Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis
Identifieur interne : 002173 ( Pmc/Checkpoint ); précédent : 002172; suivant : 002174Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis
Auteurs : Maria D. Van Kerkhove [Royaume-Uni] ; Katelijn A. H. Vandemaele ; Vivek Shinde ; Giovanna Jaramillo-Gutierrez ; Artemis Koukounari [Royaume-Uni] ; Christl A. Donnelly [Royaume-Uni] ; Luis O. Carlino [Argentine] ; Rhonda Owen [Australie] ; Beverly Paterson [Australie] ; Louise Pelletier [Canada] ; Julie Vachon [Canada] ; Claudia Gonzalez [Chili] ; Yu Hongjie [République populaire de Chine] ; Feng Zijian [République populaire de Chine] ; Shuk Kwan Chuang [Hong Kong] ; Albert Au [Hong Kong] ; Silke Buda [Allemagne] ; Gerard Krause [Allemagne] ; Walter Haas [Allemagne] ; Isabelle Bonmarin [France] ; Kiyosu Taniguichi [Japon] ; Kensuke Nakajima [Japon] ; Tokuaki Shobayashi [Japon] ; Yoshihiro Takayama [Japon] ; Tomi Sunagawa [Japon] ; Jean Michel Heraud [Madagascar] ; Arnaud Orelle [Madagascar] ; Ethel Palacios [Mexique] ; Marianne A. B. Van Der Sande [Pays-Bas] ; C. C. H. Lieke Wielders [Pays-Bas] ; Darren Hunt [Nouvelle-Zélande] ; Jeffrey Cutter [Singapour] ; Vernon J. Lee [Singapour] ; Juno Thomas [Afrique du Sud] ; Patricia Santa-Olalla [Espagne] ; Maria J. Sierra-Moros [Espagne] ; Wanna Hanshaoworakul [Thaïlande] ; Kumnuan Ungchusak [Thaïlande] ; Richard Pebody [Royaume-Uni] ; Seema Jain [États-Unis] ; Anthony W. MountsSource :
- PLoS Medicine [ 1549-1277 ] ; 2011.
Abstract
This study analyzes data from 19 countries (from April 2009 to Jan 2010), 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.
Url:
DOI: 10.1371/journal.pmed.1001053
PubMed: 21750667
PubMed Central: 3130021
Affiliations:
- Afrique du Sud, Allemagne, Argentine, Australie, Canada, Chili, Espagne, France, Hong Kong, Japon, Madagascar, Mexique, Nouvelle-Zélande, Pays-Bas, Royaume-Uni, République populaire de Chine, Singapour, Thaïlande, États-Unis
- Angleterre, Berlin, Communauté de Madrid, Grand Londres, Géorgie (États-Unis), Région de Kantō
- Berlin, Londres, Madrid, Tokyo
- Université nationale de Singapour
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Van Kerkhove</name><affiliation><nlm:aff id="aff1"><addr-line>Global Influenza Programme, World Health Organization</addr-line></nlm:aff><wicri:noCountry code="subfield">World Health Organization</wicri:noCountry></affiliation><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Vandemaele, Katelijn A H" sort="Vandemaele, Katelijn A H" uniqKey="Vandemaele K" first="Katelijn A. 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Donnelly</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Carlino, Luis O" sort="Carlino, Luis O" uniqKey="Carlino L" first="Luis O." last="Carlino">Luis O. Carlino</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Ministerio de Salud de la Nación, Buenos Aires, Argentina</addr-line></nlm:aff><country xml:lang="fr">Argentine</country><wicri:regionArea>Ministerio de Salud de la Nación, Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Owen, Rhonda" sort="Owen, Rhonda" uniqKey="Owen R" first="Rhonda" last="Owen">Rhonda Owen</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden</wicri:regionArea><wicri:noRegion>Woden</wicri:noRegion></affiliation></author><author><name sortKey="Paterson, Beverly" sort="Paterson, Beverly" uniqKey="Paterson B" first="Beverly" last="Paterson">Beverly Paterson</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden</wicri:regionArea><wicri:noRegion>Woden</wicri:noRegion></affiliation></author><author><name sortKey="Pelletier, Louise" sort="Pelletier, Louise" uniqKey="Pelletier L" first="Louise" last="Pelletier">Louise Pelletier</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Influenza Surveillance Section, Public Health Agency of Canada, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Influenza Surveillance Section, Public Health Agency of Canada, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Vachon, Julie" sort="Vachon, Julie" uniqKey="Vachon J" first="Julie" last="Vachon">Julie Vachon</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Influenza Surveillance Section, Public Health Agency of Canada, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Influenza Surveillance Section, Public Health Agency of Canada, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Gonzalez, Claudia" sort="Gonzalez, Claudia" uniqKey="Gonzalez C" first="Claudia" last="Gonzalez">Claudia Gonzalez</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Departamento de Epidemiología, División de Planificación Sanitaria, Ministerio de Salud de Chile, Santiago, Chile</addr-line></nlm:aff><country xml:lang="fr">Chili</country><wicri:regionArea>Departamento de Epidemiología, División de Planificación Sanitaria, Ministerio de Salud de Chile, Santiago</wicri:regionArea><wicri:noRegion>Santiago</wicri:noRegion></affiliation></author><author><name sortKey="Hongjie, Yu" sort="Hongjie, Yu" uniqKey="Hongjie Y" first="Yu" last="Hongjie">Yu Hongjie</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing</wicri:regionArea><wicri:noRegion>Chinese Center for Disease Control and Prevention Beijing</wicri:noRegion></affiliation></author><author><name sortKey="Zijian, Feng" sort="Zijian, Feng" uniqKey="Zijian F" first="Feng" last="Zijian">Feng Zijian</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing</wicri:regionArea><wicri:noRegion>Chinese Center for Disease Control and Prevention Beijing</wicri:noRegion></affiliation></author><author><name sortKey="Chuang, Shuk Kwan" sort="Chuang, Shuk Kwan" uniqKey="Chuang S" first="Shuk Kwan" last="Chuang">Shuk Kwan Chuang</name><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health, Hong Kong</addr-line></nlm:aff><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health</wicri:regionArea><wicri:noRegion>Centre for Health Protection of Department of Health</wicri:noRegion></affiliation></author><author><name sortKey="Au, Albert" sort="Au, Albert" uniqKey="Au A" first="Albert" last="Au">Albert Au</name><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health, Hong Kong</addr-line></nlm:aff><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health</wicri:regionArea><wicri:noRegion>Centre for Health Protection of Department of Health</wicri:noRegion></affiliation></author><author><name sortKey="Buda, Silke" sort="Buda, Silke" uniqKey="Buda S" first="Silke" last="Buda">Silke Buda</name><affiliation wicri:level="3"><nlm:aff id="aff9"><addr-line>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Krause, Gerard" sort="Krause, Gerard" uniqKey="Krause G" first="Gerard" last="Krause">Gerard Krause</name><affiliation wicri:level="3"><nlm:aff id="aff9"><addr-line>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Haas, Walter" sort="Haas, Walter" uniqKey="Haas W" first="Walter" last="Haas">Walter Haas</name><affiliation wicri:level="3"><nlm:aff id="aff9"><addr-line>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Bonmarin, Isabelle" sort="Bonmarin, Isabelle" uniqKey="Bonmarin I" first="Isabelle" last="Bonmarin">Isabelle Bonmarin</name><affiliation wicri:level="1"><nlm:aff id="aff10"><addr-line>Département des Maladies Infectieuses, Institut de Veille, Sanitaire, Saint-Maurice Cedex, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Département des Maladies Infectieuses, Institut de Veille, Sanitaire, Saint-Maurice Cedex</wicri:regionArea><wicri:noRegion>Saint-Maurice Cedex</wicri:noRegion><wicri:noRegion>Saint-Maurice Cedex</wicri:noRegion></affiliation></author><author><name sortKey="Taniguichi, Kiyosu" sort="Taniguichi, Kiyosu" uniqKey="Taniguichi K" first="Kiyosu" last="Taniguichi">Kiyosu Taniguichi</name><affiliation wicri:level="3"><nlm:aff id="aff11"><addr-line>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Nakajima, Kensuke" sort="Nakajima, Kensuke" uniqKey="Nakajima K" first="Kensuke" last="Nakajima">Kensuke Nakajima</name><affiliation wicri:level="3"><nlm:aff id="aff12"><addr-line>Ministry of Health, Labour and Welfare, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Ministry of Health, Labour and Welfare, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Shobayashi, Tokuaki" sort="Shobayashi, Tokuaki" uniqKey="Shobayashi T" first="Tokuaki" last="Shobayashi">Tokuaki Shobayashi</name><affiliation wicri:level="3"><nlm:aff id="aff12"><addr-line>Ministry of Health, Labour and Welfare, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Ministry of Health, Labour and Welfare, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Takayama, Yoshihiro" sort="Takayama, Yoshihiro" uniqKey="Takayama Y" first="Yoshihiro" last="Takayama">Yoshihiro Takayama</name><affiliation wicri:level="3"><nlm:aff id="aff12"><addr-line>Ministry of Health, Labour and Welfare, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Ministry of Health, Labour and Welfare, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Sunagawa, Tomi" sort="Sunagawa, Tomi" uniqKey="Sunagawa T" first="Tomi" last="Sunagawa">Tomi Sunagawa</name><affiliation wicri:level="3"><nlm:aff id="aff11"><addr-line>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Heraud, Jean Michel" sort="Heraud, Jean Michel" uniqKey="Heraud J" first="Jean Michel" last="Heraud">Jean Michel Heraud</name><affiliation wicri:level="1"><nlm:aff id="aff13"><addr-line>Virology Unit, Institut Pasteur from Madagascar, Antananarivo, Madagascar</addr-line></nlm:aff><country xml:lang="fr">Madagascar</country><wicri:regionArea>Virology Unit, Institut Pasteur from Madagascar, Antananarivo</wicri:regionArea><wicri:noRegion>Antananarivo</wicri:noRegion></affiliation></author><author><name sortKey="Orelle, Arnaud" sort="Orelle, Arnaud" uniqKey="Orelle A" first="Arnaud" last="Orelle">Arnaud Orelle</name><affiliation wicri:level="1"><nlm:aff id="aff13"><addr-line>Virology Unit, Institut Pasteur from Madagascar, Antananarivo, Madagascar</addr-line></nlm:aff><country xml:lang="fr">Madagascar</country><wicri:regionArea>Virology Unit, Institut Pasteur from Madagascar, Antananarivo</wicri:regionArea><wicri:noRegion>Antananarivo</wicri:noRegion></affiliation></author><author><name sortKey="Palacios, Ethel" sort="Palacios, Ethel" uniqKey="Palacios E" first="Ethel" last="Palacios">Ethel Palacios</name><affiliation wicri:level="1"><nlm:aff id="aff14"><addr-line>Directorate General of Epidemiology, Mexico City, Mexico</addr-line></nlm:aff><country xml:lang="fr">Mexique</country><wicri:regionArea>Directorate General of Epidemiology, Mexico City</wicri:regionArea><wicri:noRegion>Mexico City</wicri:noRegion></affiliation></author><author><name sortKey="Van Der Sande, Marianne A B" sort="Van Der Sande, Marianne A B" uniqKey="Van Der Sande M" first="Marianne A. B." last="Van Der Sande">Marianne A. B. Van Der Sande</name><affiliation wicri:level="1"><nlm:aff id="aff15"><addr-line>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands</addr-line></nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven</wicri:regionArea><wicri:noRegion>Bilthoven</wicri:noRegion></affiliation></author><author><name sortKey="Wielders, C C H Lieke" sort="Wielders, C C H Lieke" uniqKey="Wielders C" first="C. C. H. Lieke" last="Wielders">C. C. H. Lieke Wielders</name><affiliation wicri:level="1"><nlm:aff id="aff15"><addr-line>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands</addr-line></nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven</wicri:regionArea><wicri:noRegion>Bilthoven</wicri:noRegion></affiliation></author><author><name sortKey="Hunt, Darren" sort="Hunt, Darren" uniqKey="Hunt D" first="Darren" last="Hunt">Darren Hunt</name><affiliation wicri:level="1"><nlm:aff id="aff16"><addr-line>New Zealand Ministry of Health, Wellington, New Zealand</addr-line></nlm:aff><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>New Zealand Ministry of Health, Wellington</wicri:regionArea><wicri:noRegion>Wellington</wicri:noRegion></affiliation></author><author><name sortKey="Cutter, Jeffrey" sort="Cutter, Jeffrey" uniqKey="Cutter J" first="Jeffrey" last="Cutter">Jeffrey Cutter</name><affiliation wicri:level="1"><nlm:aff id="aff17"><addr-line>Communicable Diseases Division at the Ministry of Health, Singapore</addr-line></nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Communicable Diseases Division at the Ministry of Health</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Vernon J" sort="Lee, Vernon J" uniqKey="Lee V" first="Vernon J." last="Lee">Vernon J. Lee</name><affiliation wicri:level="1"><nlm:aff id="aff18"><addr-line>Biodefence Centre, Ministry of Defence, Singapore</addr-line></nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Biodefence Centre, Ministry of Defence</wicri:regionArea><wicri:noRegion>Ministry of Defence</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff19"><addr-line>Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore</addr-line></nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore</wicri:regionArea><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Thomas, Juno" sort="Thomas, Juno" uniqKey="Thomas J" first="Juno" last="Thomas">Juno Thomas</name><affiliation wicri:level="1"><nlm:aff id="aff20"><addr-line>Epidemiology and Surveillance Unit, Respiratory Virus Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Epidemiology and Surveillance Unit, Respiratory Virus Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg</wicri:regionArea><wicri:noRegion>Johannesburg</wicri:noRegion></affiliation></author><author><name sortKey="Santa Olalla, Patricia" sort="Santa Olalla, Patricia" uniqKey="Santa Olalla P" first="Patricia" last="Santa-Olalla">Patricia Santa-Olalla</name><affiliation wicri:level="3"><nlm:aff id="aff21"><addr-line>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Sierra Moros, Maria J" sort="Sierra Moros, Maria J" uniqKey="Sierra Moros M" first="Maria J." last="Sierra-Moros">Maria J. Sierra-Moros</name><affiliation wicri:level="3"><nlm:aff id="aff21"><addr-line>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Hanshaoworakul, Wanna" sort="Hanshaoworakul, Wanna" uniqKey="Hanshaoworakul W" first="Wanna" last="Hanshaoworakul">Wanna Hanshaoworakul</name><affiliation wicri:level="1"><nlm:aff id="aff22"><addr-line>Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand</addr-line></nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Department of Disease Control, Ministry of Public Health, Nonthaburi</wicri:regionArea><wicri:noRegion>Nonthaburi</wicri:noRegion></affiliation></author><author><name sortKey="Ungchusak, Kumnuan" sort="Ungchusak, Kumnuan" uniqKey="Ungchusak K" first="Kumnuan" last="Ungchusak">Kumnuan Ungchusak</name><affiliation wicri:level="1"><nlm:aff id="aff22"><addr-line>Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand</addr-line></nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Department of Disease Control, Ministry of Public Health, Nonthaburi</wicri:regionArea><wicri:noRegion>Nonthaburi</wicri:noRegion></affiliation></author><author><name sortKey="Pebody, Richard" sort="Pebody, Richard" uniqKey="Pebody R" first="Richard" last="Pebody">Richard Pebody</name><affiliation wicri:level="3"><nlm:aff id="aff23"><addr-line>Health Protection Agency, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Health Protection Agency, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Jain, Seema" sort="Jain, Seema" uniqKey="Jain S" first="Seema" last="Jain">Seema Jain</name><affiliation wicri:level="2"><nlm:aff id="aff24"><addr-line>Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Mounts, Anthony W" sort="Mounts, Anthony W" uniqKey="Mounts A" first="Anthony W." last="Mounts">Anthony W. Mounts</name><affiliation><nlm:aff id="aff1"><addr-line>Global Influenza Programme, World Health Organization</addr-line></nlm:aff><wicri:noCountry code="subfield">World Health Organization</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21750667</idno><idno type="pmc">3130021</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130021</idno><idno type="RBID">PMC:3130021</idno><idno type="doi">10.1371/journal.pmed.1001053</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">002891</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002891</idno><idno type="wicri:Area/Pmc/Curation">002741</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002741</idno><idno type="wicri:Area/Pmc/Checkpoint">002173</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002173</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis</title><author><name sortKey="Van Kerkhove, Maria D" sort="Van Kerkhove, Maria D" uniqKey="Van Kerkhove M" first="Maria D." last="Van Kerkhove">Maria D. Van Kerkhove</name><affiliation><nlm:aff id="aff1"><addr-line>Global Influenza Programme, World Health Organization</addr-line></nlm:aff><wicri:noCountry code="subfield">World Health Organization</wicri:noCountry></affiliation><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Vandemaele, Katelijn A H" sort="Vandemaele, Katelijn A H" uniqKey="Vandemaele K" first="Katelijn A. H." last="Vandemaele">Katelijn A. H. Vandemaele</name><affiliation><nlm:aff id="aff1"><addr-line>Global Influenza Programme, World Health Organization</addr-line></nlm:aff><wicri:noCountry code="subfield">World Health Organization</wicri:noCountry></affiliation></author><author><name sortKey="Shinde, Vivek" sort="Shinde, Vivek" uniqKey="Shinde V" first="Vivek" last="Shinde">Vivek Shinde</name><affiliation><nlm:aff id="aff1"><addr-line>Global Influenza Programme, World Health Organization</addr-line></nlm:aff><wicri:noCountry code="subfield">World Health Organization</wicri:noCountry></affiliation></author><author><name sortKey="Jaramillo Gutierrez, Giovanna" sort="Jaramillo Gutierrez, Giovanna" uniqKey="Jaramillo Gutierrez G" first="Giovanna" last="Jaramillo-Gutierrez">Giovanna Jaramillo-Gutierrez</name><affiliation><nlm:aff id="aff1"><addr-line>Global Influenza Programme, World Health Organization</addr-line></nlm:aff><wicri:noCountry code="subfield">World Health Organization</wicri:noCountry></affiliation></author><author><name sortKey="Koukounari, Artemis" sort="Koukounari, Artemis" uniqKey="Koukounari A" first="Artemis" last="Koukounari">Artemis Koukounari</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Donnelly, Christl A" sort="Donnelly, Christl A" uniqKey="Donnelly C" first="Christl A." last="Donnelly">Christl A. Donnelly</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Carlino, Luis O" sort="Carlino, Luis O" uniqKey="Carlino L" first="Luis O." last="Carlino">Luis O. Carlino</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Ministerio de Salud de la Nación, Buenos Aires, Argentina</addr-line></nlm:aff><country xml:lang="fr">Argentine</country><wicri:regionArea>Ministerio de Salud de la Nación, Buenos Aires</wicri:regionArea><wicri:noRegion>Buenos Aires</wicri:noRegion></affiliation></author><author><name sortKey="Owen, Rhonda" sort="Owen, Rhonda" uniqKey="Owen R" first="Rhonda" last="Owen">Rhonda Owen</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden</wicri:regionArea><wicri:noRegion>Woden</wicri:noRegion></affiliation></author><author><name sortKey="Paterson, Beverly" sort="Paterson, Beverly" uniqKey="Paterson B" first="Beverly" last="Paterson">Beverly Paterson</name><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden</wicri:regionArea><wicri:noRegion>Woden</wicri:noRegion></affiliation></author><author><name sortKey="Pelletier, Louise" sort="Pelletier, Louise" uniqKey="Pelletier L" first="Louise" last="Pelletier">Louise Pelletier</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Influenza Surveillance Section, Public Health Agency of Canada, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Influenza Surveillance Section, Public Health Agency of Canada, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Vachon, Julie" sort="Vachon, Julie" uniqKey="Vachon J" first="Julie" last="Vachon">Julie Vachon</name><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Influenza Surveillance Section, Public Health Agency of Canada, Ontario, Canada</addr-line></nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Influenza Surveillance Section, Public Health Agency of Canada, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Gonzalez, Claudia" sort="Gonzalez, Claudia" uniqKey="Gonzalez C" first="Claudia" last="Gonzalez">Claudia Gonzalez</name><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Departamento de Epidemiología, División de Planificación Sanitaria, Ministerio de Salud de Chile, Santiago, Chile</addr-line></nlm:aff><country xml:lang="fr">Chili</country><wicri:regionArea>Departamento de Epidemiología, División de Planificación Sanitaria, Ministerio de Salud de Chile, Santiago</wicri:regionArea><wicri:noRegion>Santiago</wicri:noRegion></affiliation></author><author><name sortKey="Hongjie, Yu" sort="Hongjie, Yu" uniqKey="Hongjie Y" first="Yu" last="Hongjie">Yu Hongjie</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing</wicri:regionArea><wicri:noRegion>Chinese Center for Disease Control and Prevention Beijing</wicri:noRegion></affiliation></author><author><name sortKey="Zijian, Feng" sort="Zijian, Feng" uniqKey="Zijian F" first="Feng" last="Zijian">Feng Zijian</name><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing</wicri:regionArea><wicri:noRegion>Chinese Center for Disease Control and Prevention Beijing</wicri:noRegion></affiliation></author><author><name sortKey="Chuang, Shuk Kwan" sort="Chuang, Shuk Kwan" uniqKey="Chuang S" first="Shuk Kwan" last="Chuang">Shuk Kwan Chuang</name><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health, Hong Kong</addr-line></nlm:aff><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health</wicri:regionArea><wicri:noRegion>Centre for Health Protection of Department of Health</wicri:noRegion></affiliation></author><author><name sortKey="Au, Albert" sort="Au, Albert" uniqKey="Au A" first="Albert" last="Au">Albert Au</name><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health, Hong Kong</addr-line></nlm:aff><country xml:lang="fr">Hong Kong</country><wicri:regionArea>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health</wicri:regionArea><wicri:noRegion>Centre for Health Protection of Department of Health</wicri:noRegion></affiliation></author><author><name sortKey="Buda, Silke" sort="Buda, Silke" uniqKey="Buda S" first="Silke" last="Buda">Silke Buda</name><affiliation wicri:level="3"><nlm:aff id="aff9"><addr-line>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Krause, Gerard" sort="Krause, Gerard" uniqKey="Krause G" first="Gerard" last="Krause">Gerard Krause</name><affiliation wicri:level="3"><nlm:aff id="aff9"><addr-line>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Haas, Walter" sort="Haas, Walter" uniqKey="Haas W" first="Walter" last="Haas">Walter Haas</name><affiliation wicri:level="3"><nlm:aff id="aff9"><addr-line>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Bonmarin, Isabelle" sort="Bonmarin, Isabelle" uniqKey="Bonmarin I" first="Isabelle" last="Bonmarin">Isabelle Bonmarin</name><affiliation wicri:level="1"><nlm:aff id="aff10"><addr-line>Département des Maladies Infectieuses, Institut de Veille, Sanitaire, Saint-Maurice Cedex, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Département des Maladies Infectieuses, Institut de Veille, Sanitaire, Saint-Maurice Cedex</wicri:regionArea><wicri:noRegion>Saint-Maurice Cedex</wicri:noRegion><wicri:noRegion>Saint-Maurice Cedex</wicri:noRegion></affiliation></author><author><name sortKey="Taniguichi, Kiyosu" sort="Taniguichi, Kiyosu" uniqKey="Taniguichi K" first="Kiyosu" last="Taniguichi">Kiyosu Taniguichi</name><affiliation wicri:level="3"><nlm:aff id="aff11"><addr-line>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Nakajima, Kensuke" sort="Nakajima, Kensuke" uniqKey="Nakajima K" first="Kensuke" last="Nakajima">Kensuke Nakajima</name><affiliation wicri:level="3"><nlm:aff id="aff12"><addr-line>Ministry of Health, Labour and Welfare, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Ministry of Health, Labour and Welfare, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Shobayashi, Tokuaki" sort="Shobayashi, Tokuaki" uniqKey="Shobayashi T" first="Tokuaki" last="Shobayashi">Tokuaki Shobayashi</name><affiliation wicri:level="3"><nlm:aff id="aff12"><addr-line>Ministry of Health, Labour and Welfare, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Ministry of Health, Labour and Welfare, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Takayama, Yoshihiro" sort="Takayama, Yoshihiro" uniqKey="Takayama Y" first="Yoshihiro" last="Takayama">Yoshihiro Takayama</name><affiliation wicri:level="3"><nlm:aff id="aff12"><addr-line>Ministry of Health, Labour and Welfare, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Ministry of Health, Labour and Welfare, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Sunagawa, Tomi" sort="Sunagawa, Tomi" uniqKey="Sunagawa T" first="Tomi" last="Sunagawa">Tomi Sunagawa</name><affiliation wicri:level="3"><nlm:aff id="aff11"><addr-line>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Heraud, Jean Michel" sort="Heraud, Jean Michel" uniqKey="Heraud J" first="Jean Michel" last="Heraud">Jean Michel Heraud</name><affiliation wicri:level="1"><nlm:aff id="aff13"><addr-line>Virology Unit, Institut Pasteur from Madagascar, Antananarivo, Madagascar</addr-line></nlm:aff><country xml:lang="fr">Madagascar</country><wicri:regionArea>Virology Unit, Institut Pasteur from Madagascar, Antananarivo</wicri:regionArea><wicri:noRegion>Antananarivo</wicri:noRegion></affiliation></author><author><name sortKey="Orelle, Arnaud" sort="Orelle, Arnaud" uniqKey="Orelle A" first="Arnaud" last="Orelle">Arnaud Orelle</name><affiliation wicri:level="1"><nlm:aff id="aff13"><addr-line>Virology Unit, Institut Pasteur from Madagascar, Antananarivo, Madagascar</addr-line></nlm:aff><country xml:lang="fr">Madagascar</country><wicri:regionArea>Virology Unit, Institut Pasteur from Madagascar, Antananarivo</wicri:regionArea><wicri:noRegion>Antananarivo</wicri:noRegion></affiliation></author><author><name sortKey="Palacios, Ethel" sort="Palacios, Ethel" uniqKey="Palacios E" first="Ethel" last="Palacios">Ethel Palacios</name><affiliation wicri:level="1"><nlm:aff id="aff14"><addr-line>Directorate General of Epidemiology, Mexico City, Mexico</addr-line></nlm:aff><country xml:lang="fr">Mexique</country><wicri:regionArea>Directorate General of Epidemiology, Mexico City</wicri:regionArea><wicri:noRegion>Mexico City</wicri:noRegion></affiliation></author><author><name sortKey="Van Der Sande, Marianne A B" sort="Van Der Sande, Marianne A B" uniqKey="Van Der Sande M" first="Marianne A. B." last="Van Der Sande">Marianne A. B. Van Der Sande</name><affiliation wicri:level="1"><nlm:aff id="aff15"><addr-line>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands</addr-line></nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven</wicri:regionArea><wicri:noRegion>Bilthoven</wicri:noRegion></affiliation></author><author><name sortKey="Wielders, C C H Lieke" sort="Wielders, C C H Lieke" uniqKey="Wielders C" first="C. C. H. Lieke" last="Wielders">C. C. H. Lieke Wielders</name><affiliation wicri:level="1"><nlm:aff id="aff15"><addr-line>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands</addr-line></nlm:aff><country xml:lang="fr" wicri:curation="lc">Pays-Bas</country><wicri:regionArea>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven</wicri:regionArea><wicri:noRegion>Bilthoven</wicri:noRegion></affiliation></author><author><name sortKey="Hunt, Darren" sort="Hunt, Darren" uniqKey="Hunt D" first="Darren" last="Hunt">Darren Hunt</name><affiliation wicri:level="1"><nlm:aff id="aff16"><addr-line>New Zealand Ministry of Health, Wellington, New Zealand</addr-line></nlm:aff><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>New Zealand Ministry of Health, Wellington</wicri:regionArea><wicri:noRegion>Wellington</wicri:noRegion></affiliation></author><author><name sortKey="Cutter, Jeffrey" sort="Cutter, Jeffrey" uniqKey="Cutter J" first="Jeffrey" last="Cutter">Jeffrey Cutter</name><affiliation wicri:level="1"><nlm:aff id="aff17"><addr-line>Communicable Diseases Division at the Ministry of Health, Singapore</addr-line></nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Communicable Diseases Division at the Ministry of Health</wicri:regionArea></affiliation></author><author><name sortKey="Lee, Vernon J" sort="Lee, Vernon J" uniqKey="Lee V" first="Vernon J." last="Lee">Vernon J. Lee</name><affiliation wicri:level="1"><nlm:aff id="aff18"><addr-line>Biodefence Centre, Ministry of Defence, Singapore</addr-line></nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Biodefence Centre, Ministry of Defence</wicri:regionArea><wicri:noRegion>Ministry of Defence</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="aff19"><addr-line>Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore</addr-line></nlm:aff><country xml:lang="fr">Singapour</country><wicri:regionArea>Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore</wicri:regionArea><orgName type="university">Université nationale de Singapour</orgName></affiliation></author><author><name sortKey="Thomas, Juno" sort="Thomas, Juno" uniqKey="Thomas J" first="Juno" last="Thomas">Juno Thomas</name><affiliation wicri:level="1"><nlm:aff id="aff20"><addr-line>Epidemiology and Surveillance Unit, Respiratory Virus Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa</addr-line></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Epidemiology and Surveillance Unit, Respiratory Virus Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg</wicri:regionArea><wicri:noRegion>Johannesburg</wicri:noRegion></affiliation></author><author><name sortKey="Santa Olalla, Patricia" sort="Santa Olalla, Patricia" uniqKey="Santa Olalla P" first="Patricia" last="Santa-Olalla">Patricia Santa-Olalla</name><affiliation wicri:level="3"><nlm:aff id="aff21"><addr-line>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Sierra Moros, Maria J" sort="Sierra Moros, Maria J" uniqKey="Sierra Moros M" first="Maria J." last="Sierra-Moros">Maria J. Sierra-Moros</name><affiliation wicri:level="3"><nlm:aff id="aff21"><addr-line>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Hanshaoworakul, Wanna" sort="Hanshaoworakul, Wanna" uniqKey="Hanshaoworakul W" first="Wanna" last="Hanshaoworakul">Wanna Hanshaoworakul</name><affiliation wicri:level="1"><nlm:aff id="aff22"><addr-line>Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand</addr-line></nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Department of Disease Control, Ministry of Public Health, Nonthaburi</wicri:regionArea><wicri:noRegion>Nonthaburi</wicri:noRegion></affiliation></author><author><name sortKey="Ungchusak, Kumnuan" sort="Ungchusak, Kumnuan" uniqKey="Ungchusak K" first="Kumnuan" last="Ungchusak">Kumnuan Ungchusak</name><affiliation wicri:level="1"><nlm:aff id="aff22"><addr-line>Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand</addr-line></nlm:aff><country xml:lang="fr">Thaïlande</country><wicri:regionArea>Department of Disease Control, Ministry of Public Health, Nonthaburi</wicri:regionArea><wicri:noRegion>Nonthaburi</wicri:noRegion></affiliation></author><author><name sortKey="Pebody, Richard" sort="Pebody, Richard" uniqKey="Pebody R" first="Richard" last="Pebody">Richard Pebody</name><affiliation wicri:level="3"><nlm:aff id="aff23"><addr-line>Health Protection Agency, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Health Protection Agency, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Jain, Seema" sort="Jain, Seema" uniqKey="Jain S" first="Seema" last="Jain">Seema Jain</name><affiliation wicri:level="2"><nlm:aff id="aff24"><addr-line>Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Mounts, Anthony W" sort="Mounts, Anthony W" uniqKey="Mounts A" first="Anthony W." last="Mounts">Anthony W. Mounts</name><affiliation><nlm:aff id="aff1"><addr-line>Global Influenza Programme, World Health Organization</addr-line></nlm:aff><wicri:noCountry code="subfield">World Health Organization</wicri:noCountry></affiliation></author></analytic><series><title level="j">PLoS Medicine</title><idno type="ISSN">1549-1277</idno><idno type="eISSN">1549-1676</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This study analyzes data from 19 countries (from April 2009 to Jan 2010), 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.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Med</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Med</journal-id><journal-id journal-id-type="publisher-id">PLoS</journal-id><journal-id journal-id-type="pmc">plosmed</journal-id><journal-title-group><journal-title>PLoS Medicine</journal-title></journal-title-group><issn pub-type="ppub">1549-1277</issn><issn pub-type="epub">1549-1676</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21750667</article-id><article-id pub-id-type="pmc">3130021</article-id><article-id pub-id-type="publisher-id">PMEDICINE-D-10-00373</article-id><article-id pub-id-type="doi">10.1371/journal.pmed.1001053</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Global Health</subject></subj-group><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Viral Diseases</subject><subj-group><subject>Influenza</subject></subj-group></subj-group></subj-group><subj-group><subject>Public Health</subject></subj-group></subj-group></article-categories><title-group><article-title>Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis</article-title><alt-title alt-title-type="running-head">Risk Factors for H1N1pdm Severity</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Van Kerkhove</surname><given-names>Maria D.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vandemaele</surname><given-names>Katelijn A. H.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Shinde</surname><given-names>Vivek</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jaramillo-Gutierrez</surname><given-names>Giovanna</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Koukounari</surname><given-names>Artemis</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Donnelly</surname><given-names>Christl A.</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Carlino</surname><given-names>Luis O.</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Owen</surname><given-names>Rhonda</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Paterson</surname><given-names>Beverly</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pelletier</surname><given-names>Louise</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vachon</surname><given-names>Julie</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gonzalez</surname><given-names>Claudia</given-names></name><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hongjie</surname><given-names>Yu</given-names></name><xref ref-type="aff" rid="aff7"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zijian</surname><given-names>Feng</given-names></name><xref ref-type="aff" rid="aff7"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chuang</surname><given-names>Shuk Kwan</given-names></name><xref ref-type="aff" rid="aff8"><sup>8</sup></xref></contrib><contrib contrib-type="author"><name><surname>Au</surname><given-names>Albert</given-names></name><xref ref-type="aff" rid="aff8"><sup>8</sup></xref></contrib><contrib contrib-type="author"><name><surname>Buda</surname><given-names>Silke</given-names></name><xref ref-type="aff" rid="aff9"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Krause</surname><given-names>Gerard</given-names></name><xref ref-type="aff" rid="aff9"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Haas</surname><given-names>Walter</given-names></name><xref ref-type="aff" rid="aff9"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bonmarin</surname><given-names>Isabelle</given-names></name><xref ref-type="aff" rid="aff10"><sup>10</sup></xref></contrib><contrib contrib-type="author"><name><surname>Taniguichi</surname><given-names>Kiyosu</given-names></name><xref ref-type="aff" rid="aff11"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Nakajima</surname><given-names>Kensuke</given-names></name><xref ref-type="aff" rid="aff12"><sup>12</sup></xref></contrib><contrib contrib-type="author"><name><surname>Shobayashi</surname><given-names>Tokuaki</given-names></name><xref ref-type="aff" rid="aff12"><sup>12</sup></xref></contrib><contrib contrib-type="author"><name><surname>Takayama</surname><given-names>Yoshihiro</given-names></name><xref ref-type="aff" rid="aff12"><sup>12</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sunagawa</surname><given-names>Tomi</given-names></name><xref ref-type="aff" rid="aff11"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Heraud</surname><given-names>Jean Michel</given-names></name><xref ref-type="aff" rid="aff13"><sup>13</sup></xref></contrib><contrib contrib-type="author"><name><surname>Orelle</surname><given-names>Arnaud</given-names></name><xref ref-type="aff" rid="aff13"><sup>13</sup></xref></contrib><contrib contrib-type="author"><name><surname>Palacios</surname><given-names>Ethel</given-names></name><xref ref-type="aff" rid="aff14"><sup>14</sup></xref></contrib><contrib contrib-type="author"><name><surname>van der Sande</surname><given-names>Marianne A. B.</given-names></name><xref ref-type="aff" rid="aff15"><sup>15</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wielders</surname><given-names>C. C. H. Lieke</given-names></name><xref ref-type="aff" rid="aff15"><sup>15</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hunt</surname><given-names>Darren</given-names></name><xref ref-type="aff" rid="aff16"><sup>16</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cutter</surname><given-names>Jeffrey</given-names></name><xref ref-type="aff" rid="aff17"><sup>17</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Vernon J.</given-names></name><xref ref-type="aff" rid="aff18"><sup>18</sup></xref><xref ref-type="aff" rid="aff19"><sup>19</sup></xref></contrib><contrib contrib-type="author"><name><surname>Thomas</surname><given-names>Juno</given-names></name><xref ref-type="aff" rid="aff20"><sup>20</sup></xref></contrib><contrib contrib-type="author"><name><surname>Santa-Olalla</surname><given-names>Patricia</given-names></name><xref ref-type="aff" rid="aff21"><sup>21</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sierra-Moros</surname><given-names>Maria J.</given-names></name><xref ref-type="aff" rid="aff21"><sup>21</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hanshaoworakul</surname><given-names>Wanna</given-names></name><xref ref-type="aff" rid="aff22"><sup>22</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ungchusak</surname><given-names>Kumnuan</given-names></name><xref ref-type="aff" rid="aff22"><sup>22</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pebody</surname><given-names>Richard</given-names></name><xref ref-type="aff" rid="aff23"><sup>23</sup></xref></contrib><contrib contrib-type="author"><name><surname>Jain</surname><given-names>Seema</given-names></name><xref ref-type="aff" rid="aff24"><sup>24</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mounts</surname><given-names>Anthony W.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><collab>on behalf of the WHO Working Group for Risk Factors for Severe H1N1pdm Infection</collab></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Global Influenza Programme, World Health Organization</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Ministerio de Salud de la Nación, Buenos Aires, Argentina</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Department of Health and Ageing, Woden, Australia</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Influenza Surveillance Section, Public Health Agency of Canada, Ontario, Canada</addr-line></aff><aff id="aff6"><label>6</label><addr-line>Departamento de Epidemiología, División de Planificación Sanitaria, Ministerio de Salud de Chile, Santiago, Chile</addr-line></aff><aff id="aff7"><label>7</label><addr-line>Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention Beijing, China</addr-line></aff><aff id="aff8"><label>8</label><addr-line>Surveillance and Epidemiology Branch, Centre for Health Protection, Centre for Health Protection of Department of Health, Hong Kong</addr-line></aff><aff id="aff9"><label>9</label><addr-line>Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany</addr-line></aff><aff id="aff10"><label>10</label><addr-line>Département des Maladies Infectieuses, Institut de Veille, Sanitaire, Saint-Maurice Cedex, France</addr-line></aff><aff id="aff11"><label>11</label><addr-line>Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan</addr-line></aff><aff id="aff12"><label>12</label><addr-line>Ministry of Health, Labour and Welfare, Tokyo, Japan</addr-line></aff><aff id="aff13"><label>13</label><addr-line>Virology Unit, Institut Pasteur from Madagascar, Antananarivo, Madagascar</addr-line></aff><aff id="aff14"><label>14</label><addr-line>Directorate General of Epidemiology, Mexico City, Mexico</addr-line></aff><aff id="aff15"><label>15</label><addr-line>Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands</addr-line></aff><aff id="aff16"><label>16</label><addr-line>New Zealand Ministry of Health, Wellington, New Zealand</addr-line></aff><aff id="aff17"><label>17</label><addr-line>Communicable Diseases Division at the Ministry of Health, Singapore</addr-line></aff><aff id="aff18"><label>18</label><addr-line>Biodefence Centre, Ministry of Defence, Singapore</addr-line></aff><aff id="aff19"><label>19</label><addr-line>Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore</addr-line></aff><aff id="aff20"><label>20</label><addr-line>Epidemiology and Surveillance Unit, Respiratory Virus Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa</addr-line></aff><aff id="aff21"><label>21</label><addr-line>Coordinating Centre for Health Alerts and Emergencies, Dirección General de Salud Pública y Sanidad Exterior Ministerio de Sanidad y Política Social, Madrid, Spain</addr-line></aff><aff id="aff22"><label>22</label><addr-line>Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand</addr-line></aff><aff id="aff23"><label>23</label><addr-line>Health Protection Agency, London, United Kingdom</addr-line></aff><aff id="aff24"><label>24</label><addr-line>Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Peiris</surname><given-names>J. S. Malik</given-names></name><role>Academic Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">The University of Hong Kong, Hong Kong</aff><author-notes><corresp id="cor1">* E-mail: <email>mountsa@who.int</email></corresp><fn fn-type="con"><p>Conceived and designed the experiments: AWM MDVK KAHV VS GJG. Analyzed the data: MDVK KAHV VS GJG AWM CAD AK. Wrote the paper: MDVK KAHV VS GJG AWM. <ext-link ext-link-type="uri" xlink:href="http://www.icmje.org/">ICMJE</ext-link> criteria for authorship read and met: MDVK KAHV VS GJG LOC RO LP JV CG YH FZ SKC AA SB GK WH IB KT KN TS YT TS JMH AO EP MABV LW DH JC VJL JT PSO MJS WH JKU RP SJ AWM CAD AK. Agree with the manuscript's results and conclusions: MDVK KAHV VS GJG LOC RO LP JV CG YH FZ SKC AA SB GK WH IB KT KN TS YT TS JMH AO EP MABV LW DH JC VJL JT PSO MJS WH JKU RP SJ AWM CAD AK. Wrote the first draft of the paper: MDVK KAHV VS GJG AWM. Reviewed and edited several versions of the manuscript: LOC RO LP JV CG YH FZ SKC AA SB GK WH IB KT KN TS YT TS JMH AO EP MABV LW DH JC VJL JT PSO MJS WH JKU RP SJ.</p></fn></author-notes><pub-date pub-type="collection"><month>7</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>5</day><month>7</month><year>2011</year></pub-date><volume>8</volume><issue>7</issue><elocation-id>e1001053</elocation-id><history><date date-type="received"><day>27</day><month>10</month><year>2010</year></date><date date-type="accepted"><day>18</day><month>5</month><year>2011</year></date></history><permissions><copyright-statement>This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.</copyright-statement><copyright-year>2011</copyright-year><license xlink:href="https://creativecommons.org/publicdomain/zero/1.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.</license-p></license></permissions><abstract abstract-type="toc"><p>This study analyzes data from 19 countries (from April 2009 to Jan 2010), 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.</p></abstract><abstract><sec><title>Background</title><p>Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its member states have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers to determine risk groups for targeted control measures.</p></sec><sec><title>Methods and Findings</title><p>Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdm patients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1 January 2010 from 19 countries or administrative regions—Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong SAR, Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom—to characterize and compare the distribution of risk factors among H1N1pdm patients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased with severity of disease. The highest per capita risk of hospitalization was among patients <5 y and 5–14 y (relative risk [RR] = 3.3 and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the age groups 50–64 y and ≥65 y (RR = 1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio of H1N1pdm deaths to hospitalizations increased with age and was the highest in the ≥65-y-old age group, indicating that while infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 y who became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reported chronic conditions increased with severity (median = 31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatal H1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion of patients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might be a risk factor for ICU admission and fatal outcome (RR = 36.3).</p></sec><sec><title>Conclusions</title><p>Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonal influenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify and protect groups at highest risk of severe outcomes.</p></sec><sec><title></title><p><italic>Please see later in the article for the Editors' Summary</italic></p></sec></abstract><abstract abstract-type="editor"><title>Editors' Summary</title><sec id="s7a1"><title>Background</title><p>In April 2009, a new strain of influenza A H1N1 was first identified in Mexico and the United States and subsequently spread around the world. In June 2009, the World Health Organization (WHO) declared a pandemic alert phase 6, which continued until August 2010. Throughout the pandemic, WHO and member states gathered information to characterize the patterns of risk associated with the new influenza A H1N1 virus infection and to assess the clinical picture. Although risk factors for severe disease following seasonal influenza infection have been well documented in many countries (for example, pregnancy; chronic medical conditions such as pulmonary, cardiovascular, renal, hepatic, neuromuscular, hematologic, and metabolic disorders; some cognitive conditions; and immunodeficiency), risk factors for severe disease following infection early in the 2009 H1N1 pandemic were largely unknown.</p></sec><sec id="s7a2"><title>Why Was This Study Done?</title><p>Many countries have recently reported data on the association between severe H1N1 influenza and a variety of underlying risk factors, but because these data are presented in different formats, making direct comparisons across countries is difficult, with no clear consensus for some conditions. Therefore, to assess the frequency and distribution of known and new potential risk factors for severe H1N1 infection, this study was conducted to collect data (from 1 April 2009 to 1 January 2010) from surveillance programs of the Ministries of Health or National Public Health Institutes in 19 countries―Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong (special administrative region), Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom.</p></sec><sec id="s7a3"><title>What Did the Researchers Do and Find?</title><p>As part of routine surveillance, countries were asked to provide risk factor data on laboratory-confirmed H1N1 in patients who were admitted to hospital, admitted to the intensive care unit (ICU), or had died because of their infection, using a standardized format. The researchers grouped potential risk conditions into four categories: age, chronic medical illnesses, pregnancy (by trimester), and other conditions that were not previously considered as risk conditions for severe influenza outcomes, such as obesity. For each risk factor (except pregnancy), the researchers calculated the percentage of each group of patients using the total number of cases reported in each severity category (hospitalization, admission to ICU, and death). To evaluate the risk associated with pregnancy, the researchers used the ratio of pregnant women to all women of childbearing age (age 15–49 years) at each level of severity to describe the differences between levels.</p><p>The researchers were able to collect data on approximately 70,000 patients requiring hospitalization, 9,700 patients admitted to the ICU, and 2,500 patients who died from H1N1 infection. The proportion of patients with H1N1 with one or more reported chronic conditions increased with severity—the median was 31.1% of hospitalized patients, 52.3% of patients admitted to the ICU, and 61.8% of patients who died. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. The proportion of patients with obesity increased with increasing disease severity—median of 6% of hospitalized patients, 11.3% of patients admitted to the ICU, and 12.0% of all deaths from H1N1.</p></sec><sec id="s7a4"><title>What Do These Findings Mean?</title><p>These findings show that risk factors for severe H1N1 infection are similar to those for seasonal influenza, with some notable differences: a substantial proportion of people with severe and fatal cases of H1N1 had pre-existing chronic illness, which indicates that the presence of chronic illness increases the likelihood of death. Cardiac disease, chronic respiratory disease, and diabetes are important risk factors for severe disease that will be especially relevant for countries with high rates of these illnesses. Approximately 2/3 of hospitalized people and 40% of people who died from H1N1 infection did not have any identified pre-existing chronic illness, but this study was not able to comprehensively assess how many of these cases had other risk factors, such as pregnancy, obesity, smoking, and alcohol misuse. Because of large differences between countries, the role of risk factors such as obesity and pregnancy need further study—although there is sufficient evidence to support vaccination and early intervention for pregnant women. Overall, the findings of this study reinforce the need to identify and target high-risk groups for interventions such as immunization, early medical advice, and use of antiviral medications.</p></sec><sec id="s7a5"><title>Additional Information</title><p>Please access these Web sites via the online version of this summary at <ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1371/journal.pmed.1001053">http://dx.doi.org/10.1371/journal.pmed.1001053</ext-link>.</p><list list-type="bullet"><list-item><p>WHO provides a <ext-link ext-link-type="uri" xlink:href="http://www.who.int/csr/disease/influenza/en/index.html">Global Alert and Response (GAR)</ext-link> with updates on a number of influenza-related topics</p></list-item><list-item><p>The US Centers for Disease Control and Prevention provides information on <ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/h1n1flu/">risk factors and H1N1</ext-link></p></list-item></list></sec></abstract><counts><page-count count="12"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Afrique du Sud</li><li>Allemagne</li><li>Argentine</li><li>Australie</li><li>Canada</li><li>Chili</li><li>Espagne</li><li>France</li><li>Hong Kong</li><li>Japon</li><li>Madagascar</li><li>Mexique</li><li>Nouvelle-Zélande</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>République populaire de Chine</li><li>Singapour</li><li>Thaïlande</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Berlin</li><li>Communauté de Madrid</li><li>Grand Londres</li><li>Géorgie (États-Unis)</li><li>Région de Kantō</li></region><settlement><li>Berlin</li><li>Londres</li><li>Madrid</li><li>Tokyo</li></settlement><orgName><li>Université nationale de Singapour</li></orgName></list><tree><noCountry><name sortKey="Jaramillo Gutierrez, Giovanna" sort="Jaramillo Gutierrez, Giovanna" uniqKey="Jaramillo Gutierrez G" first="Giovanna" last="Jaramillo-Gutierrez">Giovanna Jaramillo-Gutierrez</name><name sortKey="Mounts, Anthony W" sort="Mounts, Anthony W" uniqKey="Mounts A" first="Anthony W." last="Mounts">Anthony W. 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B." last="Van Der Sande">Marianne A. B. Van Der Sande</name></noRegion><name sortKey="Wielders, C C H Lieke" sort="Wielders, C C H Lieke" uniqKey="Wielders C" first="C. C. H. Lieke" last="Wielders">C. C. H. Lieke Wielders</name></country><country name="Nouvelle-Zélande"><noRegion><name sortKey="Hunt, Darren" sort="Hunt, Darren" uniqKey="Hunt D" first="Darren" last="Hunt">Darren Hunt</name></noRegion></country><country name="Singapour"><noRegion><name sortKey="Cutter, Jeffrey" sort="Cutter, Jeffrey" uniqKey="Cutter J" first="Jeffrey" last="Cutter">Jeffrey Cutter</name></noRegion><name sortKey="Lee, Vernon J" sort="Lee, Vernon J" uniqKey="Lee V" first="Vernon J." last="Lee">Vernon J. Lee</name><name sortKey="Lee, Vernon J" sort="Lee, Vernon J" uniqKey="Lee V" first="Vernon J." last="Lee">Vernon J. Lee</name></country><country name="Afrique du Sud"><noRegion><name sortKey="Thomas, Juno" sort="Thomas, Juno" uniqKey="Thomas J" first="Juno" last="Thomas">Juno Thomas</name></noRegion></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Santa Olalla, Patricia" sort="Santa Olalla, Patricia" uniqKey="Santa Olalla P" first="Patricia" last="Santa-Olalla">Patricia Santa-Olalla</name></region><name sortKey="Sierra Moros, Maria J" sort="Sierra Moros, Maria J" uniqKey="Sierra Moros M" first="Maria J." last="Sierra-Moros">Maria J. Sierra-Moros</name></country><country name="Thaïlande"><noRegion><name sortKey="Hanshaoworakul, Wanna" sort="Hanshaoworakul, Wanna" uniqKey="Hanshaoworakul W" first="Wanna" last="Hanshaoworakul">Wanna Hanshaoworakul</name></noRegion><name sortKey="Ungchusak, Kumnuan" sort="Ungchusak, Kumnuan" uniqKey="Ungchusak K" first="Kumnuan" last="Ungchusak">Kumnuan Ungchusak</name></country><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Jain, Seema" sort="Jain, Seema" uniqKey="Jain S" first="Seema" last="Jain">Seema Jain</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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