The time-associated impact of the Newborn Influenza Protection Act on infant influenza rates in New York State

Shetal Shah; Catherine Messina

doi:10.1515/jpm-2014-0248

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The time-associated impact of the Newborn Influenza Protection Act on infant influenza rates in New York State

Shetal Shah und Catherine Messina

Veröffentlicht/Copyright: 6. November 2014

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Aus der Zeitschrift Journal of Perinatal Medicine Band 42 Heft 6

Abstract

Background: Influenza presents with increased morbidity and mortality in children ≤5 months of age. Vaccination of caregivers is indicated, but immunization rates are estimated at only 30%. The 2009 New York State Neonatal Influenza Protection Act (NIPA) mandated offering of influenza vaccine to caregivers during the post-partum hospitalization. The purpose of this study was to determine the impact of NIPA on infant influenza rates.

Method: Data on laboratory-confirmed influenza cases between 2006 and 2012 were extracted from the New York State Electronic Clinical Laboratory Reporting System (ECLRS). Data on infant cases were categorized by age (0–5 months) and location [New York City (NYC), outside NYC] based on reporting laboratory site. The total number of influenza cases and the percentage of total cases in the infant age group were normalized to the number of reporting laboratory sites. The χ²-test was used to compare the proportions of cases pre- and post-implementation. Year-to-year trends were assessed by linear regression. All tests of significance were two-sided and evaluated at the P<0.05 level.

Results: During the 6-year study period, 3154 cases of infant influenza were detected. In bivariate analysis, 1707 (54.1%) of cases occurred prior to NIPA implementation and 1447 (45.9%) of cases occurred after (P<0.001). Of the 1422 total infant cases detected in NYC, the percentages of influenza cases pre- and post-NIPA were 54.6% (777) and 45.4% (645), respectively (P<0.006). Outside NYC, the percentage of infant cases was reduced from 53.7% (930/1732) to 46.3% (802/1732, P<0.02). Prior to implementation, there was a year-to-year increase in the number of infant influenza cases statewide (P<0.04 for trend). The ratio of infant influenza cases normalized per ECLRS site in NYC increased each year after NIPA passage (P<0.01 for trend). The ratio of infant cases outside NYC decreased annually (P<0.05 for trend). No year-to-year trends were seen in the percentage of total influenza cases in the infant age group compared to total cases across all age groups either within or outside NYC.

Conclusions: Comparison of three influenza seasons before and after NIPA suggests a total statewide reduction in infant influenza. However, the greatest driver of this reduction occurs from reduced disease in infants outside NYC. We speculate that, with increased crowding within NYC, parental immunization as encouraged by NIPA may not create cocoon immunity.

Keywords: Influenza; immunization; vaccination

Corresponding author: Shetal Shah, MD, FAAP, Division of Neonatology, Department of Pediatrics Maria Fareri Children’s Hospital, New York Medical College, 2nd Floor C-225, 100 Woods Road, Valhalla, NY 10595, USA, Tel.: +1 914 4938558, Fax: +1 914 4931005, E-mail: shahs2@wcmc.com

Acknowledgments

We gratefully acknowledge the help of Christine Waters, RN (influenza surveillance coordinator, New York State Department of Health, Bureau of Communicable Disease Control), for her help in obtaining the data used in this paper.

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-4-23

Accepted: 2014-7-23

Published Online: 2014-11-6

Published in Print: 2014-11-1

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Artikel in diesem Heft

https://doi.org/10.1515/jpm-2014-0248

Schlagwörter für diesen Artikel

Influenza; immunization; vaccination