Published Date: 2009-07-08 19:00:05
Subject: PRO/AH/EDR> Influenza pandemic (H1N1) 2009 - Viet Nam: patient data
Archive Number: 20090708.2450
INFLUENZA PANDEMIC (H1N1) 2009 - VIET NAM: PATIENT DATA
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Date: Wed 8 Jul 2009
From: Rogier van Doorn
<hrogier@gmail.com>
In the Hospital for Tropical Diseases in Ho Chi Minh City, Viet Nam,
patients with flu symptoms and a positive RT-PCR [real time polymerase
chain reaction]
result for pandemic (H1N1) 2009 virus infection with the CDC assay
(specific A(H1N1)v primers/probe) are hospitalized and treated with
oseltamivir (75mg bd) until RT-PCR results are negative.
We collected clinical data, haematology and biochemistry, and daily
virological data (nose and throat swabs) from the 1st 44 pandemic
(H1N1) 2009 RT-PCR positive patients in Viet Nam hospitalized between
29 May and 26 June 2009. The average age of the patients was 28.6
years (3-62), 19 female and 25 male. 5 patients contracted flu while
in Viet Nam but with a clear epidemiological link to someone with
"imported" pandemic (H1N1) 2009, 39 cases were thought to be directly
imported (14 US, 18 Australia, 2 Canada, 2 Thailand, 1 Japan, 1 China,
and 1 Singapore).
Fever was present in 91 percent (n=40), cough in 55 percent (n=24),
runny nose in 20 percent (n=9), sore throat in 27 percent (n=12), and
diarrhea in 2 percent (n=1). Average duration of fever on presentation
was 2 days. After 24 hours 75 percent (n=33) of patients had a normal
temperature. All patients had a mild illness course.
Viral PCR was positive on day 0 for all patients with an average Ct
value of 30.3. The number of PCR positive patients dropped to 25 after
1 day (average Ct 30.3). On day 2, 21 patients were positive (average
Ct 35.8) and on day 3 and 4, 8 patients were still PCR positive
(average Ct 37.0 and 37.2). No patients were positive on day 5, 6 and 7.
These data suggest that patients treated with oseltamivir have a
favourable clinical and virological response and are not shedding
viral RNA after 5 days of treatment. In comparison, Whitley et al
[Pediatr Infect Dis J 2001 20:127] found 55 percent (n=51/93) culture
positive patients in oseltamivir treated children with non-severe
influenza on day 4.
There have been a few anecdotal reports from Viet Nam of patients that
remained symptomatic and PCR positive for a prolonged period, and one
patient in our hospital (not included in this report) had a positive
PCR after 18 doses of oseltamivir. Investigations into the presence of
the NA H274Y mutation in [virus isolated from] these patients are
ongoing but have so far been negative.
[Byline: Tran Tinh Hien
Nguyen Thanh Truong
Nguyen van Vinh Chau
Tran Thuy Ngan
Jeremy Farrar
Rogier van Doorn
Hospital for Tropical Diseases
Ho Chi Minh City
Viet Nam]
--
Rogier van Doorn
Hospital for Tropical Diseases
Wellcome Trust Major Overseas Programme
Oxford University Clinical Research Unit
190 Ben Ham Tu
District 5
Ho Chi Minh City
Viet Nam
<rvandoorn@oucru.org>
[ProMED-mail welcomes the opportunity to make these data available to
the general healthcare community. - Mod.CP]
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Influenza A (H1N1) - worldwide 20090430.1636
Influenza A (H1N1) "swine flu": worldwide (07), update, pandemic 5
20090429.1622
Influenza A (H1N1) "swine flu": Worldwide 20090427.1583
Influenza A (H1N1) virus, human: worldwide 20090426.1577
Influenza A (H1N1) virus, human - New Zealand, susp 20090426.1574
Influenza A (H1N1) virus, human - N America (04) 20090426.1569
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Influenza A (H1N1) virus, swine, human - Spain 20090220.0715
.....................cp/ejp/jw
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