NEJM: Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in

indigo girl · Dec 24, 2009

http://content.nejm.org/cgi/content/full/NEJMoa0907673

In our study, we found that the hospitalization rate for 2009 H1N1 influenza among children was twice that for 2008 seasonal influenza in the same population. The rate of death was 10 times the rate associated with seasonal influenza for the same population in 2007 and 5 times the rate reported by the CDC for the U.S. pediatric population during the relatively severe 2003–2004 influenza season (0.2 deaths per 100,000 children).16 Mortality was particularly high among infants (7.6 deaths per 100,000 children), which was 10 times the U.S. infant death rate from seasonal influenza in 2003–2004.16 Notably, no deaths of infants with seasonal influenza were identified in Buenos Aires hospitals in either 2007 or 2008. Bacterial coinfection was uncommon in 2009. Most deaths were attributable to refractory hypoxemia.
During the pandemic season, pediatric units in Buenos Aires that provide medical care to 1.2 million children collectively reported 13 influenza-related deaths. This season was unprecedented in the number of cases, disease burden, and severity. Elective surgeries were canceled for infection-control purposes, emergency rooms and hospital wards were overwhelmed with sick children, and ICUs were forced to expand their regular facilities. Recent reports point to the severity of the upcoming pediatric influenza season in the United States.20 Hospitalized children with 2009 H1N1 influenza in the Northern Hemisphere also had high rates of preexisting illness, especially asthma and neurologic disorders.20,21,22
At the peak of the epidemic, the Argentine government closed schools, suspended community gatherings, encouraged social distancing, and conducted an intense awareness campaign. Empirical therapy with oseltamivir for patients with influenza-like symptoms was also recommended for high-risk and hospitalized children.30 The number of cases subsided soon thereafter. Yet seasonal influenza in 2007 followed a very similar pattern, complicating the interpretation of the specific effect of these interventions. A similar campaign nevertheless seemed to be successful in Mexico.31

A hat tip to Avian Flu Diary with more discussion at: http://afludiary.blogspot.com/2009/12/nejm-pediatric-h1n1-hospitalizations.html