Influenza diagnosis and treatment in children: a review of studies on clinically useful tests and antiviral treatment for influenza.
BACKGROUND
Prompt testing for influenza can help guide clinical management of patients with suspected influenza. Three antiviral medications, amantadine, oseltamivir and zanamivir, are approved for treatment of influenza in children. Rimantadine and ribavirin have also been used.


OBJECTIVE
To review the published evidence on clinically useful diagnostic tests and antiviral treatment for influenza virus infections in children.


METHODS
Studies published from 1966 through September 2002 were reviewed on clinical diagnosis, immunofluorescence and rapid influenza tests and on antiviral treatment of influenza virus infections among pediatric populations.


RESULTS
No studies assessed the accuracy of clinical diagnosis of influenza in children compared with viral culture. Compared with viral culture, direct immunofluorescence antibody and indirect immunofluorescence antibody tests for influenza had fair to moderate median sensitivities and high median specificities, whereas rapid influenza diagnostic tests had moderate median sensitivities and moderately high median specificities. No randomized, placebo-controlled studies were found of amantadine or rimantadine for treatment of influenza A. In a few separate controlled studies, oseltamivir, zanamivir and ribavirin each reduced symptom duration of influenza compared with placebo.


CONCLUSIONS
Additional data are needed about the accuracy of clinical diagnosis of influenza in children. Although direct immunofluorescence antibody staining, indirect immunofluorescence antibody staining and rapid tests are moderately to reasonably accurate in detecting influenza virus infections in children, physicians should use clinical judgment and local surveillance data about circulating influenza viruses when interpreting test results. Further controlled studies of the efficacy, adverse effects and emergence of antiviral resistance during treatment of influenza are needed for all of the antiviral drugs.
Uyeki
Timothy M
TM
Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. tukeyi@cdc.gov
D000081:Acetamides / Q000627:therapeutic use; D000293:Adolescent; D017677:Age Distribution; D000547:Amantadine / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D005500:Follow-Up Studies; D006146:Guanidines; D006801:Humans; D015994:Incidence; D007223:Infant; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D009975:Orthomyxoviridae / Q000187:drug effects / Q000302:isolation & purification*; D053139:Oseltamivir; D011714:Pyrans; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012794:Sialic Acids / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D053243:Zanamivir
D000081:Acetamides; D000998:Antiviral Agents; D004279:DNA, Viral; D006146:Guanidines; D011714:Pyrans; D012794:Sialic Acids; D053139:Oseltamivir; D000547:Amantadine; D053243:Zanamivir