Pregnant women, elderly at increased risk

KOCHI: A study in a tertiary care hospital shows that pregnancy and old age is associated with a higher rate of complications in H1N1 disease. Early recognition of the disease and prompt initiation of treatment seems to be the only way to reduce disease progression and associated mortality. Also, early respiratory support helped in preventing progression to respiratory failure in most of the patients.


After the 2009 H1N1 pandemic, a reemergence of H1N1 influenza cases was noted in India. With the number of swab-positive cases increasing in 2017 compared to early years, with the circulating strain (A/Michigan/7/2009 [H1N1] pdm09) being different from previous

pandemic

strains, doctors at

Lourdes

Hospital decided to consider the clinical profile.

“Pregnancy is associated with a higher rate of complication as during pregnancy the prognosis is very bad. Even if they recover from the disease, they will have long days in ICU and then we would have to deliver the baby preterm and the baby might have to stay in ICU. The complications risk that way is higher in

pregnant

women. Even the elderly are,” said Dr Sethulakshmi Prasad, who is the author of the study.

The aim of the study was to understand the clinical, biochemical, and radiological profile of H1N1 patients at initial presentation and its influence on the mode of treatment and outcome. For the same, they conducted a cross-sectional record-based analysis of all confirmed cases of H1N1 influenza admitted at Lourdes Hospital between 2015 and 2017. Confirmation of cases was done by

reverse transcriptase

polymerase

chain reaction

of respiratory specimens at Manipal Centre for virus research.

The results showed that of the 76 confirmed cases of H1N1 influenza detected in the hospital during the study period, 36 required ICU admission. Almost 25% of patients were between 51 and 60 years and there was also an equal number of pregnant women. The predominant presenting symptoms were fever (99%), dry cough (62%), breathlessness (54%). Around 33% of cases presented with bilateral lung infiltrates on X-ray. Almost 91% of patients survived the disease. “There is not much difference in the clinical findings between the study period and now,” said Dr AJ Indhu, department of critical care, Lourdes Hospital, who is also part of the study.


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