Outcomes of Influenza AH1N1pdm09 Virus Infection: Results from Two International Cohort StudiesReportar como inadecuado




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Background

Data from prospectively planned cohort studies on risk of major clinical outcomes and prognostic factors for patients with influenza AH1N1pdm09 virus are limited. In 2009, in order to assess outcomes and evaluate risk factors for progression of illness, two cohort studies were initiated: FLU 002 in outpatients and FLU 003 in hospitalized patients.

Methods and Findings

Between October 2009 and December 2012, adults with influenza-like illness ILI were enrolled; outpatients were followed for 14 days and inpatients for 60 days. Disease progression was defined as hospitalization and-or death for outpatients, and hospitalization for >28 days, transfer to intensive care unit ICU if enrolled from general ward, and-or death for inpatients. Infection was confirmed by RT-PCR. 590 FLU 002 and 392 FLU 003 patients with influenza A H1N1pdm09 were enrolled from 81 sites in 17 countries at 2 days IQR 1–3 and 6 days IQR 4–10 following ILI onset, respectively. Disease progression was experienced by 29 1 death outpatients 5.1%; 95% CI: 3.4–7.2% and 80 inpatients death 32, hospitalization >28 days 43 or ICU transfer 20 21.6%; 95% CI: 17.5–26.2%. Disease progression death for hospitalized patients was 53.1% 26.6% and 12.8% 3.8%, respectively, for those enrolled in the ICU and general ward. In pooled analyses for both studies, predictors of disease progression were age, longer duration of symptoms at enrollment and immunosuppression. Patients hospitalized during the pandemic period had a poorer prognosis than in subsequent seasons.

Conclusions

Patients with influenza AH1N1pdm09, particularly when requiring hospital admission, are at high risk for disease progression, especially if they are older, immunodeficient, or admitted late in infection. These data reinforce the need for international trials of novel treatment strategies for influenza infection and serve as a reminder of the need to monitor the severity of seasonal and pandemic influenza epidemics globally.

Trial Registration

ClinicalTrials.gov Identifiers: FLU 002- NCT01056354, FLU 003- NCT01056185.



Autor: Ruth Lynfield , Richard Davey, Dominic E. Dwyer, Marcelo H. Losso, Deborah Wentworth, Alessandro Cozzi-Lepri, Kathy Herman-Lamin,

Fuente: http://plos.srce.hr/



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