Children Hospitalized With 2009 Novel Influenza A(H1N1) in California

Louie, Janice K.; Gavali, Shilpa; Acosta, Meileen; Samuel, Michael C.; Winter, Kathleen; Jean, Cynthia; Glaser, Carol; Mátyás, Béla T.; Schechter, R.S.

doi:10.1001/archpediatrics.2010.203

Cited by 66 publications

(77 citation statements)

References 29 publications

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“…83,92 were excluded from the meta-analysis because one was only a synopsis 83 and one compared zanamivir to usual care and not placebo. 92 We finally included 26 zanamivir trials: 14 on treatment in adults, [71][72][73]77,[80][81][82]87,89,91,95,[97][98][99] two in children 78,84 and 10 trials in prophylaxis. 70,79,85,86,88,90,93,94,96,100 Our attempt at collecting sufficient information from regulatory files to reconstruct missing CSRs also failed because the information appeared to be insufficient for a reliable reconstruction.…”

Section: Zanamivirmentioning

confidence: 99%

“…In two zanamivir adult trials, 81,82 pneumonia reporting was based on a stricter definition of X-ray confirmation and there was also no significant treatment effect (RR 1.02, 95% CI 0.35 to 3.02; I 2 statistic = 39%). In nine zanamivir trials, 77,79,80,87,89,91,[97][98][99] pneumonia was a self-reported, investigator-mediated, unverified outcome (see Figures 8 and 9). Overall, there was no significant effect of zanamivir on mixed verified and unverified pneumonia in adult treatment (RR 0.90, 95% CI 0.58 to 1.40; I 2 statistic = 0%).…”

Section: Pneumoniamentioning

confidence: 99%

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Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

Heneghan

Onakpoya

Jones

et al. 2016

Health Technol Assess

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BackgroundNeuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide.ObjectivesTo (1) describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports (CSRs) of published and unpublished randomised, placebo-controlled trials and regulatory comments; and (2) determine the effect of oseltamivir (Tamiflu®, Roche) treatment on mortality in patients with 2009A/H1N1 influenza.MethodsWe searched trial registries, electronic databases and corresponded with regulators and sponsors to identify randomised trials of NIs. We requested full CSRs and accessed regulators’ comments. We included only those trials for which we had CSRs. To examine the effects of oseltamivir on 2009A/H1N1 influenza mortality, we requested individual patient data (IPD) from corresponding authors of all included observational studies.ResultsEffect of oseltamivir and zanamivir (Relenza®, GlaxoSmithKline) in the prevention and treatment of influenza: Oseltamivir reduced the time to first alleviation of symptoms in adults by 16.8 hours [95% confidence interval (CI) 8.4 to 25.1 hours]. Zanamivir reduced the time to first alleviation of symptoms in adults by 0.60 days (95% CI 0.39 to 0.81 days). Oseltamivir reduced unverified pneumonia in adult treatment [risk difference (RD) 1.00%, 95% CI 0.22% to 1.49%]; similar findings were observed with zanamivir prophylaxis in adults (RD 0.32%, 95% CI 0.09% to 0.41%). Oseltamivir treatment of adults increased the risk of nausea (RD 3.66%, 95% CI 0.90% to 7.39%) and vomiting (RD 4.56%, 95% CI 2.39% to 7.58%). In the treatment of children, oseltamivir induced vomiting (RD 5.34%, 95% CI 1.75% to 10.29%). Both oseltamivir and zanamivir prophylaxis reduced the risk of symptomatic influenza in individuals (oseltamivir RD 3.05%, 95% CI 1.83% to 3.88%; zanamivir RD 1.98%, 95% CI 0.98% to 2.54%) and in households (oseltamivir RD 13.6%, 95% CI 9.52% to 15.47%; zanamivir RD 14.84%, 95% CI 12.18% to 16.55%). Oseltamivir increased psychiatric adverse events in the combined on- and off-treatment periods (RD 1.06%, 95% CI 0.07% to 2.76%) and the risk of headaches while on treatment (RD 3.15%, 95% CI 0.88% to 5.78%).Effect of oseltamivir on mortality in patients with 2009A/H1N1 influenza: Analysis of summary data of 30 studies as well as IPD of four studies showed evidence of time-dependent bias. After adjusting for time-dependent bias and potential confounding variables, competing risks analysis of the IPD showed insufficient evidence that oseltamivir reduced the risk of mortality (hazard ratio 1.03, 95% CI 0.64 to 1.65).ConclusionsOseltamivir and zanamivir cause small reductions in the time to first alleviation of influenza symptoms in adults. The use of oseltamivir increases the risk of nausea, vomiting, psychiatric events in adults and vomiting in children. Oseltamivir has no protective effect on mortality among patients with 2009A/H1N1 influenza. Prophylaxis with either NI may reduce symptomatic influenza in individuals and in households. The balance between benefits and harms should be considered when making decisions about use of NIs for either prophylaxis or treatment of influenza.Study registrationThis study is registered as PROSPERO CRD42012002245.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Zanamivirmentioning

confidence: 99%

Section: Pneumoniamentioning

confidence: 99%

Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

Heneghan

Onakpoya

Jones

et al. 2016

Health Technol Assess

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“…An influenza case was defined as a patient who had laboratory confirmed influenza during the influenza season (11 June -26 August, weeks [24][25][26][27][28][29][30][31][32][33][34]2012), and was either admitted to an hospital ward or discharged after clinical assessment in the Emergency Department (ED) or Children's Acute Assessment Unit (CAA) of CDHB.…”

Section: Influenza Case Definitionmentioning

confidence: 99%

“…21,22 Oseltamivir has also been found safe and well tolerated in children for treatment of influenza within 48 hours of symptom onset, and during the 2009 pandemic, early treatment reduced the severity of disease in terms of ICU admission and death. 23,24 Large observational studies suggest better clinical and virological outcomes in hospitalized patients with seasonal influenza, treated with an antiviral, shortening viral shedding, reducing the length of hospital stay and reducing mortality. [25][26][27] These benefits were present even when treatment was initiated 48-96 hours after symptom onset.…”

Section: 20mentioning

confidence: 99%

A review of the winter influenza strategy for hospitals within a major district health board in New Zealand following the 2012 Influenza season

Schousboe

Jennings

2013

Int. j. infect. control

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Winter influenza planning is an integral part of a health services preparation for the annual increase in respiratory virus infections and associated hospital admissions in New Zealand.A moderate to severe influenza A (H3N2) outbreak occurred in the winter of 2012 resulting in an unprecedented number of attendances at ED and admission of patients with influenza-like illness to the Canterbury District Health Board (CDHB) hospitals. A review of the hospital winter influenza management strategy following this outbreak, included the use of dedicated influenza wards, extensive diagnostic testing of patients, infection control advice, staff influenza vaccination and the use of Oseltamivir for treatment of patients and prophylaxis of their contacts. The review found that 534 patients were assessed and laboratory confirmed to have influenza, 347 patients were admitted and 40 nosocomial influenza infections recorded over an 11 weeks period. The strategy contributed to the management of the hospital admission of patients with influenza, a relatively low number of nosocomial influenza infections in the dedicated admission wards and low in-hospital mortality. The use of diagnostic testing for influenza with planned escalation of services supported the clinical decision to treat patients with confirmed influenza and prophylaxis of contacts with Oseltamivir probably facilitated appropriate discharge of patients.

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“…[4] vs. [5]). Moreover, those studies reveal high frequency of underlying medical conditions (particularly asthma) among children hospitalized with RSV and influenza infections ( [1,[6][7][8]). However, studies of illness outcomes in the community can suffer from limitations such as under-detection of the presence of viral infections, and suboptimal sample sizes.…”

Section: Introductionmentioning

confidence: 99%

Hospitalizations associated with respiratory syncytial virus (RSV) and influenza in children, including children having a diagnosis of asthma

Goldstein

Finelli

et al. 2017

Preprint

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Children Hospitalized With 2009 Novel Influenza A(H1N1) in California

Cited by 66 publications

References 29 publications

Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

A review of the winter influenza strategy for hospitals within a major district health board in New Zealand following the 2012 Influenza season

Hospitalizations associated with respiratory syncytial virus (RSV) and influenza in children, including children having a diagnosis of asthma

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