The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis
Anne M. Presanis,Daniela De Angelis,Daniela De Angelis,Angela Hagy,Carrie Reed,Steven Riley,Ben S. Cooper,Lyn Finelli,Paul Biedrzycki,Marc Lipsitch +9 more
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This work uses complementary data from two US cities, Milwaukee and New York City, to assess the severity of pandemic (H1N1) 2009 influenza in the United States.Abstract:
Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data—medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York—were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%–0.096%), sCIR of 0.239% (0.134%–0.458%), and sCHR of 1.44% (0.83%–2.64%). Using self-reported ILI, we obtained estimates approximately 7–96 lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5–17 y. sCHR appears to be lowest in persons aged 5–17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn–winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0–4 and adults 18–64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed. Please see later in the article for the Editors’ Summary.read more
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Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study
Fatimah S. Dawood,A. Danielle Iuliano,Carrie Reed,Martin I. Meltzer,David K. Shay,Po Yung Cheng,Don Bandaranayake,Robert F. Breiman,W. Abdullah Brooks,W. Abdullah Brooks,Philippe Buchy,Daniel R. Feikin,Karen B. Fowler,Aubree Gordon,Aubree Gordon,Nguyen Tran Hien,Peter Horby,Q. Sue Huang,Mark A. Katz,Anand Krishnan,Renu B. Lal,Joel M. Montgomery,Kåre Mølbak,Richard Pebody,Anne M. Presanis,Hugo Razuri,Anneke Steens,Yeny Tinoco,Jacco Wallinga,Hongjie Yu,Sirenda Vong,Joseph S. Bresee,Marc-Alain Widdowson +32 more
TL;DR: The global number of deaths during the first 12 months of virus circulation in each country and the estimate of respiratory and cardiovascular mortality associated with the 2009 pandemic influenza A H1N1 was 15 times higher than reported laboratory-confirmed deaths.
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Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection.
Bautista E,Tawee Chotpitayasunondh,Zhancheng Gao,Scott A. Harper,Michael W. Shaw,Timothy M. Uyeki,Zaki,Frederick G. Hayden,David S.C. Hui,Joel Kettner,Anand Kumar,Lim M,Nikki Shindo,Charles R. Penn,Nicholson Kg +14 more
TL;DR: A review of virologic, epidemiologic, and clinical data on 2009 H1N1 virus infections and summarizes key issues for clinicians worldwide can be found in this paper, where a novel influenza A virus of swine origin caused human infection and acute respiratory illness in Mexico.
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Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis
Maria D. Van Kerkhove,Katelijn Vandemaele,Vivek Shinde,Giovanna Jaramillo-Gutierrez,Artemis Koukounari,Christl A. Donnelly,Luis O. Carlino,Rhonda Owen,Beverly Paterson,Louise Pelletier,Julie Vachon,Claudia González,Yu Hongjie,Feng Zijian,Shuk Kwan Chuang,Albert Ka-Wing Au,Silke Buda,Gérard Krause,Walter Haas,Isabelle Bonmarin,Kiyosu Taniguichi,Kensuke Nakajima,Tokuaki Shobayashi,Yoshihiro Takayama,Tomi Sunagawa,Jean-Michel Heraud,Arnaud Orelle,Ethel Palacios,Marianne A B van der Sande,C. C. H. Lieke Wielders,Darren Hunt,Jeffrey Cutter,Vernon J. Lee,Vernon J. Lee,Juno Thomas,Patricia Santa-Olalla,Maria J. Sierra-Moros,Wanna Hanshaoworakul,Kumnuan Ungchusak,Richard Pebody,Seema Jain,Anthony W. Mounts +41 more
TL;DR: This study analyzes data from 19 countries, comprising some 70,000 hospitalized patients with severe H1N1 infection, to reveal risk factors for severe pandemic influenza, which include chronic illness, cardiac disease, chronic respiratory disease, and diabetes.
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The 2009 A (H1N1) influenza virus pandemic: A review.
TL;DR: The need for an increased surveillance of influenza virus circulation in swine is outlined, and all currently registered vaccines were found to be safe and to elicit potentially protective antibody responses after the administration of a single dose of vaccine.
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Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009–April 2010)
Sundar S. Shrestha,David L. Swerdlow,Rebekah H. Borse,Vimalanand S. Prabhu,Lyn Finelli,Charisma Y. Atkins,Kwame Owusu-Edusei,Beth P. Bell,Paul S. Mead,Matthew Biggerstaff,Lynnette Brammer,Heidi A Davidson,Daniel B. Jernigan,Michael A. Jhung,Laurie Kamimoto,Toby L. Merlin,Mackenzie Nowell,Stephen C. Redd,Carrie Reed,Anne Schuchat,Martin I. Meltzer +20 more
TL;DR: In this study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza, and this results confirm the necessity of a concerted public health response to pH1N1.
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