Journal List > Korean J Pediatr Infect Dis > v.18(2) > 1096083

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

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)

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Fig. 1.
Distribution of confirmed cases of pandemic influenza A (H1N1) 2009.
kjpid-18-173f1.tif
Fig. 2.
Age-specific incidence cases for pandemic influenza A (H1N1) 2009 infection in a single Institute.
kjpid-18-173f2.tif
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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