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.