Epidemiology and Infection

Clinical effectiveness of conventional influenza vaccination in asthmatic children

A. J.  SMITS  a1, E.  HAK  a1 c1, W. A. B.  STALMAN  a1, G. A.  VAN ESSEN  a1, A. W.  HOES  a1 and Th. J. M.  VERHEIJ  a1
a1 University Medical Center Utrecht, Julius Center for General Practice and Patient Oriented Research, Location Stratenum, P.O. Box 85060, 3508 AB Utrecht, the Netherlands.


Influenza immunization rates among young asthmatics remain unsatisfactory due to persistent concern about the impact of influenza and the benefits of the vaccine. We assessed the effectiveness of the conventional inactivated trivalent sub-unit influenza vaccine in reducing acute respiratory disease in asthmatic children. We conducted a two-season retrospective cohort study covering the 1995–6 and 1996–7 influenza outbreaks in 22 computerized primary care practices in the Netherlands. In total, 349 patients aged between 0 and 12 years meeting clinical asthma-criteria were included; 14 children were lost to follow-up in the second season. The occurrence of physician-diagnosed acute respiratory disease episodes including influenza-like illness, pneumonia, bronchitis, bronchiolitis, asthma exacerbation and acute otitis media in vaccinated and unvaccinated children were compared after adjustments for age, prior health care and medication use. The occurrence of acute respiratory disease in unvaccinated children was 28% and 24% in the 1995–6 and 1996–7 season, respectively, and was highest in children under 6 years of age (43%). The overall pooled clinical vaccine effectiveness was 27% (95% confidence interval −7 to 51%, P = 0·11) after adjustments. A statistically higher vaccine protectiveness of 55% (95% CI 20–75%, P = 0·01) was observed among asthmatics under 6 years of age compared with −5% in older children (95% CI −81 to 39%). The occurrence of acute respiratory disease among asthmatic children during influenza epidemics is very high, notably in the youngest. Influenza vaccination may reduce morbidity in asthmatic infants and pre-school children. However, larger, preferably experimental, studies are needed to establish the benefits of vaccination, notably in older asthmatic children.

(Accepted October 19 2001)

c1 Author for correspondence.