Flu Poses Extra Risk for Asthmatic Kids

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Children with asthma who need inpatient care for influenza face a substantial risk of serious complications, researchers reported.

The risk of some of those complications, including pneumonia and the need for intensive care, was even higher during the 2009 H1N1 pandemic, according to Fatimah Dawood, MD, of the Centers for Disease Control and Prevention in Atlanta, and colleagues.

However, the risk of death and respiratory failure was no different from that seen during the previous six seasonal flu seasons, Dawood and colleagues reported online in Pediatrics.

The increased risks highlight the importance of flu vaccination for children with asthma, Dawood and colleagues concluded.

The findings come from data collected by the CDC's Emerging Infections Program during the flu seasons from 2003 through April 14, 2009, and the pandemic from April 15 through Dec. 31, 2009.

All told, during the first six seasons, 2,165 children, ages 2 to 17, needed inpatient care and had laboratory-confirmed flu, the researchers reported.

Of those, 701 (32%) had asthma.

In the 2009 pandemic, 1,660 children needed inpatient care and 733 (44%) had asthma, they reported. The proportions were significantly different at P<0.01.

This finding did not reflect other complicating medical conditions; 73% of these patients only had asthma, according to the investigators.

Regardless of season, Dawood and colleagues reported, the median age of children with asthma and flu who needed inpatient care ranged from 5-years-old to 7-years-old, although in the 2009 pandemic year, 76% were older than 5-years-old compared with 64% in the previous seasons. The difference was significant at P<0.01.

Among asthmatic children with seasonal flu, 16% needed intensive care, compared with 22% of those ill during the pandemic, a difference that was significant at P<0.01.

As well, 40% of asthmatic children with seasonal flu were diagnosed with pneumonia, compared with 44% during the pandemic year, a difference again significant at P<0.01.

On the other hand, equal proportions had respiratory failure (5%) or died (1%), the researchers found.

Influenza A appeared to lead to more asthma exacerbations that influenza B at 51% versus 29% respectively, a difference that was significant at P<0.01, they reported.

The proportion of children with at least one flu shot was low, Dawood and colleagues reported: Among those whose vaccination status was known, the proportion ranged from 36% to 52% during the six seasons.

But for many children between the ages of 2 and 8, and for whom two shots were needed in their first vaccination, their status could not be determined, the researchers found.

Dawood and colleagues cautioned that they had no data on asthma treatments on underlying asthma severity, which may predict complications. As well, they noted, case ascertainment may have been different during the pandemic year because of increased interest and attention.

http://www.medpagetoday.com/Pediatrics/Asthma/26871

 

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Re: Flu Poses Extra Risk for Asthmatic Kids

Pediatrics
Accepted February 28, 2011.

Copyright ? 2011 by the American Academy of Pediatrics



Children With Asthma Hospitalized With Seasonal or Pandemic Influenza, 2003?2009

Fatimah S. Dawood, MDa,
Laurie Kamimoto, MDa,
Tiffany A. D'Mello, MPHa,
Arthur Reingold, MDb,
Ken Gershman, MDc,
James Meek, MPHd,
Kathryn E. Arnold, MDe,
Monica Farley, MDf,
Patricia Ryan, MSg,
Ruth Lynfield, MDh,
Craig Morin, MPHh,
Joan Baumbach, MDi,
Shelley Zansky, PhDj,
Nancy Bennett, MDk,
Ann Thomas, MDl,
William Schaffner, MDm,
David Kirschke, MDm,
Lyn Finelli, DrPHa,
the Emerging Infections Program Network

+ Author Affiliations

aInfluenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia;
bCalifornia Emerging Infections Program, Oakland, California;
cColorado Department of Public Health and Environment, Denver, Colorado;
dConnecticut Emerging Infections Program, Yale University, New Haven, Connecticut;
eGeorgia Department of Community Health, Division of Public Health, Atlanta, Georgia;
fEmory University School of Medicine and the Atlanta Veterans Affairs Medical Center, Atlanta, Georgia;
gMaryland Department of Health and Mental Hygiene, Baltimore, Maryland;
hMinnesota Department of Health, St Paul, Minnesota;
iNew Mexico Department of Health, Santa Fe, New Mexico;
jEmerging Infections Program, New York State Department of Health, Albany, New York;
kDepartment of Medicine, University of Rochester School of Medicine and Dentistry and Monroe County Department of Health, Rochester, New York;
lOregon Public Health Division, Portland, Oregon; and
mDepartment of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee

Abstract

Objective: To describe the characteristics and clinical courses of asthmatic children hospitalized with seasonal or 2009 pandemic H1N1 influenza and compare complications by influenza type.

Methods: During the 2003?2009 influenza seasons and the 2009 pandemic, we conducted surveillance of 5.3 million children aged 17 years or younger for hospitalization with laboratory-confirmed influenza and identified those with asthma (defined as those aged 2?17 years with a history of asthma in their medical record or a discharge code for acute asthma exacerbation or status asthmaticus). We collected data from medical records on medical history and clinical course; data on asthma severity and control were not routinely collected.

Results: During the 2003?2009 influenza seasons, 701 (32%) of 2165 children hospitalized with influenza had asthma; during the 2009 pandemic, 733 (44%) of 1660 children had asthma. The median age of the asthmatic children was 7 years, and 73% had no additional medical conditions. Compared with asthmatic children with seasonal influenza, a higher proportion with 2009 pandemic H1N1 influenza required intensive care (16% vs 22%; P = .01) and were diagnosed with pneumonia (40% vs 46%; P = .04), whereas equal proportions had respiratory failure (5% vs 5%; P = .8) and died (1% vs 1%; P = .4). More asthmatic children with influenza A (seasonal or pandemic) had diagnoses of asthma exacerbations compared with those with influenza B (51% vs 29%; P < .01).

Conclusions: The majority of asthmatic children hospitalized with influenza have no additional medical conditions. Complications such as pneumonia and need for intensive care occur in a substantial proportion, highlighting the importance of influenza prevention through vaccination among asthmatic children.


http://pediatrics.aappublications.org/content/early/2011/06/01/peds.2010-3343.abstract