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Concept: Influenza vaccines

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The Canadian Paediatric Society continues to encourage annual influenza vaccination for ALL children and youth ≥6 months of age. Recommendations from the National Advisory Committee on Immunization (NACI) for the 2017/2018 influenza season are not substantially changed from those of last season. NACI has conducted a review of all available vaccine effectiveness data concerning live attenuated influenza vaccine (LAIV) and concludes that current evidence supports the continued use of LAIV in Canada, although use is not currently recommended in the USA because of concern about efficacy.

Concepts: Pneumonia, Vaccine, Vaccination, Influenza, Influenza vaccine, Live attenuated influenza vaccine, Vaccines, Influenza vaccines

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Recent observational studies in the United States indicated live attenuated influenza vaccine (LAIV) was less effective in children against clinical influenza infection caused by A(H1N1)pdm09 relative to inactivated influenza vaccine (IIV). During the 2013-2014 influenza season, we conducted an observational study among children aged 5-17 years to compare serologic responses to LAIV and IIV and explore factors associated with vaccine failure.

Concepts: Pneumonia, Vaccine, Vaccination, Influenza, Influenza vaccine, Live attenuated influenza vaccine, Vaccines, Influenza vaccines

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For many years, the UK seasonal influenza vaccination programme has been offered to people at higher risk from the complications of influenza infection, including those aged over 65 years and anyone aged over 6 months who is in a clinical risk group.(1) In 2012, the Joint Committee on Vaccination and Immunisation (JCVI) recommended extending seasonal influenza vaccination to children aged 2-16 years who are not in a clinical risk group.(2) In contrast to the vaccination programme for adults, which uses an injectable inactivated influenza vaccine, children are being offered a live attenuated influenza vaccine (LAIV) that is administered intranasally.(2) Here, we consider the evidence for the use of the intranasal influenza vaccine for children who are not in a clinical risk group.

Concepts: Immune system, Pneumonia, Vaccine, Vaccination, Influenza, Influenza vaccine, Live attenuated influenza vaccine, Influenza vaccines

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In the 2015-2016 season, quadrivalent live attenuated influenza vaccine (LAIV) and both trivalent and quadrivalent inactivated influenza vaccine (IIV) were available in the United States.

Concepts: Pneumonia, Vaccine, Vaccination, Influenza, Influenza vaccine, Live attenuated influenza vaccine, Vaccines, Influenza vaccines

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Purpose of SPR Perspectives Reviews: Address contemporary scientific issues and controversies by leveraging the expertise of SPR membersIncrease SPR member engagement with the journalPair established and younger SPR members to simultaneously increase interaction between SPR members and create opportunities for mentorship The intranasal Live Attenuated Influenza Vaccine (LAIV), FluMist, has been widely appreciated by pediatricians, parents and children alike for its ease of administration. Concerns regarding lack of effectiveness in recent influenza seasons, however, led to the CDC Advisory Committee on Immunization Practices (ACIP) recommendation to administer inactivated influenza vaccines (IIV), and not LAIV, during the 2016-17 and 2017-18 seasons. Given that data from previous years demonstrated equivalent and even improved efficacy of LAIV compared with IIV, this recent data was surprising, raising many questions about potential mechanisms underlying this change. This review seeks to summarize the history of LAIV studies and ACIP recommendations with a focus on the recent decrease in vaccine effectiveness (VE) and discordant results among studies performed in different countries. Decreased VE for A/H1N1pdm09 viruses represents the most consistent finding across studies, as VE has been low every season these viruses predominated since 2010-11. Potential explanations underlying diminished effectiveness include the hypothesis that prior vaccination, reduced thermostability of A/H1N1pdm09, addition of a fourth virus, or reduced replication fitness of A/H1N1pdm09 strains may have contributed to this phenomenon. Ongoing studies and potential alterations to LAIV formulations provide hope for a return of effective LAIV in future influenza seasons.Pediatric Research accepted article preview online, 25 September 2017. doi:10.1038/pr.2017.239.

Concepts: Vaccine, Vaccination, Influenza, Influenza vaccine, Live attenuated influenza vaccine, Vaccines, Influenza vaccines, MedImmune

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The USA has a long-standing paediatric influenza vaccination programme, including use of live attenuated influenza vaccine (LAIV). Following US evidence of apparent lack of vaccine effectiveness (VE) of LAIV in 2015/2016, particularly against A(H1N1)pdm09, the USA suspended the use of LAIV in the 2016/2017 season. The UK introduced LAIV for children in 2013/2014 and Finland in 2015/2016. Both countries have since been closely monitoring programme performance. In 2015/2016, the UK and Finland, unlike the USA, found evidence of significant VE of LAIV against laboratory-confirmed influenza. Several studies, however, reported relatively lower VE of LAIV against A(H1N1)pdm09 infection compared with inactivated influenza vaccine, although not for A(H3N2) or B. The reasons for these apparent differences remain under investigation. Both the UK and Finland continue to recommend the use of LAIV in children for the 2017/2018 season and are intensifying further monitoring of their childhood programmes against a range of end-points.

Concepts: European Union, Vaccine, Vaccination, Influenza, Olympic Games, Influenza vaccine, Live attenuated influenza vaccine, Influenza vaccines

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Trivalent inactivated and live attenuated influenza vaccines (IIV3 and LAIV3) have been reformulated with an extra B strain (IIV4 and LAIV4). They were licensed based on immunogenicity and their effectiveness (VE) still must be empirically tested.

Concepts: Pneumonia, Vaccine, Influenza, Influenza pandemic, Influenza vaccine, Vaccines, Influenza vaccines

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Live attenuated influenza vaccine (LAIV) might increase the risk of wheezing in persons with asthma or children younger than 5 years with a history of recurrent wheezing.

Concepts: Asthma, Pneumonia, Vaccine, Influenza, Influenza vaccine, Live attenuated influenza vaccine, Vaccines, Influenza vaccines

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A clinical study found that live attenuated influenza vaccine (LAIV) was superior to inactivated influenza vaccine (IIV) against drifted A(H3N2) viruses in children. During the 2014-2015 influenza season, widespread circulation of antigenically and genetically drifted A(H3N2) viruses provided an opportunity to evaluate subtype-specific vaccine effectiveness (VE) of quadrivalent LAIV (LAIV4) and IIV in children.

Concepts: Clinical trial, Virus, Vaccine, Vaccination, Influenza, Influenza vaccine, Live attenuated influenza vaccine, Influenza vaccines