Flu Shots May Prevent Respiratory Failure in Kids With Chronic Diseases

Children with neurological and neuromuscular diseases are at increased risk for respiratory failure when they catch the flu, and they should be vaccinated before every influenza season, researchers here suggested.

They characterized their finding as new but not surprising “given that these children often have compromised pulmonary function and ability to handle secretions, which are further exacerbated in the setting of influenza infection and resultant pneumonias,” Ron Keren, M.D., M.P.H. and colleagues of the Children’s Hospital of Philadephia reported in the Nov. 2 issue of the Journal of the American Medical Association.

The CDC’s Advisory Committee on Immunization Practice (ACIP) recently decided to add neurological and neuromuscular diseases to the list of chronic conditions for which a yearly flu shot is recommended. Others are asthma, chronic pulmonary disease, cardiac disease, immunosuppression, hemoglobinopathies, chronic renal dysfunction, metabolic and endocrine disorders, long-term salicylate therapy, and pregnancy.

To identify conditions associated with respiratory failure in children hospitalized for community-acquired, laboratory confirmed influenza, the authors conducted a retrospective cohort study of 745 patients who were 21 years old or younger and hospitalized with influenza at Children’s Hospital of Philadelphia during four consecutive flu seasons.

They looked at the nine categories cited by the ACIP, as well as gastroesophageal reflux disease (GERD) and a history of prematurity, all of which have been associated with increased risk for respiratory failure in children.

The investigators found that 322 (43%) of the children studied had one or more of the ACIP-designated high-risk chronic conditions. Neurological and neuromuscular diseases were present in 12% of the patients, GERD in 14%, and a history of prematurity in 3%.

A total of 32 children (4.3%) developed respiratory failure. Using multivariate logistic regression analysis, the investigators determined that neurological and neuromuscular diseases were associated with a six-fold increase in risk for respiratory failure (odds ratio 6.0, 95% confidence interval 2.7-13.5). In addition, children with chronic pulmonary disease other than asthma had a nearly fivefold greater risk (OR, 4.8; 95% CI, 1.5-15.1), and those with cardiac disease had a fourfold higher risk (OR, 4.0; 95% CI, 1.6-10.2).

Using data from the multivariate model, the investigators estimated that the probability of respiratory failure for children with neurological and neuromuscular diseases was 12% (95% CI, 7%-20%), that children with pulmonary disease had a 9% probability (95% CI, 3%-23%), and that kids with cardiac disease had an 8% chance (95% CI, 4%-18%).

The risks also appeared to be cumulative: patients with two of the three conditions (neurological and neuromuscular diseases, chronic pulmonary disease, and cardiac disease) had a 31% to 39% predicted probability of respiratory failure, they noted.

“The significantly increased probability of respiratory failure in children with neurological and neuromuscular diseases hospitalized with influenza supports the ACIP’s recent decision to add neurological and neuromuscular diseases that may compromise respiratory function to the list of chronic conditions that warrant annual influenza vaccination,” Dr. Keren and colleagues wrote.

Source: Journal of the American Medical Association

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