title: 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.
authors.affiliation: Department for Infectious Disease Epidemiology, Respiratory Infections Unit, Robert Koch Institute, Postfach 65 02 61, 13302 Berlin, Germany. altmannm@rki.de
authors.forename: Mathias
authors.initials: M
authors.lastname: Altmann
authors.forename: Lena
authors.initials: L
authors.lastname: Fiebig
authors.forename: Jana
authors.initials: J
authors.lastname: Soyka
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
authors.forename: Manuel
authors.initials: M
authors.lastname: Dehnert
authors.forename: Walter
authors.initials: W
authors.lastname: Haas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D007251:Influenza, Human / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000821:virology; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D058873:Pandemics; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index