O'Brien Megan A, Uyeki Timothy M, Shay David K, Thompson William W, Kleinman Ken, McAdam Alexander, Yu Xian-Jie, Platt Richard, Lieu Tracy A
Center for Child Health Care Studies, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA.
Pediatrics. 2004 Mar;113(3 Pt 1):585-93. doi: 10.1542/peds.113.3.585.
The Advisory Committee on Immunization Practices currently encourages influenza vaccination for all children aged 6 to 23 months when feasible, based on studies that have demonstrated that young children have high hospitalization rates attributable to influenza. The Advisory Committee on Immunization Practices recently voted to recommend influenza vaccination for all children beginning during the 2004-2005 influenza season; information on the rate of outpatient visits due to influenza is needed to better evaluate the potential health impact and cost-effectiveness of the recommendation. We estimated the incidence of outpatient visits as well as hospitalizations for specific acute respiratory illnesses and for influenza-associated outpatient-visit and hospitalization rates among healthy infants and children in a Massachusetts health maintenance organization.
DESIGN/METHODS: Surveillance data were used to identify when influenza viruses, respiratory syncytial viruses, and parainfluenza viruses were circulating in the greater Boston area during 1994-2000. Using computerized medical records, we identified outpatient visits and hospitalizations for selected respiratory illnesses. Outpatient-visit rates and hospitalizations attributed to influenza were calculated by subtracting the rate of visits during the periseasonal period from the rate of visits during the influenza period. Rates were stratified by age and risk for complications from influenza.
Between 1994 and 2000, there were 188 139 outpatient visits and 885 hospitalizations for respiratory illnesses in the study population. Among healthy children aged 6 to 23 months, the rate per 100 person-months for outpatient visits during influenza periods was 14.5 (95% confidence interval [CI]: 13.9 to 15.1), and the excess rate that could be attributed to influenza compared with the periseasonal period was 1.8 (95% CI: 1.1 to 2.4). Among healthy children, the rate of hospitalizations for acute respiratory disease was 10.4 per 10 000 person-months (95% CI: 6.0 to 17.0), and the rate that could be attributed to influenza when compared with the periseasonal baseline period was 3.9 (95% CI: -2.0 to 0.0). Among children who were at high risk for complications from influenza, the rate of outpatient visits per 100 person-months was 28.7 (95% CI: 26.6 to 30.9) during influenza periods. The rate of hospitalizations among high-risk children was 44.6 per 10 000 person-months (95% CI: 19.0 to 17.0).
Influenza season is associated with a substantial increase in outpatient visits by healthy children. These estimates of outpatient visits for influenza will help quantify the potential health benefits and cost savings from influenza vaccination of healthy children aged 6 to 23 months.
免疫实践咨询委员会目前鼓励在可行的情况下，对所有6至23个月大的儿童进行流感疫苗接种，这是基于一些研究表明幼儿因流感导致的住院率很高。免疫实践咨询委员会最近投票建议从2004 - 2005流感季节开始，对所有儿童进行流感疫苗接种；需要有关因流感导致的门诊就诊率的信息，以便更好地评估该建议对健康的潜在影响和成本效益。我们估计了马萨诸塞州一个健康维护组织中健康婴儿和儿童因特定急性呼吸道疾病的门诊就诊率以及住院率，以及与流感相关的门诊就诊和住院率。
设计/方法：利用监测数据确定1994 - 2000年期间大波士顿地区流感病毒、呼吸道合胞病毒和副流感病毒的流行时间。通过计算机化医疗记录，我们确定了选定呼吸道疾病的门诊就诊和住院情况。流感导致的门诊就诊率和住院率通过用流感期间的就诊率减去季节前期间的就诊率来计算。发病率按年龄和流感并发症风险分层。
1994年至2000年期间，研究人群中有188139次呼吸道疾病门诊就诊和885次住院。在6至23个月大的健康儿童中，流感期间每100人月的门诊就诊率为14.5（95%置信区间[CI]：13.9至15.1），与季节前期间相比可归因于流感的超额率为1.8（95%CI：1.1至2.4）。在健康儿童中，急性呼吸道疾病的住院率为每10000人月10.4（95%CI：6.0至17.0），与季节前基线期相比可归因于流感的住院率为3.9（95%CI： - 2.0至0.0）。在有流感并发症高风险的儿童中，流感期间每100人月的门诊就诊率为28.7（95%CI：26.6至30.9）。高风险儿童的住院率为每10000人月44.6（95%CI：19.0至17.0）。
流感季节与健康儿童门诊就诊大幅增加有关。这些对流感门诊就诊的估计将有助于量化对6至23个月大健康儿童进行流感疫苗接种的潜在健康益处和成本节约。
