The Spectrum of Influenza in Children
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, 2...
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| Veröffentlicht in: | Clinical infectious diseases 2023-02, Vol.76 (3), p.e1012-e1020 |
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| creator | Hoy, Gregory Kuan, Guillermina López, Roger Sánchez, Nery López, Brenda Ojeda, Sergio Maier, Hannah Patel, Mayuri Wraith, Steph Meyers, Alyssa Campredon, Lora Balmaseda, Angel Gordon, Aubree |
| description | 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 1 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 < .001). Of asymptomatic children, 43 (51.2%) shed virus, compared to 1099 (92.5%) symptomatic children (P < .001). Also, 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 (odds ratio [OR] 1.99, 95% confidence interval [CI]: 1.14–3.48; P = .015) and hospitalization (OR 3.73, 95% CI: 1.68–8.67; P = .002) than A/H3N2. B/Victoria had higher age-adjusted odds of pneumonia (OR 10.99, 95% CI: 1.34–90.28; P = .026) than B/Yamagata.
Conclusions
Asymptomatic influenza infection is much less common in children than adults, although 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.
The full clinical spectrum of influenza in children, including frequency of asymptomatic infection and sequelae, is poorly understood. We found that asymptomatic infection in children is rare and age-dependent, and that the risk of sequelae depends on virus strain. |
| doi_str_mv | 10.1093/cid/ciac734 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9907523</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/cid/ciac734</oup_id><sourcerecordid>2711306913</sourcerecordid><originalsourceid>FETCH-LOGICAL-c412t-2ccba556fd524ced48bbbbc205ab9cf6338ce1305fbe4e2f42ecdcd32a187cd3</originalsourceid><addsrcrecordid>eNp9kMtLw0AQxhdRbK2evEsuiiDRfWSTzUWQ4qNQ8GDvy2YyayN5udsI-te7pbXoxYFhBubHNzMfIaeMXjOaixuoypAGMpHskTGTIotTmbP90FOp4kQJNSJH3r9Rypii8pCMRErTnGVqTM4XS4xeeoSVG5qos9GstfWA7ZeJqjaaLqu6dNgekwNrao8n2zohi4f7xfQpnj8_zqZ38xgSxlcxByiMlKktJU8Ay0QVIYBTaYocbCqEAmSCSltggtwmHKGEUnDDVBbqhNxuZPuhaLAEbFfO1Lp3VWPcp-5Mpf9O2mqpX7sPnec0k1wEgcutgOveB_Qr3VQesK5Ni93gNc9YWB9eX6NXGxRc571Du1vDqF77qoOveutroM9-X7Zjf4wMwMUG6Ib-X6Vv-6CCnQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2711306913</pqid></control><display><type>article</type><title>The Spectrum of Influenza in Children</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Hoy, Gregory ; Kuan, Guillermina ; López, Roger ; Sánchez, Nery ; López, Brenda ; Ojeda, Sergio ; Maier, Hannah ; Patel, Mayuri ; Wraith, Steph ; Meyers, Alyssa ; Campredon, Lora ; Balmaseda, Angel ; Gordon, Aubree</creator><creatorcontrib>Hoy, Gregory ; Kuan, Guillermina ; López, Roger ; Sánchez, Nery ; López, Brenda ; Ojeda, Sergio ; Maier, Hannah ; Patel, Mayuri ; Wraith, Steph ; Meyers, Alyssa ; Campredon, Lora ; Balmaseda, Angel ; Gordon, Aubree</creatorcontrib><description>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 1 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 < .001). Of asymptomatic children, 43 (51.2%) shed virus, compared to 1099 (92.5%) symptomatic children (P < .001). Also, 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 (odds ratio [OR] 1.99, 95% confidence interval [CI]: 1.14–3.48; P = .015) and hospitalization (OR 3.73, 95% CI: 1.68–8.67; P = .002) than A/H3N2. B/Victoria had higher age-adjusted odds of pneumonia (OR 10.99, 95% CI: 1.34–90.28; P = .026) than B/Yamagata.
Conclusions
Asymptomatic influenza infection is much less common in children than adults, although 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.
The full clinical spectrum of influenza in children, including frequency of asymptomatic infection and sequelae, is poorly understood. We found that asymptomatic infection in children is rare and age-dependent, and that the risk of sequelae depends on virus strain.</description><identifier>ISSN: 1058-4838</identifier><identifier>ISSN: 1537-6591</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciac734</identifier><identifier>PMID: 36069178</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adult ; Child ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza A Virus, H3N2 Subtype ; Influenza Vaccines ; Influenza, Human - complications ; Influenza, Human - epidemiology ; Major ; Pneumonia ; Prospective Studies</subject><ispartof>Clinical infectious diseases, 2023-02, Vol.76 (3), p.e1012-e1020</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-2ccba556fd524ced48bbbbc205ab9cf6338ce1305fbe4e2f42ecdcd32a187cd3</citedby><cites>FETCH-LOGICAL-c412t-2ccba556fd524ced48bbbbc205ab9cf6338ce1305fbe4e2f42ecdcd32a187cd3</cites><orcidid>0000-0002-9352-7877</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36069178$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hoy, Gregory</creatorcontrib><creatorcontrib>Kuan, Guillermina</creatorcontrib><creatorcontrib>López, Roger</creatorcontrib><creatorcontrib>Sánchez, Nery</creatorcontrib><creatorcontrib>López, Brenda</creatorcontrib><creatorcontrib>Ojeda, Sergio</creatorcontrib><creatorcontrib>Maier, Hannah</creatorcontrib><creatorcontrib>Patel, Mayuri</creatorcontrib><creatorcontrib>Wraith, Steph</creatorcontrib><creatorcontrib>Meyers, Alyssa</creatorcontrib><creatorcontrib>Campredon, Lora</creatorcontrib><creatorcontrib>Balmaseda, Angel</creatorcontrib><creatorcontrib>Gordon, Aubree</creatorcontrib><title>The Spectrum of Influenza in Children</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>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 1 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 < .001). Of asymptomatic children, 43 (51.2%) shed virus, compared to 1099 (92.5%) symptomatic children (P < .001). Also, 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 (odds ratio [OR] 1.99, 95% confidence interval [CI]: 1.14–3.48; P = .015) and hospitalization (OR 3.73, 95% CI: 1.68–8.67; P = .002) than A/H3N2. B/Victoria had higher age-adjusted odds of pneumonia (OR 10.99, 95% CI: 1.34–90.28; P = .026) than B/Yamagata.
Conclusions
Asymptomatic influenza infection is much less common in children than adults, although 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.
The full clinical spectrum of influenza in children, including frequency of asymptomatic infection and sequelae, is poorly understood. We found that asymptomatic infection in children is rare and age-dependent, and that the risk of sequelae depends on virus strain.</description><subject>Adult</subject><subject>Child</subject><subject>Humans</subject><subject>Influenza A Virus, H1N1 Subtype</subject><subject>Influenza A Virus, H3N2 Subtype</subject><subject>Influenza Vaccines</subject><subject>Influenza, Human - complications</subject><subject>Influenza, Human - epidemiology</subject><subject>Major</subject><subject>Pneumonia</subject><subject>Prospective Studies</subject><issn>1058-4838</issn><issn>1537-6591</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNp9kMtLw0AQxhdRbK2evEsuiiDRfWSTzUWQ4qNQ8GDvy2YyayN5udsI-te7pbXoxYFhBubHNzMfIaeMXjOaixuoypAGMpHskTGTIotTmbP90FOp4kQJNSJH3r9Rypii8pCMRErTnGVqTM4XS4xeeoSVG5qos9GstfWA7ZeJqjaaLqu6dNgekwNrao8n2zohi4f7xfQpnj8_zqZ38xgSxlcxByiMlKktJU8Ay0QVIYBTaYocbCqEAmSCSltggtwmHKGEUnDDVBbqhNxuZPuhaLAEbFfO1Lp3VWPcp-5Mpf9O2mqpX7sPnec0k1wEgcutgOveB_Qr3VQesK5Ni93gNc9YWB9eX6NXGxRc571Du1vDqF77qoOveutroM9-X7Zjf4wMwMUG6Ib-X6Vv-6CCnQ</recordid><startdate>20230208</startdate><enddate>20230208</enddate><creator>Hoy, Gregory</creator><creator>Kuan, Guillermina</creator><creator>López, Roger</creator><creator>Sánchez, Nery</creator><creator>López, Brenda</creator><creator>Ojeda, Sergio</creator><creator>Maier, Hannah</creator><creator>Patel, Mayuri</creator><creator>Wraith, Steph</creator><creator>Meyers, Alyssa</creator><creator>Campredon, Lora</creator><creator>Balmaseda, Angel</creator><creator>Gordon, Aubree</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9352-7877</orcidid></search><sort><creationdate>20230208</creationdate><title>The Spectrum of Influenza in Children</title><author>Hoy, Gregory ; Kuan, Guillermina ; López, Roger ; Sánchez, Nery ; López, Brenda ; Ojeda, Sergio ; Maier, Hannah ; Patel, Mayuri ; Wraith, Steph ; Meyers, Alyssa ; Campredon, Lora ; Balmaseda, Angel ; Gordon, Aubree</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c412t-2ccba556fd524ced48bbbbc205ab9cf6338ce1305fbe4e2f42ecdcd32a187cd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Child</topic><topic>Humans</topic><topic>Influenza A Virus, H1N1 Subtype</topic><topic>Influenza A Virus, H3N2 Subtype</topic><topic>Influenza Vaccines</topic><topic>Influenza, Human - complications</topic><topic>Influenza, Human - epidemiology</topic><topic>Major</topic><topic>Pneumonia</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hoy, Gregory</creatorcontrib><creatorcontrib>Kuan, Guillermina</creatorcontrib><creatorcontrib>López, Roger</creatorcontrib><creatorcontrib>Sánchez, Nery</creatorcontrib><creatorcontrib>López, Brenda</creatorcontrib><creatorcontrib>Ojeda, Sergio</creatorcontrib><creatorcontrib>Maier, Hannah</creatorcontrib><creatorcontrib>Patel, Mayuri</creatorcontrib><creatorcontrib>Wraith, Steph</creatorcontrib><creatorcontrib>Meyers, Alyssa</creatorcontrib><creatorcontrib>Campredon, Lora</creatorcontrib><creatorcontrib>Balmaseda, Angel</creatorcontrib><creatorcontrib>Gordon, Aubree</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hoy, Gregory</au><au>Kuan, Guillermina</au><au>López, Roger</au><au>Sánchez, Nery</au><au>López, Brenda</au><au>Ojeda, Sergio</au><au>Maier, Hannah</au><au>Patel, Mayuri</au><au>Wraith, Steph</au><au>Meyers, Alyssa</au><au>Campredon, Lora</au><au>Balmaseda, Angel</au><au>Gordon, Aubree</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Spectrum of Influenza in Children</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2023-02-08</date><risdate>2023</risdate><volume>76</volume><issue>3</issue><spage>e1012</spage><epage>e1020</epage><pages>e1012-e1020</pages><issn>1058-4838</issn><issn>1537-6591</issn><eissn>1537-6591</eissn><abstract>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 1 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 < .001). Of asymptomatic children, 43 (51.2%) shed virus, compared to 1099 (92.5%) symptomatic children (P < .001). Also, 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 (odds ratio [OR] 1.99, 95% confidence interval [CI]: 1.14–3.48; P = .015) and hospitalization (OR 3.73, 95% CI: 1.68–8.67; P = .002) than A/H3N2. B/Victoria had higher age-adjusted odds of pneumonia (OR 10.99, 95% CI: 1.34–90.28; P = .026) than B/Yamagata.
Conclusions
Asymptomatic influenza infection is much less common in children than adults, although 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.
The full clinical spectrum of influenza in children, including frequency of asymptomatic infection and sequelae, is poorly understood. We found that asymptomatic infection in children is rare and age-dependent, and that the risk of sequelae depends on virus strain.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>36069178</pmid><doi>10.1093/cid/ciac734</doi><orcidid>https://orcid.org/0000-0002-9352-7877</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adult Child Humans Influenza A Virus, H1N1 Subtype Influenza A Virus, H3N2 Subtype Influenza Vaccines Influenza, Human - complications Influenza, Human - epidemiology Major Pneumonia Prospective Studies |
| title | The Spectrum of Influenza in Children |
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