European Journal of Pediatrics

, Volume 170, Issue 3, pp 371–378

Clinical and epidemiological characteristics of patients with influenza A (H1N1) 2009 attended to at the emergency room of a children's hospital

  • Esther Lera
  • Núria T.Wörner
  • Mónica Sancosmed
  • Anna Fàbregas
  • Alejandro Casquero
  • Susana Melendo
  • Mar Miserachs
  • Teresa Tórtola
  • Astrid Borrego
  • Magda Campins
  • Fernando Moraga
  • Concepció Figueras
  • Rocío Cebrián
Original Paper

Abstract

In June 2009, the first influenza pandemic of the twenty-first century, due to the swine origin influenza A (H1N1) 2009 virus, was declared. This study aimed to describe the epidemiological and clinical features, complications, lethality and risk factors for hospital admission of microbiologically confirmed cases of influenza A (H1N1) 2009 infection seen at the emergency department of a children’s hospital. All cases of children with influenza A (H1N1) 2009 viral infection, confirmed microbiologically by real-time reverse transcription polymerase chain reactions and treated in the emergency room between July and December 2009, were prospectively included. Patients were compared according to admission requirement to study variables associated with the risk of hospitalisation. Oseltamivir was the antiviral used for the treatment and its safety was analysed. Four hundred and twelve patients with influenza A (H1N1) 2009 infection were included. The most frequent symptoms were: fever (96%), cough (95%) and coryza (90%). Eighty-five patients (20.6%) were admitted: three to the paediatric intensive care unit and two died. Hospitalised children were younger than those not admitted (median age 5 vs 8 years; p = 0.001). Age under 1 year (OR 6.01; CI 95% 2.77–13.05), pneumonia (OR 7.99; CI 95% 3.50–18.22) and haemoglobinopathy or underlying blood disorders (OR 5.99; CI 95% 1.32–27.30) were statistically significant risk factors for admission. No differences were observed regarding onset of antiviral treatment among admitted and non-admitted patients. Treatment with oseltamivir was well tolerated. In conclusion, the incidence of severe cases and lethality of influenza A (H1N1) 2009 infection were low in our setting, even in a population with risk factors for developing complications.

Keywords

Influenza A H1N1 Pandemic Emergency unit 

References

  1. 1.
    Agencia Española de Medicamentos y Productos Sanitarios (2009) Recomendaciones para la preparación y administración de oseltamivir en niños menores de 1 año. Available at: http://www.aemps.es/actividad/documentos/notasPrensa/notaOseltamivir-Zanamivir_2.htm
  2. 2.
    Asociación Española de Pediatría (2009) Informe técnico en pediatría sobre la gripe pandémica A (H1N1) 2009 Tratamiento con medicamentos antivirales Available at: http://www.aeped.es/documentos/informe-tecnico-en-pediatria-sobre-gripe-pandemica-h1n1. Accessed 21 Sept 2009
  3. 3.
    Bryant PA, Tebruegge M, Papadakis G et al (2010) Clinical and microbiologic features associated with novel swine-origin influenza a pandemic 2009 (H1N1) Virus in children: a prospective cohort study. Pediatr Infect Dis J 29:694–698PubMedCrossRefGoogle Scholar
  4. 4.
    CDC (2009) H1N1 flu: patient management. Available at: http://www.cdc.gov/h1n1flu/clinicians/patient_management/. Accessed 24 Sep 2009
  5. 5.
    CDC (2009) H1N1 flu. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season. Available at: http://www.cdc.gov/h1n1flu/recommendations.htm. Accessed 24 Sep 2009
  6. 6.
    CDC (2009) Outbreak of swine-origin Influenza A (H1N1) virus infection—Mexico, March–April 2009. MMWR Morb Mortal Wkly Rep 58:467–470Google Scholar
  7. 7.
    CDC (2009) CDC estimates of 2009 H1N1 influenza cases, hospitalizations and deaths in the United States, April–November 14, 2009. Available at: http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm. Accessed 17 Dec 2009
  8. 8.
    Cox NJ, Subbarao K (1999) Influenza. Lancet 354:1277–1282PubMedCrossRefGoogle Scholar
  9. 9.
    Dawood SK, Jain S, Finelli L et al (2009) Novel swine-origin influenza A (H1N1) virus investigation team. Emergence of novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med 360:2605–2615PubMedCrossRefGoogle Scholar
  10. 10.
    Departament de Salut, Generalitat de Catalunya (2009) El departament de Salut fa balanç de la pandèmia de grip A (H1N1) a Catalunya. Available at: http://www.gencat.cat/salut/depsalut/html/ca/premsa/doc33532.html
  11. 11.
    Departament de Salut, Generalitat de Catalunya (2009) La pandèmia en xifres. Context i resposta a Catalunya. Available at: http://www.gencat.cat/salut/depsalut/html/ca/premsa/plasencia.pdf
  12. 12.
    Departament de Salut, Generalitat de Catalunya (2009) Pla d’actuació a Catalunya enfront d’una infecció pel virus pandèmic (H1N1) 2009. Available at: http://www.gencat.cat/salut/depsalut/html/ca/dir3341/gr27042009.pdf
  13. 13.
    European Medicines Agency (2009) European Public Assessment Report for Tamiflu. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Summary_for_the_public/human/000402/WC500033101.pdf
  14. 14.
    Food and Drug Administration (2009) Emergency use of Tamiflu in infants less than one year of age. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm183870.htm. Accessed 18 Nov 2009
  15. 15.
    Garten RJ, Davis CT, Russell CA et al (2009) Antigenic and genetic characteristics of swine-origin 2009 A (H1N1) influenza viruses circulating in humans. Science 325:197–201PubMedCrossRefGoogle Scholar
  16. 16.
    Health Protection Agency (2009) Pandemic (H1N1) 2009 in England: an overview of initial epidemiological findings and implications for the second wave. v3 24. Available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1258560552857. Accessed 18 Dec 2009
  17. 17.
    Jain R, Goldman RD (2009) Novel influenza A (H1N1) clinical presentation, diagnosis and management. Pediatr Emerg Care 25:791–796PubMedCrossRefGoogle Scholar
  18. 18.
    Jain S, Kamimoto L, Bramley AM et al (2009) Hospitalized patients with 2009 H1N1 Influenza in the United States, April–June 2009. N Engl J Med 361:1935–1944PubMedCrossRefGoogle Scholar
  19. 19.
    Kitching A, Roche A, Balasegaram S et al (2009) Oseltamivir adherence and side effects among children in three London schools affected by influenza A (H1N1)v, May 2009—an internet-based cross-sectorial survey. Euro surveill. Available at: http:// www.eurosurveillance.org/images/dynamic/EE/V14N30/art 19287.pdf. Accessed 25 August 2009
  20. 20.
    Kumar S, Havens PL, Chusid MJ et al (2010) Clinical and epidemiological characteristics of children hospitalized with 2009 pandemic H1N1 influenza A infection. Pediatr Infect Dis J 29:591–594PubMedCrossRefGoogle Scholar
  21. 21.
    Libster R, Bugna J, Coviello S et al (2010) Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med 362:45–55PubMedCrossRefGoogle Scholar
  22. 22.
    Ministerio de Sanidad y Política Social (2009) Comunicado sobre el brote humano de gripe de origen porcino. Available at: http://www.msps.es/servCiudadanos/alertas/gripeAH1N1.htm
  23. 23.
    Moore DL, Vaudry W, Scheifele DW et al (2006) Surveillance for influenza admissions among children hospitalized in Canadian immunization monitoring program active centers, 2003–2004. Pediatrics 118:e610–e619PubMedCrossRefGoogle Scholar
  24. 24.
    Nicholson KG (1992) Clinical features of influenza. Semin Respir Infect 7:26–37PubMedGoogle Scholar
  25. 25.
    Shun-Shin M, Thompson M, Heneghan C et al (2009) Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomized controlled trials. BMJ 339:b3172PubMedCrossRefGoogle Scholar
  26. 26.
    Suwannakarn K, Payungporn S, Chieochansin T et al (2008) Typing (A/B) and subtyping (H1/H3/H5) of influenza A viruses by multiplex real-time RT-PCR assays. J Virol Methods 152:25–31PubMedCrossRefGoogle Scholar
  27. 27.
    Torres JP, O’Ryan M, Herve B et al (2010) Impact of the novel influenza A (H1N1) during the 2009 autumn–winter season in a large hospital setting in Santiago, Chile. Clin Infect Dis 50:860–868PubMedCrossRefGoogle Scholar
  28. 28.
    U.S Department of Health and Human Services (2009) Assessment of the Influenza A (H1N1) pandemic on selected countries in the southern hemisphere: Argentina, Australia, Chile, New Zealand and Uruguay. Available at: http://www.flu.gov/professional/global/southhemilphere.html. Accessed 11 Nov 2009
  29. 29.
    Wallensten A, Oliver I, Lewis D el al (2009) Compliance and side effects of prophylactic oseltamivir treatment in a school of south-west England. Euro surveill. Available at: http://www.eurosurveillance.org/images/dynamic/EE/V14N30/art19285.pdf. Accessed 25 Aug 2009
  30. 30.
    World Health Organization (2009) Clinical management of human infection with pandemic (H1N1) 2009: revised guidance. Available at: http://www.who.int/csr/resources/publications/swineflu/clinical_managementh1n1.pdf
  31. 31.
    World Health Organization (2009) Statement to the press by World Health Organization Director-General. Available at: http://www.who.int/mediacentre/news/. Accessed 13 Aug 2009
  32. 32.
    Yorifuji T, Suzuki E, Tsudab T (2009) Oseltamivir and abnormal behaviors. True or not? Epidemiology 20:619–621PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Esther Lera
    • 1
  • Núria T.Wörner
    • 1
  • Mónica Sancosmed
    • 1
  • Anna Fàbregas
    • 1
  • Alejandro Casquero
    • 1
  • Susana Melendo
    • 1
  • Mar Miserachs
    • 1
  • Teresa Tórtola
    • 2
  • Astrid Borrego
    • 2
  • Magda Campins
    • 3
  • Fernando Moraga
    • 4
  • Concepció Figueras
    • 4
  • Rocío Cebrián
    • 1
  1. 1.Paediatric Emergency DepartmentAutonomous University of Barcelona, University Hospital Vall d’HebronBarcelonaSpain
  2. 2.Department of MicrobiologyAutonomous University of Barcelona, University Hospital Vall d’HebronBarcelonaSpain
  3. 3.Department of Preventive Medicine and EpidemiologyAutonomous University of Barcelona, University Hospital Vall d’HebronBarcelonaSpain
  4. 4.Paediatric Infectious Diseases and Immunodeficiencies UnitAutonomous University of Barcelona, University Hospital Vall d’HebronBarcelonaSpain

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