Association between vaccination status, symptom identification and healthcare use: Implications for test negative design observational studies

Asmaa El-Heneidy; Keith Grimwood; Stephen B Lambert; Mohinder Sarna; Robert S Ware

doi:10.1016/j.vaccine.2022.02.049

Association between vaccination status, symptom identification and healthcare use: Implications for test negative design observational studies

Vaccine. 2022 Mar 18;40(13):1918-1923. doi: 10.1016/j.vaccine.2022.02.049. Epub 2022 Feb 23.

Authors

Asmaa El-Heneidy¹, Keith Grimwood², Stephen B Lambert³, Mohinder Sarna⁴, Robert S Ware⁵

Affiliations

¹ School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia. Electronic address: a.el-heneidy@griffith.edu.au.
² School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia; Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Gold Coast, QLD 4215, Australia. Electronic address: k.grimwood@griffith.edu.au.
³ Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia. Electronic address: sblambert@uq.edu.au.
⁴ Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA 6009, Australia. Electronic address: minda.sarna@curtin.edu.au.
⁵ School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Gold Coast, QLD 4222, Australia. Electronic address: r.ware@griffith.edu.au.

PMID: 35216842
DOI: 10.1016/j.vaccine.2022.02.049

Abstract

Aim: To test the internal validity of the test-negative design (TND) by investigating associations between maternal influenza vaccination, and new virus detection episodes (VDEs), acute respiratory illness, and healthcare visits in their children.

Methods: Eighty-five children from a birth cohort provided daily symptoms, weekly nasal swabs, and healthcare use data until age 2-years. Effect estimates are summarised as incidence rate ratios (IRR).

Results: There was no association between maternal vaccination and VDEs in children (IRR = 1.1; 95 %CI = 0.9-1.2). Influenza-vaccinated mothers were more likely than unvaccinated mothers to both report, and seek healthcare for, acute lower respiratory illness in their children, IRR = 2.4; 95 %CI = 1.2-4.8 and IRR = 2.2; 95 %CI = 1.1-4.3, respectively.

Conclusion: A key assumption of the TND, that healthcare seeking behaviour for conditions of the same severity is not associated with vaccine receipt, did not hold. Further studies of the performance of the TND in different populations are required to confirm its validity.

Keywords: Acute respiratory illness; Healthcare seeking behaviour; Influenza vaccination; Respiratory viruses; Test-negative design.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Child, Preschool
Humans
Incidence
Influenza Vaccines*
Influenza, Human* / epidemiology
Influenza, Human* / prevention & control
Patient Acceptance of Health Care
Vaccination

Substances

Influenza Vaccines