The Clinical Characteristics of Influenza B Infection during the 2011-2012 Influenza Season

2011-2012절기 B형 인플루엔자 감염의 임상 양상

  • Kim, Min Sun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Sung, Hyun Woo (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Bae, E Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Han, Seung Beom (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Dae Chul (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kang, Jin Han (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 김민선 (가톨릭대학교 의과대학 소아과학교실) ;
  • 성현우 (가톨릭대학교 의과대학 소아과학교실) ;
  • 배이영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 한승범 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정대철 (가톨릭대학교 의과대학 소아과학교실) ;
  • 강진한 (가톨릭대학교 의과대학 소아과학교실)
  • Received : 2012.12.04
  • Accepted : 2013.01.26
  • Published : 2013.08.25

Abstract

Purpose: This retrospective study was performed to identify the clinical characteristics of influenza B infection and compare to influenza A infection. Methods: Medical records of patients diagnosed with influenza using a multiplex PCR test, admitted to Seoul St. Mary's Hospital, during the 2011-2012 influenza season were analyzed. Clinical and laboratory characteristics of influenza B patients were investigated and compared with those of influenza A patients. Results: A total of 145 influenza patients were enrolled during this study period. Among these, 66 and 78 patients were diagnosed with influenza A and B, respectively, and 1 patient was diagnosed with co-existing influenza A and B. Cough (88.2%), rhinorrhea (77.1%) and sputum (60.4%) were the most common symptoms among these influenza patients, and most were diagnosed with upper respiratory infection (31.9%) or lower respiratory infection (49.3%). In comparison to influenza A patients, influenza B patients were older ($4.7{\pm}4.1$ years vs. $3.3{\pm}2.5$ years, P=0.016), and the number of fever days before hospitalization were longer (3.0 days vs. 2.5 days, P=0.043). While sore throat (10.3% vs. 1.5%, P=0.039) and vomiting (20.5% vs. 6.1%, P=0.012) were more common in influenza B patients than in influenza A patients, other clinical and laboratory characteristics were not significantly different between the two groups. Conclusions: No significant differences in clinical and laboratory perspectives were manifested in influenza A and B infections. Preventive measures should be emphasized over treatment in influenza B due to prolonged fever duration before admission.

목 적 : 국내 B형 인플루엔자의 임상 양상 및 A형 인플루엔자와 비교를 위해 후향적 연구를 시행하였다. 방 법 : 2011-2012 인플루엔자절기에 multiplex PCR로 인플루엔자가 진단된 소아청소년 입원 환자들의 의무 기록 분석으로 B형 인플루엔자의 임상 양상과 함께 같은 기간 A형 인플루엔자와의 차이점을 조사하였다. 결 과 : 연구 기간 동안 진단 된 145명 인플루엔자 환자 중, A형 인플루엔자 66명, B형 인플루엔자 78명이 있었고, 1명은 A, B형 인플루엔자가 동시에 진단되었다. 이들은 기침(88.2%), 콧물(77.1%), 가래(60.4%) 등 호흡기 증상을 호소하며, 하기도 감염(49.3%) 및 상기도 감염(31.9%)으로 진단된 경우가 많았다. B형과 A형 인플루엔자 환자의 주요 증상 및 검사실 소견은 차이가 없었고, A형에 비해 B형 인플루엔자 환자의 입원 전 발열기간이 길었다(3.0일 vs. 2.5일, P=0.043). 결 론 : 임상 양상만으로 B형과 A형 인플루엔자 감별은 제한성이 있고, B형 인플루엔자 환자의 입원 전 발열 기간 3일을 고려한다면 진단 후 치료보다 감염 전 예방이 중요하다.

Keywords

References

  1. Neuzil KM, Mellen BG, Wright PF, Mitchel EF, Jr., Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med 2000;342:225-31. https://doi.org/10.1056/NEJM200001273420401
  2. Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, et al. Influenza-associated hospitalizations in the United States. JAMA 2004;292:1333-40. https://doi.org/10.1001/jama.292.11.1333
  3. Kang TG, Kim MJ, Kim BG, An HS, Yun HJ, Choi EJ, et al. Comparisons of clinical features among influenza A (H1N1) and seasonal influenza A and B during 2009 to 2010 at a single institution. Pediatr Allergy Respir Dis 2011;21:269-76. https://doi.org/10.7581/pard.2011.21.4.269
  4. Kim SH, Park CH, Huh K, Shim GH, Kim HB, YouSJ, et al. Comparison of clinical manifestation and laboratory findings between H1N1 and influenza B infection. Pediatr Allergy Respir Dis 2012;22:64-70. https://doi.org/10.7581/pard.2012.22.1.64
  5. Ambrose CS, Levin MJ. The rationale for quadrivalent influenza vaccines. Hum vaccin Immunother 2012;8:81-8. https://doi.org/10.4161/hv.8.1.17623
  6. Jian JW, Lai CT, Kuo CY, Kuo SH, Hsu LC, Chen PJ, et al. Genetic analysis and evaluation of the reassortment of influenza B viruses isolated in Taiwan during the 2004- 2005 and 2006-2007 epidemics. Virus Res 2008;131:243-9. https://doi.org/10.1016/j.virusres.2007.09.014
  7. Rota PA, Wallis TR, Harmon MW, Rota JS, Kendal AP, Nerome K. Cocirculation of two distinct evolutionary lineages of influenza type B virus since 1983. Virology 1990;175:59-68. https://doi.org/10.1016/0042-6822(90)90186-U
  8. Roy T, Agrawal AS, Mukherjee A, Mishra AC, Chandha MS, Kaur H, et al. Surveillance and molecular characterization of human influenza B viruses during 2006-2010 revealed co-circulation of Yamagata-like and Victorialike strains in eastern India. Infect Genet Evol 2011;11:1595-601. https://doi.org/10.1016/j.meegid.2011.05.022
  9. Korea Centers for Disease Control and Prevention. Korean influenza surveillance report, 2011-2012. Public Health Weekly Report 2012;5:873-81. Available at http://www. cdc.go.kr/CDC/info/CdcKrInfo0301.jsp?menuIds=HO ME001-MNU0004-MNU0036-MNU0037 [accessed on 1 Dec 2012].
  10. Daley AJ, Nallusamy R, Isaacs D. Comparison of influenza A and influenza B virus infection in hospitalized children. J Paediatr Child Health 2000;36:332-5. https://doi.org/10.1046/j.1440-1754.2000.00533.x
  11. Hite LK, Glezen WP, Demmler GJ, Munoz FM. Medically attended pediatric influenza during the resurgence of the Victoria lineage of influenza B virus. Int J Infect Dis 2007;11:40-7. https://doi.org/10.1016/j.ijid.2005.10.008
  12. Peltola V, Ziegler T, Ruuskanen O. Influenza A and B virus infections in children. Clin Infect Dis 2003;36:299-305. https://doi.org/10.1086/345909
  13. Belshe RB, Coelingh K, Ambrose CS, Woo JC, Wu X. Efficacy of live attenuated influenza vaccine in children against influenza B viruses by lineage and antigenic similarity. Vaccine 2010;28:2149-56. https://doi.org/10.1016/j.vaccine.2009.11.068
  14. Frey S, Vesikari T, Szymczakiewicz-Multanowska A, Lattanzi M, Izu A, Groth N, et al. Clinical efficacy of cell culture-derived and egg-derived inactivated subunit influenza vaccines in healthy adults. Clin Infect Dis 2010;51:997-1004. https://doi.org/10.1086/656578
  15. Jackson LA, Gaglani MJ, Keyserling HL, Balser J, Bouveret N, Fries L, et al. Safety, efficacy, and immunogeni city of an inactivated influenza vaccine in healthy adults: a randomized, placebo-controlled trial over two influenza seasons. BMC Infect Dis 2010;10:71. https://doi.org/10.1186/1471-2334-10-71
  16. Janjua NZ, Skowronski DM, De Serres G, Dickinson J, Crowcroft NS, Taloy M, et al. Estimates of influenza vaccine effectiveness for 2007-2008 from Canada's sentinel surveillance system: cross-protection against major and minor variants. J Infect Dis 2012;205:1858-68. https://doi.org/10.1093/infdis/jis283
  17. Monto AS, Ohmit SE, Petrie JG, Johnson E, Truscon R, Teich E, et al. Comparative efficacy of inactivated and live attenuated influenza vaccines. N Engl J Med 2009;361:1260-7. https://doi.org/10.1056/NEJMoa0808652
  18. Vesikari T, Fleming DM, Aristegui JF, Vertruyen A, Ashkenazi S, Rappaport R, et al. Safety, efficacy, and effectiveness of cold-adapted influenza vaccine-trivalent against community-acquired, culture-confirmed influenza in young children attending day care. Pediatrics 2006;118:2298-312. https://doi.org/10.1542/peds.2006-0725
  19. Lim J, Eom CS, Kim KH, Kim S, Cho B. Coverage of influenza vaccination among elderly in South Korea: A population based cross sectional analysis of the season 2004-2005. J Korean Geriatr Soc 2009;13:215-21. https://doi.org/10.4235/jkgs.2009.13.4.215
  20. Kee SY, Cheong HJ, Chun BC, Kim WJ. Influenza vaccination coverage rate and factors associated with vaccination in people with chronic disease. Infect Chemother 2011;43:406-11 https://doi.org/10.3947/ic.2011.43.5.406