Pandemic influenza and the critically ill pediatric patient: Addressing the right issues for the 'worst case' scenario

摘要

The recent outbreaks of avian influenza, severe acute respiratory syndrome, and influenza A/pHlNl_09 have renewed the public health interest in planning and preparing for the next major influenza pandemic. There were three major influenza pandemics in the last century: 1) the devastating 1918 influenza pandemic (caused by the H1N1 subtype of influenza A virus and commonly referred to as the Spanish flu); 2) the Asian flu pandemic of 1957 (caused by the H2N2 subtype of influenza A); and 3) the Hong Kong flu pandemic of 1968 (caused by the H3N2 subtype of influenza A). The Spanish flu pandemic was associated with a high fatality rate (particularly from secondary bacterial pneumonia) and caused >50 million deaths worldwide. The Asian and Hong Kong flu pandemics were not as deadly, although each was responsible for nearly 1 million deaths worldwide. The recent influenza A/pHlNl_09 outbreak was first noted in the spring of 2009 in Mexico and spread rapidly throughout the southern and northern hemispheres, prompting the World Health Organization to declare the first influenza pandemic of the 21st century on June 11,2009 (1). Hospitals in Australia, New Zealand, and England were hit particularly hard, with as many as 25% of all intensive care unit beds occupied by patients with either suspected or documented pHlNl influenza (2).