Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Coordinación de Vigilancia Epidemiológica y Apoyo en Contingencias, Unidad de Salud Pública, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Lancet. 2009 Dec 19;374(9707):2072-2079. doi: 10.1016/S0140-6736(09)61638-X. Epub 2009 Nov 11.
In April, 2009, the first cases of influenza A H1N1 were registered in Mexico and associated with an unexpected number of deaths. We report the timing and spread of H1N1 in cases, and explore protective and risk factors for infection, severe disease, and death.
We analysed information gathered by the influenza surveillance system from April 28 to July 31, 2009, for patients with influenza-like illness who attended clinics that were part of the Mexican Institute for Social Security network. We calculated odds ratios (ORs) to compare risks of testing positive for H1N1 in those with influenza-like illness at clinic visits, the risk of admission for laboratory-confirmed cases of H1N1, and of death for inpatients according to demographic characteristics, clinical symptoms, seasonal influenza vaccine status, and elapsed time from symptom onset to admission.
By July 31, 63 479 cases of influenza-like illness were reported; 6945 (11%) cases of H1N1 were confirmed, 6407 (92%) were outpatients, 475 (7%) were admitted and survived, and 63 (<1%) died. Those aged 10-39 years were most affected (3922 [56%]). Mortality rates showed a J-shaped curve, with greatest risk in those aged 70 years and older (10.3%). Risk of infection was lowered in those who had been vaccinated for seasonal influenza (OR 0.65 [95% CI 0.55-0.77]). Delayed admission (1.19 [1.11-1.28] per day) and presence of chronic diseases (6.1 [2.37-15.99]) were associated with increased risk of dying.
Risk communication and hospital preparedness are key factors to reduce mortality from H1N1 infection. Protective effects of seasonal influenza vaccination for the virus need to be investigated.
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2009 年 4 月，墨西哥首次出现甲型 H1N1 流感病例，并与大量意外死亡相关。我们报告了甲型 H1N1 病例的时间和传播情况，并探讨了感染、重症和死亡的保护和危险因素。
我们分析了 2009 年 4 月 28 日至 7 月 31 日期间，在参加墨西哥社会保障研究所网络诊所的流感样疾病患者中收集的流感监测系统信息。我们计算了比值比（OR），以比较在就诊时流感样疾病患者中甲型 H1N1 检测呈阳性的风险、实验室确诊的甲型 H1N1 病例住院的风险，以及根据人口统计学特征、临床症状、季节性流感疫苗接种情况和从发病到住院的时间间隔，住院患者的死亡风险。
截至 7 月 31 日，共报告了 63479 例流感样疾病病例；6945 例（11%）甲型 H1N1 确诊，6407 例（92%）为门诊患者，475 例（7%）住院且存活，63 例（1%）死亡。10-39 岁年龄组受影响最大（3922 例[56%]）。死亡率呈 J 形曲线，70 岁及以上人群风险最高（10.3%）。季节性流感疫苗接种降低了感染风险（OR 0.65 [95%CI 0.55-0.77]）。住院时间延迟（每天增加 1.19 [1.11-1.28]）和存在慢性疾病（6.1 [2.37-15.99]）与死亡风险增加相关。
风险沟通和医院准备是降低甲型 H1N1 感染死亡率的关键因素。需要对季节性流感疫苗对该病毒的保护作用进行调查。
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