tetano
Editor, Senior Moderator
Clin Infect Dis
. 2022 Sep 7;ciac734.
doi: 10.1093/cid/ciac734. Online ahead of print.
The Spectrum of Influenza in Children
Gregory Hoy[SUP] 1 [/SUP], Guillermina Kuan[SUP] 2 3 [/SUP], Roger López[SUP] 2 4 [/SUP], Nery Sánchez[SUP] 2 [/SUP], Brenda López[SUP] 2 [/SUP], Sergio Ojeda[SUP] 2 3 [/SUP], Hannah Maier[SUP] 1 [/SUP], Mayuri Patel[SUP] 1 [/SUP], Steph Wraith[SUP] 1 [/SUP], Alyssa Meyers[SUP] 1 [/SUP], Lora Campredon[SUP] 1 [/SUP], Angel Balmaseda[SUP] 2 4 [/SUP], Aubree Gordon[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Children constitute an important component of the influenza burden and community transmission, but the frequency of asymptomatic infection and post-influenza sequelae at the community level is poorly understood.
Methods: Two community-based prospective cohort studies (2011-2020, 2017-2020) and one case-ascertained study (2012-2017) were conducted in Managua, Nicaragua.Non-immunocompromised children aged 0-14 years with ≥1 influenza infections, determined by polymerase chain reaction and hemagglutination inhibition assay, were included.
Results: A total of 1272 influenza infections occurred in the household-based portion of the study. Influenza infection was asymptomatic in 84 (6.6%) infections, and the asymptomatic fraction increased with age (1.7%, 3.5%, and 9.1% for ages 0-1, 2-4, and 5-14, respectively; p < 0.001). Of asymptomatic children, 43 (51.2%) shed virus, compared to 1099 (92.5%) symptomatic children (p < 0.001). 2140 cases of influenza occurred in the primary care portion of the study. Sequelae of influenza were rare, with the most common being pneumonia (52, 2.4%) and acute otitis media (71, 3.3%). A/H1N1 had higher age-adjusted odds of acute otitis media (OR 1.99, 95% CI 1.14-3.48; p = 0.015) and hospitalization (OR 3.73, 95% CI 1.68-8.67; p = 0.002) than A/H3N2. B/Victoria had higher age-adjusted odds of pneumonia (OR 10.99, 95% CI 1.34-90.28; p = 0.026) than B/Yamagata.
Conclusions: Asymptomatic influenza infection is much less common in children than adults, though viral shedding still occurs in asymptomatic children. Post-influenza sequelae are rare in children in the community setting, and virus strain may be important in understanding the risk of sequelae.
Keywords: asymptomatic influenza; clinical presentation; global health; influenza; pediatrics.
. 2022 Sep 7;ciac734.
doi: 10.1093/cid/ciac734. Online ahead of print.
The Spectrum of Influenza in Children
Gregory Hoy[SUP] 1 [/SUP], Guillermina Kuan[SUP] 2 3 [/SUP], Roger López[SUP] 2 4 [/SUP], Nery Sánchez[SUP] 2 [/SUP], Brenda López[SUP] 2 [/SUP], Sergio Ojeda[SUP] 2 3 [/SUP], Hannah Maier[SUP] 1 [/SUP], Mayuri Patel[SUP] 1 [/SUP], Steph Wraith[SUP] 1 [/SUP], Alyssa Meyers[SUP] 1 [/SUP], Lora Campredon[SUP] 1 [/SUP], Angel Balmaseda[SUP] 2 4 [/SUP], Aubree Gordon[SUP] 1 [/SUP]
Affiliations
- PMID: 36069178
- DOI: 10.1093/cid/ciac734
Abstract
Background: Children constitute an important component of the influenza burden and community transmission, but the frequency of asymptomatic infection and post-influenza sequelae at the community level is poorly understood.
Methods: Two community-based prospective cohort studies (2011-2020, 2017-2020) and one case-ascertained study (2012-2017) were conducted in Managua, Nicaragua.Non-immunocompromised children aged 0-14 years with ≥1 influenza infections, determined by polymerase chain reaction and hemagglutination inhibition assay, were included.
Results: A total of 1272 influenza infections occurred in the household-based portion of the study. Influenza infection was asymptomatic in 84 (6.6%) infections, and the asymptomatic fraction increased with age (1.7%, 3.5%, and 9.1% for ages 0-1, 2-4, and 5-14, respectively; p < 0.001). Of asymptomatic children, 43 (51.2%) shed virus, compared to 1099 (92.5%) symptomatic children (p < 0.001). 2140 cases of influenza occurred in the primary care portion of the study. Sequelae of influenza were rare, with the most common being pneumonia (52, 2.4%) and acute otitis media (71, 3.3%). A/H1N1 had higher age-adjusted odds of acute otitis media (OR 1.99, 95% CI 1.14-3.48; p = 0.015) and hospitalization (OR 3.73, 95% CI 1.68-8.67; p = 0.002) than A/H3N2. B/Victoria had higher age-adjusted odds of pneumonia (OR 10.99, 95% CI 1.34-90.28; p = 0.026) than B/Yamagata.
Conclusions: Asymptomatic influenza infection is much less common in children than adults, though viral shedding still occurs in asymptomatic children. Post-influenza sequelae are rare in children in the community setting, and virus strain may be important in understanding the risk of sequelae.
Keywords: asymptomatic influenza; clinical presentation; global health; influenza; pediatrics.