Clinical and epidemiological description of the first cases of new influenza A (H1N1) attended in Spain

Miró O, Rovira E, Blanco AJ, Salmerón JM, Gatell JM, Cervera C, Trilla A, Marcos MA, Pumarola T, Sánchez M

Objective: To describe emergency consultations during the first day of the new influenza

outbreak. The description covers the first cases of new influenza virus infection

diagnosed, the epidemiologic context, and the organization of emergency services

during the first 24 hours of care provided on that day.

Material and Methods: The medical records for emergency consultations on April 26,

2009 at an urban tertiary care hospital were reviewed to identify cases related to the

new influenza virus. Clinical and epidemiologic data were extracted. When the new

influenza was suspected, the attending physician ordered a complete laboratory and

blood workup, chest x-ray, and nasal swab and throat swab to detect nucleic acids from

new influenza virus A (H1N1). Blood was extracted for influenza viral specific antibodies

testing. Information on the main organizational measures taken during the 24-hour

period were also recorded.

Results: Ninety-nine patients were attended over the course of the day. Twelve (12%)

had had some contact with cases of the new Mexican flu outbreak. The 12 cases all bore

some relationship with 6 different trips (with between 3 and 25 days passing since the

return flight). In 4 cases, it was considered that epidemiologic features were not

consistent with a diagnosis of the new influenza. Those patients were therefore

discharged without viral antigen testing. Four of the remaining 8 patients were admitted

(all placed in private rooms that allowed for respiratory and contact isolation), and 4

were discharged. Three of the 8 patients were diagnosed with the new influenza. One

case was the result of secondary transmission in the home, as the patient had not been

to Mexico. The clinical picture was not different from ordinary influenza in humans. The

patients’ progress was excellent on treatment with oseltamivir for 5 days. There were no

complications. A great deal of interaction and information exchange between

emergency care providers took place during the first day of the epidemic, making it

possible to respond effectively and in a timely manner.

Conclusions: The clinical characteristics of the new influenza A (H1N1) are similar to

those of other outbreaks in humans. Emergency services, which are the first line of

defense during outbreaks like the recent one, are capable of mobilizing the necessary

resources to cope satisfactorily.

Blanco AJ, Cervera C, Gatell JM, Marcos MA, Miró O, Pumarola T, Rovira E, Salmerón JM, Sánchez M, Trilla A