Re: patient data
Influenza Pandemic (H1N1) 2009, Vietnam, Patient Data (from ProMedMail.org, edited)
INFLUENZA PANDEMIC (H1N1) 2009 - VIET NAM: PATIENT DATA
A ProMED-mail post
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Date: Wed 8 Jul 2009
From: Rogier van Doorn
</http:></http:><http: www.promedmail.org=""><http: www.isid.org=""><hrogier@gmail.com>In the Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam, patients with flu symptoms and a positive RT-PCR [real time polymerase chain reaction] result for pandemic (H1N1) 2009 virus infection with the CDC assay (specific A(H1N1)v primers/probe) are hospitalized and treated with oseltamivir (75mg bd) until RT-PCR results are negative. </hrogier@gmail.com></http:></http:>
<http: www.promedmail.org=""><http: www.isid.org=""><hrogier@gmail.com></hrogier@gmail.com></http:></http:>
<http: www.promedmail.org=""><http: www.isid.org=""><hrogier@gmail.com>
We collected clinical data, haematology and biochemistry, and daily virological data (nose and throat swabs) from the 1st 44 pandemic (H1N1) 2009 RT-PCR positive patients in Viet Nam hospitalized between 29 May and 26 June 2009.
The average age of the patients was 28.6 years (3-62), 19 female and 25 male.
5 patients contracted flu while in Viet Nam but with a clear epidemiological link to someone with "imported" pandemic (H1N1) 2009, 39 cases were thought to be directly imported (14 US, 18 Australia, 2 Canada, 2 Thailand, 1 Japan, 1 China, and 1 Singapore).
Fever was present in 91 percent (n=40), cough in 55 percent (n=24), runny nose in 20 percent (n=9), sore throat in 27 percent (n=12), and diarrhea in 2 percent (n=1).
Average duration of fever on presentation was 2 days.
After 24 hours 75 percent (n=33) of patients had a normal temperature.
All patients had a mild illness course.
Viral PCR was positive on day 0 for all patients with an average Ct value of 30.3.
The number of PCR positive patients dropped to 25 after 1 day (average Ct 30.3).
On day 2, 21 patients were positive (average Ct 35.8) and on day 3 and 4, 8 patients were still PCR positive (average Ct 37.0 and 37.2).
No patients were positive on day 5, 6 and 7.
These data suggest that patients treated with oseltamivir have a favourable clinical and virological response and are not shedding viral RNA after 5 days of treatment.
In comparison, Whitley et al [Pediatr Infect Dis J 2001 20:127] found 55 percent (n=51/93) culture positive patients in oseltamivir treated children with non-severe influenza on day 4.
There have been a few anecdotal reports from Viet Nam of patients that remained symptomatic and PCR positive for a prolonged period, and one patient in our hospital (not included in this report) had a positive PCR after 18 doses of oseltamivir.
Investigations into the presence of the NA H274Y mutation in [virus isolated from] these patients are ongoing but have so far been negative.
[Byline:
Tran Tinh Hien
Nguyen Thanh Truong
Nguyen van Vinh Chau
Tran Thuy Ngan
Jeremy Farrar
Rogier van Doorn
Hospital for Tropical Diseases Ho Chi Minh City Viet Nam]
--
Rogier van Doorn
Hospital for Tropical Diseases
Wellcome Trust Major Overseas Programme
Oxford University Clinical Research Unit
190 Ben Ham Tu District 5 Ho Chi Minh City Viet Nam <rvandoorn@oucru.org>
[ProMED-mail welcomes the opportunity to make these data available to the general healthcare community. - Mod.CP]
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