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Association between vaccination status, symptom identification and healthcare use: Implications for test negative

Asmaa El-Heneidy1, Keith Grimwood2, Stephen B Lambert3

  • 1School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia.

Vaccine
|February 26, 2022
PubMed

Insights

Maternal influenza vaccination showed no association with virus detection in children. However, vaccinated mothers were more likely to report and seek care for their children's respiratory illnesses, challenging the test-negative design's validity.

Area of Science:

  • Epidemiology
  • Vaccinology
  • Pediatrics

Background:

  • The test-negative design (TND) is frequently used to evaluate vaccine effectiveness.
  • Assessing the internal validity of TND is crucial for reliable vaccine impact studies.

Purpose of the Study:

  • To evaluate the internal validity of the TND.
  • To investigate associations between maternal influenza vaccination and child health outcomes.

Main Methods:

  • A birth cohort of 85 children provided daily symptom, weekly nasal swab, and healthcare use data until age 2.
  • Incidence rate ratios (IRR) were used to summarize effect estimates.

Main Results:

  • No association was found between maternal influenza vaccination and virus detection episodes (VDEs) in children (IRR=1.1).
  • Mothers vaccinated against influenza were more likely to report (IRR=2.4) and seek healthcare for (IRR=2.2) acute lower respiratory illness in their children.

Conclusions:

  • A key TND assumption—that healthcare-seeking behavior is not associated with vaccine receipt—was not supported.
  • Further research is needed to confirm the TND's validity across diverse populations.
Abstract

Keywords:
Acute respiratory illnessHealthcare seeking behaviourInfluenza vaccinationRespiratory virusesTest-negative design

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