Comparison of epidemiological and clinical characteristics of SARS, pandemic (H1N1) 2009 and COVID-19, and consideration on prevention and control strategies of COVID-19 / 中华预防医学杂志

We compared the epidemiological and clinical characteristics of severe acute respiratory syndrome (SARS), pandemic (H1N1) 2009 and COVID-19 and found that COVID-19 was more contagious, more concealed in transmission, with greater infectious intensity and more severe clinical manifestations. If the COVID-19 epidemic is not effectively controlled, it will have a serious impact on human health, and even social development. Recognizing the characteristics of three diseases, especially COVID-19, and improving the disease awareness of COVID-19 will help better implement the guidelines of 'scientific prevention and treatment, precise implementation' and prevent and control COVID-19.

Viral detection profile in children with severe acute respiratory infection

ABSTRACT Objectives: The role of viral co-detection in children with severe acute respiratory infection is not clear. We described the viral detection profile and its association with clinical characteristics in children admitted to the Pediatric Intensive Care Unit (PICU) during the 2009 influenza A(H1N1) pandemic. Method: Longitudinal observational retrospective study, with patients aged 0-18 years, admitted to 11 PICUs in Rio de Janeiro, with suspected H1N1 infection, from June to November, 2009. The results of respiratory samples which were sent to the Laboratory of Fiocruz/RJ and clinical data extracted from specific forms were analyzed. Results: Of 71 samples, 38% tested positive for H1N1 virus. Of the 63 samples tested for other viruses, 58 were positive: influenza H1N1 (43.1% of positive samples), rhinovirus/enterovirus (41.4%), respiratory syncytial vírus (12.1%), human metapneumovirus (12.1%), adenovirus (6.9%), and bocavirus (3.5%). Viral codetection occured in 22.4% of the cases. H1N1-positive patients were of a higher median age, had higher frequency of fever, cough and tachypnea, and decreased leukometry when compared to H1N1-negative patients. There was no difference in relation to severity outcomes (number of organic dysfunctions, use of mechanical ventilation or amines, hospital/PICU length of stay or death). Comparing the groups with mono-detection and co-dection of any virus, no difference was found regarding the association with any clinical variable. Conclusions: Other viruses can be implicated in SARI in children. The role of viral codetection has not yet been completely elucidated.

Genotyping Influenza Virus by Next-Generation Deep Sequencing in Clinical Specimens

Rapid and accurate identification of an influenza outbreak is essential for patient care and treatment. We describe a next-generation sequencing (NGS)-based, unbiased deep sequencing method in clinical specimens to investigate an influenza outbreak. Nasopharyngeal swabs from patients were collected for molecular epidemiological analysis. Total RNA was sequenced by using the NGS technology as paired-end 250 bp reads. Total of 7 to 12 million reads were obtained. After mapping to the human reference genome, we analyzed the 3-4% of reads that originated from a non-human source. A BLAST search of the contigs reconstructed de novo revealed high sequence similarity with that of the pandemic H1N1 virus. In the phylogenetic analysis, the HA gene of our samples clustered closely with that of A/Senegal/VR785/2010(H1N1), A/Wisconsin/11/2013(H1N1), and A/Korea/01/2009(H1N1), and the NA gene of our samples clustered closely with A/Wisconsin/11/2013(H1N1). This study suggests that NGS-based unbiased sequencing can be effectively applied to investigate molecular characteristics of nosocomial influenza outbreak by using clinical specimens such as nasopharyngeal swabs.

Hospitalised Malaysian children with pandemic (H1N1) 2009 influenza: clinical characteristics, risk factors for severe disease and comparison with the 2002-2007 seasonal influenza

<p><b>INTRODUCTION</b>The pandemic caused by the H1N1 influenza virus in 2009 resulted in extensive morbidity and mortality worldwide. As the virus was a novel virus, there was limited data available on the clinical effects of the virus on children in Malaysia. Herein, we describe the clinical characteristics of children hospitalised with H1N1 influenza in a tertiary care centre; we also attempted to identify the risk factors associated with disease severity.</p><p><b>METHODS</b>In this retrospective study, we compared the characteristics of the children who were admitted into the University of Malaya Medical Centre, Malaysia, for H1N1 influenza during the pandemic with those who were admitted for seasonal influenza in 2002-2007.</p><p><b>RESULTS</b>Among the 77 children (aged ≤ 12 years) admitted to the centre due to H1N1 influenza from 1 July 2009-30 June 2010, nearly 60% were aged < 6 years and 40.3% had an underlying medical condition. The top three underlying medical conditions were bronchial asthma (14.3%), cardiac disease (10.4%) and neurological disorder (11.7%). The risk factors for severe disease were age < 2 years, underlying bronchial asthma and chronic lung disease. The three patients who died had a comorbid medical condition. The underlying cause of the deaths was acute respiratory distress syndrome or shock.</p><p><b>CONCLUSION</b>The clinical presentation of the children infected with the pandemic (H1N1) 2009 influenza virus did not differ significantly from that of children infected with seasonal influenza. However, there were more complaints of fever, cough and vomiting in the former group.</p>

Comparison of multiplex RT-PCR with virus isolation for detection, typing and sub-typing of influenza virus from influenza-like illness cases.

Purpose: Infl uenza epidemics and periodic pandemics occur worldwide resulting in signifi cant mortality, morbidity and economic loss. There is need for a sensitive, rapid and cost-effective assay to detect, type and sub-type infl uenza viruses, as cell culture has a long turnaround time. Materials and Methods: Nasopharyngeal swabs were collected from patients presenting with infl uenza-like illness (ILI) at AIIMS OPD and Primary Health Centre Ballabhgarh (Haryana). From June 2007 to January 2009 and then from September to November 2009, of 1567 specimens collected, 544 were randomly selected and were tested by virus culture using Madin-Darby Canine Kidney (MDCK) cells and by reverse transcription polymerase chain reaction (RT-PCR) for infl uenza A using primers for matrix gene and for infl uenza B using non-structural gene (NS) primers. All infl uenza A positives were sub-typed using primers for HA and NA genes of A/H1, A/H3. A separate multiplex RT-PCR having primers from matrix and HA genes of pandemic A (H1N1) pdm09 viruses was carried out on samples collected after September 2009. Results: Of the 544 samples, 136 (25%) were positive for infl uenza by RT-PCR. Further typing analysis revealed 86 (63.2%) were typed as infl uenza A and 47 (34.5%) as infl uenza B viruses and 3 (2%) samples showed dual infection with infl uenza A and B. Of the 86 infl uenza A positive samples 48 (55.8%) were identifi ed as seasonal infl uenza A/H1N1, 22 (25.6%) as A (H1N1) pdm09 and 16 (18.6%) as A/H3N2. Comparison of infl uenza positivity using virus culture revealed that only 97/136 (71.3%) were infl uenza positive. Sensitivity of viral detection was lowest for seasonal A/H1 (26/48; 54%), followed by H3N2 (11/16; 68.7%) and infl uenza B (38/47; 80.8%); all infl uenza A/H1N1pdm09 viruses were detected by both methods. Conclusion: RT-PCR is a sensitive, low cost and rapid screening test for diagnosing infl uenza infection during epidemics and pandemics. mRT-PCR increased the detection rates for infl uenza by 28.6% as compared with virus isolation and thus is a useful assay in both diagnostic and epidemiological settings in resource poor countries.

Pandemic H1N1 illness prognosis: evidence from clinical and epidemiological data from the first pandemic wave in São Paulo, Brazil

OBJECTIVES: The pandemic of 2009 H1N1 influenza A emerged in February 2009, with high morbidity and mortality, and rapidly spread globally. São Paulo was among the most affected areas in Brazil. This study compares the clinical and epidemiological characteristics of influenza-like illness between outpatients and hospitalized patients and evaluates the impact of oseltamivir therapy on the outcome of 2009 H1N1 influenza A patients. METHODS: This is a case series study comparing the clinical and epidemiological characteristics of influenza-like illness between outpatients attended at Hospital São Paulo in August 2009 (the peak of the first pandemic wave) and those patients hospitalized between May and September 2009 (the entire first pandemic wave). RESULTS: The 1651 patients evaluated were predominantly female (927×686, p<0.001) and aged 31.71±16.42 years, with 148 reporting chronic pulmonary disease. Dyspnea was presented by 381 (23.4%) patients and was more frequent among those aged 30 years or more (p<0.001). Hospitalization occurred at 3.73±2.85 days, and antiviral treatment started 2.27±2.97 days after the onset of first symptoms. A delay of more than 5 days in starting oseltamivir therapy was independently associated with hospitalization (p<0.001), a stay in the ICU (p<0.001) and a higher risk of dying (OR = 28.1, 95% CI 2.81-280.2, p = 0.007). CONCLUSION: The 2009 pandemic of H1N1 influenza A affected young adults, presented a significant disease burden and produced severe cases with a significant fatality rate. However, promptly starting specific therapy improved the outcome. .

Epidemiology of pandemic H1N1 strains in a tertiary hospital of Maharashtra.

Swine-flu is a viral fever caused by a new mutated strain Influenza A virus subtype H1N1, which infects humans. Pandemic H1N1 (pH1N1/2009) virus was detected in the first quarter of 2009 in the west coastal region of North America and spread very rapidly to the other countries during April-June, 2009. This study was conducted to assess the epidemiology of pandemic H1N1 strains using a cross-sectional study design in a tertiary hospital. The symptomatic patients attending the flu outpatient department (OPD)/emergency from August 2009 to April 2011 at Indira Gandhi Government Medical College, Nagpur were included using a standard case definition. A total of 67 (27.01%) samples from 247 patients were pandemic influenza A/H1N1 positive. None of the patients had a history of foreign travel, whereas 23.88% of the patients gave history of travel to an endemic area. Overall, 22.38% of the patients came in contact with proven cases of pandemic H1N1. pH1N1 transmission activity has increased since May 2010.

Comparative study of pandemic (H1N1) 2009, swine H1N1, and avian H3N2 influenza viral infections in quails

Quail has been proposed to be an intermediate host of influenza A viruses. However, information on the susceptibility and pathogenicity of pandemic H1N1 2009 (pH1N1) and swine influenza viruses in quails is limited. In this study, the pathogenicity, virus shedding, and transmission characteristics of pH1N1, swine H1N1 (swH1N1), and avian H3N2 (dkH3N2) influenza viruses in quails was examined. Three groups of 15 quails were inoculated with each virus and evaluated for clinical signs, virus shedding and transmission, pathological changes, and serological responses. None of the 75 inoculated (n = 45), contact exposed (n = 15), or negative control (n = 15) quails developed any clinical signs. In contrast to the low virus shedding titers observed from the swH1N1-inoculated quails, birds inoculated with dkH3N2 and pH1N1 shed relatively high titers of virus predominantly from the respiratory tract until 5 and 7 DPI, respectively, that were rarely transmitted to the contact quails. Gross and histopathological lesions were observed in the respiratory and intestinal tracts of quail inoculated with either pH1N1 or dkH3N2, indicating that these viruses were more pathogenic than swH1N1. Sero-conversions were detected 7 DPI in two out of five pH1N1-inoculated quails, three out of five quails inoculated with swH1N1, and four out of five swH1N1-infected contact birds. Taken together, this study demonstrated that quails were more susceptible to infection with pH1N1 and dkH3N2 than swH1N1.

Characteristics of Outpatients with Pandemic H1N1/09 Influenza in a Tertiary Care University Hospital in Korea

The pandemic H1N1/09 emerged rapidly in Korea. Here, we describe the clinical characteristics of outpatients in Seoul, Korea who were infected in the 2009 H1N1 pandemic. We reviewed the cases of outpatients with pandemic H1N1/09 who visited a tertiary care teaching hospital between September 1 and December 31, 2009. Infection with pandemic H1N1/09 was confirmed by molecular tests. Of a total of 7,182 tests, 3,020 (42.0%) were positive. Compared with 473 cases of influenza-like illness (ILI), the 586 confirmed cases of pandemic H1N1/09 differed in age [odds ratio (OR) 0.975] and fulfilling at least one of the following factors: age or =65 years, history of contact with other pandemic H1N1/09-infected individuals (OR 0.611), fever > or =37.8degrees C (OR 3.567), cough (OR 2.290), and myalgia (OR 1.559). The sensitivity of the best criteria, "fever (> or =37.8degrees C) plus cough" (41.03%) in this study was lower than that of the Korea Centers for Disease Control and Prevention (KCDC) criteria (47.95%), whereas the positive likelihood ratio (3.55) and positive predictive value (81.6) of this criteria was higher than those of the KCDC criteria (2.98 and 78.7, respectively). The clinical characteristics of pandemic H1N1/09 are, in many regards, indistinguishable from those of ILI. Moreover, the accuracy and predictability of criteria which include only symptoms or signs were not sufficient to diagnose pandemic H1N1/09 infection. Therefore, use of a combination of symptoms with confirmatory laboratory testing is necessary for accurate diagnosis of pandemic H1N1/09.

Epidemiological characteristics on the clustering nature of pandemic (H1N1) 2009 in China / 中华流行病学杂志

Objective To study the epidemiological characteristics on the clustering nature of pandemic (H1N1) 2009 in China.Methods Time and place distribution of pandemic (H1N1) 2009on the nature of clustering through data from Public Health Emergency Management Information System were described.Results As of August 10,2010,2773 pandemic (H1N1) 2009 clusters,a total of 77363 cases (including 20 deaths) were reported in the mainland of China.The most reported number of clusters was from schools and kindergartens with the total number of 2498 (accounted for 90.08％ of the total number).Middle schools appeared the have the most clusters (1223,accounting for 48.96％ ).The number of clusters reported in the southern provinces (cities) accounted for 77.03％ of the total,and was more than that in the northern provinces (cities).Two reported peaks in the southern provinces (cities) were in June and November,2009,respectively.There was only one reported peakin the northern provinces in September,2009.Conclusion Time and place distribution characteristics on the clusters of pandemic (H1N1) 2009 were similar to the seasonal influenza,but the beginning of winter peak was much earlier and intensity of reporting was much higher on the clusters of pandemic (H1N1 ) 2009 than that of seasonal influenza.

Medidas de resucitación precoz durante la pandemia de gripe A (H1N1). ¿Se beneficiaron los pacientes? / Resuscitation measures early in the pandemic of influenza A (H1N1). HE benefited the patients?

Objetivo. Evaluar el impacto del uso de un protocolo de medidas de detección y resucitación precoz durante la pandemia de gripe A (H1N1) sobre el ingreso de pacientes en el Servicio de Terapia Intensiva (STI). Diseño. Estudio de observación y retrospectivo de pacientes críticos. Ámbito. Un STI médico-quirúrgico. Pacientes. Adultos que ingresaron en el STI desde el Servicio de Urgencia entre el 28 de abril de 2009 y el 4 de septiembre de 2009. Variables de interés principal. Sexo, edad, comorbilidades, APACHE II, SOFA al ingreso en el STI, sintomatología clínica, imágenes radiográficas, necesidad de asistencia respiratoria mecánica (ARM), ácido láctico (AL), creatinfosfoquinasa (CPK), lactato deshidrogenasa (LDH), leucocitosis, saturación de O2 (SatO2) y PaO2/FiO2 al ingresar en el STI, presión al final de la espiración (PEEP), días de ARM, tratamiento con oseltamivir (dosis/tiempo), aislamiento bacteriológico y virológico en secreción bronquial, tratamiento con corticoides, estadía en el STI y mortalidad. Resultados. Se incluyeron 13 pacientes que ingresaron en el STI durante el período estudiado; media de la edad 45 ± 3; mujeres: 8 (61,5%), comorbilidades (n = 7, 53,8%): enfermedad pulmonar obstructiva crónica (n = 3), diabetes (n = 2), insuficiencia cardíaca (n = 1), cirrosis (n = 1), APACHE II: 18, SOFA: 9 ± 2. La sintomatología clínica predominante fue la siguiente: fiebre (n = 13, 100%), tos (n = 11, 84,6%), disnea (n = 9, 69,2%), infiltrados intersticiales (5/13, 38,4%), opacidades alveolares (6/13, 46,1%), opacidades mixtas (2/13, 15,3%), cuatro cuadrantes (9/13, 69,2%) y dos cuadrantes (4/13, 30,7%); se hallaron los siguientes valores medios: AL 25 mg/dl, CPK 480 U/l (p <0,05), LDH 2100 U/l (p <0,001), leucocitosis 12.500 mm3 , PEEP 18 cm H2O, SatO2 <91% (n = 11, 84,6%), PaO2/FiO2 <150 (n = 11, 84,6%), necesidad de ARM (n = 11, 84,6%), días de ARM 9,5 ± 3 días. Oseltamivir: dosis 150 mg/12 h; aislamiento bacteriológico: neumococo (n = 7, 53,8%); aislamiento virológico: H1N1 (n = 5, 38,4%); duración: 9,5 ± 3 días, corticoides (n = 8, 61,5%). Tiempo en el STI: 11 ± 4. No hubo muertes.    Conclusión. La aplicación de un protocolo inicial en el que además se evalúo la gravedad benefició la correcta evaluación y resucitación inicial en el grupo estudiado. Los valores de CPK y de LDH se acompañaron de hipoxemia severa y mayor compromiso pulmonar en la radiología de tórax(AU)

Objective. To evaluate the impact of a protocol for screening and resuscitation measures during the pandemic H1N1 on patients´ admission to the Intensive Care Unit (ICU). Design. Retrospective observational study of critically ill patients. Place. A medical-surgical Intensive Care Unit (ICU). Patients. Adults admitted to the ICU from the Emergency Department from April 28th 2009 to September 4th 2009. Variables of primary interest. Sex, age, comorbidities, APACHE II, SOFA at admission to the ICU, clinical symptoms, radiographic images, need for mechanical ventilation (MV), lactic acid (AL), creatine kinase (CPK), lactate dehydrogenase (LDH), leukocytosis, O2 saturation (O2Sat) and PaO2/FiO2 at admission to the ICU, end-expiratory pressure (PEEP), days of MV (DMV), oseltamivir (dose/time), bacteriological and virological isolations in bronchial secretions, corticosteroid treatment, stay in the ICU and mortality. Results. We included 13 patients admitted to ICU during the study period; mean age: 45 ± 3; females: 8 (61.5%); comorbidities (n = 7, 53.8%): COPD (n = 3), diabetes (n = 2), heart failure (n = 1), cirrhosis (n = 1), APACHE II: 18, SOFA: 9 ±-2. Clinical symptoms were: fever (n = 13, 100%), cough (n = 11, 84.6%), dyspnea (n = 9, 69.2%), interstitial infiltrates (5/13, 38.4%), alveolar opacities (6/13, 46.1%), mixed opacities (2/13, 15.3%), four quadrants (9/13, 69.2%) and two quadrants (4/13, 30.7%), average measures: AL 25 mg/dL, CPK 480 U/L (p <0.05), LDH 2,100 U/L (p <0.001), leukocytosis 12,500 mm3 , PEEP 18 cm H2O, O2Sat <91% (n = 11, 84.6%), PaO2/FiO2 <150 (n = 11, 84.6%), MV (n = 11, 84.6%), DMV: 9.5 ± 3; oseltamivir: 150 mg/12 hours; bacteriological isolation (Pneumococcus: n = 7, 53.8%), virological isolation (H1N1: n = 5, 38.4%); length: 9.5 ± 3 days, corticosteroids (n = 8, 61.5%); ICU stay 11 ± 4; no deaths were reported. Conclusion. The application of a protocol in which severity was also evaluated benefited in the correct assessment and initial resuscitation. The values of CPK and LDH were associated with severe hypoxemia and lung involvement in the thorax xrays. (AU)

Comparison of secondary attack rates in ger and apartment areas, Mongolia, November 2009 / Монголын Анагаах Ухаан

Background: Since its first identification of Pandemic H1N1 2009 in Oct 12, 09 in Mongolia, the cases have increased dramatically spreading in much of cities and provinces of Mongolia. We aimed to identify and compare the transmissibility of the infection in different household settings, so to add understanding of special characteristics of this infection.Methods: We selected 20 laboratory confirmed 2009 H1N1 influenza as the index cases from the National Surveillance System. We searched for Influenza like illness (ILI) cases in the households by questioning index-cases and household-contacts. Secondary case was defined as household-contact who developed one of the signs such as fever, dry cough, sore throat, runny nose and diarrhea within one week of symptom onset in index case. We calculated and compared attack rates in ger and apartment areas.Results: Transmissibility of 2009 H1N1 influenza was studied in 20 households. Each half was from ger and apartment residency of Ulaanbaatar city, Mongolia. The study involved 20 indexcases and 72 household-contacts. Secondary transmission occurred in 13 (65%) households with 22 (30.5%) household cases of probable Pandemic H1N1 influenza virus infection. The incidence in ger and apartment areas was 36.1% and 25.0% relatively. Cases in ger residency were 1.2 times more likely than in apartment residency to develop ILI (RR = 1.2, 95%CI: 0.86- 1.60).Conclusions: Overall secondary attack rate in this study was 30.5%, which is similar to that of 30% secondary attack rate for laboratory-confirmed 2009 H1N1 influenza in tourist group members in China. Though statistically not significant, the risk estimation of secondary ILI compared in ger and apartment residency indicates ger area residents have 20% higher risk for ILI development after illness in index case.

Molecular evolution of HA1 in pandemic H1N1 influenza viruses isolated in Guangdong during 2009 to 2011 / 中华微生物学和免疫学杂志

Objective To understand the evolutionary characterization of hemagglutinin (HA)gene of pandemic H1N1 influenza virus in Guangdong during 2009-2011. MethodsWe selected 83 pandemic H1N1 strains isolated in Guangdong during 2009-2011. The HA1 genes were sequenced and analyzed comparatively by Bioedit 7.0 and MEGA 4.0. ResultsThe evolutionary rate of Hal gene of pandemic H1N1 and seasonal H1N1 viruses was 5.2×10-3 substitutions/site/year, higher than that of seasonal H1N1 viruses. Most amino acid changes in HA1 molecules accumulated on the surface of the molecule and were partly located in antigenic sites. Two fatal infections were detected with a mutation at HA residue 222, in one virus with a change D222G, and in one virus D222N. ConclusionThe phylogenetic analysis demonstrates that the influenza epidemic in Guangdong at the beginning of 2011 are due to occurrence of genetic changes of pandemic H1N1 virus. The amino acid change at residue 222 of the HA1 are likely to be associated with severe or even fatal illness.

Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1): An experience from a tertiary care center in north India.

Objectives To describe our experience in children hospitalized with the pandemic Influenza A (H1N1) from Northern India. Methods The retrospective case study was conducted at the Pediatric ward and Pediatric Intensive Care Unit (PICU) dedicated to the children (aged 18 years or younger) with influenza-like illness (ILI) with positive laboratory test results for pandemic H1N1 by reverse-transcriptase polymerasechain- reaction assay. Results Between August 2009 and January 2010, a total of 100 children were hospitalized with suspected 2009 H1N1 influenza with Category “C” as described by the Government of India. Twenty five patients were positive for H1N1 and 9 for seasonal influenza A. The most common presentation (H1N1 positive) was with fever (100%), cough (100%), coryza (52%), respiratory distress (88%), vomiting (28%) and diarrhea (16%). One child presented with hypernatremic dehydration and seizures (Serum sodium 174 meq/l). Of the H1N1 positive hospitalized children, 7 (28%) had respiratory failure and required PICU admission, 4 (16%) required mechanical ventilation, and 3 (12%) died. The major radiological findings were bilateral pulmonary infiltrates and consolidation. All patients were treated with oral Oseltamivir suspension or capsule as per appropriate weigh band and supportive care as required. Two deaths were caused by refractory hypoxemia and one by refractory shock. Conclusions The exact incidence of Pandemic 2009 H1N1 influenza on morbidity and mortality is difficult to calculate since only Category “C” patients were screened.

Detection on the pandemic( H1N1 ) 2009 virus of an influenza epidemic situation and study on the characteristic of HA and NA gene / 中华微生物学和免疫学杂志

Objective To identify the pathogen of an influenza epidemic situation and analyze the genetic characteristic of hemagglutinin( HA ) gene and neuraminidase(NA) gene of this pathogen. Methods Real-time RT-PCR was used to dectect nucleic acid of the pandemic( H1N1 ) 2009 virus from oropharyngeal swabs of initial influenza-like illness in epidemic. The viruses were was inoculated and isolated with embryonated eggs. And the HA gene and NA gene were sequenced to analyze their characteristic. Results The influenza epidemic situation was caused by the pandemic( H1N1 ) 2009 virus. The HA and NA sequences data showed that the virus had the high homology with reference virus, and the NA sequences had not the H274Y mutation. Conclusion In this study, the pandemic( H1N1 ) 2009 virus were similar with the vaccine-like virus and the isolated virus of China, and sensitive to oseltamivir.

Infection Control Preparedness for Influenza A Pandemic (H1N1) 2009 in Healthcare Settings / 병원감염관리

BACKGROUND: This study aimed to assess the status of infection control during influenza A pandemic (H1N1) 2009. METHODS: A questionnaire survey was conducted in November 2009 at the 100 hospitals designated by the Korea Centers for Disease Control and Prevention (KCDC) as influenza A pandemic (H1N1) 2009-treatment institutions. RESULTS: In 32.3% of the hospitals, the ventilation system of the influenza A pandemic (H1N1) 2009 isolation ward was separated from the hospital's ventilation system. With regard to wearing personal protective equipment while caring for patients with H1N1 infection, during usual patient contact, masks were always worn by all medical staff at all the hospitals; however, medical staff at 38.7% and 51.6% of the hospitals did not wear gloves and gowns, respectively. During aerosol-generating procedures, some medical staff wore surgical masks, whereas medical staff at 10% and 23.3% of the hospitals did not wear gowns and protective goggles, respectively. In all, 64.5% of the hospitals responded that the contents of the guidelines established by the KCDC were insufficient for reference purposes in actual practice. CONCLUSION: Some of influenza A pandemic (H1N1) 2009-treatment institutions are believed to be inadequate in facilities, infection control during patient treatment, and administrative measures among their efforts to prevent transmission in hospital. In preparation against the outbreak of similar diseases in the future, the government needs to establish guidelines highly applicable by medical staff, to secure exclusive spaces and personnel for treating infectious disease patients, and to develop personal protective gear support and management systems.

Radiological and Clinical Characteristics of a Military Outbreak of Pandemic H1N1 2009 Influenza Virus Infection

OBJECTIVE: To describe detailed clinical and radiological features of the pandemic H1N1 2009 influenza viral infection among healthy young males in a semi-closed institutionalized setting. MATERIALS AND METHODS: A total of 18 patients confirmed with the pandemic H1N1 2009 influenza virus infection from July 18 to July 30, 2009 were enrolled in this study. Each patient underwent an evaluation to determine detailed clinical and radiological features. RESULTS: All patients presented with high fever (> 38.0degrees C), with accompanying symptoms of cough, rhinorrhea, sore throat, myalgia and diarrhea, and increased C-reactive protein (CRP) values with no leukocytosis nor elevated erythrocyte sedimentation rate (ESR). All patients, including one patient who progressed into acute respiratory distress syndrome, were treated with oseltamivir phosphate and quickly recovered from their symptoms. Chest radiographs showed abnormalities of small nodules and lobar consolidation in only two out of 18 patients. However, six of 12 patients who underwent thin-section CT examinations showed abnormal findings for small ground-glass opacities (GGOs) in addition to poorly-defined nodules with upper lobe predominance. CONCLUSION: In a population of healthy young adults, elevated CRP with normal ESR and white blood cell levels combined with GGOs and nodules on thin-section CT scans may indicate early signs of infection by the pandemic H1N1 2009 influenza virus.