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The epidemiological impact of childhood influenza vaccination using live-attenuated influenza vaccine (LAIV) in Germany: predictions of a simulation study

Markus A Rose1, Oliver Damm2, Wolfgang Greiner2, Markus Knuf34, Peter Wutzler5, Johannes G Liese6, Hagen Krüger7, Ulrich Wahn8, Tom Schaberg9, Markus Schwehm10, Thomas F Kochmann11 and Martin Eichner1213*

Author Affiliations

1 Department of Pulmonology, Allergy and Infectious Diseases, Children’s Hospital, Goethe University, Frankfurt, Germany

2 Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany

3 Department of Children and Adolescents, Dr. Horst Schmidt Klinik, Wiesbaden, Germany

4 Paediatric Infectious Diseases, University Medicine Mainz, Mainz, Germany

5 Institute of Virology and Antiviral Therapy, University Hospital, Friedrich Schiller University of Jena, Jena, Germany

6 Department of Paediatric Infectious Diseases, University Children’s Hospital Würzburg, Würzburg, Germany

7 Medical Department, AstraZeneca GmbH, Wedel, Germany

8 Department of Paediatric Pneumology and Immunology, Charité University Medicine, Berlin, Germany

9 Center of Pneumology, Deaconess Hospital Rotenburg, Rotenburg, Germany

10 ExploSYS GmbH, Leinfelden-Echterdingen, Germany

11 e. K, Wallenhorst, Germany

12 Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany

13 Epimos GmbH & Co. KG, Uhlandstraße 3, 72144 Dusslingen, Germany

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BMC Infectious Diseases 2014, 14:40  doi:10.1186/1471-2334-14-40

Published: 22 January 2014



Routine annual influenza vaccination is primarily recommended for all persons aged 60 and above and for people with underlying chronic conditions in Germany. Other countries have already adopted additional childhood influenza immunisation programmes. The objective of this study is to determine the potential epidemiological impact of implementing paediatric influenza vaccination using intranasally administered live-attenuated influenza vaccine (LAIV) in Germany.


A deterministic age-structured model is used to simulate the population-level impact of different vaccination strategies on the transmission dynamics of seasonal influenza in Germany. In our base-case analysis, we estimate the effects of adding a LAIV-based immunisation programme targeting children 2 to 17 years of age to the existing influenza vaccination policy. The data used in the model is based on published evidence complemented by expert opinion.


In our model, additional vaccination of children 2 to 17 years of age with LAIV leads to the prevention of 23.9 million influenza infections and nearly 16 million symptomatic influenza cases within 10 years. This reduction in burden of disease is not restricted to children. About one third of all adult cases can indirectly be prevented by LAIV immunisation of children.


Our results demonstrate that vaccinating children 2–17 years of age is likely associated with a significant reduction in the burden of paediatric influenza. Furthermore, annual routine childhood vaccination against seasonal influenza is expected to decrease the incidence of influenza among adults and older people due to indirect effects of herd protection. In summary, our model provides data supporting the introduction of a paediatric influenza immunisation programme in Germany.

Influenza; Vaccination; Live-attenuated influenza vaccine; Children; Transmission model; Germany