Ity between severe and moderately ill cases (17.9 vs 16.9 ). The proportion of severe cases with the delayed hospital admission ( 3 days afterTreatmentThe median number of days from inhibitor symptom onset to hospital admission was 3 days (IQR, 1? days). Of all hospitalized patientsHospitalized Cases of 2009 H1N1 after PandemicFigure 4. Days from symptom onset to antiviral treatment initiation among Hospitalized cases with influenza A (H1N1)pdm09 infection, China, during the winter season of 2010?011 (n = 342). Bar labels in the left side of each bar denote percent of hospitalized cases within 2 Days from symptom onset to Antiviral treatment initiation. Bar labels in the right side of each bar 
denote percent 
of hospitalized cases within 4 Days from symptom onset to Antiviral treatment initiation. doi:10.1371/journal.pone.0055016.gonset) (61.6 ) was significantly higher than moderately ill cases (44.6 , P,0.001). Among non-pregnant inhibitor patients aged 2 years who used antiviral treatment, the proportion of cases with initiation within 2 days of symptom onset among severe cases was significantly lower than that among moderately ill cases (17.4 vs 34.9 , P,0.001). A multivariate analysis was conducted for non-pregnant patients aged 2 years (Table 2). Male (OR, 1.69; 95 CI, 1.09?.63), atleast one chronic medical condition (OR, 2.50; 95 CI, 1.54?4.06) and increased time between illness onset and hospital admission ( 3 days) (OR, 2.00; 95 CI, 1.30?.04) were independent risk factors for severe illness among non-pregnant cases 2 years of age. In a separate model including antiviral treatment among nonpregnant cases who were treated with antiviral therapy, initiating antiviral treatment 5 days after symptom onset (OR, 3.12; 95Table 2. Factors associated with severe illness due to influenza A (H1N1)pdm09 among non-pregnant cases aged 2 years.CharacteristicsNo. of moderately ill patients ( ) n =No. of severe patients ( ) n =Univariate* OR (95 CI) p-value0.Multivariate{ aOR (95 CI)1.69 (1.09?.63)p-value,0.Male, sex Age, years 2?7 18?9213 (62.3)132 (70.2)1.43 (0.98?.09)146 (42.7) 110 (32.2) 86 (25.2)55 (29.3) 65 (34.6) 68 (36.2) 100 (53.2)Ref 1.57 (1.01?.43) 2.10 (1.35?.27) 2.53 (1.75?.65) 0.68 ,0.01 ,0.Ref 1.06 (0.63?.80) 1.01 (0.56?.83) 2.50 (1.54?.06) 0.80 0.93 ,0.At least 1 underlying medical condition 106 (31.0) Days from symptom onset to hospital admission On symptom day 0? On symptom day 3 Days from symptom onset to antiviral treatment initiation{ On symptom day 0? On symptom day 3? On symptom day .5 51 (34.9) 35 (24.0) 60 (41.1) 189 (55.4) 152 (44.6)71 (38.4) 114 (61.6)Ref 2.00 (1.39?.88) ,0.Ref 2.00 (1.30?.04) ,0.23 (17.4) 34 (25.8) 75 (56.8) 18204824 2.15 (1.09?.23) 2.77 (1.52?.04) 0.37 ,0.01 1.64 (0.77?.49) 3.12 (1.54?.35) 0.81 ,0.*The Chi-square test was performed unless otherwise indicated. { In the multivariate analysis, none of the two-way interaction terms was significant. { Only patients who received antivirus treatment were included in the analysis. doi:10.1371/journal.pone.0055016.tHospitalized Cases of 2009 H1N1 after PandemicCI, 1.54?.35) was associated with the severe illness compared with antiviral treatment initiation within 2 days from symptom onset, but initiating antiviral treatment 3? days from symptom onset (OR, 1.64; 95 CI, 0.77?.49) was not statistically associated with severity.DiscussionIn this study, we observed differences in the age distribution and risk factors for severe illness between the first winter season of postpande.Ity between severe and moderately ill cases (17.9 vs 16.9 ). The proportion of severe cases with the delayed hospital admission ( 3 days afterTreatmentThe median number of days from symptom onset to hospital admission was 3 days (IQR, 1? days). Of all hospitalized patientsHospitalized Cases of 2009 H1N1 after PandemicFigure 4. Days from symptom onset to antiviral treatment initiation among Hospitalized cases with influenza A (H1N1)pdm09 infection, China, during the winter season of 2010?011 (n = 342). Bar labels in the left side of each bar denote percent of hospitalized cases within 2 Days from symptom onset to Antiviral treatment initiation. Bar labels in the right side of each bar denote percent of hospitalized cases within 4 Days from symptom onset to Antiviral treatment initiation. doi:10.1371/journal.pone.0055016.gonset) (61.6 ) was significantly higher than moderately ill cases (44.6 , P,0.001). Among non-pregnant patients aged 2 years who used antiviral treatment, the proportion of cases with initiation within 2 days of symptom onset among severe cases was significantly lower than that among moderately ill cases (17.4 vs 34.9 , P,0.001). A multivariate analysis was conducted for non-pregnant patients aged 2 years (Table 2). Male (OR, 1.69; 95 CI, 1.09?.63), atleast one chronic medical condition (OR, 2.50; 95 CI, 1.54?4.06) and increased time between illness onset and hospital admission ( 3 days) (OR, 2.00; 95 CI, 1.30?.04) were independent risk factors for severe illness among non-pregnant cases 2 years of age. In a separate model including antiviral treatment among nonpregnant cases who were treated with antiviral therapy, initiating antiviral treatment 5 days after symptom onset (OR, 3.12; 95Table 2. Factors associated with severe illness due to influenza A (H1N1)pdm09 among non-pregnant cases aged 2 years.CharacteristicsNo. of moderately ill patients ( ) n =No. of severe patients ( ) n =Univariate* OR (95 CI) p-value0.Multivariate{ aOR (95 CI)1.69 (1.09?.63)p-value,0.Male, sex Age, years 2?7 18?9213 (62.3)132 (70.2)1.43 (0.98?.09)146 (42.7) 110 (32.2) 86 (25.2)55 (29.3) 65 (34.6) 68 (36.2) 100 (53.2)Ref 1.57 (1.01?.43) 2.10 (1.35?.27) 2.53 (1.75?.65) 0.68 ,0.01 ,0.Ref 1.06 (0.63?.80) 1.01 (0.56?.83) 2.50 (1.54?.06) 0.80 0.93 ,0.At least 1 underlying medical condition 106 (31.0) Days from symptom onset to hospital admission On symptom day 0? On symptom day 3 Days from symptom onset to antiviral treatment initiation{ On symptom day 0? On symptom day 3? On symptom day .5 51 (34.9) 35 (24.0) 60 (41.1) 189 (55.4) 152 (44.6)71 (38.4) 114 (61.6)Ref 2.00 (1.39?.88) ,0.Ref 2.00 (1.30?.04) ,0.23 (17.4) 34 (25.8) 75 (56.8) 18204824 2.15 (1.09?.23) 2.77 (1.52?.04) 0.37 ,0.01 1.64 (0.77?.49) 3.12 (1.54?.35) 0.81 ,0.*The Chi-square test was performed unless otherwise indicated. { In the multivariate analysis, none of the two-way interaction terms was significant. { Only patients who received antivirus treatment were included in the analysis. doi:10.1371/journal.pone.0055016.tHospitalized Cases of 2009 H1N1 after PandemicCI, 1.54?.35) was associated with the severe illness compared with antiviral treatment initiation within 2 days from symptom onset, but initiating antiviral treatment 3? days from symptom onset (OR, 1.64; 95 CI, 0.77?.49) was not statistically associated with severity.DiscussionIn this study, we observed differences in the age distribution and risk factors for severe illness between the first winter season of postpande.
