Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico

BackgroundThe duration of viral shedding is an important determinant of infectivity and transmissibility and provides vital information for effective infection prevention and control. However, few studies have evaluated viral shedding in patients admitted to hospital with 2009 H1N1 influenza and treated with oseltamivir.ObjectiveTo determine the incidence of prolonged 2009 H1N1 influenza viral shedding in patients treated for 5 days with oseltamivir and to identify factors that promote prolonged viral shedding.MethodsThis was a prospective, observational cohort study of 173 patients infected with 2009 H1N1 influenza (confirmed by RT‐PCR) who were admitted to isolation rooms in the emergency department of our hospital between August 25, 2009 and December 31, 2009. All of the patients were treated according to institutional protocols and received routine follow‐up RT‐PCR testing after 5 days of oseltamivir therapy. Prolonged viral shedding was defined as a positive follow‐up RT‐PCR result.ResultOf the 173 patients in our cohort, 88 (50·8%) showed persistent viral shedding after oseltamivir treatment. Viral shedding was significantly prolonged if antiviral therapy was started ≥2 days after symptom onset (OR 2·74, 95% CI 1·29–5·82), if there were major comorbidities (OR 3·07, 95% CI 1·29–7·32), and/or if respiratory symptoms were still present on the day 5 of antiviral treatment (OR 4·13, 95% CI 2·10–8·11).ConclusionsThe presence of major comorbidities, a delay in initiating antiviral treatment, and continuing respiratory symptoms after 5 days of antiviral treatment are associated with prolonged shedding of the 2009 H1N1 influenza virus.

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“…The severity of the (H1N1) 2009 influenza pandemic correlates with the extent of lymphopenia 25. In particular, Li et al .…”

Section: Discussionmentioning

confidence: 99%

Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days

Ryoo

Kim

Sohn

et al. 2012

Influenza Resp Viruses

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“…H1N1 virus infection is associated with a high fatality rate [1-4]; however, a potential explanation for such rates has not been totally elucidated. Patients who require ICU admission have frequently experienced rapidly progressive, serious lower respiratory tract disease.…”

Section: Discussionmentioning

confidence: 99%

“…The pandemic 2009 influenza A (H1N1) virus infection was first described in Mexico in April 2009, and several reports have been published regarding the presentation of this disease with severe acute respiratory symptoms in hospitalized patients [1]. However, the information regarding the incidence and impact of renal failure among these patients remains scarce.…”

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

et al. 2011

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IntroductionLittle information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.MethodsWe conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria.ResultsA total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 ± 8.3 versus 12.6 ± 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 ± 4.2 versus 4.8 ± 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3%; P < 0.01, OR 5.1, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62).ConclusionsIn our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.

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“…Several recent studies suggest that most severe outcomes for H1N1pdm infection occur in individuals with pre‐existing medical conditions, 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 although the exact percentages vary between the studies. This has been recognized in several countries, where prompt antiviral prescription to symptomatic high‐risk individuals is recommended 13 , 14 , 15 , 16 , 17 .…”

Section: Introductionmentioning

confidence: 99%

Pre‐dispensing of antivirals to high‐risk individuals in an influenza pandemic

Goldstein

Miller

O’Hagan

et al. 2010

Influenza Resp Viruses

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Please cite this paper as: Goldstein et al. (2010) Pre‐dispensing of antivirals to high‐risk individuals in an influenza pandemic. Influenza and other Respiratory Viruses 4(2), 101‐112.We consider the net benefits of pre‐dispensing antivirals to high‐risk individuals during an influenza pandemic, where the measure of the benefit is the number of severe outcomes (such as deaths or hospitalizations) prevented by antivirals in the whole population. One potential benefit of pre‐dispensing is that individuals to whom antivirals have been pre‐dispensed may be able to initiate treatment earlier than if they had to wait to obtain and fill a prescription, reducing their risk of progression to severe disease. If this benefit exceeds the side effects of misuse for the category of individuals to whom antivirals were pre‐dispensed, and if antiviral supply exceeds overall population demand (which appears relevant for several countries including US in the 2009 H1N1 pandemic), pre‐dispensing a quantity of antivirals not exceeding the difference between supply and demand is always beneficial. In this study, we consider the net benefits of pre‐dispensing antivirals under various scenarios, including demand exceeding supply, and derive mathematical conditions under which antiviral pre‐dispensing is advantageous on balance. For individuals whose relative risk of severe outcome is high enough, such as immunosuppressed individuals (particularly children) and possibly individuals with neurological disorders, pre‐dispensing is always beneficial at a given level of antiviral stockpile with modest assumptions on the relative benefit of early treatment by a pre‐dispensed course, regardless of the overall population demand for antivirals during the course of an epidemic. Making additional assumptions on either the overall population demand for antivirals (which appear relevant for the 2009 H1N1 pandemic) or on the relative benefit of pre‐dispensing would make pre‐dispensing net beneficial with inclusion of a larger number of persons such as pregnant women and morbidly obese adults.

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Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico

Abstract: ConclusionsS-OIV infection can cause severe illness, the acute respiratory distress syndrome, and death in previously healthy persons who are young to middle-aged. None of the secondary infections among health care workers were severe.

Cited by 1,204 publications

References 13 publications

Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days

Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

Pre‐dispensing of antivirals to high‐risk individuals in an influenza pandemic

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