Vaccinations and other preventive health care services for children are most often provided during well-child visits. A new study suggests, however, that a routine well-child visit to an ambulatory care clinic increases the risk of a subsequent respiratory infection in a family member unless preventive measures are taken.

Figure. Barbara Solorzano covers the face of her 16-month-old son as he coughs while they wait their turn for medical care at the St. John's Well Child and Family Center in Los Angeles. Photo by Damian Dovarganes / Associated Press.

Using data from the Medical Expenditure Panel Survey, a nationally representative sample of the U.S. population, researchers studied 84,595 families. Over 13 years of follow-up, there were 23,776 family-weeks with a well-child visit for a child younger than six years and 97,520 family-weeks with a visit for an influenza-like illness among family members of any age.

Logistic regression analysis showed that a visit by a family member for a flulike illness was strongly associated with a well-child visit in the same week or in one of the two previous weeks: the odds that a family member would have a visit for a flulike illness were 1.54 times higher if a child in the family had a well-child visit within the two weeks prior to that visit. As expected, the increased risk was greatest during the influenza season.

The study authors estimate that the additional risk translates to nearly 780,000 potentially avoidable visits for a flulike respiratory infection, with an annual cost of approximately $500 million. They emphasize that well-child visits are critically important for preventing infection through vaccination and that the benefits outweigh the risks, but they recommend that ambulatory care clinics strictly enforce existing infection-control guidelines and consider additional measures, such as scheduling well-child visits so they don't coincide with the peak of the influenza season.-Karen Rosenberg

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