Dr. Kay Wang of the University of Oxford has just published the findings of her latest study that suggests policy changes may be in order to provide the best protection possible to infants and small children against influenza. Of particular concern is the fact that current protocols do not identify babies born prematurely as an at-risk group but her research indicates the flu is really tough on preemies, many of whom are already battling other physical ailments associated with their early births.

At the moment, the US Advisory Committee on Immunization Practices, the United Kingdom’s Department of Health, and the World Health Organization acknowledge the greater risk of influenza-related complications in children who are diabetic, suffer from immune-suppressing ailments, and those with neurological disorders. The UK immunization guidelines also include all children younger than 2 and children of any age with sickle cell disease as also being at elevated risk for complications from the flu.

Nevertheless, none of these policy-making entities acknowledges preemies as being at greater risk than all other children. Wang says, “Until now, guidelines highlighting groups at greater risk of developing complications from influenza, such as pneumonia, have been based on consensus opinion rather than on systematic assessment of the evidence” so Wang and her colleagues did a systematic assessment of the evidence.

Wang’s team analyzed data gleaned from 27 studies that documented the experiences of 14,086 children, including 3,086 pediatric flu patients with underlying conditions, and found:

  • Twice as many preemies were hospitalized as a result of the flu than children born at full term.
  • 48% of children with one pre-existing condition were hospitalized.
  • 74% with multiple pre-existing conditions were hospitalized.

In spite of expectations, Wang’s team did not find an increased number of flu-related hospitalizations in children who were obese or those suffering from respiratory conditions such as asthma. The records under study did not identify the degree to which each child suffered these conditions — which child was slightly obese versus those who were morbidly obese or those who had mild respiratory distress versus those with severe distress. It’s likely those suffering the extremes of these conditions experienced more hospitalizations than their peers with less severe conditions.

Wang considers this high rate of flu-related hospitalizations for babies born prematurely to be “a significant public health issue and has major implications for policy makers.” She bases her assessment on the prevalence of premature births (before the 37th week of gestation) around the world:

  • 10% globally, representing 12.9 million premature births
  • 12% premature rate in Africa
  • 11% premature rate in the US
  • 6% across Europe

In addition to including prematurely born children in officially recognized at-risk groups, policy changes that might minimize the incidence of flu-related hospitalizations of preemies include expansion of vaccination policies to include more vigorous immunization of mothers of infants. Exploration of alternative vaccine types and supportive therapies could also prove beneficial.


  1. Nuffield Department of Primary Care Health Sciences. “Children born prematurely are at higher risk of flu-related complications.” Nuffield Department of Primary Care Health Sciences. University of Oxford. 4 Dec. 2014. Web. 12 Dec. 2014.
  2. CDC / Centers for Disease Control and Prevention. “Children, the Flu, and the Flu Vaccine.” Influenza (Flu). US Department of Health and Human Services. 15 Oct. 2014. Web. 12 Dec. 2014.