Severe Influenza-Associated Neurological Disease in Australian Children: Seasonal Population-Based Surveillance
Erin Donnelley1, Suzy Teutsch2,3, Yvonne Zurynski2,3,4
1Department of General Medicine, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Insights
Influenza-associated neurological disease (IAND) is uncommon but serious in children, often affecting those without prior health issues. This study highlights IAND
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Public Health Surveillance
Background:
- Influenza-associated neurological disease (IAND) is a rare but severe complication in children.
- It can lead to significant neurological morbidity and mortality.
- Understanding its incidence and risk factors in Australia is crucial for public health.
Purpose of the Study:
- To determine the incidence and risk factors of IAND in Australian children.
- To describe the outcomes associated with IAND.
- To inform prevention and management strategies for severe influenza in pediatric populations.
Main Methods:
- Analysis of national, population-based surveillance data.
- Inclusion of children aged 14 years and under with severe influenza and neurological involvement.
- Data collected over 11 Australian influenza seasons (2008-2018).
Main Results:
- 165 out of 633 severe influenza cases (26%) had IAND.
- Average annual incidence of IAND was 3.39 per million children.
- Children with IAND were more likely to have pre-existing neurological disease (OR 3.03), require intensive care (OR 1.79), ventilation (OR 1.99), and die (OR 2.83).
Conclusions:
- IAND is a significant cause of mortality in children, often in those without prior health conditions.
- IAND accounts for a substantial proportion of severe influenza cases and deaths in children.
- Incidence estimates support previous findings and underscore the need for awareness and prevention.
Background:
Influenza-associated neurological disease (IAND) is uncommon but can result in death or neurological morbidity in children. We aimed to describe the incidence, risk factors, and outcome of children with IAND from seasonal influenza in Australia.
Methods:
We analyzed national, population-based, surveillance data for children aged ≤ 14 years with severe influenza and neurological involvement, over 11 Australian influenza seasons, 2008-2018, by the Australian Paediatric Surveillance Unit.
Results:
There were 633 laboratory-confirmed cases of severe influenza reported. Of these, 165 (26%) had IAND. The average annual incidence for IAND was 3.39 per million children aged ≤ 14 years. Compared to cases without neurological complications, those with IAND were more likely to have a pre-existing neurological disease (odds ratio [OR] 3.03, P < .001), but most children with IAND did not (n = 135, 82%). Children with IAND were more likely to receive antivirals (OR 1.80, P = .002), require intensive care (OR 1.79, P = .001), require ventilation (OR 1.99; P = .001), and die (OR 2.83, P = .004).
Conclusions:
IAND is a preventable cause of mortality, predominantly in otherwise well children. Incidence estimates validate previous sentinel site estimates from Australia. IAND accounted for a quarter of all severe influenza, is associated with intensive care unit admission, and accounted for half of all influenza deaths.
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