Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008.

OBJECTIVES: To estimate the rates of hospitalization with seasonal influenza in children aged <18 years from a large, diverse surveillance area during 2003 to 2008. STUDY DESIGN: Through the Emerging Infections Program Network, population-based surveillance for laboratory-confirmed influenza was conducted in 10 states, including 5.3 million children. Hospitalized children were identified retrospectively; clinicians made influenza testing decisions. Data collected from the hospital record included demographics, medical history, and clinical course. Incidence rates were calculated with census data. RESULTS: The highest hospitalization rates occurred in children aged <6 months (seasonal range, 9-30/10 000 children), and the lowest rates occurred in children aged 5 to 17 years (0.3-0.8/10 000). Overall, 4015 children were hospitalized, 58% of whom were identified with rapid diagnostic tests alone. Forty percent of the children who were hospitalized had underlying medical conditions; asthma (18%), prematurity (15% of children aged <2 years), and developmental delay (7%) were the most common. Severe outcomes included intensive care unit admission (12%), respiratory failure (5%), bacterial coinfection (2%), and death (0.5%). CONCLUSIONS: Influenza-associated hospitalization rates varied by season and age and likely underestimate true rates because many hospitalized children are not tested for influenza. The proportion of children with severe outcomes was substantial across seasons. Quantifying incidence of influenza hospitalization and severe outcomes is critical to defining disease burden.

Portal vein thrombosis in a child with homozygous sickle-cell disease

A 13-year old boy with homozygous sickle-cell (SS) disease died suddenly at home folllowing a short history of abdominal pain. Autopsy revealed venous thrombosis of the hepatic, portal, superior mesenteric and splenic veins. Venous thrombosis is rare in SS disease and thrombosis of mesenteric vessels is most frequently seen in chronic myeloproliferative disorders. Its occurrence in SS disease raises the possibility of a common pathogenesis and adds another pathology to the causes of abdominal painful crisis. (AU)

Prophylactic penicillin in young chidlren with homozygous sickle-cell diseases: lack of effect on manifestations other than pneumococcal septicaemia - abstract

This study investigates the effects of prophylactic penicillin in young children with homozygous sickle-cell (SS) disease, on clinical manifestations other than the known effect of preventing pneumococcal septicaemia. Thirty-nine patients received monthly injections of intramuscular penicillin for the 30-month period between age 6 and 36 months (treatment group) and 36 SS patients were followed without penicillin prophylaxis (control group). The features investigated included common manifestations before the age of 3 years such as haematological abnormalities, dactylitis, acute chest syndrome, acute splenic sequestration, and growth delay. No significant differences were found between the two groups in haematology, the incidence of dactylitis, acute chest syndrome, or acute sequestration during the study period, or in attained weight and height at age 3 years or at 8 years. Prophylactic penicillin given as monthly IM injections has no beneficial effect for children under 3 years with homozygous sickle-cell disease, other than the known effect of preventing pneumococcal sepsis (AU)