Thorp Lauren, Fullerton Lynne, Whitesell Amy, Dehority Walter
Division of Pediatric Emergency Medicine.
Department of Emergency Medicine, School of Medicine.
Pediatrics. 2023 Apr 1;151(4). doi: 10.1542/peds.2022-059352.
From 1993 to 2018, hantavirus infections were reported in 39 states, with hantavirus pulmonary syndrome (HPS) as the most common and fatal manifestation. To identify differences in the presentation of HPS between children and adults, we hypothesized that children with HPS would be diagnosed later in their illness course given the nonspecific clinical features of HPS.
This was an evaluation of the clinical and demographic characteristics of national HPS cases from 1993 to 2018. Data were from the Centers for Disease Control and Prevention database and 1 state department of health, comprising 97% of US cases. We compared children (0 to 12 years), adolescents (13 to 18 years), and adults using nonparametric and parametric analyses, with additional exploratory analyses to identify clinical variables associated with mortality.
Among 719 HPS patients, 22 (3.0%) were aged ≤12 years, 47 (6.5%) were 13 to 18 years old, and the remaining 650 (90.4%) were adults. Overall mortality was 35.4% and did not differ between age groups (P = .8). The time between symptom onset and death differed by age group, with children living a median of 2 days (interquartile range [IQR] 2 to 3), adolescents 4 days (IQR 3 to 5), and adults 5 days (IQR 4 to 8; P = .001). The mean highest hematocrit and median highest creatinine level were significantly associated with mortality in those 0 to 18 years old but not adults.
In our dataset representing the largest study of HPS in the United States, we found that children with HPS died more quickly than adults and that highest hematocrit and creatinine levels were associated with death only among those <19 years old.
1993年至2018年期间，美国39个州报告了汉坦病毒感染病例，其中汉坦病毒肺综合征（HPS）是最常见且致命的表现形式。为了确定儿童和成人HPS临床表现的差异，我们推测由于HPS的临床特征不具特异性，患有HPS的儿童在病程中被诊断的时间会更晚。
这是一项对1993年至2018年全国HPS病例的临床和人口统计学特征的评估。数据来自疾病控制与预防中心数据库以及1个州的卫生部门，涵盖了美国97%的病例。我们使用非参数和参数分析对儿童（0至12岁）、青少年（13至18岁）和成人进行比较，并进行额外的探索性分析以确定与死亡率相关的临床变量。
在719例HPS患者中，22例（3.0%）年龄≤12岁，47例（6.5%）年龄在13至18岁之间，其余650例（90.4%）为成人。总体死亡率为35.4%，各年龄组之间无差异（P = 0.8）。症状出现至死亡的时间因年龄组而异，儿童的中位生存时间为2天（四分位间距[IQR]为2至3天），青少年为4天（IQR为3至5天），成人为5天（IQR为4至8天；P = 0.001）。0至18岁人群中，最高血细胞比容均值和最高肌酐水平中位数与死亡率显著相关，但成人中并非如此。
在我们代表美国最大规模HPS研究的数据集里，我们发现患有HPS的儿童比成人死亡更快，且仅在19岁以下人群中，最高血细胞比容和肌酐水平与死亡相关。
