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Are Well-Child Visits a Risk Factor for Subsequent Influenza-Like Illness Visits?

  • Jacob E. Simmering (a1), Linnea A. Polgreen (a1), Joseph E. Cavanaugh (a2) and Philip M. Polgreen (a3)



To determine whether well-child visits are a risk factor for subsequent influenza-like illness (ILI) visits within a child's family. DESIGN. Retrospective cohort.


Using data from the Medical Expenditure Panel Survey from the years 1996-2008, we identified 84,595 families. For each family, we determined those weeks in which a well-child visit or an ILI visit occurred. We identified 23,776 well-child-visit weeks and 97,250 ILI-visit weeks. We fitted a logistic regression model, where the binary dependent variable indicated an ILI clinic visit in a particular week. Independent variables included binary indicators to denote a well-child visit in the concurrent week or one of the previous 2 weeks, the occurrence of the ILI visit during the influenza season, and the presence of children in the family in each of the age groups 0–3, 4–7, and 8–17 years. Socioeconomic variables were also included. We also estimated the overall cost of well-child-exam-related ILI using data from 2008.


We found that an ILI office visit by a family member was positively associated with a well-child visit in the same or one of the previous 2 weeks (odds ratio, 1.54). This additional risk translates to potentially 778,974 excess cases of ILI per year in the United States, with a cost of $500 million annually.


Our results should encourage ambulatory clinics to strictly enforce infection control recommendations. In addition, clinics could consider time-shifting of well-child visits so as not to coincide with the peak of the influenza season.


Corresponding author

Division of Infectious Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242 (


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