The Spectrum and Burden of Influenza-Associated Neurological Disease in Children

Combined Encephalitis and Influenza Sentinel Site Surveillance from Australia, 2013-2015

Philip N Britton, Christopher C. Blyth, Kristine Macartney, Russell C Dale, Jean Li-Kim-Moy, Gulam Khandaker, Nigel W. Crawford, Helen Marshall, Julia E. Clark, Elizabeth J Elliott, Robert Booy, Allen C. Cheng, Cheryl A Jones, Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network

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19 Citations (Scopus)

Abstract

Background There are few longitudinal studies of seasonal influenza-associated neurological disease (IAND) and none from the Southern Hemisphere. Methods We extracted prospectively acquired Australian surveillance data from 2 studies nested within the Paediatric Active Enhanced Disease Surveillance (PAEDS) network: the Influenza Complications Alert Network (FluCAN) study and the Australian Childhood Encephalitis (ACE) study between 2013 and 2015. We described the clinical features and severity of IAND in children, including influenza-associated encephalitis/encephalopathy (IAE). We calculated the proportion of hospitalized influenza that is associated with IAND and IAE, and incidence of IAE. Results Over 3 influenza seasons, we identified 54 cases of IAND at 2 tertiary children's hospitals from Australia that accounted for 7.6% of hospitalized influenza. These included 10 cases of IAE (1.4% hospitalized influenza). The mean annual incidence of IAE among Australian children (aged ≤14 years) was 2.8 per 1000000. The spectrum of IAND was broad and included IAE (n = 10) including distinct acute encephalopathy syndromes, simple febrile seizures (n = 14), other seizures (n = 16), acute ataxia (n = 4), and other subacute syndromes (transverse myelitis [n = 1], opsoclonus myoclonus [n = 1]). Two-thirds of children with IAND were aged ≤4 years; less than half had preexisting neurological disease or other risk factors for severe influenza. IAE caused death or neurological morbidity in half of cases. Conclusions Seasonal influenza is an important cause of acute neurological disease in Australian children. The spectrum of seasonal IAND appears similar to that described during the 2009 H1N1 pandemic. IAE is associated with high morbidity and mortality.

Original languageEnglish
Pages (from-to)653-660
Number of pages8
JournalClinical Infectious Diseases
Volume65
Issue number4
DOIs
Publication statusPublished - 15 Aug 2017

Keywords

  • encephalitis
  • encephalopathy
  • influenza
  • seizures
  • surveillance

Cite this

Britton, P. N., Blyth, C. C., Macartney, K., Dale, R. C., Li-Kim-Moy, J., Khandaker, G., ... Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network (2017). The Spectrum and Burden of Influenza-Associated Neurological Disease in Children: Combined Encephalitis and Influenza Sentinel Site Surveillance from Australia, 2013-2015. Clinical Infectious Diseases, 65(4), 653-660. https://doi.org/10.1093/cid/cix412
Britton, Philip N ; Blyth, Christopher C. ; Macartney, Kristine ; Dale, Russell C ; Li-Kim-Moy, Jean ; Khandaker, Gulam ; Crawford, Nigel W. ; Marshall, Helen ; Clark, Julia E. ; Elliott, Elizabeth J ; Booy, Robert ; Cheng, Allen C. ; Jones, Cheryl A ; Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network. / The Spectrum and Burden of Influenza-Associated Neurological Disease in Children : Combined Encephalitis and Influenza Sentinel Site Surveillance from Australia, 2013-2015. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 4. pp. 653-660.
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title = "The Spectrum and Burden of Influenza-Associated Neurological Disease in Children: Combined Encephalitis and Influenza Sentinel Site Surveillance from Australia, 2013-2015",
abstract = "Background There are few longitudinal studies of seasonal influenza-associated neurological disease (IAND) and none from the Southern Hemisphere. Methods We extracted prospectively acquired Australian surveillance data from 2 studies nested within the Paediatric Active Enhanced Disease Surveillance (PAEDS) network: the Influenza Complications Alert Network (FluCAN) study and the Australian Childhood Encephalitis (ACE) study between 2013 and 2015. We described the clinical features and severity of IAND in children, including influenza-associated encephalitis/encephalopathy (IAE). We calculated the proportion of hospitalized influenza that is associated with IAND and IAE, and incidence of IAE. Results Over 3 influenza seasons, we identified 54 cases of IAND at 2 tertiary children's hospitals from Australia that accounted for 7.6{\%} of hospitalized influenza. These included 10 cases of IAE (1.4{\%} hospitalized influenza). The mean annual incidence of IAE among Australian children (aged ≤14 years) was 2.8 per 1000000. The spectrum of IAND was broad and included IAE (n = 10) including distinct acute encephalopathy syndromes, simple febrile seizures (n = 14), other seizures (n = 16), acute ataxia (n = 4), and other subacute syndromes (transverse myelitis [n = 1], opsoclonus myoclonus [n = 1]). Two-thirds of children with IAND were aged ≤4 years; less than half had preexisting neurological disease or other risk factors for severe influenza. IAE caused death or neurological morbidity in half of cases. Conclusions Seasonal influenza is an important cause of acute neurological disease in Australian children. The spectrum of seasonal IAND appears similar to that described during the 2009 H1N1 pandemic. IAE is associated with high morbidity and mortality.",
keywords = "encephalitis, encephalopathy, influenza, seizures, surveillance",
author = "Britton, {Philip N} and Blyth, {Christopher C.} and Kristine Macartney and Dale, {Russell C} and Jean Li-Kim-Moy and Gulam Khandaker and Crawford, {Nigel W.} and Helen Marshall and Clark, {Julia E.} and Elliott, {Elizabeth J} and Robert Booy and Cheng, {Allen C.} and Jones, {Cheryl A} and {Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network}",
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Britton, PN, Blyth, CC, Macartney, K, Dale, RC, Li-Kim-Moy, J, Khandaker, G, Crawford, NW, Marshall, H, Clark, JE, Elliott, EJ, Booy, R, Cheng, AC, Jones, CA & Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network 2017, 'The Spectrum and Burden of Influenza-Associated Neurological Disease in Children: Combined Encephalitis and Influenza Sentinel Site Surveillance from Australia, 2013-2015', Clinical Infectious Diseases, vol. 65, no. 4, pp. 653-660. https://doi.org/10.1093/cid/cix412

The Spectrum and Burden of Influenza-Associated Neurological Disease in Children : Combined Encephalitis and Influenza Sentinel Site Surveillance from Australia, 2013-2015. / Britton, Philip N; Blyth, Christopher C.; Macartney, Kristine; Dale, Russell C; Li-Kim-Moy, Jean; Khandaker, Gulam; Crawford, Nigel W.; Marshall, Helen; Clark, Julia E.; Elliott, Elizabeth J; Booy, Robert; Cheng, Allen C.; Jones, Cheryl A; Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network.

In: Clinical Infectious Diseases, Vol. 65, No. 4, 15.08.2017, p. 653-660.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The Spectrum and Burden of Influenza-Associated Neurological Disease in Children

T2 - Combined Encephalitis and Influenza Sentinel Site Surveillance from Australia, 2013-2015

AU - Britton, Philip N

AU - Blyth, Christopher C.

AU - Macartney, Kristine

AU - Dale, Russell C

AU - Li-Kim-Moy, Jean

AU - Khandaker, Gulam

AU - Crawford, Nigel W.

AU - Marshall, Helen

AU - Clark, Julia E.

AU - Elliott, Elizabeth J

AU - Booy, Robert

AU - Cheng, Allen C.

AU - Jones, Cheryl A

AU - Australian Childhood Encephalitis (ACE) Study Investigators, Influenza Complications Alert Network (FluCAN) Investigators, and Paediatric Active Enhanced Disease Surveillance (PAEDS) Network

PY - 2017/8/15

Y1 - 2017/8/15

N2 - Background There are few longitudinal studies of seasonal influenza-associated neurological disease (IAND) and none from the Southern Hemisphere. Methods We extracted prospectively acquired Australian surveillance data from 2 studies nested within the Paediatric Active Enhanced Disease Surveillance (PAEDS) network: the Influenza Complications Alert Network (FluCAN) study and the Australian Childhood Encephalitis (ACE) study between 2013 and 2015. We described the clinical features and severity of IAND in children, including influenza-associated encephalitis/encephalopathy (IAE). We calculated the proportion of hospitalized influenza that is associated with IAND and IAE, and incidence of IAE. Results Over 3 influenza seasons, we identified 54 cases of IAND at 2 tertiary children's hospitals from Australia that accounted for 7.6% of hospitalized influenza. These included 10 cases of IAE (1.4% hospitalized influenza). The mean annual incidence of IAE among Australian children (aged ≤14 years) was 2.8 per 1000000. The spectrum of IAND was broad and included IAE (n = 10) including distinct acute encephalopathy syndromes, simple febrile seizures (n = 14), other seizures (n = 16), acute ataxia (n = 4), and other subacute syndromes (transverse myelitis [n = 1], opsoclonus myoclonus [n = 1]). Two-thirds of children with IAND were aged ≤4 years; less than half had preexisting neurological disease or other risk factors for severe influenza. IAE caused death or neurological morbidity in half of cases. Conclusions Seasonal influenza is an important cause of acute neurological disease in Australian children. The spectrum of seasonal IAND appears similar to that described during the 2009 H1N1 pandemic. IAE is associated with high morbidity and mortality.

AB - Background There are few longitudinal studies of seasonal influenza-associated neurological disease (IAND) and none from the Southern Hemisphere. Methods We extracted prospectively acquired Australian surveillance data from 2 studies nested within the Paediatric Active Enhanced Disease Surveillance (PAEDS) network: the Influenza Complications Alert Network (FluCAN) study and the Australian Childhood Encephalitis (ACE) study between 2013 and 2015. We described the clinical features and severity of IAND in children, including influenza-associated encephalitis/encephalopathy (IAE). We calculated the proportion of hospitalized influenza that is associated with IAND and IAE, and incidence of IAE. Results Over 3 influenza seasons, we identified 54 cases of IAND at 2 tertiary children's hospitals from Australia that accounted for 7.6% of hospitalized influenza. These included 10 cases of IAE (1.4% hospitalized influenza). The mean annual incidence of IAE among Australian children (aged ≤14 years) was 2.8 per 1000000. The spectrum of IAND was broad and included IAE (n = 10) including distinct acute encephalopathy syndromes, simple febrile seizures (n = 14), other seizures (n = 16), acute ataxia (n = 4), and other subacute syndromes (transverse myelitis [n = 1], opsoclonus myoclonus [n = 1]). Two-thirds of children with IAND were aged ≤4 years; less than half had preexisting neurological disease or other risk factors for severe influenza. IAE caused death or neurological morbidity in half of cases. Conclusions Seasonal influenza is an important cause of acute neurological disease in Australian children. The spectrum of seasonal IAND appears similar to that described during the 2009 H1N1 pandemic. IAE is associated with high morbidity and mortality.

KW - encephalitis

KW - encephalopathy

KW - influenza

KW - seizures

KW - surveillance

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U2 - 10.1093/cid/cix412

DO - 10.1093/cid/cix412

M3 - Article

VL - 65

SP - 653

EP - 660

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 4

ER -