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B. -A. Gaüzère,
F. Bussienne,
B. Bouchet,
J. Jabot,
A. Roussiaux,
D. Drouet,
S. Djourhi,
B. Leauté,
D. Belcour, G. Bossard,
S. Champion,
M. -C. Jaffar-Bandjee,
O. Belmonte,
P. Vilain,
E. Brottet,
L. Hoang,
D. Vandroux
[show abstract]
[hide abstract]
ABSTRACT: Dans l’hémisphère sud, La Réunion est la sentinelle des infections survenant préférentiellement au cours de l’hiver austral,
susceptibles de gagner quelques mois plus tard l’hémisphère nord, telle l’infection à A(H1N1)v2009. Nous rapportons les caractéristiques
des patients admis en 2009 et 2010 dans notre service de réanimation principalement pour détresse respiratoire aiguë, à la
suite d’une infection à A(H1N1)v2009. Les données démographiques, cliniques, biologiques, ainsi que les traitements et le
devenir des patients admis pour infection virale à A(H1N1)v2009 exclusivement confirmée par RT-PCR ont été recueillis de façon
prospective. Au cours des années 2009 et 2010, 25 patients ont répondu aux critères définis d’infection à A(H1N1)v2009. L’âge
médian était de 40,4 (±17,4) ans. La plupart d’entre eux (22/25) présentaient des facteurs de comorbidité: pathologies chroniques,
surpoids ou obésité, grossesse, trisomie. Les principaux motifs d’admission en réanimation ont été les pneumonies virales
avec tableau de syndrome de détresse respiratoire aiguë. Le recours à la ventilation artificielle a été nécessaire chez 22
des 25 patients, avec recours à des méthodes sophistiquées et réservées à quelques centres au niveau national, telles que
les techniques d’oxygénation extracorporelle (ECMO) ou ventilation à haute fréquence (HFO). Au cours des deux années, 12 décès
(48 %) sont survenus essentiellement dans des tableaux de défaillance multiviscérale. Au cours des hivers et automnes australs
2009 et 2010 et pendant une période de plusieurs semaines, l’infection à A(H1N1) v2009 a entraîné une surcharge d’activité
notable dans les services de réanimation de La Réunion. L’échec de la campagne de vaccination, notamment des personnes à risques,
a eu pour conséquence la survenue de nouveaux cas graves en 2010, notamment parmi les personnes à risques. Le recueil de ces
données peut aider à la planification et à l’anticipation de la prise en charge d’autres épidémies grippales.
In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occurring during the austral winter
that are likely to reach the Northern hemisphere a few months later. We relate the main features concerning patients that
were admitted during years 2009 and 2010 in our intensive care unit with an A(H1N1)v2009 infection, mainly for acute respiratory
distress. Demographic, clinical, and biological data as well as given medications and outcome were prospectively collected
among all PCR-confirmed influenza-infected patients. In 2009 and 2010, 25 patients met the criteria. Patients’ median age
was 40.4 (±17.4) years. Most of them (22/25) had comorbidities such as: chronic diseases, overweight, obesity, pregnancy,
and Down syndrome. Maximum bed-occupation rate was 10 days per million inhabitants. Main diagnosis for ICU admission was virus-related
pneumonia. Twenty-two out of 25 patients needed mechanical ventilation, some required rescue therapies such as extracorporeal
membranous oxygenation (ECMO) or hi-frequency oscillation ventilation (HFOV), both only available in few French hospitals.
Within the study period, 12 patients died (48%) mainly of multi-organ failure. Through 2009 and 2010 autumn and winter periods,
for several weeks, the A(H1N1)v2009 virus infection resulted in a significant increase of workload in Réunion Island ICUs.
In 2010, the failure of the mass immunization campaign, particularly among the at-risk groups, led to severe cases of A(H1N1)v2009
infections, particularly among patients with comorbidities. Our data may contribute toward better management of influenza
virus pandemics in the future.
Mots clésGrippe A(H1N1)v2009–Cas graves–SDRA–Réanimation–Vaccination–Océan Indien–Réunion
KeywordsInfluenza A(H1N1)v2009–Severe cases–ARDS–Intensive care unit–Immunization–Indian Ocean–Réunion Island
Bulletin de la Société de pathologie exotique 04/2012; 104(2):97-104.
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[show abstract]
[hide abstract]
ABSTRACT: Une jeune femme âgée de 19 ans, porteuse d’une maladie de Hodgkin et hospitalisée dans le service d’oncologie pour une autogreffe,
a développé, au 20e jour, un tableau de détresse respiratoire avec défaillance multiviscérale fatale, secondaire à une infection par le virus
A(H1N1)v2009. L’infection a été acquise en milieu hospitalier en dépit des quelques mesures de prévention mises en place.
À cette époque, le vaccin spécifique n’était pas encore disponible localement. À la suite de cette première vague épidémique,
la vaccination spécifique a rencontré très peu de succès avec seulement 4 % de la population générale et 3,3 % du personnel
de notre hôpital vaccinés.
A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory
failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite
partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin
of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains
very low.
Mots clésA(H1N1)v2009–Infection nosocomiale–Pneumopathie–Hodgkin–ECMO–Hôpital–Île de la Réunion
KeywordsA(H1N1)v2009–Nosocomial infection–Pneumopathy–Hodgkin–ECMO–Hospital–Réunion
Bulletin de la Société de pathologie exotique 04/2012; 104(2):105-107.
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B-A Gaüzère,
F Bussienne,
B Bouchet,
J Jabot,
A Roussiaux,
D Drouet,
S Djourhi,
B Leauté,
D Belcour, G Bossard,
S Champion,
M-C Jaffar-Bandjee,
O Belmonte,
P Vilain,
E Brottet,
L Hoang,
D Vandroux
[show abstract]
[hide abstract]
ABSTRACT: In the Southern hemisphere, Réunion Island acts as a sentinel for infections preferentially occurring during the austral winter that are likely to reach the Northern hemisphere a few months later. We relate the main features concerning patients that were admitted during years 2009 and 2010 in our intensive care unit with an A(H1N1)v2009 infection, mainly for acute respiratory distress. Demographic, clinical, and biological data as well as given medications and outcome were prospectively collected among all PCR-confirmed influenza-infected patients. In 2009 and 2010, 25 patients met the criteria. Patients' median age was 40.4 (±17.4) years. Most of them (22/25) had comorbidities such as: chronic diseases, overweight, obesity, pregnancy, and Down syndrome. Maximum bed-occupation rate was 10 days per million inhabitants. Main diagnosis for ICU admission was virus-related pneumonia. Twenty-two out of 25 patients needed mechanical ventilation, some required rescue therapies such as extracorporeal membranous oxygenation (ECMO) or hi-frequency oscillation ventilation (HFOV), both only available in few French hospitals. Within the study period, 12 patients died (48%) mainly of multi-organ failure. Through 2009 and 2010 autumn and winter periods, for several weeks, the A(H1N1)v2009 virus infection resulted in a significant increase of workload in Réunion Island ICUs. In 2010, the failure of the mass immunization campaign, particularly among the at-risk groups, led to severe cases of A(H1N1)v2009 infections, particularly among patients with comorbidities. Our data may contribute toward better management of influenza virus pandemics in the future.
Bulletin de la Société de pathologie exotique 05/2011; 104(2):97-104.
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[show abstract]
[hide abstract]
ABSTRACT: A 19-year-old patient admitted in an oncology unit for an autograft (Hodgkin disease), developed on day 20 a fatal acute respiratory failure and multiple organ failure due to an infection of the A(H1N1)v2009 virus, which was acquired in the hospital, despite partial preventive measures. At that time, the specific vaccine was not available in Réunion. We discuss the nosocomial origin of the infection. Following the epidemic wave, the vaccination rate of the general population and the hospital employees remains very low.
Bulletin de la Société de pathologie exotique 03/2011; 104(2):105-7.
