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Influenza-Associated Neurologic Complications in Hospitalized Children
Sarah Frankl1, Susan E Coffin2, Jacqueline B Harrison1
1Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Influenza-associated neurologic complications are common in hospitalized children, especially those with prior neurologic conditions. Vaccination may help prevent these serious complications.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Epidemiology
Background:
- Influenza is a significant cause of childhood illness and hospitalization.
- Neurologic complications associated with influenza can be severe but are not fully characterized.
- Understanding risk factors is crucial for prevention and management strategies.
Purpose of the Study:
- To determine the incidence and characteristics of influenza-associated neurologic complications in hospitalized children.
- To identify clinical, epidemiologic, and virologic factors associated with these complications.
Main Methods:
- Historical cohort study of children aged 0.5-18 years hospitalized with laboratory-confirmed influenza between 2010 and 2017.
- Exclusion criteria included immune compromise or recent live virus vaccination.
- Influenza-associated neurologic complications were defined as new-onset neurologic symptoms without other causes.
Main Results:
- 10.8% of hospitalizations had at least one influenza-associated neurologic complication.
- Seizures and encephalopathy were the most frequent complications.
- Pre-existing neurologic diagnosis, lack of vaccination, and age ≤5 years were independently associated with complications.
Conclusions:
- Influenza-associated neurologic complications are prevalent in hospitalized children, particularly those with pre-existing neurologic conditions.
- Further research into neuropathologic mechanisms and mitigation is warranted.
- Influenza vaccination is recommended to potentially prevent these complications.
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.
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