4.6 Article

Age-specific Differences in Influenza A Epidemic Curves: Do Children Drive the Spread of Influenza Epidemics?

Journal

AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 174, Issue 1, Pages 109-117

Publisher

OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwr037

Keywords

age groups; data interpretation, statistical; diagnostic techniques and procedures; disease transmission, infectious; empirical research; influenza, human; population surveillance

Funding

  1. National FluWatch Network

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There is accumulating evidence suggesting that children may drive the spread of influenza epidemics. The objective of this study was to quantify the lead time by age using laboratory-confirmed cases of influenza A for the 1995/1996-2005/2006 seasons from Canadian communities and laboratory-confirmed hospital admissions for the H1N1/2009 pandemic strain. With alignment of the epidemic curves locally before aggregation of cases, slight age-specific differences in the timing of infection became apparent. For seasonal influenza, both the 10-19- and 20-29-year age groups peaked 1 week earlier than other age groups, while during the fall wave of the 2009 pandemic, infections peaked earlier among only the 10-19-year age group. In the H3N2 seasons, infections occurred an average of 3.9 (95% confidence interval: 1.7, 6.1) days earlier in the 20-29-year age group than for youth aged 10-19 years, while during the fall pandemic wave, the 10-19-year age group had a statistically significant lead of 3 days compared with both younger children aged 4-9 years and adults aged 20-29 years (P < 0.0001). This analysis casts doubt on the hypothesis that younger school-age children actually lead influenza epidemic waves.

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