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zoom RSS 英国ではH1N1ブタインフルエンザにより70人の子どもが死亡/英国医療事情

<<   作成日時 : 2010/10/27 20:31   >>

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 英国でH1N1ブタインフルエンザ流行により9ヶ月間で70人の子どもが死亡し、少数民族の子どもや持病を持つ子どもの死亡率が高かったという。
 バングラディシュやパキスタン人の子どもが白人英国人よりはるかに高い死亡率で、また基礎疾患として特に脳性麻痺などの慢性の神経疾患を持つ子供の死亡率も高かった。
 世界保健機構(WHO)によると、世界で約18,450人が、多くの妊婦と若者を含めてH1N1のために死亡したと確認された。
 少数民族の死亡率の高さは米国での報告と同様である。ロンドンとウエストミッドランド州など少数民族が多数住む地域で集積して発症したことが関係している。
 全体の子どもの死亡率は100万人あたり6人で、1才未満が100万人あたり14人と最も高かった。バングラディシュ人の子どもは100人あたり47人、パキスタン人は36人、英国白人は4人の死亡率だった。
 死亡した70人のうち、21人はそれまで健康だったが、64%は重症の持病があった。45人はタミフルを服用していたが、48時間以内に服用開始したのは7人にすぎず、入院前に服用していたのは3人に過ぎなかった。死亡者のうち、ワクチン接種は2名のみでしかも効果が出る前に発症した。

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UK study shows H1N1 killed 70 children in 9 months
http://www.reuters.com/article/idUSTRE69P5DX20101026
By Kate Kelland
LONDON | Tue Oct 26, 2010 7:08pm EDT

画像LONDON (Reuters) - Scientists studying swine flu have found that 70 children died from it in England in a 9 month period during the H1N1 pandemic and death rates were worst among ethnic minority children and those with other health problems.

In a study in the Lancet medical journal, Liam Donaldson, the former Chief Medical Officer for England, said children from the country's Bangladeshi and Pakistani communities had much higher mortality than white British children, as did children with serious pre-existing illnesses -- especially chronic neurological diseases such as cerebral palsy.

These high-risk groups should be a priority for H1N1 vaccination, Donaldson and his research team said.

According to the World Health Organization (WHO), which declared the pandemic over in August, some 18,450 people worldwide are confirmed to have died from H1N1, including many pregnant women and young people. But the WHO says it will take at least a year after the pandemic ends to determine the true death toll, which is likely to be much higher.

Experts say H1N1 swine flu virus has now taken over as the main seasonal flu strain and health authorities that run annual flu campaigns have included it in regular seasonal flu vaccines.

Donaldson's team said their findings of high death rates among ethnic minorities were consistent with reports from the United States of minorities suffering more severe illness during the H1N1 pandemic.

"This finding might be attributable to clustering of pandemic influenza A H1N1 cases in areas of England with high ethnic minority populations -- such as London and the West Midlands," they wrote in their study.

The findings in England also showed that from 26 June 2009 to 22 March 2010:

* The overall childhood death rate for H1N1 was 6 per million population.

* The rate was highest for children aged under 1 year, at 14 deaths per million population.

* Death rates were higher for Bangladeshi children (47 deaths per million population) and Pakistani children (36) than for white British children (4).

* Of the 70 children who died of H1N1, 21 percent were previously healthy and 64 percent had severe pre-existing disorders.

* Overall, 45 of the children had received the antiviral flu drug oseltamivir, sold under the brand name Tamiflu, but only seven had had it within 48 hours of the onset of their symptoms and only three had it before they were admitted to hospital.

* Only two of the children who died had received an H1N1 vaccine -- too late for it to be effective.

(Editing by Steve Addison)

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The Lancet, Early Online Publication, 27 October 2010
doi:10.1016/S0140-6736(10)61195-6Cite or Link Using DOI

Paediatric mortality related to pandemic influenza A H1N1 infection in England: an observational population-based study

Original Text
Nabihah Sachedina MBBS a, Prof Liam J Donaldson MD a b Corresponding AuthorEmail Address
Summary
Background
Young people (aged 0―18 years) have been disproportionately affected by pandemic influenza A H1N1 infection. We aimed to analyse paediatric mortality to inform clinical and public health policies for future influenza seasons and pandemics.
Methods
All paediatric deaths related to pandemic influenza A H1N1 infection from June 26, 2009, to March 22, 2010 in England were identified through daily reporting systems and cross-checking of records and were validated by confirmation of influenza infection by laboratory results or death certificates. Clinicians responsible for each individual child provided detailed information about past medical history, presentation, and clinical course of the acute illness. Case estimates of influenza A H1N1 were obtained from the Health Protection Agency. The primary outcome measures were population mortality rates and case-fatality rates.
Findings
70 paediatric deaths related to pandemic influenza A H1N1 were reported. Childhood mortality rate was 6 per million population. The rate was highest for children aged less than 1 year. Mortality rates were higher for Bangladeshi children (47 deaths per million population [95% CI 17―103]) and Pakistani children (36 deaths per million population [18―64]) than for white British children (4 deaths per million [3―6]). 15 (21%) children who died were previously healthy; 45 (64%) had severe pre-existing disorders. The highest age-standardised mortality rate for a pre-existing disorder was for chronic neurological disease (1536 per million population). 19 (27%) deaths occurred before inpatient admission. Children in this subgroup were significantly more likely to have been healthy or had only mild pre-existing disorders than those who died after admission (p=0?0109). Overall, 45 (64%) children had received oseltamivir: seven within 48 h of symptom onset.
Interpretation
Vaccination priority should be for children at increased risk of severe illness or death from influenza. This group might include those with specified pre-existing disorders and those in some ethnic minority groups. Early pre-hospital supportive and therapeutic care is also important.
Funding
Department of Health, UK

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英国ではH1N1ブタインフルエンザにより70人の子どもが死亡/英国医療事情 医師の一分/BIGLOBEウェブリブログ
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