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The impact of increasing vaccination coverage in children on symptomatic influenza cases using the Framework for Reconstructing Epidemiological Dynamics (FRED)
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  • Katherine V. Williams,
  • Mary G. Krauland,
  • Mary Patricia Nowalk,
  • Lee H. Harrison,
  • John V. Williams,
  • Mark S. Roberts,
  • Richard Zimmerman
Katherine V. Williams
University of Pittsburgh School of Medicine

Corresponding Author:kvw3@pitt.edu

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Mary G. Krauland
University of Pittsburgh School of Public Health
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Mary Patricia Nowalk
University of Pittsburgh School of Medicine
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Lee H. Harrison
University of Pittsburgh Division of Infectious Diseases
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John V. Williams
University of Pittsburgh Department of Pediatrics
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Mark S. Roberts
University of Pittsburgh School of Public Health
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Richard Zimmerman
University of Pittsburgh School of Medicine
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Abstract

Background: The availability of self- or caregiver-administered nasal spray live attenuated influenza vaccine (LAIV) raises the potential for increased influenza vaccine uptake and increased vaccine effectiveness (VE) via mucosal immunity. Direct and indirect benefits of increased uptake among school-age children (decreased influenza cases and hospitalizations) may be realized across the age spectrum. We used an agent-based model, the Framework for Reproducing Epidemiological Dynamics (FRED) to determine the extent to which increased vaccination of children might affect overall influenza epidemiology. Methods: FRED uses a population based on the US census and accounts for individual characteristics to estimate the effect of changes in parameters including vaccine uptake on outcomes. We modeled increases in vaccine uptake and VE among school-age children 5-17 years on influenza cases and hospitalizations by age group. Results: Increasing vaccination rates in school-aged children by 5%-15% decreased their symptomatic influenza cases by 3.2%-10.9%, and over all age groups by 3.3%-11.6%, corresponding to an estimated annual reduction in cases among school-age children of 522,867-1,810,170 and 1,394,687-4,945,952 overall. Fewer days of missed school by children and work by caregivers could offset those required to increase vaccination coverage. Annual U.S. hospitalizations could decrease by as much as 49,977, with the greatest impact (23,258) in those ages 65 years and over. If childhood influenza VE increased only 5%, the attendant improvement in cases would exceed that of a 5%-15% increase in vaccination coverage. Conclusion: The opportunity to increase vaccination coverage in school-age children using LAIV can have a positive impact across all ages.