Influenza A(H1N1)v pandemic in the dialysis population: first wave results from an international survey

Marcelli, Daniele; Marelli, Cristina; Richards, Nick

Background. After the first cases of influenza A(H1N1)v in Mexico and the USA became public, Fresenius Medical Care established a case-based reporting of cases for all of its dialysis clinics located in Europe, Middle East, Africa and Latin America. This paper aims to describe mortality rates of patients on dialysis and to assess the risk profiles. Methods. The survey was developed in Lotus Notes with a secure browser-based form. The form was open to 602 Fresenius Medical Care clinics located in Europe, Middle East, Africa and Latin America. Results. As of 3 September 2009, 306 cases have been reported by 85 clinics located in Argentina, Chile, Brazil, UK and Spain. The mean age was 52.7 ± 17.7 years. The majority of cases (70.6%) were from 20- to 44-year-old and 45- to 64-year-old subgroups. Moreover, 35.3% had no associated comorbidity, 20.3% had two and 4.6% three comorbidities, with heart disease being the most frequent. Fever was the most common symptom, present in 94.4% of the cases, followed by cough (78.8%) and muscle and joint pain (69.3%). Eighty-seven percent were treated with antiviral agents, the majority with oseltamivir. One hundred and three patients (34%) were admitted to hospital because of influenza. Pneumonia was reported for 69 cases, out of which 52 patients belonged to a high-risk group. Mortality rate of all the patients (confirmed, probable and suspected cases) was around 5%. Conclusion. End-stage renal disease patients should be included in first ranks of the priority list for the influenza A (H1N1)v vaccine, as already advocated by some healthcare authorities.