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Subtype-Specific Clinical Presentation, Medical Treatment and Family Impact of Influenza in Children One to Five Years of Age Treated in Outpatient Practices in Germany During Three Post-Pandemic Years, 2013-2015

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  • Subtype-Specific Clinical Presentation, Medical Treatment and Family Impact of Influenza in Children One to Five Years of Age Treated in Outpatient Practices in Germany During Three Post-Pandemic Years, 2013-2015

    Pediatr Infect Dis J. 2018 Feb 5. doi: 10.1097/INF.0000000000001935. [Epub ahead of print]
    Subtype-Specific Clinical Presentation, Medical Treatment and Family Impact of Influenza in Children One to Five Years of Age Treated in Outpatient Practices in Germany During Three Post-Pandemic Years, 2013-2015.

    Streng A, Prifert C1, Weissbrich B1, Sauerbrei A2, Schmidt-Ott R3, Liese JG4.
    Author information

    Abstract

    BACKGROUND:

    Limited data on the influenza burden in pediatric outpatients are available, especially regarding direct comparison of the co-circulating (sub)types A(H1N1)pdm09, A(H3N2) and B.
    METHODS:

    Children 1-5 years of age, unvaccinated against influenza and presenting with febrile acute respiratory infections (ARI), were enrolled in 33 paediatric practices in Germany from 2013-2015 (January-May). Influenza was confirmed by multiplex PCR from pharyngeal swabs and (sub)typed.
    RESULTS:

    In 805 children with ARI, influenza was the most frequently detected respiratory virus (n=305; 37.9%). Of 217 influenza patients included, 122 (56.2%) were infected with A(H3N2), 56 (25.8%) with A(H1N1)pdm09, and 39 (18.0%) with B. Median age was 3.7 years (IQR 2.1-4.8); 11% had underlying conditions. Median fever duration was 4 days (IQR 3-5), and the disease duration was 9 days (IQR 7-12). Most frequent diagnoses were pharyngitis (26%), bronchitis (18%) and acute otitis media (AOM; 10%). Children received mainly antipyretics (86%) and adrenergic nasal drops/spray (53%); 9% received antibiotics and 3% oseltamivir. Thirty-six percent required at least one additional practice visit; 1% were hospitalized. Median absences from childcare were 5 days (IQR 3-7); parents lost 4 workdays (IQR 2-6). Symptoms, severity and impact on the family were largely unrelated to (sub)type. However, patients with A(H1N1)pdm09 had fewer underlying conditions (p=0.017), whereas patients with B more often had pharyngitis (p=0.022), AOM (p=0.012) and stenosing laryngotracheitis (p=0.007).
    CONCLUSIONS:

    Influenza was the most frequently detected viral pathogen in outpatient children with febrile, mostly uncomplicated ARI. In this setting, clinical manifestations and severity were similar across the (sub)types prevalent during the post-pandemic seasons.


    PMID: 29406467 DOI: 10.1097/INF.0000000000001935
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