Clinical and epidemiological characteristics of 2009 pandemic influenza A in hospitalized pediatric patients of the Saurashtra region, India
The first case of 2009 pandemic influenza A or H1N1 virus infection in India was reported in May 2009 and in the Saurashtra region in August 2009. We describe the two waves clinicoepidemiological characteristics of children who were hospitalized with 2009 influenza A infection in the Saurashtra region.
From September 2009 to February 2011, we treated 117 children infected with 2009 influenza A virus who were admitted in different hospitals in Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test was used to confirm infection, and the clinico-epidemiological features of the disease were closely monitored.
In the 117 patients, with a median age of 2 years, 59.8% were male. The median time from onset of the disease to influenza A diagnosis was 5 days, and that from onset of the disease to hospitalization was 7 days. The admitted patients took oseltamivir, but only 11.1% of them took it within 2 days after onset of the disease. More than one fourth (29.1%) of the admitted patients died. The most common symptoms of the patients were cough (98.3%), fever (94.0%), sore throat and shortness of breathing. Pneumonia was detected by chest radiography in 80.2% of the patients.
In children with infection-related illness, the survival rate was about 71% after oseltamivir treatment. The median time for virus detection with real-time RT-PCR is 5 days. Early diagnosis and treatment may reduce the severity of the disease.
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- "Regrettably, there is no data on access at the community level. In two studies performed at hospitals, the mean time between developing symptoms of influenza at home and receiving oseltamivir as an in-patient was five days as opposed to the ideal two, indicating that the drug was too restricted to be accessible in time for a majority of the patients (31,32). While insufficiently studied, oseltamivir distribution in India is an example of an effort to limit irrational use of an antimicrobial in high demand, this coming from a health system where OTC sales of antibiotics seem to be a common occurrence (12,13). "
ABSTRACT: Abstract The increasing antibiotic resistance is a global threat to health care as we know it. Yet there is no model of distribution ready for a new antibiotic that balances access against excessive or inappropriate use in rural settings in low- and middle-income countries (LMICs) where the burden of communicable diseases is high and access to quality health care is low. Departing from a hypothetical scenario of rising antibiotic resistance among pneumococci, 11 stakeholders in the health systems of various LMICs were interviewed one-on-one to give their view on how a new effective antibiotic should be distributed to balance access against the risk of inappropriate use. Transcripts were subjected to qualitative 'framework' analysis. The analysis resulted in four main themes: Barriers to rational access to antibiotics; balancing access and excess; learning from other communicable diseases; and a system-wide intervention. The tension between access to antibiotics and rational use stems from shortcomings found in the health systems of LMICs. Constructing a sustainable yet accessible model of antibiotic distribution for LMICs is a task of health system-wide proportions, which is why we strongly suggest using systems thinking in future research on this issue.Upsala journal of medical sciences 04/2014; 119(2). DOI:10.3109/03009734.2014.904958 · 1.98 Impact Factor
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ABSTRACT: Influenza is an acute respiratory illness caused by influenza A or B viruses, which occurs in outbreaks worldwide every year, mainly during the winter seasons in temperate climates. The seasonality of influenza in tropical and subtropical region varies greatly. Influenza causes an appreciable disease burden (e.g. school and work absenteeism, increased frequency of outpatient medical visits), and children play an important role for the spread of disease. Influenza is a vaccine preventable disease, and safe and effective vaccines have been used to mitigate the impact of seasonal epidemics. The strains included in the vaccine are updated each year to correlate with the strains anticipated to circulate during the coming influenza season. Vaccine formulations are published twice annually by the World Health Organization (WHO), usually in February for NH formulation and September for next year’s SH formulation. In the current chapter, we summarize influenza biology, epidemiology, seasonality with emphasis on clinical management and intervention strategies including influenza vaccines.IAP Textbook of Vaccines, 01/2014: chapter 35: pages 341-356;
- Journal of Family Medicine and Primary Care 07/2014; 3(3):292. DOI:10.4103/2249-4863.141655