文章出處：Keren R, et al. JAMA. 2005;294:2188-2194.
Context The Advisory Committee on Immunization Practices (ACIP)
recommends annual influenza vaccination for children with certain chronic
medical conditions to prevent serious complications of influenza
infection. Little is known about the relative contribution of each of
these chronic medical conditions to the development of serious
Objective To identify chronic medical conditions that are
associated with respiratory failure in children hospitalized with
community-acquired laboratory-confirmed influenza.
Design, Setting, and Patients A retrospective cohort study of
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). We
examined 9 ACIP-designated high-risk chronic medical conditions and 3
additional chronic medical conditions (neurological and neuromuscular
disease [NNMD], gastroesophageal reflux disease [GERD], and history of
prematurity) that in recent studies have been associated with influenza
hospitalization and severe influenza-related complications.
Main Outcome Measures Rate and odds ratio (OR) of respiratory
failure, defined as need for mechanical ventilation.
Results Of 745 children hospitalized with community-acquired
laboratory-confirmed influenza, 322 (43%) had 1 or more ACIP-designated
high-risk chronic medical conditions. Neurological and neuromuscular
disease, GERD, and history of prematurity were present in 12%, 14%, and
3%, of children, respectively. Thirty-two children (4.3%) developed
respiratory failure. In multivariate logistic regression analyses,
conditions associated with respiratory failure included NNMD (OR, 6.0; 95%
confidence interval [CI], 2.7-13.5), chronic pulmonary disease other than
asthma (OR, 4.8; 95% CI, 1.5-15.1), and cardiac disease (OR, 4.0; 95% CI,
1.6-10.2). The predicted probabilities of respiratory failure derived from
the multivariate model were 12% (95% CI, 7%-20%), 9% (95% CI, 3%-23%), and
8% (95% CI, 4%-18%) for children with NNMD, chronic pulmonary disease, and
cardiac disease, respectively.
Conclusions These results support the ACIP’s recent decision to add
NNMD to the list of conditions for which annual influenza vaccine is
recommended in children. Neurologists and primary care pediatricians
should be alerted to the increased risk of respiratory failure and the
importance of influenza vaccination in children with NNMD.