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BACKGROUND: Data are limited on the economic burden of seasonal influenza in China. We estimated the cost due to influenza illness among children < 5-year-old in Suzhou, China. METHODS: This study adopted a societal perspective to estimate direct medical cost, direct non-medical cost, and indirect cost related to lost productivity. Data to calculate costs and rates of three influenza illness outcomes (non-medically attended, outpatient and hospitalization) were collected from prospective community-based cohort studies and hospital-based enhanced laboratory-confirmed influenza surveillance in Suzhou during the 2011/12 to 2016/17 influenza seasons. We used mean cost-per-episode, annual incidence rates of episodes of each outcome, and annual population size to estimate the total annual economic burden of influenza illnesses among children < 5-year-old for Suzhou. All costs were reported in 2017 U.S. dollars. RESULTS: The mean cost-per-episode (standard deviation) was $9.92 (13.26) for non-medically attended influenza, $161.05 (176.98) for influenza outpatient illnesses, and $1425.95 (603.59) for influenza hospitalizations. By applying the annual incidence rates to the population size, we estimated an annual total of 4,919 episodes of non-medically attended influenza, 21,994 influenza outpatient, and 2,633 influenza hospitalization. Total annual economic burden of influenza to society among children < 5-year-old in Suzhou was $7.37 (95% confidence interval, 6.9–7.8) million, with estimated costs for non-medically attended influenza of $49,000 (46,000–52,000), influenza outpatients $3.5 (3.3–3.8) million, and influenza hospitalizations $3.8 (3.6–3.9) million. Among outpatients, the indirect cost was 36.3% ($1.3 million) of total economic burden, accounting for 21,994 days of lost productivity annually. Among inpatients, the indirect cost was 22.1% ($829,000), accounting for 18,431 days of lost productivity annually. CONCLUSIONS: Our findings show that influenza in children < 5-year-oldcauses substantial societal economic burden in Suzhou, China. Assessing the potential economic benefit of increasing influenza vaccination coverage in this population is warranted.

Background Seasonal influenza infections among young children in China lead to substantial numbers of hospitalizations and financial burden. This study assessed the seasonal influenza vaccine effectiveness (VE) against laboratory confirmed medically attended influenza illness among children in Suzhou, China, from October 2011–September 2012. Methods We conducted a test-negative case–control study among children aged 6–59 months who sought care at Soochow University Affiliated Children's Hospital (SCH) from October 2011–September 2012. A case was defined as a child with influenza-like illness (ILI) or severe acute respiratory infection (SARI) with an influenza-positive nasopharyngeal swab by rRT-PCR. Controls were selected from children presenting with ILI or SARI without laboratory confirmed influenza. We conducted 1:1 matching by age and admission date. Vaccination status was verified from the citywide immunization system database. VE was calculated with conditional logistic regression: (1 − OR) × 100%. Result During the study period, 2634 children aged 6–59 months presented to SCH with ILI (1975) or SARI (659) and were tested for influenza. The vaccination records were available for 69% (1829; ILI: 1354, SARI: 475). Among those, 23% (427) tested positive for influenza, and were included as cases. Among influenza positive cases, the vaccination rates were 3.2% for SARI and 4.5% for ILI. Among controls, the vaccination rates were 13% for SARI, and 11% for ILI. The overall VE against lab-confirmed medically attended influenza virus infection was 67% (95% CI: 41–82). The VE for SARI was 75% (95% CI: 11–93) and for ILI was 64% (95% CI: 31–82). Conclusions The seasonal influenza vaccine was effective against medically attended lab-confirmed influenza infection in children aged 6–59 months in Suzhou, China in the 2011–12 influenza season. Increasing seasonal influenza vaccination among young children in Suzhou may decrease medically attended influenza-associated ILI and SARI cases in this population.

Background 17 million children under the age of 5 years are at elevated risk of poor development outcomes in China. We aimed to assess whether an integrated package of community-based nurturing care intervention led to a reduction in the prevalence of suspected neurodevelopmental delay to promote early development in rural China's poorest children under the age of 3 years. Methods From July 1, 2014, the Integrated Early Childhood Development (IECD) programme composing comprehensive early development services was implemented in four poverty-stricken areas in China (Liping county, Songtao county, Fenxi county, and Lin county). Five nurturing care intervention components (nutrition, responsive care, child safety and social assistance, early learning support, healthy growth, and development assessment) were delivered via home visits, group sessions, ECD centres, village clinics, and mobile resource units. We evaluated the effectiveness of the intervention using a quasi-experimental design, with baseline data collection in 2013 and endline data collection in 2016, in four interventions and two control counties in which no intervention was applied (Pan county and Fangshan county). Risk factors and outcomes were assessed by use of UNICEF's Multiple Indicator Cluster Survey, Zung Self-Rating Depression Scale, and Ages & Stages Questionnaire-Chinese Edition. We applied a difference-in-differences regression approach adjusting confounding factors to estimate the effect of the intervention on the children's neurodevelopmental outcomes. We used a path analysis to examine underlying mechanisms through which the IECD intervention package could predict children's developmental health. Ethical clearance for all aspects of the study was obtained from the Ethics Review Board in Peking University. An informed consent was obtained in writing before data collection. Findings Between July and September, 2013, 2953 children younger than 3 years and their caregivers were interviewed at baseline. Between July and September, 2016, 2745 children younger than 3 years and their caregivers were interviewed after intervention. Prevalence of overall suspected developmental delay was reduced by 18% (from 37% at baseline to 19% after intervention) in intervention villages. This reduction significantly differed from the reduction in control villages (from 30% to 20%; adjusted odds ratio 0·69 (95% CI 0·54–0·89). Consistent findings were found across the communication, gross motor, fine motor, problem solving, and personal-social domains. Path analysis indicated that higher developmental health was partly mediated by multiple family nurturing care factors, including cognitive stimulation, positive discipline, length for age, and haemoglobin. Interpretation The community-based integrated intervention package significantly reduced the prevalence of suspected developmental delay in children under age three in rural China. This nurturing care intervention could maybe to help improve human capital in China's poorest areas. Funding This work was supported by Porsche (China) Motors Ltd.