Pandemic A (H1N1) Influenza in Hospitalized Children in Warsaw, Poland

To the Editors: The report by Kumar et al1 on hospitalized children with pandemic influenza prompts us to present our data on pandemic variant A (H1N1) influenza, confirmed with reverse transcription polymerase chain reaction in 100 children (51 boys and 49 girls) with a median age of 5 years and 2 months. Most of them (85%) were diagnosed between November 15 and December 30, 2009; no case was diagnosed after January 2010. All children were admitted to Warsaw hospitals for diagnosis and therapy. Of the 100 children, 48 (48%) children had underlying medical conditions recognized as risk factors for serious influenza infection (Table 1).TABLE 1: Leading Risk FactorsBecause pandemic influenza vaccines were not purchased and registered in Poland, none of our patients had been vaccinated against A (H1N1) influenza. (The Polish Ministry of Health did not decide for central purchase of any of the “pandemic” vaccines, because the experts regarded investigations on safety as insufficient and requested that producers to take responsibility for possible adverse effects. After prolonged negotiations, producers have refused this request.) Ninety-six patients had clinically apparent influenza infection. The leading symptoms were as follows: fever in 89.6%, cough in 70.8%, coryza in 53.1%, sore throat in 34.4%, digestive tract disorders (vomiting, diarrhea, abdominal pain) in 25.0%, malaise (muscle and/or bone pains) in 19.8%, headache in 13.5%, dyspnea in 10.4%, and conjunctivitis in 7.3%. In 20 of the 96 (20.3%) cases, influenza was complicated by pneumonia. Of these, 11 (55%) children had risk factors; 4 of the latter required intensive care and mechanical ventilation for respiratory distress and heart failure. Three children died: 2 with acute lymphoblastic leukemia and 1 with bronchopulmonary dysplasia and congenital heart defect complicated by pulmonary hypertension. In 62 of 100 (62%) children, oseltamivir was administered. In 4 of 100 children with hematologic malignancy, prophylactic oseltamivir treatment was given, and despite the fact that A (H1N1) infection was confirmed by reverse transcription polymerase chain reaction, symptomatic influenza did not develop in these children. In the remaining 58 of 100 (58%) children, oseltamivir was used for treatment and in 25 of 58 (43%) children, antibiotic therapy was also given. In most of these children, 57 of 62 (91%), oseltamivir was well tolerated. The clinical course of A (H1N1) influenza infection was similar to seasonal influenza, as has been reported from the United States and Canada.2–4 Andrzej Radzikowski, MD, PhD Łukasz Dembiński, MD Department of Paediatric Gastroenterology and Nutrition Medical University of Warsaw Public Paediatric Teaching Hospital Ewa Talarek, MD, PhD Department of Children's Infectious Diseases Medical University of Warsaw Hospital of Infectious Diseases Katarzyna Smalisz-Skrzypczyk, MD Department of Paediatrics, Haematology and Oncology Medical University of Warsaw Public Paediatric Teaching Hospital Warsaw, Poland Teresa Jackowska, MD, PhD Clinical Department of Paediatrics Medical Centre for Postgraduate Education Warsaw, Poland Magdalena Marczyńska, MD, PhD Department of Children's Infectious Diseases Medical University of Warsaw Hospital of Infectious Diseases Warsaw, Poland

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