Background Despite high annual rates of influenza in children,influenza vaccines are given to children infrequently. We measuredthe disease burden of influenza in a large cohort of healthychildren in the Tennessee Medicaid program who were youngerthan 15 years of age.
Methods We determined the rates of hospitalization for acutecardiopulmonary conditions, outpatient visits, and courses ofantibiotics over a period of 19 consecutive years. Using thedifferences in the rates of these events when influenzaviruswas circulating and the rates from November through April whenthere was no influenza in the community, we calculated morbidityattributable to influenza. There was a total of 2,035,143 person-yearsof observation.
Results During periods when influenzavirus was circulating,the average number of hospitalizations for cardiopulmonary conditionsin excess of the expected number was 104 per 10,000 childrenper year for children younger than 6 months of age, 50 per 10,000per year for those 6 months to less than 12 months, 19 per 10,000per year for those 1 year to less than 3 years, 9 per 10,000per year for those 3 years to less than 5 years, and 4 per 10,000per year for those 5 years to less than 15 years. For every100 children, an annual average of 6 to 15 outpatient visitsand 3 to 9 courses of antibiotics were attributable to influenza.In winter, 10 to 30 percent of the excess number of coursesof antibiotics occurred during periods when influenzavirus wascirculating.
Conclusions Healthy children younger than one year of age arehospitalized for illness attributable to influenza at ratessimilar to those for adults at high risk for influenza. Therate of hospitalization decreases markedly with age. Influenzaaccounts for a substantial number of outpatient visits and coursesof antibiotics in children of all ages. (N Engl J Med 2000;342:225-31.)
Source Information
From the Department of Medicine, University of Washington School of Medicine, and the Department of Veterans Affairs, Puget Sound Health Care System — both in Seattle (K.M.N.); and the Departments of Preventive Medicine (B.G.M., E.F.M., M.R.G.), Pediatrics (P.F.W.), and Medicine (M.R.G.), Vanderbilt University School of Medicine, Nashville.
Address reprint requests to Dr. Neuzil at the Department of Veterans Affairs, Puget Sound Health Care System, Division of Infectious Diseases 111, 1660 S. Columbian Way, Seattle, WA 98108-1595, or at kneuzil{at}u.washington.edu.
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