Zurynski Yvonne A, Lester-Smith David, Festa Marino S, Kesson Alison M, Booy Robert, Elliott Elizabeth J
Australian Paediatric Surveillance Unit, The Children's Hospital ant Westmead, New South Wales.
Commun Dis Intell Q Rep. 2008 Mar;32(1):71-6.
Influenza contributes significantly to disease burden among children aged less than five years. Existing influenza surveillance systems do not provide detailed data on clinical presentation, management, vaccination status, risk factors and complications in hospitalised children, or link such data with laboratory results. Following a number of child deaths due to influenza in 2007, the Australian Government Department of Health and Ageing approached the Australian Paediatric Surveillance Unit (APSU) to examine the feasibility of enhancing APSU surveillance to identify children hospitalised with severe complications of influenza. Active, national, weekly surveillance was conducted during September 2007 with reporting by 1,256 Australian paediatricians working in hospitals and outpatient settings. The weekly report card return rate was 93%; detailed clinical data were provided on 88% of all notified cases and 15 children met the case criteria for severe complications of influenza. Admission to hospital occurred within 48 hours of onset of symptoms in over half of the children, of whom 13 had influenza A and two had influenza B, confirmed mostly by polymerase chain reaction on nasopharyngeal aspirate. Serious complications included pneumonia, presumed viral (67%), secondary bacterial infection, shock, cardiomyopathy, myocarditis and hypoglycaemia. No child aged six months or older had been vaccinated against influenza, including three children with underlying chronic conditions. No eligible child received an antiviral agent for influenza. Length of hospital stay ranged from 2 to 34 days; four children were admitted to a Paediatric Intensive Care Unit and one was ventilated. This study demonstrates the feasibility of using the established APSU mechanism for enhanced emergency surveillance during disease outbreaks, emergence or importation.
流感对五岁以下儿童的疾病负担有重大影响。现有的流感监测系统无法提供住院儿童的临床表现、治疗、疫苗接种状况、危险因素和并发症的详细数据，也无法将这些数据与实验室结果相联系。2007年发生多起儿童因流感死亡事件后，澳大利亚卫生与老龄部要求澳大利亚儿科监测部门（APSU）研究加强APSU监测以识别因流感严重并发症住院儿童的可行性。2007年9月开展了全国性的主动每周监测，由1256名在医院和门诊工作的澳大利亚儿科医生进行报告。每周报告卡的回收率为93%；在所有通报病例中，88%提供了详细的临床数据，15名儿童符合流感严重并发症的病例标准。超过半数儿童在症状出现后48小时内入院，其中13例为甲型流感，2例为乙型流感，大多通过鼻咽抽吸物聚合酶链反应确诊。严重并发症包括肺炎（推测为病毒性，占67%）、继发性细菌感染、休克、心肌病、心肌炎和低血糖。没有一名六个月及以上的儿童接种过流感疫苗，包括三名患有基础慢性病的儿童。没有符合条件的儿童接受流感抗病毒药物治疗。住院时间为2至34天；四名儿童入住儿科重症监护病房，一名儿童接受了通气治疗。这项研究证明了利用既定的APSU机制在疾病暴发、出现或输入期间加强应急监测的可行性。
