title: [Outbreak of influenza pandemic virus A(H1N1) 2009 infections in Emergency Department, Saint-Pierre, Reunion Island. July-August 2009].
abstract: BACKGROUND
  The 2009 pandemic influenza A (H1N1) virus has emerged to cause the first pandemic of the 21st century. On July 3, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Reunion Island, French overseas department located in the southern hemisphere. The present study describes the characteristics and the impact of the epidemic on the activity of an emergency department (ED) from July 3 to August 31, 2009.
  
  
  METHODS
  Patients consulting the ED with a discharge diagnosis of influenza-like illness were analyzed.
  
  
  RESULTS
  The ED activity in 2009, compared to 2008, increased by 0.5% in July and 9.7% in August. In July and August, respectively 7.1 and 20.0% cases of S-OIV infection were hospitalized. For the 394 patients studied (186 males, 36.2+/-18.5 years), 199 (50.5%) were reported to have comorbidity or risk factor (RF) for complications. Complications occurred in 112 patients (28.4%). The most common complications were bronchospasme (52.7%), pneumonia (32.1%), decompensation caused by comorbidity (17.9%). Seventy-three patients (18.5%) required hospitalization. Patients aged 65 and over accounted for 10.9% of all patients, 31.5% of hospitalized patients and 21.4% of complicated S-OIV infection. Regardless of age, comorbidity and / or RF was reported in 80.2% of complicated S-OIV infection and 86.3% of hospitalized patients. The circuit of patients with S-OIV infection was initially focused on "consultation S-OIV" localized in ED. This organization mobilized several health professionals, disorganized the various medical departments involved, and was unsuitable for the childcare or patient's monitoring with signs of poor tolerance. This organization, even identifying S-OIV patients at their arrival, referred patients to different areas of the hospital and various consultation rooms in ED.
  
  
  CONCLUSIONS
  Recommendations for surveillance, prevention and policy for persons with RF, particularly respiratory disease, are justified. This feedback can raise questions about the patient's circulation in hospital and adjust plans for the organization.
authors.affiliation: CHR de La Réunion, service des urgences, SMUR, UHCD, site Sud, Réunion. frederik.staikowsky@wanadoo.fr
authors.forename: Frédérik
authors.initials: F
authors.lastname: Staikowsky
authors.forename: Cyril
authors.initials: C
authors.lastname: D'Andréa
authors.forename: Laurent
authors.initials: L
authors.lastname: Filleul
authors.forename: José
authors.initials: J
authors.lastname: Guisérix
authors.forename: Christophe
authors.initials: C
authors.lastname: Vanhecke
authors.forename: Arnaud
authors.initials: A
authors.lastname: Winer
authors.forename: Alain
authors.initials: A
authors.lastname: Michault
mesh_terms: D000328:Adult; D000368:Aged; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D017508:Reunion