Confirmed Patients With 2009 Influenza A(H1N1) Infection In Shandong Of China

OBJECTIVE To describe characteristics, treatment, and outcomes of confirmed patients in Shandong of China with 2009 influenza A(H1N1) infection.DESIGN A prospective observational study of 238 RT-PCR confirmed patients with 2009 influenza A(H1N1) infection in 4 adult and pediatric intensive care units (ICUs) in Shandong of China between March 2009 and March,2010. The primary outcome measures were 14-day,28-day and 56-day mortality, and the secondary outcomes included frequency and duration of mechanical ventilation and duration of ICU stay. Describe the clinical effect of oseltamivir in different groups of health condition.RESULTS Among the 238 patients with confirmed community-acquired 2009 influenza A(H1N1) infection, the mean(SD) age was 28.2(16. 1)years, 58.8%(140/238)were female, range 2-68years, mean (SD) age was 27.6(14.1)years; 41.2%(98/238)were male, range 0.5-73years, mean (SD) age was 29.1(18.7)years. The median time from symptom onset to hospital admission was 4 days (interquartile range [IQR],3-6 days) and from hospitalization to ICU admission was 1 day (IQR,0-3 days). Shock and nonpulmonary acute organ dysfunction was common (Sequential Organ Failure Assessment mean [SD] score of 5.8 [2.9] on day1). All patients were administered with neuraminidase inhibitors (NAIs), 13.4%(39/238) of patients received mechanical ventilation, the median duration of ventilation was 7 days(IQR,4-11 days) and ICU stay was 8 days (IQR,3-11 days). Overall mortality among confirmed patients at 14 days was 5.9%(95% confidence interval,2.9%-8.9%,n=14);14-28 days was 2.5%(95% confidence interval,0.5%-4.5%,n=6); 28-56 days was 1.3%(95% confidence interval, 0.3%-3.7%,n=3). Although this overall population was young, older patients were more likely to die. The study of oseltamivir confirmed earlier administration (in 48 hours) can reduce duration of clinical symptom and reduce mortality.CONCLUSION Infection due to 2009 influenza A (H1N1) in Shandong mostly occurred in young adults, female more than male. Hemoptysis was a typical syndrome but had no correlation with critical degree. The clinical symptoms were slight and 90% of patients were discharge from hospital. The mortality of 2009 H1N1 infection had no difference with the season influenza virus. The third pregnancy, obesity and patients with comorbidities can induce death. When patients appeared suspected symptoms, oseltamivir should be used as soon as possible, especially in these critically ill patients with serious comorbidities.