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Volume 17, Number 11—November 2011

CME ACTIVITY - Research

Deaths Associated with Pandemic (H1N1) 2009 among Children, Japan, 2009–2010

Akihisa OkumuraComments to Author , Satoshi Nakagawa, Hisashi Kawashima, Takashi Muguruma, Osamu Saito, Jun-ichi Fujimoto, Chiaki Toida, Shuji Kuga, Toshihiro Imamura, Toshiaki Shimizu, Naomi Kondo, and Tsuneo Morishima
Author affiliations: Juntendo University Faculty of Medicine, Tokyo, Japan (A. Okumura, T. Shimizu); National Center for Child Health and Development, Tokyo (S. Nakagawa, T. Muguruma, O. Saito, J. Fujimoto, C. Toida, S. Kuga, T. Imamura); Tokyo Medical University, Tokyo (H. Kawashima); Gifu University Graduate School of Medicine, Gifu, Japan (N. Kondo); Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan (T. Morishima)

Main Article

Table 1

Causes of death for 41 patients <20 years of age with pandemic (H1N1) 2009, Japan, May 2009–March 2010

Cause
Definition
Unexpected cardiopulmonary arrest Cardiopulmonary arrest without clear findings of respiratory failure, cardiomyopathy, or encephalopathy
Respiratory failure Desaturation, need for oxygen supplementation or mechanical ventilation or both, associated with radiologic findings of pneumonia or acute lung injury
Myocarditis Markedly reduced cardiac output, severe and refractory arrhythmia, or severe circulatory collapse
Viral sepsis Refractory hypotension and rapidly progressing multiorgan failure associated with at least 2 of the following: tachypnea; leukopenia <4000 cells/μL or leukocytosis >12,000 cells/μL; tachycardia; body temperature >38.0°C or <36.0°C; cold extremities; and increased capillary refill time
Encephalopathy At least 1 of the following: altered mental state without profound respiratory and cardiac failure or neuroimaging findings consistent with encephalopathy such as marked brain edema, focal lesions, and blurred gray-white matter junction
Incidental Other findings that are not directly attributable to influenza infection

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