Outcome of suspected H 1 N 1 influenza cases admitted in tertiary care Govt . Hospital Solapur , Maharashtra

Introduction: Influenza (H1N1) is very sensitive and newly emerged pandemic. Influenza (H1N1) pandemics are caused by new influenza viruses that have recently adapted to humans and resemble major natural disasters both in terms of recurrence and magnitude. Aims and Objectives: To study the outcome and epidemiological factors of suspected H1N1 influenza cases. Study Design: Hospitalbased descriptive study, Study Period: Study was conducted over a period of seven months from April 2009 to October 2009. Study Variable: Outcome, age, sex, time, place of residence. Results and Discussion: The total 110 cases of suspected H1N1 influenza were admitted in Infectious diseases ward of Government Hospital Solapur. Out of 110 total suspected cases, 91 (82.72%) were cured and discharged. Among these 91 (82.72%) suspected cases, 17 (15.45%) were laboratory confirmed for Influenza (H1N1). Conclusion: In present study, maximum case fatality rate (32%) was observed in females in age group of 15-44 years as compared to male.


Criteria's for admission of H1N1 influenza cases
Those patient were admitted as influenza cases with complaints of high grade fever and severe sore throat.patient with complaints of breathlessness, chest pain, low blood pressure and haemoptysis. [4]

Study variable
The variables were outcome, age, sex, time, and place of residence.

RESULTS AND DISCUSSION
The total 110 cases of suspected H1N1 influenza were admitted in infectious diseases ward of Government Hospital Solapur [Table 1].The maximum number of cases (50) was reported in the month of October [Figure 1].Out of 110 total suspected cases, 91 (82.72%) were cured and discharged.Among these 91 (82.72%) suspected cases, 17 (15.45%)were laboratory confirmed for H1N1 influenza.Out of 110 total suspected cases, 19 (17.28%) died due H1N1 influenza.Out of 19 who died of H1N1 influenza, 10 cases (9.09%) were confirmed for H1N1 influenza (throat swab positive).

INTRODUCTION
Influenza (H1N1) is very sensitive and newly emerged pandemic.Influenza (H1N1) pandemics are caused by new influenza viruses that have recently adapted to humans and resemble major natural disasters both in terms of recurrence and magnitude.The influenza virus known to be circulating as a pathogen in the human population since at least the 16 th century is notable for its unique ability to cause recurrent epidemics and global pandemics.Genetic re-assortments in the influenza virus cause fast and unpredictable antigenic change. [1]ring Influenza (H1N1) Pandemic 2009, the first case in India was reported on 15 th May 2009 from Hyderabad and first death in India was reported on 6 th July 2009 from Pune. [2,3]The first case of suspected H1N1 influenza was reported on 8 th August 2009 from Solapur.The total number of screened case were 4229 from which 110 cases were admitted in Infectious diseases ward of Government Hospital Solapur.

Aims and objectives
To study the outcome of suspected H1N1 influenza cases.
To study the epidemiological factors affecting it.

Study design
This is a hospital based descriptive study, conducted on the cases admitted in Government Hospital Solapur as suspected Influenza (H1N1) cases form August 2009 to December 2009, over a period of 5 months.The above cases were interviewed at infectious diseases ward of this hospital on the same day of admission of patients.A pretested and predesigned questionnaire was used for data collection from patients and was analyzed on SPSS version 15.1.Out of 110 suspected H1N1cases, 27 were laboratory confirmed and 19 were deaths [Figure 4].
Out of 67 suspected H1N1 male cases, six cases were died and out of 43 female cases, 13 died.A still of H1N1 influenza patient on treatment in ICU from civil hospital Solapur [Figure 5].According to Liam de Donaldson et al (5) from England the mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000.It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000).In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57).Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England.Fifty (36%) had no, or only mild, pre-existing illness.Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive vaccine.

CONCLUSION
In the present study, maximum case fatality rate (32%) was observed in females (15-44 years).Most cases were male from rural Solapur.As suspected influenza H1N1, most cases (60.9%) reported were male while most death (68.4%) were female contributory to ignorance, illiteracy.and late reporting of female, immediate death within one day of admission were 12 (63.1%).

Recommendation
Health education as preventive measures for control of Influenza (H1N1) is essential.
There is need to increase awareness of publics about Influenza (H1N1).
Generally there is no need to become panic, as early suspicion, diagnosis and treatment with hospitalization reduces mortality due Influenza (H1N1).

Figure 1 :
Figure 1: Time trend of suspected H1N1 influenza cases

Figure 2 :
Figure 2: Sex and residence pattern of suspected H1N1 cases