miércoles, 24 de octubre de 2012

Unchanged Severity of Influenza A(H1N1)pdm09 Infection in Children during First Postpandemic Season - - Emerging Infectious Disease journal - CDC

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Unchanged Severity of Influenza A(H1N1)pdm09 Infection in Children during First Postpandemic Season - - Emerging Infectious Disease journal - CDC


Unchanged Severity of Influenza A(H1N1)pdm09 Infection in Children during First Postpandemic Season

Mathias AltmannComments to Author , Lena Fiebig, Silke Buda, Rüdiger von Kries, Manuel Dehnert, and Walter Haas
Author affiliations: Robert Koch Institute, Berlin, Germany (M. Altmann, L. Fiebig, S. Buda, M. Dehnert, W. Haas); and Ludwig-Maximilians-Universität, München, Germany (R. von Kries)
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We conducted a nationwide hospital-based prospective study in Germany of influenza A(H1N1)pdm09 cases among children <15 112="112" 14="14" 156="156" 17="17" 2009="2009" 2010="2010" 3.2="3.2" 44="44" 5.3="5.3" a="a" accounted="accounted" admitted="admitted" affected.="affected." age="age" although="although" and="and" between="between" care="care" case-patients="case-patients" cases.="cases." challenge="challenge" children.="children." children="children" death="death" deaths="deaths" died="died" difference="difference" during="during" eligible="eligible" especially="especially" factor="factor" findings="findings" for="for" hospital-acquired="hospital-acquired" identified="identified" immunosuppressed="immunosuppressed" immunosuppression="immunosuppression" in="in" infants="infants" infection="infection" infections="infections" influenza="influenza" intensive="intensive" median="median" most="most" myocarditis="myocarditis" need="need" nosocomial="nosocomial" not="not" occurred="occurred" of="of" our="our" p="0.473)." pandemic="pandemic" patients:="patients:" patients="patients" pediatric="pediatric" postpandemic="postpandemic" predictive="predictive" prevent="prevent" preventing="preventing" related="related" remained="remained" risk="risk" seasons.="seasons." seasons="seasons" severe="severe" shift="shift" significant="significant" stress="stress" the="the" to="to" transmission="transmission" underlying="underlying" units="units" virus="virus" vs.="vs." was="was" we="we" which="which" year="year" years="years" younger="younger">
In Germany during the influenza A(H1N1)pdm09 pandemic, there were ≈1,070,000 influenza-related medical consultations and ≈1,800 hospitalizations for children 0–14 years of age during October 12, 2009–January 15, 2010, as determined using data provided by the German syndromic surveillance system for acute respiratory infections (1). Moreover, 29 laboratory-confirmed A(H1N1)pdm09 infection–related deaths in children were notified through the mandatory German surveillance system for infectious diseases (2). The highest number of notified hospitalizations and deaths were among children 10–14 years of age (3,4). In a nationwide hospital-based observational study investigating severely ill children who had been admitted to pediatric intensive care units (PICUs) or had died with laboratory-confirmed A(H1N1)pdm09, we reported a high proportion (75%) of case-patients with underlying risk factors, of which neurodevelopmental disorders were most prevalent (5). In addition, we found that in 10% of the cases, children had acquired their infection while hospitalized and that few had been vaccinated, revealing a need for improving preventive measures to reduce severe disease and adverse outcomes (5).
On August 10, 2010, the general director of the World Health Organization declared the world was no longer in phase 6 of influenza pandemic alert; we were moving into the postpandemic phase (6). Experience from past pandemics suggested that the pandemic virus would gradually take on the behavior of a seasonal influenza virus and circulate for several years. However, in view of the potential for transformation of the virus into a more virulent form (7), as suggested by higher rates of mortality during second pandemic waves in Copenhagen (1918), the United States (1957), and Eurasia (1968–1970) (8,9), the World Health Organization acknowledged the unpredictability of pandemic viruses; recommended continued vigilance; and issued advice on surveillance, vaccination, and prompt clinical management of cases during the postpandemic phase (6).
Little is known about the severity of A(H1N1)pdm09 in children during the first postpandemic season (10). To obtain information on critically ill A(H1N1)pdm09-infected children and to compare risk factors and disease course, outcome, and severity for patients during the pandemic and first postpandemic season, we prospectively and continuously performed a nationwide study in Germany during August 3, 2009–July 29, 2011.

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