Although the influenza A (H1N1) 2009 virus is expected to circulate as a seasonal virus for some years after the pandemic period, its
behaviour cannot be predicted. We analysed a prospective cohort study of hospitalized adults with influenza A (H1N1) 2009 pneumonia
at 14 teaching hospitals in Spain to compare the epidemiology, clinical features and outcomes of influenza A (H1N1) 2009 pneumonia
between the pandemic period and the first post-pandemic influenza season. A total of 348 patients were included: 234 during the pandemic
period and 114 during the first post-pandemic influenza season. Patients during the post-pandemic period were older and more
likely to have chronic obstructive pulmonary disease, chronic kidney disease and cancer than the others. Septic shock, altered mental
status and respiratory failure on arrival at hospital were significantly more common during the post-pandemic period. Time from illness
onset to receipt of antiviral therapy was also longer during this period. Early antiviral therapy was less frequently administered to
patients during the post-pandemic period (22.9% versus 10.9%; p 0.009). In addition, length of stay was longer, and need for mechanical
ventilation and intensive-care unit admission were significantly higher during the post-pandemic period. In-hospital mortality (5.1% versus
21.2%; p <0.001) was also greater during this period. In conclusion, significant epidemiological changes and an increased severity of influenza
A (H1N1) 2009 pneumonia were found in the first post-pandemic influenza season. Physicians should consider influenza A (H1N1)
2009 when selecting microbiological testing and treatment in patients with pneumonia in the upcoming influenza season.
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