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Pediatr Infect Dis J. 2012 Jan 5. [Epub ahead of print]
Characteristics and Outcomes of Pandemic 2009/H1N1 versus Seasonal Influenza in Children with Cancer.
Shah DP, El Taoum KK, Shah JN, Vigil KJ, Adachi JA, Granwehr BP, Tarrand JJ, Raad II, Chemaly RF.
Source
aDepartment of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX bUniversity of Texas School of Public Health, Houston, TX cDepartment of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
BACKGROUND:
Novel 2009/H1N1 influenza has significant impact on the immunocompromised children with cancer; however, it is uncertain how it compares with seasonal influenza (SFlu) in this vulnerable population. We compared clinical characteristics and outcomes for these two infections in children with cancer and identified risk factors for progression to lower respiratory infection (LRI) and/or death.
METHODS:
Influenza infections confirmed by positive viral culture and/or fluorescence antigen test between January 1998 and February 2010 were identified from microbiology databases at a comprehensive cancer center. Characteristics and outcomes were compared for the two groups. Kaplan-Meier survival curves and Cox proportional hazards model were generated to identify risk factors for LRI and/or death.
RESULTS:
When compared with SFlu, 2009/H1N1 cases had significantly lower APACHE II score (median: 9 vs. 14), fewer comorbidities (15% vs. 46%), fewer HSCT (5% vs. 16%), more solid tumors (45% vs.16%), higher LRI at presentation (20% vs. 4%), higher rates of antiviral therapy (90% vs. 48%), and higher mortality (10% vs. 0%). Male gender (HR: 8.4; 95% CI: 1.08, 65.2; P=0.042), APACHE II score >15 (HR: 3.29; 95% CI: 1.04, 10.39; P=0.027), and a 24-hour delay in initiation of antiviral treatment (HR: 1.12; 95% CI: 1.02, 1.23; P=0.015) were the most significant predictors of progression to LRI and mortality, regardless of virus strain.
CONCLUSIONS:
Significant differences between 2009/H1N1 and SFlu with respect to clinical presentation, management, and associated outcomes were identified. Early diagnosis and prompt initiation of antiviral therapy may prevent serious complications of influenza in children with cancer.
PMID:
22228234
[PubMed - as supplied by publisher]
Characteristics and Outcomes of Pandemic 2009/H1N1 versus Seasonal Influenza in Children with Cancer.
Shah DP, El Taoum KK, Shah JN, Vigil KJ, Adachi JA, Granwehr BP, Tarrand JJ, Raad II, Chemaly RF.
Source
aDepartment of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX bUniversity of Texas School of Public Health, Houston, TX cDepartment of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
BACKGROUND:
Novel 2009/H1N1 influenza has significant impact on the immunocompromised children with cancer; however, it is uncertain how it compares with seasonal influenza (SFlu) in this vulnerable population. We compared clinical characteristics and outcomes for these two infections in children with cancer and identified risk factors for progression to lower respiratory infection (LRI) and/or death.
METHODS:
Influenza infections confirmed by positive viral culture and/or fluorescence antigen test between January 1998 and February 2010 were identified from microbiology databases at a comprehensive cancer center. Characteristics and outcomes were compared for the two groups. Kaplan-Meier survival curves and Cox proportional hazards model were generated to identify risk factors for LRI and/or death.
RESULTS:
When compared with SFlu, 2009/H1N1 cases had significantly lower APACHE II score (median: 9 vs. 14), fewer comorbidities (15% vs. 46%), fewer HSCT (5% vs. 16%), more solid tumors (45% vs.16%), higher LRI at presentation (20% vs. 4%), higher rates of antiviral therapy (90% vs. 48%), and higher mortality (10% vs. 0%). Male gender (HR: 8.4; 95% CI: 1.08, 65.2; P=0.042), APACHE II score >15 (HR: 3.29; 95% CI: 1.04, 10.39; P=0.027), and a 24-hour delay in initiation of antiviral treatment (HR: 1.12; 95% CI: 1.02, 1.23; P=0.015) were the most significant predictors of progression to LRI and mortality, regardless of virus strain.
CONCLUSIONS:
Significant differences between 2009/H1N1 and SFlu with respect to clinical presentation, management, and associated outcomes were identified. Early diagnosis and prompt initiation of antiviral therapy may prevent serious complications of influenza in children with cancer.
PMID:
22228234
[PubMed - as supplied by publisher]
