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Published on: April 14, 2011
Influenza-associated pneumonia in children hospitalized with laboratory-confirmed influenza, 2003-2008
Fatimah S Dawood1, Anthony Fiore, Laurie Kamimoto
1Epidemic Intelligence Service, Centers forDisease Control and Prevention , Atlanta, GA, USA. fdawood@cdc.gov
Insights
Hospitalized children with influenza-associated pneumonia face severe illness, including higher risks of intensive care, respiratory failure, and death. Young children (6 months to 4 years) and those with asthma are most vulnerable to this complication.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Public Health Surveillance
Background:
- Influenza is a common cause of hospitalization in children.
- Influenza-associated pneumonia is a significant complication in this population.
- Understanding risk factors for pneumonia in hospitalized children with influenza is crucial.
Purpose of the Study:
- To describe hospitalized children with influenza-associated pneumonia.
- To identify risk indicators associated with influenza-associated pneumonia in children.
- To inform prevention and treatment strategies for at-risk children.
Main Methods:
- Population-based surveillance of children (<18 years) hospitalized with laboratory-confirmed influenza and chest radiograph.
- Defined influenza-associated pneumonia as new pneumonia on chest radiograph during hospitalization.
- Compared children with and without pneumonia using univariate and multivariate analysis.
Main Results:
- 36% of hospitalized children with influenza had pneumonia (1072/2992).
- Pneumonia cases had higher rates of ICU admission (21% vs. 11%), respiratory failure (11% vs. 3%), and death (0.9% vs. 0.3%).
- Risk factors included age 6-23 months, age 2-4 years, and asthma.
Conclusions:
- Influenza-associated pneumonia leads to a more severe clinical course in hospitalized children.
- Children aged 6 months to 4 years and those with asthma are at increased risk.
- Identifying at-risk children can guide targeted prevention and treatment efforts.
Background:
Pneumonia is one of the most common complications in children hospitalized with influenza. We describe hospitalized children with influenza-associated pneumonia and associated risk indicators.
Methods:
Through Emerging Infections Program Network population based surveillance, children aged <18 years hospitalized with laboratory confirmed influenza with a chest radiograph during hospitalization were identified during the 2003-2008 influenza seasons. A case with radiologically confirmed influenza-associated pneumonia was defined as a child from the surveillance area hospitalized with: (1) laboratory-confirmed influenza and (2) evidence of new pneumonia on chest radiograph during hospitalization. Hospitalized children with pneumonia were compared with those without pneumonia by univariate and multivariate analysis.
Results:
Overall, 2992 hospitalized children with influenza with a chest radiograph were identified; 1072 (36%) had influenza-associated pneumonia.When compared with children hospitalized with influenza without pneumonia, hospitalized children with influenza-associated pneumonia were more likely to require intensive care unit admission (21% vs. 11%, P < 0.01), develop respiratory failure (11% versus 3%, P < 0.01), and die(0.9% vs. 0.3% P 0.01). In multivariate analysis, age 6 to 23 months(adjusted OR: 2.1, CI: 1.6 -2.8), age 2 to 4 years (adjusted OR: 1.7, CI:1.3-2.2), and asthma (adjusted OR: 1.4, CI: 1.1-1.8) were significantly associated with influenza-associated pneumonia.
Conclusions:
Hospitalized children with influenza-associated pneumonia were more likely to have a severe clinical course than other hospitalized children with influenza, and children aged 6 months to 4 years and those with asthma were more likely to have influenza-associated pneumonia.Identifying children at greater risk for influenza-associated pneumonia will inform prevention and treatment strategies targeting children at risk for influenza complications.
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