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zoom RSS 新型インフルエンザで入院した50才以上の患者の死亡率は高い/カリフォルニア 米国医療事情

<<   作成日時 : 2009/11/06 20:39   >>

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 H1N1パンデミックの最初の4ヶ月間にカリフォルニアで入院した1,000人以上の患者の分析によれば、乳幼児の入院が最も多く、50才以上の死亡率が最も高かった
 季節性インフルエンザ同様、基礎疾患を持つ高齢者が最も重症化したと、カリフォルニア州保健当局のJanice Louieは言う。しかし季節性インフルエンザと異なり、高齢者は子どもに比べて明らかに感染はしにくい。
 4月23日〜8月11日にカリフォルニアでのH1N1インフルエンザによる入院患者1,088人のうち、11%(118人)は死亡し、30%(340人)はICU治療を必要とした。入院患者の死亡率は、18才以下では約2%だが、50才以上は20%であった。全入院患者の約1/3は基礎疾患を持っていなかった。肥満の割合が高く、季節性インフルエンザではみられない危険因子である。BMIが判明している361人の患者のうち半分は肥満であり、さらにその半分はBMI39以上の重度肥満であった。
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Older Patients Most Likely to Die From H1N1 Influenza
California Study Shows Those 50 and Older Most Likely to Die if Hospitalized
by RITA RUBIN USA Today Nov. 4, 2009
http://abcnews.go.com/Health/SwineFluNews/severe-h1n1-swine-flu-dangerous-elderly/story?id=8993901

An analysis of more than 1,000 California patients hospitalized with H1N1 flu during the first four months of the pandemic found that infants were most likely to be admitted, and patients 50 and older were most likely to die once admitted.
California Study Shows Those 50 and Older Most Likely to Die if Hospitalized
H1N1 swine flu vaccine testing volunteer Robert Jackson, 65, of Roswell, Georgia, has the experimental vaccine administered by nurse at the Hope Clinic of the Emory University Vaccine Center in Decatur, Georgia, in this file photo.
(newscom.com)

In the first four months of the pandemic, H1N1, like the seasonal flu, was especially severe in older people, who are more likely to have underlying health conditions, says lead author Janice Louie, a public-health medical officer at the California Department of Public Health.

However, Louie says, unlike seasonal flu, older people are far less likely than children and young adults to contract the H1N1 flu in the first place. For that reason, the study won't lead the Centers for Disease Control and Prevention to add healthy older people to the list of priority groups for H1N1 vaccine, director Thomas Frieden told reporters Tuesday.
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Of 1,088 patients hospitalized with H1N1 flu in California, 11%, or 118 patients, died, and 30%, or 340 patients, were admitted to intensive-care units, Louie and her co-authors report in today's Journal of the American Medical Association. In patients 50 and older, the death rate was up to 20%, compared with about 2% in hospitalized patients under age 18.

The study focuses on patients who were hospitalized between April 23 and Aug. 11. Whether H1N1, or swine flu, will eventually mutate and cause more severe illness is not yet known, Louie says: "Influenza is pretty unpredictable."

Nearly a third of all the hospitalized patients in her study were reported to have no underlying conditions, such as lung disease, associated with an increased risk of flu complications.

But a disproportionate number of them were obese, an observation that also has been made in other countries, the authors write. Obesity doesn't appear to be a risk factor for seasonal flu.

Of the 361 patients whose body mass index -- or BMI, a number based on height and weight -- was known, half were obese, and half of those patients were morbidly obese, defined as having a BMI over 39, or roughly 100 pounds overweight.

Like the hospitalized patients overall, nearly a third of the obese patients were reported to have no known risk factor for severe influenza, although about a quarter had other health conditions, such as high blood pressure.

Because an increased risk of severe flu in obese patients has been observed in several locations, "I think it's probably real," says Gordon Rubenfeld, a critical-care specialist at the University of Toronto. Why, Rubenfeld says, remains to be seen.

Ali El Solh, an associate professor of medicine and social and preventive medicine at the State University of New York-Buffalo, speculates that obesity-related inflammation might further damage flu patients' lungs. In Louie's study, the most common causes of death were viral pneumonia and acute respiratory distress syndrome.

Contributing: Steve Sternberg

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Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California

Janice K. Louie, MD, MPH; Meileen Acosta, MPH; Kathleen Winter, MPH; Cynthia Jean, MPH; Shilpa Gavali, MPH; Robert Schechter, MD, MPH; Duc Vugia, MD; Kathleen Harriman, PhD; Bela Matyas, MD; Carol A. Glaser, MD, DVM; Michael C. Samuel, DrPH; Jon Rosenberg, MD; John Talarico, DO, MPH; Douglas Hatch, MD; for the California Pandemic (H1N1) Working Group

JAMA. 2009;302(17):1896-1902.

Context Pandemic influenza A(H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A(H1N1) disproportionately affects younger ages and causes generally mild disease.

Objective To describe the clinical and epidemiologic features of pandemic 2009 influenza A(H1N1) cases that led to hospitalization or death.

Design, Setting, and Participants Statewide enhanced public health surveillance of California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A(H1N1) infection reported to the California Department of Public Health between April 23 and August 11, 2009.

Main Outcome Measure Characteristics of hospitalized and fatal cases.

Results During the study period there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A(H1N1) infection reported in California. The median age was 27 years (range, <1-92 years) and 68% (741/1088) had risk factors for seasonal influenza complications. Sixty-six percent (547/833) of those with chest radiographs performed had infiltrates and 31% (340/1088) required intensive care. Rapid antigen tests were falsely negative in 34% (208/618) of cases evaluated. Secondary bacterial infection was identified in 4% (46/1088). Twenty-one percent (183/884) received no antiviral treatment. Overall fatality was 11% (118/1088) and was highest (18%-20%) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome.

Conclusions In the first 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized. Most cases had established risk factors for complications of seasonal influenza.

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新型インフルエンザで入院した50才以上の患者の死亡率は高い/カリフォルニア 米国医療事情 医師の一分/BIGLOBEウェブリブログ
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