Seminars in respiratory and critical care medicine
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During the Northern Hemisphere spring of 2009, a novel H1N1 influenza A virus emerged in Mexico, causing widespread human infection and acute critical respiratory illness. The 2009 H1N1 virus spread initially to the United States and Canada, with subsequent rapid global dissemination, leading the World Health Organization (WHO) to declare "a public health emergency of international concern" in April 2009, and upgrading the viral threat to pandemic status in June 2009. ⋯ The 2009 H1N1 pandemic led to rapid implementation of health care initiatives, including the provision of critical care services, to limit the effect of the influenza outbreak on the community. This review focuses on the critical care response to the H1N1 pandemic and examines whether the implementation of critical care services as planned a priori matched the reality of the clinical workload and the patient burden that transpired during the 2009 H1N1 influenza pandemic.
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Influenza viruses are major human pathogens with a global distribution, accounting for more than 500,000 annual deaths worldwide and with considerable impact on the quality of life and productivity of the society. Due to the limited efficacy of vaccination, antiviral drugs constitute a complementary approach in the control and prevention of influenza infections and thus play an important role in the management of influenza outbreaks and pandemics. Currently, adamantanes and neuraminidase inhibitors (NAIs) are the only two classes of anti-influenza agents approved for clinical use. ⋯ Nevertheless, oseltamivir-resistant strains have also been reported quite frequently, as in the case of seasonal H1N1 viruses that circulated between 2007 and 2009. Indeed, the emergence of drug-resistant virus variants is always a matter of concern because it could significantly compromise the usefulness of such intervention. This highlights the need for continuous monitoring of resistance markers, as well as the development of new anti-influenza drugs and combination therapies.