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Critical Illness From Influenza A(H1N1) in Mexico Associated With High Fatality Rate CHICAGO -- October 12, 2009 -- Critical illness from influenza A(H1N1) in Mexico occurred among young patients, was associated with severe acute respiratory distress syndrome and shock, and had a fatality rate of about 40%, according to a study to appear in the November 4 issue of JAMA. The study is being published early online to coincide with its presentation at a meeting of the European Society of Intensive Care Medicine. Between March 18 and June 1, 2009, 5,029 cases and 97 documented deaths occurred in Mexico. The population and healthcare system in Mexico City experienced the first and greatest early burden of critical illness, according to background information in the article. Guillermo Domínguez-Cherit, MD, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, and colleagues conducted an observational study of critically ill patients at 6 hospitals in Mexico that treated the majority of such patients with confirmed, probable, or suspected influenza H1N1 between March 24 and June 1, 2009. The study focused on the death rate, rate of critical illness and mechanical ventilation, and length of stay in the hospital and the intensive care unit (ICU). Among 899 patients admitted to hospitals with confirmed, probable, or suspected 2009 influenza H1N1, 58 became critically ill. The critically ill patients had a median age of 44 years. Most were treated with antibiotics, and 45 patients were treated with oseltamivir or zanamivir. Fifty-four patients required mechanical ventilation. “Our analysis of critically ill patients with influenza H1N) reveals that this disease affected a young patient group,” the authors wrote. “Fever and respiratory symptoms were harbingers of disease in almost all cases. There was a relatively long period of illness prior to presentation to the hospital, followed by a short period of acute and severe respiratory deterioration.” By 60 days, 24 of the critically ill patients (41.4%) died. Nineteen patients died within the first 2 weeks after becoming critically ill. “Patients who died had greater initial severity of illness, worse hypoxemia, higher creatinine kinase levels, higher creatinine levels, and ongoing organ dysfunction,” they wrote. “Early recognition of disease by the consistent symptoms of fever and a respiratory illness during times of outbreak, with prompt medical attention including neuraminidase inhibitors and aggressive support of oxygenation failure and subsequent organ dysfunction, may provide opportunities to mitigate the progression of illness and mortality observed in Mexico,” they concluded. SOURCE: JAMA E-mail this page to a friend or colleague! To print, use this version