title: Towards a personalised approach to managing influenza infections in infants and children - food for thought and a note on oseltamivir.
abstract: Acute respiratory infections represent common diseases in childhood and a challenge to infection control, public heath, and the clinical management of patients and their families. Children are avid spreaders of respiratory viruses, and seasonal outbreaks of influenza create additional disease burden and healthcare cost. Infants under the age of two and children with chronic conditions are at high risk. The absence of pre-defined risk factors however, does not protect from serious disease. Immunisation rates remain low, and physical interventions are of limited value in young children. Children with influenza may be contagious prior to the onset of symptoms, and school closures have been shown to have a temporary effect at most. The timely detection of influenza in at-risk patients is important to prevent hospital-based transmission and influenza-associated morbidity and mortality. Guidelines issued by professional associations and public health agencies need to be translated into everyday clinical practice. Antiviral therapy should be initiated early and monitored closely, including virologic and clinical outcomes. The duration of treatment and the decision to readmit children to schools and kindergartens should be adjusted to the individual child patient using evidence-based clinical and virologic criteria. This article presents lessons learnt from a quality management program for infants and children with influenza-like illness at the Charite Department of Paediatrics in collaboration with the National Reference Centre for Influenza at the Robert Koch Institute, in Berlin, Germany. The Charité Influenza-Like Disease (ChILD) Cohort was established during the 2009 influenza pandemic and encompasses nearly 4000 disease episodes to date.
authors.affiliation: Department of Pediatrics, Division of Pneumonology-Immunology, Charité University Medical Center, Augustenburger Platz 1, 13353 Berlin, Germany.Barbara.Rath@gmail.com.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rath
authors.forename: Franziska
authors.initials: F
authors.lastname: Tief
authors.forename: Katharina
authors.initials: K
authors.lastname: Karsch
authors.forename: Susann
authors.initials: S
authors.lastname: Muehlhans
authors.forename: Patrick
authors.initials: P
authors.lastname: Obermeier
authors.forename: Eleni
authors.initials: E
authors.lastname: Adamou
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.forename: Lea
authors.initials: L
authors.lastname: Seeber
authors.forename: Christian
authors.initials: C
authors.lastname: Peiser
authors.forename: Christian
authors.initials: C
authors.lastname: Hoppe
authors.forename: Max
authors.initials: M
authors.lastname: von Kleist
authors.forename: Tim
authors.initials: T
authors.lastname: Conrad
authors.forename: Brunhilde
authors.initials: B
authors.lastname: Schweiger
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D060085:Coinfection / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control / Q000821:virology; D024882:Drug Resistance, Viral; D042241:Early Diagnosis; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009980:Influenza A virus / Q000187:drug effects* / Q000201:enzymology / Q000254:growth & development / Q000302:isolation & purification; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D009439:Neuraminidase / Q000037:antagonists & inhibitors; D053139:Oseltamivir / Q000494:pharmacology / Q000627:therapeutic use; D010356:Patient Isolation; D057285:Precision Medicine; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control / Q000821:virology; D014764:Viral Proteins / Q000037:antagonists & inhibitors
chemical_list: D000998:Antiviral Agents; D004791:Enzyme Inhibitors; D014764:Viral Proteins; D053139:Oseltamivir; C487630:NA protein, influenza A virus; D009439:Neuraminidase