Similar findings have been reported in a number of other countries. In the UK, a study of influenza deaths in 2009 10 by Public Health England found that children with co morbidities had a higher case fatality rate when infected with 2009 pdmH1N1 compared to seasonal influenza. worldwide distributors In our study, two thirds of 2009 pdmH1N1 patients who died had significant co morbidities, in keeping with UK national data. At the start of the pandemic in August 2009, it was predicted that 3. 8% of hospitalised 2009 pdmH1N1 patients under 15 yrs in the UK would require PICU admission. Data published subsequently on the first 2009 pdmH1N1 wave showed that 7. 7% of infected patients in Birmingham, Inhibitors,Modulators,Libraries UK, 4. 8% in Turin, Italy and 19% in Buenos Aires, Argentina required PICU admission.

Mortality rate amongst those with 2009 pdmH1N1 infection in the Argentinean study was 5%, with the majority occurring in patients under 1 year. In contrast, this group in our study had a 2. 7% mortality rate, with overall mortality of 7. 3% for all 2009 pdmH1N1 admissions. In our institution, Inhibitors,Modulators,Libraries 29% of patients in whom 2009 pdmH1N1 was detected required PICU admission, with median length of stay of 5. 5 days. This very high rate may reflect the direct transfer of 2009 pdmH1N1 infected patients into our PICU from other hospitals, as it is a large regional centre. Inhibitors,Modulators,Libraries However, this would not account for all of the variation. other causes could include the high number of children Inhibitors,Modulators,Libraries with complex medical needs who are under the care of the hospital, a shortfall in HDU beds associated with the 2009 pdmH1N1 pandemic leading to direct PICU admission, or improved virological surveillance of PICU patients leading to a 2009 pdmH1N1 diagnosis.

In our study, Adenovirus was the most common organism found in co infections. however, co infection rates in our study were very low compared Inhibitors,Modulators,Libraries with international data. This disparity with other studies is likely due in large part to social, environmental and climatic differences between countries. Recent studies have found adenovirus and bocavirus particularly common in co infections. Both these viruses persist in respiratory secretions for weeks to months, so it is difficult to ascertain whether the presence of these pathogens is due to acute infection or viral persistence within the respiratory tract. We did not find a convincing link between presence of viral co infection and severity of illness.

In fact, PCR negative patients had the highest rates of PICU admission, suggesting that these patients had bacterial rather than viral illnesses. There appears to be no current consensus on whether viral co infection is associated with disease severity. Of those with ARI following surgery, Ixazomib Ki a comparable proportion to those who attended with suspected ARI were classified as severe.