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Impact of the introduction of a universal childhood influenza vaccination programme on influenza-related admissions to paediatric intensive care units in England
  1. Pia Hardelid1,
  2. Melpo Kapetanstrataki2,
  3. Lee Norman2,
  4. Sarah J Fleming2,
  5. Paula Lister3,
  6. Ruth Gilbert1 and
  7. Roger C Parslow2
  1. 1 Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
  2. 2 Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  3. 3 Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Pia Hardelid; p.hardelid{at}


Introduction A universal childhood influenza vaccination programme was introduced in the UK in September 2013. We examine the impact of the gradual introduction of this programme on influenza-related paediatric intensive care unit (PICU) admission rates in England.

Methods We extracted data on all influenza-related admissions to PICUs in England in resident children aged 0–15 years old between October 2003 and March 2017 from the Paediatric Intensive Care Audit Network (PICANet) database. We estimated influenza-associated PICU admission rates per 100 000 children by age group, sex and winter season (October to March), and used Poisson regression models to estimate incidence rate ratios (IRRs) in the winter seasons since the introduction of universal childhood vaccination compared with the two winters before the introduction of the programme (2011–2013).

Results We identified 929 influenza-related PICU admissions among 873 children. 48.3% of admissions were among children aged less than 2 years old. The influenza-associated PICU admission rate was 1.32 per 100 000 children (95% CI 1.23 to 1.40). We identified a significant increase in influenza PICU admissions in the winters following the introduction of the universal childhood vaccination programme compared with the winters of 2010/2011–2012/2013 among children aged <5 years old: IRR 1.58 (1.05, 2.37) in children <1 year, 2.71 (1.43, 5.17) in 1 year-olds and 1.98 (1.18, 3.31) in children 2–4 years old. No significant difference was found among children aged 5–15 years.

Conclusion The universal childhood influenza vaccination has not yet reduced the influenza-associated burden on PICUs in England during its early phase of introduction. Monitoring of influenza PICU admission rates needs to continue in England to assess the long-term impact of universal paediatric influenza vaccination. Linkage between PICANet and national infection surveillance databases would better enable such monitoring.

  • clinical epidemiology
  • paediatric lung disease
  • respiratory infection

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  • Contributors PH conceived the study with RCP and PL, carried out the data analyses with input from MK, LN and RCP, and drafted the paper. MK and LN extracted data from PICANet. All authors contributed to drafting the final manuscript.

  • Funding This study was funded by an NIHR postdoctoral fellowship to PH, grant number PDF-2013-06-004. Research at UCL Great Ormond Street Institute of Child Health was supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. This article represents independent research funded by the National Institute for Health Research (NIHR). The National Audit of Paediatric Intensive Care (PICANet) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing, and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the NCAPOP, comprising more than 30 clinical audits and clinical outcome review programmes that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, the Northern Ireland Department of Health, the States of Jersey, Guernsey, and the Isle of Man. The PICANet Audit is also funded by NHS Wales, NHS Lothian/National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, The National Office of Clinical Audit (NOCA) of the Republic of Ireland, and HCA Healthcare.

  • Disclaimer The views expressed are those of the authors and not those of the NHS, the NIHR or the Department of Health.

  • Competing interests PH reports receiving a travel award from the European Society for Paediatric Infectious Diseases (ESPID), supported by GSK, to present results related to this work at the annual ESPID Conference in 2016. No other authors report a conflict of interest.

  • Patient consent Not required.

  • Ethics approval Trent Medical Research Ethics Committee, Ref 05/MRE04/17 +5.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The original data for this study were collected under section 251 approval; therefore they cannot be shared.

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