Ho Chi Minh City Airport

Though some consider the precautionary measures taken during the H1N1 swine flu epidemic to have been excessive, ‘better safe than sorry’ was an understandable position for health officials to take.

That stance is justified to some degree by the results of a study published today in PLoS Medicine. The analysis of the first few months of the epidemic in Vietnam suggests that actions taken in Ho Chi Minh City probably bought healthcare services valuable time to build up their response.

The researchers, from the Wellcome Trust Major Overseas Programme and Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Vietnam, analysed records from the 2009 strain of influenza virus A (H1N1) cases from the Ministry of Health, the Hospital of Tropical Diseases and the healthcare services of Ho Chi Minh City.

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Clinical Infectious Diseases  15 March 2010  V.50  N.6  p.860–868

Juan Pablo Torres,1,5,a Miguel O’Ryan,5,a Beatrice Herve,2 Ricardo Espinoza,3 Guillermo Acuña,3 Jaime Mañalich,4 and May Chomalí4

1Department of Pediatrics, Division of Pediatric Infectious Diseases, 2Department of Microbiology, and 3Department of Internal Medicine, Division of Infectious Diseases, 4Clínica Las Condes, and 5Microbiology and Mycology Program, Faculty of Medicine, Universidad de Chile, Santiago, Chile

Background

In Chile, the novel influenza A (H1N1) epidemic began in the middle-high income area of Santiago. Clinical and laboratory surveillance was intensified with the aim to characterize the epidemic and determine its impact in a large hospital setting.

Methods

Demographic and clinical data were obtained from all patients whose symptoms met the clinical definition of influenza A (H1N1) infection during the epidemic period. Laboratory confirmation was obtained by use of a nasopharyngeal antigen detection test for influenza A and/or influenza A (H1N1) polymerase chain reaction (PCR). A case was considered confirmed if the antigen detection test result for influenza A and/or the PCR test result were positive.

Results

The total number of emergency department (ED) visits increased by 88.5% from a mean of 14,489 ED visits in 2006–2008 to a mean of 27,308 ED visits in 2009, during the epidemic period. There were 10,048 patients who were clinically diagnosed with influenza A (H1N1), and they represented 78% of all visits, of which 4591 (45.6%) were laboratory confirmed. The median time from symptom onset to diagnosis was 1 day, and 99.7% of individuals received antiviral treatment. School-aged children represented 67% of ED visits at the beginning of the epidemic and 24% of ED visits at the end of the epidemic. Only 2% of cases were hospitalized; of these, 70% of cases occurred in patients 6–50 years of age, and 32% of cases occurred in patients who had an underlying medical condition. Eleven patients (age range, 1–53 years) required admission to the intensive care unit (ICU); 6 of these patients had pneumonia with or without hemodynamic shock. No influenza-associated deaths occurred.

Conclusions

Many cases of influenza A (H1N1) occurred in school‐aged and adult individuals who required an ED visit; these visits resulted in a low impact on the use of hospital beds. Aggressive ICU management and/or experience in extracorporeal membrane oxygenation significantly improved outcomes. Early antiviral treatment may have played an important role in the low number of severe cases. Vaccines targeted for school-aged children and young adults may modify the first epidemic wave in the northern hemisphere.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/650750

PDF

http://www.journals.uchicago.edu/doi/pdf/10.1086/650750

US swine flu epidemic shows signs of being over
Feb 5 01:15 PM US/Eastern
By MIKE STOBBE
AP Medical Writer

ATLANTA (AP) – Is the U.S. swine flu epidemic over? Federal health officials won’t go so far as to day that, but on Friday they reported for the fourth week in a row that no states had widespread flu activity.

Breitbart-US swine flu epidemic shows signs of being over

This is a good sign that swine flu is over. Let’s not let our guards down.

So everyone these days seems to be so worried about the H1N1 influenza virus. Now, I know any time a new infectious microbe comes onto the scene that it could be dangerous. But it is on the national news daily, everyone is talking about it around the water cooler at work, and one case in a community causes a panic.

I get it, it is new, its sexy. The new bad guy with all of the gadgets gets the attention.

But …

What about obesity? Obesity kills or leads to the early death of more people in this country in one year than H1N1 will kill in the next 50 years. I received a link to this article through an e-mail list serve this week:
Estimated county-level prevalence of diabetes and obesity

Looking at the graphic: We have states with >30% obesity rates?

And when you look at the states that are doing well, they are ranked 0-26.2%. Is there really much of a difference between 26.2% and 30%?

When I was rotating through the hospital setting, especially when I was working in cardiology, more often than not, the patients were definitely on the heavier side. Now that is just an observation, but the literature definitely does support a link between obesity and metabolic syndrome, diabetes, and heart disease.

When are we as a society going to recognize this as a problem and call for more noticeable and health critical nutritional information labeling on unprepared and prepared foods? When are we going to get sodas, candy, and unhealthy lunches out of schools?

This definitely also links into the recent health care reform topics. What better way to lower costs and utilization in the health care system than to lower one of the primary risk factors for diabetes and heart disease and consequently their long-term complications?

What can the pharmacy profession do to help combat this epidemic?

What are pharmacists currently doing to help improve this situation?