Machablishvili A, Tsereteli D, Zakhashvili Kh, Karseladze I, Imnadze P
1National Center for Disease Control and Public Health, Tbilisi; 2I. Javakhishvili Tbilisi State University, Georgia.
Georgian Med News. 2017 Apr(265):71-78.
The aim of the study was to describe, analyze and compare clinical and epidemiological characteristics of laboratory confirmed influenza A(H1N1)pdm and B cases in hospitalized children during post pandemic season. Between 1st January and 1st May, 2011 retrospective observational study was conducted in M. Iashvili Children's Central Hospital. From 1028 patients with influenza like illness hospitalized at Children's Hospital 871 specimens were collected and 360 tested positive for influenza: A(H1N1)pdm - 139 and B - 221. Data were obtained for 290 cases: A(H1N1)pdm - 122 and B - 168. At the time of hospital admission, influenza A(H1N1)pdm and B cases had similar median age of 2 years. The median length of hospital stay was 5 days for both influenza types. Predominant clinical symptoms were fever (98.3%), cough (82.4%) and running nose (68.6%). 39.7% (115/290) of patients suffered with lower respiratory tract infection: A(H1N1)pdm - 41% (50/122) and B - 38.7% (65/168). 19% (55/290) developed pneumonia of which 12 with primary diagnosis of acute respiratory failure were admitted to ICU: A(H1N1)pdm - 4.9% (6/122) and B - 3.6% (6/168). Median length in ICU stay was 6 days. Only two patients with A(H1N1)pdm required artificial ventilation with one fatal outcome. Almost equally (31%) patients with influenza A or B viruses suffered with at least one pre-existing condition. Statistically significant association was revealed between neurological pre-existing conditions and developing pneumonia (OR=5.6; p=0.00) and ICU requirement (OR=17.5, p=0.00). Congenital malformations were also associated with sever course of disease (OR=9.1; p=0.01). Treatment with antiviral oseltamivir was prescribed to 29.5% (36/122) A(H1N1)pdm and 8.3% (14/168) B cases among whom only 24% cases received antiviral within 48 hours after symptoms onset. None of the patients was vaccinated against influenza. Our study revealed no significant difference between influenza A(H1N1)pdm and influenza B in terms of age distribution, clinical manifestation, hospital stay or complications in hospitalized children during post pandemic season. Pre-existing conditions such as neurological disorders and congenital malformations represented risk factors for severe course of influenza, therefore timely antiviral treatment and annual influenza vaccination is recommended to avoid complications.
本研究旨在描述、分析和比较大流行后季节住院儿童中实验室确诊的甲型H1N1流感大流行病毒株和乙型流感病例的临床及流行病学特征。2011年1月1日至5月1日期间，在M. Iashvili儿童中心医院开展了一项回顾性观察研究。在儿童医院住院的1028例流感样疾病患者中，采集了871份样本，其中360份流感检测呈阳性：甲型H1N1流感大流行病毒株 - 139份，乙型 - 221份。获取了290例病例的数据：甲型H1N1流感大流行病毒株 - 122例，乙型 - 168例。入院时，甲型H1N1流感大流行病毒株和乙型流感病例的中位年龄相似，均为2岁。两种流感类型的中位住院时间均为5天。主要临床症状为发热（98.3%）、咳嗽（82.4%）和流鼻涕（68.6%）。39.7%（115/290）的患者患有下呼吸道感染：甲型H1N1流感大流行病毒株 - 41%（50/122），乙型 - 38.7%（65/168）。19%（55/290）的患者发展为肺炎，其中12例初诊为急性呼吸衰竭的患者被收入重症监护病房：甲型H1N1流感大流行病毒株 - 4.9%（6/122），乙型 - 3.6%（6/168）。在重症监护病房的中位住院时间为6天。只有2例甲型H1N1流感大流行病毒株患者需要人工通气，其中1例死亡。感染甲型或乙型流感病毒的患者中几乎同样比例（31%）至少有一种基础疾病。在基础神经疾病与肺炎发生（比值比=5.6；p=0.00）以及重症监护病房需求（比值比=17.5，p=0.00）之间发现了具有统计学意义的关联。先天性畸形也与疾病的严重病程相关（比值比=9.1；p=0.01）。29.5%（36/122）的甲型H1N1流感大流行病毒株病例和8.3%（14/168）的乙型病例接受了抗病毒药物奥司他韦治疗，其中只有24%的病例在症状出现后48小时内接受了抗病毒治疗。所有患者均未接种流感疫苗。我们的研究表明，在大流行后季节住院儿童中，甲型H1N1流感大流行病毒株和乙型流感在年龄分布、临床表现、住院时间或并发症方面没有显著差异。基础疾病如神经疾病和先天性畸形是流感严重病程的危险因素，因此建议及时进行抗病毒治疗并每年接种流感疫苗以避免并发症。
