Pediatr Infect Vaccine.  2017 Apr;24(1):23-30. 10.14776/piv.2017.24.1.23.

Clinical Comparison of Influenza A and B Virus Infection in Hospitalized Children

• Jung S
• Lee JH
• Kang JH
• Lee HS
• Choi JW
• Ma SH
• Lee J

• KMID: 2390878
• DOI: http://doi.org/10.14776/piv.2017.24.1.23

Abstract

PURPOSE
The objective of this study was to compare the clinical characteristics of influenza A and B infections and analyze the effect of oseltamivir in hospitalized children.
METHODS
We investigated children under the age of 15, who were diagnosed with influenza A/H1N1, A/H3N2, or B from January to April 2014. The subjects were admitted to the Changwon Fatima Hospital and diagnosed using a rapid antigen test from nasopharyngeal swabs. The medical records of the patients were retrospectively reviewed.
RESULTS
A total of 302 pediatric patients with influenza were enrolled. Influenza B infection was the most common type (n=187, 61.9%), followed by A/H3N2 (n=100, 33.1%) and A/H1N1 (n=15, 5.0%). Compared to patients diagnosed with influenza A, patients diagnosed with influenza B were older (P=0.005), and the duration of fever was significantly longer (P=0.001). A total of 161 patients (53.3%) had been vaccinated against influenza during the season, before admission. Among the patients infected with A/H3N2 and B, the duration of fever was shorter in oseltamivir recipients compared to oseltamivir non-recipients (P=0.026 and P=0.004, respectively).
CONCLUSIONS
There were significant differences between influenza A and B groups in terms of age, demographics, and clinical course. Although the effectiveness of oseltamivir on influenza differs according to the type of influenza, our data provides evidence that oseltamivir is beneficial for both A and B infections.

Keyword

Influenza, human; Oseltamivir

MeSH Terms

Child
Child, Hospitalized*
Demography
Fever
Gyeongsangnam-do
Herpesvirus 1, Cercopithecine*
Humans
Influenza, Human*
Medical Records
Oseltamivir
Retrospective Studies
Seasons
Oseltamivir

Figure

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  Fig. 1 The number of children according to the age group.

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  Fig. 2 The number of children with or without familial contacts in (A) children under 24 months, and in (B) 24 months to 6 years old according to the type of influenza.

Reference

1. Turner D, Wailoo A, Nicholson K, Cooper N, Sutton A, Abrams K. Systematic review and economic decision modelling for the prevention and treatment of influenza A and B. Health Technol Assess. 2003; 7:1–170.

2. Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, et al. Influenza-associated hospitalizations in the United States. JAMA. 2004; 292:1333–1340.

3. Simonsen L, Clarke MJ, Williamson GD, Stroup DF, Arden NH, Schonberger LB. The impact of influenza epidemics on mortality: introducing a severity index. Am J Public Health. 1997; 87:1944–1950.

4. van den Wijngaard CC, van Asten L, Meijer A, van Pelt W, Nagelkerke NJ, Donker GA, et al. Detection of excess influenza severity: associating respiratory hospitalization and mortality data with reports of influenza-like illness by primary care physicians. Am J Public Health. 2010; 100:2248–2254.

5. Kim YH, Kim HS, Cho SH, Seo SH. Influenza B virus causes milder pathogenesis and weaker inflammatory responses in ferrets than influenza A virus. Viral Immunol. 2009; 22:423–430.

6. Wie SH, So BH, Song JY, Cheong HJ, Seo YB, Choi SH, et al. A comparison of the clinical and epidemiological characteristics of adult patients with laboratory-confirmed influenza A or B during the 2011-2012 influenza season in Korea: a multi-center study. PLoS One. 2013; 8:e62685.

7. Whitley RJ, Hayden FG, Reisinger KS, Young N, Dutkowski R, Ipe D, et al. Oral oseltamivir treatment of influenza in children. Pediatr Infect Dis J. 2001; 20:127–133.

8. Kawai N, Ikematsu H, Iwaki N, Satoh I, Kawashima T, Maeda T, et al. Factors influencing the effectiveness of oseltamivir and amantadine for the treatment of influenza: a multicenter study from Japan of the 2002-2003 influenza season. Clin Infect Dis. 2005; 40:1309–1316.

9. Sugaya N, Mitamura K, Yamazaki M, Tamura D, Ichikawa M, Kimura K, et al. Lower clinical effectiveness of oseltamivir against influenza B contrasted with influenza A infection in children. Clin Infect Dis. 2007; 44:197–202.

10. Youn SE, Chun JH, Lee KS, Rha YH, Choi SH. Clinical characteristics of influenza B virus in children and the efficacy of oseltamivir: data from two university hospitals. Korean J Pediatr Infect Dis. 2014; 21:199–206.

11. Korea Centers for Disease Control and Prevention. Influenza sentinel surveillance report [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;c2012. cited 2016 Dec 28. Available from: http://www.cdc.go.kr/CDC/info/CdcKrInfo0402.jsp?menuIds=HOME001-MNU1132-MNU1138-MNU0045&cid=26166.

12. Peltola V, Ziegler T, Ruuskanen O. Influenza A and B virus infections in children. Clin Infect Dis. 2003; 36:299–305.

13. Hite LK, Glezen WP, Demmler GJ, Munoz FM. Medically attended pediatric influenza during the resurgence of the Victoria lineage of influenza B virus. Int J Infect Dis. 2007; 11:40–47.

14. Daley AJ, Nallusamy R, Isaacs D. Comparison of influenza A and influenza B virus infection in hospitalized children. J Paediatr Child Health. 2000; 36:332–335.

15. Glezen WP, Couch RB, Taber LH, Paredes A, Allison JE, Frank AL, et al. Epidemiologic observations of influenza B virus infections in Houston, Texas, 1976-1977. Am J Epidemiol. 1980; 111:13–22.

16. Kang TG, Kim MJ, Kim BG, An HS, Yun HJ, Choi EJ, et al. Comparisons of clinical features among influenza A (H1N1) and seasonal influenza A and B during 2009 to 2010 at a single institution. Pediatr Allergy Respir Dis. 2011; 21:269–276.

17. Kim MS, Sung HW, Bae EY, Han SB, Jeong DC, Kang JH. The clinical characteristics of influenza B infection during the 2011-2012 influenza season. Korean J Pediatr Infect Dis. 2013; 20:89–97.

18. Minodier L, Charrel RN, Ceccaldi PE, van der Werf S, Blanchon T, Hanslik T, et al. Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J. 2015; 12:215.

19. Hawkes M, Schuh S, Ipp M, Bitnun A, Richardson SE, Parkin PC, et al. Natural history of pandemic H1N1 2009 influenza infection in healthy pediatric outpatients. Acad Pediatr. 2011; 11:66–74.

20. Rothberg MB, Haessler SD. Complications of seasonal and pandemic influenza. Crit Care Med. 2010; 38:4 Suppl. e91–e97.

21. Treanor JJ, Hayden FG, Vrooman PS, Barbarash R, Bettis R, Riff D, et al. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. US Oral Neuraminidase Study Group. JAMA. 2000; 283:1016–1024.

22. Lee N, Chan PK, Hui DS, Rainer TH, Wong E, Choi KW, et al. Viral loads and duration of viral shedding in adult patients hospitalized with influenza. J Infect Dis. 2009; 200:492–500.

23. Hatakeyama S, Sugaya N, Ito M, Yamazaki M, Ichikawa M, Kimura K, et al. Emergence of influenza B viruses with reduced sensitivity to neuraminidase inhibitors. JAMA. 2007; 297:1435–1442.

24. Heinonen S, Silvennoinen H, Lehtinen P, Vainionpaa R, Vahlberg T, Ziegler T, et al. Early oseltamivir treatment of influenza in children 1-3 years of age: a randomized controlled trial. Clin Infect Dis. 2010; 51:887–894.