Swine influenza A (H1N1) virus infection in infants

There are few reports on pandemic swine influenza A (H1N1) virus infection in very young infants. We aimed to discuss the clinical characteristics and management of the H1N1 influenza infection in very young infants. Clinical characteristics of ten infants diagnosed with H1N1 influenza virus infection during the 2009 outbreak season in a tertiary neonatal intensive care unit were evaluated. The diagnosis was confirmed by testing of respiratory samples with pandemic H1N1 influenza specific real-time PCR assay. Of the 46 patients with fever or respiratory problems, ten (22%) were diagnosed with H1N1 influenza virus infection during the 2009 (October?CDecember) peak outbreak season. All infants including the preterms were admitted from home, seven (70%) were full-term and three (30%) were preterm. Median age of the patients at admission was 24.5?days. Fever and cough were the most common symptoms. Apnea was the initial symptoms in three patients. Two patients required oxygen support, one of which, a preterm baby, had been mechanically ventilated for 2?days. Mean duration of hospitalization was 7.8?±?4.9?days. Chest radiography revealed radio-opacities on both lung fields in six patients. In addition, two patients had co-infection. All patients with proven infection were given oseltamivir medication. Recovery was achieved in all patients with no residual deficits or side effects from the antiviral oseltamivir treatment. The H1N1 influenza virus infection in very young infants appears to be mild to moderate in severity. The outcomes of the infants may be influenced by antiviral therapy. Treatment with antiviral oseltamivir appears to have no major adverse effects.     

Transmission of SARS-CoV-2 from mother to fetus or neonate: What to know and what to do?

SARS-CoV-2 can be vertically transmitted from the mother to the fetus and the neonate. This transmission route is rare compared to the environmental or horizontal spread and therefore, the risk can be deemed inconsequential by some medical providers. However, severe, although just as rare, feto-neonatal consequences are possible: fetal demise, severe/critical neonatal COVID-19 and multi-inflammatory syndrome (MIS-N) have been described. Therefore, it is important for the clinicians to know the mechanism of vertical transmission, how to recognize this, and how to deal with neonatal COVID-19 and MIS-N. Our knowledge about this field has significantly increased in the last three years. This is a summary of the pathophysiology, diagnostics, and therapeutics of vertical SARS-CoV-2 transmission that clinicians apply in their clinical practice.     

An influenza Epidemic among Institutionalized Children at the Time of Replacement from A(H3N2)to A(H1N1): Observation of 32 Cases Including 3 Cases of Probable Simultaneous Infection with A(H1N1) and A(H3N2)

An influenza epidemic occurred in Fukuoka, southern part of Japan in January, 1978 in which both influenza virus A(H1N1) and A (H3N2) were isolated. Thirty-two institutionalized children with influenza were studied at the time of this shift from A (H3N2) to A (H1N1). Fourteen virus strains were isolated. Thirteen strains belonged to influenza virus A (H1N1) (A/USSR/92/77-like strain) and one a mixed strain of A (H1N1) and A (H3N2) (A/Texas/77-like strain). The hemagglutination inhibition (H1)tests of paired sera indicated that of the 32 Children, 27 Showed a significant increasein HI antibody titers for influenza virus A (H1N1). 2 for A (H3N2) and the remaining 3, including the case from which the mixed virus strain was isolated, for both A (H1N1) and A (H3N2). These offers 3 cases were thought to be probably infected simulataneously with both influenza virus A (H1N1) and A (H3N2). Clinical manifestations due to influenza virus A (H1N1) were moderate and the 3 cases of probable simultaneous infection with both influenza virus A (H1N1) and A (H3N2) did not show two clinical episodes but rather a single episode with clinical manifestations similar to the cases with single virus infection.     

Maternal to fetal transmission of cervical carcinoma

Reported cases of metastases to the placenta are uncommon, and maternal transmission of tumor to the fetus is even more infrequent. However, vertical transmission of tumor can occur and should be considered as a potential etiology of malignancy in newborns and infants born to mothers with a history of cancer during gestation. Here, we present the imaging findings and clinical course of an unusual case of maternal cervical neuroendocrine carcinoma presenting as bilateral petrous temporal bone lesions in an infant.     

Pandemic A/H1N1(2009) influenza infections in very-low-birth-weight infants--a case series from the German Neonatal Network

6 cases of clinical influenza A/H1N1(2009) infections were reported within the multi-center German Neonatal Network (GNN) during the primary hospital stay in the pandemic season 2009/2010 and 2010/2011. Clinical symptoms varied from transient hyperthermia to apnea and severe respiratory distress. 1 fatal course with systemic inflammatory response after perinatal transmission of A/H1N1(2009) was observed. Oseltamivir treatment in 3/6 infants was without side effects. The reported cases have major implications for the management of VLBW infants: i) fatal courses after perinatal transmission are possible, ii) postnatal A/H1N1(2009) infection may result in life threatening events at a time when the infant is otherwise stable, iii) vaccination should be recommended for parents and medical staff to avoid nosocomial transmission, iv) more data are needed on the benefit and harm of antiviral drugs in preterm infants, v) neonatologists should suspect A/H1N1(2009) infection when unexplained sepsis-like or respiratory symptoms occur in VLBW infants.     

Human swine influenza A [H1N1]: Practical advice for clinicians early in the pandemic

The influenza pandemic the world was waiting for may have arrived, but the early indications are that the first wave of human swine influenza A [H1N1], also referred to as H1N1 Mexico 09 or “swine flu”, is highly transmissible but of no greater virulence than seasonal influenza to date. The new swine flu H1N1 virus is a mixture of avian, porcine and human influenza RNA. With twenty thousand confirmed cases worldwide and 117 deaths within 7 weeks of the first acknowledgement of a possible pandemic by Mexican and WHO experts, the mortality rate is less than 0.1% and the majority of deaths centred upon the origin of the epidemic in Mexico [83%]. Swine flu is thus far a relatively mild illness seen predominantly in those who are healthy and under 25 years of age, perhaps reflecting protection from previous human influenza exposure in older people. As the virus spreads internationally, border protection issues have surfaced and public health initiatives are being progressively rolled out to minimise the transmission. Vaccines are being developed which will be trialled in the coming months with a likely availability by August 2009, in time for the northern hemisphere autumn and winter. Vigilance without alarm appears to be the recommendation so far.     

Neonates Investigated for Influenza-Like Illness During the Outbreak of Pandemic H1N1 2009: Trivial Infections But Major Triage Implications

We report eight cases of neonates (from birth to 25 days) admitted to the neonatal service of a teaching hospital with influenza-like illness during the outbreak of pandemic H1N1 2009, and discuss their management and infection control issues. Empirical antibiotics were often promptly initiated and timely stopped when sepsis was ruled out. Also, there was no pandemic H1N1-09 but influenza A (H3N2, n = 1), parainfluenza (type 3, n = 3) and respiratory syncytial virus (n = 1) have been isolated. The infants recovered spontaneously without any antiviral therapy. There was no outbreak of the respiratory infections in the neonatal service during the admissions. Respiratory viral infections can occur in neonates although the clinical course may be milder and nonspecific. Emergency room and frontline staff must be vigilant of the non-specific clinical features of infections with respiratory viruses in the neonates so that prompt triage and isolation can be implemented to avoid outbreaks in the neonatal service.     

Hemophagocytic lymphohistiocytosis associated with 2009 pandemic influenza A (H1N1) virus infection

Hemophagocytic lymphohistiocytosis (HLH) has not been described earlier in the context of 2009 pandemic influenza A (H1N1) virus infection, although certain populations are thought to be at risk for complicated pandemic influenza A disease. Here, we report the second case of HLH after infection with the influenza A H1N1 virus treated with peroral oseltamivir successfully.     

甲型H5N1和H7N9禽流感——关注2013年H7N9禽流感疫情

禽流感病毒可以感染人类,通常病情轻微,1997年出现的H5N1禽流感和本年初出现的H7N9禽流感病情严重,病死率高。青少年和儿童H5N1禽流感病死率低于成人,年龄越小,病死率越低。有限的儿童病例经治疗迅速康复,以及儿童携带者的发现提示儿童H7N9禽流感病情轻微。禽流感治疗强调尽早使用奥司他韦进行抗病毒治疗,重症者需积极的呼吸支持、循环支持和抑制免疫反应等综合治疗。     

Swine origin influenza (swine flu)

Swine origin influenza was first recognized in the border area of Mexico and United States in April 2009 and during a short span of two months became the first pandemic. The currently circulating strain of swine origin influenza virus of the H1N1 strain has undergone triple reassortment and contains genes from the avian, swine and human viruses. It is transmitted by droplets or fomites. Incubation period is 2 to 7 days. Common clinical symptoms are indistinguishable by any viral respiratory illness, and include fever, cough, sore throat and myalgia. A feature seen more frequently with swine origin influenza is GI upset. Less than 10% of patients require hospitalization. Patients at risk of developing severe disease are - younger than five years, elderly, pregnant women, with chronic systemic illnesses, adolescents on aspirin. Of the severe manifestations of swine origin influenza, pneumonia and respiratory failure are the most common. Unusual symptoms reported are conjunctivitis, parotitis, hemophagocytic syndrome. Infants may present with fever and lethargy with no respiratory symptoms. Diagnosis is based on RT PCR, Viral culture or increasing neutralizing antibodies. Principle of treatment consist of isolation, universal precautions, good infection control practices, supportive care and use of antiviral drugs. Antiviral drugs effective against H1N1 virus include: oseltamivir and zamanavir. With good supportive care case fatality is less than 1%. Preventive measures include: social distancing, practicing respiratory etiquette, hand hygiene and use of chemoprohylaxis with antiviral drugs. Vaccine against H1N1 is not available at present, but will be available in near future.     

甲型H7N9禽流感病毒的病毒学特征

自2013年2月开始,中国东部省市陆续新发现了由甲型H7N9禽流感病毒引起人感染的病例。研究表明甲型H7N9病毒是一个单纯禽类来源的三元重配体,它的HA和PB2蛋白存在多个特征性突变（包括G186V、Q226L和E627K氨基酸替换）,这些突变可能促进了该病毒与人细胞受体的结合以及病毒的复制。目前尚未发现H7N9禽流感病毒发生稳定的人与人间的传播,但不能排除有限人传人的可能。应加强对H7N9病毒的监测,进一步了解该病毒的来源、传播以及可能造成的威胁。     

2009甲型H1N1流感研究进展

2009年3月在墨西哥出现了一种新型甲型H1N1流感病毒,这是一个四源重排的A型流感病毒:来源于猪流感病毒、禽流感病毒及人流感病毒.其临床特点与季节性流感相似,但重症病例可发生在无基础疾病的青壮年人,这与季节性流感不同,其高危人群为患有基础疾病者、孕妇及肥胖者.尽管已经出现了耐药毒株,但奥司他韦治疗仍然有效.该文主要对2009年流行的甲型H1N1流感病毒的基因特点、临床表现及治疗的最新进展进行综述.     

Analysis of Fatal Cases of Pandemic Influenza A (H1N1) Virus Infections in Pediatric Patients with Leukemia

Background: Pandemic influenza A/H1N1/2009 virus usually causes mild illness in healthy children. Chronic medical conditions are recognized as increasing the risk for complications of influenza virus infection. Although most studies including children with acute leukemia and H1N1 virus have reported no deaths, some anectodal reports with low patient numbers have reported mortality rates as high as 28.5%. Here, we report patients with leukemia and H1N1 virus and review the literature. Methods: Medical records of all children with leukemia and H1N1 virus in our institution were reviewed for demographic, clinical, and laboratory data. We also carried out a systematic review of the English-language literature. Among the 24 articles found, only patients with leukemia and pandemic H1N1 infections were reviewed by two independent reviewers. Results: Eight of 98 children who received chemotherapy for leukemia were diagnosed with pandemic H1N1 infection. One developed pneumonia and acute respiratory distress syndrome (ARDS) and died. Another one developed hemophagocytic lymphohistiocytosis (HLH) and died due to secondary infection during the 6th week of treatment for HLH. In our study, 2 of 8 patients had a fatal course (25%), compared with an overall mortality of 2.5% in the studies retrieved from PubMed (6/232). Conclusion: Pandemic H1N1 influenza virus caused mortality in patients with ARDS or HLH; an unexpected finding for pandemic H1N1 (2009) influenza virus. Thus, for children with leukemia and infected with H1N1 virus, short- and long-term complications should be kept in mind during evaluation.     

�Ϻ��ж�ͯҽԺ2011—2013�����м�����

??Objective To strengthen the cognition about the epidemiological characteristics of influenza in children and to provide reference for its prevention and control. Methods Analyze the data of influenza-like cases in Shanghai Children’s Hospital from 2011 to 2013. Results A total of 29 524 influenza-like cases were surveyed. The patients who were less than 5 years old occupied the largest proportion ??74.40%??. A total of 3168 pharyngeal swabs were collected and 559 influenza viruses were checked out ??17.65%??. Totally 232 ??41.5%?? of these influenza viruses were identified as influenza A ??H3N2?? virus?? 229 ??40.97%?? as influenza B virus and 98 ??17.53%?? as novel influenza A ??H1N1?? virus. The differences of the virus types were statistically significant each year??P??0.01??. The higher positive detection rates occurred from January to April in 2011 ??20.51%~45.89%???? from December 2011 to April 2012 ??28.77%~57.65%???? from July to August in 2012 ??44.74%??35.14%?? and in December 2013??52.29%??. Conclusion The children with influenza surveyed in 2011—2013 are infected by influenza A ??H3N2?? virus?? influenza B virus and novel influenza A ??H1N1?? virus. The epidemic strains change every year. The types of influenza viruses are popular alternatively. The influenza is with high incidence in winter-spring commonly?? but can also be popular in summer. Children less than 5 years old are more susceptible to influenza.     

Influenza in Children

In children, influenza is one among the commonest causes of acute respiratory illness and loss of school days. Influenza A, B, and C are 3 types of viruses responsible for illness. Type A virus has many subtypes based on antigens but Type B and Type C viruses have no known subtypes. Currently, influenza A/H1N1, A/H3N2, and influenza type B viruses are circulating in humans. Transmission of influenza occurs through droplets from infected person or through direct contact with person or fomites. Clinically, influenza is characterized by acute onset fever, chills, running nose, cough, sore throat, headache and myalgia. Mostly, febrile illness lasts for 3–4 d with resolution of disease in 7–10 d. Confirmation of influenza can be done either by virus culture, RT-PCR or specific neutralizing antibodies in blood. Basic principles of management include prompt institution of infection control measures, early identification of children at higher risk, supportive care and antiviral drugs. Vaccine and chemoprophylaxis are two commonly used methods for prevention of influenza. Currently, inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) are available for use with good efficacy. Cough etiquette, use of face masks and hand hygiene are the most important measures to reduce the risk of infection transmission from person to person.     

有限认识儿童H7N9禽流感的危害

流感病毒H7N9亚型自2013年3月在中国上海等地首次报告感染类以来,已经出现2例儿童患者和1例健康携带者。本文简要描述3例儿童的基本情况,结合文献讨论了禽流感病毒的变异,小聚集尚不能确定有人传人传播,H7N9人禽流感感染的防治链与预防措施,还介绍了早期使用达菲及重度阶段应用帕拉米韦等药物的应用方法。     

Treatment with oseltamivir and prone positioning for a 9‐year‐old boy with ARDS caused by pandemic H1N1 2009 influenza

Here we report the case of a 9‐year‐old boy with acute respiratory distress syndrome (ARDS) caused by novel H1N1 swine‐origin influenza virus A. A diagnosis of ARDS caused by a novel influenza A (H1N1) virus was made on the basis of chest X‐ray and computed tomography together with low oxygenation index (OI) and the detection of novel influenza A (H1N1) virus from tracheal secretion samples. Oseltamivir phosphate and prone positioning were effective in the treatment of ARDS in this case. These findings suggest that anti‐viral drugs and prone positioning can play an important role in the improvement of ARDS caused by novel H1N1 swine‐origin influenza virus A.     

儿童甲型H1N1流感12例分析

目的 了解儿童甲型H1N1流感的特点.方法 回顾分析2009年5月1日至2009年7月15日复旦大学附属儿科医院发热门诊及病房诊治的12例甲型H1N1流感的流行特征及临床特点;采取患儿鼻咽拭子标本,冰壶保存立即送上海市疾病预防控制中心,采用实时逆转录核酸扩增聚合酶链反应(RT-PCR)进行甲型H1N1流感病毒核酸检测.结果 12例儿童甲型H1N1流感均为输入性病例,5例患儿有明确的甲型H1N1流感患者密切接触史.12例有发热症状,有咳嗽、流涕、食欲不佳症状的各为7例,1例有喘息症状,所有病例均无呕吐和腹泻.11例能准确表述自身感受的患儿中,均无肌肉酸痛,6例有咽痛,3例有腹痛.2例患儿并发肺炎,其中1例患儿病情危重.1例患儿居家隔离对症治疗,11例患儿住院治疗,均参照中国国家卫生部颁布的<甲型HINI流感诊疗方案(2009年试行版第一版)>进行治疗,其中10例息儿接受奥斯他韦抗病毒治疗,未见明显不良反应,所有患儿均痊愈.结论 儿童甲型H1N1流感的症状主要表现为典型的流感症状,大部分患儿临床过程轻微,及时隔离和治疗预后良好,奥斯他韦抗病毒治疗无明显副作用.儿童甲型H1N1流感的流行特征及临床特点尚需要多地区大样本的研究资料.