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      Clinical aspects of influenza A(H1N1)pdm09 cases reported during the pandemic in Brazil, 2009-2010

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          ABSTRACT

          Objective:

          To describe the clinical aspects of cases of influenza A(H1N1)pdm09 in Brazil.

          Methods:

          A descriptive study of cases reported in Sistema de Informação de Agravos de Notificação (SINAN), 2009-2010.

          Results:

          As the final classification, we obtained 53,797 (56.79%) reported cases confirmed as a new influenza virus subtype, and 40,926 (43.21%) cases discarded. Fever was the most common sign, recorded in 99.74% of the confirmed and 98.92% of the discarded cases. Among the confirmed cases, the presence of comorbidities was reported in 32.53%, and in 38.29% of the discarded cases. The case fatality rate was 4.04%; 3,267 pregnant women were confirmed positive for influenza A new viral subtype and 2,730 of them were cured. The case fatality rate of pregnant women was 6.88%.

          Conclusion:

          The findings suggested concern of the health system with pregnant women, and patients with comorbidities and quality of care may have favored a lower mortality. We recommend that, when caring for patients with severe respiratory symptoms, with comorbidities, or pregnant women, health professionals should consider the need for hospital care, as these factors make up a worse prognosis of infection by the pandemic influenza virus.

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          Most cited references39

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          Guia de vigilância epidemiológica

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            Censo Demográfico 2010: características gerais da população, religião e pessoas com deficiência

            (2014)
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              H1N1pdm Influenza Infection in Hospitalized Cancer Patients: Clinical Evolution and Viral Analysis

              Background The novel influenza A pandemic virus (H1N1pdm) caused considerable morbidity and mortality worldwide in 2009. The aim of the present study was to evaluate the clinical course, duration of viral shedding, H1N1pdm evolution and emergence of antiviral resistance in hospitalized cancer patients with severe H1N1pdm infections during the winter of 2009 in Brazil. Methods We performed a prospective single-center cohort study in a cancer center in Rio de Janeiro, Brazil. Hospitalized patients with cancer and a confirmed diagnosis of influenza A H1N1pdm were evaluated. The main outcome measures in this study were in-hospital mortality, duration of viral shedding, viral persistence and both functional and molecular analyses of H1N1pdm susceptibility to oseltamivir. Results A total of 44 hospitalized patients with suspected influenza-like illness were screened. A total of 24 had diagnosed H1N1pdm infections. The overall hospital mortality in our cohort was 21%. Thirteen (54%) patients required intensive care. The median age of the studied cohort was 14.5 years (3–69 years). Eighteen (75%) patients had received chemotherapy in the previous month, and 14 were neutropenic at the onset of influenza. A total of 10 patients were evaluated for their duration of viral shedding, and 5 (50%) displayed prolonged viral shedding (median 23, range = 11–63 days); however, this was not associated with the emergence of a resistant H1N1pdm virus. Viral evolution was observed in sequentially collected samples. Conclusions Prolonged influenza A H1N1pdm shedding was observed in cancer patients. However, oseltamivir resistance was not detected. Taken together, our data suggest that severely ill cancer patients may constitute a pandemic virus reservoir with major implications for viral propagation.

                Author and article information

                Journal
                Einstein (Sao Paulo)
                Einstein (Sao Paulo)
                Einstein
                Instituto de Ensino e Pesquisa Albert Einstein (Sao Paulo )
                1679-4508
                2317-6385
                Apr-Jun 2015
                Apr-Jun 2015
                : 13
                : 2
                : 177-182
                Affiliations
                [1 ]Instituto de Medicina Tropical de São Paulo, São Paulo, S P, Brazil
                [1 ]Instituto de Medicina Tropical de São Paulo, São Paulo, S P, Brasil
                Author notes
                Corresponding author: Érika Valeska Rossetto – Avenida D r. Enéas Carvalho de Aguiar, 470 – Cerqueira César – Zip code: 05403-000 – São Paulo, S P, Brazil – Phone: (55 11) 3061-7011 - E-mail: erossetto@ 123456usp.br

                Conflict of interest: none.

                Autor correspondente: Érika Valeska Rossetto – Avenida Dr. Enéas Carvalho de Aguiar, 470 – Cerqueira César – CEP: 05403-000 – São Paulo, S P, Brasil – Tel.: (11) 3061-7011 – E-mail: erossetto@ 123456usp.br

                Conflitos de interesse: não há.

                Article
                S1679-45082015AO3331
                10.1590/S1679-45082015AO3331
                4943806
                26154537
                28e4c64b-52d5-4f62-a573-ccdb18f79680

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 February 2015
                : 21 May 2015
                Page count
                Figures: 6, Tables: 0, Equations: 0, References: 29, Pages: 6
                Categories
                Original Article

                influenza a virus,h1n1 subtype,pandemics,epidemiology,medical record linkage,signs and symptoms,comorbidity,brazil,vírus da influenza a subtipo h1n1,pandemias,epidemiologia,registro médico coordenado,sinais e sintomas,comorbidade,brasil

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