Abstract
Objective
To describe the clinical characteristics and outcome of Indian children infected with 2009 H1N1 influenza virus.
Study design
Retrospective chart review.
Setting
Outpatient department and hospitalized patients in a tertiary care hospital.
Methods
Clinical details of 85 children (positive for the 2009 H1N1 virus infection tested by real-time reverse-transcriptase-polymerase-chain-reaction assay) were analyzed from medical charts.
Results
Of the 85 (55 boys) children positive for 2009 H1N1 virus infection, 64.7% were between 5 years to 16 years, and 35.3% were below 5 years age. The mean age of these children was 7.5±3.5 yr. Contact history was positive only in 22 (26%) cases. High grade fever was the most common symptom, followed by cough and rhinorrhea. Twenty-nine (34%) patients had an underlying co-morbid condition. Of the 34 patients who underwent chest radiography during evaluation, 18 children (52.9%) had findings consistent with lower respiratory tract infection. Antiviral therapy was initiated in 76 patients. Hospitalization was required in 30 (35.3%) children. Risk factors for hospitalization included underlying co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph. Mean length of hospitalization was 131±76 hours, irrespective of underlying disease. Three children developed Acute Respiratory Distress Syndrome and died.
Conclusions
Clinical features and routine laboratory investigations in children with swine origin influenza were non-specific. Children with co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph were at higher risk of hospitalization.
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References
Chang LY, Shih SR, Shao PL, Huang DT, Huang LM. Novel swine-origin influenza virus A (H1N1): the first pandemic of the 21st century. J Formos Med Assoc. 2009; 108: 526–532.
Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009; 360:2605–2615. [Erratum, N Engl J Med. 2009; 361: 102.]
Garten RJ, Davis CT, Russell CA, Shu B, Lindstrom S, Balish A, et al. Antigenic and genetic characteristics of swine-origin 2009 A (H1N1) influenza viruses circulating in humans. Science. 2009;325:197–201.
Morens DM, Taubenberger JK, Fauci AS. The persistent legacy of the 1918 influenza virus. NEJM. 2009;361: 225–229.
Clinical management of human infection with new influenza A (H1N1) virus: initial guidance. World Health Organization: Global alert and response. 21 May 2009. Available from: http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html. Accessed on 15 February, 2010.
Epidemiological Trends of Pandemic Influenza A (H1N1). Ministry of Health and Family Welfare, Government of India. Available from: http://mohfw-h1n1.nic.in/Epidemiological.html. Accessed on January 15, 2010.
Lister P, Reynolds F, Parslow R, Chan A, Cooper M, Plunkett A, et al. Swine-origin influenza virus H1N1, seasonal influenza virus, and critical illness in children. Lancet. 2009;374:605–7.
Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection — United States, April–August 2009. MMWR Morb Mortal Wkly Rep.2009;58:941–947.
Hackett S, Hill L, Patel J, Ratnaraja N, Ifeyinwa A, Farooqi M, et al. Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet. 2009;374:605.
Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. Pandemic Influenza A H1N1-Clinical management Protocol and Infection Control Guidelines. Available at: http://mohfwh1n1.nic.in/documents/pdf/5.%20Clinical%20Management%20ProtocolPandemic%20influenza%20A%20H1N1.pdf. Accessed on 15 February, 2010.
Pandemic (H1N1) 2010 — update 83. Geneva: World Health Organization. Available from: http://www.who.int/csr/don/2010_01_15/en/index.html. Accessed on January 15, 2010.
Schrag SJ, Shay DK, Gershman K, Thomas A, Craig AS, Schaffner W, et al. Multistate surveillance for laboratory confirmed, influenza-associated hospitalizations in children: 2003–2004. Pediatr Infect Dis J. 2006; 25:395–400.
Keren R, Zaoutis TE, Bridges CB, Herrera G, Watson BM, Wheeler AB, et al. Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection. JAMA. 2005;294: 2188–2194.
Ampofo K, Gesteland PH, Bender J, Mills M, Daly J, Samore M, et al. Epidemiology, complications, and cost of hospitalization in children with laboratory — confirmed influenza infection. Pediatrics 2006; 118: 2409–2417.
Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April–June 2009. N Engl J Med. 2009;361:1935–1944.
Libster R, Bugna J, Coviello S, Hijano DR, Dunaiewsky M, Reynoso N, et al. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med. 2010;362:45–55.
Nicholson KG. Clinical features of influenza. Semin Respir Infect. 1992;7:26–37.
Cox NJ, Subbarao K. Influenza. Lancet. 1999;354:1277–82.
Moore DL, Vaudry W, Scheifele DW, Halperin SA, Dery P, Ford-Jones E, et al. Surveillance for influenza admissions among children hospitalized in Canadian immunization monitoring program active centers, 2003–2004. Pediatrics. 2006;118: e610–e619.
Louria DB, Blumenfield HL, Ellis JT, Kilbourne ED, Rogers DE. Studies on influenza in the pandemic of 1957–1958. II. Pulmonary complications of influenza. J Clin Invest. 1959;38:213–265.
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Das, R.R., Sami, A., Lodha, R. et al. Clinical profile and outcome of swine flu in Indian children. Indian Pediatr 48, 373–378 (2011). https://doi.org/10.1007/s13312-011-0085-y
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DOI: https://doi.org/10.1007/s13312-011-0085-y