Izurieta H S, Thompson W W, Kramarz P, Shay D K, Davis R L, DeStefano F, Black S, Shinefield H, Fukuda K
Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
N Engl J Med. 2000 Jan 27;342(4):232-9. doi: 10.1056/NEJM200001273420402.
Young children may be at increased risk for serious complications from influenzavirus infection. However, in population-based studies it has been difficult to separate the effects of influenzavirus from those of respiratory syncytial virus. Respiratory syncytial virus often circulates with influenzaviruses and is the most frequent cause of hospitalization for lower respiratory tract infections in infants and young children. We studied the rates of hospitalization for acute respiratory-disease among infants and children during periods when the circulation of influenzaviruses predominated over the circulation of respiratory syncytial virus.
For each season from October to May during the period from 1992 to 1997, we used local viral surveillance data to define periods in Washington State and northern California when the circulation of influenzaviruses predominated over that of respiratory syncytial virus. We calculated the rates of hospitalization for acute respiratory disease, excess rates attributable to influenzavirus, and incidence-rate ratios for all infants and children younger than 18 years of age who were enrolled in either the Kaiser Permanente Medical Care Program of Northern California or the Group Health Cooperative of Puget Sound.
The rates of hospitalization for acute respiratory disease among children who did not have conditions that put them at high risk for complications of influenza (e.g., asthma, cardiovascular diseases, or premature birth) and who were younger than two years of age were 231 per 100,000 person-months at Northern California Kaiser sites (from 1993 to 1997) and 193 per 100,000 person-months at Group Health Cooperative sites (from 1992 to 1997). These rates were approximately 12 times as high as the rates among children without high-risk conditions who were 5 to 17 years of age (19 per 100,000 person-months at Northern California Kaiser sites and 16 per 100,000 person-months at Group Health Cooperative sites) and approached the rates among children with chronic health conditions who were 5 to 17 years of age (386 per 100,000 person-months and 216 per 100,000 person-months, respectively).
Infants and young children without chronic or serious medical conditions are at increased risk for hospitalization during influenza seasons. Routine influenza vaccination should be considered in these children.
幼儿感染流感病毒后发生严重并发症的风险可能更高。然而，在基于人群的研究中，很难区分流感病毒与呼吸道合胞病毒的影响。呼吸道合胞病毒常与流感病毒同时传播，是婴幼儿下呼吸道感染住院的最常见原因。我们研究了在流感病毒传播超过呼吸道合胞病毒传播的时期，婴幼儿急性呼吸道疾病的住院率。
在1992年至1997年期间，对于每年10月至次年5月的每个季节，我们利用当地病毒监测数据确定华盛顿州和北加利福尼亚州流感病毒传播超过呼吸道合胞病毒传播的时期。我们计算了北加利福尼亚州凯撒永久医疗保健计划或普吉特海湾健康合作组织登记的所有18岁以下婴幼儿急性呼吸道疾病的住院率、流感病毒所致超额住院率和发病率比。
在北加利福尼亚州凯撒医疗机构（1993年至1997年），没有使他们面临流感并发症高风险状况（如哮喘、心血管疾病或早产）且年龄小于两岁的儿童，急性呼吸道疾病住院率为每100,000人月231例；在健康合作组织医疗机构（1992年至1997年）为每100,000人月193例。这些比率约为5至17岁无高风险状况儿童（北加利福尼亚州凯撒医疗机构每100,000人月19例，健康合作组织医疗机构每100,000人月16例）的12倍，接近5至17岁患有慢性健康状况儿童的比率（分别为每100,000人月386例和216例）。
在流感季节，没有慢性或严重疾病的婴幼儿住院风险增加。应考虑对这些儿童进行常规流感疫苗接种。
