A Population-Based Study of Neurologic Manifestations of Severe Influenza A(H1N1)pdm09 in California
A Population-Based Study of Neurologic Manifestations of Severe Influenza A(H1N1)pdm09 in California
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DOI：
10.1093/cid/cis454
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发表时间：
2012-08-15
影响因子：
11.8
通讯作者：
Louie, Janice K.
中科院分区：
文献类型：
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作者：
Glaser, Carol A.;Winter, Kathleen;Louie, Janice K.
背景报告的流感相关神经系统并发症通常仅限于病例系列或病例报告。我们进行了一项以人群为基础的研究，研究与严重和致命的甲型H1N1流感pdm 09（2009 H1N1）病例相关的神经系统表现。对2009年4月15日至2009年12月31日期间向加州公共卫生部报告的致命或重度（在重症监护室住院）实验室确诊的2009 H1N1患者的病历进行了审查，以确定具有原发性神经系统表现的患者。排除继发性神经系统表现（如缺氧）的病例。原发性流感相关神经系统并发症（INC）分为4组：脑病/脑炎、癫痫发作、脑膜炎和其他。2009年严重的H1N1相关的神经系统发病率是通过使用2009年加州H1N1疾病的估计来计算的。在2069例报告的严重或致命的2009年H1N1病例中，419例（20%）有神经系统表现。其中，77例（18%）符合我们对INC的定义：脑病/脑炎（n = 29）、癫痫发作（n = 44）、脑膜炎（n = 3）和其他（格林-巴利综合征）（n = 1）。中位年龄为9岁（范围：4个月-92岁）;与儿科白色、非西班牙裔（3.09/1000000）、西班牙裔（4.58/1000000）和黑人（6.57/1000000）相比，儿科亚洲/太平洋岛民（12.79/1000000）的患病率最高。中位住院时间（LOS）为4天（范围，1-142），有4例死亡。INCs的估计发病率为1.2/10万有症状的2009年H1N1疾病。在4%的致命或严重的2009年H1N1患者中观察到流感相关的神经系统并发症。最常在儿科患者中观察到，与加州人群相比，亚洲/太平洋岛民似乎比例过高。大多数INC患者的LOS相对较短，死亡率很低。
Background. Reported influenza-associated neurologic complications are generally limited to case series or case reports. We conducted a population-based study of neurologic manifestations associated with severe and fatal influenza A(H1N1)pdm09 (2009 H1N1) cases.Methods. Medical records of patients with fatal or severe (hospitalized in intensive care unit) laboratory-confirmed 2009 H1N1 reported to the California Department of Public Health from 15 April 2009 through 31 December 2009 were reviewed to identify those with primary neurological manifestations. Cases with secondary neurologic manifestations (eg, hypoxia) were excluded. Primary influenza-associated neurologic complications (INCs) were classified into 4 groups: encephalopathy/encephalitis, seizures, meningitis, and other. Severe 2009 H1N1-associated neurologic incidence was calculated by using estimates of 2009 H1N1 illnesses in California.Results. Of 2069 reported severe or fatal 2009 H1N1 cases, 419 (20%) had neurologic manifestations. Of these, 77 (18%) met our definition of INCs: encephalopathy/encephalitis (n = 29), seizures (n = 44), meningitis (n = 3), and other (Guillain-Barre Syndrome) (n = 1). The median age was 9 years (range, 4 months-92 years); the highest rate of disease was among pediatric Asian/Pacific Islanders (12.79 per 1 000 000) compared with pediatric white, non-Hispanics (3.09 per 1 000 000), Hispanics (4.58 per 1 000 000), and blacks (6.57 per 1 000 000). The median length of stay (LOS) was 4 days (range, 1-142), and there were 4 fatalities. The estimated incidence of INCs was 1.2 per 100 000 symptomatic 2009 H1N1 illnesses.Conclusions. Influenza-associated neurologic complications were observed in 4% of patients with fatal or severe 2009 H1N1. They were observed most often in pediatric patients, and Asian/Pacific Islanders appear to be overrepresented compared with the California population. Most patients with INCs had a relatively short LOS, and there were few fatalities.