Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Influenza-like Illness in Households with Children of Preschool Age

Mughini-Gras, Lapo DVM, PhD; Pijnacker, Roan MSc; Enserink, Remko PhD; Heusinkveld, Moniek MD, PhD; van der Hoek, Wim MD, PhD; van Pelt, Wilfrid PhD

The Pediatric Infectious Disease Journal: March 2016 - Volume 35 - Issue 3 - p 242–248
doi: 10.1097/INF.0000000000000988
Original Studies

Background: Influenza-like illness (ILI) is the leading cause of medical consultation amongst preschool children, who may contribute to spreading ILI-causing agents within the household. We aimed to determine the societal burden (incidence, health-care consumption and productivity loss) and correlates of ILI in households with preschool children.

Methods: A survey was performed in the Netherlands during October 2012 to October 2014. Monthly, 2000 households with children younger than 4 years were invited to report their symptoms and related medical care, productivity loss and putative risk exposures for 1 preschool child and 1 parent.

Results: Eight thousand seven hundred and sixty-eight child–parent pairs were enrolled. ILI incidence was 2.81 episodes/child-year and 1.72 episodes/parent-year. Amongst those with ILI, health-care utilization was 35.7% (children) and 17.7% (parents). Work absenteeism was 45.7% (median 2 workdays lost) and day-care absenteeism was 22.8% (median 1 day missed). Chronic respiratory conditions, developmental disabilities, parental occupation in health care/child care, having a sibling and attending day care for ≤12 months increased childhood ILI risk. Parental ILI risk increased with having chronic respiratory conditions, developmentally disabled day-care–attending children and female gender in interaction with unemployment and multiple day-care–attending children. Breastfeeding infants 6-month-old or younger and attending day care for >24 months decreased childhood ILI risk. Pregnancy, occupation in health care and having ≥3 children decreased parental ILI risk. Parents of ILI-affected children had a concurrent 4-fold higher ILI risk.

Conclusion: ILI in households with preschool children has a considerable societal impact. Risk-mitigating initiatives seem justified for day-care attendees, mothers, people with chronic respiratory conditions, and children with developmental disabilities. Children attending day care for >2 years acquire some protection to ILI.

Supplemental Digital Content is available in the text.

From the *National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (CIb), Bilthoven, the Netherlands; Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, the Netherlands; and Department of Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.

Accepted for publication August 28, 2015.

This study was internally funded by the Dutch Ministry of Health, Welfare, and Sport. No external funding for this study was obtained. The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Lapo Mughini-Gras, DVM, PhD, National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (CIb), P.O. Box 1, 3720 BA Bilthoven, the Netherlands. E-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.