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Clin Infect Dis. 2017 Aug 15;65(4):653-660. doi: 10.1093/cid/cix412.

The Spectrum and Burden of Influenza-Associated Neurological Disease in Children: Combined Encephalitis and Influenza Sentinel Site Surveillance From Australia, 2013-2015.

Author information

1
Sydney Medical School, University of Sydney, NSW.
2
Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney.
3
Children's Hospital at Westmead, New South Wales.
4
Department of Infectious Diseases and Department of Microbiology, Princess Margaret Hospital, Subiaco.
5
Department of Microbiology, PathWest Laboratory, Nedlands, Western Australia.
6
School of Medicine, University of Western Australia.
7
Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute.
8
National Centre for Immunisation Research and Surveillance, Westmead, New South Wales.
9
Royal Children's Hospital, Melbourne, Victoria.
10
Murdoch Children's Research Institute and University of Melbourne, Victoria.
11
Women's and Children's Hospital, Adelaide Medical School, University of Adelaide, South Australia.
12
Lady Cilento Children's Hospital, Queensland.
13
School of Medicine, University of Queensland, Brisbane.
14
Australian Paediatric Surveillance Unit, Westmead, New South Wales.
15
School of Public Health and Preventive Medicine, Monash University.
16
Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia.

Abstract

Background:

There are few longitudinal studies of seasonal influenza-associated neurological disease (IAND) and none from the Southern Hemisphere.

Methods:

We extracted prospectively acquired Australian surveillance data from 2 studies nested within the Paediatric Active Enhanced Disease Surveillance (PAEDS) network: the Influenza Complications Alert Network (FluCAN) study and the Australian Childhood Encephalitis (ACE) study between 2013 and 2015. We described the clinical features and severity of IAND in children, including influenza-associated encephalitis/encephalopathy (IAE). We calculated the proportion of hospitalized influenza that is associated with IAND and IAE, and incidence of IAE.

Results:

Over 3 influenza seasons, we identified 54 cases of IAND at 2 tertiary children's hospitals from Australia that accounted for 7.6% of hospitalized influenza. These included 10 cases of IAE (1.4% hospitalized influenza). The mean annual incidence of IAE among Australian children (aged ≤14 years) was 2.8 per 1000000. The spectrum of IAND was broad and included IAE (n = 10) including distinct acute encephalopathy syndromes, simple febrile seizures (n = 14), other seizures (n = 16), acute ataxia (n = 4), and other subacute syndromes (transverse myelitis [n = 1], opsoclonus myoclonus [n = 1]). Two-thirds of children with IAND were aged ≤4 years; less than half had preexisting neurological disease or other risk factors for severe influenza. IAE caused death or neurological morbidity in half of cases.

Conclusions:

Seasonal influenza is an important cause of acute neurological disease in Australian children. The spectrum of seasonal IAND appears similar to that described during the 2009 H1N1 pandemic. IAE is associated with high morbidity and mortality.

KEYWORDS:

encephalitis; encephalopathy; influenza; seizures; surveillance

PMID:
29017268
DOI:
10.1093/cid/cix412
[Indexed for MEDLINE]

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