influenza virus can infect humans and cause disease. The clinical presentation of human infection is usually mild, but the infection caused by A(H5N1) avian influenza virus occurring initially in Hongkong in 1997 or the A(H7N9) virus isolated first at the beginning of this year in China is severe and characterized by high mortality. The mortality rate of adolescents and children caused by H5N1 avian influenza is lower than that of adults and the younger the child the lower the mortality rate. A few pediatric H7N9 avian influenza cases recovered soon after treatment. A child was determined to be a H7N9 avian influenza virus carrier. These findings suggested that the pediatric H7N9 avian influenza infection was mild. It is very important to start anti-virus treatment with oseltamivir as early as possible in cases of avian influenza infection is considered. Combined therapy, including respiratory and circulatory support and inhibiting immunological reaction, is emphasized in the treatment of severe cases.
Animals ; Birds ; virology ; China ; epidemiology ; Disease Outbreaks ; Humans ; Influenza A Virus, H5N1 Subtype ; Influenza in Birds ; virology ; Influenza, Human ; diagnosis ; drug therapy ; epidemiology ; virology ; Time Factors

OBJECTIVETo analyze the clinical characteristics of severely and critically ill children with 2009 influenza A (H1N1) infection.

METHODClinical data of 150 cases with 2009 influenza A (H1N1) virus infection confirmed with the use of a real-time polymerase-chain-reaction assay on nasopharyngeal swab specimens were analyzed.

RESULTAmong 150 severely and critically ill children with 2009 influenza A (H1N1) virus infection, 103 were male, 47 were female; the median age was 5 years, 81(55%) were 5 years of age or older; 21 (14%) had underlying chronic diseases. The most common presenting symptoms were fever (95%), cough (89%), vomiting (23%), wheezing (19%), abdominal pain (16%), lethargy (7%), seizures (6%), myalgia (6%), and diarrhea (6%). The common laboratory abnormalities were increased or decreased white blood cells counts (40%), elevated of CRP (33%), LDH (29%), CK (25%) and AST (19%). Clinical complications included pneumonia (65%), encephalopathy (12%), myocarditis (5%), encephalitis (1%) and myositis (1%). All patients had received antibiotics before admission or on admission; 73% of patients had received oseltamivir treatment, 23% of patients had received corticosteroids; 32 (21%) were admitted to an ICU, 13 patients were intubated and mechanically ventilated. Fourteen patients with dyspnea who were irresponsive to the treatment experienced bronchoalveolar lavage with flexible bronchoscopy, and the branching bronchial casts were removed in 5 patients. Totally 145 (97%) patients were discharged, five (3%) died, three previously healthy patients died from severe encephalopathy, one patient died from ARDS, one previously healthy patient died from secondary fungal meningitis.

CONCLUSIONSeverely and critically ill children with 2009 influenza A (H1N1) virus infection may occur mainly in older children without underlying chronic disease. The clinical spectrum and laboratory abnormality of the patients can have a wide range. Neurologic complications may be common and severe encephalopathy can lead to death in previously healthy children. Early use of bronchoalveolar lavage with flexible bronchoscopy may reduce death associated with pulmonary complications.

Child ; Child, Hospitalized ; Child, Preschool ; China ; epidemiology ; Critical Care ; Critical Illness ; Female ; Humans ; Infant ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; diagnosis ; drug therapy ; epidemiology ; pathology ; Male

OBJECTIVES: This report describes the results of an investigation on an outbreak of novel influenza A (H1N1) in an English language Institute in Seoul, Korea in May 2009. METHODS: In this outbreak, novel influenza A (H1N1) was confirmed in 22 of 91 trainees, trainers and staff members. The trainees and 2 staff members were isolated in an assigned facility and the rest were isolated in their homes after we discovered the first patient with novel influenza A (H1N1). After the isolation, the people in the assigned facility were educated to use N95 respirators and they received oseltamivir for prophylaxis. RESULTS: The initial findings in this study suggest that the symptoms were mild and similar to those of seasonal influenza. The classmates and roommates of the infected patients were more likely to get infected with novel influenza A (H1N1) than the trainees who were not classmates or roommates of the patients (OR: 3.19, 95% CI=0.91 - 11.11 for classmates and OR: 40.0, 95% CI=7.4-215.7 for roommates). CONCLUSIONS: The public health response seems successful in terms of preventing the spread of this virus into the local community.
Adult ; *Disease Outbreaks ; Humans ; Influenza A Virus, H1N1 Subtype/*isolation & purification ; Influenza, Human/diagnosis/drug therapy/*epidemiology/physiopathology ; Republic of Korea/epidemiology ; *Schools ; Young Adult

OBJECTIVEDuring the 2009 influenza A (H1N1) epidemic in China, children are the main group among people infected with influenza A (H1N1) virus, but few reports about children are available. The present study aimed to observe the clinical, laboratory features and to analyze therapeutic result.

METHODThe research subject were 93 children infected with influenza A (H1N1), 59 male and 34 female who were treated in Beijing Ditan Hospital from 15 May 2009 to 10 September 2009. The patients' data on symptoms, signs, chest X-ray, blood routine test, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), liver function, renal function, helper T lymphocyte were collected and analyzed. The patients were treated with Oseltamivir, traditional Chinese medicine and symptomatic treatment.

RESULTThe main symptoms of children infected with influenza A (H1N1) are fever (84 cases, 90.3%), cough (62 cases, 66.7%), pharyngodynia (36 cases, 38.7%) and expectoration (19 cases, 20.4%) at onset, and fever (59 cases, 63.4%), cough (52 cases, 55.9%), pharyngodynia (23 cases, 24.7%) and expectoration (9 cases, 9.7%) were the mojor symptoms and signs while the patients visited our hospital. The main signs were fervescence, pharyngeal congestion (53 cases, 57.0%), tonsilar swelling (21 cases, 22.6%), and abnormal white blood count (WBC) was found in 32 cases, abnormal ESR in 10 cases, abnormal CRP in 10 cases, abnormal CD4 T lymphocyte count in 19 cases, abnormal liver function and renal function were found in very few patients. After treatment, the febrile duration and time to virus negative in patients treated with oseltamivir alone, traditional Chinese medicine alone, combined oseltamivir and traditional Chinese medicine as well as those who were neither treated with oseltamivir nor traditional Chinese medicine were respectively 1 - 6 days (median 1 day), 3 - 13 days (median 7 days), 1 - 6 days (median 1.5 days), 4 - 11 days (median 8 days), 1 - 5 days (median 1 days), 5 - 14 days (median 8 days), 1 - 5 days (median 2 days), 4 - 13 days (median 8 days).

CONCLUSIONClinical manifestations of 93 children cases were the same as those of adults. The traditional Chinese medicine could improve symptoms of children infected with influenza A (H1N1), but other clinical therapeutic effects need further study.

Adolescent ; Antiviral Agents ; therapeutic use ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; diagnosis ; drug therapy ; virology ; Male ; Medicine, Chinese Traditional ; Oseltamivir ; therapeutic use ; Treatment Outcome

OBJECTIVETo understand the clinical and epidemiological aspects of avian influenza A (H7N9) virus infection in children.

METHODThe clinical data of the first confirmed pediatric case of avian influenza A(H7N9) virus infection were collected, and the epidemiological information, presenting symptoms, laboratory investigation, management and outcome were analyzed. The data of the pediatric cases were also compared with those of the adults cases.

RESULTThe case reported in this paper was a previously healthy 3.6-year-old boy residing in rural area of Shanghai. He had onset of fever and mild rhinorrhea on 31 March 2013 and he was afebrile and well since April 3. Influenza A (H7N9) virus was detected in his nasopharyngeal sample collected on 1 April through national Influenza-like Illness surveillance using real-time reverse transcriptase PCR and virus culture.His family raised domestic poultry with no apparent disease and there was no virological evidence of H7N9 infection. Monitoring and testing of 16 contacts had not found any secondary infection.

CONCLUSIONThe clinical course of H7N9 avian influenza virus infection in children was relatively mild as compared to adult cases. The source of infection and detail of exposure for children have not been known yet. Continued surveillance studies of mild and severe respiratory disease and subclinical infection are essential to further characterize the epidemiology and clinical spectrum of this emerging H7N9 virus infection in children.

Animals ; Child, Preschool ; China ; epidemiology ; Communicable Diseases, Emerging ; Humans ; Influenza A Virus, H7N9 Subtype ; genetics ; isolation & purification ; Influenza in Birds ; Influenza, Human ; diagnosis ; drug therapy ; virology ; Male ; Oseltamivir ; therapeutic use ; Poultry ; Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction

The majority of Korean patients with pandemic influenza A (H1N1) during the 2009 epidemic were under 20 yr of age. The limited data on the clinical characteristics of these children led us to conduct a case note-based investigation of children admitted to 6 university hospitals with 2009 H1N1 influenza. A total of 804 children was enrolled. The median age was 5 yr; 63.8% were males; and 22.4% had at least one chronic underlying disease. Ninety-five of the patients (11.8%) were critically ill and they suffered more from shortness of breath, dyspnea and lymphopenia than the other patients. Among all the patients, 98.8% were treated with antivirals and 73% received treatment within 48 hr of illness onset. All the enrolled patients are alive and appear to have had good outcomes, probably due to the early intervention and antiviral treatment. This study deals with hospitalized children whose diagnoses of influenza A (H1N1) were confirmed, and therefore provides important new information about the clinical patterns of children with influenza A (H1N1) in Korea.
Adolescent ; Antiviral Agents/therapeutic use ; Child ; Child, Hospitalized ; Child, Preschool ; Critical Illness ; Dyspnea/etiology ; Female ; Humans ; Infant ; Infant, Newborn ; Influenza A Virus, H1N1 Subtype/genetics/*isolation & purification ; Influenza, Human/*diagnosis/drug therapy/epidemiology ; Lymphopenia/etiology ; Male ; Oseltamivir/therapeutic use ; Pandemics ; Republic of Korea/epidemiology ; Retrospective Studies