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Swine Flu Deaths Higher
In Over 50s In CA

ProMed Mail Source: The Wall Street Journal Health (edited)
Swine Flu Deaths Higher In Elderly
By Jennifer Corbett Dooren
People age 50 and older who were hospitalized with swine flu [influenza pandemic (H1N1) 2009 virus infection] in California had the highest fatality rate from the illness, while those younger than 18 had the lowest death rates. Researchers from the California Department of Public Health looked at 1088 cases of hospitalization and death attributed to [pandemic] H1N1 from 23 Apr 2009, shortly after the virus was discovered, to 11 Aug 2009. The findings are published in this week's Journal of the American Medical Association [JAMA 2009; 30(17): 1896-902, 4 Nov: Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California. JK Louie, M Acosta, K Winter, et al; http://jama.ama-assn.org/cgi/content/abstract/302/17/1896; for Abstract see comment below. - Mod.CP]
While hospitalization rates in California were highest for infants and young adults ages 18 to 29 and lower for older people, the findings suggest older people who are hospitalized are more likely to die. "Despite reports that elderly persons may be "protected" by pre-existing immunity, clinicians should closely monitor and promptly treat hospitalized patients with pandemic 2009 influenza A H1N1 infection," researchers wrote.
Still, similar to statistics collected by the federal Centers for Disease Control and Prevention (CDC), data in California show [that pandemic] H1N1 is hitting young people harder than what's typically seen for seasonal flu. The median age of hospitalized patients in California was 27. Of the 1088 hospitalization and death reports in California, 118 were deaths, which translates into a fatality rate of 11 per cent, researchers said. For people age 50 and older, the fatality rate was as high as 20 per cent. 8 of the 118 deaths were reported in children younger than age 18, whereas the remainder were in people age 18 and older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome, which are complications of influenza.
The proportion of deaths seen over the spring and summer in California differs from a recent analysis conducted by the CDC involving 292 deaths reported by 28 states from 30 Aug 2009 to 10 Oct 2009. The percentage of deaths in people age 24 and younger was 24 per cent, and in those ages 25 to 64, it was 64 per cent. 12 per cent of the deaths occurred in people age 65 and older.
communicated by ProMED-mailrapporteur Mary Marshall
[The higher death rate in the hospitalised elderly in the state of California may be a consequence of a higher rate of comorbidities peculiar to the inhabitants of that state. As elsewhere, the pattern remains true that that the elderly appear to be less susceptible to infection by the pandemic (H1N1) 2009 virus than the younger age groups, possibly due to protection by preexisting immunity.
The abstract of the JAMA paper referred to above reads as follows:
"Context: Pandemic influenza A (H1N1) emerged rapidly in California in April 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. "Objective: To describe the clinical and epidemiologic features of pandemic 2009 influenza A (H1N1) cases that led to hospitalization or death. "Design, setting, and participants: Statewide enhanced public health surveillance of California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A (H1N1) infection reported to the California Department of Public Health between [23 Apr and 11 Aug 2009].
"Results: During the study period there were 1088 cases of hospitalization or death due to pandemic 2009 influenza A (H1N1) infection reported in California. The median age was 27 years (range, younger than 1-92 years) and 68 per cent (741/1088) had risk factors for seasonal influenza complications. 66 per cent (547/833) of those with chest radiographs performed had infiltrates and 31 per cent (340/1088) required intensive care. Rapid antigen tests were falsely negative in 34 per cent (208/618) of cases evaluated. Secondary bacterial infection was identified in 4 per cent (46/1088). 21 per cent (183/884) received no antiviral treatment. Overall fatality was 11 per cent (118/1088) and was highest (18-20 per cent) in persons aged 50 years or older. The most common causes of death were viral pneumonia and acute respiratory distress syndrome.
"Conclusions: In the 1st 16 weeks of the current pandemic, the median age of hospitalized infected cases was younger than is common with seasonal influenza. Infants had the highest hospitalization rates and persons aged 50 years or older had the highest mortality rates once hospitalized. Most cases had established risk factors for complications of seasonal influenza."
The HealthMap/ProMED-mail interactive map of California can be accessed at <http://healthmap.org/r/00aj>http://healthmap.org/r/00aj. - Mod.CP
Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural Economics Univ of West Indies Please visit my "Emerging Diseases" message board at: http://www.emergingdisease.org/phpbb/index.php Also my new website: http://drpdoyle.tripod.com/ Zhan le Devlesa tai sastimasa Go with God and in Good Health 
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