Johns Hopkins University School of Medicine, 600 N Wolfe St, CMSC 2-121, Baltimore, MD 21287, USA.
Pediatrics. 2010 Feb;125(2):234-43. doi: 10.1542/peds.2009-1465. Epub 2010 Jan 25.
Children with sickle cell disease (SCD) are considered to be at high risk for complications from influenza infection despite minimal published data that characterize the burden of influenza in this population. Our objectives were to (1) estimate the rate of influenza-related hospitalizations (IRHs) among children with SCD, (2) compare this rate with rates of children with cystic fibrosis (CF) and children with neither SCD nor CF, and (3) explore mechanisms that underlie these potentially preventable hospitalizations.
We analyzed hospitalizations from 4 states (California, Florida, Maryland, and New York) across 2 influenza seasons (2003-2004 and 2004-2005) from the Healthcare Cost and Utilization Project State Inpatient Databases. We included hospitalizations with a discharge diagnosis code for influenza in a child <18 years of age. We used census data and disease prevalence estimates to calculate denominators and compare rates of IRH among children with SCD, CF, and neither disease.
There were 7896 pediatric IRHs during the 2 influenza seasons. Of these, 159 (2.0%) included a co-occurring diagnosis of SCD. Annual rates of IRHs were 112 and 2.0 per 10 000 children with and without SCD, respectively, across both seasons. Children with SCD were hospitalized with influenza at 56 times (95% confidence interval: 48-65) the rate of children without SCD. Children with SCD had approximately double the risk of IRH compared with children with CF (risk ratio: 2.1 [95% confidence interval: 1.5-2.9]). IRHs among children with SCD were not longer, more costly, or more severe than IRHs among children without SCD; they were also rarely nosocomial and co-occurred with a diagnosis of asthma in 14% of cases.
IRHs are substantially more common among children with SCD than among those without the disease, which supports the potential importance of vigorous influenza vaccination efforts that target children with SCD.
尽管有关儿童镰状细胞病（SCD）患者流感感染并发症的发表数据很少，但此类患者被认为存在流感感染的高危风险。我们的目的是：（1）评估镰状细胞病儿童流感相关住院率（IRH），（2）将这一比率与囊性纤维化（CF）儿童和既无 SCD 也无 CF 的儿童进行比较，（3）探讨导致这些潜在可预防住院的机制。
我们分析了来自加利福尼亚州、佛罗里达州、马里兰州和纽约州的四家医院在两个流感季节（2003-2004 年和 2004-2005 年）的住院情况，这些医院均来自医疗保健成本和利用项目州住院病人数据库。我们纳入了在 18 岁以下儿童中因流感而接受治疗的住院诊断编码。我们使用人口普查数据和疾病流行率估算值计算了分母，并比较了 SCD、CF 和无两种疾病的儿童的 IRH 率。
在两个流感季节期间，有 7896 例儿科 IRH。其中，159 例（2.0%）存在镰状细胞病的合并诊断。在两个季节中，每年 SCD 儿童的 IRH 率分别为 112 和 2.0/10000。SCD 儿童因流感住院的比率是无 SCD 儿童的 56 倍（95%置信区间：48-65）。SCD 儿童的 IRH 风险比 CF 儿童高 2.1 倍（95%置信区间：1.5-2.9）。与无 SCD 的儿童相比，SCD 儿童的 IRH 住院时间没有延长、费用没有增加或严重程度没有增加；IRH 也很少发生院内感染，14%的病例合并哮喘诊断。
SCD 儿童的 IRH 发生率明显高于无 SCD 儿童，这支持了针对 SCD 儿童大力开展流感疫苗接种的重要性。
