NEWS TIPS FROM THE 2009 ANNUAL MEETING OF THE PEDIATRIC ACADEMIC SOCIETIES, MAY 2-5, BALTIMORE
Children with sickle cell disease are hospitalized with influenza nearly 80 times more often than other children, a finding that should be a wake-up call for both pediatricians and health insurance providers, say researchers from Johns Hopkins Children's Center.
In the study, the Johns Hopkins team combed through records from several state databases tracking flu hospitalizations from the 2003-2004 and 2004-2005 flu seasons and found that 5,256 children were hospitalized with the flu. Among children with sickle cell disease, there were 201 flu-related hospitalizations per 10,000 children per year compared to 2.6 flu-related hospitalizations per 10,000 children among those without sickle cell disease per year.
The CDC considers children with sickle cell disease, a genetic disorder marked by abnormally shaped red blood cells, to be at high risk for complications from the flu. However, to date, there has been little evidence to prove it. The Johns Hopkins report is the first study to quantify the risk and to show how often these children end up in the hospital with the flu, pointing to the need for aggressive immunization efforts in children with sickle cell disease, much like in children with other chronic conditions, including asthma, diabetes and heart disease.
"Kids with sickle cell disease are hospitalized often enough for their disease, and the last thing they need is to be in the hospital for a preventable complication," says lead investigator David Bundy, M.D., M.P.H., of Johns Hopkins Children's. "We know from other studies that children with sickle cell disease get flu shots less than half of the time and may be overlooked as a risk category by doctors and insurance providers and within the sickle cell community itself."
Because past research has shown dismal flu vaccination rates among children with sickle cell disease, Bundy and colleagues recommend that pediatricians treating these patients should have proactive immunization plans rather than wait to vaccinate children when and if they come to the office. Because sickle cell disease is a relatively rare condition, affecting 72,000 Americans, most pediatric practices do not have many sickle cell patients. Consequently, it would not be burdensome to launch proactive vaccination efforts, such as mail alerts and phone calls, Bundy says.
He adds that another way to mass-immunize children with sickle cell disease is through Medicaid-based vaccination efforts. Medicaid is the public health insurance program for low-income children. In the study, 64 percent of the children with sickle cell disease who were hospitalized with the flu were insured by Medicaid.
"Medicaid-based efforts could be that silver bullet of mass immunization for many U.S. children with sickle-cell disease," Bundy says. "A cheap flu shot program could save millions of dollars by preventing flu-related hospitalizations, providing a great return on investment for Medicaid," Bundy says.
Abnormal, crescent-shaped red blood cells that give the disease its name block the normal flow in blood vessels and can cause organ damage. Each year, 2,000 U.S. babies are born with the disorder.
The CDC recommends that all children over 6 months of age get a flu shot, except those who are allergic to eggs or have had a severe reaction to a flu vaccine in the past.
Other investigators in the study include John Strouse, M.D., Marlene Miller, M.D., and James Casella, M.D., all of Hopkins Children's.