Determining The Relationship Between Influenza Vaccination and Disease Control in Children with Asthma

Öz

Objective: The influenza vaccine's effect on the control of asthma is debatable. The purpose of this study is to investigate the effect of the influenza vaccine on disease control in children with asthma.

Material and Methods: Children with a diagnosis of asthma were prospectively included in the study. The socio-demographic characteristics of the patients, the status of influenza vaccination in the previous year, the use of bronchodilators and systemic steroid therapy, the frequency of hospitalization, risk factors that will affect the disease's control status, and the effects of vaccination status and risk factors on the control of the disease were investigated.

Results: A total of 187 asthmatic children with a median age of 11 years were included in the study. Almost half of the patients (47.6%) did not have asthma under control. In the last year, 14.4% had one asthma attack, 14.4% had two attacks, 19.3% had ≥3 attacks, while 51.9% had no asthma attack. In the previous year, 52.4% of patients received influenza vaccination. Influenza vaccination was equally common in patients with controlled and uncontrolled asthma (54.1% vs 50.6%), and vaccination had no effect on disease control (p=0.662). Patients with allergic rhinitis and atopy had significantly higher uncontrolled asthma status than patients without allergic rhinitis (p=0.027 and p=0.041, respectively). Children with uncontrolled asthma used less prophylactic drugs than those in control (p<0.001).

Conclusion: The influenza vaccine has no effect on disease control in children with asthma. Having allergic rhinitis and atopy reduces the control of the disease.

Anahtar Kelimeler

• asthma
• allergic rhinitis
• child
• influenza
• vaccine

Astımlı Çocuklarda İnfluenza Aşısı İle Hastalık Kontrolü Arasındaki İlişkinin Belirlenmesi

Öz

Amaç: İnfluenza aşısının astım kontrolü üzerindeki etkisi tartışmalıdır. Bu çalışmanın amacı astımlı çocuklarda influenza aşısının hastalık kontrolüne etkisini araştırmaktır.

Gereç ve Yöntemler: Astım tanısı alan çocuklar prospektif olarak çalışmaya dahil edildi. Hastaların sosyo-demografik özellikleri, bir önceki yılda influenza aşısı olma durumu, bronkodilatatör kullanımı ve sistemik steroid tedavisi, hastaneye yatış sıklığı, aşılam durumunu ve hastalığın kontrol durumunu etkileyecek risk faktörleri araştırıldı.

Bulgular: Çalışmaya ortanca yaşı 11 olan toplam 187 astımlı çocuk dahil edildi. Hastaların yaklaşık yarısında (%47,6) astım kontrol altında değildi. Son bir yılda %14,4'ü, %14,4'ü iki, %19,3'ü ≥3 atağı geçirirken, %51,9'u astım atağı geçirmedi. Bir önceki yılda hastaların %52,4'ü grip aşısı olmuştu. İnfluenza aşılaması, kontrollü ve kontrolsüz astımı olan hastalarda eşit oranda yaygındı (%54.1'e karşı %50.6) ve aşılamanın hastalık kontrolü üzerinde etkisi yoktu (p=0.662). Alerjik riniti ve atopisi olan hastalarda, alerjik riniti olmayan hastalara göre anlamlı olarak daha yüksek kontrolsüz astım durumu vardı (sırasıyla p=0.027 ve p=0.041). Kontrolsüz astımı olan çocuklar kontrol grubuna göre daha az profilaktik ilaç kullanmışlardı (p<0.001).

Sonuç: İnfluenza aşısının astımlı çocuklarda hastalık kontrolüne etkisi yoktur. Alerjik rinit ve atopiye sahip olmak hastalığın kontrolünü azaltır.

Anahtar Kelimeler

• astım
• allerjik rinit
• çocuk
• influenza

Kaynakça

1. 1. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S. International Study of Asthma and Allergies in Childhood Phase Three Study Group. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax.2009;64:476-83.
2. 2. Evans R 3rd, Mullally DI, Wilson RW, Gergen PJ, Rosenberg HM, Grauman JS, et al. National trends in the morbidity and mortality of asthma in the US. Prevalence, hospitalization and death from asthma over two decades: 1965-1984. Chest 1987;91: 65S-74S.
3. 3. Akinbami LJ, Simon AE, Rossen LM. Changing Trends in Asthma Prevalence Among Children. Pediatrics 2016; 137: 1–7.
4. 4. Zilmer M, Steen NP, Zachariassen G, Duus T, Kristiansen B, Halken S. Prevalence of asthma and bronchial hyperreactivity in Danish schoolchildren: no change over 10 years. Acta Paediatr 2011; 100: 385-9.
5. 5. Wennergren G, Ekerljung L, Alm B, Eriksson J, Lötvall J, Lundbäck B. Asthma in late adolescence--farm childhood is protective and the prevalence increase has levelled off. Pediatr Allergy Immunol 2010; 21: 806-13.
6. 6. Jackson DJ, Sykes A, Mallia P, Johnston SL. Asthma exacerbations: origin, effect, and prevention. J Allergy Clin Immunol 2011; 128: 1165-74.
7. 7. Haselkorn T, Fish JE, Zeiger RS, Szefler SJ, Miller DP, Chipps BE, et al. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol 2009; 124: 895-902.e1-4.
8. 8. Peters SP, Jones CA, Haselkorn T, Mink DR, Valacer DJ, Weiss ST. Real-world Evaluation of Asthma Control and Treatment (REACT): findings from a national Web-based survey. J Allergy Clin Immunol 2007; 119: 1454-61.

9. 9. Gern JE. Viral respiratory infection and the link to asthma. Pediatr Infect Dis J. 2008; 27: S97-103.
10. 10. Jackson DJ, Lemanske Jr RF. The role of respiratory virus infections in childhood asthma inception. Immunol Allergy Clin North Am 2010; 30: 513e22.
11. 11. Papadopoulos NG, Christodoulou I, Rohde G, Almqvist C, Bruno A, Bonini S, et al. Viruses and bacteria in acute asthma exacerbations--a GA² LEN-DARE systematic review. Allergy 2011; 66: 458-68.
12. 12. Khetsuriani N, Kazerouni NN, Erdman DD, Lu X, Redd SC, Anderson LJ, et al. Prevalence of viral respiratory tract infections in children with asthma. J Allergy Clin Immunol 2007; 119: 314-21.
13. 13. National Advisory Committee on Immunization. Statement on seasonal trivalent inactivated influenza vaccine (TIV) for 2010-2011 (NACI). Can Commun Dis Rep 2010; 36:1-49.
14. 14. Centers for Disease Control and Prevention. Influenza vaccination coverage among persons with asthma—United States, 2005-06 influenza season. MMWR Morb Mortal Wkly Rep 2008; 57: 653-7.
15. 15. Kramarz P, Destefano F, Gargiullo PM, Chen RT, Lieu TA, Davis RL, et al. Vaccine Safety Datalink team. Does influenza vaccination prevent asthma exacerbations in children? J Pediatr 2001; 138: 306-10.
16. 16. Ong BA, Forester J, Fallot A. Does influenza vaccination improve pediatric asthma outcomes? J Asthma 2009; 46: 477-80.
17. 17. Martin J, Townshend J, Brodlie M. Diagnosis and management of asthma in children. BMJ Paediatrics Open 2022; 6: e001277.
18. 18. Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, Blake KV, Brooks EG, Bryant-Stephens T, et al. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol 2021; 147: 1528-30.
19. 19. Grohskopf LA, Sokolow LZ, Broder KR, Olsen SJ, Karron RA, Jernigan DB, et al. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep 2016; 65: 1-54.
20. 20. Public Health England. Influenza: the green book. Chapter 19. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/385226/Green_Book_Chapter_19_v8_2.pdf. Accessed 18 July 2022.
21. 21. Prevention and control of influenza pandemics and annual epidemics. Available at: http://apps.who.int/gb/archive/pdf_files/WHA56/ea56r19.pdf. Accessed 19 July 2022.
22. 22. Flu Vaccination Coverage, United States, 2020–21 Influenza Season. Available at: https://www.cdc.gov/flu/fluvaxview/coverage-2021estimates.htm#:~:text=Children%20(6%20months%20through%2017,(63.7%25%3B%20Figure%201). Accessed 19 July 2022.
23. 23. Dombkowski KJ, Leung SW, Clark SJ. Physician perspectives regarding annual influenza vaccination among children with asthma. Ambul Pediatr 2008; 8: 294-9.
24. 24. Dharmage SC, Perret JL, Custovic A. Epidemiology of Asthma in Children and Adults. Front Pediatr 2019; 7:246. 25. Uncontrolled Asthma among Children, 2012–2014. Available at: https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-children.htm#:~:text=A%20total%20of%2050.3%25%20of,%25)%20and%20blacks%20(62.9%25). Accessed 19 July 2022.
25. 26. Cates CJ, Jefferson TO, Bara AI, Rowe BH. Vaccines for preventing influenza in people with asthma (Cochrane Review). Cochrane Database Syst Rev 2000; (4): CD000364.
26. 27. Christy C, Aligne CA, Auinger P, Pulcino T, Weitzman M. Effectiveness of influenza vaccine for the prevention of asthma exacerbations. Arch Dis Child 2004; 89: 734-5.
27. 28. Gharagozlou M, Montazeran M, Foroozanfar M, Khalili S. The effect of influenza vaccination in the prevention of exacerbation of children asthma. Tehran Univ Med J 2006; 64: 44-50.
28. 29. Jaiwong C, Ngamphaiboon J. Effects of inactivated influenza vaccine on respiratory illnesses and asthma-related events in children with mild persistent asthma in Asia. Asian Pac J Allergy Immunol 2015; 33: 3-7.
29. 30. Otero S, Casanovas JM, Carreras M, Cercòs I, Vallés A, Campins M. Impacto de la vacunación antigripal en la frecuencia de síndromes gripales y crisis respiratorias en pacientes con asma: estudio de cohortes. Vacunas 2009; 10: 72-7.
30. 31. Watanabe S, Hoshiyama Y, Matsukura S, Kokubu F, Kurokawa M, Kugaet H, et al. Prevention of Asthma Exacerbation with Vaccination against Influenza in Winter Season. Allergology International 2005; 54: 305-9.
31. 32. Smits AJ, Hak E, Stalman WA, van Essen GA, Hoes AW, Verheij TJ. Clinical effectiveness of conventional influenza vaccination in asthmatic children. Epidemiol Infect 2002; 128: 205-11.
32. 33. Ong BA, Forester J, Fallot A. Does influenza vaccination improve pediatric asthma outcomes? J Asthma 2009; 46: 477-80.
33. 34. Murray CS, Simpson A, Custovic A. Allergens, viruses, and asthma exacerbations. Proc Am Thorac Soc 2004;1: 99-104.
34. 35. Bossios A, Gourgiotis D, Skevaki CL, Saxoni-Papageorgiou P, Lötvall J, Psarras S, et al. Rhinovirus infection and house dust mite exposure synergize in inducing bronchial epithelial cell interleukin-8 release. Clin Exp Allergy 2008; 38:1615-26.
35. 36. DiFranza JR, Aligne CA, Weitzman M. Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics 2004; 113 1007-15.