Keren Ron, Zaoutis Theoklis E, Bridges Carolyn B, Herrera Guillermo, Watson Barbara M, Wheeler Anna B, Licht Daniel J, Luan Xian Qun, Coffin Susan E
Division of General Pediatrics, Pediatric Generalist Research Group, Department of Medicine, The Children's Hospital of Philadelphia, PA 19104, USA.
JAMA. 2005 Nov 2;294(17):2188-94. doi: 10.1001/jama.294.17.2188.
The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for children with certain chronic medical conditions to prevent serious complications of influenza infection. Little is known about the relative contribution of each of these chronic medical conditions to the development of serious influenza-associated complications.
To identify chronic medical conditions that are associated with respiratory failure in children hospitalized with community-acquired laboratory-confirmed influenza.
DESIGN, SETTING, AND PATIENTS: A retrospective cohort study of 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). We examined 9 ACIP-designated high-risk chronic medical conditions and 3 additional chronic medical conditions (neurological and neuromuscular disease [NNMD], gastroesophageal reflux disease [GERD], and history of prematurity) that in recent studies have been associated with influenza hospitalization and severe influenza-related complications.
Rate and odds ratio (OR) of respiratory failure, defined as need for mechanical ventilation.
Of 745 children hospitalized with community-acquired laboratory-confirmed influenza, 322 (43%) had 1 or more ACIP-designated high-risk chronic medical conditions. Neurological and neuromuscular disease, GERD, and history of prematurity were present in 12%, 14%, and 3%, of children, respectively. Thirty-two children (4.3%) developed respiratory failure. In multivariate logistic regression analyses, conditions associated with respiratory failure included NNMD (OR, 6.0; 95% confidence interval [CI], 2.7-13.5), chronic pulmonary disease other than asthma (OR, 4.8; 95% CI, 1.5-15.1), and cardiac disease (OR, 4.0; 95% CI, 1.6-10.2). The predicted probabilities of respiratory failure derived from the multivariate model were 12% (95% CI, 7%-20%), 9% (95% CI, 3%-23%), and 8% (95% CI, 4%-18%) for children with NNMD, chronic pulmonary disease, and cardiac disease, respectively.
These results support the ACIP's recent decision to add NNMD to the list of conditions for which annual influenza vaccine is recommended in children. Neurologists and primary care pediatricians should be alerted to the increased risk of respiratory failure and the importance of influenza vaccination in children with NNMD.
免疫实践咨询委员会（ACIP）建议患有某些慢性疾病的儿童每年接种流感疫苗，以预防流感感染的严重并发症。对于这些慢性疾病中的每一种对严重流感相关并发症发展的相对贡献，人们了解甚少。
确定与社区获得性实验室确诊流感住院儿童呼吸衰竭相关的慢性疾病。
设计、地点和患者：对费城儿童医院在连续4个流感季节（2000年6月至2004年5月）因社区获得性实验室确诊流感住院的21岁及以下患者进行回顾性队列研究。我们检查了ACIP指定的9种高危慢性疾病以及另外3种慢性疾病（神经和神经肌肉疾病[NNMD]、胃食管反流病[GERD]和早产史），这些疾病在最近的研究中与流感住院和严重流感相关并发症有关。
呼吸衰竭的发生率和比值比（OR），定义为需要机械通气。
在745例因社区获得性实验室确诊流感住院的儿童中，322例（43%）患有1种或更多ACIP指定的高危慢性疾病。神经和神经肌肉疾病、GERD和早产史分别存在于1支、14%和3%的儿童中。32名儿童（4.3%）发生呼吸衰竭。在多因素逻辑回归分析中，与呼吸衰竭相关的疾病包括NNMD（OR，6.0；95%置信区间[CI]，2.7 - 13.5）、哮喘以外的慢性肺病（OR，4.8；95% CI，1.5 - 15.1）和心脏病（OR，4.0；95% CI，1.6 - 10.2）。多因素模型得出的呼吸衰竭预测概率分别为：NNMD儿童12%（95% CI，7% - 20%）、慢性肺病儿童9%（95% CI，3% - 23%）和心脏病儿童8%（95% CI，4% - 18%）。
这些结果支持ACIP最近将NNMD添加到建议儿童每年接种流感疫苗的疾病列表中的决定。神经科医生和初级保健儿科医生应警惕NNMD儿童呼吸衰竭风险增加以及流感疫苗接种的重要性。
