Vaccine-preventable Diseases

vaccines prevent diseases

Epidemiology of Vaccine-preventable Diseases

CPCE researchers are working to determine how environmental factors, social networks, and community systems affect the epidemiology of vaccine-preventable diseases. With this knowledge, we aim to inform prevention policies. This research is crucial at a time when some communities are faced with the re-emergence or ongoing transmission of vaccine-preventable diseases despite the overwhelming success of immunization programs.

After identifying both individual and community-level factors associated with the risk of vaccine-preventable diseases, especially respiratory pathogens, we plan to link these findings to health policy analysis results to help develop more robust prevention policies and pandemic preparedness.

We are investigating individual and neighborhood characteristics associated with risk of infection from influenza, pertussis and pneumococcus. Due to the high burden of these diseases in Philadelphia, where we are based, promoting vaccination within the communities we serve is an important priority for CPCE. 

Our researchers perform large-scale analyses using electronic medical record data linked to census and surveillance data, along with systems and multi-level modeling to estimate neighborhood effects. Our analytic techniques rely upon geographic information, and we also use model parameters to calculate risk profiles for our outcomes of interest.

Highlights of this line of research include:

  • An analysis of novel H1N1 pandemic and seasonal influenza cases among children who received care in the CHOP network from 2005 – 2012 found socioeconomic and racial disparities in disease risk. Read the abstract.
  • A study investigating neighborhood variation in rates of pneumococcal bacteraemia, suggests that area-level factors may explain disease risk. Read the abstract.
  • A study of factors associated with testing for pertussis infection among children in a large primary care network suggests significant clinical and sociodemographic differences, including potential racial disparities. Read the abstract.
  • An analysis of young children presenting to the CHOP primary care network during the 2012-13 and 2013-14 respiratory seasons showed that there was a higher incidence of an influenza-like illness (ILI) within 8 days of a preceding non-ILI visit. Read the abstract.

What’s Next

Researchers are actively working on the following studies regarding vaccine-preventable diseases -

  • Healthcare-associated Influenza-like Illness in Pediatric Outpatient Clinics: Researchers are measuring the risk of young children developing an acute respiratory infection after a well clinic visit and working to develop infection control interventions to prevent respiratory virus transmission in pediatric clinics.
  • Individual, Provider and Community Factors Associated with Influenza Testing and Antiviral Treatment Among Children: Researchers are studying whether there are sociodemographic disparities in influenza testing and treatment rates among children to determine whether there are any biases in case ascertainment and subsequent treatment. 
  • Pediatric Pandemic Influenza: Inpatient Surveillance: Researchers are developing methods to readily activate surveillance of children hospitalized with influenza during the next pandemic to identify risk factors for infection and measure vaccine and antiviral effectiveness.
  • The Effect of In Utero Exposure to HIV and Antiretroviral Therapy on the Microbiology and Outcomes of Severe Pneumonia: Researchers are studying whether in utero exposure to HIV without subsequent infection is associated with poorer outcomes among infants with severe pneumonia in Botswana.  

Funding: Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), the Commonwealth of Pennsylvania

Please contact Kristen A. Feemster, MD, MPH, MSHP, a CPCE core faculty member, research director for the Vaccine Education Center at CHOP, assistant professor of Pediatrics, the Perelman School of Medicine at the University of Pennsylvania, and an attending physician in the division of Infectious Diseases at CHOP, for more information about this line of research.

Epidemiology of Vaccine-preventable Diseases Research

Feemster KA, Li Y, Grundmeier R, Localio AR, Metlay JP. Validation of a Pediatric Primary Care Network in a US Metropolitan Region as a Community-Based Infectious Disease Surveillance System. Interdisciplinary Perspectives on Infectious Diseases. 2011 Dec 7; 2011(219859).  

Feemster KA, Leckerman K, Middleton M, Zerr DM, Elward A, Newland J, Asti L, Guth E, Selvarangan R, Coffin S. Use of administrative data for the identification of laboratory-confirmed influenza infection: the validity of influenza-specific ICD-9 codes. Journal of the Pediatric Infectious Diseases Society. 2012 Feb; 2(1):63-66.

Feemster KA, Li Y, Localio AR, Shults J, Edelstein P. Lautenback E, Smith TE, Metlay JP. Risk of invasive pneumococcal disease varies by neighbourhood characteristics: implications for prevention policies. Epidemiology and Infection, 2013 Aug;141(8):1679-89. PMID: 23114061

Lee GE, Fisher BT, Xiao R, Coffin SE, Feemster KA, Seif AE, Bagatell R, Li Y, Huang YV, Aplenc R. Burden of Influenza-Related Hospitalizations and Attributable Mortality in Pediatric Acute Lymphoblastic Leukemia. Journal of the Pediatric Infectious Diseases Society. 2014 July 22; 19(3).

Kelly MS, Wirth KE, Steenhoff AP, Cunningham CK, Arscott-Mills T, Boiditswe S, Patel MZ, Shah SS, Finalle R, Makone I, Feemster KA. Treatment failures and excess mortality among HIV-exposed, uninfected children with pneumonia. Journal of the Pediatric Infectious Diseases Society. 2014 Oct 8; 0(2014:092.

Kelly MS, Wirth KE, Madrigano J, Feemster KA, Cunningham CK, Arscott-Mills T, Boiditswe S, Shah SS, Finalle R, Steenhoff AP. The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana. Int J Tuberc Lung Dis. 2015 Mar;19(3):349-55.

Kelly MS, Smieja M, Luinstra K, Wirth KE, Goldfarb DM, Steenhoff AP, Arscott-Mills TA, Cunningham CK, Boiditswe S, Sethomo W, Shah SS, Finalle R, Feemster KA.. Association of Respiratory Viruses with Outcomes of Severe Childhood Pneumonia in Botswana. PLoS One. 2015 May 14;10(5).

Shaffer SM, Joshi RP, Chamber BS, Sterken D, Biaesch AG, Gabrieli DJ, Li Y, Feemster KA, Hensley SE, Issadore D, Raj A. Multiplexed detection of viral infections using rapid in situ RNA analysis on a chip. Lab Chip. 2015 Jun 26; (15): 3170-3182.


Feemster KA, Middleton M, Ramos M, Localio AR, Coffin SE.  Neighborhood factors associated with Pediatric 2009 Influenza A (H1N1) Infection (#1798). Infectious Disease Society of America Annual Meeting- Oral Abstract Session. San Diego, CA: October 2012.

Kelly MS, Steenhoff AP, Wirth KE, Monate P, Shah SS, Goldfarb D, Cunningham C, Smieja M, Finalle R, Makone I, Chua P, Feemster KA.  Treatment failures among HIV-exposed, uninfected children with severe pneumonia in Gaborone, Botswana. Pediatric Academic Societies Annual Meeting. Global Pediatric Research Platform Presentation. Washington, D.C. May 2013.

Feemster K, Localio AR, Middleton M, Chilutti M, Metlay JPM, Coffin SE.  Measuring risk of healthcare-associated influenza-like illness (HA-ILI) in pediatric ambulatory practices using a self-controlled case series. Infectious Diseases Society of America Annual Meeting- Oral Abstract Session. San Francisco, CA: October 2013.

Tribble A, Coffin SE, Campos D, Feemster KA.  Epidemic Pertussis in Children: Defining the Changing Epidemiology and Risk Factors. Pediatric Academic Societies Annual Meeting- Poster Session. Vancouver, Canada: May 2014.

Feemster KA, Vendetti N, Middleton M, Ramos M, Coffin SE. Socioeconomic and racial disparities associated with pandemic and seasonal influenza. Infectious Diseases Society of America Annual Meeting.  Philadelphia, PA: October 2014.

Kelly MS, Smieja M, Wirth KE, Luinstra K, Goldfarb D, Steenhoff A, Cunningham C, Arscott-Mills T, Shah S, Finalle R, Feemster KA.  Respiratory viruses among children with acute lower respiratory infection in Botswana.  Pediatric Academic Societies Annual Meeting. San Diego, CA: April 2015.