Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 145 No. 3132 (2015)

Clinical characteristics and outcomes in children hospitalised with pandemic influenza A/H1N1/09 virus infection – a nationwide survey by the Pediatric Infectious Diseases Group of Switzerland

  • Andres Hagerman
  • Klara M. Posfay-Barbe
  • Andrea Duppenthaler
  • Ulrich Heininger
  • Christoph Berger
  • - The PIGS Influenza Study Group
DOI
https://doi.org/10.4414/smw.2015.14171
Cite this as:
Swiss Med Wkly. 2015;145:w14171
Published
26.07.2015

Abstract

OBJECTIVE: To describe all patients admitted to children’s hospitals in Switzerland with a diagnosis of influenza A/H1N1/09 virus infection during the 2009 influenza pandemic, and to analyse their characteristics, predictors of complications, and outcome.

METHODS: All patients ≤18-years-old hospitalised in eleven children’s hospitals in Switzerland between June 2009 and January 2010 with a positive influenza A/H1N1/09 reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal specimen were included.

RESULTS: There were 326 PCR-confirmed patients of whom 189 (58%) were younger than 5 years of age, and 126 (38.7%) had one or more pre-existing medical condition. Fever (median 39.1 °C) was the most common sign (85.6% of all patients), while feeding problems (p = 0.003) and febrile seizures (p = 0.016) were significantly more frequent in children under 5 years. In 142 (43.6%) patients there was clinical suspicion of a concomitant bacterial infection, which was confirmed in 36 patients (11%). However, severe bacterial infection was observed in 4% of patients. One third (n = 108, 33.1%) of the patients were treated with oseltamivir, 64 (59.3%, or 20% overall) within 48 hours of onset of symptoms. Almost half of the patients (45.1%) received antibiotics for a median of 7 days. Twenty patients (6.1%) required intensive care, mostly for complicated pneumonia (50%) without an underlying medical condition. The median duration of hospitalisation was 2 days (range 0–39) for 304 patients. Two children (<15 months of age with underlying disease) died.

CONCLUSIONS: Although pandemic influenza A/H1N1/09 virus infection in children is mostly mild, it can be severe, regardless of past history or underlying disease.

References

  1. Office fédéral de la santé publique. Grippe pandémique (H1N1) 2009 en Suisse, semaines 17 (2009) à 8 (2010). Bull OFSP 4 mars 2010:535–43.
  2. 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;360:2605–15.
  3. Echavarria M, Querci M, Marcone D, Videla C, Martinez A, Bonvehi P, et al. Pandemic (H1N1) 2009 cases, Buenos Aires, Argentina. Emerg Infect Dis. 2010;16:311–3.
  4. Larrauri Camara A, Jimenez-Jorge S, Simon Mendez L, de Mateo Ontanon S. Surveillance of influenza pandemic (H1N1)2009 in Spain. Rev Esp Salud Publica. 2010;84:569–88.
  5. OFSP. Population résidante permanente (total) selon les cantons et l’âge, en 2009. Office fédéral de la statistique Confédération suisse 2009.
  6. Vaccinations SFCf. [Recommendations on the vaccination against Influenza A H1N1/09 as of August 13th 2009]. OFSP/BAG; 2009. French.
  7. OFSP. Office Fédéral de la Santé Publique. Grippe saisonnière 2008/2009. Epidémiologie, virologie, approvisionnement en vaccins et composition des vaccins. Bull OFSP 2009;Bulletin 29, juillet 2009:523–9.
  8. Libster R, Coviello S, Cavalieri ML, Morosi A, Alabart N, Alvarez L, et al. Pediatric hospitalizations due to influenza in 2010 in Argentina. N Engl J Med. 2010;363:2472–3.
  9. Bautista E, Chotpitayasunondh T, Gao Z, Harper SA, Shaw M, Uyeki TM, et al. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010;362:1708–19.
  10. 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;361:1935–44.
  11. Skarbinski J, Jain S, Bramley A, Lee EJ, Huang J, Kirschke D, et al. Hospitalized patients with 2009 pandemic influenza A (H1N1) virus infection in the United States – September-October 2009. Clin Infect Dis. 2011;52(Suppl 1):S50–9.
  12. Bettinger JA, Sauve LJ, Scheifele DW, Moore D, Vaudry W, Tran D, et al. Pandemic influenza in Canadian children: a summary of hospitalized pediatric cases. Vaccine. 2010;28:3180–4.
  13. Stein M, Tasher D, Glikman D, Shachor-Meyouhas Y, Barkai G, Yochai AB, et al. Hospitalization of children with influenza A(H1N1) virus in Israel during the 2009 outbreak in Israel: a multicenter survey. Arch Pediatr Adolesc Med. 2010;164:1015–22.
  14. Wieching A, Benser J, Kohlhauser-Vollmuth C, Weissbrich B, Streng A, Liese JG. Clinical characteristics of pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Northern Bavaria, Germany. BMC Res Notes. 2012;5:304.
  15. Chiu SS, Tse CY, Lau YL, Peiris M. Influenza A infection is an important cause of febrile seizures. Pediatrics. 2001;108:E63.
  16. Kedia S, Stroud B, Parsons J, Schreiner T, Curtis DJ, Bagdure D, et al. Pediatric neurological complications of 2009 pandemic influenza A (H1N1). Arch Neurol. 2011;68:455–62.
  17. Kumar S, Havens PL, Chusid MJ, Willoughby RE, Jr., Simpson P, Henrickson KJ. Clinical and epidemiologic characteristics of children hospitalized with 2009 pandemic H1N1 influenza A infection. Pediatr Infect Dis J. 2010;29:591–4.
  18. Finelli L, Fiore A, Dhara R, Brammer L, Shay DK, Kamimoto L, et al. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics. 2008;122:805–11.
  19. Williams DJ, Hall M, Brogan TV, Farris RW, Myers AL, Newland JG, et al. Influenza coinfection and outcomes in children with complicated pneumonia. Arch Pediatr Adolesc Med. 2011;165:506–12.
  20. Shun-Shin M, Thompson M, Heneghan C, Perera R, Harnden A, Mant D. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. BMJ. 2009;339:b3172.
  21. Piedra PA, Schulman KL, Blumentals WA. Effects of oseltamivir on influenza-related complications in children with chronic medical conditions. Pediatrics. 2009;124:170–8.
  22. Heininger U, Baer G, Ryser AJ, Li Y. Comparative analysis of clinical characteristics of pandemic influenza a/h1n1 and seasonal influenza a infections in hospitalized children. Pediatr Infect Dis J. 2013;32:293–6.

Most read articles by the same author(s)

1 2 > >>