Burden of influenza in Spanish pediatric population and the benefit of vaccination

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Data obtained from sentinel surveillance systems of the Spanish influenza surveillance system (SVGE). SVGE report season 2019–2020. Data for the 2010–2011 season correspond to the estimate of the graph in the 2019–2020 report. B) numerical data on cumulative incidence rate of influenza. IQR: interquartile range." ] ] ] "textoCompleto" => "IntroductionAnnual influenza epidemics are estimated to result in approximately 1 billion cases worldwide, of which 3–5 million are severe, with an estimated mortality of 290,000–6,500,000.<a class="elsevierStyleCrossRef" href="#bb0005">1</a> The population group aged ≥65 years usually receive the most attention in each epidemic, as their mortality is higher than that of other age groups.<a class="elsevierStyleCrossRef" href="#bb0010">2</a>,<a class="elsevierStyleCrossRef" href="#bb0015">3</a> However, the annual incidence of influenza in children is higher than in adults and the elderly;<a class="elsevierStyleCrossRef" href="#bb0020">4</a> children aged 5–9 years are the most commonly infected<a class="elsevierStyleCrossRef" href="#bb0025">5</a> and paediatric patients <5 years (especially those <2 years) become most acutely ill and have the highest morbidity.<a class="elsevierStyleCrossRef" href="#bb0020">4</a> In 2012, it was estimated that approximately 870,000 children <5 years were hospitalised annually for influenza worldwide<a class="elsevierStyleCrossRef" href="#bb0030">6</a> and a 2008 meta-analysis estimated between 28,000 and 111,500 paediatric deaths due to influenza-associated respiratory infections in children <5 years of age.<a class="elsevierStyleCrossRef" href="#bb0035">7</a> Furthermore, the paediatric population is described as a more efficient vector for spreading influenza in the community than adults,<a class="elsevierStyleCrossRefs" href="#bb0040">8–12</a> because children shed more viral load in their secretions and over a longer period of time.<a class="elsevierStyleCrossRef" href="#bb0065">13</a>,<a class="elsevierStyleCrossRef" href="#bb0070">14</a>Since 2005, the World Health Organisation (WHO) has advised vaccination of children ≥6 months with risk factors, healthy children aged 6–23 months, and pregnant women, to prevent severe disease during pregnancy and to protect infants, because influenza vaccines are not licenced for children <6 months.<a class="elsevierStyleCrossRef" href="#bb0025">5</a>,<a class="elsevierStyleCrossRef" href="#bb0075">15</a> In 2012, the WHO extended this recommendation to healthy children aged up to 59 months.<a class="elsevierStyleCrossRef" href="#bb0020">4</a> The Spanish Ministry of Health only recommends vaccination for people ≥65 years and those ≥6 months with comorbidities or living with people with risk factors.<a class="elsevierStyleCrossRef" href="#bb0080">16</a>The Spanish influenza surveillance system (SVGE) does not present data on the paediatric burden of influenza systematically or with the granularity necessary for analysis that would allow detailed studies. This results in incomplete and sometimes biased perception on the part of healthcare professionals, who recommend vaccination very variably, according to a recent publication based on 11,108 surveys of healthcare professionals.<a class="elsevierStyleCrossRef" href="#bb0085">17</a> Similarly, data on paediatric influenza vaccination coverage (VC) from the Ministry of Health, the SVGE, and the ECDC (European Centre for Disease Control) are limited and fragmented, compared to the data available for those aged >64 years, pregnant women, or healthcare professionals, highlighting the different strategic priorities for these groups.<a class="elsevierStyleCrossRefs" href="#bb0090">18–21</a> Data from Catalonia indicate that coverage in children with risk factors remains low (<24%),<a class="elsevierStyleCrossRef" href="#bb0110">22</a> and is 61.9% in pregnant women in Spain.<a class="elsevierStyleCrossRef" href="#bb0090">18</a>The aim of this review was to compile data on the burden of influenza in Spain's paediatric population and to contrast these data with those of countries with established vaccination strategies for the healthy paediatric population, and present them in a compiled form.MethodsFor this work we used a combination of a systematic literature review using PRISMA methodology in PubMed, Scopus, Web of Science (WoS), and Virtual Health Library (VHL) databases of the last 5 years from Spain, Canada, USA, Finland, and the UK, and the extraction of numerical or graphical data from SVGE annual reports (2010–2011 to 2019–2020 seasons), and a pragmatic search of additional literature. The latter search was conducted due to heterogeneity in the timing and method of implementing paediatric influenza vaccination programmes in the selected countries. Details of these data collection strategies are shown in the supplementary information annex to this article, and the inclusion and exclusion criteria for papers are shown in <a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>.<elsevierMultimedia ident="t0005"></elsevierMultimedia>ResultsPaediatric influenza in SpainSystematic review of studies on influenza in the paediatric populationThe result of the systematic search is described in the supplementary material. Seven observational articles were included, summarised in <a class="elsevierStyleCrossRefs" href="#t0010">Tables 2 and 3</a>. Five of these were retrospective: one through a review of clinical histories,<a class="elsevierStyleCrossRef" href="#bb0115">23</a> one on hospitalisations for severe influenza infection,<a class="elsevierStyleCrossRef" href="#bb0120">24</a> one through epidemiological surveillance studies and data,<a class="elsevierStyleCrossRef" href="#bb0125">25</a> one cohort study,<a class="elsevierStyleCrossRef" href="#bb0130">26</a> and one case–control study.<a class="elsevierStyleCrossRef" href="#bb0135">27</a> Of the remaining 2, one was a prospective study<a class="elsevierStyleCrossRef" href="#bb0140">28</a> and the other a mínimum core data set analysis.<a class="elsevierStyleCrossRef" href="#bb0145">29</a><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia>These publications show that paediatric hospitalisation for influenza occurs most frequently in children aged ≤3 years. In 2 of the selected studies (one cohort and one prospective), the median age of hospitalisation for influenza was 21 and 36 months, respectively.<a class="elsevierStyleCrossRef" href="#bb0130">26</a>,<a class="elsevierStyleCrossRef" href="#bb0140">28</a> In 2 other retrospective studies, the percentage of children aged <2 years hospitalised was 49.3% and 56.7%, respectively.<a class="elsevierStyleCrossRef" href="#bb0115">23</a>,<a class="elsevierStyleCrossRef" href="#bb0120">24</a> These children had factors associated with severe influenza complications and their admission rate to the paediatric intensive care unit (PICU) in some of the studies was considerable,<a class="elsevierStyleCrossRef" href="#bb0115">23</a>,<a class="elsevierStyleCrossRef" href="#bb0120">24</a> ranging from 0.8% to 58% (<a class="elsevierStyleCrossRef" href="#t0015">Table 3</a>).In one of the retrospective studies on the clinical and epidemiological characteristics of patients under 18 years of age hospitalised for laboratory-confirmed influenza, the most frequently reported complications, which were pneumonia of unknown origin, acute respiratory distress syndrome, and bacterial pneumonia, accounted for 62.2%, 26.8%, and 11.7% of complications, respectively.<a class="elsevierStyleCrossRef" href="#bb0120">24</a> Furthermore, a retrospective cohort study of patients hospitalised for influenza published in 2020 reported that 11.8% of paediatric patients presented neurological events before or after hospitalisation for influenza.<a class="elsevierStyleCrossRef" href="#bb0130">26</a> In that study, paediatric patients admitted to the PICU due to respiratory failure, neurological events, and septic shock accounted for 47.6%, 23.8%, and 14.3% of those hospitalised, respectively.<a class="elsevierStyleCrossRef" href="#bb0130">26</a> In another retrospective observational study of patients hospitalised for laboratory-confirmed influenza, paediatric patients requiring admission to the PICU for acute respiratory failure accounted for 10% of cases.<a class="elsevierStyleCrossRef" href="#bb0115">23</a>In another retrospective study, 69.3% of infants <6 months developed one or more of the above-mentioned complications: 46.1% had non-cardiac pneumonia, 27.1% had acute respiratory distress syndrome, 14.9% had bacterial co-infection, and 1.8%, multi-organ failure.<a class="elsevierStyleCrossRef" href="#bb0125">25</a>Deaths due to influenza observed in studies of different time periods include a number of deaths that are described in 3 of the Spanish publications found. These reported 2 (3.0%),<a class="elsevierStyleCrossRef" href="#bb0125">25</a> 3 (1.0%),<a class="elsevierStyleCrossRef" href="#bb0120">24</a> and 18 deaths (rate of 0.5 [95% CI 0.3–0.7] due to influenza per 100,000 children <12 months),<a class="elsevierStyleCrossRef" href="#bb0145">29</a> which corresponded to the study of seasons 2, 6 and 8, respectively. These publications collected data from epidemiological surveillance (infants <6 months hospitalised, several autonomous communities),<a class="elsevierStyleCrossRef" href="#bb0125">25</a> patients ≤17 years hospitalised due to severe influenza infection (study in one autonomous community),<a class="elsevierStyleCrossRef" href="#bb0120">24</a> or from the minimum core data set (infants <1 year hospitalised), respectively.<a class="elsevierStyleCrossRef" href="#bb0145">29</a>There are no data on annual influenza vaccination in healthy Spanish children. Among the selected publications that collected data on paediatric vaccination, VC against seasonal influenza in the included children, even in children with risk factors, was found to be low (<a class="elsevierStyleCrossRefs" href="#t0010">Tables 2 and 3</a>). According to a study on hospitalisation and influenza in the paediatric population, of the 131 confirmed influenza cases reported, mostly outpatients and only 11 hospitalised,<a class="elsevierStyleCrossRef" href="#bb0140">28</a> VC in children ≥6 months was only 0.8%. In another study of 291 hospitalised children ≤17 years, VC was 5.8%, rising to 27.1% in children with risk factors.<a class="elsevierStyleCrossRef" href="#bb0120">24</a> Finally, in a 2-season study of 907 hospitalised children aged <15 years with a clinical diagnóstico of influenza, the overall VC was 26%, and only 35.2% in children with risk factors despite their having a clear indication for vaccination.<a class="elsevierStyleCrossRef" href="#bb0115">23</a> Regarding vaccination history in mothers, in a case–control study in a tertiary hospital of hospitalisations for influenza in infants <6 months, only 3.4% (n = 88) of the mothers of hospitalised cases had been vaccinated during pregnancy, compared to 8.3% (n = 122) among the controls.<a class="elsevierStyleCrossRef" href="#bb0135">27</a> Analysis of data from hospitalised paediatric cases ≤6 months from 67 hospitals collected through the SVGE and severe hospitalised confirmed influenza cases (SHCIC) in one publication reflected VC of up to 17.4% (n = 69).<a class="elsevierStyleCrossRef" href="#bb0125">25</a> The latter study estimated that vaccination during pregnancy was 61% (95% CI 27%–79%) effective in preventing hospitalisations for confirmed influenza in children ≤6 months.<a class="elsevierStyleCrossRef" href="#bb0125">25</a>Revision of SVGE reportsIncidence of influenza in SpainAccording to SVGE reports from the 2010–2011 to the 2019–2020 season, the cumulative incidence of confirmed influenza per 100,000 population in Spain in the age groups 0–4 years (median: 4765.7 [IQR: 1703.9]) and 5–14 years (median: 4. 302.3 [IQR: 1545.3]) during the influenza seasons analysed (<a class="elsevierStyleCrossRef" href="#f0005">Fig. 1</a>) is always higher than in other age groups, and the population aged 0–4 years experienced the highest incidence in the last 3 seasons.<a class="elsevierStyleCrossRef" href="#bb0105">21</a> The groups aged from 15 to 64 years and those ≥65 years had a much lower cumulative incidence (median: 1617.2 [IQR 531.4] and median: 645.4 [IQR: 455.5], respectively).<elsevierMultimedia ident="f0005"></elsevierMultimedia>Hospitalisations in SpainThe published cumulative rates of SHCIC per 100,000 population show that the age groups with the highest rates are 0–4 years and ≥ 65 years (<a class="elsevierStyleCrossRef" href="#f0010">Fig. 2</a>). In 4 of the 10 seasons analysed: 2010–2011,<a class="elsevierStyleCrossRef" href="#bb0150">30</a> 2011–2012,<a class="elsevierStyleCrossRef" href="#bb0155">31</a> 2012–2013,<a class="elsevierStyleCrossRef" href="#bb0160">32</a> and 2019–2020<a class="elsevierStyleCrossRef" href="#bb0165">33</a> dominated by influenza viruses of type/subtype A(H1N1), A(H3N2), B, and A(H1N1), respectively; the 0–4 years age group had a higher number of SHCIC than the ≥65 year group, and in 2 (2013–2014<a class="elsevierStyleCrossRef" href="#bb0170">34</a> and 2015–2016<a class="elsevierStyleCrossRef" href="#bb0175">35</a>) the differences between both groups were small, as they were seasons with predominance of subtype A(H1N1) (<a class="elsevierStyleCrossRef" href="#f0010">Fig. 2</a>).<elsevierMultimedia ident="f0010"></elsevierMultimedia>The SHCIC data in which the influenza virus responsible for hospitalisation has been subtyped and reported show that in the age groups 0–4 years, 5–14 years, and ≥ 65 years, hospitalisations are due to the predominant subtype in each year. The exception is the 5–14 years age group in the 2015–2016 and 2019–2020 seasons where, despite the predominance of A(H1N1) in that age group, the severe cases that were hospitalised were due to the B virus.<a class="elsevierStyleCrossRef" href="#bb0105">21</a>,<a class="elsevierStyleCrossRef" href="#bb0165">33</a>,<a class="elsevierStyleCrossRef" href="#bb0175">35</a> It should be noted that, among adults, most SHCIC were associated with individuals with risk factors. In contrast, among the paediatric population admitted, the highest percentage showed no illness or risk factors prior to their hospitalisation for severe influenza.<a class="elsevierStyleCrossRefs" href="#bb0150">30–39</a>Admission to intensive care units in SpainPaediatric data on admission to the PICU due to influenza appear only in the reports for the 2018–2019 and 2019–2020 seasons, merged into a single group of <15 years.<a class="elsevierStyleCrossRef" href="#bb0165">33</a>,<a class="elsevierStyleCrossRef" href="#bb0195">39</a> Their cumulative percentage of admissions is higher than the group ≥65 years over the weeks of the influenza season, with a median of 30.8 (IQR: 4.1) vs. 17.9 (IQR: 2.9) in 2018–2019 and 27.4 (IQR: 6.0) vs. 16.9 (IQR: 3.2) in 2019–2020 (<a class="elsevierStyleCrossRef" href="#f0015">Fig. 3</a>).<elsevierMultimedia ident="f0015"></elsevierMultimedia>MortalityInfluenza mortality in children was analysed irregularly and inconsistently in the SVGE reports throughout the seasons analysed (from 2011 to 2019). Unlike reports from other countries with a similar tradition of influenza surveillance to Spain, the SVGE lacks granularity in the data they provide on child mortality. Therefore, it was not possible to extract information on mortality by age between the seasons 2010 and 2018. In the seasons 2018–2019 and 2019–2020, mortality was analysed as impact levels according to the Z-scores of the excesses of all-cause mortality over the mean in the different age groups. In the season 2018–2019, the value for those ≥65 years ranged from low to medium, was low for the 15–64 age group, and for those <15 years, nil.<a class="elsevierStyleCrossRef" href="#bb0195">39</a> Finally, in the season 2019–2020, the level of impact was nil or low for all (varying between weeks throughout the influenza season) except for the 15–64 years age group, for which it was moderate in week 5.<a class="elsevierStyleCrossRef" href="#bb0165">33</a>TransmissibilityThis new measurement parameter of influenza epidemics reflects the ease with which the influenza virus circulates between individuals and communities. High transmissibility means very rapid spread of the virus from person to person. The main factors influencing this parameter are the ability of the virus to spread from person to person, the dynamics of the spread, the vulnerability of the exposed population, and social and climatic circumstances.This new information is presented broken down by age group only in the annual report for the season 2019–2020.<a class="elsevierStyleCrossRef" href="#bb0165">33</a> These transmissibility levels are calculated through intensity thresholds using the mobile epidemic method, obtaining different thresholds for each age group considered.<a class="elsevierStyleCrossRef" href="#bb0200">40</a>,<a class="elsevierStyleCrossRef" href="#bb0205">41</a> As shown in <a class="elsevierStyleCrossRef" href="#f0020">Fig. 4</a>, those aged ≥65 years show zero or low levels of transmissibility, while those in the 15–64 years age group range from zero, low, or moderate. In contrast, the age group <15 years shows high and moderate values, as well as much higher crude values than the other 2 groups.<elsevierMultimedia ident="f0020"></elsevierMultimedia>Systematic literature review on influenza in the paediatric population in countries with paediatric vaccinationIn the last 20 years, several countries have adopted a strategy of vaccinating all healthy children ≥6 months.<a class="elsevierStyleCrossRef" href="#bb0210">42</a>,<a class="elsevierStyleCrossRef" href="#bb0215">43</a> For this section of the review, the 3 countries that pioneered paediatric vaccination (Canada, USA, and Finland) and the UK, which started its programme later with intranasal vaccination in ≥2 years old and parenteral vaccination in <2 years old, were selected. The summary of the data is presented in <a class="elsevierStyleCrossRefs" href="#t0020">Tables 4 and 5</a> and the description of the results of the systematic search for each country can be found in the supplementary material. Documents and articles located through the additional pragmatic search were incorporated to complement the results of the systematic search.<elsevierMultimedia ident="t0020"></elsevierMultimedia><elsevierMultimedia ident="t0025"></elsevierMultimedia>CanadaEpidemiological context and paediatric influenza vaccination scheduleThe Canadian National Advisory Committee on Immunisation (NACI) recommended influenza vaccination for all healthy persons (including children) from 2000.<a class="elsevierStyleCrossRef" href="#bb0220">44</a> Subsequently, in 2004, the Canadian programme included infants aged 6–23 months under the category of people at high risk for influenza-related complications.<a class="elsevierStyleCrossRef" href="#bb0225">45</a>,<a class="elsevierStyleCrossRef" href="#bb0230">46</a> This universal influenza vaccination programme was initially implemented in Ontario.<a class="elsevierStyleCrossRef" href="#bb0235">47</a>According to NACI epidemic surveillance data, the burden of influenza B disease is higher in children than in other age groups, accounting for 17% of laboratory-confirmed paediatric influenza cases. This type of influenza virus is also responsible for 15.5%–58.3% of their influenza hospitalisations, and its mortality is higher than that of type A.<a class="elsevierStyleCrossRef" href="#bb0240">48</a>The vaccines administered in Canada to infants aged 6–23 months are the tri- or tetravalent inactivated type, IIV3-SD, or IIV4-SD Standard Dose (Inactivated Influenza Vaccine, trivalent or tetravalent, Standard Dose). IIV4-SD is preferred.<a class="elsevierStyleCrossRef" href="#bb0240">48</a> IIV3-SD, IIV4-SD, or LAIV4 (Live Attenuated Influenza Vaccine tetravalent) are recommended in children aged 2–17 years. Adolescents aged 9–17 years can also be vaccinated with the inactivated tetravalent vaccine produced in cell culture (IIV4-CC) and LAIV4, or IIV4-CC can be used interchangeably, unless the patient has certain clinical conditions of the patient.<a class="elsevierStyleCrossRef" href="#bb0240">48</a> For example, LAIV4 is not recommended for patients with severe asthma and is contraindicated in adolescent and immunosuppressed pregnant women, but is recommended in children with stable, non-severe asthma, or in children with cystic fibrosis who are not being treated with immunosuppressants.<a class="elsevierStyleCrossRef" href="#bb0230">46</a>In Quebec, it is estimated that 62.9%–78.7% of children <2 years have full coverage with all vaccines in their immunisation schedule, which also includes influenza vaccination.<a class="elsevierStyleCrossRef" href="#bb0245">49</a>Burden of disease related to paediatric influenza vaccinationThree observational studies related to clinical outcomes during the period of implementation of the current vaccination programme (one retrospective cohort study,<a class="elsevierStyleCrossRef" href="#bb0250">50</a> one prospective study,<a class="elsevierStyleCrossRef" href="#bb0255">51</a> and one epidemiological surveillance analysis<a class="elsevierStyleCrossRef" href="#bb0260">52</a>) were selected through a systematic search. All the studies included hospitalised patients. The studies are described in <a class="elsevierStyleCrossRef" href="#t0020">Table 4</a>.According to the Canadian retrospective, multicentre, cohort study conducted over 5 seasons, the incidence of hospitalisation in children <5 years of age for laboratory-confirmed influenza was 8.7% for non-subtyped influenza A, 3.7% for subtype A(H1N1), and 4.5% for B virus.<a class="elsevierStyleCrossRef" href="#bb0250">50</a> Admission to the PICU was estimated at 6% of those infected with influenza A without risk factors (both non-subtyped and H1N1pdm subtype) and between 6%–11% in children with comorbidities.<a class="elsevierStyleCrossRef" href="#bb0250">50</a>In the prospective study of 8 consecutive non-pandemic seasons, in which cases of hospitalisation due to influenza were recorded in children under 18 years of age, the median age was 2 years, and children under 2 years of age accounted for 54.5% of the cases.<a class="elsevierStyleCrossRef" href="#bb0255">51</a> In the 8-year period studied, influenza B was responsible, each season, for between 15.5% and 58.3% of influenza hospitalisations in children under 16 years of age.<a class="elsevierStyleCrossRef" href="#bb0260">52</a> While in the prospective study cited above, with data from 8 seasons (2011–2019), no deaths were reported and there were 1.1% PICU admissions. In another study conducted using Canadian epidemiological surveillance monitoring data from 2004 to 2013, 0.4% of deaths were observed due to influenza A and 1.1% due to influenza B (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>).<a class="elsevierStyleCrossRef" href="#bb0260">52</a>Studies with a higher number of hospitalisations and information on patients' vaccination history, observe that in the paediatric population aged <16 and < 18 years hospitalised for influenza, only 6.5%–6.9%<a class="elsevierStyleCrossRef" href="#bb0260">52</a> and 11.3%<a class="elsevierStyleCrossRef" href="#bb0255">51</a> of patients, respectively, were vaccinated. And the absence of influenza vaccination is reported as a possible factor associated with hospitalisation (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>).United States of AmericaEpidemiological context and paediatric influenza vaccination programmeIn the USA, from 2002 reports by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunisation Practices (ACIP) the indication was suggested for influenza vaccination in healthy children aged 6–23 months due to the high incidences of hospitalisation recorded in this age group.<a class="elsevierStyleCrossRef" href="#bb0265">53</a> The definitive recommendation following these reports was established 2 years later,<a class="elsevierStyleCrossRef" href="#bb0270">54</a> giving preference to the inactivated vaccine over LAIV until 2007, when equal preference was established for both inactivated and attenuated vaccines.<a class="elsevierStyleCrossRef" href="#bb0275">55</a> From 2009, the ACIP included in its recommendations the entire paediatric population (with or without risk factors) from ≥6 months to <18 years,<a class="elsevierStyleCrossRef" href="#bb0280">56</a> and from 2010 it extended the recommendation to universal vaccination for the entire population from ≥6 months.<a class="elsevierStyleCrossRef" href="#bb0285">57</a> Between 2012 and 2019, VC in children ≤17 years gradually increased with some exceptions in certain seasons to 63.7%<a class="elsevierStyleCrossRef" href="#bb0290">58</a> in the 2019–2020 season, although it decreased in the 2020–2021 season to 58.6%.<a class="elsevierStyleCrossRef" href="#bb0295">59</a>CDC influenza records for <18 years show that the number of paediatric (1 month to <18 years) influenza deaths between the 2004–2005 and 2019–2020 seasons ranged from 37 to 199 each season. The exception was the 2009 pandemic, when 358 deaths were reported, of which about 80% were unvaccinated.<a class="elsevierStyleCrossRef" href="#bb0300">60</a> These figures are a minimum declaration, as only laboratory-confirmed influenza deaths are included (CDC statistical models estimate that up to 434 children and adolescents under 18 years of age may have died during the 2009 pandemic). Finally, studies indicate that vaccination reduced the likelihood of admission to the PICU by 74% (2010–2012 seasons) and death by 65%–51% (2010–2014 seasons).<a class="elsevierStyleCrossRef" href="#bb0305">61</a>,<a class="elsevierStyleCrossRef" href="#bb0310">62</a>Burden of disease associated with paediatric influenza vaccinationSeven publications on clinical outcomes during the paediatric vaccination programme in the USA were selected through the systematic review. Four were retrospective observational studies,<a class="elsevierStyleCrossRefs" href="#bb0315">63–66</a> two were analyses of epidemiological data<a class="elsevierStyleCrossRef" href="#bb0335">67</a>,<a class="elsevierStyleCrossRef" href="#bb0340">68</a> and one described an analysis of cases and estimates.<a class="elsevierStyleCrossRef" href="#bb0345">69</a><a class="elsevierStyleCrossRef" href="#t0020">Table 4</a> shows the data from these studies.The data obtained from the different studies show that the incidence of influenza was higher the younger the age of the patients,<a class="elsevierStyleCrossRef" href="#bb0315">63</a>,<a class="elsevierStyleCrossRef" href="#bb0325">65</a> thus younger children (<3 years) were more likely to attend the emergency department,<a class="elsevierStyleCrossRef" href="#bb0315">63</a>,<a class="elsevierStyleCrossRef" href="#bb0335">67</a>,<a class="elsevierStyleCrossRef" href="#bb0345">69</a> be hospitalised,<a class="elsevierStyleCrossRef" href="#bb0315">63</a>,<a class="elsevierStyleCrossRef" href="#bb0335">67</a>,<a class="elsevierStyleCrossRef" href="#bb0345">69</a> or admitted to the PICU<a class="elsevierStyleCrossRef" href="#bb0320">64</a> than the rest (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>). This likelihood increased if they also had respiratory diseases (such as bronchiolitis) or non-respiratory diseases (such as congenital heart disease).<a class="elsevierStyleCrossRef" href="#bb0315">63</a> In another recently published study focusing on transmissibility in households with ≥2 members, children accounted for the highest percentage of primary and secondary cases reported (62%).<a class="elsevierStyleCrossRef" href="#bb0330">66</a> Moreover, among children aged <12 years, this proportion was 33.8% in cases associated with a first outbreak, 43.9% when the primary and secondary cases were reported on the same day and 38.1% in secondary cases diagnosed on subsequent days. However, in children aged 12–18 years, these proportions were 17.2%, 16.0%, and 14.2%, respectively.<a class="elsevierStyleCrossRef" href="#bb0330">66</a>Paediatric mortality is reflected in 4 of the articles analysed.<a class="elsevierStyleCrossRef" href="#bb0320">64</a>,<a class="elsevierStyleCrossRefs" href="#bb0335">67–69</a> One of them analysed prospective epidemiological surveillance data from the 2018–2019 season in children aged 6 months to 17 years, showing one death among 226 children hospitalised with a confirmed diagnóstico of influenza.<a class="elsevierStyleCrossRef" href="#bb0335">67</a> In another retrospective study, focusing on patients <2 years seen in the ED during the 2009–2017 seasons, 4 deaths were recorded: 2 during ED admission and 2 among those hospitalised, giving a mortality rate of 7 per 100,000.<a class="elsevierStyleCrossRef" href="#bb0320">64</a> The case analysis and estimates article, based on 2015 data, estimated a mortality rate among the population aged 0–17 years of 4 (lower-upper range: 2–6) per million.<a class="elsevierStyleCrossRef" href="#bb0345">69</a>Finally, one of the most relevant studies of paediatric deaths with laboratory-confirmed influenza diagnóstico in the USA reported 675 deaths during 6 post-pandemic seasons. This represents an annual average of more than 100 influenza deaths in children and adolescents <18 years of age. Thus, the mean annual incidence of influenza deaths calculated between the seasons 2010–2011 and 2016–2017 was 0.2/100000 for <18 years (95% CI: 0.1–0.2) with a median age of 6 years (IQR: 2–12 years). The highest incidence was in infants <6 months (0.7; 95% CI: 0.5–0.8).<a class="elsevierStyleCrossRef" href="#bb0340">68</a> The same article highlights that children without pre-existing conditions (asthma, cancer, heart disease, etc.) had a lower median age than those with comorbidities, and a higher likelihood (77%) of dying before they could be hospitalised than those with previous comorbidities (48%).<a class="elsevierStyleCrossRef" href="#bb0340">68</a> Furthermore, 65% of the children died within the first week from symptom onset and 13% died the day after symptom onset (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>).Finally, this study reveals that the vaccination rate among the 477 deceased children ≥6 months was 31%, and only 22% of them had the 2 doses required to complete their vaccination schedule.<a class="elsevierStyleCrossRef" href="#bb0340">68</a>In 2 retrospective studies with data on influenza VC in children ≤17 years, VC ranged from 27%–31% in one study<a class="elsevierStyleCrossRef" href="#bb0325">65</a> to 40%–47% in the other.<a class="elsevierStyleCrossRef" href="#bb0335">67</a> In the latter, the VC was reported in confirmed influenza cases, and the VC in the group with symptomatic influenza was lower than the mean coverage of the paediatric population that season who had not had influenza (40%–47% vs. 58%–62%).<a class="elsevierStyleCrossRef" href="#bb0335">67</a> This study also notes that in the season 2018–2019, vaccination reduced hospitalisations and emergency department visits by 40% and 60% respectively, which for its authors reinforces the recommended annual vaccination of ≥6 months.<a class="elsevierStyleCrossRef" href="#bb0335">67</a>FinlandEpidemiological context and paediatric influenza vaccination programmeSince 2007, a seasonal influenza vaccination programme has been in place in Finland for all children aged 6–35 months, regardless of whether they have risk factors. This age was extended to <7 years from the season 2018–2019.<a class="elsevierStyleCrossRef" href="#bb0350">70</a> Since 2015, this age group has been vaccinated with IIV3 (IIV4 from 2020) or LAIV4.<a class="elsevierStyleCrossRef" href="#bb0355">71</a> The VC of children in this age group in 2014–2015 was 11%, increasing progressively in the following seasons (17%, 22%, 24%) to reach 31.1% in 2018–2019, the last season recorded in their database at the date of this paper.<a class="elsevierStyleCrossRef" href="#bb0360">72</a>Moreover, the incidence of influenza reported in Finland from surveillance system data shows a monthly incidence in children <9 years exceeding 200 per 100,000 in the February of the seasons 2018–2019 and 2019–2020, while the peak monthly incidences for the same month (corresponding to the epidemic acme) remained below 150 per 100,000 in the rest of the age groups.<a class="elsevierStyleCrossRef" href="#bb0365">73</a>Burden of disease associated with paediatric influenza vaccinationFour studies were selected, three observational studies (one retrospective<a class="elsevierStyleCrossRef" href="#bb0370">74</a> and two prospective cohort studies [one of which was a birth cohort]<a class="elsevierStyleCrossRef" href="#bb0375">75</a>,<a class="elsevierStyleCrossRef" href="#bb0380">76</a>) and an analysis of two prospective observational cohort studies. The extracted information is summarised in <a class="elsevierStyleCrossRef" href="#t0020">Table 4</a>.These studies show that, although the incidence of influenza was higher in the 3–13 years age group than in the <3 years age group (65% vs. 35%), in the latter the illness more frequently manifested as moderate or severe (66%), while severe disease was observed in less than half of the 3–13 years age group (41%).<a class="elsevierStyleCrossRef" href="#bb0385">77</a> One prospective study estimated the incidence of laboratory-confirmed influenza in children <2 years of age over 3 consecutive seasons (2008–2009 to 2010–2011) at 5.1%, 2.7%, and 5%, respectively.<a class="elsevierStyleCrossRef" href="#bb0380">76</a> Another prospective birth cohort study in which data were collected to compare the incidence and clinical aspects of influenza in the first influenza season in infants <1 year showed that 13.5% of infants (55/408), whose mean age was 7.6 months (4.3–11.0), were diagnosed with influenza.<a class="elsevierStyleCrossRef" href="#bb0375">75</a> The severity of influenza A (52% of those diagnosed with influenza) or B (48%) was not significantly different (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>).In a prospective cohort study among children <13 years conducted to assess the social and clinical impact of influenza, 3% of those <3 years in the moderate–severe influenza group attended the emergency department.<a class="elsevierStyleCrossRef" href="#bb0385">77</a> The set of Finnish articles reporting hospitalisation in children <3 years show percentages of 1<a class="elsevierStyleCrossRef" href="#bb0385">77</a>, 2,<a class="elsevierStyleCrossRef" href="#bb0375">75</a> and 5%.<a class="elsevierStyleCrossRef" href="#bb0380">76</a> The only study with data on the percentage of children requiring admission to the PICU after hospitalisation showed that 12.9% of children <16 years with influenza A and 15.2% with influenza B were admitted to the PICU between the seasons 2004–2005 and 2017–2018.<a class="elsevierStyleCrossRef" href="#bb0370">74</a> Two deaths were reported in <2 years, one due to influenza A (accounting for 0.7% of those hospitalised with influenza A) and one due to influenza B (2.6% of those hospitalised with influenza B) (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>).<a class="elsevierStyleCrossRef" href="#bb0370">74</a>Of the 4 studies mentioned, only 2 had data on vaccination,<a class="elsevierStyleCrossRef" href="#bb0375">75</a>,<a class="elsevierStyleCrossRef" href="#bb0380">76</a> in which VC in children aged <2 years ranged from a maximum of 80% in 2009–2010, coinciding with the influenza A(H1N1)pm pandemic, and lower percentages between 33% and 47% for the other 2 non-pandemic seasons. The highest vaccine effectiveness (VE) was achieved with pandemic influenza vaccination in 2009–2010.<a class="elsevierStyleCrossRef" href="#bb0380">76</a> This was 97% (95% CI 76–100), and coincided with a halving of incidence compared to the other 2 seasons. In the post-pandemic season (2010–2011) the VE was 41% (95% CI -75-80).<a class="elsevierStyleCrossRef" href="#bb0380">76</a> In the study on burden of influenza disease in the first year of life, only 14.3% of infants (54/379), whose vaccination status was known, were vaccinated and only 4 of them had a laboratory-confirmed diagnóstico of influenza (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>).<a class="elsevierStyleCrossRef" href="#bb0375">75</a>United KingdomEpidemiological context and paediatric influenza vaccination programmeThe UK has had a paediatric influenza vaccination programme in place since 2014, including children ≥6 months with risk factors and all children aged 2–15 years.<a class="elsevierStyleCrossRef" href="#bb0390">78</a> The programme was rolled out as a pilot in the 2013–2014 season, and LAIV was administered to children aged 2–12 years, and was extended nationwide from the following season,<a class="elsevierStyleCrossRef" href="#bb0395">79</a> however, VC in these age cohorts differs between geographical and national areas in the UK. Therefore, in England it ranges between 40% and 60%, while in schools in Northern Ireland VC is over 75%, in Scotland over 70%, and in Wales 65%.<a class="elsevierStyleCrossRef" href="#bb0395">79</a>However, the VE of LAIV has shown differences over the seasons, estimated at between 26.9% and 65.8%. In the 2015–2016 season it was 57.6% (95% CI: 25.1%–76.0%); 65.8% (95% CI: 30.3%–83.2%) in 2016–2017; 26.9% (95% CI: 32.6%–59.7%) in 2017–2018, and 48.6% (95% CI: 4.4–74.7%) in 2018–2019. Antigenic mismatch between the predominant circulating strains and those included in the vaccine is not mentioned for these seasons.<a class="elsevierStyleCrossRef" href="#bb0395">79</a> Generally VE is calculated for the vaccine as a whole (all strains included in the vaccine), However, VE values vary for each type and subtype and strain of influenza virus included in each year's vaccine.Influenza surveillance reports from the 2012–2013 season to 2020–2021<a class="elsevierStyleCrossRef" href="#bb0400">80</a> are published on the UK government health website. The annual reports publish outbreaks of respiratory viruses in institutions such as schools, hospitals, or care homes. Only in the 2012–2013 season, influenza outbreaks in institutions were detailed, and it was observed that during the first weeks of the season, outbreaks in schools accounted for the majority (exceeding 25 outbreaks between weeks 49 and 51 of the year) and were mostly caused by influenza B (73%), while in care homes, influenza A virus was the most frequent cause of outbreaks (81%).<a class="elsevierStyleCrossRef" href="#bb0405">81</a> In addition, outbreaks in schools were the second largest in number (after care homes), and the earliest, being reported in week 50 of 2012, earlier than outbreaks in care homes, which started in week 9 of 2013.Burden of disease associated with paediatric influenza vaccinationFive articles were selected through the systematic search, three retrospective observational<a class="elsevierStyleCrossRefs" href="#bb0410">82–84</a> and two observational case studies<a class="elsevierStyleCrossRef" href="#bb0425">85</a>,<a class="elsevierStyleCrossRef" href="#bb0430">86</a> (<a class="elsevierStyleCrossRef" href="#t0020">Table 4</a>).One of the retrospective studies focusing on the impact of LAIV in children without previous illness in Northern Ireland, over 7 influenza seasons, described data before and after the introduction of influenza vaccination in children. The VC of the different seasons collected in the study showed a very significant increase in VC from the year of the start of the vaccination programme, reaching annual coverage rates of >54% in children aged 2–4 years and >76% in children aged 4–11 years.<a class="elsevierStyleCrossRef" href="#bb0410">82</a> On the other hand, the cumulative incidence rate of urgent outpatient consultations (known as “out-of-hours” consultations in the UK) halved after the introduction of influenza vaccination in children. The incidence of urgent consultations fell from 10.0/100000 in the pre-vaccination season (2010–2011) to half in seasons with vaccination in children (4.7 in 2013–2014 and 5.1 in the 2014–2017 seasons). There were also declines in the number of primary care visits per 100,000 population: from 15.1 in the pre-vaccination season, to 8.3 in 2013–2014 and 9.2 in 2014–2017 (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>).<a class="elsevierStyleCrossRef" href="#bb0410">82</a>The case–control study that analysed VE by negative test provides VE figures for the reduction in laboratory-confirmed influenza hospitalisations. A total of 307 hospitalised cases and 679 hospitalised controls were identified. Of the cases with confirmed influenza virus infection; 156 cases were non-subtyped influenza A, 104 were infected with A(H1N1)pdm09, 40 with A(H3N2), and 6 with B virus; of these, 112, 78, 28, and 4 children, respectively, were unvaccinated.<a class="elsevierStyleCrossRef" href="#bb0425">85</a> The overall VE of LAIV against any influenza hospitalisation was 53% (95% CI 36.2–68.5); particularly for influenza A(H1N1)pdm09 subtype 63.5% (95% CI 34.4–79.7) and 31.1% (95% CI 53.9–69.2) for the A(H3N2) subtype.<a class="elsevierStyleCrossRef" href="#bb0425">85</a> The adjusted VE of LAIV to prevent any influenza was 49.1% (95% CI: 25.9–65.0) for all types and subtypes and 70.7% (95% CI: 41.8–85.3) for the A(H1N1)pdm09 subtype, while for those who received IIV4-SD, it was 64.4% (95% CI: 29.4–82.0) and 44.4% (95% CI: −51.9-79.6), respectively. Overall, effectiveness was higher in healthy children than in those with at-risk conditions.In the only cohort study on VE to prevent laboratory-confirmed influenza in infants <6 months during 2 seasons (2013–2014 and 2014–2015),<a class="elsevierStyleCrossRef" href="#bb0430">86</a> data on vaccination of their mothers during pregnancy indicated that <25% of mothers had been vaccinated in the study seasons. In particular, only 20% of mothers of hospitalised infants in 2013–2014 and 24.6% in 2014–2015 were vaccinated (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>). Of the infants with confirmed infection 81.1% (30/37) and 85.2% (69/81) were hospitalised in each season, respectively. Overall, VE was 66% (95% CI 18–84) and 50% (95% CI 11–72) in 2013–2014 and 2014–2015, respectively. However, VE against the dominant circulating influenza strain each year was higher, at 78% (95% CI: 16–94) against A(H1N1)pdm09 in 2013–2014, and 60% (95% CI: 16–81) against A(H3N2) in 2014–2015.<a class="elsevierStyleCrossRef" href="#bb0430">86</a>The 2 studies conducted in children <16 years with a clinical diagnóstico of influenza admitted to the PICU showed that the highest rate of admissions was in children <2 years. In one study, which focused on characterising the paediatric population with severe influenza and their risk of death, most of those admitted had at least one risk factor (78.5%).<a class="elsevierStyleCrossRef" href="#bb0415">83</a> A total of 143 deaths were recorded, the majority children with risk factors (137 children). Although the authors could not establish whether the deceased were vaccinated, they explain that, in general, children with risk factors have a low vaccination rate of <30% in those aged 6 months to <2 years and <50% in 2 to 15 years.Finally, another paper that studied the impact of the universal vaccination programme on adolescent and child PICU admissions over 14 seasons estimated that the rate of influenza-related PICU admissions was 1.3/100000.<a class="elsevierStyleCrossRef" href="#bb0420">84</a> The authors concluded that there was no difference between admission rates before and after introduction of the programme. However, they did not report vaccination coverage data among the patients whose data they had collected (<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>) and recommend a longer follow-up of the new vaccination policy.Discussion and conclusionsTo the best of our knowledge, there are few estimates of the burden of influenza in the paediatric population in Spain based on published data. This paper compiles scientific evidence published or reported on the official websites of governmental institutions. The Spanish Ministry of Health, through the document on Influenza Vaccination Recommendations, season 2021–2022, states that influenza vaccination is aimed at protecting people at higher risk of complications and potential transmitters to vulnerable individuals.<a class="elsevierStyleCrossRef" href="#bb0080">16</a> To date, vaccination strategy in Spain has focused most of its efforts on protecting those aged ≥65 years, due to their higher mortality rate from influenza and high levels of hospitalisation.<a class="elsevierStyleCrossRef" href="#bb0105">21</a> Years ago, the focus began to be placed on the paediatric population, and it became clear that hospitalisation and antibiotic consumption increased in children, especially the youngest, during seasonal influenza epidemics, and that they even exceeded excess hospitalisations due to influenza in those aged ≥65 years,<a class="elsevierStyleCrossRef" href="#bb0435">87</a> and thus vaccination of the paediatric population was recommended.<a class="elsevierStyleCrossRef" href="#bb0440">88</a>The evidence gathered in this review shows that in children <15 years of age the incidence of laboratory-confirmed influenza is higher than in adults and the elderly,<a class="elsevierStyleCrossRef" href="#bb0105">21</a> their percentage of admission to the PICU is higher than that of the group aged ≥65 years<a class="elsevierStyleCrossRef" href="#bb0105">21</a> and the rates and percentages of hospitalisation in the population ≤ 4 years<a class="elsevierStyleCrossRef" href="#bb0105">21</a>,<a class="elsevierStyleCrossRef" href="#bb0115">23</a>,<a class="elsevierStyleCrossRef" href="#bb0120">24</a>,<a class="elsevierStyleCrossRef" href="#bb0140">28</a> are very significant. However, while adults admitted to hospital for influenza or its complications mostly have previous illness, this clinical condition is significantly lower in those aged <15 years (< 20% since the season 2012–2013; in 3 seasons, <10%),<a class="elsevierStyleCrossRef" href="#bb0105">21</a> and therefore the absence of previous risk factors is not a clinical datum that rules out the possibility of the paediatric population developing severe or complicated influenza. Moreover, as mentioned, the absence of risk factors in children with severe influenza increases the possibility of failing to anticipate severe consequences and therefore their being hospitalised in time, and children, especially those <5 years old, may develop severe complications: pneumonia, acute respiratory distress, neurological complications, multi-organ failure, and death.<a class="elsevierStyleCrossRef" href="#bb0105">21</a>,<a class="elsevierStyleCrossRefs" href="#bb0120">24–26</a>,<a class="elsevierStyleCrossRef" href="#bb0145">29</a>Therefore, Canada, the USA, Finland, and later the UK changed their strategy and recommendations for annual vaccination, extending it to the paediatric population to a lesser or greater extent. In fact, 10 years ago (2012), in its “position paper” on vaccination, the WHO recommended the implementation of the vaccine in the entire population of children under 5 years of age based on the aspects mentioned above.<a class="elsevierStyleCrossRef" href="#bb0020">4</a> Different countries, with very different health systems and different childhood vaccination policies, have implemented paediatric vaccination against influenza, achieving significant reductions in incidence, hospitalisations, complications, sequelae, and deaths in the population aged 0–17 years.<a class="elsevierStyleCrossRef" href="#bb0210">42</a>,<a class="elsevierStyleCrossRef" href="#bb0220">44</a>,<a class="elsevierStyleCrossRef" href="#bb0265">53</a>,<a class="elsevierStyleCrossRef" href="#bb0270">54</a>,<a class="elsevierStyleCrossRef" href="#bb0350">70</a>,<a class="elsevierStyleCrossRef" href="#bb0395">79</a>,<a class="elsevierStyleCrossRef" href="#bb0445">89</a>,<a class="elsevierStyleCrossRef" href="#bb0450">90</a> Hospitalisation data in these countries and in Spain show that among the hospitalised paediatric population (0–17 years), vaccination has been less frequent than in the non-hospitalised population.<a class="elsevierStyleCrossRef" href="#bb0115">23</a>,<a class="elsevierStyleCrossRef" href="#bb0120">24</a>,<a class="elsevierStyleCrossRef" href="#bb0140">28</a>,<a class="elsevierStyleCrossRef" href="#bb0255">51</a>,<a class="elsevierStyleCrossRef" href="#bb0260">52</a>,<a class="elsevierStyleCrossRef" href="#bb0325">65</a>,<a class="elsevierStyleCrossRef" href="#bb0335">67</a>,<a class="elsevierStyleCrossRef" href="#bb0340">68</a>,<a class="elsevierStyleCrossRef" href="#bb0375">75</a>,<a class="elsevierStyleCrossRef" href="#bb0425">85</a> However, some of these studies confirm low VC in the paediatric population with risk factors. Thus, only half of the children and adolescents aged 2–15 years with risk factors are vaccinated and less than 30% of children aged 6 months to 2 years with risk factors and an indication for vaccination are vaccinated.<a class="elsevierStyleCrossRef" href="#bb0255">51</a>,<a class="elsevierStyleCrossRef" href="#bb0260">52</a>,<a class="elsevierStyleCrossRef" href="#bb0300">60</a>,<a class="elsevierStyleCrossRef" href="#bb0325">65</a>,<a class="elsevierStyleCrossRef" href="#bb0340">68</a>,<a class="elsevierStyleCrossRef" href="#bb0360">72</a>,<a class="elsevierStyleCrossRef" href="#bb0415">83</a>Furthermore, several studies<a class="elsevierStyleCrossRef" href="#bb0455">91</a>,<a class="elsevierStyleCrossRef" href="#bb0460">92</a> have shown that influenza vaccination is more effective in children aged ≥6 months or ≥4 years than in adults. This fact is clearly evident in the pandemic vaccination of children, whose effectiveness is maximum, reaching percentages close to 90% or even exceeding them in some of the youngest age groups.<a class="elsevierStyleCrossRef" href="#bb0375">75</a>,<a class="elsevierStyleCrossRef" href="#bb0380">76</a> There is sufficient scientific evidence to show that paediatric vaccination protects children from hospitalisation, admission to the PICU, or death.<a class="elsevierStyleCrossRef" href="#bb0465">93</a> Recent experience in the UK demonstrates how paediatric influenza vaccination reduces “out-of-hours” consultations, which in Spain would correspond to outpatient emergency or hospital visits that saturate these services during seasonal influenza epidemics. Mortality in children is infrequent in developed countries; most paediatric influenza deaths occur in developing countries.<a class="elsevierStyleCrossRef" href="#bb0020">4</a> The most consistent studies come from the USA, where the data point to low VC (31%) or incomplete vaccination (22%) in the deaths <18 years, in a country where annual influenza VC in children <18 years ranges from 50%–60% of the population.<a class="elsevierStyleCrossRef" href="#bb0340">68</a>Finally, an additional benefit is that, because of the role as super transmitters that children play in influenza epidemics, due to their longer period of virus shedding, and higher viral load than adults, vaccinating them may indirectly contribute to reducing the spread of seasonal influenza epidemics to other groups at higher risk, such as the elderly,<a class="elsevierStyleCrossRefs" href="#bb0040">8–10</a>,<a class="elsevierStyleCrossRef" href="#bb0060">12</a> cohabiting minors (as in the case of siblings),<a class="elsevierStyleCrossRef" href="#bb0135">27</a>,<a class="elsevierStyleCrossRef" href="#bb0330">66</a>,<a class="elsevierStyleCrossRef" href="#bb0375">75</a> and the immunocompromised, etc. This would help reduce the burden of care in healthcare centres and primary paediatric care<a class="elsevierStyleCrossRef" href="#bb0470">94</a> and could modify traditional incidence profiles by age group.<a class="elsevierStyleCrossRef" href="#bb0395">79</a> Therefore, a recommendation for a strategy of vaccination “in the nest” is all the more necessary.Influenza indications often begin in those aged ≥65 years and those with comorbidities. This probably tends to take the focus away from the need for vaccination in children and adolescents with risk factors, and this aspect could be improved with universal vaccination for them, which would also significantly reduce hospitalisations, PICU admissions, and avoidable deaths in the rest of the paediatric population. This is why, in the last quarter of 2021 the Spanish Paediatrics Association (AEP) included the recommendations for 2021–2022 following the guidelines initiated by the USA (2008), the WHO (2012), and the ECDC in 2009, advising universal vaccination for all children between 6 and 59 months.<a class="elsevierStyleCrossRef" href="#bb0020">4</a>,<a class="elsevierStyleCrossRef" href="#bb0475">95</a>,<a class="elsevierStyleCrossRef" href="#bb0480">96</a>On the other hand, in September 2022, some autonomous communities included influenza vaccination of the paediatric population between 6 and 59 months of age in the 2022–2023 season and others announced it for the next season. The Ponencia del Programa y Registro de Vacunaciones has prepared a document, “Recommendations for influenza vaccination in the paediatric population aged 6 to 59 months”, which was reviewed and approved by the Public Health Commission on 20 October 2022. The report concludes that after a review of the scientific literature and an evaluation of influenza vaccination in children aged 6–59 years, its inclusion in the vaccination schedule is recommended. Furthermore, to achieve good coverage in implementing the programme, a single dose is recommended, in people not previously vaccinated as well. The recommendation to vaccinate children over 59 months of age and at risk, as well as their close contacts, is retained.<a class="elsevierStyleCrossRef" href="#bb0485">97</a>In conclusion, this article presents the results of an eclectic approach based on a search of official information, a systematic search of scientific literature and additional literature, and the latest Spanish recommendations on the subject. From the study of the evidence gathered, even with the limitations of available data sources, we confirm that vaccinating healthy children <5 years of age, as recommended by the WHO, the ECDC, and the AEP, brings direct benefits to this population, avoiding hospitalisations and deaths, as well as alleviating the burden of seasonal influenza disease in Spain, which is always important but was even more so during the COVID-19 pandemic. There are also indirect benefits on transmissibility to the adult population. Universal paediatric vaccination should be the next step as it is already in some countries. Controlled observational studies are needed in Spain to assess the real impact of influenza on the entire paediatric population.FundingThe drafting and editing of this article was supported by professional medical writers funded by AstraZeneca. AstraZeneca has in no way influenced the content or the authors' decision to publish." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1894877" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "as0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1639554" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1894876" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "as0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "as0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "as0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1639555" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "s0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "s0015" "titulo" => "Results" "secciones" => array:7 [ 0 => array:3 [ "identificador" => "s0020" "titulo" => "Paediatric influenza in Spain" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "s0025" "titulo" => "Systematic review of studies on influenza in the paediatric population" ] ] ] 1 => array:3 [ "identificador" => "s0030" "titulo" => "Revision of SVGE reports" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "s0035" "titulo" => "Incidence of influenza in Spain" ] 1 => array:2 [ "identificador" => "s0040" "titulo" => "Hospitalisations in Spain" ] 2 => array:2 [ "identificador" => "s0045" "titulo" => "Admission to intensive care units in Spain" ] 3 => array:2 [ "identificador" => "s0050" "titulo" => "Mortality" ] 4 => array:2 [ "identificador" => "s0055" "titulo" => "Transmissibility" ] ] ] 2 => array:2 [ "identificador" => "s0060" "titulo" => "Systematic literature review on influenza in the paediatric population in countries with paediatric vaccination" ] 3 => array:3 [ "identificador" => "s0065" "titulo" => "Canada" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "s0070" "titulo" => "Epidemiological context and paediatric influenza vaccination schedule" ] 1 => array:2 [ "identificador" => "s0075" "titulo" => "Burden of disease related to paediatric influenza vaccination" ] ] ] 4 => array:3 [ "identificador" => "s0080" "titulo" => "United States of America" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "s0085" "titulo" => "Epidemiological context and paediatric influenza vaccination programme" ] 1 => array:2 [ "identificador" => "s0090" "titulo" => "Burden of disease associated with paediatric influenza vaccination" ] ] ] 5 => array:3 [ "identificador" => "s0095" "titulo" => "Finland" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "s0100" "titulo" => "Epidemiological context and paediatric influenza vaccination programme" ] 1 => array:2 [ "identificador" => "s0105" "titulo" => "Burden of disease associated with paediatric influenza vaccination" ] ] ] 6 => array:3 [ "identificador" => "s0110" "titulo" => "United Kingdom" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "s0115" "titulo" => "Epidemiological context and paediatric influenza vaccination programme" ] 1 => array:2 [ "identificador" => "s0120" "titulo" => "Burden of disease associated with paediatric influenza vaccination" ] ] ] ] ] 7 => array:2 [ "identificador" => "s0125" "titulo" => "Discussion and conclusions" ] 8 => array:2 [ "identificador" => "s0130" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "xack665605" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-12-20" "fechaAceptado" => "2023-12-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1639554" "palabras" => array:6 [ 0 => "Paediatric influenza" 1 => "Disease burden" 2 => "Influenza vaccine" 3 => "Paediatric influenza vaccination" 4 => "Influenza attenuated vaccine" 5 => "Intranasal vaccine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1639555" "palabras" => array:6 [ 0 => "Gripe pediátrica" 1 => "Carga de enfermedad" 2 => "Vacuna de gripe" 3 => "Vacunación pediátrica gripe" 4 => "Vacuna atenuada gripe" 5 => "Vacuna intranasal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionThe burden of influenza in the paediatric population is often underestimated by healthcare professionals and the general population, mainly due to poor perception of its clinical importance at the individual level and its health impact at the healthcare level. The aim of this review was to collect data on the burden of paediatric influenza in Spain and to compare them with data of countries where vaccination strategies for healthy paediatric populations have been implemented. MethodsWe collected data on the burden of paediatric influenza in Spain through a systematic search of literature published between 2016–2021 (PRISMA methodology). We conducted a review of reports from the Spanish Influenza Surveillance System (SVGE) (2010–2011 to 2019–2020) and of international reports (from Canada, Finland, USA, and UK) through a systematic (2016–2021) and pragmatic search. Results1366 articles were obtained from the systematic searches by country; 26 met the inclusion criteria. According to the SVGE (Spain's Influenza Surveillance System), those <15 years have the highest incidence of influenza per 100,000 population (cumulative-mean rate: 9457.9) compared to those ≥15 years (2285.6), and percentage of admission to the Paediatric Intensive Care Unit (PICU) greater than those >65 years (mean: 29.1% vs. 17.5%). Hospitalisation of severe cases per 100,000 population in children aged 0–4 years and those >65 years is similar (median: 20.2 vs. 28.4). Those aged <15 years have a higher incidence rate per 100,000 population (213.3), in contrast to those aged 15–64 years (21.9) and those aged ≥65 years (65.2). In countries with paediatric vaccination programmes (USA, Finland, and UK) the burden of influenza in children is reduced by 40%–74%, whereas 50%-93.5-% of cases presenting to the ED, hospitalised, admitted to PICU, or dying from influenza are unvaccinated. ConclusionsThe burden of paediatric influenza in Spain includes a significant number of hospitalisations and PICU admissions and justifies the vaccination strategy recommended by the WHO since 2012. In countries with this recommendation, the vaccinated paediatric population is better protected against severe forms of influenza and potential benefits for reducing the burden of paediatric influenza in Spain can be extracted from their data." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "as0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "as0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "as0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa carga de gripe en población pediátrica suele estar infravalorada por los sanitarios y por la población general debido fundamentalmente a la escasa percepción de su importancia clínica a nivel individual como al impacto sanitario a nivel asistencial. El objetivo de esta revisión es recopilar datos sobre la carga de gripe pediátrica en España y contrastarlos con los de países en los que hay implementadas estrategias de vacunación de población pediátrica sana. MétodosSe recopilaron datos de carga de gripe pediátrica en España mediante búsqueda sistemática de literatura publicada entre 2016–2021 (metodología PRISMA) y revisión de informes del Sistema de Vigilancia de la Gripe en España (SVGE) (2010–2011 a 2019–2020) e internacionales (de Canadá, Finlandia, EE. UU. y Reino Unido) mediante búsqueda sistemática (2016–2021) y pragmática. ResultadosSe obtuvieron 1366 artículos de las búsquedas sistemáticas por países; 26 cumplían los criterios de inclusión. Según el SVGE, los <15 años presentan la mayor incidencia de gripe por 100,000 habitantes (tasa acumulada-mediana: 9457,9) respecto a los ≥15 años (2285,6); y porcentaje de ingreso en la Unidad de Cuidados Intensivos Pediátricos (UCIP) mayor que los >65 años (media: 29,1% vs. 17,5%). La hospitalización de casos graves por 100,000 habitantes en niños de 0–4 años y en los >65 años es similar (mediana: 20,2 vs. 28,4). Los <15 años tienen mayor tasa de incidencia por 100,000 habitantes (213,3), en contraste con la de los de 15–64 años (21,9) y los ≥65 años (65,2). En los países con programa de vacunación pediátrica (EE. UU., Finlandia y Reino Unido) se reduce la carga de la gripe en niños entre un 40–74% mientras que 50–93,5-% de los casos que acuden a Urgencias, son hospitalizados, ingresan en UCIP o fallecen por gripe no están vacunados. ConclusionesLa carga de gripe pediátrica en España incluye un importante número de hospitalizaciones e ingresos en la UCIP y justifica la estrategia de vacunación recomendada por la OMS desde 2012. En países con dicha recomendación, la población pediátrica vacunada está más protegida frente a formas graves de gripe y de sus datos se extraen potenciales beneficios para disminuir la carga de gripe pediátrica en España." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "as0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "as0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "as0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "as0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ortiz de Lejarazu Leonardo R, Moraga-Llop F. Carga de gripe en la población pediátrica en España y los beneficios de la vacunación. Vacunas. 2022. https://doi.org/10.1016/j.vacun.2023.01.001" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<elsevierMultimedia ident="ec0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "s0135" ] ] ] ] "multimedia" => array:10 [ 0 => array:8 [ "identificador" => "f0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1917 "Ancho" => 1660 "Tamanyo" => 349037 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "A) Cumulative incidence rate of influenza by age over the seasons 2010–2020 per 100,000 population. Data obtained from sentinel surveillance systems of the Spanish influenza surveillance system (SVGE). SVGE report season 2019–2020. Data for the 2010–2011 season correspond to the estimate of the graph in the 2019–2020 report. B) numerical data on cumulative incidence rate of influenza. IQR: interquartile range." ] ] 1 => array:8 [ "identificador" => "f0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1736 "Ancho" => 1660 "Tamanyo" => 294718 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "SHCIC estimates by age for the seasons 2010–2011 and 2019–2020. A) Graph on data obtained/estimated on 100,000 population from the graphs of each SVGE annual report between the 2010–2011 and 2019–2020 seasons. B) Estimated numerical data on 100,000 population from the graphs of each SVGE annual report between the 2010–2011 and 2019–2020 seasons. ¶Data obtained from the different annual SVGE reports. ‡For all seasons except 2019–2020 the categories 15–44 years and 45–64 years are shown. In the 2019–2020 season this category disappears and is simplified to 15–64 years. In the annual reports of the 2010–2011 season, the data for the groups 0–4 years and 5–14 years were disaggregated (information on the 0–4 years group is shown in graphical form in the 2010–2011 season report as 2 different groups (< 1 year and 1–14 years); in the 2011–2012 season, for the 0–4 years group. IQR: interquartile range." ] ] 2 => array:8 [ "identificador" => "f0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2958 "Ancho" => 1660 "Tamanyo" => 377975 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Clinical severity of influenza according to cumulative percentage of admission to PICU/ICU in the seasons 2018–2019 and 2019–2020. A) Seasons 2018–2019 and 2019–2020. The SVGE report does not specify whether these results are from hospitalised severe cases with influenza; B) Numerical data from SVGE reports, Median and interquartile range (IQR) of the season for each age group and average of the medians for each age group in the 2 seasons. Low (no symbol); Moderate‡; High‡.‡N.A.: not applicable; ICU: intensive care unit; IQR: interquartile range; PICU: paediatric intensive care unit; SVGE: Spanish influenza surveillance system." ] ] 3 => array:8 [ "identificador" => "f0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1348 "Ancho" => 1660 "Tamanyo" => 177890 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Transmissibility levels of the 2019–2020 influenza epidemic per 100,000 population. A) Graph based on data from the SVGE report 2019–2020. B) Numerical data from the SVGE on transmissibility levels in the season 2019–2020." ] ] 4 => array:8 [ "identificador" => "t0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inclusion criteria \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exclusion criteria \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• National and/or local studies conducted in the Spanish population under 18 years of age• Studies reflecting the burden of influenza disease in children and adolescents in Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">• Systematic reviews<a class="elsevierStyleCrossRef" href="#tf0005">a</a>• Over 5 years of age• Specific to COVID-19, including only the adult population, and referring to the Spanish Influenza of 1918–1919• Any language other than Spanish or English• Preclinical studies• Veterinary studies \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3167217.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tf0005" "etiqueta" => "a" "nota" => "We conducted an analysis of the literature references of the systematic reviews located to identify original publications of potential interest that would not have emerged under the search strategy used." ] ] ] "descripcion" => array:1 [ "en" => "Inclusion and exclusion criteria for studies located by systematic search on the burden of influenza in the paediatric population." ] ] 5 => array:8 [ "identificador" => "t0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IQR: interquartile range." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age distribution \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seasons \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of seasons \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Geographical scope \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Participating hospitals (n) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aristegui et al.<a class="elsevierStyleCrossRef" href="#bb0115">23</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidemiological, observational, retrospective, through review of medical records of patients hospitalised for influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">907 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.3% were < 2 years and 77.6% were < 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2014–2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Basque Country, Madrid, Catalonia, Andalusia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bustamante et al.<a class="elsevierStyleCrossRef" href="#bb0135">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, case–control study in children admitted to a tertiary hospital due to influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 6 months(with no comorbidity) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">210(88 cases and 122 controls) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cases = 1.6 months (IQR = 1.0–3.1).Controls = 1.9 months (IQR = 0.9–3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010–2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jané et al.<a class="elsevierStyleCrossRef" href="#bb0120">24</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, retrospective descriptive in children hospitalised for severe influenza infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 17 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">291 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.7% were < 2 years and 24.4% were < 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010–2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Catalonia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mazagatos et al.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, retrospective, epidemiological surveillance. Hospitalised patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age = 2 months (range 1–4 months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2017–2019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asturias, Cantabria, Basque Country, Aragon, Valencian C., Castilla La Mancha, Madrid, Murcia, Andalusia, Balearic I. Canary I., Ceuta and Melilla \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 67 hospitals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ortiz-Lana et al.<a class="elsevierStyleCrossRef" href="#bb0140">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, prospective study in a tertiary hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">501 (confirmed, 131 [26.1%]) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age = 36 months (range 0–179 months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010–2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilbao \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solís-García et al.<a class="elsevierStyleCrossRef" href="#bb0130">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, retrospective cohort study of patients hospitalised with a diagnóstico of influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 16 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">245 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age = 21 months (IQR = 6–57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2015–2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Madrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">San Román Montero et al.<a class="elsevierStyleCrossRef" href="#bb0145">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational. Analysis of the Minimum Basic Data Set. Hospitalised patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5618 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age = 3.05 months; 68.6% were < 6 months; 37.1% < 2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009–2015/ 2015–2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98% of Spanish public hospitals \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3167218.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Studies on influenza in children in Spain located by systematic search (2016–2021)." ] ] 6 => array:8 [ "identificador" => "t0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IQR = Interquartile range; PICU: paediatric intensive care unit; N.A: not applicable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Influenza cases confirmed in ED \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospitalisations \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PICU \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortality \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transmissibility \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other relevant considerations \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aristegui et al.<a class="elsevierStyleCrossRef" href="#bb0115">23</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Paediatric admissions = 1.6% (95% CI = 1.5–1.7%)Mean annual hospitalisation incidence = 0.51/ 1000 children <15 years (95% CI = 0.5–0.6)Total stay = 6129 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10%881 total days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 50% were < 6 months or had underlying diseases.74% were not vaccinated and 35.2% were children with risk factors indicating vaccination \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bustamante et al.<a class="elsevierStyleCrossRef" href="#bb0135">27</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Having siblings is a risk factor for hospital admission and vaccinated grandparents a “protective”. factor against admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaccination during pregnancy was uncommon both in cases and controls (3.5% vs. 8.3%; p = .3) despite being recommended in 71.6% of cases and 71% of controls, p = .93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jané et al.<a class="elsevierStyleCrossRef" href="#bb0120">24</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the total number of hospitalised children, 56.7% were < 2 years and 24.4% < 1 yearTotal stay = 9.2 days (± SD 13.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.3% (12.8 days ± SD 9.7)54.8% of admitted children <2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The vaccination rate 5.8%; 27.1% in cases with chronic diseaseThe A(H1N1)pdm09 subtype was found more frequently and was more severe in children <2 years (63.1%), while influenza B was more frequent in children aged from 3–11 years (58.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mazagatos et al.<a class="elsevierStyleCrossRef" href="#bb0125">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the hospitalised cases, 69% developed one or more complications.Only 17.4% of the mothers were vaccinated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ortiz-Lana et al.<a class="elsevierStyleCrossRef" href="#bb0140">28</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29.3% (120/410, 95% CI = 24.9–33.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1% (11/91; 95% CI = 6.2–20.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Household contacts with symptoms 25.8% (95% CI = 21.2–31.1%) vs. 17.5% (95% CI = 15.0–20.2%; p = .0032) in children without confirmed diagnóstico \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the 131 cases of laboratory confirmed influenza, 107 (81.7%) returned to the ED and 2 (1.5%) were admitted after being discharged. Global cost median = 177.0 € (range = 19.0–4288.0 €).71.8% school absenteeism (6.6 days, range = 1–15 days)Only 1/131 children were vaccinated (0.8%). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Solís-García et al.<a class="elsevierStyleCrossRef" href="#bb0130">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Say 4 days (IQR = 3–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.9%(0.6 días IQR = 0.3–1.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.8% had underlying conditions.29 patients (11.8%) developed neurological events before or during hospitalisation, 9 of whom required antiepileptic drugs at discharge \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">San Román Montero et al.<a class="elsevierStyleCrossRef" href="#bb0145">29</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">156.1 (95% CI = 152.4–160.6%) per 100,000 children <12 months.Mean stay = 6.6 days (95% CI = 6.4%–6.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1812 of whom were < 6 months.Mortality rate = 0.5 (95% CI = 0.27–0.73%) /100000 < 12 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3167220.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of the populations and clinical outcomes of studies on influenza in children in Spain located through the systemic search (2016–2021)." ] ] 7 => array:8 [ "identificador" => "t0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age distribution \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seasons \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of seasons \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Geographical scope \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Participating hospitals/ information sources (n) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CANADA</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buchan et al.<a class="elsevierStyleCrossRef" href="#bb0250">50</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective, multicentre, cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–59 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7659 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age in influenza A = 17 (IQR = 5–31)Median age in subtype pH1N1 = 21 (IQR = 7–38)Median age in influenza B = 25 (IQR = 10–45) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009–2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ontario \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83, although 80% of the patients came from 23 hospitals \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gilca et al.<a class="elsevierStyleCrossRef" href="#bb0255">51</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective, hospitalisations due to acute respiratory tract infections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Children and adults \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 18 years = 1171 > 18 years = 3933 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011–2019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Quebec \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tran et al.<a class="elsevierStyleCrossRef" href="#bb0260">52</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidemiological surveillance study of the Canadian Immunisation Monitoring Program ACTive \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤ 16 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4155 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age in influenza A = 2.0 (0.6–4.8)Median age in influenza B = 3.9 (1.4–7.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2004–2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Newfoundland, Nova Scotia, Quebec,Ontario, Manitoba, Saskatchewan,Alberta, and British Columbia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buck et al.<a class="elsevierStyleCrossRef" href="#bb0315">63</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective, cohort, patients diagnosed with influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months-18 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Commercial database = 478,002 patients and 955,893 controlsMedicaid database 399,868 patients and 799,341 controls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6–35 months:14.4% (Commercial cohort); 24.9% (Medicaid)6 months-5 years:27.9% (Commercial); 43.8% (Medicaid);5–13 years:51% (Commercial), 44.6% (Medicaid)13–18 years:21.1% (Commercial); 51.9% (Medicaid) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010–2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<a class="elsevierStyleCrossRef" href="#tf0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Campbell et al.<a class="elsevierStyleCrossRef" href="#bb0335">67</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective, epidemiological surveillance data analysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months-17 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 groups:Hospitalised = 1792ED = 1944 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 18 years hospitalised in all centres, < 18 years in EDs in 4 centres. < 5 years in 3 centres \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2018–2019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kansas City, MO; Rochester, NY;Cincinnati, OH; Pittsburgh, PA;Nashville, TN; Houston, TX; andSeattle, WA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥ 7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chaudhari et al.<a class="elsevierStyleCrossRef" href="#bb0320">64</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective, patients presenting to the emergency department with suspected influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55,986 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age of the sample = 10.7 (IQR = 5.7–16.8) months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009–2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evers et al.<a class="elsevierStyleCrossRef" href="#bb0325">65</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective, patients presenting to the emergency department with suspected influenza in a tertiary hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≤ 18 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">818 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 2 years = 359 ≥ 2 years = 459 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2012–2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Seattle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Putri et al.<a class="elsevierStyleCrossRef" href="#bb0345">69</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analysis of cases and estimates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–100 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA population in 2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 5 years, 5–17 years, 18–49 years, 50–64 years, and ≥ 65 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shang et al.<a class="elsevierStyleCrossRef" href="#bb0340">68</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidemiological surveillance analysis focusing on influenza-associated deaths \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 18 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">675 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median age = 6 years; IQR = 2–12 years. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010–2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wallick et al.<a class="elsevierStyleCrossRef" href="#bb0330">66</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective, cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1,224,808 households with ≥2 members \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 12 years; 12–18 years; 19–34 years; 35–44 years; 45–54 years; 55–64 years; 65–74 years;75–84 years;≥ 85 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2014–2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2b \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FINLAND</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heikkinen et al.<a class="elsevierStyleCrossRef" href="#bb0385">77</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Analysis of 2 prospective cohort studies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">a. ≤ 13 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">a. 2231 b. 1185 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">a. n = 282 b. n = 152 (of a total 434 diagnosed with influenza) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">a. 2000–2002 b. 2007–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Turku \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2c \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">  \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">b. 1–3 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza A median = 2.6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">     \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mattila et al.<a class="elsevierStyleCrossRef" href="#bb0370">74</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective, in all patients with laboratory-diagnosed influenza in a tertiary hospital during the seasons under study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 16 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">391 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">   Influenza B median B = 6.4 years.p < .0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2004–2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Turku \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mattila et al.<a class="elsevierStyleCrossRef" href="#bb0375">75</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective, cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">431 (408 active) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age at time of diagnosis = 7.6 months (range = 4.3–11.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2017–2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Turku \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Teros- Jaakkola et al.<a class="elsevierStyleCrossRef" href="#bb0380">76</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prospective, birth cohort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">923 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age in months (range) at start of each season:3.7 (0.03–8.0)8.1 (0.1–17.4)15.6 (7.3–23.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2008–2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Southwest Finland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UNITED KINGDOM</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gallagher et al.<a class="elsevierStyleCrossRef" href="#bb0410">82</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidemiological retrospective \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 14 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010–2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Northern Ireland \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1e \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hardelid et al.<a class="elsevierStyleCrossRef" href="#bb0415">83</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective epidemiological data analysis of children with influenza admitted to PICUs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1778 influenza-related PICU admissions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 6 months = 5096–24 months = 5892–5 years = 3495–15 years = 514(of the total admitted to PICU, which was 1961) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2003–2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1f \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hardelid et al.<a class="elsevierStyleCrossRef" href="#bb0420">84</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Retrospective epidemiological data analysis on children admitted to PICU diagnosed with influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">873 influenza-associated PICU admissions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 1 year = 3061 year = 1432–4 years:1835–15 years = 297 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2003–2017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">United Kingdom \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1f \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pebody et al.<a class="elsevierStyleCrossRef" href="#bb0425">85</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Test-negative case control study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–17 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">482 positive for influenza in laboratory tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2018–2019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">England \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1g \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Walker et al.<a class="elsevierStyleCrossRef" href="#bb0430">86</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case study \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–23 weeks of age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 in 2013/1481 in 2014/15with laboratory-confirmed influenza \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–7 weeks = 15; 338–15 weeks = 11; 4116–23 weeks = 11; 7(The 1st figure represents the n in the 2013/2014 season and the 2nd figure represents the n in the 2014/2015 season) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2013–2015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">England \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1h \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3167216.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tf0010" "etiqueta" => "a" "nota" => "The data were obtained from Truven Health MarketScan Commercial Claims and Encounters (Commercial) and Multi-State Medicaid (Medicaid).b The data were obtained from MarketScan® Commercial Claims and Encounters Database and MarketScan® Medicare Supplemental and Coordination of Benefits Database (IBM Watson Health, Cambridge, MA).cMedical records and daily symptom cards (completed by patients).dPrimary care clinic.eHealth Protection Public Health Agency (PHA) routine primary care influenza enhanced surveillance system.fPaediatric Intensive Care Audit Network (PICANet)gRespiratory DataMart Surveillance system (RDS).hClinical Practice Research Datalink. IQR: interquartile range; N.A: not applicable." ] ] ] "descripcion" => array:1 [ "en" => "Studies located through the systematic search on influenza in children in countries with an influenza vaccination programme in healthy children (2016–2021)." ] ] 8 => array:8 [ "identificador" => "t0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0045" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "*In Campbell et al.<a class="elsevierStyleCrossRef" href="#bb0335">67</a> 3 centres only provided ED patients <5 years old. IQR = interquartile range; N.A = not applicable; PICU = paediatric intensive care unit." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Confirmed cases of influenza in ED \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospitalised patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PICU \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortality \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transmissibility \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other relevant considerations \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CANADA</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buchan et al.<a class="elsevierStyleCrossRef" href="#bb0250">50</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza A = 0.19 ± 0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza A = 8.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Children with no comorbidities vs. children with comorbidities: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The baseline population was hospitalised due to influenza or respiratory syncytial virus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pH1N1 subtype = 0.15 ± 0.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pH1N1subtype = 3.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Due to influenza A: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Children with influenza B were older (median age: 25 months; IQR = 10–45 months) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza B = 0.17 ± 0.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza B = 4.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6% (47 h [IQR = 37–114]) vs. 11% (75 h [IQR = 43–185]) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Due to pH1N1 subtype = 6% (32 [IQR = 19–107]) vs. 6% (83 [IQR = 19–384]) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Due to influenza B ≤ 3% (112 [IQR = 97–210]) vs. 11% (78 [IQR = 33–166]) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gilca et al.<a class="elsevierStyleCrossRef" href="#bb0255">51</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (1.1%)</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The patients at study baseline were hospitalised due to acute respiratory infection \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza was detected in 268 of the children, 91 of whom were co-infected with another virus. The 6–23 months age group showed higher incidence \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">146/268 (54.5%) of the influenza infections were detected in children <2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The median age in children with monoinfection was 2 years, p < .001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only 29 (11.3%) of the children for whom there was vaccination data were vaccinated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tran et al.<a class="elsevierStyleCrossRef" href="#bb0260">52</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza B was responsible for 15.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">337/2645 due to influenza A; 190/1510 due to influenza B</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10/2645 due to influenza A; 16/1510 due to influenza B</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Children admitted during the 2009–2010 pandemic, and cases admitted for influenza A in April 2009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">At 58.3% of seasonal influenza-related admissions (median:34.8%; IQR = 29.9–45.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only 98/1504 (6.5%) of admissions due to influenza A and 59/855 (6.9%) of admissions due to influenza B, had been vaccinated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The proportion of influenza B hospitalisations was significantly higher in seasons with tetravalent vaccine antigenic mismatch than in seasons with antigenic match (46.3% vs. 28.5%; p < .0001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">USA</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="10" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Buck et al.<a class="elsevierStyleCrossRef" href="#bb0315">63</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The 6–35-month age group was more likely to need ED care (19.1% with complications; 11.2% without complications, Commercial and 36.2% with complications; 31.3% Medicaid). p < .001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Admissions: (Commercial = 4.5% with complications and 0.7% without complications; Medicaid = 5.5% with complications and 0.8% without complications). p < .001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="10" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="10" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="10" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cases and controls had similar comorbidity frequencies \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not only were influenza patients suffering a complication more likely to visit the ED than those without complications, but they were also more likely to need hospitalisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Admission costs contributed to 30% and 43% of total healthcare costs in the Commercial and Medicaid cohorts, respectively \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Incidence of cases diagnosed with influenza per 1000 patients in each season: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Commercial = 20.3 (95% CI = 20.23–20.34%); the highest incidence was in patients aged 6–35 months, 26.8 (95% CI = 26.6–27.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicaid = 32.6 (95% CI = 32.5–32.7%); the highest incidence was also in patients aged 6–35 months, 47.9 (95% CI = 47.6–48.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients with influenza-associated complications: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Commercial = 11.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicaid = 17.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The highest incidence of patients with complications was again in patients aged 6–35 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The Medicaid cohort had a lower rate of vaccinated patients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cases diagnosed with influenza incurred a mean $615 in all-cause medical costs unadjusted for patient characteristics vs. $168 (p < .001) in the Commercial cohort, and $707 vs. $207 (p < .001) in the Medicaid cohort. Again, the 6–35-month age group had the highest cost. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Campbell et al.<a class="elsevierStyleCrossRef" href="#bb0335">67</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the 1944 patients with acute respiratory disease in ED they tested, 420 were positive for influenza. In that group, the <6 months-5 years age group had the most positives = 290/420*.</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the 1792 admissions with acute respiratory disease they tested, 226 were positive for influenza. In that group, those <6 months-5 years were almost half of the sample = 109/226 positive for influenza.</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (hospitalised group)</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the hospitalised group, 226 (13%) were positive for influenza, of which 47% were positive for influenza A(H3N2), 36% for A(H1N1)pdm09, 9% for A (not subtyped), and 7% for influenza B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the ED group, 420 (22%) were positive for influenza; 48% for A(H3N2), 35% for A(H1N1)pdm09, 11% for A (not subtyped), and 5% for influenza B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The cases positive for influenza tended to be less vaccinated than the control patients in hospitalised patients (47% vs. 62%) and ED patients (40% vs. 58%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The 2018–2019 season vaccine reduced influenza A-associated hospitalisations and ED visits in 40% -60%, data that supported the recommendation to vaccinate children >6 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chaudhari et al.<a class="elsevierStyleCrossRef" href="#bb0320">64</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The study was conducted in children presenting to the ED with signs consistent with influenza (meeting diagnostic codes for influenza or influenza-like illness; patients with chronic conditions were excluded)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalisation rate in children <2 years: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% (1090 admissions) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (2 in ED and 2 during hospitalisation); mortality rate of 7 per 100,000</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% (10,960/55.986); Stay ≥3 days = 6.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Children <3 months have higher rates 2.7% (95% CI = 2.0%–3.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evers et al.<a class="elsevierStyleCrossRef" href="#bb0325">65</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The sample was drawn from children with influenza-like disease in the emergency department, and who did not require hospital care</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21% of the population < 2 years, and 46% of those ≥2 years were diagnosed as influenza positive \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of these only 31% and 27%, respectively, were vaccinated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaccination status was unknown in 26% of those <2 years and 36% ≥ 2 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Putri et al.<a class="elsevierStyleCrossRef" href="#bb0345">69</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The group with the highest mean number of ED visits was 0–7 years = 10.2 (Range 4.0–26.4) per 1000 people. The group with the next highest mean was ≥65 years, at 2.5 (range 2.0–2.9)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Children <1 year had the second highest mean hospitalisation among the groups = 2.0 (1.0–6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–17 years = 4 (2–6) per 1,000,000</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All values are estimates \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(those >65 years had a mean of 3.2 (1.9–11.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They estimated 1,851,377 (range = 1,632,397–2,209,708) cases in <5 years annually, of which 1,145,563 (range = 1,126,150–1,067,728) were ill, but were not seen in healthcare centres \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1–4 years = 0.5 (0.2–2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In the 5–17 years age group, there were an estimated 4,590,823 (range = 4,257,330–4,884,960) cases annually, with an estimated 2,741,258 (range = 2,599,283–2,708,924) not seen in healthcare centres \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The age group with the highest estimated cost in ED was 0–4 years ($ 86,425; range $648.19 -$ 1080.31)), above the second highest estimated cost group, those aged ≥65 years ($ 605.53; range $ 604.51–607.59) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The cost of hospitalisations in those <1 year was estimated at $ 5211.68; range $ 3908.76–6514.61); in 1–17-year-olds $7346.58; range $ 5509.94–9183.23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Shang et al.<a class="elsevierStyleCrossRef" href="#bb0340">68</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Study based on data on influenza-associated paediatric deaths from the US Centers for Disease Control and Prevention.</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean annual incidence = 0.15 per 100,000 children (95% CI = 0.1–0.2%), higher in <6 months (0.66; 95% CI = 0.5–0.8%), followed by the 6–23-month age group (0.3; 95% CI = 0.3–0.4%).</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only 31% of those aged ≥6 months had been vaccinated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">327 of 654 had no pre-existing medical conditions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compared with the children with previous conditions, those with none were younger (5 years vs. 8 years), were less vaccinated (27% vs. 36%), and were less likely to die before hospital admission 77% vs. 48%). They also had a shorter illness duration (4 days vs. 7 days); p < .05 for all. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wallick et al.<a class="elsevierStyleCrossRef" href="#bb0330">66</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The highest proportion of primary or secondary diagnosed cases was reported in children (62%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FINLAND</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heikkinen et al.<a class="elsevierStyleCrossRef" href="#bb0385">77</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 of 100 children aged <3 years with moderate/severe influenza</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 of 100 children <3 years with moderate/severe influenza</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">437 children were diagnosed with influenza, of which 3 were excluded for the study due to co-infection or unknown data. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">152 children (35%) were < 3 years and 282 (65%) were aged 3–13 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">349 children (80%) had influenza A (221 children A(H1N1) and 128, A(H3N2), and 73 children (17%) influenza B. In 12 (3%) the virus was not subtyped \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parental absenteeism rates were 184 (95 CI = 153%–215%) days per 100 children with moderate/severe influenza and 135 (95% CI = 109%–161%) days per 100 children with mild influenza (p = .02) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">School absenteeism was ≥1 day in 137 (77%) of 177 cases of moderate/severe influenza and in 133 (73%) of the 181 cases of mild influenza \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mattila et al.<a class="elsevierStyleCrossRef" href="#bb0370">74</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">With the exception of the 2009–2010 pandemic, the proportion of hospitalisations in the different seasons for: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (12.9%, p = .55) children with influenza A; mean duration = 2.7 (SD 3.5) days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (in the age group 0–2)</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.4% of the patients were diagnosed with influenza A and 28.6% influenza B</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza A = 45%–93% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (15.2%, p = .55) with influenza B; mean duration = 4.2 (SD 7.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean duration = 2.3 days, p = .34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Influenza B = 7%–55% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean duration = 2.7 days, p = .34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mattila et al.<a class="elsevierStyleCrossRef" href="#bb0375">75</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A cohort of children born between 01/09/2017 and 30/06/2018. Their parents were required to bring them to the clinic as soon as symptoms consistent with influenza began. 80% of the children diagnosed with influenza attended the clinic within 48 h of symptom onset</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jan-55</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N.A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The study population is a cohort of children born in 2017 followed up for 10 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55/408 were diagnosed with laboratory-confirmed influenza, 28 virus A and 27 virus B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only 4 had received the 2 doses of influenza vaccine \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Five were ruled out with co-infection of influenza and another non-influenza predominant respiratory virus. Of the monoinfections, virus A was detected in 26 cases and virus B in 24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Teros- Jaakkola et al.<a class="elsevierStyleCrossRef" href="#bb0380">76</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5%)</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The baseline population was a birth cohort \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The number of children during the years of the study varied at the beginning of each season (335–637) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Incidence in each season = 2008–2009, of 335 children, 17 were influenza positive (14 for influenza A[H3N2], and 3 for B), in 2009–2010, of 637 children, 17 were influenza positive (12 for influenza A[H1N1] and 5 for influenza B), and in 2010–2011, of 444 children, 22 were influenza positive (4 for influenza A[H1N1], and 18 for influenza B) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age of the children with influenza = A(H3N2) = 6.1 months; A(H1N1)pdm09 = 11.9 months and B = 13.1 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Of the 758 (82%) children whose vaccination status was available, 60 were from the 2008–2009 season, for which vaccine effectiveness was not estimated due to the low number of subjects. For the other 2 seasons, vaccine effectiveness in 2009–2010 was estimated at 97% (95% CI = 76%–100%) and in 2010–2011 at 41% (95% CI = 75%–80%). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UNITED KINGDOM</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gallagher et al.<a class="elsevierStyleCrossRef" href="#bb0410">82</a></td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The cumulative incidence rate for “out-of-hours” consultations was 10.01/100000 in phase 0, 4.7 in phase 1, and 5.13 in phase 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The data analysed were from the paediatric primary care population \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The incidence rate in primary care consultations was higher in phase 0 (15.1/100000) than in phase 1 (8.3) and phase 2 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vaccination \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(they were visits for influenza and influenza-like illness) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phase 0 = 2010–2013 the vaccine was not offered to children with no associated risk \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phase 1 = 2013–2014, 55.5% of pre-schoolers and 80.5% of primary school children were vaccinated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phase 2 = 2014–2017, 54.5, 50.5, and 52.6% of pre-schoolers vaccinated in each season (from 2014–2015 to 2016–2017, respectively) and 79.7, 76.8 and 78.3% of primary children were vaccinated in each season (from 2014–2015 to 2016–2017, respectively) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hardelid et al.<a class="elsevierStyleCrossRef" href="#bb0415">83</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143 (7.3%) of those admitted to PICU died, of which only 5 (3.5%) did not have high risk conditions</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The baseline population was the population admitted to the PICU \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1961 admissions (487 in period 1, 375 in period 2, 371 in period 3, 367 in period 4, and 361 in period 5), of which 1540 (78.5%) were children with at least one at-risk condition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">To examine changes over time, the authors defined 5 seasons: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rate by ages: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">October 2003–March 2009 (pre-pandemic) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 2 years = 10.5/100000 (9.8–11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 2009–March 2010 (2 pandemic waves) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–5 years = 2.6/100000 (2.3–2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April 2010–March 2011 (third pandemic wave) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5–16 years = 1.0/100000 (0.9–1.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April Period 2011–2013 (post-pandemic period) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">September 2013–March 2015 (within the paediatric vaccination programme) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VC in the season 2015–2016 was 18.6% in the group aged 6 months-2 years and with severe risk factors, 34.4% in pre-schoolers, and 53.6% in children aged 6–7 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hardelid et al.<a class="elsevierStyleCrossRef" href="#bb0420">84</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The vaccination rate in England in infants aged 6 months - < 2 years in high-risk groups was <26%, and in the 2–15-year age group also at high risk, < 50%, between 2009 and 2016. It is 38.1% in pre-schoolers and 64.9% in the 6–8 years age group (data from winter 2016/2017) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">929, of which 48.3% were in <2 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They defined 5 periods: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The influenza-associated admission rate during winters of all seasons was 1.32/100000 children (95% CI = 1.2%–1.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">October 2003–March 2009 (pre-pandemic) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">There was considerable variability. Rates increased in the winter of 2010–2011 in children <5 and in the 2009–2010 season in children aged 5–15 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">October 2009–March 2010 (wave 2 of the pandemic influenza A[H1N1]pdm09) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Admission rates were highest in children <1 year (6.70; 5.97–7.49), and decreased with increasing age: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">October 2010–March 2011 (third wave of the pandemic) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 year = 3.15/100000 children (2.7–3.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">October 2011–March 2013 (post-pandemic period) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2–4 years = 1.4/100000 (1.2–1.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">October 2013–March 2017 (start of the paediatric vaccination programme) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5–15 years = 0.6/100000 (0.6–0.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">They did not identify a decrease in PICU admission rates following the introduction of the paediatric vaccination programme \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pebody et al.<a class="elsevierStyleCrossRef" href="#bb0425">85</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">307 = 104 due to influenza A(H1N1)pdm09, 40 due to A(H3N2), 156 due to influenza A not subtyped, and 6 due to influenza B. One case was co-infection with influenza A and B</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N.A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N.A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N.A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In the hospitalised patients, 78 of the influenza A(H1N1) positives, 28 of the influenza A(H3N1) positives, 112 of the non-subtyped influenza A(H1N1) positives, and 4 of the influenza B positives were not vaccinated \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The vaccination status of one of the influenza A (H3N1) positives, of 4 non-subtyped influenza A positives, and one of the influenza B positives was not known \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Walker et al.<a class="elsevierStyleCrossRef" href="#bb0430">86</a></td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Season 2013/2014 = 30 hospitalised infants (6 of their mothers were vaccinated, 20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N. A</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pregnant women were considered vaccinated if they had received the vaccine ≥2 weeks postpartum \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Season 2014/2015 = 69 hospitalised infants (17 of their mothers were vaccinated, 25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19% of pregnant women were vaccinated in the season 2013/2014 and 25% in the season 2014/2015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t">In 2013/2014, vaccine effectiveness per week and season was estimated in all cases at 70% (95% CI = 26%–88%) and in 2014/2015, at 50% (95% CI = 12%–78%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3167219.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Description of populations and clinical outcomes of localised influenza studies in children through systematic search of countries with a paediatric influenza vaccination programme (2016–2021)." ] ] 9 => array:7 [ "identificador" => "ec0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "detalles" => array:1 [ 0 => array:3 [ "identificador" => "al0050" "detalle" => "Image " "rol" => "short" ] ] "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 211688 ] "descripcion" => array:1 [ "en" => "Supplementary material" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:97 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "[1]." 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Burden of influenza in Spanish pediatric population and the benefit of vaccination

Carga de gripe en la población pediátrica en España y los beneficios de la vacunación

Raúl Ortiz de Lejarazu Leonardoa,

Corresponding author

lejarazu@gmail.com

Corresponding auhtor.

, Fernando Moraga-Llopb

a Centro Nacional de Gripe, Hospital Clínico y Universidad de Valladolid, Spain

b Práctica de Pediatría, Barcelona, Spain

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    "titulo" => "Burden of influenza in Spanish pediatric population and the benefit of vaccination"
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Cumulative incidence rate of influenza by age over the seasons 2010&#8211;2020 per 100&#44;000 population&#46; Data obtained from sentinel surveillance systems of the Spanish influenza surveillance system &#40;SVGE&#41;&#46; SVGE report season 2019&#8211;2020&#46; Data for the 2010&#8211;2011 season correspond to the estimate of the graph in the 2019&#8211;2020 report&#46; B&#41; numerical data on cumulative incidence rate of influenza&#46; <span class="elsevierStyleBold">IQR</span>&#58; interquartile range&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Annual influenza epidemics are estimated to result in approximately 1 billion cases worldwide&#44; of which 3&#8211;5 million are severe&#44; with an estimated mortality of 290&#44;000&#8211;6&#44;500&#44;000&#46;<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> The population group aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years usually receive the most attention in each epidemic&#44; as their mortality is higher than that of other age groups&#46;<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a> However&#44; the annual incidence of influenza in children is higher than in adults and the elderly&#59;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> children aged 5&#8211;9&#8239;years are the most commonly infected<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> and paediatric patients &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years &#40;especially those &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years&#41; become most acutely ill and have the highest morbidity&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> In 2012&#44; it was estimated that approximately 870&#44;000 children &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years were hospitalised annually for influenza worldwide<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a> and a 2008 meta-analysis estimated between 28&#44;000 and 111&#44;500 paediatric deaths due to influenza-associated respiratory infections in children &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years of age&#46;<a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> Furthermore&#44; the paediatric population is described as a more efficient vector for spreading influenza in the community than adults&#44;<a class="elsevierStyleCrossRefs" href="#bb0040"><span class="elsevierStyleSup">8&#8211;12</span></a> because children shed more viral load in their secretions and over a longer period of time&#46;<a class="elsevierStyleCrossRef" href="#bb0065"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">Since 2005&#44; the World Health Organisation &#40;WHO&#41; has advised vaccination of children &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months with risk factors&#44; healthy children aged 6&#8211;23&#8239;months&#44; and pregnant women&#44; to prevent severe disease during pregnancy and to protect infants&#44; because influenza vaccines are not licenced for children &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> In 2012&#44; the WHO extended this recommendation to healthy children aged up to 59&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> The Spanish Ministry of Health only recommends vaccination for people &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years and those &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months with comorbidities or living with people with risk factors&#46;<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">The Spanish influenza surveillance system &#40;SVGE&#41; does not present data on the paediatric burden of influenza systematically or with the granularity necessary for analysis that would allow detailed studies&#46; This results in incomplete and sometimes biased perception on the part of healthcare professionals&#44; who recommend vaccination very variably&#44; according to a recent publication based on 11&#44;108 surveys of healthcare professionals&#46;<a class="elsevierStyleCrossRef" href="#bb0085"><span class="elsevierStyleSup">17</span></a> Similarly&#44; data on paediatric influenza vaccination coverage &#40;VC&#41; from the Ministry of Health&#44; the SVGE&#44; and the ECDC &#40;European Centre for Disease Control&#41; are limited and fragmented&#44; compared to the data available for those aged &#62;<span class="elsevierStyleHsp" style=""></span>64&#8239;years&#44; pregnant women&#44; or healthcare professionals&#44; highlighting the different strategic priorities for these groups&#46;<a class="elsevierStyleCrossRefs" href="#bb0090"><span class="elsevierStyleSup">18&#8211;21</span></a> Data from Catalonia indicate that coverage in children with risk factors remains low &#40;&#60;24&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a> and is 61&#46;9&#37; in pregnant women in Spain&#46;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">The aim of this review was to compile data on the burden of influenza in Spain&#39;s paediatric population and to contrast these data with those of countries with established vaccination strategies for the healthy paediatric population&#44; and present them in a compiled form&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Methods</span><p id="p0025" class="elsevierStylePara elsevierViewall">For this work we used a combination of a systematic literature review using PRISMA methodology in PubMed&#44; Scopus&#44; Web of Science &#40;WoS&#41;&#44; and Virtual Health Library &#40;VHL&#41; databases of the last 5&#8239;years from Spain&#44; Canada&#44; USA&#44; Finland&#44; and the UK&#44; and the extraction of numerical or graphical data from SVGE annual reports &#40;2010&#8211;2011 to 2019&#8211;2020 seasons&#41;&#44; and a pragmatic search of additional literature&#46; The latter search was conducted due to heterogeneity in the timing and method of implementing paediatric influenza vaccination programmes in the selected countries&#46; Details of these data collection strategies are shown in the supplementary information annex to this article&#44; and the inclusion and exclusion criteria for papers are shown in <a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Results</span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Paediatric influenza in Spain</span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Systematic review of studies on influenza in the paediatric population</span><p id="p0030" class="elsevierStylePara elsevierViewall">The result of the systematic search is described in the supplementary material&#46; Seven observational articles were included&#44; summarised in <a class="elsevierStyleCrossRefs" href="#t0010">Tables 2 and 3</a>&#46; Five of these were retrospective&#58; one through a review of clinical histories&#44;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> one on hospitalisations for severe influenza infection&#44;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> one through epidemiological surveillance studies and data&#44;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> one cohort study&#44;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> and one case&#8211;control study&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> Of the remaining 2&#44; one was a prospective study<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> and the other a m&#237;nimum core data set analysis&#46;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a></p><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0035" class="elsevierStylePara elsevierViewall">These publications show that paediatric hospitalisation for influenza occurs most frequently in children aged &#8804;<span class="elsevierStyleHsp" style=""></span>3&#8239;years&#46; In 2 of the selected studies &#40;one cohort and one prospective&#41;&#44; the median age of hospitalisation for influenza was 21 and 36&#8239;months&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> In 2 other retrospective studies&#44; the percentage of children aged &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years hospitalised was 49&#46;3&#37; and 56&#46;7&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> These children had factors associated with severe influenza complications and their admission rate to the paediatric intensive care unit &#40;PICU&#41; in some of the studies was considerable&#44;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> ranging from 0&#46;8&#37; to 58&#37; &#40;<a class="elsevierStyleCrossRef" href="#t0015">Table 3</a>&#41;&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">In one of the retrospective studies on the clinical and epidemiological characteristics of patients under 18&#8239;years of age hospitalised for laboratory-confirmed influenza&#44; the most frequently reported complications&#44; which were pneumonia of unknown origin&#44; acute respiratory distress syndrome&#44; and bacterial pneumonia&#44; accounted for 62&#46;2&#37;&#44; 26&#46;8&#37;&#44; and 11&#46;7&#37; of complications&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> Furthermore&#44; a retrospective cohort study of patients hospitalised for influenza published in 2020 reported that 11&#46;8&#37; of paediatric patients presented neurological events before or after hospitalisation for influenza&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> In that study&#44; paediatric patients admitted to the PICU due to respiratory failure&#44; neurological events&#44; and septic shock accounted for 47&#46;6&#37;&#44; 23&#46;8&#37;&#44; and 14&#46;3&#37; of those hospitalised&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> In another retrospective observational study of patients hospitalised for laboratory-confirmed influenza&#44; paediatric patients requiring admission to the PICU for acute respiratory failure accounted for 10&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a></p><p id="p0045" class="elsevierStylePara elsevierViewall">In another retrospective study&#44; 69&#46;3&#37; of infants &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months developed one or more of the above-mentioned complications&#58; 46&#46;1&#37; had non-cardiac pneumonia&#44; 27&#46;1&#37; had acute respiratory distress syndrome&#44; 14&#46;9&#37; had bacterial co-infection&#44; and 1&#46;8&#37;&#44; multi-organ failure&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a></p><p id="p0050" class="elsevierStylePara elsevierViewall">Deaths due to influenza observed in studies of different time periods include a number of deaths that are described in 3 of the Spanish publications found&#46; These reported 2 &#40;3&#46;0&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> 3 &#40;1&#46;0&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> and 18 deaths &#40;rate of 0&#46;5 &#91;95&#37; CI 0&#46;3&#8211;0&#46;7&#93; due to influenza per 100&#44;000 children &#60;<span class="elsevierStyleHsp" style=""></span>12&#8239;months&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> which corresponded to the study of seasons 2&#44; 6 and 8&#44; respectively&#46; These publications collected data from epidemiological surveillance &#40;infants &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months hospitalised&#44; several autonomous communities&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> patients &#8804;<span class="elsevierStyleHsp" style=""></span>17&#8239;years hospitalised due to severe influenza infection &#40;study in one autonomous community&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> or from the minimum core data set &#40;infants &#60;<span class="elsevierStyleHsp" style=""></span>1&#8239;year hospitalised&#41;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a></p><p id="p0055" class="elsevierStylePara elsevierViewall">There are no data on annual influenza vaccination in healthy Spanish children&#46; Among the selected publications that collected data on paediatric vaccination&#44; VC against seasonal influenza in the included children&#44; even in children with risk factors&#44; was found to be low &#40;<a class="elsevierStyleCrossRefs" href="#t0010">Tables 2 and 3</a>&#41;&#46; According to a study on hospitalisation and influenza in the paediatric population&#44; of the 131 confirmed influenza cases reported&#44; mostly outpatients and only 11 hospitalised&#44;<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> VC in children &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months was only 0&#46;8&#37;&#46; In another study of 291 hospitalised children &#8804;<span class="elsevierStyleHsp" style=""></span>17&#8239;years&#44; VC was 5&#46;8&#37;&#44; rising to 27&#46;1&#37; in children with risk factors&#46;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> Finally&#44; in a 2-season study of 907 hospitalised children aged &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years with a clinical diagn&#243;stico of influenza&#44; the overall VC was 26&#37;&#44; and only 35&#46;2&#37; in children with risk factors despite their having a clear indication for vaccination&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a> Regarding vaccination history in mothers&#44; in a case&#8211;control study in a tertiary hospital of hospitalisations for influenza in infants &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months&#44; only 3&#46;4&#37; &#40;n&#8239;&#61;&#8239;88&#41; of the mothers of hospitalised cases had been vaccinated during pregnancy&#44; compared to 8&#46;3&#37; &#40;n&#8239;&#61;&#8239;122&#41; among the controls&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> Analysis of data from hospitalised paediatric cases &#8804;<span class="elsevierStyleHsp" style=""></span>6&#8239;months from 67 hospitals collected through the SVGE and severe hospitalised confirmed influenza cases &#40;SHCIC&#41; in one publication reflected VC of up to 17&#46;4&#37; &#40;n&#8239;&#61;&#8239;69&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> The latter study estimated that vaccination during pregnancy was 61&#37; &#40;95&#37; CI 27&#37;&#8211;79&#37;&#41; effective in preventing hospitalisations for confirmed influenza in children &#8804;<span class="elsevierStyleHsp" style=""></span>6&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a></p></span></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Revision of SVGE reports</span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Incidence of influenza in Spain</span><p id="p0060" class="elsevierStylePara elsevierViewall">According to SVGE reports from the 2010&#8211;2011 to the 2019&#8211;2020 season&#44; the cumulative incidence of confirmed influenza per 100&#44;000 population in Spain in the age groups 0&#8211;4&#8239;years &#40;median&#58; 4765&#46;7 &#91;IQR&#58; 1703&#46;9&#93;&#41; and 5&#8211;14&#8239;years &#40;median&#58; 4&#46; 302&#46;3 &#91;IQR&#58; 1545&#46;3&#93;&#41; during the influenza seasons analysed &#40;<a class="elsevierStyleCrossRef" href="#f0005">Fig&#46; 1</a>&#41; is always higher than in other age groups&#44; and the population aged 0&#8211;4&#8239;years experienced the highest incidence in the last 3 seasons&#46;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> The groups aged from 15 to 64&#8239;years and those &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years had a much lower cumulative incidence &#40;median&#58; 1617&#46;2 &#91;IQR 531&#46;4&#93; and median&#58; 645&#46;4 &#91;IQR&#58; 455&#46;5&#93;&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Hospitalisations in Spain</span><p id="p0065" class="elsevierStylePara elsevierViewall">The published cumulative rates of SHCIC per 100&#44;000 population show that the age groups with the highest rates are 0&#8211;4&#8239;years and&#8239;&#8805;&#8239;65&#8239;years &#40;<a class="elsevierStyleCrossRef" href="#f0010">Fig&#46; 2</a>&#41;&#46; In 4 of the 10 seasons analysed&#58; 2010&#8211;2011&#44;<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a> 2011&#8211;2012&#44;<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> 2012&#8211;2013&#44;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a> and 2019&#8211;2020<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a> dominated by influenza viruses of type&#47;subtype A&#40;H1N1&#41;&#44; A&#40;H3N2&#41;&#44; B&#44; and A&#40;H1N1&#41;&#44; respectively&#59; the 0&#8211;4&#8239;years age group had a higher number of SHCIC than the &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;year group&#44; and in 2 &#40;2013&#8211;2014<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> and 2015&#8211;2016<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a>&#41; the differences between both groups were small&#44; as they were seasons with predominance of subtype A&#40;H1N1&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0070" class="elsevierStylePara elsevierViewall">The SHCIC data in which the influenza virus responsible for hospitalisation has been subtyped and reported show that in the age groups 0&#8211;4&#8239;years&#44; 5&#8211;14&#8239;years&#44; and&#8239;&#8805;&#8239;65&#8239;years&#44; hospitalisations are due to the predominant subtype in each year&#46; The exception is the 5&#8211;14&#8239;years age group in the 2015&#8211;2016 and 2019&#8211;2020 seasons where&#44; despite the predominance of A&#40;H1N1&#41; in that age group&#44; the severe cases that were hospitalised were due to the B virus&#46;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> It should be noted that&#44; among adults&#44; most SHCIC were associated with individuals with risk factors&#46; In contrast&#44; among the paediatric population admitted&#44; the highest percentage showed no illness or risk factors prior to their hospitalisation for severe influenza&#46;<a class="elsevierStyleCrossRefs" href="#bb0150"><span class="elsevierStyleSup">30&#8211;39</span></a></p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0105">Admission to intensive care units in Spain</span><p id="p0075" class="elsevierStylePara elsevierViewall">Paediatric data on admission to the PICU due to influenza appear only in the reports for the 2018&#8211;2019 and 2019&#8211;2020 seasons&#44; merged into a single group of &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a> Their cumulative percentage of admissions is higher than the group &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years over the weeks of the influenza season&#44; with a median of 30&#46;8 &#40;IQR&#58; 4&#46;1&#41; vs&#46; 17&#46;9 &#40;IQR&#58; 2&#46;9&#41; in 2018&#8211;2019 and 27&#46;4 &#40;IQR&#58; 6&#46;0&#41; vs&#46; 16&#46;9 &#40;IQR&#58; 3&#46;2&#41; in 2019&#8211;2020 &#40;<a class="elsevierStyleCrossRef" href="#f0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="f0015"></elsevierMultimedia></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0110">Mortality</span><p id="p0080" class="elsevierStylePara elsevierViewall">Influenza mortality in children was analysed irregularly and inconsistently in the SVGE reports throughout the seasons analysed &#40;from 2011 to 2019&#41;&#46; Unlike reports from other countries with a similar tradition of influenza surveillance to Spain&#44; the SVGE lacks granularity in the data they provide on child mortality&#46; Therefore&#44; it was not possible to extract information on mortality by age between the seasons 2010 and 2018&#46; In the seasons 2018&#8211;2019 and 2019&#8211;2020&#44; mortality was analysed as impact levels according to the Z-scores of the excesses of all-cause mortality over the mean in the different age groups&#46; In the season 2018&#8211;2019&#44; the value for those &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years ranged from low to medium&#44; was low for the 15&#8211;64 age group&#44; and for those &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years&#44; nil&#46;<a class="elsevierStyleCrossRef" href="#bb0195"><span class="elsevierStyleSup">39</span></a> Finally&#44; in the season 2019&#8211;2020&#44; the level of impact was nil or low for all &#40;varying between weeks throughout the influenza season&#41; except for the 15&#8211;64&#8239;years age group&#44; for which it was moderate in week 5&#46;<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a></p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0115">Transmissibility</span><p id="p0085" class="elsevierStylePara elsevierViewall">This new measurement parameter of influenza epidemics reflects the ease with which the influenza virus circulates between individuals and communities&#46; High transmissibility means very rapid spread of the virus from person to person&#46; The main factors influencing this parameter are the ability of the virus to spread from person to person&#44; the dynamics of the spread&#44; the vulnerability of the exposed population&#44; and social and climatic circumstances&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">This new information is presented broken down by age group only in the annual report for the season 2019&#8211;2020&#46;<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a> These transmissibility levels are calculated through intensity thresholds using the mobile epidemic method&#44; obtaining different thresholds for each age group considered&#46;<a class="elsevierStyleCrossRef" href="#bb0200"><span class="elsevierStyleSup">40</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0205"><span class="elsevierStyleSup">41</span></a> As shown in <a class="elsevierStyleCrossRef" href="#f0020">Fig&#46; 4</a>&#44; those aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years show zero or low levels of transmissibility&#44; while those in the 15&#8211;64&#8239;years age group range from zero&#44; low&#44; or moderate&#46; In contrast&#44; the age group &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years shows high and moderate values&#44; as well as much higher crude values than the other 2 groups&#46;</p><elsevierMultimedia ident="f0020"></elsevierMultimedia></span></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0120">Systematic literature review on influenza in the paediatric population in countries with paediatric vaccination</span><p id="p0095" class="elsevierStylePara elsevierViewall">In the last 20&#8239;years&#44; several countries have adopted a strategy of vaccinating all healthy children &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0215"><span class="elsevierStyleSup">43</span></a> For this section of the review&#44; the 3 countries that pioneered paediatric vaccination &#40;Canada&#44; USA&#44; and Finland&#41; and the UK&#44; which started its programme later with intranasal vaccination in &#8805;<span class="elsevierStyleHsp" style=""></span>2&#8239;years old and parenteral vaccination in &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years old&#44; were selected&#46; The summary of the data is presented in <a class="elsevierStyleCrossRefs" href="#t0020">Tables 4 and 5</a> and the description of the results of the systematic search for each country can be found in the supplementary material&#46; Documents and articles located through the additional pragmatic search were incorporated to complement the results of the systematic search&#46;</p><elsevierMultimedia ident="t0020"></elsevierMultimedia><elsevierMultimedia ident="t0025"></elsevierMultimedia></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0125">Canada</span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0130">Epidemiological context and paediatric influenza vaccination schedule</span><p id="p0100" class="elsevierStylePara elsevierViewall">The Canadian National Advisory Committee on Immunisation &#40;NACI&#41; recommended influenza vaccination for all healthy persons &#40;including children&#41; from 2000&#46;<a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a> Subsequently&#44; in 2004&#44; the Canadian programme included infants aged 6&#8211;23&#8239;months under the category of people at high risk for influenza-related complications&#46;<a class="elsevierStyleCrossRef" href="#bb0225"><span class="elsevierStyleSup">45</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">46</span></a> This universal influenza vaccination programme was initially implemented in Ontario&#46;<a class="elsevierStyleCrossRef" href="#bb0235"><span class="elsevierStyleSup">47</span></a></p><p id="p0105" class="elsevierStylePara elsevierViewall">According to NACI epidemic surveillance data&#44; the burden of influenza B disease is higher in children than in other age groups&#44; accounting for 17&#37; of laboratory-confirmed paediatric influenza cases&#46; This type of influenza virus is also responsible for 15&#46;5&#37;&#8211;58&#46;3&#37; of their influenza hospitalisations&#44; and its mortality is higher than that of type A&#46;<a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a></p><p id="p0110" class="elsevierStylePara elsevierViewall">The vaccines administered in Canada to infants aged 6&#8211;23&#8239;months are the tri- or tetravalent inactivated type&#44; IIV3-SD&#44; or IIV4-SD Standard Dose &#40;Inactivated Influenza Vaccine&#44; trivalent or tetravalent&#44; Standard Dose&#41;&#46; IIV4-SD is preferred&#46;<a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a> IIV3-SD&#44; IIV4-SD&#44; or LAIV4 &#40;Live Attenuated Influenza Vaccine tetravalent&#41; are recommended in children aged 2&#8211;17&#8239;years&#46; Adolescents aged 9&#8211;17&#8239;years can also be vaccinated with the inactivated tetravalent vaccine produced in cell culture &#40;IIV4-CC&#41; and LAIV4&#44; or IIV4-CC can be used interchangeably&#44; unless the patient has certain clinical conditions of the patient&#46;<a class="elsevierStyleCrossRef" href="#bb0240"><span class="elsevierStyleSup">48</span></a> For example&#44; LAIV4 is not recommended for patients with severe asthma and is contraindicated in adolescent and immunosuppressed pregnant women&#44; but is recommended in children with stable&#44; non-severe asthma&#44; or in children with cystic fibrosis who are not being treated with immunosuppressants&#46;<a class="elsevierStyleCrossRef" href="#bb0230"><span class="elsevierStyleSup">46</span></a></p><p id="p0115" class="elsevierStylePara elsevierViewall">In Quebec&#44; it is estimated that 62&#46;9&#37;&#8211;78&#46;7&#37; of children &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years have full coverage with all vaccines in their immunisation schedule&#44; which also includes influenza vaccination&#46;<a class="elsevierStyleCrossRef" href="#bb0245"><span class="elsevierStyleSup">49</span></a></p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0135">Burden of disease related to paediatric influenza vaccination</span><p id="p0120" class="elsevierStylePara elsevierViewall">Three observational studies related to clinical outcomes during the period of implementation of the current vaccination programme &#40;one retrospective cohort study&#44;<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a> one prospective study&#44;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a> and one epidemiological surveillance analysis<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a>&#41; were selected through a systematic search&#46; All the studies included hospitalised patients&#46; The studies are described in <a class="elsevierStyleCrossRef" href="#t0020">Table 4</a>&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">According to the Canadian retrospective&#44; multicentre&#44; cohort study conducted over 5 seasons&#44; the incidence of hospitalisation in children &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years of age for laboratory-confirmed influenza was 8&#46;7&#37; for non-subtyped influenza A&#44; 3&#46;7&#37; for subtype A&#40;H1N1&#41;&#44; and 4&#46;5&#37; for B virus&#46;<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a> Admission to the PICU was estimated at 6&#37; of those infected with influenza A without risk factors &#40;both non-subtyped and H1N1pdm subtype&#41; and between 6&#37;&#8211;11&#37; in children with comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a></p><p id="p0130" class="elsevierStylePara elsevierViewall">In the prospective study of 8 consecutive non-pandemic seasons&#44; in which cases of hospitalisation due to influenza were recorded in children under 18&#8239;years of age&#44; the median age was 2&#8239;years&#44; and children under 2&#8239;years of age accounted for 54&#46;5&#37; of the cases&#46;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a> In the 8-year period studied&#44; influenza B was responsible&#44; each season&#44; for between 15&#46;5&#37; and 58&#46;3&#37; of influenza hospitalisations in children under 16&#8239;years of age&#46;<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> While in the prospective study cited above&#44; with data from 8 seasons &#40;2011&#8211;2019&#41;&#44; no deaths were reported and there were 1&#46;1&#37; PICU admissions&#46; In another study conducted using Canadian epidemiological surveillance monitoring data from 2004 to 2013&#44; 0&#46;4&#37; of deaths were observed due to influenza A and 1&#46;1&#37; due to influenza B &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a></p><p id="p0135" class="elsevierStylePara elsevierViewall">Studies with a higher number of hospitalisations and information on patients&#39; vaccination history&#44; observe that in the paediatric population aged &#60;<span class="elsevierStyleHsp" style=""></span>16 and&#8239;&#60;&#8239;18&#8239;years hospitalised for influenza&#44; only 6&#46;5&#37;&#8211;6&#46;9&#37;<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a> and 11&#46;3&#37;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a> of patients&#44; respectively&#44; were vaccinated&#46; And the absence of influenza vaccination is reported as a possible factor associated with hospitalisation &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46;</p></span></span><span id="s0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0140">United States of America</span><span id="s0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0145">Epidemiological context and paediatric influenza vaccination programme</span><p id="p0140" class="elsevierStylePara elsevierViewall">In the USA&#44; from 2002 reports by the Centers for Disease Control and Prevention &#40;CDC&#41; and the Advisory Committee on Immunisation Practices &#40;ACIP&#41; the indication was suggested for influenza vaccination in healthy children aged 6&#8211;23&#8239;months due to the high incidences of hospitalisation recorded in this age group&#46;<a class="elsevierStyleCrossRef" href="#bb0265"><span class="elsevierStyleSup">53</span></a> The definitive recommendation following these reports was established 2&#8239;years later&#44;<a class="elsevierStyleCrossRef" href="#bb0270"><span class="elsevierStyleSup">54</span></a> giving preference to the inactivated vaccine over LAIV until 2007&#44; when equal preference was established for both inactivated and attenuated vaccines&#46;<a class="elsevierStyleCrossRef" href="#bb0275"><span class="elsevierStyleSup">55</span></a> From 2009&#44; the ACIP included in its recommendations the entire paediatric population &#40;with or without risk factors&#41; from &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months to &#60;<span class="elsevierStyleHsp" style=""></span>18&#8239;years&#44;<a class="elsevierStyleCrossRef" href="#bb0280"><span class="elsevierStyleSup">56</span></a> and from 2010 it extended the recommendation to universal vaccination for the entire population from &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0285"><span class="elsevierStyleSup">57</span></a> Between 2012 and 2019&#44; VC in children &#8804;<span class="elsevierStyleHsp" style=""></span>17&#8239;years gradually increased with some exceptions in certain seasons to 63&#46;7&#37;<a class="elsevierStyleCrossRef" href="#bb0290"><span class="elsevierStyleSup">58</span></a> in the 2019&#8211;2020 season&#44; although it decreased in the 2020&#8211;2021 season to 58&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0295"><span class="elsevierStyleSup">59</span></a></p><p id="p0145" class="elsevierStylePara elsevierViewall">CDC influenza records for &#60;<span class="elsevierStyleHsp" style=""></span>18&#8239;years show that the number of paediatric &#40;1&#8239;month to &#60;<span class="elsevierStyleHsp" style=""></span>18&#8239;years&#41; influenza deaths between the 2004&#8211;2005 and 2019&#8211;2020 seasons ranged from 37 to 199 each season&#46; The exception was the 2009 pandemic&#44; when 358 deaths were reported&#44; of which about 80&#37; were unvaccinated&#46;<a class="elsevierStyleCrossRef" href="#bb0300"><span class="elsevierStyleSup">60</span></a> These figures are a minimum declaration&#44; as only laboratory-confirmed influenza deaths are included &#40;CDC statistical models estimate that up to 434 children and adolescents under 18&#8239;years of age may have died during the 2009 pandemic&#41;&#46; Finally&#44; studies indicate that vaccination reduced the likelihood of admission to the PICU by 74&#37; &#40;2010&#8211;2012 seasons&#41; and death by 65&#37;&#8211;51&#37; &#40;2010&#8211;2014 seasons&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0305"><span class="elsevierStyleSup">61</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0310"><span class="elsevierStyleSup">62</span></a></p></span><span id="s0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0150">Burden of disease associated with paediatric influenza vaccination</span><p id="p0150" class="elsevierStylePara elsevierViewall">Seven publications on clinical outcomes during the paediatric vaccination programme in the USA were selected through the systematic review&#46; Four were retrospective observational studies&#44;<a class="elsevierStyleCrossRefs" href="#bb0315"><span class="elsevierStyleSup">63&#8211;66</span></a> two were analyses of epidemiological data<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> and one described an analysis of cases and estimates&#46;<a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a><a class="elsevierStyleCrossRef" href="#t0020">Table 4</a> shows the data from these studies&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">The data obtained from the different studies show that the incidence of influenza was higher the younger the age of the patients&#44;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a> thus younger children &#40;&#60;3&#8239;years&#41; were more likely to attend the emergency department&#44;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a> be hospitalised&#44;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a> or admitted to the PICU<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a> than the rest &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46; This likelihood increased if they also had respiratory diseases &#40;such as bronchiolitis&#41; or non-respiratory diseases &#40;such as congenital heart disease&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a> In another recently published study focusing on transmissibility in households with &#8805;<span class="elsevierStyleHsp" style=""></span>2 members&#44; children accounted for the highest percentage of primary and secondary cases reported &#40;62&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a> Moreover&#44; among children aged &#60;<span class="elsevierStyleHsp" style=""></span>12&#8239;years&#44; this proportion was 33&#46;8&#37; in cases associated with a first outbreak&#44; 43&#46;9&#37; when the primary and secondary cases were reported on the same day and 38&#46;1&#37; in secondary cases diagnosed on subsequent days&#46; However&#44; in children aged 12&#8211;18&#8239;years&#44; these proportions were 17&#46;2&#37;&#44; 16&#46;0&#37;&#44; and 14&#46;2&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a></p><p id="p0160" class="elsevierStylePara elsevierViewall">Paediatric mortality is reflected in 4 of the articles analysed&#46;<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0335"><span class="elsevierStyleSup">67&#8211;69</span></a> One of them analysed prospective epidemiological surveillance data from the 2018&#8211;2019 season in children aged 6&#8239;months to 17&#8239;years&#44; showing one death among 226 children hospitalised with a confirmed diagn&#243;stico of influenza&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a> In another retrospective study&#44; focusing on patients &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years seen in the ED during the 2009&#8211;2017 seasons&#44; 4 deaths were recorded&#58; 2 during ED admission and 2 among those hospitalised&#44; giving a mortality rate of 7 per 100&#44;000&#46;<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a> The case analysis and estimates article&#44; based on 2015 data&#44; estimated a mortality rate among the population aged 0&#8211;17&#8239;years of 4 &#40;lower-upper range&#58; 2&#8211;6&#41; per million&#46;<a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a></p><p id="p0165" class="elsevierStylePara elsevierViewall">Finally&#44; one of the most relevant studies of paediatric deaths with laboratory-confirmed influenza diagn&#243;stico in the USA reported 675 deaths during 6 post-pandemic seasons&#46; This represents an annual average of more than 100 influenza deaths in children and adolescents &#60;<span class="elsevierStyleHsp" style=""></span>18&#8239;years of age&#46; Thus&#44; the mean annual incidence of influenza deaths calculated between the seasons 2010&#8211;2011 and 2016&#8211;2017 was 0&#46;2&#47;100000 for &#60;<span class="elsevierStyleHsp" style=""></span>18&#8239;years &#40;95&#37; CI&#58; 0&#46;1&#8211;0&#46;2&#41; with a median age of 6&#8239;years &#40;IQR&#58; 2&#8211;12&#8239;years&#41;&#46; The highest incidence was in infants &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months &#40;0&#46;7&#59; 95&#37; CI&#58; 0&#46;5&#8211;0&#46;8&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> The same article highlights that children without pre-existing conditions &#40;asthma&#44; cancer&#44; heart disease&#44; etc&#46;&#41; had a lower median age than those with comorbidities&#44; and a higher likelihood &#40;77&#37;&#41; of dying before they could be hospitalised than those with previous comorbidities &#40;48&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a> Furthermore&#44; 65&#37; of the children died within the first week from symptom onset and 13&#37; died the day after symptom onset &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46;</p><p id="p0170" class="elsevierStylePara elsevierViewall">Finally&#44; this study reveals that the vaccination rate among the 477 deceased children &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months was 31&#37;&#44; and only 22&#37; of them had the 2 doses required to complete their vaccination schedule&#46;<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a></p><p id="p0175" class="elsevierStylePara elsevierViewall">In 2 retrospective studies with data on influenza VC in children &#8804;<span class="elsevierStyleHsp" style=""></span>17&#8239;years&#44; VC ranged from 27&#37;&#8211;31&#37; in one study<a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a> to 40&#37;&#8211;47&#37; in the other&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a> In the latter&#44; the VC was reported in confirmed influenza cases&#44; and the VC in the group with symptomatic influenza was lower than the mean coverage of the paediatric population that season who had not had influenza &#40;40&#37;&#8211;47&#37; vs&#46; 58&#37;&#8211;62&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a> This study also notes that in the season 2018&#8211;2019&#44; vaccination reduced hospitalisations and emergency department visits by 40&#37; and 60&#37; respectively&#44; which for its authors reinforces the recommended annual vaccination of &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a></p></span></span><span id="s0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0155">Finland</span><span id="s0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0160">Epidemiological context and paediatric influenza vaccination programme</span><p id="p0180" class="elsevierStylePara elsevierViewall">Since 2007&#44; a seasonal influenza vaccination programme has been in place in Finland for all children aged 6&#8211;35&#8239;months&#44; regardless of whether they have risk factors&#46; This age was extended to &#60;<span class="elsevierStyleHsp" style=""></span>7&#8239;years from the season 2018&#8211;2019&#46;<a class="elsevierStyleCrossRef" href="#bb0350"><span class="elsevierStyleSup">70</span></a> Since 2015&#44; this age group has been vaccinated with IIV3 &#40;IIV4 from 2020&#41; or LAIV4&#46;<a class="elsevierStyleCrossRef" href="#bb0355"><span class="elsevierStyleSup">71</span></a> The VC of children in this age group in 2014&#8211;2015 was 11&#37;&#44; increasing progressively in the following seasons &#40;17&#37;&#44; 22&#37;&#44; 24&#37;&#41; to reach 31&#46;1&#37; in 2018&#8211;2019&#44; the last season recorded in their database at the date of this paper&#46;<a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a></p><p id="p0185" class="elsevierStylePara elsevierViewall">Moreover&#44; the incidence of influenza reported in Finland from surveillance system data shows a monthly incidence in children &#60;<span class="elsevierStyleHsp" style=""></span>9&#8239;years exceeding 200 per 100&#44;000 in the February of the seasons 2018&#8211;2019 and 2019&#8211;2020&#44; while the peak monthly incidences for the same month &#40;corresponding to the epidemic acme&#41; remained below 150 per 100&#44;000 in the rest of the age groups&#46;<a class="elsevierStyleCrossRef" href="#bb0365"><span class="elsevierStyleSup">73</span></a></p></span><span id="s0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0165">Burden of disease associated with paediatric influenza vaccination</span><p id="p0190" class="elsevierStylePara elsevierViewall">Four studies were selected&#44; three observational studies &#40;one retrospective<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a> and two prospective cohort studies &#91;one of which was a birth cohort&#93;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a>&#41; and an analysis of two prospective observational cohort studies&#46; The extracted information is summarised in <a class="elsevierStyleCrossRef" href="#t0020">Table 4</a>&#46;</p><p id="p0195" class="elsevierStylePara elsevierViewall">These studies show that&#44; although the incidence of influenza was higher in the 3&#8211;13&#8239;years age group than in the &#60;<span class="elsevierStyleHsp" style=""></span>3&#8239;years age group &#40;65&#37; vs&#46; 35&#37;&#41;&#44; in the latter the illness more frequently manifested as moderate or severe &#40;66&#37;&#41;&#44; while severe disease was observed in less than half of the 3&#8211;13&#8239;years age group &#40;41&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a> One prospective study estimated the incidence of laboratory-confirmed influenza in children &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years of age over 3 consecutive seasons &#40;2008&#8211;2009 to 2010&#8211;2011&#41; at 5&#46;1&#37;&#44; 2&#46;7&#37;&#44; and 5&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> Another prospective birth cohort study in which data were collected to compare the incidence and clinical aspects of influenza in the first influenza season in infants &#60;<span class="elsevierStyleHsp" style=""></span>1&#8239;year showed that 13&#46;5&#37; of infants &#40;55&#47;408&#41;&#44; whose mean age was 7&#46;6&#8239;months &#40;4&#46;3&#8211;11&#46;0&#41;&#44; were diagnosed with influenza&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a> The severity of influenza A &#40;52&#37; of those diagnosed with influenza&#41; or B &#40;48&#37;&#41; was not significantly different &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46;</p><p id="p0200" class="elsevierStylePara elsevierViewall">In a prospective cohort study among children &#60;<span class="elsevierStyleHsp" style=""></span>13&#8239;years conducted to assess the social and clinical impact of influenza&#44; 3&#37; of those &#60;<span class="elsevierStyleHsp" style=""></span>3&#8239;years in the moderate&#8211;severe influenza group attended the emergency department&#46;<a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a> The set of Finnish articles reporting hospitalisation in children &#60;<span class="elsevierStyleHsp" style=""></span>3&#8239;years show percentages of 1<a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a>&#44; 2&#44;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a> and 5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> The only study with data on the percentage of children requiring admission to the PICU after hospitalisation showed that 12&#46;9&#37; of children &#60;<span class="elsevierStyleHsp" style=""></span>16&#8239;years with influenza A and 15&#46;2&#37; with influenza B were admitted to the PICU between the seasons 2004&#8211;2005 and 2017&#8211;2018&#46;<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a> Two deaths were reported in &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years&#44; one due to influenza A &#40;accounting for 0&#46;7&#37; of those hospitalised with influenza A&#41; and one due to influenza B &#40;2&#46;6&#37; of those hospitalised with influenza B&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a></p><p id="p0205" class="elsevierStylePara elsevierViewall">Of the 4 studies mentioned&#44; only 2 had data on vaccination&#44;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> in which VC in children aged &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years ranged from a maximum of 80&#37; in 2009&#8211;2010&#44; coinciding with the influenza A&#40;H1N1&#41;pm pandemic&#44; and lower percentages between 33&#37; and 47&#37; for the other 2 non-pandemic seasons&#46; The highest vaccine effectiveness &#40;VE&#41; was achieved with pandemic influenza vaccination in 2009&#8211;2010&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> This was 97&#37; &#40;95&#37; CI 76&#8211;100&#41;&#44; and coincided with a halving of incidence compared to the other 2 seasons&#46; In the post-pandemic season &#40;2010&#8211;2011&#41; the VE was 41&#37; &#40;95&#37; CI -75-80&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> In the study on burden of influenza disease in the first year of life&#44; only 14&#46;3&#37; of infants &#40;54&#47;379&#41;&#44; whose vaccination status was known&#44; were vaccinated and only 4 of them had a laboratory-confirmed diagn&#243;stico of influenza &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a></p></span></span><span id="s0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0170">United Kingdom</span><span id="s0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0175">Epidemiological context and paediatric influenza vaccination programme</span><p id="p0210" class="elsevierStylePara elsevierViewall">The UK has had a paediatric influenza vaccination programme in place since 2014&#44; including children &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months with risk factors and all children aged 2&#8211;15&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bb0390"><span class="elsevierStyleSup">78</span></a> The programme was rolled out as a pilot in the 2013&#8211;2014 season&#44; and LAIV was administered to children aged 2&#8211;12&#8239;years&#44; and was extended nationwide from the following season&#44;<a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a> however&#44; VC in these age cohorts differs between geographical and national areas in the UK&#46; Therefore&#44; in England it ranges between 40&#37; and 60&#37;&#44; while in schools in Northern Ireland VC is over 75&#37;&#44; in Scotland over 70&#37;&#44; and in Wales 65&#37;&#46;<a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a></p><p id="p0215" class="elsevierStylePara elsevierViewall">However&#44; the VE of LAIV has shown differences over the seasons&#44; estimated at between 26&#46;9&#37; and 65&#46;8&#37;&#46; In the 2015&#8211;2016 season it was 57&#46;6&#37; &#40;95&#37; CI&#58; 25&#46;1&#37;&#8211;76&#46;0&#37;&#41;&#59; 65&#46;8&#37; &#40;95&#37; CI&#58; 30&#46;3&#37;&#8211;83&#46;2&#37;&#41; in 2016&#8211;2017&#59; 26&#46;9&#37; &#40;95&#37; CI&#58; 32&#46;6&#37;&#8211;59&#46;7&#37;&#41; in 2017&#8211;2018&#44; and 48&#46;6&#37; &#40;95&#37; CI&#58; 4&#46;4&#8211;74&#46;7&#37;&#41; in 2018&#8211;2019&#46; Antigenic mismatch between the predominant circulating strains and those included in the vaccine is not mentioned for these seasons&#46;<a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a> Generally VE is calculated for the vaccine as a whole &#40;all strains included in the vaccine&#41;&#44; However&#44; VE values vary for each type and subtype and strain of influenza virus included in each year&#39;s vaccine&#46;</p><p id="p0220" class="elsevierStylePara elsevierViewall">Influenza surveillance reports from the 2012&#8211;2013 season to 2020&#8211;2021<a class="elsevierStyleCrossRef" href="#bb0400"><span class="elsevierStyleSup">80</span></a> are published on the UK government health website&#46; The annual reports publish outbreaks of respiratory viruses in institutions such as schools&#44; hospitals&#44; or care homes&#46; Only in the 2012&#8211;2013 season&#44; influenza outbreaks in institutions were detailed&#44; and it was observed that during the first weeks of the season&#44; outbreaks in schools accounted for the majority &#40;exceeding 25 outbreaks between weeks 49 and 51 of the year&#41; and were mostly caused by influenza B &#40;73&#37;&#41;&#44; while in care homes&#44; influenza A virus was the most frequent cause of outbreaks &#40;81&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0405"><span class="elsevierStyleSup">81</span></a> In addition&#44; outbreaks in schools were the second largest in number &#40;after care homes&#41;&#44; and the earliest&#44; being reported in week 50 of 2012&#44; earlier than outbreaks in care homes&#44; which started in week 9 of 2013&#46;</p></span><span id="s0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0180">Burden of disease associated with paediatric influenza vaccination</span><p id="p0225" class="elsevierStylePara elsevierViewall">Five articles were selected through the systematic search&#44; three retrospective observational<a class="elsevierStyleCrossRefs" href="#bb0410"><span class="elsevierStyleSup">82&#8211;84</span></a> and two observational case studies<a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0430"><span class="elsevierStyleSup">86</span></a> &#40;<a class="elsevierStyleCrossRef" href="#t0020">Table 4</a>&#41;&#46;</p><p id="p0230" class="elsevierStylePara elsevierViewall">One of the retrospective studies focusing on the impact of LAIV in children without previous illness in Northern Ireland&#44; over 7 influenza seasons&#44; described data before and after the introduction of influenza vaccination in children&#46; The VC of the different seasons collected in the study showed a very significant increase in VC from the year of the start of the vaccination programme&#44; reaching annual coverage rates of &#62;<span class="elsevierStyleHsp" style=""></span>54&#37; in children aged 2&#8211;4&#8239;years and&#8239;&#62;76&#37; in children aged 4&#8211;11&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a> On the other hand&#44; the cumulative incidence rate of urgent outpatient consultations &#40;known as &#8220;out-of-hours&#8221; consultations in the UK&#41; halved after the introduction of influenza vaccination in children&#46; The incidence of urgent consultations fell from 10&#46;0&#47;100000 in the pre-vaccination season &#40;2010&#8211;2011&#41; to half in seasons with vaccination in children &#40;4&#46;7 in 2013&#8211;2014 and 5&#46;1 in the 2014&#8211;2017 seasons&#41;&#46; There were also declines in the number of primary care visits per 100&#44;000 population&#58; from 15&#46;1 in the pre-vaccination season&#44; to 8&#46;3 in 2013&#8211;2014 and 9&#46;2 in 2014&#8211;2017 &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a></p><p id="p0235" class="elsevierStylePara elsevierViewall">The case&#8211;control study that analysed VE by negative test provides VE figures for the reduction in laboratory-confirmed influenza hospitalisations&#46; A total of 307 hospitalised cases and 679 hospitalised controls were identified&#46; Of the cases with confirmed influenza virus infection&#59; 156 cases were non-subtyped influenza A&#44; 104 were infected with A&#40;H1N1&#41;pdm09&#44; 40 with A&#40;H3N2&#41;&#44; and 6 with B virus&#59; of these&#44; 112&#44; 78&#44; 28&#44; and 4 children&#44; respectively&#44; were unvaccinated&#46;<a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a> The overall VE of LAIV against any influenza hospitalisation was 53&#37; &#40;95&#37; CI 36&#46;2&#8211;68&#46;5&#41;&#59; particularly for influenza A&#40;H1N1&#41;pdm09 subtype 63&#46;5&#37; &#40;95&#37; CI 34&#46;4&#8211;79&#46;7&#41; and 31&#46;1&#37; &#40;95&#37; CI 53&#46;9&#8211;69&#46;2&#41; for the A&#40;H3N2&#41; subtype&#46;<a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a> The adjusted VE of LAIV to prevent any influenza was 49&#46;1&#37; &#40;95&#37; CI&#58; 25&#46;9&#8211;65&#46;0&#41; for all types and subtypes and 70&#46;7&#37; &#40;95&#37; CI&#58; 41&#46;8&#8211;85&#46;3&#41; for the A&#40;H1N1&#41;pdm09 subtype&#44; while for those who received IIV4-SD&#44; it was 64&#46;4&#37; &#40;95&#37; CI&#58; 29&#46;4&#8211;82&#46;0&#41; and 44&#46;4&#37; &#40;95&#37; CI&#58; &#8722;<span class="elsevierStyleHsp" style=""></span>51&#46;9-79&#46;6&#41;&#44; respectively&#46; Overall&#44; effectiveness was higher in healthy children than in those with at-risk conditions&#46;</p><p id="p0240" class="elsevierStylePara elsevierViewall">In the only cohort study on VE to prevent laboratory-confirmed influenza in infants &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months during 2 seasons &#40;2013&#8211;2014 and 2014&#8211;2015&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0430"><span class="elsevierStyleSup">86</span></a> data on vaccination of their mothers during pregnancy indicated that &#60;<span class="elsevierStyleHsp" style=""></span>25&#37; of mothers had been vaccinated in the study seasons&#46; In particular&#44; only 20&#37; of mothers of hospitalised infants in 2013&#8211;2014 and 24&#46;6&#37; in 2014&#8211;2015 were vaccinated &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41;&#46; Of the infants with confirmed infection 81&#46;1&#37; &#40;30&#47;37&#41; and 85&#46;2&#37; &#40;69&#47;81&#41; were hospitalised in each season&#44; respectively&#46; Overall&#44; VE was 66&#37; &#40;95&#37; CI 18&#8211;84&#41; and 50&#37; &#40;95&#37; CI 11&#8211;72&#41; in 2013&#8211;2014 and 2014&#8211;2015&#44; respectively&#46; However&#44; VE against the dominant circulating influenza strain each year was higher&#44; at 78&#37; &#40;95&#37; CI&#58; 16&#8211;94&#41; against A&#40;H1N1&#41;pdm09 in 2013&#8211;2014&#44; and 60&#37; &#40;95&#37; CI&#58; 16&#8211;81&#41; against A&#40;H3N2&#41; in 2014&#8211;2015&#46;<a class="elsevierStyleCrossRef" href="#bb0430"><span class="elsevierStyleSup">86</span></a></p><p id="p0245" class="elsevierStylePara elsevierViewall">The 2 studies conducted in children &#60;<span class="elsevierStyleHsp" style=""></span>16&#8239;years with a clinical diagn&#243;stico of influenza admitted to the PICU showed that the highest rate of admissions was in children &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years&#46; In one study&#44; which focused on characterising the paediatric population with severe influenza and their risk of death&#44; most of those admitted had at least one risk factor &#40;78&#46;5&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bb0415"><span class="elsevierStyleSup">83</span></a> A total of 143 deaths were recorded&#44; the majority children with risk factors &#40;137 children&#41;&#46; Although the authors could not establish whether the deceased were vaccinated&#44; they explain that&#44; in general&#44; children with risk factors have a low vaccination rate of &#60;<span class="elsevierStyleHsp" style=""></span>30&#37; in those aged 6&#8239;months to &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years and&#8239;&#60;50&#37; in 2 to 15&#8239;years&#46;</p><p id="p0250" class="elsevierStylePara elsevierViewall">Finally&#44; another paper that studied the impact of the universal vaccination programme on adolescent and child PICU admissions over 14 seasons estimated that the rate of influenza-related PICU admissions was 1&#46;3&#47;100000&#46;<a class="elsevierStyleCrossRef" href="#bb0420"><span class="elsevierStyleSup">84</span></a> The authors concluded that there was no difference between admission rates before and after introduction of the programme&#46; However&#44; they did not report vaccination coverage data among the patients whose data they had collected &#40;<a class="elsevierStyleCrossRef" href="#t0025">Table 5</a>&#41; and recommend a longer follow-up of the new vaccination policy&#46;</p></span></span></span><span id="s0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0185">Discussion and conclusions</span><p id="p0255" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; there are few estimates of the burden of influenza in the paediatric population in Spain based on published data&#46; This paper compiles scientific evidence published or reported on the official websites of governmental institutions&#46; The Spanish Ministry of Health&#44; through the document on Influenza Vaccination Recommendations&#44; season 2021&#8211;2022&#44; states that influenza vaccination is aimed at protecting people at higher risk of complications and potential transmitters to vulnerable individuals&#46;<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a> To date&#44; vaccination strategy in Spain has focused most of its efforts on protecting those aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years&#44; due to their higher mortality rate from influenza and high levels of hospitalisation&#46;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> Years ago&#44; the focus began to be placed on the paediatric population&#44; and it became clear that hospitalisation and antibiotic consumption increased in children&#44; especially the youngest&#44; during seasonal influenza epidemics&#44; and that they even exceeded excess hospitalisations due to influenza in those aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years&#44;<a class="elsevierStyleCrossRef" href="#bb0435"><span class="elsevierStyleSup">87</span></a> and thus vaccination of the paediatric population was recommended&#46;<a class="elsevierStyleCrossRef" href="#bb0440"><span class="elsevierStyleSup">88</span></a></p><p id="p0260" class="elsevierStylePara elsevierViewall">The evidence gathered in this review shows that in children &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years of age the incidence of laboratory-confirmed influenza is higher than in adults and the elderly&#44;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> their percentage of admission to the PICU is higher than that of the group aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> and the rates and percentages of hospitalisation in the population&#8239;&#8804;&#8239;4&#8239;years<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> are very significant&#46; However&#44; while adults admitted to hospital for influenza or its complications mostly have previous illness&#44; this clinical condition is significantly lower in those aged &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years &#40;&#60; 20&#37; since the season 2012&#8211;2013&#59; in 3 seasons&#44; &#60;10&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a> and therefore the absence of previous risk factors is not a clinical datum that rules out the possibility of the paediatric population developing severe or complicated influenza&#46; Moreover&#44; as mentioned&#44; the absence of risk factors in children with severe influenza increases the possibility of failing to anticipate severe consequences and therefore their being hospitalised in time&#44; and children&#44; especially those &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years old&#44; may develop severe complications&#58; pneumonia&#44; acute respiratory distress&#44; neurological complications&#44; multi-organ failure&#44; and death&#46;<a class="elsevierStyleCrossRef" href="#bb0105"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0120"><span class="elsevierStyleSup">24&#8211;26</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a></p><p id="p0265" class="elsevierStylePara elsevierViewall">Therefore&#44; Canada&#44; the USA&#44; Finland&#44; and later the UK changed their strategy and recommendations for annual vaccination&#44; extending it to the paediatric population to a lesser or greater extent&#46; In fact&#44; 10&#8239;years ago &#40;2012&#41;&#44; in its &#8220;position paper&#8221; on vaccination&#44; the WHO recommended the implementation of the vaccine in the entire population of children under 5&#8239;years of age based on the aspects mentioned above&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> Different countries&#44; with very different health systems and different childhood vaccination policies&#44; have implemented paediatric vaccination against influenza&#44; achieving significant reductions in incidence&#44; hospitalisations&#44; complications&#44; sequelae&#44; and deaths in the population aged 0&#8211;17&#8239;years&#46;<a class="elsevierStyleCrossRef" href="#bb0210"><span class="elsevierStyleSup">42</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0220"><span class="elsevierStyleSup">44</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0265"><span class="elsevierStyleSup">53</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0270"><span class="elsevierStyleSup">54</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0350"><span class="elsevierStyleSup">70</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0445"><span class="elsevierStyleSup">89</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0450"><span class="elsevierStyleSup">90</span></a> Hospitalisation data in these countries and in Spain show that among the hospitalised paediatric population &#40;0&#8211;17&#8239;years&#41;&#44; vaccination has been less frequent than in the non-hospitalised population&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a> However&#44; some of these studies confirm low VC in the paediatric population with risk factors&#46; Thus&#44; only half of the children and adolescents aged 2&#8211;15&#8239;years with risk factors are vaccinated and less than 30&#37; of children aged 6&#8239;months to 2&#8239;years with risk factors and an indication for vaccination are vaccinated&#46;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0300"><span class="elsevierStyleSup">60</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0360"><span class="elsevierStyleSup">72</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0415"><span class="elsevierStyleSup">83</span></a></p><p id="p0270" class="elsevierStylePara elsevierViewall">Furthermore&#44; several studies<a class="elsevierStyleCrossRef" href="#bb0455"><span class="elsevierStyleSup">91</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0460"><span class="elsevierStyleSup">92</span></a> have shown that influenza vaccination is more effective in children aged &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months or &#8805;<span class="elsevierStyleHsp" style=""></span>4&#8239;years than in adults&#46; This fact is clearly evident in the pandemic vaccination of children&#44; whose effectiveness is maximum&#44; reaching percentages close to 90&#37; or even exceeding them in some of the youngest age groups&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a> There is sufficient scientific evidence to show that paediatric vaccination protects children from hospitalisation&#44; admission to the PICU&#44; or death&#46;<a class="elsevierStyleCrossRef" href="#bb0465"><span class="elsevierStyleSup">93</span></a> Recent experience in the UK demonstrates how paediatric influenza vaccination reduces &#8220;out-of-hours&#8221; consultations&#44; which in Spain would correspond to outpatient emergency or hospital visits that saturate these services during seasonal influenza epidemics&#46; Mortality in children is infrequent in developed countries&#59; most paediatric influenza deaths occur in developing countries&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> The most consistent studies come from the USA&#44; where the data point to low VC &#40;31&#37;&#41; or incomplete vaccination &#40;22&#37;&#41; in the deaths &#60;<span class="elsevierStyleHsp" style=""></span>18&#8239;years&#44; in a country where annual influenza VC in children &#60;<span class="elsevierStyleHsp" style=""></span>18&#8239;years ranges from 50&#37;&#8211;60&#37; of the population&#46;<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a></p><p id="p0275" class="elsevierStylePara elsevierViewall">Finally&#44; an additional benefit is that&#44; because of the role as super transmitters that children play in influenza epidemics&#44; due to their longer period of virus shedding&#44; and higher viral load than adults&#44; vaccinating them may indirectly contribute to reducing the spread of seasonal influenza epidemics to other groups at higher risk&#44; such as the elderly&#44;<a class="elsevierStyleCrossRefs" href="#bb0040"><span class="elsevierStyleSup">8&#8211;10</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0060"><span class="elsevierStyleSup">12</span></a> cohabiting minors &#40;as in the case of siblings&#41;&#44;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a> and the immunocompromised&#44; etc&#46; This would help reduce the burden of care in healthcare centres and primary paediatric care<a class="elsevierStyleCrossRef" href="#bb0470"><span class="elsevierStyleSup">94</span></a> and could modify traditional incidence profiles by age group&#46;<a class="elsevierStyleCrossRef" href="#bb0395"><span class="elsevierStyleSup">79</span></a> Therefore&#44; a recommendation for a strategy of vaccination &#8220;in the nest&#8221; is all the more necessary&#46;</p><p id="p0280" class="elsevierStylePara elsevierViewall">Influenza indications often begin in those aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years and those with comorbidities&#46; This probably tends to take the focus away from the need for vaccination in children and adolescents with risk factors&#44; and this aspect could be improved with universal vaccination for them&#44; which would also significantly reduce hospitalisations&#44; PICU admissions&#44; and avoidable deaths in the rest of the paediatric population&#46; This is why&#44; in the last quarter of 2021 the Spanish Paediatrics Association &#40;AEP&#41; included the recommendations for 2021&#8211;2022 following the guidelines initiated by the USA &#40;2008&#41;&#44; the WHO &#40;2012&#41;&#44; and the ECDC in 2009&#44; advising universal vaccination for all children between 6 and 59&#8239;months&#46;<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0475"><span class="elsevierStyleSup">95</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0480"><span class="elsevierStyleSup">96</span></a></p><p id="p0285" class="elsevierStylePara elsevierViewall">On the other hand&#44; in September 2022&#44; some autonomous communities included influenza vaccination of the paediatric population between 6 and 59&#8239;months of age in the 2022&#8211;2023 season and others announced it for the next season&#46; The <span class="elsevierStyleItalic">Ponencia del Programa y Registro de Vacunaciones</span> has prepared a document&#44; &#8220;Recommendations for influenza vaccination in the paediatric population aged 6 to 59 months&#8221;&#44; which was reviewed and approved by the Public Health Commission on 20 October 2022&#46; The report concludes that after a review of the scientific literature and an evaluation of influenza vaccination in children aged 6&#8211;59&#8239;years&#44; its inclusion in the vaccination schedule is recommended&#46; Furthermore&#44; to achieve good coverage in implementing the programme&#44; a single dose is recommended&#44; in people not previously vaccinated as well&#46; The recommendation to vaccinate children over 59&#8239;months of age and at risk&#44; as well as their close contacts&#44; is retained&#46;<a class="elsevierStyleCrossRef" href="#bb0485"><span class="elsevierStyleSup">97</span></a></p><p id="p0290" class="elsevierStylePara elsevierViewall">In conclusion&#44; this article presents the results of an eclectic approach based on a search of official information&#44; a systematic search of scientific literature and additional literature&#44; and the latest Spanish recommendations on the subject&#46; From the study of the evidence gathered&#44; even with the limitations of available data sources&#44; we confirm that vaccinating healthy children &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years of age&#44; as recommended by the WHO&#44; the ECDC&#44; and the AEP&#44; brings direct benefits to this population&#44; avoiding hospitalisations and deaths&#44; as well as alleviating the burden of seasonal influenza disease in Spain&#44; which is always important but was even more so during the COVID-19 pandemic&#46; There are also indirect benefits on transmissibility to the adult population&#46; Universal paediatric vaccination should be the next step as it is already in some countries&#46; Controlled observational studies are needed in Spain to assess the real impact of influenza on the entire paediatric population&#46;</p></span><span id="s0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0190">Funding</span><p id="p0295" class="elsevierStylePara elsevierViewall">The drafting and editing of this article was supported by professional medical writers funded by AstraZeneca&#46; AstraZeneca has in no way influenced the content or the authors&#39; decision to publish&#46;</p></span></span>"
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            1 => "Disease burden"
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            3 => "Paediatric influenza vaccination"
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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Introduction</span><p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">The burden of influenza in the paediatric population is often underestimated by healthcare professionals and the general population&#44; mainly due to poor perception of its clinical importance at the individual level and its health impact at the healthcare level&#46; The aim of this review was to collect data on the burden of paediatric influenza in Spain and to compare them with data of countries where vaccination strategies for healthy paediatric populations have been implemented&#46;</p></span> <span id="as0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Methods</span><p id="sp0070" class="elsevierStyleSimplePara elsevierViewall">We collected data on the burden of paediatric influenza in Spain through a systematic search of literature published between 2016&#8211;2021 &#40;PRISMA methodology&#41;&#46; We conducted a review of reports from the Spanish Influenza Surveillance System &#40;SVGE&#41; &#40;2010&#8211;2011 to 2019&#8211;2020&#41; and of international reports &#40;from Canada&#44; Finland&#44; USA&#44; and UK&#41; through a systematic &#40;2016&#8211;2021&#41; and pragmatic search&#46;</p></span> <span id="as0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Results</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">1366 articles were obtained from the systematic searches by country&#59; 26 met the inclusion criteria&#46; According to the SVGE &#40;Spain&#39;s Influenza Surveillance System&#41;&#44; those &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years have the highest incidence of influenza per 100&#44;000 population &#40;cumulative-mean rate&#58; 9457&#46;9&#41; compared to those &#8805;<span class="elsevierStyleHsp" style=""></span>15&#8239;years &#40;2285&#46;6&#41;&#44; and percentage of admission to the Paediatric Intensive Care Unit &#40;PICU&#41; greater than those &#62;<span class="elsevierStyleHsp" style=""></span>65&#8239;years &#40;mean&#58; 29&#46;1&#37; vs&#46; 17&#46;5&#37;&#41;&#46; Hospitalisation of severe cases per 100&#44;000 population in children aged 0&#8211;4&#8239;years and those &#62;<span class="elsevierStyleHsp" style=""></span>65&#8239;years is similar &#40;median&#58; 20&#46;2 vs&#46; 28&#46;4&#41;&#46; Those aged &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years have a higher incidence rate per 100&#44;000 population &#40;213&#46;3&#41;&#44; in contrast to those aged 15&#8211;64&#8239;years &#40;21&#46;9&#41; and those aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years &#40;65&#46;2&#41;&#46; In countries with paediatric vaccination programmes &#40;USA&#44; Finland&#44; and UK&#41; the burden of influenza in children is reduced by 40&#37;&#8211;74&#37;&#44; whereas 50&#37;-93&#46;5-&#37; of cases presenting to the ED&#44; hospitalised&#44; admitted to PICU&#44; or dying from influenza are unvaccinated&#46;</p></span> <span id="as0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Conclusions</span><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">The burden of paediatric influenza in Spain includes a significant number of hospitalisations and PICU admissions and justifies the vaccination strategy recommended by the WHO since 2012&#46; In countries with this recommendation&#44; the vaccinated paediatric population is better protected against severe forms of influenza and potential benefits for reducing the burden of paediatric influenza in Spain can be extracted from their data&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="as0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Introducci&#243;n</span><p id="sp0085" class="elsevierStyleSimplePara elsevierViewall">La carga de gripe en poblaci&#243;n pedi&#225;trica suele estar infravalorada por los sanitarios y por la poblaci&#243;n general debido fundamentalmente a la escasa percepci&#243;n de su importancia cl&#237;nica a nivel individual como al impacto sanitario a nivel asistencial&#46; El objetivo de esta revisi&#243;n es recopilar datos sobre la carga de gripe pedi&#225;trica en Espa&#241;a y contrastarlos con los de pa&#237;ses en los que hay implementadas estrategias de vacunaci&#243;n de poblaci&#243;n pedi&#225;trica sana&#46;</p></span> <span id="as0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">M&#233;todos</span><p id="sp0090" class="elsevierStyleSimplePara elsevierViewall">Se recopilaron datos de carga de gripe pedi&#225;trica en Espa&#241;a mediante b&#250;squeda sistem&#225;tica de literatura publicada entre 2016&#8211;2021 &#40;metodolog&#237;a PRISMA&#41; y revisi&#243;n de informes del Sistema de Vigilancia de la Gripe en Espa&#241;a &#40;SVGE&#41; &#40;2010&#8211;2011 a 2019&#8211;2020&#41; e internacionales &#40;de Canad&#225;&#44; Finlandia&#44; EE&#46; UU&#46; y Reino Unido&#41; mediante b&#250;squeda sistem&#225;tica &#40;2016&#8211;2021&#41; y pragm&#225;tica&#46;</p></span> <span id="as0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Resultados</span><p id="sp0095" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron 1366 art&#237;culos de las b&#250;squedas sistem&#225;ticas por pa&#237;ses&#59; 26 cumpl&#237;an los criterios de inclusi&#243;n&#46; Seg&#250;n el SVGE&#44; los &#60;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os presentan la mayor incidencia de gripe por 100&#44;000 habitantes &#40;tasa acumulada-mediana&#58; 9457&#44;9&#41; respecto a los &#8805;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os &#40;2285&#44;6&#41;&#59; y porcentaje de ingreso en la Unidad de Cuidados Intensivos Pedi&#225;tricos &#40;UCIP&#41; mayor que los &#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os &#40;media&#58; 29&#44;1&#37; vs&#46; 17&#44;5&#37;&#41;&#46; La hospitalizaci&#243;n de casos graves por 100&#44;000 habitantes en ni&#241;os de 0&#8211;4 a&#241;os y en los &#62;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os es similar &#40;mediana&#58; 20&#44;2 vs&#46; 28&#44;4&#41;&#46; Los &#60;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os tienen mayor tasa de incidencia por 100&#44;000 habitantes &#40;213&#44;3&#41;&#44; en contraste con la de los de 15&#8211;64 a&#241;os &#40;21&#44;9&#41; y los &#8805;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os &#40;65&#44;2&#41;&#46; En los pa&#237;ses con programa de vacunaci&#243;n pedi&#225;trica &#40;EE&#46; UU&#46;&#44; Finlandia y Reino Unido&#41; se reduce la carga de la gripe en ni&#241;os entre un 40&#8211;74&#37; mientras que 50&#8211;93&#44;5-&#37; de los casos que acuden a Urgencias&#44; son hospitalizados&#44; ingresan en UCIP o fallecen por gripe no est&#225;n vacunados&#46;</p></span> <span id="as0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Conclusiones</span><p id="sp0100" class="elsevierStyleSimplePara elsevierViewall">La carga de gripe pedi&#225;trica en Espa&#241;a incluye un importante n&#250;mero de hospitalizaciones e ingresos en la UCIP y justifica la estrategia de vacunaci&#243;n recomendada por la OMS desde 2012&#46; En pa&#237;ses con dicha recomendaci&#243;n&#44; la poblaci&#243;n pedi&#225;trica vacunada est&#225; m&#225;s protegida frente a formas graves de gripe y de sus datos se extraen potenciales beneficios para disminuir la carga de gripe pedi&#225;trica en Espa&#241;a&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "as0025"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "as0030"
            "titulo" => "M&#233;todos"
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            "identificador" => "as0040"
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        "nota" => "<p class="elsevierStyleNotepara" id="np4005">Please cite this article as&#58; Ortiz de Lejarazu Leonardo R&#44; Moraga-Llop F&#46; Carga de gripe en la poblaci&#243;n pedi&#225;trica en Espa&#241;a y los beneficios de la vacunaci&#243;n&#46; Vacunas&#46; 2022&#46; <span class="elsevierStyleInterRef" id="ir3005" href="https://doi.org/10.1016/j.vacun.2023.01.001">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;vacun&#46;2023&#46;01&#46;001</span></p>"
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Cumulative incidence rate of influenza by age over the seasons 2010&#8211;2020 per 100&#44;000 population&#46; Data obtained from sentinel surveillance systems of the Spanish influenza surveillance system &#40;SVGE&#41;&#46; SVGE report season 2019&#8211;2020&#46; Data for the 2010&#8211;2011 season correspond to the estimate of the graph in the 2019&#8211;2020 report&#46; B&#41; numerical data on cumulative incidence rate of influenza&#46; <span class="elsevierStyleBold">IQR</span>&#58; interquartile range&#46;</p>"
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">SHCIC estimates by age for the seasons 2010&#8211;2011 and 2019&#8211;2020&#46; <span class="elsevierStyleBold">A&#41;</span> Graph on data obtained&#47;estimated on 100&#44;000 population from the graphs of each SVGE annual report between the 2010&#8211;2011 and 2019&#8211;2020 seasons&#46; <span class="elsevierStyleBold">B&#41;</span> Estimated numerical data on 100&#44;000 population from the graphs of each SVGE annual report between the 2010&#8211;2011 and 2019&#8211;2020 seasons&#46; <span class="elsevierStyleSup">&#182;</span>Data obtained from the different annual SVGE reports&#46; <span class="elsevierStyleSup">&#8225;</span>For all seasons except 2019&#8211;2020 the categories 15&#8211;44&#8239;years and 45&#8211;64&#8239;years are shown&#46; In the 2019&#8211;2020 season this category disappears and is simplified to 15&#8211;64&#8239;years&#46; In the annual reports of the 2010&#8211;2011 season&#44; the data for the groups 0&#8211;4&#8239;years and 5&#8211;14&#8239;years were disaggregated &#40;information on the 0&#8211;4&#8239;years group is shown in graphical form in the 2010&#8211;2011 season report as 2 different groups &#40;&#60; 1&#8239;year and 1&#8211;14&#8239;years&#41;&#59; in the 2011&#8211;2012 season&#44; for the 0&#8211;4&#8239;years group&#46; <span class="elsevierStyleBold">IQR&#58;</span> interquartile range&#46;</p>"
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          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Clinical severity of influenza according to cumulative percentage of admission to PICU&#47;ICU in the seasons 2018&#8211;2019 and 2019&#8211;2020&#46; A&#41; Seasons 2018&#8211;2019 and 2019&#8211;2020&#46; The SVGE report does not specify whether these results are from hospitalised severe cases with influenza&#59; B&#41; Numerical data from SVGE reports&#44; Median and interquartile range &#40;IQR&#41; of the season for each age group and average of the medians for each age group in the 2 seasons&#46; Low &#40;no symbol&#41;&#59; Moderate<span class="elsevierStyleSup">&#8225;</span>&#59; High<span class="elsevierStyleSup">&#8225;</span>&#46;<span class="elsevierStyleSup">&#8225;</span>N&#46;A&#46;&#58; not applicable&#59; ICU&#58; intensive care unit&#59; IQR&#58; interquartile range&#59; PICU&#58; paediatric intensive care unit&#59; SVGE&#58; Spanish influenza surveillance system&#46;</p>"
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        "etiqueta" => "Fig&#46; 4"
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        "mostrarFloat" => true
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          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Transmissibility levels of the 2019&#8211;2020 influenza epidemic per 100&#44;000 population&#46; A&#41; Graph based on data from the SVGE report 2019&#8211;2020&#46; B&#41; Numerical data from the SVGE on transmissibility levels in the season 2019&#8211;2020&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Inclusion criteria</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Exclusion criteria</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8226; National and&#47;or local studies conducted in the Spanish population under 18&#8239;years of age&#8226; Studies reflecting the burden of influenza disease in children and adolescents in Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#8226; Systematic reviews<a class="elsevierStyleCrossRef" href="#tf0005"><span class="elsevierStyleSup">a</span></a>&#8226; Over 5&#8239;years of age&#8226; Specific to COVID-19&#44; including only the adult population&#44; and referring to the Spanish Influenza of 1918&#8211;1919&#8226; Any language other than Spanish or English&#8226; Preclinical studies&#8226; Veterinary studies&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="np0005">We conducted an analysis of the literature references of the systematic reviews located to identify original publications of potential interest that would not have emerged under the search strategy used&#46;</p>"
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          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Inclusion and exclusion criteria for studies located by systematic search on the burden of influenza in the paediatric population&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study design&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age distribution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seasons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of seasons&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Geographical scope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Participating hospitals &#40;<span class="elsevierStyleItalic">n</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Aristegui</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">23</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">Epidemiological&#44; observational&#44; retrospective&#44; through review of medical records of patients hospitalised for influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&#60; 15&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">907&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#46;3&#37; were&#8239;&#60;&#8239;2&#8239;years and 77&#46;6&#37; were&#8239;&#60;&#8239;5&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2014&#8211;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basque Country&#44; Madrid&#44; Catalonia&#44; Andalusia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bustamante</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">27</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational&#44; case&#8211;control study in children admitted to a tertiary hospital due to influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 6&#8239;months&#40;with no comorbidity&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">210&#40;88 cases and 122 controls&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cases&#8239;&#61;&#8239;1&#46;6&#8239;months &#40;IQR&#8239;&#61;&#8239;1&#46;0&#8211;3&#46;1&#41;&#46;Controls&#8239;&#61;&#8239;1&#46;9&#8239;months &#40;IQR&#8239;&#61;&#8239;0&#46;9&#8211;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Jan&#233;</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">24</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational&#44; retrospective descriptive in children hospitalised for severe influenza infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 17&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">291&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;7&#37; were&#8239;&#60;&#8239;2&#8239;years and 24&#46;4&#37; were&#8239;&#60;&#8239;1&#8239;year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010&#8211;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Catalonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mazagatos</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">25</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational&#44; retrospective&#44; epidemiological surveillance&#46; Hospitalised patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 6&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age&#8239;&#61;&#8239;2&#8239;months &#40;range 1&#8211;4&#8239;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&#8211;2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asturias&#44; Cantabria&#44; Basque Country&#44; Aragon&#44; Valencian C&#46;&#44; Castilla La Mancha&#44; Madrid&#44; Murcia&#44; Andalusia&#44; Balearic I&#46; Canary I&#46;&#44; Ceuta and Melilla&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 67 hospitals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ortiz-Lana</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">28</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational&#44; prospective study in a tertiary hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 15&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">501 &#40;confirmed&#44; 131 &#91;26&#46;1&#37;&#93;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age&#8239;&#61;&#8239;36&#8239;months &#40;range 0&#8211;179&#8239;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010&#8211;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bilbao&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sol&#237;s-Garc&#237;a</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">26</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational&#44; retrospective cohort study of patients hospitalised with a diagn&#243;stico of influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 16&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age&#8239;&#61;&#8239;21&#8239;months &#40;IQR&#8239;&#61;&#8239;6&#8211;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&#8211;2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Madrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">San Rom&#225;n Montero</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">29</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Observational&#46; Analysis of the Minimum Basic Data Set&#46; Hospitalised patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 1&#8239;year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5618&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age&#8239;&#61;&#8239;3&#46;05&#8239;months&#59; 68&#46;6&#37; were&#8239;&#60;&#8239;6&#8239;months&#59; 37&#46;1&#37;&#8239;&#60;&#8239;2&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&#8211;2015&#47; 2015&#8211;2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#37; of Spanish public hospitals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "tabla" => array:2 [
          "leyenda" => "<p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">IQR&#8239;&#61;&#8239;Interquartile range&#59; PICU&#58; paediatric intensive care unit&#59; N&#46;A&#58; not applicable&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Influenza cases confirmed in ED&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospitalisations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transmissibility&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other relevant considerations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Aristegui</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">23</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Paediatric admissions&#8239;&#61;&#8239;1&#46;6&#37; &#40;95&#37; CI&#8239;&#61;&#8239;1&#46;5&#8211;1&#46;7&#37;&#41;Mean annual hospitalisation incidence&#8239;&#61;&#8239;0&#46;51&#47; 1000 children &#60;<span class="elsevierStyleHsp" style=""></span>15&#8239;years &#40;95&#37; CI&#8239;&#61;&#8239;0&#46;5&#8211;0&#46;6&#41;Total stay&#8239;&#61;&#8239;6129&#8239;days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#37;881 total days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 50&#37; were&#8239;&#60;&#8239;6&#8239;months or had underlying diseases&#46;74&#37; were not vaccinated and 35&#46;2&#37; were children with risk factors indicating vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Bustamante</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">27</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Having siblings is a risk factor for hospital admission and vaccinated grandparents a &#8220;protective&#8221;&#46; factor against admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaccination during pregnancy was uncommon both in cases and controls &#40;3&#46;5&#37; vs&#46; 8&#46;3&#37;&#59; p&#8239;&#61;&#8239;&#46;3&#41; despite being recommended in 71&#46;6&#37; of cases and 71&#37; of controls&#44; p&#8239;&#61;&#8239;&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Jan&#233;</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">24</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the total number of hospitalised children&#44; 56&#46;7&#37; were&#8239;&#60;&#8239;2&#8239;years and 24&#46;4&#37;&#8239;&#60;&#8239;1&#8239;yearTotal stay&#8239;&#61;&#8239;9&#46;2&#8239;days &#40;&#177; SD 13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;3&#37; &#40;12&#46;8&#8239;days &#177; SD 9&#46;7&#41;54&#46;8&#37; of admitted children &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The vaccination rate 5&#46;8&#37;&#59; 27&#46;1&#37; in cases with chronic diseaseThe A&#40;H1N1&#41;pdm09 subtype was found more frequently and was more severe in children &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years &#40;63&#46;1&#37;&#41;&#44; while influenza B was more frequent in children aged from 3&#8211;11&#8239;years &#40;58&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mazagatos</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">25</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the hospitalised cases&#44; 69&#37; developed one or more complications&#46;Only 17&#46;4&#37; of the mothers were vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ortiz-Lana</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">28</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;3&#37; &#40;120&#47;410&#44; 95&#37; CI&#8239;&#61;&#8239;24&#46;9&#8211;33&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;1&#37; &#40;11&#47;91&#59; 95&#37; CI&#8239;&#61;&#8239;6&#46;2&#8211;20&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#47;131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Household contacts with symptoms 25&#46;8&#37; &#40;95&#37; CI&#8239;&#61;&#8239;21&#46;2&#8211;31&#46;1&#37;&#41; vs&#46; 17&#46;5&#37; &#40;95&#37; CI&#8239;&#61;&#8239;15&#46;0&#8211;20&#46;2&#37;&#59; p&#8239;&#61;&#8239;&#46;0032&#41; in children without confirmed diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the 131 cases of laboratory confirmed influenza&#44; 107 &#40;81&#46;7&#37;&#41; returned to the ED and 2 &#40;1&#46;5&#37;&#41; were admitted after being discharged&#46; Global cost median&#8239;&#61;&#8239;177&#46;0 &#8364; &#40;range&#8239;&#61;&#8239;19&#46;0&#8211;4288&#46;0 &#8364;&#41;&#46;71&#46;8&#37; school absenteeism &#40;6&#46;6&#8239;days&#44; range&#8239;&#61;&#8239;1&#8211;15&#8239;days&#41;Only 1&#47;131 children were vaccinated &#40;0&#46;8&#37;&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sol&#237;s-Garc&#237;a</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">26</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Say 4&#8239;days &#40;IQR&#8239;&#61;&#8239;3&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;9&#37;&#40;0&#46;6 d&#237;as IQR&#8239;&#61;&#8239;0&#46;3&#8211;1&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;8&#37; had underlying conditions&#46;29 patients &#40;11&#46;8&#37;&#41; developed neurological events before or during hospitalisation&#44; 9 of whom required antiepileptic drugs at discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">San Rom&#225;n Montero</span> et al&#46;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup"><span class="elsevierStyleItalic">29</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156&#46;1 &#40;95&#37; CI&#8239;&#61;&#8239;152&#46;4&#8211;160&#46;6&#37;&#41; per 100&#44;000 children &#60;<span class="elsevierStyleHsp" style=""></span>12&#8239;months&#46;Mean stay&#8239;&#61;&#8239;6&#46;6&#8239;days &#40;95&#37; CI&#8239;&#61;&#8239;6&#46;4&#37;&#8211;6&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1812 of whom were&#8239;&#60;&#8239;6&#8239;months&#46;Mortality rate&#8239;&#61;&#8239;0&#46;5 &#40;95&#37; CI&#8239;&#61;&#8239;0&#46;27&#8211;0&#46;73&#37;&#41; &#47;100000&#8239;&#60;&#8239;12&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age distribution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seasons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of seasons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Geographical scope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Participating hospitals&#47; information sources &#40;n&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CANADA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Buchan et al&#46;<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&#44; multicentre&#44; cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8211;59&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7659&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age in influenza A&#8239;&#61;&#8239;17 &#40;IQR&#8239;&#61;&#8239;5&#8211;31&#41;Median age in subtype pH1N1&#8239;&#61;&#8239;21 &#40;IQR&#8239;&#61;&#8239;7&#8211;38&#41;Median age in influenza B&#8239;&#61;&#8239;25 &#40;IQR&#8239;&#61;&#8239;10&#8211;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&#8211;2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ontario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44; although 80&#37; of the patients came from 23 hospitals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gilca et al&#46;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&#44; hospitalisations due to acute respiratory tract infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children and adults&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 18&#8239;years&#8239;&#61;&#8239;1171 &#62; 18&#8239;years&#8239;&#61;&#8239;3933&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011&#8211;2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quebec&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tran et al&#46;<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidemiological surveillance study of the Canadian Immunisation Monitoring Program ACTive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8804; 16&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age in influenza A&#8239;&#61;&#8239;2&#46;0 &#40;0&#46;6&#8211;4&#46;8&#41;Median age in influenza B&#8239;&#61;&#8239;3&#46;9 &#40;1&#46;4&#8211;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2004&#8211;2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Newfoundland&#44; Nova Scotia&#44; Quebec&#44;Ontario&#44; Manitoba&#44; Saskatchewan&#44;Alberta&#44; and British Columbia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">USA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Buck et al&#46;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&#44; cohort&#44; patients diagnosed with influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8239;months-18&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Commercial database&#8239;&#61;&#8239;478&#44;002 patients and 955&#44;893 controlsMedicaid database 399&#44;868 patients and 799&#44;341 controls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8211;35&#8239;months&#58;14&#46;4&#37; &#40;Commercial cohort&#41;&#59; 24&#46;9&#37; &#40;Medicaid&#41;6&#8239;months-5&#8239;years&#58;27&#46;9&#37; &#40;Commercial&#41;&#59; 43&#46;8&#37; &#40;Medicaid&#41;&#59;5&#8211;13&#8239;years&#58;51&#37; &#40;Commercial&#41;&#44; 44&#46;6&#37; &#40;Medicaid&#41;13&#8211;18&#8239;years&#58;21&#46;1&#37; &#40;Commercial&#41;&#59; 51&#46;9&#37; &#40;Medicaid&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010&#8211;2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">National&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<a class="elsevierStyleCrossRef" href="#tf0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Campbell et al&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&#44; epidemiological surveillance data analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#8239;months-17&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 groups&#58;Hospitalised&#8239;&#61;&#8239;1792ED&#8239;&#61;&#8239;1944&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 18&#8239;years hospitalised in all centres&#44; &#60; 18&#8239;years in EDs in 4 centres&#46; &#60; 5&#8239;years in 3 centres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&#8211;2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kansas City&#44; MO&#59; Rochester&#44; NY&#59;Cincinnati&#44; OH&#59; Pittsburgh&#44; PA&#59;Nashville&#44; TN&#59; Houston&#44; TX&#59; andSeattle&#44; WA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805; 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chaudhari et al&#46;<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&#44; patients presenting to the emergency department with suspected influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 2&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;986&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age of the sample&#8239;&#61;&#8239;10&#46;7 &#40;IQR&#8239;&#61;&#8239;5&#46;7&#8211;16&#46;8&#41; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&#8211;2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">National&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evers et al&#46;<a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&#44; patients presenting to the emergency department with suspected influenza in a tertiary hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8804; 18&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">818&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 2&#8239;years&#8239;&#61;&#8239;359 &#8805; 2&#8239;years&#8239;&#61;&#8239;459&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&#8211;2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Seattle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Putri et al&#46;<a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Analysis of cases and estimates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8211;100&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA population in 2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 5&#8239;years&#44; 5&#8211;17&#8239;years&#44; 18&#8211;49&#8239;years&#44; 50&#8211;64&#8239;years&#44; and&#8239;&#8805;&#8239;65&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">National&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shang et al&#46;<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidemiological surveillance analysis focusing on influenza-associated deaths&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 18&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">675&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median age&#8239;&#61;&#8239;6&#8239;years&#59; IQR&#8239;&#61;&#8239;2&#8211;12&#8239;years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010&#8211;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">National&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wallick et al&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&#44; cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;224&#44;808 households with &#8805;<span class="elsevierStyleHsp" style=""></span>2 members&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 12&#8239;years&#59; 12&#8211;18&#8239;years&#59; 19&#8211;34&#8239;years&#59; 35&#8211;44&#8239;years&#59; 45&#8211;54&#8239;years&#59; 55&#8211;64&#8239;years&#59; 65&#8211;74&#8239;years&#59;75&#8211;84&#8239;years&#59;&#8805; 85&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2014&#8211;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">National&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FINLAND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heikkinen et al&#46;<a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Analysis of 2 prospective cohort studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">a&#46; &#8804; 13&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">a&#46; 2231 b&#46; 1185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">a&#46; n&#160;&#61;&#160;282 b&#46; n&#160;&#61;&#160;152 &#40;of a total 434 diagnosed with influenza&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">a&#46; 2000&#8211;2002 b&#46; 2007&#8211;2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turku&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8239;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">b&#46; 1&#8211;3&#160;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza A median&#160;&#61;&#160;2&#46;6&#160;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8239;&#8239;&#8239;&#8239;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mattila et al&#46;<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective&#44; in all patients with laboratory-diagnosed influenza in a tertiary hospital during the seasons under study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 16&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8239;&#8239;&#8239;Influenza B median B&#8239;&#61;&#8239;6&#46;4&#8239;years&#46;p&#8239;&#60;&#8239;&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2004&#8211;2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turku&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mattila et al&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&#44; cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 1&#8239;year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">431 &#40;408 active&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean age at time of diagnosis&#8239;&#61;&#8239;7&#46;6&#8239;months &#40;range&#8239;&#61;&#8239;4&#46;3&#8211;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&#8211;2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Turku&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleSup">d</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Teros- Jaakkola et al&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prospective&#44; birth cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 2&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">923&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean age in months &#40;range&#41; at start of each season&#58;3&#46;7 &#40;0&#46;03&#8211;8&#46;0&#41;8&#46;1 &#40;0&#46;1&#8211;17&#46;4&#41;15&#46;6 &#40;7&#46;3&#8211;23&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2008&#8211;2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Southwest Finland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="9" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UNITED KINGDOM</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gallagher et al&#46;<a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Epidemiological retrospective&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 14&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2010&#8211;2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Northern Ireland&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleSup">e</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hardelid et al&#46;<a class="elsevierStyleCrossRef" href="#bb0415"><span class="elsevierStyleSup">83</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective epidemiological data analysis of children with influenza admitted to PICUs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 15&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1778 influenza-related PICU admissions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 6&#8239;months&#8239;&#61;&#8239;5096&#8211;24&#8239;months&#8239;&#61;&#8239;5892&#8211;5&#8239;years&#8239;&#61;&#8239;3495&#8211;15&#8239;years&#8239;&#61;&#8239;514&#40;of the total admitted to PICU&#44; which was 1961&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2003&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleSup">f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hardelid et al&#46;<a class="elsevierStyleCrossRef" href="#bb0420"><span class="elsevierStyleSup">84</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrospective epidemiological data analysis on children admitted to PICU diagnosed with influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 15&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">873 influenza-associated PICU admissions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 1&#8239;year&#8239;&#61;&#8239;3061&#8239;year&#8239;&#61;&#8239;1432&#8211;4&#8239;years&#58;1835&#8211;15&#8239;years&#8239;&#61;&#8239;297&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2003&#8211;2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">United Kingdom&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleSup">f</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pebody et al&#46;<a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Test-negative case control study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8211;17&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">482 positive for influenza in laboratory tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2018&#8211;2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">England&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleSup">g</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Walker et al&#46;<a class="elsevierStyleCrossRef" href="#bb0430"><span class="elsevierStyleSup">86</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Case study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8211;23&#8239;weeks of age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 in 2013&#47;1481 in 2014&#47;15with laboratory-confirmed influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8211;7&#8239;weeks&#8239;&#61;&#8239;15&#59; 338&#8211;15&#8239;weeks&#8239;&#61;&#8239;11&#59; 4116&#8211;23&#8239;weeks&#8239;&#61;&#8239;11&#59; 7&#40;The 1st figure represents the n in the 2013&#47;2014 season and the 2nd figure represents the n in the 2014&#47;2015 season&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2013&#8211;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">England&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1<span class="elsevierStyleSup">h</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tf0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="np0010">The data were obtained from Truven Health MarketScan Commercial Claims and Encounters &#40;Commercial&#41; and Multi-State Medicaid &#40;Medicaid&#41;&#46;<span class="elsevierStyleSup">b</span> The data were obtained from MarketScan&#174; Commercial Claims and Encounters Database and MarketScan&#174; Medicare Supplemental and Coordination of Benefits Database &#40;IBM Watson Health&#44; Cambridge&#44; MA&#41;&#46;<span class="elsevierStyleSup">c</span>Medical records and daily symptom cards &#40;completed by patients&#41;&#46;<span class="elsevierStyleSup">d</span>Primary care clinic&#46;<span class="elsevierStyleSup">e</span>Health Protection Public Health Agency &#40;PHA&#41; routine primary care influenza enhanced surveillance system&#46;<span class="elsevierStyleSup">f</span>Paediatric Intensive Care Audit Network &#40;PICANet&#41;<span class="elsevierStyleSup">g</span>Respiratory DataMart Surveillance system &#40;RDS&#41;&#46;<span class="elsevierStyleSup">h</span>Clinical Practice Research Datalink&#46; IQR&#58; interquartile range&#59; N&#46;A&#58; not applicable&#46;</p>"
            ]
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          "en" => "<p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">Studies located through the systematic search on influenza in children in countries with an influenza vaccination programme in healthy children &#40;2016&#8211;2021&#41;&#46;</p>"
        ]
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        "identificador" => "t0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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            "identificador" => "al0045"
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        "tabla" => array:2 [
          "leyenda" => "<p id="sp0060" class="elsevierStyleSimplePara elsevierViewall">&#42;In Campbell et al&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a> 3 centres only provided ED patients &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years old&#46; IQR&#8239;&#61;&#8239;interquartile range&#59; N&#46;A&#8239;&#61;&#8239;not applicable&#59; PICU&#8239;&#61;&#8239;paediatric intensive care unit&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Publication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Confirmed cases of influenza in ED&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospitalised patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mortality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transmissibility&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other relevant considerations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CANADA</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Buchan et al&#46;<a class="elsevierStyleCrossRef" href="#bb0250"><span class="elsevierStyleSup">50</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza A&#8239;&#61;&#8239;0&#46;19&#8239;&#177;&#8239;0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza A&#8239;&#61;&#8239;8&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children with no comorbidities vs&#46; children with comorbidities&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The baseline population was hospitalised due to influenza or respiratory syncytial virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pH1N1 subtype&#8239;&#61;&#8239;0&#46;15&#8239;&#177;&#8239;0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pH1N1subtype&#8239;&#61;&#8239;3&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Due to influenza A&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children with influenza B were older &#40;median age&#58; 25&#8239;months&#59; IQR&#8239;&#61;&#8239;10&#8211;45&#8239;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza B&#8239;&#61;&#8239;0&#46;17&#8239;&#177;&#8239;0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza B&#8239;&#61;&#8239;4&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#37; &#40;47&#8239;h &#91;IQR&#8239;&#61;&#8239;37&#8211;114&#93;&#41; vs&#46; 11&#37; &#40;75&#8239;h &#91;IQR&#8239;&#61;&#8239;43&#8211;185&#93;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#8239;days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Due to pH1N1 subtype&#8239;&#61;&#8239;6&#37; &#40;32 &#91;IQR&#8239;&#61;&#8239;19&#8211;107&#93;&#41; vs&#46; 6&#37; &#40;83 &#91;IQR&#8239;&#61;&#8239;19&#8211;384&#93;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Due to influenza B&#8239;&#8804;&#8239;3&#37; &#40;112 &#91;IQR&#8239;&#61;&#8239;97&#8211;210&#93;&#41; vs&#46; 11&#37; &#40;78 &#91;IQR&#8239;&#61;&#8239;33&#8211;166&#93;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gilca et al&#46;<a class="elsevierStyleCrossRef" href="#bb0255"><span class="elsevierStyleSup">51</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#46;1&#37;&#41;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The patients at study baseline were hospitalised due to acute respiratory infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza was detected in 268 of the children&#44; 91 of whom were co-infected with another virus&#46; The 6&#8211;23&#8239;months age group showed higher incidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">146&#47;268 &#40;54&#46;5&#37;&#41; of the influenza infections were detected in children &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The median age in children with monoinfection was 2&#8239;years&#44; p&#8239;&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Only 29 &#40;11&#46;3&#37;&#41; of the children for whom there was vaccination data were vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tran et al&#46;<a class="elsevierStyleCrossRef" href="#bb0260"><span class="elsevierStyleSup">52</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza B was responsible for 15&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">337&#47;2645 due to influenza A&#59; 190&#47;1510 due to influenza B</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;2645 due to influenza A&#59; 16&#47;1510 due to influenza B</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children admitted during the 2009&#8211;2010 pandemic&#44; and cases admitted for influenza A in April 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">At 58&#46;3&#37; of seasonal influenza-related admissions &#40;median&#58;34&#46;8&#37;&#59; IQR&#8239;&#61;&#8239;29&#46;9&#8211;45&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Only 98&#47;1504 &#40;6&#46;5&#37;&#41; of admissions due to influenza A and 59&#47;855 &#40;6&#46;9&#37;&#41; of admissions due to influenza B&#44; had been vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The proportion of influenza B hospitalisations was significantly higher in seasons with tetravalent vaccine antigenic mismatch than in seasons with antigenic match &#40;46&#46;3&#37; vs&#46; 28&#46;5&#37;&#59; p&#8239;&#60;&#8239;&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="10" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Buck et al&#46;<a class="elsevierStyleCrossRef" href="#bb0315"><span class="elsevierStyleSup">63</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The 6&#8211;35-month age group was more likely to need ED care &#40;19&#46;1&#37; with complications&#59; 11&#46;2&#37; without complications&#44; Commercial and 36&#46;2&#37; with complications&#59; 31&#46;3&#37; Medicaid&#41;&#46; p&#8239;&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Admissions&#58; &#40;Commercial&#8239;&#61;&#8239;4&#46;5&#37; with complications and 0&#46;7&#37; without complications&#59; Medicaid&#8239;&#61;&#8239;5&#46;5&#37; with complications and 0&#46;8&#37; without complications&#41;&#46; p&#8239;&#60;&#8239;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="10" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="10" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="10" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cases and controls had similar comorbidity frequencies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not only were influenza patients suffering a complication more likely to visit the ED than those without complications&#44; but they were also more likely to need hospitalisation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Admission costs contributed to 30&#37; and 43&#37; of total healthcare costs in the Commercial and Medicaid cohorts&#44; respectively&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incidence of cases diagnosed with influenza per 1000 patients in each season&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleUnderline">Commercia</span>l&#8239;&#61;&#8239;20&#46;3 &#40;95&#37; CI&#8239;&#61;&#8239;20&#46;23&#8211;20&#46;34&#37;&#41;&#59; the highest incidence was in patients aged 6&#8211;35&#8239;months&#44; 26&#46;8 &#40;95&#37; CI&#8239;&#61;&#8239;26&#46;6&#8211;27&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicaid&#8239;&#61;&#8239;32&#46;6 &#40;95&#37; CI&#8239;&#61;&#8239;32&#46;5&#8211;32&#46;7&#37;&#41;&#59; the highest incidence was also in patients aged 6&#8211;35&#8239;months&#44; 47&#46;9 &#40;95&#37; CI&#8239;&#61;&#8239;47&#46;6&#8211;48&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients with influenza-associated complications&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Commercial&#8239;&#61;&#8239;11&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicaid&#8239;&#61;&#8239;17&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The highest incidence of patients with complications was again in patients aged 6&#8211;35&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The Medicaid cohort had a lower rate of vaccinated patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cases diagnosed with influenza incurred a mean &#36;615 in all-cause medical costs unadjusted for patient characteristics vs&#46; &#36;168 &#40;p&#8239;&#60;&#8239;&#46;001&#41; in the Commercial cohort&#44; and &#36;707 vs&#46; &#36;207 &#40;p&#8239;&#60;&#8239;&#46;001&#41; in the Medicaid cohort&#46; Again&#44; the 6&#8211;35-month age group had the highest cost&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Campbell et al&#46;<a class="elsevierStyleCrossRef" href="#bb0335"><span class="elsevierStyleSup">67</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the 1944 patients with acute respiratory disease in ED they tested&#44; 420 were positive for influenza&#46; In that group&#44; the &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months-5&#8239;years age group had the most positives&#8239;&#61;&#8239;290&#47;420&#42;&#46;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the 1792 admissions with acute respiratory disease they tested&#44; 226 were positive for influenza&#46; In that group&#44; those &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months-5&#8239;years were almost half of the sample&#8239;&#61;&#8239;109&#47;226 positive for influenza&#46;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;hospitalised group&#41;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the hospitalised group&#44; 226 &#40;13&#37;&#41; were positive for influenza&#44; of which 47&#37; were positive for influenza A&#40;H3N2&#41;&#44; 36&#37; for A&#40;H1N1&#41;pdm09&#44; 9&#37; for A &#40;not subtyped&#41;&#44; and 7&#37; for influenza B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the ED group&#44; 420 &#40;22&#37;&#41; were positive for influenza&#59; 48&#37; for A&#40;H3N2&#41;&#44; 35&#37; for A&#40;H1N1&#41;pdm09&#44; 11&#37; for A &#40;not subtyped&#41;&#44; and 5&#37; for influenza B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The cases positive for influenza tended to be less vaccinated than the control patients in hospitalised patients &#40;47&#37; vs&#46; 62&#37;&#41; and ED patients &#40;40&#37; vs&#46; 58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The 2018&#8211;2019 season vaccine reduced influenza A-associated hospitalisations and ED visits in 40&#37; -60&#37;&#44; data that supported the recommendation to vaccinate children &#62;<span class="elsevierStyleHsp" style=""></span>6&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chaudhari et al&#46;<a class="elsevierStyleCrossRef" href="#bb0320"><span class="elsevierStyleSup">64</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The study was conducted in children presenting to the ED with signs consistent with influenza &#40;meeting diagnostic codes for influenza or influenza-like illness&#59; patients with chronic conditions were excluded&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitalisation rate in children &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#37; &#40;1090 admissions&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2 in ED and 2 during hospitalisation&#41;&#59; mortality rate of 7 per 100&#44;000</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37; &#40;10&#44;960&#47;55&#46;986&#41;&#59; Stay &#8805;<span class="elsevierStyleHsp" style=""></span>3&#8239;days&#8239;&#61;&#8239;6&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children &#60;<span class="elsevierStyleHsp" style=""></span>3&#8239;months have higher rates 2&#46;7&#37; &#40;95&#37; CI&#8239;&#61;&#8239;2&#46;0&#37;&#8211;3&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Evers et al&#46;<a class="elsevierStyleCrossRef" href="#bb0325"><span class="elsevierStyleSup">65</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The sample was drawn from children with influenza-like disease in the emergency department&#44; and who did not require hospital care</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#37; of the population&#8239;&#60;&#8239;2&#8239;years&#44; and 46&#37; of those &#8805;<span class="elsevierStyleHsp" style=""></span>2&#8239;years were diagnosed as influenza positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of these only 31&#37; and 27&#37;&#44; respectively&#44; were vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaccination status was unknown in 26&#37; of those &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years and 36&#37;&#8239;&#8805;&#8239;2&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Putri et al&#46;<a class="elsevierStyleCrossRef" href="#bb0345"><span class="elsevierStyleSup">69</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The group with the highest mean number of ED visits was 0&#8211;7&#8239;years&#8239;&#61;&#8239;10&#46;2 &#40;Range 4&#46;0&#8211;26&#46;4&#41; per 1000 people&#46; The group with the next highest mean was &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years&#44; at 2&#46;5 &#40;range 2&#46;0&#8211;2&#46;9&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Children &#60;<span class="elsevierStyleHsp" style=""></span>1&#8239;year had the second highest mean hospitalisation among the groups&#8239;&#61;&#8239;2&#46;0 &#40;1&#46;0&#8211;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8211;17&#8239;years&#8239;&#61;&#8239;4 &#40;2&#8211;6&#41; per 1&#44;000&#44;000</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">All values are estimates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;those &#62;<span class="elsevierStyleHsp" style=""></span>65&#8239;years had a mean of 3&#46;2 &#40;1&#46;9&#8211;11&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">They estimated 1&#44;851&#44;377 &#40;range&#8239;&#61;&#8239;1&#44;632&#44;397&#8211;2&#44;209&#44;708&#41; cases in &#60;<span class="elsevierStyleHsp" style=""></span>5&#8239;years annually&#44; of which 1&#44;145&#44;563 &#40;range&#8239;&#61;&#8239;1&#44;126&#44;150&#8211;1&#44;067&#44;728&#41; were ill&#44; but were not seen in healthcare centres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8211;4&#8239;years&#8239;&#61;&#8239;0&#46;5 &#40;0&#46;2&#8211;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In the 5&#8211;17&#8239;years age group&#44; there were an estimated 4&#44;590&#44;823 &#40;range&#8239;&#61;&#8239;4&#44;257&#44;330&#8211;4&#44;884&#44;960&#41; cases annually&#44; with an estimated 2&#44;741&#44;258 &#40;range&#8239;&#61;&#8239;2&#44;599&#44;283&#8211;2&#44;708&#44;924&#41; not seen in healthcare centres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The age group with the highest estimated cost in ED was 0&#8211;4&#8239;years &#40;&#36; 86&#44;425&#59; range &#36;648&#46;19 -&#36; 1080&#46;31&#41;&#41;&#44; above the second highest estimated cost group&#44; those aged &#8805;<span class="elsevierStyleHsp" style=""></span>65&#8239;years &#40;&#36; 605&#46;53&#59; range &#36; 604&#46;51&#8211;607&#46;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The cost of hospitalisations in those &#60;<span class="elsevierStyleHsp" style=""></span>1&#8239;year was estimated at &#36; 5211&#46;68&#59; range &#36; 3908&#46;76&#8211;6514&#46;61&#41;&#59; in 1&#8211;17-year-olds &#36;7346&#46;58&#59; range &#36; 5509&#46;94&#8211;9183&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Shang et al&#46;<a class="elsevierStyleCrossRef" href="#bb0340"><span class="elsevierStyleSup">68</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Study based on data on influenza-associated paediatric deaths from the US Centers for Disease Control and Prevention&#46;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean annual incidence&#8239;&#61;&#8239;0&#46;15 per 100&#44;000 children &#40;95&#37; CI&#8239;&#61;&#8239;0&#46;1&#8211;0&#46;2&#37;&#41;&#44; higher in &#60;<span class="elsevierStyleHsp" style=""></span>6&#8239;months &#40;0&#46;66&#59; 95&#37; CI&#8239;&#61;&#8239;0&#46;5&#8211;0&#46;8&#37;&#41;&#44; followed by the 6&#8211;23-month age group &#40;0&#46;3&#59; 95&#37; CI&#8239;&#61;&#8239;0&#46;3&#8211;0&#46;4&#37;&#41;&#46;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Only 31&#37; of those aged &#8805;<span class="elsevierStyleHsp" style=""></span>6&#8239;months had been vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">327 of 654 had no pre-existing medical conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compared with the children with previous conditions&#44; those with none were younger &#40;5&#8239;years vs&#46; 8&#8239;years&#41;&#44; were less vaccinated &#40;27&#37; vs&#46; 36&#37;&#41;&#44; and were less likely to die before hospital admission 77&#37; vs&#46; 48&#37;&#41;&#46; They also had a shorter illness duration &#40;4&#8239;days vs&#46; 7&#8239;days&#41;&#59; p&#8239;&#60;&#8239;&#46;05 for all&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wallick et al&#46;<a class="elsevierStyleCrossRef" href="#bb0330"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The highest proportion of primary or secondary diagnosed cases was reported in children &#40;62&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FINLAND</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Heikkinen et al&#46;<a class="elsevierStyleCrossRef" href="#bb0385"><span class="elsevierStyleSup">77</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 of 100 children aged &#60;<span class="elsevierStyleHsp" style=""></span>3&#8239;years with moderate&#47;severe influenza</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 of 100 children &#60;<span class="elsevierStyleHsp" style=""></span>3&#8239;years with moderate&#47;severe influenza</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">437 children were diagnosed with influenza&#44; of which 3 were excluded for the study due to co-infection or unknown data&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">152 children &#40;35&#37;&#41; were&#8239;&#60;&#8239;3&#8239;years and 282 &#40;65&#37;&#41; were aged 3&#8211;13&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">349 children &#40;80&#37;&#41; had influenza A &#40;221 children A&#40;H1N1&#41; and 128&#44; A&#40;H3N2&#41;&#44; and 73 children &#40;17&#37;&#41; influenza B&#46; In 12 &#40;3&#37;&#41; the virus was not subtyped&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parental absenteeism rates were 184 &#40;95 CI&#8239;&#61;&#8239;153&#37;&#8211;215&#37;&#41; days per 100 children with moderate&#47;severe influenza and 135 &#40;95&#37; CI&#8239;&#61;&#8239;109&#37;&#8211;161&#37;&#41; days per 100 children with mild influenza &#40;p&#8239;&#61;&#8239;&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">School absenteeism was &#8805;<span class="elsevierStyleHsp" style=""></span>1&#8239;day in 137 &#40;77&#37;&#41; of 177 cases of moderate&#47;severe influenza and in 133 &#40;73&#37;&#41; of the 181 cases of mild influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mattila et al&#46;<a class="elsevierStyleCrossRef" href="#bb0370"><span class="elsevierStyleSup">74</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">With the exception of the 2009&#8211;2010 pandemic&#44; the proportion of hospitalisations in the different seasons for&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;12&#46;9&#37;&#44; p&#8239;<span class="elsevierStyleItalic">&#61;</span>&#8239;&#46;55&#41; children with influenza A&#59; mean duration&#8239;&#61;&#8239;2&#46;7 &#40;SD 3&#46;5&#41; days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;in the age group 0&#8211;2&#41;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&#46;4&#37; of the patients were diagnosed with influenza A and 28&#46;6&#37; influenza B</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza A&#8239;&#61;&#8239;45&#37;&#8211;93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;15&#46;2&#37;&#44; p&#8239;<span class="elsevierStyleItalic">&#61;</span>&#8239;&#46;55&#41; with influenza B&#59; mean duration&#8239;&#61;&#8239;4&#46;2 &#40;SD 7&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean duration&#8239;&#61;&#8239;2&#46;3&#8239;days&#44; p&#8239;&#61;&#8239;&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Influenza B&#8239;&#61;&#8239;7&#37;&#8211;55&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean duration&#8239;&#61;&#8239;2&#46;7&#8239;days&#44; p&#8239;&#61;&#8239;&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mattila et al&#46;<a class="elsevierStyleCrossRef" href="#bb0375"><span class="elsevierStyleSup">75</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A cohort of children born between 01&#47;09&#47;2017 and 30&#47;06&#47;2018&#46; Their parents were required to bring them to the clinic as soon as symptoms consistent with influenza began&#46; 80&#37; of the children diagnosed with influenza attended the clinic within 48&#8239;h of symptom onset</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jan-55</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="4" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The study population is a cohort of children born in 2017 followed up for 10&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#47;408 were diagnosed with laboratory-confirmed influenza&#44; 28 virus A and 27 virus B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Only 4 had received the 2 doses of influenza vaccine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Five were ruled out with co-infection of influenza and another non-influenza predominant respiratory virus&#46; Of the monoinfections&#44; virus A was detected in 26 cases and virus B in 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Teros- Jaakkola et al&#46;<a class="elsevierStyleCrossRef" href="#bb0380"><span class="elsevierStyleSup">76</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#37;&#41;</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The baseline population was a birth cohort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The number of children during the years of the study varied at the beginning of each season &#40;335&#8211;637&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Incidence in each season&#8239;&#61;&#8239;2008&#8211;2009&#44; of 335 children&#44; 17 were influenza positive &#40;14 for influenza A&#91;H3N2&#93;&#44; and 3 for B&#41;&#44; in 2009&#8211;2010&#44; of 637 children&#44; 17 were influenza positive &#40;12 for influenza A&#91;H1N1&#93; and 5 for influenza B&#41;&#44; and in 2010&#8211;2011&#44; of 444 children&#44; 22 were influenza positive &#40;4 for influenza A&#91;H1N1&#93;&#44; and 18 for influenza B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean age of the children with influenza&#8239;&#61;&#8239;A&#40;H3N2&#41;&#8239;&#61;&#8239;6&#46;1&#8239;months&#59; A&#40;H1N1&#41;pdm09&#8239;&#61;&#8239;11&#46;9&#8239;months and B&#8239;&#61;&#8239;13&#46;1&#8239;months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Of the 758 &#40;82&#37;&#41; children whose vaccination status was available&#44; 60 were from the 2008&#8211;2009 season&#44; for which vaccine effectiveness was not estimated due to the low number of subjects&#46; For the other 2 seasons&#44; vaccine effectiveness in 2009&#8211;2010 was estimated at 97&#37; &#40;95&#37; CI&#8239;&#61;&#8239;76&#37;&#8211;100&#37;&#41; and in 2010&#8211;2011 at 41&#37; &#40;95&#37; CI&#8239;&#61;&#8239;75&#37;&#8211;80&#37;&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="7" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UNITED KINGDOM</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gallagher et al&#46;<a class="elsevierStyleCrossRef" href="#bb0410"><span class="elsevierStyleSup">82</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The cumulative incidence rate for &#8220;out-of-hours&#8221; consultations was 10&#46;01&#47;100000 in phase 0&#44; 4&#46;7 in phase 1&#44; and 5&#46;13 in phase 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The data analysed were from the paediatric primary care population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The incidence rate in primary care consultations was higher in phase 0 &#40;15&#46;1&#47;100000&#41; than in phase 1 &#40;8&#46;3&#41; and phase 2 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vaccination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;they were visits for influenza and influenza-like illness&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Phase 0&#8239;&#61;&#8239;2010&#8211;2013 the vaccine was not offered to children with no associated risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Phase 1&#8239;&#61;&#8239;2013&#8211;2014&#44; 55&#46;5&#37; of pre-schoolers and 80&#46;5&#37; of primary school children were vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Phase 2&#8239;&#61;&#8239;2014&#8211;2017&#44; 54&#46;5&#44; 50&#46;5&#44; and 52&#46;6&#37; of pre-schoolers vaccinated in each season &#40;from 2014&#8211;2015 to 2016&#8211;2017&#44; respectively&#41; and 79&#46;7&#44; 76&#46;8 and 78&#46;3&#37; of primary children were vaccinated in each season &#40;from 2014&#8211;2015 to 2016&#8211;2017&#44; respectively&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hardelid et al&#46;<a class="elsevierStyleCrossRef" href="#bb0415"><span class="elsevierStyleSup">83</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143 &#40;7&#46;3&#37;&#41; of those admitted to PICU died&#44; of which only 5 &#40;3&#46;5&#37;&#41; did not have high risk conditions</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The baseline population was the population admitted to the PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1961 admissions &#40;487 in period 1&#44; 375 in period 2&#44; 371 in period 3&#44; 367 in period 4&#44; and 361 in period 5&#41;&#44; of which 1540 &#40;78&#46;5&#37;&#41; were children with at least one at-risk condition&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">To examine changes over time&#44; the authors defined 5 seasons&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rate by ages&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 2003&#8211;March 2009 &#40;pre-pandemic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 2&#8239;years&#8239;&#61;&#8239;10&#46;5&#47;100000 &#40;9&#46;8&#8211;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2009&#8211;March 2010 &#40;2 pandemic waves&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8211;5&#8239;years&#8239;&#61;&#8239;2&#46;6&#47;100000 &#40;2&#46;3&#8211;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2010&#8211;March 2011 &#40;third pandemic wave&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8211;16&#8239;years&#8239;&#61;&#8239;1&#46;0&#47;100000 &#40;0&#46;9&#8211;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April Period 2011&#8211;2013 &#40;post-pandemic period&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">September 2013&#8211;March 2015 &#40;within the paediatric vaccination programme&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VC in the season 2015&#8211;2016 was 18&#46;6&#37; in the group aged 6&#8239;months-2&#8239;years and with severe risk factors&#44; 34&#46;4&#37; in pre-schoolers&#44; and 53&#46;6&#37; in children aged 6&#8211;7&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hardelid et al&#46;<a class="elsevierStyleCrossRef" href="#bb0420"><span class="elsevierStyleSup">84</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="8" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The vaccination rate in England in infants aged 6&#8239;months -&#8239;&#60;&#8239;2&#8239;years in high-risk groups was &#60;<span class="elsevierStyleHsp" style=""></span>26&#37;&#44; and in the 2&#8211;15-year age group also at high risk&#44; &#60; 50&#37;&#44; between 2009 and 2016&#46; It is 38&#46;1&#37; in pre-schoolers and 64&#46;9&#37; in the 6&#8211;8&#8239;years age group &#40;data from winter 2016&#47;2017&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">929&#44; of which 48&#46;3&#37; were in &#60;<span class="elsevierStyleHsp" style=""></span>2&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">They defined 5 periods&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The influenza-associated admission rate during winters of all seasons was 1&#46;32&#47;100000 children &#40;95&#37; CI&#8239;&#61;&#8239;1&#46;2&#37;&#8211;1&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 2003&#8211;March 2009 &#40;pre-pandemic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">There was considerable variability&#46; Rates increased in the winter of 2010&#8211;2011 in children &#60;<span class="elsevierStyleHsp" style=""></span>5 and in the 2009&#8211;2010 season in children aged 5&#8211;15&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 2009&#8211;March 2010 &#40;wave 2 of the pandemic influenza A&#91;H1N1&#93;pdm09&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Admission rates were highest in children &#60;<span class="elsevierStyleHsp" style=""></span>1&#8239;year &#40;6&#46;70&#59; 5&#46;97&#8211;7&#46;49&#41;&#44; and decreased with increasing age&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 2010&#8211;March 2011 &#40;third wave of the pandemic&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#8239;year&#8239;&#61;&#8239;3&#46;15&#47;100000 children &#40;2&#46;7&#8211;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 2011&#8211;March 2013 &#40;post-pandemic period&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#8211;4&#8239;years&#8239;&#61;&#8239;1&#46;4&#47;100000 &#40;1&#46;2&#8211;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 2013&#8211;March 2017 &#40;start of the paediatric vaccination programme&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#8211;15&#8239;years&#8239;&#61;&#8239;0&#46;6&#47;100000 &#40;0&#46;6&#8211;0&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">They did not identify a decrease in PICU admission rates following the introduction of the paediatric vaccination programme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pebody et al&#46;<a class="elsevierStyleCrossRef" href="#bb0425"><span class="elsevierStyleSup">85</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">307&#8239;&#61;&#8239;104 due to influenza A&#40;H1N1&#41;pdm09&#44; 40 due to A&#40;H3N2&#41;&#44; 156 due to influenza A not subtyped&#44; and 6 due to influenza B&#46; One case was co-infection with influenza A and B</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">In the hospitalised patients&#44; 78 of the influenza A&#40;H1N1&#41; positives&#44; 28 of the influenza A&#40;H3N1&#41; positives&#44; 112 of the non-subtyped influenza A&#40;H1N1&#41; positives&#44; and 4 of the influenza B positives were not vaccinated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The vaccination status of one of the influenza A &#40;H3N1&#41; positives&#44; of 4 non-subtyped influenza A positives&#44; and one of the influenza B positives was not known&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Walker et al&#46;<a class="elsevierStyleCrossRef" href="#bb0430"><span class="elsevierStyleSup">86</span></a></td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Season 2013&#47;2014&#8239;&#61;&#8239;30 hospitalised infants &#40;6 of their mothers were vaccinated&#44; 20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowgroup " rowspan="3" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46; A</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">Pregnant women were considered vaccinated if they had received the vaccine &#8805;<span class="elsevierStyleHsp" style=""></span>2&#8239;weeks postpartum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Season 2014&#47;2015&#8239;&#61;&#8239;69 hospitalised infants &#40;17 of their mothers were vaccinated&#44; 25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#37; of pregnant women were vaccinated in the season 2013&#47;2014 and 25&#37; in the season 2014&#47;2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In 2013&#47;2014&#44; vaccine effectiveness per week and season was estimated in all cases at 70&#37; &#40;95&#37; CI&#8239;&#61;&#8239;26&#37;&#8211;88&#37;&#41; and in 2014&#47;2015&#44; at 50&#37; &#40;95&#37; CI&#8239;&#61;&#8239;12&#37;&#8211;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information

ISSN: 24451460
Original language: English

DOI:10.1016/j.vacune.2023.03.003

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