Changes in trends and impact of testing for influenza in infants with fever &lt;90 days of age

Kim, Suji; Moon, Hye Min; Lee, Joon Kee; Rhie, Kyuyol; Yoon, Ki Wook; Choi, Eun Hwa; Lee, Hoan Jong; Lee, Hyunju

doi:10.1111/ped.13428

Cited by 10 publications

(12 citation statements)

References 25 publications

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“…Studies show that most febrile infants who were diagnosed with flu/RSV had either respiratory symptoms and/or sick contacts. 8,9,16,17,18 Identifying influenza and RSV may reduce antibiotic use and decrease unnecessary diagnostic testing. 2 Benito-Fernandez found that about 40% of all febrile infants <3 months of age who were tested for flu during the flu season were positive.…”

Section: Discussionmentioning

confidence: 99%

“…One study also found decrease in antibiotic use in flu positive infants. 16 Smitherman evaluated the rate of SBI in flu positive infants 0-36 months of age and found that the odds of any SBI (excluding pneumonia) in the flunegative group were 86% less than in those in the flu-positive group (OR: 0.14; 95% CI (Confidence Interval): 0.04 -0.46). 17 Febrile infants < 60 days of age with RSV infections were at significantly lower risk of SBI compared to the infants with negative RSV (rate of SBIs 7% vs 12.5%) but risk of UTI still remained significant.…”

Section: Discussionmentioning

confidence: 99%

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Febrile infants without respiratory symptoms or sick contacts: Are chest radiographs or RSV/influenza testing indicated?

Ozcan

Laskowski

Sahai

et al. 2020

Preprint

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Objectives: Serious bacterial infection rates in febrile infants <60 days are about 8-11%. Less than 1% of febrile infants with no respiratory symptoms will have pneumonia however, chest radiography (CXR) rates remain between 30-60%. Rapid Respiratory Syncytial Virus (RSV) and influenza (flu) testing is common, however, there is not enough data to determine if febrile infants without any respiratory symptoms should be tested. The goal of this study is to determine the rate of positive CXR and RSV/flu results in febrile infants with no respiratory symptoms and no sick contacts. Methods: Well-appearing febrile infants between 7-60 days of age who presented to the pediatric emergency department (PED) from September 1 st , 2015 through October 30 th , 2017 were enrolled. Demographic data, respiratory symptoms, CXR findings and RSV/flu results were collected. SAS statistical software was used for analysis. Results: 129 infants met enrollment criteria. Of the 129 infants, 58 (45.0%) had no respiratory symptoms and no sick contacts. Of these 58, 36 (62%) received a CXR and none of them had any abnormal findings, 48 (83%) had RSV/flu testing, no patients tested positive for RSV and only one patient tested positive for flu. Costs of CXR and RSV/flu testing for this cohort was $19,788. Conclusion: The absence of positive CXRs in this patient population reinforces the current recommendations that CXR is not indicated. The low incidence of RSV/flu indicate that routine testing may not be necessary in this population especially outside of the flu season. Reduced testing could decrease overall costs to the healthcare system as well as radiation exposure to this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Febrile infants without respiratory symptoms or sick contacts: Are chest radiographs or RSV/influenza testing indicated?

Ozcan

Laskowski

Sahai

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Studies show that most febrile infants who were diagnosed with u/RSV had either respiratory symptoms and/or sick contacts. 8,9,16,17,18 Identifying in uenza and RSV may reduce antibiotic use and decrease unnecessary diagnostic testing. 2 Benito-Fernandez found that about 40% of all febrile infants <3 months of age who were tested for u during the u season were positive.…”

Section: Discussionmentioning

confidence: 99%

“…One study also found decrease in antibiotic use in u positive infants. 16 Smitherman evaluated the rate of SBI in u positive infants 0-36 months of age and found that the odds of any SBI (excluding pneumonia) in the u-negative group were 86% less than in those in the u-positive group (OR: 0.14; 95% CI (Con dence Interval): 0.04 -0.46). 17 Febrile infants < 60 days of age with RSV infections were at signi cantly lower risk of SBI compared to the infants with negative RSV (rate of SBIs 7% vs 12.5%) but risk of UTI still remained signi cant.…”

Section: Discussionmentioning

confidence: 99%

Febrile infants without respiratory symptoms or sick contacts: Are chest radiographs or RSV/influenza testing indicated?

Ozcan

Laskowski

Sahai

et al. 2020

Preprint

View full text Add to dashboard Cite

Objectives: Serious bacterial infection rates in febrile infants <60 days are about 8-11%. Less than 1% of febrile infants with no respiratory symptoms will have pneumonia however, chest radiography (CXR) rates remain between 30-60%. Rapid Respiratory Syncytial Virus (RSV) and influenza (flu) testing is common, however, there is not enough data to determine if febrile infants without any respiratory symptoms should be tested. The goal of this study is to determine the rate of positive CXR and RSV/flu results in febrile infants with no respiratory symptoms and no sick contacts. Methods: Well-appearing febrile infants between 7-60 days of age who presented to the pediatric emergency department (PED) from September 1st, 2015 through October 30th, 2017 were enrolled. Demographic data, respiratory symptoms, CXR findings and RSV/flu results were collected. SAS statistical software was used for analysis. Results: 129 infants met enrollment criteria. Of the 129 infants, 58 (45.0%) had no respiratory symptoms and no sick contacts. Of these 58, 36 (62.1%) received a CXR and none of them had any abnormal findings, 48 (82.8%) had RSV/flu testing, no patients tested positive for RSV and only one patient tested positive for flu. Costs of CXR and RSV/flu testing for this cohort was $19,788. Conclusion: The absence of positive CXRs in this patient population reinforces the current recommendations that CXR is not indicated. The low incidence of RSV/flu indicate that routine testing may not be necessary in this population especially outside of the flu season. Reduced testing could decrease overall costs to the healthcare system as well as radiation exposure to this population.

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“…According to the global statistics, approximately 228,000 (95% CI 150,000 to 344,000) hospitalizations in infants < 6 months, were associated with in uenza, annually [4]. According to the previous studies, infants less than 6 months of age, with con rmed in uenza infection, were at the highest risk of hospitalization due to in uenza, neurologic or pulmonary complications and admission to intensive care unit [5,6]. Several studies have demonstrated the effectiveness of maternal in uenza vaccination for protection of infants aged below 6 months from in uenza illness, respiratory infections, and severe pneumonia [7,8].…”

Section: Introductionmentioning

confidence: 99%

Influenza Vaccination During Pregnancy And Influencing Factors In Korea: A Multicenter Questionnaires Study of Pregnant Women and Obstetrics and Gynecology Doctors.

Kang¹,

Lee²,

Kim³

et al. 2020

Preprint

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BackgroundOur objective was to investigate: (1) the proportion of influenza vaccination, attitudes, and barriers among pregnant women, (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination in pregnant women, and (3) the influencing factors in Korea, during the flu season of 2019-2020, following the introduction of free influenza vaccination program for pregnant women.MethodsTwo separate anonymized questionnaires were developed for pregnant or postpartum women and physicians, and distributed to public or private healthcare centers and clinics, in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend influenza vaccine for pregnant women were analyzed. Independent influencing factors of influenza vaccination and OBGYN doctors’ routine recommendation for pregnant women were analyzed using multivariate logistic regression analysis, respectively.Result The self-reported proportion of influenza vaccination during pregnancy among 522 women was 63.2%. Independent factors influencing maternal influenza vaccination were ‘(ever) received information about influenza vaccination during pregnancy’, ‘information obtained from OBGYN doctors’, and ‘2nd/3rd trimester or postpartum period’ (OR 8.988, 95% CI 4.21–19.188, p < 0.001, OR 2.611, 95% CI 1.705-3.998, p < 0.001 and OR 3.082, 95% CI 1.508–6.297, p < 0.001, respectively).In 372 OBGYN doctors, the proportion of doctors with the routine recommendation of influenza vaccine for pregnant women was 76.9%. Independent factors affecting the routine recommendation were: 1) affiliation with private hospital or clinic (OR 4.508, 95% CI 2.225–9.133, p<0.001); 2) awareness of guidelines (OR 3.153, 95% CI 1.118–8.894, p=0.03); (3) awareness of 2019 National free influenza vaccination program for pregnant women (OR 4.955, 95%CI 2.377–10.329, p<0.001). For a future recommendation of influenza vaccine for pregnant women, the guidelines proposed by the government or public health care [108 (46%)] and academic committees [59 (25%)] were most commonly chosen by OBGYN doctors.Conclusion This study demonstrated that providing information about maternal influenza vaccination and the recommendation by OBGYN doctors are crucial for increasing the vaccination coverage in pregnant women.

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Changes in trends and impact of testing for influenza in infants with fever <90 days of age

Abstract: During the influenza epidemic season, diagnostic tests for influenza based on a detailed contact history are necessary in assessing the cause of fever. Targeted testing for influenza may lead to a decrease in antibiotic use and admission rates in young infants.

Cited by 10 publications

References 25 publications

Febrile infants without respiratory symptoms or sick contacts: Are chest radiographs or RSV/influenza testing indicated?

Febrile infants without respiratory symptoms or sick contacts: Are chest radiographs or RSV/influenza testing indicated?

Febrile infants without respiratory symptoms or sick contacts: Are chest radiographs or RSV/influenza testing indicated?

Influenza Vaccination During Pregnancy And Influencing Factors In Korea: A Multicenter Questionnaires Study of Pregnant Women and Obstetrics and Gynecology Doctors.

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