The comparison of COVID-19 vs seasonal influenza in children

Yayla B. C. C., Aykac K., Boluk O., Fidanci I., Tasar M. A., Pamuk U., ...More

Pediatrics International, vol.65, no.1, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 65 Issue: 1
  • Publication Date: 2023
  • Doi Number: 10.1111/ped.15684
  • Journal Name: Pediatrics International
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CAB Abstracts, CINAHL, MEDLINE, Veterinary Science Database
  • Keywords: COVID-19, influenza, pediatric
  • Hacettepe University Affiliated: Yes


Background: Influenza in children has been well described, whereas there has been a paucity of pediatric data regarding COVID-19. It is crucial for clinicians to differentiate cases of COVID-19 from cases of influenza because of the upcoming influenza season in the new pandemic era. Methods: This retrospective study included pediatric patients who were diagnosed with laboratory-confirmed COVID-19 between March and September 2020, or seasonal influenza between October 2019 and March 2020. Results: A total of 315 children were included in this study; 151 were diagnosed with influenza and 164 had confirmed COVID-19. The median age of patients with COVID-19 was 10 years (interquartile range [IQR]: 3–15 years), whereas the median age of patients with influenza was 4 years (IQR: 1–6 years) (p = 0.001). In the COVID-19 group, 6.3% of patients had underlying diseases, the most frequent being neurological conditions (3%). In the influenza group, 20.9% of patients had an underlying disease, the most frequent being asthma (14.5%). Fever (odds ratio [OR]: 20.476; 95% confidence interval [CI]: 2.438–171.995; p = 0.005), dyspnea/tachypnea (OR 13.950; 95% CI: 2.607–74.634; p = 0.002), and increased C-reactive protein (CRP) (OR: 7.650; 95% CI: 2.094–27.955; p = 0.002) were main predictors of influenza diagnosis in comparison to COVID-19. Lymphopenia was detected in 43.2% of patients with influenza and 19.9% of patients with COVID-19 (p = 0.001). Conclusions: The accurate differentiation between “influenza or COVID-19” seems possible by evaluating a combination of factors including cough, fever, vomiting, leucopenia, lymphopenia, pneumonia, in pediatric patients with high CRP as well as age.