Influenza A(H1N1) -- what does it mean for child and adolescent health?
In late April 2009, WHO received reports of sustained person-to-person infections with a new influenza A (H1N1) virus in the Americas. There are now confirmed cases of the virus in all but one of WHO's regions. Cases of human infection with the new influenza A(H1N1) virus have mostly occurred in children and young adults.
The most common form of disease observed is mild upper respiratory tract illness, and the most severe cases have progressed to pneumonia. Unlike seasonal influenza, many A(H1N1) patients have experienced gastrointestinal symptoms, such as diarrhoea.
In response to the urgent need expressed by countries, on 21 May 2009, WHO published initial guidance on the clinical management of human infection with new influenza A (H1N1) virus, following consultation with experts and examination of the available evidence. The guidance includes the following information of particular relevance to children and adolescents:
- Clinicians and caregivers should watch for signs of possible clinical deterioration (for example, difficulty in breathing, chest pain, coughing up coloured sputum, altered level of consciousness and confusion) and refer such patients immediately to hospital;
- The WHO recommendations for pneumonia advise oxygen therapy to maintain oxygen saturations above 90%; however, this threshold may be increased to 92–95% in some clinical situations, for example during pregnancy;
- Patients with severe hypoxaemia need high flow oxygen -- 1-2 litres per minute delivered by nasal catheter for children, 10 litres per minute delivered by face mask for adolescents and adults. Oxygen treatment of newborn infants should follow guidelines. WHO has included oxygen in its List of Essential Medicines since 1979, but unfortunately oxygen is still not widely available in some countries;
- When pneumonia is present, treatment with antibiotics should generally follow recommendations from published evidence-based guidelines for community-acquired pneumonia;
- Salicylates (such as aspirin and aspirin-containing products) should not be used in children and adolescents (aged <18 years) because of the risk of Reye’s syndrome;
- Pregnant women with suspected or confirmed new influenza A(H1N1) infections warrant closer observation and, if in accordance with national policies, treatment with antivirals; and
- Oseltamivir is indicated for treatment of patients one year of age and older.
There are also a number of questions and answers on the WHO web site related to new influenza A(H1N1), including one on breastfeeding.
Clinical management of human infection with new influenza A(H1N1) virus: initial guidance
Influenza A(H1N1) patient care checklist
- Frequently Asked Questions, including on breastfeeding and new influenza A(H1N1)
- Oxygen therapy for acute respiratory infections in young children in developing countries