Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age

Sophia R. Newcomer; Matthew F. Daley; Komal J. Narwaney; Stan Xu; Frank Destefano; Holly C. Groom; Michael L. Jackson; Bruno J. Lewin; Huong Q. McLean; James D. Nordin; Ousseny Zerbo; Jason M. Glanz

doi:10.1097/INF.0000000000002550

Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age

Sophia R. Newcomer
, Matthew F. Daley
, Komal J. Narwaney
, Stan Xu
, Frank Destefano
, Holly C. Groom
, Michael L. Jackson
, Bruno J. Lewin
, Huong Q. McLean
, James D. Nordin
, Ousseny Zerbo
, Jason M. Glanz

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background: Some findings from observational studies have suggested that recent receipt of live vaccines may be associated with decreased non-vaccine-targeted infection risk and mortality. Our objective was to estimate risk of non-vaccine-targeted infections based on most recent vaccine type (live vaccines only, inactivated vaccines only or both concurrently) received in US children 11-23 months of age. Methods: We conducted a retrospective cohort study within the Vaccine Safety Datalink. We examined electronic health record and immunization data from children born in 2003-2013 who received 3 diphtheria-tetanus-acellular pertussis vaccines before their first birthday. We modeled vaccine type as a time-varying exposure and estimated risk of non-vaccine-targeted infections identified in emergency department and inpatient settings, adjusting for multiple confounders. Results: Among 428,608 children, 48.9% were female, 4.9% had ≥1 immunization visit with live vaccines only and 10.3% had a non-vaccine-targeted infection. In males, lower risk of non-vaccine-targeted infections was observed following last receipt of live vaccines only or live and inactivated vaccines concurrently as compared with last receipt of inactivated vaccines only [live vaccines-only adjusted hazard ratio (aHR) = 0.83, 95% confidence interval (CI): 0.72-0.94; live and inactivated vaccines concurrently aHR: 0.91, 95% CI: 0.88-0.94]. Among females, last receipt of live and inactivated vaccines concurrently was significantly associated with non-vaccine-targeted infection risk (aHR = 0.94, 95% CI: 0.91-0.97 vs. last receipt of inactivated vaccines only). Conclusions: We observed modest associations between live vaccine receipt and non-vaccine-targeted infections. In this observational study, multiple factors, including healthcare-seeking behavior, may have influenced results.

Original language	English
Pages (from-to)	247-253
Number of pages	7
Journal	Pediatric Infectious Disease Journal
Volume	39
Issue number	3
DOIs	https://doi.org/10.1097/INF.0000000000002550
State	Published - Mar 1 2020

Funding

This research was funded by the Centers for Disease Control and Prevention (CDC), through the Vaccine Safety Datalink project (contract #200-2012-53582). CDC co-authors were involved in the design and conduct of the study; interpretation of the data; and review and approval of the manuscript. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. Huong McClean reports receiving funding from Seqirus Inc. in the past 36 months for work unrelated to this study. James Nordin reports receiving funding from the National Institute of Allergy and Infectious Disease in the past 36 months for work unrelated to this study. All authors have no conflicts of interest to disclose.

Funders	Funder number
200-2012-53582
Centers for Disease Control and Prevention

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

child
infectious diseases
vaccination

Access to Document

10.1097/INF.0000000000002550

Cite this

Newcomer, S. R., Daley, M. F., Narwaney, K. J., Xu, S., Destefano, F., Groom, H. C., Jackson, M. L., Lewin, B. J., McLean, H. Q., Nordin, J. D., Zerbo, O., & Glanz, J. M. (2020). Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age. Pediatric Infectious Disease Journal, 39(3), 247-253. https://doi.org/10.1097/INF.0000000000002550

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title = "Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age",

abstract = "Background: Some findings from observational studies have suggested that recent receipt of live vaccines may be associated with decreased non-vaccine-targeted infection risk and mortality. Our objective was to estimate risk of non-vaccine-targeted infections based on most recent vaccine type (live vaccines only, inactivated vaccines only or both concurrently) received in US children 11-23 months of age. Methods: We conducted a retrospective cohort study within the Vaccine Safety Datalink. We examined electronic health record and immunization data from children born in 2003-2013 who received 3 diphtheria-tetanus-acellular pertussis vaccines before their first birthday. We modeled vaccine type as a time-varying exposure and estimated risk of non-vaccine-targeted infections identified in emergency department and inpatient settings, adjusting for multiple confounders. Results: Among 428,608 children, 48.9\% were female, 4.9\% had ≥1 immunization visit with live vaccines only and 10.3\% had a non-vaccine-targeted infection. In males, lower risk of non-vaccine-targeted infections was observed following last receipt of live vaccines only or live and inactivated vaccines concurrently as compared with last receipt of inactivated vaccines only [live vaccines-only adjusted hazard ratio (aHR) = 0.83, 95\% confidence interval (CI): 0.72-0.94; live and inactivated vaccines concurrently aHR: 0.91, 95\% CI: 0.88-0.94]. Among females, last receipt of live and inactivated vaccines concurrently was significantly associated with non-vaccine-targeted infection risk (aHR = 0.94, 95\% CI: 0.91-0.97 vs. last receipt of inactivated vaccines only). Conclusions: We observed modest associations between live vaccine receipt and non-vaccine-targeted infections. In this observational study, multiple factors, including healthcare-seeking behavior, may have influenced results.",

keywords = "child, infectious diseases, vaccination",

author = "Newcomer, \{Sophia R.\} and Daley, \{Matthew F.\} and Narwaney, \{Komal J.\} and Stan Xu and Frank Destefano and Groom, \{Holly C.\} and Jackson, \{Michael L.\} and Lewin, \{Bruno J.\} and McLean, \{Huong Q.\} and Nordin, \{James D.\} and Ousseny Zerbo and Glanz, \{Jason M.\}",

year = "2020",

month = mar,

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doi = "10.1097/INF.0000000000002550",

language = "English",

volume = "39",

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Newcomer, SR, Daley, MF, Narwaney, KJ, Xu, S, Destefano, F, Groom, HC, Jackson, ML, Lewin, BJ, McLean, HQ, Nordin, JD, Zerbo, O & Glanz, JM 2020, 'Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age', Pediatric Infectious Disease Journal, vol. 39, no. 3, pp. 247-253. https://doi.org/10.1097/INF.0000000000002550

TY - JOUR

T1 - Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age

AU - Newcomer, Sophia R.

AU - Daley, Matthew F.

AU - Narwaney, Komal J.

AU - Xu, Stan

AU - Destefano, Frank

AU - Groom, Holly C.

AU - Jackson, Michael L.

AU - Lewin, Bruno J.

AU - McLean, Huong Q.

AU - Nordin, James D.

AU - Zerbo, Ousseny

AU - Glanz, Jason M.

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Background: Some findings from observational studies have suggested that recent receipt of live vaccines may be associated with decreased non-vaccine-targeted infection risk and mortality. Our objective was to estimate risk of non-vaccine-targeted infections based on most recent vaccine type (live vaccines only, inactivated vaccines only or both concurrently) received in US children 11-23 months of age. Methods: We conducted a retrospective cohort study within the Vaccine Safety Datalink. We examined electronic health record and immunization data from children born in 2003-2013 who received 3 diphtheria-tetanus-acellular pertussis vaccines before their first birthday. We modeled vaccine type as a time-varying exposure and estimated risk of non-vaccine-targeted infections identified in emergency department and inpatient settings, adjusting for multiple confounders. Results: Among 428,608 children, 48.9% were female, 4.9% had ≥1 immunization visit with live vaccines only and 10.3% had a non-vaccine-targeted infection. In males, lower risk of non-vaccine-targeted infections was observed following last receipt of live vaccines only or live and inactivated vaccines concurrently as compared with last receipt of inactivated vaccines only [live vaccines-only adjusted hazard ratio (aHR) = 0.83, 95% confidence interval (CI): 0.72-0.94; live and inactivated vaccines concurrently aHR: 0.91, 95% CI: 0.88-0.94]. Among females, last receipt of live and inactivated vaccines concurrently was significantly associated with non-vaccine-targeted infection risk (aHR = 0.94, 95% CI: 0.91-0.97 vs. last receipt of inactivated vaccines only). Conclusions: We observed modest associations between live vaccine receipt and non-vaccine-targeted infections. In this observational study, multiple factors, including healthcare-seeking behavior, may have influenced results.

AB - Background: Some findings from observational studies have suggested that recent receipt of live vaccines may be associated with decreased non-vaccine-targeted infection risk and mortality. Our objective was to estimate risk of non-vaccine-targeted infections based on most recent vaccine type (live vaccines only, inactivated vaccines only or both concurrently) received in US children 11-23 months of age. Methods: We conducted a retrospective cohort study within the Vaccine Safety Datalink. We examined electronic health record and immunization data from children born in 2003-2013 who received 3 diphtheria-tetanus-acellular pertussis vaccines before their first birthday. We modeled vaccine type as a time-varying exposure and estimated risk of non-vaccine-targeted infections identified in emergency department and inpatient settings, adjusting for multiple confounders. Results: Among 428,608 children, 48.9% were female, 4.9% had ≥1 immunization visit with live vaccines only and 10.3% had a non-vaccine-targeted infection. In males, lower risk of non-vaccine-targeted infections was observed following last receipt of live vaccines only or live and inactivated vaccines concurrently as compared with last receipt of inactivated vaccines only [live vaccines-only adjusted hazard ratio (aHR) = 0.83, 95% confidence interval (CI): 0.72-0.94; live and inactivated vaccines concurrently aHR: 0.91, 95% CI: 0.88-0.94]. Among females, last receipt of live and inactivated vaccines concurrently was significantly associated with non-vaccine-targeted infection risk (aHR = 0.94, 95% CI: 0.91-0.97 vs. last receipt of inactivated vaccines only). Conclusions: We observed modest associations between live vaccine receipt and non-vaccine-targeted infections. In this observational study, multiple factors, including healthcare-seeking behavior, may have influenced results.

KW - child

KW - infectious diseases

KW - vaccination

UR - https://www.scopus.com/pages/publications/85079083852

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DO - 10.1097/INF.0000000000002550

M3 - Article

C2 - 32032310

AN - SCOPUS:85079083852

SN - 0891-3668

VL - 39

SP - 247

EP - 253

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

IS - 3

ER -

Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age

Abstract

Funding

UN SDGs

Keywords

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