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correspondence

Indian Pediatr 2011;48: 989

Clinical Spectrum of Category ‘C’ Swine Flu in Indian Children


Vidushi Mahajan and Suksham Jain

Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, India.
Email: [email protected]
 
 


We read with interest the article by Das, et al. [1]. The article has lucidly elaborated the clinical profile of confirmed swine flu positive cases. However, authors state that the data might not be representative of the cases who were not tested for swine flu [1]. We share our data of children presenting as category ‘C’ cases collected retrospectively from August to December 2009 [2]. Category ‘C’ is defined by the presence of fever and cough/ sore throat and one or more of the following: (1) breathlessness, chest pain, drowsiness, hypotension, hemoptysis, cyanosis; (2) a severe disease as manifested by the red flag signs; and (3) worsening of underlying chronic conditions. These children were therefore tested and treated for swine flu according to MoHFW guidelines [2].

Ours is a tertiary care referral teaching hospital in north India which caters to low-middle income groups. During the outbreak, patients of all age groups with suspected swine flu were treated in a ‘hybrid unit’. A total of 2,335 patients attended the hybrid swine flu OPD services, of which 530 were children. Seventy three (13.7 %) children were categorized as Category ‘C’. Thirty eight (52%) children were between 5–12 years, and 35 (48 %) were <5 years age. History of contact with a confirmed case of swine flu or residence where there are one or more confirmed swine flu cases [2], was present in 18 (25%) of the children. Fever, cough, breathlessness and nasal catarrah/ sore throat were predominant complaints. Nasopharyngeal swabs of all 73 patients were collected by a microbiologist and tested with real-time reverse transcriptase polymerase chain reaction assay. All children received antiviral therapy (oseltamivir) [2]. Of category C children, 27 (37%) were positive for 2009 Novel H1N1-virus. Most common symptoms were fever and cough similar to the study by Das et al [1]. Of all category C children, there were 3 (4.1%) deaths. All 3 children developed acute respiratory distress syndrome and died within 5 days of hospitalization. Two of them had co-morbid conditions-one was a known case of epilepsy but seizure free for past 1 year, and other had pulmonary tuberculosis and was on anti-tubercular therapy under DOTS. All 3 deaths reported by Das, et al. [1] also suffered from underlying chronic diseases.

A high index of suspicion should be kept as the features of swine flu are nonspecific. Underlying co-morbidities might increase chances of death, hence such patients should be closely monitored.

Acknowledgements: Our sincere thanks to Department of Hospital Administration, Government Medical College and Hospital, Chandigarh for assistance in data collection.

References

1. Das RR, Sami A, Lodha R, Jain R, Broor S, Kaushik S, et al. Clinical profile and outcome of swine flu in Indian children. Indian Pediatr. 2011;48:373-8.

2. Ministry of Health and Family Welfare, Government of India. Pandemic Influenza A (H1N1): Clinical Management Protocol and Infection Control Guidelines. Available at http://mohfw-h1n1.nic.in/Guidelines.html. Accessed on 8 June, 2011.
 

 

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