• Mary Iskander, Alison Kesson, Dominic Dwyer, Laura Rost, Margaret Pym, Han Wang, Mary McCaskill, and Robert Booy.
• National Centre for Immunisation Research and Surveillance, Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. maryi@chw.edu.au <maryi@chw.edu.au>
• J Paediatr Child Health. 2009 Dec 1;45(12):698-703.

ObjectiveActive surveillance to determine influenza disease burden in children admitted to hospital with influenza-like illness (ILI).MethodsA prospective hospital-based cohort study conducted June-October 2006 in children <5 years hospitalised at The Children's Hospital at Westmead with ILI (fever and respiratory symptoms). Influenza and other viral infections were diagnosed either by antigen detection using immunofluorescence or nucleic acid amplification testing of nasopharyngeal aspirates. Data were collected using researcher-administered questionnaires. Main outcome measures include proportion of hospitalisations with influenza, vaccination and treatment, risk factors for influenza and associated medical and social burdens.ResultsData on 275 children with ILI aged <5 years were analysed. Thirty-one (11%) children with ILI had influenza (22 had influenza A and 9 had influenza B). Thirty-five percent were under 6 months of age and 61% under 1 year. Twenty-nine percent of children with influenza A were born prematurely. The mean duration of hospital stay for influenza was 2.8 days (95% confidence interval 2.1-3.4) and 26% had a lumbar puncture. Although 68% received intravenous antibiotics, only 3% (one case) was given an antiviral. Eighty-four percent had visited their local doctor before admission and all came through the emergency department. On average, in one-third (32%) of families of children with influenza a parent developed, ILI during admission or soon after hospital discharge resulted in an average of 3.2 days of work absenteeism. Only 3.5% (7/199) of children older than 6 months with ILI received any influenza vaccination.ConclusionsBoth the burden of influenza in childhood morbidity and its social impact are substantial. There is considerable room for improvement in both the prevention and early recognition (trigger treatment with antivirals) of influenza. Our data will inform decisions regarding the value of a universal influenza vaccine programme.

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