Abstract
BackgroundThe recent H1N1 influenza A pandemic was marked by multiple reports of illness and hospitalization in children, suggesting that children may have played a major role in the propagation of the virus. A comprehensive detailed analysis of the attack rates among children as compared with their contacts in various settings is of great importance for understanding their unique role in influenza pandemics.Methodology/Principal FindingsWe searched MEDLINE (PubMed) and Embase for published studies reporting outbreak investigations with direct measurements of attack rates of the 2009 pandemic H1N1 influenza A among children, and quantified how these compare with those of their contacts. We identified 50 articles suitable for review, which reported school, household, travel and social events. The selected reports and our meta-analysis indicated that children had significantly higher attack rates as compared to adults, and that this phenomenon was observed for both virologically confirmed and clinical cases, in various settings and locations around the world. The review also provided insight into some characteristics of transmission between children and their contacts in the various settings.Conclusion/SignificanceThe consistently higher attack rates of the 2009 pandemic H1N1 influenza A among children, as compared to adults, as well as the magnitude of the difference is important for understanding the contribution of children to disease burden, for implementation of mitigation strategies directed towards children, as well as more precise mathematical modeling and simulation of future influenza pandemics.
Highlights
The 2009 pandemic H1N1 influenza A affected individuals in more than 208 countries, territories and communities worldwide and caused at least 13,554 deaths [1]
A quantitative analysis based on a detailed review of attacks in various settings is important for accurate simulation modeling and impact assessment
The high rates of pandemic influenza in children led to school closures around the world in an effort to mitigate the spread of the virus [60]
Summary
The 2009 pandemic H1N1 influenza A affected individuals in more than 208 countries, territories and communities worldwide and caused at least 13,554 deaths [1]. In comparison to previous pandemics, novel technological methods were available for diagnosis, analysis, medications and communication, providing unique opportunity for both clinical and epidemiological analysis In this recent pandemic, more cases were reported in children and young adults than in older adults [2], and more hospitalizations occurred among children under 5 years of age [3]. A quantitative analysis of pandemic influenza attack rates in the pediatric population with comparison to their contacts is vital for understanding the role of children in the propagation of the virus and their burden of disease. Such understanding is of paramount importance for establishing effective planning efforts and mitigation strategies, vaccination policies and social distancing efforts. A comprehensive detailed analysis of the attack rates among children as compared with their contacts in various settings is of great importance for understanding their unique role in influenza pandemics
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