Giuseppe
Emeritus
[Source: PLoS ONE, full text: (LINK). Abstract, edited.]
An Analysis of 332 Fatalities Infected with Pandemic 2009 Influenza A (H1N1) in Argentina
Ana M. Balanzat<SUP>1</SUP><SUP>*</SUP>, Christian Hertlein<SUP>1</SUP>, Carlos Apezteguia<SUP>2</SUP>, Pablo Bonvehi<SUP>3</SUP>, Luis C?mera<SUP>4</SUP>, Angela Gentile<SUP>5</SUP>, Oscar Rizzo<SUP>6</SUP>, Manuel G?mez-Carrillo<SUP>7</SUP>, Fatima Coronado<SUP>8</SUP>, Eduardo Azziz-Baumgartner<SUP>8</SUP>, Pollyanna R. Ch?vez<SUP>8</SUP>, Marc-Alain Widdowson<SUP>8</SUP>
1 National Ministry of Health of Argentina, Buenos Aires, Argentina, 2 Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina, 3 Sociedad Argentina de Infectolog?a, Capital Federal, Argentina, 4 Sociedad Argentina de Medicina, Buenos Aires, Argentina, 5 Sociedad Argentina de Pediatr?a, Buenos Aires, Argentina, 6 Asociaci?n Argentina de Medicina Respiratoria, Buenos Aires, Argentina, 7 Asociaci?n Argentina de Microbiolog?a, Buenos Aires, Argentina, 8 Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Abstract
Background
The apparent high number of deaths in Argentina during the 2009 pandemic led to concern that the influenza A H1N1pdm disease was different there. We report the characteristics and risk factors for influenza A H1N1pdm fatalities.
Methods
We identified laboratory-confirmed influenza A H1N1pdm fatalities occurring during June-July 2009. Physicians abstracted data on age, sex, time of onset of illness, medical history, clinical presentation at admission, laboratory, treatment, and outcomes using standardize questionnaires. We explored the characteristics of fatalities according to their age and risk group.
Results
Of 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged <50 years. Acute respiratory failure was the leading cause of death. Of all cases, 249 (75%) had at least one comorbidity as defined by Advisory Committee on Immunization Practices. Obesity was reported in 32% with data and chronic pulmonary disease in 28%. Among the 40 deaths in children aged <5 years, chronic pulmonary disease (42%) and neonatal pathologies (35%) were the most common co-morbidities. Twenty (6%) fatalities were among pregnant or postpartum women of which only 47% had diagnosed co-morbidities. Only 13% of patients received antiviral treatment within 48 hours of symptom onset. None of children aged <5 years or the pregnant women received antivirals within 48 h of symptom onset. As the pandemic progressed, the time from symptom-onset to medical care and to antiviral treatment decreased significantly among case-patients who subsequently died (p<0.001).
Conclusion
Persons with co-morbidities, pregnant and who received antivirals late were over-represented among influenza A H1N1pdm deaths in Argentina, though timeliness of antiviral treatment improved during the pandemic.
Citation: Balanzat AM, Hertlein C, Apezteguia C, Bonvehi P, C?mera L, et al. (2012) An Analysis of 332 Fatalities Infected with Pandemic 2009 Influenza A (H1N1) in Argentina. PLoS ONE 7(4): e33670. doi:10.1371/journal.pone.0033670
Editor: Rory Edward Morty, University of Giessen Lung Center, Germany
Received: October 20, 2011; Accepted: February 14, 2012; Published: April 10, 2012
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: This work was supported by the Pan American Health Organization (PAHO)-Argentina. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: balanzat@fibertel.com.ar
- -------Ana M. Balanzat<SUP>1</SUP><SUP>*</SUP>, Christian Hertlein<SUP>1</SUP>, Carlos Apezteguia<SUP>2</SUP>, Pablo Bonvehi<SUP>3</SUP>, Luis C?mera<SUP>4</SUP>, Angela Gentile<SUP>5</SUP>, Oscar Rizzo<SUP>6</SUP>, Manuel G?mez-Carrillo<SUP>7</SUP>, Fatima Coronado<SUP>8</SUP>, Eduardo Azziz-Baumgartner<SUP>8</SUP>, Pollyanna R. Ch?vez<SUP>8</SUP>, Marc-Alain Widdowson<SUP>8</SUP>
1 National Ministry of Health of Argentina, Buenos Aires, Argentina, 2 Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina, 3 Sociedad Argentina de Infectolog?a, Capital Federal, Argentina, 4 Sociedad Argentina de Medicina, Buenos Aires, Argentina, 5 Sociedad Argentina de Pediatr?a, Buenos Aires, Argentina, 6 Asociaci?n Argentina de Medicina Respiratoria, Buenos Aires, Argentina, 7 Asociaci?n Argentina de Microbiolog?a, Buenos Aires, Argentina, 8 Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Abstract
Background
The apparent high number of deaths in Argentina during the 2009 pandemic led to concern that the influenza A H1N1pdm disease was different there. We report the characteristics and risk factors for influenza A H1N1pdm fatalities.
Methods
We identified laboratory-confirmed influenza A H1N1pdm fatalities occurring during June-July 2009. Physicians abstracted data on age, sex, time of onset of illness, medical history, clinical presentation at admission, laboratory, treatment, and outcomes using standardize questionnaires. We explored the characteristics of fatalities according to their age and risk group.
Results
Of 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged <50 years. Acute respiratory failure was the leading cause of death. Of all cases, 249 (75%) had at least one comorbidity as defined by Advisory Committee on Immunization Practices. Obesity was reported in 32% with data and chronic pulmonary disease in 28%. Among the 40 deaths in children aged <5 years, chronic pulmonary disease (42%) and neonatal pathologies (35%) were the most common co-morbidities. Twenty (6%) fatalities were among pregnant or postpartum women of which only 47% had diagnosed co-morbidities. Only 13% of patients received antiviral treatment within 48 hours of symptom onset. None of children aged <5 years or the pregnant women received antivirals within 48 h of symptom onset. As the pandemic progressed, the time from symptom-onset to medical care and to antiviral treatment decreased significantly among case-patients who subsequently died (p<0.001).
Conclusion
Persons with co-morbidities, pregnant and who received antivirals late were over-represented among influenza A H1N1pdm deaths in Argentina, though timeliness of antiviral treatment improved during the pandemic.
Citation: Balanzat AM, Hertlein C, Apezteguia C, Bonvehi P, C?mera L, et al. (2012) An Analysis of 332 Fatalities Infected with Pandemic 2009 Influenza A (H1N1) in Argentina. PLoS ONE 7(4): e33670. doi:10.1371/journal.pone.0033670
Editor: Rory Edward Morty, University of Giessen Lung Center, Germany
Received: October 20, 2011; Accepted: February 14, 2012; Published: April 10, 2012
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Funding: This work was supported by the Pan American Health Organization (PAHO)-Argentina. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: balanzat@fibertel.com.ar