From the Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
Pediatr Infect Dis J. 2023 Aug 1;42(8):648-653. doi: 10.1097/INF.0000000000003966. Epub 2023 Jun 7.
To determine the epidemiological trends in pediatric influenza and changes in healthcare resource use from 2005 to 2021 using nationally representative outpatient database in Japan.
We conducted a retrospective cohort study consisting of 3.5 million children with 177 million person-months during 2005-2021 using Japan Medical Data Center claims database in Japan. We investigated trends in incidence rates of influenza and changes in healthcare resource use (eg, use of antivirals) over 17 years. Generalized estimation equations were used to investigate the impact of the 2009 influenza pandemic and the coronaviral disease 2019 (COVID-19) pandemic on incidence rates of influenza and related healthcare utilization.
Annual incidence rates of influenza were estimated at 55 cases per 1000 person-years with a 93% relative increase [95% confidence interval (CI): 80%-107%] during the 2009 influenza pandemic and a 99.4% relative reduction (95% CI: 99.3%-99.4%) during the COVID-19 pandemic. Similar patterns were observed for health resource use, total healthcare costs, admission rates and antiviral agent use. Approximately 80% of children with influenza received prescriptions for antivirals. The most prescribed antivirals were oseltamivir, but we observed a temporal increase in zanamivir use during 2007-2009, an increasing trend in laminamivir use during 2010-2017, a temporal increase in baloxavir use in 2018. Symptomatic medications with serious side effects (codeine, salicylate, sedative antihistamine) showed decreasing trends over the study period.
Influenza incidence and healthcare resource use were largely affected by the 2009 influenza pandemic and the COVID-19 pandemic. Our study indicates improvement of quality in healthcare delivered to children.
本研究旨在使用日本全国代表性的门诊数据库，确定儿科流感的流行病学趋势，并分析 2005 年至 2021 年期间医疗资源使用的变化。
我们使用日本医疗数据中心的索赔数据库进行了一项回顾性队列研究，该研究纳入了 2005 年至 2021 年期间的 350 万名儿童，共计 1.77 亿人月。我们调查了 17 年来流感发病率的变化趋势，以及医疗资源使用（例如抗病毒药物的使用）的变化情况。使用广义估计方程研究了 2009 年流感大流行和 2019 年冠状病毒病（COVID-19）大流行对流感发病率和相关医疗保健利用的影响。
流感的年发病率估计为每 1000 人年 55 例，2009 年流感大流行期间相对增加了 93%（95%置信区间：80%-107%），COVID-19 大流行期间相对减少了 99.4%（95%置信区间：99.3%-99.4%）。健康资源使用、总医疗费用、住院率和抗病毒药物使用也呈现出类似的模式。约 80%的流感患儿接受了抗病毒药物处方。最常开的抗病毒药物是奥司他韦，但我们观察到扎那米韦的使用在 2007-2009 年期间呈上升趋势，拉米那韦的使用在 2010-2017 年期间呈上升趋势，巴洛沙韦在 2018 年的使用呈上升趋势。有严重副作用的对症药物（可待因、水杨酸盐、镇静抗组胺药）在研究期间呈下降趋势。
流感发病率和医疗资源使用受到 2009 年流感大流行和 COVID-19 大流行的极大影响。我们的研究表明，为儿童提供的医疗服务质量有所提高。
