• Clinical and Experimental Pediatrics
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• v.54 no.8
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• pp.345-349
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• 2011

A 3-year-old girl with acute respiratory distress syndrome due to a H1N1 2009 influenza virus infection was complicated by necrotizing pneumonia was successfully treated with extracorporeal membrane oxygenation (ECMO). This is the first reported case in which a pediatric patient was rescued with ECMO during the H1N1 influenza epidemic in Korea in 2009.

• Journal of the Korean Professional Engineers Association
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• v.42 no.6
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• pp.42-46
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• 2009

Every year influenza contributes to the death of 72 people in the South korea, 20,000 in the U.S. and perhaps millions worldwide. The swine fever so-called the noble flu A H1N1, a strain of the flu virus, which jumped species and burst into the human population in March and April of this year. The outbreak of 2009 novel H1N1 was the fourth in 100 years. Fortunately, it led to today's comparatively tame swine flu than the vicious 1918, which was original H1N1 pandemic flu virus, killed at least 40 million worldwide in an ongoing pandemic era. Although the 2009 H1N1 which is still in full swing, this global flu epidemic is already teaching scientists valuable lessons about pandemics. Evidence accumulated these days indicates that the 2009 H1N1 was not entirely new to all human immune systems. This article introduces only an outline for our better understanding the basic mechanisms of influenza and the vaccination about longstanding fears of that worst-case scenario engendered pandemic that are paying off today.

• Clinical and Experimental Pediatrics
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• v.53 no.10
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• pp.886-891
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• 2010

Purpose: This study aims to investigate the clinical characteristics of children diagnosed with the novel influenza A (H1N1) in the winter of 2009 at a single medical institution. Methods: Out of 545 confirmed cases of influenza A (H1N1) in children, using the real time RT-PCR method at Kosin University Gospel Hospital from September to December of 2009, 149 patients and their medical records were reviewed in terms of symptoms, laboratory findings, complications and transmission within a family. Results: Median age of subjects was 7 years (range: 2 months-18 years). New cases increased rapidly from September to reach a peak in November, then declined rapidly. Most frequently observed symptoms were fever (96.7%), cough (73.2%), rhinorrhea (36.9%) and sore throat (31.5%). Average body temperatures on the 1st, 2nd and 3rd hospital day were $38.75{\pm}0.65^{\circ}C$, $38.08{\pm}0.87^{\circ}C$ and $37.51{\pm}0.76^{\circ}C$, respectively. Complete blood counts and biochemical tests performed on the first admission day showed within the reference values in most cases. Of the 82 patients with simple chest radiography, 18 (22%) had pneumonic lesions; multi-focal bronchopneumonia in eleven, single or multi-segmental lobar pneumonia in five, and diffuse interstitial pneumonia in two patients. All of the 149 patients improved from their symptoms and discharged within 9 days of admission without any late complication. Conclusion: Children with 2009 pandemic influenza A (H1N1) at our single institution displayed nonspecific symptoms and laboratory findings, resembling those of common viral respiratory illnesses, and did not appear to develop more severe disease.

• Korean Journal of Adult Nursing
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• v.22 no.3
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• pp.250-259
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• 2010

Purpose: This study was examined to identify the relationship among knowledge, attitude, and compliance with preventive behavior on influenza A (H1N1) by University students. Methods: The sample consisted of 101 students. The data were collected from August to September 2009 and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression. Results: The mean scores of knowledge ($11.89{\pm}1.39$), attitude ($30.16{\pm}2.87$), and compliance with preventive behavior ($22.35{\pm}3.51$) on influenza A (H1N1) were above the average. The level of knowledge was not significantly different regardless of characteristics. Students' attitude differed according to gender (p<.001), and plan to seasonal influenza vaccination for this year (p=.007). Compliance with preventive behavior was significantly different according to experience of seasonal influenza vaccination during last year (p=.010), experience of obtained information about influenza A (H1N1) (p=.037). Significant correlations were found between knowledge and compliance with preventive behavior (p<.001), attitude and compliance with preventive behavior (p<.001). Knowledge and attitude was a predictor of compliance with preventive behavior (23.4%). Conclusion : These findings indicate that perceived knowledge and attitude may be necessary to improve compliance with preventive behavior on influenza A (H1N1) among university students. The results of the study can be utilized in educational programs about preventing the occurrence of influenza among university students.

• Korean Journal of Health Education and Promotion
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• v.27 no.1
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• pp.9-19
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• 2010

Objectives: This study is to identify the factors which affect children's preventive behavior for novel influenza A(H1N1) and to provide basic data to health education for children. Methods: The subject of this study were 551 children who were attending on the 4~6th grade in elementary school in Seoul. The data were collected using a self-reporting questionnaire for 5 days from October 12 through 16, 2009. Data were all digitized and analyzed using SPSS 17.0K. Results: As for relationship between preventive behavior and the other variables, correlations were observed with sensibility, self efficacy, respond efficacy and behavior intention, and it was statistically significant(p<.001). According to the result of analyzing factors affecting preventive behavior for Novel Influenza A(H1N1), it was affected by variables such as perceived threat, perceived efficacy, behavior intention. Behavior intention was the most influencing variable and has shown influence in order of self efficacy, sensibility, severity and respond efficacy as follows. Conclusion: The results showed effects on preventive behavior of perceived threat, perceived efficacy and behavior intention. It may be beneficial to improve empowerment for students to prevent influenza A(H1N1) by focusing on perceived threat, perceived efficacy, behavior intention.

• Korean Journal of Clinical Laboratory Science
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• v.41 no.4
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• pp.145-152
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• 2009

Novel influenza A virus, subtype H1N1 of swine-lineage, has been transmitted rapidly to many regions of the world. Rapid detection of the virus is essential to instigate appropriate patient care and public health management and for disease surveillance. The aim of this study is to determine the prevalence of novel influenza A (H1N1) virus in Korea using reverse-transcription real time polymerase chain reaction (rRT-PCR). Novel H1N1 virus was detected in a total of 8,948 nasopharyngeal samples from patients with influenza-like illness throughout Korea from August to September 2009. RNA was extracted from $300{\mu}l$of sample using an RNA extraction kit (Zymo Research, CA, USA). In the present study, Genekam kit (Genekam, Duisburg, Germany) was used to detect novel H1N1 virus. Novel H1N1 virus was found in 1,130 samples from a total of 8,948 samples (12.6%). The highest frequency was found in 10- to 19-year-olds (M: 29.3% vs. F: 16.4%), followed by 20- to 29-year-olds (M: 17.9% vs. F: 15.4%), 40- to 49-year-olds (M: 6.5% vs. F: 8.1%), 50- to 59-year-olds (M: 6.0% vs. F: 5.5%), and 30- to 39-year-olds (M: 4.6% vs. F: 3.8%). The mean positive rate was higher in men than in women (M: 14.7% vs. F: 7.4%). Novel H1N1 virus showed the lowest prevalence in patients over 60 years old. The positive rate increased daily and showed a significant high peak in mid-September 2009. In 19 provinces of Korea, Cheonan (41.1%), Busan (37.3%), Gangneung (33.3%), Jinju (32.1%), Ulsan (24.6%), Deajeon (23.7%) areas showed high frequencies and other provinces were found less than 10% of novel H1N1 virus. Since reverse-transcription real time PCR assay is rapid, accurate, and convenient, it may assist public health laboratories in detecting novel H1N1 virus. Moreover, these data could be useful for the management of patients with influenza-like illness.

• Journal of Microbiology and Biotechnology
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• v.19 no.11
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• pp.1470-1474
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• 2009

This paper describes the development a of direct multiplex reverse transcription-nested polymerase chain reaction (PCR) method, devised for simultaneous detection and typing of influenza viruses. This method combines the direct reverse transcription reaction without RNA purification with the enhancement of sensitivity and specificity of nested PCR. The method successfully detected three major human influenza viruses: influenza virus A subtype 1 (H1N1) and subtype 3 (H3N2), and influenza B virus (B). The minimum number of virus particles (pfu/ml) necessary for detection in spiked saliva samples was 200 (H1N1), 140 (H3N2), and 4.5 (B). The method's sensitivity and simplicity will be convenient for use in clinical laboratories for the detection and subtyping of influenza and possibly other RNA viruses.

• Tuberculosis and Respiratory Diseases
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• v.72 no.6
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• pp.493-500
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• 2012

Background: This study investigated the clinical characteristics and risk factors of the severity of pandemic influenza A (H1N1) 2009 infection in pediatric patients in Busan and Gyeongsangnam-do. Methods: Cases of influenza A (H1N1) 2009 in patients under the age of 18 years, confirmed by reverse transcription polymerase chain reaction, at Pusan National University Hospital and Pusan National University Yangsan Hospital from the last week of August 2009 through the last week of February 2010 were retrospectively analyzed. Results: Of the 3,777 confirmed cases of influenza A (H1N1) 2009, 2,200 (58.2%) were male and 1,577 (41.8%) were female. The average age of the patients was $8.4{\pm}4.8$ years. The total cases peaked during 44th to 46th week. Most of the patients were in the 5- to 9-year-old age group. Oseltamivir was administered to 2,959 (78.3%) of the patients. 221 patients (5.9%) were hospitalized, age an average of $6.7{\pm}4.5$ years. The average duration of hospitalization was $7.4{\pm}5.6$ days. One hundred cases (45.2%) had pneumonia. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. Children with asthma were at very high risk of hospitalization, over 20 times the non-asthmatic children (odds ratio [OR], 21.684; confidence interval [CI], 13.295~39.791). Likewise the children with neurologic deficits faced a 16 times higher risk (OR, 15.738; CI, 7.961~31.111). Ten of the patients (4.5%) were admitted to the intensive care unit, and eight (3.6%) required mechanical ventilation. Conclusion: Of the pediatric patients with pandemic influenza A (H1N1) 2009, most of the patients were in the 5- to 9-year-old age group. Risk factors for hospitalization included male gender, <2 years of age, and underlying disease. The most common complication was pneumonia. The very high risk of severe morbidity in children with asthma or neurologic disease shows the critical importance of targeted vaccine coverage, special awareness and swift care by both guardians and primary care providers.

• Clinical and Experimental Pediatrics
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• v.55 no.12
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• pp.474-480
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• 2012

Purpose: For evaluating the immunogenicity of an influenza vaccine, the microneutralization (MN) test has a higher sensitivity and specificity as compared to the hemagglutination inhibition (HI) test. However, the MN test is more time consuming and is difficult to standardize. We performed the MN test to determine its usefulness as an alternative or complementary test to the HI test for evaluating the immunogenicity of influenza vaccines. Methods: We compared the MN test with the HI test using 50 paired samples taken from a previous clinical study (2008-2009) in Korean children under 18 years of age. Results: The linear correlation coefficients of the 2 tests for H3N2, H1N1, and influenza B were 0.69, 0.70, and 0.66, respectively. We identified a high index of coincidence between the 2 tests. For an influenza vaccine, the postvaccination seroprotection rates and seroconversion rates determined by the MN test were 78.0% and 96.0%, 90% and 42.0%, and 42.0% and 48.0% for H3N2, H1N1, and influenza B, respectively. Geometric mean titer fold increases of H3N2, H1N1, and influenza B were 2.89, 5.04, and 4.29, respectively, and were 2.5-fold higher. We obtained good results in the evaluation of the immunogenicity of the 2008-2009 seasonal influenza vaccines. Conclusion: We found that the MN test was as effective as the HI test. Therefore, we suggest that the MN test can be used as an alternative or complementary test to the HI test for evaluating the immunogenicity of influenza vaccines.

• Pediatric Infection and Vaccine
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• v.19 no.3
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• pp.149-156
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• 2012

Purpose : We conducted a prospective comparative clinical study to determine the field efficacy of the 2010-2011 influenza vaccines [Influenza virus strains; A/California/7/2009 (H1N1), A/Perth/16/2009 (H3N2), B/Brisbane/60/2008] in healthy Korean children under 18 years of age. Methods : In this study, we enrolled subjects aged between 6 months and 18 years and divided them into 2 study groups: a group who received the influenza vaccines (407 subjects), and a control group who did not receive the influenza vaccines (230 subjects). Ours was a multicenter study that involved 7 hospitals, including the Korea Cancer Center Hospital. The study was conducted between September 2010 and February 2011. We collected nasal wash or throat swab samples from subjects who presented with acute febrile respiratory or influenza-like illnesses at the hospital. We used PCR to confirm the presence of the influenza virus in the respiratory samples and characterize the virus type. Results : In this study, we collected 22 respiratory samples from the influenza-vaccinated group and found 3 cases of influenza virus infection. Similarly, we collected 21 samples from the control group and found 12 cases of influenza virus infection among 10 subjects during the study period. We determined the field efficacy of the 2010-2011 seasonal influenza vaccines to be 83.2% in healthy Korean children and adolescents. Conclusion : In this study, we determined the field efficacy of the 2010-2011 seasonal influenza vaccines in healthy Korean children and adolescents. We found that the field efficacy of 2010-2011 seasonal influenza vaccines was adequate.