Louie Janice K, Gavali Shilpa, Acosta Meileen, Samuel Michael C, Winter Kathleen, Jean Cynthia, Glaser Carol A, Matyas Bela T, Schechter Robert
California Department of Public Health, 850 Marina Bay Pkwy., Richmond, CA 94804, USA.
Arch Pediatr Adolesc Med. 2010 Nov;164(11):1023-31. doi: 10.1001/archpediatrics.2010.203.
To describe clinical and epidemiologic features of 2009 novel influenza A(H1N1) in children.
Analysis of data obtained from standardized report forms and medical records.
Statewide public health surveillance in California.
Three hundred forty-five children who were hospitalized with or died of 2009 novel influenza A(H1N1).
Laboratory-confirmed 2009 novel influenza A(H1N1).
Hospitalization and death.
From April 23 to August 11, 2009, 345 cases in children younger than 18 years were reported. The median age was 6 years. The hospitalization rate per 100 000 per 110 days was 3.5 (0.97 per 100 000 person-months), with rates highest in infants younger than 6 months (13.9 per 100 000 or 3.86 per 100 000 person-months). Two-thirds (230; 67%) had comorbidities. More than half (163 of 278; 59%) had pneumonia, 94 (27%) required intensive care, and 9 (3%) died; in 3 fatal cases (33%), children had secondary bacterial infections. More than two-thirds (221 of 319; 69%) received antiviral treatment, 44% (88 of 202) within 48 hours of symptom onset. In multivariate analysis, congenital heart disease (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.9-13.5) and cerebral palsy/developmental delay (OR, 3.5; 95% CI, 1.7-7.4) were associated with increased likelihood of intensive care unit admission and/or death; likelihood was decreased in Hispanic (OR, 0.4; 95% CI, 0.2-0.8) and black (OR, 0.3; 95% CI, 0.1-1.0) children compared with white children.
More than one-quarter of children hospitalized with 2009 novel influenza A(H1N1) reported to the California Department of Public Health required intensive care and/or died. Regardless of rapid test results, when 2009 novel influenza A(H1N1) is circulating, clinicians should maintain a high suspicion in children with febrile respiratory illness and promptly treat those with underlying risk factors, especially infants.
描述2009年新型甲型H1N1流感在儿童中的临床和流行病学特征。
对从标准化报告表和病历中获取的数据进行分析。
加利福尼亚州的全州公共卫生监测。
345名因2009年新型甲型H1N1流感住院或死亡的儿童。
实验室确诊的2009年新型甲型H1N1流感。
住院和死亡。
2009年4月23日至8月11日，报告了18岁以下儿童中的345例病例。中位年龄为6岁。每10万人每110天的住院率为3.5（每10万人月0.97），6个月以下婴儿的住院率最高（每10万人13.9或每10万人月3.86）。三分之二（230例；67%）有合并症。超过一半（278例中的163例；59%）患有肺炎，94例（27%）需要重症监护，9例（3%）死亡；在3例死亡病例（33%）中，儿童有继发性细菌感染。超过三分之二（319例中的221例；69%）接受了抗病毒治疗，44%（202例中的88例）在症状出现后48小时内接受治疗。在多变量分析中，先天性心脏病（比值比[OR]，5.0；95%置信区间[CI]，1.9 - 13.5）和脑瘫/发育迟缓（OR，3.5；95%CI，1.7 - 7.4）与入住重症监护病房和/或死亡的可能性增加相关；与白人儿童相比，西班牙裔（OR，0.4；95%CI，0.2 - 0.8）和黑人（OR，0.3；95%CI，0.1 - 1.0）儿童的可能性降低。
向加利福尼亚州公共卫生部报告的因2009年新型甲型H1N1流感住院的儿童中，超过四分之一需要重症监护和/或死亡。无论快速检测结果如何，当2009年新型甲型H1N1流感流行时，临床医生应对发热呼吸道疾病儿童保持高度怀疑，并及时治疗有潜在危险因素的儿童，尤其是婴儿。
