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The impact of antibiotic use on influenza vaccine effectiveness in children aged 6-59 months

Brosseau, Jennifer Lynn (2013)
Master's Thesis (52 pages)
Committee Chair / Thesis Adviser: Omer, Saad B
Committee Members: Bednarczyk, Robert A ; Orenstein, Walter
Research Fields: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Immunology
Partnering Agencies: Hospital or other health care provider
Keywords: influenza; antibiotic; vaccine; microflora; commensals; immunology
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/f49ff

Abstract

Background: Recent studies in animals have suggested that immune response to the influenza virus may be impacted by the likely change in intestinal commensals associated with antibiotics. This study examined the relationship between antibiotic use and influenza vaccine effectiveness to determine whether the same altered immune response occurs in children. Methods: Data were obtained from the Kaiser Permanente Georgia (KPGA) managed care organization (MCO) research databases, and included 6 influenza seasons from 2005-2011. Poisson regression analysis was conducted to determine the effect of antibiotic use and influenza vaccination on rates of MAARI among children aged 6-59 months. Logistic regression was used to evaluate confounding. Results: We found no significant difference in the incidence rate ratios (IRRs) of MAARI among the vaccinated versus the unvaccinated, stratified by antibiotic use. The ratio of IRRs for non-antibiotic users comparing the period of widespread activity with the pre-influenza period was 0.98 (95% CI, 0.79-1.23). The ratio of IRRs for antibiotic users for the same comparison period was 0.90 (95% CI, 0.63-1.30). No significant differences existed in vaccine effectiveness (VE). During the pre-influenza period, we found VE to be 10% (95% CI, -9%-26%) among non-antibiotic users and 17% (95% CI, -12%-39%) among non-antibiotic users, even after adjustment for known confounders. During the period of widespread influenza activity, VE was 2% (95% CI, -23%-21%) among non-antibiotic users and 10% (95% CI, -30%-37%) among antibiotic users. Conclusions: The presence of vaccine effectiveness in the pre-influenza period demonstrates that we were unable to eliminate unmeasured confounding, limiting our ability to draw conclusions. It does appear the likely change in intestinal commensals associated with antibiotic use does not reduce TIV effectiveness.. However, given evidence exists for the biological possibility of interaction between antibiotic use and immune response to influenza vaccination, further studies should be undertaken to address this topic.

Table of Contents

Table of Contents -- Background/Literature Review.................................................................................... 1 -- Manuscript..................................................................................................................... 17 -- Abstract........................................................................................................................ 17 -- Introduction................................................................................................................. 18 -- Methods........................................................................................................................ 20 -- Results.......................................................................................................................... 25 -- Discussion..................................................................................................................... 28 -- Public Health Implications and Future Directions................................................ 35 -- References...................................................................................................................... 38 -- --

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