Ten Years of National Seasonal Surveillance for Severe Complications of Influenza in Australian Children.

Background: Severe complications of influenza in children are uncommon but may result in admission to hospital or an intensive care unit (ICU) and death.

Methods: Active prospective surveillance using the Australian Paediatric Surveillance Unit with monthly reporting by pediatricians of national demographic and clinical data on children with <15 years of age hospitalized with severe complications of laboratory-confirmed influenza during ten influenza seasons 2008-2017.

Results: Of 722 children notified, 613 had laboratory-confirmed influenza and at least one severe complication.

Recurrent fevers.

An 11-year-old girl had four episodes of fever in a year, lasting 7-10 days and associated with headache and neck stiffness. She had a long history of recurrent urticaria, usually preceding the fevers. There was also a history of vague pains in her knees and in the small joints of her hands.

Comparing the use of, and considering the need for, lumbar puncture in children with influenza or other respiratory virus infections.

Background: The clinical presentation of influenza in infancy may be similar to serious bacterial infection and be investigated with invasive procedures like lumbar puncture (LP), despite very limited evidence that influenza occurs concomitantly with bacterial meningitis, perhaps because the diagnosis of influenza is very often not established when the decision to perform LP is being considered.

Methods: A retrospective medical record review was undertaken in all children presenting to the Children's Hospital at Westmead, Sydney, Australia, in one winter season with laboratory-confirmed influenza or other respiratory virus infections (ORVIs) but excluding respiratory syncytial virus, to compare the use of, and reflect on the need for, the performance of invasive diagnostic procedures, principally LP, but also blood culture, in influenza and non-influenza cases. We also determined the rate of concomitant bacterial meningitis or bacteraemia.

Rheumatic fever - identification, management and secondary prevention.

Background: Acute rheumatic fever is a rare multisystem disease caused by an immunological response to Group A streptococcus infection. Acute rheumatic fever usually has onset in childhood and is most prevalent in Aboriginal and Maori populations and other disadvantaged groups.

Objective: In this article we outline the clinical features of acute rheumatic fever and describe the important role of primary healthcare providers in its identification, management and secondary prevention.

Clinical features, oseltamivir treatment and outcome in infants aged <12 months with laboratory-confirmed influenza A in 2009.

Background: Data on the use of oseltamivir in infants is limited. We documented the clinical presentations of infants aged <12 months hospitalized with laboratory-confirmed influenza A in the southern hemisphere winter of 2009 and compared outcomes in relation to oseltamivir therapy.

Methods: Data were extracted from prospectively collected and collated influenza case reports (June-September 2009) ascertained through Paediatric Active Enhanced Disease Surveillance, an in-patient surveillance system operating at the Children's Hospital at Westmead (CHW), Sydney, NSW, Australia.

Persistence of acute rheumatic fever in a tertiary children's hospital.

Aim: To identify and describe all children admitted with acute rheumatic fever (ARF) to a tertiary paediatric hospital in Sydney over a 9-year period and to describe their demographic and clinical characteristics, management and short-term outcomes. Delays in diagnosis, recurrence of ARF and use of secondary prophylaxis were also documented.

Methods: Retrospective review of medical records for children aged < 15 years admitted to the Children's Hospital at Westmead, Sydney, with ARF (International Classification of Diseases (ICD)-10 classification I0.

Using the clinical challenges encountered by junior residents to inform curriculum for paediatric pre-intern students.

Aim: To develop and evaluate a novel skills-based education programme for medical students completing a paediatric pre-internship (PrInt) at the Children's Hospital at Westmead (CHW), Sydney which incorporated a mini-clinical evaluation exercise style formative assessment component and was based upon a local needs assessment of junior staff.

Methods: We designed a teaching programme which included four interactive tutorials and formative assessment tasks using observed clinical exercises (OCE). The final programme was informed by a local need-based assessment of out-of-hours junior doctors' tasks.

The burden of childhood influenza in a tertiary paediatric setting.

Influenza is usually considered a mild winter-time illness but can be associated with a range of serious complications. We undertook a retrospective medical record review to study the impact of admissions of children with laboratory-confirmed influenza to The Children's Hospital at Westmead, Sydney, during 2007. One hundred and twenty-two children were identified, representing 530 hospital admission days.

Enhanced surveillance for serious complications of influenza in children: role of the Australian Paediatric Surveillance Unit.

Influenza contributes significantly to disease burden among children aged less than five years. Existing influenza surveillance systems do not provide detailed data on clinical presentation, management, vaccination status, risk factors and complications in hospitalised children, or link such data with laboratory results. Following a number of child deaths due to influenza in 2007, the Australian Government Department of Health and Ageing approached the Australian Paediatric Surveillance Unit (APSU) to examine the feasibility of enhancing APSU surveillance to identify children hospitalised with severe complications of influenza.