Skip to main content
PMC home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2010 Aug 1;48(5):373. doi: 10.1007/s13312-011-0085-y

Clinical profile and outcome of swine flu in Indian children

Rashmi Ranjan Das 1, Abdus Sami 1, Rakesh Lodha 1, Richa Jain 1, S Broor 2, S Kaushik 2, B B Singh 2, M Ahmed 2, Rachna Seth 1, Sushil K Kabra 1,✉
PMCID: PMC7097331  PMID: 20972300

Abstract

Objective

To describe the clinical characteristics and outcome of Indian children infected with 2009 H1N1 influenza virus.

Study design

Retrospective chart review.

Setting

Outpatient department and hospitalized patients in a tertiary care hospital.

Methods

Clinical details of 85 children (positive for the 2009 H1N1 virus infection tested by real-time reverse-transcriptase-polymerase-chain-reaction assay) were analyzed from medical charts.

Results

Of the 85 (55 boys) children positive for 2009 H1N1 virus infection, 64.7% were between 5 years to 16 years, and 35.3% were below 5 years age. The mean age of these children was 7.5±3.5 yr. Contact history was positive only in 22 (26%) cases. High grade fever was the most common symptom, followed by cough and rhinorrhea. Twenty-nine (34%) patients had an underlying co-morbid condition. Of the 34 patients who underwent chest radiography during evaluation, 18 children (52.9%) had findings consistent with lower respiratory tract infection. Antiviral therapy was initiated in 76 patients. Hospitalization was required in 30 (35.3%) children. Risk factors for hospitalization included underlying co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph. Mean length of hospitalization was 131±76 hours, irrespective of underlying disease. Three children developed Acute Respiratory Distress Syndrome and died.

Conclusions

Clinical features and routine laboratory investigations in children with swine origin influenza were non-specific. Children with co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph were at higher risk of hospitalization.

Key words: Acute lung injury, ARDS, H1N1 influenza, Pandemic influenza, Swine origin influenza

References

  • 1.Chang L.Y., Shih S.R., Shao P.L., Huang D.T., Huang L.M. Novel swine-origin influenza virus A (H1N1): the first pandemic of the 21st century. J Formos Med Assoc. 2009;108:526–532. doi: 10.1016/S0929-6646(09)60369-7. [DOI] [PubMed] [Google Scholar]
  • 2.Dawood F.S., Jain S., Finelli L., Shaw M.W., Lindstrom S., Garten R.J., et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009;360:2605–2615. doi: 10.1056/NEJMoa0903810. [DOI] [PubMed] [Google Scholar]
  • 3.Garten R.J., Davis C.T., Russell C.A., Shu B., Lindstrom S., Balish A., et al. Antigenic and genetic characteristics of swine-origin 2009 A (H1N1) influenza viruses circulating in humans. Science. 2009;325:197–201. doi: 10.1126/science.1176225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Morens D.M., Taubenberger J.K., Fauci A.S. The persistent legacy of the 1918 influenza virus. NEJM. 2009;361:225–229. doi: 10.1056/NEJMp0904819. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Clinical management of human infection with new influenza A (H1N1) virus: initial guidance. World Health Organization: Global alert and response. 21 May 2009. Available from: http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html. Accessed on 15 February, 2010.
  • 6.Epidemiological Trends of Pandemic Influenza A (H1N1). Ministry of Health and Family Welfare, Government of India. Available from: http://mohfw-h1n1.nic.in/Epidemiological.html. Accessed on January 15, 2010.
  • 7.Lister P., Reynolds F., Parslow R., Chan A., Cooper M., Plunkett A., et al. Swine-origin influenza virus H1N1, seasonal influenza virus, and critical illness in children. Lancet. 2009;374:605–7. doi: 10.1016/S0140-6736(09)61512-9. [DOI] [PubMed] [Google Scholar]
  • 8.Surveillance for pediatric deaths associated with 2009 pandemic influenza A MMWR Morb Mortal Wkly Rep. 2009;58:941–947. [PubMed] [Google Scholar]
  • 9.Hackett S., Hill L., Patel J., Ratnaraja N., Ifeyinwa A., Farooqi M., et al. Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet. 2009;374:605. doi: 10.1016/S0140-6736(09)61511-7. [DOI] [PubMed] [Google Scholar]
  • 10.Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. Pandemic Influenza A H1N1-Clinical management Protocol and Infection Control Guidelines. Available at: http://mohfwh1n1.nic.in/documents/pdf/5.%20Clinical%20Management%20ProtocolPandemic%20influenza%20A%20H1N1.pdf. Accessed on 15 February, 2010.
  • 11.Pandemic (H1N1) 2010 — update 83. Geneva: World Health Organization. Available from: http://www.who.int/csr/don/2010_01_15/en/index.html. Accessed on January 15, 2010.
  • 12.Schrag S.J., Shay D.K., Gershman K., Thomas A., Craig A.S., Schaffner W., et al. Multistate surveillance for laboratory confirmed, influenza-associated hospitalizations in children: 2003–2004. Pediatr Infect Dis J. 2006;25:395–400. doi: 10.1097/01.inf.0000214988.81379.71. [DOI] [PubMed] [Google Scholar]
  • 13.Keren R., Zaoutis T.E., Bridges C.B., Herrera G., Watson B.M., Wheeler A.B., et al. Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection. JAMA. 2005;294:2188–2194. doi: 10.1001/jama.294.17.2188. [DOI] [PubMed] [Google Scholar]
  • 14.Ampofo K., Gesteland P.H., Bender J., Mills M., Daly J., Samore M., et al. Epidemiology, complications, and cost of hospitalization in children with laboratory — confirmed influenza infection. Pediatrics. 2006;118:2409–2417. doi: 10.1542/peds.2006-1475. [DOI] [PubMed] [Google Scholar]
  • 15.Jain S., Kamimoto L., Bramley A.M., Schmitz A.M., Benoit S.R., Louie J., et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April–June 2009. N Engl J Med. 2009;361:1935–1944. doi: 10.1056/NEJMoa0906695. [DOI] [PubMed] [Google Scholar]
  • 16.Libster R., Bugna J., Coviello S., Hijano D.R., Dunaiewsky M., Reynoso N., et al. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med. 2010;362:45–55. doi: 10.1056/NEJMoa0907673. [DOI] [PubMed] [Google Scholar]
  • 17.Nicholson K.G. Clinical features of influenza. Semin Respir Infect. 1992;7:26–37. [PubMed] [Google Scholar]
  • 18.Cox N.J., Subbarao K. Influenza. Lancet. 1999;354:1277–82. doi: 10.1016/S0140-6736(99)01241-6. [DOI] [PubMed] [Google Scholar]
  • 19.Moore D.L., Vaudry W., Scheifele D.W., Halperin S.A., Dery P., Ford-Jones E., et al. Surveillance for influenza admissions among children hospitalized in Canadian immunization monitoring program active centers, 2003–2004. Pediatrics. 2006;118:e610–e619. doi: 10.1542/peds.2005-2744. [DOI] [PubMed] [Google Scholar]
  • 20.Louria D.B., Blumenfield H.L., Ellis J.T., Kilbourne E.D., Rogers D.E. Studies on influenza in the pandemic of 1957–1958. II. Pulmonary complications of influenza. J Clin Invest. 1959;38:213–265. doi: 10.1172/JCI103791. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Indian Pediatrics are provided here courtesy of Nature Publishing Group

RESOURCES