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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Clinical and Pathological Findings of Fatal 2009–2010 Pandemic Influenza A (H1N1) Infection in Estonia

Anaesthesiology and Intensive Care Clinic, Tartu University Hospital, Tartu, Estonia
Institute of Pathological Anatomy and Forensic Medicine, University of Tartu, Tartu, Estonia
Institute of Clinical Medicine, Tallinn University of Technology, Tallinn, Estonia
Infection Control Department, Tartu University Hospital, Tartu, Estonia
Estonian Forensic Science Institute, Tallinn, Estonia, 6Department of Microbiology, University of Tartu, Tartu, Estonia
Author to whom correspondence should be addressed.
Medicina 2012, 48(1), 7;
Received: 18 July 2011 / Accepted: 30 January 2012 / Published: 4 February 2012
The aim of this study was to analyze all deaths from A (H1N1) in Estonia during the 2009–2010 epidemic to find out the reasons of high mortality and optimize management strategies for future influenza epidemics.
Material and Methods
. A retrospective review of medical records, autopsy reports, and reassessment of autopsy slides of all fatal cases of proven A (H1N1) influenza in Estonia from October 2009 to May 2010 was carried out.
. There were a total of 21 proven fatal cases (median age, 57 years); the population mortality rate of 1.56 per 100 000 inhabitants was one of the highest in the world. Altogether, 18 of the 21 patients had known risk factors for influenza, and 3 patients were previously healthy children. Three decedents had received antiviral treatment, and none had been immunized. There were 19 decedents autopsied, with viral pneumonia (58%) being the most frequent pathological finding; 40% had evidence of bacterial superinfection. In 4 cases, influenza was not clinically suspected and was diagnosed postmortem. Influenza was the primary cause of death in 15 decedents, while in 9 cases, comorbidities played a significant role in fatal outcome. In the remaining 4 cases, another illness was considered the primary cause of death with influenza as an accompanying factor.
. High autopsy rate and liberal postmortem PCR testing enables the detection of additional A (H1N1) influenza cases, yet it might lead to overestimation of the population mortality rates, especially in a small population with low number of events. Increased vaccine coverage, vigilant diagnosing including wide PCR testing, and early more liberal use of antiviral medications during the influenza A (H1N1) epidemic may hold the potential of lowering population mortality.
Keywords: influenza A (H1N1); fatal influenza; pathological findings; antiviral therapy influenza A (H1N1); fatal influenza; pathological findings; antiviral therapy
MDPI and ACS Style

Tamme, K.; Minajeva, A.; Adamson, V.; Ristmägi, K.; Põder, J.; Lutsar, I. Clinical and Pathological Findings of Fatal 2009–2010 Pandemic Influenza A (H1N1) Infection in Estonia. Medicina 2012, 48, 7.

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