Cases of childhood influenza have recently been more common than earlier observations. The alarming increase in cases is mainly causes by the failure of diagnosing influenza among children which thereafter facilitates further spreading of the disease. In specific cities in the United States such as Cincinnati (Ohio), Rochester (New York) and Nashville (Tennessee), the number of influenza cases among children below 18 years old1 increased from 5. 6% during the winter season of 2002/2003 to 12. 2% during the winter season of 2003/2004.
There is an increasing number of healthcare professionals who campaign for the vaccination of children aged six months to five years old every winter. Vaccination prevents the further spread of the infectious disease and it also reduces the effects of the virus in the body. The average hospitalization rates of the three countries examined was 1 child per thousand, which was within the range of the national average hospitalization rate2 of 1 to 3 per 1,000 children. This was based on a count of approximately 95 visits to the clinic and 27 visits to the emergency room per 1,000 children.
Unfortunately, only 28% of inpatient minors were properly diagnosed with influenza while 17% of outpatient consultations were appropriately ascertained for influenza. A variation in the number of cases of influenza changes from one state to another and this is mainly due to the differences in the use of healthcare services of the residents of each state. In addition, most reports describe influenza cases that reached the hospital hence any influenza cases that are confined inside the homes are not represented.
Influenza infections affect almost all individuals of different ethnicities, yet there are particular cases wherein a specific ethnic group is much more prone to this disease. This may be due to the migrant status of the children, wherein immigrant children as a whole are less likely to have health insurance, less likely to have a usual source of care, and less likely to have had a doctor’s visit in the past year were limited in that they did not differentiate Hispanic subgroups or generations. First-generation Mexican American children had much worse health care access than previously described for Hispanic children as a whole.
Previous studies showed that majority of Hispanic children had a usual source of care. With regard to immigrant children, 51% of all foreign-born children (including Latino, white, black, and Asian children) in working-poor families were uninsured and that 65% had a usual source of care, suggesting that first-generation Mexican American children may also fare worse than immigrant children considered as a whole. Even when first-generation Mexican American children were insured, they had the lowest likelihood of having a regular source of care or a specific provider.
First-generation Mexican American children also demonstrated the lowest levels of utilization of health care services3, as assessed by visits to a physician and use of prescription medications. Poor health care access is a known predictor of poor health care utilization; however, the data also suggest that the first-generation group might have had decreased needs. For example, fewer reported earaches/infections in the first-generation group and lower levels of treatment for ear infections were consistent with fewer visits to a physician for earache/infection.
First-generation Mexican American children also had lower rates of reported cold or flu, pneumonia, and ear infections, which were consistent with lower rates of prescription medication use. Better health outcomes in recent immigrant populations form the basis of what has been described4 as the “epidemiologic paradox”. Despite the presence of demographic and socioeconomic risk factors, foreign-born Mexican American women have low birth weight infant birth rates and infant mortality rates similar to those of white women.
It has not been confirmed that any advantage at birth persists into early childhood, and study results are conflicting. Mexican American mothers report low rates of asthma, coordination problems, psychologic and behavioral problems, speech problems, and mental retardation among their children, suggesting that immigrant children may fare better with regard to specific illnesses.
References
1. Poehling KA, Edwards KM, Weinberg GA, Szilagyi P, Staat MA, Iwane MK, Bridges CB, Grijalva CG, Zhu Y, Bernstein DI, Herrera G, Erdman D, Hall CB, Seither R and Griffin.The underrecognized burden of influenza in young children. N. Engl. J. Med. 2006; 355:31-40. 2. Bhat N, Wright JG, Broder KR. Influenza-associated deaths among children in the United States, 2003–2004. N Engl J Med 2005; 353:2559-67. 3. Holl JL, Szilagyi PG, Rodewald LE, Byrd RS and Weitzman ML. Profile of uninsured children in the United States. Arch. Pediatr. Adolesc. Med. 2005; 149:398–406. 4. Trevino FM, Moyer ME, Valdez RB, Stroup-Benham CA. Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans. JAMA 1991; 265:233–237.