Abstract
BackgroundThe demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm09 infection during 2009–2010, in seven countries in the American tropics.MethodsWe used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records.ResultsDuring May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18–46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset.ConclusionsThe pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2064-z) contains supplementary material, which is available to authorized users.
Highlights
The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood
Investment in health varies between 5-11 % of gross domestic product, the density of beds varies 0.7-2.4 per 1000 inhabitants; physician density 0.4-1.9 per 1000 inhabitants; and rural population of 25–50 % [22]. In this manuscript we explore the impact of the pandemic in Central America and the Dominican Republic through a description of the demographics, clinical characteristics, and oseltamivir treatment of persons who died with laboratory-confirmed influenza A(H1N1)pdm09
Epidemiologic and demographic case characteristics During epidemiological week (EW) 19 in 2009 through EW 25 in 2010, we identified 183 severe acute respiratory infection (SARI) decedents who tested positive for influenza A(H1N1)pdm09 in seven countries (Belize did not identify any influenza A(H1N1)pdm09 deaths)
Summary
The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm infection during 2009–2010, in seven countries in the American tropics. The epidemiologic and clinical characteristics of influenza A (H1N1)pdm were poorly understood. Pending information about this emerging pathogen, influenza prevention and control policies in the American tropics still targeted persons at risk of developing complications as a result of seasonal influenza. At the start of the pandemic, Central American countries used CDC’s Guidelines for Treatment of Suspected Cases of Influenza A(H1N1)pdm09 [5]. National guidelines recommended to treat patients with oseltamivir when it was most effective (i.e. within 48 h from symptom onset) [1, 7, 9, 11, 18, 19]
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