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Influenza: Underestimated in Children Below 2 Years of Age
A Wrotek1,2, M Czajkowska1,2, E Zawłocka1,2
1Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland.
Insights
Clinical signs and rapid influenza diagnostic tests (RIDTs) show low sensitivity for diagnosing influenza in young children. Reverse transcription polymerase chain reaction (RT-PCR) is recommended, despite access challenges.
Area of Science:
- Pediatrics
- Infectious Diseases
- Diagnostic Medicine
Background:
- Influenza diagnosis in children under 2 years is challenging due to unclear signs.
- Antiviral therapy is considered for suspected influenza in this age group.
- Accurate diagnosis is crucial for appropriate treatment decisions.
Purpose of the Study:
- To evaluate the diagnostic utility of clinical signs and rapid influenza diagnostic tests (RIDTs).
- To assess the impact of diagnostic methods on treatment timing and cost-effectiveness.
- To compare RIDTs and reverse transcription polymerase chain reaction (RT-PCR) for influenza diagnosis in young children.
Main Methods:
- Retrospective analysis of 89 children under 2 years hospitalized with influenza during the 2015-2016 season.
- Clinical data collection including fever and cough prevalence.
- Performance evaluation of RIDTs and RT-PCR, including time to diagnosis and cost analysis.
Main Results:
- Clinical signs like fever and cough had low diagnostic sensitivity.
- RIDTs showed low overall sensitivity, with positive results primarily within 24 hours of symptom onset.
- RIDTs reduced diagnosis time and treatment costs compared to RT-PCR, but RT-PCR offered a more reliable diagnosis.
Conclusions:
- Clinical assessment alone is insufficient for diagnosing influenza in infants and toddlers.
- RIDTs are only effective within the first 24 hours of illness onset.
- RT-PCR is the preferred diagnostic method, contingent on consistent availability.
Abstract:
Children under 2 years of age may receive antiviral therapy when influenza is suspected. Signs of influenza are frequently unclear and testing is indicated. The aim of the study was to assess the usefulness of clinical signs and the rapid influenza diagnostic test (RIDT) in diagnosing influenza and in choosing the appropriate treatment. In the 2015-2016 influenza season, 89 children under 2 years of age (56.7% of 157 children diagnosed with influenza) were hospitalized. There were 74 RIDT and 70 reverse transcription polymerase chain reactions (RT-PCR) performed for the purpose of diagnosis, either test per child. Eighty-three percent of children (74/89) presented with fever, 55.1% (49/89) with cough, and 39.3% (35/89) with both cough and fever. The RIDT was positive in 31.1% (23/74) of cases. The highest percentage of positive RIDT was within the first 24 h of disease, decreasing dramatically thereafter (70% vs. 13-17%, respectively). The RIDT shortened the time to diagnosis by 43.8 h/patient (an average €149 gain in treatment costs). The mean delay for RT-PCR-based diagnosis was 33.5 h/patient (an average €114 loss in treatment costs). We conclude that clinical signs have a low diagnostic sensitivity in children under 2 years of age. Likewise, RIDT is of low sensitivity, being diagnostically useful only in the first 24 h. The PCR is recommended for the diagnosis, but that requires a constant access to the method.
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