Influenza, A Real Threat To Young Children

In their imaginary world, children could be superheroes fighting fearsome monsters.  In real life, however, children are quite helpless against many threats to their health and well-being.  Influenza is one of them.  Worldwide, this disease is responsible for between 290,000 and 650,000 respiratory-related deaths annually[1], many involving young children.

Younger Age, Higher Risk

Children are a high-risk group when it comes to influenza. While healthy individuals tend to experience mild to moderate symptoms[2], young children may suffer severe flu.

This is shown in a study where children hospitalised from influenza were either admitted into intensive care (12%), developed respiratory failure (5%), had bacterial co-infection (2%), or even died (0.5%)[3]

Centers for Disease Control and Prevention (CDC) also estimates that every year, flu-related hospitalisations among children younger than five years ranged from 7,000 to 26,000 in the United States[4]. This could be because such young children have immature immune systems[1]; furthermore, those below six months are not old enough to be vaccinated.[2]

Children with pre-existing medical conditions have a higher likelihood of getting hospitalised for influenza.  Of the 40% of children studied by Dawood, 18% had asthma, 15% (of those below two years) had been born prematurely, and 7% had developmental delay[5]

However, this does not mean that other children are safe.  A 25 year-long study of 1,665 healthy children found that influenza was associated with high death rates in otherwise healthy children aged below five years.  Acute otitis media (painful middle ear infection) and lower respiratory tract disease were highest among children aged under two years old[6]

Children Easily Catch & Spread Influenza

Influenza can spread in a couple of ways.  If an infected person coughs or sneezes openly, influenza viruses are released into the air. When inhaled by someone else, these viruses make their way into the respiratory tract and start to replicate.[7]

Alternatively, the droplets may land on, or be transferred by touch to, items like toys, remote controls, door handles, bed sheets, blankets and so on.  The viruses can live there for hours or days.  In that time, anyone handling those contaminated objects (called fomites) will get the viruses on their hands and eventually into their mouths, nasal passages, and eyes where the viruses can enter the body.[4]

Seeing how children share toys and have close context with their school friends, siblings and other family members, it is no surprise that they can easily catch and spread the disease.  In fact, they shed greater amounts of the virus for long periods than adults do, despite displaying symptomatic illnesses for a shorter time.[8]

All this often comes at their own and their families’ detriment.  A study by Principi et al found that most children with influenza attended day-care centres or schools.  They also had a higher likelihood of fever and croup (an infection of the upper airway characterised by a barking cough), and a longer school absence.[9]

Their parents and siblings also had more respiratory illnesses, needed more medical visits, missed more work or school days, and needed help at home to care for the ill children for a longer period of time.[10]

Vaccinate Children Against Influenza

It helps to teach children good hygiene and etiquette to reduce the risk of influenza infection, to some extent. These include hand washing, and staying away from friends who show signs of influenza.[11]

However, vaccination is the best way to prevent influenza.[12] CDC recommends it for all children older than six months of age (as well as adults who care for children). Two doses of vaccine should be given to children aged six months to eight years while only one dose is required subsequently.[13]

Influenza vaccination should be given annually[4] to protect against new mutations of the viruses that are expected in the coming season.[14]

This will substantially reduce the risk of severe disease that may result in hospitalisation or serious complications.  It will also help prevent the virus from spreading at home (particularly if you have a baby under six months old) or in school.[15]

While temperate countries experience influenza seasons in winter, we in Malaysia have it all year round.  As such, you should get your child vaccinated as soon as possible, and repeat the process every year.

Article courtesy of the Immunise4Life programme by Ministry of Health Malaysia, Malaysian Paediatric Association & Malaysian Society of Infectious Diseases & Chemotherapy, supported by Sanofi Pasteur. Learn more at https://immunise4life.my/beattheflu/ or www.ifl.my/btf


References:
[1]Bresee, J., Fitzner, J., Campbell, H., Cohen, C., Cozza, V., & Jara, J. et al. (2018). Progress and Remaining Gaps in Estimating the Global Disease Burden of Influenza. Emerging Infectious Diseases, 24(7), 1173-1177. doi: 10.3201/eid2407.171270
[2]Mancinelli, L., Onori, M., Concato, C., Sorge, R., Chiavelli, S., & Coltella, L. et al. (2015). Clinical features of children hospitalized with influenza A and B infections during the 2012–2013 influenza season in Italy. BMC Infectious Diseases, 16(1). doi: 10.1186/s12879-015-1333-x
[3]Dawood, F., Fiore, A., Kamimoto, L., Bramley, A., Reingold, A., & Gershman, K. et al. (2010). Burden of Seasonal Influenza Hospitalization in Children, United States, 2003 to 2008. The Journal Of Pediatrics, 157(5), 808-814. doi: 10.1016/j.jpeds.2010.05.012
[4]Children & Influenza (Flu) | CDC. (2019). Retrieved from https://www.cdc.gov/flu/protect/children.htm
[5]Dawood, F., Fiore, A., Kamimoto, L., Bramley, A., Reingold, A., & Gershman, K. et al. (2010). Burden of Seasonal Influenza Hospitalization in Children, United States, 2003 to 2008. The Journal Of Pediatrics, 157(5), 808-814.
[6]Neuzil, K., Zhu, Y., Griffin, M., Edwards, K., Thompson, J., Tollefson, S., & Wright, P. (2002). Burden of Interpandemic Influenza in Children Younger than 5 Years: A 25‐Year Prospective Study. The Journal Of Infectious Diseases, 185(2), 147-152. doi: 10.1086/338363
[7]Morris, D. E., Cleary, D. W., & Clarke, S. C. (2017). Secondary Bacterial Infections Associated with Influenza Pandemics. Frontiers in microbiology, 8, 1041. doi:10.3389/fmicb.2017.01041
[8]Petrie, J., Ohmit, S., Cowling, B., Johnson, E., Cross, R., & Malosh, R. et al. (2013). Influenza Transmission in a Cohort of Households with Children: 2010-2011. Plos ONE, 8(9), e75339. doi: 10.1371/journal.pone.0075339
[9]Principi, N. (2004). Burden of influenza in healthy children and their households. Archives Of Disease In Childhood, 89(11), 1002-1007. doi: 10.1136/adc.2003.045401
[10]Hurwitz, E. S. (2000). Effectiveness of Influenza Vaccination of Day Care Children in Reducing Influenza-Related Morbidity Among Household Contacts. JAMA, 284(13), 1677. doi:10.1001/jama.284.13.1677
[11]Germs in the School Room. (2012) Retrieved from https://www.webmd.com/children/features/germs-in-school-room#1
[12]Prevent Seasonal Flu | CDC. (2018). Retrieved from https://www.cdc.gov/flu/prevent/index.html
[13]Diseases, C. O. (2018). Recommendations for Prevention and Control of Influenza in Children, 2018-2019. Retrieved from https://pediatrics. Aappublications.org/content/142/4/e20182367
[14]WHO | Seasonal influenza and influenza A(H1N1). (2019). Retrieved from https://www.who.int/ith/diseases/si_iAh1n1/en/
[15]Bracht, M., Basevitz, D., Cranis, M., & Paulley, R. (2012). Impact of respiratory syncytial virus: the nurse’s perspective. Drugs in R&D, 11(3), 215-26.

SPMY.IFLU.19.03.0110 (04/19)