Experience with pandemic 2009 H1N1 influenza in a large pediatric hospital
Arturo S Gastañaduy1, Rodolfo E Bégué
1Department of Pediatrics, Divisions of Emergency Medicine and Infectious Diseases, Louisiana State University Health Sciences Center and Children's Hospital, New Orleans, LA, USA.
Insights
The 2009 pandemic influenza A (pH1N1) significantly impacted pediatric facilities, with most cases being mild. However, some children experienced severe illness, hospitalization, and complications, highlighting the need for continued vigilance.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- In 2009, a novel influenza A strain, H1N1, emerged and rapidly became a pandemic (pH1N1).
- This pandemic disproportionately affected pediatric populations, necessitating a review of its impact on children.
- Understanding the clinical characteristics and outcomes of pH1N1 in children is crucial for public health preparedness.
Purpose of the Study:
- To describe the clinical experience and outcomes of pandemic H1N1 influenza in a large pediatric hospital.
- To analyze the demographic and clinical factors associated with pH1N1 infection and hospitalization in children.
- To identify risk factors for severe disease and intensive care unit (ICU) admission among pediatric patients with pH1N1.
Main Methods:
- A retrospective review of clinical records of children diagnosed with influenza A was conducted.
- The study period spanned from April 2009 to May 2010 at Children's Hospital, New Orleans.
- Influenza A diagnosis was confirmed using rapid influenza tests, direct fluorescent antibody assays, and reverse-transcription-polymerase chain reaction (RT-PCR).
Main Results:
- Out of 10,470 children tested, 1463 (14%) were positive for influenza A.
- Boys (53%) were more frequently infected than girls (47%).
- Hospitalized children (11%) were younger, more often white, had non-Medicaid insurance, and presented with comorbidities, which were also associated with increased ICU admission. Three deaths occurred, all in children with severe predisposing illnesses.
Conclusions:
- Pandemic H1N1 influenza placed a significant burden on pediatric healthcare facilities during the 2009-2010 season.
- While most pediatric pH1N1 cases were mild and self-limiting, a subset experienced severe disease, requiring hospitalization and intensive care.
- The findings underscore the potential for severe outcomes and long-term complications in children infected with pH1N1, emphasizing the importance of ongoing surveillance and clinical management strategies.
Objective:
In 2009, a new strain of influenza A, H1N1, was detected in two children in the United States. It spread quickly and became pandemic (pH1N1), disproportionately affecting children. The aim of the present study was to describe our experience with pH1N1 in a large pediatric hospital.
Methods:
We reviewed the clinical records of all of the children diagnosed as having influenza A at Children's Hospital, New Orleans, LA, for the period April 2009 to May 2010. Diagnosis was made by rapid influenza test or direct fluorescent antibody. Specimens form hospitalized children were sent to the Louisiana Office of Public Health for confirmation by reverse-transcription-polymerase chain reaction.
Results:
During the 14-month study period, 10,470 children were tested and 1463 (14%) tested positive for influenza A. Boys were more commonly infected than girls (53% vs 47%, P < .001). Of the cases, 1308 (89%) were ambulatory and 155 (11%) were hospitalized. Hospitalized children were younger, more frequently white, had non-Medicaid insurance, and had comorbidity. Of the 155 admissions, 14 (9%) were admitted to the intensive care unit. Having a comorbidity increased and being black decreased the chances of being admitted to the intensive care unit. Three children died, all with severe neurologic or respiratory predisposing illness. Eight cases of hospital-onset influenza and 6 of repeat infection were detected.
Conclusions:
pH1N1 burdened pediatric facilities during the 2009-2010 influenza season. Even though most cases were mild and self-limited, some resulted in severe disease and long-term complications.
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