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Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China.
N Engl J Med 2009; 361(26):2507-17NEJM

Abstract

BACKGROUND

The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease.

METHODS

During May and June 2009, we observed 426 persons infected with the 2009 pandemic influenza A (H1N1) virus who were quarantined in 61 hospitals in 20 provinces. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection, the clinical features of the disease were closely monitored, and 254 patients were treated with oseltamivir within 48 hours after the onset of disease.

RESULTS

The mean age of the 426 patients was 23.4 years, and 53.8% were male. The diagnosis was made at ports of entry (in 32.9% of the patients), during quarantine (20.2%), and in the hospital (46.9%). The median incubation period of the virus was 2 days (range, 1 to 7). The most common symptoms were fever (in 67.4% of the patients) and cough (69.5%). The incidence of diarrhea was 2.8%, and the incidence of nausea and vomiting was 1.9%. Lymphopenia, which was common in both adults (68.1%) and children (92.3%), typically occurred on day 2 (range, 1 to 3) and resolved by day 7 (range, 6 to 9). Hypokalemia was observed in 25.4% of the patients. Duration of fever was typically 3 days (range, 1 to 11). The median length of time during which patients had positive real-time RT-PCR test results was 6 days (range, 1 to 17). Independent risk factors for prolonged real-time RT-PCR positivity included an age of less than 14 years, male sex, and a delay from the onset of symptoms to treatment with oseltamivir of more than 48 hours.

CONCLUSIONS

Surveillance of the 2009 H1N1 virus in China shows that the majority of those infected have a mild illness. The typical period during which the virus can be detected with the use of real-time RT-PCR is 6 days (whether or not fever is present). The duration of infection may be shortened if oseltamivir is administered.

Authors+Show Affiliations

Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20007555

Citation

Cao, Bin, et al. "Clinical Features of the Initial Cases of 2009 Pandemic Influenza a (H1N1) Virus Infection in China." The New England Journal of Medicine, vol. 361, no. 26, 2009, pp. 2507-17.
Cao B, Li XW, Mao Y, et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med. 2009;361(26):2507-17.
Cao, B., Li, X. W., Mao, Y., Wang, J., Lu, H. Z., Chen, Y. S., ... Wang, C. (2009). Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. The New England Journal of Medicine, 361(26), pp. 2507-17. doi:10.1056/NEJMoa0906612.
Cao B, et al. Clinical Features of the Initial Cases of 2009 Pandemic Influenza a (H1N1) Virus Infection in China. N Engl J Med. 2009 Dec 24;361(26):2507-17. PubMed PMID: 20007555.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. AU - Cao,Bin, AU - Li,Xing-Wang, AU - Mao,Yu, AU - Wang,Jian, AU - Lu,Hong-Zhou, AU - Chen,Yu-Sheng, AU - Liang,Zong-An, AU - Liang,Lirong, AU - Zhang,Su-Juan, AU - Zhang,Bin, AU - Gu,Li, AU - Lu,Lian-He, AU - Wang,Da-Yan, AU - Wang,Chen, AU - ,, Y1 - 2009/12/09/ PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/1/6/medline SP - 2507 EP - 17 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 361 IS - 26 N2 - BACKGROUND: The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease. METHODS: During May and June 2009, we observed 426 persons infected with the 2009 pandemic influenza A (H1N1) virus who were quarantined in 61 hospitals in 20 provinces. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection, the clinical features of the disease were closely monitored, and 254 patients were treated with oseltamivir within 48 hours after the onset of disease. RESULTS: The mean age of the 426 patients was 23.4 years, and 53.8% were male. The diagnosis was made at ports of entry (in 32.9% of the patients), during quarantine (20.2%), and in the hospital (46.9%). The median incubation period of the virus was 2 days (range, 1 to 7). The most common symptoms were fever (in 67.4% of the patients) and cough (69.5%). The incidence of diarrhea was 2.8%, and the incidence of nausea and vomiting was 1.9%. Lymphopenia, which was common in both adults (68.1%) and children (92.3%), typically occurred on day 2 (range, 1 to 3) and resolved by day 7 (range, 6 to 9). Hypokalemia was observed in 25.4% of the patients. Duration of fever was typically 3 days (range, 1 to 11). The median length of time during which patients had positive real-time RT-PCR test results was 6 days (range, 1 to 17). Independent risk factors for prolonged real-time RT-PCR positivity included an age of less than 14 years, male sex, and a delay from the onset of symptoms to treatment with oseltamivir of more than 48 hours. CONCLUSIONS: Surveillance of the 2009 H1N1 virus in China shows that the majority of those infected have a mild illness. The typical period during which the virus can be detected with the use of real-time RT-PCR is 6 days (whether or not fever is present). The duration of infection may be shortened if oseltamivir is administered. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/20007555/Clinical_features_of_the_initial_cases_of_2009_pandemic_influenza_A__H1N1__virus_infection_in_China_ L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa0906612?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -