Clinical Presentation, Laboratory Findings, Complications, and Mortality of Influenza during the Epidemic of October 2019-February 2020 in Iran

Main Article Content

Javad Tafaroji
Hosein Heydari
Zahra Movahedi
Hadi Bakhshandeh

Abstract

Background: Influenza remains a major cause of pediatric morbidity worldwide. We evaluated clinical characteristics, complications, and outcomes of influenza infection in children during Iran's 2019-2020 epidemic.


Methods: This cross-sectional study analyzed 357 hospitalized children (<15 yr) with PCR-confirmed influenza at a tertiary center in Qom, Iran (Oct 2019-Feb 2020), representing 375 total PCR-positive cases after excluding 18 with incomplete data.


Results: Among 357 patients (mean age 3.2±2.1 yr; 61.3% male), fever (89.6%) and cough (76.8%) were most common. Laboratory findings included lymphopenia (26.3%) and leukopenia (21.8%). Complications occurred in 70 patients (19.6%), including pneumonia (4.8%), otitis media (4.5%), myositis (4.5%), sinusitis (2.8%), and seizures (2.8%). No mortality was observed.


Conclusions: Nearly 20% of hospitalized children with influenza developed complications, primarily respiratory and musculoskeletal. While no deaths occurred, the substantial complication rate underscores the importance of early detection and management in high-risk pediatric populations.

Article Details

How to Cite
Tafaroji , J., Heydari , H., Movahedi , Z., & Bakhshandeh, H. (2025). Clinical Presentation, Laboratory Findings, Complications, and Mortality of Influenza during the Epidemic of October 2019-February 2020 in Iran. Afghanistan Journal of Infectious Diseases, 3(2), 150–155. https://doi.org/10.60141/ajid.107
Section
Research Article

References

Caini S, Kroneman M, Wiegers T, El Guerche‐Séblain C, Paget J. Clinical characteristics and severity of influenza infections by virus type, subtype, and lineage: A systematic literature review. Influenza Other Respi Viruses. 2018;12:780-792.

Ding Q, Lu P, Fan Y, Xia Y, Liu M. The clinical characteristics of pneumonia patients coinfected with 2019 novel coronavirus and influenza virus in Wuhan, China. J Med Virol. 2020;92:1549-1555.

Noori E, Vahedian M, Rezvan S, Minaei N, Tabaraii R. The proposed scoring system for hospitalization or discharge of patients with covid-19. Journal of Emergency Practice and Trauma. 2022;8:60-63.

Taubenberger JK, Morens DM. 1918 influenza: The mother of all pandemics. Revista Biomed. 2006;17:69-79.

Mastalerz-Migas A, Kuchar E, Nitsch-Osuch A, Mamcarz A, Sybilski A, Wełnicki M, DUDA-KRÓL WB, Antczak A. Recommendations for the prevention, diagnosis and treatment of influenza in adults for primary care physicians: Flu compas pcp-adults. Family Medicine & Primary Care Review. 2020;22

Kaiser L, Wat C, Mills T, Mahoney P, Ward P, Hayden F. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations. Arch Intern Med. 2003;163:1667-1672.

Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, et al. Estimates of global seasonal influenza-associated respiratory mortality: A modelling study. The Lancet. 2018;391:1285-1300.

Byington CL, Barnett ED, Davies HD, Edwards KM, Jackson MA, et al. Recommendations for prevention and control of influenza in children, 2014-2015. Pediatrics. 2014;134:e1503-e1519.

Teunis PF, Brienen N, Kretzschmar ME. High infectivity and pathogenicity of influenza a virus via aerosol and droplet transmission. Epidemics. 2010;2:215-222.

Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, Fukuda K. Influenza-associated hospitalizations in the united states. JAMA. 2004;292:1333-1340.

Cromer D, Van Hoek AJ, Jit M, Edmunds WJ, Fleming D, Miller E. The burden of influenza in england by age and clinical risk group: A statistical analysis to inform vaccine policy. J Infect. 2014;68:363-371.

Okumura A, Nakagawa S, Kawashima H, Muguruma T, Saito O, Fujimoto J-i, Toida C, Kuga S, Imamura T, Shimizu T. Deaths associated with pandemic (h1n1) 2009 among children, Japan, 2009–2010. Emerg Infect Dis. 2011;17:1993.

Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, Vugia D, Harriman K, Matyas B, Glaser CA. Factors associated with death or hospitalization due to pandemic 2009 influenza a (h1n1) infection in california. JAMA. 2009;302:1896-1902.

Altayep KM, Ahmed HG, a Tallaa AT, Alzayed AS, Alshammari AJ, Talla ATA. Epidemiology and clinical complication patterns of influenza a (h1n1 virus) in northern Saudi Arabia. Infect Dis Rep. 2017;9:6930.

Pebody RG, Warburton F, Andrews N, Sinnathamby M, Yonova I, Reynolds A, Robertson C, Cottrell S, Sartaj M, Gunson R. Uptake and effectiveness of influenza vaccine in those aged 65 years and older in the united kingdom, influenza seasons 2010/11 to 2016/17. Eurosurveillance. 2018;23:1800092.

Tokars JI, Olsen SJ, Reed C. Seasonal incidence of symptomatic influenza in the United States. Clin Infect Dis. 2018;66:1511-1518.

Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, Sugerman DE, Druckenmiller JK, Ritger KA, Chugh R. Hospitalized patients with 2009 h1n1 influenza in the United States, April–June 2009. N Engl J Med. 2009;361:1935-1944.

Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (covid-19): Systematic review and meta-analysis. J Intensive Care. 2020;8:36.

Naderi H, Sheybani F, Sarvghad M, Meshkat Z, Jabbari Nooghabi M. Etiological diagnosis of community-acquired pneumonia in adult patients: A prospective hospital-based study in Mashhad, Iran. Jundishapur J Microbiol. 2015;8:e22780.

Khandaker G, Zurynski Y, Buttery J, Marshall H, Richmond PC, Dale RC, et al. Neurologic complications of influenza a(h1n1)pdm09: Surveillance in 6 pediatric hospitals. Neurology. 2012;79:1474-1481.

Andrew MK, Pott H, Staadegaard L, Paget J, Chaves SS, Ortiz JR, McCauley J, Bresee J, Nunes MC, Baumeister E. Age differences in comorbidities, presenting symptoms, and outcomes of influenza illness requiring hospitalization: A worldwide perspective from the global influenza hospital surveillance network. Open forum infectious diseases. 2023;10:ofad244