Severe cases of pandemic (H1N1) 2009 in children, Germany

Abstract

In a hospital-based observational study in Germany, we investigated children admitted to pediatric intensive care units and deaths caused by confirmed pandemic (H1N1) 2009 to identify risk factors and outcomes in critically ill children. Ninety-three children were eligible for our study, including 9 with hospital-acquired infections. Seventy-five percent had underlying chronic medical conditions; neurodevelopmental disorders were most prevalent (57%). The proportion of patients having ≥1 risk factor increased with age in years (odds ratio 1.21, p = 0.007). Of 15 deaths, 11 occurred in a pediatric intensive care unit (case-fatality rate 12%, 95% confidence interval 6%-21%). Only 9% of the children had been vaccinated against pandemic (H1N1) 2009; all survived. Our results stress the role of underlying risk factors, especially neurodevelopmental disorders, and the need for improving preventive measures to reduce severe disease and adverse outcomes of pandemic (H1N1) 2009 in children.

Figure 1

Overview of study participation and participant groups among children with severe pandemic (H1N1) 2009, Germany, 2009–2010. PICU, pediatric intensive care unit.

Figure 2

Date of symptom onset for 86 children with severe pandemic (H1N1) 2009, Germany, September 21, 2009–February 22, 2010. Only children with available information are included.

Figure 3

Age distribution of 93 children with severe pandemic (H1N1) 2009, Germany, 2009–2010.

Figure 4

Age group distribution of 89 children with severe pandemic (H1N1) 2009, by number of underlying chronic medical conditions (risk factors), Germany, 2009–2010. Only children with available information are listed. Risk factors are chronic respiratory diseases, cardiac diseases, immunodeficiency, and neurodevelopmental disorders.