Volume 17, Number 11—November 2011
CME ACTIVITY
Deaths Associated with Pandemic (H1N1) 2009 among Children, Japan, 2009–2010
Akihisa Okumura
, Satoshi Nakagawa, Hisashi Kawashima, Takashi Muguruma, Osamu Saito, Jun-ichi Fujimoto, Chiaki Toida, Shuji Kuga, Toshihiro Imamura, Toshiaki Shimizu, Naomi Kondo, and Tsuneo Morishima
Suggested citation for this article , Satoshi Nakagawa, Hisashi Kawashima, Takashi Muguruma, Osamu Saito, Jun-ichi Fujimoto, Chiaki Toida, Shuji Kuga, Toshihiro Imamura, Toshiaki Shimizu, Naomi Kondo, and Tsuneo MorishimaAbstract
To clarify the cause of deaths associated with pandemic (H1N1) 2009 among children in Japan, we retrospectively studied 41 patients <20 years of age who had died of pandemic (H1N1) 2009 through March 31, 2010. Data were collected through interviews with attending physicians and chart reviews. Median age of patients was 59 months; one third had a preexisting condition. Cause of death was categorized as unexpected cardiopulmonary arrest for 15 patients, encephalopathy for 15, and respiratory failure for 6. Preexisting respiratory or neurologic disorders were more frequent in patients with respiratory failure and less frequent in patients with unexpected cardiopulmonary arrest. The leading causes of death among children with pandemic (H1N1) 2009 in Japan were encephalopathy and unexpected cardiopulmonary arrest. Deaths associated with respiratory failure were infrequent and occurred primarily among children with preexisting conditions. Vaccine use and public education are necessary for reducing influenza-associated illness and death.A novel reassortant strain of influenza A (H1N1) virus containing swine, avian, and human elements (1) emerged in Mexico in March 2009. The virus initially spread within North America, causing severe respiratory illnesses in Mexico (2) and the United States (3,4), and then began to spread rapidly worldwide. On June 11, 2009, the World Health Organization confirmed an influenza pandemic.
In Japan, the first case of pandemic (H1N1) 2009 was confirmed on May 16, 2009. The first outbreak occurred in western Japan, where the number of cases increased then decreased quickly. The second outbreak started in early June and quickly spread to all parts of Japan. The first death associated with pandemic (H1N1) 2009 in Japan was confirmed August 15, and the first death of a child occurred September 17. As of March 31, 2010, the Ministry of Health, Labour, and Welfare (MHLW) reported on its website (www.mhlw.go.jp/kinkyu/kenkou/influenza/houdou.html
) that 198 patients in Japan with pandemic (H1N1) 2009 had died, of whom 41 were children <20 years of age.
Several authors have reported that respiratory diseases associated with pandemic (H1N1) 2009, including viral pneumonia and acute lung injury, that required intensive care occurred most often in children (5–16). In Japan, hospitalizations of children because of severe pneumonia or other respiratory complications increased (17). Concerns were raised regarding deaths among children from acute encephalopathy in association with pandemic (H1N1) 2009 because acute encephalopathy has been associated with death from seasonal influenza in Japan (18,19). Neurologic complications associated with pandemic (H1N1) 2009, including acute encephalopathy, altered mental status, and status epilepticus, also have been reported from other countries (20–23).
Accurate data on the causes of death associated with pandemic (H1N1) 2009 among children are necessary for making a counterplan against future pandemic influenza. We investigated detailed clinical data collected by MHLW for children whose deaths were associated with pandemic (H1N1) 2009. We focused on the direct cause of death and clinical differences by cause of death.
In Japan, the first case of pandemic (H1N1) 2009 was confirmed on May 16, 2009. The first outbreak occurred in western Japan, where the number of cases increased then decreased quickly. The second outbreak started in early June and quickly spread to all parts of Japan. The first death associated with pandemic (H1N1) 2009 in Japan was confirmed August 15, and the first death of a child occurred September 17. As of March 31, 2010, the Ministry of Health, Labour, and Welfare (MHLW) reported on its website (www.mhlw.go.jp/kinkyu/kenkou/influenza/houdou.html
) that 198 patients in Japan with pandemic (H1N1) 2009 had died, of whom 41 were children <20 years of age.Several authors have reported that respiratory diseases associated with pandemic (H1N1) 2009, including viral pneumonia and acute lung injury, that required intensive care occurred most often in children (5–16). In Japan, hospitalizations of children because of severe pneumonia or other respiratory complications increased (17). Concerns were raised regarding deaths among children from acute encephalopathy in association with pandemic (H1N1) 2009 because acute encephalopathy has been associated with death from seasonal influenza in Japan (18,19). Neurologic complications associated with pandemic (H1N1) 2009, including acute encephalopathy, altered mental status, and status epilepticus, also have been reported from other countries (20–23).
Accurate data on the causes of death associated with pandemic (H1N1) 2009 among children are necessary for making a counterplan against future pandemic influenza. We investigated detailed clinical data collected by MHLW for children whose deaths were associated with pandemic (H1N1) 2009. We focused on the direct cause of death and clinical differences by cause of death.
full-text:
Deaths Associated with Pandemic (H1N1) 2009 among Children, Japan, 2009–2010 - Vol. 17 No. 11 - November 2011 - Emerging Infectious Disease journal - CDC
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