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Does Influenza Vaccination Exacerbate Asthma?
Analysis of a Large Cohort of Children With Asthma
Piotr Kramarz, MD;
Frank DeStefano, MD;
Paul M. Gargiullo, PhD;
Robert L. Davis, MD, MPH;
Robert T. Chen, MD;
John P. Mullooly, PhD;
Steve B. Black, MD;
Henry R. Shinefield, MD;
Kari Bohlke, ScD;
Joel I. Ward, MD;
Michael S. Marcy, MD;
for the Vaccine Safety Datalink Team
Arch Fam Med. 2000;9:617-623.
Context Although influenza vaccination is recommended for children with asthma, only a minority are vaccinated. One reason for low influenza vaccine coverage among children with asthma may be concern that influenza vaccination may induce an exacerbation of asthma.
Objective To evaluate the safety of influenza vaccination in children with asthma, we studied the incidence of hospitalizations and emergency department visits for asthma following influenza vaccination.
Design Retrospective cohort study–analysis of population-based computerized medical and vaccination records.
Setting Four large health maintenance organizations on the West Coast of the United States.
Subjects Children with asthma 1 through 6 years of age, identified by search of computerized databases of medical encounters and pharmacy prescriptions.
Main Outcome Measures Exacerbations of asthma.
Results In unadjusted analyses vaccination was associated with high rates of asthma exacerbations. However, after adjusting for asthma severity using a self-control method, the incidence rate ratios of asthma exacerbations after vaccination were 0.58 (95% confidence interval, 0.36-0.95), 0.74 (95% confidence interval, 0.47-1.17), and 0.98 (95% confidence interval, 0.76-1.27) during the 3 influenza seasons.
Conclusions After controlling for asthma severity, we found that influenza vaccination does not result in acute asthma exacerbations in children. Concern about possible exacerbation of asthma is not a valid reason to not vaccinate children with asthma against influenza.
From the Centers for Disease Control and Prevention, Atlanta, Ga (Drs Kramarz, DeStefano, Gargiullo, and Chen); Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Wash (Drs Davis and Bohlke); Pediatric Vaccine Study Center, Northern California Kaiser Permanente, Oakland (Drs Black and Shinefield); Center for Health Research, Northwest Kaiser Permanente, Portland, Ore (Dr Mullooly); Center for Vaccine Research Harbor-UCLA Medical Center, Torrance (Dr Ward); Kaiser Foundation Hospital, Panorama City, Calif (Dr Marcy).
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