tetano
Editor, Senior Moderator
Neurology. 2012 Sep 19. [Epub ahead of print]
Neurologic complications of influenza A(H1N1)pdm09: Surveillance in 6 pediatric hospitals.
Khandaker G, Zurynski Y, Buttery J, Marshall H, Richmond PC, Dale RC, Royle J, Gold M, Snelling T, Whitehead B, Jones C, Heron L, McCaskill M, Macartney K, Elliott EJ, Booy R.
Source
From the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (G.K., T.S., L.H., K.M., R.B.), Sydney; The Discipline of Paediatrics and Child Health (G.K., Y.Z., R.C.D., C.J., L.H., K.M., E.J.E., R.B.), The University of Sydney, Sydney; The Australian Paediatric Surveillance Unit (Y.Z., E.J.E.), Sydney; Murdoch Children's Research Institute (J.B., J.R.), and Immunisation Service, Department of General Medicine, Royal Children's Hospital, Melbourne; Department of Paediatrics (J.B.), Monash University, Melbourne; Vaccinology and Immunology Research Trials Unit (H.M.), Women's and Children's Hospital, Adelaide, South Australia; School of Paediatrics and Reproductive Health (H.M., M.G.), University of Adelaide, South Australia; School of Paediatrics and Child Health (P.C.R.), University of Western Australia, Perth; Sydney Children's Hospital (T.S.), Randwick; Respiratory Medicine (B.W.), John Hunter Children's Hospital, New South Wales; Department of Emergency Medicine (M.M.), The Children's Hospital at Westmead, Sydney; and The Sydney Institute for Emerging Infections and Biosecurity (SEIB) (C.J., L.H., K.M., E.J.E., R.B.), Sydney Medical School, The University of Sydney, Sydney, Australia.
Abstract
OBJECTIVE:
We sought to determine the range and extent of neurologic complications due to pandemic influenza A (H1N1) 2009 infection (pH1N1'09) in children hospitalized with influenza.
METHODS:
Active hospital-based surveillance in 6 Australian tertiary pediatric referral centers between June 1 and September 30, 2009, for children aged <15 years with laboratory-confirmed pH1N1'09.
RESULTS:
A total of 506 children with pH1N1'09 were hospitalized, of whom 49 (9.7%) had neurologic complications; median age 4.8 years (range 0.5-12.6 years) compared with 3.7 years (0.01-14.9 years) in those without complications. Approximately one-half (55.1%) of the children with neurologic complications had preexisting medical conditions, and 42.8% had preexisting neurologic conditions. On presentation, only 36.7% had the triad of cough, fever, and coryza/runny nose, whereas 38.7% had only 1 or no respiratory symptoms. Seizure was the most common neurologic complication (7.5%). Others included encephalitis/encephalopathy (1.4%), confusion/disorientation (1.0%), loss of consciousness (1.0%), and paralysis/Guillain-Barr? syndrome (0.4%). A total of 30.6% needed intensive care unit (ICU) admission, 24.5% required mechanical ventilation, and 2 (4.1%) died. The mean length of stay in hospital was 6.5 days (median 3 days) and mean ICU stay was 4.4 days (median 1.5 days).
CONCLUSIONS:
Neurologic complications are relatively common among children admitted with influenza, and can be life-threatening. The lack of specific treatment for influenza-related neurologic complications underlines the importance of early diagnosis, use of antivirals, and universal influenza vaccination in children. Clinicians should consider influenza in children with neurologic symptoms even with a paucity of respiratory symptoms.
PMID:
22993280
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/22993280
Neurologic complications of influenza A(H1N1)pdm09: Surveillance in 6 pediatric hospitals.
Khandaker G, Zurynski Y, Buttery J, Marshall H, Richmond PC, Dale RC, Royle J, Gold M, Snelling T, Whitehead B, Jones C, Heron L, McCaskill M, Macartney K, Elliott EJ, Booy R.
Source
From the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (G.K., T.S., L.H., K.M., R.B.), Sydney; The Discipline of Paediatrics and Child Health (G.K., Y.Z., R.C.D., C.J., L.H., K.M., E.J.E., R.B.), The University of Sydney, Sydney; The Australian Paediatric Surveillance Unit (Y.Z., E.J.E.), Sydney; Murdoch Children's Research Institute (J.B., J.R.), and Immunisation Service, Department of General Medicine, Royal Children's Hospital, Melbourne; Department of Paediatrics (J.B.), Monash University, Melbourne; Vaccinology and Immunology Research Trials Unit (H.M.), Women's and Children's Hospital, Adelaide, South Australia; School of Paediatrics and Reproductive Health (H.M., M.G.), University of Adelaide, South Australia; School of Paediatrics and Child Health (P.C.R.), University of Western Australia, Perth; Sydney Children's Hospital (T.S.), Randwick; Respiratory Medicine (B.W.), John Hunter Children's Hospital, New South Wales; Department of Emergency Medicine (M.M.), The Children's Hospital at Westmead, Sydney; and The Sydney Institute for Emerging Infections and Biosecurity (SEIB) (C.J., L.H., K.M., E.J.E., R.B.), Sydney Medical School, The University of Sydney, Sydney, Australia.
Abstract
OBJECTIVE:
We sought to determine the range and extent of neurologic complications due to pandemic influenza A (H1N1) 2009 infection (pH1N1'09) in children hospitalized with influenza.
METHODS:
Active hospital-based surveillance in 6 Australian tertiary pediatric referral centers between June 1 and September 30, 2009, for children aged <15 years with laboratory-confirmed pH1N1'09.
RESULTS:
A total of 506 children with pH1N1'09 were hospitalized, of whom 49 (9.7%) had neurologic complications; median age 4.8 years (range 0.5-12.6 years) compared with 3.7 years (0.01-14.9 years) in those without complications. Approximately one-half (55.1%) of the children with neurologic complications had preexisting medical conditions, and 42.8% had preexisting neurologic conditions. On presentation, only 36.7% had the triad of cough, fever, and coryza/runny nose, whereas 38.7% had only 1 or no respiratory symptoms. Seizure was the most common neurologic complication (7.5%). Others included encephalitis/encephalopathy (1.4%), confusion/disorientation (1.0%), loss of consciousness (1.0%), and paralysis/Guillain-Barr? syndrome (0.4%). A total of 30.6% needed intensive care unit (ICU) admission, 24.5% required mechanical ventilation, and 2 (4.1%) died. The mean length of stay in hospital was 6.5 days (median 3 days) and mean ICU stay was 4.4 days (median 1.5 days).
CONCLUSIONS:
Neurologic complications are relatively common among children admitted with influenza, and can be life-threatening. The lack of specific treatment for influenza-related neurologic complications underlines the importance of early diagnosis, use of antivirals, and universal influenza vaccination in children. Clinicians should consider influenza in children with neurologic symptoms even with a paucity of respiratory symptoms.
PMID:
22993280
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/22993280