Children with neurological and neuromuscular diseases at risk
for flu-related respiratory failure
November 02, 2005
Laptop Battery Children with neurological and neuromuscular diseases should
receive an annual influenza vaccination because of a higher risk of
respiratory failure if they are hospitalized with influenza,
according to a study in the November 2 issue of JAMA.
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Thinkpad Influenza is a common disease of childhood and is responsible
for significant illness, according to background information in the
article. Healthy young children are hospitalized for
influenza-related illness at rates similar to those for elderly
persons and adults with chronic medical conditions. Perhaps most
concerning to parents and physicians is the potential for serious
influenza-associated complications, including carditis
(inflammation of the heart), encephalitis, myositis (inflammation
of muscle tissue), pneumonia, respiratory failure, and death.
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Microsoft Population-based studies suggest that individuals with certain
chronic medical conditions are at increased risk of serious
complications of influenza infection. The Advisory Committee on
Immunization Practices (ACIP) has identified 9 groups of chronic
medical conditions for which annual influenza vaccination is
recommended. They include asthma, chronic lung disease, cardiac
disease, immunosuppression, hemoglobinopathies (a blood disease
characterized by the presence of abnormal hemoglobins in the
blood), chronic renal dysfunction, metabolic and endocrine
conditions, long-term salicylate (aspirin and some other drugs)
therapy, and pregnancy. Despite the frequency of influenza
infection and the prevalence of these chronic medical conditions,
little is known about their relative contribution to the
development of serious influenza-associated complications.
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Laptop Computers Ron Keren, M.D., M.P.H., of The Children's Hospital of
Philadelphia, and colleagues conducted a study to identify chronic
medical conditions that were associated with respiratory failure in
children hospitalized with influenza. In addition to the current
ACIP-designated high-risk conditions, the researchers also examined
three other categories of chronic medical conditions-neurological
and neuromuscular disease (NNMD, such as muscular dystrophy),
gastroesophageal reflux disease (GERD), and history of prematurity,
that in recent studies have been associated with influenza
hospitalization and severe influenza-related complications. The
study included patients aged 21 years or younger hospitalized at
The Children's Hospital of Philadelphia, with community-acquired
laboratory-confirmed influenza during 4 consecutive influenza
seasons (June 2000 through May 2004).
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Laptop Computer Of 745 children hospitalized with influenza, 322 (43 percent)
had one or more ACIP-designated high-risk chronic medical
conditions. NNMD, GERD, and history of prematurity were present in
12 percent, 14 percent, and 3 percent, of children, respectively.
Thirty-two children (4.3 percent) developed respiratory failure. In
further analyses, conditions associated with respiratory failure
included NNMD (6 times increased risk), chronic pulmonary disease
other than asthma (4.8 times increased risk), and cardiac disease
(4 times increased risk). The predicted probabilities of
respiratory failure derived from the multivariate model were 12
percent, 9 percent, and 8 percent for children with NNMD, chronic
pulmonary disease, and cardiac disease, respectively. Children
hospitalized with influenza who had 2 of these 3 chronic conditions
had a 31 percent to 39 percent predicted probability of respiratory
failure.
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Desktop Computer "The significantly increased probability of respiratory failure
in children with NNMD hospitalized with influenza supports the
ACIP's recent decision to add NNMD that may compromise respiratory
function to the list of chronic conditions that warrant annual
influenza vaccination. Coordinated efforts are needed to educate
parents, primary care pediatricians, and pediatric neurologists
about the risks of serious influenza complications and the need for
annual vaccination for children with NNMD. Future studies should
determine the risk of hospitalization among children with NNMD, the
number of additional children with NNMD who will require annual
vaccination, as well as the effectiveness and cost-effectiveness of
the influenza vaccine in preventing hospitalizations and serious
complications in these children," the authors conclude.
Notebooks JAMA and Archives Journals
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