Written by Kimiko Dunbar
Spoon Feed
Serious neurologic complications associated with influenza are uncommon but higher in kids with underlying neurologic conditions, with the most common complication being seizure.
Flu frenzy!
This retrospective cohort study assessed the population-based incidence of serious influenza-associated neurologic events in children under five years enrolled in Tennessee Medicaid (2016–2020). Neurologic events included seizure, encephalitis or encephalopathy, altered mental status and ataxia, and movement disorders. Among 79,727 influenza cases, the incidence was 38.0 per 100,000 influenza person-weeks, with seizures (34.5) as the most common event. This did not include febrile seizures. Incidence was markedly higher in children with neurologic disorders (1788.2) but similar in those with or without the use of influenza directed antivirals. Incidence rates were highest among children less than 2; however, there were no reported events in children less than 6 months. Limitations include reliance on administrative data and potential misclassification of cases. Further, there was no data on vaccination rate as it pertained to patients in this study. Findings highlight the need for influenza prevention in high-risk children.
How will this change my practice?
Influenza A has been particularly nasty for kids this year – I’ll be on the lookout for those with neurologic complications. Perhaps most importantly, this is yet another reason why patients with medical complexity, especially those with underlying neurologic disorders, should be strongly urged to get the flu shot. That said, I do wonder if those with epilepsy who present with seizure are seizing because of an influenza complication or because the illness simply lowers their seizure threshold. We see countless patients admitted in need of an AED bridge in the setting of any infectious process, influenza or otherwise. Given the GI side effects associated with meds like oseltamivir, I suspect we could be less stringent about treatment if a patient’s primary symptoms upon admission are neurologic, although I’d like dedicated research on this data before holding off on antivirals.
Source
Serious Neurologic Events with Seasonal Influenza in Young Children. Acad Pediatr. 2025 Feb 12:102801. doi: 10.1016/j.acap.2025.102801. Epub ahead of print. PMID: 39952395
