Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

[Laidback Al]

The Lancet, Early Online Publication, 12 November 2009
doi:10.1016/S0140-6736(09)61638-X

Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

Santiago Echevarr?a-Zuno MD, Juan Manuel Mej?a-Arangur? PhD, Alvaro J Mar-Obeso MD, Concepci?n Grajales-Mu?iz MD, Eduardo Robles-P?rez MSc, Margot Gonz?lez-Le?n MD, Manuel Carlos Ortega-Alvarez MSc, Cesar Gonzalez-Bonilla PhD, Ram?n Alberto Rasc?n-Pacheco MSc, Dr V?ctor Hugo Borja-Aburto PhD

Summary

Background
In April, 2009, the first cases of influenza A H1N1 were registered in Mexico and associated with an unexpected number of deaths. We report the timing and spread of H1N1 in cases, and explore protective and risk factors for infection, severe disease, and death.
Methods
We analysed information gathered by the influenza surveillance system from April 28 to July 31, 2009, for patients with influenza-like illness who attended clinics that were part of the Mexican Institute for Social Security network. We calculated odds ratios (ORs) to compare risks of testing positive for H1N1 in those with influenza-like illness at clinic visits, the risk of admission for laboratory-confirmed cases of H1N1, and of death for inpatients according to demographic characteristics, clinical symptoms, seasonal influenza vaccine status, and elapsed time from symptom onset to admission.
Findings
By July 31, 63 479 cases of influenza-like illness were reported; 6945 (11%) cases of H1N1 were confirmed, 6407 (92%) were outpatients, 475 (7%) were admitted and survived, and 63 (<1%) died. Those aged 10?39 years were most affected (3922 [56%]). Mortality rates showed a J-shaped curve, with greatest risk in those aged 70 years and older (10?3%). Risk of infection was lowered in those who had been vaccinated for seasonal influenza (OR 0?65 [95% CI 0?55?0?77]). Delayed admission (1?19 [1?11?1?28] per day) and presence of chronic diseases (6?1 [2?37?15?99]) were associated with increased risk of dying.
Interpretation
Risk communication and hospital preparedness are key factors to reduce mortality from H1N1 infection. Protective effects of seasonal influenza vaccination for the virus need to be investigated.
Funding
None.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61638-X/abstract

 

[Flari]

Re: Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

At first sorry for my bad english, i?m german.

I can?t understand, why lancet published this "story".
Do they want to loose all respect?
This will be an analyse?

Mexico made over long time a very good job in collection the dada of h1n1, only without a short time in open dada in may, while at example france want to isolated them.

While the who only collect data of laboratory-confirmed cases and published it by the day after, mexico sort it back to the spring of the cases!
The realtime may often lay 2-4 weeks in the past.

Two examples (in german):

http://pandemie.de.tl/Mexiko.htm

A few weeks ago mexico changed there system and refreshed the information of the past.
So everybody can see the real data from end of july:

http://portal.salud.gob.mx/sites/salud/descargas/pdf/influenza/situacion_actual_epidemia_300709.pdf

The real data contains 16,442 laboratory-confirmed cases within 146 deaths.
May be, the tests will take max. 4 weeks to be confirmed, then we have rel data from middle of october with 41,920 laboratory-confirmed cases within 260 deaths.:

http://portal.salud.gob.mx/sites/salud/descargas/pdf/influenza/situacion_actual_epidemia_141009.pdf

With one mail or call The Lancet can get many more information from mexico gov, for a much better retrospective analysis.

I can?t understand them....

 

[Flari]

Re: Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

ops, a little mistake...

If the data from mexiko added inbetween 2-4 weeks, we can look to the latest update from Nov 09.2009 with 59,762 laboratory-confirmed cases within 452 deaths :

http://portal.salud.gob.mx/sites/salud/descargas/pdf/influenza/situacion_actual_epidemia_091109.pdf

 

[sharon sanders]

Re: Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

Willkommen Flari!

 

[Flari]

thx!

thx!

Willkommen Flari!

thx :smartass:

 

[Tonka]

Re: Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

Hello Flari, and welcome!

I clearly understand your question and I believe what they are trying to say is of the confirmed cases, 6,945, 92% of THOSE were outpatients. 475 (7%) were admitted and survived, and 63 (<1%) died.

63,479 possible cases, the magic word must be CONFIRMED.

Tonka

 

[Flari]

Re: Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

Hello Flari, and welcome!

I clearly understand your question and I believe what they are trying to say is of the confirmed cases, 6,945, 92% of THOSE were outpatients. 475 (7%) were admitted and survived, and 63 (<1%) died.

63,479 possible cases, the magic word must be CONFIRMED.

Tonka

Hello Tonka, I know exactly what CONFIRMED means. :magnify:

In this study they used the wrong data!

By July 31, 63 479 cases of influenza-like illness were reported; 6945 (11%) cases of H1N1 were confirmed,

Ok, till the July 31 there was tested only a part of the reported cases, the most tested in August!
And then they have to wrote:

By July 31, 63 479 cases of influenza-like illness were reported; 16,422 (25%) cases of H1N1 were confirmed,

They also wrote:

Those aged 10?39 years were most affected (3922 [56%])

Absolut stupid!

There were 4590 (28%) in the group 0-9 years, 5281 (32%) in the group 10-19, 2941 (18%) in the group 20-29, 1574 (9,5%) in the group 30-39.

And in the real comirmed cases there were 146 death.
4 in the group 70 and more, but in the group <1 year 8 death!
Where is the higher risc?

Right is: IF older people get this flu, the risc to die may be a little bit higher.
But this interesting?
When only 252 (1,5%) in the group 60 and older got the flu?
Over 70 may be only 0,5%?

Many newspapers around the world wrote yesterday and today in big letters:

Older people will die! Highest risc!

 

[DrRugby]

Re: Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

Just to add a bit of confusion to the mix, consider this.

Not tropical mind you, but guess what looks exactly like a severe
influenza for the first 2 or 3 days and then ends causing death by hemorrhage?

CCHF, Congo-Crimean Hemorrhagic Fever, found in southern Ukraine, Turkey, all the -stans.

 

[sharon sanders]

Re: Lancet. Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis

From this thread.

"China - Anhui Province - Public Health Director Describes Rapid Death in Some H1N1 Cases <hr style="color: rgb(204, 204, 204); background-color: rgb(204, 204, 204);" size="1"> <!-- / icon and title --> <!-- message --> This means they have this kind of disease progression for A/H1N1 in China.


Since November 5 the first case of a province since the flow of critically ill patients, and now has emerged one cases of severe illness.

针 对我省出现的两例重症病例，市疾控中心主任马尔健告诉记者，目前的?甲流?重症患者主要分为两 种情况，其一 是流感引起肺炎，重症?甲流?患者病情一般进展 非常迅速，最短2天，通常3天～5天就可迅速发展为肺炎、咯血痰、气短、呼吸困难，甚至在24 小时内进展到 急性呼吸衰竭；其二是流感导致患者本身的基础病 加重，如心脏病等，病情严重者可导致死亡。​

Two cases arise for the province severe cases, CDC director of the Urban Health Mull told reporters that the current "A flow" critically ill patients can be divided into two kinds of circumstances, one is caused by influenza pneumonia, severe, "a flow" condition in patients with normal progress very rapidly, the shortest two days, usually 3 days to 5 days can be quickly developed into pneumonia, hemoptysis, sputum, shortness of breath, difficulty breathing, or even within 24 hours of progress to acute respiratory failure; the other is the very foundation of influenza cause disease in patients with increase, such as heart disease, a serious condition can lead to death.

http://www.hf365.com/html/01/01/2009...69%80%49%8b%04