The Burden of childhood influenza in a tertiary paediatric setting
DOI:
https://doi.org/10.33321/cdi.2009.33.21Keywords:
influenza, child, hospitalisation, immunisationAbstract
Influenza is usually considered a mild winter-time illness but can be associated with a range of serious complications. We undertook a retrospective medical record review to study the impact of admissions of children with laboratory-confirmed influenza to The Children's Hospital at Westmead, Sydney, during 2007. One hundred and twenty-two children were identified, representing 530 hospital admission days. There was no clearly documented evidence of influenza vaccination for any patient eligible for vaccination. Fever (97.5%) and cough (69.7%) were the most frequent manifestations. Admissions occurred almost entirely between June and September with a peak in July (n=61, 50%). Two-thirds of the children were aged less than 2 years (median 1.5 years). Most (61.5%) had an underlying chronic medical disorder. Lumbar puncture was performed in 28 (23%) children, mostly infants aged less than 3 months (n=18). Antibiotics were commonly prescribed (67.2%), but use of available influenza-specific antiviral agents was uncommon (13.1%). The nosocomial infection rate was 9.8% and the clinical staff vaccination rate was low (less than 30%). Pneumonia was the most common complication (12.3%). No influenza-related deaths occurred. Influenza in young children poses a significant burden to health care services, tertiary admissions representing the tip-of-the-iceberg. Vaccination rates are inappropriately low in both eligible patients and hospital clinical staff. Early 'point of care' testing, use of influenza-specific antiviral agents, and extension of current vaccination schedules to include all children aged six to 23 months could considerably reduce over-investigation, unnecessary use of antibiotics and the health care impact of influenza. Commun Dis Intell 2009;33:209–215.
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Ploin D, Gillet Y, Morfin F, Fouilhoux A, Billaud G, Liberas S, et al. Influenza burden in febrile infants and young children in a pediatric emergency department. Pediatr Infect Dis J 2007;26(2):142–147.
Smitherman HF, Caviness AC, Macias CG. Retrospective review of serious bacterial infections in infants who are 0 to 36 months of age and have influenza A infection. Pediatrics 2005;115(3):710–718.
Iskander M, Booy R, Lambert S. The burden of influenza in children. Current Opinion Infect Dis 2007;20(3):259–263.
Agyeman P, Duppenthaler A, Heininger U, Aebi C. Influenza-associated myositis in children. Infection 2004;32(4):199–203.
Aymard M, Valette M, Luciani J, Sentinel Physicians from the Grippe et Infections Respiratoires Aigües Pédiatriques Network. Burden of influenza in children: preliminary data from a pilot survey network on community diseases. Pediatr Infect Dis J 2003;22(10:Suppl):S211–214.
Bhat N, Wright JG, Broder KR, Murray EL, Greenberg ME, Glover MJ, et al. Influenza-associated deaths among children in the United States, 2003–2004. N Engl J Med 2005;353(24):2559–2567.
Centers for Disease Control and Prevention. Update: influenza-associated deaths reported among children aged <18 years-–United States, 2003–04 influenza season. MMWR Morb Mortal Wkly Rep 2004;52(51–52):1254–1255.
Grose C. The puzzling picture of acute necrotizing encephalopathy after influenza A and B virus infection in young children. Pediatr Infect Dis J 2004;23(3):253–254.
Heikkinen T, Silvennoinen H, Peltola V, Ziegler T, Vainionpaa R, Vuorinen T, et al. Burden of influenza in children in the community. J Infect Dis 2004;190(8):1369–1373.
Kappagoda C, Isaacs D, Mellis C, Peat J, De Silva L, O'Connell A. Critical influenza virus infection. J Paediatr Child Health 2000;36(4):318–321.
Maricich SM, Neul JL, Lotze TE, Cazacu AC, Uyeki TM, Demmler GJ, et al. Neurologic complications associated with influenza A in children during the 2003–2004 influenza season in Houston, Texas. Pediatr 2004;114(5):e626–e633.
Milne BG, Williams S, May ML, Kesson AM, Gillis J, Burgess MA. Influenza A associated morbidity and mortality in a paediatric intensive care unit. Commun Dis Intell 2004;28(4):504–509.
Poehling KA, Edwards KM, Weinberg GA, Szilagyi P, Staat MA, Iwane MK, et al. The underrecognized burden of influenza in young children. N Engl J Med 2006;355(1):31–40.
Keren R, Zaoutis TE, Saddlemire S, Luan XQ, Coffin SE. Direct medical cost of influenza-related hospitalizations in children. Pediatr 2006;118(5):e1321–e1327.
Tsolia MN, Logotheti I. Papadopoulos NG, Mavrikou M, Spyridis NP, Drossatou P, et al. Impact of influenza infection in healthy children examined as outpatients and their families. Vaccine 2006;24(33–34):5970–5976.
Molinari NA, Ortega-Sanchez IR, Messonnier ML, Thompson WW, Wortley PM, Weintraub E, et al. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 2007;25(27):5086–5096.
Brotherton J, Wang H, Schaffer A, Quinn H, Menzies R, Hull B, et al. Vaccine preventable diseases and vaccination coverage in Australia, 2003 to 2005. Commun Dis Intell 2007;31:Suppl-152.
National Health and Medical Research Council. 3.9 Influenza. The Australian Immunisation Handbook. 2007. National Health and Medical Research Council; Canberra: pp160–169.
Fiore AE, Shay DK, Haber P, Iskander JK, Uyeki TM, Mootrey G, et al. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007. MMWR Morb Mortal Wkly Rep 2007;56(RR–6):1–54.
Matheson NJ, Harnden AR, Perera R, Sheikh A, Symmonds-Abrahams M. Neuraminidase inhibitors for preventing and treating influenza in children. Cochrane Database Syst Rev 2007;(1):CD002744.
Centers for Disease Control and Prevention. Update: influenza activity–-United States and worldwide, May 20–September 15, 2007. MMWR Morb Mortal Wkly Rep 2007;56(38):1001–1004.
Childrens Hospital at Westmead. Demographic and child health profile. The Children's Hospital at Westmead Healthcare Services Plan 2007–2011. 2008: pp16–18.
Mizuguchi M, Yamanouchi H, Ichiyama T, Shiomi M. Acute encephalopathy associated with influenza and other viral infections. Acta Neurol Scand 2007;186:45–56.
Newland JG, Laurich VM, Rosenquist AW, Heydon K, Licht DJ, Keren R, et al. Neurologic complications in children hospitalized with influenza: characteristics, incidence, and risk factors. J Pediatr 2007;150(3):306–310.
Augustin SL, Horton S, Thuys C, Bennett M, Claessen C, Brizard C. The use of extracorporeal life support in the treatment of influenza-associated myositis/rhabdomyolysis. Perfusion 2006;21(2):121–125.
Poehling KA. Zhu Y. Tang YW. Edwards K. Accuracy and impact of a point-of-care rapid influenza test in young children with respiratory illnesses. Archives Pediatr Adolescent Med 160(7):713–718, 2006.
Hageman JC, Uyeki TM, Francis JS, Jernigan DB, Wheeler JG, Bridges CB, et al. Severe community-acquired pneumonia due to Staphylococcus aureus, 2003–04 influenza season. Emerg Infect Dis 2006;12(6):894–899.
Jensen ES, Lundbye-Christensen S, Samuelsson S, Sorensen HT, Schonheyder HC. A 20-year ecological study of the temporal association between influenza and meningococcal disease. Eur J Epidemiol 2004;19(2):181–187.
O'Brien KL, Walters MI, Sellman J, Quinlisk P, Regnery H, Schwartz B, et al. Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection. Clin Infect Dis 2000;30(5):784–789.
Podewils LJ, Liedtke LA, McDonald LC, Hageman JC, Strausbaugh LJ, Fischer TK, et al. A national survey of severe influenza-associated complications among children and adults, 2003–2004. Clin Infect Dis 2005;40(11):1693–1696.
Neuzil KM, Edwards KM. Influenza vaccines in children. [Review] [52 refs]. Seminars Pediatr Infect Dis 2002;13(3):174–181.
Maltezou HC, Drancourt M. Nosocomial influenza in children. [Review] [71 refs]. J Hosp Infect 2003;55(2):83–91.
Slinger R, Dennis P. Nosocomial influenza at a Canadian pediatric hospital from 1995 to 1999: opportunities for prevention. Infect Control Hosp Epidemiol 2002;23(10):627–629.
Evans ME, Hall KL, Berry SE. Influenza control in acute care hospitals. Am J Infect Control 1997;25(4):357–362.
Isaacs D. Should all Australian children be vaccinated against influenza? Questions of cost-effectiveness, vaccine efficacy and feasibility are yet to be answered. Med J Aust 2005;182(11):553–554.
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