An analysis of 332 fatalities infected with pandemic 2009 influenza A (H1N1) in Argentina.

BackgroundThe 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.MethodsWe 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.ResultsOf 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged ConclusionPersons 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

Description of pregnant, postpartum and fertile age women among influenza A H1N1pdm confirmed deceased patients, Argentina, June 15^th–July 31^st, 2009.

<p><b>n/a</b> not applicable.</p

Pandemic H1N1 (influenza A H1N1pdm) confirmed hospitalizations and deaths by week of symptom onset and case fatality proportion among hospitalized cases, Argentina, May 3^rd 2009–August 29^th 2009.

<p>Pandemic H1N1 (influenza A H1N1pdm) confirmed hospitalizations and deaths by week of symptom onset and case fatality proportion among hospitalized cases, Argentina, May 3^rd 2009–August 29^th 2009.</p

Treatment and Clinical course of 332 influenza A H1N1pdm-confirmed fatalities, June 15^th–July 31^st, 2009.

**<p>eleven case-patients were ventilated outside of the ICU because of space-limitations.</p>***<p>excluding influenza A H1N1pdm nosocomial infections.</p

Comorbidities^* and underlying conditions among influenza A H1N1pdm confirmed fatalities by age groups, Argentina, June 15^th–July 31^st, 2009.

*<p>Comorbidities as defined by the Advisory Committee on Immunization Practices ¹⁰.</p>†<p>Including asthma.</p>§<p>Excluding hypertension.</p>¶<p>Including diabetes.</p>#<p>Persons who have immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus, HIV).</p>**<p>Persons who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration.</p>††<p>Including cerebrovascular disease, cerebral palsy, epilepsy, down syndrome, neurochronic disease.</p>§§<p>Does not include former and passive smokers.</p>¶¶<p>Women only.</p><p><b>n/a</b> not applicable.</p

Selected symptoms and physical signs at time of admission by age group in influenza A H1N1pdm confirmed fatalities (excluding patients with influenza A H1N1pdm nosocomial infections unless otherwise reported), Argentina, June 15^th–July 31^st, 2009.

*<p>Unless otherwise stated.</p>†<p>Median (IQR).</p>#<p>Elevated respiration rate was defined as more than 40 breaths per minute for patients less than 5 years old and 25 breaths per minute for patients 5+ years old.</p>§<p>Elevated resting heart rate was defined as more than 120 beats per minute for patients less than 5 years old and 100 beats per minute for patients 5+ years old.</p>¶<p>Low systolic tension was defined as <90 mmHg.</p

Selected X-ray patterns at time of admission by age group in influenza A H1N1pdm confirmed fatalities (excluding patients with influenza A H1N1pdm nosocomial infections unless otherwise reported), Argentina, June 15^th–July 31^st, 2009.

¶¶<p>COPD, Asthma, atelectasis, tuberculosis, respiratory failure.</p>***<p>Fever syndrome, septic shock, leukemia, gastrointestinal problems, pregnancy, HIV/AIDS.</p

Mean number of days from date of onset to date of first doctor visit (A), hospitalization (B), and antiviral treatment (C); Mean number of days from first doctor visit (D) and hospitalization (E) to antiviral treatment among influenza A H1N1pdm fatalities by epidemiological week of onset.

<p>Mean number of days from date of onset to date of first doctor visit (A), hospitalization (B), and antiviral treatment (C); Mean number of days from first doctor visit (D) and hospitalization (E) to antiviral treatment among influenza A H1N1pdm fatalities by epidemiological week of onset.</p

Selected hematology at time of admission by age group in influenza A H1N1pdm confirmed fatalities (excluding patients with influenza A H1N1pdm nosocomial infections unless otherwise reported), Argentina, June 15–July 31, 2009.

**<p>Lymphopenia was defined as <3000 cells/ml for patients under 5 years old, <2000 cells/ml for patients 5-12 years old and <1,500 cells/ml for patients over 12 years old.</p>††<p>Anemia was defined as less than 11 g/dl of hemoglobin (Hb) for patients less than 5 years old and for pregnant women (>15 years old), less than 11.5 g/dl Hb for patients 5–12 years old, less than 12 g/dl Hb for patients 12–15 years old and for non-pregnant women (>15 years old), and less than 13 g/dl Hb for men 15 years and older.</p>§§<p>“Acidosis or hypoxemia” is defined as pH under 7.36 or oxygen saturation less than 96%.</p