and Rural Health Care, University of Western Australia; and ‖‖Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Blyth
authors.forename: Peter
authors.initials: P
authors.lastname: Jacoby
authors.forename: Paul V
authors.initials: PV
authors.lastname: Effler
authors.forename: Heath
authors.initials: H
authors.lastname: Kelly
authors.forename: David W
authors.initials: DW
authors.lastname: Smith
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Borland
authors.forename: Gabriela A
authors.initials: GA
authors.lastname: Willis
authors.forename: Avram
authors.initials: A
authors.lastname: Levy
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Keil
authors.forename: Peter C
authors.initials: PC
authors.lastname: Richmond
mesh_terms: D002675:Child, Preschool; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D005260:Female; D049674:History, 21st Century; D006801:Humans; D007223:Infant; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000276:immunology; D007251:Influenza, Human / Q000266:history / Q000517:prevention & control*; D008297:Male; D017063:Outcome Assessment, Health Care; D012306:Risk; D012307:Risk Factors; D014611:Vaccination; D015164:Vaccines, Inactivated; D014904:Western Australia / Q000453:epidemiology
chemical_list: D007252:Influenza Vaccines; D015164:Vaccines, Inactivated