Distinguishing characteristics between pandemic 2009-2010 influenza a (H1N1) and other viruses in patients hospitalized with respiratory illness

Philip A. Chan, Leonard A. Mermel, Sarah B. Andrea, Russell McCulloh, John P. Mills, Ignacio Echenique, Emily Leveen, Natasha Rybak, Cheston Cunha, Jason T. Machan, Terrance T. Healey, Kimberle C. Chapin

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Abstract

Background: Differences in clinical presentation and outcomes among patients infected with pandemic 2009 influenza A H1N1 (pH1N1) compared to other respiratory viruses have not been fully elucidated. Methodology/Principal Findings: A retrospective study was performed of all hospitalized patients at the peak of the pH1N1 season in whom a single respiratory virus was detected by a molecular assay targeting 18 viruses/subtypes (RVP, Luminex xTAG). Fifty-two percent (615/1192) of patients from October, 2009 to December, 2009 had a single respiratory virus (291 pH1N1; 207 rhinovirus; 45 RSV A/B; 37 parainfluenza; 27 adenovirus; 6 coronavirus; and 2 metapneumovirus). No seasonal influenza A or B was detected. Individuals with pH1N1, compared to other viruses, were more likely to present with fever (92% & 70%), cough (92% & 86%), sore throat (32% & 16%), nausea (31% & 8%), vomiting (39% & 30%), abdominal pain (14% & 7%), and a lower white blood count (8,500/L & 13,600/L, all p-values<0.05). In patients with cough and gastrointestinal complaints, the presence of subjective fever/chills independently raised the likelihood of pH1N1 (OR 10). Fifty-five percent (336/615) of our cohort received antibacterial agents, 63% (385/615) received oseltamivir, and 41% (252/615) received steroids. The mortality rate of our cohort was 1% (7/615) and was higher in individuals with pH1N1 compared to other viruses (2.1% & 0.3%, respectively; p = 0.04). Conclusions/Significance: During the peak pandemic 2009-2010 influenza season in Rhode Island, nearly half of patients admitted with influenza-like symptoms had respiratory viruses other than influenza A. A high proportion of patients were treated with antibiotics and pH1N1 infection had higher mortality compared to other respiratory viruses.

Original languageEnglish (US)
Article numbere24734
JournalPloS one
Volume6
Issue number9
DOIs
StatePublished - Sep 16 2011

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H1N1 Subtype Influenza A Virus
Pandemics
pandemic
Viruses
influenza
Human Influenza
viruses
cough
Cough
Fever
fever
Metapneumovirus
Anti-Bacterial Agents
Oseltamivir
antibiotics
Paramyxoviridae Infections
Rhinovirus
Chills
Coronavirus
Pharyngitis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Distinguishing characteristics between pandemic 2009-2010 influenza a (H1N1) and other viruses in patients hospitalized with respiratory illness. / Chan, Philip A.; Mermel, Leonard A.; Andrea, Sarah B.; McCulloh, Russell; Mills, John P.; Echenique, Ignacio; Leveen, Emily; Rybak, Natasha; Cunha, Cheston; Machan, Jason T.; Healey, Terrance T.; Chapin, Kimberle C.

In: PloS one, Vol. 6, No. 9, e24734, 16.09.2011.

Research output: Contribution to journalArticle

Chan, PA, Mermel, LA, Andrea, SB, McCulloh, R, Mills, JP, Echenique, I, Leveen, E, Rybak, N, Cunha, C, Machan, JT, Healey, TT & Chapin, KC 2011, 'Distinguishing characteristics between pandemic 2009-2010 influenza a (H1N1) and other viruses in patients hospitalized with respiratory illness', PloS one, vol. 6, no. 9, e24734. https://doi.org/10.1371/journal.pone.0024734
Chan, Philip A. ; Mermel, Leonard A. ; Andrea, Sarah B. ; McCulloh, Russell ; Mills, John P. ; Echenique, Ignacio ; Leveen, Emily ; Rybak, Natasha ; Cunha, Cheston ; Machan, Jason T. ; Healey, Terrance T. ; Chapin, Kimberle C. / Distinguishing characteristics between pandemic 2009-2010 influenza a (H1N1) and other viruses in patients hospitalized with respiratory illness. In: PloS one. 2011 ; Vol. 6, No. 9.
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abstract = "Background: Differences in clinical presentation and outcomes among patients infected with pandemic 2009 influenza A H1N1 (pH1N1) compared to other respiratory viruses have not been fully elucidated. Methodology/Principal Findings: A retrospective study was performed of all hospitalized patients at the peak of the pH1N1 season in whom a single respiratory virus was detected by a molecular assay targeting 18 viruses/subtypes (RVP, Luminex xTAG). Fifty-two percent (615/1192) of patients from October, 2009 to December, 2009 had a single respiratory virus (291 pH1N1; 207 rhinovirus; 45 RSV A/B; 37 parainfluenza; 27 adenovirus; 6 coronavirus; and 2 metapneumovirus). No seasonal influenza A or B was detected. Individuals with pH1N1, compared to other viruses, were more likely to present with fever (92{\%} & 70{\%}), cough (92{\%} & 86{\%}), sore throat (32{\%} & 16{\%}), nausea (31{\%} & 8{\%}), vomiting (39{\%} & 30{\%}), abdominal pain (14{\%} & 7{\%}), and a lower white blood count (8,500/L & 13,600/L, all p-values<0.05). In patients with cough and gastrointestinal complaints, the presence of subjective fever/chills independently raised the likelihood of pH1N1 (OR 10). Fifty-five percent (336/615) of our cohort received antibacterial agents, 63{\%} (385/615) received oseltamivir, and 41{\%} (252/615) received steroids. The mortality rate of our cohort was 1{\%} (7/615) and was higher in individuals with pH1N1 compared to other viruses (2.1{\%} & 0.3{\%}, respectively; p = 0.04). Conclusions/Significance: During the peak pandemic 2009-2010 influenza season in Rhode Island, nearly half of patients admitted with influenza-like symptoms had respiratory viruses other than influenza A. A high proportion of patients were treated with antibiotics and pH1N1 infection had higher mortality compared to other respiratory viruses.",
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AU - McCulloh, Russell

AU - Mills, John P.

AU - Echenique, Ignacio

AU - Leveen, Emily

AU - Rybak, Natasha

AU - Cunha, Cheston

AU - Machan, Jason T.

AU - Healey, Terrance T.

AU - Chapin, Kimberle C.

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