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        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The first case of pandemic &#40;H1N1&#41; 2009 virus infection was diagnosed in the central region of Portugal on June 16&#44; 2009&#44; in a woman infected in Canada&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of our study was&#44; first to characterize the clinical and epidemiologic aspects of all the patients with clinical manifestations included in the definition of a <span class="elsevierStyleItalic">case for investigation</span> with samples submitted to diagnosis of the pandemic &#40;H1N1&#41; 2009 virus infection&#44; in the central region of Portugal&#59; second&#44; to assess the precision of the case definition of case for <span class="elsevierStyleItalic">investigation</span> considered in the study according to the presence or the absence of fever at the moment of clinical observation&#46; We reviewed the medical records of all the patients presenting with Influenza like-illness classified as a <span class="elsevierStyleItalic">case for investigation</span> and the first cases of patients infected with the new pandemic &#40;H1N1&#41; 2009 virus&#44; diagnosed in the central region of Portugal during the pandemic period between June and August&#44; 2009&#44; were analyzed&#46; Real-time reverse-transcriptase polymerase-chain-reaction &#40;RT-PCR&#41; testing was used to confirm the pandemic &#40;H1N1&#41; 2009 virus infection&#46; Data collection was performed using a standardized paper format in agreement with the General Health Directorate&#46;</p> <span class="elsevierStyleSectionTitle">Results and discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pandemic &#40;H1N1&#41; 2009 virus infection was confirmed in 255 patients&#46; Overall&#44; median age was 23 years and 42&#46;7&#37; were included in the category of 20 to 29 years&#46; Confirmed infection in patients with less than 2 years or greater than 50 years was a rare event&#46; The first cases were imported from Europe&#44; namely France&#44; Spain and England&#46; In a second phase&#44; pandemic &#40;H1N1&#41; 2009 virus infection was acquired in the south of Portugal &#40;Algarve&#41;&#46; The incidence rate for pandemic &#40;H1N1&#41; 2009 virus infection was 10&#46;7 per 100&#44;000 persons and was different according to the district&#46; It was higher in the district of Coimbra and Guarda where the main roads are connecting to Europe&#46; The median calculated incubation period for the for pandemic &#40;H1N1&#41; 2009 virus infection was 2 days&#46; The length of the clinical manifestations until the patients sough for medical observation had a median time of 2 days&#46; All the cases were of mild to moderate severity&#46; No deaths were observed&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The early days of pandemic &#40;H1N1&#41; 2009 virus infection were characterized by cases of disease of mild to moderate severity&#44; in our region&#46; Most affected patients were young adults&#44; with the extreme ages of life being spared&#46; An early diagnosis&#44; strict isolation and treatment procedures could have slowed the spread of the infection&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O primeiro caso de infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; foi diagnosticado na regi&#227;o centro de Portugal no dia 16 de Junho de 2009&#44; numa mulher infectada no Canad&#225;&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O nosso estudo tem por objectivos&#44; em primeiro lugar caracterizar os aspectos cl&#237;nicos e epidemiol&#243;gicos de todos os doentes que tiveram manifesta&#231;&#245;es cl&#237;nicas inclu&#237;das na defini&#231;&#227;o de caso para investiga&#231;&#227;o com amostras submetidas para diagn&#243;stico da infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#59; em segundo lugar&#44; avaliar a precis&#227;o da defini&#231;&#227;o de caso para investiga&#231;&#227;o de acordo com a presen&#231;a ou aus&#234;ncia de febre no momento da observa&#231;&#227;o cl&#237;nica&#46; Efectu&#225;mos a revis&#227;o dos registos m&#233;dicos de todos os doentes classificados como caso para investiga&#231;&#227;o e analisaram-se os primeiros casos de doentes infectados com o novo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; diagnosticados na regi&#227;o centro de Portugal durante o per&#237;odo pand&#233;mico compreendido entre Junho e Agosto de 2009&#46; Foi utilizado o m&#233;todo da reac&#231;&#227;o em cadeia da polimerase de retrotranscrip&#231;&#227;o em tempo real para confirma&#231;&#227;o da infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#46; A colheita de dados foi efectuada de forma padronizada em suporte de papel de acordo com as normas da Direc&#231;&#227;o Geral de Sa&#250;de&#46;</p> <span class="elsevierStyleSectionTitle">Resultados e discuss&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; foi confirmada laboratorialmente em 255 casos&#46; A idade m&#233;dia foi de 23 anos e 42&#44;7&#37; foram inclu&#237;dos na categoria dos 20 aos 29 anos&#46; A infec&#231;&#227;o em doentes com menos de 2 anos ou mais de 50 anos foi um acontecimento raro&#46; Os primeiros casos foram importados da Europa&#58; Fran&#231;a&#44; Espanha e Inglaterra&#46; Numa segunda fase&#44; a infec&#231;&#227;o foi adquirida no sul de Portugal &#40;Algarve&#41;&#46; A taxa de incid&#234;ncia de infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009 foi de 10&#44;7 por 100 000 pessoas e foi diferente consoante o distrito&#46; Foi mais elevado no distrito de Coimbra e da Guarda onde est&#227;o as principais estradas de conex&#227;o com a Europa&#46; O per&#237;odo de incuba&#231;&#227;o calculado para a infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009 foi de 2 dias&#46; A dura&#231;&#227;o das manifesta&#231;&#245;es cl&#237;nicas at&#233; os doentes procurarem observa&#231;&#227;o m&#233;dica teve um valor mediano de 2 dias&#46; Todos os casos foram de gravidade ligeira a moderada&#44; sem casos de morte&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os dias iniciais da infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; foram caracterizados por casos de doen&#231;a com gravidade ligeira a moderada&#44; na nossa regi&#227;o&#46; Os mais afectados foram os jovens adultos&#44; com as idades extremas da vida poupadas&#46; O diagn&#243;stico precoce&#44; o isolamento estrito e o tratamento podem ter diminu&#237;do a dissemina&#231;&#227;o da infec&#231;&#227;o&#46;</p>"
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Original article
The early days of pandemic (H1N1) 2009 virus infection in the central region of Portugal
Os dias iniciais da infecção pelo vírus da gripe pandémica (H1N1) 2009 na região centro de Portugal
V. Duquea,
Corresponding author
duque.vitor@gmail.com

Corresponding author.
, E. Cordeirob, V. Motac, J. Vazd, C. Moraise, F. Rodriguesf, F. Coelhog, J. Saraiva da Cunhah, A. Meliço-Silvestrei
a Serviço de Doenças Infecciosas dos Hospitais da Universidade de Coimbra, EPE, Laboratório de Virologia dos Hospitais da Universidade de Coimbra, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
b Epidemiologia, Departamento de Saúde Pública e Planeamento, Administração Regional de Saúde do Centro, IP, Brazil
c Laboratório de Virologia, Hospitais da Universidade de Coimbra, EPE, Coimbra, Portugal
d Laboratório de Virologia, Hospitais da Universidade de Coimbra, EPE, Coimbra, Portugal
e Departamento de Diagnóstico e Terapêutica, Laboratório de Virologia, Hospitais da Universidade de Coimbra, EPE,Coimbra, Portugal
f Pediatria, Unidade de Infecciologia e Serviço de Urgência, Hospital Pediátrico de Coimbra, Coimbra, Portugal
g Comissão de Higiene e Epidemiologia Infecciosa, Serviço de Doenças Infecciosas, Hospitais da Universidade de Coimbra, EPE, Coimbra, Portugal
h Serviço de Doenças Infecciosas, Hospitais da Universidade de Coimbra, EPE, Faculdade de Medicina da Universidade de Coimbra,Coimbra, Portugal
i Área de Gestão Integrada II, Hospitais da Universidade de Coimbra, EPE, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The first case of pandemic &#40;H1N1&#41; 2009 virus infection was diagnosed in the central region of Portugal on June 16&#44; 2009&#44; in a woman infected in Canada&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of our study was&#44; first to characterize the clinical and epidemiologic aspects of all the patients with clinical manifestations included in the definition of a <span class="elsevierStyleItalic">case for investigation</span> with samples submitted to diagnosis of the pandemic &#40;H1N1&#41; 2009 virus infection&#44; in the central region of Portugal&#59; second&#44; to assess the precision of the case definition of case for <span class="elsevierStyleItalic">investigation</span> considered in the study according to the presence or the absence of fever at the moment of clinical observation&#46; We reviewed the medical records of all the patients presenting with Influenza like-illness classified as a <span class="elsevierStyleItalic">case for investigation</span> and the first cases of patients infected with the new pandemic &#40;H1N1&#41; 2009 virus&#44; diagnosed in the central region of Portugal during the pandemic period between June and August&#44; 2009&#44; were analyzed&#46; Real-time reverse-transcriptase polymerase-chain-reaction &#40;RT-PCR&#41; testing was used to confirm the pandemic &#40;H1N1&#41; 2009 virus infection&#46; Data collection was performed using a standardized paper format in agreement with the General Health Directorate&#46;</p> <span class="elsevierStyleSectionTitle">Results and discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pandemic &#40;H1N1&#41; 2009 virus infection was confirmed in 255 patients&#46; Overall&#44; median age was 23 years and 42&#46;7&#37; were included in the category of 20 to 29 years&#46; Confirmed infection in patients with less than 2 years or greater than 50 years was a rare event&#46; The first cases were imported from Europe&#44; namely France&#44; Spain and England&#46; In a second phase&#44; pandemic &#40;H1N1&#41; 2009 virus infection was acquired in the south of Portugal &#40;Algarve&#41;&#46; The incidence rate for pandemic &#40;H1N1&#41; 2009 virus infection was 10&#46;7 per 100&#44;000 persons and was different according to the district&#46; It was higher in the district of Coimbra and Guarda where the main roads are connecting to Europe&#46; The median calculated incubation period for the for pandemic &#40;H1N1&#41; 2009 virus infection was 2 days&#46; The length of the clinical manifestations until the patients sough for medical observation had a median time of 2 days&#46; All the cases were of mild to moderate severity&#46; No deaths were observed&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The early days of pandemic &#40;H1N1&#41; 2009 virus infection were characterized by cases of disease of mild to moderate severity&#44; in our region&#46; Most affected patients were young adults&#44; with the extreme ages of life being spared&#46; An early diagnosis&#44; strict isolation and treatment procedures could have slowed the spread of the infection&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introdu&#231;&#227;o</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">O primeiro caso de infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; foi diagnosticado na regi&#227;o centro de Portugal no dia 16 de Junho de 2009&#44; numa mulher infectada no Canad&#225;&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">O nosso estudo tem por objectivos&#44; em primeiro lugar caracterizar os aspectos cl&#237;nicos e epidemiol&#243;gicos de todos os doentes que tiveram manifesta&#231;&#245;es cl&#237;nicas inclu&#237;das na defini&#231;&#227;o de caso para investiga&#231;&#227;o com amostras submetidas para diagn&#243;stico da infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#59; em segundo lugar&#44; avaliar a precis&#227;o da defini&#231;&#227;o de caso para investiga&#231;&#227;o de acordo com a presen&#231;a ou aus&#234;ncia de febre no momento da observa&#231;&#227;o cl&#237;nica&#46; Efectu&#225;mos a revis&#227;o dos registos m&#233;dicos de todos os doentes classificados como caso para investiga&#231;&#227;o e analisaram-se os primeiros casos de doentes infectados com o novo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; diagnosticados na regi&#227;o centro de Portugal durante o per&#237;odo pand&#233;mico compreendido entre Junho e Agosto de 2009&#46; Foi utilizado o m&#233;todo da reac&#231;&#227;o em cadeia da polimerase de retrotranscrip&#231;&#227;o em tempo real para confirma&#231;&#227;o da infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#46; A colheita de dados foi efectuada de forma padronizada em suporte de papel de acordo com as normas da Direc&#231;&#227;o Geral de Sa&#250;de&#46;</p> <span class="elsevierStyleSectionTitle">Resultados e discuss&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; foi confirmada laboratorialmente em 255 casos&#46; A idade m&#233;dia foi de 23 anos e 42&#44;7&#37; foram inclu&#237;dos na categoria dos 20 aos 29 anos&#46; A infec&#231;&#227;o em doentes com menos de 2 anos ou mais de 50 anos foi um acontecimento raro&#46; Os primeiros casos foram importados da Europa&#58; Fran&#231;a&#44; Espanha e Inglaterra&#46; Numa segunda fase&#44; a infec&#231;&#227;o foi adquirida no sul de Portugal &#40;Algarve&#41;&#46; A taxa de incid&#234;ncia de infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009 foi de 10&#44;7 por 100 000 pessoas e foi diferente consoante o distrito&#46; Foi mais elevado no distrito de Coimbra e da Guarda onde est&#227;o as principais estradas de conex&#227;o com a Europa&#46; O per&#237;odo de incuba&#231;&#227;o calculado para a infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009 foi de 2 dias&#46; A dura&#231;&#227;o das manifesta&#231;&#245;es cl&#237;nicas at&#233; os doentes procurarem observa&#231;&#227;o m&#233;dica teve um valor mediano de 2 dias&#46; Todos os casos foram de gravidade ligeira a moderada&#44; sem casos de morte&#46;</p> <span class="elsevierStyleSectionTitle">Conclus&#245;es</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Os dias iniciais da infec&#231;&#227;o pelo v&#237;rus da gripe pand&#233;mica &#40;H1N1&#41; 2009&#44; foram caracterizados por casos de doen&#231;a com gravidade ligeira a moderada&#44; na nossa regi&#227;o&#46; Os mais afectados foram os jovens adultos&#44; com as idades extremas da vida poupadas&#46; O diagn&#243;stico precoce&#44; o isolamento estrito e o tratamento podem ter diminu&#237;do a dissemina&#231;&#227;o da infec&#231;&#227;o&#46;</p>"
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