A Chilean hospital's early use of antiviral treatment in influenza
patients and other aggressive measures helped reduce the number of
severe H1N1 cases and related deaths. Those are the findings of a new
study, now available online, published in the March 15, 2010 issue of Clinical Infectious Diseases.
From
May to July 2009, the number of patients visiting the emergency
department at the Santiago hospital increased significantly, by 88.5
percent, compared with the same period in previous years. More than
10,000 patients were clinically diagnosed with H1N1, representing 78
percent of the excess emergency department visits.
There were no
deaths associated with influenza during this period, and only 2 percent
of H1N1 patients were hospitalized. Twelve pregnant women who required
hospitalization ultimately recovered, contrary to reports of increased
fatalities in this group in other countries. Virtually all of the H1N1
patients, 99.7 percent, were given antiviral treatment, most within 48
hours of having symptoms. In addition to early treatment, the authors
credited aggressive management of the hospital's intensive care unit and
experience with extracorporeal membrane oxygenation (ECMO), an extreme
type of life support, in the improved patient outcomes.
"The main
implications of our study are that early antiviral treatment for
children and adults with influenza-like-illness would reduce mortality
and the spread of the virus in the community," said study author Juan
Pablo Torres, MD, PhD, of the Clínica Las Condes and Universidad de
Chile in Santiago, who also highlighted the importance of vaccinating
children. "As most of the pediatric deaths due to the novel H1N1
influenza virus reported in the United States occurred in school-aged
children, vaccination would be very beneficial."
In an accompanying
editorial, W. Paul Glezen, MD, of Baylor College of Medicine in Houston,
agreed with the recommendations. "The strategy of early treatment for
all who present to urgent care facilities deserves consideration as a
means of reducing serious complications of influenza," wrote Dr. Glezen,
who also suggested the use of vaccination clinics in schools.
"School-based vaccine clinics could facilitate rapid distribution of
vaccine to a high proportion of children and not only reduce mortality
but also dampen the spread of virus in the community to allow more time
to vaccinate all other segments of the population."
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