Socio-Economic Burden of Influenza among Children Younger than 5 Years in the Outpatient Setting in Suzhou, China

Abstract

BackgroundThe disease burden of children with laboratory-confirmed influenza in China has not been well described. The aim of this study was to understand the epidemiology and socio-economic burden of influenza in children younger than 5 years in outpatient and emergency department settings.MethodsA prospective study of laboratory-confirmed influenza among children presenting to the outpatient settings in Soochow University Affiliated Children's Hospital with symptoms of influenza-like illness (ILI) was performed from March 2011 to February 2012. Throat swabs were collected for detection of influenza virus by reverse transcription polymerase chain reaction assay. Data were collected using a researcher administered questionnaire, concerning demographics, clinical characteristics, direct and indirect costs, day care absence, parental work loss and similar respiratory illness development in the family.ResultsAmong a total of 6,901 children who sought care at internal outpatient settings, 1,726 (25%) fulfilled the criteria of ILI and 1,537 were enrolled. Influenza was documented in 365 (24%) of enrolled 1,537 ILI cases. Among positive patients, 52 (14%) were type A and 313 (86%) were type B. About 52% of influenza outpatients had over-the-counter medications before physician visit and 41% visited hospitals two or more times. Children who attended daycare missed an average of 1.9 days. For each child with influenza-confirmed disease, the parents missed a mean of 1.8 work days. Similar respiratory symptoms were reported in 43% of family contacts of influenza positive children after onset of the child's illness. The mean direct and indirect costs per episode of influenza were $123.4 for outpatient clinics and $134.6 for emergency departments, and $125.9 for influenza A and $127.5 for influenza B.ConclusionsInfluenza is a common cause of influenza-like illness among children and has substantial socio-economic impact on children and their families regarding healthcare seeking and day care/work absence. The direct and indirect costs of childhood influenza impose a heavy financial burden on families. Prevention measures such as influenza vaccine could reduce the occurrence of influenza in children and the economic burden on families.

Seasonal influenza vaccine effectiveness against medically attended influenza illness among children aged 6–59 months, October 2011–September 2012: A matched test-negative case–control study in Suzhou, China

“…Suzhou is the most economically developed city in Jiangsu province with a resident population of 10,460,000 of which 960,000 are children less than 14 years of age, per the 2010 Census. An investigation of medical records showed that in 2011 the total number of outpatient visits among children less than 5 years of age at this hospital was 396,568, which accounted for approximately 28.5% of all outpatient visits among children this age in the municipal district of Suzhou [16]. A health care utilization survey conducted in 2012 showed that among the municipal districts of Suzhou, 65.2% of children less than 5 years old requiring hospitalization were admitted at SCH (data unpublished).…”

“…Specimens were stored at −20 • C and sent to Suzhou CDC laboratory, one of the national ILI network laboratories, every 2 days to test for influenza by rRT-PCR [16].…”

“…Excluded children were younger and more often lived outside of Suzhou city (Table 1). Among the 1829 ILI and SARI cases included in the study (ILI: 1354, SARI: 475), 4.1% (95% CI: 3.2-5.0%) were vaccinated (ILI: 59; SARI: 16), and 427 (23%) had laboratory-confirmed influenza. Matching by age and date of presentation, 427 test negative children were included as controls for a case-control ratio of 1:1.…”

The effects of age on clinical characteristics, hospitalization and mortality of patients with influenza‐related illness at a tertiary care centre in Malaysia

“…3 Furthermore, the influenza virus is also implicated in a large number of outpatient visits and subsequent hospitalization, accounting for 10%-26% of outpatient visits with influenza-like illness (ILI) and 6%-14% pneumonia hospitalization in East and South-East Asia. [4][5][6][7] Children, older persons, individuals with chronic respiratory diseases and the immunocompromised are considered high-risk groups for complications from influenza viral infections. 5 Clinical manifestations have also been known to differ with age, as older adults are less likely to report classical ILI symptoms.…”

Technical guidelines for the application of seasonal influenza vaccine in China (2014–2015)

“…69 In Chinese children aged <5 y, 41% of children infected by influenza need to see a doctor more than twice on average. 70 In China, a series of studies on etiology of acute respiratory infection showed that the positive rate for influenza in ILI or ARI cases is 3.2% to 25.8% in outpatient and emergent children respectively, 70-75 and 1.4%-35.4% in inpatient children. [76][77][78][79][80][81] The risk of death in children with underlying diseases is significantly higher than healthy children.…”