Demographic and Clinical Characteristics of Pandemic Influenza A (H1N1) 2009 Outbreak in Kerala, Southern India.

Aims: To study the clinical and epidemiological features in the affected individuals from different areas of Kerala, India. Study design: Population based cross sectional study. Place and Duration of Study: Regional Facility for Molecular Diagnostics, Rajiv Gandhi Center for Biotechnology and Directorate of Health Services, Kerala, between August 2009 and September 2010. Methodology: We conducted active surveillance for referral hospitals with specialist inpatient care in Kerala during pandemic periods. Oropharyngeal or nasopharyngeal swabs were tested for influenza viruses by Real time reverse transcriptase PCR. Results: A total of 4252 samples were tested for H1N1 influenza virus, of which, 30.17% were positive for pandemic influenza A H1N1 and 10.49% were positive for Influenza A (seasonal flu). Severe disease and mortality in the pandemic influenza A (H1N1) 2009 infection predominantly affected relatively healthy adolescents and adults between the age of 10 and 50 years. Both Males (29.28%) and Females (31.15%) were equally effected even though we observed a significant difference (P=.02). 141 cases exhibited lower respiratory tract symptoms. Pneumonia alone accounted for 28% of complicated cases. It was observed that the majority of cases (29.28%) during the first outbreak season were imported from affected overseas regions. Conclusion: In this study, prevalence of Influenza A H1N1 was high in the healthy younger population and there wasn’t any sex related susceptibility for Influenza infection. Majority of districts showed a positivity of approximately 10-30%, few with high positivity of >30%. Our findings highlight the importance of regular influenza immunization as it is significant to understand that the H1N1 (2009) virus may still circulate for many years with similar high severity.

Guillain-Barre Syndrome With Treatment-Related Fluctuations

No abstract available.

Clinical and Laboratory Characteristics of Pandemic Influenza A/H1N1 2009 Infection among Patients with Malignancy in Korea / 감염과화학요법

BACKGROUND: Patients with malignancy are considered to be at high risk of severe pandemic influenza A/H1N1 2009. This study was conducted to identify the severity of pandemic influenza A/H1N1 2009 among patients with malignancy. MATERIALS AND METHODS: Between August 2009 and December 2009, we reviewed clinical data and medical records of 31 patients with malignancy and 63 hospitalized patients without malignancy. RESULTS: Eighty-three patients with laboratory-confirmed pandemic influenza A/H1N1 2009 were admitted. The rate of ICU admission was higher among patients with malignancy (without malignancy 13% vs with malignancy 35%, P=0.024). The mortality rate was higher among patients with malignancy (without malignancy 6% vs with malignancy 25%, P=0.033). Patients using immunosuppressants showed a higher rate of lower respiratory tract infection (83% vs 24%, P=0.013). CONCLUSIONS: Pandemic influenza A/H1N1 2009 in patients with malignancy was more severe than in patients without malignancy.

Respiratory virus infections among hospitalized patients with suspected influenza A H1N1 2009 virus during the first pandemic wave in Brazil

INTRODUCTION: During the first pandemic wave of the influenza A H1N1 2009 virus, morbidity was particularly high in Brazil. Hospitalizations resulting from severe respiratory disease due to suspected influenza-like illness created an opportunity to identify other respiratory viruses causing lower respiratory infections. OBJECTIVE: The purpose of this study was to assess viral etiologies among samples collected during the first pandemic wave of H1N1 2009 from hospitalized patients with suspected cases in a Brazilian Sentinel Hospital. PATIENTS AND METHODS: Viral etiologies were investigated in samples from 98 children and 61 adults with fever, cough and dyspnea who were admitted to São Paulo Sentinel Hospital with suspected H1N1 infection. RESULTS: From August to November 2009, in 19.5 percent (31/159) of the samples 2009 H1N1 virus was detected with 23 percent (14/61) in adults (median age 25 years, range: 14-55 years) and 18.4 percent (17/92) in children (median age 5 years, range: 4 months - 11 years). Among the negative samples, a wide range of causative etiologic agents was identified. Human rhinovirus was the most frequent virus (23.91 percent) in children and human metapneumovirus (11.48 percent) was the second most frequent in adults, following 2009 H1N1 virus (22.95 percent). CONCLUSION: These data highlight the need to diagnose other viral infections that can co-circulate with influenza and may have been neglected by physicians as causes of severe respiratory diseases.

A Prediction Rule to Identify Severe Cases among Adult Patients Hospitalized with Pandemic Influenza A (H1N1) 2009

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 or = 65 yr) were independent risk factors for severe cases (all P or = 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of > or = 13. As a prediction rule, the presence of > or = 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.

Caracterización clínica de adultos menores y mayores de 50 años hospitalizados por influenza A H1N1 2009 en un centro hospitalario privado en Santiago, Chile / Clinical features of adults younger and older than 50 years hospitalized with influenza A H1N1 2009 in a private hospital in Santiago, Chile

Introduction: The new pandemic influenza A H1N1 2009 virus has shown a different clinical behavior in different age groups. Objective: To describe the clinical features of adult patients hospitalized with influenza AH1N1 2009 and compare the clinical and demographic variables among adults < 50 years and over 50 years old. Patients and Method: We included hospitalized patients between May 17 and July 17, 2009 confirmed by polymerase chain reaction (PCR) and/or rapid test for influenza A. Results: 124 patients were hospitalized with a median age of 33 years (range: 15-82 years). 36 percent had comorbidities and the main symptoms were fever, cough, myalgia and sore throat. There were 16 cases with pneumonia. From 124 patients, 77 percent were A-49 and 23 percentA-50, with comorbidity of 21 percent and 86 percent, respectively. There were no fatalities. Conclusions: Hospitalized patients had mild to moderate disease, a benign course and short hospitalization stay. There were more hospitalizations in A-49 and higher comorbidity in A-50.

Introducción: El nuevo virus influenza AH1N1 2009 ha mostrado un comportamiento clínico diferente en distintos grupos etáreos. Objetivo: Describir las características clínicas de los pacientes adultos hospitalizados con influenza A H1N1 2009 y comparar las variables clínicas y demográficas entre menores y mayores de 50 años. Pacientes y Método: Se incluyeron los pacientes hospitalizados entre el 17 de mayo y 17 de julio del 2009 confirmados por reacción de polimerasa en cadena (RPC) y/o pruebas rápidas para influenza A. Resultados: Se hospitalizaron 124 pacientes con una mediana de edad de 33 años (rango: 15-82 años). Un 36 por ciento presentó co-morbilidad y los síntomas principales fueron: fiebre, tos, mialgias y odinofagia. Hubo 16 casos con neumonía. Del total, 77 por ciento fueron < 50 y 23 por ciento ≥ 50 años. Tenían co-morbilidades 21 por ciento en el grupo < 50 versus 86 por ciento en ≥ 50 años. No hubo casos fatales. Conclusiones: Los pacientes presentaron una enfermedad leve a moderada, de curso benigno y corta hospitalización. Hubo más hospitalizados en < 50 y mayor co-morbilidad en ≥ 50 años.

Serologic survey on pandemic influenza A (H1N1) virus among aged ≥3 years population from Jiangsu province in 2009, China / 中华流行病学杂志

Objective To understand the antibody levels against pandemic influenza A (H1N1) virus (2009 H1N1 ) among aged ≥3 years population in 2009, from Jiangsu province, and to describe the distribution of 2009 H1N1. Methods Serum specimens were collected from natural populations at four different periods in Jiangsu, and tested with hernagglutination-inhibition (HI)assays. Rates of protective antibody against 2009 H1N1 and Geometric mean titers (GMTs)were estimated. Results The rates of protective antibody against 2009 H1N1 rose with the and November, 2009. There were no significant differences on the rates of protective antibody between males and females at four different cross-sectional periods (P＞0.05), and no significant differences on GMTs were observed at different periods except for November 2009. Significant differences on rates of protective antibody and GMTs among various age groups were observed at four different periods (P＜0.05), and similar results were observed among different periods in various age groups (P＜0.05). There were significant differences on rates of protective antibody and GMTs among different areas (P＜0.05). Conclusion The 2009 H1N1 strain had been widely spread out in Jiangsu province since July 2009. People aged 12-17 years became the major victims after August. As of November 2009, the rate of protective antibody against 2009 H1N1 was still low, predicting that the epidemic might continue to exist for a certain period of time.

Management of Healthcare Workers and Patients on Exposure to Pandemic Influenza A (H1N1 2009) Virus in a Hospital / 병원감염관리

BACKGROUND: This study is aimed at describing the outcomes of the management of the patients, caregivers, and healthcare workers (HCWs) who are exposed to the pandemic influenza (H1N1 2009) virus and at evaluating the adequacy in exposure management and infection control. METHODS: From July 2009 to January 2010, for 7 a month period, we managed patients and healthcare workers without any respiratory protective devices, who came within 1 m distance of H1N1-positive individuals for more than 1 h and performed a 1-week follow-up. RESULTS: The total of 157 cases with exposure to pandemic influenza (H1N1 2009) virus and exposed individuals of 907 were reported. Of the exposed individuals who were under management, 15 were confirmed to be infected with the infection rate being 1.7%. The confirmed individuals did not have a secondary infection after the exposure. Rates of infection of the exposed patients and healthcare workers were 1.8% and 1.6%, respectively, and these figures were not statistically significant. CONCLUSION: The exposure management results at the hospital revealed that the infection had spread by contact with individuals who were positive for the infection. The high incidence of early exposure to the virus warrants the need to ensure the use of protective equipment and the adoption of assertive teaching methods that have long lasting effects.