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Characteristics of pandemic influenza A (H1N1) infection in patients presenting to a university hospital in Riyadh, Saudi Arabia
BinSaeed Abdulaziz
Annals of Saudi Medicine , 2010,
Abstract: Background and Objectives : A national plan of management for flu-like illnesses was developed by the Saudi Ministry of Health after the first outbreak in Saudi Arabia in June. We describe the clinical presentation of the H1N1 cases attending King Khalid University Hospital (KKUH) between July through September 2009 and identify the high-risk age groups. Methods : All patients presenting with influenza-like illnesses (ILI) in the H1N1 clinics during the specified period were clinically examined and tested using reverse transcription polymerase chain reaction (RT-PCR). Those who were clinically diagnosed and confirmed positive for novel influenza A (H1N1) were included in the study. Results : Over a 6-week period, 117 cases of laboratory-confirmed cases were reported in KKUH with a mean (SD) age of 19.6 (16.7) years, of whom 72 (62.1%) were males. Most reported cases were Saudis (n=99, 85.3%); 94 (81%) had no travel history outside the country; 100 (86.2%) had had no contact with an H1N1-identified patient; 33% were aged 5-14 years and 28.4% were aged 15-29 years. The most commonly reported symptoms were fever in 99 (85.3%), cough in 9 (81%), runny nose (33.6%) and sore throat (21.3%). All 117 cases were confirmed positive using real time RT-PCR testing. Thirty-one cases (26%) were admitted and 22 of those (71%) recovered after receiving oseltamivir. Two deaths were attributed to the 2009 pandemic. One patient died of chronic pulmonary disease. The other cause of death was unknown. Conclusion : These findings indicate indigenous influenza A (H1N1) transmission, and confirm the urgent need for prevention strategies which specifically target children and young adults, who appear to have a higher risk of infection and hospitalization. Such measures include immunization, improved personal hygiene, and increased ventilation in habitations.
Estimation of the Burden of Pandemic(H1N1)2009 in Developing Countries: Experience from a Tertiary Care Center in South India  [PDF]
Mahesh Moorthy, Prasanna Samuel, John Victor Peter, Saranya Vijayakumar, Dipika Sekhar, Valsan P. Verghese, Indira Agarwal, Prabhakar D. Moses, Kala Ebenezer, Ooriapadickal Cherian Abraham, Kurien Thomas, Prasad Mathews, Akhilesh C. Mishra, Renu Lal, Jayaprakash Muliyil, Asha Mary Abraham
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0041507
Abstract: Background The burden of the pandemic (H1N1) 2009 influenza might be underestimated if detection of the virus is mandated to diagnose infection. Using an alternate approach, we propose that a much higher pandemic burden was experienced in our institution. Methodology/Principal Findings Consecutive patients (n = 2588) presenting to our hospital with influenza like illness (ILI) or severe acute respiratory infection (SARI) during a 1-year period (May 2009–April 2010) were prospectively recruited and tested for influenza A by real-time RT-PCR. Analysis of weekly trends showed an 11-fold increase in patients presenting with ILI/SARI during the peak pandemic period when compared with the pre-pandemic period and a significant (P<0.001) increase in SARI admissions during the pandemic period (30±15.9 admissions/week) when compared with pre-pandemic (7±2.5) and post-pandemic periods (5±3.8). However, Influenza A was detected in less than one-third of patients with ILI/SARI [699 (27.0%)]; a majority of these (557/699, 79.7%) were Pandemic (H1N1)2009 virus [A/H1N1/09]. An A/H1N1/09 positive test was correlated with shorter symptom duration prior to presentation (p = 0.03). More ILI cases tested positive for A/H1N1/09 when compared with SARI (27.4% vs. 14.6%, P = 0.037). When the entire study population was considered, A/H1N1/09 positivity was associated with lower risk of hospitalization (p<0.0001) and ICU admission (p = 0.013) suggesting mild self-limiting illness in a majority. Conclusion/Significance Analysis of weekly trends of ILI/SARI suggest a higher burden of the pandemic attributable to A/H1N1/09 than estimates assessed by a positive PCR test alone. The study highlights methodological consideration in the estimation of burden of pandemic influenza in developing countries using hospital-based data that may help assess the impact of future outbreaks of respiratory illnesses.
Effectiveness of Pandemic H1N1-2009 Vaccination in Reducing Laboratory Confirmed Influenza Infections among Military Recruits in Tropical Singapore  [PDF]
Vernon J. Lee, Chi Hsien Tan, Jonathan Yap, Alex R. Cook, Pei-Jun Ting, Jin-Phang Loh, Qiuhan Gao, Mark I. Chen, Wee Lee Kang, Boon Huan Tan, Paul A. Tambyah
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026572
Abstract: Background Limited information is available about pandemic H1N1-2009 influenza vaccine effectiveness in tropical communities. We studied the effectiveness of a pandemic H1N1 vaccination program in reducing influenza cases in Singapore. Methods A surveillance study was conducted among military personnel presenting with febrile respiratory illness from mid-2009 to mid-2010. Consenting individuals underwent nasal washes, which were tested with RT-PCR and subtyped. A vaccination program (inactivated monovalent Panvax H1N1-2009 vaccine) was carried out among recruits. A Bayesian hierarchical model was used to quantify relative risks in the pre- and post-vaccination periods. An autoregressive generalised linear model (GLM) was developed to minimise confounding. Results Of 2858 participants, 437(15.3%), 60(2.1%), and 273(9.6%) had pandemic H1N1, H3N2, and influenza B. The ratio of relative risks for pandemic H1N1 infection before and after vaccination for the recruit camp relative to other camps was 0.14(0.016,0.49); for H3N2, 0.44(0.035,1.8); and for influenza B, 18(0.77,89). Using the GLM for the recruit camp, post-vaccination weekly cases decreased by 54%(37%,67%, p<0.001) from that expected without vaccination; influenza B increased by 66 times(9–479 times, p<0.001); with no statistical difference for H3N2 (p = 0.54). Conclusions Pandemic vaccination reduced H1N1-2009 disease burden among military recruits. Routine seasonal influenza vaccination should be considered.
Dynamic Patterns of Circulating Seasonal and Pandemic A(H1N1)pdm09 Influenza Viruses From 2007–2010 in and around Delhi, India  [PDF]
Shobha Broor, Anand Krishnan, Dipanjan S. Roy, Shivram Dhakad, Samander Kaushik, Muneer A. Mir, Yashpal Singh, Ann Moen, Mandeep Chadha, Akhilesh C. Mishra, Renu B. Lal
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0029129
Abstract: Influenza surveillance was carried out in a subset of patients with influenza-like illness (ILI) presenting at an Employee Health Clinic (EHS) at All India Institute of Medical Sciences (AIIMS), New Delhi (urban) and pediatric out patients department of civil hospital at Ballabhgarh (peri-urban), under the Comprehensive Rural Health Services Project (CRHSP) of AIIMS, in Delhi region from January 2007 to December 2010. Of the 3264 samples tested, 541 (17%) were positive for influenza viruses, of which 221 (41%) were pandemic Influenza A(H1N1)pdm09, 168 (31%) were seasonal influenza A, and 152 (28%) were influenza B. While the Influenza viruses were detected year-round, their types/subtypes varied remarkably. While there was an equal distribution of seasonal A(H1N1) and influenza B in 2007, predominance of influenza B was observed in 2008. At the beginning of 2009, circulation of influenza A(H3N2) viruses was observed, followed later by emergence of Influenza A(H1N1)pdm09 with co-circulation of influenza B viruses. Influenza B was dominant subtype in early 2010, with second wave of Influenza A(H1N1)pdm09 in August-September, 2010. With the exception of pandemic H1N1 emergence in 2009, the peaks of influenza activity coincided primarily with monsoon season, followed by minor peak in winter at both urban and rural sites. Age group analysis of influenza positivity revealed that the percent positivity of Influenza A(H1N1)pdm09 influenza virus was highest in >5–18 years age groups (OR 2.5; CI = 1.2–5.0; p = 0.009) when compared to seasonal influenza. Phylogenetic analysis of Influenza A(H1N1)pdm09 from urban and rural sites did not reveal any major divergence from other Indian strains or viruses circulating worldwide. Continued surveillance globally will help define regional differences in influenza seasonality, as well as, to determine optimal periods to implement influenza vaccination programs among priority populations.
Outbreak of H3N2 Influenza at a US Military Base in Djibouti during the H1N1 Pandemic of 2009  [PDF]
Michael T. Cosby, Guillermo Pimentel, Remington L. Nevin, Salwa Fouad Ahmed, John D. Klena, Ehab Amir, Mary Younan, Robert Browning, Peter J. Sebeny
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082089
Abstract: Background Influenza pandemics have significant operational impact on deployed military personnel working in areas throughout the world. The US Department of Defense global influenza-like illness (ILI) surveillance network serves an important role in establishing baseline trends and can be leveraged to respond to outbreaks of respiratory illness. Objective We identified and characterized an operationally unique outbreak of H3N2 influenza at Camp Lemonnier, Djibouti occurring simultaneously with the H1N1 pandemic of 2009 [A(H1N1)pdm09]. Methods Enhanced surveillance for ILI was conducted at Camp Lemonnier in response to local reports of a possible outbreak during the A(H1N1)pdm09 pandemic. Samples were collected from consenting patients presenting with ILI (utilizing a modified case definition) and who completed a case report form. Samples were cultured and analyzed using standard real-time reverse transcriptase PCR (rt-RT-PCR) methodology and sequenced genetic material was phylogenetically compared to other published strains. Results rt-RT-PCR and DNA sequencing revealed that 25 (78%) of the 32 clinical samples collected were seasonal H3N2 and only 2 (6%) were A(H1N1)pdm09 influenza. The highest incidence of H3N2 occurred during the month of May and 80% of these were active duty military personnel. Phylogenetic analysis revealed that sequenced H3N2 strains were genetically similar to 2009 strains from the United States of America, Australia, and South east Asia. Conclusions This outbreak highlights challenges in the investigation of influenza among deployed military populations and corroborates the public health importance of maintaining surveillance systems for ILI that can be enhanced locally when needed.
Estimating the Disease Burden of 2009 Pandemic Influenza A(H1N1) from Surveillance and Household Surveys in Greece  [PDF]
Vana Sypsa,Stefanos Bonovas,Sotirios Tsiodras,Agoritsa Baka,Panos Efstathiou,Meni Malliori,Takis Panagiotopoulos,Ilias Nikolakopoulos,Angelos Hatzakis
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020593
Abstract: The aim of this study was to assess the disease burden of the 2009 pandemic influenza A(H1N1) in Greece.
The investigation of Risk factors of influenza pandemic H1N1  [PDF]
koorosh Holakooyi Naeini,Reza Chaman,Abbas Rahimi,Masoomeh Javaheri
Knowledge & Health Journal , 2010,
Abstract: Introduction: Influenza pandemic H1N1 is an acute respiratory infectious disease that is combination of two types of influenza virus type A (H1N1). This study aimed to identify risk factors affecting influenza pandemic H1N1. Methods: In this case-control study, the cases were 18 positive cases of pandemic influenza H1N1 and the controls were the patients who were admitted during the same time as the cases to sections of Orthopedics, Urology, Surgery and Women of the same hospital for reasons other than influenza. The data were collected through a form by two experienced nurses and then were fed into SPSS, and were analyzed using independent T-test and chi-square. Results: A significant relationship was observed between pandemic H1N1 influenza infection and a history of domestic travel, contact with confirmed patients, respiratory diseases, and diabetes (P0.05). Conclusion: People with underlying diseases, especially respiratory diseases, diabetes, heart disease and a secondary infection and cardiovascular disease most likely are susceptible to influenza pandemic H1N1.
Absence of 2009 Pandemic H1N1 Influenza A Virus in Fresh Pork  [PDF]
Amy L. Vincent,Kelly M. Lager,Michelle Harland,Alessio Lorusso,Eraldo Zanella,Janice R. Ciacci-Zanella,Marcus E. Kehrli Jr.,Alexander Klimov
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0008367
Abstract: The emergence of the pandemic 2009 H1N1 influenza A virus in humans and subsequent discovery that it was of swine influenza virus lineages raised concern over the safety of pork. Pigs experimentally infected with pandemic 2009 H1N1 influenza A virus developed respiratory disease; however, there was no evidence for systemic disease to suggest that pork from pigs infected with H1N1 influenza would contain infectious virus. These findings support the WHO recommendation that pork harvested from pandemic influenza A H1N1 infected swine is safe to consume when following standard meat hygiene practices.
Diagnostic Accuracy of a Rapid Influenza Test for Pandemic Influenza A H1N1  [PDF]
Aubree Gordon,Elsa Videa,Saira Saborío,Roger López,Guillermina Kuan,Angel Balmaseda,Eva Harris
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0010364
Abstract: With the current influenza A H1N1 pandemic (H1N1pdm), it is extremely important that clinicians can quickly and accurately identify influenza cases.
Age Distribution of Cases of 2009 (H1N1) Pandemic Influenza in Comparison with Seasonal Influenza  [PDF]
Drosos E. Karageorgopoulos,Evridiki K. Vouloumanou,Ioanna P. Korbila,Anastasios Kapaskelis,Matthew E. Falagas
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0021690
Abstract: Several aspects of the epidemiology of 2009 (H1N1) pandemic influenza have not been accurately determined. We sought to study whether the age distribution of cases differs in comparison with seasonal influenza.
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