Elsevier

The Journal of Pediatrics

Volume 137, Issue 6, December 2000, Pages 856-864
The Journal of Pediatrics

Original Articles
The burden of influenza illness in children with asthma and other chronic medical conditions☆,☆☆

https://doi.org/10.1067/mpd.2000.110445Get rights and content

Abstract

Objective: Although influenza immunization is recommended for children with high-risk medical conditions, the majority of such children do not receive influenza vaccine. This study was designed to measure the burden of influenza among children with asthma and other chronic medical conditions. Study design: We performed a retrospective cohort study of children younger than 15 years with medically treated asthma or other chronic medical conditions enrolled in the Tennessee Medicaid program from 1973 to 1993. We determined rates of hospitalization for acute cardiopulmonary disease, outpatient visits, and antibiotic courses throughout the year. Annual differences between event rates when influenza virus was circulating and event rates during winter months when there was no influenza in the community were used to calculate influenza-attributable morbidity. Results: Influenza accounted for an average of 19, 8, and 2 excess hospitalizations for cardiopulmonary disease yearly per 1000 high-risk children aged <1 year, 1 to <3 years, and 3 to <15 years, respectively. For every 1000 children, an estimated 120 to 200 outpatient visits and 65 to 140 antibiotic courses were attributable to influenza annually. Conclusions: Children younger than 15 years with asthma and other chronic medical conditions experience substantial morbidity requiring inpatient and outpatient care during influenza season. More effective targeting of this population for annual influenza immunization is warranted. (J Pediatr 2000;137:856-64)

Section snippets

METHODS

We performed a retrospective cohort study of children aged <15 years with chronic pulmonary or other medical conditions to determine rates of hospitalizations for acute cardiopulmonary disease, outpatient visits, and antibiotic courses during 19 consecutive years. Annual differences between event rates when influenza virus was circulating and event rates during winter months when there was no influenza in the community were used to calculate influenza-attributable morbidity.

RESULTS

Children with a high-risk medical condition accounted for 8.7% of all children younger than 15 years enrolled in the Tennessee Medicaid program and contributed 194,725 person-years during the study (Table I).

. Distribution of number of person-years (%) of children enrolled in the Tennessee Medicaid Program, 1974-1993 by demographic characteristics and medical conditions

CharacteristicAsthmaOther respiratory conditionOther high-risk medical conditionNo high-risk condition
Age
 <1 yNA35,604 (14.4)

DISCUSSION

Children aged <15 years with a variety of chronic medical diseases enrolled in the Tennessee Medicaid program had high rates of hospitalization and outpatient morbidity when influenza virus was circulating in the community. Influenza-associated hospitalization rates in these high-risk children were highest in the youngest children, at 19 per 1000 children aged <1 year, and decreased to 8 per 1000 children in those aged 1 to <3 years and 2 per 1000 children in those aged 3 to <15 years. These

Acknowledgements

We thank Drs Kathryn Edwards and Kathy Poehling for their thoughtful review of the manuscript.

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    ☆

    Supported in part by Centers for Disease Control and Prevention Cooperative Agreement No. U50/CCU41398-01 to the Tennessee State Department of Health for Epidemiology and Laboratory Capacity.

    ☆☆

    Reprint requests: Kathleen M. Neuzil, MD, MPH, Department of Veterans Affairs, Puget Sound Health Care System, Medical Service 111, 1660 S Columbian Way, Seattle, WA 98108.

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