Disease Burden of the 2024–2025 Influenza Season in Children: Insights from a Tertiary Center in Turkey

To the Editors: The 2024–2025 influenza season has been notable for its severity, with an unexpectedly high impact on otherwise healthy children. According to the US Centers for Disease Control and Prevention (CDC), 267 pediatric deaths were reported, the highest number recorded in any nonpandemic influenza season since 2004, underscoring the serious consequences of influenza across all pediatric populations.1 While annual vaccination is recommended for all children ≥6 months of age in the United States, vaccine uptake remains suboptimal.2 In Turkey, the influenza vaccine is not included in the routine childhood immunization schedule and is recommended only for high-risk groups; coverage is very low. At our tertiary-care hospital, we retrospectively reviewed the medical records of hospitalized children with polymerase chain reaction (PCR)-confirmed influenza between December 2024 and May 2025. We identified 42 patients aged 1 month to 18 years old. The mean age was 56.3 ± 34.4 months, with 23.8% <2 years and 52.4% <5 years. The median hospital stay was 4 days (range: 2–7). Underlying medical conditions were present only in 23.8% (n = 10), including asthma, recurrent bronchiolitis, neurofibromatosis type 1, psoriasis, allergic rhinitis, juvenile idiopathic arthritis on biologics and prematurity. Clinical presentations were diverse: lower respiratory tract infection (28.6%), myositis (26.2%), gastroenteritis (19%), upper respiratory tract infection (23.8%) and prolonged fever ≥5 days (21.4%). Three children experienced seizures (1 simple febrile seizure, 1 fever-associated seizure and 1 status epilepticus). Influenza A accounted for 64.3% of cases and influenza B for 35.7%, with peaks in March (28.6%), January (26.2%), and February (19%). Myositis was significantly more frequent in influenza B and in children >5 years (P = 0.013 and P = 0.034, respectively). Our findings underscore the substantial disease burden of influenza in children, including those without recognized risk factors and older age groups. These preventable admissions consume considerable healthcare resources, increasing costs in already strained systems. The occurrence of serious outcomes in otherwise healthy children highlights the limitations of a risk-group-only vaccination strategy. Broader immunization policies, including consideration of routine childhood influenza vaccination, could reduce morbidity, mortality and associated healthcare expenditures. This is particularly relevant for countries like Turkey, where current coverage is minimal and seasonal surges put additional pressure on pediatric wards. Given the global variability in vaccination policies, our data provide local evidence supporting the need for expanded prevention strategies. Early protection, particularly in younger children and school-aged populations, could mitigate complications, decrease hospital utilization, and contribute to cost savings. We believe these observations are highly relevant for policymakers, pediatricians, and public health authorities aiming to optimize influenza prevention in children.