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Winter Viruses
Influenza- and Respiratory Syncytial Virus–Related Morbidity in Chronic Lung Disease
Marie R. Griffin, MD, MPH;
Christopher S. Coffey, PhD;
Kathleen M. Neuzil, MD, MPH;
Edward F. Mitchel, Jr, MS;
Peter F. Wright, MD;
Kathryn M. Edwards, MD
Arch Intern Med. 2002;162:1229-1236.
Background Chronic lung disease predisposes to serious consequences of respiratory
viruses. While increasing influenza immunization rates in older adults signals
an awareness of the impact of influenza, children with asthma are infrequently
immunized. While respiratory syncytial virus (RSV) is recognized as an important
target of vaccine development for infants, its impact on adults is underappreciated.
Methods We performed a retrospective cohort study to estimate rates of hospitalizations,
deaths, outpatient visits, and antibiotic courses due to influenza and RSV
in persons with chronic lung disease in the Tennessee Medicaid program from
1995 to 1999. Differences between study event rates when influenza was cocirculating
with RSV and event rates when RSV was circulating alone were used to calculate
influenza-attributable morbidity. Differences in rates when RSV was circulating
alone and during summer months were calculated to assess the effect of RSV.
Results Influenza- and RSV-associated hospitalizations were highest at the extremes
of age. There were an estimated 8 and 23 hospitalizations per 1000 children
younger than 5 years annually due to influenza and RSV, respectively. There
were 23 and 18 hospitalizations, as well as 2 and 5 deaths per 1000 persons
65 years or older annually due to influenza and RSV, respectively. Both viruses
were associated with an excess of outpatient visits in children, and antibiotic
prescriptions in all age groups.
Conclusion Among persons with chronic lung disease, influenza virus and RSV accounted
for 15% to 33% of acute respiratory hospitalizations in children, 7% to 9%
of such hospitalizations in adults, and 9% of deaths in those 65 years or
older.
From the Departments of Preventive Medicine (Drs Griffin and Coffey
and Mr Mitchel), Medicine (Dr Griffin), and Pediatrics (Drs Wright and Edwards),Vanderbilt
University School of Medicine and the Geriatric Research Education and Clinical
Center, and Nashville Veterans Affairs Medical Center (Dr Griffin), Nashville,
Tenn; and the Department of Medicine, University of Washington, Seattle (Dr
Neuzil). Dr Coffey is now with the Department of Biostatistics, University
of Alabama, Birmingham.
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