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and epidemic : many similarities and little differences Olga Dzupova, Kristyna Herrmannova, Milan Trojanek, Zuzana Blechova, Martina Havlickova, Helena Jirincova, Alexander Nagy Third and Second Faculty of Medicine, Charles University, State Veterinary Institute Prague, National Institute of , National Reference Laboratory for Influenza, Department of Infectious , Hospital Na Bulovce, Prague, Czech Republic

Introduction Results

While two post pandemic influenza seasons were rather weak in terms of Clinical symptoms 2009- 2012- p influenza-related hospitalisation at our department, the last epidemic season 2010 2013 2009- 2012- 2012-2013 approached the figures of pandemic season 2009-2010. The p 2010 2013 Complications increased rate of more severe clinical courses was reported across all regions of the country. Fever 100 % 92 % 1,000 viral pneumonia 26 pts 21 pts 0,157 Headache 41 53 0,039 bacterial pneumonia 11 35 0,002 Materials and Methods Myalgia 36 50 0,009 respir. insuficiency 13 15 1,000 A prospective cohort study was carried out at the Department of Infectious Arthralgia 29 46 0,001 cardiac insuficiency 5 14 0,103 Diseases, Na Bulovce Hospital, Prague, during all influenza seasons from 2009 to 2013. We enrolled patients hospitalized with moderate to severe influenza-like Cough 93 91 0,444 renal insuficiency 4 2 0,415 illness whose nasopharyngeal swab was positive for influenza A and B by Dyspnea 37 43 0,283 neurosymptomatology 16 19 1,000 PCR. The epidemiological and clinical characteristics of patients from the Haemoptysis 7 3 0,131 pandemic season 2009/2010 and epidemic season 2012/2013 were evaluated. Hospital care and outcome characteristics Sore throat 24 28 0,541 length of stay, non-ICU, M[d] 4 5 0,767

Coryza 34 43 0,097 length of stay, ICU, M[d] 19 18 0,089 Results Vomiting 26 25 0,805 intensive care [pts] 16 23 0,614 Patients hospitalized in pandemic and epidemic season DiarheaAdd text 24 19 0,236 ventilatory support 9 6 0,292

Virus type/subtype, No of patients Chronic underlying illness Neurosymptomsfont size - words 10 10 1,000 fatal outcome 4 6 1,000

resp failure 1 Pathol 9. auscultation - 1000 89 45 0,001 resp failure 2 Virus 2009-2010 2012-2013 2009- 2012- heart failure 4 heart failure 2 p 10 - 800 brain edema 1 2010 2013 X-ray infiltrate 33 33 1,000 A 163 136 11 - 680 mean age nonsurvivors [ys] 47 57 0,453 Chronic illness 28 % 54 % <0,001 - bilateral 12 - 580 16 14 0,734 H1N1 140 91

Pulmonary Conclusions H3N2 0 33 15 19 0,327 (COPD, asthma) The identified differences were following: older age, higher rate of comorbidities and more B 0 66 (A+B 3) Cardiovascular frequent secondary bacterial pneumonia in epidemic influenza compared to pandemic. However, there were many similarities such as total number of hospitalized patients, fever and Total 163 199 (excl. isolated 6 20 <0,001 hypertension ) cough being the main symptoms, similar rate of pneumonia including bilateral involvement, Demography inflammatory parameters, the type and rate of main complications, the need for intensive care, Renal 4 4 1,000 length of stay and fatal outcomes. Females 67 85 Immune Epidemic influenza has to be perceived with the same respect as pandemic influenza and a 7 12 0,148 Males 96 114 compromise great effort has to be made to increase coverage in the population.

Age (ys) 1-86 1,5-87 Diabetes 3 13 0,001 References References Obesity 18 21 0,422 Median 31 47 Montefiore Medical Center (2013, January 10). Significant increase in flu cases as severe gains momentum. ScienceDaily [online]. Available at: http://www.sciencedaily.com/releases/2013/01/130110152602.htm p <0,001 Santa-Olalla Peralta P, et al. Risk factors for severity among hospitalised patients with 2009 pandemic influenza A (H1N1) in Spain, April - December 2009. Euro Surveill, 2010; 15(38),1-9 The study was supported by grant IGA MZ CR NT/12493-3. Rothberg MB, et al. Complications of viral influenza. Am J Med 2008; 121, 258-64 [email protected]