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Week of March 21, 2010 < Back ¦ 2010 ¦ Home

Hot Paper in Medicine

"Emergence of a novel swine-origin influenza A (H1N1) virus in humans," by the Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team (F.S. Dawood, et al.), New England Journal of Medicine, 360(25): 2605-15, 18 June 2009.

[Authors affiliation (writing group): Centers for Disease Control and Prevention, Atlanta, GA]

Abstract: "BACKGROUND On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U. S. outbreak.

METHODS Enhanced surveillance was implemented in the United States for human infection with influenza A viruses that could not be subtyped. Specimens were sent to the Centers for Disease Control and Prevention for real-time reverse-transcriptase-polymerase chain-reaction confirmatory testing for S-OIV.

RESULTS From April 15 through May 5, a total of 642 confirmed cases of S-OIV infection were identified in 41 states. The ages of patients ranged from 3 months to 81 years; 60% of patients were 18 years of age or younger. Of patients with available data, 18% had recently traveled to Mexico, and 16% were identified from school outbreaks of S-OIV infection. The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%); 25% of patients had diarrhea, and 25% had vomiting. Of the 399 patients for whom hospitalization status was known, 36 (9%) required hospitalization. Of 22 hospitalized patients with available data, 12 had characteristics that conferred an increased risk of severe seasonal influenza, 11 had pneumonia, 8 required admission to an intensive care unit, 4 had respiratory failure, and 2 died. The S-OIV was determined to have a unique genome composition that had not been identified previously.

CONCLUSIONS A novel swine-origin influenza A virus was identified as the cause of outbreaks of febrile respiratory infection ranging from self-limited to severe illness. It is likely that the number of confirmed cases underestimates the number of cases that have occurred."

This 2009 report from the New England Journal of Medicine was cited 81 times in current journal articles indexed by Clarivate Analytics during November-December 2009. Only one other medicine paper published in the last two years, aside from reviews, collected a greater number of citations during that two-month period. In fact, this report ranked in the top ten of papers published in 2009 that were most cited by year's end--an impressive feat, given that it did not appear until June. Prior to the most recent bimonthly count, citations to the paper have accrued as follows:

September-October 2009: 30 citations
July-August 2009: 19

Total citations to date: 130

SOURCE: Hot Papers Database (Included with a subscription to the print newsletter Science Watch®, available from the Research Services Group of Thomson Reuters. Packaged on a CD that is mailed with each Science Watch issue, the Hot Papers Database contains data on hundreds of highly cited papers published during the last two years. User interface permits searching by author, organization, journal, field, and more. Total citations, as well as citations accrued during successive bimonthly periods, can be assessed and graphed. An updated CD containing the most recent bimonthly data is mailed with every new issue of Science Watch, six times a year. The CD also includes an electronic version of the Science Watch issue in HTML format, for personal desktop access.

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