Abstract
Background
The first case of 2009 pandemic influenza A or H1N1 virus infection in India was reported in May 2009 and in the Saurashtra region in August 2009. We describe the two waves clinicoepidemiological characteristics of children who were hospitalized with 2009 influenza A infection in the Saurashtra region.
Methods
From September 2009 to February 2011, we treated 117 children infected with 2009 influenza A virus who were admitted in different hospitals in Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test was used to confirm infection, and the clinico-epidemiological features of the disease were closely monitored.
Results
In the 117 patients, with a median age of 2 years, 59.8% were male. The median time from onset of the disease to influenza A diagnosis was 5 days, and that from onset of the disease to hospitalization was 7 days. The admitted patients took oseltamivir, but only 11.1% of them took it within 2 days after onset of the disease. More than one fourth (29.1%) of the admitted patients died. The most common symptoms of the patients were cough (98.3%), fever (94.0%), sore throat and shortness of breathing. Pneumonia was detected by chest radiography in 80.2% of the patients.
Conclusions
In children with infection-related illness, the survival rate was about 71% after oseltamivir treatment. The median time for virus detection with real-time RT-PCR is 5 days. Early diagnosis and treatment may reduce the severity of the disease.
Key words: antiviral drug, clinical features, epidemiology, influenza A, intensive care
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.Ministry of Health and Family Welfare, Government of India. Factsheet Influenza A (H1N1), 2010. www.pib.nic.in/h1n1/factsheet.pdf (accessed March 6, 2010).
- 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.Centers for Disease ControlPrevention Outbreak of swine origin influenza A (H1N1) virus infection — Mexico, March–April 2009. MMWR Morb Mortal Wkly Rep. 2009;58:467–470. [PubMed] [Google Scholar]
- 5.Centers for Disease ControlPrevention Swineorigin influenza A (H1N1) virus infections in a school - New York City, April 2009. MMWR Morb Mortal Wkly Rep. 2009;58:470–472. [PubMed] [Google Scholar]
- 6.World Health Organization, 2009. www.who.int/csr/don/2009_05_04a/en/index.html (accessed February 27, 2010).
- 7.Human swine influenza: a pandemic threat. Director General of Health Services. Government of India. CD Alert 2009;12:1–8.
- 8.Ministry of Health and Family Welfare, Government of India. Situation update on H1N1, 2010. www.mohfw-h1n1.nic.in/documents/PDF/EpidemiologicalTrendsInIndia.pdf (accessed February 15, 2010).
- 9.The Times of India, 2009. www.timesofindia.indiatimes.com/city/ahmedabad/First-swine-flu-case-surfaces-in-Gujarat/articleshow/4669250.cms (accessed March 1, 2010).
- 10.The Indian Express, 2010. www.expressindia.com/latestnews/saurashtras-first-confirmed-swine-flu-case-detected-inbhavnagar/503678/ (accessed February 27, 2010).
- 11.Das R.R., Sami A., Lodha R., Jain R., Broor S., Kaushik S., et al. Clinical profile and outcome of swine flu in Indian children. Indian Pediatr. 2011;48:373–378. doi: 10.1007/s13312-011-0085-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Ministry of Health and Family Welfare, 2009. Guidelines on categorization of influenza A H1N1 cases during screening for home isolation, testing, treatment and hospitalization. http://mohfw-h1n1.nic.in/documents/pdf/3.Categorisation%20of%20Influenza%20A%20H1N1%20cases%20screening.pdf (accessed January 15, 2010).
- 13.The Indian Express, 2009. www.expressindia.com/latestnews/epidemic-control-act-invoked-to-thwart-h1n1-scare-instate/504144/ (accessed March 3, 2010).
- 14.World Health Organization, 2009. www.who.int/csr/resources/publications/swineflu/CDCrealtimeRTPCRprotocol_20090428.pdf (accessed January 15, 2010).
- 15.Centers for Disease Control and Prevention, 2008. www.cdc.gov/epiinfo/ (accessed August 15, 2008).
- 16.Bettinger J.A., SauvA L.J., Scheifele D.W., Moore D., Vaudry W., Tran D., et al. Pandemic influenza in Canadian children: a summary of hospitalized pediatric cases. Vaccine. 2010;28:3180–3184. doi: 10.1016/j.vaccine.2010.02.044. [DOI] [PubMed] [Google Scholar]
- 17.Tamma P.D., Turnbull A.E., Milstone A.M., Cosgrove S.E., Valsamakis A., Budd A., et al. Clinical outcomes of seasonal influenza and pandemic influenza A (H1N1) in pediatric inpatients. BMC Pediatr. 2010;10:72. doi: 10.1186/1471-2431-10-72. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Libster R., Hijano D.R., Cavalieri M.L., Gilligan T., Gregorio G.L., Panigasi A.L., 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]
- 19.Riordan S.O., Barton M., Yau Y., Read S.E., Allen U., Tran D. Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza. CMAJ. 2009;182:39–44. doi: 10.1503/cmaj.091724. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Xie X.B., Zhu Q.R., Ge Y.L., Wang Z.L., Zhao G.C., Wang X.H. Analysis of 12 children with novel influenza A (H1N1) virus infection. Zhonghua Er Ke Za Zhi. 2009;47:935–938. [PubMed] [Google Scholar]
- 21.Bhat N., Wright J.G., Broder K.R., Murray E.L., Greenberg M.E., Glover M.J., et al. Influenza associated deaths among children in the United States, 2003–2004. N Engl J Med. 2005;353:2559–2567. doi: 10.1056/NEJMoa051721. [DOI] [PubMed] [Google Scholar]
- 22.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]
- 23.Centers for Disease Control and Prevention, 2009. www.cdc.gov/h1n1flu/recommendations.htm (accessed January 24, 2010).
- 24.Centers for Disease Control and Prevention, 2009. www.cdc.gov/h1n1flu/recommendations.htm (accessed October 21, 2009).
- 25.Kumar A., Zarychanski R., Pinto R., Cook D.J., Marshall J., Lacroix J., et al. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA. 2009;302:1872–1879. doi: 10.1001/jama.2009.1496. [DOI] [PubMed] [Google Scholar]
- 26.Jain S., Schmitz A.M., Louie J., Druckenmiller J.K., Chugh R., Deutscher M., 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]
- 27.Guinard A., Grout L., Durand C., Schwoebel V. Outbreak of influenza A (H1N1) without travel history in a school in the Toulouse district, France, June 2009. Euro Surveill. 2009;14:19265. doi: 10.2807/ese.14.27.19265-en. [DOI] [PubMed] [Google Scholar]
- 28.Bagdure D., Curtis D.J., Dobyns E., Golde M.P., Dominguez S.R. Hospitalized children with 2009 pandemic influenza A (H1N1): comparison to seasonal influenza and risk factors for admission to the ICU. PLoS One. 2010;5:e15173. doi: 10.1371/journal.pone.0015173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Parakh A., Kumar A., Kumar V., Dutta A.K., Khare S. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1): an experience from a tertiary care centre in North India. Indian J Pediatr. 2010;77:981–985. doi: 10.1007/s12098-010-0168-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Saha A., Jha N., Dubey N.K., Gupta V.K., Kalaivani M. Swine origin influenza A (H1N1) in Indian children. Ann Trop Pediatr. 2010;30:51–55. doi: 10.1179/146532810X12637745452031. [DOI] [PubMed] [Google Scholar]
- 31.Centers for Disease ControlPrevention Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection-United States, April–August 2009. MMWR Morb Mortal Wkly Rep. 2009;58:941–947. [PubMed] [Google Scholar]
- 32.Neuzil K.M., Maynard C., Griffin M.R., Heagerty P. Winter respiratory viruses and health care use: a populationbased study in the northwest United States. Clin Infect Dis. 2003;37:201–207. doi: 10.1086/375604. [DOI] [PubMed] [Google Scholar]
