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Serious Neurologic Events With Seasonal Influenza in Young Children
Brooke P Quertermous1, Derek J Williams1, Jean Bruce2
1Department of Pediatrics (BP Quertermous, DJ Williams, M Sekmen, and JW Antoon), Vanderbilt University Medical Center, Nashville, Tenn.
Insights
Serious neurologic events from influenza are uncommon in young children, but more frequent in those with pre-existing neurologic conditions. Prevention and prompt treatment of influenza are crucial for this group.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Epidemiology
Background:
- Influenza can cause serious complications in children.
- Neurologic events are a potential complication of influenza.
Purpose of the Study:
- To determine the population-based incidence of influenza-associated serious neurologic events in children under 5 years old.
- To identify risk factors for these events.
Main Methods:
- Retrospective cohort study of children under 5 years old in a Medicaid program.
- Analysis of influenza seasons from 2016-2017 through 2019-2020.
- Calculation of incidence per 100,000 influenza person-weeks, stratified by various factors.
Main Results:
- Overall incidence of serious neurologic events was 38.0 per 100,000 person-weeks.
- Seizures were the most common event; encephalitis and ataxia were least common.
- Incidence was higher in children under 2 years and those with prior neurologic conditions.
Conclusions:
- Serious neurologic complications of influenza are uncommon in young children.
- Children with underlying neurologic conditions have a markedly higher risk.
- Emphasizes the importance of influenza prevention and treatment in this population.
Objective:
The objective of this study was to determine the population-based incidence of influenza-associated serious neurologic events in children <5 years of age.
Methods:
We conducted a retrospective cohort of children <5 years of age enrolled in a Medicaid program during the 2016 to 2017 through 2019 to 2020 influenza seasons. Serious influenza-associated neurologic events were defined as a neurologic event resulting in hospitalization. Population-based incidence of serious influenza-associated neurologic events was calculated by dividing the number of events by the total accrued follow-up time and expressed per 100,000 influenza person-weeks. Incidence estimates were stratified by neurologic event category, age, sex, neurologic comorbidity, influenza season, and antiviral use.
Results:
A total of 79,727 influenza cases among 70,258 unique children were included. The overall incidence of serious influenza-associated neurologic events was 38.0 (95% confidence interval [CI] 27.5-51.2) per 100,000 person-weeks of influenza. The most common serious neurologic event was seizure (34.5 per 100,000 influenza person-weeks of influenza, 95% CI 24.5-47.1) whereas encephalitis and ataxia/movement disorders were least common (0.9 per 100,000 influenza person-weeks of influenza, 95% CI 0.02-4.9). Incidence rates were generally higher in children <2 years and significantly more common in children with neurologic conditions compared to those without neurologic conditions. Incidence rates were similar among those with and without influenza antiviral use.
Conclusions:
Our findings reveal that serious neurologic complications are uncommon in young children with influenza but markedly higher in those with underlying neurologic conditions. These data emphasize the importance of preventing, identifying, and treating influenza in this vulnerable population.
