What question did this study set out to answer?

To evaluate the epidemiology and disease severity of influenza viruses in hospitalized children over a 17-year period, including during the 2009 H1N1 and post-COVID-19.

February 14, 2026Open Access

Hospitalized children with influenza virus: a 17 year-long observational study including the 2009 H1N1 influenza pandemic and COVID-19 pandemic

Key Points

To evaluate the epidemiology and disease severity of influenza viruses in hospitalized children over a 17-year period, including during the 2009 H1N1 and post-COVID-19.
Analyzed nasopharyngeal samples from children with respiratory symptoms from 2006 to 2023.
Conducted PCR testing for influenza A/B and other pathogens.
Compared hospitalization rates during the 2009 H1N1 pandemic and post-COVID-19 using age-adjusted logistic regression.
502 children with influenza A/B were included, with 50% hospitalized for over 24 hours.
Hospitalization rates increased significantly during the 2009 H1N1 pandemic compared to pre-pandemic rates.
Post-COVID-19, hospitalization rates rose in children over 5 years, but fewer had severe complications.

Abstract

Abstract Background Influenza viruses (IFV) have major impacts on children’s health. We studied IFV A/B epidemiology and disease severity during a 17 year-long period including the 2009 H1N1 influenza pandemic and post-COVID-19 in 2021–2023. Methods Nasopharyngeal samples from children referred with fever or respiratory symptoms to a Norwegian hospital from 2006 to 2023 were tested with PCR for IFV A/B and 17 other pathogens. We compared IFV hospitalization rates and disease severity before and during the 2009 influenza pandemic, and before and after the COVID-19 pandemic, respectively, using age-adjusted logistic regression analyses. Results From 2006 to 2023, 502 children with IFV A/B were included (IFV A 74%, IFV B 26%). Two-hundred-fifty-one (50%) were hospitalized > 24 h. During the 2009 H1N1 influenza pandemic rates of hospitalization > 24 h in children ≤ 5 and > 5 years of age increased from 44 to 72, and 4 to 20 per 100,000, respectively, compared to 2006–2009. The median age of IFV positive children doubled from 23 to 49 months ( p =.006), but no other clinical changes occurred. Post-COVID-19 (2021–2023), the hospitalization rates only increased in children > 5 years from 12 to 25 per 100,000, and the median age almost doubled from 33 to 62 months ( p <.001) compared to 2010–2020. Post-COVID-19, fewer children had lower respiratory tract infections (aOR 0.32, 95% CI 0.20–0.53) and severe complications (aOR 0.24, 95% CI 0.07–0.82). Conclusions Compared to other influenza seasons, disease severity during the 2009 H1N1 influenza pandemic was unchanged, but post-COVID-19 children referred to hospital with IFV A/B had milder disease.

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