1. A model of outhospital management of H1N1v influenza epidemic by SOS Doctors in Greece. Spyridon G. Barbas, MD, Theodore Spiropoulos, MD, George Peppas,MD, George Theocharis, MD

2. Pandemic 2009 influenza A (H1N1v) - Virus Infection epidemiology  H1N1 influenza was a major concern in every country of the world in 2009.  17.700 deaths were reported to World Health Organization due to influenza H1N1.  In USA 59.000.000 illnesses, 265.000 hospitalizations,12.000 deaths due to influenza were reported from CDC.  In Greece 18.830 laboratory confirmed cases, 149 deaths due to influenza were reported from KEEL, equivalent of CDC.

3. H1N1v Virus infection burden Influenza is an important clinical entity with significant burden in community:  Increased indirect cost from work or school absenteeism.  Increased medical costs because of the excess of hospitalizations, drug prescriptions and outpatients visits.  Excessive morbidity and significant mortality.

4. H1N1v influenza clinical characteristics  Most cases of 2009 H1N1 virus have been acute and self-limited.  Highest incidence was reported among children and young adults.  Low incidence in people older than 60 years.

5. Outhospital management of H1N1v influenza  H1N1 influenza is an acute and self-limited illness, that rarely necessitates hospitalization. The high rate of transmission of H1N1 combined to the overcrowding of Emergency Medicine Departments shows that outhospital management of influenza is rational and probably cost effective.  House calls remain in Europe and Greece a valuable practice that is well accepted from patients and physicians.  In big European cities there are organized medical systems that provide emergency home visits on 24 hour basis.

6. SOS Doctors of Athens, Greece SOS Doctors is an organized provider of home visits in Athens, that operates since 1993 and performs currently about 40.000 home visits per year. About 75% of cases can be characterized as emergency medical cases.

7. Model of SOS Doctors  Call center with medical coordinator on line 24 hours a day.  Specialized doctors perform emergency home visits with properly equipped vehicles.  Performing blood tests, x-rays, total body ultra sound and other tests immediately in patient’ s home.  Rapid Point Of Care diagnostic tests.  Provision of hospital type care at home.  Secondary hospital of reference

8. RESULTS Acute Respiratory infections, including influenza, for the period 1997-2010 according to the SOS Doctors’ registry

9. Acute Respiratory infections(influenza activity) for the period 12/2008-2/2010 according to the SOS Doctors’ house calls

10. H1N1 influenza epidemic in Athens occurred mainly during the period 1/11/2009-30/04/2010

11. Diagnosis of influenza with rapid test performed during house call

12. Age groups of H1N1 pts according to SOS DOCTORS

13. The percentage of patients with acute respiratory infections, during the H1N1v epidemic wave, on the total cases was 23,02%

14. The percentage of positive influenza rapid test performed during house calls was 34.9%

15. The percentage of hospitalization after home visit for acute respiratory infection was 1.65%

16. The percentage of hospitalization in patients with positive influenza H1N1 was 1.8%

17. Experience of SOS Doctors in outhospital management of influenza  During the last ten years we have managed 31.058 cases of acute respiratory infections, including influenza, with small percentage (2,4%) of hospitalization.  Every year we have to be prepared for the next epidemic wave of influenza, because of the excessive demand of home visits during this period.  Most cases of H1N1 were people between 15-40 years old.  Rapid influenza test was used by doctors and was accepted as a necessary diagnostic option in contrast to our previous experience.

18. Conclusion  Most of cases infected by H1N1 influenza do not need hospitalization.  In our study, outhospital management of H1N1 infection seems to be effective.  It provides avoidance of unnecessary hospital visits while it minimizes the risk of nosocomial infections and outpatient department overcrowding.