Chudasama Rajesh K, Verma Pramod B, Amin Chikitsa D, Gohel Bharat, Savariya Dinkar, Ninama Rakesh
Department of Community Medicine, Government Medical College, Rajkot, Gujarat, India.
Indian J Crit Care Med. 2010 Jul;14(3):113-20. doi: 10.4103/0972-5229.74169.
India reported its first case of 2009 pandemic influenza A (H1N1) virus infection in May 2009 and in Saurashtra region in August 2009. We describe the epidemiology and factors associated with severe and non-severe cases of 2009 influenza A (H1N1) infection reported in Saurashtra region.
From September 2009 to February 2010, we observed 274 patients who were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals in Rajkot city. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing was used to confirm infection. Factors associated with severe disease were determined by comparing with non-severe cases.
Out of 274 patients, 87 had severe disease (requiring intensive care or died) and 187 had non-severe diseases (admitted in wards and survived). The median age of severe disease patients was 30 years; the median time was 5 days from the onset of illness to diagnosis, and 4 days median time was reported for hospital stay. More than half of the patients (56.3%) were females, and 58.6% patients were residing in urban area (OR = 1.65, CI = 0.97-2.8), among severe disease patients. Significant association (P < 0.01) was reported among severe disease patients for delayed referral from general practitioner/physician after initial treatment. All patients received antiviral drug, but only 19.5% received the same within 2 days of illness. Presence of coexisting condition [odds ratio (OR) = 0.53, confidence interval (CI) = 0.31-0.90], mainly pregnancy (OR = 0.22, CI = 0.06-0.76), was strongly associated with severe disease.
Delayed referral from general practitioner/physician, duration of antiviral treatment, and presence of coexisting condition (especially pregnancy) were responsible for intensive care or mortality in patients of severe influenza A (H1N1) illness.
印度于2009年5月报告了首例2009年甲型H1N1流感大流行病毒感染病例，并于2009年8月在索拉什特拉地区出现该病例。我们描述了索拉什特拉地区报告的2009年甲型H1N1流感感染的严重和非严重病例的流行病学及相关因素。
2009年9月至2010年2月，我们观察了274例感染2009年甲型H1N1流感病毒并入住拉杰果德市不同医院的患者。采用实时逆转录-聚合酶链反应（RT-PCR）检测来确诊感染。通过与非严重病例比较来确定与严重疾病相关的因素。
274例患者中，87例患有严重疾病（需要重症监护或死亡），187例患有非严重疾病（入住病房并存活）。严重疾病患者的中位年龄为30岁；从发病到诊断的中位时间为5天，住院中位时间为4天。超过一半的患者（56.3%）为女性，在严重疾病患者中，58.6%的患者居住在城市地区（比值比[OR]=1.65，可信区间[CI]=0.97-2.8）。在严重疾病患者中，初治后从全科医生/内科医生处延迟转诊之间存在显著关联（P<0.01）。所有患者均接受了抗病毒药物治疗，但只有19.5%的患者在发病后2天内接受了治疗。存在并存疾病[比值比（OR）=0.53，可信区间（CI）=0.31-0.90]，主要是妊娠（OR=0.22，CI=0.06-0.76），与严重疾病密切相关。
全科医生/内科医生的延迟转诊、抗病毒治疗的持续时间以及并存疾病（尤其是妊娠）的存在导致了严重甲型H1N1流感疾病患者的重症监护或死亡。
