Friday, July 31, 2009

Notes on H1N1 in Chile

I recently made rounds in the adult and pediatric ICUs of one of the university hospitals in Chile, Hospital ClĂ­nico UC. The staff there confirmed that about one-third of non-ICU patients that are admitted have no fever. Even more interesting, half of the outpatients with confirmed H1N1 also exhibit no fever.

Physicians from both ICUs described screening patients with no other symptoms than rhinorrhea (runny nose), that turned out to have confirmed cases of H1N1.

The lesson here is that the clinical expression of H1N1 is extremely broad. Screening only the patients who exhibit a high fever will result in many overlooked cases. Further, when counting infected patients, if fever is part of the case definition, the denominator will be greatly underestimated.

It is surprising to see how differently H1N1 is being managed throughout Latin America, especially between Chile and Brazil. In Chile, clinicians make a clinical diagnosis—confirmation is not essential—and Oseltamivir is administered. The drug is given to patients free of charge.