title: Complications and factors associated with severity of influenza in hospitalized children and adults during the pandemic wave of A(H1N1)pdm2009 infections--the Fluco French cohort.
abstract: BACKGROUND
  The emergence of novel A(H1N1)pdm2009 virus threatened to lead to frequent severe manifestations.
  
  
  OBJECTIVE
  To describe the clinical, virological, and biological characteristics of the disease and identify the factors associated with severe presentations.
  
  
  METHODS
  This prospective multicenter study recruited consecutive hospitalized patients with confirmed A(H1N1)pdm2009 disease. Clinical, virological and biological assessments were carried out at inclusion and 30 days post-inclusion. Disease manifestations were assessed by an adjudication committee using pre-identified definitions of complications and severity scores.
  
  
  RESULTS
  The study analyzed from November 30th, 2009 to February 8th, 2010, 40 hospitalized patients, 21 children and 19 adults. Eighteen (45%) were considered to have severe presentations. Except age, main characteristics in children and adults did not differ. The majority (18/21) of children and all adults had a respiratory presentation; extra-respiratory manifestations tended to be more frequent in children (12 vs. 6, P=0.10). Two children against 5 adults presented acute respiratory distress syndrome (ARDS, P=0.23), but more children suffered respiratory failure (7 vs. 1, P=0.046) without ARDS. At day 30, one death had occurred in each group. The main factor associated with non-severe presentation was an early (<48 h) implementation of oseltamivir treatment (P=0.038).
  
  
  CONCLUSIONS
  Although the study failed to achieve its main objective, due mainly to the difficulty of carrying a study of this nature in the midst of a pandemic, it allowed the description of a panel of unusual and complicated forms and confirmed the added value of early oseltamivir treatment in limiting severity in hospitalized children and adults.
authors.affiliation: Urgences et Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Bd Pinel, 69677 Bron Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Ploin
authors.forename: C
authors.initials: C
authors.lastname: Chidiac
authors.forename: F
authors.initials: F
authors.lastname: Carrat
authors.forename: B
authors.initials: B
authors.lastname: Cohen
authors.forename: E
authors.initials: E
authors.lastname: Javouhey
authors.forename: C
authors.initials: C
authors.lastname: Mayaud
authors.forename: J-C
authors.initials: JC
authors.lastname: Desenclos
authors.forename: B
authors.initials: B
authors.lastname: Lina
authors.forename: C
authors.initials: C
authors.lastname: Leport
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005602:France; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology* / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir
keywords: A(H1N1)pdm2009 virus; Complication; Influenza; Pandemic; Severity