Oct 16, 2009 (CIDRAP News) – The susceptibility of some young, healthy people to severe illness with pandemic H1N1 influenza marks a striking difference from the pattern of disease seen in seasonal flu epidemics, the World Health Organization (WHO) said today.The factors that increase the risk of severe illness in previously healthy people remain unknown, the WHO said in reporting on the results of a 3-day conference on the features of severe H1N1 cases. The meeting involved about 100 clinicians, virologists, and other experts at the Pan American Health Organization headquarters in Washington, DC.The ability of the virus to make young, healthy people dangerously sick has been noted for months, but the WHO put new emphasis on the phenomenon today. At the same time, the agency said pregnant women, children younger than 2 years, and people with chronic lung disease face the greatest risk of severe illness.In a statement, the WHO said the experts confirmed that the vast majority of patients around the world experience an uncomplicated flu-like illness and recover within a week, even without treatment.Patients hard to treat But concern now focuses on “small subsets of patients who rapidly develop very severe progressive pneumonia,” the agency said. “In these patients, severe pneumonia is often associated with failure of other organs, or marked worsening of underlying asthma or chronic obstructive airway disease.”These patients are hard to treat, which suggests that emergency rooms and intensive care units will bear the heaviest burden during the pandemic, the statement said. That conclusion matched the message from several medical journal reports published in the past week on hospitalized H1N1 cases.Primary viral pneumonia is the most common finding in severe cases and often causes death, the WHO said. However, bacterial infections have been found in about 30% of fatal cases—more common than previously recognized.Data from animal studies also show the virus’s ability to cause severe pneumonia. “This virus really likes the lower respiratory tract,” said the WHO’s Dr.Nikki Shindo at a press teleconference today. “That means this virus is likely to cause viral pneumonia.”Physicians who have managed severe cases “agreed that the clinical picture in severe cases is strikingly different from the disease pattern seen during epidemics of seasonal influenza,” the WHO statement said. “While people with certain underlying medical conditions, including pregnancy, are known to be at increased risk, many severe cases occur in previously healthy young people. In these patients, predisposing factors that increase the risk of severe illness are not presently understood, though research is under way.”In a separate pandemic update today, the WHO noted that about a third of intensive care unit patients with H1N1 in Australia and New Zealand had no predisposing conditions. Likewise, Canadian and Mexican researchers who recently reported on severe cases were “impressed” by the number that occurred in previously healthy people, the agency said.The latest US figures suggest that an even higher proportion of patients hit hardest by the virus were previously healthy. The Centers for Disease Control and Prevention reported this week that 45% of about 1,400 adult H1N1 patients who were hospitalized had no preexisting health problems.In severe cases, patients usually begin deteriorating about 3 to 5 days after their first symptoms, the WHO statement said. Many of them then slip into respiratory failure, requiring admission to an ICU and ventilatory support. Some patients don’t respond well to conventional ventilatory support, making treatment even harder.Known at-risk groupsOf groups with conditions that raise the risk of severe illness, conference participants agreed that three lead the list: pregnant women, especially in the third trimester; children under the age of 2 years, and people with chronic lung disease, including asthma, the WHO reported.Disadvantaged populations, such as minority groups and indigenous people, also are disproportionately subject to severe disease, the WHO said. The reasons are not clear, but possibilities include lack of access to care and an increased prevalence of conditions like asthma and diabetes.The statement also noted that obesity—especially morbid obesity—has been present in many of the severe H1N1 cases, but its role remains poorly understood.More support for antiviralsOn the brighter side, the meeting pointed up a growing body of evidence that prompt treatment with the antiviral drugs oseltamivir and zanamivir is helpful, the WHO said.”We have increased evidence that timely antiviral treatment really helps to decrease the severe disease,” said Shindo at the press conference.Where the virus is circulating, clinicians should base antiviral treatment decisions on epidemiologic and clinical findings and not wait for lab test results, she said. “The message for clinicians is, don’t miss this opportunity for early treatment.”Shindo said the WHO has shipped antivirals from its stockpile to 72 countries so far.See also: Oct 16 WHO report on clinical consultationhttp://www.who.int/csr/disease/swineflu/notes/h1n1_clinical_features_20091016/en/index.htmlOct 16 WHO weekly update on pandemichttp://www.who.int/csr/don/2009_10_16/en/index.htmlAug 28 WHO briefing note on lessons from recent outbreakshttp://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html
The Spaniard had watched that match from high in the stands as he served out a suspension.But he played down any significance in being closer to the action as Riyad Mahrez scored twice, his first goals for the club, in an emphatic victory which kept them in touch with the Premier League pace-setters.“I don’t play,” said Guardiola, after watching Sergio Aguero, Bernardo Silva and Ilkay Gundogan help his team score five or more goals for the 10th time since he took charge before the 2016-17 season.“The managers, we are there to be there when they have little doubts, to support them.“I don’t know what’s going to happen with these guys. It’s the same group, they keep reacting, they are an exceptional group.“But they know when the situation is not good in terms of results, the closer I am to them.“They deserve all my respect. They made me happy the last two seasons, and that’s why, always, I will be with them.”City were 3-0 ahead and cruising at half-time, before Mahrez replaced Aguero on the hour mark and scored twice, his first goals since his move from Leicester in July.The Algerian has only started two Premier League games for the champions and Guardiola admitted he wished he could offer more minutes on the field to both Mahrez and young England hopeful Phil Foden, who also came off the bench in the second half.“It’s good for him to get the first goals,” added Guardiola.“Of course it’s important for him. He came here, he’s an incredibly talented player. He deserves to play more minutes, like Phil Foden.“It’s a pleasure to watch Phil play football and, of course, Riyad as well.“But the season is too long and they have to be ready, prepared, because they are going to play a lot of minutes.”– Slick City –City are now only two points behind leaders Liverpool after emphatically banishing any suggestions their European angst might leak into their domestic form.They toyed with Cardiff for much of a one-sided contest and if they had doubled their scoreline then the Bluebirds, who dropped into the relegation zone, could have had few complaints.“After a not good result in midweek, we responded with the same level we had for the last 12 or 13 months,” Guardiola said.“The first 20-25 minutes is always complicated, not easy, but after one or two goals immediately it was easier.”For Cardiff manager Neil Warnock, the defeat means they are still seeking their first victory of the campaign.They also lost full-back Lee Peltier with a dislocated shoulder, which Warnock expects will keep the defender out for a number of months.Warnock acknowledged the divide in class between the teams and added: “It was a long afternoon. We are finding it difficult at the moment against the top clubs.“But, like I have said before, it’s not going to define our season.“It will knock our chins to the floor for a bit, but the lads have got to get over this and get on with next week.”0Shares0000(Visited 1 times, 1 visits today) 0Shares0000Manchester City’s Riyad Mahrez celebrates with team-mates after scoring his second goal © AFP / Geoff CADDICKCARDIFF, United Kingdom, Sep 22 – Pep Guardiola insisted it was his players who deserved the spotlight after the Manchester City manager returned to the dug-out to inspire a 5-0 thrashing of Cardiff on Saturday.Guardiola was back on the touchline in the Welsh capital and the champions were back in the old routine after their shock midweek defeat at home by Lyon in the Champions League.