Upper respiratory tract infections

The aim of this study was to estimate the incidence ,clinical characteristics, outcomes and costs (both social and economic) of acute respiratory infections (ARI) in the paediatric age group, and the role of influenza.
A further aim was to verify the applicability of a rapid test for the bedside identification of the influenza virus and the creation of clinical predictive score for influenza.

17 family paediatricians connected to the Pedianet network, working the Veneto area, were recruited (collectively covering 16.760 children). All children seen from 10/11/1999 to 30/3/2000 were included in this prospective study. A specially designed electronic form was filled out for every child with a febbrile ARI. Every first child of the day diagnosed with a febrile ARI was tested with an enzyme immunoassay test (FLU OIA) to identify influenza (a total of 1003 tests carried out). 4017 episodes of febrile ARI were included in the study in a total of 3242 children. The peak incidence was observed in January.
A fever above 39°C and subjective signs of being unwell (headache, myalgia, sore throat) were more common in older children. Vomiting and diarrhoea were almost exclusively present in younger children.
In 1003 cases in which the rapid test for influenza was carried out, 232 (28%) had a positive result. This is lower in children under the age of one (19,4%) and higher in children over the age of 9 years (50,0%).
Fever on average was higher i children over one year of age. The duration of fever was greatest in children positive for influenza compared to those with a negative rapid test (3,81 days vs. 3,43 days). 45 children (1,2%) were admitted to hospital with bronchopneumonia or bronchiolitis. In 85% cases at least one school day was lost, but only n 11% did a parent also loose a day of work.
In 1/3 cases (32%) the children were prescribed antibiotics, their use was not related to the presence of any particular symptom if not vomiting and negatively correlated to the presence of myalgia. It was also not correlated to the severity of symptoms or the influenza test result. The prescription of other medications was negligible.

The results of this study show that ARI remains one of the commonest paediatric illnesses. Despite this it’s economic and social costs is modest and definitely inferior to that registered in the USA, both for the different family structure (resulting in less days lost from work) and the presence of a National Health System. 
The percentage patients hospitalised and the drugs used were both very modest.