Download PDF
J Pediatr Infect Dis 2022; 17(02): 076-082
DOI: 10.1055/s-0041-1741003
Original Article

Evaluation of Influenza Patients Admitted in 2019–2020 Flu Season

Bahar Öztelcan Gündüz 
1   Department of Pediatrics, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
,
Erman Ataş
2   Division of Pediatric Hematology and Oncology, Deparment of Pediatrics, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
,
Bülent Ünay
3   Division of Pediatric Neurology, Deparment of Pediatrics, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
,
Halit Halil 
4   Division of Pediatric Emergency Medicine, Deparment of Pediatrics, University of Health Sciences, Dr Sami Ulus Training and Research Hospital, Ankara, Turkey
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective Influenza viruses are among the most common respiratory pathogens for all age groups, and may cause seasonal outbreaks. The aim of our study was to describe the clinical characteristics of influenza cases in the 2019–2020 flu season and to study the risk factors for hospital admission and complications.

Methods This was a retrospective study in 251 children (group 1: nonhospitalized; group 2: hospitalized) with influenza in the 2019–2020 flu season. Data on demographic features, influenza type, complaints, complications, and hospitalization length were collected and recorded.

Results Influenza A was detected in 199 (79.3%) patients, and influenza B was detected in 52 (20.7%); 43.4% of patients were girls and 56.6% were boys. The mean age of the patients was 3.91 ± 3.3 years (16 days to 18 years). A total of 52 (20.7%) patients were hospitalized. The age of the patients in group 2 was lower than that in group 1 (3.1 vs. 4.2 years, p = 0.03). Group 2 patients were more likely to have creatine kinase (CK) elevation, febrile seizures, and physical examination abnormalities. Group 2 patients were also more likely to have influenza A. Patients with febrile seizures, chronic diseases, abnormal physical examination findings, developed complications, and additional drug use apart from oseltamivir in the treatment were also more likely to require hospitalization.

Conclusion Infants and children with chronic diseases, history of febrile seizures, complications, and the use of drugs other than antiviral drugs should be carefully evaluated in case they need hospitalization. Increasing vaccination rates, initiation of antiviral treatment for selected patients, and close monitoring of patients in risk groups can decrease morbidity and mortality. Myalgias are a common complaint in patients with acute influenza infection. Previous studies suggest CK measurement be part of the work-up for the hospitalized patient with acute influenza infection.

Keywords

influenza - healthy children - hospital admission - complications


Publication History

Received: 15 February 2021

Accepted: 14 November 2021

Article published online:
03 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Sellers SA, Hagan RS, Hayden FG, Fischer II WA. The hidden burden of influenza: a review of the extra-pulmonary complications of influenza infection. Influenza Other Respir Viruses 2017; 11 (05) 372-393
    CrossrefPubMedGoogle Scholar
  • 2 Lafond KE, Nair H, Rasooly MH. et al; Global Respiratory Hospitalizations—Influenza Proportion Positive (GRIPP) Working Group. Global role and burden of influenza in pediatric respiratory hospitalizations, 1982–2012: a systematic analysis. PLoS Med 2016; 13 (03) e1001977
    CrossrefPubMedGoogle Scholar
  • 3 Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and Control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices - United States, 2019-20 influenza season. MMWR Recomm Rep 2019; 68 (03) 1-21
    CrossrefPubMedGoogle Scholar
  • 4 Demir SÖ, Atıcı S, Kadayifci EK. et al. Influenza A (H1N1)-associated severe complications; hemolytic uremic syndrome, myocarditis, acute necrotizing encephalopathy. J Infect Dev Ctries 2019; 13 (01) 83-86
    CrossrefPubMedGoogle Scholar
  • 5 Dai Z, Zhang L, Yu Q, Liu L, Yang M, Fan K. Early administration of oseltamivir within 48 hours after onset of flulike symptoms can reduce the risk of influenza B Virus-Associated Pneumonia in hospitalized pediatric patients with influenza B virus infection. Pediatr Infect Dis J 2020; 39 (02) e20-e22
    CrossrefPubMedGoogle Scholar
  • 6 Cruz AT, Demmler-Harrison GJ, Caviness AC, Buffone GJ, Revell PA. Performance of a rapid influenza test in children during the H1N1 2009 influenza a outbreak. Pediatrics 2010; 125 (03) e645-e650
    CrossrefPubMedGoogle Scholar
  • 7 World Health Organization. Influenza (seasonal). Factsheet No 211. WHO Website. Accessed February 4, 2016 at: https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/vaccines-quality/influenza
    PubMedGoogle Scholar
  • 8 Çiftçi E, Tuygun N, Özdemir H. et al. Clinical and epidemiological features of Turkish children with 2009 pandemic influenza A (H1N1) infection: experience from multiple tertiary paediatric centres in Turkey. Scand J Infect Dis 2011; 43 (11–12): 923-929
    CrossrefPubMedGoogle Scholar
  • 9 El Guerche-Séblain C, Moureau A, Schiffler C. et al. Epidemiology and burden of influenza in healthy children aged 6 to 35 months: analysis of data from the placebo arm of a phase III efficacy trial. BMC Infect Dis 2019; 19 (01) 308
    CrossrefPubMedGoogle Scholar
  • 10 Turkish Ministry of Health, General Directorate of Public Health, Department of Infectious Diseases, Weekly Influenza Surveillance Report. 2020 . Available at: https://grip.gov.tr/tr/2019-2020-haftal%C4%B1k-i%CC%87nfluenza-raporlar%C4%B1.html
    PubMedGoogle Scholar
  • 11 Cantekin K. Turkey: government takes extraordinary administrative measures for the coronavirus pandemic. 2020 . Available at: https://www.loc.gov/item/global-legal-monitor/2020-03-24/turkey-government-takes-extraordinary-administrative-measures-for-the-coronavirus-pandemic/
    PubMedGoogle Scholar
  • 12 Emukule GO, Namagambo B, Owor N. et al. Influenza-associated pneumonia hospitalizations in Uganda, 2013-2016. PLoS One 2019; 14 (07) e0219012
    CrossrefPubMedGoogle Scholar
  • 13 Dawood FS, Fiore A, Kamimoto L. et al; Emerging Infections Program Network. Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008. J Pediatr 2010; 157 (05) 808-814
    CrossrefPubMedGoogle Scholar
  • 14 Sambala EZ, Ngcobo N, Machingaidze S. et al. A global review of seasonal influenza vaccine introduction: analysis of the WHO/UNICEF Joint Reporting Form. Expert Rev Vaccines 2019; 18 (08) 859-865
    CrossrefPubMedGoogle Scholar
  • 15 Böncüoğlu E, Kıymet E, Çağlar İ. et al. Influenza-related hospitalizations due to acute lower respiratory tract infections in a tertiary care children's hospital in Turkey. J Clin Virol 2020; 128: 104355
    CrossrefPubMedGoogle Scholar
  • 16 Oh YN, Kim S, Choi YB, Woo SI, Hahn Y-S, Lee JK. Clinical similarities between influenza A and B in children: a single-center study, 2017/18 season, Korea. BMC Pediatr 2019; 19 (01) 472
    CrossrefPubMedGoogle Scholar
  • 17 Middleton PJ, Alexander RM, Szymanski MT. Severe myositis during recovery from influenza. Lancet 1970; 2 (7672): 533-535
    CrossrefPubMedGoogle Scholar
  • 18 Agyeman P, Duppenthaler A, Heininger U, Aebi C. Influenza-associated myositis in children. Infection 2004; 32 (04) 199-203
    CrossrefPubMedGoogle Scholar
  • 19 Dietzman DE, Schaller JG, Ray CG, Reed ME. Acute myositis associated with influenza B infection. Pediatrics 1976; 57 (02) 255-258
    PubMedGoogle Scholar
  • 20 Mall S, Buchholz U, Tibussek D. et al. A large outbreak of influenza B-associated benign acute childhood myositis in Germany, 2007/2008. Pediatr Infect Dis J 2011; 30 (08) e142-e146
    CrossrefPubMedGoogle Scholar
  • 21 Kerr J, Macartney K, Britton PNJEJP. Influenza-associated myositis: a single-centre, 5-year retrospective study. Eur J Pediatr 2021; 180 (02) 577-584
    CrossrefPubMedGoogle Scholar
  • 22 Committee on Infectious Diseases. Recommendations for Prevention and Control of Influenza in Children, 2017 - 2018. Pediatrics 2018; 141 (01) e20173535
    CrossrefPubMedGoogle Scholar
  • 23 Committee on Infectious Diseases. Recommendations for prevention and control of influenza in children, 2019-2020. Pediatrics 2019; 144 (04) e20192478
    CrossrefPubMedGoogle Scholar
  • 24 Lee JJ, Bankhead C, Smith M, Kousoulis AA, Butler CC, Wang K. Risk factors for influenza-related complications in children during the 2009/10 pandemic: a UK primary care cohort study using linked routinely collected data. Epidemiol Infect 2018; 146 (07) 817-823
    CrossrefPubMedGoogle Scholar
  • 25 Paksu MS, Aslan K, Kendirli T. et al. Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study). Childs Nerv Syst 2018; 34 (02) 335-347
    CrossrefPubMedGoogle Scholar
  • 26 Carman KB, Calik M, Karal Y. et al. Viral etiological causes of febrile seizures for respiratory pathogens (EFES Study). Hum Vaccin Immunother 2019; 15 (02) 496-502
    CrossrefPubMedGoogle Scholar
  • 27 Kumar S, Havens PL, Chusid MJ, Willoughby Jr RE, Simpson P, Henrickson KJ. Clinical and epidemiologic characteristics of children hospitalized with 2009 pandemic H1N1 influenza A infection. Pediatr Infect Dis J 2010; 29 (07) 591-594
    CrossrefPubMedGoogle Scholar
  • 28 Bettinger JA, Sauvé LJ, Scheifele DW. et al. Pandemic influenza in Canadian children: a summary of hospitalized pediatric cases. Vaccine 2010; 28 (18) 3180-3184
    CrossrefPubMedGoogle Scholar
  • 29 Misurski DA, Lipson DA, Changolkar AK. Inappropriate antibiotic prescribing in managed care subjects with influenza. Am J Manag Care 2011; 17 (09) 601-608
    PubMedGoogle Scholar
  • 30 Eşki A, Öztürk GK, Gülen F, Çiçek C, Demir E. Risk factors for influenza virus related severe lower respiratory tract infection in children. Pediatr Infect Dis J 2019; 38 (11) 1090-1095
    CrossrefPubMedGoogle Scholar
  • 31 Antonova EN, Rycroft CE, Ambrose CS, Heikkinen T, Principi N. Burden of paediatric influenza in Western Europe: a systematic review. BMC Public Health 2012; 12 (12) 968
    CrossrefPubMedGoogle Scholar
  • 32 Baselga-Moreno V, Trushakova S, McNeil S. et al; Global Influenza Hospital Surveillance Network (GIHSN). Influenza epidemiology and influenza vaccine effectiveness during the 2016-2017 season in the Global Influenza Hospital Surveillance Network (GIHSN). BMC Public Health 2019; 19 (01) 487
    CrossrefPubMedGoogle Scholar
  • 33 Danier J, Rivera L, Claeys C. et al; Flu4VEC Study Group. Clinical presentation of influenza in children 6 to 35 months of age: findings from a randomized clinical trial of inactivated quadrivalent influenza vaccine. Pediatr Infect Dis J 2019; 38 (08) 866-872
    CrossrefPubMedGoogle Scholar
  • 34 Hekimoğlu CH, Emek M, Avcı E, Topal S, Demiröz M, Ergör G. Seasonal influenza vaccine effectiveness in preventing laboratory confirmed influenza in 2014–2015 season in Turkey: a test-negative case control Study. Balkan Med J 2018; 35 (01) 77-83
    CrossrefPubMedGoogle Scholar
  • 35 Arısoy ES, Çiftçi E, Hacımustafaoğlu M. et al. Vaccination in previously-healthy children: practice recommendations on vaccines included and not included in the national immunization schedule of the Republic of Turkey. J Pediatr Inf 2020; 14 (03) 160-174
    CrossrefPubMedGoogle Scholar
  • 36 Özceylan G, Toprak D, Esen ES. Vaccine rejection and hesitation in Turkey. Hum Vaccin Immunother 2020; 16 (05) 1034-1039
    CrossrefPubMedGoogle Scholar
  • 37 Yörük S, Türkmen H, Durgut A, Erbek M. Vaccine mistrust among family healthcare professionals and vaccine hesitancy in the communities they serve in Turkey in 2019: a cross-sectional study. Hum Vaccin Immunother 2020; 16 (12) 3155-3162
    CrossrefPubMedGoogle Scholar