Impact of the Novel Influenza A (H1N1) during the 2009 Autumn-Winter Season in a Large Hospital Setting in 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.