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Risk of Severe Influenza among Adults with Chronic Medical Conditions

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  • Risk of Severe Influenza among Adults with Chronic Medical Conditions


    J Infect Dis. 2019 Nov 4. pii: jiz570. doi: 10.1093/infdis/jiz570. [Epub ahead of print] Risk of Severe Influenza among Adults with Chronic Medical Conditions.

    Walker TA1, Waite B1, Thompson MG2, McArthur C3, Wong C4, Baker MG5, Wood T6, Haubrock J1, Roberts S7, Gross DK2, Huang QS1, Newbern EC6.
    Author information

    1 WHO National Influenza Centre, Institute of Environmental Science and Research, New Zealand. 2 Influenza Division, Centers for Disease Control and Prevention, Atlanta, GeorgiaUSA. 3 Department of Critical Care Medicine, Auckland District Health Board, Greenlane, Auckland, New Zealand. 4 Department of Respiratory Medicine, Counties Manukau District Health Board, Papatoetoe, Auckland, New Zealand. 5 Department of Public Health, University of Otago, School of Medicine, Newtown, Wellington, New Zealand. 6 Health Intelligence Team, Institute of Environmental Science and Research, New Zealand. 7 Department of Microbiology, Auckland District Health Board, Greenlane, Auckland, New Zealand.

    Abstract

    BACKGROUND:

    Severe influenza illness is presumed more common in adults with chronic medical conditions (CMC), but evidence is sparse and often combined into broad CMC categories.
    METHODS:

    Residents (aged 18-80 years) of Central and South Auckland hospitalized for WHO-defined severe acute respiratory illness (SARI) (2012-2015) underwent influenza virus PCR testing. CMC statuses for Auckland residents were modelled using hospitalization ICD-10 codes, pharmaceutical claims, and laboratory results. Population-level influenza rates in adults with congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus (DM), and end-stage renal disease (ESRD) were calculated by Poisson regression stratified by age and adjusted for ethnicity.
    RESULTS:

    Among 891,276 adults, 2,435 influenza-associated SARI hospitalizations occurred. Rates were significantly higher in those with CMCs compared with those without the respective CMC except older adults with DM or those aged <65 years with CVA. The largest effects occurred with CHF (Incidence Rate Ratio [IRR] range: 4.84-13.4 across age strata), ESRD (IRR range: 3.30-9.02), CAD (IRR range= 2.77-10.7), and COPD (IRR range: 5.89-8.78) and tapered with age.
    CONCLUSIONS:

    Our findings support the increased risk of severe, laboratory-confirmed influenza disease among adults with specific CMCs compared those without these conditions.
    The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.


    KEYWORDS:

    chronic medical conditions; influenza hospitalizations; influenza incidence; influenza risk

    PMID: 31678990 DOI: 10.1093/infdis/jiz570

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