苏州市2011-2017年5岁以下儿童流感门诊病例临床特征及疾病负担

Clinical characteristics and economic burden of influenza among children under 5 years old, in Suzhou, 2011-2017

目的 了解2011-2017年苏州大学附属儿童医院〈5岁儿童流感样病例（ILI）临床特征及疾病负担。方法 2011年3月至2017年2月于苏州市儿童医院监测因流感样疾病就诊的〈5岁门诊病例，通过问卷调查和电话随访收集人口学信息、临床信息、疾病史及与医疗有关的直接和间接费用，比较ILI及不同流感亚型确诊病例的临床特征和社会经济负担。结果 共纳入6 310例，其中791例（12.9%）流感病毒检测阳性，其中A/H1N1阳性88例（11.1%），A/H3N2阳性288例（36.4%），B型415例（52.5%）。流感阳性儿童发生咳嗽、流涕、喘息、呕吐、抽搐的比例皆高；A/H1N1、A/H3N2、B型感染导致临床特征的主要差异为咳嗽（χ2=9.227，P=0.010）、喘息（χ2=7.273，P=0.026）和呕吐（χ2=8.163，P=0.017）。流感病毒阴性者治疗平均费用688.4（95%CI：630.1-746.7）元，流感病毒阳性者为768.0（95%CI：686.8-849.3）元。A/H1N1阳性者治疗总费用明显高于A/H3N2阳性和B型阳性者（χ2=7.237，P=0.028）。结论 儿童感染流感病毒更易发生咳嗽、流涕、喘息、呕吐、抽搐等临床症状，并造成严重的疾病负担，其中A/H1N1亚型感染造成的疾病负担高于其他2种亚型。

Objective To understand the clinical characteristics and economic burden of influenza-like illness （ILI） children aged 0-59 months in the outpatient settings in Suzhou, China, 2011-2017.Methods From March 2011 to February 2017, we conducted a prospective surveillance program on ILI for children aged less than 5 years at Soochow University Affiliated Children＇s Hospital. Through standard questionnaires and follow-up survey via telephone, we collected information regarding the demographic characteristics, medical history, clinical symptoms and both direct and indirect costs associated with influenza, of the patients. We then compared clinical characteristics and economic burden of influenza A/H1N1, A/H3N2, and B infections among children with ILI.Results We enrolled 6 310 patients with ILI from March 2011 to February 2017 and collected all their throat swabs. 791 （12.9%） of the swabs showed positive for influenza virus, including 88 （11.1%） subtype influenza A/H1N1, 288 （36.4%） subtype influenza A/H3N2, and 415 （52.5%） type influenza B. The proportions of cough, rhinorrhea, wheezing, vomiting and convulsion in influenza-positive children were higher than those influenza-negative children. Except for the prevalence rates of cough （χ2=9.227, P=0.010）, wheezing （χ2=7.273, P=0.026） and vomiting （χ2=8.163, P=0.017）, other clinical symptoms appeared similar between the three viral subtypes. Among all the ILI children, the average total cost per episode of influenza was 688.4 Yuan （95% CI：630.1-746.7） for influenza-negative children; 768.0 Yuan （95% CI：686.8-849.3） for influenza-positive children and 738.3 Yuan （95% CI：655.5-821.1） for influenza B. Children with influenza A/H1N1 spent much more than those with influenza A/H3N2 or influenza B in the total cost （χ2=7.237, P=0.028）.Conclusion Children infected influenza showed higher prevalence rates of cough, rhinorrhea, wheezing, vomiting and convulsion than those without influenza. Influenza A/H1N1 subtype caused heavier economic burden than the other two influenza subtypes.