Pandemic influenza A (H1N1) virus infections in children with sickle cell disease

Inusa, Baba; Zuckerman, Mark; Gadong, Nimze; Afif, Michele; Arnott, Sarah; Heath, Paul T; Marais, G; Robertson, Paula; Payne, Helen; Wilkey, Olu; Rees, David C.

doi:10.1182/blood-2009-12-260836

Cited by 31 publications

(30 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, most patients managed on an outpatient basis had no complications. Our findings are consistent with reports on the overall impact of the H1N1 pandemic indicating that the disease was milder than expected in the general population [7] but differ significantly from a prior report on its impact on patients with SCD, which described a significantly higher rate of ACS of 34%, with 10% of all patients requiring ventilatory support [8]. Additionally, there appeared to be no significant difference in patient characteristics or clinical course between patients evaluated for H1N1 influenza and those evaluated for other illnesses during the period of the pandemic.…”

Section: Discussionsupporting

confidence: 90%

“…Although the benefit of simple transfusions in reversing early ACS has not been rigorously proven [12], our experience suggests that this practice, which is in accordance with Sickle Cell Disease Care Consortium guidelines [10], helped minimize the impact of ACS associated with H1N1 influenza infections in our patients. Of note, the previously described study of SCD patients with H1N1 influenza [8] had a lower rate of transfusion and of antiviral therapy (34% and 79% respectively), which may partially explain the better outcomes in our patient group.…”

Section: Discussionmentioning

confidence: 65%

“…There has, however, been limited data published to date describing the impact of the H1N1 pandemic on patients with SCD. One analysis of pediatric patients with SCD in London, England described 21 cases of PCR-confirmed H1N1 infection, with 19 being admitted and 10 developing ACS; the authors estimated an overall admission rate of 50% and an incidence rate of 25% for ACS [8]. Another report of 10 pediatric SCD patients with confirmed H1N1 influenza in Baltimore, MD described an 86% admission rate, a 34% incidence of ACS and a 10% requirement for mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of the 2009 H1N1 influenza pandemic on pediatric patients with sickle cell disease

George

Benton

Pratt

et al. 2011

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background Respiratory infections are associated with clinically significant illness in patients with sickle cell disease (SCD). The 2009 H1N1 pandemic was perceived as a significant threat to this population. Methods We undertook a chart review of all patients with SCD followed at our institution to identify those with confirmed H1N1 infection. Further chart and laboratory data was collected on affected patients to analyze clinical courses and the factors that correlated with disease severity. Results Approximately half of the patients with confirmed H1N1 infection were managed successfully on an outpatient basis with oseltamivir therapy. Among the patients admitted, the most common diagnosis was acute chest syndrome (ACS). Most admitted patients had uncomplicated clinical courses, with a median length of admission of 3 days and no mortality or requirement for mechanical ventilation. A past history of ACS or reactive airway disease correlated with a higher rate of admission and of ACS incidence during the acute illness. Chronic transfusion therapy or hydroxyurea therapy with high hemoglobin F levels had a strong inverse correlation with incidence of ACS. Conclusions Our results indicate that that in general the impact of the H1N1 influenza pandemic on patients with SCD was mild but that past clinical history correlated with the severity of illness. Additionally, effective hydroxyurea therapy and chronic transfusion therapy appeared to be protective against the incidence of ACS. Our results suggest guidelines for the management of patients with SCD during future influenza pandemics as well as during seasonal influenza epidemics.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of the 2009 H1N1 influenza pandemic on pediatric patients with sickle cell disease

George

Benton

Pratt

et al. 2011

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…Case series of H1N1 influenza in SCD have reported severe illness, with 10 in 21 children and 2 in 2 adults developing acute chest syndrome (ACS). 7,8 To assess the relative severity of pandemic H1N1 versus seasonal influenza in SCD, we performed a comprehensive analysis at our institution. …”

mentioning

confidence: 99%

Severe pandemic H1N1 and seasonal influenza in children and young adults with sickle cell disease

Strouse

Reller²,

Bundy³

et al. 2010

Blood

View full text Add to dashboard Cite

Influenza causes excess morbidity in sickle cell disease (SCD). H1N1 pandemic influenza has been severe in children. To compare H1N1 with seasonal influenza in SCD (patients younger than 22), we reviewed medical records (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)). We identified 123 cases of laboratory-confirmed influenza (94 seasonal, 29 H1N1). Those with seasonal influenza were younger (median 4.4 vs 8.7 years old, P ‫؍‬ .006) and had less asthma (24% vs 56%, P ‫؍‬ .002). Those with H1N1 influenza more often had acute chest syndrome (ACS; 34% vs 13%, P ‫؍‬ .01) and required intensive care (17% vs 3%, P ‫؍‬ .02), including mechanical ventilation (10% vs 0%, P ‫؍‬ .02). In multivariate analysis, older age (odds ratio [OR] 1.1 per year, P ‫؍‬ .04) and H1N1 influenza (OR 3.0, P ‫؍‬ .04) were associated with ACS, and older age (OR 1.1 per year, P ‫؍‬ .02) and prior ACS (OR 3.3 per episode in last year, P < .006) with intensive care. Influenza, especially H1N1, causes critical illness in SCD and should be prevented. IntroductionInfluenza causes disproportionate morbidity in sickle cell disease (SCD), an inherited hemoglobinopathy affecting 1 in 2500 children in the United States. 1 In one study, SCD was associated with a 56-fold increased risk of influenza-related hospitalization. 2 Yet, despite its effectiveness, 3,4 most children with SCD do not receive the influenza vaccine yearly. 5 Recognition of the influenza A virus of swine origin (H1N1) in March 2009 6 caused heightened concern. Case series of H1N1 influenza in SCD have reported severe illness, with 10 in 21 children and 2 in 2 adults developing acute chest syndrome (ACS). 7,8 To assess the relative severity of pandemic H1N1 versus seasonal influenza in SCD, we performed a comprehensive analysis at our institution. Methods Study populationWe identified patients aged Ͻ 22 years with SCD and influenza by searching for SCD and respiratory virus testing from September 1, 1993, to April 30, 2007, in the discharge and billing databases of Johns Hopkins Hospital (JHH). From May 1, 2007, to December 10, 2009, we also prospectively identified patients with SCD and influenza admitted to the pediatric hematology service or seen in the pediatric emergency department at JHH. We reviewed clinical records to identify influenza vaccination and administrative records to estimate the number of patients aged Ͻ 22 years with SCD seen at JHH. Additional information appears in supplemental data (available on the Blood Web site; see the Supplemental Materials link at the top of the online article). DefinitionsWe defined influenza as laboratory-confirmed influenza A or B and ACS as a new pulmonary infiltrate involving Ն 1 complete lung segment with fever (Ͼ 38.5°C), tachypnea, cough, wheezing, or chest pain. 9 We defined severe pain as pain requiring Ͼ 2 doses of opiates and asthma exacerbation as bronchodilator-treated wheezing. Diagnosis of influenzaInfluenza was detected by rapid antigen-based test (immunochromatograp...

show abstract

“…Infectious diseases, especially of the upper and lower respiratory tract, are thought to be a possible trigger of ACS in patients with SCD, with excessive inflammatory lung injury thought to be one cause of ACS development1. During the 2009 H1N1 pandemic, several epidemiological studies showed that influenza infection was significantly associated with development of ACS and that the risk of ACS from pH1N1 infection was almost 3-fold higher than that associated with previous seasonal influenza epidemics732. Although this enhanced susceptibility is well known to occur in this patient population, the specific mechanism underlying this observation is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Vascular Permeability Drives Susceptibility to Influenza Infection in a Murine Model of Sickle Cell Disease

Karlsson

Oguin

Meliopoulos

et al. 2017

Sci Rep

View full text Add to dashboard Cite

Sickle cell disease (SCD) is a major global health concern. Patients with SCD experience disproportionately greater morbidity and mortality in response to influenza infection than do others. Viral infection is one contributing factor for the development of Acute Chest Syndrome (ACS), a major cause of morbidity and mortality in SCD patients. We determined whether the heightened sensitivity to influenza infection could be reproduced in the two different SCD murine models to ascertain the underlying mechanisms of increased disease severity. In agreement with clinical observations, we found that both genetic and bone marrow-transplanted SCD mice had greater mortality in response to influenza infection than did wild-type animals. Despite similar initial viral titers and inflammatory responses between wild-type and SCD animals during infection, SCD mice continued to deteriorate and failed to resolve the infection, resulting in increased mortality. Histopathology of the lung tissues revealed extensive pulmonary edema and vascular damage following infection, a finding confirmed by heightened vascular permeability following virus challenge. These findings implicate the development of exacerbated pulmonary permeability following influenza challenge as the primary factor underlying heightened mortality. These studies highlight the need to focus on prevention and control strategies against influenza infection in the SCD population.

show abstract

Pandemic influenza A (H1N1) virus infections in children with sickle cell disease

Cited by 31 publications

References 6 publications

The impact of the 2009 H1N1 influenza pandemic on pediatric patients with sickle cell disease

The impact of the 2009 H1N1 influenza pandemic on pediatric patients with sickle cell disease

Severe pandemic H1N1 and seasonal influenza in children and young adults with sickle cell disease

Vascular Permeability Drives Susceptibility to Influenza Infection in a Murine Model of Sickle Cell Disease

Contact Info

Product

Resources

About