Statistics and Surveillance:

New Vaccine Surveillance Network

Introduction to NVSN

The New Vaccine Surveillance Network (NVSN) was established in 1999 to evaluate the impact of new vaccines and vaccine policies through active sentinel surveillance at three U.S. medical centers. These NVSN sentinel sites include the University of Rochester in Rochester NY, Vanderbilt University in Nashville Tennessee, and Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. The sites conduct population-based inpatient and enhanced outpatient surveillance for vaccine-preventable disease outcomes, applied epidemiologic and health service research, and investigator-initiated studies to achieve the goals of the network.

The program complements existing surveillance programs for vaccine-preventable diseases by conducting seasonal active population-based surveillance for hospitalizations associated with acute respiratory illness (ARI) and acute gastroenteritis (AGE) in children who reside within the counties under NVSN surveillance (Monroe County NY, Davidson County TN, Hamilton County OH). Active surveillance is also conducted in emergency departments and outpatient clinics.

Specimens are collected for laboratory testing for both ARI and AGE surveillance. ARI specimens are tested using viral culture and RT-PCR for respiratory pathogens. The viruses tested depend on study year and setting and have included influenza A and B annually as well as RSV, parainfluenza, human metapneumovirus, rhinovirus, bocavirus, and coronaviruses for selected years. AGE specimens are tested for rotavirus antigens using an EIA and positive specimens undergo typing using RT-PCR.

In addition to surveillance, the NVSN has conducted special studies regarding new vaccines/vaccine recommendations including vaccine effectiveness, feasibility/KAP of implementing new vaccine recommendation, uptake and impact of vaccination with influenza and pneumococcal conjugate vaccine (PCV7), and collected data on other childhood vaccines. Although new vaccines and vaccine policies have focused on young children with ARI and AGE, the NVSN is not restricted to this age group or to respiratory and enteric pathogens. Future activities may include other vaccines that are in development.

NVSN Partners

• University of Rochester School of Medicine and Dentistry, Rochester, NY
  
  • Principal Investigator: Peter Szilagyi, MD, MPH
  • Co-Principal Investigators: Caroline Hall, MD and Geoff Weinberg, MD
  Vanderbilt University School of Medicine, Nashville, TN
  • Principal Investigator: Kathryn Edwards, MD
  • Co-Principal Investigator: Marie Griffin, MD, MPH 
  Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
  • Principal Investigator: Mary Allen Staat, MD, MPH
  • Co-Principal Investigator: Ardythe Morrow, PhD, Gerry Fairbrother, PhD, Richard Ward, PhD, Richard Rudy, MD and David Bernstein, MD.
  Centers for Disease Control and Prevention, National Immunization Program, Atlanta, GA
  • ARI Principal Investigator/Project Officer: Marika Iwane, PhD, MPH
  • AGE Principal Investigator/Project Officer: Daniel Payne, PhD, MSPH
  • CDC Surveillance Coordinators: Laura Stockman, MPH, and Haley Clayton, MPH

Selected Studies

ARI

• Population-based seasonal surveillance of children <12 years of age hospitalized for fever/ARI.
• Surveillance for respiratory viruses in children <13 years of age with medically-attended visits for fever/ARI in emergency departments and outpatient practices.
• Assessing clinical and other risk factors for serious ARI outcomes among young children and disease/risk subgroups.
• Assessing influenza vaccine effectiveness in young children.
• Assessing missed opportunities for influenza vaccination and impact of new vaccine recommendations on the childhood vaccination schedule.
• Assessing direct and indirect economic costs of influenza for inpatient and outpatient care through household interviews and chart reviews.
• Feasibility of implementing expanded recommendations for influenza vaccination of young children through surveys, time motion studies, and database assessment of visit burden on practices.
• Measuring the impact of PCV7 on disease burden in infants and young children using insurance claims databases.
• Assessing the impact of PCV7 on the number of vaccination visits and shots, delivery of other vaccines, and disease outcomes.
• Assessing provider practices during the PCV7 shortage in 2001-03 with provider surveys and chart reviews in a sample of practices to assess compliance with vaccine recommendations.

AGE

• Population-based seasonal surveillance for rotavirus among children <3 years of age hospitalized for acute gatstroenteritis.
• Surveillance for rotavirus among children <3 years of age with medically-attended visits for acute gastroenteritis in emergency departments and outpatient practices.
• Characterizing the clinical and epidemiologic factors of children having rotavirus AGE resulting in hospitalizations, emergency department, and outpatient office visits
• Assessing rotavirus vaccine effectiveness using both a case-control and a case-cohort study
• Assessing serious health outcomes related to rotavirus gastroenteritis

* Note: Supplemental funding from non-CDC sources provided support for some of these studies.

Selected Publications

Poehling KA , Edwards KM, Weinberg GA, Szilagyi P, Staat MA, Iwane MK, Bridges CB, Grijalva CG, Zhu Y, Bernstein DI, Herrera G, Erdman D, Hall CB, Seither R, Griffin MR. The underrecognized burden of influenza in young children. N Engl J Med 2006; 6:355(1):31-40.

Update: Influenza Activity -- United States and Worldwide, 2005-06 Season, and Composition of the 2006-07 Influenza Vaccine. Morb Mort Wkly Rep 2006; 55(23);648-653.

Szilagyi PG, Griffin MR, MD, Shone LP, Bartha R, Zhu Y, Schaffer S, Ambrose S, Roy H, Poehling KA, MD, Edwards KM, Walker FJ, Schwartz B, The Impact of Conjugate Pneumococcal Vaccination on Routine Childhood Vaccination and Primary Care Use in 2 Counties. Pediatrics 2006;118;1394-1402.

Grijalva CG, Weinberg GA, Bennett NM, Staat MA, Craig AS, Dupont WD, Iwane MK, Postema AS, Schaffner W, Edwards KM, Griffin MR. Estimating the undetected burden of influenza hospitalizations in children. Epidemiol Infect 2006 Dec 7;1-8.

Grijalva CG , Craig AS, Dupont WD, Bridges CB, Schrag SJ, Iwane MK, Schaffner W, Edwards KM, Griffin MR. Estimating influenza hospitalizations among children. Emerg Infect Dis 2006 Jan;12(1):103-9.

Update: Influenza Activity -- United States, 2004-05 Season. Morb Mort Wkly Rep 2005;54(13);328-331.

Iwane MK, Edwards KM, Szilagyi PG, et al. Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children. Pediatrics 2004;113:1758-64.

Mullins JA, Erdman DD, Weinberg GA, Edwards K, Hall CB, Walker FJ, Iwane M, Anderson LJ. Human metapneumovirus infection among children hospitalized with acute respiratory illness. Emerg Infect Dis 2004 Apr;10(4):700-5.

Griffin MR, Walker FJ, Iwane MK, Weinberg GA, Staat MA, Erdman DD. Epidemiology of respiratory infections in young children: insights from the New Vaccine Surveillance Network. Pediatr Infect Dis J 2004;23:Suppl:S188-S192.

Humiston SG , Szilagyi PG, Iwane MK, Schaffer SJ, Santoli J, Shone L, Barth R, McInerny T, Schwartz B. The feasibility of universal influenza vaccination for infants and toddlers. Arch Pediatr Adolesc Med . 2004;158(9):867-74.

Poehling KA, Lafleur BJ, Szilagyi PG, Edwards KM, Mitchel E, Barth R, Schwartz B, Griffin MR. Population-based impact of pneumococcal conjugate vaccine in young children. Pediatrics 2004 Sep;114(3):755-61.

Weinberg GA, Erdman DD, Edwards KM, Hall CB, Walker FJ, Griffin MR, Schwartz B. Superiority of Reverse-transcription Polymerase Chain Reaction to Conventional Viral Culture in the Diagnosis of Acute Respiratory Tract Infections in Children. JID 2004;189:706-710.

Szilagyi, PG, Iwane MK, Schaffer S, Humiston SG, Barth R, McInerny T, Shone L, Schwartz B. Potential Burden of Universal Influenza Vaccination of Young Children on Visits to Primary Care Practices. Pediatrics 2003;112:821-828.

Erdman D, Weinberg GA, Edwards KM, Walker FJ, Anderson B, Winter J, Gonzalez M, Anderson LJ. GeneScan reverse transcription-PCR assay for detection of 6 common respiratory viruses in young children hospitalized with acute respiratory illness. J Clin Microbiol 2003; 41:4298-4303.

Poehling KA, Szilagyi PG, Edwards K, Mitchel E, Barth R, Hughes H, LaFleur B, Schaffer SJ, Schwartz B, Griffin MR. Streptococcus pneumoniae-related illnesses in young children: secular trends and regional variation. Pediatric Infectious Disease Journal 2003; 22:391-394.

Poehling KA, Szilagyi PG, Edwards K, Mitchel E, Barth R, Hughes H, Lafleur B, Schaffer SJ, Schwartz B, Griffin MR. Streptococcus pneumoniae-related illnesses in young children: secular trends and regional variation. Pediatr Infect Dis J 2003 May;22(5):413-8.

Szilagyi PG, Iwane MK, Humiston SE, Schaffer S, McInerny T, Shone L, Jennings J, Washington ML, Schwartz B. Time spent by primary care practices on pediatric influenza vaccination visits: Implications for universal influenza vaccination. Archives of Pediatrics & Adolescent Medicine 2003. 157(2):191-195.

Schaffer SJ, Szilagyi PG, Shone LP, Ambrose SJ, Dunn K, Barth RD, Edwards K, Weinberg GA, Balter S, Schwartz B. Physician Perspectives regarding Pneumococcal Conjugate Vaccine. Pediatrics 2002;110(6). http://pediatrics.aappublications.org/cgi/content/full/110/6/e68 (exit)

In Press

GrijalvaCG, Poehling KA, Edwards KM, Weinberg GA, Staat MA, Iwane MK, Schaffner W, Griffin MR. Accuracy and interpretation of rapid influenza tests in children. Pediatrics (in press).

Miller KE, Lu X , Erdman DD, Poehling KA, Zhu Y, Griffin MR, Hartert TV, Anderson LJ, Weinberg GA, Hall CB, Iwane MK, Edwards KM. Rhinovirus Hospitalizations in Young Children. Journal of Infectious Diseases (in press).

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