PEDIATRICS Vol. 112 No. 2 August 2003, pp. 494
WINTER VIRUSES: INFLUENZA- AND RESPIRATORY SYNCYTIAL VIRUS-RELATED MORBIDITY IN CHRONIC LUNG DISEASE
Allen Adinoff, MD
Aurora, CO
Griffin MR, Coffey CS, Neuzil KM, Mitchel EF Jr, Wright PF, Edwards KM. Arch Intern Med. 2002;162:12291236
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Purpose of the Study.
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Chronic lung disease predisposes to serious consequences of
respiratory viruses. Although increasing influenza immunization
rates in older adults signal an awareness of the impact of influenza,
children with asthma are infrequently immunized. Although respiratory
syncytial virus (RSV) is recognized as an important target of
vaccine development for infants, its impact on adults is underappreciated.
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Patient Population and Methods.
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We performed a retrospective cohort study to estimate rates
of hospitalizations, deaths, outpatient visits, and antibiotic
courses attributable to influenza and RSV in persons with chronic
lung disease in the Tennessee Medicaid program from 19951999.
Differences between study event rates when influenza was co-circulating
with RSV and event rates when RSV was circulating alone were
used to calculate influenza-attributable morbidity. Differences
in rates when RSV was circulating alone and during summer months
were calculated to assess the effect of RSV.
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Results.
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Influenza- and RSV-associated hospitalizations were highest
at the extremes of age. There were an estimated 8 and 23 hospitalizations
per 1000 children younger than 5 years annually attributable
to influenza and RSV, respectively. There were 23 and 18 hospitalizations,
as well as 2 and 5 deaths per 1000 persons 65 years or older
annually attributable to influenza and RSV, respectively. Both
viruses were associated with an excess of outpatient visits
in children, and antibiotic prescriptions in all age groups.
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Conclusions.
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Among persons with chronic lung disease, influenza virus and
RSV accounted for 15% to 33% of acute respiratory hospitalizations
in children, 7% to 9% of such hospitalizations in adults, and
9% of deaths in those 65 years or older.
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Reviewers Comments.
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This study reminds us that influenza and RSV remain potentially
serious infectious illnesses in patients with chronic lung disease.
It seems to me that we might be more vigorous in our effects
to vaccinate seniors (who often initiate the process themselves)
than younger children with asthma whose parents may resist giving
an injection.
PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics

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