The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children

N Engl J Med. 2000 Jan 27;342(4):225-31. doi: 10.1056/NEJM200001273420401.


Background: Despite high annual rates of influenza in children, influenza vaccines are given to children infrequently. We measured the disease burden of influenza in a large cohort of healthy children in the Tennessee Medicaid program who were younger than 15 years of age.

Methods: We determined the rates of hospitalization for acute cardiopulmonary conditions, outpatient visits, and courses of antibiotics over a period of 19 consecutive years. Using the differences in the rates of these events when influenzavirus was circulating and the rates from November through April when there was no influenza in the community, we calculated morbidity attributable to influenza. There was a total of 2,035,143 person-years of observation.

Results: During periods when influenzavirus was circulating, the average number of hospitalizations for cardiopulmonary conditions in excess of the expected number was 104 per 10,000 children per year for children younger than 6 months of age, 50 per 10,000 per year for those 6 months to less than 12 months, 19 per 10,000 per year for those 1 year to less than 3 years, 9 per 10,000 per year for those 3 years to less than 5 years, and 4 per 10,000 per year for those 5 years to less than 15 years. For every 100 children, an annual average of 6 to 15 outpatient visits and 3 to 9 courses of antibiotics were attributable to influenza. In winter, 10 to 30 percent of the excess number of courses of antibiotics occurred during periods when influenzavirus was circulating.

Conclusions: Healthy children younger than one year of age are hospitalized for illness attributable to influenza at rates similar to those for adults at high risk for influenza. The rate of hospitalization decreases markedly with age. Influenza accounts for a substantial number of outpatient visits and courses of antibiotics in children of all ages.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Age Factors
  • Ambulatory Care / statistics & numerical data*
  • Anti-Bacterial Agents / therapeutic use*
  • Cardiac Output, Low / epidemiology
  • Cardiac Output, Low / etiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant
  • Influenza, Human / complications
  • Influenza, Human / epidemiology*
  • Male
  • Myocarditis / epidemiology
  • Myocarditis / etiology
  • Respiratory Tract Infections / epidemiology
  • Respiratory Tract Infections / etiology
  • Retrospective Studies
  • Risk Factors
  • Tennessee / epidemiology


  • Anti-Bacterial Agents