Seasonal Influenza In Children Research Articles

Seasonal influenza in children: complications, treatment, prevention (subject publication review).

Aim: To study the specificity of seasonal flu in children, in particular, in young children, as well as treatment, prevention and complications of seasonal flu. Materials and Methods: For the methodological justification of the article, we used the pool of research technologies. Methods of theoretical analysis, system-analytical, comparative methods provided us with the opportunity to characterize the features of influenza incidence in children. Conclusions: A distinctive feature of influenza is the high lability of the genes of the infectious agent. In this regard, it is extremely important to timely update information about new strains of the pathogen, creation of new types of vaccines and antiviral drugs, as well as changes in the course of the disease. Our literature review is intended to improve the medical community.

The comparison of COVID-19 vs seasonal influenza in children.

Influenza in children has been well described, whereas there has been a paucity of pediatric data regarding COVID-19. It is crucial for clinicians to differentiate cases of COVID-19 from cases of influenza because of the upcoming influenza season in the new pandemic era. This retrospective study included pediatric patients who were diagnosed with laboratory-confirmed COVID-19 between March and September 2020, or seasonal influenza between October 2019 and March 2020. A total of 315 children were included in this study; 151 were diagnosed with influenza and 164 had confirmed COVID-19. The median age of patients with COVID-19 was 10 years (interquartile range [IQR]: 3-15 years), whereas the median age of patients with influenza was 4 years (IQR: 1-6 years) (p = 0.001). In the COVID-19 group, 6.3% of patients had underlying diseases, the most frequent being neurological conditions (3%). In the influenza group, 20.9% of patients had an underlying disease, the most frequent being asthma (14.5%). Fever (odds ratio [OR]: 20.476; 95% confidence interval [CI]: 2.438-171.995; p = 0.005), dyspnea/tachypnea (OR 13.950; 95% CI: 2.607-74.634; p = 0.002), and increased C-reactive protein (CRP) (OR: 7.650; 95% CI: 2.094-27.955; p = 0.002) were main predictors of influenza diagnosis in comparison to COVID-19. Lymphopenia was detected in 43.2% of patients with influenza and 19.9% of patients with COVID-19 (p = 0.001). The accurate differentiation between "influenza or COVID-19" seems possible by evaluating a combination of factors including cough, fever, vomiting, leucopenia, lymphopenia, pneumonia, in pediatric patients with high CRP as well as age.

Parental Attitudes and Perceptions of Support after Brief Clinician Intervention Predict Intentions to Accept the Adjuvanted Seasonal Influenza Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-I.

Adjuvanted trivalent influenza vaccine (aTIV) provides enhanced protection against seasonal influenza in children compared with nonadjuvanted trivalent influenza vaccine (TIV). This prospective cohort study assessed parental attitudes, beliefs, and intentions to vaccinate their infants aged 6-23 months with aTIV. Parents were surveyed before and after routine healthy baby visits, and post clinician interaction results were analyzed using multivariable logistic regression. Physicians at 15 community practice clinics and nurses at 3 public health clinics participated; 207 parents were surveyed. After clinician consultation, most parents considered immunization with aTIV to be safe (72.9%), effective (69.6%), and important (69.0%); most perceived support for vaccination from significant others (62.8%) and clinicians (81.6%); and 66.6% intended to vaccinate their infant with aTIV. Parental attitudes toward vaccinating their infant with aTIV were strongly correlated with perceptions of vaccine safety, efficacy, and importance, and these represented the strongest influence on intentions to vaccinate (odds ratio (OR) 79.25; 95% confidence interval (CI) 6.05-1037.50). Parental intentions were further influenced by perceived strength of clinician recommendation (OR 4.55, 95% CI 1.38-15.06) and social support for vaccination (OR 3.46, 95% CI 0.50-24.13). These findings may inform clinician approaches to parental education to ensure optimal seasonal pediatric influenza vaccination.

Rate of diagnosed seasonal influenza in children with influenza-like illness: A cross-sectional study

IntroductionAlthough influenza surveillance systems have been used to monitor influenza epidemics, these systems generally evaluate diagnostic information obtained from medical institutions and they do not include patients who have not been examined. In contrast, community based epidemiological studies target people with influenza-like illness (ILI) that self-reported influenza-like symptoms whether they have medical examinations or not. Because the criteria for influenza surveillance systems and ILI differ, there is a gap between them. The purpose of this study was to clarify this gap using school-based survey data.MethodsQuestionnaires about both ILI and the influenza diagnosis history during the 2018/19 season were administered to the guardians of 11,684 elementary schoolchildren in a single city in Japan. Based on their responses, a Bayesian model was constructed to estimate the probability of infection, ILI onset, and diagnosis at medical institutions.ResultsResponses were obtained from guardians of 10,309 children (88.2%). Of these, 3,380 children (32.8%) had experienced ILI, with 2,380 (23.1%) diagnosed as influenza at a medical institution. Bayesian estimation showed that the probability of influenza cases being diagnosed among ILI symptomatic children was 70% (95% credible interval, 69–71%). Of the infected children, 5% were without ILI symptoms, with 11% of these patients diagnosed with influenza.ConclusionsThis epidemiological study clarified the proportion gap between ILI and influenza diagnosis among schoolchildren. These results may help to establish epidemic control measures and secure sufficient medical resources.

Seasonal influenza in children: Costs for the health system and society in Europe.

BackgroundPediatric influenza causes significant morbidity annually, resulting in an increased economic burden. Therefore, we aimed to summarize existing literature regarding the costs of pediatric influenza in Europe, paying particular attention to the direct and indirect costs considered in the economic evaluations. Knowing health and social costs of childhood influenza is essential to support value‐based health decisions to implement effective immunization strategies.MethodsWe searched three databases for articles published to September 3, 2021. Eligible studies were those reporting the economic burden of influenza in the pediatric and youth population in European countries written in English language.ResultsOverall, 2225 records were screened, and 9 articles were included. Costs estimates are different across countries and in the age groups considered. Direct costs per episode, whose major expense driver are hospitalizations and pediatric examinations, range from about €74 in Italy to €252 in Germany. Important variations are observed based on age, with the youngest group absorbing in some cases double the resources of the older ones such as (in Italy, in France and in Germany). Regarding indirect costs, workdays lost by parents resulted in higher costs for children <2 years and 2–5 years than those >5 years of age and their economic impact was variable reaching €251 per week in Germany.ConclusionEvidence obtained in our review strengthened the awareness about the economic impact, in terms of direct and indirect costs, of pediatric influenza requiring, as a priority action in Europe, the implementation of influenza vaccination policies in this target population.

Burden of severe illness associated with laboratory confirmed influenza in adults aged 50-64 years: A rapid review.

BackgroundWhile the high burden of illness caused by seasonal influenza in children and the elderly is well recognize, less is known about the burden in adults 50–64 years of age. The lack of data for this age group is a key challenge in evaluating the cost‐effectiveness of immunization programs. We aimed to assess influenza‐associated hospitalization and mortality rates and case fatality rates for hospitalized cases among adults aged 50–64 years.MethodsThis rapid review was conducted according to the PRISMA; we searched MEDLINE, EMBASE, Cochrane, Web of Science, and grey literature for articles and reports published since 2010. Studies reporting rates of hospitalization and/or mortality associated with laboratory‐confirmed influenza among adults 50–64 or 45–64 years of age for the 2010–11 through 2019–20 seasons were included.ResultsTwenty studies from 13 countries were reviewed. Reported rates of hospitalization associated with laboratory‐confirmed influenza were 5.7 to 112.8 per 100,000. Rates tended to be higher in the 2015–2019 compared with the 2010–2014 seasons and were higher in studies reporting data from high‐income versus low and middle‐income countries. Mortality rates were reported in only one study, with rates ranging from 0.8 to 3.5 per 100,000 in four different seasons. The case fatality rate among those hospitalized with influenza, as reported by population‐based studies, ranged from 1.3% to 5.6%.ConclusionsSeasonal influenza imposes a significant burden of morbidity on adults 50–64 years of age but with high heterogeneity across seasons and geographic regions. Ongoing surveillance is required to improve estimates of burden to better inform influenza vaccination and other public health policies.

Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study

SummaryBackgroundSeasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI occurred in children under 5 years globally. Despite this substantial burden, only a few low-income and middle-income countries have adopted routine influenza vaccination policies for children and, where present, these have achieved only low or unknown levels of vaccine uptake. Moreover, the influenza burden might have changed due to the emergence and circulation of influenza A/H1N1pdm09. We aimed to incorporate new data to update estimates of the global number of cases, hospital admissions, and mortality from influenza-virus-associated respiratory infections in children under 5 years in 2018.MethodsWe estimated the regional and global burden of influenza-associated respiratory infections in children under 5 years from a systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies. We adapted the Newcastle-Ottawa Scale to assess the risk of bias. We estimated incidence and hospitalisation rates of influenza-virus-associated respiratory infections by severity, case ascertainment, region, and age. We estimated in-hospital deaths from influenza virus ALRI by combining hospital admissions and in-hospital case-fatality ratios of influenza virus ALRI. We estimated the upper bound of influenza virus-associated ALRI deaths based on the number of in-hospital deaths, US paediatric influenza-associated death data, and population-based childhood all-cause pneumonia mortality data in six sites in low-income and lower-middle-income countries.FindingsIn 2018, among children under 5 years globally, there were an estimated 109·5 million influenza virus episodes (uncertainty range [UR] 63·1–190·6), 10·1 million influenza-virus-associated ALRI cases (6·8–15·1); 870 000 influenza-virus-associated ALRI hospital admissions (543 000–1 415 000), 15 300 in-hospital deaths (5800–43 800), and up to 34 800 (13 200–97 200) overall influenza-virus-associated ALRI deaths. Influenza virus accounted for 7% of ALRI cases, 5% of ALRI hospital admissions, and 4% of ALRI deaths in children under 5 years. About 23% of the hospital admissions and 36% of the in-hospital deaths were in infants under 6 months. About 82% of the in-hospital deaths occurred in low-income and lower-middle-income countries.InterpretationA large proportion of the influenza-associated burden occurs among young infants and in low-income and lower middle-income countries. Our findings provide new and important evidence for maternal and paediatric influenza immunisation, and should inform future immunisation policy particularly in low-income and middle-income countries.FundingWHO; Bill & Melinda Gates Foundation.

Meta-analysis on effectiveness of live attenuated influenza vaccine against seasonal influenza in children

Objective: To evaluate the effectiveness of live attenuated influenza vaccine (LAIV) in the prevention of seasonal influenza in children aged 2-17 years. Methods: Literature retrieval of case-control studies on the effectiveness of LAIV against seasonal influenza in children published from January 2003 to November 2018 was conducted through Web of Science, PubMed, and ScienceDirect databases. The Stata 13.1 software was used for Meta-analysis. Results: A total of 14 studies were included in this study, and all were test-negative design (TND) studies. Our Meta-analysis showed that the effectiveness of LAIV in children was 49% (95%CI: 40%-57%). Subgroup analysis found that the protection rate of LAIV was 35% against influenza A (H1N1) pdm09 (95%CI: 5%-56%), 35% against influenza A (H3N2) (95%CI: 21%-46%), and 71% against influenza B (95%CI: 55%-82%). The protection rates of trivalent LAIV and quadrivalent LAIV in children were 56% (95%CI: 48%-63%) and 44% (95%CI: 27%-57%), respectively. The protection rates of LAIV in Europe and North America were 65% (95%CI: 47%-77%) and 46% (95%CI: 36%-55%), respectively. Conclusion: LAIV has a certain preventive effect on seasonal influenza in children aged 2-17 years.

Клинико-лабораторные характеристики гриппа у детей с ожирением

Objective. To determine the most general patterns of the clinical and laboratory course of seasonal influenza in children with obesity compared with normal weight children. Patients and methods. A retrospective comparative study of 117 medical records of children with influenza admitted from 2016 to 2019 to the Regional Infectious Diseases Hospital was conducted. The study included two groups of children with seasonal influenza: children with obesity (cases, n = 36) and children with normal weight (controls, n = 81). Nasopharyngeal swabs were tested for influenza and other common respiratory pathogens by PCR. A comparative analysis of structure, prevalence and duration of main clinical symptoms and syndromes, occurrence of influenza complications, data of laboratory general, biochemical and instrumental methods of examination in children with and without obesity was carried out. Results. A prevalence of type A influenza virus (H1N1 sw2009) in all children regardless their body weight status was detected. Children with obesity were admitted to the hospital from out-patient department faster (p &lt; 0.005), duration of their hospitalization were longer (p &lt; 0.005). They had higher frequency of pneumonia (p &gt; 0.05), ketoacidosis (p &lt; 0.001). Intravenous maintenance fluid therapy was ordered more often in patients with obesity (p &lt; 0.03). Hematologic factors of blood in children with obesity were defined by significantly higher level of erythrocyte sedimentation rate (p = 0.0006) and platelet level (p = 0.0032). Conclusion. Obesity is considered as an unfavorable factor which aggravates the course of influenza in children. Higher probability of complications in children with obesity and overweight defines the importance of development of additional approaches to the therapy and prevention of acute respiratory diseases in children. Key words: children, clinical symptoms, influenza, obesity, retrospective study

A Retrospective Cohort Study of the Incidence, Health Care Resource Utilization and Costs of International Classification of Diseases, Clinical Modification, 9th Revision Diagnosed Influenza and Related Complications in US Children.

There is a paucity of data on the clinical and economic impact of seasonal influenza in children. This study estimated the incidence of diagnosed influenza and related complications and associated health care resource utilization and costs in US children. Children ≥6 months and <18 years old diagnosed with influenza using International Classification of Diseases, Clinical Modification, 9th revision codes and enrolled in a health plan during at least one influenza season between 2010 and 2014 were matched to similar patients without diagnosed influenza (GSK study identifier: HO-15-15728). Outcomes included incidence of influenza and complications, health care resource utilization frequency and health care costs during 21 days of follow-up. Adjusted costs were estimated using generalized linear models. Incidence (per 1000) of influenza was 20.3 (commercially insured) and 32.6 (Medicaid), with the highest incidence among 6-35 months old (Commercial: 26.8; Medicaid: 47.9). Approximately 12%-17% of influenza patients experienced complications, with the 6-35 months group having the highest percentage (25%-30%). The 6-35-month-old influenza patients with complications had the highest proportion with hospitalizations (5%-6%) and emergency room visits (Commercial: 19%; Medicaid: 36%). Influenza patients with (vs. without) complications had greater adjusted mean influenza-specific costs (Commercial: $1161 vs. $337; Medicaid: $1199 vs. $354; P<0.05), and influenza cases (vs. controls) had greater adjusted mean all-cause costs (Commercial: $688 vs. $470; Medicaid: $818 vs. $453; P < 0.05). Pediatric patients with influenza incurred higher health care costs compared with matched controls, and influenza-specific costs were greater among those with complications.

Neurologic and Neuromuscular Complications of Seasonal Influenza in Children

목적: 인플루엔자는 호흡기 증상을 일으키는 흔한 원인이지만 드물게 심각한 신경학적 증상 또한 일으키는 것으로 알려져 있다. 본 연구에서는 2013년 계절성 인플루엔자 유행기간 동안 인플루엔자의 신경학적 합병증을 보인 소아 환자들에 대해서 기술하고 계절성 인플루엔자의 신경학적 합병증은 대부분 양성 경과를 보이는지에 대해서 알아보고자 하였다. 방법:...

Burden of seasonal influenza in children with neurodevelopmental conditions.

Studies have identified certain neurologic and neurodevelopmental conditions (NNC) as risk factors for severe influenza infection. The Canadian National Advisory Committee on Immunization does not currently recognize children with NNC as having a high risk of complicated influenza infection unless their condition compromises handling of respiratory secretions. We describe the burden of influenza in hospitalized children with NNC, focusing on those without potential airway compromise. Using multi-year surveillance data obtained by the Canadian Immunization Monitoring Program, Active (IMPACT), we examined presenting signs and symptoms, risk factors and outcomes of children hospitalized with seasonal influenza at 12 Canadian pediatric referral centers. Comparisons were made between children with various NNC and other medical conditions, with and without influenza vaccine indications. The analysis is descriptive with selected comparisons made among groups for important indicators of disease severity. We identified 1991 children hospitalized with influenza over 5 seasons: 293 had NNC, 115 of whom did not have airway compromise or another vaccine indication. The latter group presented with seizures more frequently than those with NNC and a vaccine indication (41.7% vs. 26.4%; P = 0.006) and required intensive care unit admission (20.9% vs. 11.8%; P = 0.02) and mechanical ventilation (14.8% vs. 4.5%; P < 0.001) more often than children without NNC but with a vaccine indication. The burden of influenza infection in children with NNC, even those whose conditions do not obviously compromise respiratory function, is significant. All children with NNC should be recognized as having a high risk of complicated influenza infection and be targeted to receive influenza immunization.

Economic benefits of inactivated influenza vaccines in the prevention of seasonal influenza in children

The aim of this study was to systematically review published studies that evaluated the efficiency of inactivated influenza vaccination in preventing seasonal influenza in children. The vaccine evaluated was the influenza-inactivated vaccine in 10 studies and the virosomal inactivated vaccine in 3 studies. The results show that yearly vaccination of children with the inactivated influenza vaccine saves money from the societal and family perspectives but not from the public or private provider perspective. When vaccination does not save money, the cost-effectiveness ratios were very acceptable. It can be concluded, that inactivated influenza vaccination of children is a very efficient intervention.

The effect of physician's recommendation on seasonal influenza immunization in children with chronic diseases.

BackgroundDespite recommendations by Health Authorities, influenza immunization coverage remains low in children with chronic diseases. Different medical providers involved in the management of children with chronic conditions may affect the pattern of influenza vaccine recommendations and coverage. The likelihood of vaccination by type of provider in children with chronic conditions is poorly understood. Therefore, the objectives of this study were to analyze the pattern and the effect of recommendations for seasonal influenza immunization provided by different physician profiles to families of children with chronic diseases and to measure the frequency of immunization in the study population.MethodsWe recruited children with chronic diseases aged 6 months–18 years who subsequently presented to specialty clinics for routine follow-up visits, during spring 2009, in three Italian Regions Families of children with chronic diseases were interviewed during routine visits at reference centers through a face-to-face interview. We analyzed the following immunization predictors: having received a recommendation toward influenza immunization by a health provider; child’s sex and age; mothers and fathers’ age; parental education and employment; underlying child’s disease; number of contacts with health providers in the previous year. Influenza immunization coverage was calculated as the proportion of children who received at least one dose of seasonal influenza vaccine in the previous season. We calculated prevalence ratios and we used a generalized linear model with Poisson family, log link and robust error variance to assess the effect of socio-demographic variables, underlying diseases, and recommendations provided by physicians on influenza immunization.ResultsWe enrolled 275 families of children with chronic diseases. Overall influenza coverage was 57.5%, with a low of 25% in children with neurological diseases and a high of 91.2% in those with cystic fibrosis. While 10.6% of children who did not receive any recommendation toward influenza immunization were immunized, among those who received a recommendation 87.5-94.7% did, depending on the health professional providing the recommendation. Receiving a recommendation by any provider is a strong predictor of immunization (PR = 8.5 95% CI 4.6;15.6) Most children received an immunization recommendation by a specialty (25.8%) or a family pediatrician (23.3%) and were immunized by a family pediatrician (58.7%) or a community vaccinator (55.2%).ConclusionsReceiving a specific recommendation by a physician is a strong determinant of being immunized against seasonal influenza in children with chronic diseases independently of other factors. Heterogeneity exists among children with different chronic diseases regarding influenza recommendation despite international guidelines. Increasing the frequency of appropriate recommendations toward influenza immunization by physicians is a single powerful intervention that may increase coverage in children with chronic conditions.

Cost-Effectiveness of Oseltamivir Treatment for Children With Uncomplicated Seasonal Influenza

TA Lavelle, TM Uyeki, LA Prosser. J Pediatr. 2012;160(1):67–73.e6 To evaluate the cost-effectiveness of oseltamivir treatment for seasonal influenza in children and consider the impact of oseltamivir resistance on these findings. Unvaccinated children, stratified according to age groups (12–23 months, 2 years, 3–4 years, 5–11 years, and 12–17 years) visiting a physician’s office with age-appropriate symptoms of uncomplicated influenza-like illness. The investigators developed a model to evaluate 1-year clinical and economic outcomes associated with 3 …

Safety and tolerability of a 6‐week course of oseltamivir prophylaxis for seasonal influenza in children

Please cite this paper as: Reisinger et al. Safety and tolerability of a 6‐week course of oseltamivir prophylaxis for seasonal influenza in children. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00367.x.In an open‐label study, 49 children aged 1–12 years received oseltamivir (30–75 mg once daily depending on bodyweight) for 6 weeks for influenza prophylaxis. Seventeen participants reported 22 adverse events (AEs); in three participants, AEs were considered probably drug related (nausea or vomiting). No serious AEs were reported. The tolerability profile was similar to pooled safety data from treatment studies (duration of 5 days) in children.

Characteristics and Outcomes of Pandemic 2009/H1N1 Versus Seasonal Influenza in Children With Cancer

Novel 2009/H1N1 influenza has significant impact on immunocompromised children with cancer; however, it is uncertain how it compares with seasonal influenza (SFlu) in this vulnerable population. We compared clinical characteristics and outcomes for these 2 infections in children with cancer and identified risk factors for progression to lower respiratory infection (LRI) and/or death. Influenza infections confirmed by positive viral culture and/or fluorescence antigen test between January 1998 and February 2010 were identified from microbiology databases at a comprehensive cancer center. Characteristics and outcomes were compared for the 2 groups. Kaplan-Meier survival curves and Cox proportional hazards model were generated to identify risk factors for LRI and/or death. When compared with SFlu, 2009/H1N1 cases had significantly lower acute physiology and chronic health evaluation II score (median: 9 versus 14), fewer comorbidities (15% versus 46%), fewer hematopoietic stem-cell transplantation (5% versus 16%), more solid tumors (45% versus 16%), higher LRI at presentation (20% versus 4%), higher rates of antiviral therapy (90% versus 48%) and higher mortality (10% versus 0%). Male gender (hazard ratio [HR]: 8.4, 95% confidence interval [CI]: 1.08-65.2, P = 0.042), acute physiology and chronic health evaluation II score > 15 (HR: 3.29, 95% CI: 1.04-10.39, P = 0.027) and a 24-hour delay in initiation of antiviral treatment (HR: 1.12, 95% CI: 1.02-1.23, P = 0.015) were the most significant predictors of progression to LRI and mortality, regardless of virus strain. Significant differences between 2009/H1N1 and SFlu with respect to clinical presentation, management and associated outcomes were identified. Early diagnosis and prompt initiation of antiviral therapy may prevent serious complications of influenza in children with cancer.

ACUTE CHEST SYNDROME with RESPIRATORY Syncytial VIRUS and SEASONAL INFLUENZA In CHILDREN with SICKLE CELL DISEASE

Abstract 4845 Background:Respiratory syncytial virus (RSV) has been recognized as a cause of acute chest syndrome (ACS) in children with sickle cell disease (SCD). However, the proportion of children with RSV and SCD that are admitted to hospital or develop ACS is unknown. In studies of young children without SCD, RSV has traditionally been associated with more hospitalizations in the first three years of life then influenza has. To compare the relative severity of RSV vs. seasonal influenza in children with SCD, we compared the clinical characteristics and complications associated with these infections at a single tertiary care hospital. Methods:We defined a case as laboratory-confirmed RSV infection in a patient <18 years with SCD who was evaluated at Johns Hopkins Hospital from 1 September 1993 to June 30 2008. Through July 2006, we searched the discharge and billing databases for Johns Hopkins Hospital to identify those with SCD and laboratory testing for respiratory infections. Thereafter, we prospectively identified cases through divisional records. We confirmed the diagnosis of RSV by review of microbiology results in each patient’s paper and/or electronic medical record. We used Fisher’s exact test to compare proportions, Student’s t-test or Wilcoxon rank-sum test to compare continuous variables, and logistic regression to evaluate associations. Results:We identified 47 patients with SCD and RSV and 76 with influenza during the study period. Clinical symptoms, such as reported fever (83% vs. 89%), cough (98% vs. 93%), and rhinorrhea (90% vs. 80%), were similar for RSV and influenza as were complications, including acute chest syndrome (Table). Treatments given for RSV and influenza including antibacterials (100% vs. 97%), transfusions (7% vs. 11%), and invasive ventilation (4% vs. 0%, p=0.15),with possibly more bronchodilator use for RSV (50% vs. 33%, p=0.055). In a multivariable logistic regression model, older age (OR 1.3 per year, 95% CI 1.04 –1.5, P=.02) and increased white blood cell count (WBC) at presentation (OR 1.2 per 1000/ul increase, 95% CI 1.03 – 1.4, P=0.02) were independently associated with increased risk of ACS in children with RSV. Discussion:Laboratory confirmed RSV infection was predominantly identified in infants and toddlers, while influenza infection was identified in children of all ages. This parallels RSV hospitalizations in the general population, where children are most likely to be hospitalized in the first few years of life. Both older age and high WBC at presentation may be a risk factor for more severe disease. This is unlikely to reflect referral bias (with only the sickest older children being referred for tertiary pediatric care) as a similar pattern was not seen for influenza infection. We conclude that RSV infection is often associated with ACS and similar in severity to influenza infection in children with SCD. An episode of ACS in the first three years of life was associated with more frequent ACS episodes later in childhood in the Dallas Newborn cohort. Since a significant proportion of patients with RSV develop ACS at a young age, RSV infection may represent a modifiable risk factor for recurrent ACS. An area for further study would be the efficacy or cost effectiveness of prevention of RSV-related hospitalizations. Palivizumab, a monoclonal antibody to RSV, has been shown to prevent complications related to RSV in other high risk groups and could be considered as an intervention in SCD that may decrease morbidity.Table:Characteristics of Children with Respiratory Syncytial Virus (RSV) and Sickle Cell Disease (SCD), Johns Hopkins Hospital 1993–2008VariableRSV n=47Influenza n=76P-ValueAge (years)1.5 (0.7 − 3.4)4.3 (1.7 – 10.9)0.0001Male62%53%0.34HbSS79%84%0.57Acute chest syndrome22% (9/41)12% (8/69)0.15Hospital admission100%88%0.02Intensive Care4%3%0.64RBC Transfusion7%11%0.66Length of stay (days)2 (1 – 3)2 (1−3)0.11Hospital Charges ($)4676 (3350-6348)4569 (3008-6419)0.53IQR, interquartile range; HbSS, sickle cell anemia; RBC, red blood cells; Disclosures:No relevant conflicts of interest to declare.

Cost-Effectiveness of Oseltamivir Treatment for Children with Uncomplicated Seasonal Influenza

To evaluate the cost-effectiveness of oseltamivir treatment for seasonal influenza in children and consider the impact of oseltamivir resistance on these findings. We developed a model to evaluate 1-year clinical and economic outcomes associated with 3 outpatient management strategies for unvaccinated children with influenza-like-illness: no antiviral treatment; diagnostic testing and oseltamivir treatment when positive; and empiric oseltamivir treatment. The model depicted a hypothetical non-pandemic influenza season with a 29% level of oseltamivir resistance in circulating viruses, and 14% to 54% probability of seasonal influenza with influenza-like-illness. Strategies were compared with incremental cost-effectiveness ratios. In our primary analysis, empiric oseltamivir treatment consistently produced the greatest benefit. The incremental cost-effectiveness of this alternative, compared with testing and treating, was <$100,000 per quality-adjusted life year gained in all age groups except the oldest. The testing strategy was consistently more effective compared with no treatment and cost between $25,900 and $71,200 per quality-adjusted life year gained, depending on age. Results were sensitive to the prevalence of oseltamivir resistance in circulating viruses. Empiric oseltamivir treatment of seasonal influenza is associated with favorable cost-effectiveness ratios, particularly in children aged 1 to <12 years, but ratios are highly dependent on the prevalence of oseltamivir resistance among circulating influenza viruses.

Severe pandemic H1N1 and seasonal influenza in children and young adults with sickle cell disease

AbstractInfluenza causes excess morbidity in sickle cell disease (SCD). H1N1 pandemic influenza has been severe in children. To compare H1N1 with seasonal influenza in SCD (patients younger than 22), we reviewed medical records (1993-2009). We identified 123 cases of laboratory-confirmed influenza (94 seasonal, 29 H1N1). Those with seasonal influenza were younger (median 4.4 vs 8.7 years old, P = .006) and had less asthma (24% vs 56%, P = .002). Those with H1N1 influenza more often had acute chest syndrome (ACS; 34% vs 13%, P = .01) and required intensive care (17% vs 3%, P = .02), including mechanical ventilation (10% vs 0%, P = .02). In multivariate analysis, older age (odds ratio [OR] 1.1 per year, P = .04) and H1N1 influenza (OR 3.0, P = .04) were associated with ACS, and older age (OR 1.1 per year, P = .02) and prior ACS (OR 3.3 per episode in last year, P < .006) with intensive care. Influenza, especially H1N1, causes critical illness in SCD and should be prevented.