Clinical Profile of Swine Flu in Children at Puducherry

The 2009 swine flu pandemic is a global outbreak of novel H1N1 strain and was first recognized in the state of Veracruz, at the border between Mexico and United states in April 2009, and during a short span of two months became the first pandemic of the 21st century. This outbreak involved more than 170 countries spread over all the continents with more than one lakh affected people [5]. The reason for the rapidity of spread is because many people have mild symptoms and never seek treatment and those who get treatment don’t officially get tested and many times it is only the hospitalized patients who get tested [6].

In India, the first case reported was from pune and the pandemic has spread quite rapidly with more than 2,000 confirmed cases equally affecting both sexes with 25 deaths in the initial phase of the epidemic itself. Children and Young adults were commonly affected and nearly 40% of those affected have been children less than 14 yrs [7].

Swine flu is transmitted by droplets or fomites and the incubation period is 2 to 7 days. Most of them present with mild symptoms in the form of fever, cough, sore throat, headache, joint pain and myalgia [8]. A feature seen more frequently with swine flu origin influenza is gastrointestinal symptoms with, almost one fourth of them presenting with vomiting and diarrhea. Unusual symptoms reported are conjunctivitis, parotitis, and hemophagocytic syndrome [9].

Less than 10% of Children present with severe manifestations in the form of pneumonia and respiratory failure and need hospitalization [10]. Patients at risk of developing severe disease include age less than 5 years, chronic systemic illness, on steroids or immunosuppressive therapy. Children younger than 2 years have the highest complication rates. Antiviral drugs effective against H1N1 virus include oseltamivir and Zamanavir and with good supportive care the case fatality is less than 1% [11, 12].

The preventive measures include: social distancing, prevention of the spread of infection in schools, practicing respiratory etiquette, use of facial masks, hand hygiene and use of chemoprophylaxis with antiviral drugs [13, 14]

In our hospital, 18.6% of the total cases screened were children and majority of them presented with mild symptoms and 6.3% with severe symptoms requiring hospitalization. The number of suspected cases given oseltmavir was 69.6% and most of them had B2 symptoms. Sixteen of the nineteen cases, that were tested, were indigenous cases. The most important source of infection is at schools, public places and gatherings. Throat swab was taken in 79.7% of suspected cases which yielded positivity in 30.2%. So, most children with flu symptoms do not need a test for pandemic H1N1/09 especially since the test results do not affect the recommended course of treatment [15, 16]. There were no deaths in children with confirmed H1N1 infection in our hospital. This was quite contrary to pattern present in other parts of the country where the percentage of positive cases and deaths were more in children and young adults.