Safety of live attenuated influenza vaccine (LAIV) in children with moderate to severe asthma

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:145

Article

Turner, Paul J.^1,2  Fleming, Louise¹  Saglani, Sejal¹  Southern, Jo²  Andrews, Nick J.²  Miller, Elizabeth² 

[1] Imperial Coll London, Natl Heart & Lung Inst, Sect Inflammat Repair & Dev, London, England

[2] Publ Hlth England, Immunisat Hepatitis & Blood Safety Dept, London, England

关键词: Asthma;    children;    immunization;    influenza;    live attenuated influenza vaccine;   

DOI  :  10.1016/j.jaci.2019.12.010

来源: Elsevier

【 摘 要 】

Background: Live attenuated influenza vaccine (LAIV) is recommended for annual influenza vaccination in children from age 2 years. However, some guidelines recommend against its use in children with asthma or recurrent wheeze due to concerns over its potential to induce wheezing. Objective: We sought to assess the safety of LAIV in children with moderate to severe asthma, and in preschool children with recurrent wheeze. Methods: Prospective, multicenter, open-label, phase IV intervention study in 14 specialist UK clinics. LAIV was administered under medical supervision, with follow-up of asthma symptoms 72 hours and 4 weeks late, using validated questionnaires. Results: A total of 478 young people (median, 9.3; range, 2-18 years) with physician-diagnosed asthma or recurrent wheeze were recruited, including 208 (44%) prescribed high-dose inhaled corticosteroids and 122 (31%) with severe asthma. There was no significant change in asthma symptoms in the 4 weeks after administration (median change, 0; P=.26, McNemar test), with no impact of level of baseline asthma control/symptoms in predicting either a worsening of asthma or exacerbation after LAIV using a regression model. A total of 47 subjects (14.7%; 95% CI, 11%-19.1%) reported a severe asthma exacerbation in the 4 weeks after immunization, requiring a short course of systemic corticosteroids; in 4 cases, this occurred within 72 hours of vaccination. No association with asthma severity, baseline lung function, or asthma control was identified. Conclusions: LAIV appears to be well tolerated in the vast majority of children with asthma or recurrent wheeze, including those whose asthma is categorized as severe or poorly controlled.

【 授权许可】

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