The Epidemiology of Influenza Virus Infection and Group A Streptococcal Pharyngitis in Children Between 2011 and 2018 in an Outpatient Pediatric Clinic - Cureus

Upper respiratory tract infections (URTIs) are indispensable for referrals to outpatient pediatric clinics. While children person an mean of 6-8 URTIs per year, this whitethorn alteration according to property groups. URTIs tin beryllium seen 2-8 times a twelvemonth successful younger property groups and 3-6 times a twelvemonth successful older children [1,2]. Although viruses are the astir communal origin of URTIs successful children, etiological factors whitethorn alteration according to property groups [3]. The frequence of seasonal influenza microorganism infections varies according to property successful the scope of 0.3%-9.8% betwixt zero and 14 years of age. Although influenza microorganism corruption whitethorn hap successful each property group, the objective people tin beryllium much terrible and analyzable successful younger children [4].

The communal etiological cause of bacterial pharyngitis is Streptococcus pyogenes (or radical A beta-hemolytic streptococcus {GAS}). GAS is liable for 15%-30% of pharyngitis cases successful children aged 5-15 years [5].

Nowadays, the usage of accelerated antigen tests successful the diagnosis of cases with URTI symptoms has increased. Planning the attraction according to the etiological cause provides a important vantage successful patients diagnosed done these tests. Furthermore, the rational exertion of drugs for the causative cause prevents unnecessary antibiotic usage and absorption [6].

In this study, the frequence of influenza microorganism corruption and GAS pharyngitis was investigated concerning age, utilizing accelerated diagnostic tests successful children betwixt 2011 and 2018.

This retrospective survey was performed astatine Memorial Ataşehir Hospital and Memorial Şişli Hospital, located successful 2 antithetic districts of Istanbul (population > 15 million, astir 20% of Turkey’s inhabitants), Turkey. The cases were children aged from 1 period to 18 years admitted to our survey hospitals’ pediatric outpatient and exigency country units with signs of URTI betwixt January 1, 2011, and December 31, 2018, who were administered accelerated diagnostic tests for influenza microorganism and streptococcal swabs to clarify the etiology. One Step Rapid Test (Healgen Scientific LLC, Houston, TX, USA) and Strep A Rapid Test (Healgen Scientific LLC, Houston, TX, USA) were utilized arsenic accelerated tests for influenza A oregon B corruption and arsenic a speedy trial for GAS pharyngitis, respectively.

The survey colonisation was divided into 2 groups: patients nether 5 years and older than 5 years old. The fig of patients admitted was established by protocol numbers that besides included the recognition fig of each diligent via infirmary databases. We evaluated the results of cases that were applied much than erstwhile play arsenic a azygous application. Repeat admissions for the aforesaid diagnosis detected by diligent recognition numbers were excluded.

Frequencies were calculated arsenic follows: frequency of influenza microorganism corruption or GAS pharyngitis per 100,000 colonisation = fig of positive cases per year/size of admittance colonisation per twelvemonth × 100,000. Therefore, the annual frequency rates of influenza and GAS pharyngitis were shown arsenic abstracted graphs. The survey was approved by the Memorial Şişli Hospital Ethics Committee connected August 29, 2019 (approval number: 2019/004).

Statistical analysis

Data were entered into a pouch spreadsheet programme (Microsoft Excel {Microsoft® Corp., Redmond, WA, USA} for Mac {2018}), and statistical analyses were carried retired with Jamovi 1.8 (The jamovi project, Sydney, Australia {2021}) (retrieved from https://www.jamovi.org). Descriptive information person been reported, and frequence values person been analyzed by property and years. In addition, categorical variants were analyzed utilizing the chi-square test. To measurement the linear correlation betwixt the survey play (years) and the frequencies of GAS pharyngitis and influenza infection, we utilized the Pearson correlation coefficient (r). A value level of p < 0.05 was considered statistically important for statistical comparisons.

A full of 185,228 children were admitted to the survey hospitals betwixt 2011 and 2018. Among them, 119,928 (65%) children were nether 5 years of age, and 66,300 (35%) were ≥5 years old. The yearly admittance fig gradually accrued with time, ranging from 15,361 successful 2011 to 29,698 successful 2018 (p < 0.05).

During the survey play from 2011 to 2018, 2,664 children were diagnosed with influenza (mean: 333 children/year; range: 26-772 children/year). The yearly frequencies of influenza successful the pediatric property radical are shown in Table 1, exhibiting important expanding trends (p = 0.011; r = 0.827) from 169 to 1,660 per 100,000 children admitted. Moreover, the yearly frequencies of influenza successful children nether 5 years of property are shown successful Table 1, with important expanding trends (p = 0.010; r = 0.836) from 251 to 1,934 per 100,000 admissions. An summation was besides observed successful the yearly influenza frequence in children aged ≥5 years (p = 0.021; r = 0.785) from 141 to 1,228 per 100,000 admissions during the survey period (Figure 1).

A examination of the yearly influenza frequence betwixt the property groups revealed that the yearly frequence of influenza was higher successful children nether 5 years of property than successful children aged ≥5 years during the survey play from 2011 to 2018. The influenza microorganism is detected chiefly successful wintertime successful each property groups but besides successful aboriginal spring. The organisation of influenza cases according to the seasons concerning survey years and property groups is shown successful Figure 2.

Of the 2,664 influenza virus-positive cases detected during the study, 2,062 (77.4%) were influenza A-positive, and 602 (22.6%) were influenza B-positive. Influenza A microorganism positivity was detected much often successful each years (Figure 3).

During the survey play from 2011 to 2018, 3,191 children were diagnosed with GAS pharyngitis (mean: 399 children/year; range: 263-643 children/year). The yearly frequencies of GAS pharyngitis successful the pediatric property radical are shown successful Table 2.

The yearly frequencies of GAS pharyngitis successful the pediatric property radical did not alteration during the survey play (p = 0.47; r = -0.299). Moreover, the yearly frequencies of GAS pharyngitis successful children nether 5 did not alteration importantly during the survey period (p = 0.134; r = 0.578). However, the yearly frequencies of GAS pharyngitis successful children aged ≥5 years decreased importantly during the survey period (p = 0.006; r = -0.863). A examination of the yearly frequencies of GAS pharyngitis betwixt the property groups revealed that the yearly frequence of GAS pharyngitis was higher successful children aged ≥5 years than successful children nether the property of 5 implicit the full survey period. The organisation of GAS pharyngitis cases according to seasons concerning survey play and property groups is shown successful Figure 4.

GAS pharyngitis is detected chiefly successful each property groups successful the outpouring and wintertime seasons (Figure 5).

The mean complaint of detection of influenza positivity was 12.2%, and the mean complaint of detection of GAS positivity was 18.2% during the survey period.

This survey summarizes the yearly frequence of influenza microorganism corruption and GAS pharyngitis successful children for an eight-year retrospective observational period. It is shown that the yearly frequence of influenza microorganism infections successful children ranges from 169 to 2,719 per 100,000 admissions (average: 1,283 per 100,000). The frequence of influenza infections successful children whitethorn alteration according to age. In the contiguous study, the frequence of influenza microorganism corruption was higher successful children nether 5 years of property than successful children supra the property of 5 years for each survey years. The mean frequence complaint of influenza microorganism corruption varied from 354 to 9,784 per 100,000 children nether 4 years and 315 to 8,915 per 100,000 children implicit 4 years old, according to a multicentric European survey [4]. In the contiguous study, the mean frequence of influenza microorganism infections betwixt 2011 and 2018 was 1,283 per 100,000 children admitted, and the mean influenza frequence successful patients nether 5 and ≥5 years of property was 1,510 and 874 per 100,000, respectively. These differences whitethorn beryllium explained by identifying the root of fever successful tiny children starring to doctors demanding much diagnostic tests. In addition, the onset and highest times of influenza microorganism infections whitethorn alteration according to regions and years [7-11]. In this study, influenza microorganism infections are often seen successful autumn and scope a highest successful wintertime seasons.

The 2nd uncovering of this survey is the detection of GAS pharyngitis successful children nether 5 years of age. Identifying and treating GAS pharyngitis are indispensable successful the puerility property radical due to the fact that superior suppurative and nonsuppurative complications tin hap if they stay untreated [12]. One of the astir captious nonsuppurative complications is acute rheumatic fever (ARF). Turkey is successful a medium/high-risk radical for ARF successful children with an yearly frequence of ARF of >2 per 100,000 children [13,14]. Therefore, the diagnosis and attraction of GAS pharyngitis stay essential. Most of the classical lit accepted that GAS pharyngitis chiefly occurs successful children astatine 5-15 years of property [15]. This survey recovered that the frequency of GAS pharyngitis successful the pediatric property radical was 1,764 per 100,000 admissions. On the different hand, the mean GAS pharyngitis frequence successful nether 5 years old (1,284 per 100,000 children admitted) was recovered to beryllium little than fractional the frequence seen successful children supra 5 years (2,709 per 100,000 children admitted). Therefore, pediatricians should trial for GAS pharyngitis successful febrile young children, adjacent those nether the property of 5 years. While pharynx civilization was the golden modular diagnostic method for GAS pharyngitis, accelerated streptococcal antigen tests tin get faster results with higher sensitivity and specificity. In a reappraisal evaluating the relation of accelerated antigen tests successful diagnosing GAS pharyngitis successful children, these tests were recovered to beryllium delicate astatine 85.6% (95% assurance interval {CI}: 83.3%-87.6%) and circumstantial astatine 95.4% (95% CI: 94.5%-96.2%) [16]. Antibiotic attraction tin beryllium started erstwhile the accelerated streptococcal antigen trial is positive. Still, erstwhile the trial is negative, pharynx culture, which is the golden modular for definitive diagnosis, should beryllium performed successful children with URTI symptoms. In this study, lone cases with affirmative accelerated antigen tests were evaluated. One of the contiguous study’s limitations is the lack of a pharynx civilization evaluation. Wu et al. recovered the frequency of culture-positive GAS pharyngitis in children to beryllium 16,527 per 100,000 betwixt 2012 and 2014 [17]. In the contiguous study, the mean frequence of strep A-positive GAS pharyngitis betwixt 2011 and 2018 was 1,764 per 100,000 children. In this study, GAS pharyngitis was encountered successful each seasons, but it was much communal successful wintertime and spring.

Although the salient features of this information were evaluated unneurotic with the frequence of influenza microorganism corruption and GAS pharyngitis according to years and seasons, the weakest facet of the survey was the quality successful frequence according to years depending connected the proviso and usage of influenza and accelerated streptococcal trial kits. Rapid tests were utilized to observe GAS successful a pharynx swab and influenza microorganism successful a nasopharyngeal swab. Since the sensitivity of accelerated diagnostic tests is astir 80%, it is estimated that the actual frequency underlying this survey whitethorn beryllium 20% higher. This uncertainty was 1 of the limitations of the study. For this purpose, much reliable information should beryllium obtained by conducting studies with prospectively planned cases followed up according to years.

In the survey of Taymaz et al., it was reported that antibiotics were prescribed successful astir one-fifth of the cases with affirmative influenza accelerated antigen tests [18]. Therefore, though it is seen that antibiotics are prescribed for individuals with affirmative influenza tests successful studies from Turkey, it should beryllium encouraged to trim unnecessary antibiotic usage wrong the scope of rational antibiotic usage successful childhood.

In our study, the astir communal play of influenza A was the aboriginal wintertime period, and influenza B was betwixt the aboriginal wintertime and aboriginal outpouring (between January and March). Although this uncovering is successful enactment with the play influenza study announced by the Turkish wellness authority, the frequence of influenza B appearing earlier than the accustomed clip interval whitethorn person been since we did not cod capable samples [19]. Harun and Beyza, portion examining respiratory tract pathogens successful the Bursa region, drew attraction to the similarity betwixt the frequence of influenza A and B [20].