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Burden of Seasonal Influenza in Children With Neurodevelopmental Conditions

Burton, Catherine MD*; Vaudry, Wendy MD*; Moore, Dorothy MD; Bettinger, Julie A. PhD, MPH; Tran, Dat MD, MSc§; Halperin, Scott A. MD; Scheifele, David W. MDfor the IMPACT investigators

The Pediatric Infectious Disease Journal: July 2014 - Volume 33 - Issue 7 - p 710–714
doi: 10.1097/INF.0000000000000272
Original Studies

Background: Studies have identified certain neurologic and neurodevelopmental conditions (NNC) as risk factors for severe influenza infection. The Canadian National Advisory Committee on Immunization does not currently recognize children with NNC as having a high risk of complicated influenza infection unless their condition compromises handling of respiratory secretions. We describe the burden of influenza in hospitalized children with NNC, focusing on those without potential airway compromise.

Methods: Using multi-year surveillance data obtained by the Canadian Immunization Monitoring Program, Active (IMPACT), we examined presenting signs and symptoms, risk factors and outcomes of children hospitalized with seasonal influenza at 12 Canadian pediatric referral centers. Comparisons were made between children with various NNC and other medical conditions, with and without influenza vaccine indications. The analysis is descriptive with selected comparisons made among groups for important indicators of disease severity.

Results: We identified 1991 children hospitalized with influenza over 5 seasons: 293 had NNC, 115 of whom did not have airway compromise or another vaccine indication. The latter group presented with seizures more frequently than those with NNC and a vaccine indication (41.7% vs. 26.4%; P = 0.006) and required intensive care unit admission (20.9% vs. 11.8%; P = 0.02) and mechanical ventilation (14.8% vs. 4.5%; P < 0.001) more often than children without NNC but with a vaccine indication.

Conclusions: The burden of influenza infection in children with NNC, even those whose conditions do not obviously compromise respiratory function, is significant. All children with NNC should be recognized as having a high risk of complicated influenza infection and be targeted to receive influenza immunization.

Supplemental Digital Content is available in the text.

From the *Division of Infectious Diseases, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta; Division of Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, Québec; Vaccine Evaluation Center, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia; §Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; and Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, Nova Scotia, Canada.

Accepted for publication December 11, 2013.

The Canadian Immunization Monitoring Program, Active (IMPACT) is managed by the Canadian Paediatric Society, which receives ongoing funding from the PHAC’s Centre for Immunization and Respiratory Infectious Diseases for IMPACT influenza surveillance. Canadian Paediatric Society and the PHAC had no role in data collection and analysis or decision to publish. PHAC was involved in the review and approval of the study design and manuscript.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

The authors have no conflicts of interest to disclose.

Address for correspondence: Wendy Vaudry, MD, Department of Pediatrics, University of Alberta: 3-588D Edmonton Clinic Health Academy, 11405 87 Ave. NW, Edmonton, Alberta, Canada, T6G 1C9. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.