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Published on: December 10, 2013
[Clinical features and outcome of 2009 H1N1 influenza in the pediatric setting. Multicenter prospective study in the
C Desmoulins1, A-P Michard-Lenoir2, J Naud3
1Service des urgences pédiatriques, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
Insights
Young infants under three months are not at higher risk for 2009 H1N1 influenza complications. Oseltamivir treatment did not shorten symptom duration in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Context:
- The 2009 H1N1 influenza pandemic posed a significant public health concern, particularly for vulnerable pediatric populations.
- Understanding the clinical course and outcomes of H1N1 influenza in children is crucial for effective management and resource allocation.
- Emergency departments serve as critical entry points for diagnosing and managing acute respiratory infections in children.
Purpose:
- To describe the clinical manifestations and outcomes of infants and children diagnosed with 2009 H1N1 influenza in emergency departments.
- To identify risk factors and complications associated with 2009 H1N1 influenza in pediatric patients.
- To evaluate the impact of antiviral treatment on symptom duration.
Summary:
- A prospective multicenter case series included 466 children with confirmed 2009 H1N1 influenza admitted to pediatric emergency departments.
- Infants younger than three months and children with pre-existing chronic conditions (PECs) were analyzed separately.
- Complication rates did not significantly differ between at-risk and non-at-risk children, although at-risk children experienced longer hospital stays.
Impact:
- Findings indicate that infants under three months are not a high-risk group for influenza complications.
- Oseltamivir treatment did not demonstrate a significant reduction in the duration of fever or cough in the studied pediatric population.
- This study contributes to the understanding of H1N1 influenza epidemiology and clinical management in children, informing public health strategies.
Study Objective:
The clinical manifestations and outcome of infants and children with confirmed 2009 H1N1 influenza in emergency departments is described.
Methods:
We conducted a prospective multicenter case series involving children with symptoms of influenza-like illness in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase chain reaction assay on a nasopharyngeal swab or nasal aspirates and who were admitted to the ED of four university pediatric hospitals. The following data were collected: age, gender, preexisting chronic conditions (PECs) associated with a high risk for influenza-related complications, clinical symptoms, outcome, antiviral treatment, and complications. We recorded length of cough and fever during a phone-call on day 8.
Results:
Between 1st October and 31st December 2009, 466 children were included. Their median age was 4 years (range, 1 day to 17 years). The median time to consultation was 24h. Of these 466 infants and children, 55 were aged less than three months and 153 had one or more PECs. Asthma was the most frequent condition. Children at risk and children without risk did not differ for complications (28% vs 31%, P>0.05). Respiratory complications (17%) and decompensations of preexisting disease were the most frequent. Infants aged less than three months did not have more complications than infants without PECs. At-risk infants and children were more frequently hospitalized (P<0.02) and the duration of the pediatric ward stay was longer (P<0.02). This was true only for children aged less than three months. Of the hospitalized children, 17 (9%) were admitted to an ICU. Duration of fever (3.8 days) and duration of cough (6.3 days) did not differ according to whether or not children received oseltamivir.
Conclusion:
Infants younger than three months of age are not a group at risk for influenza-related complications. Oseltamivir did not reduce duration of symptoms in this population.
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