/ 151 Profile of 213 cases infected with influenza A (H1N1) in Eastern Anatolia Serhat Vancelik, Zekeriya Akturk, Rukiye Cetin Seckin, Hamit Acemoglu

/ 152 Introduction and Aim As to 10 th of January 2010, 627 persons died since the beginning of the pandemy in Turkey, Though only around 5% (due to resistence to vaccination) of the population in Turkey was vaccinated against H1N1. This study aimed to describe the profile of people diagnosed with the H1N1 infection in and around Erzurum, a city with inhabitants at the north-east side of Turkey.

Method All patients suspected of having H1N1 infection between October 2009 and end of January 2010 were referred to one of the five secondary and tertiary hospitals in the city. Blood was collected and sent for laboratory approval of the diagnosis. Diagnostic test were done by the Refik Saydam reference laboratory using the in-house real time PCR method. / 153

Patients with positive test results were compared to the negative ones with respect to the possible risk factors. In addition to signs and symptoms, patient demographics were recorded and analyzed for each patient. High grade fever was defined as axillary temperature > 38.3°C. H1N1 positive patients were followed up for mortality status and the medication administered. / 154

Results Results analyzed for 445 suspected H1N1 cases, 213 (47.9%) were proven to be lab positive. Positive cases were younger (24,5 vs 28,8; p=0,047) None of the patients were vaccinated for H1N1 Mean age: 26.8±22.7 years. 55.5% males. / 155 H1N1 (-)H1N1 (+) p Fever176 (48%)191 (52%) <0,05 Cough181 (49,6%)184 (50,4%) <0,05 Muscle pain130 (50%) >0,05 Headache129 (51%)124 (49%) >0,05 Sore throat105 (48,4%)112 (51,6%) >0,05 Running nose95 (47%)107 (53%) <0,05 Breathlessness99 (49,7%)100 (50,3%) >0,05

/ 156 Flu vaccination

In a logistic regression model, fever was the only independent predictor of H1N1 infection (OR=2.83; p<0.001). –Factors included: Fever, Cough, Myalgia, Headache, Sore throat, Running nose, Dyspnea, seasonal flu vaccination status, comorbidity, contact with flu case, contact with international traveler, age, sex. / 157

Profile of the H1N1 positive cases –20 cases (9.4%) ended up with mortality (9 of these patients were from Erzurum, the remaining 11 from neighboring cities). –Majority of the patients (56.8%; n=121) were males. Median patient age was 19 years (min. 2 months, max. 83 years). –Median duration of symptoms from the beginning of symptoms and application to a health center was 2 days (min. 0, max. 9). –Most frequent symptoms were fever (89.7%; n=191) and cough (86.4%; n=184). / 158

–43 patients received intensive care therapy and out of these, 23 required ventilator support. –130 patients (61%) received antiviral therapy. –There was no relationship between antiviral therapy administration and mortality (p>0.05). –There was no significant relationship between mortality and flu vaccination or sex (p>0.05). –Mortality was significantly related with patient age. Median age of the deceased vs cured patients was 42 and 19 years respectively (p=0.048) / 159

–Patients with absence of headache, absence of sore throat, absence of runny nose, presence of fever, presence of cough, presence of breathlessness, presence of ARDS, and presence of co-morbidity –had significantly higher mortality rates (p<0.05). / 1510

/ 1511 Outcome CureEx p FeverNo17150,024 8,825,0 Yes ,2%75,0% CoughNo2360,025 11,9%30,0% Yes ,1%70,0% Muscle painNo72110,122 37,3%55,0% Yes ,2%45,0% HeadacheNo7316<0,001 37,8%80,0% Yes ,2%20,0% Sore throatNo86150,009 44,6%75,0% Yes ,40%25,0% Running noseNo8818<0,001 45,6%90,0% Yes ,4%10,0%

Outcome CureEx p BreathlessnessNo10760,03 55,4%30,0% Yes ,6%70,0% Flu vaccinationNo185200,355 95,9%100,0% Yes80 4,1%0,0% ComorbidityNo13280,011 68,4%40,0% Yes ,6%60,0% Contact with flu caseNo137170,182 71,0%85,0% Yes563 29,0%15,0% International travelNo188190,535 97,4%95,0% Yes51 2,6%5,0% Contact with international travelerNo186200,386 96,4%100,0% Yes70 3,6%0,00% / 1512

In a logistic regression model we found –age (OR=1.05), –female sex (OR=6.1), –absence of headache (OR=12.20), –absence of runny nose (OR=11.11), and –presence of ARDS (OR=105.4) as significant independent variables predicting mortality (all p<0.05). / 1513

Conclusion This study supports the evidence that high grade fever and cough are major symptoms of patients infected with H1N1. The seemingly protective effect of symptoms such as headache and runny nose on mortality needs further investigation. The disease may have present as seasonal flu in these cases. / 1514

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