Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study
Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study
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DOI：
10.1016/s0140-6736(10)61195-6
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发表时间：
2010-11-01
期刊：
影响因子：
168.9
通讯作者：
Donaldson, Liam J.
中科院分区：
文献类型：
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作者：
Sachedina, Nabihah;Donaldson, Liam J.
研究背景0-18岁的年轻人受到甲型H1N1流感感染的影响尤为严重。我们的目的是分析儿科死亡率，为未来的流感季节和pandemics.Methods的临床和公共卫生政策提供信息，所有的儿科死亡相关的甲型H1N1流感大流行性感染，从2009年6月26日至2010年3月22日在英格兰，通过每日报告系统和交叉检查的记录，并确认流感感染的实验室结果或死亡证明。负责每个儿童的临床医生提供了有关急性疾病的既往病史、表现和临床病程的详细信息。甲型H1N1流感的病例估计数来自卫生保护局。主要结果指标是人口死亡率和病死率。结果报告了70例与甲型H1N1流感相关的儿科死亡。儿童死亡率为每百万人口6人。1岁以下儿童的死亡率最高。孟加拉国儿童（每百万人口47例死亡[95% CI 17-103]）和巴基斯坦儿童（每百万人口3 - 6例死亡[18-64]）的死亡率高于英国白色儿童（每百万人口4例死亡[3-6]）。15名（21%）死亡的儿童以前是健康的; 45名（64%）有严重的预先存在的疾病。既存疾病的最高年龄标准化死亡率是慢性神经系统疾病（每百万人口1536人）。19例（27%）死亡发生在住院前。与入院后死亡的儿童相比，该亚组中的儿童更有可能是健康的或仅患有轻度预先存在的疾病（p=0-0109）。总体而言，45名（64%）儿童接受了奥司他韦：7个在48小时内症状onset.Interpretation接种疫苗的优先权应在儿童重症疾病或流感死亡的风险增加。这个群体可能包括那些特定的预先存在的障碍和那些在一些少数民族群体。早期的院前支持和治疗护理也很重要。
Background Young people (aged 0-18 years) have been disproportionately affected by pandemic influenza A H1N1 infection. We aimed to analyse paediatric mortality to inform clinical and public health policies for future influenza seasons and pandemics.Methods All paediatric deaths related to pandemic influenza A H1N1 infection from June 26,2009, to March 22,2010 in England were identified through daily reporting systems and cross-checking of records and were validated by confirmation of influenza infection by laboratory results or death certificates. Clinicians responsible for each individual child provided detailed information about past medical history, presentation, and clinical course of the acute illness. Case estimates of influenza A H1N1 were obtained from the Health Protection Agency. The primary outcome measures were population mortality rates and case-fatality rates.Findings 70 paediatric deaths related to pandemic influenza A H1N1 were reported. Childhood mortality rate was 6 per million population. The rate was highest for children aged less than 1 year. Mortality rates were higher for Bangladeshi children (47 deaths per million population [95% CI 17-103]) and Pakistani children (36 deaths per million population [18-64]) than for white British children (4 deaths per million [3-6]). 15 (21%) children who died were previously healthy; 45 (64%) had severe pre-existing disorders. The highest age-standardised mortality rate for a preexisting disorder was for chronic neurological disease (1536 per million population). 19 (27%) deaths occurred before inpatient admission. Children in this subgroup were significantly more likely to have been healthy or had only mild pre-existing disorders than those who died after admission (p=0-0109). Overall, 45 (64%) children had received oseltamivir: seven within 48 h of symptom onset.Interpretation Vaccination priority should be for children at increased risk of severe illness or death from influenza. This group might include those with specified pre-existing disorders and those in some ethnic minority groups. Early pre-hospital supportive and therapeutic care is also important.