High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit

Torres, Silvio; Iolster, Thomas; Schnitzler, Eduardo; Farias, Júlio A.; Bordogna, Adriana; Rufach, Daniel; Montes, María José; Siaba, Alejandro; Rodríguez, María Gabriela Lagos; Jabornisky, Roberto; Colman, Carmen; Fernández, A.; Caprotta, Gustavo; Díaz, Silvia; Poterala, Roxana; Meyer, Marcela De; Penazzi, Matías; González, Gustavo; Saenz, Silvia; Recupero, Oscar; Zapico, Luis; Alarcon, Blanca; Ariel, Esen; Minces, Pablo; Mari, Eduardo; Carnie, Antonio; Garea, M.; Jaén, R

doi:10.1097/pcc.0b013e318219266b

Cited by 31 publications

(26 citation statements)

References 10 publications

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“…This is consistent with the finding that viral coinfection had little impact on morbidity and mortality in a sample consisting mostly of adult patients (79.3%) admitted to an intensive care unit (ICU) in Australia [11]. In a retrospective observational study with 142 critically ill children patients, showed that the co-infection of swine origin influenza A (H1N1) with respiratory syncytial virus (RSV) is a risk factor for respiratory failure and increased mortality [12]. None of these studies were mentioning the time frame of acquiring the second viral infection except, a recently published retrospective cohort study [13] reported that co-infection with H1N1 and another respiratory virus within 72 h of admission was not associated with worse clinical outcomes.…”

Section: Discussionsupporting

confidence: 69%

Prevalence of Pandemic Influenza a (H1N1) Virus and Cytomegalovirus Co- Existence at an Early Stage in Evangelismos Hospital-ICU Patients

Ee¹,

Asimakos²,

Grispou³

et al. 2017

J Infect Dis Ther

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Objective: Cytomegalovirus (CMV) infections in immunocompetent ICU patients have been associated with poor outcomes. We determined the distribution of cytomegalovirus coinfection among patients admitted in the ICU1 of Evangelismos Hospital of Athens with or diagnosed with pandemic influenza A (H1N1) respiratory infection. Patients:We examined retrospectively 33 ICU consequently patients with community or hospital-acquired pulmonary infection. Investigation of viral-viral coinfection rate was determined at the first 48 h after ICU admission.Results: A total of 13 patients that received a diagnosis of influenza A (H1N1) had their diagnosis confirmed by influenza A rapid antigen testing and/or by influenza A (H1N1) polymerase chain reaction (PCR). Only three out of the 13 H1N1 positive patients were cytomegalovirus bronchoalveolar lavage (BAL)-PCR positive and 10 were negative. Additionally 2 out of the 20 H1N1 negative patients were CMV-BAL-PCR positive. Conclusion:We did not find significant CMV distribution in our H1N1 positive patients at least at the early 4-5 days period after H1N1 infection. However, the study is interesting because patients with a combination of H1N1 and CMV infections have been described only rarely. The scarce presence of CMV in H1N1 patients may suggest that endogenous reactivation of CMV infection within the lungs does occur and that these patients may profit from antiviral therapy. The interplay between host and viruses is very complex and therefore the triggering for the CMV disease activation following H1N1 pneumonia is possible to require more than the absolute presents of the H1N1 virus especially in the ICU patients.

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Section: Discussionsupporting

confidence: 69%

Prevalence of Pandemic Influenza a (H1N1) Virus and Cytomegalovirus Co- Existence at an Early Stage in Evangelismos Hospital-ICU Patients

Ee¹,

Asimakos²,

Grispou³

et al. 2017

J Infect Dis Ther

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“…As would be expected, mortality risk is much higher when the infection follows a more severe course. In H1N1pdm09-infected children with severe illness admitted to ICUs, 81 % of whom underwent mechanical ventilation, death rates were 47 % [124]; many of these children had pre-existing illnesses such as asthma and congenital heart disease, and co-infection with RSV was found to be significantly associated with mortality.…”

Section: Burden Of Influenza In Childrenmentioning

confidence: 99%

The burden of seasonal and pandemic influenza in infants and children

2013

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The burden of influenza is unevenly distributed, with more severe outcomes in children aged <5 years than older children and adults. In spite of this, immunisation policies for young children are far from universal. This article provides an overview of the published evidence on the burden of influenza in children worldwide, with a particular interest in the impact of pandemic influenza in 2009–2010 (caused by the H1N1pdm09 virus). In an average season, up to 9.8 % of 0- to 14-year olds present with influenza, but incidence rates can be markedly higher in younger children. Children aged <5 years have greater rates of hospitalisation and complications than their older counterparts, particularly if the children have co-existing illnesses; historically, this age group have had higher mortality rates from the disease than other children, although during the 2009–2010 pandemic the median age of those who died of influenza was higher than in previous seasons. Admissions to hospital and emergency departments appear to have been more frequent in children with H1N1pdm09 infections than during previous seasonal epidemics, with pneumonia continuing to be a common complication in this setting. Outcomes in children hospitalised with severe disease also seem to have been worse for those infected with H1N1pdm09 viruses compared with seasonal viruses. Studies in children confirm that vaccination reduces the incidence of seasonal influenza and the associated burden, underlining the importance of targeting this group in national immunisation policies. Conclusions: Children aged <5 years are especially vulnerable to influenza, particularly that caused by seasonal viruses, and vaccination in this group can be an effective strategy for reducing disease burden.

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“…Canada † [11] Turkey [55] Argentina [56] USA [57] France [58] Population studied (million habitants) Special Report also resulted in an increase in neonatal ICU admission indirectly or directly related to pandemic influenza A(H1N1)pdm09 in many jurisdictions [13]; however, this increase was not observed in Canada, where low birth weight admission in neonatal ICUs remained the same as during historical periods [101].…”

Section: Table 3 Main Children Characteristics In Intensive Care Unimentioning

confidence: 99%

H1N1 pandemic: clinical and epidemiologic characteristics of the Canadian pediatric outbreak

Fléchelles

Fowler

Jouvet

2013

Expert Review of Anti-infective Therapy

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Canada was one of the first countries affected by the 2009 influenza H1N1 pandemic with two waves - one from May to June and one from October to December. The 2009 influenza H1N1 pandemic had many unique features when compared with seasonal influenza, including the following: more than half of the affected people were children; asthma was the most significant risk factor for hospital admission; and Aboriginal and pregnant women had a higher risk of hospital admission and complications. Antiviral therapy was widely used but data did not show any effect on the pediatric population. Outbreak spread was possibly promoted from child-child and child-adult contact, and therefore the vaccination campaign targeted the pediatric population and achieved good coverage among young children (57%). Vaccination efficacy was difficult to test because of the vaccination delay. Improvement in models of prevention and treatment are urgently needed to prepare for the possible future pandemics.

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High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit

Abstract: The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.

Cited by 31 publications

References 10 publications

Prevalence of Pandemic Influenza a (H1N1) Virus and Cytomegalovirus Co- Existence at an Early Stage in Evangelismos Hospital-ICU Patients

Prevalence of Pandemic Influenza a (H1N1) Virus and Cytomegalovirus Co- Existence at an Early Stage in Evangelismos Hospital-ICU Patients

The burden of seasonal and pandemic influenza in infants and children

H1N1 pandemic: clinical and epidemiologic characteristics of the Canadian pediatric outbreak

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