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Clinical Spectrum of Disease. Influenza AH1N1 2009
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14th International Congress on Infectious Diseases (ICID) Abstracts
Travel medicine and the influenza pandemic (Invited Presentation) 07.001 From the Americas to the World J. Sotelo Morales National Autonomous University of Mexico, Mexico City, Mexico In April, 2009 a new influenza virus, from porcine origin, was detected in Mexico City and blamed as responsible for the death of young adults with pneumonia. The patients were seen within the brief lapse of a week at the National Institute of Respiratory Diseases of Mexico; three main factors contributed to trigger the awakening call from the Mexican Health authority that evolved, within a few weeks, into an unprecedented international epidemiological alert orchestrated by the World Health Organization which culminated with the ‘‘Pandemic alert grade VI’’; it meant that the disease had already disseminated worldwide; the factors were: a) the presence of various cases of severe influenza in healthy adults, b) the presence of the disease in the middle of spring, an abnormal timing for seasonal influenza and c) the identification by molecular methods of a brand new influenza virus from porcine origin infecting humans. According to the standards settled by the WHO these characteristics represented the much feared possibility of an influenza pandemic of potential catastrophic consequences; thus, the Ministry of Health of Mexico implemented at measures which had already been planned two years before in the case of facing such event. The Minister of Health appeared on national TV indicating the closure of schools at all levels in Mexico City and various other actions aiming to social distancing and medical alert in all health institutions, together with the development of technical skills for the reliable detection of the new virus in specialized laboratories. Through the epidemic in Mexico several new factors were learned, the capacity of society to deal with similar events was put to test. From this experience, several scientific reports from our Institutes have been published; they provide a new framework for more efficient responses in future events. doi:10.1016/j.ijid.2010.02.1494 07.002 Clinical Spectrum of Disease. Influenza AH1N1 2009 J. Dabanch Pena Hospital Militar de Santiago, Santiago, Chile In Chile, the first case of 2009 pandemic influenza A H1N1 virus infection was detected on May 17. Since then all influenza like illness cases were notified to Chilean Health Secretary. A total of 367.041 cases were reported, 1585 required hospitalization (0.56%) and 130 died. The surveillance in Chile shows that the majority of those infected had a mild disease. The most affected age group was between 5 and 14. Febrile respiratory infection was the most common clinical manifestation and range from self limited to severe illness.
In the outpatient group, 97% had fever, 97% headache, 93.5% myalgias, 90% cough, 88.3% sore throat, 84% rhinorrhea, 43.8% join pain, 36% nausea, 29.4% diarrhea. Time between onset symptoms and second case was 3.6 days (range 1 — 9). Of the 1585 admitted to hospital, 52% were females, median age 33 years (range11 to 94), 56% had underlying medical condition, average time from the onset of illness to hospital admission was 3.6 days. Symptoms at presentation included fever 83%, cough 92.7%, dyspnea 83%, myalgias 63%, hypoxia 50.8%, cyanosis 27.4%, hypotension 18.6%, and 8.3% seizures. Pneumonia was the diagnosis in 77% patients. 130 patients died, all has been admitted to and ICU. The median age was 44 years (range 4 months to 89 years), 87.5% had underlying medical condition. The cause of death was severe respiratory failure in 34%, septic shock in 19%, bilateral pneumonia 17% and multi organic failure in 16%. Almost all patients received antiviral treatment. Surveillance in Chile of the 2009 influenza A H1N1 cases allow to characterize the clinical spectrum of the disease in this first pandemic wave. doi:10.1016/j.ijid.2010.02.1495 07.003 Interim lessons from 2009 J. Alves Institute for Infectious Diseases Emilio Ribas, Sao Paulo, Brazil Through the epidemiological week 37/2009, WHO reported more than 300,000 confirmed cases and almost 4,000 deaths produced by pandemic influenza H1N1 in 191 affiliated countries. During the peak of transmission in 2009, the Southern Cone countries, Chile, Argentina and Southern regions of Brazil, reported the highest number of cases. According to PAHO, through the week 20/2009, 92,773 H1N1 cases were confirmed in Latin America as well as in Caribbean islands and a total of 2,494 deaths had been reported. Brazil accounted for the highest number of deaths and an elevated mortality rate when compared to countries like Chile. Initial containment measures, such as screening symptomatic people in airports and aircrafts and isolating patients who had recently traveled and presented flu-like symptoms, proved ineffective. Different strategies developed in each country showed that the early identification and treatment of high risk patients were responsible for reducing mortality. Although some demographic differences and distinctive clinical outcomes were noticed in different countries, various reports demonstrated that patients with underlying conditions such as asthma, diabetes, cardiac and lung diseases as well as pregnant women were more susceptible to complications. General experience made the benefit of early use of antiviral drugs clear. Based on what had been learnt during the pandemic and in line with WHO directives, Latin America countries are working on a vaccination program targeting the most vulnerable populations. These countries had to deal with a high number of cases earlier than other regions and before the impact on health care systems could be observed. Cooperation between countries requires clear
14th International Congress on Infectious Diseases (ICID) Abstracts
Travel medicine and the influenza pandemic (Invited Presentation) 07.001 From the Americas to the World J. Sotelo Morales National Autonomous University of Mexico, Mexico City, Mexico In April, 2009 a new influenza virus, from porcine origin, was detected in Mexico City and blamed as responsible for the death of young adults with pneumonia. The patients were seen within the brief lapse of a week at the National Institute of Respiratory Diseases of Mexico; three main factors contributed to trigger the awakening call from the Mexican Health authority that evolved, within a few weeks, into an unprecedented international epidemiological alert orchestrated by the World Health Organization which culminated with the ‘‘Pandemic alert grade VI’’; it meant that the disease had already disseminated worldwide; the factors were: a) the presence of various cases of severe influenza in healthy adults, b) the presence of the disease in the middle of spring, an abnormal timing for seasonal influenza and c) the identification by molecular methods of a brand new influenza virus from porcine origin infecting humans. According to the standards settled by the WHO these characteristics represented the much feared possibility of an influenza pandemic of potential catastrophic consequences; thus, the Ministry of Health of Mexico implemented at measures which had already been planned two years before in the case of facing such event. The Minister of Health appeared on national TV indicating the closure of schools at all levels in Mexico City and various other actions aiming to social distancing and medical alert in all health institutions, together with the development of technical skills for the reliable detection of the new virus in specialized laboratories. Through the epidemic in Mexico several new factors were learned, the capacity of society to deal with similar events was put to test. From this experience, several scientific reports from our Institutes have been published; they provide a new framework for more efficient responses in future events. doi:10.1016/j.ijid.2010.02.1494 07.002 Clinical Spectrum of Disease. Influenza AH1N1 2009 J. Dabanch Pena Hospital Militar de Santiago, Santiago, Chile In Chile, the first case of 2009 pandemic influenza A H1N1 virus infection was detected on May 17. Since then all influenza like illness cases were notified to Chilean Health Secretary. A total of 367.041 cases were reported, 1585 required hospitalization (0.56%) and 130 died. The surveillance in Chile shows that the majority of those infected had a mild disease. The most affected age group was between 5 and 14. Febrile respiratory infection was the most common clinical manifestation and range from self limited to severe illness.
In the outpatient group, 97% had fever, 97% headache, 93.5% myalgias, 90% cough, 88.3% sore throat, 84% rhinorrhea, 43.8% join pain, 36% nausea, 29.4% diarrhea. Time between onset symptoms and second case was 3.6 days (range 1 — 9). Of the 1585 admitted to hospital, 52% were females, median age 33 years (range11 to 94), 56% had underlying medical condition, average time from the onset of illness to hospital admission was 3.6 days. Symptoms at presentation included fever 83%, cough 92.7%, dyspnea 83%, myalgias 63%, hypoxia 50.8%, cyanosis 27.4%, hypotension 18.6%, and 8.3% seizures. Pneumonia was the diagnosis in 77% patients. 130 patients died, all has been admitted to and ICU. The median age was 44 years (range 4 months to 89 years), 87.5% had underlying medical condition. The cause of death was severe respiratory failure in 34%, septic shock in 19%, bilateral pneumonia 17% and multi organic failure in 16%. Almost all patients received antiviral treatment. Surveillance in Chile of the 2009 influenza A H1N1 cases allow to characterize the clinical spectrum of the disease in this first pandemic wave. doi:10.1016/j.ijid.2010.02.1495 07.003 Interim lessons from 2009 J. Alves Institute for Infectious Diseases Emilio Ribas, Sao Paulo, Brazil Through the epidemiological week 37/2009, WHO reported more than 300,000 confirmed cases and almost 4,000 deaths produced by pandemic influenza H1N1 in 191 affiliated countries. During the peak of transmission in 2009, the Southern Cone countries, Chile, Argentina and Southern regions of Brazil, reported the highest number of cases. According to PAHO, through the week 20/2009, 92,773 H1N1 cases were confirmed in Latin America as well as in Caribbean islands and a total of 2,494 deaths had been reported. Brazil accounted for the highest number of deaths and an elevated mortality rate when compared to countries like Chile. Initial containment measures, such as screening symptomatic people in airports and aircrafts and isolating patients who had recently traveled and presented flu-like symptoms, proved ineffective. Different strategies developed in each country showed that the early identification and treatment of high risk patients were responsible for reducing mortality. Although some demographic differences and distinctive clinical outcomes were noticed in different countries, various reports demonstrated that patients with underlying conditions such as asthma, diabetes, cardiac and lung diseases as well as pregnant women were more susceptible to complications. General experience made the benefit of early use of antiviral drugs clear. Based on what had been learnt during the pandemic and in line with WHO directives, Latin America countries are working on a vaccination program targeting the most vulnerable populations. These countries had to deal with a high number of cases earlier than other regions and before the impact on health care systems could be observed. Cooperation between countries requires clear