Abstract
BackgroundThere have been few studies on children hospitalized with influenza published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven influenza hospitalized children in Suzhou, China.MethodsRetrospective study on children with documented influenza infection hospitalized at Suzhou Children Hospital during 2005–2009 was conducted using a structured chart review instrument.ResultsA total of 480 children were positive by immuno-fluorescent assay for influenza during 2005–2009. The hospitalizations for influenza occurred in 8–12 months of the year, most commonly in the winter with a second late summer peak (August-September). Influenza A accounted for 86.3%, and of these 286 (59.6%) were male, and 87.2% were <5 years of age. The median length of hospital stay was 7 days. Fever was the most common symptom, occurring in 398 (82.9%) children. There were 394 (82.1%) children with pneumonia and 70.2% of these hospitalized children had radiographic evidence of a pulmonary infiltrate. One hundred and twelve children (23.3%) required oxygen treatments and 13 (2.7%) were transferred to the ICU. Multivariable logistic regression showed that compared with the ≤6 months children, those aged >60 months old had shorter hospital stay (OR = 0.45); children with oxygen treatment tended to have longer hospital stays than those without oxygen treatment (OR = 2.14). The mean cost of each influenza-related hospitalization was US$ 624 (US$ 1323 for children referred to ICU and US$ 617 for those cared for on the wards). High risk children had higher total cost than low-risk patients.ConclusionCompared to other countries, in Suzhou, children hospitalized with influenza have longer hospital stay and higher percentage of pneumonia. The direct medical cost is high relative to family income. Effective strategies of influenza immunization of young children in China may be beneficial in addressing this disease burden.
Highlights
Seasonal epidemics of influenza are responsible for respiratory diseases in children each year, resulting substantial morbidity, mortality and increased burden on health utilization, but this has tended to be under-recognized, especially in the Asian region [1,2]
In the United States, 80% of influenza-associated hospitalization in children occur in children,5 years of age and more than half of influenza mortality among children occurs in this age group
Several studies [6,7] have shown that young children are important in the spread of community influenza since they often introduce the infection to their families, disseminate infection through schools to the broader community with accumulating evidences demonstrating that immunization of young children can reduce disease rates in unimmunized members of the local community [8]
Summary
Seasonal epidemics of influenza are responsible for respiratory diseases in children each year, resulting substantial morbidity, mortality and increased burden on health utilization, but this has tended to be under-recognized, especially in the Asian region [1,2]. Various studies have indicated that young children are at high risk for serious illness and hospitalization from influenza virus infection [3,4]. A study using an excess-hospitalization analysis framework showed that admission rates in Hong Kong for influenza were 3 to 10 times as high as those reported for children in the United States [5]. In 2009, the American Advisory Committee on Immunization Practices (ACIP) recommended that annual influenza vaccination be administrated to all children 6 months -18years [9]. There have been few studies on children hospitalized with influenza published from mainland China. We performed a retrospective review of medical charts to describe the epidemiology, clinical features and direct medical cost of laboratory-proven influenza hospitalized children in Suzhou, China
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