{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:23:07Z","timestamp":1785435787770,"version":"3.56.0"},"reference-count":68,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cDun\u0103rea de Jos\u201d University of Gala\u021bi"},{"id":[{"id":"https:\/\/ror.org\/052sta926","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Influenza vaccination coverage among children remains critically low in Romania, yet regional data contextualizing the clinical burden relative to local vaccine uptake are scarce. Methods: A retrospective descriptive study was conducted at \u201cSf. Ioan\u201d Clinical Emergency Pediatric Hospital in Gala\u021bi, Romania, including all patients aged 0\u201314 years with Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-confirmed influenza over six consecutive seasons (October 2019\u2013April 2025). Regional influenza vaccination coverage data for children aged 0\u201314 years and pregnant women were obtained from county public health authority records and contextualized against Romanian National Institute of Statistics population data. Results: A total of 525 unvaccinated children were included. The median age was 2 years (IQR 1\u20135); 50.5% were aged 2 years or younger. Multisystem clinical involvement was documented in 97.52% of patients, with respiratory involvement predominating (86.66%). The median length of hospital stay was 5 days (IQR 4\u20137). Regional vaccination coverage never exceeded 2.0% of the eligible pediatric population in any study year, falling to 0.3% in 2023 and 0.1% in 2025. Infants aged 0\u20132 years were consistently the least vaccinated group (0\u20135 months not eligible for vaccination). Maternal vaccination was effectively absent in most seasons. Conclusions: These findings document a critical and persistent influenza vaccination gap among children and pregnant women in Gala\u021bi County. Targeted public health interventions to improve vaccine uptake\u2014particularly for infants, young children, and pregnant women\u2014are urgently needed in this and similar low-coverage Eastern European settings.<\/jats:p>","DOI":"10.3390\/vaccines14060478","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T09:57:43Z","timestamp":1779962263000},"page":"478","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influenza-Associated Hospitalizations in Unvaccinated Children Across Six Consecutive Seasons: Clinical Burden and Regional Vaccination Coverage Trends in Gala\u021bi County, Romania"],"prefix":"10.3390","volume":"14","author":[{"given":"Irina","family":"Profir","sequence":"first","affiliation":[{"name":"Clinical Medical Department, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800216 Gala\u021bi, Romania"},{"name":"\u201cSf. Ioan\u201d Clinical Emergency Pediatric Hospital in Gala\u021bi, 800487 Gala\u021bi, Romania"},{"name":"Medical and Pharmaceutical Research Center, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9079-2831","authenticated-orcid":false,"given":"Cristina-Mihaela","family":"Popescu","sequence":"additional","affiliation":[{"name":"\u201cSf. Ioan\u201d Clinical Emergency Pediatric Hospital in Gala\u021bi, 800487 Gala\u021bi, Romania"},{"name":"Medical and Pharmaceutical Research Center, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"},{"name":"Dental-Medicine Department, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Nechifor","sequence":"additional","affiliation":[{"name":"Medical and Pharmaceutical Research Center, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"},{"name":"Department of Individual Sports and Physiotherapy, Faculty of Physical Education and Sport, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u0103d\u0103lin","family":"Guliciuc","sequence":"additional","affiliation":[{"name":"Medical and Pharmaceutical Research Center, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"},{"name":"Department of Surgery, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"},{"name":"Department of Urology, St. Apostol Andrei Emergency Clinical Hospital, 800578 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2726-137X","authenticated-orcid":false,"given":"Ada","family":"Stefanescu","sequence":"additional","affiliation":[{"name":"Medical and Pharmaceutical Research Center, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800008 Gala\u021bi, Romania"},{"name":"Dental-Medicine Department, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 800201 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1016\/j.vaccine.2020.09.048","article-title":"The disease burden of influenza beyond respiratory illness","volume":"39","author":"Macias","year":"2021","journal-title":"Vaccine"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Dondi, A., Guida, F., Trombetta, L., De Peppo Cocco, M., Piccirilli, G., Andreozzi, L., Battelli, E., Castaldo, P., Corsini, I., and Pierantoni, L. (2025). Burden and Clinical Characteristics of Influenza and Its Complications in Children Across Multiple Epidemic Seasons. Viruses, 17.","DOI":"10.3390\/v17121574"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1146\/annurev-virology-111821-115447","article-title":"Block the Spread: Barriers to Transmission of Influenza Viruses","volume":"10","author":"Lowen","year":"2023","journal-title":"Annu. Rev. Virol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1542\/pir.2023-005962","article-title":"Influenza in Children and Adolescents: Epidemiology, Management, and Prevention","volume":"44","author":"Wolf","year":"2023","journal-title":"Pediatr. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"242","DOI":"10.18683\/germs.2025.1471","article-title":"A literature review of influenza chemoprophylaxis and treatment in children","volume":"15","author":"Luca","year":"2025","journal-title":"Germs"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"04003","DOI":"10.7189\/jogh.13.04003","article-title":"Global and national influenza-associated hospitalisation rates: Estimates for 40 countries and administrative regions","volume":"13","author":"Paget","year":"2023","journal-title":"J. Glob. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e497","DOI":"10.1016\/S2214-109X(19)30545-5","article-title":"Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: A systematic review and modelling study","volume":"8","author":"Wang","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Committee on Infectious Diseases (2025). Recommendations for Prevention and Control of Influenza in Children, 2025-2026: Technical Report. Pediatrics, 156, e2025073622.","DOI":"10.1542\/peds.2025-073622"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1001\/jamapediatrics.2023.5639","article-title":"Maternal Vaccine Effectiveness Against Influenza-Associated Hospitalizations and Emergency Department Visits in Infants","volume":"178","author":"Sahni","year":"2024","journal-title":"JAMA Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Saleh, T., Shirazi, M., Cambou, M.C., and Nielsen-Saines, K. (2025). The Impact of the COVID-19 Pandemic on Influenza Vaccination Coverage Among Young U.S. Children: A Socioeconomic Analysis. COVID, 5.","DOI":"10.3390\/covid5020020"},{"key":"ref_11","unstructured":"Centers for Disease Control and Prevention (2026, May 11). Flu Vaccination Coverage, United States, 2019\u20132020 Influenza Season, Available online: https:\/\/www.cdc.gov\/fluvaxview\/coverage-by-season\/vaccination-2019-2020.html?CDC_AAref_Val=https:\/\/www.cdc.gov\/flu\/fluvaxview\/coverage-1920estimates.htm."},{"key":"ref_12","unstructured":"Centers for Disease Control and Prevention (2026, May 11). 2023\u20132024 Flu Vaccine Coverage Update, Available online: https:\/\/www.cdc.gov\/flu\/whats-new\/2023-2024-flu-coverage-update.html."},{"key":"ref_13","unstructured":"ECDC (2026, January 26). Survey Report: National Seasonal Influenza Vaccination Recommendations. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/seasonal-flu-coverage-recommendations.pdf."},{"key":"ref_14","unstructured":"Romanian College of Pharmacists (2025, November 26). Pilot Vaccination Programme in Pharmacies\u2014Order No. 3262\/2022. Available online: https:\/\/www.colegfarm.ro\/userfiles\/file\/ORIN%20Nr.%203.262%20din%2019%20otombrie%202022%20si%20anexe_program%20pilot%20vaccinare%20antigripala%20in%20farmacii.pdf."},{"key":"ref_15","unstructured":"INSP (2025, November 26). Analysis of the 2019\u20132020 Influenza Season, Available online: https:\/\/insp.gov.ro\/centrul-national-de-supraveghere-si-control-al-bolilor-transmisibile-cnscbt\/rapoarte-anuale\/."},{"key":"ref_16","unstructured":"INSP (2025, November 26). Analysis of the 2020\u20132021 Influenza Season, Available online: https:\/\/insp.gov.ro\/centrul-national-de-supraveghere-si-control-al-bolilor-transmisibile-cnscbt\/rapoarte-anuale\/."},{"key":"ref_17","unstructured":"INSP (2025, November 26). Analysis of the 2021\u20132022 Influenza Season, Available online: https:\/\/insp.gov.ro\/centrul-national-de-supraveghere-si-control-al-bolilor-transmisibile-cnscbt\/rapoarte-anuale\/."},{"key":"ref_18","unstructured":"INSP (2025, November 26). Analysis of the 2022\u20132023 Influenza Season, Available online: https:\/\/insp.gov.ro\/centrul-national-de-supraveghere-si-control-al-bolilor-transmisibile-cnscbt\/rapoarte-anuale\/."},{"key":"ref_19","unstructured":"INSP (2025, November 26). Analysis of the 2023\u20132024 Influenza Season, Available online: https:\/\/insp.gov.ro\/centrul-national-de-supraveghere-si-control-al-bolilor-transmisibile-cnscbt\/rapoarte-anuale\/."},{"key":"ref_20","first-page":"1289","article-title":"The influenza vaccination uptake in Romania during the 2022\u20132023 season","volume":"71","author":"Enciu","year":"2023","journal-title":"Farm. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1038\/s41467-021-21157-9","article-title":"Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand","volume":"12","author":"Huang","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Abu-Helalah, M., Al-Shatnawi, S.F., Abu Lubad, M., Al-Zayadneh, E., Al-Hanaktah, M., Harahsheh, M., Al-Iede, M., Nafi, O., Yousef, R., and Almaaitah, I. (2024). The Epidemiology and Health Burdens of Influenza Infections Amongst Hospitalized Children Under 5 Years of Age in Jordan: A National Multi-Center Cross-Sectional Study. Vaccines, 13.","DOI":"10.3390\/vaccines13010012"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez-Ju\u00e1rez, R.N., Moreno-Espinosa, S., Reyes-Lopez, A., Parra-Ortega, I., Laris-Gonzalez, A., De la Rosa-Zamboni, D., Guerra-de-Blas, P., and Gami\u00f1o-Arroyo, A.E. (2025). Impact of Influenza on Children in a Referral Hospital in Mexico City: Clinical Burden and Predictors of Mechanical Ventilation. Viruses, 17.","DOI":"10.3390\/v17060771"},{"key":"ref_24","unstructured":"INSP (2025, November 26). Annual Reports\u2014National Centre for Surveillance and Control of Communicable Diseases, Available online: https:\/\/insp.gov.ro\/centrul-national-de-supraveghere-si-control-al-bolilor-transmisibile-cnscbt\/rapoarte-anuale\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7305a1","article-title":"Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices\u2014United States, 2024\u20132025Influenza Season","volume":"73","author":"Grohskopf","year":"2024","journal-title":"MMWR Recomm. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e20201368","DOI":"10.1542\/peds.2020-1368","article-title":"Vaccine Effectiveness Against Pediatric Influenza Hospitalizations and Emergency Visits","volume":"146","author":"Campbell","year":"2020","journal-title":"Pediatrics"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2452512","DOI":"10.1001\/jamanetworkopen.2024.52512","article-title":"New Vaccine Surveillance Network Collaborators. Estimated Vaccine Effectiveness for Pediatric Patients With Severe Influenza, 2015-2020","volume":"7","author":"Sumner","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kanecki, K., Lewtak, K., Gory\u0144ski, P., Tyszko, P., Bogdan, M., Rz\u0105d, M., and Nitsch-Osuch, A. (2022). Hospitalization of Children Aged <5 Years Due to Influenza: Study Based on the National Hospitalization Registry. Children, 9.","DOI":"10.3390\/children9070930"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"a038430","DOI":"10.1101\/cshperspect.a038430","article-title":"Influenza in Children","volume":"11","author":"Nayak","year":"2021","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ilboudo, A.K., Ciss\u00e9, A., Milucky, J., Tialla, D., Mirza, S.A., Diallo, A.O., Bicaba, B.W., Charlemagne, K.J., Diagbouga, P.S., and Owusu, D. (2024). Predictors of severity and prolonged hospital stay of viral acute respiratory infections (ARI) among children under five years in Burkina Faso, 2016\u20132019. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09219-x"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Profir, I., Popescu, C.M., Popa, G.V., and Nechita, A. (2025). Beyond Passive Immunity: Three Neonatal Influenza Cases Highlighting Impact of Missed Maternal Vaccination. Clin. Pract., 15.","DOI":"10.3390\/clinpract15070124"},{"key":"ref_32","first-page":"e77475","article-title":"Evaluating Disparities in Urban Versus Rural Mortality for Influenza and Pneumonia in the United States Using the CDC-WONDER Database Over a 22-Year Period","volume":"17","author":"Barua","year":"2025","journal-title":"Cureus"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e440","DOI":"10.1097\/INF.0000000000004090","article-title":"Epidemiology and Burden of Influenza in Children 0-14 Years Over Ten Consecutive Seasons in Italy","volume":"42","author":"Barbieri","year":"2023","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Miron, V.D., B\u0103nic\u0103, L., S\u0103ndulescu, O., Paraschiv, S., Surleac, M., Florea, D., Vlaicu, O., Milu, P., Streinu-Cercel, A., and Bila\u0219co, A. (2021). Clinical and molecular epidemiology of influenza viruses from Romanian patients hospitalized during the 2019\/20 season. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0258798"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Peer, V., Mandelboim, M., Jurkowicz, M., and Green, M.S. (2025). Sex differences in acute respiratory tract infections-multi-year analysis based on data from a large tertiary care medical center in Israel. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1502036"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"McGrath, L.J., Moran, M.M., Alfred, T., Reimbaeva, M., Di Fusco, M., Khan, F., Welch, V.L., Malhotra, D., Cane, A., and Lopez, S.M.C. (2023). Clinical outcomes of COVID-19 and influenza in hospitalized children <5 years in the US. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1261046"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Kanecki, K., Lewtak, K., Tyszko, P., Gory\u0144ski, P., Rz\u0105d, M., Okr\u0119glicka, K., and Nitsch-Osuch, A. (2025). Hospitalizations and In-Hospital Fatality Among Influenza Patients in the Pre-Pandemic and COVID-19 Pandemic Periods. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061785"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.ss7706a1","article-title":"Laboratory-Confirmed Influenza-Associated Hospitalizations Among Children and Adults\u2014Influenza Hospitalization Surveillance Network, United States, 2010-2023","volume":"73","author":"Naquin","year":"2024","journal-title":"MMWR Surveill. Summ."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s00431-025-06289-0","article-title":"Burden of disease and seasonal data of children hospitalized due to RSV and Influenza infection before, during and after the COVID-19 pandemic","volume":"184","author":"Kurz","year":"2025","journal-title":"Eur. J. Pediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e13178","DOI":"10.1111\/irv.13178","article-title":"Increased influenza severity in children in the wake of SARS-CoV-2","volume":"17","author":"Hoy","year":"2023","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Liu, H.F., Hu, X.Z., Huang, R.W., Guo, Z.H., Gao, J.R., Xiang, M., Lu, R., Ban, D., Liu, C.Y., and Wang, Y.Y. (2024). Evaluation of disease severity and prediction of severe cases in children hospitalized with influenza A (H1N1) infection during the post-COVID-19 era: A multicenter retrospective study. BMC Pediatr., 24.","DOI":"10.1186\/s12887-024-04645-x"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"piae108","DOI":"10.1093\/jpids\/piae108","article-title":"Pediatric Clinical Influenza Disease by Type and Subtype 2015-2020: A Multicenter, Prospective Study","volume":"14","author":"Grioni","year":"2025","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"397","DOI":"10.5152\/TurkArchPediatr.2024.23286","article-title":"Comparison of Clinical Presentations and Disease Severity of Children Hospitalized with Influenza A and B","volume":"59","author":"Demir","year":"2024","journal-title":"Turk. Arch. Pediatr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1002\/jmv.27400","article-title":"Severe influenza virus infection in children admitted to the PICU: Comparison of influenza A and influenza B virus infection","volume":"94","author":"Turanli","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1093\/cid\/ciy874","article-title":"Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa","volume":"68","author":"Uyeki","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/irv.12862","article-title":"Oseltamivir treatment of influenza A and B infections in infants","volume":"15","author":"Mattila","year":"2021","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e2021050417","DOI":"10.1542\/peds.2021-050417","article-title":"Influenza Antiviral Treatment and Length of Stay","volume":"148","author":"Campbell","year":"2021","journal-title":"Pediatrics"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s15010-023-02124-6","article-title":"Antibiotic use in children hospitalised for influenza, 2010-2021: The Canadian Immunization Monitoring Program Active (IMPACT)","volume":"52","author":"Schober","year":"2024","journal-title":"Infection"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"04063","DOI":"10.7189\/jogh.13.04063","article-title":"The prevalence of influenza bacterial co-infection and its role in disease severity: A systematic review and meta-analysis","volume":"13","author":"Qiao","year":"2023","journal-title":"J. Glob. Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2074","DOI":"10.1016\/j.jfma.2022.03.002","article-title":"Clinical characteristics and outcomes of mixed virus or bacterial infection in children with laboratory-confirmed influenza infection","volume":"121","author":"Chien","year":"2022","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Meri\u0219escu, M.M., Luminos, M.L., Pavelescu, C., and Jugulete, G. (2023). 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, 15.","DOI":"10.20944\/preprints202309.0132.v1"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.15585\/mmwr.mm7150a4","article-title":"Prevalence of SARS-CoV-2 and Influenza Coinfection and Clinical Characteristics Among Children and Adolescents Aged <18 Years Who Were Hospitalized or Died with Influenza\u2014United States, 2021\u20132022 Influenza Season","volume":"71","author":"Adams","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.anpedi.2020.12.024","article-title":"Coinfections of influenza and other respiratory viruses are associated to children","volume":"96","author":"Sanz","year":"2022","journal-title":"An. Pediatr."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"ofaa223","DOI":"10.1093\/ofid\/ofaa223","article-title":"The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010-2017","volume":"7","author":"Klein","year":"2020","journal-title":"Open Forum Infect. Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"fmab090","DOI":"10.1093\/tropej\/fmab090","article-title":"Influenza Virus Associated Pediatric Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcomes","volume":"67","author":"Yener","year":"2021","journal-title":"J. Trop. Pediatr."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Profir, I., Popescu, C.M., and Moraru, I. (2025). Life-Threatening Anemia and Thrombocytopenia in a Toddler with Influenza B: Case Report and Literature Review. Children, 12.","DOI":"10.3390\/children12050632"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"7995","DOI":"10.2147\/IJGM.S385307","article-title":"A Comparative Study of Severe and Critical Influenza B in Children in the 2021-2022 Winter Season","volume":"15","author":"Li","year":"2022","journal-title":"Int. J. Gen. Med."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Kamin, W., Adams, O., Kardos, P., Matthys, H., Meister, N., and Strassburg, C.P. (2022). Liver Involvement in Acute Respiratory Infections in Children and Adolescents\u2014Results of a Non-interventional Study. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.840008"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"4107","DOI":"10.1002\/jmv.27817","article-title":"Influenza is more severe than our newest enemy (COVID-19) in hospitalized children: Experience from a tertiary center","volume":"94","author":"Tasar","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Huang, X., Zhang, J., and Tao, Z. (2024). Risk factors for hospitalization and pneumonia development of pediatric patients with seasonal influenza during February-April 2023. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1300228"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"S\u0103s\u0103ran, M.O., Muntean, C.V., Stoica, A.B., Schwesig, C., V\u0103sie\u0219iu, A.M., Ple\u0219ca, A.D., and M\u0103rginean, C.O. (2025). Clinical and Paraclinical Peculiarities of SARS-CoV-2 and Influenza Infections in Children: A Comparative Study. Life, 15.","DOI":"10.3390\/life15050784"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e13075","DOI":"10.1111\/irv.13075","article-title":"Neurological complications associated with influenza in hospitalized children","volume":"17","author":"Jantarabenjakul","year":"2023","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Hu, Q., Liang, W., Yi, Q., Zheng, Y., Wang, W., and Wu, Y. (2023). Risk factors for death associated with severe influenza in children and the impact of the COVID-19 pandemic on clinical characteristics. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1249058"},{"key":"ref_64","first-page":"39","article-title":"Rare pediatric case of two episodes of fulminant myocarditis and cardiac dysfunction after viral infection","volume":"30","author":"Seki","year":"2024","journal-title":"J. Cardiol. Cases"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Profir, I., Popescu, C.M., and Nechita, A. (2025). Fatal Influenza B-MRSA Coinfection in a Healthy Adolescent: Necrotizing Pneumonia, Cytokine Storm, and Multi-Organ Failure. Children, 12.","DOI":"10.3390\/children12060766"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"15563","DOI":"10.1038\/s41598-024-66550-8","article-title":"Age, comorbidity burden and late presentation are significant predictors of hospitalization length and acute respiratory failure in patients with influenza","volume":"14","author":"Miron","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Ramos-Rinc\u00f3n, J.M., Pinargote-Celorio, H., Gonz\u00e1lez-de-la-Aleja, P., S\u00e1nchez-Pay\u00e1, J., Reus, S., Rodr\u00edguez-D\u00edaz, J.C., and Merino, E. (2024). Impact of influenza related hospitalization in Spain: Characteristics and risk factor of mortality during five influenza seasons (2016 to 2021). Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1360372"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"El Guerche-S\u00e9blain, C., Etcheto, A., Parmentier, F., Afshar, M., Macias, A.E., Puentes, E., Gresset-Bourgeois, V., Akcay, M., Petitjean, A., and Coudeville, L. (2022). Hospital admissions with influenza and impact of age and comorbidities on severe clinical outcomes in Brazil and Mexico. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0273837"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/6\/478\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T10:17:23Z","timestamp":1779963443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/14\/6\/478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":68,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["vaccines14060478"],"URL":"https:\/\/doi.org\/10.3390\/vaccines14060478","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}