台灣中部區域型教學醫院小兒科H1N1新型流感住院病例分析

The Clinical Features and Fever Related Factors of Hospitalized Pediatric Patients with Novel Influenza A (H1N1) Virus in a Regional Hospital in Middle Taiwan

疾病管制局於2009年6月發佈台灣第一個實驗室診斷確認的新型H1N1病例，A型流行性感冒病毒 (H1N1)逐漸造成台灣島內全面的大流行；本文回顧本院109位小兒科新型H1N1非重症住院個案的病歷（自2009年8月19日到2009年12月28日），所有病人皆在流行性感冒病毒A型+B型快速診斷檢查確定陽性後入院；百分之十五個案的最高額溫未超過攝氏38度，百分之八十四個案的淋巴球比例低於25％，百分之九十五個案的單核球比例高於6％，百分之九十個案的嗜酸性白血球比例低於3％；百分之十七的個案接受黴漿菌抗體試驗，其中的百分之六十一高於正常值；百分之七十三的個案胸部X光檢查報告為異常；所有的病人皆接受抗病毒藥oseltamivir治療，其中的百分之九十七在發燒開始的三天內開始服用；第一天就開始服用oseltamivir的個案平均發燒持續時間是4.37天，第二天開始服用個案的平均發燒時間是5.22天，第三天後才開始服用的個案平均發燒時間6.06天；百分之三十五個案接受抗生素治療，平均發燒天數顯著比未接受抗生素治個案長；最高額溫是唯一和服用oseltamivir後發燒持續時間有正相關的因子。大多數新型H1N1非重症的小兒科個案表現淋巴球減少、嗜酸性白血球減少、單核球增加及胸部X光報告異常；因高達百分之十五個案的最高額溫未超過攝氏38，因此最高額溫未超過38度不應做為不篩檢的決定因素；本研究個案越早服用oseltamivir，發燒持續時間越短。

Background: Since the Communicable Disease Center reported the first aboratory-confirmed case of novel H1N1 in June 2009, there has been a nation-wide pandemic of influenza A (H1N1) virus infection in Taiwan. In this paper we describe the clinical characteristics of non-severe novel H1N1-infected pediatric patients and analyze factors related to the course of their illnesses. Patients and methods: Between August 19 and December 28, 2009, we admitted 109 non-severe novel H1N1-infected pediatric patients confirmed by the Influenza (A+B) Antigen test. By reviewing medical charts, we collected data from the onset of illness until afebrile status for these 109 pediatric inpatients was achieved. Results: Of the 109 patients, 15% had a highest forehead temperature less than 38.0°C. Eighty four percent of the patients had less than 25% lymphocytes and 95% had over 6% monocytes. Ninety percent had less than 3% eosinophils. Seventeen percent received a Mycoplasma antibody test and in 61% of these it was higher than normal. Seventy three percent had an abnormal chest x-ray. All patients were treated with oseltamivir; 97% within the first 3 days after onset of fever. The average duration of fever was 4.37 days if oseltamivir was given on the first day of fever, 5.22 days if given on the second day, and 6.06 days if given on and after the third day. Thirty five percent were treated with antibiotics, but the duration of fever of treated patients was significantly longer than that of untreated patients. The highest forehead temperature was the only factor significantly associated with the duration of fever after oseltamivir treatment. Conclusions: Most non-severe novel H1N1-infected pediatric patients presented with lymphocytopenia, eosinopenia, monocytosis, and abnormal chest x-ray findings. Fever less than 38°C could not be a deciding factor in screening for novel H1N1. Whether or not patients were treated with antibiotics, the earlier oseltamivir was administered, the shorter was the duration of fever during the illness.