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Neurologic, neuromuscular comorbidities increase risk for severe ILI complications
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Children with neurologic and neuromuscular disease have an increased risk for severe complications of influenza-like illness, according to study findings in Pediatrics.
Rakesh D. Mistry, MD, MS, of Children’s Hospital Colorado, in Aurora, Colo., and colleagues conducted a secondary analysis of a prospective cohort study of children who presented to the ED during peak respiratory viral season. Study participants (n=241) had a median age of 27.4 months and had either a clinical presentation or a moderate-to-severe presentation of influenza-like illness (ILI). Children presented to an urban children’s hospital ED during peak respiratory viral season, defined as early winter to late spring, from 2008 to 2010.
More than half of study participants had at least one chronic illness; asthma was the most common.
Approximately 60% of children’s cause of infection was a single virus (95% CI, 53.6-65.9). Twelve percent had multiple infecting viruses simultaneously. Household exposures were common. Children had an average of 4.5 members per household. More than half of the study cohort were in day care or school.
Influenza was the most common virus isolated, and was the sole virus among 19.5% of children (95% CI, 14.5-24.5). Influenza was present in 13 of 29 children with more than one virus identified. Overall, 24.9% of children (95% CI, 19.4-30.4) had an influenza virus as a cause of infection. Of the 60 children who had influenza virus, 49 (81.7%) were influenza A and 11 (18.3%) were influenza B. Of the influenza A viruses, 29 (59.1%) were pandemic subtype H1N1.
Other respiratory infections caused by a single virus included rhinovirus (14.5%); RSV (11.6%); and smaller proportions of human metapneumovirus, adenovirus, and parainfluenza viruses.
Thirty-five percent of children developed severe complications. Twenty-six percent developed pneumonia; 7.1% developed respiratory failure; and 5.8% developed seizures. The risk for severe complication was significantly increased among children with neurologic or neuromuscular conditions (RR=4; 95% CI, 1.9-8.2). No other specific high-risk conditions were associated with severe complications.
Sub-analyses did not indicate severe complications were significantly associated with other viral infections present.
Those with subtype H1N1 were more likely to develop pneumonia (RR=7.6; 95% CI, 1.1-54.2). Respiratory failure was less likely to develop among children with subtype H1N1.
“Although most children presenting with respiratory illnesses during peak influenza seasons manifest uncomplicated ILI, as many as one in three children presenting with more acute illness are at high risk for development of severe, complicated illness. Those children with neurologic or neuromuscular comorbid conditions are at greatest risk of developing severe complications of [influenza-like illness],” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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