Influenza-associated outpatient visits among children less than 5 years of age in eastern China, 2011-2014.
The disease burden of influenza in China has not been well described, especially among young children. The aim of this study was to estimate the incidence of outpatient visits associated with influenza in young children in Suzhou, a city of more than 11 million residents in Jiangsu Province in eastern China.



Influenza-like illness (ILI) was defined as the presence of fever (axillary temperature ≥38 °C) and cough or sore throat. We collected throat swabs for children less than 5 years of age with ILI who visited Suzhou University Affiliated Children's Hospital (SCH) outpatient clinic or emergency room between April 2011 and March 2014. Suzhou CDC, a national influenza surveillance network laboratory, tested for influenza viruses by real-time reverse transcription-polymerase chain reaction assay (rRT-PCR). Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza by rRT-PCR. To calculate the incidence of influenza-associated outpatient visits, we conducted community-based healthcare utilization surveys to determine the proportion of hospital catchment area residents who sought care at SCH.



The estimated incidence of influenza-associated ILI outpatient visits among children aged <5 years in the catchment area of Suzhou was, per 100 population, 17.4 (95 % CI 11.0-25.3) during April 2011-March 2012, 14.6 (95 % CI 5.2-26.2) during April 2012-March 2013 and 21.4 (95 % CI: 10.9-33.5) during April 2013-March 2014. The age-specific outpatient visit rates of influenza-associated ILI were 4.9, 21.1 and 21.2 per 100 children aged 0- <6 months, 6- <24 months and 24- <60 months, respectively.



Influenza virus infection causes a substantial burden of outpatient visits among young children in Suzhou, China. Targeted influenza prevention and control strategies for young children in Suzhou are needed to reduce influenza-associated outpatient visits in this age group.
Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
Tao
T
Zhang
Suzhou Center for Disease Prevention and Control, Suzhou, China.
Jun
J
Zhang
Suzhou University Affiliated Children's Hospital, Suzhou, China.
Jun
J
Hua
Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
Dan
D
Wang
Suzhou Center for Disease Prevention and Control, Suzhou, China.
Liling
L
Chen
Suzhou University Affiliated Children's Hospital, Suzhou, China.
Yunfang
Y
Ding
Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
Shanshan
S
Zeng
Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
Jing
J
Wu
Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
Yanwei
Y
Jiang
Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
Qian
Q
Geng
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Suizan
S
Zhou
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Ying
Y
Song
Centers for Disease Control and Prevention, Atlanta, GA, USA.
A Danielle
AD
Iuliano
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Carolyn M
CM
Greene
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Jeffrey
J
McFarland
Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China. gmzhao@shmu.edu.cn.|Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China. gmzhao@shmu.edu.cn.|Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China. gmzhao@shmu.edu.cn.
Genming
G
Zhao
D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003371:Cough / Q000453:epidemiology* / Q000821:virology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000821:virology; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology*; D007753:Laboratories; D008297:Male; D009975:Orthomyxoviridae / Q000235:genetics; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D010612:Pharyngitis / Q000453:epidemiology* / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013048:Specimen Handling
Children; China; Influenza; Influenza-like illness; Outpatient visit