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Editor, Senior Moderator
By Todd Neale , Staff Writer, MedPage Today
Published: November 01, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news
Action Points
* Note that in both the California and Israel studies, hospitalization rates for H1N1 among children were comparable with seasonal influenza in the U.S. and were highest among young infants.
More than a quarter of the children hospitalized with pandemic H1N1 influenza in California required intensive care -- mostly young children with other underlying illnesses, researchers found.
A review of statewide surveillance records found that among more than 300 children hospitalized during last year's flu pandemic, 27% were admitted to an intensive care unit (ICU) and 3% died, Janice Louie, MD, MPH, of the California Department of Public Health, and colleagues reported in the November issue of the Archives of Pediatrics & Adolescent Medicine.
Similar to previous studies, the majority of hospitalized children (67%) had underlying illnesses. Those with congenital heart disease and cerebral palsy/developmental delay were at significantly increased risk of needing intensive care or dying (OR 5.0 and 3.5, respectively).
According to Louie and colleagues, the findings support recommendations for vaccinating high-risk groups -- including those caring for infants younger than 6 months, pregnant women, all children ages 6 months up to 5 years, and any children with conditions that increase the risk of flu-related complications.
Louie and her colleagues looked at records from the statewide public health surveillance of the pandemic from 345 children younger than 18 (median age 6) hospitalized from April 23 to Aug. 11 of last year. All cases of H1N1 flu were laboratory-confirmed.
The hospitalization rate per 100,000 population per 110 days was 3.5, comparable to that with seasonal influenza. The highest rate was observed in infants younger than 6 months (13.9).
"Increased hospitalization rates may in part reflect a lower threshold for clinicians to admit young infants for evaluation of febrile illness," according to the authors.
Two-thirds of the children had comorbidities, most commonly chronic pulmonary disease, underlying neurologic disorders, and immunosuppression. Of those with information on body mass index, 19% were obese.
As has been observed in previous reports, the most common presenting symptoms were fever, cough, dyspnea, nausea or vomiting, diarrhea, and muscle aches. A minority of children (8.7%) had signs of central nervous system problems, including seizures, altered mental status, or both.
More than half (59%) of the children had evidence of pneumonia or acute respiratory distress syndrome.
Among the nine children who died, three had secondary bacterial infections, and eight had serious comorbidities -- neurologic disorders in five, chronic pulmonary disease in four, immunosuppression in three, chronic heart disease in three, a history of prematurity in three, and gastrointestinal disorders in two.
The ninth death occurred in a child who was previously healthy.
In a separate study, Eli Somekh, MD, of Edith Wolfson Medical Center in Holon, Israel, and colleagues examined the characteristics of children hospitalized with lab-confirmed H1N1 flu at seven centers in Israel.
The study, which included 478 patients 18 and younger (mean age 6.1), covered July 12 to Dec. 24, 2010, which spanned the period before, during, and after peak H1N1 activity in Israel.
The mean hospital stay was 3.9 days; 8.8% of the children required intensive care, 3.1% required mechanical ventilation, and 0.6% (three patients) died.
The hospitalization rate was 0.7 per 1,000 children, with the highest rate in infants younger than 3 months (3.2 per 1,000). As in the California study, the hospitalization rate for H1N1 was similar to that seen with seasonal influenza in the U.S.
Considering all nine of the children who died during the pandemic in Israel (including the three in this study), the mortality rate was 3.6 per 1,000,000 children. In this study, all nine children who died had serious underlying illnesses, including two cases of inherited metabolic disorder and one case of leukemia.
The most frequent presentations were pneumonia (36%), flu-like illness (28%), wheezing exacerbation (8.8%), and convulsions (8.6%). Slightly less than half (48.7%) had underlying illnesses, mostly respiratory, neurologic, and cardiovascular.
The highest risks of severe complications were seen in children with metabolic disorders and neurologic disorders (risk ratios 6.5 and 2.9, respectively).
In addition, patients with cyanotic heart lesions and infants 3 months and younger born prematurely tended to have a greater need for mechanical ventilation.
Somekh and his colleagues acknowledged that their study may have underestimated hospitalization rates because they only included lab-confirmed disease, and also that the percentage of severe cases may have been diluted by more liberal indications for hospital admission in Israel.
The California researchers noted some limitations as well, including the use of data from nonstandardized medical records, the use of passive reporting for case ascertainment, and the possibility that clinicians were more likely to report severe cases to health officials, which could overestimate intensive care unit admissions.
http://www.medpagetoday.com/InfectiousDisease/SwineFlu/23088
Published: November 01, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news
Action Points
* Note that in both the California and Israel studies, hospitalization rates for H1N1 among children were comparable with seasonal influenza in the U.S. and were highest among young infants.
More than a quarter of the children hospitalized with pandemic H1N1 influenza in California required intensive care -- mostly young children with other underlying illnesses, researchers found.
A review of statewide surveillance records found that among more than 300 children hospitalized during last year's flu pandemic, 27% were admitted to an intensive care unit (ICU) and 3% died, Janice Louie, MD, MPH, of the California Department of Public Health, and colleagues reported in the November issue of the Archives of Pediatrics & Adolescent Medicine.
Similar to previous studies, the majority of hospitalized children (67%) had underlying illnesses. Those with congenital heart disease and cerebral palsy/developmental delay were at significantly increased risk of needing intensive care or dying (OR 5.0 and 3.5, respectively).
According to Louie and colleagues, the findings support recommendations for vaccinating high-risk groups -- including those caring for infants younger than 6 months, pregnant women, all children ages 6 months up to 5 years, and any children with conditions that increase the risk of flu-related complications.
Louie and her colleagues looked at records from the statewide public health surveillance of the pandemic from 345 children younger than 18 (median age 6) hospitalized from April 23 to Aug. 11 of last year. All cases of H1N1 flu were laboratory-confirmed.
The hospitalization rate per 100,000 population per 110 days was 3.5, comparable to that with seasonal influenza. The highest rate was observed in infants younger than 6 months (13.9).
"Increased hospitalization rates may in part reflect a lower threshold for clinicians to admit young infants for evaluation of febrile illness," according to the authors.
Two-thirds of the children had comorbidities, most commonly chronic pulmonary disease, underlying neurologic disorders, and immunosuppression. Of those with information on body mass index, 19% were obese.
As has been observed in previous reports, the most common presenting symptoms were fever, cough, dyspnea, nausea or vomiting, diarrhea, and muscle aches. A minority of children (8.7%) had signs of central nervous system problems, including seizures, altered mental status, or both.
More than half (59%) of the children had evidence of pneumonia or acute respiratory distress syndrome.
Among the nine children who died, three had secondary bacterial infections, and eight had serious comorbidities -- neurologic disorders in five, chronic pulmonary disease in four, immunosuppression in three, chronic heart disease in three, a history of prematurity in three, and gastrointestinal disorders in two.
The ninth death occurred in a child who was previously healthy.
In a separate study, Eli Somekh, MD, of Edith Wolfson Medical Center in Holon, Israel, and colleagues examined the characteristics of children hospitalized with lab-confirmed H1N1 flu at seven centers in Israel.
The study, which included 478 patients 18 and younger (mean age 6.1), covered July 12 to Dec. 24, 2010, which spanned the period before, during, and after peak H1N1 activity in Israel.
The mean hospital stay was 3.9 days; 8.8% of the children required intensive care, 3.1% required mechanical ventilation, and 0.6% (three patients) died.
The hospitalization rate was 0.7 per 1,000 children, with the highest rate in infants younger than 3 months (3.2 per 1,000). As in the California study, the hospitalization rate for H1N1 was similar to that seen with seasonal influenza in the U.S.
Considering all nine of the children who died during the pandemic in Israel (including the three in this study), the mortality rate was 3.6 per 1,000,000 children. In this study, all nine children who died had serious underlying illnesses, including two cases of inherited metabolic disorder and one case of leukemia.
The most frequent presentations were pneumonia (36%), flu-like illness (28%), wheezing exacerbation (8.8%), and convulsions (8.6%). Slightly less than half (48.7%) had underlying illnesses, mostly respiratory, neurologic, and cardiovascular.
The highest risks of severe complications were seen in children with metabolic disorders and neurologic disorders (risk ratios 6.5 and 2.9, respectively).
In addition, patients with cyanotic heart lesions and infants 3 months and younger born prematurely tended to have a greater need for mechanical ventilation.
Somekh and his colleagues acknowledged that their study may have underestimated hospitalization rates because they only included lab-confirmed disease, and also that the percentage of severe cases may have been diluted by more liberal indications for hospital admission in Israel.
The California researchers noted some limitations as well, including the use of data from nonstandardized medical records, the use of passive reporting for case ascertainment, and the possibility that clinicians were more likely to report severe cases to health officials, which could overestimate intensive care unit admissions.
http://www.medpagetoday.com/InfectiousDisease/SwineFlu/23088