Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Clin Infect Dis. 2010 Mar 15;50(6):860-8. doi: 10.1086/650750.
In Chile, the novel influenza A (H1N1) epidemic began in the middle-high income area of Santiago. Clinical and laboratory surveillance was intensified with the aim to characterize the epidemic and determine its impact in a large hospital setting.
Demographic and clinical data were obtained from all patients whose symptoms met the clinical definition of influenza A (H1N1) infection during the epidemic period. Laboratory confirmation was obtained by use of a nasopharyngeal antigen detection test for influenza A and/or influenza A (H1N1) polymerase chain reaction (PCR). A case was considered confirmed if the antigen detection test result for influenza A and/or the PCR test result were positive.
The total number of emergency department (ED) visits increased by 88.5% from a mean of 14,489 ED visits in 2006-2008 to a mean of 27,308 ED visits in 2009, during the epidemic period. There were 10,048 patients who were clinically diagnosed with influenza A (H1N1), and they represented 78% of all visits, of which 4591 (45.6%) were laboratory confirmed. The median time from symptom onset to diagnosis was 1 day, and 99.7% of individuals received antiviral treatment. School-aged children represented 67% of ED visits at the beginning of the epidemic and 24% of ED visits at the end of the epidemic. Only 2% of cases were hospitalized; of these, 70% of cases occurred in patients 6-50 years of age, and 32% of cases occurred in patients who had an underlying medical condition. Eleven patients (age range, 1-53 years) required admission to the intensive care unit (ICU); 6 of these patients had pneumonia with or without hemodynamic shock. No influenza-associated deaths occurred.
Many cases of influenza A (H1N1) occurred in school-aged and adult individuals who required an ED visit; these visits resulted in a low impact on the use of hospital beds. Aggressive ICU management and/or experience in extracorporeal membrane oxygenation significantly improved outcomes. Early antiviral treatment may have played an important role in the low number of severe cases. Vaccines targeted for school-aged children and young adults may modify the first epidemic wave in the northern hemisphere.
在智利，新型甲型 H1N1 流感首先在圣地亚哥中高收入地区爆发。临床和实验室监测得到加强，目的是对大医院环境中的疫情进行特征描述并确定其影响。
在疫情期间，所有符合甲型 H1N1 流感临床定义的患者，均获取其人口统计学和临床数据。通过使用甲型流感鼻咽抗原检测和/或甲型 H1N1 聚合酶链反应（PCR）来进行实验室确认。如果甲型流感抗原检测和/或 PCR 检测结果阳性，则认为确诊病例。
急诊就诊人数从 2006-2008 年的平均 14489 人次增加了 88.5%，在疫情期间增加到了 27308 人次。有 10048 例患者被临床诊断为甲型 H1N1 流感，占所有就诊人数的 78%，其中 4591 例（45.6%）经实验室确认。从症状发作到诊断的中位时间为 1 天，99.7%的人接受了抗病毒治疗。在疫情开始时，学龄儿童占急诊就诊人数的 67%，在疫情结束时占 24%。只有 2%的病例住院；其中，70%的病例发生在 6-50 岁的患者中，32%的病例发生在有基础疾病的患者中。11 例（年龄 1-53 岁）患者需要入住重症监护病房（ICU）；其中 6 例患者有肺炎并伴有或不伴有血流动力学休克。没有流感相关死亡病例。
许多甲型 H1N1 流感病例发生在学龄期和成年的需要就诊的个体中；这些就诊对住院床位的使用影响不大。积极的 ICU 管理和/或体外膜氧合经验显著改善了结果。早期抗病毒治疗可能在严重病例数量较少方面发挥了重要作用。针对学龄儿童和年轻成年人的疫苗可能会改变北半球的首次疫情浪潮。
