Burden of influenza in children and the impact of the COVID-19 pandemic Epidemiology and severity of influenza episodes in children at St Olavs hospital over 17 years (2006-2023)
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Abstract
Bakgrunn Influensavirus (IFV) og koronavirus-pandemier har påvirket barn over hele verden. Vi har studert IVF-epidemiologi og om alvorligheten av IFV-sykdom økte under 2009/2010 influensa A-pandemien og etter COVID-19 pandemien.
Metode Prøver fra barn ved St. Olavs hospital i perioden 2006 til 2023 med feber eller luftveissymptomer ble testet ved PCR og viruskultur-dyrkning for IFV A/B og 15 andre virus/atypiske bakterier. Ved hjelp av aldersjusterte logistiske regresjonsanalyser sammenliknet vi alder, sykehusinnleggelser, klinisk presentasjon og alvorlighetsgrad av IFV hos barn før og under 2009/2010 influensa A-pandemien og før og etter COVID-19-pandemien.
Resultater Fra 2006 til 2023 hadde 460 barn IVF A/B (IFV-A 74%, IFV-B 26%) og gjennomsnittlig sykehusinnleggelsesrate hos barn under 5 år var 53 per 100 000 barn (95% konfidensintervall [KI] 47-59). Median alder ble doblet under 2009/2010 influensa A-pandemien (40.2 vs. 19.2 måneder, p=0.005) og etter COVID-19 pandemien (61.6 vs. 28.9 måneder, p<0.001). Det skjedde ingen endringer i kliniske presentasjoner under 2009/2010 influensa A-pandemien. Etter COVID-19 pandemien var det derimot mindre sannsynlig at barn som ble innlagt med IFV-A/B, fikk diagnosen nedre luftveisinfeksjon (odds ratio [OR] 0.24, 95 % KI 0.15-0.39), ble innlagt på sykehus i mer enn 24 timer (OR 0.36, 95 % KI 0.24-0.59) og utviklet alvorlig sykdom (klinisk score) (OR 0.51, 95 % KI 0.26-1.0).
Konklusjon Barn innlagt på sykehus under 2009/2010 influensa A-pandemien og etter COVID-19 pandemien var eldre enn før pandemiene. Under 2009/2010 influensa A-pandemien var alvorlighetsgraden av sykdommen uendret, men etter COVID-19-pandemien hadde barna mildere sykdom. Background Influenza virus (IFV) and coronavirus pandemics have influenced children globally. We have studied IFV epidemiology and if IFV disease severity increased during the 2009/2010 influenza A pandemic and after the COVID-19 pandemic.
Methods Nasopharyngeal samples collected from children admitted at St. Olavs University Hospital, Norway from 2006-2023 with fever or respiratory symptoms were tested with PCR for IFV A/B and 15 other viruses/atypical bacteria. We compared age, hospitalizations rates, clinical presentation, and disease severity of IFV in children before and during the 2009/2010 influenza A pandemic, and before and after the COVID-19 pandemic, respectively, using age-adjusted logistic regression analyses.
Results From 2006 to 2023, 460 children had IFV A/B (IFV-A 74%, IFV B 26%), and mean hospitalization rate in children <5 years old was 53 per 100,000 children (95% CI 47-59). Median age doubled during the 2009/2010 influenza A pandemic (40.2 vs 19.2 months, p=0.005) and after the COVID-19 pandemic (61.6 vs 28.9 months, p<0.001). No changes in clinical presentations occurred during the 2009/2010 influenza A pandemic. In contrast, after the COVID-19 pandemic, children admitted with IFV-A/B were less likely to be diagnosed with a lower respiratory tract infection (OR 0.24, 95% CI 0.15-0.39), to be hospitalized >24 hours (OR 0.36, 95% CI 0.24-0.59) and develop a severe disease (clinical score) (OR 0.51, 95% CI 0.26-1.0).
Conclusion Children admitted to hospital during the 2009/2010 influenza A pandemic and after the COVID-19 pandemic were older than before the pandemics. During the 2009/2010 influenza A pandemic disease severity was unchanged, but after the COVID-19 pandemic children admitted with IFV had a milder disease.