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Chowdhury SR, Nadua KD, Li J, Kam KQ, Thoon KC, Tan NWH, Yung CF, Chong CY. Predictors of complicated influenza infection in children presenting in a tertiary hospital in a tropical country: A case-control study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:390-395. [PMID: 38979995 DOI: 10.47102/annals-acadmedsg.2023231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Influenza causes significant healthcare burden globally1 with highest risks in children and the elderly. In children, multiple studies have identified risk factors for severe influenza such as young age (<5 years), presence of comorbidities, abnormal vital signs (e.g. hypoxia, shock) and bacterial coinfections.2-4 We found similar findings in our centre which included children during the influenza A (H1N1) 2009 pandemic with age <2 years and comorbidity as risk factors for complicated influenza.5
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Affiliation(s)
- Sudipta Roy Chowdhury
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Karen Donceras Nadua
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jiahui Li
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai-Qian Kam
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Fu Yung
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Tan NC, Tan Q, Aau WK, Ng CWM. The Implementation and Impact of a Revised National Childhood Immunization Schedule in an Urban Asian Community. Vaccines (Basel) 2022; 10:vaccines10071148. [PMID: 35891312 PMCID: PMC9319496 DOI: 10.3390/vaccines10071148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
Changes to the national childhood immunization schedule (NCIS) can have a potential impact on vaccine uptake in the community. The NCIS in Singapore has undergone several revisions over the years, with the most recent modification on 1 November 2020. The new NCIS includes, as routine, the influenza and the varicella vaccine, as well as two combination vaccines, the measles, mumps, rubella and varicella vaccine (MMRV), and the hexavalent diphtheria, acellular pertussis, tetanus, haemophilus influenza b, injectable polio, and hepatitis B vaccine (6-in-1). This retrospective database study aims to assess the effect of the new NCIS on (a) the vaccination uptake of children at 6 and 12 months and (b) the cost difference to the healthcare system and to parents. One-year vaccination data from two cohorts of children immunized according to the old (n = 10,916) and new NCIS (n = 10,299) were extracted, respectively, from their electronic medical records. The vaccine uptake at 6 and 12 months increased by 10.8 and 2.1%, respectively, with the new NCIS as compared to the old NCIS. The mean number of required visits to the primary care clinic for each child was reduced from six to four. There is an estimated 6.41% cost reduction with the new NCIS.
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Affiliation(s)
- Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore 150167, Singapore; (Q.T.); (W.K.A.); (C.W.M.N.)
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore 150167, Singapore
- Correspondence:
| | - Qifan Tan
- SingHealth Polyclinics, Singapore 150167, Singapore; (Q.T.); (W.K.A.); (C.W.M.N.)
| | - Wai Keong Aau
- SingHealth Polyclinics, Singapore 150167, Singapore; (Q.T.); (W.K.A.); (C.W.M.N.)
| | - Chung Wai Mark Ng
- SingHealth Polyclinics, Singapore 150167, Singapore; (Q.T.); (W.K.A.); (C.W.M.N.)
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore 150167, Singapore
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Hospitalization of Children Aged <5 Years Due to Influenza: Study Based on the National Hospitalization Registry. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9070930. [PMID: 35883914 PMCID: PMC9321516 DOI: 10.3390/children9070930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022]
Abstract
Background: Influenza constitutes a significant health care burden that can be related to an increased morbidity and mortality. The aim of the study is to show up-to-date information on influenza hospitalization cases in Poland in children aged <5 years. Methods: The data used in the study were hospitalization records from 2015−2019, which had been gathered in a Nationwide General Hospital Morbidity Study and made available by the National Institute of Public Health. Results: 8565 records of patients with influenza were subject to analysis. The mean and median age of the patients were 2.2 and 2.1 years, respectively. Influenza hospitalization incidence was estimated at 90 per 100,000 person-years (PY) in children aged <5 years. The number of hospitalization cases was significantly higher in patients living in urban regions than in those living in rural regions (97 vs. 77 per 100,000 PY; p < 0.001). The age of patients living in urban regions was significantly lower than the age of patients living in rural regions (2.2 vs. 2.3 years; p < 0.001). A statistically significant increase in hospitalization was observed. Conclusions: The reported increasing trend in hospitalizations indicates the need to take focused measures. Presented data may be useful in comparative analyses in a European context.
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Phetcharakupt V, Pasomsub E, Kiertiburanakul S. Clinical manifestations of influenza and performance of rapid influenza diagnostic test: A university hospital setting. Health Sci Rep 2021; 4:e408. [PMID: 34622032 PMCID: PMC8485631 DOI: 10.1002/hsr2.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rapid influenza diagnostic test (RIDT) is a diagnostic tool that detects the influenza virus nucleoprotein antigen. The RIDT is widely used in clinical practice because it is simple and cost-effective, and provides results within 10-15 minutes. OBJECTIVE We aimed at evaluating the sensitivity and specificity of the Sofia® RIDT compared with the Luminex® multiplex polymerase chain reaction (PCR). The other goal was to determine the predicting factors for diagnosing influenza among individuals with influenza-like illness (ILI). METHOD Patients with ILI who had the results of both tests were retrospectively reviewed. We determined the performances of the RIDT. RESULTS A total of 473 patients were included with a median age of 58 (interquartile range 41-74) years. Of these, 47.1% were male, and 16.2% were diagnosed with influenza by the RIDT or RT-PCR's positive test. For influenza A, the RIDT showed a sensitivity of 76.3% (95% confidence interval [CI] 59.8-88.6) and a specificity of 97.9% (95% CI 96.1-99.0), whereas for influenza B, it showed a sensitivity of 47.1% (95% CI 23.0-72.2) and a specificity of 97.1% (95% CI 95.2-98.5). Patients with influenza were more likely to present with fever (81.8% vs 63.1%), cough (81.8% vs 66.1%), and rhinorrhea (41.6% vs 26.5%) compared to those without influenza (P < 0.05, all), and had a higher proportion of pneumonia (19.5% vs 10.6%, P = 0.029) and acute respiratory distress syndrome (5.2% vs 1.5%, P = 0.063). The predicting factors for influenza among patients presented with ILI were cough (odds ratio [OR] 2.77; 95% CI 0.21-0.81, P = 0.010), rhinorrhea (OR 1.87; 95% CI 1.03-3.36, P = 0.037), and higher body temperature (OR 1.64; 95% CI 1.23-2.19, P = 0.001). CONCLUSIONS The sensitivity of the RIDT for the diagnosis of influenza is fair in contrast to the specificity. Among patients with ILI, cough, rhinorrhea, and higher body temperature might be factors for predicting influenza.
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Affiliation(s)
- Varistha Phetcharakupt
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Ekawat Pasomsub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
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Kang BS, Lee SH, Kim WJ, Wie JH, Park IY, Ko HS. Influenza vaccination during pregnancy and influencing factors in Korea: A multicenter questionnaire study of pregnant women and obstetrics and gynecology doctors. BMC Pregnancy Childbirth 2021; 21:511. [PMID: 34271867 PMCID: PMC8285826 DOI: 10.1186/s12884-021-03984-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 07/07/2021] [Indexed: 01/13/2023] Open
Abstract
Background Although the World Health Organization and health authorities in most countries recommend that pregnant women receive inactivated influenza virus vaccines, coverage remains low. This study aimed to investigate (1) the proportion of pregnant women who received an influenza vaccination and influencing factors and (2) the proportion of obstetrics and gynecology (OBGYN) doctors who routinely recommend influenza vaccination to pregnant women and influencing factors. Methods Two separate, anonymized questionnaires were developed for physicians and pregnant and postpartum women and were distributed to multicenters and clinics in South Korea. The proportions of women who received influenza vaccination during pregnancy and OBGYN doctors who routinely recommend the influenza vaccine to pregnant women were analyzed. Independent influencing factors for both maternal influenza vaccination and OBGYN doctors’ routine recommendations to pregnant women were analyzed using log-binomial regression analysis. Results The proportion of self-reported influenza vaccination during pregnancy among 522 women was 63.2%. Pregnancy-related independent factors influencing maternal influenza vaccination were “(ever) received information about influenza vaccination during pregnancy” (OR 8.9, 95% CI 4.17–19.01), “received vaccine information about from OBGYN doctors” (OR 11.44, 95% CI 5.46–24.00), “information obtained from other sources” (OR 4.38, 95% CI 2.01–9.55), and “second/third trimester” (OR 2.41, 95% CI 1.21–4.82).. Among 372 OBGYN doctors, 76.9% routinely recommended vaccination for pregnant women. Independent factors effecting routine recommendation were “working at a private clinic or hospital” (OR 5.33, 95% CI 2.44–11.65), “awareness of KCDC guidelines” (OR 3.11, 95% CI 1.11–8.73), and “awareness of the 2019 national free influenza vaccination program for pregnant women” (OR 4.88, 95% CI 2.34–10.17). OBGYN doctors most commonly chose ‘guidelines proposed by the government or public health (108, 46%) and academic committees (59, 25%), as a factor which expect to affect the future recommendation Conclusion This study showed that providing information about maternal influenza vaccination, especially by OBGYN doctors, is crucial for increasing vaccination coverage in pregnant women. Closer cooperation between the government and OBGYN academic societies to educate OBGYN doctors might enhance routine recommendations. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03984-2.
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Affiliation(s)
- Byung Soo Kang
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - San Ha Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo Jeng Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Ha Wie
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Al-Iede M, Sarhan L, Abushanab L, BaniAhmad T, Almiani R, Alyasi A, Khader S, Aleidi SM, Alqutawneh B, Al-Zayadneh E. Influenza Viral Infections Surveillance and Clinical Presentations in Hospitalized Children: A Cross-sectional Study. CURRENT RESPIRATORY MEDICINE REVIEWS 2021. [DOI: 10.2174/1573398x17666210319094524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Influenza virus and other respiratory viruses have been identified as an essential
cause of acute respiratory infections (ARIs) in children worldwide. However, there are few
data on its frequency and clinical presentation in Jordan.
Objectives:
We aimed to identify the viral etiology of acute respiratory infections and the various
clinical presentations in hospitalized children, especially those with influenza viruses compared to
other respiratory viruses.
Methods:
A retrospective study was conducted at the Jordan University Hospital. All the positive
nasopharyngeal aspirates that were collected from hospitalized children aged 0-19 years from January
2017 to January 2019 were reviewed.
Results:
A total of 338 nasopharyngeal aspirates (NPAs) with positive viral serology results were
reviewed. Among the patients younger than four years, the RSV virus was the most frequently detected.
However, the Influenza B virus was the most commonly seen in patients older than 5 years,
H1N1 was more frequent in autumn (29.5%), and RSV was the most frequent virus in winter. Bronchopneumonia
was the most frequent diagnosis among all hospitalized patients, followed by bronchiolitis.
Out of 338 patients, 50.3% had tachypnea, 70.7% of patients were admitted to the pediatric
floor, while 18.6% presented with a severe illness and required admission to the pediatric intensive
care unit (PICU).
Infants under the age of one were more likely to have higher co-infection rates with other viruses
compared to children over five years that had influenza.
Conclusion:
Presentations of influenza and other respiratory viruses vary between different age
groups, such as sepsis in children younger than one year.
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Affiliation(s)
| | - Lena Sarhan
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Leen Abushanab
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Refa Almiani
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Aysha Alyasi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Shatha Khader
- School of Medicine, The University of Jordan, Amman, Jordan
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朱 欣, 刘 小, 王 小, 杨 亚. [A clinical study of influenza A virus infection with neurological symptoms in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:451-455. [PMID: 34020732 PMCID: PMC8140337 DOI: 10.7499/j.issn.1008-8830.2102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the clinical features of children with influenza A virus infection and neurological symptoms. METHODS A retrospective analysis was performed for the clinical data of children with laboratory-confirmed influenza A and neurological symptoms who were treated in Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University from January to December, 2019. RESULTS A total of 895 children were diagnosed with influenza A, among whom 291 had neurological symptoms. Boys had a significantly higher incidence rate of influenza A than girls (P < 0.05), and the children aged 1-3 years had a significantly higher incidence rate than the other age groups (P < 0.05). Common neurological symptoms included seizures (97.3%), vomiting (24.1%), and headache (7.2%). Febrile seizures were the most common type of seizures, accounting for 88%. There was no significant difference in the time from disease onset to seizures and frequency seizures between the children with a history of febrile seizures and those without such history (P > 0.05). Of all the children, 3 were diagnosed with acute necrotizing encephalopathy (ANE), all of whom were girls and suffered seizures; the time from the first seizures to the occurrence of disturbance of consciousness was 0-7 hours, and 2 girls died within 2 days after disease onset. All children, except 2 who died of ANE and 1 with neurological sequelae, were cured. CONCLUSIONS There is a high incidence rate of neurological symptoms in children with influenza A, and seizures are the most common symptom. Most of the patients with neurological symptoms tend to have a good prognosis, but those with ANE may have a poor prognosis.
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Affiliation(s)
- 欣欣 朱
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
| | - 小乖 刘
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
| | - 小燕 王
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
| | - 亚荣 杨
- />西安交通大学附属西安市儿童医院感染科, 陕西西安 710003Department of Infection, Xi'an Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710003, China
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Watanabe S, Hoshina T, Kojiro M, Kusuhara K. The recent characteristics of influenza-related hospitalization in Japanese children. Eur J Clin Microbiol Infect Dis 2021; 40:2011-2015. [PMID: 33661411 DOI: 10.1007/s10096-021-04208-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
We investigated the recent epidemiology and characteristics of influenza-related hospitalization in Japanese children. This study included 3741 children with influenza. Children hospitalized for febrile seizures (FS) induced by etiologies other than influenza also served as a disease control. Most outpatients (92.8%) visited our hospital with complaints of respiratory symptoms, whereas FS were the most predominant symptoms of inpatients (58/154, 37.7%). Children with influenza-induced FS were significantly older than those with FS induced by other etiologies (P <0.001). Although the characteristics of severe influenza may vary throughout the world, the analysis of influenza-induced neurological disorders is important for understanding its epidemiology.
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Affiliation(s)
- Shunsuke Watanabe
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.,Department of Pediatrics, Kitakyushu General Hospital, Kitakyushu, Japan
| | - Takayuki Hoshina
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Masumi Kojiro
- Department of Pediatrics, Kitakyushu General Hospital, Kitakyushu, Japan
| | - Koichi Kusuhara
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Chong CY, Yung CF, Gan C, Thio ST, Tan NWH, Tee NWS, Lin C, Lin RTP, Thoon KC. The burden and clinical manifestation of hospitalized influenza among different pediatric age-groups in the tropics. Influenza Other Respir Viruses 2019; 14:46-54. [PMID: 31608598 PMCID: PMC6928028 DOI: 10.1111/irv.12692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction In tropical Singapore, influenza occurs all year‐round. This study of influenza‐confirmed hospitalized pediatric patients compared clinical characteristics and complications by age‐group and differences between influenza A and B. Methods This was a retrospective study of pediatric inpatients from January 2013 to December 2014. Patients were grouped into: <6 months, 6 months to <5 years, 5‐ to <10‐year and ≥10 years. Complications were classified into neurologic, pulmonary, and other. We also calculated the incidence of hospitalized influenza cases per 100 000 age‐related population. Results There were a total of 1272 patients with a median age of 37 months. The highest hospitalization rates were in the <6 months age‐group. Majority (75.2%) had no comorbidity; 25.6% had complications: neurologic 11.9%, pulmonary 9.6%, other 4.1%. Patients with other complications were older, male, and had the highest influenza B rates and the longest length of stay. Influenza A comprised 76.9% of cases and had higher complication rates especially neurologic, compared to influenza B. Influenza B patients were older and were more likely to develop other complications. The 6‐month to <5‐year‐age‐group had the highest complication rate (30.6%), especially neurologic. However, ≥10 years old had the highest other complications, ICU/ high‐dependency admissions and influenza B Victoria rates. Conclusions Infants <6 months had the highest hospitalization rates for influenza. The 6‐month to <5‐year‐age‐group had the highest complication rate especially neurologic. Influenza A patients were younger, had higher seizure rates and complications compared to influenza B.
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Affiliation(s)
- Chia-Yin Chong
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Chee-Fu Yung
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Cherie Gan
- Singhealth Residency Programme, Singapore General Hospital, Singapore
| | - Szu-Tien Thio
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Natalie Woon-Hui Tan
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Nancy Wen-Sim Tee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore
| | - Cui Lin
- National Public Health Laboratory, Ministry of Health, Singapore
| | - Raymond Tze-Pin Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore.,National Public Health Laboratory, Ministry of Health, Singapore
| | - Koh-Cheng Thoon
- Infectious Diseases, Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-NUS Medical School, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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