title: Demographic and clinical characteristics of deaths associated with influenza A(H1N1) pdm09 in Central America and Dominican Republic 2009-2010.
abstract: BACKGROUND
  The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm09 infection during 2009-2010, in seven countries in the American tropics.
  
  
  METHODS
  We used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records.
  
  
  RESULTS
  During May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18-46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset.
  
  
  CONCLUSIONS
  The pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. rchaconf@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Chacon
authors.affiliation: Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA. zjk4@cdc.gov.
authors.forename: Sara
authors.initials: S
authors.lastname: Mirza
authors.affiliation: Ministry of Health, San Salvador, El Salvador. davidsaulrodriguezaraujo@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Rodriguez
authors.affiliation: Ministry of Health, Guatemala, Guatemala. parsama92@hotmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Paredes
authors.affiliation: Social Security of Costa Rica, San Jose, Costa Rica. guiselle23@gmail.com.
authors.forename: Giselle
authors.initials: G
authors.lastname: Guzman
authors.affiliation: Ministry of Health, Panama, Panama. lmorenocastillo@yahoo.com.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Moreno
authors.affiliation: Ministry of Health, Dominican Republic, Dominican Republic. ceciliathen@hotmail.com.
authors.forename: Cecilia J
authors.initials: CJ
authors.lastname: Then
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. jorherja@gmail.com.
authors.forename: Jorge
authors.initials: J
authors.lastname: Jara
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. nataliavanessa00@yahoo.com.
authors.forename: Natalia
authors.initials: N
authors.lastname: Blanco
authors.affiliation: Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala. luisbonillavargas@gmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Bonilla
authors.affiliation: Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA. willclara@yahoo.com.
authors.forename: Wilfrido A
authors.initials: WA
authors.lastname: Clara
authors.affiliation: Training of Epidemiology and Public Health Intervention Network, Guatemala, Guatemala. percyminaya@gmail.com.
authors.forename: Percy
authors.initials: P
authors.lastname: Minaya
authors.affiliation: Influenza Group. Pan-American Health Organization, Washington DC, USA. palekarr@paho.org.
authors.forename: Rakhee
authors.initials: R
authors.lastname: Palekar
authors.affiliation: Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA. eha9@cdc.gov.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Azziz-Baumgartner
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001249:Asthma / Q000401:mortality; D002489:Central America; D015897:Comorbidity; D003364:Costa Rica; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004293:Dominican Republic / Q000453:epidemiology; D004544:El Salvador; D005260:Female; D005334:Fever / Q000188:drug therapy; D006166:Guatemala; D006721:Honduras; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009527:Nicaragua; D053139:Oseltamivir / Q000627:therapeutic use; D011247:Pregnancy; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir