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Influenza A/H1N1 in Pediatric Oncology Patients

Dotan, Amit MD; Ben-Shimol, Shalom MD; Fruchtman, Yariv MD; Avni-Shemer, Yonat PhD; Kapelushnik, Joseph MD; Ben-Harush, Miri MD; Givon-Lavi, Noga PhD; Leibovitz, Eugene MD; Greenberg, David MD

Journal of Pediatric Hematology/Oncology:
doi: 10.1097/MPH.0000000000000043
Online Articles: Original Articles

Background: Our aim was to determine the clinical and epidemiological features of pandemic influenza A/H1N1 in immunocompromised children with solid tumors and hematological malignancies.

Patients and Methods: A prospective study was conducted during the H1N1 pandemic between August 2009 and February 2010 in a pediatric hematology-oncology unit. Demographic and clinical data were obtained from all children with suspected H1N1 infection (high fever with or without respiratory symptoms). Laboratory diagnosis of influenza A/H1N1 was performed by means of polymerase chain reaction analysis of nasopharyngeal wash specimens.

Results: We identified 57 episodes of suspected influenza A/H1N1 infection in 40 children. In all episodes, children were treated with oseltamivir and antibiotics until influenza A/H1N1 results were received. Of all episodes, 13 (22.8%) tested positive for influenza A/H1N1. Two of the H1N1-positive children (15.4%) had been previously immunized against influenza A/H1N1. No differences between H1N1-positive and H1N1-negative children were noted in terms of demographic features, clinical presentation, laboratory findings, and underlying disease.

Three polymerase chain reaction-positive (23.0%) children and 1 H1N1-negative (2.3%) child were admitted to the pediatric intensive care unit and were mechanically ventilated (P=0.03). One (7.7%) H1N1-positive patient died versus none of the H1N1-negative patients (P=0.2). The condition of all other children in both the groups improved rapidly during hospitalization.

Conclusions: Febrile hospitalized pediatric oncology patients, with and without pandemic influenza A/H1N1, had a similar demographic and clinical presentation with a relatively good outcome. This was probably because of early antiviral treatment and possibly because of the relatively low virulence of the virus. Immunization should be encouraged in these patients.

Author Information

*Pediatric Hemato-Oncology Unit

Pediatric Infectious Diseases Unit

Viral Clinical Laboratory, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

The authors declare no conflict of interest.

Reprints: David Greenberg, MD, The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, 84101, Israel (e-mail:

Received June 17, 2013

Accepted August 29, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.