Risk conditions in children hospitalized with influenza in Norway, 2017-2019

Abstract

Background Norwegian children are more frequently hospitalized with influenza than adults. Little is known about the characteristics of these children. Our aim was to investigate the presence of pre-existing risk conditions and to determine the duration of influenza hospitalizations in children during two influenza seasons. Methods The Norwegian Patient Registry holds data on all hospitalized patients in Norway. We included all patients younger than 18 years hospitalized with a diagnosis of influenza during the influenza seasons 2017-18 and 2018-19. Pre-existing risk conditions for influenza were identified by ICD-10 diagnoses in the Norwegian Patient Registry. In addition, information on asthma diagnoses were also retrieved from the Norwegian Registry for Primary Health Care. To estimate the prevalence of risk conditions in the child population, we obtained diagnoses on all Norwegian children in a two-year period prior to each influenza season. We calculated age-specific rates for hospitalization and risk for being hospitalized with influenza in children with risk conditions. Results In total, 1013 children were hospitalized with influenza during the two influenza seasons. Children younger than 6 months had the highest rate of hospitalization, accounting for 13.5% of all admissions (137 children). Hospitalization rates decreased with increasing age. Among children hospitalized with influenza, 25% had one or more pre-existing risk conditions for severe influenza, compared to 5% in the general population under 18 years. Having one or more risk conditions significantly increased the risk of hospitalization, (Odds Ratio (OR) 6.1, 95% confidence interval (CI) 5.0-7.4 in the 2017-18 season, and OR 6.8, 95% CI 5.4-8.4 in the 2018-19 season). Immunocompromised children and children with epilepsy had the highest risk of hospitalization with influenza, followed by children with heart disease and lung disease. The average length of stay in hospital were 4.6 days, and this did not differ with age. Conclusion Children with pre-existing risk conditions for influenza had a higher risk of hospitalization for influenza. However, most children (75%) admitted to hospital with influenza in Norway during 2017-2019 did not have pre-existing risk conditions. Influenza vaccination should be promoted in particular for children with risk conditions and pregnant women to protect new-borns.

Influenza risk groups in Norway by education and employment status

“…However, as mentioned above, the study estimate of the medical risk population among individuals <18 years of age was 5.5%. This is comparable to the results of a recent Norwegian register study which found that 5% of the population <18 years of age had at least one diagnosis related to risk of severe influenza in Norway [4]. Furthermore, for diabetes prevalence, the T&V-survey estimate of 3.9% is lower than the national estimate of 4.7% [16].…”

“…Furthermore, based on Norwegian registry data [4,11,12] in combination with proportions reporting chronic disease by 10-year age groups among individuals aged 18–64 years in the T&V-study, we estimated the size of the risk group by age group in absolute numbers.…”

“…The hospitalisation rate is about 48 per 100,000, and excess influenza-related mortality is estimated at more than 900 deaths [1,2]. While anyone can become seriously ill if infected, risk of severe influenza is elevated in certain groups, such as the very young and the very old, as well as individuals with certain chronic medical conditions [1,3,4]. Annual influenza vaccination is the most effective intervention to prevent severe influenza-related disease and mortality.…”

Influenza vaccine administration in a paediatric intensive care unit

“…Influenza in children is associated with high rates of hospitalisation and complications, particularly in children with comorbidities. 1,2 Influenza vaccination reduces the incidence of seasonal influenza and associated burden. 3,4 Children and adolescents with conditions which put them at higher risk, are funded in Australia to receive the annual seasonal influenza vaccine under the National Immunisation Program (NIP), 5 but there is limited data on uptake.…”

“…Influenza in children is associated with high rates of hospitalisation and complications, particularly in children with comorbidities 1,2 . Influenza vaccination reduces the incidence of seasonal influenza and associated burden 3,4 .…”