In preparing the article on flu in China, reassuring, I arrived on this publication about influenza in Argentina quite disturbing. This article is not published in the journal but accessible only online , which explains why it eluded me for a few days because I do not spend my life on the net, and it's Christmas.
Despite the Christmas break where everything is wonderful, I must inform you:
The comments of Dr. Gamin are blue.
Preamble
Geography
Argentina is a vast country (more than 5 times that of France) extending over 3700 km from north to south and 1,400 km from east to west
image Wikipedia licensed Creative Commons Attribution 3.0 Unported .
Its population is 40 million.
Its economy is dramatic. The political and economic instability has plunged the Argentine economy in the hell of an unprecedented crisis in 2002. This crisis has led more than 50% of the population below the poverty line. Events were then held, followed by looting stores. The global economic crisis of 2008 led plunge this country that just emerged.
Health System :
Argentina spent in 2005 7% of its GDP on health and social services. For a country in ruins but it is already so vast a country where 15 to 50% of people live below the poverty line, with two successive crises that abruptly change the status of people (loss of income, home ...) may be this does not do everything.
"This may explain that"
Flu thus:
Between May and July 2009, 251 children were hospitalized with influenza. Hospitalization rates were double those of seasonal influenza in 2008. Among children who were hospitalized, 47 (19%) were admitted to ICU, 42 (17%) required ventilation and 13 (5%) died. The overall death rate was 1.1 per 100,000 children, compared to 0.1 per 100,000 children against seasonal flu in 2007. (No pediatric deaths associated with seasonal influenza in 2008.) Most of the deaths were caused by refractory hypoxemia. In infants under 1 year the death rate is 7.6 per 100,000.
This chart shows in A blue, the occurrence of influenza by week, B in green, the age distribution and the existence of infections involved more often in small, C in orange, the severity depending on age (Death = death, ICU = Intensive Care Unit or ICU, Hospital Ward = classic). The graph shows that D small are over-represented. The graph shows E age of deceased children. It is not fully consistent with the following table.
Two small So tables ( click on them to enlarge ) drawn from the section studied, even in English, are worth a thousand words.
worry, medical English is almost as simple as the medical French, which is not always easy I admit (but not worse than the legalese). The proof is that I did "German and Russian," which is hardly useful in medicine, then English, early in my medical studies for the "fun" but it remained industrious, for me too. So I learned a little Japanese that I find much more difficult than English to read and write above. But I digress, let.
The second table shows:
13 deaths in total, occurred in children under 15 years of which 9 were carriers of diseases that are already very severe.
avec10 deaths of small children under 3 years of which 4 had no risk factors (age 1 month, 10 months, 2.2 and 2.5 years). The others were already seriously ill.
What lessons for us in northern hemisphere?
published studies that I have, it appears that:
Small children under 2 years are most at risk for influenza
risk factors already described are the same
severity seems lower in rich countries (as often )
And the vaccination?
We have a vaccine adjuvant for small children, must therefore vaccinate small children, especially if they have a risk factor
Should we lower the age of vaccination for small Infants under 6 months at risk? I do not know if the vaccine is effective, but our scientists are surely aware.
must help poor countries because the flu is most dangerous when the existing situation is bad.
Conclusion:
Influenza is more severe in young children . In Argentina, it has killed.
vaccinate children 6 months to 2 years especially if they are at risk.
" flu in China "
Medicine is not always funny but this is not his vocation. We're here to heal people and enable them to live in the best health conditions.
"It truce joyous Christmas, Happy New Year 2010 to all and thank you for reading "
Reference:
Romina libst, MD, Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina N Eng J Med 361; 26 December 24, 2009: published on the NEJM website
Keywords: Argentina, vaccine, flu, influenza, child, infant, A (H1N1), severity
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