New hospital standards needed for pediatric flu vaccines

A new study published in the February 2008 issue of Pediatrics finds that many children hospitalized for influenza have had a recent, previous hospitalization that would have provided an easy, convenient opportunity to receive a hospital-based influenza vaccination. The authors suggest that evaluating and establishing industry standards for flu vaccines for hospitalized children could help prevent additional hospitalizations and complications from influenza.

In the peer-reviewed article “Hospital-Based Influenza Vaccination of Children: An Opportunity to Prevent Subsequent Hospitalization,” the research team led by Danielle M. Zerr, MD, MPH, medical director of infection control at Seattle Children’s Hospital and associate professor of Pediatrics at the University of Washington School of Medicine (UWSOM), evaluated the frequency of previous hospitalizations among children hospitalized with influenza.

Overall, they found that 23% of children hospitalized with influenza and another complicating illness had a previous hospitalization during the most recent flu-vaccine season. This suggests that reaching those children at highest risk for influenza complications and reducing rates of pediatric hospitalization for influenza may be aided by providing in-hospital vaccinations when children are hospitalized during flu vaccine season.

The study looked at five years of hospital discharge data from the Pediatric Health Information System (PHIS) database from 2001 through 2006 to determine how many children hospitalized with influenza or respiratory illness had a previous hospitalization during the most recent flu-vaccine season. PHIS is an administrative database developed by the Child Health Corporation of America (CHCA), used by 42 free-standing pediatric hospitals. Subjects included newborns through age 18. A previous hospitalization during flu vaccination season was considered if it occurred in the two weeks to six months prior to the influenza admission and between September 1 and March 1. Approximately 14,000 cases of children hospitalized with influenza and 170,000 hospitalized with influenza or a respiratory illness were reviewed.

Researchers found approximately 16% of those hospitalized with influenza and 23% of those hospitalized with influenza and another underlying condition had previous hospital admissions during the vaccination season.

“This information will help pediatricians recognize hospitalization as an important opportunity to vaccinate the highest-risk children, and may hopefully prompt the development of hospital-based flu vaccine programs,” said Zerr.

Influenza is a highly contagious illness causing an average of 36,000 deaths and 200,000 hospitalizations per year in the United States; pneumonia is the most common complication in high-risk groups. Young children and those with certain health conditions are at high risk for serious flu complications.

Influenza, unlike the common cold, has a swift onset of severe symptoms beginning with two to seven days of fever, headache, muscle aches, extreme fatigue, runny nose and sore throat, and a cough that is often severe and may last seven days or more. The flu season is generally from November to April, with most cases occurring between late December and early March.

In 2007 the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommended that unvaccinated patients of all ages (including children with high-risk conditions) and all persons aged 6 months to 4 years as well as those 50 and older who are hospitalized at any time, beginning from the time flu vaccine becomes available for the upcoming flu season and continuing throughout flu season, should be offered and strongly encouraged to receive influenza vaccine before being discharged from the hospital.

Seattle Children’s has had a long-standing aggressive flu prevention program, offering free flu shots to inpatients, outpatients and staff. In 2007-2008 Seattle Children’s also offered free vaccines to those with close contact with patients such as family members, teachers, day care staff, nannies and more.

“Many of the sickest children have very fragile immune systems. At Seattle Children’s we’ve already expanded our program beyond patients and staff to ensure we’re doing everything we can to reduce the risk of exposing our high-risk patients to the flu and its complications,” said Zerr. She adds “With findings from this study, we can see that an industry-wide review of hospital-based flu vaccines for all children could take flu-prevention to the next level.”

Source: Children's Hospital and Regional Medical Center of Seattle

Related stories:

Flu shot does not reduce risk of death
The widely-held perception that the influenza vaccination reduces overall mortality risk in the elderly does not withstand careful scrutiny, according to researchers in Alberta. The vaccine does confer protection against specific strains of influenza, but its overall benefit appears to have been exaggerated by a number of observational studies that found a very large reduction in all-cause mortality among elderly patients who had been vaccinated.
Study shows why cigarette smoke makes flu, other viral infections worse
A new study by researchers at Yale School of Medicine could explain why the cold and flu virus symptoms that are often mild and transient in non-smokers can seriously sicken smokers. Published in the Journal of Clinical Investigation, the study also identified the mechanism by which viruses and cigarette smoke interact to increase lung inflammation and damage.
New strategies against bird flu
The Spanish flu outbreak of 1918 killed between 30 and 50 million people. In the infected patients, the ultimate cause of death was acute respiratory distress syndrome (ARDS). This fatal condition is a massive reaction of the body during which the lung becomes severely damaged. ARDS can be induced by various bacterial and viral infections, but also by chemical agents. These could be toxic gases that are inhaled or gastric acid when aspirated. Once ARDS has developed, survival rates drop dramatically. Among patients infected with H5N1 bird flu, about 50 percent die of ARDS.
1 in 7 cases of bird flu could be prevented by closing schools in event of pandemic
Closing schools in the event of a flu pandemic could slow the spread of the virus and prevent up to one in seven cases, according to a new study published today in the journal Nature. School closure is the non-pharmaceutical policy option that health organisations and governments most often consider to control the spread of a future flu pandemic, but there had previously been little evidence about its potential effectiveness.
Four Mass. children die of flu virus
Public health officials said four Massachusetts children have died of the flu this month.
Swine flu monitoring needed for farm workers, study says
A University of Alberta study recommends that workers on pig farms be monitored as part of influenza pandemic preparedness, after a child on a communal farm in Canada was diagnosed with swine flu in 2006.
Protein enhances lethality of influenza virus
Often called the most devastating epidemic in the recorded history of the world, the 1918 influenza virus pandemic was responsible for more than 40 million deaths across the globe. The incredible lethality of the 1918 flu strain is not well understood, despite having been under intense scrutiny for many years.
Pollution causes 40 percent of deaths worldwide, study finds
About 40 percent of deaths worldwide are caused by water, air and soil pollution, concludes a Cornell researcher. Such environmental degradation, coupled with the growth in world population, are major causes behind the rapid increase in human diseases, which the World Health Organization has recently reported. Both factors contribute to the malnourishment and disease susceptibility of 3.7 billion people, he says.

News discussion:

Medicine & Health news