PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1080 (doi:10.1542/peds.2008-0628)
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LETTER TO THE EDITOR |
Influenza Virus and Acute Asthma in Children: In Reply
Katherine A. Poehling, MD, MPHDepartments of Pediatrics and Epidemiology and Prevention,
Wake Forest University Health Sciences,
Winston-Salem, NC 27157
E. Kathryn Miller, MD, MPH
Department of Pediatrics,
Vanderbilt University Medical Center,
Nashville, TN 37232
Geoffrey A. Weinberg, MD
Department of Pediatrics
Caroline B. Hall, MD
Departments of Pediatrics and Medicine,
University of Rochester School of Medicine and Dentistry,
Rochester, NY 14642
Gerry Fairbrother, PhD
Department of Pediatrics and Cincinnati Children's Hospital Medical Center,
University of Cincinnati College of Medicine,
Cincinnati, OH 45229
We thank Drs Jartti and Ruuskanen for clarifying and emphasizing important considerations concerning the burden of influenza among young children. Consistent with their work on respiratory viruses and asthma exacerbations in children and that of others, we also have found that rhinoviruses are commonly identified among hospitalized children with asthma.1 Although rhinoviruses and other viruses are more commonly identified among hospitalized children with asthma exacerbations than influenza, we focused on influenza because it is the only respiratory virus for which a vaccine and antiviral medications currently are available. Our work, along with that of others, demonstrates that children with asthma have an increased burden of medically attended visits associated with influenza as compared with healthy children.2–6 However, we acknowledge that our understanding of why children have this extra burden of influenza needs additional study. If social or perceptional factors, rather than asthma exacerbations, contribute to this extra burden as Drs Jartti and Ruuskanen suggest, then vaccination would provide the benefit of diminished risk of illness with influenza observed for all children, but children with asthma would continue to have excess costs associated with their increased use of medical care. Future studies that estimate the effectiveness of influenza vaccination to prevent asthma exacerbations, as well as all visits for acute respiratory illnesses, could enhance our understanding of why children with asthma have this increased burden associated with influenza.
The fact remains that influenza vaccine is underused in children despite being safe and generally effective.7–14 We strongly agree that all young children, including children with asthma, are likely to benefit from influenza vaccine given the large number of annual influenza-associated illnesses among both hospitalized and outpatient children.
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- Miller EK, Griffin MR, Edwards KM, et al. Influenza burden for children with asthma.
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[Abstract/Free Full Text] - Shuler CM, Iwamoto M, Bridges CB, et al. Vaccine effectiveness against medically attended, laboratory-confirmed influenza among children aged 6 to 59 months, 2003–2004. Pediatrics. 2007;119 (3). Available at: www.pediatrics.org/cgi/content/full/119/3/e587
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[Abstract/Free Full Text] - Kramarz P, DeStefano F, Gargiullo PM, et al. Does influenza vaccination prevent asthma exacerbations in children? J Pediatr. 2001;138 :306 –310[CrossRef][Web of Science][Medline]
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[Abstract/Free Full Text] - 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]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
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