德国门诊实践中 1-5 岁儿童流感的亚型特异性临床表现、医疗处理及对家庭的影响：2013-2015 年三个大流行年后的情况。

Subtype-specific Clinical Presentation, Medical Treatment and Family Impact of Influenza in Children 1-5 Years of Age Treated in Outpatient Practices in Germany During Three Postpandemic Years, 2013-2015.

机构信息

From the Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany.

Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany.

出版信息

Pediatr Infect Dis J. 2018 Sep;37(9):861-867. doi: 10.1097/INF.0000000000001935.

DOI:10.1097/INF.0000000000001935

PMID:29406467

Abstract

BACKGROUND

Limited data on the influenza burden in pediatric outpatients are available, especially regarding direct comparison of the cocirculating (sub)types A(H1N1)pdm09, A(H3N2) and B.

METHODS

Children 1-5 years of age, unvaccinated against influenza and presenting with febrile acute respiratory infections (ARIs), were enrolled in 33 pediatric practices in Germany from 2013 to 2015 (January-May). Influenza was confirmed by multiplex polymerase chain reaction from pharyngeal swabs and (sub)typed.

RESULTS

In 805 children with ARI, influenza was the most frequently detected respiratory virus (n = 305; 37.9%). Of 217 influenza patients included, 122 (56.2%) were infected with A(H3N2), 56 (25.8%) with A(H1N1)pdm09 and 39 (18.0%) with B. Median age was 3.7 years [interquartile range (IQR), 2.1-4.8]; 11% had underlying conditions. Median fever duration was 4 days (IQR, 3-5), and the disease duration was 9 days (IQR, 7-12). Most frequent diagnoses were pharyngitis (26%), bronchitis (18%) and acute otitis media (10%). Children received mainly antipyretics (86%) and adrenergic nasal drops/spray (53%); 9% received antibiotics and 3% oseltamivir. Thirty-six percent required at least 1 additional practice visit; 1% was hospitalized. Median absences from childcare were 5 days (IQR, 3-7); parents lost 4 workdays (IQR, 2-6). Symptoms, severity and impact on the family were largely unrelated to (sub)type. However, patients with A(H1N1)pdm09 had fewer underlying conditions (P = 0.017), whereas patients with B more often had pharyngitis (P = 0.022), acute otitis media (P = 0.012) and stenosing laryngotracheitis (P = 0.007).

CONCLUSIONS

Influenza was the most frequently detected viral pathogen in outpatient children with febrile, mostly uncomplicated ARI. In this setting, clinical manifestations and severity were similar across the (sub)types prevalent during the postpandemic seasons.

摘要

背景

儿科门诊患者的流感负担数据有限，尤其是关于循环（亚）型 A(H1N1)pdm09、A(H3N2)和 B 的直接比较。

方法

2013 年至 2015 年（1 月至 5 月），德国 33 家儿科诊所招募了 1-5 岁未接种流感疫苗且出现发热急性呼吸道感染（ARI）的儿童。通过咽拭子的多重聚合酶链反应（PCR）确认流感并进行（亚）分型。

结果

在 805 例 ARI 患儿中，流感是最常检测到的呼吸道病毒（n = 305；37.9%）。217 例流感患者中，122 例（56.2%）感染 A(H3N2)，56 例（25.8%）感染 A(H1N1)pdm09，39 例（18.0%）感染 B。中位年龄为 3.7 岁[四分位间距（IQR），2.1-4.8]；11%有基础疾病。中位发热持续时间为 4 天（IQR，3-5），病程为 9 天（IQR，7-12）。最常见的诊断是咽炎（26%）、支气管炎（18%）和急性中耳炎（10%）。患儿主要接受退热剂（86%）和拟交感神经滴鼻/喷雾（53%）；9%接受抗生素治疗，3%接受奥司他韦治疗。36%的患儿需要至少 1 次额外的就诊；1%的患儿住院。中位数缺勤天数为 5 天（IQR，3-7）；父母缺勤 4 天（IQR，2-6）。症状、严重程度和对家庭的影响与（亚）型基本无关。然而，感染 A(H1N1)pdm09 的患儿基础疾病较少（P = 0.017），而感染 B 的患儿更常出现咽炎（P = 0.022）、急性中耳炎（P = 0.012）和缩窄性喉气管支气管炎（P = 0.007）。