Influenza and the Rates of Hospitalization for Respiratory Disease among Infants and Young Children

doi:10.1056/NEJM200001273420402

Volume 342:232-239		January 27, 2000		Number 4

Influenza and the Rates of Hospitalization for Respiratory Disease among Infants and Young Children

Héctor S. Izurieta, M.D., M.P.H., William W. Thompson, Ph.D., Piotr Kramarz, M.D., David K. Shay, M.D., M.P.H., Robert L. Davis, M.D., M.P.H., Frank DeStefano, M.D., M.P.H., Steven Black, M.D., Henry Shinefield, M.D., and Keiji Fukuda, M.D., M.P.H.

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by McIntosh, K.

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ABSTRACT

Background Young children may be at increased risk for seriouscomplications from influenzavirus infection. However, in population-basedstudies it has been difficult to separate the effects of influenzavirusfrom those of respiratory syncytial virus. Respiratory syncytialvirus often circulates with influenzaviruses and is the mostfrequent cause of hospitalization for lower respiratory tractinfections in infants and young children. We studied the ratesof hospitalization for acute respiratory disease among infantsand children during periods when the circulation of influenzavirusespredominated over the circulation of respiratory syncytial virus.

Methods For each season from October to May during the periodfrom 1992 to 1997, we used local viral surveillance data todefine periods in Washington State and northern California whenthe circulation of influenzaviruses predominated over that ofrespiratory syncytial virus. We calculated the rates of hospitalizationfor acute respiratory disease, excess rates attributable toinfluenzavirus, and incidence-rate ratios for all infants andchildren younger than 18 years of age who were enrolled in eitherthe Kaiser Permanente Medical Care Program of Northern Californiaor the Group Health Cooperative of Puget Sound.

Results The rates of hospitalization for acute respiratory diseaseamong children who did not have conditions that put them athigh risk for complications of influenza (e.g., asthma, cardiovasculardiseases, or premature birth) and who were younger than twoyears of age were 231 per 100,000 person-months at NorthernCalifornia Kaiser sites (from 1993 to 1997) and 193 per 100,000person-months at Group Health Cooperative sites (from 1992 to1997). These rates were approximately 12 times as high as therates among children without high-risk conditions who were 5to 17 years of age (19 per 100,000 person-months at NorthernCalifornia Kaiser sites and 16 per 100,000 person-months atGroup Health Cooperative sites) and approached the rates amongchildren with chronic health conditions who were 5 to 17 yearsof age (386 per 100,000 person-months and 216 per 100,000 person-months,respectively).

Conclusions Infants and young children without chronic or seriousmedical conditions are at increased risk for hospitalizationduring influenza seasons. Routine influenza vaccination shouldbe considered in these children.

Source Information

From the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (H.S.I., W.W.T., D.K.S., K.F.), and the Epidemiology and Surveillance Division, National Immunization Program (P.K., F.D.), Centers for Disease Control and Prevention, Atlanta; Group Health Cooperative, Seattle (R.L.D.); and Northern California Kaiser Permanente, Oakland, Calif. (S.B., H.S.).

Address reprint requests to Dr. Thompson at the Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Mailstop A-32, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, or at wct2{at}cdc.gov.

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