Back to Search Start Over

Excess mortality is associated with influenza A (H1N1) in patients with severe acute respiratory illness

Authors :
Flavia Queiroz
Livia Gonçalez de Godoy
Nathália Pimentel Furlan
Maria Lúcia Machado Salomão
Estela Silva Simões
Guilherme Hirassawa Sacillotto
Rayane Estefani Ribas Da Silva Teixeira
Inara Cristina Marciano Frini
Maurício Lacerda Nogueira
Luis Henrique Simões Covello
Aripuanã Sakurada Aranha Watanabe
Neymar Elias de Oliveira
Suzana Margareth Lobo
Joelma Vilafanha Gandolfi
Karina Rocha Dutra
Source :
Journal of Clinical Virology. 116:62-68
Publication Year :
2019
Publisher :
Elsevier BV, 2019.

Abstract

Background Acute respiratory infections caused by viruses are among the leading causes of morbidity and mortality. The inflammatory response that follows viral infection is important for the control of virus proliferation. However, if overwhelming, may be associated with complicated outcomes. Objectives We assessed the clinical characteristics of patients with severe acute respiratory illness (SARI) evolving to acute respiratory distress syndrome (ARDS) and the factors related to death. Study design. Prospective study in 273 adult patients with SARI performed in a university-affiliated 800-bed hospital serving an area of epidemiologic vigilance of 102 municipalities and more than 2 million inhabitants. Influenza A (H1N1) 2009 (A/H1N1), influenza A H3N2, and influenza B were tested in all patients by RT-PCR. Results The overall hospital mortality rate was 17.6%. A total of 30.4% of patients tested positive for influenza A/H1N1. Patients with SARI that evolved to ARDS took significantly longer to take the first dose of oseltamivir (6.0 vs 1.0 days, p=0.002). Patients with H1N1 positive tests had almost 3 times higher probability of death, despite having significantly less comorbidities (p=0.027). The influenza A/H1N1 pdm09 vaccine reduced the odds of death by 78%. Nonsurvivors had a more intense inflammatory response than did survivors at 48 h (C-reactive protein: 31.0 ± 17.5 vs. 14.6 ± 8.9 mg/dl, p=0.001) as well as a more positive fluid balance. Conclusions Hospital mortality associated with influenza H1N1-associated SARI and ARDS continued to be high years after the 2009 pandemic in a population with low vaccine coverage. Antiviral treatment started more than two days after onset of symptoms was more frequently associated with ARDS and death and, having had vaccine against influenza A (H1N1) was a factor independently related to survival.

Details

ISSN :
13866532
Volume :
116
Database :
OpenAIRE
Journal :
Journal of Clinical Virology
Accession number :
edsair.doi.dedup.....2e8185c6d7ffcc765960de8c7aa605e8
Full Text :
https://doi.org/10.1016/j.jcv.2019.05.003