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Influenza Vaccine Effectiveness Against Influenza-like Illness in Post-Operative Children with Congenital Heart

Rui Liu1, Pengfei Deng2, Tian Yang2

  • 1School of Public Health, Dali University, 2 Hongsheng Road, Dali 671003, China.

Vaccines
|July 27, 2026
PubMed

Insights

Influenza vaccination offers about 51% protection against flu-like illness in children with congenital heart disease (CHD) after surgery. This finding supports prioritizing flu shots for this vulnerable pediatric group in China.

Area of Science:

  • Pediatric Cardiology
  • Infectious Diseases
  • Vaccinology

Background:

  • Children with congenital heart disease (CHD) are at increased risk of severe influenza complications.
  • Limited real-world data exist on influenza vaccine effectiveness (VE) in post-operative CHD patients, particularly in China.
  • This study addresses the need for VE data in this high-risk pediatric population.

Purpose of the Study:

  • To estimate the real-world influenza vaccine effectiveness (VE) against medically attended influenza-like illness (ILI) in post-operative children with CHD in China.
  • To utilize robust statistical methods, including inverse probability of treatment weighting (IPTW), to minimize confounding.
  • To provide evidence supporting influenza immunization strategies for vulnerable pediatric populations.

Main Methods:

  • Retrospective cohort study of 194 children undergoing CHD surgery in Shanghai (January-July 2023).
  • Influenza vaccination status ascertained from the Shanghai Immunization Information System.
  • Medically attended influenza-like illness (ILI) captured through structured interviews.
  • Doubly robust quasi-Poisson regression on an IPTW pseudo-population for primary VE estimation.
  • Sensitivity analyses using multivariable Poisson regression, marginal structural models, and stabilized IPTW.

Main Results:

  • Vaccination coverage among the study cohort was 21.6%.
  • Inverse probability of treatment weighting (IPTW) successfully balanced all covariates (SMD < 0.10).
  • The primary estimated influenza VE was 50.9% (95% CI: 11.0-72.9%).
  • Sensitivity analyses yielded consistent VE estimates ranging from 49.6% to 56.6%.
  • Subgroup analyses demonstrated consistently protective point estimates across different groups.

Conclusions:

  • Influenza vaccination provides moderate and robust protection against ILI in post-operative children with CHD.
  • The estimated VE (approximately 51%) is comparable to that observed in healthy pediatric populations.
  • These findings underscore the importance of prioritizing influenza immunization for post-operative CHD children in China.
  • The study provides crucial baseline VE data for this vulnerable group within the Chinese context.

Keywords:
childrencongenital heart diseasedoubly robust estimationinfluenza vaccineinverse probability of treatment weightingvaccine effectiveness

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