From the *Division of Infectious Diseases, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta; †Division of Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Québec; ‡Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia; §Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; and ¶Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.
Pediatr Infect Dis J. 2014 Jul;33(7):710-4. doi: 10.1097/INF.0000000000000272.
Studies have identified certain neurologic and neurodevelopmental conditions (NNC) as risk factors for severe influenza infection. The Canadian National Advisory Committee on Immunization does not currently recognize children with NNC as having a high risk of complicated influenza infection unless their condition compromises handling of respiratory secretions. We describe the burden of influenza in hospitalized children with NNC, focusing on those without potential airway compromise.
Using multi-year surveillance data obtained by the Canadian Immunization Monitoring Program, Active (IMPACT), we examined presenting signs and symptoms, risk factors and outcomes of children hospitalized with seasonal influenza at 12 Canadian pediatric referral centers. Comparisons were made between children with various NNC and other medical conditions, with and without influenza vaccine indications. The analysis is descriptive with selected comparisons made among groups for important indicators of disease severity.
We identified 1991 children hospitalized with influenza over 5 seasons: 293 had NNC, 115 of whom did not have airway compromise or another vaccine indication. The latter group presented with seizures more frequently than those with NNC and a vaccine indication (41.7% vs. 26.4%; P = 0.006) and required intensive care unit admission (20.9% vs. 11.8%; P = 0.02) and mechanical ventilation (14.8% vs. 4.5%; P < 0.001) more often than children without NNC but with a vaccine indication.
The burden of influenza infection in children with NNC, even those whose conditions do not obviously compromise respiratory function, is significant. All children with NNC should be recognized as having a high risk of complicated influenza infection and be targeted to receive influenza immunization.
研究已经确定了某些神经和神经发育状况（NNC）是严重流感感染的危险因素。加拿大国家免疫咨询委员会目前并不认为患有 NNC 的儿童有发生复杂流感感染的高风险，除非他们的病情影响呼吸道分泌物的处理。我们描述了患有 NNC 的住院儿童的流感负担，重点关注那些没有潜在气道损伤的儿童。
我们使用加拿大免疫监测计划（IMPACT）多年的监测数据，研究了在加拿大 12 个儿科转诊中心因季节性流感住院的儿童的临床表现、危险因素和结局。我们比较了患有各种 NNC 和其他医疗条件的儿童，以及有和没有流感疫苗接种指征的儿童。该分析是描述性的，对各组中疾病严重程度的重要指标进行了选择比较。
我们在 5 个季节中发现了 1991 名因流感住院的儿童：293 名患有 NNC，其中 115 名没有气道损伤或其他疫苗接种指征。后一组的癫痫发作发生率高于有 NNC 和疫苗接种指征的儿童（41.7%比 26.4%；P=0.006），需要入住重症监护病房（20.9%比 11.8%；P=0.02）和机械通气（14.8%比 4.5%；P<0.001）的比例也高于没有 NNC 但有疫苗接种指征的儿童。
即使是那些病情没有明显影响呼吸功能的患有 NNC 的儿童，流感感染的负担也是显著的。所有患有 NNC 的儿童都应被认为有发生复杂流感感染的高风险，应将其作为目标人群接种流感疫苗。
