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. 2014 Mar;173(3):265-76.
doi: 10.1007/s00431-013-2023-6. Epub 2013 May 10.

The burden of seasonal and pandemic influenza in infants and children

Bernhard R Ruf  1 , Markus Knuf
Affiliations

The burden of seasonal and pandemic influenza in infants and children

Bernhard R Ruf et al. Eur J Pediatr. 2014 Mar.

Abstract

The burden of influenza is unevenly distributed, with more severe outcomes in children aged <5 years than older children and adults. In spite of this, immunisation policies for young children are far from universal. This article provides an overview of the published evidence on the burden of influenza in children worldwide, with a particular interest in the impact of pandemic influenza in 2009-2010 (caused by the H1N1pdm09 virus). In an average season, up to 9.8 % of 0- to 14-year olds present with influenza, but incidence rates can be markedly higher in younger children. Children aged <5 years have greater rates of hospitalisation and complications than their older counterparts, particularly if the children have co-existing illnesses; historically, this age group have had higher mortality rates from the disease than other children, although during the 2009-2010 pandemic the median age of those who died of influenza was higher than in previous seasons. Admissions to hospital and emergency departments appear to have been more frequent in children with H1N1pdm09 infections than during previous seasonal epidemics, with pneumonia continuing to be a common complication in this setting. Outcomes in children hospitalised with severe disease also seem to have been worse for those infected with H1N1pdm09 viruses compared with seasonal viruses. Studies in children confirm that vaccination reduces the incidence of seasonal influenza and the associated burden, underlining the importance of targeting this group in national immunisation policies.

Conclusions: Children aged <5 years are especially vulnerable to influenza, particularly that caused by seasonal viruses, and vaccination in this group can be an effective strategy for reducing disease burden.

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Figures

Fig. 1
Fig. 1
Deaths from influenza in US children <5 years old as a proportion of all child deaths, comparing H1N1pdm09 influenza in summer 2009 with seasonal influenza in 2007–2008 and 2010–2011 [17, 20, 92]
Fig. 2
Fig. 2
Distribution of influenza-related deaths in children by age group, comparing H1N1pdm09 influenza in April 2009–January 2010 with seasonal influenza in October 2007–April 2009. The difference in median ages was statistically significant (p < 0.01) [29]
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