Assessing the Burden of Paediatric Influenza in Europe: the European Paediatric Influenza Analysis (EPIA) Project

Overview

Journal Eur J Pediatr

Specialty Pediatrics

Date 2010 Mar 16

PMID 20229049

Citations 41

Authors

W John Paget

Catherine Balderston

Inmaculada Casas

Ge Donker

Laurel Edelman

Douglas Fleming

Amparo Larrauri

Adam Meijer

Simona Puzelli

Caterina Rizzo

Lone Simonsen

Affiliations

Soon will be listed here.

Abstract

The European Paediatric Influenza Analysis (EPIA) project is a multi-country project that was created to collect, analyse and present data regarding the paediatric influenza burden in European countries, with the purpose of providing the necessary information to make evidence-based decisions regarding influenza immunisation recommendations for children. The initial approach taken is based on existing weekly virological and age-specific influenza-like illness (ILI) data from surveillance networks across Europe. We use a multiple regression model guided by longitudinal weekly patterns of influenza virus to attribute the weekly ILI consultation incidence pattern to each influenza (sub)type, while controlling for the effect of respiratory syncytial virus (RSV) epidemics. Modelling the ILI consultation incidence during 2002/2003-2008 revealed that influenza infections that presented for medical attention as ILI affected between 0.3% and 9.8% of children aged 0-4 and 5-14 years in England, Italy, the Netherlands and Spain in an average season. With the exception of Spain, these rates were always higher in children aged 0-4 years. Across the six seasons analysed (five seasons were analysed from the Italian data), the model attributed 47-83% of the ILI burden in primary care to influenza virus infection in the various countries, with the A(H3N2) virus playing the most important role, followed by influenza viruses B and A(H1N1). National season averages from the four countries studied indicated that between 0.4% and 18% of children consulted a physician for ILI, with the percentage depending on the country and health care system. Influenza virus infections explained the majority of paediatric ILI consultations in all countries. The next step will be to apply the EPIA modelling approach to severe outcomes indicators (i.e. hospitalisations and mortality data) to generate a complete range of mild and severe influenza burden estimates needed for decision making concerning paediatric influenza vaccination.

Citing Articles

Disease Burden of RSV Infections and Bronchiolitis in Young Children (< 5 Years) in Primary Care and Emergency Departments: A Systematic Literature Review.

Heemskerk S, van Heuvel L, Asey T, Bangert M, Kramer R, Paget J Influenza Other Respir Viruses. 2024; 18(8):e13344.

PMID: 39098881 PMC: 11298312. DOI: 10.1111/irv.13344.

The economic rationale for cell-based influenza vaccines in children and adults: A review of cost-effectiveness analyses.

Fisman D, Giglio N, Levin M, Nguyen V, Pelton S, Postma M Hum Vaccin Immunother. 2024; 20(1):2351675.

PMID: 38835218 PMC: 11155702. DOI: 10.1080/21645515.2024.2351675.

A single-cell atlas of the peripheral immune response in patients with influenza A virus infection.

Zhang Y, Zong L, Zheng Y, Zhang Y, Li N, Li Y iScience. 2023; 26(12):108507.

PMID: 38089584 PMC: 10711475. DOI: 10.1016/j.isci.2023.108507.

Acute respiratory infection emergency access in a tertiary care children hospital in Italy, prior and after the SARS-CoV-2 emergence.

Ciofi Degli Atti M, Rizzo C, DAmore C, Rava L, Reale A, Barbieri M Influenza Other Respir Viruses. 2023; 17(3):e13102.

PMID: 36950039 PMC: 10026100. DOI: 10.1111/irv.13102.

The Epidemiology of Influenza Virus Infection and Group A Streptococcal Pharyngitis in Children Between 2011 and 2018 in an Outpatient Pediatric Clinic.

Yildiz I, Gonullu E, Soysal A, Oner C, Karabocuoglu M Cureus. 2023; 15(1):e33492.

PMID: 36756026 PMC: 9902056. DOI: 10.7759/cureus.33492.

References

Mangtani P, Cumberland P, Hodgson C, Roberts J, Cutts F, Hall A . A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom general practice research database. J Infect Dis. 2004; 190(1):1-10. DOI: 10.1086/421274. View

Katz M, Rubino A, Collier J, Rosen J, Ehrich J . Demography of pediatric primary care in Europe: delivery of care and training. Pediatrics. 2002; 109(5):788-96. DOI: 10.1542/peds.109.5.788. View

Bhat N, Wright J, Broder K, Murray E, Greenberg M, Glover M . Influenza-associated deaths among children in the United States, 2003-2004. N Engl J Med. 2005; 353(24):2559-67. DOI: 10.1056/NEJMoa051721. View

Mereckiene J, Cotter S, Weber J, Nicoll A, Levy-Bruhl D, Ferro A . Low coverage of seasonal influenza vaccination in the elderly in many European countries. Euro Surveill. 2008; 13(41). DOI: 10.2807/ese.13.41.19001-en. View

van Gageldonk-Lafeber A, Heijnen M, Bartelds A, Peters M, van der Plas S, Wilbrink B . A case-control study of acute respiratory tract infection in general practice patients in The Netherlands. Clin Infect Dis. 2005; 41(4):490-7. PMC: 7107976. DOI: 10.1086/431982. View

Jansen A, Sanders E, Wallinga J, Groen E, van Loon A, Hoes A . Rate-difference method proved satisfactory in estimating the influenza burden in primary care visits. J Clin Epidemiol. 2008; 61(8):803-12. DOI: 10.1016/j.jclinepi.2007.08.017. View

Cohen G, Nettleman M . Economic impact of influenza vaccination in preschool children. Pediatrics. 2000; 106(5):973-6. DOI: 10.1542/peds.106.5.973. View

Larrauri A, DE Mateo S . Characterisation of swabbing for virological analysis in the Spanish Influenza Sentinel Surveillance System during four influenza seasons in the period 2002-2006. Euro Surveill. 2007; 12(5):E5-6. DOI: 10.2807/esm.12.05.00706-en. View

Arkema J, Meijer A, Meerhoff T, Velden J, Paget W . Epidemiological and virological assessment of influenza activity in Europe, during the 2006-2007 winter. Euro Surveill. 2008; 13(34). DOI: 10.2807/ese.13.34.18958-en. View

10.

Neuzil K, Mellen B, Wright P, Mitchel Jr E, Griffin M . The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med. 2000; 342(4):225-31. DOI: 10.1056/NEJM200001273420401. View

11.

Jefferson T, Rivetti A, Harnden A, Di Pietrantonj C, Demicheli V . Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2008; (2):CD004879. DOI: 10.1002/14651858.CD004879.pub3. View

12.

Pitman R, Melegaro A, Gelb D, Siddiqui M, Gay N, Edmunds W . Assessing the burden of influenza and other respiratory infections in England and Wales. J Infect. 2006; 54(6):530-8. DOI: 10.1016/j.jinf.2006.09.017. View

13.

Fleming D, Miles J . The representativeness of sentinel practice networks. J Public Health (Oxf). 2009; 32(1):90-6. DOI: 10.1093/pubmed/fdp087. View

14.

Heikkinen T, Silvennoinen H, Peltola V, Ziegler T, Vainionpaa R, Vuorinen T . Burden of influenza in children in the community. J Infect Dis. 2004; 190(8):1369-73. DOI: 10.1086/424527. View

15.

Jansen A, Sanders E, Hoes A, van Loon A, Hak E . Influenza- and respiratory syncytial virus-associated mortality and hospitalisations. Eur Respir J. 2007; 30(6):1158-66. DOI: 10.1183/09031936.00034407. View

16.

Meijer A, Valette M, Manuguerra J, Perez-Brena P, Paget J, Brown C . Implementation of the community network of reference laboratories for human influenza in Europe. J Clin Virol. 2005; 34(2):87-96. DOI: 10.1016/j.jcv.2005.02.005. View

17.

Del Torso S, Bussi R, DeWITT T . Primary care pediatrics in Italy: eighteen years of clinical care, research, and teaching under a national health service system. Pediatrics. 1997; 99(1):E8. DOI: 10.1542/peds.99.1.e8. View

18.

Dijkstra F, Donker G, Wilbrink B, van Gageldonk-Lafeber A, van der Sande M . Long time trends in influenza-like illness and associated determinants in The Netherlands. Epidemiol Infect. 2008; 137(4):473-9. DOI: 10.1017/S095026880800126X. View

19.

Boron M, Edelman L, Groothuis J, Malinoski F . A novel active respiratory syncytial virus surveillance system in the United States: variability in the local and regional incidence of infection. Pediatr Infect Dis J. 2008; 27(12):1095-8. DOI: 10.1097/INF.0b013e3181812c8e. View

20.

Weycker D, Edelsberg J, Halloran M, Longini Jr I, Nizam A, Ciuryla V . Population-wide benefits of routine vaccination of children against influenza. Vaccine. 2005; 23(10):1284-93. DOI: 10.1016/j.vaccine.2004.08.044. View