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. 2010 May 7;5(5):e10540.
doi: 10.1371/journal.pone.0010540.

Pandemic influenza (H1N1) 2009 is associated with severe disease in India

Akhilesh C Mishra  1 , Mandeep S Chadha, Manohar L Choudhary, Varsha A Potdar
Affiliations

Pandemic influenza (H1N1) 2009 is associated with severe disease in India

Akhilesh C Mishra et al. PLoS One. .

Abstract

Background: Pandemic influenza A (H1N1) 2009 has posed a serious public health challenge world-wide. In absence of reliable information on severity of the disease, the nations are unable to decide on the appropriate response against this disease.

Methods: Based on the results of laboratory investigations, attendance in outpatient department, hospital admissions and mortality from the cases of influenza like illness from 1 August to 31 October 2009 in Pune urban agglomeration, risk of hospitalization and case fatality ratio were assessed to determine the severity of pandemic H1N1 and seasonal influenza-A infections.

Results: Prevalence of pandemic H1N1 as well as seasonal-A cases were high in Pune urban agglomeration during the study period. The cases positive for pandemic H1N1 virus had significantly higher risk of hospitalization than those positive for seasonal influenza-A viruses (OR: 1.7). Of 93 influenza related deaths, 57 and 8 deaths from Pune (urban) and 27 and 1 death from Pune (rural) were from pandemic H1N1 positive and seasonal-A positive cases respectively. The case fatality ratio 0.86% for pandemic H1N1 was significantly higher than that of seasonal-A (0.13%) and it was in category 3 of the pandemic severity index of CDC, USA. The data on the cumulative fatality of rural and urban Pune revealed that with time the epidemic is spreading to rural areas.

Conclusions: The severity of the H1N1 influenza pandemic is less than that reported for 'Spanish flu 1918' but higher than other pandemics of the 20(th) century. Thus, pandemic influenza should be considered as serious health threat and unprecedented global response seems justified.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Age distribution of the OPD cases in Pune (Urban).
Figure 2
Figure 2. Epidemic curve of the confirmed IPD cases.
Figure 3
Figure 3. Age distribution of the IPD cases in Pune (Urban).
Figure 4
Figure 4. Trends in the cumulative numbers.
(a) IPD cases and the deaths in Pune (Urban) (b) Death cases in Pune.
Figure 5
Figure 5
(a) Age-wise distribution of death cases in Pune (b) The normalized age specific CFR.
See this image and copyright information in PMC

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