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Uncovering the burden of Influenza in children in Portugal, 2008-2018
Alberto Caldas Afonso1,2,3,4, Catarina Gouveia5,6, Gustavo Januário7,8
1Unidade de Nefrologia Pediátrica, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal. caldasafonso.cmin@chporto.min-saude.pt.
Insights
Influenza causes significant hospitalizations in young Portuguese children, with most previously healthy. This highlights the need for better preventive strategies to protect this vulnerable population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Limited data exists on the burden of influenza in children under 5 years old in Portugal.
- Children under 5 have a higher risk of severe influenza disease.
- This study addresses the knowledge gap regarding influenza's clinical and economic impact in this demographic.
Purpose of the Study:
- To estimate the clinical and economic burden of severe influenza in children under 5 years old in Portugal.
- To analyze influenza hospitalizations and mortality over ten influenza seasons (2008/09-2017/18).
Main Methods:
- Utilized anonymized administrative data from mainland Portugal public hospitals for children under 5.
- Estimated direct influenza burden and indirect burden (influenza-associated excess hospitalizations/mortality) using cyclic regression models.
- Analyzed diagnoses including pneumonia, respiratory, respiratory or cardiovascular, and all-cause conditions.
Main Results:
- An average of 189 annual hospitalizations (41.3 per 100,000 children) were coded as influenza-related.
- Most hospitalized children (90%) were previously healthy; comorbidities increased with age.
- Estimated 1,850 excess hospitalizations and 95 excess deaths due to influenza over ten years, costing the National Health Service at least €2.9 million.
Conclusions:
- Influenza significantly contributes to hospitalizations in young children, predominantly those who are otherwise healthy.
- The findings underscore the necessity for enhanced preventive measures targeting this age group.
- Results call for a re-evaluation of influenza prevention strategies for children under 5 in Portugal.
Background:
Despite their higher risk of developing severe disease, little is known about the burden of influenza in Portugal in children aged < 5 years old. This study aims to cover this gap by estimating the clinical and economic burden of severe influenza in children, in Portugal, during ten consecutive influenza seasons (2008/09-2017/18).
Methods:
We reviewed hospitalizations in children aged < 5 years old using anonymized administrative data covering all public hospitals discharges in mainland Portugal. The burden of hospitalization and in-hospital mortality directly coded as due to influenza was supplemented by the indirect burden calculated from excess hospitalization and mortality (influenza-associated), estimated for four groups of diagnoses (pneumonia or influenza, respiratory, respiratory or cardiovascular, and all-cause), through cyclic regression models integrating the incidence of influenza. Means were reported excluding the H1N1pdm09 pandemic (2009/10).
Results:
The mean annual number of hospitalizations coded as due to influenza was 189 (41.3 cases per 100,000 children aged < 5 years old). Hospitalization rates decreased with increasing age. Nine-in-ten children were previously healthy, but the presence of comorbidities increased with age. Children stayed, on average, 6.1 days at the hospital. Invasive mechanical ventilation was used in 2.4% of hospitalizations and non-invasive in 3.1%. Influenza-associated excess hospitalizations between 2008 and 2018 were estimated at 1,850 in pneumonia or influenza, 1,760 in respiratory, 1,787 in respiratory or cardiovascular, and 1,879 in all-cause models. A total of 95 influenza-associated excess deaths were estimated in all-cause, 14 in respiratory or cardiovascular, and 9 in respiratory models. Over ten years, influenza hospitalizations were estimated to have cost the National Health Service at least €2.9 million, of which 66.5% from healthy children.
Conclusions:
Influenza viruses led to a high number of hospitalizations in children. Most were previously healthy. Results should lead to a reflection on the adequate preventive measures to protect this age group.
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