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The authors declare that they have no competing interests.
RC has designed the research, has participate in acquisition of data; He has been performed the analysis and interpretation of data; and have been involved in drafting the manuscript. SM participated in the analysis of data, and helped to draft the manuscript. DR participated in the data acquisition from El Salvador, and helped to draft the manuscript. AP participated in the data acquisition from Guatemala, and helped to draft the manuscript. GG participated in the data acquisition from Costa Rica, participated in recovery of background and design and to draft the manuscript. LM participated in the data acquisition from Panama. CT participated in the data acquisition from Dominican Republic. JJ helped to draft the manuscript. NB helped to draft the manuscript. LB participated in the design and helped to draft the manuscript. WC has advised all steps of the study, included design, interpretation of data and drafting the manuscript. PM participated in the design of the study. RP helped to draft the manuscript. EA has advised on data interpretation, design of the manuscript and helped to draft the manuscript. All authors have read and approved the final manuscript.
The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm09 infection during 2009–2010, in seven countries in the American tropics.
We used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records.
During May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18–46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset.
The pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.