RESUMO
AIM OF THE STUDY: To evaluate the values of clinical signs and the rapid diagnostic test (RDT) in the diagnosis of influenza H1N1 new variant in the pediatric emergency room. METHOD: From 18 August to 1st December 2009, children admitted to the pediatric emergency department of CHU Nord (Marseille, France) and suspected of flu according to French guidelines, were tested for influenza using both an influenza RDT and a polymerase chain reaction (PCR) assay specific for H1N1. From 3 November to 3 December, clinical signs were also noted (fever, headaches, myalgia-arthralgia, shivers, diarrhea). RESULTS: A total of 1122 children were tested: 367 children (32.1%) had a positive specific PCR. The RDT value was: sensitivity 65.2% [55.8-73.6], specificity 99.5% [98.1-100], positive predictive value (PPV) 97.5% [91.8-100], negative predictive value (NPV) 91.2% [90.3-91.5], positive likelihood ratio (LRP) 153.7 [53.5-452.9] and negative likelihood ratio (LRN) 0.393 [0.387-0.411]. Clinical data were available for 504 children (328 over 2 years of age). In children more than 2 years of age and in multivariate analysis, headaches were the only sign significantly associated with a positive PCR (aOR=2.53 [1.25-5.12]). Overall, headaches and/or myalgia-arthralgia were valuable indicators for clinical diagnosis of flu, with a 75.8% NPV. Among children with a positive PCR, diarrhea was more frequent in children under 2 years of age (OR=2.76 [1.19-6.40]). The sensitivity of the RDT improved (90.9% [85.2-94.6]) when flu signs were also present. CONCLUSION: Associating clinical signs and RDT for the diagnosis of influenza A (H1N1) new variant in a pediatric emergency room improves selection of children requiring appropriate antiviral treatment.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/diagnóstico , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Pediatria , Reação em Cadeia da Polimerase , Estudos Prospectivos , Avaliação de Sintomas , Fatores de TempoRESUMO
AIM OF THE STUDY: To evaluate vaccine coverage in at-risk newborns during the maternity hospital stay and at the age of 3 months, before and after the change in the French national Calmette-Guérin Bacillus (BCG) vaccine policy. METHODS: A vaccine program targeting newborns at risk for tuberculosis was implemented in a university maternity hospital in Marseille, France, in 2007. At-risk newborns were mainly defined as those with 1 parent born in an endemic country for tuberculosis, those planning to travel in such a country for at least 1 month in their 1st year of life, or those with previous tuberculosis cases within the family. From February to November 2007, the French BCG policy changed (BCG was no longer mandatory, but only recommended for at-risk children). Parental acceptance of a targeted vaccine delivered during the hospital stay and BCG vaccination during the infant's first 3 months were evaluated before and after the change. RESULTS: A total of 289 newborns at risk of tuberculosis were included. BCG vaccine coverage in the maternity hospital was 72%, significantly higher when BCG was not mandatory (81% versus 66%; p<0.05). At 3 months of age, 90% of the children were BCG vaccinated. Among the infants whose parents refused an early vaccine, the BCG coverage rate at 3 months of age decreased from 78 to 41% (p<0.005) when only a targeted vaccine was recommended. CONCLUSION: Targeted vaccination of newborns at risk for tuberculosis in a maternity hospital is acceptable. When BCG was not mandatory, parental acceptance of an early-targeted vaccine increased, whereas the policy change decreased later vaccination rates within the first 3 months in children whose parents had previously refused. Early BCG vaccination of at-risk newborns in the maternity hospital may prevent a low BCG coverage rate at 3 months and subsequent tuberculosis cases in this population.
