WFPICCS 2022: Have protective measures against Covid-19 influenced the transmission of influenza in neonatal and pediatric ICUs?

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At the last congress of World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS 2022), which took place online from July 12 to 16, researchers from Spain presented the study Influenza Virus Infection in children admitted to the Pediatric Intensive Care Unit, whose objective was to write the frequency, clinical evolution and complications of influenza in a Neonatal and Pediatric Intensive Care Unit (ICU) during five epidemic seasons. In general, the flu is benign, although it can cause serious complications on occasion.

WFPICCS 2022

Methodology

A retrospective observational study was performed, which included patients diagnosed with influenza admitted to the ICU between 2015 and 2022. The following data were collected: demographic variables, morbidity, virus serotype, treatments, mortality, and length of stay in the ICU.

Results

A total of 25 pediatric patients were admitted to the unit with a diagnosis of influenza. The median age of these patients was 2 years (interquartile range [IQR] 2 – 6.5) years. Fifty-two percent were male and 40% had associated morbidity.

Influenza A represented 80%, influenza B 12% and influenza A+B coinfection was equal to 8%. Bacterial coinfection was present in 20%, with the most common organisms being Streptococcus pneumoniae and Streptococcus pyogenes.

Complications such as sepsis/septic shock, bacterial pneumonia, pleural effusion, myocarditis, supraventricular tachycardia, and seizures occurred in 80% of cases; 64% received antibiotic therapy and 40% oseltamivir. The use of non-invasive mechanical ventilation (NIV) was required in 48%. Invasive mechanical ventilation (IMV) was performed in 28% and 20% received inotropic vasopressor drugs.

During the Covid-19 pandemic, there were no hospitalizations for influenza in the 2020-2021 season, with the first hospitalization taking place in March 2022. 24 influenza-free months were observed. During the study period, the mean ICU stay was two days. [IQR 2 – 6,5]. Three children died (12%).

conclusions

The researchers observed a high rate of complications and mortality, particularly during the last pre-pandemic Covid-19 season. Since then, they have reported that they have had only one mild case admitted. Thus, they believe that preventive measures against the SARS-CoV-2 virus probably contributed to reducing the transmission of influenza.

Comment

Despite being retrospective and carried out in only one center, this study shows us how serious an influenza condition can be, reinforcing the need for health professionals to educate the population on the importance of vaccination in the pediatric age group.

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