title: 2009 pandemic influenza A (H1N1) virus outbreak and response--Rwanda, October, 2009-May, 2010.
abstract: BACKGROUND
  In October 2009, the first case of pandemic influenza A(H1N1)pdm09 (pH1N1) was confirmed in Kigali, Rwanda and countrywide dissemination occurred within several weeks. We describe clinical and epidemiological characteristics of this epidemic.
  
  
  METHODS
  From October 2009 through May 2010, we undertook epidemiologic investigations and response to pH1N1. Respiratory specimens were collected from all patients meeting the WHO case definition for pH1N1, which were tested using CDC's real time RT-PCR protocol at the Rwandan National Reference Laboratory (NRL). Following documented viral transmission in the community, testing focused on clinically severe and high-risk group suspect cases.
  
  
  RESULTS
  From October 9, 2009 through May 31, 2010, NRL tested 2,045 specimens. In total, 26% (n = 532) of specimens tested influenza positive; of these 96% (n = 510) were influenza A and 4% (n = 22) were influenza B. Of cases testing influenza A positive, 96.8% (n = 494), 3% (n = 15), and 0.2% (n = 1) were A(H1N1)pdm09, Seasonal A(H3) and Seasonal A(non-subtyped), respectively. Among laboratory-confirmed cases, 263 (53.2%) were children <15 years and 275 (52%) were female. In total, 58 (12%) cases were hospitalized with mean duration of hospitalization of 5 days (Range: 2-15 days). All cases recovered and there were no deaths. Overall, 339 (68%) confirmed cases received oseltamivir in any setting. Among all positive cases, 26.9% (143/532) were among groups known to be at high risk of influenza-associated complications, including age <5 years 23% (122/532), asthma 0.8% (4/532), cardiac disease 1.5% (8/532), pregnancy 0.6% (3/532), diabetes mellitus 0.4% (2/532), and chronic malnutrition 0.8% (4/532).
  
  
  CONCLUSIONS
  Rwanda experienced a PH1N1 outbreak which was epidemiologically similar to PH1N1 outbreaks in the region. Unlike seasonal influenza, children <15 years were the most affected by pH1N1. Lessons learned from the outbreak response included the need to strengthen integrated disease surveillance, develop laboratory contingency plans, and evaluate the influenza sentinel surveillance system.
authors: King Faisal Hospital, Kigali, Rwanda.
authors: Justin
authors: J
authors: Wane
authors: Thierry
authors: T
authors: Nyatanyi
authors: Richard
authors: R
authors: Nkunda
authors: Joseph
authors: J
authors: Rukelibuga
authors: Zara
authors: Z
authors: Ahmed
authors: Caitlin
authors: C
authors: Biedron
authors: Adeline
authors: A
authors: Kabeja
authors: Marie Aimée
authors: MA
authors: Muhimpundu
authors: Alice
authors: A
authors: Kabanda
authors: Simon
authors: S
authors: Antara
authors: Olivier
authors: O
authors: Briet
authors: Jean Baptiste
authors: JB
authors: Koama
authors: André
authors: A
authors: Rusanganwa
authors: Odette
authors: O
authors: Mukabayire
authors: Corine
authors: C
authors: Karema
authors: Pratima
authors: P
authors: Raghunathan
authors: David
authors: D
authors: Lowrance
mesh_terms: D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D008297:Male; D012432:Rwanda / Q000453:epidemiology