Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesi’nde 2016-2017 ve 2017-2018 Mevsimsel İnfluenza Sezonunda İnfluenza Enfeksiyonuyla İlişkili Olabilecek Semptomlarla Hastaneye Yatmış ve Nazofarengeal Sürüntü Örneğinde İnfluenza Virüsü Tespit Edilmiş Çocuk Hastaların Klinik ve Epidemiyolojik Özelliklerinin ve Hastalığın Aileye Sosyal Yükünün Değerlendirilmesi

Abstract

Influenza (also known as “flu”) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. It is estimated that influenza is associated with 10% of hospitalizations due to respiratory ilness under the age of 18, with approximately 870 000 children under the age of 5 hospitalized for influenza each year, and influenza-related hospitalization rates are estimated to be 3 times higher in developing countries than in industrialized countries. In this study, we aimed to investigate the clinical and virological findings, epidemiological characteristics, risk factors for severe illness, treatment approaches hospitalized and laboratory confirmed influenza cases in Hacettepe University İhsan Doğramacı Children's Hospital in 2016-2017 and 2017-2018 influenza season. In addition to the well-known medical complications of the disease, it was aimed to reveal the financial and social burdens that are not sufficiently known in our country, especially in childhood, so parental workplace absenteeism and school absenteeism also questioned. A total of 72 patients aged between 1 month and 18 years were included in the study. There were 29 patients under 2 years of age and 49 patients under 5 years of age, and the majority of patients were under 2 years of age. Fifty-two of 72 patients (72.2%) had comorbid diseases. The most common chronic disease group with influenza was chronic lung disease (18.1%). Only 4 (5.6%) of the patients were vaccinated. Only 10 patients (13.9%) had received oseltamivir treatment before hospitalization. Only 6 (9.5%) of 63 patients who were antiviral treatment indicated had received antiviral before hospitalization. Fifty-six patients (77.8%) received antiviral treatment during hospitalization. Of the 56 patients who were started on antiviral, 30 (53.6%) patients received oseltamivir on the day of admission, and 26 patients (46.4%) received oseltamivir treatment on the second and subsequent days of hospitalization. It was seen that the duration of hospitalization was shorter in those who started oseltamivir in the first 24 hours of hospitalization than those who were started later (p = 0.048). Twenty-eight (38.9%) of the patients had İnfluenza A, 14 (19.4%) had İnfluenza B, 30 (41.7%) had more than one viral nucleic acid positivity. Patients with multiple viral nucleic acids were more likely to develop respiratory complications than those with influenza alone (p = 0.031). When the distribution of the patients with influenza was observed according to months, it was seen that the most hospitalization was in December and January in both 2016-2017 and 2017-2018 seasons. All patients had a history of fever or fever. Cough was the most common symptom after fever in patients older than 5 years. Sixty-seven (93.1%) of the patients in the study group had complications that could be associated with influenza. The most common complication was pneumonia. Sixty percent of our patients over the age of 5 (n = 23) were going to school. The mean duration of absenteeism was 9.0 days. Eight (88.9%) of 9 working mothers had to take leave from work due to this disease. 97.1% of the fathers of the patients were working. Out of 68 working fathers, 38 (55.9%) had to take leave from work. When only actively working mothers were taken into account, the average workday loss was 6.6 days and the average cost of labor loss was 1866 TL. The average workday loss of the fathers was 3.3 days and the average cost of the labor loss was 529 TL. When we look at the cost of hospitalization in the study group, the average value was calculated as 4825 TL and the avarage value of total cost was calculated as 5662 TL. Total cost was over 2000 TL in 48.6% of our patients. In the study group, hospitalization of the patients in the intensive care unit was determined as a factor that increased the cost and was statistically significant (p = 0.001). The need for mechanical ventilators was determined as the factor that increased the cost (p = 0.002). The presence of cardiac complications or sepsis / multiple organ failure (MOF) increased the cost and was statistically significant (p = 0.002, p = 0.013). As a result, influenza has significant social and economic burdens as well as medical burdens and further studies are needed especially in our country.