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November 2004

Childhood Severe Acute Respiratory Syndrome in Taiwan and How to Differentiate It From Childhood Influenza Infection

Author Affiliations

Author Affiliations: Departments of Pediatrics (Drs Chang, Lee, and L.-M. Huang), Radiology (Dr Peng), and Laboratory Medicine (Ms Kao), National Taiwan University Hospital, College of Medicine, National Taiwan University; Department of Pediatrics, Mackay Memorial Hospital (Drs F.-Y. Huang and Chiu); and Center for Disease Control, Department of Health (Drs Wu, Su, Chen, and Lin, and Ms Wu); Taipei, Taiwan.

Arch Pediatr Adolesc Med. 2004;158(11):1037-1042. doi:10.1001/archpedi.158.11.1037

Objective  To investigate clinical features and outcomes of children in Taiwan with laboratory-confirmed severe acute respiratory syndrome (SARS) vs those of children with influenza to differentiate the 2 diseases.

Design, Setting, and Participants  Patients 20 years or younger with clinical, epidemiological, and laboratory evidence of SARS from March to July 2003 vs children with virus culture–confirmed influenza in a 1:1 age- and sex-matched control group.

Main Outcome Measures  Rates of symptoms, abnormal laboratory data, and outcomes of recovery, sequelae, or death.

Results  The 15 SARS patients (9 girls and 6 boys) had a median age of 17 years (age range, 4-20 years). Nine patients (60%) were infected through household contact, 4 (27%) nosocomially, 1 (7%) through contact with a neighbor, and 1 (7%) after returning from Hong Kong. All 15 patients had fever, 3 (20%) had chills, and 11 (73%) had cough. Only 1 patient (7%) had sputum production; 1 (7%) had rhinorrhea. At presentation, 5 patients (33%) had leukopenia, 6 (40%) had lymphopenia, and 5 (33%) had monocytopenia. All children recovered without sequelae. Children with SARS had significantly lower incidences of rhinorrhea (odds ratio [OR], 0.01; 95% confidence interval [CI], 0.00-0.09), sputum production (OR, 0.10; 95% CI, 0.02-0.63), and sore throat (OR, 0.17; 95% CI, 0.03-0.85) than children with influenza. Both groups had similar incidences of leukopenia or lymphopenia, but SARS patients had a significantly higher incidence of monocytopenia (33% vs 0%, P = .04).

Conclusions  Childhood SARS is usually not fatal. The absence of rhinorrhea and presence of monocytopenia in SARS may distinguish it from influenza.