Abstract
While significant morbidity due to respiratory syncytial virus (RSV) infection in the paediatric population has been well acknowledged, little is known about the burden of influenza in primarily healthy children in Europe. In our institution, a University Children’s Hospital in Switzerland, medical staff were encouraged to take nasopharyngeal specimens for multiplex polymerase chain reaction assays for influenza A and B, RSV and several other pathogens from patients hospitalised with respiratory symptoms. We took advantage of this strategy and performed a retrospective study to compare specific characteristics of influenza virus infections with those of RSV during two consecutive winter seasons. Overall, 126 patients were positive for RSV and 60 patients were positive for influenza (type A: 45; type B: 15). The median age of children with RSV, influenza A, and influenza B infection was 4 months; 2 years and 4 months; and 6 years and 2 months, respectively (P<0.001). Fever and cough predominated in children with influenza infection whereas cough, rhinorrhoea, feeding difficulties and dyspnoea were the major symptoms in children with RSV infection. Of patients with influenza, 41% suffered from lower respiratory tract infection compared to 91% of those with RSV infection (P<0.001). Of 60 patients hospitalised with influenza, 12 (20%) experienced febrile convulsions. None of the patients with influenza had been immunised in the respective winter season, although 27% of them had at least one underlying medical condition that would have counted as an indication for immunisation in Switzerland. Conclusion: influenza virus infections, like respiratory syncytial virus infections, are a major cause of hospitalisation in children with respiratory illness during the winter season. Since it is impossible to make an aetiological diagnosis on clinical grounds, it is important to apply specific diagnostic tools in children hospitalised with respiratory illness in order to better characterise the relative burden of disease caused by the respective agents.
Similar content being viewed by others
Abbreviations
- LRTI :
-
lower respiratory tract infection
- NPS :
-
nasopharyngeal specimens
- RAT :
-
rapid antigen test
- RSV :
-
respiratory syncytial virus
References
Abels S, Nadal D, Stroehle A, Bossart W (2001) Reliable detection of respiratory syncytial virus infection in children for adequate hospital infection control management. J Clin Microbiol 39: 3135–3139
Anderson LJ, Parker RA, Strikas RL (1990) Association between respiratory syncytial virus outbreaks and lower respiratory tract deaths of infants and young children. J Infect Dis 161: 640–646
Bridges CB, Harper SA, Fukuda K, Uyeki TM, Cox NJ, Singleton JA, Practices ACoI (2003) Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 52: 526
Brouard J, Ribet V, Petitjean J, Freymuth F, Duhamel JF (1992) Infection à virus influenza A chez l’enfant. Spectre clinique et comparaison avec l’atteinte par le virus respiratoire syncytial durant l’hiver 1989–1990. Arch Fr Pediatr 49: 693–697
Bulkow LR, Singleton RJ, Karron RA, Harrison LH, Group ARS (2002) Risk factors for severe respiratory syncytial virus infection among Alaska native children. Pediatrics 109: 210–216
Chiu SS, Lau YL, Chan KH, Wong WH, Peiris JS (2002) Influenza-related hospitalizations among children in Hong Kong. N Engl J Med 347: 2097–2103
Claas EC, Sprenger MJ, Kleter GE, van Beek R, Quint WG, Masurel N (1992) Type-specific identification of influenza viruses A, B and C by the polymerase chain reaction. J Virol Methods 39: 1-13
Duppenthaler A, Gorgievski-Hrisoho M, Frey U, Aebi C (2003) Two-year periodicity of respiratory syncytial virus epidemics in Switzerland. Infection 31: 75–80
Fan J, Henrickson KJ (1996) Rapid diagnosis of human parainfluenza virus type 1 infection by quantitative reverse transcription-PCR-enzyme hybridization assay. J Clin Microbiol 34: 1914–1917
Glezen WP (1998) Influenza viruses. In: Feigin RD, Cherry JD (eds) Textbook of pediatric infectious diseases. Saunders, Philadelphia, pp 2024–2041
Hall CB (1998) Respiratory syncytial virus. In: Feigin RD, Cherry JD (eds) Textbook of pediatric infectious disease. Saunders, Philadelphia, pp 2084–2111
Izurieta HS, Thompson WW, Kramarz P, Shay DK, Davis RL, DeStefano F, Black S, Shinefield H, Fukuda K (2000) Influenza and the rates of hospitalization for respiratory disease among infants and young children. N Engl J Med 342: 232–239
Karron RA, O’Brien KL, Froehlich JL, Brown VA (1993) Molecular epidemiology of a parainfluenza type 3 virus outbreak on a pediatric ward. J Infect Dis 167: 1441–1445
Lyon JL, Stoddard G, Ferguson D, Caravati M, Kaczmare A, Thompson G, Hegmann K, Hegmann C (1996) An every other year cyclic epidemic of infants hospitalized with respiratory syncytial virus. Pediatrics 97: 152–153
Meier CR, Napalkov PN, Wegmüller Y, Jefferson T, Jick H (2000) Population-based study on incidence, risk factors, clinical complications and drug utilisation associated with influenza in the United Kingdom. Eur J Clin Microbiol Infect Dis 19: 834–842
Morris DJ, Cooper RJ, Barr T, Bailey AS (1996) Polymerase chain reaction for rapid diagnosis of respiratory adenovirus infection. J Infect 32: 113–117
Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR (2000) The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med 342: 225–231
Neuzil KM, Zhu Y, Griffin MR, Edwards KM, Thompson JM, Tollefson SJ, Wright PF (2002) Burden of interpandemic influenza in children younger than 5 years: a 25-year prospective study. J Infect Dis 185: 147–152
Paton AW, Paton JC, Lawrence AJ, Goldwater PN, Harris RJ (1992) Rapid detection of respiratory syncytial virus in nasopharyngeal aspirates by reverse transcription and polymerase chain reaction amplification. J Clin Microbiol 30: 901–904
Peltola V, Ziegler T, Ruuskanen O (2003) Influenza A and B virus infections in children. Clin Infect Dis 36: 299–305
Reuman PD, Ayoub EM, Small PA (1987) Effect of passive maternal antibody on influenza illness in children: a prospective study of influenza A in mother-infant pairs. Pediatr Infect Dis J 6: 398–403
Sugaya N, Mitamura K, Nirasawa M, Takahashi K (2000) The impact of winter epidemics of influenza and respiratory syncytial virus on paediatric admissions to an urban general hospital. J Med Virol 60: 102–106
Weigl JAI, Puppe W, Schmitt HJ (2002) The incidence of influenza-associated hospitalizations in children in Germany. Epidemiol Infect 129: 525–533
Wever-Hess J, Wever AM, Yntema JL (1991) Mortality and morbidity from respiratory diseases in childhood in The Netherlands, 1980–1987. Eur Respir J 4: 429–433
Winter GF, Hallam NF, Hargreaves FD, Molyneaux PJ, Burns SM, Inglis JM (1996) Respiratory viruses in a hospitalized paediatric population in Edinburgh 1985–1994. J Infect 33: 207–211
Acknowledgements
We are grateful to our colleagues and staff at the University Children’s Hospital Basel for obtaining patients’ specimens. The assistance of R. Hertel and technicians in the Microbiology Department of our hospital is greatly acknowledged.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work forms the medical thesis of Susanne Meury at the Medical Faculty, University of Basel, Switzerland.
Rights and permissions
About this article
Cite this article
Meury, S., Zeller, S. & Heininger, U. Comparison of clinical characteristics of influenza and respiratory syncytial virus infection in hospitalised children and adolescents. Eur J Pediatr 163, 359–363 (2004). https://doi.org/10.1007/s00431-004-1445-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-004-1445-6