title: Risk factors for death during a resurgence of influenza-A (H1N1) pdm09 in Punjab State in 2013.
abstract: In 2013, high mortality from influenza-A (H1N1) pdm09 (pH1N1) was observed in Punjab, India.
  
  
  
  To describe cases and deaths of 2013 pH1N1 positives, to evaluate the high case fatality ratio and risk factors for pH1N1-associated mortality among the hospitalized cases in Punjab for 2013.
  
  
  
  A case-control study was conducted and compared those who died from confirmed pH1N1 with those who survived in the hospital between January 1, 2013, and April 30, 2013. Sociodemographic and clinical details were extracted from hospital records and from telephone interviews with controls and next of kin of cases using pretested questionnaires. Logistic regression analysis was performed.
  
  
  
  A total of 182 laboratory-confirmed pH1N1 cases (99 males and 83 females) were hospitalized in 30 hospitals in Punjab; 42 (23%) patients died. Those who died were significantly more likely to be younger than 50 years of age (adjusted odds ratio [AOR] =10.6, 95% confidence interval [CI] =1.8-21.1), be obese (AOR = 16.7, 95% CI = 1.6-170.7), and have visited more than two health-care facilities before laboratory confirmation (AOR = 25.8, 95% CI = 5.4-121.6).
  
  
  
  The health-care community should have a high index of suspicion for influenza, and general community should be sensitized about risk factors and to seek medical advice early in the illness.
authors.affiliation: EIS Officer, Central Surveillance Unit, Integrated Disease Surveillance Program, National Centre for Disease Control, New Delhi, India.
authors.forename: Tripurari
authors.initials: T
authors.lastname: Kumar
authors.affiliation: State Surveillance Officer, State Surveillance Unit, Integrated Disease Surveillance Program, Director Health Services, Chandigarh, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhatia
authors.affiliation: Additional Professor of Epidemiology and Professor and Head, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pinnaka Venkata
authors.initials: PV
authors.lastname: Maha Lakshmi
authors.affiliation: Country Director, Center for Global Health, Centers for Disease Control and Prevention (CDC), India-CDC, New Delhi, India.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.affiliation: Senior Advisor, EIS Programme, National Centre for Disease Control, Delhi, India.
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Narain
authors.affiliation: Professor and Head, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors