California H1N1 Study Finds Those Over 50 Most
Likely to Die in Hospital, Elderly Least Likely
JAMA report shows hospitalizations occurring at all ages; fewer hospitalizations and
fatalities occurring in elderly persons
Nov. 4, 2009 A study out of California in todays
Journal of the American Medical Association creates a warning for older
Americans about the H1N1 flu hospitalization and death can occur at
all ages. The study found those age 50 or older had the highest death
rate among those hospitalized. Still, however, the elderly have fewer
deaths and hospitalizations.
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FLU
NEWS |
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In contrast with some common perceptions regarding
2009 influenza A(H1N1) infections, an examination of cases in California
indicates that hospitalization and death can occur at all ages, and
about 30 percent of hospitalized cases have been severe enough to
require treatment in an intensive care unit.
"Since April 17, 2009, when the first 2 cases of
pandemic influenza A(H1N1) virus infection were reported in California,
the virus has rapidly spread throughout the world," the authors write.
They add that preliminary comparisons with seasonal influenza suggest
that this influenza infection disproportionately affects younger ages
and causes generally mild disease.
Janice K. Louie, M.D., M.P.H., of the California
Department of Public Health, Richmond, Calif., and colleagues examined
the clinical and epidemiologic features of the first 1,088 hospitalized
and fatal cases due to pandemic 2009 influenza A(H1N1) infection
reported in California, between April 23 and August 11, 2009.
On April
20 of this year the California Department of Public Health and 61 local
health departments initiated enhanced surveillance for hospitalized and
fatal cases of this infection.
The researchers found that of the 1,088 A(H1N1)
cases, 344 (32 percent) were children younger than 18 years, with
infants having the highest rate of hospitalization and persons age 50
years or older having the highest rate of death once hospitalized.
The median (midpoint) age of all cases was 27
years. Fever, cough, and shortness of breath were the most common
symptoms. Underlying conditions previously associated with severe
influenza were reported in 68 percent of cases. Other underlying medical
illnesses recorded included obesity, hypertension, hyperlipidemia and
gastrointestinal disease. The median length of hospitalization among all
cases was 4 days.
Three hundred forty cases (31 percent) were
admitted to intensive care units, and of the 297 intensive care cases
with available information, 65 percent required mechanical ventilation.
Of the 884 cases with available information, 79
percent received antiviral treatment, including 496 patients (71
percent) with established risk factors for severe influenza.
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"Clinicians should maintain a
high level of suspicion for pandemic 2009 influenza A(H1N1)
infection in patients presenting currently with influenza-like
illness who are older than 50 years or have known risk factors
for influenza complications, regardless of rapid test results." |
Of the 833 patients who had chest radiographs, 66
percent had infiltrates (evidence of infection involving the lungs),
suggestive of pneumonia or acute respiratory distress syndrome. Rapid
antigen tests were falsely negative in 34 percent of cases evaluated.
"Overall fatality was 11 percent (118/1,088) and
was highest (18 percent - 20 percent) in persons aged 50 years or
older," the researchers write.
"Of the deaths, 8 (7 percent) were children younger
than 18 years. Among fatal cases, the median time from onset of symptoms
to death was 12 days." The most common causes of death were viral
pneumonia and acute respiratory distress syndrome.
"In the first 16 weeks of the current pandemic,
2009 influenza A(H1N1) appears to be notably different from seasonal
influenza, with fewer hospitalizations and fatalities occurring in
elderly persons. In contrast with the common perception that pandemic
2009 influenza A(H1N1) infection causes only mild disease,
hospitalization and death occurred at all ages, and up to 30 percent of
hospitalized cases were severely ill.
Most hospitalized cases had identifiable
established risk factors; obesity may be a newly identified risk factor
for fatal pandemic 2009 influenza A(H1N1) infection andmerits further
study."
"Clinicians should maintain a high level of
suspicion for pandemic 2009 influenza A(H1N1) infection in patients
presenting currently with influenza-like illness who are older than 50
years or have known risk factors for influenza complications, regardless
of rapid test results. Hospitalized infected cases should be carefully
monitored and treated promptly with antiviral agents," the authors
conclude.
