Pandemic (H1N1) 2009 Viral Load and Shedding | CDC EID

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Volume 16, Number 8–August 2010
Research
Correlation of Pandemic (H1N1) 2009 Viral Load with Disease Severity and Prolonged Viral Shedding in Children
Chung-Chen Li,1 Lin Wang,1 Hock-Liew Eng,1 Huey-Ling You, Ling-Sai Chang, Kuo-Shu Tang, Ying-Jui Lin, Hsuan-Chang Kuo, Ing-Kit Lee, Jien-Wei Liu, Eng-Yen Huang, and Kuender D. Yang
Author affiliation: Chang Gung Memorial Hospital–Kaohsiung Medical Center, Kaohsiung, Taiwan; and Chang Gung University College of Medicine, Kaohsiung

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Abstract
Pandemic (H1N1) 2009 virus causes severe illness, including pneumonia, which leads to hospitalization and even death. To characterize the kinetic changes in viral load and identify factors of influence, we analyzed variables that could potentially influence the viral shedding time in a hospital-based cohort of 1,052 patients. Viral load was inversely correlated with number of days after the onset of fever and was maintained at a high level over the first 3 days. Patients with pneumonia had higher viral loads than those with bronchitis or upper respiratory tract infection. Median viral shedding time after the onset of symptoms was 9 days. Patients <13 years of age had a longer median viral shedding time than those >13 years of age (11 days vs. 7 days). These results suggest that younger children may require a longer isolation period and that patients with pneumonia may require treatment that is more aggressive than standard therapy for pandemic (H1N1) 2009 virus.
The influenza A pandemic (H1N1) 2009 virus, initially identified in Mexico and the United States in April 2009, has been reported in >213 countries (1 ). Severe illness and death can occur in humans infected with this virus, particularly young persons and pregnant women (2–5). Recent data from the United States showed that almost half of hospitalized case-patients were children <18 years of age and suggested that antiviral drugs were beneficial in these patients, especially when initiated early (6). This finding implies that the successful control of viral replication by using antiviral drugs is associated with a good clinical outcome.

Because viral replication is necessary for disease pathogenesis in other influenza infections (7,8), information on the correlation between viral load and the clinical spectrum of illnesses among persons infected with pandemic (H1N1) 2009 virus is emerging. However, viral replication patterns and the effect of antiviral drugs on viral load have not been adequately studied.

We undertook the present study to characterize the kinetic changes in viral load and shedding in a hospital-based cohort by real-time reverse transcription–PCR (RT-PCR) and to analyze the factors that influence the rate of viral RNA clearance. A correlation between the virologic profile and the clinical features of pandemic (H1N1) 2009 virus–infected patients would provide essential information for epidemiologic control and clinical management in terms of antiviral therapy and infection control approaches.

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Suggested Citation for this Article
Suggested citation for this article: Li C-C, Wang L, Eng H-W, You H-W, Chang L-S, Tang K-S, et al. Correlation of pandemic (H1N1) 2009 viral load with disease severity and prolonged viral shedding in children. Emerg Infect Dis [serial on the Internet]. 2010 Aug [date cited]. Available from http://www.cdc.gov/EID/content/16/8/1265.htm

DOI: 10.3201/eid1608.091918

1These authors contributed equally to this article.