Children with neurological and neuromuscular diseases at risk for flu-related respiratory failure

November 01, 2005

Children with neurological and neuromuscular diseases should receive an annual influenza vaccination because of a higher risk of respiratory failure if they are hospitalized with influenza, according to a study in the November 2 issue of JAMA.

Influenza is a common disease of childhood and is responsible for significant illness, according to background information in the article. Healthy young children are hospitalized for influenza-related illness at rates similar to those for elderly persons and adults with chronic medical conditions. Perhaps most concerning to parents and physicians is the potential for serious influenza-associated complications, including carditis (inflammation of the heart), encephalitis, myositis (inflammation of muscle tissue), pneumonia, respiratory failure, and death.

Population-based studies suggest that individuals with certain chronic medical conditions are at increased risk of serious complications of influenza infection. The Advisory Committee on Immunization Practices (ACIP) has identified 9 groups of chronic medical conditions for which annual influenza vaccination is recommended. They include asthma, chronic lung disease, cardiac disease, immunosuppression, hemoglobinopathies (a blood disease characterized by the presence of abnormal hemoglobins in the blood), chronic renal dysfunction, metabolic and endocrine conditions, long-term salicylate (aspirin and some other drugs) therapy, and pregnancy. Despite the frequency of influenza infection and the prevalence of these chronic medical conditions, little is known about their relative contribution to the development of serious influenza-associated complications.

Ron Keren, M.D., M.P.H., of The Children's Hospital of Philadelphia, and colleagues conducted a study to identify chronic medical conditions that were associated with respiratory failure in children hospitalized with influenza. In addition to the current ACIP-designated high-risk conditions, the researchers also examined three other categories of chronic medical conditions--neurological and neuromuscular disease (NNMD, such as muscular dystrophy), gastroesophageal reflux disease (GERD), and history of prematurity, that in recent studies have been associated with influenza hospitalization and severe influenza-related complications. The study included 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).

Of 745 children hospitalized with influenza, 322 (43 percent) had one or more ACIP-designated high-risk chronic medical conditions. NNMD, GERD, and history of prematurity were present in 12 percent, 14 percent, and 3 percent, of children, respectively. Thirty-two children (4.3 percent) developed respiratory failure. In further analyses, conditions associated with respiratory failure included NNMD (6 times increased risk), chronic pulmonary disease other than asthma (4.8 times increased risk), and cardiac disease (4 times increased risk). The predicted probabilities of respiratory failure derived from the multivariate model were 12 percent, 9 percent, and 8 percent for children with NNMD, chronic pulmonary disease, and cardiac disease, respectively. Children hospitalized with influenza who had 2 of these 3 chronic conditions had a 31 percent to 39 percent predicted probability of respiratory failure.

"The significantly increased probability of respiratory failure in children with NNMD hospitalized with influenza supports the ACIP's recent decision to add NNMD that may compromise respiratory function to the list of chronic conditions that warrant annual influenza vaccination. Coordinated efforts are needed to educate parents, primary care pediatricians, and pediatric neurologists about the risks of serious influenza complications and the need for annual vaccination for children with NNMD. Future studies should determine the risk of hospitalization among children with NNMD, the number of additional children with NNMD who will require annual vaccination, as well as the effectiveness and cost-effectiveness of the influenza vaccine in preventing hospitalizations and serious complications in these children," the authors conclude.
-end-
(JAMA.2005; 294:2188-2194. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This work was supported by a grant from the Centers for Disease Control and Prevention (CDC). Dr. Keren was supported by a grant from the National Institute of Child Health and Human Development, Bethesda, Md.

The JAMA Network Journals

Related Influenza Articles from Brightsurf:

Predicting influenza epidemics
Researchers at Linköping University, Sweden, have developed a unique method to predict influenza epidemics by combining several sources of data.

Common cold combats influenza
As the flu season approaches, a strained public health system may have a surprising ally -- the common cold virus.

Scent-sensing cells have a better way to fight influenza
Smell receptors that line the nose get hit by Influenza B just like other cells, but they are able to clear the infection without dying.

New antivirals for influenza and Zika
Leuven researchers have deployed synthetic amyloids to trigger protein misfolding as a strategy to combat the influenza A and Zika virus.

Assessment of deaths from COVID-19, seasonal influenza
Publicly available data were used to analyze the number of deaths from seasonal influenza deaths compared with deaths from COVID-19.

Obesity promotes virulence of influenza
Obesity promotes the virulence of the influenza virus, according to a study conducted in mice published in mBio, an open-access journal of the American Society for Microbiology.

Influenza: combating bacterial superinfection with the help of the microbiota
Frenc researchers and from Brazilian (Belo Horizonte), Scottish (Glasgow) and Danish (Copenhagen) laboratories have shown for the first time in mice that perturbation of the gut microbiota caused by the influenza virus favours secondary bacterial superinfection.

Chemists unveil the structure of an influenza B protein
MIT chemists have discovered the structure of an influenza B protein called BM2, a finding that could help researchers design drugs that block the protein and help prevent the virus from spreading.

How proteins help influenza A bind and slice its way to cells
Researchers have provided new insight on how two proteins help influenza A virus particles fight their way to human cells.

Eating elderberries can help minimize influenza symptoms
Conducted by Professor Fariba Deghani, Dr. Golnoosh Torabian and Dr.

Read More: Influenza News and Influenza Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.