2009 Pandemic Influenza A(H1N1) Infections in the Pediatric Cancer Patients and Comparative Analysis with Seasonal Influenza

Soo Han Choi; Keon Hee Yoo; Kangmo Ahn; Ki Woong Sung; Hong Hoe Koo; Yae Jean Kim

doi:10.14776/kjpid.2012.19.2.61

Journal List > Korean J Pediatr Infect Dis > v.19(2) > 1096070

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Choi, Yoo, Ahn, Sung, Koo, and Kim: 2009 Pandemic Influenza A(H1N1) Infections in the Pediatric Cancer Patients and Comparative Analysis with Seasonal Influenza

Original Article

Korean Journal of Pediatric Infectious Diseases

Korean Journal of Pediatric Infectious Diseases 2012; 19(2): 61-70.

Published online: 31 August 2012

DOI: https://doi.org/10.14776/kjpid.2012.19.2.61

2009 Pandemic Influenza A(H1N1) Infections in the Pediatric Cancer Patients and Comparative Analysis with Seasonal Influenza

Soo Han Choi, M.D.^*, Keon Hee Yoo, M.D.^*,^†, Kangmo Ahn, M.D.^*,^†, Ki Woong Sung, M.D.^*,^†, Hong Hoe Koo, M.D.^*,^†, Yae Jean Kim, M.D.^*,^†

^*Department of Pediatrics, Samsung Medical Center, Seoul, Korea.

^†Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (yaejeankim@skku.edu)

Received 28 December 2011 Revised 7 February 2012 Accepted 16 February 2012

Abstract

Purpose

This study was performed to compare the clinical characteristics of 2009 pandemic influenza A(H1N1) [A(H1N1) pdm09] and seasonal influenza A infection in the pediatric cancer patients.

Methods

A retrospective review was performed in the pediatric cancer patients who had confirmed A(H1N1)pdm09 infection at Samsung Medical Center from August 2009 to February 2010. For the comparison, the medical records of pediatric cancer patients with seasonal influenza A from January 2000 to May 2009 were reviewed retrospectively.

Results

Eighty-two A(H1N1)pdm09 infections were confirmed in the pediatric cancer patients. Ten patients (12.2%) developed complicated clinical course by lower respiratory infections or extrapulmonary infections; 4 pneumonia, 1 bronchitis, 1 pericarditis with pneumonia, 1 encephalitis with pneumonia, 2 meningitis and 1 pericarditis. Three patients received mechanical ventilator and ICU care. Three pediatric cancer patients (3.7%) died. The risk factors related to complicated A(H1N1)pdm09 infections were date of infection (44-45th week 2009) and nosocomial infection. When comparing with previous seasonal influenza A infections, more prompt and aggressive antiviral therapy was given in A(H1N1)pdm09 infections.

Conclusion

The A(H1N1)pdm09 infections caused a various clinical manifestations including fatal cases in pediatric cancer patient during pandemic season. There was no significant difference in clinical course between influenza A(H1N1)pdm09 and seasonal influenza A infections except the antiviral treatment strategy.

Keywords: 2009 pandemic Influenza A(H1N1), A(H1N1)pdm09, Seasonal influenza, Child, Cancer

Figures and Tables

Fig. 1

Weekly occurrence of A(H1N1)pdm09 infections in pediatric cancer patients. Most A(H1N1)pdm09 infections developed in 43-46^th week 2009.

Table 1

Characteristics of Pediatric Cancer Patients with A(H1N1)pdm09 and Seasonal Influenza A Infection

Abbreviations: HCT, hematopoietic cell transplant; GVHD, graft versus host disease

Table 2

Comparisons of Clinical Characteristics between Uncomplicated and Complicated Group in Pediatric Cancer Patients with A(H1N1)pdm09 Infections

^*Lower respiratory tract infections or extrapulmonary infections

^†Within 2 weeks before A(H1N1)pdm09 infections

^‡Overall death at 6 weeks

Abbreviation: HCT, hematopoietic cell transplant

Table 3

Factors Related to Complicated^* A(H1N1)pdm09 Infections, by Multivariable Analyses

^*Lower respiratory tract infections or extrapulmonary infections

^†Within 2 weeks before infection

Abbreviation: CI, confidence interval

Table 4

Comparison between Two Groups of Pediatric Cancer Patients with A(H1N1)pdm09 and Seasonal Influenza A Infection

^*Time between the onset of symptoms and initiation of antiviral treatment

Abbreviation: HCT, hematopoietic cell transplant

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