Hospital triage system for adult patients using an influenza-like illness scoring system during the 2009 pandemic--Mexico.

BACKGROUND: Pandemic influenza A (H1N1) virus emerged during 2009. To help clinicians triage adults with acute respiratory illness, a scoring system for influenza-like illness (ILI) was implemented at Hospital Civil de Guadalajara, Mexico. METHODS: A medical history, laboratory and radiology results were collected on emergency room (ER) patients with acute respiratory illness to calculate an ILI-score. Patients were evaluated for admission by their ILI-score and clinicians' assessment of risk for developing complications. Nasal and throat swabs were collected from intermediate and high-risk patients for influenza testing by RT-PCR. The disposition and ILI-score of those oseltamivir-treated versus untreated, clinical characteristics of 2009 pandemic influenza A (H1N1) patients versus test-negative patients were compared by Pearson's Chi(2), Fisher's Exact, and Wilcoxon rank-sum tests. RESULTS: Of 1840 ER patients, 230 were initially hospitalized (mean ILI-score = 15), and the rest were discharged, including 286 ambulatory patients given oseltamivir (median ILI-score = 11), and 1324 untreated (median ILI-score = 5). Fourteen (1%) untreated patients returned, and 3 were hospitalized on oseltamivir (median ILI-score = 19). Of 371 patients tested by RT-PCR, 104 (28%) had pandemic influenza and 42 (11%) had seasonal influenza A detected. Twenty (91%) of 22 imaged hospitalized pandemic influenza patients had bilateral infiltrates compared to 23 (38%) of 61 imaged hospital test-negative patients (p<0.001). One patient with confirmed pandemic influenza presented 6 days after symptom onset, required mechanical ventilation, and died. CONCLUSIONS: The triaging system that used an ILI-score complimented clinicians' judgment of who needed oseltamivir and inpatient care and helped hospital staff manage a surge in demand for services.

Influenza vaccination in patients with breast cancer: a case-series analysis.

BACKGROUND: Our aim was to evaluate the serological response and safety of influenza vaccine in patients with breast cancer in Mexico. MATERIAL/METHODS: Between October and December 2001, patients with breast cancer were vaccinated with a split virus vaccine. Hemagglutination inhibition assay titers were measured before vaccination and 4-6 weeks later. Titer ratios were used as the primary measure of response. When comparing rate of response according to treatment, stage, or other patient-related variables, individuals with post vaccination titers >/=1:40 for all 3 antigen strains were called respondents. RESULTS: We analyzed 146 patients who were vaccinated and had influenza antibodies measured before and after vaccination. Seventy-two (49.3%) had locally advanced breast cancer, 117 (80.1%) were receiving cancer treatment, 91 (62.3%) were on chemotherapy. Response to vaccine was 47.2%; we found an additional 25.3% of patients who responded to two of the serotypes. In patients receiving chemotherapy the response rate was lower (p=NS). CONCLUSIONS: The results of the present study show that influenza vaccine is safe and well tolerated in patients with breast cancer, but we observed a lessening of the immune response among patients receiving chemotherapy. Influenza vaccination should be recommended in all patients with breast cancer, regardless of the anti-neoplastic treatment.