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Influenza-related hospitalization and ED visits in children less than 5 years: 2000-2011
Astride Jules1, Carlos G Grijalva1, Yuwei Zhu2
1Departments of Health Policy.
Insights
Annual influenza vaccination coverage for young children increased but remained below 50%. Influenza still caused significant illness, especially during years with predominant influenza A(H3N2) strains.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Policy
- Vaccinology
Background:
- US influenza vaccination recommendations expanded for children aged 6 months and older between 2004-2008.
- The impact of these expanded policies on vaccine uptake and influenza-related healthcare visits in young children was not well understood.
Purpose of the Study:
- To evaluate trends in influenza vaccine uptake among children aged 6-59 months.
- To examine the annual incidence of influenza-associated healthcare encounters (hospitalizations and emergency department visits) in this age group.
Main Methods:
- Laboratory-confirmed influenza hospitalizations and ED visits were estimated by testing children with acute respiratory illness or fever.
- Influenza-related healthcare encounters were calculated by applying these proportions to county-wide illness data.
- Temporal trends in vaccination coverage and influenza-associated visit rates were analyzed.
Main Results:
- Vaccination coverage increased from 6% to 38% between the 2000-2001 and 2010-2011 seasons.
- Annual influenza-related hospitalizations ranged from 1.9 to 16.0 per 10,000 children.
- Annual influenza-related ED visits ranged from 89 to 620 per 10,000 children, with higher rates during influenza A(H3N2) circulation.
Conclusions:
- Despite increased vaccination, less than 50% of young children were fully vaccinated annually.
- Influenza poses a substantial burden of illness in young children, particularly during strains like A(H3N2).
Background And Objectives:
In the United States, recommendations for annual influenza vaccination gradually expanded from 2004 to 2008, to include all children aged ≥6 months. The effects of these policies on vaccine uptake and influenza-associated health care encounters are unclear. The objectives of the study were to examine the annual incidence of influenza-related health care encounters and vaccine uptake among children age 6 to 59 months from 2000-2001 through 2010-2011 in Davidson County, TN.
Methods:
We estimated the proportion of laboratory-confirmed influenza-related hospitalizations and emergency department (ED) visits by enrolling and testing children with acute respiratory illness or fever. We estimated influenza-related health care encounters by multiplying these proportions by the number of acute respiratory illness/fever hospitalizations and ED visits for county residents. We assessed temporal trends in vaccination coverage, and influenza-associated hospitalizations and ED visit rates.
Results:
The proportion of fully vaccinated children increased from 6% in 2000-2001 to 38% in 2010-2011 (P < .05). Influenza-related hospitalizations ranged from 1.9 to 16.0 per 10 000 children (median 4.5) per year. Influenza-related ED visits ranged from 89 to 620 per 10 000 children (median 143) per year. Significant decreases in hospitalizations (P < .05) and increases in ED visits (P < .05) over time were not clearly related to vaccination trends. Influenza-related encounters were greater when influenza A(H3N2) circulated than during other years with median rates of 8.2 vs 3.2 hospitalizations and 307 vs 143 ED visits per 10 000 children, respectively.
Conclusions:
Influenza vaccination increased over time; however, the proportion of fully vaccinated children remained <50%. Influenza was associated with a substantial illness burden particularly when influenza A(H3N2) predominated.
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