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Inicio Enfermedades Infecciosas y Microbiología Clínica Considerations on antiviral treatment of suspected influenza infections in hospi...
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Vol. 34. Núm. 10.
Páginas 686-687 (Diciembre 2016)
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Vol. 34. Núm. 10.
Páginas 686-687 (Diciembre 2016)
Scientific letter
DOI: 10.1016/j.eimc.2016.02.005
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Considerations on antiviral treatment of suspected influenza infections in hospitalised children
Consideraciones acerca del tratramiento de las sospechas de gripe en niños hospitalizados
Cristina Calvoa,
Autor para correspondencia

Corresponding author.
, María Luz García-Garcíaa, Francisco Pozob, Inmaculada Casasb
a Pediatrics Department, Severo Ochoa Hospital, Leganés, Madrid, Spain
b Respiratory Virus and Influenza Unit, National Microbiology Center (ISCIII), Madrid, Spain
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Tablas (1)
Table 1. Viruses detected by polymerase chain reaction in hospitalized children in the flu epidemic weeks.
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Dear Editor,

NICE guidance in 2009 recommended oseltamivir treatment to all hospitalized children with suspected flu in the epidemic weeks, based on the possibility of influenza infection in children with compatible symptoms, is about 58%.1 Recognizing that this may be overestimating the rate of influenza, they recommend further research into the probability that an influenza-like illness is true influenza. Since then, the recommendations have remained virtually unchanged.2 The American Academy of Pediatrics (AAP) has also, this year, recommended treatment for all hospitalized children.3 Rapid detection influenza tests have moderate sensitivity (50–70%). Therefore, antiviral treatment has been recommended even in cases with negative laboratory results. Oseltamivir has demonstrated to reduce the duration of symptoms, especially if it is administrated in the first 48h of the illness with mild or inexistent side effects. Its role to prevent complications is not enough proven. Summarizing, emergence of antiviral resistance is an important clinical and public health concern.4

In the Pediatric Department at the Severo-Ochoa Hospital in Spain, we conducted a prospective study of viral etiology of respiratory infection during seven consecutive seasons. Between December and February each season (12 weeks that included the epidemic peak), all children under 14 years hospitalized with criteria of suspected flu (febrile syndrome, upper or lower respiratory tract infection, bronchiolitis, wheezing episodes or pneumonia), were included in the study. In the 2009–10 season, patients were recruited from September to December, coinciding with the H1N1 pandemic. A total of 1612 cases were analyzed. Polymerase chain reaction for 17 respiratory viruses in nasopharyngeal aspirate was performed in the Respiratory Virus and Influenza Unit at the National Microbiology Center (ISCIII, Madrid, Spain).

Influenza viruses were detected in the 5.6–12% of cases, depending on the season, with the highest incidence corresponding to the H1N1 pandemic season (Fig. 1). The proportion of different viruses detected is shown in Table 1, being respiratory syncytial virus the most frequent. Following the current recommendations, 1477 children without influenza virus confirmed by laboratory, would had been treated with oseltamivir.

Fig. 1.

Influenza cases during the 12 weeks of highest incidence of flu, in hospitalized children.

Table 1.

Viruses detected by polymerase chain reaction in hospitalized children in the flu epidemic weeks.

  Number of identified virus (%)
  2008–09  2009  2010–11  2011–12  2012–13  2013–14  2014–15 
Months  D–F  S–D  D–F  D–F  D–F  D–F  D–F 
Patients  229  341  314  248  206  117  157 
RSV  121  102  99  121  87  68  89 
Rhinovirus  64  118  63  56  61  27  44 
Human bocavirus  24  41  45  33  16 
Adenovirus  17  28  43  16  17  19 
Parainfluenza (1, 2, 3, 4)  15  40 
Human metapneumovirus 
Influenza (A, B, C)  28  38  24  14  14  10 
Coronavirus  12 
Negative  34  69  98  51  49  18  29 

RSV: respiratory syncytial virus, D: December, F: February, S: September.

The number of total virus is superior to patients because the presence of co-infections.

As other authors, we think that the greater value of using oseltamivir is to ensure it remains an effective defense against future seasonal and pandemic influenza viruses. Careful monitoring of levels of viral resistance in the circulating viruses combined with the further development of new anti-influenza drugs might be the best way for control.5 Based on our personal experience, we recommend making an effort to improve diagnosis in children with suspected influenza, performing molecular techniques or a rapid diagnostic test with high sensitivity,6 especially in children with risk factors and children requiring hospitalization. This may help to guide treatment with oseltamivir to patients who really need it.

Amantadine, oseltamivir and zanamivir for the treatment of influenza. NICE technology appraisal guidance [TA168].
PHE guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza (2015–16) Version 6.0.
Committee on Infectious Diseases.
Recommendations for prevention and control of influenza in children, 2015–2016.
Pediatrics, 136 (2015), pp. 792-808
T.C. Li, M.C. Chan, N. Lee.
Clinical implications of antiviral resistance in influenza.
Viruses, 7 (2015), pp. 4929-4944
A.C. Hurt, J.K. Holien, M.W. Parker, I.G. Barr.
Oseltamivir resistance and the H274Y neuraminidase mutation in seasonal, pandemic and highly pathogenic influenza viruses.
C.K. Lee, C.H. Cho, M.K. Woo, A.E. Nyeck, C.S. Lim, W.J. Kim.
Evaluation of Sofia fluorescent immunoassay analyzer for influenza A/B virus.
J Clin Virol, 55 (2012), pp. 239-243

This study has been partially supported by FIS (Fondo de Investigaciones Sanitarias – Spanish Health Research Fund) Grants N°: PI06/0532, PI09/00246, and PI12/01291.

Copyright © 2016. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
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