Sarah Frankl1, Susan E Coffin2, Jacqueline B Harrison1, Sanjeev K Swami2, Jennifer L McGuire3. 1. Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA. 2. Division Infectious Disease, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 3. Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: mcguirej@email.chop.edu.
Abstract
OBJECTIVES: To define the incidence and characteristics of influenza-associated neurologic complications in a cohort of children hospitalized at a tertiary care pediatric hospital with laboratory-confirmed influenza and to identify associated clinical, epidemiologic, and virologic factors. STUDY DESIGN: This was an historical cohort study of children aged 0.5-18.0 years old hospitalized between 2010 and 2017 with laboratory-confirmed influenza. Children with immune compromise or a positive test due to recent receipt of live virus vaccine or recently resolved illness were excluded. Influenza-associated neurologic complications were defined as new-onset neurologic signs/symptoms during acute influenza illness without another clear etiology. RESULTS: At least 1 influenza-associated neurologic complication was identified in 10.8% (95% CI 9.1-12.6%, n = 131 of 1217) of hospitalizations with laboratory-confirmed influenza. Seizures (n = 97) and encephalopathy (n = 44) were the most commonly identified influenza-associated neurologic complications, although an additional 20 hospitalizations had other influenza-associated neurologic complications. Hospitalizations with influenza-associated neurologic complications were similar in age and influenza type (A/B) to those without. Children with a pre-existing neurologic diagnosis (n = 326) had a greater proportion of influenza-associated neurologic complications compared with those without (22.7% vs 6.4%, P < .001). Presence of a pre-existing neurologic diagnosis (aOR 4.6, P < .001), lack of seasonal influenza vaccination (aOR 1.6, P = .020), and age ≤5 years (aOR 1.6, P = .017) were independently associated with influenza-associated neurologic complications. CONCLUSIONS: Influenza-associated neurologic complications are common in children hospitalized with influenza, particularly those with pre-existing neurologic diagnoses. A better understanding of the epidemiology and factors associated with influenza-associated neurologic complications will direct future investigation into potential neuropathologic mechanisms and mitigating strategies. Vaccination is recommended and may help prevent influenza-associated neurologic complications in children.
OBJECTIVES: To define the incidence and characteristics of influenza-associated neurologic complications in a cohort of children hospitalized at a tertiary care pediatric hospital with laboratory-confirmed influenza and to identify associated clinical, epidemiologic, and virologic factors. STUDY DESIGN: This was an historical cohort study of children aged 0.5-18.0 years old hospitalized between 2010 and 2017 with laboratory-confirmed influenza. Children with immune compromise or a positive test due to recent receipt of live virus vaccine or recently resolved illness were excluded. Influenza-associated neurologic complications were defined as new-onset neurologic signs/symptoms during acute influenza illness without another clear etiology. RESULTS: At least 1 influenza-associated neurologic complication was identified in 10.8% (95% CI 9.1-12.6%, n = 131 of 1217) of hospitalizations with laboratory-confirmed influenza. Seizures (n = 97) and encephalopathy (n = 44) were the most commonly identified influenza-associated neurologic complications, although an additional 20 hospitalizations had other influenza-associated neurologic complications. Hospitalizations with influenza-associated neurologic complications were similar in age and influenza type (A/B) to those without. Children with a pre-existing neurologic diagnosis (n = 326) had a greater proportion of influenza-associated neurologic complications compared with those without (22.7% vs 6.4%, P < .001). Presence of a pre-existing neurologic diagnosis (aOR 4.6, P < .001), lack of seasonal influenza vaccination (aOR 1.6, P = .020), and age ≤5 years (aOR 1.6, P = .017) were independently associated with influenza-associated neurologic complications. CONCLUSIONS: Influenza-associated neurologic complications are common in children hospitalized with influenza, particularly those with pre-existing neurologic diagnoses. A better understanding of the epidemiology and factors associated with influenza-associated neurologic complications will direct future investigation into potential neuropathologic mechanisms and mitigating strategies. Vaccination is recommended and may help prevent influenza-associated neurologic complications in children.
Authors: Ericka L Fink; Courtney L Robertson; Mark S Wainwright; Juan D Roa; Marlina E Lovett; Casey Stulce; Mais Yacoub; Renee M Potera; Elizabeth Zivick; Adrian Holloway; Ashish Nagpal; Kari Wellnitz; Theresa Czech; Katelyn M Even; Werther Brunow de Carvalho; Isadora Souza Rodriguez; Stephanie P Schwartz; Tracie C Walker; Santiago Campos-Miño; Leslie A Dervan; Andrew S Geneslaw; Taylor B Sewell; Patrice Pryce; Wendy G Silver; Jieru Egeria Lin; Wendy S Vargas; Alexis Topjian; Alicia M Alcamo; Jennifer L McGuire; Jesus Angel Domínguez Rojas; Jaime Tasayco Muñoz; Sue J Hong; William J Muller; Matthew Doerfler; Cydni N Williams; Kurt Drury; Dhristie Bhagat; Aaron Nelson; Dana Price; Heda Dapul; Laura Santos; Robert Kahoud; Conall Francoeur; Brian Appavu; Kristin P Guilliams; Shannon C Agner; Karen H Walson; Lindsey Rasmussen; Anna Janas; Peter Ferrazzano; Raquel Farias-Moeller; Kellie C Snooks; Chung-Chou H Chang; James Yun; Michelle E Schober Journal: Pediatr Neurol Date: 2021-12-28 Impact factor: 3.372