INFLUENZA: A FAMILIAR STRANGER. SOME ASPECTS OF CLINICAL PRESENTATION, DIAGNOSIS, AND THERAPY ON THE EVE OF A NEW WAVE

  2. 2025
  3. INFLUENZA: A FAMILIAR STRANGER. SOME ASPECTS OF CLINICAL PRESENTATION, DIAGNOSIS, AND THERAPY ON THE EVE OF A NEW WAVE

Koniushevska A. A., Kuzevanova M. V., Gerasymenko V. V., Grinevich E. G.

INFLUENZA: A FAMILIAR STRANGER. SOME ASPECTS OF CLINICAL PRESENTATION, DIAGNOSIS, AND THERAPY ON THE EVE OF A NEW WAVE

Show/Download

About the author:

Koniushevska A. A., Kuzevanova M. V., Gerasymenko V. V., Grinevich E. G.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

The emergence of the novel SARS-CoV-2 coronavirus resulted in the largest pandemic of the past century, signifi- cantly influencing the course of influenza epidemic seasons and all other acute respiratory viral infections. During the pandemic, transmission of influenza and other acute respiratory viral infections declined due to both competition between SARS-CoV-2 and these viruses and the implementation of strict sanitary and anti-epidemic measures. For the first time in the history of research on influenza epidemics, influenza viruses were temporarily “displaced” by the SARS-CoV-2 coronavirus. This led to the temporary complete dominance of the COVID-19 virus. At present, influenza has regained its position and continues to pose a considerable threat to public health, particularly among children. According to epidemiological principles, a population of non-immune individuals has formed during the pandemic, in whom the disease may present with severe manifestations and complications when they encounter the influenza virus. Therefore, even with a decline in influenza incidence, vaccination must continue without interruption. It should be emphasised that the influenza virus has always been, and remains, extremely dangerous due to its ability to mutate and generate pandemic strains. For this reason, effective monitoring of the pathogen’s circulation and timely vaccination, especially among high-risk groups, continue to be of paramount importance.

Tags:

children, clinical aspects, diagnosis, epidemiology, influenza, treatment

Bibliography:

  1. Korenyuk ES, Ivanchenko VV, Alekseeva OG. Osobennosti techeniya grippa u detej v epidsezone 2016-2017 gg. Zdorovye Rebenka. 2017;12(6):696-701. DOI: 10.22141/2224-0551.12.6.2017.112839.
  2.  Banadyha NV, Rogalskyy IO. Hostri respiratorni virusni infektsii ta hryp u ditei: do, pid chas, pislia pandemii Covid-19. Modern Pediatrics. Ukraine. 2024;(4):23-33. DOI: 10.15574/SP.2024.140.23. [in Ukrainian].
  3. European Scientific Working group on Influenza. Influenza prevalence. Brussels: ESWI; 2022. Available from: http://www.eswi.org/influenza-facls/introducticxt.
  4.  Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, et al. Global seasonal influenza-associated mortality collaborator network. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2018;391(10127):1285-1300. DOI: 10.1016/S0140-6736(17)33293-2.
  5.  WHO. Guidelines for the clinical management of severe illness from influenza virus infections. Geneva: WHO; 2022. 78 p. Available from: https://apps.who.int/iris/handle/10665/352453.
  6. Mawatari M, Saito R, Hibino A, Kondo H, Yagami R, Odagiri T, et al. Effectiveness of four types of neuraminidase inhibitors approved in Japan for the treatment of influenza. PLoS One. 2019;14(11):e0224683. DOI: 10.1371/journal.pone.0224683.
  7. Sun Y, Wagatsuma K, Saito R, Sato I, Kawashima T, Saito T, et al. Duration of fever in children infected with influenza A(H1N1)pdm09, A(H3N2) or B virus and treated with baloxavir marboxil, oseltamivir, laninamivir, or zanamivir in Japan during the 2012-2013 and 2019- 2020 influenza seasons. Antiviral Res. 2024;228:105938. DOI:10.1016/j.antiviral.2024.105938.
  8. Paget J, Spreeuwenberg P, Charu V, Taylor RJ, Iuliano AD, Bresee J, et al. Global mortality associated with seasonal influenza epidemics: New burden estimates and predictors from the GLaMOR Project. J Glob Health. 2019;9(2):020421. DOI: 10.7189/jogh.09.020421.
  9. Bhattacharya S, Agarwal S, Shrimali NM, Guchhait P. Interplay between hypoxia and inflammation contributes to the progression and severity of respiratory viral diseases. Mol Aspects Med. 2021;81:101000. DOI: 10.1016/ j.mam.2021.101000.
  10. Kumar V. Influenza in Children. Indian J Pediatr. 2017;84:139-143. DOI: 10.1007/s12098-016-2232-x.
  11. Wolf RM, Antoon JW. Influenza in Children and Adolescents: Epidemiology, Management, and Prevention. Pediatr. Rev. 2023;44(11):605-617. DOI: 10.1542/pir.2023-005962.
  12.  Bhat YR. Influenza B infections in children: A review. World J. Clin. Pediatr. 2020;9(3):44-52. DOI: 10.5409/wjcp.v9.i3.44.
  13. Mattila JM, Vuorinen T, Heikkinen T. Comparative Severity of Influenza A and B Infections in Hospitalized Children. Pediatr. Infect. Dis. J. 2020;39(6):489-493. DOI: 10.1097/INF.0000000000002610.
  14.  Akçay N, Bingöl İ, Tosun D, Umur Ö, Çitak A, Başak G, et al. Severe Influenza Virus Infection After COVID-19 Pandemic: Comparison of Influenza A and Influenza B. Pediatr. Infect. Dis. J. 2025;44(8):e278-e284. DOI: 10.1097/INF.0000000000004801.
  15. Hoy G, Kuan G, López R, Sánchez N, López B, Ojeda S, et al. The Spectrum of Influenza in Children. Clin. Infect. Dis. 2023;76(3):e1012-e1020. DOI: 10.1093/cid/ciac734.
  16.  Scholz S, Damm O, Schneider U, Ultsch B, Wichmann O, Greiner W. Epidemiology and cost of seasonal influenza in Germany - a claims data analysis. BMC Public Health. 2019;19:1090. DOI: 10.1186/s12889-019-7458-x.
  17. Ávila-Morales S, Ospina-Henao S, Ulloa-Gutierrez R, Ávila-Agüero ML. Epidemiological and clinical profile between influenza A and B virus in Costa Rican children. Int. J. Infect. Dis. 2021;105:763-768. DOI: 10.1016/j.ijid. 2021.03.006.
  18. Yazici Özkaya P, Turanli EE, Metin H, Aydın Uysal A, Çiçek C, Karapinar B. Severe influenza virus infection in children admitted to the PICU: Comparison of influenza A and influenza B virus infection. J. Med. Virol. 2022;94(2):575-581. DOI: 10.1002/jmv.27400.
  19. Hoy G, Maier HE, Kuan G, Sánchez N, López R, Meyers A, et al. Increased influenza severity in children in the wake of SARS-CoV-2. Influenza Other Respir. Viruses. 2023;17(7):e13178. DOI: 10.1111/irv.13178.
  20. Merișescu MM, Luminos ML, Pavelescu C, Jugulete G. Clinical Features and Outcomes of the Association of Co-Infections in Children with Laboratory-Confirmed Influenza during the 2022–2023 Season: A Romanian Perspective. Viruses. 2023;15(10):2035. DOI: 10.3390/v15102035.
  21.  Oliynyk VS, Yushchenko LO. Osoblyvosti perebihu hrypu u ditei i suchasni mozhlyvosti spetsyfichnoi profilaktyky. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu. 2022;26(1):66-71. DOI: 10.31393/reports-vnmedical-2022-26(1)-12. [in Ukrainian].
  22. Profir I, Popescu C-M, Moraru I. Life-Threatening Anemia and Thrombocytopenia in a Toddler with Influenza B: Case Report and Literature Review. Children. 2025;12(5):632. DOI: 10.3390/children12050632.
  23. Raadsen M, Du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in Virus Infections. J. Clin. Med. 2021;10(4):877. DOI: 10.3390/jcm10040877.
  24. Lalueza A, Trujillo H, Laureiro J, Ayuso B, Hernández-Jiménez P, Castillo C, et al. Impact of severe hematological abnormalities in the outcome of hospitalized patients with influenza virus infection. Eur. J. Clin. Microbiol. Infect. Dis. 2017;36(10):1827-1837. DOI: 10.1007/s10096-017-2998-4.
  25.  Ozsurekci Y, Aykac K, Bal F, Bayhan C, Basaranoglu ST, Alp A, et al. Outcome predictors of influenza for hospitalization and mortality in children. J. Med. Virol. 2021;93(11):6148-6154. DOI: 10.1002/jmv.26833.
  26. Kamidani S, Garg S, Rolfes MA, Campbell AP, Cummings CN, Haston JC, et al. Epidemiology, clinical characteristics, and outcomes of influenza-associated hospitalizations in U.S. children over 9 seasons following the 2009 H1N1 pandemic. Clin. Infect. Dis. 2022;75:1930-1939. DOI: 10.1093/cid/ ciac296.
  27.  Committee on Infectious Diseases. Recommendations for Prevention and Control of Influenza in Children, 2023-2024. Pediatrics. 2023;152(4):e2023063773. DOI: 10.1542/peds.2023-063773.
  28. Foust AM, Winant AJ, Chu WC, Das KM, Grace SP, Lee EY. Pediatric SARS, H1N1, MERS, EVALI, and Now Coronavirus Disease (COVID-19) Pneumonia: What Radiologists Need to Know. AJR Am J Roentgenol. 2020;215(3):1-9. DOI: 10.2214/AJR.20.23267.
  29. Asai N, Suematsu H, Sakanashi D, Kato H, Hagihara M, Watanabe H, et al. A severe case of Streptococcal pyogenes empyema following influenza A infection. BMC Pulm Med. 2019;19(1):25. DOI: 10.1186/s12890-019-0787-9.
  30. Lee PY, Garan H, Wan EY, Scully BE, Biviano A, Yarmohammadi H. Cardiac arrhythmias in viral infections. J Interv Card Electrophysiol. 2023;66(8):1939-1953. DOI: 10.1007/s10840-023-01525-9.
  31. Grundtvig Skaarup K, Modin D, Nielsen L, Stæhr Jensen JU, Biering-Sørensen T. Influenza and cardiovascular disease pathophysiology: strings attached. Eur Heart J Suppl. 2023;25(A):A5-A11. DOI: 10.1093/ eurheartjsupp/suac117.
  32. Aykac K, Ozsurekci Y, Kahyaoglu P, Basaranoglu ST, Ertugrul I, Alp A, et al. Myocarditis associated with influenza infection in five children. J Infect Public Health. 2018;11(5):698-701. DOI: 10.1016/j.jiph.2018.05.003.
  33. Gao C, Wang Y, Gu X, Shen X, Zhou D, Zhou S, et al. Association Between Cardiac Injury and Mortality in Hospitalized Patients Infected with Avian Influenza A (H7N9) Virus. Crit Care Med. 2020; 48(4):451-458. DOI: 10.1097/CCM.0000000000004207.
  34. Ukimura A, Izumi T, Matsumori A. A national survey on myocarditis associated with the 2009 influenza A (H1N1) pandemic in Japan. Circ J. 2010;74(10):2193-9. DOI: 10.1253/circj.cj-10-0452.
  35. Alam MM, Paul T, Aggarwal A, Zarich S. Influenza associated cardiac arrhythmia - a systematic review. Am J Med Sci. 2024;367(4):235-242. DOI: 10.1016/j.amjms.2024.01.004.
  36.  Bailey HE. Acute Necrotizing Encephalopathy Associated with Influenza A. Neurodiagn J. 2020;60(1):41-49. DOI: 10.1080/21646821.2020.1725864.
  37.  Li XF, Ai B, Ye JW, He DM, Tan LM, Chen MX, et al. Clinical analysis of seven cases of H1N1 influenza-associated encephalopathy in children. Zhonghua Er Ke Za Zhi. 2019;57(7):538-542. DOI: 10.3760/cma.j.issn.0578-1310.2019.07.009.
  38. Sun R, Zhang X, Jia W, Li P, Song C. Analysis of clinical characteristics and risk factors for death due to severe influenza in children. Eur. J. Clin. Microbiol. Infect. Dis. 2024;43(3):567-575. DOI: 10.1007/s10096-024-04759-1.
  39. Kulik-Rechberger B, Dubel M. Iron deficiency, iron deficiency anaemia and anaemia of inflammation - an overview. Ann. Agric. Environ. Med. 2024;31(1):151-157. DOI: 10.26444/aaem/171121.
  40. Cohen A, Owolabi FS, Dowdell-Smith CP, Laufman J, Iacobas I, Bass L, et al. Weakness, Anemia, and Neutropenia in a 9-Year-Old Girl With Influenza. Pediatrics. 2020;145(4):e20192574. DOI: 10.1542/peds.2019-2574.
  41. Bitzan M, Zieg J. Influenza-associated thrombotic microangiopathies. Pediatr. Nephrol. 2018;33(11):2009-2025. DOI: 10.1007/s00467- 017-3783-4.
  42.  Jansen AJG, Spaan T, Low HZ, Di Iorio D, van den Brand J, Tieke M, et al. Influenza-induced thrombocytopenia is dependent on the subtype and sialoglycan receptor and increases with virus pathogenicity. Blood Adv. 2020;4(13):2967-2978. DOI: 10.1182/bloodadvances.2020001640.
  43.  Fettah A, Kara SS, Hafizoglu D, Volkan B, Özel M, Erten I, et al. Respiratory Viral Infectious Aetiologies of Transient Cytopenia in Previously Healthy Children. HK J. Paediatr (new series). 2017;22:10-13.
  44. Silecchia V, D’Onofrio G, Valerio E, Rubin G, Vidal E, Murer L. Influenza-associated hemolytic uremic syndrome: The pathogenic role of the virus. Clin. Nephrol. Case Stud. 2021;16:9:45-48. DOI: 10.5414/CNCS110219.
  45. McGraw KE, Porter AP, Moffitt AM, Golden MEM, Stewart H. Atypical Hemolytic Uremic Syndrome Following Influenza B: A Case Report. HCA Healthc. J. Med. 2024;5(4):459-464. DOI: 10.36518/2689-0216.1669.
  46. Bote J, Corkrey HA, Koupenova M. Human Platelets and Influenza Virus: Internalization and Platelet Activation. Platelets. 2022;33(2):184-191. DOI:10.1080/09537104.2021.1961710.
  47.  Bandyopadhyay P, Biswas T, Lahiri M. Autoimmune hemolytic anemia following influenza a pandemic H1N1 infection: A case report. J. Paediatr. Nurs. Sci. 2020;3(1):28-29. DOI: 10.18231/j.ijpns.2020.005.
  48. Caballero IC, Ramos MI, Sánchez AB, Anguita E, Amador JTR. Autoimmune neutropenia associated with influenza virus infection in childhood: a case report. BMC Infect. Dis. 2021;21(1):830. DOI: 10.1186/s12879-021-06506-9.
  49. Gao J, Pasion J, Sanchez-Petitto G, Law J. Influenza virus B-associated hemophagocytic lymphohistiocytosis. Hematol. Rep. 2019;11(3):8268. DOI: 10.4081/hr.2019.8268.
  50. Maignan M, Viglino D, Hablot M, Masson NT, Lebeugle A, Muret RC, et al. Diagnostic accuracy of a rapid RT-PCR assay for point-of-care detection of influenza A/B virus at emergency department admission: A prospective evaluation during the 2017/2018 influenza season. PLoS One. 2019;14(5):e0216308. DOI: 10.1371/journal.pone.0216308.
  51. Yoon J, Yun SG, Nam J, Choi SH, Lim CS. The use of saliva specimens for detection of influenza A and B viruses by rapid influenza diagnostic tests. J Virol Methods. 2017;243:15-19. DOI: 10.1016/j.jviromet.2017.01.013.
  52. Benirschke RC, McElvania E, Thomson Jr RB, Kaul KL, Das S. Clinical Impact of Rapid Point-of-Care PCR Influenza Testing in an Urgent Care Setting: a Single-Center Study. J Clin Microbiol. 2019;57(3):e01281-18. DOI: 10.1128/JCM.01281-18.
  53. Centers for disease control and prevention. Seasonal influenza. Rapid diagnostic testing for influenza. Atlanta: CDC; 2021. Available from: http://www.cdc.gov/flu/professionals/diagnosis/rapidclin.html.
  54.  Sakurai A, Takayama K, Nomura N, Kajiwara N, Okamatsu M, Yamamoto N, et al. Fluorescent Immunochromatography for Rapid and Sensitive Typing of Seasonal Influenza Viruses. PLoS ONE. 2015;10(2):e0116715. DOI: 10.1371/journal.pone.0116715.
  55. Shamenova MG, Glebova TI, Klivleyeva N, Baiseiit SB. Serological studies of influenza infection among population in southern region of Kazakhstan during the 2018-2021 epidemic season. J Pak Med Assoc. 2023;73(4):804-807. DOI: 10.47391/JPMA.6348.
  56. Li Z, He L, Li S, He W, Zha C, Ou W, et al. Combination of procalcitonin and C-reactive protein levels in the early diagnosis of bacterial co-infections in children with H1N1 influenza. Influenza Other Respir Viruses. 2019;13(2):184-190. DOI: 10.1111/irv.12621.
  57. Xie Z, Lin Y, Chen Y. Analysis of clinical characteristics of severe and critically ill influenza A (H1N1). Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019;31(9):1154-1157. DOI: 10.3760/cma.j.issn.2095-4352.2019.09.019.
  58.  Wan DM, Kang XH, Bai W, Zeng Z G, Zhang W. The clinical characteristics and prognosis of 20 patients with H7N9 avian influenza. Zhonghua Jie He He Hu Xi Za Zhi. 2019;42(10):750-754. DOI: 10.3760/cma.j.issn.1001-0939.2019.10.007.
  59. Chow EJ, Doyle JD, Uyeki TM. Influenza virus-related critical illness: prevention, diagnosis, treatment. Crit Care. 2019;23(1):214. DOI: 10.1186/s13054-019-2491-9.
  60.  Mawatari M, Saito R, Hibino A, Kondo H, Yagami R, Odagiri T, et al. Effectiveness of four types of neuraminidase inhibitors approved in Japan for the treatment of influenza. PLoS One. 2019;14(11):e0224683. DOI: 10.1371/journal.pone.0224683.
  61. Butler CC, van der Velden AW, Bongard E, Saville BR, Holmes J, Coenen S, et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. Lancet. 2020;395(10217):42-52. DOI: 10.1016/S0140-6736(19)32982-4.
  62.  Tagarro A, Cruz-Cañete M, Otheo E, Launes C, Couceiro JA, Pérez C, et al. Oseltamivir for the treatment of influenza in children and adolescents. An Pediatr (Barc). 2019;90(5):317.e1-317.e8. DOI: 10.1016/j.anpedi.2019.01. 009.
  63. Roosenhoff R, Reed V, Kenwright A, Schutten M, Boucher CA, Monto A, et al. Viral Kinetics and Resistance Development in Children Treated with Neuraminidase Inhibitors: The Influenza Resistance Information Study (IRIS). Clin Infect Dis. 2020;71(5):1186-1194. DOI:10.1093/cid/ciz939.
  64.  Uyeki T.M. Oseltamivir Treatment of Influenza in Children. Clin Infect Dis. 2018;66(10):1501-1503. DOI: 10.1093/cid/cix1150.
  65. Hayden FG, Sugaya N, Hirotsu N, Lee N, de Jong MD, Hurt AC, et al. Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. N Engl J Med. 2018;379:913-923. DOI: 10.1056/NEJMoa1716197.
  66. Ison MG, Portsmouth S, Yoshida Y, Shishido T, Mitchener M, Tsuchiya K, et al. Early treatment with baloxavir marboxil in high-risk adolescent and adult outpatients with uncomplicated influenza (CAPSTONE-2): a randomised, placebo-controlled, phase 3 trial. Lancet Infect Dis. 2020;20(10):1204-1214. DOI: 10.1016/S1473-3099(20)30004-9.
  67. Baker J, Block SL, Matharu B, Macutkiewicz LB, Wildum S, Dimonaco S, et al. Baloxavir Marboxil Single-dose Treatment in Influenza- infected Children: A Randomized, Double-blind, Active Controlled Phase 3 Safety and Efficacy Trial (miniSTONE-2). Pediatr Infect Dis J. 2020;39(8):700-705. DOI: 10.1097/INF.0000000000002747.
  68.  Baker JB, Block SL, Cagas SE, Macutkiewicz LB, Collins C, Sadeghi M, et al. Safety and Efficacy of Baloxavir Marboxil in Influenza- infected Children 5-11 Years of Age. F Post Hoc Analysis of a Phase 3 Study (miniSTONE-2). Pediatr Infect Dis J. 2023;42(11):983-989. DOI: 10.1097/INF.000000000 0004062.
  69.  Li TC, Chan MC, Lee N. Clinical Implications of Antiviral Resistance in Influenza Viruses. 2015;7(9):4929-4944. DOI: 10.3390/v7092850.
  70. King D, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015;4:CD006821. DOI: 10.1002/14651858.CD006821.pub3.
  71.  Tan E, Braithwaite I, McKinlay ChJ, Dalziel St. Comparison of Acetaminophen (Paracetamol) With Ibuprofen for Treatment of Fever or Pain in Children Younger Than 2 Years: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(10):e2022398. DOI: 10.1001/jamanetworkopen. 2020.22398.
  72.  Luo Sh, Ran M, Luo Q, Shu M, Guo Q, Zhu Yu, et al. Alternating Acetaminophen and Ibuprofen versus Monotherapies in Improvements of Distress and Reducing Refractory Fever in Febrile Children: A Randomized Controlled Trial. Paediatr Drugs. 2017;19(5):479-486. DOI: 10.1007/s40272-017-0237-1.
  73. Moffett BS, Gutierrez K, Davis K, Sigdel B, Strobel N. Antipyretic Efficacy of Acetaminophen and Ibuprofen in Critically Ill Pediatric Patients. Pediatr Crit Care Med. 2019;20(8):e386-e393. DOI: 10.1097/PCC.00000000000 02072.
  74. Taymaz T, Ergönül Ö, Kebapcı A, Okyay R. Significance of the detection of influenza and other respiratory viruses for antibiotic stewardship: Lessons from the post-pandemic period. Int J Infect Dis. 2018;77:53-56. DOI: 10.1016/j.ijid.2018.10.003.
  75. Jia L, Xie J, Zhao J, Cao D, Liang Y, Hou X, et al. Mechanisms of Severe Mortality-Associated Bacterial Co-infections Following Influenza Virus Infection. Front Cell Infect Microbiol. 2017;7:338. DOI: 10.3389/fcimb. 2017.00338.
  76. Dale AP, Ebell M, McKay B, Handel A, Forehand R, Dobbin K. Impact of a Rapid Point of Care Test for Influenza on Guideline Consistent Care and Antibiotic Use. J Am Board Fam Med. 2019;32(2):226-233. DOI: 10.3122/jabfm.2019.02.180183.
  77. Grohskopf LA, Blanton LH, Ferdinands JM, Reed C, Dugan VG, Daskalakis DC. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2025-26 Influenza Season. MMWR Morb Mortal Wkly Rep. 2025;74(32):500-507. DOI: 10.15585/mmwr.mm7432a2.
  78. CDC. Advisory Committee on Immunization Practices grading of recommendations assessment, development, and evaluation handbook for developing evidence-based recommendations. Atlanta: US Department of Health and Human Services, CDC; 2024. Available from: https://www.cdc.gov/acip-grade-handbook/hcp/table-of-contents/index.html.
  79.  Food and Drug Administration. Influenza vaccine composition for the 2025-2026 U.S. influenza season. Silver Spring: US Department of Health and Human Services, Food and Drug Administration; 2025. Available from: https://www.fda.gov/vaccines-blood-biologics/influenza-vaccine-composition-2025-2026-us-influenza-season.

Publication of the article:

«Bulletin of problems biology and medicine», 2025 Issue 3,178, 36-58 pages, index UDC 616.98:578.832]-092-07-085-036.22

DOI:

10.29254/2077-4214-2025-3-178-36-58

2025 Issue 3,178
children clinical aspects diagnosis epidemiology influenza treatment
27.10.2025
Was this article helpful?
5
5

Leave a Reply

Your email address will not be published. Required fields are marked *


The reCAPTCHA verification period has expired. Please reload the page.