Contrary to current guidelines, children born before 37 weeks’ gestation should be considered at high risk for complications of influenza, a new meta-analysis shows.
British researchers reviewed 27 studies with a total of 14,086 children who saw a healthcare provider for influenza or flu-like illness, including 3086 children with underlying medical conditions. They sought to develop an evidence-based definition of children at greatest risk of flu-related complications because existing guidelines “are based on consensus opinion rather than evidence and do not specify risk factors in children.”
In addition to confirming some known risk factors mentioned in current guidelines (neurologic disorders, sickle cell disease, immunosuppression, diabetes, age younger than 2 years), the study identified preterm birth as a strong new risk. Children with flu who had been born prematurely were twice as likely to be admitted to the hospital with complications as children with no underlying medical conditions.
More than 1 underlying condition increased the risk. About 20% of children with flu have at least 1 comorbidity, the researchers note, and these conditions raise the risk of flu-related hospital admissions nearly 6 times in children aged between 5 and 14 years. The researchers recommend targeting high-risk groups for intervention, such as antiviral medication, to prevent complications and also considering intervention for children with more than 1 risk factor or severe underlying medical problems.
An editorial accompanying the study urges implementation of measures to prevent flu-related complications worldwide before the next pandemic. Such measures include increasing influenza and pneumococcal immunization; vaccinating mothers against flu to protect young infants; and investigating potentially more effective vaccines.
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