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Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy
C L Park1, A L Frank, M Sullivan
1Department of Pediatrics, University of Illinois at Chicago 60612, USA.
Insights
Influenza vaccination is safe and effective for children with asthma, even during exacerbations or prednisone treatment. Vaccinating these children can significantly improve overall influenza immunization rates.
Area of Science:
- Pediatric Allergy and Pulmonology
- Immunology
- Vaccinology
Background:
- Influenza vaccination rates are low in children with moderate to severe asthma.
- Concerns about vaccine efficacy and safety during asthma exacerbations and prednisone use may contribute to low vaccination rates.
- This study aimed to assess the safety and immunogenicity of influenza vaccination in asthmatic children experiencing acute exacerbations and receiving prednisone therapy.
Purpose of the Study:
- To evaluate the safety and immunogenicity of trivalent subvirion influenza vaccine in children with asthma.
- To compare the antibody response and adverse effects in children with and without acute asthma exacerbations requiring prednisone therapy.
- To determine if influenza vaccination can be safely administered to asthmatic children regardless of their current asthma status or treatment.
Main Methods:
- A study involving 109 children (6 months to 18 years) with asthma was conducted in a pediatric clinic and emergency department.
- Participants were divided into two groups: those without asthma symptoms (control) and those with acute exacerbations requiring prednisone.
- Both groups received the influenza vaccine, with antibody titers measured before and after vaccination, and adverse effects monitored.
Main Results:
- Antibody responses to influenza A strains (H3N2 and H1N1) were similar between the prednisone-treated and control groups.
- A significantly better antibody response to the influenza B strain was observed in the prednisone group.
- No significant differences in adverse effects, including asthma exacerbation, were reported between the two groups.
Conclusions:
- Influenza vaccination is safe and effective for children with asthma, irrespective of asthma symptoms or concurrent prednisone therapy.
- Administering influenza vaccines to moderate to severe asthmatic patients in clinical or emergency settings can substantially increase vaccination coverage.
- The findings support routine influenza vaccination for all children with moderate to severe asthma.
Objectives:
The influenza vaccination rate is very low among children with moderate to severe asthma. This may be partly because of poor patient motivation and failure to visit clinics for vaccination. Another important factor may be health care providers' deferral of vaccination because of concern about the efficacy and safety of influenza vaccination during asthma exacerbations and concurrent prednisone therapy. We therefore examined the safety and immunogenicity of influenza vaccination during acute asthma exacerbation with concomitant prednisone therapy.
Setting:
A pediatric allergy and pulmonology clinic and a pediatric emergency department.
Design:
Children (n = 109) with a known diagnosis of asthma 6 months to 18 years of age were recruited. All participating patients, 59 without asthma symptoms (no prednisone, control group) and 50 with acute asthma exacerbation requiring prednisone burst therapy (prednisone group) received trivalent subvirion influenza vaccine. Fifteen children in the control group and 12 in the prednisone group received a booster dose according to American Academy of Pediatrics guidelines. Serum antibody titers to influenza A/Beijing/32/92 (H3N2), influenza A/Texas/36/91 (H1N1), and influenza B/Panama/45/90 were measured before and 2 weeks after vaccination. Adverse effects noted within 48 hours after vaccine dose were ascertained during the follow-up visit.
Results:
The antibody response was analyzed by comparing mean postvaccine titers, the percentage of patients achieving protective antibody levels (> or = 5log2), and the percentage of patients achieving rises in titers of 2log2 or greater. Antibody responses to influenza A/Beijing/32/92 (H3N2) and influenza A/Texas/36/91 (H1N1) in the prednisone-treated and control groups were not different. A significantly better response to the influenza B/Panama/45/90 antigen was seen in the prednisone group for all three parameters. Children who received a booster dose and the subgroup of children with low prevaccination titers (< or = 3log2) showed similar patterns. Adverse effects, including asthma exacerbation, local swelling at the injection site, fever, rash, and headache, were not different in the two groups.
Conclusions:
Influenza vaccination can be given safely and effectively to asthmatic children regardless of asthma symptoms or concurrent prednisone therapy when necessary. Vaccination of all moderate to severe asthmatic patients visiting clinics or emergency departments would improve the overall vaccination rate significantly.