[Influenza A(H1N1) epidemic in Argentina. Experience in a National General Hospital (Hospital Nacional Alejandro Posadas)]

The preparation and medical care during the influenza A(H1N1) outbreak (June 2009) in a high complexity level, public, general hospital with laboratory diagnosis, general and intensive care (ICU) hospitalization is described. A plan was designed to increase the hospital’s surge capacity, reallocate resources and guarantee bio-safety. The number of consultations was 7.1 +/- 3.8 times higher than during June 2006-2008. Detection of A(H1N1) cases were confirmed by PCR-RT in 186/486 (38.3%) in-patients and 56/176 (31.8%) out-patients. Median age among in-patients was 20 years; 75% <45 and 32.3% <15. Global mortality: 6.8%; 9.1% among confirmed cases. Adults were directed to a reception area of out-patient care, hospitalization (isolation) and mechanical ventilation. general ward: 110 patients with oxygen saturation <96% and/or risk factors (65.5% had asthma, chronic obstructive pulmonary disease, obesity, pregnancy or other) were admitted (5 times more than in 1999-2006). Chest X-ray showed lung infiltrates and/or lung consolidation in 97.3%. Severe hypoxemia: 43.5%. There were no significant clinical or X-ray differences between 21/49 confirmed and non confirmed A(H1N1) cases.
Treatment: oseltamivir, ampicillin-sulbactam, and clarithromycin. ICU: 28 severe pneumonia patients were admitted (21 with associated conditions); 24 with acute respiratory distress syndrome received mechanical ventilation, 21 of them had shock; 8/9 acute renal failure cases required hemodialysis. Mortality: 14/28; 7/14 with confirmed A(H1N1) infection. Seventy A(H1N1) infected children were hospitalized (27 required ICU, 6 of them died). The children’s median age was 11 months; 61.8% presented comorbidities (prematurity, asthma, broncho-pulmonary dysplasia and congenital heart disease). Oseltamivir and antibiotics were administered. Children’s mortality: 8.6%