American Journal of Epidemiology Advance Access originally published online on March 22, 2006
American Journal of Epidemiology 2006 163(9):838-848; doi:10.1093/aje/kwj095
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Original Contribution |
Community Influenza Activity and Risk of Acute Influenza-like Illness Episodes among Healthy Unvaccinated Pregnant and Postpartum Women
1 Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC
2 Center for Health Studies, Group Health Cooperative, Seattle, WA
3 Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
4 Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC
5 Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
6 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
* Reprint requests to Dr. Lisa A. Jackson, Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Seattle, WA 98101 (e-mail: jackson.l{at}ghc.org).
This study investigated the relation between weekly levels of influenza activity and the risk of acute influenza-like illness episodes among 8,323 healthy pregnant and postpartum women enrolled in a Puget Sound region, Washington, health maintenance organization, Group Health Cooperative, between June 1991 and December 1997. The authors classified weeks between October and May for isolate activity level based on surveillance data for influenza, respiratory syncytial virus, parainfluenza, and adenovirus infection. Influenza-like illness episodes were identified from medical encounters assigned a diagnostic code consistent with a symptomatic influenza infection. The authors compared the occurrence of influenza-like illness episodes within each pregnancy stage for periods with varying levels of influenza isolate detection in the community. Repeated-measures logistic regression methods accounted for time-dependent factors. The adjusted strength of association between influenza exposure and influenza-like illness episodes increased as the pregnancy stage progressed (first trimester odds ratio = 1.12, 95% confidence interval: 0.79, 1.59; second trimester odds ratio = 1.30, 95% confidence interval: 0.97, 1.73; third trimester odds ratio = 1.84, 95% confidence interval: 1.31, 2.59; postpartum period odds ratio = 2.28, 95% confidence interval: 1.42, 3.68). Pregnancy stage modified the association between influenza activity and influenza-like illness episodes. Findings estimate that 20–43 pregnant/postpartum women would need to be vaccinated with an 80% effective vaccine to prevent one influenza-like illness episode.
cohort studies; immunization; influenza, human; postpartum period; pregnancy; regression analysis; respiratory tract infections; sentinel surveillance
Abbreviations: ACIP, Advisory Committee on Immunization Practices
Deceased.
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