Epidemiological characteristics of pregnant females and children with H1N1-infected during the global pandemic in 2009: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Meng ^1,2 ,  TANG Jun ^1,2 , HE Yang ^1,2 , LI Wenxing ^1,2 , YUE Yan ^1,2 , HU Peng ^1,2 , ZENG Yan ^1,2 , XIONG Tao ^1,2 , MU Dezhi ^1,2 ,  LI Youping ³

1. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, P.R.China;
3. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

TANG Jun, Email: tj1234753@sina.com; LI Youping, Email: yzmylab@hotmail.com

Keywords：

H1N1 influenza; Children; Pregnant women; Infant; Epidemiological characteristics; Systematic review

DOI：

10.7507/1672-2531.202002105

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Objective To analyze the clinical data of pregnant females and children infected with H1N1 during the global pandemic in 2009, and summarize the epidemiological characteristics.Methods PubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched to collect studies on H1N1 infection in pregnant females and children during the 2009 pandemic from January 1^st, 2009 to February 17^th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, epidemiological characteristics were descriptively analyzed.Results A total of 33 studies involving 939 children, 5 newborns and 2 416 maternal infections were included. The results showed that the age span of children was 0 to 18, the male-to-female ratio was 1.2:1, and the history of close contact accounts was 18.8% (80/425). The primary symptoms were fever, cough, headache, vomiting and other symptoms in some children. More than half of the children received oseltamivir antiviral treatment (545/807, 67.5%), and 6 died (6/861, 0.7%). The primary symptoms of pregnant females were fever, cough, sore throat, muscle pain, fatigue, headache, diarrhea, and so on. The majority of patients received antiviral therapy (1 571 to 1 783, 88.1%). A total of 178 mortalities (178/2 335, 7.6%), 48 stillbirths (48/966, 5.0%), and 9 live birth mortalities (9/494, 1.8%) were reported. All 5 newborns were positive for RT-PCR detection, including 4 premature infants. The mode of transmission was close contact in 3 cases (including 1 case in contact with sick medical staff), 1 case of vertical transmission from mother to child, and 1 case of unknown. The primary clinical manifestation of newborns was dyspnea. After treatment with oseltamivir, 4 cases were cured and 1 case deceased.Conclusions Pregnant females and children are at high risk of serious complications of H1N1 influenza. H1N1 infection in pregnancy is associated with an increased risk of adverse pregnancy outcomes. The symptoms of H1N1 infection in children and pregnant females are similar to those in adults, primarily respiratory and systemic symptoms. Oseltamivir and zanamivir are effective antiviral drugs.

Citation： ZHANG Meng, TANG Jun, HE Yang, LI Wenxing, YUE Yan, HU Peng, ZENG Yan, XIONG Tao, MU Dezhi, LI Youping. Epidemiological characteristics of pregnant females and children with H1N1-infected during the global pandemic in 2009: a systematic review. Chinese Journal of Evidence-Based Medicine, 2020, 20(6): 661-671. doi: 10.7507/1672-2531.202002105 Copy

1.	Dawood FS, Iuliano AD, Reed C, et al. Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study. Lancet Infect Dis, 2012, 12(9): 687-695.
2.	徐翠玲, 孙闪华, 张彦平, 等. 2009-2010年中国内地甲型H1N1流感确诊病例流行特征分析. 疾病监测, 2011, 26(10): 780-784.
3.	Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 2020, 382(8): 727-733.
4.	WHO. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. Available at: https://www.whoint/dg/speeches/detail.
5.	国家卫生健康委员会. 截至2月16日24时新型冠状病毒肺炎疫情最新情况. Available at: http://www.nhc.gov.cn/xcs/xxgzbd/gzbd_index.shtml.
6.	中华医学会儿科学分会, 中华儿科杂志编辑委员会. 儿童2019新型冠状病毒感染的诊断与防治建议(试行第一版). 中华儿科杂志, 2020, 58(3): 169-174.
7.	Bryant PA, Tebruegge M, Papadakis G, et al. Clinical and microbiologic features associated with novel swine-origin influenza a pandemic 2009 (H1N1) virus in children: a prospective cohort study. Pediatr Infect Dis J, 2010, 29(8): 694-698.
8.	Bettinger JA, Sauvé LJ, Scheifele DW, et al. Pandemic influenza in Canadian children: a summary of hospitalized pediatric cases. Vaccine, 2010, 28(18): 3180-3184.
9.	Miroballi Y, Baird JS, Zackai S, et al. Novel influenza A(H1N1) in a pediatric health care facility in New York City during the first wave of the 2009 pandemic. Arch Pediatr Adolesc Med, 2010, 164(1): 24-30.
10.	Koliou M, Soteriades ES, Toumasi MM, et al. Epidemiological and clinical characteristics of influenza A(H1N1)v infection in children: The first 45 cases in Cyprus, June - August 2009. Euro Surveill, 2009, 14(33): 19312.
11.	Calitri C, Gabiano C, Garazzino S, et al. Clinical features of hospitalised children with 2009 H1N1 influenza virus infection. Eur J Pediatr, 2010, 169(12): 1511-1515.
12.	Sriram P, Kumar M, Renitha R, et al. Clinical profile of swine flu in children at Puducherry. Indian J Pediatr, 2010, 77(10): 1093-1095.
13.	Parakh A, Kumar A, Kumar V, et al. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1): an experience from a tertiary care center in north India. Indian J Pediatr, 2010, 77(9): 981-985.
14.	Saha A, Jha N, Dubey NK, et al. Swine-origin influenza A (H1N1) in Indian children. Ann Trop Paediatr, 2010, 30(1): 51-55.
15.	Hackett S, Hill L, Patel J, et al. Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet, 2009, 374(9690): 605.
16.	沙莉, 曹玲, 陈慧中, 等. 2009甲型H1N1流感住院患儿159例分析. 中华儿科杂志, 2010, 48(8): 575-579.
17.	ANZIC influenza investigators and australasian maternity outcomes surveillance system. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ, 2010, 340: c1279.
18.	Hewagama S, Walker SP, Stuart RL, et al. 2009 H1N1 influenza A and pregnancy outcomes in Victoria, Australia. Clin Infect Dis, 2010, 50(5): 686-690.
19.	Ang LT, Gandhi K, Qin Y. Respiratory failure in pregnant women infected by Swine-Origin influenza A (H1N1). Aust N Z J Obstet Gynaecol, 2010, 50(3): 294-296.
20.	Ribeiro AF, Pellini ACG, Kitagawa BY, et al. Severe influenza A(H1N1)pdm09 in pregnant women and neonatal outcomes, State of Sao Paulo, Brazil, 2009. PLoS One, 2018, 13(3): e0194392.
21.	Jiménez MF, El Beitune P, Salcedo MP, et al. Outcomes for pregnant women infected with the influenza A (H1N1) virus during the 2009 pandemic in Porto Alegre, Brazil. Int J Gynaecol Obstet, 2010, 111(3): 217-219.
22.	Dubar G, Azria E, Tesnière A, et al. French experience of 2009 A/H1N1v influenza in pregnant women. PLoS One, 2010, 5(10): e13112.
23.	Gérardin P, El Amrani R, Cyrille B, et al. Low clinical burden of 2009 pandemic influenza A (H1N1) infection during pregnancy on the island of La Réunion. PLoS One, 2010, 5(5): e10896.
24.	Djibré M, Berkane N, Salengro A, et al. Non-invasive management of acute respiratory distress syndrome related to Influenza A (H1N1) virus pneumonia in a pregnant woman. Intensive Care Med, 2010, 36(2): 373-374.
25.	Kunstyr J, Lips M, Belohlavek J, et al. Spontaneous delivery during veno-venous extracorporeal membrane oxygenation in swine influenza-related acute respiratory failure. Acta Anaesthesiol Scand, 2010, 54(9): 1154-1155.
26.	Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA, 2010, 303(15): 1517-1525.
27.	Centers for Disease Control and Prevention (CDC). Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)--United States, April 2009-August 2010. MMWR Morb Mortal Wkly Rep, 2011, 60(35): 1193-1196.
28.	Creanga AA, Johnson TF, Graitcer SB, et al. Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol, 2010, 115(4): 717-726.
29.	Maraví-Poma E, Martin-Loeches I, Regidor E, et al. Severe 2009 A/H1N1v influenza in pregnant women in Spain. Crit Care Med, 2011, 39(5): 945-951.
30.	Lim ML, Chong CY, Tee WS, et al. Influenza A/H1N1 (2009) infection in pregnancy--an Asian perspective. BJOG, 2010, 117(5): 551-556.
31.	Pramanick A, Rathore S, Peter JV, et al. Pandemic (H1N1) 2009 virus infection during pregnancy in South India. Int J Gynaecol Obstet, 2011, 113(1): 32-35.
32.	Robertson LC, Allen SH, Konamme SP, et al. The successful use of extra-corporeal membrane oxygenation in the management of a pregnant woman with severe H1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome. Int J Obstet Anesth, 2010, 19(4): 443-447.
33.	田丽丽, 石伟先, 崔淑娟, 等. 2009-2010年北京市孕妇甲型H1N1流感流行病学特征. 首都公共卫生, 2011, 5(2): 56-59.
34.	何智辉, 伍国宝, 欧阳琳, 等. 重症孕妇甲流患者治愈1例附文献复习. 中南大学学报(医学版), 2010, 35(5): 534-536.
35.	Squires K, Watkins A, König K. H1N1 influenza in an extremely premature baby with chronic lung disease. Pediatr Pulmonol, 2010, 45(4): 409-410.
36.	Dulyachai W, Makkoch J, Rianthavorn P, et al. Perinatal pandemic (H1N1) 2009 infection, Thailand. Emerg Infect Dis, 2010, 16(2): 343-344.
37.	Sert A, Yazar A, Odabas D, et al. An unusual cause of fever in a neonate: influenza A (H1N1) virus pneumonia. Pediatr Pulmonol, 2010, 45(7): 734-736.
38.	Barak S, Kushnir A, Chulski E, et al. Influenza A/H1N1 virus in very low-birth-weight premature infant: case report. Am J Perinatol, 2010, 27(7): 513-515.
39.	Jajoo M, Gupta R. H1N1 influenza in a preterm neonate. Indian J Pediatr, 2010, 77(9): 1045-1046.
40.	WHO. Pandemic (H1N1) 2009 guidance documents. Available at: http://www.whoint/csr/resources/publications/swineflu/en/indexhtml.
41.	W HO. Transmission dynamics and impact of pandemic influenza A (H1N1) 2009 virus. Wkly Epidemiol Rec, 2010, 84(46): 481-484.
42.	Blachere FM, Lindsley WG, Pearce TA, et al. Measurement of airborne influenza virus in a hospital emergency department. Clin Infect Dis, 2009, 48(4): 438-440.
43.	Boone SA, Gerba CP. The occurrence of influenza A virus on household and day care center fomites. J Infect, 2005, 51(2): 103-109.
44.	Centers for Disease Control and Prevention. Considerations regarding novel H1N1 flu virus in obstetric settings. Available at: http://www.cdc.gov/H1N1flu/guidance/obstetric.htm.

1. Dawood FS, Iuliano AD, Reed C, et al. Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study. Lancet Infect Dis, 2012, 12(9): 687-695.
2. 徐翠玲, 孙闪华, 张彦平, 等. 2009-2010年中国内地甲型H1N1流感确诊病例流行特征分析. 疾病监测, 2011, 26(10): 780-784.
3. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 2020, 382(8): 727-733.
4. WHO. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. Available at: https://www.whoint/dg/speeches/detail.
5. 国家卫生健康委员会. 截至2月16日24时新型冠状病毒肺炎疫情最新情况. Available at: http://www.nhc.gov.cn/xcs/xxgzbd/gzbd_index.shtml.
6. 中华医学会儿科学分会, 中华儿科杂志编辑委员会. 儿童2019新型冠状病毒感染的诊断与防治建议(试行第一版). 中华儿科杂志, 2020, 58(3): 169-174.
7. Bryant PA, Tebruegge M, Papadakis G, et al. Clinical and microbiologic features associated with novel swine-origin influenza a pandemic 2009 (H1N1) virus in children: a prospective cohort study. Pediatr Infect Dis J, 2010, 29(8): 694-698.
8. Bettinger JA, Sauvé LJ, Scheifele DW, et al. Pandemic influenza in Canadian children: a summary of hospitalized pediatric cases. Vaccine, 2010, 28(18): 3180-3184.
9. Miroballi Y, Baird JS, Zackai S, et al. Novel influenza A(H1N1) in a pediatric health care facility in New York City during the first wave of the 2009 pandemic. Arch Pediatr Adolesc Med, 2010, 164(1): 24-30.
10. Koliou M, Soteriades ES, Toumasi MM, et al. Epidemiological and clinical characteristics of influenza A(H1N1)v infection in children: The first 45 cases in Cyprus, June - August 2009. Euro Surveill, 2009, 14(33): 19312.
11. Calitri C, Gabiano C, Garazzino S, et al. Clinical features of hospitalised children with 2009 H1N1 influenza virus infection. Eur J Pediatr, 2010, 169(12): 1511-1515.
12. Sriram P, Kumar M, Renitha R, et al. Clinical profile of swine flu in children at Puducherry. Indian J Pediatr, 2010, 77(10): 1093-1095.
13. Parakh A, Kumar A, Kumar V, et al. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1): an experience from a tertiary care center in north India. Indian J Pediatr, 2010, 77(9): 981-985.
14. Saha A, Jha N, Dubey NK, et al. Swine-origin influenza A (H1N1) in Indian children. Ann Trop Paediatr, 2010, 30(1): 51-55.
15. Hackett S, Hill L, Patel J, et al. Clinical characteristics of paediatric H1N1 admissions in Birmingham, UK. Lancet, 2009, 374(9690): 605.
16. 沙莉, 曹玲, 陈慧中, 等. 2009甲型H1N1流感住院患儿159例分析. 中华儿科杂志, 2010, 48(8): 575-579.
17. ANZIC influenza investigators and australasian maternity outcomes surveillance system. Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study. BMJ, 2010, 340: c1279.
18. Hewagama S, Walker SP, Stuart RL, et al. 2009 H1N1 influenza A and pregnancy outcomes in Victoria, Australia. Clin Infect Dis, 2010, 50(5): 686-690.
19. Ang LT, Gandhi K, Qin Y. Respiratory failure in pregnant women infected by Swine-Origin influenza A (H1N1). Aust N Z J Obstet Gynaecol, 2010, 50(3): 294-296.
20. Ribeiro AF, Pellini ACG, Kitagawa BY, et al. Severe influenza A(H1N1)pdm09 in pregnant women and neonatal outcomes, State of Sao Paulo, Brazil, 2009. PLoS One, 2018, 13(3): e0194392.
21. Jiménez MF, El Beitune P, Salcedo MP, et al. Outcomes for pregnant women infected with the influenza A (H1N1) virus during the 2009 pandemic in Porto Alegre, Brazil. Int J Gynaecol Obstet, 2010, 111(3): 217-219.
22. Dubar G, Azria E, Tesnière A, et al. French experience of 2009 A/H1N1v influenza in pregnant women. PLoS One, 2010, 5(10): e13112.
23. Gérardin P, El Amrani R, Cyrille B, et al. Low clinical burden of 2009 pandemic influenza A (H1N1) infection during pregnancy on the island of La Réunion. PLoS One, 2010, 5(5): e10896.
24. Djibré M, Berkane N, Salengro A, et al. Non-invasive management of acute respiratory distress syndrome related to Influenza A (H1N1) virus pneumonia in a pregnant woman. Intensive Care Med, 2010, 36(2): 373-374.
25. Kunstyr J, Lips M, Belohlavek J, et al. Spontaneous delivery during veno-venous extracorporeal membrane oxygenation in swine influenza-related acute respiratory failure. Acta Anaesthesiol Scand, 2010, 54(9): 1154-1155.
26. Siston AM, Rasmussen SA, Honein MA, et al. Pandemic 2009 influenza A(H1N1) virus illness among pregnant women in the United States. JAMA, 2010, 303(15): 1517-1525.
27. Centers for Disease Control and Prevention (CDC). Maternal and infant outcomes among severely ill pregnant and postpartum women with 2009 pandemic influenza A (H1N1)--United States, April 2009-August 2010. MMWR Morb Mortal Wkly Rep, 2011, 60(35): 1193-1196.
28. Creanga AA, Johnson TF, Graitcer SB, et al. Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women. Obstet Gynecol, 2010, 115(4): 717-726.
29. Maraví-Poma E, Martin-Loeches I, Regidor E, et al. Severe 2009 A/H1N1v influenza in pregnant women in Spain. Crit Care Med, 2011, 39(5): 945-951.
30. Lim ML, Chong CY, Tee WS, et al. Influenza A/H1N1 (2009) infection in pregnancy--an Asian perspective. BJOG, 2010, 117(5): 551-556.
31. Pramanick A, Rathore S, Peter JV, et al. Pandemic (H1N1) 2009 virus infection during pregnancy in South India. Int J Gynaecol Obstet, 2011, 113(1): 32-35.
32. Robertson LC, Allen SH, Konamme SP, et al. The successful use of extra-corporeal membrane oxygenation in the management of a pregnant woman with severe H1N1 2009 influenza complicated by pneumonitis and adult respiratory distress syndrome. Int J Obstet Anesth, 2010, 19(4): 443-447.
33. 田丽丽, 石伟先, 崔淑娟, 等. 2009-2010年北京市孕妇甲型H1N1流感流行病学特征. 首都公共卫生, 2011, 5(2): 56-59.
34. 何智辉, 伍国宝, 欧阳琳, 等. 重症孕妇甲流患者治愈1例附文献复习. 中南大学学报(医学版), 2010, 35(5): 534-536.
35. Squires K, Watkins A, König K. H1N1 influenza in an extremely premature baby with chronic lung disease. Pediatr Pulmonol, 2010, 45(4): 409-410.
36. Dulyachai W, Makkoch J, Rianthavorn P, et al. Perinatal pandemic (H1N1) 2009 infection, Thailand. Emerg Infect Dis, 2010, 16(2): 343-344.
37. Sert A, Yazar A, Odabas D, et al. An unusual cause of fever in a neonate: influenza A (H1N1) virus pneumonia. Pediatr Pulmonol, 2010, 45(7): 734-736.
38. Barak S, Kushnir A, Chulski E, et al. Influenza A/H1N1 virus in very low-birth-weight premature infant: case report. Am J Perinatol, 2010, 27(7): 513-515.
39. Jajoo M, Gupta R. H1N1 influenza in a preterm neonate. Indian J Pediatr, 2010, 77(9): 1045-1046.
40. WHO. Pandemic (H1N1) 2009 guidance documents. Available at: http://www.whoint/csr/resources/publications/swineflu/en/indexhtml.
41. W HO. Transmission dynamics and impact of pandemic influenza A (H1N1) 2009 virus. Wkly Epidemiol Rec, 2010, 84(46): 481-484.
42. Blachere FM, Lindsley WG, Pearce TA, et al. Measurement of airborne influenza virus in a hospital emergency department. Clin Infect Dis, 2009, 48(4): 438-440.
43. Boone SA, Gerba CP. The occurrence of influenza A virus on household and day care center fomites. J Infect, 2005, 51(2): 103-109.
44. Centers for Disease Control and Prevention. Considerations regarding novel H1N1 flu virus in obstetric settings. Available at: http://www.cdc.gov/H1N1flu/guidance/obstetric.htm.

Chinese Journal of Evidence-Based Medicine

Epidemiological characteristics of pregnant females and children with H1N1-infected during the global pandemic in 2009: a systematic review

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