Clinical Infectious Diseases (CID)
Volume 61 Issue 10 November 15, 2015
http://cid.oxfordjournals.org/content/current

.
Association of Influenza Vaccination Coverage in Younger Adults With Influenza-Related Illness in the Elderly
Glen B. Taksler, Michael B. Rothberg, and David M. Cutler
Clin Infect Dis. (2015) 61 (10): 1495-1503 doi:10.1093/cid/civ630
Abstract
Background.
Older adults have the highest influenza-related morbidity and mortality risk, but the influenza vaccine is less effective in the elderly. It is unknown whether influenza vaccination of nonelderly adults confers additional disease protection on the elderly population.
Methods.
We examined the association between county-wide influenza vaccination coverage among 520 229 younger adults (aged 18–64 years) in the Behavioral Risk Factors Surveillance System Survey and illnesses related to influenza in 3 317 709 elderly Medicare beneficiaries aged ≥65 years, between 2002 and 2010 (13 267 786 person-years). Results were stratified by documented receipt of a seasonal influenza vaccine in each Medicare beneficiary.
Results.
Increases in county-wide vaccine coverage among younger adults were associated with lower adjusted odds of illnesses related to influenza in the elderly. Compared with elderly residents of counties with ≤15% of younger adults vaccinated, the adjusted odds ratio for a principal diagnosis of influenza among elderly residents was 0.91 (95% confidence interval, .88–.94) for counties with 16%–20% of younger adults vaccinated, 0.87 (.84–.90) for counties with 21%–25% vaccinated, 0.80 (.77–.83) for counties with 26%–30% vaccinated, and 0.79 (.76–.83) for counties with ≥31% vaccinated (P for trend <.001). Stronger associations were observed among vaccinated elderly adults, in peak months of influenza season, in more severe influenza seasons, in influenza seasons with greater antigenic match to influenza vaccine, and for more specific definitions of influenza-related illness.
Conclusions.
In a large, nationwide sample of Medicare beneficiaries, influenza vaccination among adults aged 18–64 years was inversely associated with illnesses related to influenza in the elderly.

.
The Effect of Oral Polio Vaccine at Birth on Infant Mortality: A Randomized Trial
Najaaraq Lund, Andreas Andersen, Anna Sofie K. Hansen, Frida S. Jepsen, Amarildo Barbosa,
Sofie Biering-Sørensen, Amabelia Rodrigues, Henrik Ravn, Peter Aaby, and Christine Stabell Benn
Clin Infect Dis. (2015) 61 (10): 1504-1511 doi:10.1093/cid/civ617
Abstract
Background.
Routine vaccines may have nonspecific effects on mortality. An observational study found that OPV given at birth (OPV0) was associated with increased male infant mortality. We investigated the effect of OPV0 on infant mortality in a randomized trial in Guinea-Bissau.
Methods.
A total of 7012 healthy normal-birth-weight neonates were randomized to BCG only (intervention group) or OPV0 with BCG (usual practice). All children were to receive OPV with pentavalent vaccine (diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and hepatitis B) at 6, 10, and 14 weeks of age. Seven national OPV campaigns were also conducted during the trial period. Children were followed to age 12 months. We used Cox regression to calculate hazard ratios (HRs) for mortality.
Results.
The trial contradicted the original hypothesis about OPV0 increasing male infant mortality. Within 12 months, 73 children in the BCG + OPV group and 87 children in the BCG-only group died, all from infectious diseases. Comparing BCG + OPV0 vs BCG only, the HR was 0.83 (95% confidence interval [CI], .61–1.13): 0.72 (95% CI, .47–1.10) in boys and 0.97 (95% CI, .61–1.54) in girls. For children enrolled within the first 2 days of life, the HR for BCG + OPV0 vs BCG only was 0.58 (95% CI, .38–.90). From enrollment until the time of OPV campaigns, the HR was 0.68 (95% CI, .45–1.00), the beneficial effect being separately significant for males (0.55 [95% CI, .32–.95]).
Conclusions.
This is the only randomized trial of the effect of OPV0 on mortality. OPV0 may be associated with nonspecific protection against infectious disease mortality, particularly when given early in life. There are reasons to monitor mortality when OPV is being phased out.

.
Editorial Commentary: Oral Polio Vaccine at Birth
Lawrence D. Frenkel
Clin Infect Dis. (2015) 61 (10): 1512-1513 doi:10.1093/cid/civ619
Extract
The carefully done randomized study by Lund and colleagues, published in this issue of Clinical Infectious Diseases [1], is reassuring, after a previous observational study reported an increase in male infant mortality following oral poliovirus vaccine (OPV) given at birth [2]. That article by Benn and colleagues was disconcerting to vaccine advocates around the world, both for the possible detrimental effect on the control of polio disease in the few remaining endemic countries and because it could give additional fodder to antivaccine groups. The study by Lund et al reports the opposite—namely, a protective effect of OPV given within 2–3 days of birth, and an overall (uncensored) reduction in mortality of 16% by specifically decreasing male infant mortality. The specific causes of mortality are unfortunately not documented in this article, although the statement is made that they were all related to infectious diseases.
It is important to note that none of the studies of nonspecific effects of live viral vaccines given at birth show the same protective or detrimental effects in female infants as is seen in males. It is generally hypothesized that females have an extra …

.
Chicago Ebola Response Network (CERN): A Citywide Cross-hospital Collaborative for Infectious Disease Preparedness
Omar Lateef, Bala Hota, Emily Landon, Larry K. Kociolek, Julie Morita, Stephanie Black, Gary Noskin, Michael Kelleher, Krista Curell, Amy Galat, David Ansell, John Segreti, and Stephen G. Weber
Clin Infect Dis. (2015) 61 (10): 1554-1557 doi:10.1093/cid/civ510
Abstract
The Chicago Ebola Response Network, a hospital and public health collaboration, was formed in response to the 2014–2015 Ebola virus epidemic and is a roadmap for how a region can prepare to respond to public health emergencies.