Predictors of severe H1N1 infection in children presenting within Pediatric Emergency Research Networks (PERN): retrospective case-control study

Abstract

Objective To identify historical and clinical findings at emergency department presentation associated with severe H1N1 outcome in children presenting with influenza-like illness.Design Multicentre retrospective case-control study.Setting 79 emergency departments of hospitals associated with the Pediatric Emergency Research Networks in 12 countries.Participants 265 children (<16 years), presenting between 16 April and 31 December 2009, who fulfilled Centers for Disease Control and Prevention criteria for influenza-like illness and developed severe outcomes from laboratory confirmed H1N1 infection. For each case, two controls presenting with influenza-like illness but without severe outcomes were included: one random control and one age matched control.Main outcome measures Severe outcomes included death or admission to intensive care for assisted ventilation, inotropic support, or both. Multivariable conditional logistic regression was used to compare cases and controls, with effect sizes measured as adjusted odds ratios.Results 151 (57%) of the 265 cases were male, the median age was 6 (interquartile range 2.3-10.0) years, and 27 (10%) died. Six factors were associated with severe outcomes in children presenting with influenza-like illness: history of chronic lung disease (odds ratio 10.3, 95% confidence interval 1.5 to 69.8), history of cerebral palsy/developmental delay (10.2, 2.0 to 51.4), signs of chest retractions (9.6, 3.2 to 29.0), signs of dehydration (8.8, 1.6 to 49.3), requirement for oxygen (5.8, 2.0 to 16.2), and tachycardia relative to age). ConclusionThese independent risk factors may alert clinicians to children at risk of severe outcomes when presenting with influenza-like illness during future pandemics. IntroductionIn June 2009 the World Health Organization declared the first global influenza pandemic in 41 years.1 From early in the pandemic, children-particularly those aged under 5 years 2 -were considered a population at higher risk of morbidity and mortality from pandemic H1N1 (pH1N1) infection. 1Several studies from around the world have included children and adults admitted to hospital or intensive care units with pH1N1 infection. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, these data vary in format andCorrespondence to: S R Dalziel sdalziel@adhb.govt.nzExtra material supplied by the author (see

Active Surveillance of Influenza A and Other Respiratory Viruses in Children with Influenza-like-illness in Two Seasons

“…Vandepitte et al reported that, older age, having an underlying co-morbidty and a history of being premature were risk factors for influenza infection in logistic regression anlysis [17]. In another study, Dalziel et al showed that a history of chronic lung disease, history of cerebral palsy / developmental delay are significantly associated with severe infection in children with ILI [18]. Because of the low frequency of H3N2 positivity in our study, it was difficult to evaluate risk factors in this study group.…”

SELECTED EPIDEMICS & EMERGING PATHOGENS – RESPIRATORY ILLNESSES – AN OVERVIEW

“…It has long been recognized that influenza viruses exchange genetic material, (reassortment) either emerging as a new strain, as we continue to see with H5N1 [16,[23][24][25], H1N1 [26][27][28], and now the latest H7N9 [3,4,29,30]. But this likely holds true for other viruses, as recently demonstrated with a novel coronavirus, most recently referred to as Middle East Respiratory Syndrome (MERS CoV) [11,12].…”

“…The spread of pulmonary infections occurs readily from both the upper and lower respiratory tracts (Figure 1) How respiratory illnesses spread [6,[26][27][28] Droplets Proximity (Less than 6 feet social distancing especially) Environment (overcrowding for example) Fomites Mucosa Prior immunity (or lack thereof) Poor hygiene Inherent transmissibility of pathogen (Ro)…”

A platform for paediatric acute care research

“…This global network can answer questions with very infrequent outcomes, conduct studies that are generalisable across many settings, compare management across countries and health systems and develop international consensus. The first global PERN study, on the epidemiology of the H1N1 epidemic, was led by a PREDICT researcher and published in the British Medical Journal . Further PERN studies on toxicology, child traumatic stress and bronchiolitis management are in the data collection or the late concept phase.…”

“…The first global PERN study, on the epidemiology of the H1N1 epidemic, was led by a PREDICT researcher and published in the British Medical Journal. 26 Further PERN studies on toxicology, child traumatic stress and bronchiolitis management are in the data collection or the late concept phase.…”