[Technical report on the 2009 influenza A (H1N1) pandemic.]
ABSTRACT INTRODUCTION: Since its appearance in April 2009, the influenza A (H1N1) pandemic has been a subject of continued attention by national and international health authorities, as well as in the communication media. It has been six months since the first cases were published and the winter season has just ended in the southern hemisphere. Therefore, we now have quite extensive knowledge on the behaviour of the disease, its severity and the way it manifests itself in the child/adolescent population. The Spanish Paediatric Association commissioned its Evidence Based Medicine Working Group to prepare a technical report on the influenza pandemic. This report has been prepared following the highly structured working methodology proposed by the so-called Evidence Based Medicine (EBM). This methodology requires formulating clinical questions, carrying out a systematic review of the literature looking for research works that could answer them, the critical reading of these, evaluating their methodology quality and clinical importance and finally, establishing recommendations based on those studies considered valid and important as well as on good clinical judgement. SCOPE: The present report approaches all aspects of the influenza pandemic considered to be of interest: extent of the disease, clinical and laboratory diagnosis, physical prevention measures, vaccination and pharmacological treatment. The target population of the report are children and adolescents. Many of the considerations made may also be applied to other age groups. OBJECTIVES: The primary objective of this report is to establish a group of recommendations which may serve as a generic framework for the prevention, diagnosis and treatment of the pandemic influenza in children and adolescents. The final targets of the report are paediatricians and also general/family doctors and nurses who look after children and adolescents.
SourceAvailable from: Lyn Finelli[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identi- fied from the rapidly evolving U.S. outbreak. METHODS Enhanced surveillance was implemented in the United States for human infection with influenza A viruses that could not be subtyped. Specimens were sent to the Cen- ters for Disease Control and Prevention for real-time reverse-transcriptase-poly- merase-chain-reaction confirmatory testing for S-OIV. RESULTS From April 15 through May 5, a total of 642 confirmed cases of S-OIV infection were identified in 41 states. The ages of patients ranged from 3 months to 81 years; 60% of patients were 18 years of age or younger. Of patients with available data, 18% had recently traveled to Mexico, and 16% were identified from school outbreaks of S-OIV infection. The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%); 25% of patients had diarrhea, and 25% had vomiting. Of the 399 patients for whom hospitalization status was known, 36 (9%) required hospitalization. Of 22 hospitalized patients with available data, 12 had characteristics that conferred an increased risk of severe seasonal influenza, 11 had pneumonia, 8 required admission to an intensive care unit, 4 had respiratory failure, and 2 died. The S-OIV was determined to have a unique genome composi- tion that had not been identified previously. CONCLUSIONS A novel swine-origin influenza A virus was identified as the cause of outbreaks of febrile respiratory infection ranging from self-limited to severe illness. It is likely that the number of confirmed cases underestimates the number of cases that have occurred.New England Journal of Medicine 06/2009; 360(25). DOI:10.1056/NEJMoa0903810 · 54.42 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Knowledge of the incubation period is essential in the investigation and control of infectious disease, but statements of incubation period are often poorly referenced, inconsistent, or based on limited data. In a systematic review of the literature on nine respiratory viral infections of public-health importance, we identified 436 articles with statements of incubation period and 38 with data for pooled analysis. We fitted a log-normal distribution to pooled data and found the median incubation period to be 5.6 days (95% CI 4.8-6.3) for adenovirus, 3.2 days (95% CI 2.8-3.7) for human coronavirus, 4.0 days (95% CI 3.6-4.4) for severe acute respiratory syndrome coronavirus, 1.4 days (95% CI 1.3-1.5) for influenza A, 0.6 days (95% CI 0.5-0.6) for influenza B, 12.5 days (95% CI 11.8-13.3) for measles, 2.6 days (95% CI 2.1-3.1) for parainfluenza, 4.4 days (95% CI 3.9-4.9) for respiratory syncytial virus, and 1.9 days (95% CI 1.4-2.4) for rhinovirus. When using the incubation period, it is important to consider its full distribution: the right tail for quarantine policy, the central regions for likely times and sources of infection, and the full distribution for models used in pandemic planning. Our estimates combine published data to give the detail necessary for these and other applications.The Lancet Infectious Diseases 06/2009; 9(5):291-300. DOI:10.1016/S1473-3099(09)70069-6 · 19.45 Impact Factor
New England Journal of Medicine 06/2009; 361(2):112-5. DOI:10.1056/NEJMp0904380 · 54.42 Impact Factor