Influenza and pneumococcal vaccination status as an effect modifier in COVID-19 pneumonia radiograph characteristics in Filipino children and adolescent : a cross sectional analytic study / Ron Kristofer P. Lapada and Maria Theresa M. Bisquera.

Includes bibliographical references.

Abstract: The coronavirus infection is a highly acute infection which was discovered and was rampant during the first quarter of 2020; with a high mortality rate and vicious clinical course. Vaccinations in the Philippines did not start until January 2021 wherein at least 10% of the population were inoculated, prioritizing the elderly and essential workers. While COVID-19 vaccination efficacy and its effects in the pediatric population in carefully being explored, some studies infer that routine vaccinations such as flu and pneumonia may improve survival or clinical trends in pediatric patients afflicted with COVID-19. This study aims to determine whether influenza and pneumococcal vaccine status is an effect modifier in COVID-19 Pneumonia radiograph characteristics in Filipino children and adolescents. A retrospective cross sectional analytical study of COVID-19 pediatric from December 2020 to December 2021 in a tertiary hospital in Fairview, Quezon City was done. Pediatric patients who had their COVID-19 vaccinations were excluded from this study. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. Frequency and proportion were used for categorical variables. Mann-Whitney U test and Fisher's Exact/Chi-square test were used to determine the difference of median and frequency between those with and without vaccine, respectively. Odds ratios and the corresponding 95% confidence interval from binary logistic regression was computed. A total of 822 pediatric patients were included in this study, of which 404 have had prior flu or pneumococcal vaccines and 418 without. Ten percent had a previous history of respiratory disease and it was significantly higher in patients with flu or pneumococcal vaccines. Sixty-nine patients had exposure to smokers, and it was significantly higher in patients without flu/pneumococcal vaccines. Ninety percent of participants had abnormal chest findings, mostly presence of linear and hazy opacities, which were significantly higher among unvaccinated participants. Flu vaccination and/or pneumococcal vaccination were associated with decreased odds of a chest abnormality. Flu vaccination was associated with 78.8% decreased odds, pneumococcal vaccination with 78.6% decreased odds, having either flu vaccine or PCV with 77.3% decreased odds, and having both with 87.8% decreased odds of a chest imaging abnormality. Results from this study indicate that concomitant flu or pneumococcal vaccination may be effect modifiers in COVID-19 pneumonia in pediatric patients. Patients up to date with these vaccines had significantly decreased odds of having a chest imaging abnormality in COVID-19 pneumonia. Potential confounding variables such as socioeconomic and household characteristics were not included in this retrospective study and may be addressed in future larger, prospective studies.

Research - Department of Radiology