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Original ArticleOpen Access
Clinical Presentations of Pandemic 2009 Influenza A (H1N1) Virus Infection in Hospitalized Thai Children
Lochindarat S 
,
Bunnag T
,
Bunnag T Background: A novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in
Mexico during the spring of 2009. After that, the virus spread globally, resulting in the influenza pandemic.
Objective: To observe the clinical manifestations of the 2009 pandemic influenza A (H1N1) and the epidemic waves of
hospitalized children for a period of one year.
Material and Method: A prospective observational study of children under eighteen years old, confirmed having the 2009
pandemic influenza (H1N1) infection by real-time reverse-transcription-polymerase-chain-reaction (RT-PCR), admitted at
Queen Sirikit National Institute of Child Health, Bangkok, Thailand during one year, from 1st June 2009 to 31st May 2010.
Results: A total of 83 pandemic influenza infected children were admitted during a one-year period. There were two waves of
epidemic outbreak, the first wave from June to August 2009 and the second wave from January to February 2010. There were
47 cases of males (56.6%), with the highest attack rates among children 1-5 years of age (48.2%). The youngest case was a
29-day old girl. The correct provisional diagnosis of pandemic influenza infection are 39.5%, the other initial diagnosis are
pneumonia, bronchiolitis, tonsillitis, encephalitis, and dengue infection. Most patients coming for care had typical, influenzalike
symptoms with fever (98.8%), cough (92.6%) and rhinorrhea (74.1%). Systemic symptoms are frequent. Gastrointestinal
symptoms (including vomiting (46.9%) and diarrhea (24.7%)) occur more commonly than seasonal influenza. Pneumonia
is the most common complication (43.2%); other complications include bronchiolitis, hemoptysis, acute respiratory distress
syndrome (ARDS) and encephalitis. In one case, a seven year old girl suffered from ARDS, sepsis, multi-organ dysfunction
syndrome and ventilator associated pneumonia, but survived with some neurological sequelae. Radiographic findings
included diffuse interstitial, alveolar infiltrates and some in lobar distributions. Apart from oseltamivir, the other antibiotics
included ceftriaxone, cefotaxime, amplicillin and azithromycin, were added for pneumonia. All patients in the present study
survived.
Conclusion: The burden and character of pandemic influenza infection in developing countries are still incompletely understood.
Early therapy with oseltamivir in severely ill patients, without waiting for laboratory confirmation for diagnosis, will save
patients from severe complications.
Keywords: Pandemic influenza, Pneumonia
Mexico during the spring of 2009. After that, the virus spread globally, resulting in the influenza pandemic.
Objective: To observe the clinical manifestations of the 2009 pandemic influenza A (H1N1) and the epidemic waves of
hospitalized children for a period of one year.
Material and Method: A prospective observational study of children under eighteen years old, confirmed having the 2009
pandemic influenza (H1N1) infection by real-time reverse-transcription-polymerase-chain-reaction (RT-PCR), admitted at
Queen Sirikit National Institute of Child Health, Bangkok, Thailand during one year, from 1st June 2009 to 31st May 2010.
Results: A total of 83 pandemic influenza infected children were admitted during a one-year period. There were two waves of
epidemic outbreak, the first wave from June to August 2009 and the second wave from January to February 2010. There were
47 cases of males (56.6%), with the highest attack rates among children 1-5 years of age (48.2%). The youngest case was a
29-day old girl. The correct provisional diagnosis of pandemic influenza infection are 39.5%, the other initial diagnosis are
pneumonia, bronchiolitis, tonsillitis, encephalitis, and dengue infection. Most patients coming for care had typical, influenzalike
symptoms with fever (98.8%), cough (92.6%) and rhinorrhea (74.1%). Systemic symptoms are frequent. Gastrointestinal
symptoms (including vomiting (46.9%) and diarrhea (24.7%)) occur more commonly than seasonal influenza. Pneumonia
is the most common complication (43.2%); other complications include bronchiolitis, hemoptysis, acute respiratory distress
syndrome (ARDS) and encephalitis. In one case, a seven year old girl suffered from ARDS, sepsis, multi-organ dysfunction
syndrome and ventilator associated pneumonia, but survived with some neurological sequelae. Radiographic findings
included diffuse interstitial, alveolar infiltrates and some in lobar distributions. Apart from oseltamivir, the other antibiotics
included ceftriaxone, cefotaxime, amplicillin and azithromycin, were added for pneumonia. All patients in the present study
survived.
Conclusion: The burden and character of pandemic influenza infection in developing countries are still incompletely understood.
Early therapy with oseltamivir in severely ill patients, without waiting for laboratory confirmation for diagnosis, will save
patients from severe complications.
Keywords: Pandemic influenza, Pneumonia
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