There were 18,002 records in the laboratory database of which 17,783 could be matched with the hospital number to the CMS data and included in the analysis. The remaining

219 records were either not within the age range or could not be matched with their hospital number. In the 6M and 18Y groups, NPAs were requested on 2066 (24.8%) and 17,783 (39.4%) admissions (Appendix 7) and were positive in 6.5% (range 4.8–9.9%) and 13.2% (range 9.2–21.5%) during the 6 year period respectively (Appendix 8). Overall 1.6% of admissions in the 6M group and 5.2% in the 18Y group had a positive NPA for influenza (Appendix 7). In both age groups the highest positivity rate was in the 2009/10 period during which time the 2009 pandemic influenza A (H1NI) virus (A(H1N1)pdm09) influenza strain circulated but this effect was less marked in the 6M group Protein Tyrosine Kinase inhibitor (Appendix 8). In all HA hospitals the proportion of all admissions, and the proportion of admissions to general wards and intensive care units, that had a CMS diagnosis of influenza was almost double during the 2009/10 period (Appendix 9). Including all children from 0 days to below 18 years, 1993 had both a laboratory positive result and CMS diagnosis (ICD9-CM 487–487.9) of influenza (Table 1). There were an additional 359 children without a CMS diagnosis of influenza but with

a laboratory confirmed result, and 253 with a Dasatinib manufacturer CMS diagnosis of influenza but without laboratory confirmation. This indicates that a CMS diagnosis of influenza under-estimates disease burden relative to the laboratory results despite wide and routine laboratory testing with NPAs in children with fever or respiratory illnesses. Since there appeared to be no obvious age effect (Appendix 3) an overall mean value of 1.05 was used for adjustment factor 1 for all age groups. Of the Isotretinoin 11,063 children

with a primary-respiratory associated diagnosis, 1490 did not have an NPA sent. Adjustment factor 2 assumed the influenza positive rate in these 1490 children was the same as in the 9573 children that had an NPA sent (Table 1). Again this factor did not appear to vary consistently with age and overall mean value of 1.13 was applied to all age groups (Appendix 3). Adjustment factor 3 was the proportion of all admissions by age group that had a laboratory diagnosis of influenza at PWH (Table 1). This factor varied by age group and a smoothed value excluding the first two months was applied to each monthly age group for the complete HA dataset (Appendix 3). The incidence rates of hospitalisation for influenza per 100,000 person-years based on any CMS influenza diagnosis (CMS flu) for the whole of Hong Kong were lowest in the first two months of life, then peaked between 2 and 6 months, and then declined from about 3 to 4 years of age (Fig. 2 and Fig. 3). Similar patterns were observed over the full 6 years of the study.