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. 2014 Jul;21(7):709-15.
doi: 10.1016/j.arcped.2014.04.017. Epub 2014 Jun 16.

[Viral epidemiology and clinical severity during the peak of the influenza A(H1N1) variant epidemic in febrile respiratory diseases of children]

[Article in French]
V Feret  1 , J Naud  2 , J Harambat  2 , L Malato  3 , H Fleury  3 , M Fayon  4
Affiliations

[Viral epidemiology and clinical severity during the peak of the influenza A(H1N1) variant epidemic in febrile respiratory diseases of children]

[Article in French]
V Feret et al. Arch Pediatr. 2014 Jul.

Abstract
in English, French

In 2009, a new emerging flu virus, A(H1N1), was identified. Its true medical impact on children's health remains widely debated.

Aim: To define the prevalence of respiratory disease in children hospitalized with fever during the influenza A(H1N1) epidemic and to determine the clinical, paraclinical, and outcome characteristics according to the viruses identified.

Material and methods: Children hospitalized for a febrile respiratory disease were included in this prospective cohort study conducted at Bordeaux University's Children's Hospital (France) during the influenza epidemic from 2009/11/23 to 2009/12/20.

Results: Seventy-three children were included in the study. Viruses were identified by PCR in 52% (38/73) of cases, including 23% (17/73) A(H1N1) virus and 29% (21/73) other viruses, 22% (16/73) of which were syncytial respiratory viruses. There was only one case of co-infection between A(H1N1) virus and another virus from the para-influenza virus or adenovirus or bocavirus pool. No significant difference regarding age, sex, or risk factors in the different viral groups was noted. Regarding the A(H1N1) virus, the most frequent symptoms were deterioration of the overall health status, cough, ENT disease, and rapid breathing, with significantly less increased breathing effort and auscultatory abnormality albeit with more seizures. There was no significant difference between groups regarding laboratory data. Management and outcome were similar.

Conclusion: The prevalence of A(H1N1) virus during the 2009 epidemic in Aquitaine was low among febrile hospitalized children with breathing symptoms. Clinical and paraclinical signs were non-specific. The tolerance and prognosis of influenza A(H1N1) infection in children was satisfactory.

En mars 2009, un nouveau virus a fait émergence, le virus Influenzae A(H1N1) variant. Nous avons voulu en étudier la répercussion médicale.

Objectifs: Définir la prévalence virale dans les atteintes respiratoires fébriles hospitalisées de l’enfant en période d’épidémie grippale A(H1N1) variant et déterminer les caractéristiques cliniques, paracliniques et évolutives liées aux virus identifiés.

Méthodes: Il s’est agi d’une étude épidémiologique, prospective, monocentrique menée à l’hôpital des Enfants du centre hospitalier universitaire de Bordeaux (Aquitaine, France) pendant l’épidémie grippale du 23 novembre au 20 décembre 2009 inclus. Tous les enfants hospitalisés pour atteinte respiratoire fébrile ont été inclus.

Résultats: Soixante-treize enfants ont été inclus. Une identification virale a été possible dans 52 % des cas, incluant 23 % de A(H1N1) variant [A(H1N1)v] et 29 % d’autres identifications dont 22 % de virus respiratoires syncitiaux. Une seule co-infection a été observée entre le virus [A(H1N1)v] et un pool viral (adénovirus ou virus para-influenzae ou bocavirus). Il n’existait pas de différence significative concernant l’âge, le sexe ou les facteurs de risque de gravité en fonction des virus identifiés. Concernant le virus [A(H1N1)v], les symptômes les plus fréquents étaient l’altération de l’état général, la toux, les atteintes oto-rhino-laryngologiques et les anomalies de la fréquence respiratoire, avec significativement moins de signes de lutte et d’anomalie auscultatoire mais plus de convulsions. Sur le plan paraclinique, il n’y avait pas de différence significative entre les groupes. Évolution et prise en charge ont été comparables.

Conclusion: Une faible prédominance du virus [A(H1N1)v] a été notée pendant l’épidémie grippale en Aquitaine dans les atteintes respiratoires fébriles justifiant une hospitalisation. Les caractéristiques cliniques, paracliniques et évolutives étaient peu spécifiques. L’ensemble de ces éléments n’a pas révélé de gravité particulière liée au virus [A(H1N1)v].

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Figures

Figure 1
Figure 1
Proportion des différents virus observés pendant l’hiver 2009 chez les enfants hospitalisés pour atteinte respiratoire fébrile à Bordeaux. A(H1N1) : virus influenza A(H1N1) variant ; VRS : virus respiratoire syncytial ; RV : rhinovirus ; MPV : métapneumovirus ; ADV : adénovirus ; Pool 1 : ADV ; virus para-influenza ou bocavirus ; Aucun : aucune identification virale.
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