1136. Viral Dynamics in Children Hospitalized with Influenza Infection
Session: Poster Abstract Session: Influenza and H1N1 Diagnosis, Epidemiology, and Viral Outcome
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Children with influenza infection typically develop respiratory symptoms. Novel 2009 influenza/A (nH1N1) has been associated with respiratory and gastrointestinal (GI) symptoms. Whether disease manifestations at non-respiratory sites are associated with the presence of influenza virus has not been established.

Methods: Children age <18 yrs admitted during January 2009 – April 2011 with laboratory-confirmed influenza infection were eligible for enrollment. In 2010-2011, the study was expanded to the emergency department. Up to 3 nasal wash (NW), 1 blood and 3 stool specimens were collected from enrolled patients. Specimens were tested by cell culture (NW, stool) and RT-PCR (NW, blood, stool) for seasonal and novel influenza viruses. 

Results: 20 children were enrolled (8 during 2010 – 2011 season, 2 from the ED); mean age was 4.1 yrs (range 0.1-15). Most were male (55%); 40% hispanic. 12 (60%) had chronic lung disease; mainly asthma (n=5, 42%). Of 18 vaccine-eligible children, vaccine history was verified in 10; 1 was complete (admitted 4 months post-vaccination), 3 partially and 6 not vaccinated. Remaining 8 were “up to date” as per parent. 13 (65%) presented with GI symptoms. 74 specimens were collected (35 NW, 29 stool, 10 blood). The mean period between clinical onset and initial NW collection was 4.8 days. Influenza was detected by RT-PCR in 32 (91%) NW (21 nH1N1, 11 seasonal), 1 (10%) blood (RBC, nH1N1) and 8 (28%) stool specimens (all nH1N1). Of the 13 with GI symptoms, 2(15%) had nH1N1 in their stool. The mean Ct value for the first positive nH1N1 in stool was 36.3. There were no significant differences between children with and without influenza detected in stool with respect to age, underlying diseases, hospital duration, ICU stay, ventilator use or initial NW Ct value (32.4 vs. 28.4, p-value 0.13). 

Conclusion: Over half of the children admitted with influenza infection presented with GI symptoms. Many were admitted despite reports of having been vaccinated against influenza. Neither the presence of GI symptoms or NW viral load correlated with the detection of influenza in the stool by PCR. We hypothesize that the GI tract may serve as a source for influenza transmission and should be further evaluated particularly in young children.

Subject Category: P. Pediatric and perinatal infections

Elizabeth Aguilera, MD1, Alan Jewell, BS2, Kirtida Patel, BS2, James Murphy, PhD1, Pedro Piedra, MD2 and Susan Wootton, MD1, (1)University of Texas (UT) Health, Houston, TX, (2)Baylor College of Medicine, Houston, TX


E. Aguilera, None

A. Jewell, None

K. Patel, None

J. Murphy, None

P. Piedra, None

S. Wootton, None

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