Clinical predictors of influenza in young children

the limitations of “influenza-like illness”

Nicholas T. Conway (Lead / Corresponding author), Zoe V. Wake, Peter C. Richmond, David W. Smith, Anthony D. Keil, Simon Williams, Heath Kelly, Dale Carcione, Paul V. Effler, Christopher C. Blyth, on Behalf of the Western Australia Influenza Vaccine Effectiveness (WAIVE) Team

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    Abstract

    Background Influenza-like illness (ILI) definitions have been infrequently studied in young children. Despite this, clinical definitions of ILI play an important role in influenza surveillance. This study aims to identify clinical predictors of influenza infection in children =5 years old from which age-specific ILI definitions are then constructed.

    Methods Children aged 6–59 months with a history of fever and acute respiratory symptoms were recruited in the Western Australia Influenza Vaccine Effectiveness (WAIVE) Study. Clinical data and per-nasal specimens were obtained from all children. Logistic regression identified significant predictors of influenza infection. Different ILI definitions were compared for diagnostic accuracy.

    Results Children were recruited from 2 winter influenza seasons (2008–2009; n = 944). Of 919 eligible children, 179 (19.5%) had laboratory-confirmed influenza infection. Predictors of infection included increasing age, lack of influenza vaccination, lower birth weight, fever, cough, and absence of wheeze. An ILI definition comprising fever =38°C, cough, and no wheeze had 58% sensitivity (95% confidence interval [CI], 50–66), 60% specificity (95% CI, 56–64), 26% positive predictive value (95% CI, 21–31), and 86% negative predictive value (95% CI, 82–89). The addition of other symptoms or higher fever thresholds to ILI definition had little impact. The Centers for Disease Control and Prevention definition of ILI (presence of fever [=37.8°C] and cough and/or sore throat) was sensitive (92%; 95% CI, 86–95), yet lacked specificity (10%; 95% CI, 8–13) in this population.

    Conclusions Influenza-like illness is a poor predictor of laboratory-confirmed influenza infection in young children but can be improved using age-specific data. Incorporating age-specific ILI definitions and/or diagnostic testing into influenza surveillance systems will improve the accuracy of epidemiological data.
    Original languageEnglish
    Pages (from-to)21-29
    Number of pages9
    JournalJournal of the Pediatric Infectious Disease Society
    Volume2
    Issue number1
    Early online date3 Sep 2012
    DOIs
    Publication statusPublished - Mar 2013

    Fingerprint

    Human Influenza
    Confidence Intervals
    Fever
    Cough
    Infection
    Western Australia
    Pharyngitis
    Influenza Vaccines
    Centers for Disease Control and Prevention (U.S.)
    Nose
    Birth Weight
    Vaccination

    Keywords

    • Influenza, Human
    • Population Surveillance
    • Preschool children

    Cite this

    Conway, N. T., Wake, Z. V., Richmond, P. C., Smith, D. W., Keil, A. D., Williams, S., ... on Behalf of the Western Australia Influenza Vaccine Effectiveness (WAIVE) Team (2013). Clinical predictors of influenza in young children: the limitations of “influenza-like illness”. Journal of the Pediatric Infectious Disease Society, 2(1), 21-29. https://doi.org/10.1093/jpids/pis081
    Conway, Nicholas T. ; Wake, Zoe V. ; Richmond, Peter C. ; Smith, David W. ; Keil, Anthony D. ; Williams, Simon ; Kelly, Heath ; Carcione, Dale ; Effler, Paul V. ; Blyth, Christopher C. ; on Behalf of the Western Australia Influenza Vaccine Effectiveness (WAIVE) Team. / Clinical predictors of influenza in young children : the limitations of “influenza-like illness”. In: Journal of the Pediatric Infectious Disease Society. 2013 ; Vol. 2, No. 1. pp. 21-29.
    @article{fedce64be03f4aa0b86d25844c628d00,
    title = "Clinical predictors of influenza in young children: the limitations of “influenza-like illness”",
    abstract = "Background Influenza-like illness (ILI) definitions have been infrequently studied in young children. Despite this, clinical definitions of ILI play an important role in influenza surveillance. This study aims to identify clinical predictors of influenza infection in children =5 years old from which age-specific ILI definitions are then constructed.Methods Children aged 6–59 months with a history of fever and acute respiratory symptoms were recruited in the Western Australia Influenza Vaccine Effectiveness (WAIVE) Study. Clinical data and per-nasal specimens were obtained from all children. Logistic regression identified significant predictors of influenza infection. Different ILI definitions were compared for diagnostic accuracy.Results Children were recruited from 2 winter influenza seasons (2008–2009; n = 944). Of 919 eligible children, 179 (19.5{\%}) had laboratory-confirmed influenza infection. Predictors of infection included increasing age, lack of influenza vaccination, lower birth weight, fever, cough, and absence of wheeze. An ILI definition comprising fever =38°C, cough, and no wheeze had 58{\%} sensitivity (95{\%} confidence interval [CI], 50–66), 60{\%} specificity (95{\%} CI, 56–64), 26{\%} positive predictive value (95{\%} CI, 21–31), and 86{\%} negative predictive value (95{\%} CI, 82–89). The addition of other symptoms or higher fever thresholds to ILI definition had little impact. The Centers for Disease Control and Prevention definition of ILI (presence of fever [=37.8°C] and cough and/or sore throat) was sensitive (92{\%}; 95{\%} CI, 86–95), yet lacked specificity (10{\%}; 95{\%} CI, 8–13) in this population.Conclusions Influenza-like illness is a poor predictor of laboratory-confirmed influenza infection in young children but can be improved using age-specific data. Incorporating age-specific ILI definitions and/or diagnostic testing into influenza surveillance systems will improve the accuracy of epidemiological data.",
    keywords = "Influenza, Human , Population Surveillance, Preschool children",
    author = "Conway, {Nicholas T.} and Wake, {Zoe V.} and Richmond, {Peter C.} and Smith, {David W.} and Keil, {Anthony D.} and Simon Williams and Heath Kelly and Dale Carcione and Effler, {Paul V.} and Blyth, {Christopher C.} and {on Behalf of the Western Australia Influenza Vaccine Effectiveness (WAIVE) Team}",
    year = "2013",
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    language = "English",
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    Conway, NT, Wake, ZV, Richmond, PC, Smith, DW, Keil, AD, Williams, S, Kelly, H, Carcione, D, Effler, PV, Blyth, CC & on Behalf of the Western Australia Influenza Vaccine Effectiveness (WAIVE) Team 2013, 'Clinical predictors of influenza in young children: the limitations of “influenza-like illness”', Journal of the Pediatric Infectious Disease Society, vol. 2, no. 1, pp. 21-29. https://doi.org/10.1093/jpids/pis081

    Clinical predictors of influenza in young children : the limitations of “influenza-like illness”. / Conway, Nicholas T. (Lead / Corresponding author); Wake, Zoe V.; Richmond, Peter C.; Smith, David W.; Keil, Anthony D.; Williams, Simon; Kelly, Heath; Carcione, Dale; Effler, Paul V.; Blyth, Christopher C.; on Behalf of the Western Australia Influenza Vaccine Effectiveness (WAIVE) Team.

    In: Journal of the Pediatric Infectious Disease Society, Vol. 2, No. 1, 03.2013, p. 21-29.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Clinical predictors of influenza in young children

    T2 - the limitations of “influenza-like illness”

    AU - Conway, Nicholas T.

    AU - Wake, Zoe V.

    AU - Richmond, Peter C.

    AU - Smith, David W.

    AU - Keil, Anthony D.

    AU - Williams, Simon

    AU - Kelly, Heath

    AU - Carcione, Dale

    AU - Effler, Paul V.

    AU - Blyth, Christopher C.

    AU - on Behalf of the Western Australia Influenza Vaccine Effectiveness (WAIVE) Team

    PY - 2013/3

    Y1 - 2013/3

    N2 - Background Influenza-like illness (ILI) definitions have been infrequently studied in young children. Despite this, clinical definitions of ILI play an important role in influenza surveillance. This study aims to identify clinical predictors of influenza infection in children =5 years old from which age-specific ILI definitions are then constructed.Methods Children aged 6–59 months with a history of fever and acute respiratory symptoms were recruited in the Western Australia Influenza Vaccine Effectiveness (WAIVE) Study. Clinical data and per-nasal specimens were obtained from all children. Logistic regression identified significant predictors of influenza infection. Different ILI definitions were compared for diagnostic accuracy.Results Children were recruited from 2 winter influenza seasons (2008–2009; n = 944). Of 919 eligible children, 179 (19.5%) had laboratory-confirmed influenza infection. Predictors of infection included increasing age, lack of influenza vaccination, lower birth weight, fever, cough, and absence of wheeze. An ILI definition comprising fever =38°C, cough, and no wheeze had 58% sensitivity (95% confidence interval [CI], 50–66), 60% specificity (95% CI, 56–64), 26% positive predictive value (95% CI, 21–31), and 86% negative predictive value (95% CI, 82–89). The addition of other symptoms or higher fever thresholds to ILI definition had little impact. The Centers for Disease Control and Prevention definition of ILI (presence of fever [=37.8°C] and cough and/or sore throat) was sensitive (92%; 95% CI, 86–95), yet lacked specificity (10%; 95% CI, 8–13) in this population.Conclusions Influenza-like illness is a poor predictor of laboratory-confirmed influenza infection in young children but can be improved using age-specific data. Incorporating age-specific ILI definitions and/or diagnostic testing into influenza surveillance systems will improve the accuracy of epidemiological data.

    AB - Background Influenza-like illness (ILI) definitions have been infrequently studied in young children. Despite this, clinical definitions of ILI play an important role in influenza surveillance. This study aims to identify clinical predictors of influenza infection in children =5 years old from which age-specific ILI definitions are then constructed.Methods Children aged 6–59 months with a history of fever and acute respiratory symptoms were recruited in the Western Australia Influenza Vaccine Effectiveness (WAIVE) Study. Clinical data and per-nasal specimens were obtained from all children. Logistic regression identified significant predictors of influenza infection. Different ILI definitions were compared for diagnostic accuracy.Results Children were recruited from 2 winter influenza seasons (2008–2009; n = 944). Of 919 eligible children, 179 (19.5%) had laboratory-confirmed influenza infection. Predictors of infection included increasing age, lack of influenza vaccination, lower birth weight, fever, cough, and absence of wheeze. An ILI definition comprising fever =38°C, cough, and no wheeze had 58% sensitivity (95% confidence interval [CI], 50–66), 60% specificity (95% CI, 56–64), 26% positive predictive value (95% CI, 21–31), and 86% negative predictive value (95% CI, 82–89). The addition of other symptoms or higher fever thresholds to ILI definition had little impact. The Centers for Disease Control and Prevention definition of ILI (presence of fever [=37.8°C] and cough and/or sore throat) was sensitive (92%; 95% CI, 86–95), yet lacked specificity (10%; 95% CI, 8–13) in this population.Conclusions Influenza-like illness is a poor predictor of laboratory-confirmed influenza infection in young children but can be improved using age-specific data. Incorporating age-specific ILI definitions and/or diagnostic testing into influenza surveillance systems will improve the accuracy of epidemiological data.

    KW - Influenza, Human

    KW - Population Surveillance

    KW - Preschool children

    U2 - 10.1093/jpids/pis081

    DO - 10.1093/jpids/pis081

    M3 - Article

    VL - 2

    SP - 21

    EP - 29

    JO - Journal of the Pediatric Infectious Disease Society

    JF - Journal of the Pediatric Infectious Disease Society

    SN - 2048-7193

    IS - 1

    ER -