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INFLUENZA PANDEMIC (H1N1) 2009 (02): OBESITY RISK FACTOR
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A ProMED-mail post
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International Society for Infectious Diseases
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Date: Sat 11 Jul 2009
Source: Reuters AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/N10537105.htm>
Obesity emerges as new risk factor for severe flu
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People who are obese but otherwise healthy may be at special risk of
severe complications and death from the new influenza pandemic (H1N1)
2009 virus, U.S. researchers reported on Friday [10 Jul 2009]. They
described the cases of 10 patients at a Michigan hospital who were so
ill they had to be put on ventilators. 3 died. 9 of the 10 were
obese, 7 were severely obese, including 2 of the 3 who died.
The study, published in advance in the Centers for Disease Control
and Prevention's (CDC) weekly report on death and disease, also
suggests doctors can safely double the usual dose of oseltamivir,
Roche AG's antiviral drug sold under the Tamiflu brand name.
"What this suggests is that there can be severe complications
associated with this virus infection, especially in severely obese
patients," said CDC virus expert Dr. Tim Uyeki. "And 5 of these
patients had ... evidence of blood clots in the lungs. This has not
been previously known to occur in patients with severe influenza
virus infections," Uyeki said in a telephone interview.
Dr. Lena Napolitano of the University of Michigan Medical Center and
colleagues studied the cases of 10 patients admitted to the
university's intensive care unit with severe acute respiratory
distress syndrome caused by infection with H1N1. "Of the 10 patients,
9 were obese (body mass index [BMI] more than 30), including 7 who
were extremely obese (BMI more than 40)," they wrote in their report.
Their study was not designed to see if obesity or anything else poses
a special risk factor for flu. But the researchers were surprised to
see that 7 of the 10 patients were extremely obese. 9 had multiple
organ failure, which can be seen in influenza, but 5 had blood clots
in the lungs, and 6 had kidney failure. None has fully recovered, the
researchers said.
The H1N1 swine flu virus 1st emerged in Mexico in March [2009] and
was spreading out of control in the United States by the time it was
identified at the end of April. The World Health Organization
declared a pandemic in June. While it is causing moderate illness,
all influenza viruses can be deadly and this one is no exception. It
has killed close to 500 people globally, more than 200 in the United
States alone.
However, the new virus has a slightly different pattern from seasonal
flu -- it spreads in the summer months, attacks young adults and
older children, and may affect the body slightly differently. As with
H5N1 avian influenza, which only rarely attacks people, patients seem
to survive better if they get Tamiflu for longer than the usual 5-day
treatment course, Uyeki said. "We don't know if it is necessary for a
higher dose of the drug to be given to patients who are obese," he said.
"The high prevalence of obesity in this case series is striking," the
CDC's commentary accompany the report reads. "Whether obesity is an
independent risk factor for severe complications of novel influenza A
(H1N1) virus infection is unknown. Obesity has not been identified
previously as a risk factor for severe complications of seasonal influenza."
[Byline: Maggie Fox]
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[While the pandemic (H1N1) 2009 virus has predominantly affected
older children and young adults causing relatively mild illness, the
observations reported above suggest that obesity may be risk factor
for severe complications following infections with this virus,
although it has not been identified as a risk factor for serious
complications following season influenza virus infection. 9 of 10
severely obese people in intensive care had multiple organ failure,
which can be seen in influenza but an unusual feature was that 5 had
blood clots in their lungs. None of these patients has fully
recovered. The high prevalence of obesity in the general populations
suggests that there may be an increasing number of fatalities. - Mod.CP.
It is of interest that 9 of the 10 patients were male. - Mod.DK]
[see also:
Influenza pandemic (H1N1) 2009 - Viet Nam: patient data 20090708.2450
Influenza A (H1N1) - worldwide (86): official nomenclature 20090706.2430
Influenza A (H1N1) - worldwide (83): antiviral resistance 20090705.2417
Influenza A (H1N1) - worldwide (82): transmission 20090704.2402
Influenza A (H1N1) - worldwide (81): epidemic analysis 20090703.2391
Influenza A (H1N1) - worldwide (80): Argentina, human to pig 20090701.2376
Influenza A (H1N1) - worldwide (79): case count 20090701.2372
Influenza A (H1N1) - worldwide (78): Tamiflu resistance, DK 20090630.2359
Influenza A (H1N1) - worldwide (76): comments on 1918 virus (03) 20090625.2309
Influenza A (H1N1) - worldwide (74): susp. origin 20090624.2303
Influenza A (H1N1) - worldwide (73): case count, epidemiology 20090622.2288
Influenza A (H1N1) - worldwide (72): case count, epidemiology 20090619.2261
Influenza A (H1N1) - worldwide (70): risk factors 20090619.2260
Influenza A (H1N1) - worldwide (69): other viral infections 20090618.2254
Influenza A (H1N1) - worldwide (68): southern hemisphere 20090618.2253
Influenza A (H1N1) - worldwide (65): antivirals in pregnancy 20090616.2224
Influenza A (H1N1) - worldwide (64): case count, pandemic 20090616.2221
Influenza A (H1N1) - worldwide (62): Egypt, Lebanon 20090611.2150
Influenza A (H1N1) - worldwide (62): Egypt, Lebanon 20090611.2150
Influenza A (H1N1) - worldwide (60): Egypt (Cairo) 20090608.2117
Influenza A (H1N1) - worldwide (59): Worldwide 20060608.2117
Influenza A (H1N1) - worldwide (58): USA, Africa 20090607.2109
Influenza A (H1N1) - worldwide (57): Brazil, USA 20090605.2090
Influenza A (H1N1) - worldwide (55) 20090603.2056
Influenza A (H1N1) - worldwide (47): China, epidemiology 20090526.1962
Influenza A (H1N1) - worldwide (45) 20090525.1951
Influenza A (H1N1) - worldwide (42) 20090523.1929
Influenza A (H1N1) - worldwide (39) 20090521.1903
Influenza A (H1N1) - worldwide (37) 20090520.1893
Influenza A (H1N1) - worldwide (34) 20090518.1863
Influenza A (H1N1) - worldwide (31) 20090516.1835
Influenza A (H1N1) - worldwide (29) 20090515.1824
Influenza A (H1N1) - worldwide (26) 20090514.1798
Influenza A (H1N1) - worldwide (23) 20090511.1764
Influenza A (H1N1) - worldwide (21) 20090510.1749
Influenza A (H1N1) - worldwide (19) 20090509.1733
Influenza A (H1N1) - worldwide (17) 20090508.1722
Influenza A (H1N1) - worldwide (15) 20090507.1709
Influenza A (H1N1) - worldwide (13) 20090506.1695
Influenza A (H1N1) - worldwide (11): coincident H3N2 variation 20090505.1679
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
Influenza A (H1N1) virus, human - N America 20090425.1552
Acute respiratory disease - Mexico, swine virus susp 20090424.1546
Influenza A (H1N1) virus, swine, human - USA (02): (CA, TX) 20090424.1541
Influenza A (H1N1) virus, swine, human - USA: (CA) 20090422.1516
Influenza A (H1N1) virus, swine, human - Spain 20090220.0715]
.....................cp/ejp/dk
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