Impact of influenza vaccine on childhood otitis media in Taiwan: A population-based study
Identifieur interne : 000685 ( Pmc/Curation ); précédent : 000684; suivant : 000686Impact of influenza vaccine on childhood otitis media in Taiwan: A population-based study
Auteurs : Pei-Wen Wu [Taïwan] ; Chien-Chia Huang [Taïwan] ; Wei-Chieh Chao [Taïwan] ; Chi-Chin Sun [Taïwan] ; Cheng-Hsun Chiu [Taïwan] ; Ta-Jen Lee [Taïwan]Source :
- PLoS ONE [ 1932-6203 ] ; 2018.
Abstract
Acute otitis media (AOM) is a common infectious disease in children and usually accompanied by a preceding viral respiratory tract infection, especially in the preschool-age population. The study aimed to evaluate impact of influenza vaccine on childhood otitis media.
This retrospective cohort study included data for 803,592 children (<10 years old) recorded in Taiwan’s National Health Insurance Research Database. AOM incidence and tympanostomy tube insertion incidence in each influenza season before and after the introduction of traditional injectable trivalent influenza vaccine (TIV) were compared using the Poisson regression analysis to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs).
In children < 2 years old, the age group eligible for free influenza vaccination, there was a significant reduction in seasonal AOM incidence after TIV introduction in 2004 (from 98.4 episodes/1000 person-seasons [95% CI: 96.4–100.5] to 66.1 episodes/1000 person-seasons [95% CI: 64–68.1]). In addition, with the increased vaccine coverage rate, the outpatient visits for AOM in the influenza season of 2005 and 2006 were significantly lower than that in 2004 (IRR = 0.85 and 0.80, respectively, p < 0.0001).
A significant reduction in primary care consultations for children <2 years old was observed after the introduction of the TIV in Taiwan in 2004. With the increased vaccine coverage, there was an additional decline in 2005 and 2006. In addition of the direct protection provided by the vaccination, we believe that TIV may have induced some herd immunity that further contributed to the reduction in influenza attack rates and the rates of associated AOM in that age group. These reductions were observed only in vaccine-eligible children, while older children, who were not enrolled in the influenza vaccination program during the study period, have experienced increases in the AOM incidence during the 2004–2006 period compared to the 2000–2003 period.
Url:
DOI: 10.1371/journal.pone.0190507
PubMed: 29304178
PubMed Central: 5755876
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Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, Keelung</wicri:regionArea></affiliation></author><author><name sortKey="Chiu, Cheng Hsun" sort="Chiu, Cheng Hsun" uniqKey="Chiu C" first="Cheng-Hsun" last="Chiu">Cheng-Hsun Chiu</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, 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Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">29304178</idno><idno type="pmc">5755876</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755876</idno><idno type="RBID">PMC:5755876</idno><idno type="doi">10.1371/journal.pone.0190507</idno><date when="2018">2018</date><idno type="wicri:Area/Pmc/Corpus">000685</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000685</idno><idno type="wicri:Area/Pmc/Curation">000685</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000685</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Impact of influenza vaccine on childhood otitis media in Taiwan: A population-based study</title><author><name sortKey="Wu, Pei Wen" sort="Wu, Pei Wen" uniqKey="Wu P" first="Pei-Wen" last="Wu">Pei-Wen Wu</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan</wicri:regionArea></affiliation></author><author><name sortKey="Huang, Chien Chia" sort="Huang, Chien Chia" uniqKey="Huang C" first="Chien-Chia" last="Huang">Chien-Chia Huang</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan</wicri:regionArea></affiliation></author><author><name sortKey="Chao, Wei Chieh" sort="Chao, Wei Chieh" uniqKey="Chao W" first="Wei-Chieh" last="Chao">Wei-Chieh Chao</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung</wicri:regionArea></affiliation></author><author><name sortKey="Sun, Chi Chin" sort="Sun, Chi Chin" uniqKey="Sun C" first="Chi-Chin" last="Sun">Chi-Chin Sun</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, Keelung</wicri:regionArea></affiliation></author><author><name sortKey="Chiu, Cheng Hsun" sort="Chiu, Cheng Hsun" uniqKey="Chiu C" first="Cheng-Hsun" last="Chiu">Cheng-Hsun Chiu</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Ta Jen" sort="Lee, Ta Jen" uniqKey="Lee T" first="Ta-Jen" last="Lee">Ta-Jen Lee</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></nlm:aff><country xml:lang="fr">Taïwan</country><wicri:regionArea>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2018">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Purpose</title><p>Acute otitis media (AOM) is a common infectious disease in children and usually accompanied by a preceding viral respiratory tract infection, especially in the preschool-age population. The study aimed to evaluate impact of influenza vaccine on childhood otitis media.</p></sec><sec id="sec002"><title>Methods</title><p>This retrospective cohort study included data for 803,592 children (<10 years old) recorded in Taiwan’s National Health Insurance Research Database. AOM incidence and tympanostomy tube insertion incidence in each influenza season before and after the introduction of traditional injectable trivalent influenza vaccine (TIV) were compared using the Poisson regression analysis to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs).</p></sec><sec id="sec003"><title>Results</title><p>In children < 2 years old, the age group eligible for free influenza vaccination, there was a significant reduction in seasonal AOM incidence after TIV introduction in 2004 (from 98.4 episodes/1000 person-seasons [95% CI: 96.4–100.5] to 66.1 episodes/1000 person-seasons [95% CI: 64–68.1]). In addition, with the increased vaccine coverage rate, the outpatient visits for AOM in the influenza season of 2005 and 2006 were significantly lower than that in 2004 (IRR = 0.85 and 0.80, respectively, p < 0.0001).</p></sec><sec id="sec004"><title>Conclusions</title><p>A significant reduction in primary care consultations for children <2 years old was observed after the introduction of the TIV in Taiwan in 2004. With the increased vaccine coverage, there was an additional decline in 2005 and 2006. In addition of the direct protection provided by the vaccination, we believe that TIV may have induced some herd immunity that further contributed to the reduction in influenza attack rates and the rates of associated AOM in that age group. These reductions were observed only in vaccine-eligible children, while older children, who were not enrolled in the influenza vaccination program during the study period, have experienced increases in the AOM incidence during the 2004–2006 period compared to the 2000–2003 period.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Alho, O" uniqKey="Alho O">O Alho</name></author><author><name sortKey="Koivu, M" uniqKey="Koivu M">M Koivu</name></author><author><name sortKey="Sorri, M" uniqKey="Sorri M">M Sorri</name></author><author><name sortKey="Rantakallio, P" uniqKey="Rantakallio P">P Rantakallio</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ingvarsson, L" uniqKey="Ingvarsson L">L Ingvarsson</name></author><author><name sortKey="Lundgren, K" uniqKey="Lundgren K">K Lundgren</name></author><author><name sortKey="Stenstrom, C" 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Lave</name></author><author><name sortKey="Kearney, Dh" uniqKey="Kearney D">DH Kearney</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Uhari, M" uniqKey="Uhari M">M Uhari</name></author><author><name sortKey="M Ntysaari, K" uniqKey="M Ntysaari K">K Mäntysaari</name></author><author><name sortKey="Niemel, M" uniqKey="Niemel M">M Niemelä</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">29304178</article-id><article-id pub-id-type="pmc">5755876</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0190507</article-id><article-id pub-id-type="publisher-id">PONE-D-17-34008</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Viral Diseases</subject><subj-group><subject>Influenza</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Infectious Disease Control</subject><subj-group><subject>Vaccines</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Geographical Locations</subject><subj-group><subject>Asia</subject><subj-group><subject>Taiwan</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Vaccination and Immunization</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Immunology</subject><subj-group><subject>Vaccination and Immunization</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Public and Occupational Health</subject><subj-group><subject>Preventive Medicine</subject><subj-group><subject>Vaccination and Immunization</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Patients</subject><subj-group><subject>Outpatients</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Otorhinolaryngology</subject><subj-group><subject>Otology</subject><subj-group><subject>Otitis Media</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Population Groupings</subject><subj-group><subject>Age Groups</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Ears</subject><subj-group><subject>Middle Ear</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Ears</subject><subj-group><subject>Middle Ear</subject></subj-group></subj-group></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Impact of influenza vaccine on childhood otitis media in Taiwan: A population-based study</article-title><alt-title alt-title-type="running-head">Influenza vaccine and childhood otitis media</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Pei-Wen</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Writing – original draft</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Huang</surname><given-names>Chien-Chia</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Formal analysis</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chao</surname><given-names>Wei-Chieh</given-names></name><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sun</surname><given-names>Chi-Chin</given-names></name><role content-type="http://credit.casrai.org/">Funding acquisition</role><role content-type="http://credit.casrai.org/">Resources</role><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Chiu</surname><given-names>Cheng-Hsun</given-names></name><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="aff" rid="aff005"><sup>5</sup></xref><xref ref-type="aff" rid="aff006"><sup>6</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Lee</surname><given-names>Ta-Jen</given-names></name><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Otolaryngology–Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan</addr-line></aff><aff id="aff004"><label>4</label><addr-line>Department of Ophthalmology, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan</addr-line></aff><aff id="aff005"><label>5</label><addr-line>Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></aff><aff id="aff006"><label>6</label><addr-line>Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Goldstein</surname><given-names>Edward</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Harvard School of Public Health, UNITED STATES</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><corresp id="cor001">* E-mail: <email>d0300102@stmail.cgu.edu.tw</email> (TJL); <email>chchiu@cgmh.org.tw</email> (CHC)</corresp></author-notes><pub-date pub-type="epub"><day>5</day><month>1</month><year>2018</year></pub-date><pub-date pub-type="collection"><year>2018</year></pub-date><volume>13</volume><issue>1</issue><elocation-id>e0190507</elocation-id><history><date date-type="received"><day>19</day><month>9</month><year>2017</year></date><date date-type="accepted"><day>15</day><month>12</month><year>2017</year></date></history><permissions><copyright-statement>© 2018 Wu et al</copyright-statement><copyright-year>2018</copyright-year><copyright-holder>Wu et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pone.0190507.pdf"></self-uri><abstract><sec id="sec001"><title>Purpose</title><p>Acute otitis media (AOM) is a common infectious disease in children and usually accompanied by a preceding viral respiratory tract infection, especially in the preschool-age population. The study aimed to evaluate impact of influenza vaccine on childhood otitis media.</p></sec><sec id="sec002"><title>Methods</title><p>This retrospective cohort study included data for 803,592 children (<10 years old) recorded in Taiwan’s National Health Insurance Research Database. AOM incidence and tympanostomy tube insertion incidence in each influenza season before and after the introduction of traditional injectable trivalent influenza vaccine (TIV) were compared using the Poisson regression analysis to estimate the incidence rate ratios (IRRs) and 95% confidence intervals (CIs).</p></sec><sec id="sec003"><title>Results</title><p>In children < 2 years old, the age group eligible for free influenza vaccination, there was a significant reduction in seasonal AOM incidence after TIV introduction in 2004 (from 98.4 episodes/1000 person-seasons [95% CI: 96.4–100.5] to 66.1 episodes/1000 person-seasons [95% CI: 64–68.1]). In addition, with the increased vaccine coverage rate, the outpatient visits for AOM in the influenza season of 2005 and 2006 were significantly lower than that in 2004 (IRR = 0.85 and 0.80, respectively, p < 0.0001).</p></sec><sec id="sec004"><title>Conclusions</title><p>A significant reduction in primary care consultations for children <2 years old was observed after the introduction of the TIV in Taiwan in 2004. With the increased vaccine coverage, there was an additional decline in 2005 and 2006. In addition of the direct protection provided by the vaccination, we believe that TIV may have induced some herd immunity that further contributed to the reduction in influenza attack rates and the rates of associated AOM in that age group. These reductions were observed only in vaccine-eligible children, while older children, who were not enrolled in the influenza vaccination program during the study period, have experienced increases in the AOM incidence during the 2004–2006 period compared to the 2000–2003 period.</p></sec></abstract><funding-group><award-group id="award001"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/501100004606</institution-id><institution>Chang Gung Medical Foundation</institution></institution-wrap></funding-source><award-id>CLRPG2C0024</award-id><principal-award-recipient><name><surname>Sun</surname><given-names>Chi-Chin</given-names></name></principal-award-recipient></award-group><award-group id="award002"><funding-source><institution-wrap><institution-id institution-id-type="funder-id">http://dx.doi.org/10.13039/501100005795</institution-id><institution>Chang Gung Memorial Hospital, Linkou</institution></institution-wrap></funding-source><award-id>CMRPG3E0122</award-id><principal-award-recipient><name><surname>Huang</surname><given-names>Chien-Chia</given-names></name></principal-award-recipient></award-group><funding-statement>Funding for this project was provided by the grants from Chang Gung Memorial Hospital, Taiwan (CLRPG2C0024, CMRPG3E0122).</funding-statement></funding-group><counts><fig-count count="2"></fig-count><table-count count="3"></table-count><page-count count="9"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>The data underlying this study are from the National Health Insurance Research Database (NHIRD), which has been transferred to the Health and Welfare Data Science Center (HWDC). Interested researchers can obtain the data through formal application to the HWDC, Department of Statistics, Ministry of Health and Welfare, Taiwan (<ext-link ext-link-type="uri" xlink:href="http://dep.mohw.gov.tw/DOS/np-2497-113.html">http://dep.mohw.gov.tw/DOS/np-2497-113.html</ext-link>).</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>The data underlying this study are from the National Health Insurance Research Database (NHIRD), which has been transferred to the Health and Welfare Data Science Center (HWDC). Interested researchers can obtain the data through formal application to the HWDC, Department of Statistics, Ministry of Health and Welfare, Taiwan (<ext-link ext-link-type="uri" xlink:href="http://dep.mohw.gov.tw/DOS/np-2497-113.html">http://dep.mohw.gov.tw/DOS/np-2497-113.html</ext-link>).</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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