title: An analysis of 332 fatalities infected with pandemic 2009 influenza A (H1N1) in Argentina.
abstract: BACKGROUND
  The apparent high number of deaths in Argentina during the 2009 pandemic led to concern that the influenza A H1N1pdm disease was different there. We report the characteristics and risk factors for influenza A H1N1pdm fatalities.
  
  
  METHODS
  We identified laboratory-confirmed influenza A H1N1pdm fatalities occurring during June-July 2009. Physicians abstracted data on age, sex, time of onset of illness, medical history, clinical presentation at admission, laboratory, treatment, and outcomes using standardize questionnaires. We explored the characteristics of fatalities according to their age and risk group.
  
  
  RESULTS
  Of 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged <50 years. Acute respiratory failure was the leading cause of death. Of all cases, 249 (75%) had at least one comorbidity as defined by Advisory Committee on Immunization Practices. Obesity was reported in 32% with data and chronic pulmonary disease in 28%. Among the 40 deaths in children aged <5 years, chronic pulmonary disease (42%) and neonatal pathologies (35%) were the most common co-morbidities. Twenty (6%) fatalities were among pregnant or postpartum women of which only 47% had diagnosed co-morbidities. Only 13% of patients received antiviral treatment within 48 hours of symptom onset. None of children aged <5 years or the pregnant women received antivirals within 48 h of symptom onset. As the pandemic progressed, the time from symptom-onset to medical care and to antiviral treatment decreased significantly among case-patients who subsequently died (p<0.001).
  
  
  CONCLUSIONS
  Persons with co-morbidities, pregnant and who received antivirals late were over-represented among influenza A H1N1pdm deaths in Argentina, though timeliness of antiviral treatment improved during the pandemic.
authors.affiliation: National Ministry of Health of Argentina, Buenos Aires, Argentina. balanzat@fibertel.com.ar
authors.forename: Ana M
authors.initials: AM
authors.lastname: Balanzat
authors.forename: Christian
authors.initials: C
authors.lastname: Hertlein
authors.forename: Carlos
authors.initials: C
authors.lastname: Apezteguia
authors.forename: Pablo
authors.initials: P
authors.lastname: Bonvehi
authors.forename: Luis
authors.initials: L
authors.lastname: Cámera
authors.forename: Angela
authors.initials: A
authors.lastname: Gentile
authors.forename: Oscar
authors.initials: O
authors.lastname: Rizzo
authors.forename: Manuel
authors.initials: M
authors.lastname: Gómez-Carrillo
authors.forename: Fatima
authors.initials: F
authors.lastname: Coronado
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
authors.forename: Pollyanna R
authors.initials: PR
authors.lastname: Chávez
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000401:mortality* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D012307:Risk Factors; D055815:Young Adult