Pandemic (H1N1) 2009 Virus and Down Syndrome Patients
http://www.cdc.gov/eid/content/16/8/1312.htm
Rogelio P?rez-Padilla
, Rosario Fern?ndez, Cecilia Garc?a-Sancho, Francisco Franco-Marina, Octavio Aburto, Hugo L?pez-Gatell, and Ietza Boj?rquez
National Institute of Respiratory Diseases, Mexico City, Mexico (R. P?rez-Padilla, R. Fern?ndez, C. Garc?a-Sancho, F. Franco-Marina, O. Aburto); and Secretariat of Health, Mexico City (H. L?pez-Gatell, I. Boj?rquez)
Suggested citation for this article
Abstract
We compared prevalence of hospitalization, endotracheal intubation, and death among case-patients with and without Down syndrome during pandemic (H1N1) 2009 in Mexico. Likelihoods of hospitalization, intubation, and death were 16-fold, 8-fold, and 335-fold greater, respectively, for patients with Down syndrome. Vaccination and early antiviral drug treatment are recommended during such epidemics.
Down syndrome is the most common chromosomal abnormality in persons worldwide; prevalence is ≈1/1,000 live births (1). It is characterized by a variety of dysmorphic features, congenital malformations, and other health problems. Several risk factors for influenza also occur in Down syndrome patients (2): congenital heart disease in one half of patients (3), childhood obesity or excess weight in the majority (4), and a 8? higher prevalence of type 1 diabetes than in an age-matched control population (5). In addition, specific alterations in immune response are frequently present, including leukopenia, chemotactic defects (6), decreased immunoglobulin G<sub>4</sub> levels (7), and T- and B-cell abnormalities (7,8) with reduced B lymphocytes (9). Patients with Down syndrome have an increased need for hospitalization because of lower respiratory tract disease caused by respiratory syncytial virus (10) and other respiratory infections (11) as well as reduced access to healthcare (12). An increased proportion of patients with Down syndrome have pneumonia as cause of death (13). However, respiratory infections have not been associated with congenital heart disease (14). Although persons with Down syndrome are likely at increased risk for complications, these patients are not explicitly listed in groups that should receive priority vaccination or for early treatment of influenza. The objective of the study was to determine whether Down syndrome was associated with adverse outcomes in cases of influenza-like illness (ILI) and severe acute respiratory illness (SARI) during the first months of the outbreak of influenza A pandemic (H1N1) 2009 virus (15).
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http://www.cdc.gov/eid/content/16/8/1312.htm
Rogelio P?rez-Padilla
, Rosario Fern?ndez, Cecilia Garc?a-Sancho, Francisco Franco-Marina, Octavio Aburto, Hugo L?pez-Gatell, and Ietza Boj?rquezNational Institute of Respiratory Diseases, Mexico City, Mexico (R. P?rez-Padilla, R. Fern?ndez, C. Garc?a-Sancho, F. Franco-Marina, O. Aburto); and Secretariat of Health, Mexico City (H. L?pez-Gatell, I. Boj?rquez)
Suggested citation for this article
Abstract
We compared prevalence of hospitalization, endotracheal intubation, and death among case-patients with and without Down syndrome during pandemic (H1N1) 2009 in Mexico. Likelihoods of hospitalization, intubation, and death were 16-fold, 8-fold, and 335-fold greater, respectively, for patients with Down syndrome. Vaccination and early antiviral drug treatment are recommended during such epidemics.
Down syndrome is the most common chromosomal abnormality in persons worldwide; prevalence is ≈1/1,000 live births (1). It is characterized by a variety of dysmorphic features, congenital malformations, and other health problems. Several risk factors for influenza also occur in Down syndrome patients (2): congenital heart disease in one half of patients (3), childhood obesity or excess weight in the majority (4), and a 8? higher prevalence of type 1 diabetes than in an age-matched control population (5). In addition, specific alterations in immune response are frequently present, including leukopenia, chemotactic defects (6), decreased immunoglobulin G<sub>4</sub> levels (7), and T- and B-cell abnormalities (7,8) with reduced B lymphocytes (9). Patients with Down syndrome have an increased need for hospitalization because of lower respiratory tract disease caused by respiratory syncytial virus (10) and other respiratory infections (11) as well as reduced access to healthcare (12). An increased proportion of patients with Down syndrome have pneumonia as cause of death (13). However, respiratory infections have not been associated with congenital heart disease (14). Although persons with Down syndrome are likely at increased risk for complications, these patients are not explicitly listed in groups that should receive priority vaccination or for early treatment of influenza. The objective of the study was to determine whether Down syndrome was associated with adverse outcomes in cases of influenza-like illness (ILI) and severe acute respiratory illness (SARI) during the first months of the outbreak of influenza A pandemic (H1N1) 2009 virus (15).
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