Demographic and clinical characteristics of deaths associated with influenza A(H1N1) pdm09 in Central America and Dominican Republic 2009-2010.

Demographic and clinical characteristics of deaths associated with influenza A(H1N1) pdm09 in Central America and Dominican Republic 2009-2010.

BMC Public Health. 2015 Jul 31;15:734. doi: 10.1186/s12889-015-2064-z.

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Description

Author information:
1. Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. rchaconf@gmail.com.
2. Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA. zjk4@cdc.gov.
3. Ministry of Health, San Salvador, El Salvador. davidsaulrodriguezaraujo@gmail.com.
4. Ministry of Health, Guatemala, Guatemala. parsama92@hotmail.com.
5. Social Security of Costa Rica, San Jose, Costa Rica. guiselle23@gmail.com.
6. Ministry of Health, Panama, Panama. lmorenocastillo@yahoo.com.
7. Ministry of Health, Dominican Republic, Dominican Republic. ceciliathen@hotmail.com.
8. Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. jorherja@gmail.com.
9. Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. nataliavanessa00@yahoo.com.
10. Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. luisbonillavargas@gmail.com.
11. Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA. willclara@yahoo.com.
12. Training of Epidemiology and Public Health Intervention Network, Guatemala, Guatemala. percyminaya@gmail.com.
13. Influenza Group. Pan-American Health Organization, Washington DC, USA. palekarr@paho.org.
14. Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA. eha9@cdc.gov.

BACKGROUND:
The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm09 infection during 2009-2010, in seven countries in the American tropics.
METHODS:
We used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records.
RESULTS:
During May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18-46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset.
CONCLUSIONS:
The pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.

PMCID: PMC4521479 Free PMC Article
PMID: 26227404 [Indexed for MEDLINE]

Publication types
• Research Support, N.I.H., Extramural
• Research Support, U.S. Gov’t, P.H.S.
MeSH terms
• Adolescent
• Adult
• Antiviral Agents/therapeutic use
• Asthma/mortality
• Central America
• Comorbidity
• Costa Rica
• Disease Outbreaks/statistics & numerical data*
• Dominican Republic/epidemiology
• El Salvador
• Female
• Fever/drug therapy
• Guatemala
• Honduras
• Humans
• Influenza A Virus, H1N1 Subtype*
• Influenza, Human/drug therapy
• Influenza, Human/mortality*
• Male
• Middle Aged
• Nicaragua
• Oseltamivir/therapeutic use
• Pregnancy
• Pulmonary Disease, Chronic Obstructive/mortality
• Young Adult
Substances
• Antiviral Agents
• Oseltamivir
Grant support
• U01 GH000028/GH/CGH CDC HHS/United States
• 1U01GH000028-03/GH/CGH CDC HHS/United States

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