Clinical and Laboratory Finding of the 2009 Pandemic influenza A (H1N1) in Children

Yu Rak Sohn; Su Hyun Park; Won Duck Kim

doi:10.14776/kjpid.2011.18.2.173

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Sohn, Park, and Kim: Clinical and Laboratory Finding of the 2009 Pandemic influenza A (H1N1) in Children

Original Article

Korean J Pediatr Infect Dis 2011;18(2):173-181.

Published online: 10 January 2011

DOI: https://doi.org/10.14776/kjpid.2011.18.2.173

Clinical and Laboratory Finding of the 2009 Pandemic influenza A (H1N1) in Children

Yu Rak Sohn, M.D., Su Hyun Park, M.D., Won Duck Kim, M.D.

Department of Pediatrics, Fatima Hospital, Daegu, Korea

책임저자:김원덕, 대구파티마병원 소아청소년과 Tel: 053)940-7244, Fax: 053)954-7417 E-Mail: neogubugi@yahoo.co.kr

Received 1 July 2011 Revised 1 October 2011 Accepted 3 October 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

2009 Pandemic influenza A (H1N1) virus was identified in March 2009 and subsequently caused worldwide outbreaks. We described the clinical and epidemiological characteristics of H1N1 influenza infection.

Methods

We used retrospective medical chart reviews to collect data on the visiting patients from a single institute. H1N1 infection was confirmed in specimens with the use of a RT-PCR (real time reverse transcriptase polymerase chain reaction assay).

Result

6,836 patients had H1N1 RT-PCR test, and 2,781 were confirmed with H1N1 virus infection. 158 patients (5.7%) had ± ± hospital treatment and inpatients were significantly younger (5.4 3.3 years) than outpatients (7.5 3.9 years) among H1N1 virus confirmed patients. Oxygen, steroid, immunoglobulin, ventilator treatment was provided in a substantial proportion among pneumonia patients accompanying wheezy respiration. In addition more intensive care was needed in patients accompanying segmental, lobar, interstitial, mixed pneumonia and lung effusion (27.2%) than patients with bronchopneumonia (7.3%) among H1N1 virus infection confirmed patients. Seventy-one infants had oseltamivir treatment out of 83 infants under 1 year, and no significant side effects and complications were identified.

Conclusion

In 2009 pandemic influenza A (H1N1), hospital treatment was needed in younger patients. Early intensive care was needed in pneumonia patients accompanying wheezy respiration, and patients accompanying segmental, lobar, inter_-stitial, mixed pneumonia and lung effusion. (Korean J Pediatr Infect Dis 2011;18:173–181)

Keywords: H1N1, Pneumonia, Asthma, Oseltamivir

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Fig. 1.

Distribution of confirmed cases of pandemic influenza A (H1N1) 2009.

Fig. 2.

Age-specific incidence cases for pandemic influenza A (H1N1) 2009 infection in a single Institute.

Table 1.

Characteristics of the Inpatients and Outpatients Who Had Confirmed Infection Pandemic Influenza A(H1N1) 2009

	Inpatient (N=158)	Outpatient (N=2,623)	Total (N=2,781)	P-value
Age	5.4±3.3	7.5±3.9	7.4±3.9	<0.001
M/F	M: 104 (65.8)	M: 1,537 (58.5)	M:1,641 (59.0)	0.073
	F: 54 (34.2)	F: 1,086 (41.5)	F:1,140 (41.0)
Symptom & Sign
Fever No. (%)	155 (98.1)	2,574 (98.1)	2,730 (98.1)	0.95
Cough No. (%)	140 (88.6)	2,276 (88.6)	2,416 (86.8)	0.507
Rhinorrea No. (%)	107 (67.7)	1,454 (55.4)	1,561 (56.1)	0.003
Sore throat No. (%)	8 (5.0)	909 (34.6)	917 (32.9)	<0.001
headache No. (%)	8 (5.0)	760 (28.9)	768 (27.6)	<0.001
Generalache No. (%)	6 (3.7)	297 (11.3)	303 (10.8)	0.003
Vomiting No. (%)	11 (6.9)	289 (11.0)	300 (10.7)	0.110
Nausea No. (%)	3 (1.8)	126 (4.8)	129 (4.6)	0.092
wheezing No. (%)	57 (36.0)	12 (0.4)	69 (2.4)	<0.001
Dyspnea No. (%)	20 (12.6)	0 (0)	20 (0.7)	<0.001
Diarrhea No. (%)	3 (1.8)	15 (0.5)	18 (0.6)	0.043
Laboratory findings	Inpatient (N=158)	Outpatient (N=123)^†	Total (N=281)	P-value
WBC (/mm³)	8,651.1±4,324.0	7,602.3±3,069.2	8,141.4±3,849.1	0.038
ESR (mm/Hr)	11.2±10.9	7.6±7.5	9.6±9.9	0.001
CRP (mg/dL)	3.1±3.8	1.1±1.3	2.2±3.1	<0.001
Lymphopenia (%)	20.3±17.4	20.9±12.8	20.6±15.5	0.76
Lymphocyte (/mm³)	1,479.8±1,362.0	1517.3±1082.6	1496.0±1252.1	0.389

*P values represent the relationship between inpatient & outpatient in each parameter

^† 123 patients out of 2623 outpatients had laboratory examinations

Table 2.

Laboratory Findings of Bronchopneumonia and Other Pneumonia for the Diagnosis of 2009 Influenza A (H1N1) Virus Infection

	Broncho	Seg. Lob, Int, Eff	Total	P-value
WBC (/mm³)	8,283.5±3,577.5	105,88.5±6,591.4	9,051.9±4,866.0	0.076
ESR (mm/Hr)	14.7±12.2	17.8±14.1	15.4±12.8	0.501
CRP (mg/dL)	9.6±37.4	5.5±4.8	8.2±30.6	0.619
Lymphocytes count (/mm³)	1,496.5±1,484.0	1,364.5±1,432.1	1,451.0±1,456.6	0.741

* P values represent the relationship between bronchopneumonia & other pneumonia in each parameter

Abbreviations: Broncho, bronchopneumonia; Seg, segmental pneumonia; Lob, lobar pneumonia; Int, interstitial pneumonia; Eff, effusion

Table 3.

Comparison between Pneumonia Patients and Pneumonia Patients Accompanying Wheezy Respiraton for the Diagnosis of 2009 Influenza A (H1N1) Virus Infection

	Pneumonia (n=63)	Pneumonia & wheezing (n=43)	Total (n=106)	P-value
AGE (years)	5.7±3.3	5.9±2.0	5.8±2.8	0.664
Intensive care	9 (14.2)	15 (34.8)	24 (22.6)	0.013
M/F	M 42 (66.6)/F 21 (33.3)	M 31 (72.0)/F 12 (28.0)	M 73 (68.8)/F 33 (31.2)	0.554
WBC (/mm³)	9,051.9±4,866.0	9,134.1±4,691.3	9,085.2±4,773.5	0.931
ESR (mm/Hr)	15.4±12.8	10.0±9.8	13.2±11.9	0.021
CRP (mg/dL)	8.2±30.6	2.9±2.8	6.1±23.7	0.173
Lymphocyte count (/mm³)	1,451.2±1,456.6	1,109.9±662.0	1,313.0±1,206.8	0.107

*P values represent the relationship between pneumonia patients & pneumonia with asthma patients in each parameter

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