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Iwayama H, Ishihara N, Kawahara K, Madokoro Y, Togawa Y, Muramatsu K, Murakami A, Kuru S, Kumagai T, Ohashi W, Nanya K, Hasegawa S, Katsuno M, Okumura A. Early immunological responses to the mRNA SARS-CoV-2 vaccine in patients with neuromuscular disorders. Front Immunol 2022; 13:996134. [PMID: 36248823 PMCID: PMC9558231 DOI: 10.3389/fimmu.2022.996134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds Intramuscular injection of the SARS-CoV-2 vaccine has raised concerns about its use in patients with neuromuscular disorders (NMDs). We evaluated the response of patients with NMDs to the BNT162b2 vaccine. Methods Healthy subjects, patients with spinal muscular atrophy (SMA), and patients with Duchenne muscular dystrophy (DMD) were included. All participants received two BNT162b2 doses. SARS-CoV-2 antibody titers at baseline and 2 weeks after each vaccination were compared between groups. Residual muscle volume was evaluated in NMDs group. A questionnaire documented adverse reactions. Results Eleven patients with NMDs (9 with SMA, 2 with DMD; 7 males; aged 32.7 ± 19.3 years) and 346 healthy subjects (60 males, aged 40.0 ± 12.4 years) were included. Antibody titers (U/mL) were similar between groups (baseline: <0.40 vs. <0.40, first vaccination, 145 ± 258 vs. 103 ± 1192, and second vaccination, 1528 ± 1265 vs. 1429 ± 944; p = 1.000, 0.909, and 0.736, respectively). A negative correlation was found between antibody titers and residual muscle volume but was not significant (Mercuri scale, r = −0.429, p = 0.249; fat infiltration rate, r = −0.194, p = 0.618). The adverse reactions were comparable between groups. Conclusion The BNT162b2 vaccine is safe and effective in patients with NMDs.
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Affiliation(s)
- Hideyuki Iwayama
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Japan
- *Correspondence: Hideyuki Iwayama,
| | - Naoko Ishihara
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kohei Kawahara
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yuta Madokoro
- Department of Neurology, Nagoya City University Hospital, Nagoya, Japan
| | - Yasuko Togawa
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Kanji Muramatsu
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Ayuka Murakami
- Department of Neurology, National Hospital Organization Suzuka Hospital, Suzuka, Japan
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Kuru
- Department of Neurology, National Hospital Organization Suzuka Hospital, Suzuka, Japan
| | - Toshiyuki Kumagai
- Department of Pediatric Neurology, Aichi Prefectural Colony Central Hospital, Kasugai, Japan
- Kuma Home Medical Care Clinic, Nagoya, Japan
| | - Wataru Ohashi
- Division of Biostatistics, Clinical Research Center, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kengo Nanya
- Clinical Laboratory, Nagoya Memorial Hospital, Nagoya, Japan
| | - Shinji Hasegawa
- Department of Pediatrics, Nagoya Memorial Hospital, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University School of Medicine, Nagakute, Japan
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2
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Augustine EF, Adams HR, de Los Reyes E, Drago K, Frazier M, Guelbert N, Laine M, Levin T, Mink JW, Nickel M, Peifer D, Schulz A, Simonati A, Topcu M, Turunen JA, Williams R, Wirrell EC, King S. Management of CLN1 Disease: International Clinical Consensus. Pediatr Neurol 2021; 120:38-51. [PMID: 34000449 DOI: 10.1016/j.pediatrneurol.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/01/2021] [Accepted: 04/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND CLN1 disease (neuronal ceroid lipofuscinosis type 1) is a rare, genetic, neurodegenerative lysosomal storage disorder caused by palmitoyl-protein thioesterase 1 (PPT1) enzyme deficiency. Clinical features include developmental delay, psychomotor regression, seizures, ataxia, movement disorders, visual impairment, and early death. In general, the later the age at symptom onset, the more protracted the disease course. We sought to evaluate current evidence and to develop expert practice consensus to support clinicians who have not previously encountered patients with this rare disease. METHODS We searched the literature for guidelines and evidence to support clinical practice recommendations. We surveyed CLN1 disease experts and caregivers regarding their experiences and recommendations, and a meeting of experts was conducted to ascertain points of consensus and clinical practice differences. RESULTS We found a limited evidence base for treatment and no clinical management guidelines specific to CLN1 disease. Fifteen CLN1 disease experts and 39 caregivers responded to the surveys, and 14 experts met to develop consensus-based recommendations. The resulting management recommendations are uniquely informed by family perspectives, due to the inclusion of caregiver and advocate perspectives. A family-centered approach is supported, and individualized, multidisciplinary care is emphasized in the recommendations. Ascertainment of the specific CLN1 disease phenotype (infantile-, late infantile-, juvenile-, or adult-onset) is of key importance in informing the anticipated clinical course, prognosis, and care needs. Goals and strategies should be periodically reevaluated and adapted to patients' current needs, with a primary aim of optimizing patient and family quality of life.
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Affiliation(s)
- Erika F Augustine
- Department of Neurology and Neurogenetics, Kennedy Krieger Institute, Baltimore, Maryland; Departments of Neurology and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
| | - Heather R Adams
- Departments of Neurology and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Emily de Los Reyes
- Department of Pediatrics and Neurology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | | | | | - Norberto Guelbert
- Metabolic Diseases Section, Children's Hospital of Cordoba, Cordoba, Argentina
| | - Minna Laine
- Department of Pediatric Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tanya Levin
- Medical Writing Consultant, Atlanta, Georgia
| | - Jonathan W Mink
- Departments of Neurology, Neuroscience, and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Miriam Nickel
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Angela Schulz
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Simonati
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona School of Medicine, Verona, Italy
| | - Meral Topcu
- Professor Emeritus, Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey
| | - Joni A Turunen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ruth Williams
- Children's Neurosciences Centre, Evelina London Children's Hospital, London, United Kingdom
| | - Elaine C Wirrell
- Divisions of Epilepsy and Child and Adolescent Neurology, Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Hauge SH, Bakken IJ, de Blasio BF, Håberg SE. Risk conditions in children hospitalized with influenza in Norway, 2017-2019. BMC Infect Dis 2020; 20:769. [PMID: 33076855 PMCID: PMC7569759 DOI: 10.1186/s12879-020-05486-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/07/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Norwegian children are more frequently hospitalized with influenza than adults. Little is known about the characteristics of these children. Our aim was to investigate the presence of pre-existing risk conditions and to determine the duration of influenza hospitalizations in children during two influenza seasons. METHODS The Norwegian Patient Registry holds data on all hospitalized patients in Norway. We included all patients younger than 18 years hospitalized with a diagnosis of influenza during the influenza seasons 2017-18 and 2018-19. Pre-existing risk conditions for influenza were identified by ICD-10 diagnoses in the Norwegian Patient Registry. In addition, information on asthma diagnoses were also retrieved from the Norwegian Registry for Primary Health Care. To estimate the prevalence of risk conditions in the child population, we obtained diagnoses on all Norwegian children in a two-year period prior to each influenza season. We calculated age-specific rates for hospitalization and risk for being hospitalized with influenza in children with risk conditions. RESULTS In total, 1013 children were hospitalized with influenza during the two influenza seasons. Children younger than 6 months had the highest rate of hospitalization, accounting for 13.5% of all admissions (137 children). Hospitalization rates decreased with increasing age. Among children hospitalized with influenza, 25% had one or more pre-existing risk conditions for severe influenza, compared to 5% in the general population under 18 years. Having one or more risk conditions significantly increased the risk of hospitalization, (Odds Ratio (OR) 6.1, 95% confidence interval (CI) 5.0-7.4 in the 2017-18 season, and OR 6.8, 95% CI 5.4-8.4 in the 2018-19 season). Immunocompromised children and children with epilepsy had the highest risk of hospitalization with influenza, followed by children with heart disease and lung disease. The average length of stay in hospital were 4.6 days, and this did not differ with age. CONCLUSION Children with pre-existing risk conditions for influenza had a higher risk of hospitalization for influenza. However, most children (75%) admitted to hospital with influenza in Norway during 2017-2019 did not have pre-existing risk conditions. Influenza vaccination should be promoted in particular for children with risk conditions and pregnant women to protect new-borns.
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Affiliation(s)
- Siri Helene Hauge
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Inger Johanne Bakken
- Department of Health Registries, Norwegian Directorate of Health, Trondheim, Norway
| | - Birgitte Freiesleben de Blasio
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Siri Eldevik Håberg
- Norwegian Institute of Public Health, Centre for Fertility and Health, Oslo, Norway
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Mastrolia MV, Rubino C, Resti M, Trapani S, Galli L. Characteristics and outcome of influenza-associated encephalopathy/encephalitis among children in a tertiary pediatric hospital in Italy, 2017-2019. BMC Infect Dis 2019; 19:1012. [PMID: 31783806 PMCID: PMC6884834 DOI: 10.1186/s12879-019-4636-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Influenza is the most frequent cause of acute upper respiratory tract infections during winter season. Although rare, neurological manifestations are known to occur during influenza infection and approximatively three-quarters of cases are in children. In this study, we aimed to characterize the burden and clinical spectrum of influenza-associated encephalopathy and encephalitis in children admitted at a tertiary pediatric hospital in Italy over two influenza seasons (2017–2019). Methods We retrospectively analyzed clinical, laboratory, instrumental data and outcome of patients discharged with ICD9-CM 487.0 code. Results Fifteen children (13.1% of those discharged with a diagnosis of influenza infection in the study period), had influenza-associated central nervous system (CNS) manifestations. Eight patients (53.3%) were diagnosed as influenza encephalitis, 7 (46.7%) as influenza encephalopathy. Median age was 27 months. In children under 2 years of age (40% of all cases) altered consciousness was the most frequent neurological manifestation while respiratory symptoms were present at admission in all cases. Younger children also required intensive care support more frequently. Five subjects (33.3%) presented comorbidity. None of the patients had received seasonal influenza vaccination. The median time from onset of respiratory signs to onset of neurological manifestations was 24 h. Cerebrospinal fluid (CSF) analysis was normal in most patients and polymerase chain reaction for influenza virus RNA on CSF, when performed, was negative in all samples. Neuroradiological investigations, performed in 5 children, reported cortical and subcortical white matter signal alterations. Oseltamivir was administered only in 2 cases. Fourteen patients recovered without sequelae, and only a 2-year-old girl had minimal impairment in fine motor skills at discharge. Conclusions All children presenting acute neurological features during influenza season should be evaluated for influenza-associated CNS complications even if the respiratory involvement is mild. Absence of underlying diseases or other risk factors are not protective factors against CNS influenza-associated complications. The lack of CSF pleocytosis does not exclude CNS involvement. Children under 2 years of age are at higher risk of requiring intensive care support.
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Affiliation(s)
- Maria Vincenza Mastrolia
- Post-graduate School of Pediatrics, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy.
| | - Chiara Rubino
- Post-graduate School of Pediatrics, University of Florence, Viale Gaetano Pieraccini, 24, 50139, Florence, Italy
| | - Massimo Resti
- Pediatric Department, Anna Meyer Children's University Hospital, Florence, Italy
| | - Sandra Trapani
- Pediatric Department, Anna Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence, Paediatric Infectious Diseases Division, Anna Meyer Children's University Hospital, Florence, Italy
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5
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Williams L. Role of the Pediatric Nurse Practitioner in Enhancing Vaccination Rates. AACN Adv Crit Care 2019; 30:278-281. [DOI: 10.4037/aacnacc2019992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Lori Williams
- Lori Williams is Clinical Nurse Specialist, Pediatric Universal Care Unit and Float Team, American Family Children’s Hospital, University of Wisconsin Hospitals and Clinics, Room 7404, 1675 Highland Ave, Madison, WI 53792
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Szenborn L, Toczek-Kubicka K, Zaryczański J, Marchewka-Kowalik M, Miśkiewicz K, Kuchar E. Benign Acute Childhood Myositis During Influenza B Outbreak. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1039:29-34. [PMID: 28795360 DOI: 10.1007/5584_2017_79] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Benign acute childhood myositis (BACM) is a syndrome classically occurring in children during the convalescent phase from a febrile upper respiratory tract infection, most commonly after influenza B. BACM can cause difficulty walking due to severe calf pain. Laboratory results show increased serum creatinine kinase and AST. Although alarming, BACM is self-limiting with symptoms disappearing within a week. Herein, we described a case series of BCAM in children in two cities in Poland during the influenza outbreaks in 2012/2013 and 2014/2015. We discussed the presentation and the clinical workup and examinations of the myositic syndrome. In addition, we evaluated the association of BACM with influenza B. We detected specific IgG against influenza B virus in 83% of the children diagnosed with BCAM. Reports from the National Institute of Public Health - National Institute of Hygiene in Warsaw, Poland confirmed a high rate of influenza B cases during both epidemic seasons in question.
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Affiliation(s)
- L Szenborn
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, 2-2A Chałubińskiego Street, 50-368, Wrocław, Poland.
| | - K Toczek-Kubicka
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, 2-2A Chałubińskiego Street, 50-368, Wrocław, Poland
| | | | | | - K Miśkiewicz
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, 2-2A Chałubińskiego Street, 50-368, Wrocław, Poland
| | - E Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
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Abstract
BACKGROUND Studies report that the influenza vaccination uptake rate among children with chronic conditions is alarmingly low. In Hong Kong, there has been no study examining parental decision making about influenza vaccination for children with chronic conditions, thereby limiting the knowledge base to inform the development of specific strategies to improve influenza vaccination rates. The aim of this study was to identify factors determining the uptake of influenza vaccination among children with chronic conditions. METHODS We conducted a cross-sectional survey of 623 parents with children having a chronic condition recruited from pediatric wards and specialty outpatient departments of 2 acute hospitals. A questionnaire developed by Daley et al based on the Health Belief Model was used to examine parents' beliefs and attitudes toward influenza and vaccination. RESULTS The parents' and their children's mean age were 40.1 ± 8.1 and 8.0 ± 4.5 years, respectively. Among the children, the most prevalent chronic conditions were asthma, chronic respiratory disease and cardiomyopathy. One-third (33%) of the children had influenza vaccination in the past 12 months. More than one-third (39%) of parents intended to vaccinate their children against influenza in the coming influenza season. A multivariable logistic regression analysis revealed that all subscale scores except perceived severity and knowledge about influenza were independently significantly associated with uptake. CONCLUSIONS The findings indicate that parents of children with chronic conditions lack awareness of the risks of influenza and have insufficient understanding about the benefits of vaccination. These findings could inform the development of interventions to promote vaccination uptake among children with chronic conditions.
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Flannery B, Reynolds SB, Blanton L, Santibanez TA, O'Halloran A, Lu PJ, Chen J, Foppa IM, Gargiullo P, Bresee J, Singleton JA, Fry AM. Influenza Vaccine Effectiveness Against Pediatric Deaths: 2010-2014. Pediatrics 2017; 139:e20164244. [PMID: 28557757 PMCID: PMC5728382 DOI: 10.1542/peds.2016-4244] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Surveillance for laboratory-confirmed influenza-associated pediatric deaths since 2004 has shown that most deaths occur in unvaccinated children. We assessed whether influenza vaccination reduced the risk of influenza-associated death in children and adolescents. METHODS We conducted a case-cohort analysis comparing vaccination uptake among laboratory-confirmed influenza-associated pediatric deaths with estimated vaccination coverage among pediatric cohorts in the United States. Case vaccination and high-risk status were determined by case investigation. Influenza vaccination coverage estimates were obtained from national survey data or a national insurance claims database. We estimated odds ratios from logistic regression comparing odds of vaccination among cases with odds of vaccination in comparison cohorts. We used Bayesian methods to compute 95% credible intervals (CIs) for vaccine effectiveness (VE), calculated as (1 - odds ratio) × 100. RESULTS From July 2010 through June 2014, 358 laboratory-confirmed influenza-associated pediatric deaths were reported among children aged 6 months through 17 years. Vaccination status was determined for 291 deaths; 75 (26%) received vaccine before illness onset. Average vaccination coverage in survey cohorts was 48%. Overall VE against death was 65% (95% CI, 54% to 74%). Among 153 deaths in children with underlying high-risk medical conditions, 47 (31%) were vaccinated. VE among children with high-risk conditions was 51% (95% CI, 31% to 67%), compared with 65% (95% CI, 47% to 78%) among children without high-risk conditions. CONCLUSIONS Influenza vaccination was associated with reduced risk of laboratory-confirmed influenza-associated pediatric death. Increasing influenza vaccination could prevent influenza-associated deaths among children and adolescents.
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Affiliation(s)
| | | | | | - Tammy A Santibanez
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alissa O'Halloran
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peng-Jun Lu
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - James A Singleton
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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Havers F, Fry AM, Chen J, Christensen D, Moore C, Peacock G, Finelli L, Reed C. Hospitalizations Attributable to Respiratory Infections among Children with Neurologic Disorders. J Pediatr 2016; 170:135-41.e1-5. [PMID: 26687576 DOI: 10.1016/j.jpeds.2015.11.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/29/2015] [Accepted: 11/10/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To characterize respiratory infection hospitalizations in children with neurologic disorders and to compare them with those of the general pediatric population. STUDY DESIGN We analyzed claims data from commercial insurance and Medicaid enrollees < 19 years of age from July 2006 to June 2011 who had ≥ 1 visit with an International Classification of Diseases, Ninth Revision, diagnosis code for a neurologic disorder. We identified hospitalizations with primary diagnosis codes indicating a respiratory infection and compared hospitalization rates with random samples of children from the commercial and Medicaid databases (comparison groups). RESULTS Among 33,651923 children, 255,046 (0.76%) had ≥ 1 neurologic condition. Among children with neurologic conditions, 8249 of 68,717 hospitalizations (12%) were attributed to a respiratory infection (rate: 21/1000 person-years), although rates varied by disorder. Children with neurologic disorders had greater rates than children in comparison groups (relative rate: Commercial Claims 7.4 [95% CI 7.1-7.7]; Medicaid 5.0 [95% CI 4.8-5.2]). Children < 2 years were most likely to be hospitalized, although those 10-18 years were 14.5 (95% CI 13.3-16.7) times more likely to be hospitalized than age-matched comparison groups. Co-occurring deafness, blindness, and scoliosis were associated with increased respiratory hospitalization rates. CONCLUSIONS Children with neurologic disorders are at 5- to 7-fold greater risk for hospitalization from respiratory infections compared with all children, although rates vary widely by disorder type, age, and comorbidities. Children with specific neurologic disorders and those who had co-occurring conditions have the highest rates.
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Affiliation(s)
- Fiona Havers
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jufu Chen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah Christensen
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cynthia Moore
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Georgina Peacock
- Division of Human Development and Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lyn Finelli
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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