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Why did healthy children fall critically ill in the 2009 H1N1 flu pandemic?
Date:11/6/2011

ted to 35 pediatric ICUs around the country with probable 2009 H1N1 influenza from April 2009 to April 2010. Their vaccination status wasn't consistently known, but H1N1 vaccine did not become available until September 2009 or later.

The median age of the children critically ill with H1N1 was 6 years. Most had respiratory failure, two thirds required mechanical ventilation, and some required extracorporeal membrane oxygenation (ECMO) for advanced cardiac and respiratory support. Their disease progressed rapidly, and 75 children (9 percent) died, two thirds of them within two weeks of ICU admission.

"Some children were quickly overwhelmed, and many died despite centers doing everything to save them," says Randolph. "Early in the pandemic, centers were worried that they would run out of ventilators, that they would run out of ICU beds."

While most of the children critically ill with H1N1 had one or more chronic health conditions that increased their risk, such as asthma, neurologic disorders or compromised immune systems, 251 children (30 percent) were previously healthy.

Among these otherwise healthy children, the only risk factor that was identified for death from influenza was a presumed diagnosis of MRSA co-infection in the lung which increased the risk for mortality 8-fold (P<0.0001).

"It is not common in the U.S. to lose a previously healthy child to pneumonia," says Randolph. "Unfortunately, these children had necrotizing pneumonia eating away at their tissue and killing off whole areas of the lung. They looked like immunocompromised patients in the way MRSA went through their body. It's not that flu alone can't kill it can but in most cases children with flu alone survived."

Treatment challenges

Use of antiviral agents for critically ill patients with influenza is now routinely recommended. In this study, 88 percent of the children admitted to the ICU received Tamiflu (oseltamivir) durin
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Contact: Keri Stedman
keri.stedman@childrens.harvard.edu
617-919-3110
Children's Hospital Boston
Source:Eurekalert

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