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DGI-054 Post-Pandemic Influenza A (H1N1) Infection in Critically Ill Patients Previously Vaccinated
  1. L Canadell Vilarrasa1,
  2. AH Rodriguez Oviedo2,
  3. E Diaz Santos2
  1. 1Hospital Universitari Joan XXIII de Tarragona, Pharmacy, Tarragona, Spain
  2. 2Hospital Universitari Joan XXIII de Tarragona, ICU, Tarragona, Spain

Abstract

Background The A H1N1 2009 virus caused a worldwide pandemic during 2009. Vaccination of high-risk individuals was one of the recommendations of the World Health Organization before the post-pandemic period. Since this period, influenza activity has again associated with A H1N1 virus in Spain.

1059 cases of severe flu were hospitalised during the post-pandemic period in Spain and 41% of them were admitted to the ICU. The status of influenza vaccination was determined in 92% of the ICU patients.

Purpose To compare differential characteristics in morbidity, mortality and clinical manifestations of vaccinated patients who were admitted to Spanish ICUs during the flu season 2010–11 versus unvaccinated patients.

Materials and Methods Prospective, observational and multicentre study performed in 148 ICUs. Data were recorded in the GTEI/SEMICYUC registry. Adult patients with influenza A (H1N1) confirmed by rt-PCR were included in the analysis. Database records discriminated between having or not having been vaccinated.

Results 397 patients were admitted to Spanish ICUs during the post-pandemic period 2010/11 and supplied information about previous vaccination. A total of 22 (5.8%) patients had previously been vaccinated.

Vaccinated patients had a higher percentage of comorbidities compared to the other patients, (95.5% vs. 74.1%; p = 0.021). The mean number of comorbidities was also higher in vaccinated patients [1.91 (1.41) vs. 1.18 (0.99); p = 0.026].

Vaccinated patients showed higher rate of overall pneumonia but not bacterial coinfection. They received empiric antiviral treatment in a similar percentage and dosage, but they were treated for less time [6.9 (4.07) days vs. 8.99 (3.76) days; p = 0.003]. There was 2 days of delay in the initiation of empiric antiviral treatment in vaccinated patients (7.64 vs. 5.59 days), although it was not statistically significant. Data also showed that a greater percentage of vaccinated patients were treated with zanamivir compared to the rest of the group (22.7% vs. 5.3% p = 0.008). Vaccinated patients did not differ from the rest of the group in time from onset of symptoms, days to hospital admission or time until diagnosis.

Conclusions Clinical presentation, management and antiviral treatment was different in patients who had been previously vaccinated against influenza A (H1N1) virus.

No conflict of interest.

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