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Published on: February 23, 2014
Risks of invasive pneumococcal disease in children with underlying chronic diseases
Thomas Hjuler1, Jan Wohlfahrt, Margit Staum Kaltoft
1Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. tta@ssi.dk
Insights
Children with cancer, chronic renal disease, splenectomy, or transplantation face a higher risk of invasive pneumococcal disease. Other chronic conditions may increase risk due to frequent hospitalizations.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Chronic Disease Management
Background:
- Invasive pneumococcal disease (IPD) poses a significant threat to children.
- Certain chronic health conditions are known risk factors for IPD.
Purpose of the Study:
- To quantify the risk of invasive pneumococcal disease (IPD) across a broad spectrum of chronic diseases in children.
- To identify specific chronic conditions associated with increased IPD risk.
Main Methods:
- A nationwide case-control study in Denmark (1977-2005) identified 1655 children with IPD.
- Each case was matched with 10 controls to assess disease risk.
- Chronic diseases were pre-defined for analysis.
Main Results:
- 19% of children with IPD had a history of chronic disease compared to 5% of controls.
- Significantly increased IPD risk was noted for children with cancer, chronic renal disease, splenectomy, and transplantation.
- Children with other chronic diseases had a 1.4-fold increased risk, largely attributed to frequent hospital contact.
Conclusions:
- Cancer, chronic renal diseases, splenectomy, and transplantation are strongly linked to higher IPD risk in children.
- For other chronic conditions, the excess risk appears primarily associated with frailty and repeated hospitalizations rather than the underlying disease itself.
Objective:
The risk of invasive pneumococcal disease is increased among children with some chronic diseases. The objective of this study was to quantify the risk of invasive pneumococcal disease in a wide range of chronic diseases.
Patients And Methods:
Cases of invasive pneumococcal disease among children (aged 0-17 years) were identified from 1977 through 2005 by using a national surveillance program in Denmark. Rate ratios were assessed in a case-control study by using 10 age- and gender-matched controls per case. Chronic diseases were defined a priori.
Results:
Among 1655 children with invasive pneumococcal disease, 19% had a history of chronic disease, according to our definition, versus 5% of controls. An increased risk of invasive pneumococcal disease was observed for children followed >30 days after initial hospital contact for a chronic disease, but it was also increased in children with >or=5 hospital contacts for any other reason. Children with a history of cancer, chronic renal disease, splenectomy, and transplantation were particularly susceptible to invasive pneumococcal disease. Adjusted for number of hospital contacts, the risk for children with other types of chronic disease was 1.4-fold more than for those with hospital contacts for any reason.
Conclusions:
Cancer, chronic renal diseases, splenectomy, and transplantation were strongly associated with an increased risk of invasive pneumococcal disease in children. For children with other chronic diseases, their excess risk seemed to be attributable mostly to frail children having repeated hospital contact rather than their underlying condition.
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