DOI: http://dx.doi.org/10.18203/2349-3933.ijam20191038

A cross sectional analysis on the clinical presentation and outcome of H1N1 influenza patients in a tertiary care hospital in Central Kerala

Alvin Treasa George, Grace George, David K. Simson, T. P. Antony

Abstract


Background: The World Health Organization raised pandemic H1N1 influenza alert level to phase 6 in June 2009 due to a widespread community transmission on two continents. The recent surge in positive H1N1 cases necessitates a revisit to the clinical profile of the 2009 pandemic. This study was aimed to analyse the clinical profile and outcome of swab positive H1N1 patients.

Methods: A cross sectional analysis on the clinical presentation and primary out come in the confirmed H1N1 influenza cases was done. H1N1 confirmation was done using real time reverse transcriptase-Polymerase Chain Reaction in throat swab samples. The data were analysed statistically and presented in percentage.

Results: Total 31 cases of severe H1N1 were included in the study. Majority of the cases (16/31) were between15 to 30 yrs of age. Among the total cases, 27 cases were females (87.1%) of which 11 cases were pregnant (35.5%). The predominant presenting symptoms were fever (100%), breathlessness (80.6%), body ache (45.2%), headache (29%) and sore throat (29%). Twenty three of the 31 patients (74.2%) survived while 8 succumbed to the illness (25.8%). All the patients required ICU admission and 8 underwent invasive ventilation. The mortality was high among the ventilated patients (p=0.0064).

Conclusions: Pregnancy was associated with higher rate of complications. Early respiratory support did not help in preventing progression to respiratory failure in most of the patients. Vaccination, early recognition of the disease and prompt initiation of treatment appear to be the only way to reduce H1N1 disease progression and mortality.


Keywords


H1N1 virus, Influenza A virus, Pneumonia, Respiratory failure, Ventilation

Full Text:

PDF

References


Baden LR, Drazen JM, Kritek PA, Curfman GD, Morrissey S,Campion EW, et al. H1N1 influenza a disease - Information for healthprofessionals. N Engl J Med. 2009;360:2666‑7.

Belshe RB. Implications of the emergence of a novel H1 influenza virus. N Engl J Med. 2009;360:2667‑8.

Ministry of Health and Family Welfare, Government of India. Guidelineson Categorization of Influenza A H1N1 cases During Screening for HomeIsolation, Testing Treatment, and Hospitalization. Availabele at: http://mohfw.gov.in/showfile.php?lid=3071. Accessed on 2018 May 02.

Vishnu RP, Bansal N, Gopalakrishnan R, Ramasubramanian V, Madhumitha R, Nambi S, Suresh Kumar Epidemiology, Clinical Features and Outcome of Hospitalised Patients with H1N1 Influenza in Chennai, India. Austin Virol Retrovirol. 2017;4:1-4.

Pajankar S, Al Qassabi SS, Al Harthi SM. Clinical Features and Outcome of 65 Laboratory Confirmed Cases of H1N1 in Muscat, Sultanate of Oman. Oman Med J. 2012;27:201-6.

Chudasama RK, Patel UV, Verma PB, Amin CD, Savaria D, Ninama R, et al. Clinico-epidemiological features of the hospitalized patients with 2009 pandemic influenza A (H1N1) virus infection in Saurashtra region, India (September, 2009 to February, 2010). Lung India. 2011 Jan;28(1):11.

Mehta AA, Kumar VA, Nair SG, K Joseph F, Kumar G, Singh SK, et al. Clinical profile of patients admitted with swine‑origin influenza A (H1N1) virus infection: An experience from A tertiary care hospital. J Clin Diagn Res. 2013;7:2227‑30.

Prasad S, Indhu AJ, Margos RAP, Philip S. Clinical profile and outcome of H1N1 influenza patients in a tertiary care hospital in Kochi, Kerala. Indian J Respir Care. 2018;7:97-101.

Amaravathi KS, Sakuntala P, Sudarsi B, Manohar S, Nagamani R, Rao SR Clinical profile and outcome of recent outbreak of influenza A H1N1 (swine flu) at a tertiary care center in Hyderabad, Telangana. Ann Trop Med Public Health. 2015;8:267-71.

Kashinkunti MD, Gundikeri SK, Dhananjaya M. Study of clinical profile of patients with H1N1 influenza in a teaching hospital of North Karnataka. Diab. 2013;11:50.

Malhotra B, Singh R, Sharma P, Meena D, Gupta J, Atreya A, Meena BR. Epidemiological & clinical profile of influenza A (H1N1) 2009 virus infections during 2015 epidemic in Rajasthan. Indian J Med Res. 2016 Dec;144(6):918.

Puvanalingam A, Rajendiran C, Sivasubramanian K, Ragunanthanan S, Suresh S, Gopalakrishnan S. Case series study of the clinical profile of H1N1 swine flu influenza. J Assoc Physicians India. 2011 Jan;59(8).

Agarwal S, Nawal CI, Agarwal A, Mittal P. Paripex Indian J Res. 2018;7:39‑41.

Murhekar M, Mehendale S. The 2015 influenza A (H1N1) pdm09 outbreak in India. Indian J Med Res. 2016 Jun;143(6):821.

Mossad SB. Influenza: Still more important than zika virus in 2016‑2017.Cleve Clin J Med. 2016;83:836‑40.