Child, Household, and Caregiver Characteristics Associated with Hospitalization for Influenza Among Children 6-59 Months of Age An Emerging Infections Program Study

• Type of Material: Article
• Authors: Nila J. Dharan, Centers for Disease Control and Prevention; Leslie Z. Sokolow, Centers for Disease Control and Prevention; Po-Yung Cheng, Centers for Disease Control and Prevention; Paul Gargiullo, Centers for Disease Control and Prevention; Ken Gershman, Colorado Department of Public Health and Environment; Ruth Lynfield, Minnesota Department of Health; Craig Morin, Minnesota Department of Health; Ann Thomas, Oregon Public Health Division; James Meek, Connecticut Emerging Infections Program; Monica Farley, Emory University; Katherine E. Arnold, Georgia Emerging Infections Program; Art Reingold, Emory University; Allen S. Craig, Tennessee Department of Health; William Schaffner, Vanderbilt University; Nancy M. Bennett, University of Rochester; Shelley Zansky, New York State Department of Health; Joan Baumbach, New Mexico Department of Health; Sarah Lathrop, University of New Mexico; Laurie Kamimoto, Centers for Disease Control and Prevention; David K. Shay, Centers for Disease Control and Prevention
• Language: English
• Date: 2014-06-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: © 2013 by Lippincott Williams & Wilkins.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1097/INF.0000000000000283
• Title of Journal or Parent Work: Pediatric Infectious Disease Journal
• ISSN: 0891-3668
• Volume: 33
• Issue: 6
• Start Page: E141
• End Page: E150
• Keywords: Immunology; children; Pediatrics; influenza; RESPIRATORY SYNCYTIAL VIRUS; Life Sciences & Biomedicine; DISPARITIES; Science & Technology; Infectious Diseases; INFANTS; UNITED-STATES; SURVEILLANCE; hospitalization; household; RISK-FACTORS; TEST-NEGATIVE DESIGN; risk factors; VACCINE; YOUNG-CHILDREN; DISEASE
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

BACKGROUND: Young children are at increased risk of severe outcomes from influenza illness, including hospitalization. We conducted a case-control study to identify risk factors for influenza-associated hospitalizations among children in US Emerging Infections Program sites. METHODS: Cases were children 6-59 months of age hospitalized for laboratory-confirmed influenza infections during 2005-2008. Age- and zip-code-matched controls were enrolled. Data on child, caregiver and household characteristics were collected from parents and medical records. Conditional logistic regression was used to identify independent risk factors for hospitalization. RESULTS: We enrolled 290 (64%) of 454 eligible cases and 1089 (49%) of 2204 eligible controls. Risk for influenza hospitalization increased with maternal age < 26 years [odds ratio (OR): 1.8, 95% confidence interval (CI): 1.1-2.9]; household income below the poverty threshold (OR: 2.2, 95% CI: 1.4-3.6); smoking by > 50% of household members (OR: 2.9, 95% CI: 1.4-6.6); lack of household influenza vaccination (OR: 1.8, 95% CI: 1.2-2.5) and presence of chronic illnesses, including hematologic/oncologic (OR: 11.8, 95% CI: 4.5-31.0), pulmonary (OR: 2.9, 95% CI: 1.9-4.4) and neurologic (OR: 3.8, 95% CI: 1.6-9.2) conditions. Full influenza immunization decreased the risk among children 6-23 months of age (OR: 0.5, 95% CI: 0.3-0.9) but not among those 24-59 months of age (OR: 1.5, 95% CI: 0.8-3.0; P value for difference = 0.01). CONCLUSIONS: Chronic illnesses, young maternal age, poverty, household smoking and lack of household influenza vaccination increased the risk of influenza hospitalization. These characteristics may help providers to identify young children who are at greatest risk for severe outcomes from influenza illness.