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Profile of 213 cases Profile of 213 cases

infected with influenza A (infected with influenza A (H1N1H1N1) ) inin

Eastern AnatoliaEastern Anatolia

Serhat Vancelik, Zekeriya Akturk, Rukiye Cetin Seckin, Hamit Acemogluzekeriya.akturk@gmail.com, www.aile.net

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Introduction and Aim

• As to 10th of January 2010, 627 persons died since the beginning of the pandemy in Turkey,

• Though only around 5% (due to resistence to vaccination) of the population in Turkey was vaccinated against H1N1.

• This study aimed to describe the profile of people diagnosed with the H1N1 infection in and around Erzurum, a city with 785 000 inhabitants at the north-east side of Turkey.

Method• All patients suspected of having H1N1 infection

between October 2009 and end of January 2010 were referred to one of the five secondary and tertiary hospitals in the city.

• Blood was collected and sent for laboratory approval of the diagnosis.

• Diagnostic test were done by the Refik Saydam reference laboratory using the in-house real time PCR method.

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• Patients with positive test results were compared to the negative ones with respect to the possible risk factors.

• In addition to signs and symptoms, patient demographics were recorded and analyzed for each patient.

• High grade fever was defined as axillary temperature > 38.3°C.

• H1N1 positive patients were followed up for mortality status and the medication administered. / 154

Results• Results analyzed for 445 suspected H1N1 cases, 213

(47.9%) were proven to be lab positive.

• Positive cases were younger (24,5 vs 28,8; p=0,047)

• None of the patients were vaccinated for H1N1

• Mean age: 26.8±22.7 years. 55.5% males.

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  H1N1 (-) H1N1 (+) pFever 176 (48%) 191 (52%) <0,05Cough 181 (49,6%) 184 (50,4%) <0,05Muscle pain 130 (50%) 130 (50%) >0,05Headache 129 (51%) 124 (49%) >0,05Sore throat 105 (48,4%) 112 (51,6%) >0,05Running nose 95 (47%) 107 (53%) <0,05Breathlessness 99 (49,7%) 100 (50,3%) >0,05

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Flu va

ccina

tion

• In a logistic regression model, fever was the only independent predictor of H1N1 infection (OR=2.83; p<0.001).– Factors included: Fever, Cough, Myalgia,

Headache, Sore throat, Running nose, Dyspnea, seasonal flu vaccination status, comorbidity, contact with flu case, contact with international traveler, age, sex.

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Profile of the H1N1 positive cases– 20 cases (9.4%) ended up with mortality (9 of these

patients were from Erzurum, the remaining 11 from neighboring cities).

– Majority of the patients (56.8%; n=121) were males. Median patient age was 19 years (min. 2 months, max. 83 years).

– Median duration of symptoms from the beginning of symptoms and application to a health center was 2 days (min. 0, max. 9).

– Most frequent symptoms were fever (89.7%; n=191) and cough (86.4%; n=184).

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– 43 patients received intensive care therapy and out of these, 23 required ventilator support.

– 130 patients (61%) received antiviral therapy. – There was no relationship between antiviral

therapy administration and mortality (p>0.05). – There was no significant relationship between

mortality and flu vaccination or sex (p>0.05). – Mortality was significantly related with patient age.

Median age of the deceased vs cured patients was 42 and 19 years respectively (p=0.048) / 159

– Patients with • absence of headache,

• absence of sore throat,

• absence of runny nose,

• presence of fever,

• presence of cough,

• presence of breathlessness,

• presence of ARDS,

• and presence of co-morbidity

– had significantly higher mortality rates (p<0.05)./ 1510

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 Outcome  

Cure Ex p

Fever No 17 15 0,024

8,8 25,0

Yes 176 15

91,2% 75,0%  

Cough No 23 6 0,025

11,9% 30,0%  

Yes 170 14  

88,1% 70,0%  

Muscle pain No 72 11 0,122

37,3% 55,0%  

Yes 121 9  

67,2% 45,0%  

Headache No 73 16 <0,001

37,8% 80,0%  

Yes 120 4  

62,2% 20,0%  

Sore throat No 86 15 0,009

44,6% 75,0%  

Yes 107 5  

55,40% 25,0%  

Running nose No 88 18 <0,001

45,6% 90,0% 

Yes 105 2 

54,4% 10,0% 

 Outcome  

Cure Ex p

Breathlessness No 107 6 0,0355,4% 30,0% 

Yes 86 14 44,6% 70,0% 

Flu vaccination No 185 20 0,35595,9% 100,0% 

Yes 8 0 4,1% 0,0% 

Comorbidity No 132 8 0,01168,4% 40,0% 

Yes 61 12 31,6% 60,0% 

Contact with flu case No 137 17 0,18271,0% 85,0% 

Yes 56 3 29,0% 15,0% 

International travel No 188 19 0,53597,4% 95,0% 

Yes 5 1 2,6% 5,0% 

Contact with international traveler No 186 20 0,38696,4% 100,0% 

Yes 7 0 3,6% 0,00%  / 1512

• In a logistic regression model we found – age (OR=1.05), – female sex (OR=6.1), – absence of headache (OR=12.20), – absence of runny nose (OR=11.11), and – presence of ARDS (OR=105.4)

• as significant independent variables predicting mortality (all p<0.05).

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Conclusion

• This study supports the evidence that high grade fever and cough are major symptoms of patients infected with H1N1.

• The seemingly protective effect of symptoms such as headache and runny nose on mortality needs further investigation.

• The disease may have present as seasonal flu in these cases.

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