Risk Parameters of Fulminant Acute Respiratory Distress Syndrome and Avian Influenza (H5N1) Infection in Vietnamese Children

Abstract

A clinical picture of patients with acute respiratory distress syndrome (ARDS) induced by highly pathogenic avian influenza A (H5N1) has been reported. We reviewed 37 sets of clinical data for pediatric patients with ARDS at the National Hospital of Pediatrics (Hanoi, Vietnam); 12 patients with H5N1-positive and 25 with H5N1-negative ARDS were enrolled. The H5N1-negative patients had a clinical picture and mortality rate similar to that for the pediatric ARDS patients. However, the H5N1-positive patients had ARDS with normal ventilation capacity at the time of hospital admission, then rapidly proceeded to severe respiratory failure. The survival probability and days until final outcome in groups of H5N1-positive (n=12) vs. H5N1-negative (n=25) patients were 17% versus 52% and 12.3+/-5.7 days (median, 11 days) versus 21.5+/-13.8 days (median, 22 days), respectively. Our observations clarified the clinical picture of H5N1-induced fulminant ARDS and also confirmed that relatively older age (approximately 6 years of age), high fever at onset, and leukopenia and/or thrombocytopenia at the time of hospital admission are risk parameters for H5N1-induced fulminant ARDS.

Emerging New Infections: Importance in Child Health

“…It has been estimated that children could constitute up to 40% of influenza cases in the United States during a pandemic, and that infants and young children will experience very high rates of severe morbidity and mortality, rates higher than experienced during interpandemic periods [143,144,146] . Epidemiological studies of human H5N1 and A(H1N1)v influenza virus infections support these suggestions as they indicate disproportionately high rates of infection in children and the highest burden of complications and mortality among children [112][113][114][147][148][149][150][151][152][153][154][155][156] .…”

“…Mortality rates associated with H5N1 are consistently 1 50%, with death most commonly occurring in previously healthy children following a rapidly fulminating course of acute respiratory van distress [147][148][149][150]156] . It has been estimated that if H5N1 were to mutate so as to acquire the ability to be transmitted efficiently between humans, while maintaining its present level of virulence, mortality within the ensuing pandemic would be in the millions [141,157] .…”

Nuevas infecciones emergentes: importancia en la salud de los niños

“…Se ha estimado que los niños podían constituir hasta el 40% de los casos de gripe en Estados Unidos durante una pandemia, y que los lactantes y los niños pequeños experimentarán tasas muy elevadas de morbilidad grave y mortalidad, tasas superiores a las experimentadas durante los periodos interpandémicos [143,144,146] . En estudios epidemiológicos de infecciones por los virus gripales humanos H5N1 y A(H1N1) se respaldan estas sugerencias, dado que indican tasas desproporcionadamente elevadas de infección en niños y la 115 carga máxima de complicaciones y mortalidad en ellos [112][113][114][147][148][149][150][151][152][153][154][155][156] .…”

“…Las tasas de mortalidad asociadas al H5N1 son uniformemente de 1 50%, con aparición más común de casos de muerte en niños previamente sanos tras un curso rápida-mente fulminante de síndrome disneico agudo [147][148][149][150]156] . Se ha estimado que si H5N1 mutase de tal forma que adquiriese la capacidad de ser transmitido eficientemente entre humanos manteniendo al mismo tiempo su presente nivel de virulencia, la mortalidad dentro de la pandemia consecuente sería del orden de millones [141,157] .…”

Nouvelles infections émergentes: Impact sur la santé de l’enfant

“…On estime que lors d'une pandémie, les enfants pourraient représenter jusqu'à 40% des cas de grippe aux États-Unis et que les nourrissons et les jeunes enfants pré-senteraient des taux de morbidité et de mortalité très éle-vés et supérieurs à ceux observés durant les périodes interpandémiques [143,144,146] . Des études épidémiolo-giques portant sur les infections par les virus humains H5N1 et A(H1N1) vont dans le même sens, indiquant des taux d'infection particulièrement élevés chez les enfants, avec les complications les plus graves et la mortalité la plus importante chez les enfants [112][113][114][147][148][149][150][151][152][153][154][155][156] .…”