Influenza: Underestimated in Children Below 2 Years of Age
Children under 2 years of age may receive antiviral therapy when influenza is suspected. Signs of influenza are frequently unclear and testing is indicated. The aim of the study was to assess the usefulness of clinical signs and the rapid influenza diagnostic test (RIDT) in diagnosing influenza and in choosing the appropriate treatment. In the 2015–2016 influenza season, 89 children under 2 years of age (56.7% of 157 children diagnosed with influenza) were hospitalized. There were 74 RIDT and 70 reverse transcription polymerase chain reactions (RT-PCR) performed for the purpose of diagnosis, either test per child. Eighty-three percent of children (74/89) presented with fever, 55.1% (49/89) with cough, and 39.3% (35/89) with both cough and fever. The RIDT was positive in 31.1% (23/74) of cases. The highest percentage of positive RIDT was within the first 24 h of disease, decreasing dramatically thereafter (70% vs. 13–17%, respectively). The RIDT shortened the time to diagnosis by 43.8 h/patient (an average €149 gain in treatment costs). The mean delay for RT-PCR-based diagnosis was 33.5 h/patient (an average €114 loss in treatment costs). We conclude that clinical signs have a low diagnostic sensitivity in children under 2 years of age. Likewise, RIDT is of low sensitivity, being diagnostically useful only in the first 24 h. The PCR is recommended for the diagnosis, but that requires a constant access to the method.
KeywordsChildren Diagnostics Costs Infants Influenza Rapid diagnostic test Reverse transcription polymerase chain reaction Sensitivity
This study was supported by CMKP grant no. 501-1-20-19-17.
Conflicts of Interest
The authors declare no conflicts of interest in relation to this article.
- AAP (2017) Committee on infectious diseases. Recommendations for prevention and control of influenza in children, 2017–2018. Pediatrics 140(4):e20172550Google Scholar
- Avril E, Lacroix S, Vrignaud B, Moreau–Klein A, Coste–Burel M, Launay E, Gras–Le Guen C (2016) Variability in the diagnostic performance of a bedside rapid diagnostic influenza test over four epidemic seasons in a pediatric emergency department. Diagn Microbiol Infect Dis 85:334–337CrossRefGoogle Scholar
- CDC (2018) Centers for disease control and prevention. https://www.cdc.gov/flu/treatment/index.html. Accessed 16 Feb 2018
- Eggers M, Enders M, Terletskaina–Ladwig E (2015) Evaluation of the Becton Dickinson rapid influenza diagnostic tests in outpatients in Germany during seven influenza seasons. PLoS One:10–e0127070Google Scholar
- Pham NT, Ushijima H, Thongprachum A, Trinh QD, Khamrin P, Arakawa C, Ishii W, Okitsu S, Komine–Aizawa S, Hayakawa S (2017) Multiplex PCR for the detection of 10 viruses causing encephalitis/encephalopathy and its application to clinical samples collected from Japanese children with suspected viral. Clin Lab 63:91–100PubMedGoogle Scholar
- van Elden L, van Essen G, Boucher C, van Loon AM, Nijhuis M, Schipper P, Verheij TJ, Hoepelman IM (2001) Clinical diagnosis of influenza virus infection: evaluation of diagnostic tools in general practice. Brit J Gen Pract 51:630–634Google Scholar