Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
BMC Infect Dis. 2011 Oct 12;11:271. doi: 10.1186/1471-2334-11-271.
There are few and debated data regarding possible differences in the clinical presentations of influenza A/H1N1, A/H3N2 and B viruses in children. This study evaluates the clinical presentation and socio-economic impact of laboratory-confirmed influenza A/H1N1, A/H3N2 or B infection in children attending an Emergency Room because of influenza-like illness.
Among the 4,726 children involved, 662 had influenza A (143 A/H1N1 and 519 A/H3N2) and 239 influenza B infection detected by means of real-time polymerase chain reaction. Upon enrollment, systematic recordings were made of the patients' demographic characteristics and medical history using standardised written questionnaires. The medical history of the children was re-evaluated 5-7 days after enrollment and until the resolution of their illness by means of interviews and a clinical examination by trained investigators using standardised questionnaires. During this evaluation, information was also obtained regarding illnesses and related morbidity among households.
Children infected with influenza A/H1N1 were significantly younger (mean age, 2.3 yrs) than children infected with influenza A/H3N2 (mean age, 4.7 yrs; p < 0.05)) or with influenza B (mean age, 5.2 yrs; p < 0.05). Adjusted for age and sex, children with influenza A/H3N2 in comparison with those infected by either A/H1N1 or with B influenza virus were more frequently affected by fever (p < 0.05) and lower respiratory tract involvement (p < 0.05), showed a worse clinical outcome (p < 0.05), required greater drug use (p < 0.05), and suffered a worse socio-economic impact (p < 0.05). Adjusted for age and sex, children with influenza B in comparison with those infected by A/H1N1 influenza virus had significantly higher hospitalization rates (p < 0.05), the households with a disease similar to that of the infected child (p < 0.05) and the need for additional household medical visits (p < 0.05).
Disease due to influenza A/H3N2 viral subtype is significantly more severe than that due to influenza A/H1N1 subtype and influenza B virus, which indicates that the characteristics of the different viral types and subtypes should be adequately considered by health authorities when planning preventive and therapeutic measures.
关于甲型流感 H1N1、H3N2 和 B 型病毒在儿童中的临床表现可能存在差异，目前相关数据较少且存在争议。本研究评估了因流感样疾病而前往急诊室的儿童中实验室确诊的甲型流感 H1N1、H3N2 或 B 型感染的临床特征和社会经济影响。
在纳入的 4726 名儿童中，有 662 名儿童的流感 A（143 名甲型 H1N1 和 519 名甲型 H3N2）和 239 名流感 B 通过实时聚合酶链反应检测到。在登记时，使用标准化书面问卷系统记录患者的人口统计学特征和病史。在登记后 5-7 天，通过培训调查员使用标准化问卷进行访谈和临床检查，对儿童的病史进行重新评估，直到其疾病痊愈。在此评估过程中，还获得了家庭中与疾病相关的发病率和疾病信息。
感染甲型流感 H1N1 的儿童明显比感染甲型流感 H3N2（平均年龄为 4.7 岁；p < 0.05）或 B 型流感（平均年龄为 5.2 岁；p < 0.05）的儿童年龄小。调整年龄和性别后，与感染 A/H1N1 或 B 型流感病毒的儿童相比，感染 A/H3N2 的儿童更常出现发热（p < 0.05）和下呼吸道受累（p < 0.05），临床结局更差（p < 0.05），需要更多药物治疗（p < 0.05），社会经济影响更差（p < 0.05）。调整年龄和性别后，与感染甲型流感 H1N1 病毒的儿童相比，感染 B 型流感的儿童住院率显著更高（p < 0.05），感染儿童的家庭（p < 0.05）和需要额外家庭医疗就诊的家庭（p < 0.05）。
与乙型流感病毒相比，甲型流感 H3N2 病毒亚型引起的疾病明显更严重，这表明卫生当局在制定预防和治疗措施时应充分考虑不同病毒类型和亚型的特征。
