title: Epidemiology and clinical characteristics of pandemic (H1N1) 2009 influenza infection in pediatric hemato-oncology and hematopoietic stem cell transplantation patients.
abstract: BACKGROUND
  For children with hemato-oncologic diseases, especially after hematopoietic stem cell transplantation (HSCT), the risk for developing complications related to pandemic influenza A (H1N1) 2009 (pH1N1) infection is largely unknown.
  
  
  METHODS
  A retrospective chart study was performed of pH1N1 cases diagnosed between October 2009 to January 2010 in the hemato-oncologic unit of the University Children's Hospital of Düsseldorf, Germany.
  
  
  RESULTS
  In total, 21 children were diagnosed with laboratory-confirmed pH1N1; in 16 patients with malignancies (acute leukemia 7, lymphoma 4, solid tumors 2, others 3) and in 5 with benign hematologic disorders. Five patients had undergone prior HSCT, although 1 patient was diagnosed during conditioning therapy with high-dose chemotherapy in preparation for haploidentical HSCT. Most frequent symptoms were fever (>38.5°C) and cough (in 100%), and rhinorrhea (57%). The 2 patients acquiring pH1N1 infection under high-dose or intensive chemotherapy did not require intensive care or mechanical ventilation, and both recovered under antiviral therapy. Oseltamivir was administered to 11 patients; in 1 patient, therapy was switched, on a compassionate-use basis, to intravenous zanamivir because of lack of clinical improvement after oseltamivir therapy. Complications were hospitalization (19%), demand of oxygen supplementation, delay/interruption of antineoplastic therapy, and prolonged administration of antibiotics and antipyretics.
  
  
  CONCLUSIONS
  In the investigated patient population, pH1N1 was mild in most cases, but was associated with substantial morbidity in a proportion of patients and led to interruption and delay in anticancer treatment.
authors.affiliation: Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany. florian.babor@med.uni-duesseldorf.de
authors.forename: F
authors.initials: F
authors.lastname: Babor
authors.forename: S
authors.initials: S
authors.lastname: Grund
authors.forename: M
authors.initials: M
authors.lastname: Siepermann
authors.forename: P T
authors.initials: PT
authors.lastname: Oommen
authors.forename: M
authors.initials: M
authors.lastname: Kuhlen
authors.forename: F R
authors.initials: FR
authors.lastname: Schuster
authors.forename: H-J
authors.initials: HJ
authors.lastname: Laws
authors.forename: R
authors.initials: R
authors.lastname: Wessalowski
authors.forename: K
authors.initials: K
authors.lastname: Bienemann
authors.forename: G
authors.initials: G
authors.lastname: Janßen
authors.forename: O
authors.initials: O
authors.lastname: Adams
authors.forename: A
authors.initials: A
authors.lastname: Borkhardt
authors.forename: R
authors.initials: R
authors.lastname: Meisel
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000188:drug therapy / Q000821:virology*; D008297:Male; D009369:Neoplasms / Q000150:complications*; D053139:Oseltamivir / Q000627:therapeutic use; D058873:Pandemics; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D053139:Oseltamivir