151 Profile of 213 cases infected with influenza A (H1N1) in Eastern Anatolia Serhat Vancelik,...
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Profile of 213 cases Profile of 213 cases
infected with influenza A (infected with influenza A (H1N1H1N1) ) inin
Eastern AnatoliaEastern Anatolia
Serhat Vancelik, Zekeriya Akturk, Rukiye Cetin Seckin, Hamit [email protected], www.aile.net
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Introduction and Aim
• As to 10th of January 2010, 627 persons died since the beginning of the pandemy in Turkey,
• Though only around 5% (due to resistence to vaccination) of the population in Turkey was vaccinated against H1N1.
• This study aimed to describe the profile of people diagnosed with the H1N1 infection in and around Erzurum, a city with 785 000 inhabitants at the north-east side of Turkey.
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Method• All patients suspected of having H1N1 infection
between October 2009 and end of January 2010 were referred to one of the five secondary and tertiary hospitals in the city.
• Blood was collected and sent for laboratory approval of the diagnosis.
• Diagnostic test were done by the Refik Saydam reference laboratory using the in-house real time PCR method.
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• Patients with positive test results were compared to the negative ones with respect to the possible risk factors.
• In addition to signs and symptoms, patient demographics were recorded and analyzed for each patient.
• High grade fever was defined as axillary temperature > 38.3°C.
• H1N1 positive patients were followed up for mortality status and the medication administered. / 154
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Results• Results analyzed for 445 suspected H1N1 cases, 213
(47.9%) were proven to be lab positive.
• Positive cases were younger (24,5 vs 28,8; p=0,047)
• None of the patients were vaccinated for H1N1
• Mean age: 26.8±22.7 years. 55.5% males.
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H1N1 (-) H1N1 (+) pFever 176 (48%) 191 (52%) <0,05Cough 181 (49,6%) 184 (50,4%) <0,05Muscle pain 130 (50%) 130 (50%) >0,05Headache 129 (51%) 124 (49%) >0,05Sore throat 105 (48,4%) 112 (51,6%) >0,05Running nose 95 (47%) 107 (53%) <0,05Breathlessness 99 (49,7%) 100 (50,3%) >0,05
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Flu va
ccina
tion
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• In a logistic regression model, fever was the only independent predictor of H1N1 infection (OR=2.83; p<0.001).– Factors included: Fever, Cough, Myalgia,
Headache, Sore throat, Running nose, Dyspnea, seasonal flu vaccination status, comorbidity, contact with flu case, contact with international traveler, age, sex.
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Profile of the H1N1 positive cases– 20 cases (9.4%) ended up with mortality (9 of these
patients were from Erzurum, the remaining 11 from neighboring cities).
– Majority of the patients (56.8%; n=121) were males. Median patient age was 19 years (min. 2 months, max. 83 years).
– Median duration of symptoms from the beginning of symptoms and application to a health center was 2 days (min. 0, max. 9).
– Most frequent symptoms were fever (89.7%; n=191) and cough (86.4%; n=184).
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– 43 patients received intensive care therapy and out of these, 23 required ventilator support.
– 130 patients (61%) received antiviral therapy. – There was no relationship between antiviral
therapy administration and mortality (p>0.05). – There was no significant relationship between
mortality and flu vaccination or sex (p>0.05). – Mortality was significantly related with patient age.
Median age of the deceased vs cured patients was 42 and 19 years respectively (p=0.048) / 159
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– Patients with • absence of headache,
• absence of sore throat,
• absence of runny nose,
• presence of fever,
• presence of cough,
• presence of breathlessness,
• presence of ARDS,
• and presence of co-morbidity
– had significantly higher mortality rates (p<0.05)./ 1510
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Outcome
Cure Ex p
Fever No 17 15 0,024
8,8 25,0
Yes 176 15
91,2% 75,0%
Cough No 23 6 0,025
11,9% 30,0%
Yes 170 14
88,1% 70,0%
Muscle pain No 72 11 0,122
37,3% 55,0%
Yes 121 9
67,2% 45,0%
Headache No 73 16 <0,001
37,8% 80,0%
Yes 120 4
62,2% 20,0%
Sore throat No 86 15 0,009
44,6% 75,0%
Yes 107 5
55,40% 25,0%
Running nose No 88 18 <0,001
45,6% 90,0%
Yes 105 2
54,4% 10,0%
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Outcome
Cure Ex p
Breathlessness No 107 6 0,0355,4% 30,0%
Yes 86 14 44,6% 70,0%
Flu vaccination No 185 20 0,35595,9% 100,0%
Yes 8 0 4,1% 0,0%
Comorbidity No 132 8 0,01168,4% 40,0%
Yes 61 12 31,6% 60,0%
Contact with flu case No 137 17 0,18271,0% 85,0%
Yes 56 3 29,0% 15,0%
International travel No 188 19 0,53597,4% 95,0%
Yes 5 1 2,6% 5,0%
Contact with international traveler No 186 20 0,38696,4% 100,0%
Yes 7 0 3,6% 0,00% / 1512
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• In a logistic regression model we found – age (OR=1.05), – female sex (OR=6.1), – absence of headache (OR=12.20), – absence of runny nose (OR=11.11), and – presence of ARDS (OR=105.4)
• as significant independent variables predicting mortality (all p<0.05).
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Conclusion
• This study supports the evidence that high grade fever and cough are major symptoms of patients infected with H1N1.
• The seemingly protective effect of symptoms such as headache and runny nose on mortality needs further investigation.
• The disease may have present as seasonal flu in these cases.
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