BACKGROUND: It is necessary to analyse the severe cases of pandemic influenza infection in order to identify vulnerable populations and adapt prevention and control policies accordingly. We analysed the clinical and epidemiological characteristics and risk factors associated with death in patients with 2009 pandemic influenza A (H1N1) infection hospitalised in intensive care units (ICUs) in Spain and reported from 24 April 2009 to 31 January 2010. METHODS: As part of the national strategy for surveillance of hospitalized cases with pandemic influenza, cased-based clinical and epidemiological information on all cases admitted to an ICU with 2009 pandemic virus (H1N1) infection was collected nationwide. RESULTS: Of 1,231 cases admitted to ICU, 271 died (case fatality ratio, 22%). The median age was 40 years (range: 0-90). A total of 838 (76.3%) patients had an underlying risk condition, being respiratory disease the most frequently reported (34.1%), followed by morbid obesity (18.8%), in adults. Antiviral treatment was given in 93.1% patients and in 25.6% (n = 231) it was initiated within 48 hours of symptoms onset. In a multivariate analysis, cancer (OR 2.71, 95%CI 1.44 to 5.1), immunodeficiency (OR 2.25, 95%CI 1.29 - 3.92) and morbid obesity (OR 1.79, 95%CI 1.13 to 2.85) were significantly associated with death in adults. CONCLUSIONS: The characterization of severe pandemic influenza cases has been crucial in identifying as risk factors of complications and death from influenza the presence of cancer and immunodeficiencies and for the first time, morbid obesity in adults.
BACKGROUND: It is necessary to analyse the severe cases of pandemic influenza infection in order to identify vulnerable populations and adapt prevention and control policies accordingly. We analysed the clinical and epidemiological characteristics and risk factors associated with death in patients with 2009 pandemic influenza A (H1N1) infection hospitalised in intensive care units (ICUs) in Spain and reported from 24 April 2009 to 31 January 2010. METHODS: As part of the national strategy for surveillance of hospitalized cases with pandemic influenza, cased-based clinical and epidemiological information on all cases admitted to an ICU with 2009 pandemic virus (H1N1) infection was collected nationwide. RESULTS: Of 1,231 cases admitted to ICU, 271 died (case fatality ratio, 22%). The median age was 40 years (range: 0-90). A total of 838 (76.3%) patients had an underlying risk condition, being respiratory disease the most frequently reported (34.1%), followed by morbid obesity (18.8%), in adults. Antiviral treatment was given in 93.1% patients and in 25.6% (n = 231) it was initiated within 48 hours of symptoms onset. In a multivariate analysis, cancer (OR 2.71, 95%CI 1.44 to 5.1), immunodeficiency (OR 2.25, 95%CI 1.29 - 3.92) and morbid obesity (OR 1.79, 95%CI 1.13 to 2.85) were significantly associated with death in adults. CONCLUSIONS: The characterization of severe pandemic influenza cases has been crucial in identifying as risk factors of complications and death from influenza the presence of cancer and immunodeficiencies and for the first time, morbid obesity in adults.
Authors: Maria D Van Kerkhove; Katelijn A H Vandemaele; Vivek Shinde; Giovanna Jaramillo-Gutierrez; Artemis Koukounari; Christl A Donnelly; Luis O Carlino; Rhonda Owen; Beverly Paterson; Louise Pelletier; Julie Vachon; Claudia Gonzalez; Yu Hongjie; Feng Zijian; Shuk Kwan Chuang; Albert Au; Silke Buda; Gerard Krause; Walter Haas; Isabelle Bonmarin; Kiyosu Taniguichi; Kensuke Nakajima; Tokuaki Shobayashi; Yoshihiro Takayama; Tomi Sunagawa; Jean Michel Heraud; Arnaud Orelle; Ethel Palacios; Marianne A B van der Sande; C C H Lieke Wielders; Darren Hunt; Jeffrey Cutter; Vernon J Lee; Juno Thomas; Patricia Santa-Olalla; Maria J Sierra-Moros; Wanna Hanshaoworakul; Kumnuan Ungchusak; Richard Pebody; Seema Jain; Anthony W Mounts Journal: PLoS Med Date: 2011-07-05 Impact factor: 11.069
Authors: Miguel Delgado-Rodríguez; Jesús Castilla; Pere Godoy; Vicente Martín; Nuria Soldevila; Jordi Alonso; Jenaro Astray; Maretva Baricot; Rafael Cantón; Ady Castro; Fernando Gónzález-Candelas; José María Mayoral; José María Quintana; Tomás Pumarola; Sonia Tamames; Marc Sáez; Angela Domínguez Journal: J Antimicrob Chemother Date: 2012-03-30 Impact factor: 5.790
Authors: José María Mayoral; Jordi Alonso; Olatz Garín; Zaida Herrador; Jenaro Astray; Maretva Baricot; Jesús Castilla; Rafael Cantón; Ady Castro; Miguel Delgado-Rodríguez; Alicia Ferri; Pere Godoy; Fernando Gónzález-Candelas; Vicente Martín; Tomás Pumarola; José María Quintana; Núria Soldevila; Sonia Tamames; Angela Domínguez Journal: BMC Public Health Date: 2013-02-07 Impact factor: 3.295
Authors: Charatdao Bunthi; Somsak Thamthitiwat; Henry C Baggett; Pasakorn Akarasewi; Ruchira Ruangchira-urai; Susan A Maloney; Kumnuan Ungchusak Journal: PLoS One Date: 2013-02-04 Impact factor: 3.240
Authors: Miguel Delgado-Rodríguez; Jesús Castilla; Pere Godoy; Vicente Martín; Nuria Soldevila; Jordi Alonso; Jenaro Astray; Maretva Baricot; Juan C Galán; Ady Castro; Fernando Gónzález-Candelas; José M Mayoral; José M Quintana; Tomás Pumarola; Sonia Tamames; Marc Sáez; Angela Domínguez Journal: Influenza Other Respir Viruses Date: 2013-05-04 Impact factor: 4.380