Çocuklarda Pandemik 2009 İnfluenza A H1N1 Enfeksiyonu

Yıl 2011, Cilt: 9 Sayı: 3, 53 - 59, 01.12.2011

Deniz Çakır Solmaz Çelebi Mustafa Turhan Hacımustafaoğlu Enes Salı Taner Özgür

Öz

Gi rifl: Kasım-Aralık 2009 tarihleri arasında influenza benzeri hastalık tanımına uyan vepnömoniyle gelişen, hastaneye yatırılan 68 olgu ile ilgili deneyimlerimizin paylaşılmasıamaçlandı.Gereç ve Yöntem: Kanıtlanmış pandemik 2009 influenza pozitif olgular ile negatifolgular klinik belirti ve bulgular, laboratuvar ve radyolojik görüntüleme sonuçları,hastanede ve yoğun bakımda yatış süreleri, almış oldukları tedaviler vekomplikasyonlar açısından karşılaştırıldı.Bulgular: Her iki grup arasında cinsiyet dağılımı açısından anlamlı bir fark saptanmadı.Pozitif olgularda 5 yaş üstü olgu sayısı aynı yaş grubundaki negatif olgulara göreanlamlı oranda yüksek saptandı p=0,004 . Pozitif olguların %78,8'inin, negatif olguların%68,8'inin altta yatan hastalığı vardı p=0,57 . Pozitif grupta ishal görülme oranı negatifgruptan anlamlı olarak yüksek saptandı p=0,02 . Mevsimsel influenza aşılanmaoranlarının düşüklüğü dikkat çekiciydi. Her iki grup arasında aşılanma oranlarıaçısından anlamlı bir fark saptanmadı p=0,99 .Sonuç: Hastalığın ciddiyeti pozitif ve negatif olgularda benzer seyretmiştir. Her ikigrupta da altta yatan hastalığı olanların oranının yükseldiği dikkat çekmektedir

Anahtar Kelimeler

Pandemik 2009 influenza A, çocukluk çağı, pnömoni

Pandemic 2009 Influenza A H1N1 Infection in Children

Öz

In tro duc ti on: The aim of this study is to share our experience of sixty-eight pediatric hospitalizations associated with influenza-like illness and pneumonia betweenNovember, 2009 and December, 2009.Materials and Methods: Clinical signs and symptoms, laboratory and radiological results,length of stay in hospital and intensive care unit, treatments and complications werecompared in laboratory confirmed pandemic influenza A positive and negative cases.Results: There was no significant difference in gender distribution between the twogroups. The number of positive cases in patients over 5 years of age were significantlyhigher than the same age group in negative patients p=0.004 . There were underlyinghealth conditions in 78.8% of the positive cases and in 68.8% of the negative cases p=0.57 . The incidence of diarrhea in positive group was significantly higher than in thenegative group p=0.02 . Low immunization rates of the seasonal influenza vaccine wereremarkable in each group. There was no significant difference in vaccination ratesbetween the two groups p=0.99 .Conclusions: The severity of the disease remained similar in patients with positive andnegative groups. In both groups, the high ratio of those having an underlying disease wasnoteworthy

Anahtar Kelimeler

Pandemic 2009 influenza A, childhood, pneumonia

Kaynakça

• 1. Centers for Disease Control and Prevention (CDC). Outbreak of swine-origin influenza A (H1N1) virus infection-Mexico, March￾April 2009. MMWR Morb Mortal Wkly Rep 2009;58:467-70.
• 2. World Health Organization (WHO). Pandemic (H1N1) 2009- update 70. Available from http://www.who.int/csr/don/ 2009_10_16/en/index.html (accessed October 20, 2009).
• 3. World Health Organization (WHO). Preparing for the second wave: lessons from current outbreaks. Available from http://www.who.int/csr/disease/swineflu/notes/h1n1_second _wave_20090828/en/ index.html (accessed October 25, 2009).
• 4. World Health Organization (WHO). Pandemic (H1N1) 2009- update 69. Available from http://www.who.int/csr/don/ 2009_10_09/en/index.html (accessed October 11, 2009).
• 5. T.C. Sağlık Bakanlığı. Erişim http://www.grip.gov.tr/images/ stories/sunum/ saglik_personeli_ h1n1 _ sunum_20039.pdf (Erişim Tarihi:25 Haziran 2010).
• 6. Centers for Disease Control and Prevention (CDC). Hospitalized patients with novel influenza A (H1N1) virus infection￾California, April-May, 2009. MMWR Morb Mortal Wkly Rep 2009;58:536-41.
• 7. Perez-Padilla R, De La Rosa-Zamboni D, De Leon SP, Hernandez M, Quiñones-Falconi F, Bautista E et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361:680-9.
• 8. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ et al. Emergence of a novel swine origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360:2605-15.
• 9. 2009-2010 Influenza season triage algorithm for children (≤18 years) with influenza-like illness. Available from http://www.cdc.gov/h 1n1flu/clinicians/pdf/childalgorithm2.pdf (accessed October 16,2009).
• 10. Wardlaw TM, Johansson EW, Hodge M (eds) Pneumonia: the forgotten killer of children. UNICEF/WHO, 2006, p.24-5.
• 11. 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.
• 12. O'Riordan S, Barton M, Yau Y, Read SE, Allen U, Tran D. Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza. CMAJ 2010;182:39-44.
• 13. Hancock K, Veguilla V, Lu X, Zhong W, Butler EN, Sun H et al. Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med 2009;361:1945-52.
• 14. Dolin R, Wise TG, Mazur MH, Tuazon CU, Ennis FA. Immunogenicity and reactogenicity of influenza A/New Jersey/76 virus vaccines in normal adults. J Infect Dis 1977;136 Suppl:435-42.
• 15. Centers for Disease Control and Prevention (CDC). Serum cross-reactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine. MMWR Morb Mortal Wkly Rep 2009;58:521-4.
• 16. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009;361: 1935-44.
• 17. Kelly H, Grant K. Interim analysis of pandemic influenza (H1N1) 2009 in Australia: surveillance trends, age of infection and effectiveness of seasonal vaccination. Euro Surveill 2009;14(31). pii: 19288.
• 18. 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.
• 19. Larcombe PJ, Moloney SE, Schmidt PA. Pandemic (H1N1) 2009: a clinical spectrum in the general paediatric population. Arch Dis Child. 2011;96:96-8.
• 20. Bettinger A, Sauve LJ, Schefeile DW, Moore D, Vaudry W, Tran D et al. Pandemic influenza in Canadian children: A summary of hospitalized pediatric cases. Vaccine 2010;28:3180-4.
• 21. Libster R, Bugna J, Coviello S, Hijano DR, 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.
• 22. Turner SJ, Brown LE, Doherty PC, Kelso A. Q&A: What have we found out about the influenza A (H1N1) 2009 pandemic virus? J Biol 2009;8:69.
• 23. Maines TR, Jayaraman A, Belser JA, Wadford DA, Pappas C, Zeng H et al. Transmission and pathogenesis of swine-origin 2009 A(H1N1) influenza viruses inferrets and mice. Science 2009;325:484-7.
• 24. Lyon JB, Remigio C, Milligan T, Deline C. Acute necrotizing encephalopathy in a child with H1N1 influenza infection. Pediatr Radiol 2010;40:200-5.
• 25. Department of Health (DH). Pandemic H1N1 2009 Influenza: Clinical Management Guidelines or Adults and Children. Available from http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_107769 (accessed November 19, 2009)
• 26. Cao B, Li XW, Mao Y, Wang J, Lu HZ, Chen YS et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med 2009;361:2507-17.
• 27. Centers for Disease Control and Prevention (CDC). Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection: United States, April–August 2009. MMWR Morb Mortal Wkly Rep 2009;58:941-7.
• 28. Centers for Disease Control and Prevention (CDC). Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1): United States, May–August 2009. MMWR Morb Mortal Wkly Rep 2009;58:1071-4.
• 29. Finelli L, Fiore A, Dhara R, Brammer L, Shay DK, Kamimoto L et al. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics 2008;122:805-11.
• 30. Poehling KA, Edwards KM, Weinberg GA, Szilagyi P, Staat MA, Iwane MK et al. The underrecognized burden of influenza in young children. N Engl J Med 2006;355:31-40.
• 31. Neuzil KM, Mellen BG, Wright PF, Mitchel EF Jr, Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med 2000;342:225-31.
• 32. WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. Geneva: World Health Organization, August 20, 2009 Available from http://www.who.int/csr/resources/publications/swineflu/ h1n1_use_antivirals_20090820/en/index.html (accessed October 21,2009).
• 33. Palacios G, Hornig M, Cisterna D, Savji N, Bussetti AV, Kapoor V et al. Streptococcus pneumoniae coinfection is correlated with the severity of H1N1 pandemic influenza. PLoS One 2009;4:e8540.
• 34. Morens DM, Taubenberger, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis 2008;198:962-70.
• 35. Lee EY, McAdam AJ, Chaudry G, Fishman MP, Zurakowski D, Boiselle PM. Swine-Origin Infl uenza A (H1N1) Viral Infection in Children: Initial Chest Radiographic Findings. Radiology 2010;254:934-41.
• 36. Denholm JT, Gordon C, Johnson P, Hewagama SS, Stuart RL, Aboltins C et al. Hospitalised adult patients with pandemic (H1N1) 2009 influenza in Melbourne, Australia. Med J Aust 2010;192:84-6.