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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Rhinoviruses and coronaviruses cause significant morbidity in immunocompetent people of all ages and in patients with underlying chronic medical or immunosuppressed conditions. Newer diagnostic tests, such as polymerase chain reaction (PCR), have expanded our understanding of these respiratory viruses in clinical infections. These sensitive diagnostic tests have been used to describe new members of these virus families, such as human rhinovirus C (HRVC) and human coronavirus NL-63 (HCoV-NL63). The epidemiology of these newly described viruses will help us develop better intervention strategies.
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Respiratory syncytial virus (RSV), an enveloped RNA virus in the Paramyxovirus family, is the most important cause of lower respiratory tract infection in infants and young children, accounting for ~100,000 pediatric hospitalizations and 250 deaths annually in the United States. Despite primarily being recognized as a pediatric pathogen, RSV reinfection causes substantial disease in all adult populations, including healthy young persons, old and frail individuals, those with chronic obstructive pulmonary disease and immunocompromised patients. Most illnesses are mild in adults, but significant morbidity and mortality can develop. ⋯ Currently, specific antiviral therapy is generally reserved for severely immunocompromised patients or severe respiratory failure. The greatest promise for reducing the impact of RSV in adults may be through immunization. However, an effective vaccine for RSV is not currently available.
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Semin Respir Crit Care Med · Aug 2011
ReviewInfluenza: epidemiology, clinical features, therapy, and prevention.
Influenza A and B are important causes of respiratory illness in all age groups. Influenza causes seasonal outbreaks globally and, less commonly, pandemics. In the United States, seasonal influenza epidemics account for >200,000 hospitalizations and >30,000 deaths annually. ⋯ Vaccines are the cornerstone of influenza control. Currently, trivalent inactivated vaccine (TIV) and live attenuated influenza vaccine (LAIV) are available. These agents reduce mortality and morbidity in high-risk patients (i.e., the elderly or patients with comorbidities), and expanding the use of vaccines to healthy children and adults reduces the incidence of influenza, pneumonia, and hospitalizations due to respiratory illnesses in the community.