Assessing Fever Frequency After Pediatric Live Attenuated Versus Inactivated Influenza Vaccination.
BACKGROUND
Some studies have found a higher frequency of fever with trivalent live attenuated influenza vaccine (LAIV) than with inactivated influenza vaccine (IIV), but quadrivalent LAIV has not been assessed. Understanding fever is important for safety reviews and for parents and providers. In addition, there have been only a limited number of studies in which text messaging was used for vaccine adverse-event (AE) surveillance.


METHODS
We conducted a prospective observational study in 3 community clinics in New York City to assess post-influenza vaccination fever in 24- to 59-month-olds during the 2013-2014 season. Enrolled families of children who received quadrivalent LAIV (LAIV4) or IIV (trivalent IIV3 or quadrivalent IIV4) replied to text messages that assessed their temperature on vaccination night and the next 10 nights (days 0 to 10); missing data were collected via telephone and a diary. We compared frequencies of fever (temperature ≥ 100.4°F) according to vaccine group on days 0 to 2 and 3 to 10 by using χ2 and multivariate log-binomial regression adjusted for age, previous influenza vaccination, and vaccine coadministration. We also assessed outcomes using all sources versus only text messages.


RESULTS
Most (84.1% [n = 540]) eligible parents enrolled. Fever frequencies on days 0 to 2 did not differ between LAIV4 and any IIV (3.8% vs 5.7%, respectively; adjusted relative risk [aRR] [95% confidence interval], 0.60 [0.25-1.46]), between LAIV4 and IIV4 (4.2% vs 7.1%, respectively; aRR, 0.58 [0.19-1.72]), or between IIV4 and IIV3 (7.1% vs 6.0%, respectively; aRR, 1.02 [0.30-3.46]). The findings were similar when all data sources versus text-message data alone were used. There were no significant differences on days 3 to 10.


CONCLUSIONS
Postvaccination fever frequencies were low overall and did not differ according to influenza vaccine type during the 2013-2014 influenza season. The similarity of results when data were limited to text messages lends support to its use for surveillance of vaccine adverse events.
Department of Pediatrics.|Department of Population and Family Health, Mailman School of Public Health, Columbia University.|NewYork-Presbyterian Hospital, New York.
Melissa S
MS
Stockwell
Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia.
Karen R
KR
Broder
Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia.
Paige
P
Lewis
Department of Pediatrics.
Kathleen
K
Jakob
Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia.
Shahed
S
Iqbal
Department of Pediatrics.
Nadira
N
Fernandez
Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia.
Devindra
D
Sharma
Department of Pediatrics.
Angela
A
Barrett
Department of Pediatrics.
Philip
P
LaRussa
D001831:Body Temperature / Q000187:drug effects; D002675:Child, Preschool; D003153:Community Health Services; D005260:Female; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D009519:New York City / Q000453:epidemiology; D010865:Pilot Projects; D011446:Prospective Studies; D011930:Reaction Time; D060145:Text Messaging; D013997:Time Factors; D014611:Vaccination / Q000009:adverse effects*; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000009:adverse effects*; D015164:Vaccines, Inactivated / Q000008:administration & dosage / Q000009:adverse effects*
D007252:Influenza Vaccines; D014613:Vaccines, Attenuated; D015164:Vaccines, Inactivated
fever; influenza; live attenuated; text message; vaccination; vaccine safety