Serious Influenza Complications Common in Children

Andrew Bowser

April 21, 2004

April 21, 2004 (Philadelphia) — Pediatric infectious disease specialists saw a considerable number of influenza-related complications, including pneumonia, encephalopathy, and death, in the early part of the last influenza season, results of a survey described here at the Society for Healthcare Epidemiology annual meeting suggest.

Of 7,550 influenza cases reported by 87 physicians, there were 18 deaths, 39 cases of encephalopathy, and 654 viral pneumonia cases; in addition, almost 17% of cases required hospitalization and 1.5% required intubation, the data show.

These findings suggest "widespread" incidence of "severe complications and poor outcomes" among pediatric patients, the authors write in their study abstract. However, lead investigator Laura J. Podewils, MS, PhD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, told Medscape that these numbers should not be misconstrued as nationally representative.

The data are just a "snapshot" of what was seen in the early part of this season, as reported by a group of pediatric infectious disease specialists, who are more likely than general pediatricians to see sicker patients, and thus may be more likely to see serious complications, Dr. Podewils said.

The survey was a "way to gauge what the situation is, in the absence of national surveillance" in the pediatric population, Dr. Podewils told Medscape. "It's a nice complement to what exists…there wasn't any national surveillance for pediatric disease activity or complications."

The 2003-2004 influenza season arrived earlier than usual and was more severe than the preceding three seasons, the CDC previously reported in its April 9, 2004, issue. However, this survey doesn't shed any light on "whether this season is worse or better than previous seasons," Dr. Podewils added. "It's going to take additional seasons to put it in a bigger framework."

While limited in scope, the survey was conducted with the hope that its results would "lead to surveillance efforts or additional research," she said.

In mid-December, Dr. Podewils and colleagues sent surveys by email or fax to 250 U.S. pediatric providers, of whom 122 (48.8%) responded; of those, 87 provided specific data on patients, reporting a total of 7,550 cases, almost half of which were in the South (3,392 cases, or 44.9%). The first report of illness was on Sept 15, 2003.

Primary viral pneumonia was presumed in 654 patients (8.7%). Patients who were hospitalized numbered 1,258 (16.7%), and 113 (1.5%) of these required intubation. In addition to the 18 deaths, other findings included 39 cases of encephalopathy and 151 cases of secondary bacterial infection.

Pediatricians responding to the survey were members of the Emerging Infections Network of the Infectious Diseases Society of America.

"This is a very efficient and effective way to get a handle on what's going on around the nation, but they are infectious disease specialists, so the children they see are more likely to be hospitalized, and therefore may or may not be representative of what is seen in general practice," Dr. Podewils said.

The authors reported no commercial relationships relevant to the study.

SHEA 14th Annual Scientific Meeting: Abstract LB-1. Presented April 20, 2004.

Reviewed by Gary D. Vogin, MD

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