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Influenza virus infection can predispose patients to secondary pneumococcal infections. Children are at greatest risk for pneumococcal infection in the first year of life, and are not considered fully protected by PCV until their third dose at 6 months of age. Infants less than 6 months cannot receive influenza vaccination, though maternal influenza vaccination can protect infants.

METHODS:: We conducted a retrospective cohort study of 9,807 mother-infant pairs enrolled in a managed care organization for infants born June 1, 2002-Dec. 31, 2009. Exposure was assessed for receipt of infant pneumococcal vaccine (PCV) only, and the combination of PCV and maternal influenza vaccine (TIV). Outcomes of interest were acute otitis media (AOM) and medically attended acute respiratory infection (MAARI) in the first year of life. We estimated the adjusted incidence of illness, incidence rate ratios, and vaccine effectiveness using the ratio of incidence rate ratios between the periods of non-circulating influenza and that of at least local influenza circulation.

RESULTS:: For MAARI, vaccine effectiveness for the combination of TIV and PCV was 39.6% (95% CI: 31.6% , 46.7%) and for PCV only was 29.8% (95% CI: 11.4% , 44.3%). For AOM vaccine effectiveness for the combination of TIV and PCV was 47.9% (95% CI: 42% , 53.3%) and for PCV only was 37.6% (95% CI: 23.1% , 49.4%).

CONCLUSION:: In infants, the combination of maternal influenza vaccine and infant pneumococcal conjugate vaccination confers greater protection from acute otitis media infections and medically attended acute respiratory infections than does pneumococcal conjugate vaccine alone.