tetano
Editor, Senior Moderator
Oxford Journals
Medicine
Journal of Infectious Diseases
Volume203, Issue12
Pp. 1739-1747.
Complications and Outcomes of Pandemic 2009 Influenza A (H1N1) Virus Infection in Hospitalized Adults: How Do They Differ From Those in Seasonal Influenza?
Nelson Lee1,2,
Paul K. S. Chan2,3,
Grace C. Y. Lui1,
Bonnie C. K. Wong1,
Winnie W. Y. Sin4,
Kin-Wing Choi4,
Rity Y. K. Wong1,
Elaine L. Y. Lee4,
Apple C. M. Yeung3,
Karry L. K. Ngai3,
Martin C. W. Chan1,
Raymond W. M. Lai3,
Alex W. Y. Yu4 and
David. S. C. Hui1,2
+ Author Affiliations
1Department of Medicine and Therapeutics, Prince of Wales Hospital
2Stanley Ho Center for Emerging Infectious Diseases
3Department of Microbiology
4Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Chinese University of Hong Kong, People?s Republic of China
Correspondence: David S. C. Hui, MD, 9/F Clinical Sciences Bldg, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Peoples Republic of China (dschui@cuhk.edu.hk).
Abstract
Background. It is unclear whether pandemic 2009 influenza A (pH1N1) infection caused more significant disease among hospitalized adults than seasonal influenza.
Methods. A prospective, observational study was conducted in adults hospitalized with polymerase chain reaction?confirmed pH1N1 infection in 2 acute-care general hospitals from June 2009 to May 2010 (n = 382). Complications and outcomes were described and compared with those in a seasonal influenza cohort (2007?2008, same hospitals; n = 754).
Results. Hospitalized patients with pH1N1 influenza were younger than those with seasonal influenza (mean age ? standard deviation, 47 ? 20 vs 70 ? 19 years) and fewer had comorbid conditions (48% vs 64%). The rate of positive immunofluorescence assay results was low (54% vs 84%), and antiviral use was frequent (96% vs 52%). Most patients in both cohorts developed complicated illnesses (67.8% vs 77.1%), but patients with pH1N1 influenza had higher rates of extrapulmonary complications (23% vs 16%; P = .004) and intensive care unit admission and/or death (patient age <35 years, 2.3% vs 0%; 35?65 years, 12.4% vs 3.2%; >65 years, 13.5% vs 8.5%; adjusted odds ratio [OR] 2.13; 95% confidence interval [CI], 1.25?3.62; P = .005). Patients who received antiviral treatment within 96 h after onset had better survival (log-rank test, P < .001). However, without timely treatment, the mortality risk was higher with pH1N1 infection (9.0% vs 5.8% for seasonal influenza; adjusted OR, 6.85; 95% CI, 1.64?28.65; P = .008]. Bacterial superinfection worsened outcomes.
Conclusions. Adults hospitalized for pH1N1 influenza had significant complications and mortality despite being younger than patients with seasonal influenza. Antiviral treatment within 96 h may improve survival.
http://jid.oxfordjournals.org/content/203/12/1739.short
Medicine
Journal of Infectious Diseases
Volume203, Issue12
Pp. 1739-1747.
Complications and Outcomes of Pandemic 2009 Influenza A (H1N1) Virus Infection in Hospitalized Adults: How Do They Differ From Those in Seasonal Influenza?
Nelson Lee1,2,
Paul K. S. Chan2,3,
Grace C. Y. Lui1,
Bonnie C. K. Wong1,
Winnie W. Y. Sin4,
Kin-Wing Choi4,
Rity Y. K. Wong1,
Elaine L. Y. Lee4,
Apple C. M. Yeung3,
Karry L. K. Ngai3,
Martin C. W. Chan1,
Raymond W. M. Lai3,
Alex W. Y. Yu4 and
David. S. C. Hui1,2
+ Author Affiliations
1Department of Medicine and Therapeutics, Prince of Wales Hospital
2Stanley Ho Center for Emerging Infectious Diseases
3Department of Microbiology
4Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Chinese University of Hong Kong, People?s Republic of China
Correspondence: David S. C. Hui, MD, 9/F Clinical Sciences Bldg, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Peoples Republic of China (dschui@cuhk.edu.hk).
Abstract
Background. It is unclear whether pandemic 2009 influenza A (pH1N1) infection caused more significant disease among hospitalized adults than seasonal influenza.
Methods. A prospective, observational study was conducted in adults hospitalized with polymerase chain reaction?confirmed pH1N1 infection in 2 acute-care general hospitals from June 2009 to May 2010 (n = 382). Complications and outcomes were described and compared with those in a seasonal influenza cohort (2007?2008, same hospitals; n = 754).
Results. Hospitalized patients with pH1N1 influenza were younger than those with seasonal influenza (mean age ? standard deviation, 47 ? 20 vs 70 ? 19 years) and fewer had comorbid conditions (48% vs 64%). The rate of positive immunofluorescence assay results was low (54% vs 84%), and antiviral use was frequent (96% vs 52%). Most patients in both cohorts developed complicated illnesses (67.8% vs 77.1%), but patients with pH1N1 influenza had higher rates of extrapulmonary complications (23% vs 16%; P = .004) and intensive care unit admission and/or death (patient age <35 years, 2.3% vs 0%; 35?65 years, 12.4% vs 3.2%; >65 years, 13.5% vs 8.5%; adjusted odds ratio [OR] 2.13; 95% confidence interval [CI], 1.25?3.62; P = .005). Patients who received antiviral treatment within 96 h after onset had better survival (log-rank test, P < .001). However, without timely treatment, the mortality risk was higher with pH1N1 infection (9.0% vs 5.8% for seasonal influenza; adjusted OR, 6.85; 95% CI, 1.64?28.65; P = .008]. Bacterial superinfection worsened outcomes.
Conclusions. Adults hospitalized for pH1N1 influenza had significant complications and mortality despite being younger than patients with seasonal influenza. Antiviral treatment within 96 h may improve survival.
http://jid.oxfordjournals.org/content/203/12/1739.short