Influenza in Yucatan in 2018: Chronology, characteristics and outcomes of ambulatory and hospitalized patients

Mendez-Dominguez, Nina I.; Bobadilla-Rosado, Luis O.; Fajardo-Ruiz, Lizbeth S.; Camara-Salazar, Andrea; Gomez-Carro, Salvador

doi:10.1016/j.bjid.2019.08.009

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Brazilian Journal of Infectious Diseases

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Brief Communication • Braz J Infect Dis 23 (5) • Sep-Oct 2019 • https://doi.org/10.1016/j.bjid.2019.08.009 copy

Influenza in Yucatan in 2018: Chronology, characteristics and outcomes of ambulatory and hospitalized patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Influenza season is expected between October and February in the northern hemisphere, including Mexico. Previous studies suggested that transmission peak may occur earlier in Yucatan, a state in southeast Mexico.

Objectives:

(a) Describe the seasonality of 2018 influenza cases seen at O´Horan hospital, statewide, and nationwide; (b) analyze the characteristics, clinical manifestations and outcomes of ambulatory and hospitalized patients; (c) analyze fatal outcomes occurrence among vaccinated and unvaccinated individuals.

Methods:

Retrospective analytic cohort of all confirmed influenza cases assisted at O´Horan hospital during 2018, along with a chronologic graphic description of the statewide epidemic curve from the epidemiological surveillance registries.

Results:

A total of 264 influenza cases were analyzed; 145 (55%) were female; 26% were vaccinated. Health workers and unvaccinated individuals were more prone to develop severe cases. Dyspnea and tachypnea were strong predictors of hospitalization; headache, myalgias, arthralgias and rhinorrhea correlated inversely. 236 (89.47%) cases occurred in July and 22 of the 23 deaths occurred before October. No fatal outcomes were observed among vaccinated individuals. Influenza AH1N1 represented 83.6% of serotyped cases.

Discussion:

Onset of influenza season in Yucatan may reflect a need for rethinking timing of vaccination and of preventive campaigns, as most cases occurred before vaccination period.

Keywords:
Influenza virus; Infection; Hospitalization; Signs and symptoms

Characteristics	General Population frequency/mean			General Population Percentage		Hospitalization	Adjusted (Pseudo R2 = 0.4713)			Hospitalization	Unadjusted
Characteristics	Hospitalized	Ambulatory	Total/ Average	Hospitalized (N = 145)	Ambulatory (N = 149)	ODDS RATIO	Stdandard Error	z	p-value	ODDS RATIO	Stdandard Error	z	p-value
Male	59	60	119	39.60	41.38	1.02	0.01	1.80	0.07	1.56	0.39	1.78	0.075
Age	27	28	27	27.22	26.98	1.07	0.31	0.22	0.82	1.00	0.01	0.21	0.831
Pregnancy	7	4	11	4.83	2.68	6.67	*5.37*	*2.35*	*0.02*	2.35	1.50	1.34	0.182
Indigenous Ethnicity	7	3	10	4.83	2.01	1.32	1.04	0.35	0.73	3.15	2.21	1.64	0.102
*Health Worker*	5	41	46	*3.45*	*27.52*	*1.33*	*0.08*	*4.89*	*0.00*	*1.31*	*0.06*	*5.42*	*0.000*
*Vaccinated*	9	40	49	*6.21*	*26.85*	*0.17*	*0.08*	*−3.90*	*0.00*	*0.23*	*0.09*	*−3.72*	*0.000*
Pediatric	47	45	92	32.41	30.20	1.90	1.05	1.17	0.24	1.40	0.36	1.28	0.200
Fever	112	147	259	97.30	98.60	0.36	0.44	−0.83	0.406	0.51	0.47	−0.74	0.462
Cough	135	111	246	96.50	90.60	4.92	4.41	1.78	0.075	2.88	1.67	1.82	0.069
Odynophagia	64	99	163	58.10	66.40	1.33	0.58	0.65	0.515	0.65	0.17	−1.70	0.089
*Dyspnea*	*102*	75	*177*	*90.20*	*50.30*	*4.33*	*1.98*	*3.20*	*0.001*	*8.39*	*2.91*	*6.14*	*0.000*
Irritability	67	88	155	58.70	59.00	0.46	0.19	−1.89	0.059	0.99	0.25	−0.05	0.962
*Diarrhea*	14	33	47	*12.20*	*22.10*	*0.56*	*0.26*	*−1.28*	*0.202*	*0.49*	*0.17*	*−2.04*	*0.041*
Chest pain	53	60	113	45.90	40.50	1.46	0.63	0.86	0.389	1.27	0.32	0.95	0.344
Chills	57	90	147	51.80	60.80	0.66	0.31	−0.90	0.368	0.64	0.16	−1.75	0.079
*Headache*	85	*134*	*219*	*75.00*	*89.90*	*0.32*	*0.18*	*−2.02*	*0.044*	*0.32*	*0.11*	*−3.33*	*0.001*
*Myalgias*	65	*122*	*187*	*61.50*	*82.40*	*0.46*	*0.29*	*−1.23*	*0.219*	*0.29*	*0.08*	*−4.39*	*0.000*
*Arthralgia*	60	*112*	*172*	*57.10*	*75.60*	*0.49*	*0.29*	*−1.22*	*0.223*	*0.36*	*0.10*	*−3.84*	*0.000*
Malaise	106	131	237	92.10	87.90	*3.86*	*2.56*	*2.04*	*0.042*	1.62	0.69	1.12	0.261
*Rhinorrhea*	84	*129*	*213*	*73.60*	*86.50*	*0.23*	*0.12*	*−2.91*	*0.004*	*0.42*	*0.13*	*−2.72*	*0.007*
*Tachypnea*	85	33	*121*	*74.50*	*24.10*	*8.69*	*3.65*	*5.15*	*0.000*	*8.89*	*2.54*	*7.64*	*0.000*
Vomit	22	32	54	20.00	21.60	0.41	0.19	−1.89	0.059	0.86	0.27	−0.50	0.620
Abdominal pain	22	29	51	20.70	19.40	1.75	0.85	1.16	0.248	0.98	0.31	−0.07	0.946
Conjunctivitis	28.00	42.00	70	25.00	28.10	0.73	0.30	−0.75	0.451	0.82	0.23	−0.70	0.484
A type H1N1	47	4	51	35.17	23.61	5.88	5.94	1.75	0.080	2.94	2.78	1.14	0.255
A (unspecified)	3	0	3	2.07	1.39								0.920
B Yamagata	4	2	6	4.14	2.78								0.777
B Victoria	1	0	1	0.69	0.46								0.980
Deaths reported among influenza patients according to vaccination status
Deaths	General population frequency			General Population Percentage		Adjusted				Unadjusted
	Hospitalized	Ambulatory	Total	Hospitalized	Ambulatory	Death Odds Ratio	Stdandard Error	z	p-value	Death Odds Ratio	Stdandard Error	z	p-value
Unvaccinated	21	1	22	*95.45*	*1.05*	*12.84*	*15.18*	*2.16*	*0.031*	*31.16*	*32.19*	*3.33*	*0.001*
Vaccinated	0	0	0	No observations
Post hoc Hosmer Lewenshow p = 0.930

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[1] *Corresponding author at: Universidad Marista de Merida, School of Medicine, Periférico Norte Tablaje Catastral Carretera Mérida - Progreso, C.P. 97300, Mérida, Yucatán, Mexico. E-mail addresses: o.r.luis@hotmail.com (L.O. Bobadilla-Rosado), sabrinafajardoruiz@gmail.com (L.S. Fajardo-Ruiz), andrea.camarasalazar@gmail.com (A. Camara-Salazar), salvador.gomez@ssy.gob.mx (S. Gomez-Carro).URL: http://nmendezmarista.edu.mx (N.I. Mendez-Dominguez).