Estimated impact of maternal vaccination on global paediatric influenza-related in-hospital mortality: A retrospective case series

• Published in: EClinicalMedicine Vol. 37; p. 100945
• Main Authors: Löwensteyn, Yvette N, Nair, Harish, Nunes, Marta C, van Roessel, Ichelle, Vernooij, Femke S, Willemsen, Joukje, Bont, Louis J, Mazur, Natalie I, Thorburn, Kentigern, Nunes, Marta, Chawana, Richard, Madhi, Shabir A., Vittuci, Anna C., Bassat, Quique, Bardají, Azucena, Goka, Edward, Roglić, Srđan, Paes, Bosco, Elliott, LouAnn, Oshitani, Hitoshi, Lupisan, Socorro, Gentile, Angela, Lucion, María Florencia, Spaeder, Michael C., Butt, Warwick, Thompson, Jenny, Mejias, Asuncion, Ramilo, Octavio, Fasce, Rodrigo A., Werner, Marta, Hijano, Diego R., Allison, Kim J., Pires, Márcia Rosane, de-Paris, Fernanda, Chakhunashvili, Giorgi, Karseladze, Irakli, Otieno, Grieven P., Nokes, D. James, Scheuerman, Oded, Prais, Dario, Amad, Mohammed Al, Serouri, Abdul Wahed Al, Ali, Asad, Yousafzai, Mohammad Tahir, Bruno, Alfredo, de Mora, Domenica, Ojeda, Jenny, Dbaibo, Ghassan, Hanna-Wakim, Rima, Papaevangelou, Vassiliki, Kartisouni, Elpiniki, Cohen, Cheryl, Walaza, Sibongile, Linssen, Rosalie S., Chi, Hsin, Eşki, Aykut, Demir, Esen, Saha, Senjuti, Saha, Samir K, Sochet, Anthony A., Teppa-Sanchez, Beatriz E., Ravindranath, Thyyar M., Baird, J. Scott, Morris, Shaun K., Wong, Waison, Breiman, Robert F., Gurley, Emily S., Arifeen, Shams El, Assefa, Nega, Scott, J. Anthony G., Onyango, Dickens, Kotloff, Karen L., Sow, Samba O., Mandomando, Inacio, Ogbuanu, Ikechukwu U., Jambai, Amara, Kendirli, Tanil, Botan, Edin, Rubio, Franco Díaz, Serra, Alberto, Martinez, Luis, Pedroso, Luis, Menta, Soledad, Pardo, Rosalba, Donoso, Alejandro, Mahmood, Syed Faisal, Khan, Naveera
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2021; Elsevier
• Subjects: Research Paper
• ISSN: 2589-5370; 2589-5370
• DOI: 10.1016/j.eclinm.2021.100945

Influenza virus infection is an important cause of under-five mortality. Maternal vaccination protects children younger than 3 months of age from influenza infection. However, it is unknown to what extent paediatric influenza-related mortality may be prevented by a maternal vaccine since global age-stratified mortality data are lacking.
We invited clinicians and researchers to share clinical and demographic characteristics from children younger than 5 years who died with laboratory-confirmed influenza infection between January 1, 1995 and March 31, 2020. We evaluated the potential impact of maternal vaccination by estimating the number of children younger than 3 months with in-hospital influenza-related death using published global mortality estimates.
We included 314 children from 31 countries. Comorbidities were present in 166 (53%) children and 41 (13%) children were born prematurely. Median age at death was 8·6 (IQR 4·5–16·6), 11·5 (IQR 4·3–24·0), and 15·5 (IQR 7·4–27·0) months for children from low- and lower-middle-income countries (LMICs), upper-middle-income countries (UMICs), and high-income countries (HICs), respectively. The proportion of children younger than 3 months at time of death was 17% in LMICs, 12% in UMICs, and 7% in HICs. We estimated that 3339 annual influenza-related in-hospital deaths occur in the first 3 months of life globally.
In our study, less than 20% of children is younger than 3 months at time of influenza-related death. Although maternal influenza vaccination may impact maternal and infant influenza disease burden, additional immunisation strategies are needed to prevent global influenza-related childhood mortality. The missing data, global coverage, and data quality in this study should be taken into consideration for further interpretation of the results.
Bill & Melinda Gates Foundation.