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奥司他韦在 COVID-19 大流行后两个流感季节未接种疫苗的儿科流感患者中的临床疗效和耐受性:合并症对儿童流感住院的影响。

The Clinical Effectiveness and Tolerability of Oseltamivir in Unvaccinated Pediatric Influenza Patients during Two Influenza Seasons after the COVID-19 Pandemic: The Impact of Comorbidities on Hospitalization for Influenza in Children.

机构信息

Faculty of Medicine, University of Medicine and Pharmacy, "Carol Davila", No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania.

"Matei Balş" National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania.

出版信息

Viruses. 2024 Oct 7;16(10):1576. doi: 10.3390/v16101576.

Abstract

Antiviral therapy such as oseltamivir has been recommended for hospitalized children with suspected and confirmed influenza for almost 20 years. The therapy is officially authorized for newborns two weeks of age or older, however, questions about its safety and effectiveness still surround it. Our goals were to assess the epidemiological features of two consecutive seasonal influenza cases in children following the COVID-19 pandemic; to observe the clinical effectiveness and tolerability of oseltamivir in hospitalized children who were not vaccinated against influenza and had different influenza subtypes, including A(H1N1), A(H3N2), and B; and to identify specific comorbidities associated with influenza in children. We performed an observational study on 1300 children, enrolled between 1 October 2022 and 30 May 2023 and between 1 October 2023 and 4 May 2024, to the IX Pediatric Infectious Diseases Clinical Section of the National Institute of Infectious Diseases "Prof. Dr. Matei Balș". During the 2022-2023 influenza season, 791 pediatric patients tested positive for influenza and received oseltamivir. Of these, 89% (704/791) had influenza A, with 86.4% having subtype A(H1N1) and 13.6% of cases having A(H3N2), and for influenza B, 11% (87/791) of the pediatric patients. Of the total group, 59% were male, and the median age was 2.4 years (1.02-9.28). For the 2023-2024 influenza season, 509 pediatric patients tested positive for influenza, with 56.9% being of the male gender and who were treated with oseltamivir. Of these patients, 81.6% had influenza A and 18.4% had influenza B. Treatment with neuraminidase inhibitors, specifically oseltamivir, 2 mg/kg/dose administered twice daily for 5 days, was well tolerated by the children, and we recorded no deaths. The duration of hospitalization for patients with a fever after the oseltamivir administration was significantly longer for patients with A(H1N1) infection than A(H3N2), during both seasons. We identified more complications in the 2022-2023 season and a decreasing number of influenza B for the 2023-2024 season. Among children with comorbidities, the most common were asthma, gastrointestinal diseases, and metabolic and endocrine diseases. In terms of effectiveness, oseltamivir significantly reduced the intensity of influenza symptoms, thus reducing the number of days of hospitalization ( = 0.001) as well as post-infection complications ( = 0.005) in both groups. In this study, we evaluated the clinical effectiveness of oseltamivir therapy for all influenza types/subtypes in children, and the length of hospitalization. We identified comorbidities associated with the prolonged duration of hospitalization. Influenza vaccination should be the main tool in the prevention of influenza and its complications in children, especially those with comorbidities.

摘要

抗病毒疗法,如奥司他韦,已被推荐用于疑似和确诊流感的住院儿童近 20 年。该疗法官方授权给两周龄或以上的新生儿使用,但关于其安全性和有效性的问题仍然存在。我们的目标是评估 COVID-19 大流行后连续两个季节性流感病例在儿童中的流行病学特征;观察未接种流感疫苗且具有不同流感亚型(包括 A(H1N1)、A(H3N2)和 B)的住院儿童使用奥司他韦的临床疗效和耐受性;并确定与儿童流感相关的特定合并症。我们对 1300 名儿童进行了一项观察性研究,这些儿童于 2022 年 10 月 1 日至 2023 年 5 月 30 日和 2023 年 10 月 1 日至 2024 年 5 月 4 日期间入组到国家传染病研究所“Matei Balș 教授”第九儿科传染病临床科。在 2022-2023 流感季节,791 名儿科患者流感检测呈阳性并接受了奥司他韦治疗。其中,89%(704/791)为甲型流感,其中 86.4%为 A(H1N1)亚型,13.6%为 A(H3N2)亚型,81%为乙型流感。在总人群中,59%为男性,中位年龄为 2.4 岁(1.02-9.28)。在 2023-2024 流感季节,509 名儿科患者流感检测呈阳性,其中 56.9%为男性,并接受了奥司他韦治疗。这些患者中,81.6%为甲型流感,18.4%为乙型流感。神经氨酸酶抑制剂(具体为奥司他韦)治疗,2mg/kg/剂量,每日两次,连用 5 天,儿童耐受性良好,我们没有记录到死亡。在两个季节中,A(H1N1)感染患者的奥司他韦治疗后发热持续时间明显长于 A(H3N2)感染患者。我们在 2022-2023 季节中发现了更多的并发症,而在 2023-2024 季节中发现了较少的乙型流感。在合并症儿童中,最常见的是哮喘、胃肠道疾病以及代谢和内分泌疾病。在疗效方面,奥司他韦显著降低了流感症状的强度,从而减少了住院天数(=0.001)和感染后并发症的数量(=0.005)。在这项研究中,我们评估了奥司他韦治疗所有流感类型/亚型儿童的临床疗效以及住院时间。我们确定了与住院时间延长相关的合并症。流感疫苗接种应该是预防儿童流感及其并发症的主要工具,尤其是那些有合并症的儿童。

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