Risk factors associated with severe influenza infections in childhood:: Implication for vaccine strategy

Infections caused by influenza virus lead to an excess rate of hospitalization of children during winter months. Current recommendations for vaccination target only children > 6 months who belong to specific risk groups. Objective. To identify possible benefits of universal influenza vaccination, this study aims to determine characteristics of children hospitalized at the Montreal Children's Hospital (MCH) because of an infection attributable to influenza virus as well as risk factors associated with hospitalization. Methods. We retrospectively reviewed records of all children with a laboratory-proven diagnosis of influenza seen at MCH between April 1, 1999, and April 1, 2002. Data were analyzed using the Student t test and logistic regression. Results. We identified 182 patients hospitalized because of influenza and 114 patients who were not. Admission diagnoses were suspected sepsis (31%), lower respiratory tract infections (27%), and asthma or bronchiolitis (15%). Mean age of hospitalized patients was 26.1 month ( median: 12 months), which was similar to that of patients not hospitalized, and 34% were < 6 months. Seventy percent of those hospitalized did not have any underlying medical disorder and only 18% ( 33) were vaccine candidates according to current recommendations. Of the latter, less than half had been vaccinated. Factors associated with hospitalization were age < 12 months ( odds ratio [ OR]: 2.3; 95% confidence interval [CI]: 1.1 - 4.8), male gender ( OR: 1.9; 95% CI: 1.0 - 3.7), dehydration ( OR: 4.3; 95% CI: 1.2 - 16.0), and decreased oxygen saturation ( OR: 32.1; 95% CI: 4.1 - 249). Conclusions. Considering that the majority of children hospitalized for influenza do not belong to the specific risk groups targeted by current recommendations, and that one third are < 6 months of age, the target population for vaccination needs to be reexamined. Extending vaccination to all young children, to additional high-risk groups, and to pregnant women has potential to reduce the impact of influenza on children.