Influenza Burden for Children With Asthma

Miller, E. Kathryn; Griffin, Marie R.; Edwards, Kathryn M.; Weinberg, Geoffrey A.; Szilâgyi, Peter G.; Staat, Mary Allen; Iwane, Marika K.; Zhu, Yuwei; Hall, Caroline Breese; Fairbrother, Gerry; Seither, Ranee; Erdman, Dean D.; Lu, Peng–jun; Poehling, Katherine A.

doi:10.1542/peds.2007-1053

Cited by 110 publications

(99 citation statements)

References 26 publications

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“…Morbidity was high, with 87,000 children requiring hospitalization. The most common comorbidity for patients hospitalized as a result of H1N1 infection was asthma (2), and the percentage of children with asthma hospitalized because of the 2009 H1N1 virus was two-to fivefold higher than previous reports of hospitalization due to seasonal influenza (3,4). Despite the observation that subjects with asthma suffer H1N1 illness with increased severity, it remains unclear at what rate they are infected and whether their symptom severity is greater than those of their nonasthmatic counterparts.…”

mentioning

confidence: 94%

Increased H1N1 Infection Rate in Children with Asthma

Kloepfer¹,

Olenec²,

Lee³

et al. 2012

Am J Respir Crit Care Med

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Rationale: The 2009 H1N1 flu appeared to cause more severe cold symptoms during the 2009-2010 flu season. Objectives: We evaluated H1N1 infections during peak viral season in children with and without asthma to determine whether the H1N1 infectivity rate and illness severity were greater in subjects with asthma. Methods: One hundred and eighty children, 4-12 years of age, provided eight consecutive weekly nasal mucus samples from September 5 through October 24, 2009, and scored cold and asthma symptoms daily. Viral diagnostics were performed for all nasal samples. Measurements and Main Results: One hundred and sixty-one children (95 with asthma, 66 without asthma) completed at least 6 of the 8 nasal samples. The incidence of H1N1 infection was significantly higher in children with asthma (41%) than in children without asthma (24%; odds ratio, 4; 95% confidence interval, 1.8-9; P , 0.001), but rates of human rhinovirus infection (90% each) and other viral infections (47 vs. 41%) were similar. In children with asthma, there was a nonsignificant trend for increased loss of asthma control during H1N1 infections compared with human rhinovirus infections (38 vs. 21%; odds ratio, 2.6; 95% confidence interval, 0.9-7.2; P ¼ 0.07). Conclusions: During peak 2009 H1N1 flu season, children with asthma were infected almost twice as often with H1N1 compared with other respiratory viruses. H1N1 infection also caused increased severity of cold symptoms compared with other viral infections. Given the increased susceptibility of children with asthma to infection, these findings reinforce the need for yearly influenza vaccination to prevent infection, and raise new questions about the mechanism for enhanced susceptibility to influenza infection in asthma.Keywords: asthma; viral infection; influenza 2009 H1N1 Flu was first reported in the United States in the spring of 2009, and eventually affected 61 million people (1), one-third of them children. Morbidity was high, with 87,000 children requiring hospitalization. The most common comorbidity for patients hospitalized as a result of H1N1 infection was asthma (2), and the percentage of children with asthma hospitalized because of the 2009 H1N1 virus was two-to fivefold higher than previous reports of hospitalization due to seasonal influenza (3, 4). Despite the observation that subjects with asthma suffer H1N1 illness with increased severity, it remains unclear at what rate they are infected and whether their symptom severity is greater than those of their nonasthmatic counterparts. Previous studies of H1N1 infectivity reflect symptomatic infections with limited reporting of mild or asymptomatic infection (5-7).A study by our group demonstrated that 90% of children with asthma are infected with human rhinoviruses (HRVs) during the month of September, and that the severity of clinical illness varies from no symptoms to severe wheezing illnesses (8). This study provided the foundation on which we designed a larger cohort to prospectively examine the relationship between illness symptom...

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mentioning

confidence: 94%

Increased H1N1 Infection Rate in Children with Asthma

Kloepfer¹,

Olenec²,

Lee³

et al. 2012

Am J Respir Crit Care Med

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“…For example, infection with human rhinovirus in children before 3 years of age increases the later risk of developing asthma (8), while other respiratory viral infections appear to protect against the later development of asthma (9)(10)(11)(12)(13)(14). However, in older individuals with established asthma, respiratory viral infection, particularly with influenza A virus, almost always triggers acute symptoms of asthma (15)(16)(17). These discrepancies may be due to the timing of the infection, since infection in very young children may profoundly alter the developing innate immune system in such a way as to protect against the later development of asthma, or to the specific immunological cell types activated by a given infectious agent.…”

Section: Introductionmentioning

confidence: 99%

Influenza infection in suckling mice expands an NKT cell subset that protects against airway hyperreactivity

Chang¹,

Kim²,

Albacker³

et al. 2011

J. Clin. Invest.

138

151

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“…By contrast, influenza‐associated outpatient visits are plentiful, so rates of laboratory‐confirmed visits should be easier to document. However, relatively few studies have made population‐based estimates of influenza‐confirmed outpatient visit rates 12, 13, 14, 15, 16, 17. Most have focused on children, typically in a single site 12, 14, 15, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

“…While a key characteristic of influenza is season‐to‐season variability in intensity and severity, most studies have focused on a few seasons,12, 13, 17, 18 or reported summary estimates from multiple seasons 14, 15, 16. Finally, studies testing for influenza per protocol are not common,12, 13, 15, 17 as prospective studies are resource‐intensive. Thus, such studies are rarely conducted in large populations including persons of all ages, in multiple sites, or during multiple influenza seasons.…”

Section: Introductionmentioning

confidence: 99%

Estimated rates of influenza‐associated outpatient visits during 2001‐2010 in 6 US integrated healthcare delivery organizations

Zhou

Thompson

Belongia

et al. 2018

Influenza Resp Viruses

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BackgroundPopulation‐based estimates of influenza‐associated outpatient visits including both pandemic and interpandemic seasons are uncommon. Comparisons of such estimates with laboratory‐confirmed rates of outpatient influenza are rare.ObjectiveTo estimate influenza‐associated outpatient visits in 6 US integrated healthcare delivery organizations enrolling ~7.7 million persons.MethodsUsing negative binomial regression methods, we modeled rates of influenza‐associated visits with ICD‐9‐CM‐coded pneumonia or acute respiratory outpatient visits during 2001‐10. These estimated counts were added to visits coded specifically for influenza to derive estimated rates. We compared these rates with those observed in 2 contemporaneous studies recording RT‐PCR‐confirmed influenza outpatient visits.ResultsOutpatient rates estimated with pneumonia visits were 39 (95% confidence interval [CI], 30‐70) and 203 (95% CI, 180‐240) per 10 000 person‐years, respectively, for interpandemic and pandemic seasons. Corresponding rates estimated with respiratory visits were 185 (95% CI, 161‐255) and 542 (95% CI, 441‐823) per 10 000 person‐years. During the pandemic, children aged 2‐17 years had the largest increase in rates (when estimated with pneumonia visits, from 64 [95% CI, 50‐121] to 381 [95% CI, 366‐481]). Rates estimated with pneumonia visits were consistent with rates of RT‐PCR‐confirmed influenza visits during 4 of 5 seasons in 1 comparison study. In another, rates estimated with pneumonia visits during the pandemic for children and adults were consistent in timing, peak, and magnitude.ConclusionsEstimated rates of influenza‐associated outpatient visits were higher in children than adults during pre‐pandemic and pandemic seasons. Rates estimated with pneumonia visits plus influenza‐coded visits were similar to rates from studies using RT‐PCR‐confirmed influenza.

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Influenza Burden for Children With Asthma

Abstract: Influenza-attributable health care utilization is high among children with asthma and is generally higher than among healthy children.

Cited by 110 publications

References 26 publications

Increased H1N1 Infection Rate in Children with Asthma

Increased H1N1 Infection Rate in Children with Asthma

Influenza infection in suckling mice expands an NKT cell subset that protects against airway hyperreactivity

Estimated rates of influenza‐associated outpatient visits during 2001‐2010 in 6 US integrated healthcare delivery organizations

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