Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1079-1080 (doi:10.1542/peds.2008-0399)

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LETTER TO THE EDITOR

Influenza Virus and Acute Asthma in Children

Tuomas Jartti, MD
Olli Ruuskanen, MD
Department of Pediatrics
Turku University Hospital
FIN-20520, Turku, Finland

To the Editor.—

Miller et al¹ reported the burden of influenza-attributable health care utilization to be high among children with asthma. The reason for this, however, remained unanswered. The authors speculated that children with a history of asthma could be (1) more likely to have severe illness with influenza infections or (2) just be more likely to seek medical care for upper respiratory infection (or be hospitalized) than healthy children with the same clinical presentation because of concern of asthma exacerbation. First, because their enrollment criteria were upper respiratory infection or fever, and exacerbation of asthma was not ascertained from the medical charts, we emphasize that there is no proof in their article, or in the literature, that influenza virus infection is a major trigger of airway hyperreactivity or exacerbation of asthma in children.^2–4 The authors correctly avoided claiming this. In fact, influenza virus has been one of the least prevalent viral findings in wheezing children. Furthermore, the data on the efficacy of the vaccination in preventing influenza virus induced asthma exacerbations is anecdotal in children.^5–8 Second, we think that it is important to investigate reasons for this influenza-attributable health care utilization in asthmatic children. Regardless of whether it is just a false concern by the parents and physicians that influenza virus infection is a major trigger of asthma exacerbations, there is an important educational aim. Taken together, the burden of influenza is inevitably high among young children, and all young children, rather than just those who are asthmatic, are likely to benefit from influenza vaccination.^9,10

REFERENCES

1. Miller EK, Griffin MR, Edwards KM, et al. Influenza burden for children with asthma. Pediatrics. 2008;121 (1):1 –8[Abstract/Free Full Text]
2. Khetsuriani N, Kazerouni NN, Erdman DD, et al. Prevalence of viral respiratory tract infections in children with asthma. J Allergy Clin Immunol. 2007;119 (2):314 –321[CrossRef][Web of Science][Medline]
3. Allander T, Jartti T, Gupta S, et al. Human bocavirus and acute wheezing in children. Clin Infect Dis. 2007;44 (7):904 –910[CrossRef][Medline]
4. Jartti T, Waris M, Niesters HG, Allander T, Ruuskanen O. Respiratory viruses and acute asthma in children. J Allergy Clin Immunol. 2007;120 (1):216[CrossRef][Web of Science][Medline]
5. Bueving HJ, Bernsen RM, de Jongste JC, et al. Influenza vaccination in children with asthma: randomized double-blind placebo-controlled trial. Am J Respir Crit Care Med. 2004;169 (4):488 –493[Abstract/Free Full Text]
6. Bueving HJ, van der Wouden JC, Raat H, et al. Influenza vaccination in asthmatic children: effects on quality of life and symptoms. Eur Respir J. 2004;24 (6):925 –931[Abstract/Free Full Text]
7. Cates CJ, Jefferson TO, Bara AI, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev. 2004;(2) :CD000364[Medline]
8. Fleming DM, Crovari P, Wahn U, et al. Comparison of the efficacy and safety of live attenuated cold-adapted influenza vaccine, trivalent, with trivalent inactivated influenza virus vaccine in children and adolescents with asthma. Pediatr Infect Dis J. 2006;25 (10):860 –869[CrossRef][Web of Science][Medline]
9. Heikkinen T, Silvennoinen H, Peltola V, et al. Burden of influenza in children in the community. J Infect Dis. 2004;190 (8):1369 –1373[CrossRef][Web of Science][Medline]
10. Vesikari T, Fleming DM, Aristegui JF, et al. Safety, efficacy, and effectiveness of cold-adapted influenza vaccine-trivalent against community-acquired, culture-confirmed influenza in young children attending day care. Pediatrics. 2006;118 (6):2298 –2312[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Jartti, T. Articles by Ruuskanen, O. Search for Related Content PubMed PubMed Citation Articles by Jartti, T. Articles by Ruuskanen, O. Related Collections Asthma Related AAP Red Book topics: Influenza Social Bookmarking                         What's this?