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Clinical and microbiologic features associated with novel swine-origin influenza A pandemic 2009 (H1N1) virus in children: a prospective cohort study

Clinical and microbiologic features associated with novel swine-origin influenza A pandemic 2009 (H1N1) virus in children: a prospective cohort study
Clinical and microbiologic features associated with novel swine-origin influenza A pandemic 2009 (H1N1) virus in children: a prospective cohort study
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.
694-698
Bryant, PA
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Tebruegge, M.
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Papadakis, G
bcaa7a99-2206-4c57-96c5-10557682826c
Clarke, C
87187b5a-a6c7-43eb-b754-f306bd1f698c
Barnett, P
00772e2b-8166-4e32-b2a1-ca523bd678a7
Daley, AJ
9d2c798d-6091-4774-a755-98bd8b6bbeae
South, M
1b37462e-4f58-4ce4-8544-2a4a9d0f63c0
Curtis, N
1b87d286-995f-4fea-a008-aa5dd7f634b7
Bryant, PA
a4f66fd6-5dd7-477a-a4bd-d64f56dd42e2
Tebruegge, M.
2c3dff22-0b5f-48a7-bb36-ce323705f74a
Papadakis, G
bcaa7a99-2206-4c57-96c5-10557682826c
Clarke, C
87187b5a-a6c7-43eb-b754-f306bd1f698c
Barnett, P
00772e2b-8166-4e32-b2a1-ca523bd678a7
Daley, AJ
9d2c798d-6091-4774-a755-98bd8b6bbeae
South, M
1b37462e-4f58-4ce4-8544-2a4a9d0f63c0
Curtis, N
1b87d286-995f-4fea-a008-aa5dd7f634b7

Bryant, PA, Tebruegge, M., Papadakis, G, Clarke, C, Barnett, P, Daley, AJ, South, M and Curtis, N (2010) Clinical and microbiologic features associated with novel swine-origin influenza A pandemic 2009 (H1N1) virus in children: a prospective cohort study. Pediatric Infectious Disease Journal, 29 (8), 694-698. (doi:10.1097/INF.0b013e3181de4b9c). (PMID:20458257)

Record type: Article

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.

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Published date: August 2010
Organisations: Faculty of Medicine

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Local EPrints ID: 337626
URI: https://eprints.soton.ac.uk/id/eprint/337626
PURE UUID: 65076e97-1ca3-4c1e-9095-98c915483d4d

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Date deposited: 01 May 2012 12:47
Last modified: 16 Jul 2019 22:06

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Contributors

Author: PA Bryant
Author: M. Tebruegge
Author: G Papadakis
Author: C Clarke
Author: P Barnett
Author: AJ Daley
Author: M South
Author: N Curtis

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