Fatal Cases of Influenza A in Childhood 英文参考文献.docVIP

FatalCasesofInfluenzaAinChildhood BenjaminF.Johnson1,2,LouiseE.Wilson3,JoannaEllis1,AlexJ.Elliot4¤,WendyS.Barclay2,RichardG. Pebody1,JimMcMenamin3,DouglasM.Fleming4,MariaC.Zambon1* 1Centrefor Infections,HealthProtectionAgency,London,UnitedKingdom, 2DepartmentofVirology,Faculty ofMedicine,ImperialCollegeLondon, London,United Kingdom, 3Health Protection Scotland, Glasgow, United Kingdom, 4Royal College of General Practitioners Research and Surveillance Centre, Birmingham, United Kingdom Abstract Background:Inthenorthernhemispherewinterof2003–04antigenicvariantstrains(A/Fujian/411/02–like)ofinfluenzaA H3N2 emerged. Circulation of these strains in the UK was accompanied by an unusually high number of laboratory confirmedinfluenzaassociatedfatalitiesinchildren.Thisstudywascarriedouttobetterunderstandriskfactorsassociated withfatalcasesofinfluenzainchildren. Methodology/Principal Findings: Case histories, autopsy reports and death registration certificates for seventeen fatal casesoflaboratoryconfirmedinfluenzainchildrenwereanalyzed.Nonehadarecognizedpre-existingriskfactorforsevere influenza andnonehadbeenvaccinated. Threecases hadevidenceof significantbacterialco-infection. Influenza strains recovered from fatal cases were antigenically similar to those circulating in the community. A comparison of protective antibody titres in age stratified cohort sera taken before and after winter 2003–04 showed that young children had the highest attack rate during this season (21% difference, 95% confidence interval from 0.09 to 0.33, p=0.0009). Clinical incidences of influenza-like illness (ILI) in young age groups were shown to be highest only in the years when novel antigenicdriftvariantsemerged. Conclusions/Significance:ThisworkpresentsarareinsightintofatalinfluenzaH3N2inhealthychildren.Itconfirmsthat circulatingseasonalinfluenzaAH3N2strainscancauseseverediseaseanddeathinchildrenintheapparentabsenceof associatedbacterialinfectionorpredisposingriskfactors.Thisaddstoth