深圳市宝安区医务人员甲型H1N1流感疫苗接种率及影响因素研究

目的了解深圳市宝安区医务人员甲型H1N1流感疫苗接种率及其影响因素。方法在宝安区区级医院、街道医院以及所辖社区健康服务中心中随机抽取770名医务人员作为调查对象,进行不记名问卷调查。采用卡方检验和Logistic回归分析分别对疫苗接种率的影响因素进行单因素和多因素分析。结果宝安区医务人员甲型H1N1流感疫苗接种率为55.03%,未接种的主要原因是担心出现疫苗不良反应,占39.10%。影响疫苗接种率的因素分别为高文化程度(大专:OR=0.462,95%CI 0.269~0.794;大学及以上:OR=0.250,95%CI 0.140~0.446)、医疗岗位为护士(OR=0.392,95%CI 0.228~0.675)、工作年限≤5年(OR=0.303,95%CI 0.197~0.465)、知道甲流疫苗接种时间(OR=1.413,95%CI 1.022~1.953)和近3年接种过季节性流感疫苗(OR=3.822,95%CI 2.634~5.544)等。结论宝安区医务人员甲流疫苗接种率较高,但仍需加强甲流疫苗有效性和安全性宣传,重点为大专以上文化程度、护士、工作年限小于5年、不知道甲流接种时间和近3年无季节性流感疫...     

乌鲁木齐市某大学甲型H1N1流感督导防控工作浅析

为有效控制甲型H1N1流感疫情在学校传播、蔓延,保障学生、教职员工的身体健康和生命安全,掌握学校防控甲型H1N1流感各项工作的落实情况,促进学校防控甲型H1N1流感各项工作的扎实开展,新疆维吾尔自治区疾病预防控制中心2009年9月5日派督导员驻点乌鲁木齐市各大学院校,检查指导各大学院校甲型H1N1流感防控工作,现将我们对乌鲁木齐市某大学甲型H1N1流感督导防控工作分析如下。     

甲型H1N1流感34例临床分析

目前，甲型H1N1流感防控形势严峻，故提高早期诊断率，有助于控制疫情的蔓延，有助于减少并发症的发生。我院发热门诊在2009年5～10月诊断甲型H1N1流感34例。现分析报告如下。     

从甲型H1N1流感防控研究卫生应急能力提升

甲型H1N1流感疫情防控,是中国继2003年＂非典＂疫情之后应对重大突发公共卫生事件的重要经历。近年来,中国卫生应急能力建设取得的成果,为成功应对甲型H1N1流感全球大流行奠定了基础。本文分析了当前中国卫生应急能力现状,以及甲型H1N1流感防控经验和成效,并就中国卫生应急能力提出针对性对策建议。     

应对甲型H1N1流感疫情开展培训的实践与思考

根据2009年甲型H1N1流感防控形势，我院及时开展了防治知识和技能的培训。在培训中把握重点，抓住关键，形式多样，内容丰富，收到了良好效果；同时也体会到加强部门间协作，重视国家有关政策法规的学习，加强住院医师毕业后教育的多学科培训和实践教育都是十分必要的。     

甲型H1N1流感专题研究——甲型H1N1流感防控管理工作的研究

目的探索甲型H1N1流感及群体性突发公共卫生事件防控管理工作方法。方法对今年8月＂龙愿-2009两岸四地大学生创业文化交流营＂师生共198人甲型H1N1流感排查隔离管理工作进行总结。结果198人中患甲型H1N1流感15例,其中港澳台地区学生8例,内地学生7例,确诊病例转传染病专科医院治疗,密切接触者通过医疗卫生单位介入采取有效隔离观察措施后,发病人数无继续增加,所有人员按时解除隔离。结论甲型H1N1流感防控工作的重点在于对密切接触者采取有效隔离观察措施。     

从SARS到甲型H1N1型流感看标准预防

1995年美国疾病预防控制中心提出标准预防的概念,并于1996年在全美实施,我国在2000年将其编入卫生部颁布的《医院感染管理规范》（试行）中。随着社会的发展,各种传染病发病呈增高的趋势,如艾滋病、SARS、甲型H1N1型流感对人类都构成了极大的威胁。医务人员由于职业特点、工作环境的特殊性,处在高危领域,面临着极大的职业暴露危险,其特殊环境可使医务人员在工作过程中发生医院感染。     

综合性医院中呼吸道传染病医院感染的防控

呼吸道传染疾病是一种比较常见的公共卫生问题,如果不及时进行防治和控制将会产生大规模的传染,综合性医院是防控呼吸道传染疾病的重要场所的关键点,在呼吸道传染疾病的防控过程中发挥着不可替代的重要作用。对于综合性医院来说,在呼吸道传染疾病防控的过程中,加强对呼吸道传染病的诊治,控制疾病的传播,对于保证患者和医务人员的安全具有十分重要的意义。本文基于此对综合性医院中呼吸道传染病医院感染的防控对策进行了深入的分析和研究,希望对于加强综合性医院中呼吸道传染病医院感染的防控有一定的帮助。     

甲型H1N1流感防控管理工作的研究

目的 探索甲型H1N1流感及群体性突发公共卫生事件防控管理工作方法.方法 对今年8月"龙愿-2009两岸四地大学生创业文化交流营"师生共198人甲型H1N1流感排查隔离管理工作进行总结.结果 198人中患甲型H1N1流感15例,其中港澳台地区学生8例,内地学生7例,确诊病例转传染病专科医院治疗,密切接触者通过医疗卫生单位介入采取有效隔离观察措施后,发病人数无继续增加,所有人员按时解除隔离.结论 甲型H1N1流感防控工作的重点在于对密切接触者采取有效隔离观察措施.     

北京市1 292名医务人员AIDS相关知识态度及培训需求调查

目的 了解北京市部分医院医务人员艾滋病（AIDS）相关知识、态度及培训需求状况。方法 利用方便抽样的方法，对北京市4个区县的32家不同级别综合性医院的1292名医务人员进行自填式问卷调查。结果 北京市1292名医务人员的AIDS相关知识水平整体较高，但对AIDS诊断治疗及职业防护方面的知识掌握相对较差。39．7％的医务人员既往接受过AIDS专门培训，30％的医务人员有接受AIDS相关知识培训需求和意愿。大多数医务人员对艾滋病病毒（HIV）／AIDS患者持“同情”和“理解”态度，但仍然有一定比例的医务人员持“恐惧”和“回避”态度。91．3％医务人员表示“HIV感染者和AIDS病人应该和其他病人享有同等医疗服务”，但49．2％医务人员表示“不愿意”去治疗HIV感染者和AIDS病人的医院或科室工作。80％医务人员对“职业感染HIV很担心和有些担心”；有52．7％的医务人员认为自己有“职业感染HIV的危险”。结论 北京市医务人员的AIDS相关知识有待提高，应开展有针对性的AIDS防治知识的专门培训；大多数医务人员对HIV／AIDS患者持不歧视态度，但存在有恐惧和对职业暴露感染HIV风险的担忧。     

Pandemic H1N1 influenza

The 2009 H1N1 influenza A virus that has targeted not only those with chronic medical illness, the very young and old, but also a large segment of the patient population that has previously been afforded relative protection - those who are young, generally healthy, and immune naive. The illness is mild in most, but results in hospitalization and severe ARDS in an important minority. Among those who become critically ill, 20-40% will die, predominantly of severe hypoxic respiratory failure. However, and potentially in part due to the young age of those affected, intensive care with aggressive oxygenation support will allow most people to recover. The volume of patients infected and with critical illness placed substantial strain on the capacity of the health care system and critical care most specifically. Despite this, the 2009 pandemic has engaged our specialty and highlighted its importance like no other. Thus far, the national and global critical care response has been brisk, collaborative and helpful - not only for this pandemic, but for subsequent challenges in years ahead.     

Pandemic H1N1 influenza-associated hospitalizations in children in Madrid, Spain

Please cite this paper as: del Rosal et al. (2011) Pandemic H1N1 influenza‐associated hospitalizations in children in Madrid, Spain. Influenza and Other Respiratory Viruses 5(6), e544–e551. Objective To describe the epidemiological and clinical characteristics of children hospitalized with 2009 pandemic influenza (pH1N1) in Madrid, Spain. Patients/Methods We included patients less than 14 years of age admitted to one of 18 hospitals in Madrid, Spain, between May 1 and November 30, 2009 and diagnosed with pH1N1 by polymerase chain reaction. A retrospective chart review was conducted and data were compared by age, presence of high‐risk medical conditions, and pediatric intensive care unit (PICU) admission. Results A total of 517 pH1N1 cases were included for final analysis. One hundred and forty‐two patients (27·5%) had predisposing underlying illnesses, with immunosuppression (36 children, 7%) and moderate persistent asthma (34, 6·6%) being the most common ones. Patients with underlying medical conditions had longer hospital stays [median 5, interquartile range (IQR) 3–8 days, versus median 4, IQR 3–6, P < 0·001] and required intensive care (20·4% versus 5·9%, P < 0·001) and mechanical ventilation more frequently than previously healthy children. Globally, intensive care was required for 51 patients (10%) and invasive mechanical ventilation for 12 (2%). Pediatric intensive care unit admission was significantly associated with abnormal initial chest X‐ray [Odds Ratio (OR) 3·5, 95% confidence interval (CI) 1·5–8·5], underlying neurological condition (OR 3·1, CI 1·2–7·5) and immunosuppression (OR 2·9, 1·2–6·8). Five patients (0·9%) died; two with severe neurological disease, two with leukemia, and one with a malignant solid tumor. Conclusions Children with underlying medical conditions experienced more severe pH1N1 disease. Risk factors for admission to the PICU included underlying neurological conditions, immunosuppression and abnormal initial chest X‐ray.     

Epidemiology of influenza A (H1N1)pdm09‐associated deaths in the United States,September–October 2009

Please cite this paper as: Regan et al. (2012) Epidemiology of influenza A (H1N1)pdm09‐associated deaths in the United States, September–October 2009. Influenza and Other Respiratory Viruses 6(601), e169–e177. Background From April to July 2009, the United States experienced a wave of influenza A (H1N1)pdm09 virus (H1N1pdm09) infection. The majority of the deaths during that period occurred in persons <65 years of age with underlying medical conditions. Objective To describe the epidemiology of H1N1pdm09‐associated deaths in the US during the fall of 2009. Methods We collected demographic, medical history, and cause of death information on a nationally representative, stratified random sample of 323 H1N1pdm09‐associated deaths that occurred during September 1–October 31, 2009. Results Data were available for 302/323 (93%) deaths. Most cases (74%) were 18–64 years of age and had ≥1 underlying medical condition (72%). Among cases aged <18 years, 16/43 (37%) had a chronic lung disease, and 15/43 (35%) a neurological disorder; among cases aged ≥18 years, 94/254 (37%) had a chronic lung disease and 84/254 (33%) had a metabolic disorder. The median number of days between symptom onset and death was six among children (range, 1–48) and 12 among adults (range, 0–109). Influenza antiviral agents were prescribed for 187/268 (70%) of cases, but only 48/153 (31%) received treatment within 2 days of illness onset. Conclusions The characteristics of H1N1pdm09 deaths identified during the fall of 2009 were similar to those occurring April–July 2009. While most cases had conditions that were known to increase the risk for severe outcomes and were recommended to receive antiviral therapy, a minority of cases received antivirals early in the course of illness.     

The role of initial radiologic and clinical manifestations in predicting the prognosis for pneumonia caused by H1N1 influenza virus

Objective

The aim of this study is to investigate the prognostic values of initial radiologic findings and preexisting medical conditions in pneumonia caused by H1N1 influenza virus that were obtained during the novel swine-origin influenza A (H1N1) virus (S-OIV) pandemic spread.

Methods

Thirty-nine patients hospitalized due to H1N1 infection between September and December 2009 were retrospectively evaluated regarding the radiologic and clinical aspects. The thoracic computed tomography (CT) findings of all patients were assessed and accompanying conditions that may raise the morbidity were stated. The patients were divided into two groups as those who needed the intensive care unit administration and those treated with brief hospitalization; initial radiologic findings and preexisting medical situations of patients were compared among both groups respectively in terms of their prognostic value.

Results

In 39 patients with H1N1 infection (21 males and 18 females; mean age of 53.9±14 in range between 19 and 99 years); the necessity of intensive care was significantly higher in patients with solely chronic obstructive pulmonary disease (COPD) (P=0.008, Odds ratio: 27) or co-existence of COPD and malignity (Odds ratio: 13); however, no statistically significant difference between two groups was observed regarding the radiologic facts or other combinations of accompanying medical conditions in terms of any effects to the prognosis.

Conclusions

In the H1N1 (S-OIV) pandemic, we observed that merely the contribution to the diagnostic process; the radiologic features have no significance as being prognostic indicator. Additionally; the superposition of H1N1 infection in patients with either COPD or COPD by malignity was stated to be a potential risk factor in terms of increased morbidity.     

Transmission of influenza A(H1N1) 2009 pandemic viruses in Australian swine

Please cite this paper as: Deng et al. (2012). Transmission of influenza A(H1N1) 2009 pandemic viruses in Australian swine. Influenza and Other Respiratory Viruses 6(3), e42–e47. Background Swine have receptors for both human and avian influenza viruses and are a natural host for influenza A viruses. The 2009 influenza A(H1N1) pandemic (H1N1pdm) virus that was derived from avian, human and swine influenza viruses has infected pigs in various countries. Objectives To investigate the relationship between the H1N1pdm viruses isolated from piggery outbreaks in Australia and human samples associated with one of the outbreaks by phylogenetic analysis, and to determine whether there was any reassortment event occurring during the human‐pig interspecies transmission. Methods Real‐time RT‐PCR and full genome sequencing were carried out on RNA isolated from nasal swabs and/or virus cultures. Phylogenetic analysis was performed using the Geneious package. Results The influenza H1N1pdm outbreaks were detected in three pig farms located in three different states in Australia. Further analysis of the Queensland outbreak led to the identification of two distinct virus strains in the pigs. Two staff working in the same piggery were also infected with the same two strains found in the pigs. Full genome sequence analysis on the viruses isolated from pigs and humans did not identify any reassortment of these H1N1pdm viruses with seasonal or avian influenza A viruses. Conclusions This is the first report of swine infected with influenza in Australia and marked the end of the influenza‐free era for the Australian swine industry. Although no reassortment was detected in these cases, the ability of these viruses to cross between pigs and humans highlights the importance of monitoring swine for novel influenza infections.     

New influenza A/H1N1 ("swine flu"): information needs of airport passengers and staff

Please cite this paper as: Dickmann et al. (2010) New Influenza A/H1N1 (“Swine Flu”): information needs of airport passengers and staff. . Influenza and Other Respiratory Viruses 5(1), 39–46. Background Airports are the entrances of infectious diseases. Particularly at the beginning of an outbreak, information and communication play an important role to enable the early detection of signs or symptoms and to encourage passengers to adopt appropriate preventive behaviour to limit the spread of the disease. Objectives To determine the adequacy of the information provided to airport passengers and staff in meeting their information needs in relation to their concerns. Methods At the start of the influenza A/H1N1 epidemic (29–30 April 2009), qualitative semi‐structured interviews (N = 101) were conducted at Frankfurt International Airport with passengers who were either returning from or going to Mexico and with airport staff who had close contact with these passengers. Interviews focused on knowledge about swine flu, information needs and fear or concern about the outbreak. Results The results showed that a desire for more information was associated with higher concern – the least concerned participants did not want any additional information, while the most concerned participants reported a range of information needs. Airport staff in contact with passengers travelling from the epicentre of the outbreak showed the highest levels of fear or concern, coupled with a desire to be adequately briefed by their employer. Conclusions Our results suggest that information strategies should address not only the exposed or potentially exposed but also groups that feel at risk. Identifying what information these different passenger and staff groups wish to receive will be an important task in any future infectious disease outbreak.     

H1N1 swine origin influenza infection in the United States and Europe in 2009 may be similar to H1N1 seasonal influenza infection in two Australian states in 2007 and 2008

Background The population‐based impact of infection with swine origin influenza A (H1N1) virus infection was not clear in the early days of the epidemic towards the end of May 2009. Australia had seven confirmed cases by 22 May 2009. We aimed to compare available data on swine origin influenza A (H1N1) virus infection overseas with seasonal influenza A (H1N1) virus infection in Australia to assist with forward planning. Methods Data on infection with seasonal influenza A (H1N1) virus in patients recruited through sentinel general practices in Victoria and Western Australia in 2007 and 2008 were compared with early publications on infection with swine origin influenza A (H1N1) virus in the United States and Europe. Results Influenza A (H1N1) virus infection was predominantly a disease of younger people, regardless of whether the virus was of swine or human origin. The median age of infection with swine origin virus was 20 years in the United States and 22 years in Spain, while the median age of infection with human origin virus was 18 years in Western Australia and 23 years in Victoria. Conclusions The median age of infection with influenza A (H1N1) virus was around 20 ± 3 years, independent of the origin of the H1N1 virus but a higher proportion of swine origin influenza infections occurred in people aged 10–18 years. This is at least partially explained by biased sampling among surveillance patients, although it may also reflect a different infection pattern.     

Acute Respiratory Distress Syndrome as a presenting manifestation in young patients infected with H1N1 influenza virus

Introduction

The new strain of influenza A (H1N1) 2009, often referred to colloquially as “swine flu”, which was first detected in April 2009, raised to a pandemic of which the impact was not completely predictable. As reported, numerous cases with severe respiratory failure were also seen among young previously healthy people.

Patients

In the present study, we report eight cases of influenza A (H1N1) 2009 admitted to our medical intensive care with severe respiratory failure between November and December 2009 and in January 2011. All patients were older than 30 but younger than 50 years, had clinical and radiological evidence of an Acute Respiratory Distress Syndrome (ARDS) and needed invasive ventilatory support.

Results

Six of the eight patients had no relevant underlying disease; one had a pre-existing idiopathic lung fibrosis and another had a chronic obstructive pulmonary disease (COPD), an abuse of alcohol and an adiposities grade 3. Four patients needed an extracorporeal membrane oxygenation (ECMO) due to severe respiratory failure with global respiratory insufficiency that could not be treated by conservative ventilatory support. The one patient with a pre-existing lung fibrosis died shortly after lung transplantation despite use of an extracorporeal membrane oxygenation. One other patient died due to a subarachnoidal bleeding under the anticoagulatory regime during ECMO therapy. The adipose COPD-patient died due to septic shock with multiple organ failure without possibility for ECMO support.

Conclusions

The clinical course of severe cases of influenza A (H1N1) 2009-infection is markedly different from the disease pattern seen during epidemics of seasonal influenza. Most of the patients admitted to our intensive care unit due to influenza A (H1N1) 2009 associated ARDS were previously healthy young people.     

Severe H1N1-Associated Acute Respiratory Distress Syndrome: A Case Series

Background

Acute respiratory distress syndrome resulting from novel influenza A virus (H1N1) infection remains uncommon.

Methods

We describe the clinical profiles of adult patients with acute respiratory distress syndrome due to microbiologically confirmed H1N1 admitted to a medical intensive care unit in San Francisco, California over a 2-month period.

Results

Between June 1 and July 31, 2009, 7 patients (age range: 25-66 years; 4 patients under the age of 40 years; 6 male; 1 pregnant) were diagnosed with H1N1, with 5 of 6 (83%) having initial false-negative rapid testing. All developed respiratory failure complicated by acute respiratory distress syndrome, with 4 additionally developing multiorgan dysfunction. All were managed with a lung protective ventilator strategy (average number of days on the ventilator: 16), and 4 patients also required additional rescue therapies for refractory hypoxemia, including very high positive end-expiratory pressure, inhaled epoprostenol, recruitment maneuvers, and prone positioning. Despite these measures, 3 patients (43%) ultimately died.

Conclusions

Clinicians should be vigilant for the potential of H1N1 infection to progress to severe acute respiratory distress syndrome in a variety of patient demographics, including younger patients without baseline cardiopulmonary disease. A high degree of suspicion is critical, especially with the relative insensitivity of rapid testing, and should prompt empiric antiviral therapy.