tetano
Editor, Senior Moderator
Pediatr Infect Dis J. 2010 May 7. [Epub ahead of print]
Clinical and Microbiologic Features Associated With Novel Swine-Origin Influenza A Pandemic 2009 (H1N1) Virus in Children: A Prospective Cohort Study.
Bryant PA, Tebruegge M, Papadakis G, Clarke C, Barnett P, Daley AJ, Paed D, South M, Curtis N.
From the *The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; daggerDepartment of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; double daggerMurdoch Children's Research Institute, Parkville, Victoria, Australia; and section signVictorian Infectious Diseases Reference Laboratory, Royal Parade, Parkville, Victoria, Australia.
Abstract
BACKGROUND:: Novel swine-origin influenza A pandemic 2009 (H1N1) virus (S-OIV) infection in the context of other respiratory viruses circulating in winter has not been studied. METHODS:: Clinical and microbiologic data were collected prospectively from 444 consecutive patients presenting with an influenza-like illness (ILI) to a large pediatric hospital at the beginning of the S-OIV outbreak in Australia. RESULTS:: Of 444 patients, 119 had polymerase chain reaction-confirmed S-OIV. Influenza A virus was detected by direct immunofluorescence in only 69 of these. Overall, inadequate respiratory samples were more common with rayon than flocked swabs (P = 0.01). The mean age of patients with S-OIV was higher than those with another cause of an ILI (10.2 vs. 6.4 years; P < 0.0001). The commonest symptoms in S-OIV were fever (93%) and cough (92%), followed by coryza (78%), sore throat (72%), headache (59%), myalgia (49%), vomiting (23%), and diarrhea (16%). Clinical features did not discriminate between patients with S-OIV and those with another ILI, except headache and myalgia, which were more common in children younger than 5 years who had S-OIV than those who did not (headache: P < 0.0001; myalgia: P = 0.0004). More patients with S-OIV had contact with a confirmed case but contact history had insufficient positive predictive value (44%) and negative predictive value (78%) for identifying S-OIV. Only 2% of the patients had a history of travel, and only 1 of these had S-OIV. CONCLUSIONS:: A clinical case definition is unlikely to be useful for discriminating patients with S-OIV from those with another cause of an ILI during winter. Direct immunofluorescence for influenza A cannot be used alone to reliably detect S-OIV.
PMID: 20458257 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20458257
Clinical and Microbiologic Features Associated With Novel Swine-Origin Influenza A Pandemic 2009 (H1N1) Virus in Children: A Prospective Cohort Study.
Bryant PA, Tebruegge M, Papadakis G, Clarke C, Barnett P, Daley AJ, Paed D, South M, Curtis N.
From the *The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; daggerDepartment of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; double daggerMurdoch Children's Research Institute, Parkville, Victoria, Australia; and section signVictorian Infectious Diseases Reference Laboratory, Royal Parade, Parkville, Victoria, Australia.
Abstract
BACKGROUND:: Novel swine-origin influenza A pandemic 2009 (H1N1) virus (S-OIV) infection in the context of other respiratory viruses circulating in winter has not been studied. METHODS:: Clinical and microbiologic data were collected prospectively from 444 consecutive patients presenting with an influenza-like illness (ILI) to a large pediatric hospital at the beginning of the S-OIV outbreak in Australia. RESULTS:: Of 444 patients, 119 had polymerase chain reaction-confirmed S-OIV. Influenza A virus was detected by direct immunofluorescence in only 69 of these. Overall, inadequate respiratory samples were more common with rayon than flocked swabs (P = 0.01). The mean age of patients with S-OIV was higher than those with another cause of an ILI (10.2 vs. 6.4 years; P < 0.0001). The commonest symptoms in S-OIV were fever (93%) and cough (92%), followed by coryza (78%), sore throat (72%), headache (59%), myalgia (49%), vomiting (23%), and diarrhea (16%). Clinical features did not discriminate between patients with S-OIV and those with another ILI, except headache and myalgia, which were more common in children younger than 5 years who had S-OIV than those who did not (headache: P < 0.0001; myalgia: P = 0.0004). More patients with S-OIV had contact with a confirmed case but contact history had insufficient positive predictive value (44%) and negative predictive value (78%) for identifying S-OIV. Only 2% of the patients had a history of travel, and only 1 of these had S-OIV. CONCLUSIONS:: A clinical case definition is unlikely to be useful for discriminating patients with S-OIV from those with another cause of an ILI during winter. Direct immunofluorescence for influenza A cannot be used alone to reliably detect S-OIV.
PMID: 20458257 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20458257