Pandemic (H1N1) 2009-associated Deaths Detected by Unexplained Death and Medical Examiner Surveillance

Lees, Christine H.; Avery, Catherine; Asherin, Ryan; Rainbow, Jean; Danila, Richard; Smelser, Chad; Schmitz, Ann; Ladd-Wilson, Stephen; Nolte, Kurt B.; Nagle, Kayla; Lynfield, Ruth

doi:10.3201/eid1708.101914

Cited by 9 publications

(22 citation statements)

References 8 publications

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“…We found that the majority of influenza A(H1N1)pdm09-associated pneumonia deaths in Thailand occurred in adults aged 20 to 60 years, which is similar to previous studies [16], [17], but differed from the older age predominance of seasonal influenza deaths [18], [19]. Only 53% of fatal cases with medical records reviewed had evidence of high-risk conditions for severe influenza infection, although the proportion was higher (67%) among all 198 fatal cases reported to NAIS.…”

Section: Discussionsupporting

confidence: 88%

“…Although 198 hospitalized influenza A(H1N1)pdm09-associated pneumonia fatalities were identified, medical records were only available for review for 90 (45%). Additionally, some influenza A(H1N1)pdm09 deaths likely occurred outside of the hospital [34]. Therefore, our findings may not be representative of all hospitalized influenza A(H1N1)pdm09 pneumonia deaths or of fatal influenza A(H1N1)pdm09 cases in Thailand overall.…”

Section: Discussionmentioning

confidence: 85%

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Influenza A(H1N1)pdm09-Associated Pneumonia Deaths in Thailand

et al. 2013

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BackgroundThe first human infections with influenza A(H1N1)pdm09 virus were confirmed in April 2009. We describe the clinical and epidemiological characteristics of influenza A(H1N1)pdm09-associated pneumonia deaths in Thailand from May 2009-January 2010.MethodsWe identified influenza A(H1N1)pdm09-associated pneumonia deaths from a national influenza surveillance system and performed detailed reviews of a subset.ResultsOf 198 deaths reported, 49% were male and the median age was 37 years; 146 (73%) were 20–60 years. Among 90 deaths with records available for review, 46% had no identified risk factors for severe influenza. Eighty-eight patients (98%) received antiviral treatment, but only 16 (18%) initiated therapy within 48 hours of symptom onset.ConclusionsMost influenza A(H1N1)pdm09 pneumonia fatalities in Thailand occurred in adults aged 20–60 years. Nearly half lacked high-risk conditions. Antiviral treatment recommendations may be especially important early in a pandemic before vaccine is available. Treatment should be considered as soon as influenza is suspected.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 85%

Influenza A(H1N1)pdm09-Associated Pneumonia Deaths in Thailand

et al. 2013

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“…1 The identification of influenza ribonucleic acid in endomyocardial biopsies suggests that myocarditis (including fulminant cardiomyopathy) complicating influenza is caused by disseminated influenza infection. 2 The finding that influenza RNA has been identified in the myocardium in cases of sudden death, 2 and a recent study reporting that 15.4% of deaths due to pH1N1 in the United States occurred at home, 3 suggest that influenza infection may trigger arrhythmias and cardiac arrest. However, the incidence of myocardial involvement in influenza is not known.…”

Section: Discussionmentioning

confidence: 99%

Cardiac complications of influenza infection in 3 adults

Jeyanathan

Overgaard

McGeer

2013

CMAJ

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A 57-year-old man was admitted to the coronary intensive care unit with severe pulmonary edema after a 5-day history of influenza-like illness. His medical history included previous tobacco use and a family history of early myocardial infarction. He had received the seasonal influenza vaccine in the fall before presentation.On examination, he was in marked respiratory distress. His temperature was 38.4 ºC, respiratory rate was 33 breaths/min, and oxygen saturation was 86% on 100% nonrebreather mask. His blood pressure and heart rate were within normal limits. Respiratory examination revealed diffuse bilateral crackles. An electrocardiogram (ECG) taken on admission showed left bundle branch block, and his cardiac troponin I level was 0.77 (normal < 0.07) µg/L. There was no previous ECG available for comparison. Echocardiography showed left ventricular dilatation, moderate hypokinesis with regional variability and an ejection fraction of about 30% (Figure 1). A radiograph of his chest showed left ventricular dilatation with air-space opacification consistent with moderate pulmonary edema. The differential diagnosis was viral myocarditis with heart failure, acute coronary syndrome with heart failure or community-acquired pneumonia with acute respiratory distress syndrome.Despite supplemental oxygen and diuresis therapy, the patient's hypoxemia worsened and intubation was required; high-frequency oscillatory support and norepinephrine for blood pressure support were also required. He was given empirical treatment with oseltamivir, ceftriaxone and azithromycin, and dual antiplatelet therapy (acetylsalicylic acid and clopidogrel).On repeat testing, the patient's cardiac troponin I level was 0.48 µg/L, and his creatine kinase level was 2561 (normal < 240) U/L. Influenza A (pH1N1) was detected in bronchoalveolar lavage samples by polymerase chain reaction. All other culture samples were negative. Repeat echocardiography showed no improvement in left ventricular function. His course in hospital was complicated by dysphagia, and magnetic resonance imaging showed a small lacunar infarct. He was discharged to a stroke rehabilitation centre 40 days after admission. A persantine cardiolite study performed on an outpatient basis did not show any cardiac ischemia but suggested possible prior myocardial infarction. Diagnostic coronary angiography showed mild to moderate plaque in several small branch vessels but no hemodynamically important atherosclerotic coronary artery disease.In the second case, a 67-year-old woman presented to the emergency department with a 1-week history of cough and pleuritic chest pain. Her medical history included hypertension, dyslipidemia, diabetes, obesity and smoking, and she had a family history of coronary artery disease. She had not previously received influenza vaccine. In the emergency department, she had cardiac arrest with pulseless electrical activity that required intubation, mechanical ventilation and 10 minutes of cardiopulmonary resuscitation. An ECG obtained after the arrest showed 0.5...

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“…In addition, these individuals were younger and healthier than those found through active surveillance among hospitalized patients with influenza. UNEX/MED-X cases were more likely to have an autopsy done and were more likely to have died in their residences [18].…”

Section: Analysis and Dissemination Of Datamentioning

confidence: 99%