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Wolf RM, Antoon JW. Influenza in Children and Adolescents: Epidemiology, Management, and Prevention. Pediatr Rev 2023; 44:605-617. [PMID: 37907421 PMCID: PMC10676733 DOI: 10.1542/pir.2023-005962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
EDUCATION GAP Influenza is among the most common infectious causes of pediatric emergency department visits and hospitalizations. Clinicians should use evidence-based guidelines to learn how to identify, manage, prevent, and treat influenza cases. Disease caused by influenza virus can be mitigated with appropriate treatment and prevention efforts. OBJECTIVES After completing this article, readers should be able to: 1. Describe the virology and epidemiology of influenza. 2. List the clinical features and complications of influenza infections. 3. List the benefits and limitations of testing modalities for the diagnosis of influenza. 4. Appropriately apply American Academy of Pediatrics, Infectious Diseases Society of America, and Centers for Disease Control and Prevention (CDC) treatment guidelines for influenza or suspected influenza. 5. Describe the importance of influenza vaccination.
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Affiliation(s)
- Ryan M Wolf
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - James W Antoon
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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Yayla BCC, Aykac K, Boluk O, Fidanci I, Tasar MA, Pamuk U, Karakoc AE, Karakaya J, Ozsurekci Y. The comparison of COVID-19 vs seasonal influenza in children. Pediatr Int 2023; 65:e15684. [PMID: 38037544 DOI: 10.1111/ped.15684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Burcu Ceylan Cura Yayla
- Department of Pediatric Infectious Diseases, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Kubra Aykac
- Department of Pediatric Infectious Diseases, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Oguz Boluk
- Department of Pediatric Disease, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Ilknur Fidanci
- Department of Pediatric Emergency, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Medine Aysin Tasar
- Department of Pediatric Emergency, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Utku Pamuk
- Department of Pediatric Cardiology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Ayse Esra Karakoc
- Department of Pediatric Cardiology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Jale Karakaya
- Department of Bioistatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Esposito S, Caminiti C, Giordano R, Argentiero A, Ramundo G, Principi N. Myocarditis Following COVID-19 Vaccine Use: Can It Play a Role for Conditioning Immunization Schedules? Front Immunol 2022; 13:915580. [PMID: 35833128 PMCID: PMC9271782 DOI: 10.3389/fimmu.2022.915580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022] Open
Abstract
Myocarditis (MYO) is a relatively uncommon inflammatory disease that involves the heart muscle. It can be a very severe disease as it can lead to the development of acute or chronic heart failure and, in a not marginal number of cases, to death. Most of the cases are diagnosed in healthy people younger than 30 years of age. Moreover, males are affected about twice as much as females. Viruses are among the most common causes of MYO, but how viral infection can lead to MYO development is not precisely defined. After COVID-19 pandemic declaration, incidence rate of MYO has significantly increased worldwide because of the SARS-CoV-2 infection. After the introduction of anti-COVID-19 vaccines, reports of post-immunization MYO have emerged, suggesting that a further cause of MYO together with the SARS-CoV-2 infection could increase the risk of heart damage during pandemic. Main aim of this study is to discuss present knowledge regarding etiopathogenesis and clinical findings of MYO associated with COVID-19 vaccine administration and whether the risk of this adverse events can modify the initially suggested recommendation for the use of COVID-19 vaccines in pediatric age. Literature analysis showed that MYO is an adverse event that can follow the COVID-19 immunization with mRNA vaccines in few persons, particularly young adults, adolescents, and older children. It is generally a mild disease that should not modify the present recommendations for immunization with the authorized COVID-19 mRNA vaccines. Despite this, further studies are needed to evaluate presently undefined aspects of MYO development after COVID-19 vaccine administration and reduce the risk of development of this kind of vaccine complication. Together with a better definition of the true incidence of MYO and the exact role of the various factors in conditioning incidence variations, it is essential to establish long-term evolution of acute COVID-19 related MYO.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
- *Correspondence: Susanna Esposito,
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, Parma, Italy
| | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Greta Ramundo
- Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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Ozsurekci Y, Aykac K, Bal F, Bayhan C, Basaranoglu ST, Alp A, Cengiz AB, Kara A, Ceyhan M. Outcome predictors of influenza for hospitalization and mortality in children. J Med Virol 2021; 93:6148-6154. [PMID: 33512015 PMCID: PMC8014286 DOI: 10.1002/jmv.26833] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 01/09/2023]
Abstract
Severity of disease caused by influenza virus and the influencing factors that may be different. Moreover, the disease course actually may not be determined specifically in children because of lower seroprotection rates of children. Herein, the results clinic and outcome data of children with influenza from Turkey were reported. We present here the results from 2013 to 2017. Nasopharyngeal swab samples of the children with influenza were investigated via multiplex polymerase chain reaction. A total of 348 children were diagnosed with influenza; 143 (41.1%) were influenza A, 85 (24.4%) were influenza B, and 120 (34.5%) were mixt infection with other respiratory viruses. Fifty-four percent of children admitted to intensive care unit (ICU) were under 2 years of age (p = .001). Having an underlying disease was detected as the main predictor for both hospitalization and ICU stay according to multiple logistic regression analysis (odds ratio [OR], 11.784: 95% confidence interval [CI], 5.212-26.643; p = .001 and OR, 4.972: 95% CI, 2.331-10.605; p = .001, respectively). Neurological symptoms most frequently seen in cases who died (44.4%; p = .02). Lymphopenia was relatively higher (55.6%) and thrombocytopenia was most frequently seen in cases who died (77.8%) with a significant ratio (p = .001). Underlying diseases was found a risk factor for influenza being hospitalized and being admitted to ICU. Children under 2 years of age and with underlying diseases should be vaccinated particularly in countries where the influenza vaccination is still not routinely implemented in the immunization schedule. Highlights Underlying diseases is a risk factor for influenza to be hospitalized and admitted to ICU. Influenza vaccination is of great importance to prevent life-threatening complications of influenza, particularly in children require ICU admission. The possibility to reduce the outpatient visit number by vaccination has a great impact on disease burden in addition to the underestimated crucial social benefits, as well.
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Affiliation(s)
- Yasemin Ozsurekci
- Department of Pediatric Infectious DiseasesHacettepe University Faculty of MedicineAnkaraTurkey
| | - Kubra Aykac
- Department of Pediatric Infectious DiseasesHacettepe University Faculty of MedicineAnkaraTurkey
| | - Fatma Bal
- Department of PediatricsHacettepe University Faculty of MedicineAnkaraTurkey
| | - Cihangul Bayhan
- Department of Pediatric Infectious DiseasesHacettepe University Faculty of MedicineAnkaraTurkey
| | - Sevgen T. Basaranoglu
- Department of Pediatric Infectious DiseasesHacettepe University Faculty of MedicineAnkaraTurkey
| | - Alpaslan Alp
- Department of MicrobiologyHacettepe University Faculty of MedicineAnkaraTurkey
| | - Ali Bulent Cengiz
- Department of Pediatric Infectious DiseasesHacettepe University Faculty of MedicineAnkaraTurkey
| | - Ates Kara
- Department of Pediatric Infectious DiseasesHacettepe University Faculty of MedicineAnkaraTurkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious DiseasesHacettepe University Faculty of MedicineAnkaraTurkey
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Neagu O, Rodríguez AF, Callon D, Andréoletti L, Cohen MC. Myocarditis Presenting as Sudden Death in Infants and Children: A Single Centre Analysis by ESGFOR Study Group. Pediatr Dev Pathol 2021; 24:327-336. [PMID: 33872111 DOI: 10.1177/10935266211007262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute myocarditis is an inflammatory disease of the heart mostly diagnosed in young people, which can present as sudden death. The etiology includes infectious agents (mostly viruses), systemic diseases and toxins. We aim to characterize infants and children with myocarditis at post-mortem presenting as sudden deaths. METHODS Retrospective evaluation of 813 post-mortems in infants and children dying suddenly and unexpectedly between 2009-2019. Data retrieved included histological features, microbiology and clinical history. RESULTS 23 of 813 post-mortems reviewed corresponded to acute myocarditis and 1 to dilated cardiomyopathy related to remote Parvovirus infection. PCR identified enterovirus (7), parvovirus (7 cases, 2 also with HHV6 and 1 case with EVB), Influenza A (1), Parainfluenza type 3 (1). Two cases corresponded to hypersensitivity myocarditis, 1 was Group A Streptococcus and 5 idiopathic myocarditis. Enterovirus was frequent in infants (7/10), and in newborns was associated with meningoencephalitis or congenital myocarditis. More than 50% were less than 2 years of age and all remained clinically unsuspected. CONCLUSION Myocarditis represents almost 3% of all sudden pediatric deaths. Enterovirus and parvovirus were the most common viruses. This retrospective analysis showed that patients experienced viral symptoms but remained unsuspected, highlighting the need for more clinical awareness of myocarditis.
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Affiliation(s)
- Oana Neagu
- Histopathology Department, Sheffield Children's NHS FT, Sheffield, UK
| | - Amparo Fernández Rodríguez
- Forensic Microbiology Laboratory, Instituto Nacional de Toxicología y Ciencias Forenses, Madrid, Spain.,Joint Working Group of the European Society of Clinical Microbiology and Infectious Diseases Study Group of Forensic and Postmortem Microbiology and the European Society of Pathology, Basel, Switzerland
| | - Domitille Callon
- Joint Working Group of the European Society of Clinical Microbiology and Infectious Diseases Study Group of Forensic and Postmortem Microbiology and the European Society of Pathology, Basel, Switzerland.,Clinical and Molecular Virology Unit, Centre Hospitalier Universitaire, Reims, France
| | - Laurent Andréoletti
- Joint Working Group of the European Society of Clinical Microbiology and Infectious Diseases Study Group of Forensic and Postmortem Microbiology and the European Society of Pathology, Basel, Switzerland.,Clinical and Molecular Virology Unit, Centre Hospitalier Universitaire, Reims, France
| | - Marta C Cohen
- Histopathology Department, Sheffield Children's NHS FT, Sheffield, UK.,Joint Working Group of the European Society of Clinical Microbiology and Infectious Diseases Study Group of Forensic and Postmortem Microbiology and the European Society of Pathology, Basel, Switzerland.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Abstract
Myocarditis in the pediatric population can be a challenging diagnosis to make and often requires utilization of multiple diagnostic modalities. The cause is often due to a viral infection with activation of the innate and acquired immune response with either recovery or disease progression. Laboratory testing often includes inflammatory markers, cardiac troponin levels, and natriuretic peptides. Noninvasive testing should include electrocardiogram, echocardiogram, and possibly an MRI. Treatment of myocarditis remains controversial with most providers using immune modulators with intravenous immunoglobulin and corticosteroids.
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Abstract
PURPOSE OF REVIEW Influenza causes a range of illnesses in children, from uncomplicated self-limited illness to severe disease and death. This review provides an update on the severity and burden of influenza in US children over recent seasons. RECENT FINDINGS The 2017-2018 influenza season was widespread and severe across all ages, including children. Disease severity is influenced by influenza virologic characteristics and host factors, as well as public health interventions such as influenza vaccination and antiviral treatment. In recent influenza A (H3N2)-predominant seasons (2016-2017 and 2017-2018), influenza vaccination effectiveness was higher in younger children compared with older children and adolescents, although the reasons for this are unclear. Interestingly, even in seasons when influenza A (H3N2) viruses predominate, influenza A (H1N1)pdm09 and B viruses can play a large role in severe pediatric disease. Although children less than 5 years of age and those with underlying medical conditions are at increased risk for severe disease, influenza-associated hospitalizations and deaths occur every season in healthy children. SUMMARY Influenza causes a substantial burden of outpatient visits, hospitalizations, and deaths among children. Ongoing research is important to better characterize factors that contribute to influenza severity, and to identify strategies to improve the impact of influenza vaccination and treatment.
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