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Yokomichi H, Mochizuki M, Lee JJ, Kojima R, Yokoyama T, Yamagata Z. Incidence of hospitalisation for severe complications of influenza virus infection in Japanese patients between 2012 and 2016: a cross-sectional study using routinely collected administrative data. BMJ Open 2019; 9:e024687. [PMID: 30782739 PMCID: PMC6340484 DOI: 10.1136/bmjopen-2018-024687] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To calculate the incidence of hospitalisation due to acute respiratory failure, pneumonia, acute respiratory distress syndrome (ARDS), febrile seizures and encephalitis/encephalopathy among influenza-positive patients in Japan, where point-of-care tests are routinely used to diagnose influenza. DESIGN A cross-sectional study using routinely collected data. SETTING Japanese clinics and hospitals between 2012 and 2016. PARTICIPANTS Japanese patients aged 0-74 years diagnosed with influenza by a rapid test in employment-related health insurance records. PRIMARY OUTCOME MEASURES Incidence of hospitalisation per 100 000 influenza-positive episodes. RESULTS We included over 16 million influenza-positive episodes, 1.0% of whom were hospitalised. Of these, 3361 were acute respiratory failure, 27 253 pneumonia, 18 ARDS, 2603 febrile seizure and 159 encephalitis/encephalopathy. The percentage of hospitalisations by age was 2.96% of patients aged 0-1 years, 0.77% aged 2-5, 0.51% aged 6-12, 0.78% aged 13-18, 1.36% aged 19-44, 1.19% aged 45-64, and 2.21% aged 65-74. The incidence of hospitalisations from these five complications combined was highest in influenza-positive patients aged 0-1 years (943 per 100 000) compared with 307 in those aged 2-5 years and 271 in those aged 65-74 years. For pneumonia, the incidence was highest for influenza-positive patients aged 0-5 years and 65 years or more. There were statistically significant decreasing trends over the years in the incidence of all-cause hospitalisations, pneumonia and febrile seizures. CONCLUSIONS Japanese administrative data revealed that 1.0% of influenza-positive patients aged under 75 years were hospitalised. Male patients had a higher incidence of pulmonary complications and febrile seizures. Children aged 0-5 years and adults aged 65-74 years were at high risk of being admitted to hospital for pneumonia.
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Affiliation(s)
- Hiroshi Yokomichi
- Department of Health Sciences, University of Yamanashi, Chuo City, Japan
| | - Mie Mochizuki
- Department of Pediatrics, University of Yamanashi, Chuo City, Japan
| | - Joseph Jonathan Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Reiji Kojima
- Department of Health Sciences, University of Yamanashi, Chuo City, Japan
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Wako City, Japan
| | - Zentaro Yamagata
- Department of Health Sciences, University of Yamanashi, Chuo City, Japan
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Rao S, Torok MR, Bagdure D, Cunningham MA, Williams JTB, Curtis DJ, Wilson K, Dominguez SR. A comparison of H1N1 influenza among pediatric inpatients in the pandemic and post pandemic era. J Clin Virol 2015; 71:44-50. [PMID: 26370314 DOI: 10.1016/j.jcv.2015.07.308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/24/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The novel influenza A H1N1 (A[H1N1]pdm09) strain emerged in 2009, contributing to significant morbidity and mortality. It is not known whether illness associated with A(H1N1) pdm09 in the post-pandemic era exhibits a similar disease profile. OBJECTIVE The objectives of this study were to compare the burden of disease of A(H1N1) pdm09 influenza from the 2009 pandemic year to the post-pandemic years (2010-2014), and to explore potential reasons for any differences. STUDY DESIGN We conducted a retrospective cohort study of inpatients admitted to Children's Hospital Colorado with a positive respiratory specimen for influenza from May-December, 2009 and December, 2010-April, 2014. Univariate and multivariate analyses were conducted to compare the demographics and clinical characteristics of patients with H1N1 during the two periods. RESULTS There were 388 inpatients with influenza A(H1N1) pdm09 in 2009, and 117 during the post-pandemic years. Ninety-four percent of all H1N1 during the post-pandemic era was observed during the 2013-2014 influenza season. Patients with A(H1N1) pdm09 during the post-pandemic year were less likely to have an underlying medical condition (P<0.01). Patients admitted to the ICU during the post-pandemic year had a lower median age (5 vs 8 years, P=0.01) and a lower proportion of patients were intubated, had mental status changes, and ARDS compared with the pandemic years, (P<0.01 for all), with decreased mortality (P=0.02). CONCLUSION Patients with influenza A(H1N1) pdm09 during the post-pandemic years appeared to have less severe disease than patients with A(H1N1) pdm09 during the pandemic year. The reasons for this difference are likely multifactorial.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics (Hospital Medicine and Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Michelle R Torok
- University of Colorado School of Medicine, Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Dayanand Bagdure
- Department of Pediatrics, University of Maryland School of Medicine, MD, USA
| | - Maureen A Cunningham
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Joshua T B Williams
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Donna J Curtis
- Department of Pediatrics (Infectious Diseases), University of Colorado School Of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Karen Wilson
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Samuel R Dominguez
- Department of Pediatrics (Infectious Diseases), University of Colorado School Of Medicine and Children's Hospital Colorado, Aurora, CO, USA
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Urashima M, Mezawa H, Noya M, Camargo CA. Effects of vitamin D supplements on influenza A illness during the 2009 H1N1 pandemic: a randomized controlled trial. Food Funct 2015; 5:2365-70. [PMID: 25088394 DOI: 10.1039/c4fo00371c] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In a prior randomized trial, we found that the incidence of influenza A was less in the vitamin D3 group than among those on placebo, but the total incidence of either influenza A or B did not differ between groups. In this trial, the incidence of influenza A or B was less in the vitamin D3 group than in the placebo group only during the first half of the study. To elucidate whether vitamin D3 has preventive actions against influenza A, we conducted another trial during the 2009 pandemic of the H1N1 subtype of influenza A. Students (n = 247) of a Japanese high school were randomly assigned to receive vitamin D3 supplements (n = 148; 2000 IU per day) or a placebo (n = 99) in a double-blind study for 2 months. The primary outcome was incidence of influenza A diagnosed by a rapid influenza diagnostic test by medical doctors. Influenza A was equally likely in the vitamin D3 group (20/148: 13.5%) compared with the placebo group (12/99: 12.1%). By post hoc analysis, influenza A occurred significantly less in the vitamin D3 group (2/148: 1.4%) compared with the placebo group (8/99: 8.1%) (risk ratio, 0.17; 95% confidence interval, 0.04 to 0.77; P = 0.009) in the first month. However, during the second month, the vitamin D3 group experienced more events and effectively caught up with the placebo group. Vitamin D3 supplementation did not lower the overall incidence of influenza A during the 2009 H1N1 pandemic. A post hoc analysis suggests that the initial benefit during the first month of treatment was lost during the second month.
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Affiliation(s)
- Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Jikei University School of Medicine, Nishi-shimbashi 3-25-8, Minato-ku, Tokyo 105-8461, Japan.
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Santesso N, Hsu J, Mustafa R, Brozek J, Chen YL, Hopkins JP, Cheung A, Hovhannisyan G, Ivanova L, Flottorp SA, Saeterdal I, Wong AD, Tian J, Uyeki TM, Akl EA, Alonso-Coello P, Smaill F, Schünemann HJ. Antivirals for influenza: a summary of a systematic review and meta-analysis of observational studies. Influenza Other Respir Viruses 2014; 7 Suppl 2:76-81. [PMID: 24034489 DOI: 10.1111/irv.12085] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Despite the use of antivirals to treat patients with severe influenza, questions remain with respect to effects and safety. Although a recent systematic review has provided some indication of benefit, the analysis is limited by the quality of the available evidence from randomized controlled trials. To supplement the existing information, the authors conducted a systematic review of observational studies of antiviral treatment for influenza. This report summarises the findings of that review. Similar to the randomised trials, the confidence in the estimates of the effects for decision-making is low to very low primarily due to the risk of selection and publication bias in the observational studies. From these observational studies, the summary estimates suggest that oseltamivir may reduce mortality, hospitalisation and duration of symptoms compared with no treatment. Inhaled zanamivir may also reduce symptom duration and hospitalisations, but patients may experience more complications compared with no treatment. Earlier treatment with antivirals is generally associated with better outcomes than later treatment. Further high-quality evidence is needed to inform treatment guidelines because of the overall low to very low quality of evidence.
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Affiliation(s)
- Nancy Santesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Beck CR, Sokal R, Arunachalam N, Puleston R, Cichowska A, Kessel A, Zambon M, Nguyen-Van-Tam JS. Neuraminidase inhibitors for influenza: a review and public health perspective in the aftermath of the 2009 pandemic. Influenza Other Respir Viruses 2013; 7 Suppl 1:14-24. [PMID: 23279893 DOI: 10.1111/irv.12048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The objectives of this study were to: (1) reflect on key stages in the discovery, development and pre-pandemic use of neuraminidase inhibitors (NAIs), (2) summarise the evidence of NAI effectiveness for treatment and prophylaxis of seasonal influenza prior to the 2009 pandemic, and (3) summarise the evidence base generated during the 2009 pandemic period. DESIGN A rapid systematic review of evidence published to June 2010 was conducted where existing high-quality systematic reviews formed a baseline and were supplemented with data from other reviews, randomised controlled trials (RCTs) and observational studies. MAIN OUTCOME MEASURES Severity and duration of symptoms; rates of severe illness, complications and death following treatment for influenza or influenza-like illness; rates of influenza and influenza-like illness following long-term prophylaxis or post-exposure prophylaxis of household contacts. RESULTS Prior to the 2009 pandemic, evidence from RCTs conducted in seasonal influenza epidemics indicated that NAIs used to treat laboratory-confirmed influenza in healthy adults reduced the duration of illness by one day. NAIs provide high levels of protective efficacy in adults when given long-term or in household-based post-exposure prophylaxis for seasonal influenza. Several 2009 pandemic period observational studies suggest that early treatment may reduce rates of hospitalisation and in-hospital mortality, but data from that period do not substantially increase the evidence base on prophylaxis, although they confirm effectiveness. CONCLUSIONS NAIs should be deployed during a future pandemic for either post-exposure prophylaxis or treatment depending on national policy considerations and logistics. The existing evidence base on effectiveness against severe outcomes requires supplementation.
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Affiliation(s)
- Charles R Beck
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham, Nottingham, UK
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Inamasu T, Sudo K, Kato S, Deguchi H, Ichikawa M, Shimizu T, Maeda T, Fujimoto S, Takebayashi T, Saito T. Pandemic influenza virus surveillance, Izu-Oshima Island, Japan. Emerg Infect Dis 2013; 18:1882-5. [PMID: 23092603 PMCID: PMC3559151 DOI: 10.3201/eid1811.111681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A population-based influenza surveillance study (using PCR virus subtyping) on Izu-Oshima Island, Japan, found that the cumulative incidence of influenza A(H1N1)pdm09 virus infections 2 seasons after the pandemic was highest for those 10–14 years of age (43.1%). No postpandemic A(H1N1)pdm09 case-patients had been infected with A(H1N1)pdm09 virus during the pandemic season.
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Affiliation(s)
- Tomoko Inamasu
- Keio University Global Security Research Institute,Tokyo, Japan
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Mansour DEAA, El-Shazly AAF, Elawamry AI, Ismail AT. Comparison of ocular findings in patients with H1N1 influenza infection versus patients receiving influenza vaccine during a pandemic. Ophthalmic Res 2012; 48:134-8. [PMID: 22572924 DOI: 10.1159/000337138] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/23/2012] [Indexed: 12/27/2022]
Abstract
AIM To evaluate ocular findings during the pandemic influenza A (H1N1) and after vaccination for the same strain. PATIENTS AND METHODS This study was conducted on 89 patients with H1N1 influenza infection (group 1) and 28 subjects who received vaccination for H1N1 (group 2). All patients were subjected to history taking, ophthalmological examination, fundus examination, conjunctival impression cytology and conjunctival swabs. RESULTS The patients' age ranged between 5 and 60 years (19.25 ± 11.70 years). Group 1 included 43 (48.1%) males and 46 (51.9%) females, while group 2 included 13 (46.43%) males and 15 (53.57%) females. The most common ocular finding of patients in group 1 was bilateral acute conjunctivitis in 58 cases (65.17%), while in group 2, we found 3 (10.71%) cases of mild conjunctivitis, and 2 (7.14%) cases of moderate conjunctivitis. Retinopathy, uveal affection, and optic neuritis were not statistically different between the 2 groups. Impression cytology of the conjunctiva for group 1 showed squamous metaplasia grade 3 with enlargement of epithelial cells, and fragmentation of the nucleus which is similar to virus-infected structural changes. CONCLUSION Pandemic influenza H1N1 was able to induce different ocular manifestations including acute conjunctivitis, retinopathy, uveal effusion syndrome and optic neuritis.
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Hsu J, Santesso N, Mustafa R, Brozek J, Chen YL, Hopkins JP, Cheung A, Hovhannisyan G, Ivanova L, Flottorp SA, Saeterdal I, Wong AD, Tian J, Uyeki TM, Akl EA, Alonso-Coello P, Smaill F, Schünemann HJ. Antivirals for treatment of influenza: a systematic review and meta-analysis of observational studies. Ann Intern Med 2012; 156:512-24. [PMID: 22371849 PMCID: PMC6679687 DOI: 10.7326/0003-4819-156-7-201204030-00411] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systematic reviews of randomized, controlled trials in patients with influenza suggest a lack of evidence about the effects of antiviral therapy on several patient-important outcomes of influenza. PURPOSE To systematically review observational studies for benefits and harms of oseltamivir, zanamivir, amantadine, or rimantadine in the treatment of influenza. DATA SOURCES MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, SIGLE, the Chinese Biomedical Literature Database, Panteleimon, and LILACS up to November 2010; contact with pharmaceutical companies; and reference lists. STUDY SELECTION Observational studies in any language that compared single antiviral therapy with no therapy or other antiviral therapy, or that had no comparator, for influenza or influenza-like illness. DATA EXTRACTION Two independent investigators extracted data. Confidence in the estimates of the obtained effects (quality of evidence) was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS 74 studies fulfilled the inclusion criteria. Meta-analyses of the few studies providing effects with adjustment for confounders suggest that, in high-risk populations, oral oseltamivir may reduce mortality (odds ratio, 0.23 [95% CI, 0.13 to 0.43]; low-quality evidence), hospitalization (odds ratio, 0.75 [CI, 0.66 to 0.89]; low-quality evidence), and duration of symptoms (33 hours [CI, 21 to 45 hours]; very low-quality evidence) compared with no treatment. Earlier treatment with oseltamivir was generally associated with better outcomes. Inhaled zanamivir may lead to shorter symptom duration (23 hours [CI, 17 to 28 hours]; moderate-quality evidence) and fewer hospitalizations (odds ratio, 0.66 [CI, 0.37 to 1.18]) but more complications than no treatment. Direct comparison of oral oseltamivir and inhaled zanamivir suggests no important differences in key outcomes. Data from 1 study suggest that oral amantadine may reduce mortality and pneumonia associated with influenza A. No included study evaluated rimantadine. LIMITATIONS Mortality was assessed in high-risk patients, and generalizability is limited. The overall body of evidence is limited by risk for confounding and selection, reporting, and publication bias. CONCLUSION Therapy with oral oseltamivir and inhaled zanamivir may provide a net benefit over no treatment of influenza. However, as with the randomized trials, the confidence in the estimates of the effects for decision making is low to very low. PRIMARY FUNDING SOURCES: World Health Organization and McMaster University.
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Gu Y, Komiya N, Kamiya H, Yasui Y, Taniguchi K, Okabe N. Pandemic (H1N1) 2009 transmission during presymptomatic phase, Japan. Emerg Infect Dis 2012; 17:1737-9. [PMID: 21888808 PMCID: PMC3322057 DOI: 10.3201/eid1709.101411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
During an epidemiologic investigation of pandemic influenza (H1N1) 2009 virus infection in May 2009 in Osaka, Japan, we found 3 clusters in which virus transmission occurred during the presymptomatic phase. This finding has public health implications because it indicates that viral transmission in communities cannot be prevented solely by isolating symptomatic case-patients.
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Affiliation(s)
- Yoshiaki Gu
- National Institute of Infectious Diseases, Tokyo, Japan.
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Radosavljevic V, Belojevic G. Unusual epidemic events: a new method of early orientation and differentiation between natural and deliberate epidemics. Public Health 2011; 126:77-81. [PMID: 22136700 DOI: 10.1016/j.puhe.2011.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 07/12/2011] [Accepted: 11/10/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To develop a model for quick and accurate evaluation of unusual epidemic events (UEE), based on the original model of bioterrorism risk assessment. METHODS A new scoring system was developed for quick differentiation between a biological attack and other epidemics, using eight qualitative and six quantitative indicators. RESULTS A new scoring system was applied to three UEEs: (1) a spontaneous outbreak of a new or re-emerging disease ('swine flu'); (2) a spontaneous outbreak following accidental release of a pathogen (Sverdlovsk anthrax); and (3) a spontaneous natural outbreak of a known endemic disease that may mimic bioterrorism or biowarfare (Kosovo tularaemia). The disease agent was found to be the most important and the most informative UEE component of the scoring system. CONCLUSIONS This new scoring system may be useful for public health institutions and federal civil and military officials responsible for bio-attack investigations.
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Donner B, Bader-Weder S, Schwarz R, Peng MM, Smith JR, Niranjan V. Safety profile of oseltamivir during the 2009 influenza pandemic. Pharmacoepidemiol Drug Saf 2011; 20:532-43. [PMID: 21448900 DOI: 10.1002/pds.2136] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study evaluated the safety of oseltamivir during the 2009 influenza pandemic. METHODS Case reports were obtained from the Roche safety database. The incidence of adverse events (AEs) during the pandemic (1 May 2009 to 31 December 2009) was compared with that beforehand (during previous influenza seasons) for USA and Japan only, as exposure data in other countries were collected inconsistently. Events with significantly higher reporting during the pandemic (lower bound of 95%CI for crude rate ratio >1) were analyzed further. RESULTS Global exposure in the pandemic and prepandemic periods was 18.3 and 64.7 million patients, respectively. In USA and Japan, exposure was 15.5 (1382 cases, 2225 events) and 62.0 million (8387 cases, 12,749 events), respectively. AEs with significantly higher reporting during the pandemic were generally consistent with influenza and its complications and/or with the circulation of a novel virus strain. As might be expected in a pandemic, mortality increased (crude rate ratio, 2.83; 95%CI, 2.23-3.59) versus the prepandemic period. Medical review of serious AEs (fatal or non-fatal outcome) found that most were consistent with pre-existing risk factors, underlying disease, and/or progression of influenza or its complications. Analysis of the remainder did not suggest a causal link with oseltamivir. A review of AEs in previously underexposed subpopulations did not support an association with oseltamivir. CONCLUSIONS During the first 8 months of the 2009 influenza pandemic, AEs reported in patients exposed to oseltamivir were consistent with the drug's labeled safety profile, underlying medical conditions, or infection with the pandemic virus.
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Abstract
BACKGROUND Emergency department (ED) presentation of pediatric pandemic H1N1 (pH1N1) infection is not well characterized. Our objective was to describe the clinical manifestations of pH1N1 in the pediatric ED. We also compared these characteristics to seasonal influenza A, and explored risk factors for pH1N1 hospitalization. METHODS We conducted a retrospective cohort study at a pediatric hospital in Quebec City, Canada. Subjects were ED patients aged 0 to 17 years with laboratory-confirmed pH1N1 (April-July 2009) or seasonal influenza A (June 2006-March 2009). Clinical and laboratory data were analyzed by univariate and multivariate log-binomial regression. RESULTS A total of 127 pH1N1 cases and 110 seasonal influenza cases were identified. pH1N1 patients were older (9.5 vs. 5.6 years; P < 0.0001) and presented more rapidly (2.8 vs. 3.5 days; P = 0.02). Clinical manifestations were similar, although gastrointestinal findings were less frequent in pH1N1 (relative risk [RR]: 0.49; 95% confidence interval [CI]: 0.37-0.65). Hospitalization risk was similar (RR: 1.12; 95% CI: 0.81-1.55), but hospitalized pH1N1 subjects were more frequently diagnosed with pneumonia (RR: 2.41; 95% CI: 1.16-5.00). In a multivariable model, age <2 years was independently associated with pH1N1 hospitalization (RR: 3.17; 95% CI: 1.78-5.65), whereas the absence of significant comorbidities decreased its risk (RR: 0.51; 95% CI: 0.31-0.85). CONCLUSIONS After adjustment for age and delay to presentation, clinical manifestations and 21-day outcomes of pediatric pH1N1 were similar to those of seasonal influenza. pH1N1 patients with previously established risk factors for severe seasonal influenza experienced increased hospitalization risk. Our results suggest that pH1N1 clinical diagnosis and management in the pediatric ED can be performed in a manner similar to seasonal influenza.
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Abstract
AIM To report on a different clinical course of pandemic influenza A (H1N1) infection among children who were neurologically impaired before the acute onset of the disease, in comparison with children who were neurologically intact. METHODS In a period of 6 months, six children with neurological complications associated with pandemic A (H1N1) infection were identified in a single institution paediatric emergency room. The children suffered from seizures or altered mental status during pandemic A (H1N1) infection. All children underwent extensive clinical and laboratory assessment. Three children were neurologically impaired before the acute onset of the H1N1 infection. The other three were neurologically intact before the acute viral infection. RESULTS In all six patients, pandemic influenza A (H1N1) viral RNA was detected in nasopharyngeal specimens but none in the cerebrospinal fluid. Five children fully recovered or returned to baseline at discharge. The clinical course of the disease and recovery were different between the children who were neurologically impaired before the acute viral infection and those who were neurologically intact. CONCLUSIONS It is possible that children with various neurological conditions are in a higher risk to develop further neurological complications during pandemic influenza A (H1N1) infection.
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Affiliation(s)
- Ibrahim Omari
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus Campus, Jerusalem, Israel
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14
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Khandaker G, Dierig A, Rashid H, King C, Heron L, Booy R. Systematic review of clinical and epidemiological features of the pandemic influenza A (H1N1) 2009. Influenza Other Respir Viruses 2011; 5:148-56. [PMID: 21477133 PMCID: PMC5657010 DOI: 10.1111/j.1750-2659.2011.00199.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Please cite this paper as: Khandaker et al. (2011) Systematic review of clinical and epidemiological features of the pandemic influenza A (H1N1) 2009. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2011.00199.x. The aim of this systematic review was to summarise the clinical and epidemiological features of the pandemic influenza A (H1N1) 2009. We did a systematic search of published literature reporting clinical features of laboratory‐confirmed pandemic influenza A (H1N1) 2009 from 1 April 2009 to 31 January 2010. Forty‐four articles met our inclusion criteria for the review. The calculated weighted mean age of confirmed cases was 18·1 years, with the median ranging from 12 to 44 years. Cough (84·9%), fever (84·7%), headache (66·5%), runny nose (60·1%) and muscle pain (58·1%) were the most common symptoms of confirmed cases. One or more pre‐existing chronic medical conditions were found in 18·4% of cases. Almost two‐thirds (64%) of cases were aged between 10 and 29 years, 5·1% were aged over 50 years and only 1·1% were aged over 60 years. The confirmed case fatality ratio was 2·9% (95% CI 0·0–6·7%), an extracted average from 12 of 42 studies reporting fatal cases (937 fatal cases among 31 980 confirmed cases), which gives an overall estimated infected case fatality ratio of 0·02%. Early in the pandemic, disease occurred overwhelmingly in children and younger adults, with cough and fever as the most prevalent clinical symptoms of the confirmed cases. A high infection rate in children and young adults, with sparing of the elderly population, has implications for pandemic influenza management and control policies.
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Affiliation(s)
- Gulam Khandaker
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and the University of Sydney, New South Wales, Australia.
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Protheroe RE, Kirkland KE, Pearce RM, Kaminaris K, Bloor A, Potter MN, Nagra S, Gilleece MH, McQuaker IG, Jackson G, Cook G, Marks DI. The clinical features and outcome of 2009 H1N1 influenza infection in allo-SCT patients: a British Society of Blood and Marrow Transplantation study. Bone Marrow Transplant 2011; 47:88-94. [PMID: 21358686 DOI: 10.1038/bmt.2011.12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The clinical course of 2009 H1N1 influenza in Allo-SCT patients is unknown. Data were collected in the UK from October 2009 to April 2010 on laboratory-confirmed cases of H1N1 influenza in Allo-SCT recipients. H1N1 infection was diagnosed in 60 patients, median age 42 years, at a median of 10 months post-SCT. Twenty-one patients (35%) developed pneumonia and nine (15%) required admission to intensive care units. Actuarial mortality was 7% at 28 days and 19% 4 months post-diagnosis of 2009 H1N1 influenza. Increasing age and pre-existing lung disease were risk factors for pneumonia (P=0.006 and 0.037, respectively); older age was a risk factor for death (P=0.012). Morbidity and mortality from 2009 H1N1 influenza in SCT patients exceeds that of immunocompetent patients, but parallels that in other critically ill hospitalised cohorts; the elderly and those with chronic pulmonary disease are at greatest risk.
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Affiliation(s)
- R E Protheroe
- Bristol Adult Bone Marrow Transplant Unit, University Hospitals Bristol, Bristol, UK
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Fretzayas A, Moustaki M, Kotzia D, Nicolaidou P. Rash, an uncommon but existing feature of H1N1 influenza among children. Influenza Other Respir Viruses 2011; 5:223-4. [PMID: 21651731 PMCID: PMC4634543 DOI: 10.1111/j.1750-2659.2011.00197.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Andrew Fretzayas
- 3rd Department of Pediatrics, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Maria Moustaki
- 3rd Department of Pediatrics, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Doxa Kotzia
- 3rd Department of Pediatrics, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
| | - Polyxeni Nicolaidou
- 3rd Department of Pediatrics, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
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17
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Ciblak MA, Kanturvardar M, Asar S, Bozkaya E, Yenen OS, Badur S. Sensitivity of rapid influenza antigen tests in the diagnosis of pandemic (H1N1)2009 compared with the standard rRT-PCR technique during the 2009 pandemic in Turkey. ACTA ACUST UNITED AC 2010; 42:902-5. [PMID: 20662619 DOI: 10.3109/00365548.2010.502903] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The real-time reverse transcription polymerase chain reaction (rRT-PCR) technique has been used as the reference technique for the diagnosis of pandemic (H1N1)2009 virus infections. However, rapid influenza diagnostics tests (RIDTs) have been considered in the diagnosis of pandemic (H1N1)2009 by some healthcare institutions in Turkey due to their ease of use and generation of fast results. Nevertheless, their low sensitivity has caused concern during the control of the pandemic. This study aimed to determine the sensitivity of 4 different rapid tests available on the market in Turkey in the diagnosis of pandemic (H1N1)2009 infections compared to the reference rRT-PCR technique. One hundred and four patient samples that tested positive and 88 samples that tested negative for pandemic (H1N1)2009 by rRT-PCR were tested with RIDTs available on the market. The sensitivity of the rapid tests ranged from 31.7% to 50% depending on the brand of RIDT. Specificity ranged from 97.7% to 100%. Currently available RIDTs are not sensitive enough and could lead physicians to delay the treatment of patients, adversely affecting control efforts to mitigate the pandemic. Therefore, these tests should only be used for screening, and negative results should not rule out influenza. More sensitive and rapid point-of-care techniques are needed to meet the demands of point-of-care testing.
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Affiliation(s)
- Meral Akcay Ciblak
- National Influenza Reference Laboratory, Department of Microbiology and Clinical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Cui W, Zhao H, Lu X, Wen Y, Zhou Y, Deng B, Wang Y, Wang W, Kang J, Liu P. Factors associated with death in hospitalized pneumonia patients with 2009 H1N1 influenza in Shenyang, China. BMC Infect Dis 2010; 10:145. [PMID: 20513239 PMCID: PMC2890005 DOI: 10.1186/1471-2334-10-145] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 05/31/2010] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics and factors associated with the death of patients who were hospitalized with 2009 H1N1 influenza pneumonia in Shenyang, China, from November to December 2009. METHODS We carried out a retrospective chart review of 68 patients who were hospitalized with pneumonia and confirmed to have 2009 H1N1 virus infection by a real time RT-PCR assay of respiratory specimens. RESULTS Of the 68 patients we studied, 30 (44%) were admitted to an intensive care unit and 10 (14.7%) died. The median age of patients was 41 years (range, 18-66), and only one patient was over 65 years of age. The male to female ratio was 2.78:1 (50:18). Of the 68 patients, 23 (34%) had at least one underlying medical condition, 9 (13%) had a cigarette index > or =400 and 22 (32%) were obese. All patients underwent chest radiography on admission and the findings were consistent with pneumonia in all cases. All patients were treated with oseltamivir and treatment was initiated at a median time of seven days after the onset of illness. The laboratory test results indicated lymphopenia, hypoproteinemia and elevated lactic dehydrogenase and C reactive protein levels. Of the 68 patients, 33 (52%) showed a reduction in CD4 T cell counts. Of the 58 patients who survived, 31 (53%) had lymphopenia and 27 recovered from this condition after five days. Of the 10 patients who died, nine (90%) had lymphopenia and only two patients recovered from this condition after five days. Obesity and recovery from lymphopenia after five days were factors associated with death, as determined by multivariate logistic-regression analysis (obesity, odds ratio = 23.06; lymphocytopenia reversion, odds ration = 28.69). CONCLUSIONS During the evaluation period in Shenyang, China, 2009 H1N1 influenza caused severe illness requiring hospitalization in 68 patients, 10 (14.7%) of which died. Many of these patients were considered healthy adults and few were elderly (65 years or older). Obesity and lymphopenia, which was not restored after five days of treatment, were factors associated with poor outcomes of 2009 H1N1 influenza infection.
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Affiliation(s)
- Wei Cui
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongwen Zhao
- Department of Respiratory Medicine, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xu Lu
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Ying Wen
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Ying Zhou
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Baocheng Deng
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Yu Wang
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Wen Wang
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory Medicine, the First Affiliated Hospital, China Medical University, Shenyang, China
| | - Pei Liu
- Department of Infectious Diseases, the First Affiliated Hospital, China Medical University, Shenyang, China
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19
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Neghina AM, Marincu I, Neghina R. Occurrence of influenza A(H1N1)v virus in Western Romania in relationship to international travel. Vector Borne Zoonotic Dis 2010; 10:935-8. [PMID: 20370428 DOI: 10.1089/vbz.2009.0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Epidemiological and clinical characteristics of the first cases of infection with the novel influenza A (H1N1) variant virus [A(H1N1)v] admitted to a reference hospital in Western Romanian from mid-June to mid-July 2009 are overviewed. Of 74 suspected cases, 7 were laboratory confirmed. All patients were either Romanian citizens, or people originating from Romania and established overseas. The median age was 13 years and the mean length of hospital stay was 7.7 days. Cough (n = 6) and fever (n = 4) were the most commonly reported symptoms, and all cases made complete recovery. Early diagnosis and management of H1N1 flu was not problematic for the infectious disease specialists. Because many Romanians established overseas come yearly to visit their relatives, special attention must be addressed to the international flight passengers.
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Affiliation(s)
- Adriana M Neghina
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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Iwata K, Shinya K, Makino A, Yoshida H, Kinoshita S, Ohji G, Kato K. A case of pandemic 2009 influenza A (H1N1) in a patient with HIV infection. J Infect Chemother 2010; 16:298-300. [PMID: 20306107 DOI: 10.1007/s10156-010-0054-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 02/19/2010] [Indexed: 11/28/2022]
Abstract
Little is known about pandemic 2009 influenza A (H1N1) among patients with human immunodeficiency virus (HIV) infection. We report a case of 2009 influenza A (H1N1) in a patient who was newly diagnosed as having HIV. His general condition was good, and he was successfully treated in an outpatient setting. The literature was reviewed for the diagnosis, treatment, prevention, and infection control of pandemic 2009 influenza A (H1N1) among those who have HIV infection.
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Affiliation(s)
- Kentaro Iwata
- Division of Infectious Diseases, Kobe University Hospital, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
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21
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Treatment options for 2009 H1N1 influenza: evaluation of the published evidence. Int J Antimicrob Agents 2010; 35:421-30. [PMID: 20185273 DOI: 10.1016/j.ijantimicag.2010.01.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 01/06/2023]
Abstract
We evaluated the evidence regarding the effectiveness of various treatment strategies used for 2009 H1N1 influenza by reviewing available relevant studies. In total, 22 studies (15 cohort studies involving >10 patients, 5 cohort studies with < or = 10 patients and 2 case reports) were included. A total of 3020 patients [1068 (35.4%) critically ill, 1722 (57.0%) hospitalised and 230 (7.6%) outpatients, including 909 (30.1%) children] were involved. Notably, 487 (16.1%) were obese [body mass index (BMI) >30)], 362 (12.0%) had asthma or chronic obstructive pulmonary disease and 255 (8.4%) were pregnant. Antiviral treatment was administered to 1622 patients (53.7%), of whom 661 (40.8%) received oseltamivir monotherapy. Corticosteroids were administered in 323 (31.8%) of 1016 patients for whom relevant data were available. Similarly, 633 (85.0%) of 745 patients received antibiotics. Comparative data from the largest included study (involving 1088 patients) indicated that administration of antivirals within 2 days from symptom onset was significantly associated with reduced mortality (P<0.001). In summary, the scarcity of comparative available data hampered the establishment of any firm conclusions regarding the benefit that various treatment strategies may confer to patients with 2009 H1N1 influenza. Studies with a comparative design, as well as randomised studies are needed to clarify further this issue of major importance.
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Abstract
Within 2 months of its discovery last spring, a novel influenza A (H1N1) virus, currently referred to as 2009 H1N1, caused the first influenza pandemic in decades. The virus has caused disproportionate disease among young people with early reports of virulence similar to that of seasonal influenza. This clinical review provides an update encompassing the virology, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of the 2009 H1N1 virus. Because information about this virus, its prevention, and treatment are rapidly evolving, readers are advised to seek additional information. We performed a literature search of PubMed using the following keywords: H1N1, influenza, vaccine, pregnancy, children, treatment, epidemiology, and review. Studies were selected for inclusion in this review on the basis of their relevance. Recent studies and articles were preferred.
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Affiliation(s)
- Seth J Sullivan
- Mayo Vaccine Research Group, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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23
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Winzer R, Kanig N, Schneitler S, Reuter S, Jensen B, Müller-Stöver I, Oh J, Adams O, Mayatepek E, Hengel H, Schneitler H, Häussinger D. Early clinical experiences with the new influenza A (H1N1/09). DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:770-6. [PMID: 20019861 DOI: 10.3238/arztebl.2009.0770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 11/03/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because of ongoing person-to-person transmission of the disease, the World Health Organization has declared a phase 6 pandemic alert for the new type of influenza A (H1N1/09). This means that the spread of the disease must be closely monitored. METHODS At the Düsseldorf University Hospital, patients with flu-like symptoms and their contacts have been tested for the new type of influenza A since April 2009. RESULTS The first patients that tested positive for H1N1/09 were treated on 20 May 2009. By mid-September, 3372 persons underwent PCR testing of a sample obtained by deep nasal swabbing, and the results were positive in 450 (13.3%). 379 of these 450 infections, or 84.2%, had been contracted abroad. Most patients came to the hospital with flu-like symptoms within three days of becoming ill. An analysis of the first 60 patients revealed a median core temperature of 37.8 degrees C and a mildly elevated C-reactive protein concentration. All patients were treated with oseltamivir. Most of the initially symptomatic patients were asymptomatic again within 3 days; the median duration of treatment was 5 days. The median time to the first negative deep nasal swab was 4 days. No oseltamivir resistance has been found to date in our patient collective. CONCLUSION The clinical manifestations of the new type of influenza were still mild in the patient population that we studied up to mid-September 2009. At that time, the second wave of the pandemic had not yet begun in Germany. At present, however, the number of cases acquired within the country is on the rise.
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Affiliation(s)
- Ralf Winzer
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf , Düsseldorf, Germany
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Petrosillo N, Di Bella S, Drapeau CM, Grilli E. The novel influenza A (H1N1) virus pandemic: An update. Ann Thorac Med 2009; 4:163-72. [PMID: 19881161 PMCID: PMC2801040 DOI: 10.4103/1817-1737.56008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 08/20/2009] [Indexed: 11/05/2022] Open
Abstract
In the 4 months since it was first recognized, the pandemic strain of a novel influenza A (H1N1) virus has spread to all continents and, after documentation of human-to-human transmission of the virus in at least three countries in two separate World Health Organization (WHO) regions, the pandemic alert was raised to level 6. The agent responsible for this pandemic, a swine-origin influenza A (H1N1) virus (S-OIV), is characterized by a unique combination of gene segments that has not previously been identified among human or swine influenza A viruses. As of 31th July 2009, 168 countries and overseas territories/communities have each reported at least one laboratory-confirmed case of pandemic H1N1 infection. There have been a total of 162,380 reported cases and 1154 associated deaths. Influenza epidemics usually take off in autumn, and it is important to prepare for an earlier start this season. Estimates from Europe indicate that 230 millions Europe inhabitants will have clinical signs and symptoms of S-OIV this autumn, and 7- 35% of the clinical cases will have a fatal outcome, which means that there will be 160,000- 750,000 H1N1-related deaths. A vaccine against H1N1 is expected to be the most effective tool for controlling influenza A (H1N1) infection in terms of reducing morbidity and mortality and limiting diffusion. However, there are several issues with regard to vaccine manufacture and approval, as well as production capacity, that remain unsettled. We searched the literature indexed in PubMed as well as the websites of major international health agencies to obtain the material presented in this update on the current S-OIV pandemic.
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Affiliation(s)
- N Petrosillo
- 2nd Infectious Diseases Division, National Institute for Infectious Diseases, "Lazzaro Spallanzani," Rome, Italy.
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Abraham-Inpijn L. Nieuwe influenza A (H1N1) - Mexicaanse griep. TANDARTSPRAKTIJK 2009; 30:66-70. [PMID: 32287552 PMCID: PMC7111923 DOI: 10.1007/bf03080980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
Het viel te verwacht dat het nieuwe influenzavirus bij veel tandartsen en mondhygiënisten vragen oproept in verband met de kans op besmetting in de praktijk. Enkele van deze vragen waren:
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