Early Oseltamivir Treatment of Influenza in Children 1–3 Years of Age: A Randomized Controlled Trial

Heinonen, Santtu; Silvennoinen, Heli; Lehtinen, Pasi; Vainionpää, Raija; Vahlberg, Tero; Ziegler, Thedi; Ikonen, Niina; Puhakka, Tuomo; Heikkinen, Terho

doi:10.1086/656408

Cited by 155 publications

(135 citation statements)

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“…Almost no children with influenza were treated with oseltamivir, even though the drug is well tolerated in children and treatment started within 24 hours of symptom onset provides substantial benefits to children with influenza A infection 24. It is urgent to make oseltamivir more widely available for influenza patients, and educate Chinese clinicians about the clinical benefit of early oseltamivir treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China

Yang¹,

Guan

Liu

et al. 2016

Influenza Resp Viruses

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BackgroundInfluenza is an important cause of respiratory illness in children, but data are limited on hospitalized children with laboratory‐confirmed influenza in China.MethodsWe conducted active surveillance for severe acute respiratory infection (SARI; fever and at least one sign or symptom of acute respiratory illness) among hospitalized pediatric patients in Jingzhou, Hubei Province, from April 2010 to April 2012. Data were collected from enrolled SARI patients on demographics, underlying health conditions, clinical course of illness, and outcomes. Nasal swabs were collected and tested for influenza viruses by reverse transcription polymerase chain reaction. We described the clinical and epidemiological characteristics of children with influenza and analyzed the association between potential risk factors and SARI patients with influenza.ResultsDuring the study period, 15 354 children aged <15 years with signs and symptoms of SARI were enrolled at hospital admission. severe acute respiratory infection patients aged 5–15 years with confirmed influenza (H3N2) infection were more likely than children without influenza to have radiographic diagnosis of pneumonia (11/31, 36% vs 15/105, 14%. P<.05). Only 16% (1116/7145) of enrolled patients had received seasonal trivalent influenza vaccination within 12 months of hospital admission. Non‐vaccinated influenza cases were more likely than vaccinated influenza cases to have pneumonia (31/133, 23% vs 37/256, 15%, P<.05). severe acute respiratory infection cases aged 5–15 years diagnosed with influenza were also more likely to have a household member who smoked cigarettes compared with SARI cases without a smoking household member (54/208, 26% vs 158/960, 16%, P<.05).ConclusionsInfluenza A (H3N2) virus infection was an important contributor to pneumonia requiring hospitalization. Our results highlight the importance of surveillance in identifying factors for influenza hospitalization, monitoring adherence to influenza prevention and treatment strategies, and evaluating the disease burden among hospitalized pediatric SARI patients. Influenza vaccination promotion should target children.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China

Yang¹,

Guan

Liu

et al. 2016

Influenza Resp Viruses

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“…39 However, timely administration of oseltamivir has been associated with shorter hospitalizations among critically ill children, 40 faster resolution of illness (1.0-1.5 days in healthy children), and less parental work absenteeism. [41][42][43] Also, 43% to 44% fewer outpatient children who received oseltamivir within 48 hours of influenza symptoms developed acute otitis media. [43][44][45] When the 2009 pandemic influenza began in the United States in mid-April 2009, recommendations were made for expanded use of antiviral medications and were associated with increased antiviral usage 46 ; thus, usage patterns from before versus after the 2009 pandemic may differ.…”

Section: Figurementioning

confidence: 99%

The Burden of Influenza in Young Children, 2004–2009

Poehling

Edwards²,

Griffin³

et al. 2013

Pediatrics

162

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OBJECTIVE: To characterize the health care burden of influenza from 2004 through 2009, years when influenza vaccine recommendations were expanded to all children aged ≥6 months. METHODS: Population-based surveillance for laboratory-confirmed influenza was performed among children aged <5 years presenting with fever and/or acute respiratory illness to inpatient and outpatient settings during 5 influenza seasons in 3 US counties. Enrolled children had nasal/throat swabs tested for influenza by reverse transcriptase-polymerase chain reaction and their medical records reviewed. Rates of influenza hospitalizations per 1000 population and proportions of outpatients (emergency department and clinic) with influenza were computed. RESULTS: The study population comprised 2970, 2698, and 2920 children from inpatient, emergency department, and clinic settings, respectively. The single-season influenza hospitalization rates were 0.4 to 1.0 per 1000 children aged <5 years and highest for infants <6 months. The proportion of outpatient children with influenza ranged from 10% to 25% annually. Among children hospitalized with influenza, 58% had physician-ordered influenza testing, 35% had discharge diagnoses of influenza, and 2% received antiviral medication. Among outpatients with influenza, 7% were tested for influenza, 7% were diagnosed with influenza, and <1% had antiviral treatment. Throughout the 5 study seasons, <45% of influenza-negative children ≥6 months were fully vaccinated against influenza. CONCLUSIONS: Despite expanded vaccination recommendations, many children are insufficiently vaccinated, and substantial influenza burden remains. Antiviral use was low. Future studies need to evaluate trends in use of vaccine and antiviral agents and their impact on disease burden and identify strategies to prevent influenza in young infants.

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“…Data regarding the use of oseltamivir, an inhibitor of the infl uenza enzyme neuraminidase, 5 have been confl icting with some studies showing shortened duration and severity of seasonal infl uenza infection in adults and children including patients with high-risk conditions. [6][7][8][9][10][11][12][13][14][15][16] However, 2 recent meta-analyses have suggested that although oseltamivir decreases the duration of symptoms or the time to fi rst alleviation of symptoms, it did not decrease the rate of provider-diagnosed pneumonia or hospitalization. 17,18 These new fi ndings arise in part from the fact that 9 randomized controlled trials sponsored by manufacturers had not previously been published in full even though patients agreed to be subjects in a study of what was an experimental medication.…”

Section: Hospital Readmissions Among Children With H1n1 Infl Uenza Inmentioning

confidence: 99%

Hospital Readmissions Among Children With H1N1 Influenza Infection

Brogan

Hall

Sills

et al. 2014

Hospital Pediatrics

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Objectives: To describe readmissions among children hospitalized with H1N1 (influenza subtype, hemagglutinin1, neuraminidase 1) pandemic influenza and secondarily to determine the association of oseltamivir during index hospitalization with readmission. Methods: We reviewed data from 42 freestanding children’s hospitals contributing to the Pediatric Health Information System from May through December 2009 when H1N1 was the predominant influenza strain. Children were divided into 2 groups by whether they experienced complications of influenza during index hospitalization. Primary outcome was readmission at 3, 7, and 30 days among both patient groups. Secondary outcome was the association of oseltamivir treatment with readmission. Results: The study included 8899 children; 6162 patients had uncomplicated index hospitalization, of whom 3808 (61.8%) received oseltamivir during hospitalization, and 2737 children had complicated influenza, of whom 1055 (38.5%) received oseltamivir. Median 3-, 7-, and 30-day readmission rates were 1.6%, 2.5%, and 4.7% for patients with uncomplicated index hospitalizations and 4.3%, 5.8%, and 10.3% among patients with complicated influenza. The 30-day readmission rates did not differ by treatment group among patients with uncomplicated influenza; however, patients with complicated index hospitalizations who received oseltamivir had lower all-cause 30-day readmissions than untreated patients. The most common causes of readmission were pneumonia and asthma exacerbations. Conclusions: Oseltamivir use for hospitalized children did not decrease 30-day readmission rates in children after uncomplicated index hospitalization but was associated with a lower 30-day readmission rate among children with complicated infections during the 2009 H1N1 pandemic. Readmission rates for children who had complicated influenza infection during index hospitalizations are high.

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Early Oseltamivir Treatment of Influenza in Children 1–3 Years of Age: A Randomized Controlled Trial

Abstract: Oseltamivir treatment started within 24 hours of symptom onset provides substantial benefits to children with influenza A infection. Clinical trials registration. ClinicalTrials.gov identifier: NCT00593502.

Cited by 155 publications

References 35 publications

Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China

Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China

The Burden of Influenza in Young Children, 2004–2009

Hospital Readmissions Among Children With H1N1 Influenza Infection

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