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Published in: BMC Infectious Diseases 1/2016

Open Access 01-12-2016 | Research article

Influenza-associated outpatient visits among children less than 5 years of age in eastern China, 2011–2014

Authors: Tao Zhang, Jun Zhang, Jun Hua, Dan Wang, Liling Chen, Yunfang Ding, Shanshan Zeng, Jing Wu, Yanwei Jiang, Qian Geng, Suizan Zhou, Ying Song, A. Danielle Iuliano, Carolyn M. Greene, Jeffrey McFarland, Genming Zhao

Published in: BMC Infectious Diseases | Issue 1/2016

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Abstract

Background

The disease burden of influenza in China has not been well described, especially among young children. The aim of this study was to estimate the incidence of outpatient visits associated with influenza in young children in Suzhou, a city of more than 11 million residents in Jiangsu Province in eastern China.

Methods

Influenza-like illness (ILI) was defined as the presence of fever (axillary temperature ≥38 °C) and cough or sore throat. We collected throat swabs for children less than 5 years of age with ILI who visited Suzhou University Affiliated Children’s Hospital (SCH) outpatient clinic or emergency room between April 2011 and March 2014. Suzhou CDC, a national influenza surveillance network laboratory, tested for influenza viruses by real-time reverse transcription-polymerase chain reaction assay (rRT-PCR). Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza by rRT-PCR. To calculate the incidence of influenza-associated outpatient visits, we conducted community-based healthcare utilization surveys to determine the proportion of hospital catchment area residents who sought care at SCH.

Results

The estimated incidence of influenza-associated ILI outpatient visits among children aged <5 years in the catchment area of Suzhou was, per 100 population, 17.4 (95 % CI 11.0–25.3) during April 2011-March 2012, 14.6 (95 % CI 5.2–26.2) during April 2012-March 2013 and 21.4 (95 % CI: 10.9–33.5) during April 2013-March 2014. The age-specific outpatient visit rates of influenza-associated ILI were 4.9, 21.1 and 21.2 per 100 children aged 0- <6 months, 6- <24 months and 24- <60 months, respectively.

Conclusion

Influenza virus infection causes a substantial burden of outpatient visits among young children in Suzhou, China. Targeted influenza prevention and control strategies for young children in Suzhou are needed to reduce influenza-associated outpatient visits in this age group.
Literature
1.
go back to reference Thompson W, DK S, E W, et al. Influenza-associated hospitalizations in the United States. JAMA. 2004;292:1333–40.CrossRefPubMed Thompson W, DK S, E W, et al. Influenza-associated hospitalizations in the United States. JAMA. 2004;292:1333–40.CrossRefPubMed
2.
go back to reference O'Brien MA, Uyeki TM, Shay DK, et al. Incidence of outpatient visits and hospitalizations related to influenza in infants and young children. Pediatrics. 2004;113:585–93.CrossRefPubMed O'Brien MA, Uyeki TM, Shay DK, et al. Incidence of outpatient visits and hospitalizations related to influenza in infants and young children. Pediatrics. 2004;113:585–93.CrossRefPubMed
3.
go back to reference Heikkinen T, Pulkkinen J, Kainulainen L, et al. Incidence of influenza in Finnish children. The Pediatr Iinfect Dis J. 2003;22:S204–6.CrossRef Heikkinen T, Pulkkinen J, Kainulainen L, et al. Incidence of influenza in Finnish children. The Pediatr Iinfect Dis J. 2003;22:S204–6.CrossRef
4.
go back to reference Bueving HJ, van der Wouden JC, Berger MY, Thomas S. Incidence of influenza and associated illness in children aged 0-19 years: a systematic review. Rev Med Virol. 2005;15:383–91.CrossRefPubMed Bueving HJ, van der Wouden JC, Berger MY, Thomas S. Incidence of influenza and associated illness in children aged 0-19 years: a systematic review. Rev Med Virol. 2005;15:383–91.CrossRefPubMed
5.
go back to reference Paget WJ, Balderston C, Casas I, et al. Assessing the burden of paediatric influenza in Europe: the European Paediatric Influenza Analysis (EPIA) project. Eur J Pediatr. 2010;169:997–1008.CrossRefPubMedPubMedCentral Paget WJ, Balderston C, Casas I, et al. Assessing the burden of paediatric influenza in Europe: the European Paediatric Influenza Analysis (EPIA) project. Eur J Pediatr. 2010;169:997–1008.CrossRefPubMedPubMedCentral
6.
go back to reference Poehling KA, Edwards KM, Weinberg GA, et al. The Underrecognized Burden of Influenza in Young Children. N Engl J Med. 2006;335:31–40.CrossRef Poehling KA, Edwards KM, Weinberg GA, et al. The Underrecognized Burden of Influenza in Young Children. N Engl J Med. 2006;335:31–40.CrossRef
8.
go back to reference Steinhoff MC. Influenza in young children: burden, immunisation, and policy. Lancet Infect Dis. 2011;11:2–3.CrossRefPubMed Steinhoff MC. Influenza in young children: burden, immunisation, and policy. Lancet Infect Dis. 2011;11:2–3.CrossRefPubMed
9.
go back to reference Simmerman JM, Uyeki TM. The burden of influenza in East and South-East Asia: a review of the English language literature. Influenza Other Respi Viruses. 2008;2:81–92.CrossRef Simmerman JM, Uyeki TM. The burden of influenza in East and South-East Asia: a review of the English language literature. Influenza Other Respi Viruses. 2008;2:81–92.CrossRef
10.
go back to reference Feikin DR, Ope MO, Aura B, et al. The population-based burden of influenza-associated hospitalization in rural western Kenya, 2007-2009. Bull World Health Organ. 2012;90:256–63.CrossRefPubMedPubMedCentral Feikin DR, Ope MO, Aura B, et al. The population-based burden of influenza-associated hospitalization in rural western Kenya, 2007-2009. Bull World Health Organ. 2012;90:256–63.CrossRefPubMedPubMedCentral
11.
go back to reference Karve S, Meier G, Davis KL, Misurski DA, Wang CE. Influenza-related health care utilization and productivity losses during seasons with and without a match between the seasonal and vaccine virus B lineage. Vaccine. 2013;31:3370–88.CrossRefPubMed Karve S, Meier G, Davis KL, Misurski DA, Wang CE. Influenza-related health care utilization and productivity losses during seasons with and without a match between the seasonal and vaccine virus B lineage. Vaccine. 2013;31:3370–88.CrossRefPubMed
12.
go back to reference Azziz-Baumgartner E, Alamgir AS, Rahman M, et al. Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008-2010. Bull World Health Organ. 2012;90:12–9.CrossRefPubMed Azziz-Baumgartner E, Alamgir AS, Rahman M, et al. Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008-2010. Bull World Health Organ. 2012;90:12–9.CrossRefPubMed
13.
go back to reference Statistics National Bureau Of C, editor. China statistical yearbook 2013. Beijing: China Statistics Press; 2013. Statistics National Bureau Of C, editor. China statistical yearbook 2013. Beijing: China Statistics Press; 2013.
14.
go back to reference Feng L, Mounts AW, Feng Y, et al. Seasonal influenza vaccine supply and target vaccinated population in China, 2004–2009. Vaccine. 2010;28:6778–82.CrossRefPubMed Feng L, Mounts AW, Feng Y, et al. Seasonal influenza vaccine supply and target vaccinated population in China, 2004–2009. Vaccine. 2010;28:6778–82.CrossRefPubMed
15.
go back to reference Zhou L, Situ S, Feng Z, et al. Cost-Effectiveness of Alternative Strategies for Annual Influenza Vaccination among Children Aged 6 Months to 14 Years in Four Provinces in China. PLoS One. 2014;9:e87590.CrossRefPubMedPubMedCentral Zhou L, Situ S, Feng Z, et al. Cost-Effectiveness of Alternative Strategies for Annual Influenza Vaccination among Children Aged 6 Months to 14 Years in Four Provinces in China. PLoS One. 2014;9:e87590.CrossRefPubMedPubMedCentral
16.
go back to reference Zhou L, Su Q, Xu Z, et al. Seasonal Influenza Vaccination Coverage Rate of Target Groups in Selected Cities and Provinces in China by Season (2009/10 to 2011/12). PLoS One. 2013;8:e73724.CrossRefPubMedPubMedCentral Zhou L, Su Q, Xu Z, et al. Seasonal Influenza Vaccination Coverage Rate of Target Groups in Selected Cities and Provinces in China by Season (2009/10 to 2011/12). PLoS One. 2013;8:e73724.CrossRefPubMedPubMedCentral
17.
go back to reference Yu H, Huang J, Huai Y, et al. The substantial hospitalization burden of influenza in central China: surveillance for severe, acute respiratory infection, and influenza viruses, 2010-2012. Influenza Other Respir Viruses. 2014;8:53–65.CrossRefPubMed Yu H, Huang J, Huai Y, et al. The substantial hospitalization burden of influenza in central China: surveillance for severe, acute respiratory infection, and influenza viruses, 2010-2012. Influenza Other Respir Viruses. 2014;8:53–65.CrossRefPubMed
20.
go back to reference Tsai W, Chi Y, Chen C. Interval estimation of binomial proportion in clinical trials with a two-stage design. Stat Med. 2008;27:15–35.CrossRefPubMed Tsai W, Chi Y, Chen C. Interval estimation of binomial proportion in clinical trials with a two-stage design. Stat Med. 2008;27:15–35.CrossRefPubMed
21.
go back to reference Broor S, Parveen S, Bharaj P, et al. A Prospective Three-Year Cohort Study of the Epidemiology and Virology of Acute Respiratory Infections of Children in Rural India. PLoS One. 2007;2:e491.CrossRefPubMedPubMedCentral Broor S, Parveen S, Bharaj P, et al. A Prospective Three-Year Cohort Study of the Epidemiology and Virology of Acute Respiratory Infections of Children in Rural India. PLoS One. 2007;2:e491.CrossRefPubMedPubMedCentral
22.
go back to reference Simmerman JM, Lertiendumrong J, Dowell SF, et al. The cost of influenza in Thailand. Vaccine. 2006;24:4417–26.CrossRefPubMed Simmerman JM, Lertiendumrong J, Dowell SF, et al. The cost of influenza in Thailand. Vaccine. 2006;24:4417–26.CrossRefPubMed
23.
go back to reference Ng T, Pwee K, Niti M, Goh L. Influenza in Singapore: assessing the burden of illness in the community. Ann Acad Med Singapore. 2002;31:181–8. Ng T, Pwee K, Niti M, Goh L. Influenza in Singapore: assessing the burden of illness in the community. Ann Acad Med Singapore. 2002;31:181–8.
24.
go back to reference Nair H, Brooks WA, Katz M, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet. 2011;378:1917–30.CrossRefPubMed Nair H, Brooks WA, Katz M, et al. Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet. 2011;378:1917–30.CrossRefPubMed
25.
go back to reference Peng Z, Feng L, Carolyn GM, et al. Characterizing the epidemiology, virology, and clinical features of influenza in China’s first severe acute respiratory infection sentinel surveillance system, February 2011 - October 2013. BMC Infect Dis. 2015;15:143.CrossRefPubMedPubMedCentral Peng Z, Feng L, Carolyn GM, et al. Characterizing the epidemiology, virology, and clinical features of influenza in China’s first severe acute respiratory infection sentinel surveillance system, February 2011 - October 2013. BMC Infect Dis. 2015;15:143.CrossRefPubMedPubMedCentral
26.
go back to reference Esposito S, Molteni CG, Daleno C, et al. Clinical and socioeconomic impact of different types and subtypes of seasonal influenza viruses in children during influenza seasons 2007/2008 and 2008/2009. BMC Infect Dis. 2011;11:271.CrossRefPubMedPubMedCentral Esposito S, Molteni CG, Daleno C, et al. Clinical and socioeconomic impact of different types and subtypes of seasonal influenza viruses in children during influenza seasons 2007/2008 and 2008/2009. BMC Infect Dis. 2011;11:271.CrossRefPubMedPubMedCentral
27.
go back to reference Fraaij PLA, Heikkinen T. Seasonal influenza: The burden of disease in children. Vaccine. 2011;29:7524–8.CrossRefPubMed Fraaij PLA, Heikkinen T. Seasonal influenza: The burden of disease in children. Vaccine. 2011;29:7524–8.CrossRefPubMed
28.
go back to reference Chiu SS, Chan K, So LY, Chen R, Chan ELY, Peiris JSM. The population based socioeconomic burden of pediatric influenza-associated hospitalization in Hong Kong. Vaccine. 2012;30:1895–900.CrossRefPubMed Chiu SS, Chan K, So LY, Chen R, Chan ELY, Peiris JSM. The population based socioeconomic burden of pediatric influenza-associated hospitalization in Hong Kong. Vaccine. 2012;30:1895–900.CrossRefPubMed
29.
go back to reference Tsolia MN, Logotheti I, Papadopoulos NG, et al. Impact of influenza infection in healthy children examined as outpatients and their families. Vaccine. 2006;24:5970–6.CrossRefPubMed Tsolia MN, Logotheti I, Papadopoulos NG, et al. Impact of influenza infection in healthy children examined as outpatients and their families. Vaccine. 2006;24:5970–6.CrossRefPubMed
30.
go back to reference Wang D, Zhang T, Wu J, et al. Socio-Economic Burden of Influenza among Children Younger than 5 Years in the Outpatient Setting in Suzhou, China. PLoS One. 2013;8:e69035.CrossRefPubMedPubMedCentral Wang D, Zhang T, Wu J, et al. Socio-Economic Burden of Influenza among Children Younger than 5 Years in the Outpatient Setting in Suzhou, China. PLoS One. 2013;8:e69035.CrossRefPubMedPubMedCentral
31.
go back to reference Silvennoinen H, Peltola V, Vainionp R, Ruuskanen O, Heikkinen T. Admission diagnoses of children 0–16 years of age hospitalized with influenza. Eur J Clin Microbiol Infect Dis. 2012;31:225–31.CrossRefPubMed Silvennoinen H, Peltola V, Vainionp R, Ruuskanen O, Heikkinen T. Admission diagnoses of children 0–16 years of age hospitalized with influenza. Eur J Clin Microbiol Infect Dis. 2012;31:225–31.CrossRefPubMed
32.
go back to reference Spencer S, Gaglani M, Naleway A, et al. Consistency of influenza A virus detection test results across respiratory specimen collection methods using real-time reverse transcription-PCR. J Clin Microbiol. 2013;51:3880–2.CrossRefPubMedPubMedCentral Spencer S, Gaglani M, Naleway A, et al. Consistency of influenza A virus detection test results across respiratory specimen collection methods using real-time reverse transcription-PCR. J Clin Microbiol. 2013;51:3880–2.CrossRefPubMedPubMedCentral
33.
go back to reference Kim C, Ahmed JA, Eidex RB, et al. Comparison of nasopharyngeal and oropharyngeal swabs for the diagnosis of eight respiratory viruses by real-time reverse transcription-PCR assays. PLoS One. 2011;6:e21610.CrossRefPubMedPubMedCentral Kim C, Ahmed JA, Eidex RB, et al. Comparison of nasopharyngeal and oropharyngeal swabs for the diagnosis of eight respiratory viruses by real-time reverse transcription-PCR assays. PLoS One. 2011;6:e21610.CrossRefPubMedPubMedCentral
Metadata
Title
Influenza-associated outpatient visits among children less than 5 years of age in eastern China, 2011–2014
Authors
Tao Zhang
Jun Zhang
Jun Hua
Dan Wang
Liling Chen
Yunfang Ding
Shanshan Zeng
Jing Wu
Yanwei Jiang
Qian Geng
Suizan Zhou
Ying Song
A. Danielle Iuliano
Carolyn M. Greene
Jeffrey McFarland
Genming Zhao
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2016
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-016-1614-z

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