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 3 U.S. medical centers. The 3 original NVSN sentinel sites include the University of Rochester in Rochester, NY, Vanderbilt University in Nashville, TN, and Cincinnati Children’s Hospital Medical Center in Cincinnati, OH. 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.

This program conducts surveillance for vaccine-preventable diseases by performing 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.

In 2009, 3 additional sentinel sites were selected to supplement AGE surveillance. Those sites are Texas Children’s Hospital in Houston, TX, Seattle Children’s Hospital in Seattle, WA, and Children’s Mercy Hospital and Clinics in Kansas City, MO. A 7th site, Children’s Hospital Research Center, Oakland in Oakland, California, was added in 2010.  These added sites are funded through 2011 by the American Recovery and Reinvestment Act (ARRA). The 7-site surveillance system is termed the NVSN-Extended System (NVSN-ES).

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 the study year and setting and have included influenza A and B each year as well as RSV, parainfluenza, human metapneumovirus, rhinovirus, bocavirus, and coronaviruses for selected years.  AGE specimens are tested for rotavirus antigens by using an EIA; additional laboratory tests are used to determine rotavirus strains and to test for other AGE pathogens.

In addition to surveillance, NVSN has conducted special studies regarding new vaccines and vaccine recommendations, including studies on vaccine effectiveness, the cost-benefits of vaccination programs, coverage of new childhood vaccines, and the feasibility of implementing new vaccine recommendations.

NVSN Partners

Vanderbilt University School of Medicine, Nashville, TN

• Principal Investigator: Kathryn Edwards, MD

University of Rochester School of Medicine and Dentistry, Rochester, NY

• Principal Investigator: Peter Szilagyi, MD, MPH

Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

• Principal Investigator: Mary Allen Staat, MD, MPH

Texas Children’s Hospital, Houston, TX

• Clinical Principal Investigator: Julie Boom, MD
• State Principal Investigator: Marilyn Felkner, DrPH

Seattle Children’s Hospital, Seattle, WA

• Clinical Principal Investigator: Eileen Klein, MD, MPH
• State Principal Investigator: Chas DeBolt, RN, MPH

Children’s Mercy Hospital and Clinics, Kansas City, MO

• Clinical Principal Investigator: Raj Selvarangan, BVSc, PhD, D(ABMM)
• State Principal Investigator: D. Charles Hunt, MPH

Children’s Hospital and Research Center Oakland, Oakland, CA

• Clinical Principal Investigator: Parvin Azimi, MD
• State Principal Investigator: Kathleen Harriman, PhD, MPH, RN

Centers for Disease Control and Prevention, NCIRD, Atlanta, GA

• ARI Principal Investigator/Project Officer: Marika Iwane, PhD, MPH
• AGE Principal Investigator/Project Officer: Daniel Payne, PhD, MSPH

Selected Studies

ARI

• Population-based seasonal surveillance of children <5 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.
• Assessing the impact of PCV7 on the number of vaccination visits and shots, delivery of other vaccines, and disease outcomes using various sources of data.

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

AGE

• Assessing rotavirus vaccine effectiveness.
• Assessing trends in the burden of rotavirus gastroenteritis among US children.
• Population-based seasonal surveillance for rotavirus among children <5 years of age with medically-attended hospitalizations and emergency department visits for acute gastroenteritis.
• Characterizing the clinical and epidemiologic factors of children having AGE pathogens resulting in hospitalizations, emergency department, and outpatient office visits.
• Monitoring rotavirus strain distributions during the post-licensure vaccine period.
• Assessing rotavirus vaccine coverage, provider acceptance, and cost-benefit assessments of the US rotavirus vaccination program.
• Determining population-based rates of intussusception in children attending emergency departments.
• Assessing the accuracy/completeness of rotavirus ICD-9-CM coding.
• Assessing health outcomes related to rotavirus gastroenteritis and other AGE pathogens.

Selected Publications

Payne DC, Edwards KE, Bowen MD, Keckley E, Peters J, Esona M, et al.  Sibling transmission of RotaTeq vaccine-derived rotavirus associated with rotavirus gastroenteritis.  Pediatrics 2010;126;249-52.

Cortese MM, Staat MA, Weinberg GA, Edwards K, Rice MA, Szilagyi PG, Hall CB, Payne DC, Parashar UP.  Underestimates of intussusception rates in infants: Implications for monitoring vaccine safety.  J Infect Dis 2009;200(Suppl 1):S264–70.

Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, Auinger P, Griffin MR, Poehling KA, Erdman D, Grijalva CG, Zhu Y, Szilagyi P. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009;360:588-98.

Miller EK, Edwards KM, Weinberg GA, Iwane MK, Griffin MR, Hall CB, Zhu Y, Szilagyi PG, Morin LL, Heil LH, Lu X, Williams JV; New Vaccine Surveillance Network. A novel group of rhinoviruses is associated with asthma hospitalizations. J Allergy Clin Immunol 2009;123:98-104.

Payne DC, Szilagyi P, Staat MA, Edwards K,  Hall CB, Gentsch JR, et al.  Secular variation in US rotavirus disease rates and serotypes – Implications for assessing the rotavirus vaccination program.  Pediatr Infect Dis J 2009;28:948–53.

Talbot HKB, Crowe JE, Edwards KM, Griffin MR, Zhu Y, Weinberg GA, Szilagyi PG,  Hall CB, Podsiad AB, Iwane MK, Williams JV. Coronavirus infection and hospitalizations for acute respiratory illness in young children. J Med Virol 2009;81:853–6.

Tate JE, Panozzo CA, Payne DC, Patel MM, Cortese MM, Fowlkes AL, Parashar UD.  Decline and change in seasonal patterns of rotavirus activity after the introduction of rotavirus vaccine in the United States. Pediatrics 2009;124:465-71.

Weinberg GA, Hall CB, Iwane MK, Poehling KA, Edwards KM, Griffin MR, Staat MA, Curns AT, Erdman DD, Szilagyi PG. Parainfluenza virus infection of young children: estimates of the population-based burden of hospitalization. J Pediatr 2009;154:694-9.

Eisenberg KW, B, Szilagyi PG, Fairbrother G, Griffin MG, Staat M, Shone LP, Weinberg GA, Hall CB, Poehling KA, Edwards KM, Lofthus G, Fisher SG, Bridges CB, Iwane MK Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003–2004 and 2004–2005 influenza seasons. Pediatrics 2008;122:911–9.

Miller EK, Griffin MR, Edwards KM, Weinberg GA, Szilagyi PG, Staat MA, Zhu Y, Hall CB, Fairbrother G, Seither R, Erdman D, Lu P, Poehling KA; New Vaccine Surveillance Network. Influenza burden for children with asthma. Pediatrics 2008;121:1-8.

Payne DC, Staat MA, Edwards KM, Szilagyi PG, Gentsch JR, Stockman LJ, Curns AT, Griffin M, Weinberg GA, Hall CB, Fairbrother G, Alexander J, Parashar UD.  Active, population-based surveillance for severe rotavirus gastroenteritis in children in the United States. Pediatrics 2008;122:1235-43.

Szilagyi PG, Fairbrother G, Griffin MR, Hornung RW, Donauer S, Morrow A, Altaye M, Zhu Y, Ambrose S, Edwards KM, Poehling KA, Lofthus G, Holloway M, Finelli L, Iwane M, Staat MA; New Vaccine Surveillance Network. Influenza vaccine effectiveness among children 6 to 59 months of age during 2 influenza seasons. Arch Pediatr Adolesc Med 2008;162:943-51.

Miller EK, Lu X, Erdman DD, Poehling KA, Zhu Y, Griffin MR, Hartert TV, Anderson LJ, Weinberg GA, Hall CB, Iwane MK, Edwards KM; New Vaccine Surveillance Network. Rhinovirus-associated hospitalizations in young children. J Infect Dis 2007;195:773-81.

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;12:103-9.

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;135:951-8.

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;6:355:31-40.

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;1394-402.

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-S92.

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;158:867-74.

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;10:700-5.

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;114:755-61.

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. J Infect Dis 2004;189:706-10.

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;41:4298-303.

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;22:413-8.

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. Arch Pediatr Adolesc Med 2003;157:191-5.

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;112:821-8.

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:e68.

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