Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) in Children's Hospital, Australia

Khandaker, Gulam; Lester-Smith, David; Zurynski, Yvonne; Elliott, Elizabeth J; Booy, Robert

doi:10.3201/eid1710.101670_article.htm

Cited by 3 publications

(6 citation statements)

References 3 publications

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“…Consistent with other studies, we report a high burden of paediatric hospitalisation due to pandemic influenza in 2009 (33·9 per 1000 admission in 2009) . One in ten children hospitalised with pandemic influenza in 2009 required PICU admission, a rate similar to that reported at SCHN for seasonal influenza in 2003 (8·6%) and 2007 (10·1%) . Consistent with seasonal influenza studies, most hospitalisations in 2009 were in young children (median age 3·7 years) and almost a quarter (22·2%) were aged <12 months …”

Section: Discussionsupporting

confidence: 88%

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Khandaker

Zurynski

Ridley

et al. 2014

Influenza Resp Viruses

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BackgroundThere are few large-scale, prospective studies of influenza A(H1N1)pdm09 in children that identify predictors of adverse outcomes.ObjectivesWe aimed to examine clinical epidemiology and predictors for adverse outcomes in children hospitalised with influenza A(H1N1)pdm09 in Australia.MethodsActive hospital surveillance in six tertiary paediatric referral centres (June–September, 2009). All children aged <15 years admitted with laboratory-confirmed influenza A(H1N1)pdm09 were studied.ResultsOf 601 children admitted with laboratory-confirmed influenza, 506 (84·2%) had influenza A(H1N1)pdm09. Half (51·0%) of children with influenza A(H1N1)pdm09 were previously healthy. Hospital stay was longer in children with pre-existing condition (mean 6·9 versus 4·9 days; P = 0·02) as was paediatric intensive care unit (PICU) stay (7·0 versus 2·3 days; P = 0·005). Rapid diagnosis decreased both antibiotic use and length of hospital and PICU stay. Fifty (9·9%) children were admitted to a PICU, 30 (5·9%) required mechanical ventilation and 5 (0·9%) died. Laboratory-proven bacterial co-infection and chronic lung disease were significant independent predictors of PICU admission (OR 6·89, 95% CI 3·15–15·06 and OR 3·58, 95% CI 1·41–9·07, respectively) and requirement for ventilation (OR 5·61, 95% CI 2·2–14·28 and OR 5·18, 95% CI 1·8–14·86, respectively). Chronic neurological disease was a predictor of admission to PICU (OR 2·30, 95% CI 1·14–4·61).ConclusionsDuring the 2009 pandemic, influenza was a major cause of hospitalisation in tertiary paediatric hospitals. Co-infection and underlying chronic disease increased risk of PICU admission and/or ventilation. Half the children admitted were previously healthy, supporting a role for universal influenza vaccination in children.

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Section: Discussionsupporting

confidence: 88%

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Khandaker

Zurynski

Ridley

et al. 2014

Influenza Resp Viruses

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“…Children hospitalized with influenza had a rate of complications comparable to adults, including pneumonia and seizures in 1/10, with ICU admission required in 1/12 children, similar to reports from seasonal and pandemic years [22, 31, 32]. Despite the median LOS being shorter than in adults, these findings confirm that influenza should not be regarded as a benign paediatric illness.…”

Section: Discussionsupporting

confidence: 75%

“…Infants aged 0-6 months represented the highest proportion (by 6-month age cohorts) of hospitalized children in our study; this age group is too young for influenza vaccination, but may be afforded protection from maternal vaccination [29,30]. Children hospitalized with influenza had a rate of complications comparable to adults, including pneumonia and seizures in 1/10, with ICU admission required in 1/12 children, similar to reports from seasonal and pandemic years [22,31,32]. Despite the median LOS being shorter than in adults, these findings confirm that influenza should not be regarded as a benign paediatric illness.…”

Section: Discussionsupporting

confidence: 74%

Influenza hospitalizations in Australian children

et al. 2017

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Australia's National Immunisation Program (NIP) provides free influenza vaccination for children at high risk of severe influenza; a pilot-funded programme for vaccine in all children aged 6 months to <5 years in one of eight states, has seen poor vaccine impact, related to recent vaccine safety concerns. This retrospective review examined influenza hospitalizations in children aged <16 years from three seasons (2011-2013) at two paediatric hospitals on opposite sides of the country. Comparisons of this cohort were made with state-based data on influenza-coded hospitalizations and national immunization register data on population-level immunization coverage. Of 740 hospitalizations, the majority were aged <5 years (476/740, 64%), and a substantial proportion (57%) involved healthy children, not currently funded for influenza vaccine. Intensive care unit admission occurred in 8·5%, and 1·5% of all children developed encephalitis. Use of antiviral therapy was uncommon (20·5%) and decreasing. Of those hospitalized, only 5·0% of at-risk children, who are currently eligible for free vaccine, and 0·7% of healthy children were vaccinated prior to hospitalization. This was consistent with low population-wide estimates of influenza vaccine uptake. It highlights the need to examine alternative strategies, such as universally funded paediatric influenza vaccination, to address disease burden in Australian children.

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“…Subjects for this study were identified by searching the database of the department of virology at the CHW for positive test results with influenza A, influenza B, parainfluenza viruses 1, 2, 3 and adenoviruses from nasopharyngeal aspirates and/or nose/throat swabs collected between 1 January and 31 December 2007. This year was chosen as it was a peak influenza year 12 . Respiratory syncytial virus infections were excluded from the study as it is already established that the rate of RSV and concomitant bacteraemia and meningitis is very low in children 8,11 …”

Section: Methodsmentioning

confidence: 99%

“…This year was chosen as it was a peak influenza year. 12 Respiratory syncytial virus infections were excluded from the study as it is already established that the rate of RSV and concomitant bacteraemia and meningitis is very low in children. 8,11 Medical records for all children thus identified were reviewed to confirm that they had respiratory illness; additional data on clinical presentation, investigations performed and the course of illness were collected for analysis.…”

Section: Study Population and Settingmentioning

confidence: 99%

Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections

Khandaker

Heron

Rashid

et al. 2012

Influenza Resp Viruses

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Please cite this paper as: Khandaker et al. (2012) Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections. Influenza and Other Respiratory Viruses DOI:10.1111/irv.12039. Background The clinical presentation of influenza in infancy may be similar to serious bacterial infection and be investigated with invasive procedures like lumbar puncture (LP), despite very limited evidence that influenza occurs concomitantly with bacterial meningitis, perhaps because the diagnosis of influenza is very often not established when the decision to perform LP is being considered. Methods A retrospective medical record review was undertaken in all children presenting to the Children’s Hospital at Westmead, Sydney, Australia, in one winter season with laboratory‐confirmed influenza or other respiratory virus infections (ORVIs) but excluding respiratory syncytial virus, to compare the use of, and reflect on the need for, the performance of invasive diagnostic procedures, principally LP, but also blood culture, in influenza and non‐influenza cases. We also determined the rate of concomitant bacterial meningitis or bacteraemia. Findings Of 294 children, 51% had laboratory‐confirmed influenza and 49% had ORVIs such as parainfluenza viruses (34%) and adenoviruses (15%). Of those with influenza, 18% had a LP and 71% had a blood culture performed compared with 6·3% and 55·5% in the ORVI group (for both P < 0·01). In multivariate analysis, diagnosis of influenza was a strong independent predictor of both LP (P = 0·02) and blood culture (P = 0·05) being performed, and, in comparison with ORVIs, influenza cases were almost three times more likely to have a LP performed on presentation to hospital. One child with influenza (0·9%) had bacteraemia and none had meningitis. Interpretation Children with influenza were more likely to undergo LP on presentation to hospital compared with those presenting with ORVIs. If influenza is confirmed on admission by near‐patient testing, clinicians may be reassured and less inclined to perform LP, although if meningitis is clinically suspected, the clinician should act accordingly. We found that the risk of bacterial meningitis and bacteraemia was very low in hospitalised children with influenza and ORVIs. A systematic review should be performed to investigate this across a large number of settings.

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Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) in Children's Hospital, Australia

Cited by 3 publications

References 3 publications

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Influenza hospitalizations in Australian children

Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections

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