children with asthma or recurrent wheezing

Children with asthma and recurrent wheezing who received the intranasal live attenuated influenza vaccine (LAIV) did not experience increased lower respiratory events (LREs) compare with children who receive the inactivate influenza vaccine (IIV) injection, a large study has found.

James D. Nordin, MD, HealthPartners Institute, Minneapolis, Minnesota, and colleagues conduct a retrospective cohort study in 4771 children age 2 to 17 years with asthma who receive one or more influenza vaccines before and after the implementation of a guideline recommending LAIV over IIV for children with asthma or recurrent wheezing.

Children with asthma

The current recommendations from the Advisory Committee on Immunization Practices; so of the US Centers for Disease Control and Prevention are more cautious about the use of LAIV in children with asthma or recurrent wheezing. Currently, LAIV is not recommend for children 2-4 with asthma, coauthor Elyse O. Kharbanda, MD, MPH, also of HealthPartners Institute.

For children 5 and older, asthma is a precaution for receiving LAIV. As far as we know there have not been any recent changes to these guidelines. The researchers publish their findings online June 10 in Vaccine. They believe that the findings from this study; so along with those from relate studies; hence support the safety of LAIV in children 2 and older; so including those with asthma or reactive airway disease, Kharbanda said.

The children receive their vaccinations at two medical groups; so within a large nonprofit integrate healthcare system between 2007 and 2016. Both medical groups follow standard guidelines; so recommending IIV preferentially over LAIV for children with asthma until 2010; in 2010, one group (LAIV group) began recommending the LAIV preferentially over IIV for all children and adolescents including those with asthma. The children receive a total of 7851 influenza vaccinations.

Adolescents with asthma

The use of LAIV increase from 23% before the guideline to 68% after the guideline; so in those with asthma in the LAIV group; so compare with an increase from 7% to 11% in the control group after adjusting for age, asthma severity, and asthma control. Strengths of the study include the large number of children; also adolescents with asthma who receive influenza vaccination and the fact that the researchers use the ROR analytic approach.

Our study differs from prior observational studies of LAIV in patients with asthma; so because the vaccine was routinely recommend to all patients with asthma in the post guideline period. As such, our cohort includes patients with persistent asthma; also our findings are less prone to bias by indications (where only mild asthmatics would receive LAIV),” Kharbanda explained.

Study limitations include the fact that the researchers were limit to data that were available in the electronic health record or claims records, and the researchers were not able to analyze data on LREs that may have care for at home. The researchers also did not address upper respiratory events that can occur after influenza vaccination, including nasal drainage and sinusitis.

These additional data strengthen existing data suggesting that the LAIV vaccine is safe for children with asthma older than 2 years of age, and that guidelines for influenza vaccination in children with asthma over age 2 should allow use of either vaccine and be base on vaccine effectiveness, the authors conclude.