Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 14 , ISSUE 3 ( July, 2010 ) > List of Articles

RESEARCH ARTICLE

Correlates of severe disease in patients admitted with 2009 pandemic influenza A (H1N1) infection in Saurashtra region, India

Bharat Gohel, Dinkar Savariya, Rakesh Ninama, Rajesh Chudasama, Pramod Verma, Chikitsa Amin

Keywords : Epidemiology, influenza A (H1N1), intensive care, pregnancy, reverse transcriptase-polymerase chain reaction, severe disease

Citation Information : Gohel B, Savariya D, Ninama R, Chudasama R, Verma P, Amin C. Correlates of severe disease in patients admitted with 2009 pandemic influenza A (H1N1) infection in Saurashtra region, India. Indian J Crit Care Med 2010; 14 (3):113-120.

DOI: 10.4103/0972-5229.74169

License: CC BY-ND 3.0

Published Online: 01-07-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: India reported its first case of 2009 pandemic influenza A (H1N1) virus infection in May 2009 and in Saurashtra region in August 2009. We describe the epidemiology and factors associated with severe and non-severe cases of 2009 influenza A (H1N1) infection reported in Saurashtra region. Materials and Methods: From September 2009 to February 2010, we observed 274 patients who were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals in Rajkot city. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing was used to confirm infection. Factors associated with severe disease were determined by comparing with non-severe cases. Results: Out of 274 patients, 87 had severe disease (requiring intensive care or died) and 187 had non-severe diseases (admitted in wards and survived). The median age of severe disease patients was 30 years; the median time was 5 days from the onset of illness to diagnosis, and 4 days median time was reported for hospital stay. More than half of the patients (56.3%) were females, and 58.6% patients were residing in urban area (OR = 1.65, CI = 0.97-2.8), among severe disease patients. Significant association (P < 0.01) was reported among severe disease patients for delayed referral from general practitioner/physician after initial treatment. All patients received antiviral drug, but only 19.5% received the same within 2 days of illness. Presence of coexisting condition [odds ratio (OR) = 0.53, confidence interval (CI) = 0.31-0.90], mainly pregnancy (OR = 0.22, CI = 0.06-0.76), was strongly associated with severe disease. Conclusion: Delayed referral from general practitioner/physician, duration of antiviral treatment, and presence of coexisting condition (especially pregnancy) were responsible for intensive care or mortality in patients of severe influenza A (H1N1) illness.


PDF Share
  1. Neumann G, Noda T, Kawaoka Y. Emergence and pandemic potential of swine-origin H1N1 influenza virus. Nature 2009;459:931-9.
  2. Swine influenza A (H1N1) infection in two children - Southern California, March - April 2009. MMWR Morb Mortal Wkly Rep 2009;58:400-2.
  3. Swine-origin influenza A (H1N1) virus infections in a school - New York City, April 2009. MMWR Morb Mortal Wkly Rep 2009;58:470-2.
  4. Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, et al. Emergence of a novel swine origin influenza A (H1N1) virus in humans. N Engl J Med 2009;360:2605-15.
  5. Ministry of Health and Family Welfare, Government of India: Factsheet Influenza A (H1N1). 2010. Available from: http://www.pib.nic.in/h1n1/factsheet.pdf. [last accessed on 2010 Mar 06].
  6. Garten RJ, Davis CT, Russell CA, Shu B, Lindstrom S, Balish A, et al. Antigenic and genetic characteristics of swine origin 2009 A (H1N1) influenza viruses circulating in humans. Science 2009;325:197-201.
  7. World Health Organization. Influenza A (H1N1) - update 14. Geneva; 2009. Available from: http://www.who.int/csr/don/2009_05_04a/en/index.html. [last accessed on 2010 Feb 27].
  8. Director General of Health Services. Human swine influenza: A pandemic threat. Vol. 12. Government of India: CD Alert; 2009. p. 1-8.
  9. The Times of India. First swine flu case surfaces in Gujarat. 18th June, 2009. Available from: http://www.timesofindia.indiatimes.com/city/ahmedabad/First-swine-flu-case-surfaces-in-Gujarat/articleshow/4669250.cms [last accessed on 2010 Mar 1].
  10. The Indian Express. Saurashtra`s first confirmed swine flu case detected. 19th August, 2010. Available from: http://www.expressindia.com/latest-news/saurashtras-first-confirmed-swine-flu-case-detected-in-bhavnagar/503678/ [last accessed on 2010 Feb 27].
  11. Dominguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, et al. Critically ill patients with 2009 influenza A (H1N1) in Mexico. JAMA 2009;302:1880-7.
  12. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A (H1N1) infection in Canada. JAMA 2009;302:1872-9.
  13. Zarychanski R, Stuart TL, Kumar A, Doucette S, Elliott L, Kettner J, et al. Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infection. CMAJ 2010;182:257-64.
  14. Webb SA, Pettila V, Seppelt I, Bellomo R, Bailey M, Cooper DJ, et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med 2009;361:1925-34.
  15. Ministry of Health and Family Welfare, Government of India: Guidelines on categorization of influenza A H1N1. May, 2009. Available from: http://www.mohfw-h1n1.nic.in/documents/pdf/3.Categorization%20of%20Influenza%20A%20H1N1%20cases%20screening.pdf. [last accessed on 2010 Jan 15].
  16. Ministry of Health and Family Welfare, Government of Gujarat: Epidemic Disease Control Act, 1897. Available from: http://www.expressindia.com/latest-news/epidemic-control-act-invoked-to-thwart-h1n1-scare-in-state/504144/ [last accessed on 2010 Mar 3].
  17. World Health Organization: CDC protocol of realtime RTPCR for swine influenza A (H1N1). Geneva; April 28, 2009. Available from: http://www.who.int/csr/resources/publications/swineflu/CDCrealtimeRTPCRprotocol_20090428pdf [last accessed on 2010 Jan 15].
  18. Centers for Disease Control and Prevention: Epi Info version 3.5.1, 2008. Available from: www.cdc.gov/epiinfo/ [last accessed on 2008 Aug 15].
  19. Cao B, Li XW, Mao Y, Wang J, Lu HZ, Chen YS, et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med 2009;361:2507-17.
  20. Jain S, Schmitz AM, Louie J, Druckenmiller JK, Chugh R, Deutscher M, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med 2009;361:1935-44.
  21. Centers for Disease Control and Prevention. FluView: a weekly influenza surveillance report prepared by the Influenza Division. Atlanta. Available from: http://www.cdc.gov/flu/weekly/ [last accessed on 2010 Jan 21].
  22. Centers for Disease Control and Prevention: Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 seasons. Atlanta. Available from: http://www.cdc.gov/h1n1flu/recommendations.htm. [last accessed on 2010 Jan 24].
  23. McGeer A, Green KA, Plevneshi A, Shigayeva A, Siddiqi N, Raboud J, et al. Antiviral therapy and outcomes of influenza requiring hospitalization in Ontario, Canada. Clin Infect Dis 2007;45:1568-75.
  24. Donaldson LJ, Rutter PD, Ellis BM, Greaves FE, Mytton OT, Pebody RG, et al. Mortality from pandemic A/H1N1 2009 influenza in England: Public health surveillance study. BMJ 2009;339:b5213.
  25. Vaillant L, La Ruche G, Tarantola A, Barboza P, Epidemic intelligence team at InVS. Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009. Euro Surveill 2009;14:19309. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19309. [last accessed on 2010 Jan 19].
  26. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374:451-8.
  27. Dodds L, McNeil SA, Fell DB, Allen VM, Coombs A, Scott J, et al. Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. CMAJ 2007;176:463-8.
  28. Neuzil KM, Reed GW, Mitchel EF, Simonsen L, Griffin MR. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. Am J Epidemiol 1998;148:1094-102.
  29. Archer BN, Cohen C, Naidoo D, Thomas J, Makunga C, Blumberg L, et al. Interim report on pandemic H1N1 influenza virus infections in South Africa, April to October 2009: Epidemiology and factors associated with fatal cases. Euro Surveill 2009;14:19369. Available from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19369 [last accessed on 2010 Mar 12].
  30. Harper SA, Bradley JS, Englund JA, File TM, Gravenstein S, Hayden FG, et al. Seasonal influenza in adults and children-diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: Clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1003-32.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.