Going by typical H1N1 symptoms in kids not enough: Lancet

The study suggests that instead of looking for the typical symtoms of swine flu like fever,cough and a running nose before recommending a test,doctors could go in for the same if a child has complaints like an earache and swollen eyes and suffers from underlying illnesses.

The Birmingham doctors found that besides cough,fever and running nose,many children who were later diagnosed with H1N1 came with symptoms like ear ache,photophobia,chest pain,swollen eyes and blood in vomit.

The doctors reviewed 78 of 89 children who tested positive and were admitted to hospitals between June 5 and July 4,2009,at paediatric hospitals in Birmingham and London. The data showed that 29 of 71 patients did not fulfil the H1N1 influenza case definition as described by the UK’s Health Protection Agency (HPA) and other agencies. This includes a temperature of at least 38°C or a history of fever and cough,sore throat,limb or joint pain,headache,vomiting or diarrhoea,or a life-threatening illness.

“To have followed the HPA algorithm would have meant that 40 per cent of children with H1N1 influenza would not have been diagnosed… Both H1N1 influenza and common respiratory viral infections are likely to spread commonly this autumn and winter in children,making clinical diagnosis of influenza more difficult. Clinicians should consider H1N1 influenza in the differential diagnosis of children with pre-existing disorders who present acutely to health services even if HPA diagnostic criteria are incomplete or an alternative diagnosis is suspected,especially if there are severe symptoms or underlying disease,” the researchers said.

Twelve of the 64 children reviewed did not have temperature of at least 38°C or a history of fever. After fever,cough (49/67) and a runny nose (45/73) were the most common symptoms. Other symptoms included blood in vomit,photophobia,earache,infection and eye inflammation,chest pain and acute abdomen pain. Thirty-one of the 77 patients had significant pre-existing disorders.