title: Differential use of antivirals for treatment of patients with influenza A(H1N1)pdm09 in Germany.
abstract: BACKGROUND
  The World Health Organization recommends early antiviral treatment for patients with severe influenza illness or those at increased risk for severe illness.
  
  
  OBJECTIVE
  The aim of this study was to determine the proportion of cases with laboratory-confirmed A(H1N1)pdm09 infection that have been treated with antivirals in Germany during the pandemic (H1N1) 2009 and to investigate factors associated with the use of antivirals.
  
  
  METHODS
  We analyzed cases with laboratory-confirmed A(H1N1)pdm09 infection notified to national health authorities in Germany between week 29/2009 and week 17/2010 using multivariable logistic regression. Severity of disease was defined by pneumonia or death.
  
  
  CONCLUSIONS
  Of 160,804 cases with laboratory-confirmed A(H1N1)pdm09 infection, 22% were treated with antivirals. Cases with severe disease were more likely to be treated with antivirals than cases without severe disease (odds ratio=1·66; 95% confidence interval: 1·46-1·89). In the group with at least one underlying medical condition, only children aged between 1 and 4 years had significant lower odds for receiving antiviral treatment compared with cases in the age group 15 to 49 years (odds ratio=0·75; 95% confidence interval: 0·6-0·94). In conclusion, the implementation of international recommendations on use of antivirals differed according to the age of patients in Germany during the pandemic (H1N1) 2009. This indicates that the potential of antivirals to prevent severe influenza might not have been fully exhausted. The reasons leading to the observed differences in patient management need to be investigated.
authors: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors: Annicka
authors: A
authors: Reuss
authors: Manuel
authors: M
authors: Dehnert
authors: Silke
authors: S
authors: Buda
authors: Walter
authors: W
authors: Haas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy* / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology*; D012720:Severity of Illness Index; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: A(H1N1)pdm09; H1N1 subtype; age groups; antiviral agents; influenza A virus
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