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??Objective To strengthen the cognition about the epidemiological characteristics of influenza in children and to provide reference for its prevention and control. Methods Analyze the data of influenza-like cases in Shanghai Children’s Hospital from 2011 to 2013. Results A total of 29 524 influenza-like cases were surveyed. The patients who were less than 5 years old occupied the largest proportion ??74.40%??. A total of 3168 pharyngeal swabs were collected and 559 influenza viruses were checked out ??17.65%??. Totally 232 ??41.5%?? of these influenza viruses were identified as influenza A ??H3N2?? virus?? 229 ??40.97%?? as influenza B virus and 98 ??17.53%?? as novel influenza A ??H1N1?? virus. The differences of the virus types were statistically significant each year??P??0.01??. The higher positive detection rates occurred from January to April in 2011 ??20.51%~45.89%???? from December 2011 to April 2012 ??28.77%~57.65%???? from July to August in 2012 ??44.74%??35.14%?? and in December 2013??52.29%??. Conclusion The children with influenza surveyed in 2011—2013 are infected by influenza A ??H3N2?? virus?? influenza B virus and novel influenza A ??H1N1?? virus. The epidemic strains change every year. The types of influenza viruses are popular alternatively. The influenza is with high incidence in winter-spring commonly?? but can also be popular in summer. Children less than 5 years old are more susceptible to influenza.     

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??Abstract??Objective??To discuss the clinical features and realizations of severe influenza A??H1N1?? virus infection in children. Methods??Analyzed the clinical features?? laboratory examinations and imaging data of 5 children with severe influenza A??H1N1?? virus infection. Results??5 children with severe influenza A??H1N1?? virus infection do not have special symptoms and signs?? just have flu-like symptoms such as fever?? cough?? headache?? some children are also accompanied with digestive symptoms such as abdominal pain?? vomit and diahorrea. When the patients’ conditions worsen?? they have bad coughs?? breathing difficulties?? wet rales in the lungs?? high heart rates?? poor peripheral circulation?? drowsiness or dysphoric and so on. The patients often experience MODS?? among them the lungs are prominent. In laboratory examinations?? white blood cells counts normal?? low or high?? most patients experience abnormal function of the liver?? kidney and coagulation. The main x-ray manifest that many parts of the lungs are damaged. Conclusion??Severe influenza A??H1N1?? virus infection in children develop at an alarming rate?? the risk of death is high. Early recognization?? early diagnosis and early treatment is the key to decrease the death rate of severe influenza A??H1N1?? virus infection.     

Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza

BACKGROUND: Prompt testing for influenza can help guide clinical management of patients with suspected influenza. Three antiviral medications, amantadine, oseltamivir and zanamivir, are approved for treatment of influenza in children. Rimantadine and ribavirin have also been used. OBJECTIVES: To review the published evidence on clinically useful diagnostic tests and antiviral treatment for influenza virus infections in children. METHODS: Studies published from 1966 through September 2002 were reviewed on clinical diagnosis, immunofluorescence and rapid influenza tests and on antiviral treatment of influenza virus infections among pediatric populations. RESULTS: No studies assessed the accuracy of clinical diagnosis of influenza in children compared with viral culture. Compared with viral culture, direct immunofluorescence antibody and indirect immunofluorescence antibody tests for influenza had fair to moderate median sensitivities and high median specificities, whereas rapid influenza diagnostic tests had moderate median sensitivities and moderately high median specificities. No randomized, placebo-controlled studies were found of amantadine or rimantadine for treatment of influenza A. In a few separate controlled studies, oseltamivir, zanamivir and ribavirin each reduced symptom duration of influenza compared with placebo. CONCLUSIONS: Additional data are needed about the accuracy of clinical diagnosis of influenza in children. Although direct immunofluorescence antibody staining, indirect immunofluorescence antibody staining and rapid tests are moderately to reasonably accurate in detecting influenza virus infections in children, physicians should use clinical judgment and local surveillance data about circulating influenza viruses when interpreting test results. Further controlled studies of the efficacy, adverse effects and emergence of antiviral resistance during treatment of influenza are needed for all of the antiviral drugs.     

Antiviral treatment of influenza in children

Influenza causes substantial morbidity in children in the United States each year. The 2009 influenza A (H1N1) pandemic disproportionately affected the pediatric population and resulted in a substantially increased number of hospitalizations and deaths among children. Early influenza antiviral treatment reduces the duration of illness, frequency of complications, antibiotic use, and health care utilization costs attributable to influenza. A comprehensive strategy to reduce influenza-associated hospitalizations and deaths among children should include empiric antiviral treatment for suspected or confirmed influenza of any severity in children who are hospitalized; who have severe, complicated, or progressive illness; or who are at high risk for influenza complications. Here, we summarize data on the burden of influenza among children in the United States, the indications for influenza antiviral treatment among children, the available evidence for influenza antiviral treatment, and antiviral treatment considerations, including resistance and adverse events.     

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??Objective To summarize and analyze the clinical characteristics?? diagnostic and therapeutic measures for the first child case of severe H5N6 avian influenza pneumonia in China. Methods The clinical data of the first case of severe H5N6 avian influenza infection in China admitted in April 13?? 2016 in Department of Emergency Center?? Hunan Children’s Hospital were analyzed and summarized. Results The case was an 11 years old girl?? acute onset?? was similar with early symptoms of common respiratory infection including high fever?? fatigue?? vomiting?? but catarrhal symptoms was not obvious. Since fever of unknown origin?? obvious weakness?? vomiting and other suspected influenza symptoms??clinicians speculated “flu” or “bird flu” possibility considering her history of exposure to her mother died of unknown illness. The girl was admitted to the Department of Infectious Isolation Ward and received oral oseltamivir treatment. On the 8th day of the course?? the condition was aggravated?? which showed large areas of dense shadow on chest X-ray film.The girl was diagnosed as acute respiratory distress syndrome??ARDS???? and was transferred to the Intensive Care Unit for isolation and treatment. Based on the reports of Hunan CDC and National CDC?? the girl was confirmed to be a case of avian influenza A H5N6 virus infection case. The treatment started with oseltamivir and then peramivir antivirus treatmnet?? nCPAP ventilation?? synchronous glucocorticoid treatment?? and the gradual weaning of noninvasive ventilator. The girl recovered and was tolerance without oxygen therapy?? then discharged from hospital. Conclusion It is very important for clinicians to pay more attention to epidemiological history. Timely detection?? early diagnosis are crucial to the treatment of avian influenza virus pneumonia and the effective treatment can get better prognosis.     

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??Objective??To describe the clinical characteristics of neurologic complications associated with 2009 influenza A ??H1N1?? infection in children. Methods??A prospective study of 150 children confirmed 2009 influenza A ??H1N1?? infection in Shenzhen Children Hospital from November 4, 2009, to January 19, 2010 was conducted. The clinical features and outcome of the patients with neurologic complications were analyzed. Results??The incidence rate of neurologic complications associated with 2009 influenza A ??H1N1?? infection was 14% of the hospitalized patients. 18??85.7%?? patients were diagnosed as encephalopathy??2??9.5%?? patients were diagnosed as seizures??1??4.7%?? patient was diagnosed as encephalitis. 14 were male, 7 were female?? the median age was 5 years. 12??57%?? patients were admitted to an ICU, 6??28.5%?? required mechanical ntilation. 17??80.9%?? patients were fully recovered and discharged, three ??14%?? died from severe encephalopathy. Conclusion??The incidence rate of neurologic complications associated with 2009 influenza was high, severe encephalopathy canlead to death. This result should attract a great deal of attention as 2009 influenza A ??H1N1?? pandemic continues.     

Management of influenza symptoms in healthy children: cost-effectiveness of rapid testing and antiviral therapy

OBJECTIVE: To determine the cost-effectiveness of rapid testing and antiviral therapy for children of different ages with symptoms of influenza. DESIGN: Cost-effectiveness analysis from the societal perspective using a decision model based on published data. SETTING: Physician's office during an influenza A epidemic. PARTICIPANTS: Hypothetical children aged 2, 7, and 15 years. INTERVENTIONS: Rapid testing or clinical diagnosis followed by treatment with amantadine hydrochloride or oseltamivir phosphate compared with no antiviral therapy. OUTCOME MEASURES: Costs and quality-adjusted life expectancy. RESULTS: Empirical therapy with antiviral medication resulted in the greatest quality-adjusted life expectancy in all age groups. Compared with not treating, antiviral therapy improved quality-adjusted life expectancy by 0.003 quality-adjusted life-year by shortening the duration of illness and preventing otitis media. In young children it saved up to USD 121 per child mostly by avoiding parental work loss. Excluding work loss, antiviral therapy improved quality-adjusted life expectancy at a cost of USD 800 to 1800 per quality-adjusted life-year saved. Compared with amantadine, oseltamivir was not cost-effective when influenza A predominated. The incremental cost-effectiveness of oseltamivir fell below USD 50 000 per quality-adjusted life-year saved when the proportion of influenza B exceeded 14% for a 2-year-old, 27% for a 7-year-old, or 43% for a 15-year-old. Rapid testing was cost-effective only when the probability of influenza was 60% or less. CONCLUSIONS: For children presenting with influenza symptoms during a local influenza outbreak, treatment with antiviral therapy appears to offer the best outcome and often saves money. The choice of antiviral drug should be based on the prevalence of influenza B.     

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??Objective??To explore the pathogen characteristics and risk factors of nosocomial infection in children with refractory pneumonia caused by Mycoplasma pneumoniae. Methods??A total of 160 children??nosocomial infection??45 cases?? as observation group??no nosocomial infection??115 cases?? as control group?? with refractory MPP who were admitted from January 2015 to January 2018 were selected for pathogen detection and pathogen species analysis. Analyze the differences of two groups to detect the risk factors of hospital infection by means of univariate and multivariate logistic analysis. Results??According to the analysis of the pathogens??32 of them were bacterial infections??71.1%????and Gram-negative bacteria were the main pathogens??including Haemophilus influenza??9 cases????Klebsiella pneumonia??7 cases????Escherichia coli ??5 cases?? and Legionella pneumophila??2 cases????13 of them were viral infections??28.9%????including influenza B virus??6 cases????respiratory syncytial virus??5 cases??and adenovirus??2 cases??. After univariate and multivariate logistic analysis??no differences were found in sex??age??congenital heart disease or anemia between observation group and control group??P??0.05??. However??the length of hospitalization??season of onset??invasive procedures??non-single ward??and the irrational use of antibiotics in the two groups had significant differences??P??0.05??. Conclusion??The main infection pathogen of children with refractory MMP in nosocomial infection is Gram-negative bacteria. The risk factors of nosocomial infection are the length of hospitalization?? season of onset??invasive procedures??non-single ward??and the irrational use of antibiotics.     

Antiviral therapy of influenza

The prevention of influenza virus infections by the use of vaccines remains the most cost-effective and practical method of influenza virus control, but the use of antiviral prophylaxis and treatment in certain populations or high-risk individuals is also possible. Four antiviral drugs are currently licensed in the United States for the treatment and/or prevention of influenza virus infection in children. The M2 blockers, (amantadine and rimantadine) have been licensed for the prophylaxis and treatment of influenza in diverse high-risk populations, including children, for years. Advantages of these agents include the low cost, high oral bioavailability, and relative tolerability of one of these agents (rimantadine) in children. Disadvantages include efficacy against influenza A viruses only (not type B), the relative rapid development of resistance, and adverse effects associated with amantadine in particular (especially in the elderly and those with decreased renal function). Two agents in a new antiviral class, the neuraminidase inhibitors, have been licensed recently for the treatment and prophylaxis of influenza in the United States. Oseltamivir is licensed for the treatment of influenza in children older than 1 year and for the prophylaxis in children older than 13 years. This drug is safe and well-tolerated, and is available in capsules or a liquid suspension. Another neuraminidase inhibitor, zanamivir, is administered as an inhaled powder via a special inhaler device and is licensed for the treatment of influenza in children older than 7 years. Both neuraminidase inhibitors appear to be similarly effective and are not associated with the development of antiviral resistance. No direct comparisons of any of these antiviral agents has been performed; all result in clinical improvement approximately 1 to 2 days earlier in otherwise healthy children when therapy is initiated within 48 hours of onset of symptoms.     

儿童呼吸道病毒感染的流行病学特点

呼吸系统感染是儿童门诊就诊最为常见的病因，也是造成＜5岁儿童死亡的首要原因。病毒是儿童时期呼吸道感染最为常见的病原，需要引起儿科医师关注。该文讨论了常见呼吸道病毒的流行病学特征，着重介绍了呼吸道合胞病毒、流感病毒、鼻病毒和腺病毒等较为常见的呼吸道病毒的好发年龄、好发季节、流行区域等流行病学特点。同时，也简要介绍了副流感病毒、偏肺病毒和冠状病毒等近期新发现的病毒的流行病学特征，并回顾了病毒共感染的相关信息。