Zhang R, Wen J, Wu K, Lin S, Tan K, Bi J, Deng J. Influenza-associated neurologic complications in children from an H3N2 outbreak in Shenzhen, China during COVID-19 lockdown. Int J Infect Dis. 2023 May 30:S1201-9712(23)00616-
Methods: A retrospective cohort study of INC in children hospitalized with H3N2 infection was conducted.
Results: From June 1, 2022 to July 1, 2022, 513 children with H3N2 infection were hospitalized and 97 developed INC. Of 18 patients with encephalopathy/encephalitis, 13 were previously healthy. Three developed acute necrotizing encephalopathy and two died. Of 63 patients with febrile seizures, 55 (87%) had simple febrile seizures. Of 14 patients with exacerbation of seizure with underlying epilepsy (ESUE), seizure symptoms occurred mostly within 24 hours of disease onset (13/14). Comparison of 3 groups (encephalopathy/encephalitis, febrile seizure and ESUE) reported no significant differences in sex, preexisting neurologic diseases, vaccination rate, white blood cell count, C-reactive protein, procalcitonin, blood glucose, lactic acid, or duration of fever. Influenza vaccination rates were generally low (22% vs 32% vs 21%). Patients with encephalopathy/encephalitis had a higher rate of elevated alanine aminotransferase (28% vs 3% vs 0, p=0.005).
Conclusions: H3N2-related neurologic complications in children mainly occur early in the disease course. Most patients are previously healthy and unvaccinated against influenza. Elevated alanine aminotransferase is more common in encephalopathy/encephalitis.
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