Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China.
BACKGROUND
The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease.


METHODS
During May and June 2009, we observed 426 persons infected with the 2009 pandemic influenza A (H1N1) virus who were quarantined in 61 hospitals in 20 provinces. Real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection, the clinical features of the disease were closely monitored, and 254 patients were treated with oseltamivir within 48 hours after the onset of disease.


RESULTS
The mean age of the 426 patients was 23.4 years, and 53.8% were male. The diagnosis was made at ports of entry (in 32.9% of the patients), during quarantine (20.2%), and in the hospital (46.9%). The median incubation period of the virus was 2 days (range, 1 to 7). The most common symptoms were fever (in 67.4% of the patients) and cough (69.5%). The incidence of diarrhea was 2.8%, and the incidence of nausea and vomiting was 1.9%. Lymphopenia, which was common in both adults (68.1%) and children (92.3%), typically occurred on day 2 (range, 1 to 3) and resolved by day 7 (range, 6 to 9). Hypokalemia was observed in 25.4% of the patients. Duration of fever was typically 3 days (range, 1 to 11). The median length of time during which patients had positive real-time RT-PCR test results was 6 days (range, 1 to 17). Independent risk factors for prolonged real-time RT-PCR positivity included an age of less than 14 years, male sex, and a delay from the onset of symptoms to treatment with oseltamivir of more than 48 hours.


CONCLUSIONS
Surveillance of the 2009 H1N1 virus in China shows that the majority of those infected have a mild illness. The typical period during which the virus can be detected with the use of real-time RT-PCR is 6 days (whether or not fever is present). The duration of infection may be shortened if oseltamivir is administered.
Cao
Bin
B
Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China.
Li
Xing-Wang
XW
Mao
Yu
Y
Wang
Jian
J
Lu
Hong-Zhou
HZ
Chen
Yu-Sheng
YS
Liang
Zong-An
ZA
Liang
Lirong
L
Zhang
Su-Juan
SJ
Zhang
Bin
B
Gu
Li
L
Lu
Lian-He
LH
Wang
Da-Yan
DY
Wang
Chen
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017963:Azithromycin / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D016015:Logistic Models; D008231:Lymphopenia / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000009:adverse effects / Q000627:therapeutic use; D053139:Oseltamivir / Q000009:adverse effects / Q000627:therapeutic use*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D013997:Time Factors; D017201:Virus Shedding; D055815:Young Adult
D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D053139:Oseltamivir; D017963:Azithromycin; D015242:Ofloxacin