title: A comparison of the epidemiology and clinical presentation of seasonal influenza A and 2009 pandemic influenza A (H1N1) in Guatemala.
abstract: BACKGROUND
  A new influenza A (H1N1) virus was first found in April 2009 and proceeded to cause a global pandemic. We compare the epidemiology and clinical presentation of seasonal influenza A (H1N1 and H3N2) and 2009 pandemic influenza A (H1N1) (pH1N1) using a prospective surveillance system for acute respiratory disease in Guatemala.
  
  
  RESULTS
  Patients admitted to two public hospitals in Guatemala in 2008-2009 who met a pneumonia case definition, and ambulatory patients with influenza-like illness (ILI) at 10 ambulatory clinics were invited to participate. Data were collected through patient interview, chart abstraction and standardized physical and radiological exams. Nasopharyngeal swabs were taken from all enrolled patients for laboratory diagnosis of influenza A virus infection with real-time reverse transcription polymerase chain reaction. We identified 1,744 eligible, hospitalized pneumonia patients, enrolled 1,666 (96%) and tested samples from 1,601 (96%); 138 (9%) had influenza A virus infection. Surveillance for ILI found 899 eligible patients, enrolled 801 (89%) and tested samples from 793 (99%); influenza A virus infection was identified in 246 (31%). The age distribution of hospitalized pneumonia patients was similar between seasonal H1N1 and pH1N1 (P = 0.21); the proportion of pneumonia patients <1 year old with seasonal H1N1 (39%) and pH1N1 (37%) were similar (P = 0.42). The clinical presentation of pH1N1 and seasonal influenza A was similar for both hospitalized pneumonia and ILI patients. Although signs of severity (admission to an intensive care unit, mechanical ventilation and death) were higher among cases of pH1N1 than seasonal H1N1, none of the differences was statistically significant.
  
  
  CONCLUSIONS
  Small sample sizes may limit the power of this study to find significant differences between seasonal influenza A and pH1N1. In Guatemala, influenza, whether seasonal or pH1N1, appears to cause severe disease mainly in infants; targeted vaccination of children should be considered.
authors.affiliation: Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America. kil2@cdc.gov
authors.forename: Kim A
authors.initials: KA
authors.lastname: Lindblade
authors.forename: Wences
authors.initials: W
authors.lastname: Arvelo
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gray
authors.forename: Alejandra
authors.initials: A
authors.lastname: Estevez
authors.forename: Gal
authors.initials: G
authors.lastname: Frenkel
authors.forename: Lissette
authors.initials: L
authors.lastname: Reyes
authors.forename: Fabiola
authors.initials: F
authors.lastname: Moscoso
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Moir
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Fry
authors.forename: Sonja J
authors.initials: SJ
authors.lastname: Olsen
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006166:Guatemala; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000235:genetics*; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology*; D008297:Male; D058873:Pandemics; D011014:Pneumonia / Q000453:epidemiology / Q000821:virology*; D012621:Seasons