Clinical epidemiology and predictors of outcome in children hospitalised with influenza A(H1N1)pdm09 in 2009: a prospective national study

Influenza and Other Respiratory Viruses

Gulam Khandaker⁸  Yvonne Zurynski⁸  Greta Ridley⁸  Jim Buttery⁶  Helen Marshall⁵  Peter C. Richmond¹  Jenny Royle³  Michael Gold⁹  Tony Walls²  Bruce Whitehead⁷  Peter McIntyre⁴  Nicholas Wood⁴  Robert Booy⁴ 

[1] School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Perth, WA, Australia;The Sydney Children's Hospitals Network (SCHN), Sydney, NSW, Australia;Immunisation Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Vic., Australia;National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead, Sydney, NSW, Australia;Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Robinson Institute and School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia;Department of Paediatrics, Murdoch Children's Research Institute, Monash Children's Hospital, Monash University, Melbourne, Vic., Australia;Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia;The Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia;School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia

关键词: Children;    influenza;    influenza A(H1N1)pdm09;    outcome;    pandemic;   

DOI  :  10.1111/irv.12286

来源: Wiley

【 摘 要 】

Abstract

Background

There are few large-scale, prospective studies of influenza A(H1N1)pdm09 in children that identify predictors of adverse outcomes.

Objectives

We aimed to examine clinical epidemiology and predictors for adverse outcomes in children hospitalised with influenza A(H1N1)pdm09 in Australia.

Methods

Active hospital surveillance in six tertiary paediatric referral centres (June–September, 2009). All children aged <15 years admitted with laboratory-confirmed influenza A(H1N1)pdm09 were studied.

Results

Of 601 children admitted with laboratory-confirmed influenza, 506 (84·2%) had influenza A(H1N1)pdm09. Half (51·0%) of children with influenza A(H1N1)pdm09 were previously healthy. Hospital stay was longer in children with pre-existing condition (mean 6·9 versus 4·9 days; P = 0·02) as was paediatric intensive care unit (PICU) stay (7·0 versus 2·3 days; P = 0·005). Rapid diagnosis decreased both antibiotic use and length of hospital and PICU stay. Fifty (9·9%) children were admitted to a PICU, 30 (5·9%) required mechanical ventilation and 5 (0·9%) died. Laboratory-proven bacterial co-infection and chronic lung disease were significant independent predictors of PICU admission (OR 6·89, 95% CI 3·15–15·06 and OR 3·58, 95% CI 1·41–9·07, respectively) and requirement for ventilation (OR 5·61, 95% CI 2·2–14·28 and OR 5·18, 95% CI 1·8–14·86, respectively). Chronic neurological disease was a predictor of admission to PICU (OR 2·30, 95% CI 1·14–4·61).

Conclusions

During the 2009 pandemic, influenza was a major cause of hospitalisation in tertiary paediatric hospitals. Co-infection and underlying chronic disease increased risk of PICU admission and/or ventilation. Half the children admitted were previously healthy, supporting a role for universal influenza vaccination in children.

【 授权许可】

CC BY   
© 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

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