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Volume 17, Number 11—November 2011

CME ACTIVITY

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)

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Table 2

Comparisons by cause of death among patients <20 years of age, Japan, May 2009–March 2010*

Characteristic Unexpected CPA, n = 15† Encephalopathy, n = 15† Respiratory failure, n = 6† p value
Median age, mo (range) 43 (7–164) 62 (17–200) 78 (45–206) 0.053
Male sex, no. (%) patients
9 (60)
10 (67)
2 (33)
NS
Preexisting condition, no. (%) patients
Any 1 (7)‡ 5 (33) 5 (83)§ <0.05
Respiratory disorders 0‡ 3 (20) 4 (67)§ <0.05
Neurologic disorders 1 (7)‡ 3 (20) 5 (83)§ <0.05
Previous history of febrile seizures
2 (13)
3 (20)
0
NS
Days from influenza onset to life-threatening event (range) 1 (0–9) 1 (0–2) 1 (0–9) NS
Days from influenza onset to death (range)
1 (0–9)
3 (0–45)
1.5 (1–11)
<0.05¶
Clinical signs, no. (%) patients
Cough 5 (36), n = 14 11 (73) 3 (50) NS
Rhinorrhea 4 (29), n = 14 7 (47) 1 (17) NS
Tachypnea or dyspnea 1 (7), n = 14 4 (27) 3 (50) NS
Wheezing 1 (7), n = 14 1 (7) 2 (33) NS
Vomiting or diarrhea
2 (14), n = 14
5 (33)
0
NS
Drugs received before life-threatening event, no. (%) patients
Oseltamivir 7 (47) 6 (40) 5 (83) NS
Zanamivir 1 (7) 2 (13) 2 (33) NS
Acetaminophen
3 (30), n = 10
7 (50), n = 14
2 (40), n = 5
NS
Leukocyte count, cells/μL, median (range) 6,600 (4,200–11,100), n = 11 9,350 (3,100–28,730), n = 14 10,500 (8,650–101,200), n = 5 NS
Platelet count, × 104 cells/μL, median (range) 20.5 (11.4–45.8), n = 11 15.1 (6.2–32.2) 11.5 (8.4–49.0), n = 5 NS
Aspartate aminotransferase, IU/L, median (range) 248 (55–1,981), n = 12 233 (18–1,760) 52 (34–73), n = 4 0.060
Alanine transaminase, IU/L, median (range) 157 (32–845), n = 12 70 (9–1,058) 26 (16–57), n = 4 <0.05¶
Lactate dehydrogenase, IU/L, median (range) 704 (215–4,801), n = 12 899 (160–3,610), n = 14 535 (222–1,022), n = 4 NS
Creatine kinase, IU/L, median (range) 302 (136–10,612), n = 12 190 (63–1,026), n = 14 64 (16–211), n = 4 <0.01#
Blood urea nitrogen, mg/dL, median (range) 11.2 (7.0–31.0), n = 12 22.5 (11.7–40.0), n = 14 10.0 (4.0–15.0), n = 4 <0.01**
Creatinine, mg/dL, median (range) 0.65 (0.17–1.40), n = 12 1.01 (0.62–1.39) 0.25 (0.08–1.00), n = 4 <0.05**

*CPA, cardiopulmonary arrest; NS, not significant.
†n is for all values unless indicated otherwise.
‡Percentage significantly lower than for the other groups.
§Percentage significantly higher than for the other groups.
¶p<0.05 unexpected CPA vs. encephalopathy.
#p<0.05 unexpected CPA vs. respiratory failure.
**p<0.01 unexpected CPA vs. encephalopathy; p<0.05 respiratory failure vs. encephalopathy.

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