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Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis

Identifieur interne : 000B70 ( Main/Exploration ); précédent : 000B69; suivant : 000B71

Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis

Auteurs : Maria Van Kerkhove [Royaume-Uni] ; Katelijn Vandemaele [Suisse] ; Vivek Shinde [Suisse] ; Giovanna Jaramillo-Gutierrez [Suisse] ; Artemis Koukounari [Royaume-Uni] ; Christl Donnelly [Royaume-Uni] ; Luis 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 [République populaire de Chine] ; Albert Au [République populaire de Chine] ; 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. Lieke Wielders [Pays-Bas] ; Darren Hunt [France] ; Jeffrey Cutter [Singapour] ; Vernon Lee [Singapour] ; Juno Thomas [Afrique du Sud] ; Patricia Santa-Olalla [Espagne] ; Maria Sierra-Moros [Espagne] ; Wanna Hanshaoworakul [Thaïlande] ; Kumnuan Ungchusak [Thaïlande] ; Richard Pebody [Royaume-Uni] ; Seema Jain [Géorgie] ; Anthony W. Mounts [Suisse]

Source :

RBID : Hal:pasteur-01665262

Abstract

Background: Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its memberstates have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers todetermine risk groups for targeted control measures.Methods and Findings: Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdmpatients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1January 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, theUnited States, and the United Kingdom—to characterize and compare the distribution of risk factors among H1N1pdmpatients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased withseverity of disease. The highest per capita risk of hospitalization was among patients ,5 y and 5–14 y (relative risk [RR] = 3.3and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the agegroups 50–64 y and $65 y (RR = 1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio ofH1N1pdm deaths to hospitalizations increased with age and was the highest in the $65-y-old age group, indicating thatwhile infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 ywho became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reportedchronic conditions increased with severity (median = 31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatalH1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion ofpatients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimesterconsistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might bea risk factor for ICU admission and fatal outcome (RR = 36.3).Conclusions: Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonalinfluenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify andprotect groups at highest risk of severe outcomes.


Url:
DOI: 10.1371/journal.pmed.1001053


Affiliations:


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<addrLine>Singapore</addrLine>
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</hal:affiliation>
<country>Singapour</country>
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<author>
<name sortKey="Thomas, Juno" sort="Thomas, Juno" uniqKey="Thomas J" first="Juno" last="Thomas">Juno Thomas</name>
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<orgName>Epidemiology and Surveillance Unit, Respiratory Virus Unit</orgName>
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<orgName>National Institute for Communicable Diseases</orgName>
<orgName type="acronym">NICD</orgName>
<date type="start">1909-01-01</date>
<desc>
<address>
<addrLine>Johannesburg</addrLine>
<country key="ZA"></country>
</address>
<ref type="url">http://www.nicd.ac.za/</ref>
</desc>
</org>
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</tutelles>
</hal:affiliation>
<country>Afrique du Sud</country>
</affiliation>
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<author>
<name sortKey="Santa Olalla, Patricia" sort="Santa Olalla, Patricia" uniqKey="Santa Olalla P" first="Patricia" last="Santa-Olalla">Patricia Santa-Olalla</name>
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<orgName>Coordinating centre for Health Alerts and Emergencies</orgName>
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<address>
<country key="ES"></country>
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<tutelle active="#struct-524847" type="direct">
<org type="institution" xml:id="struct-524847" status="INCOMING">
<orgName> Direccion General de Salud Publica y Sanidad Exterior Ministerio de Sanidad y Polıtica Social</orgName>
<desc>
<address>
<addrLine>Madrid</addrLine>
<country key="ES"></country>
</address>
</desc>
</org>
</tutelle>
</tutelles>
</hal:affiliation>
<country>Espagne</country>
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</author>
<author>
<name sortKey="Sierra Moros, Maria" sort="Sierra Moros, Maria" uniqKey="Sierra Moros M" first="Maria" last="Sierra-Moros">Maria Sierra-Moros</name>
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<orgName>Coordinating centre for Health Alerts and Emergencies</orgName>
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<address>
<country key="ES"></country>
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<org type="institution" xml:id="struct-524847" status="INCOMING">
<orgName> Direccion General de Salud Publica y Sanidad Exterior Ministerio de Sanidad y Polıtica Social</orgName>
<desc>
<address>
<addrLine>Madrid</addrLine>
<country key="ES"></country>
</address>
</desc>
</org>
</tutelle>
</tutelles>
</hal:affiliation>
<country>Espagne</country>
</affiliation>
</author>
<author>
<name sortKey="Hanshaoworakul, Wanna" sort="Hanshaoworakul, Wanna" uniqKey="Hanshaoworakul W" first="Wanna" last="Hanshaoworakul">Wanna Hanshaoworakul</name>
<affiliation wicri:level="1">
<hal:affiliation type="department" xml:id="struct-407370" status="INCOMING">
<orgName>Bureau of Vector Borne Disease, Department of Disease Control</orgName>
<desc>
<address>
<country key="TH"></country>
</address>
</desc>
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<relation active="#struct-321861" type="direct"></relation>
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<tutelle active="#struct-321861" type="direct">
<org type="institution" xml:id="struct-321861" status="INCOMING">
<orgName>Ministry of Public Health - Thailande</orgName>
<desc>
<address>
<country key="FR"></country>
</address>
</desc>
</org>
</tutelle>
</tutelles>
</hal:affiliation>
<country>Thaïlande</country>
</affiliation>
</author>
<author>
<name sortKey="Ungchusak, Kumnuan" sort="Ungchusak, Kumnuan" uniqKey="Ungchusak K" first="Kumnuan" last="Ungchusak">Kumnuan Ungchusak</name>
<affiliation wicri:level="1">
<hal:affiliation type="department" xml:id="struct-407370" status="INCOMING">
<orgName>Bureau of Vector Borne Disease, Department of Disease Control</orgName>
<desc>
<address>
<country key="TH"></country>
</address>
</desc>
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<tutelle active="#struct-321861" type="direct">
<org type="institution" xml:id="struct-321861" status="INCOMING">
<orgName>Ministry of Public Health - Thailande</orgName>
<desc>
<address>
<country key="FR"></country>
</address>
</desc>
</org>
</tutelle>
</tutelles>
</hal:affiliation>
<country>Thaïlande</country>
</affiliation>
</author>
<author>
<name sortKey="Pebody, Richard" sort="Pebody, Richard" uniqKey="Pebody R" first="Richard" last="Pebody">Richard Pebody</name>
<affiliation wicri:level="1">
<hal:affiliation type="institution" xml:id="struct-92343" status="VALID">
<orgName>Health Protection Agency</orgName>
<desc>
<address>
<addrLine>London</addrLine>
<country key="GB"></country>
</address>
</desc>
</hal:affiliation>
<country>Royaume-Uni</country>
</affiliation>
</author>
<author>
<name sortKey="Jain, Seema" sort="Jain, Seema" uniqKey="Jain S" first="Seema" last="Jain">Seema Jain</name>
<affiliation wicri:level="1">
<hal:affiliation type="laboratory" xml:id="struct-267184" status="INCOMING">
<orgName>Epidemiology and Prevention Branch, Influenza Division</orgName>
<desc>
<address>
<addrLine>1600 Clifton Road NE MS A-32, Atlanta 30333, Georgia</addrLine>
<country key="GE"></country>
</address>
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<orgName>Centers for Disease Control and Prevention</orgName>
<orgName type="acronym">CDC</orgName>
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<address>
<country key="US"></country>
</address>
<ref type="url">https://www.cdc.gov/</ref>
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</hal:affiliation>
<country>Géorgie</country>
</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 wicri:level="1">
<hal:affiliation type="laboratory" xml:id="struct-216505" status="VALID">
<orgName>Global Influenza Programme</orgName>
<desc>
<address>
<addrLine>Geneva</addrLine>
<country key="CH"></country>
</address>
</desc>
<listRelation>
<relation active="#struct-548010" type="direct"></relation>
</listRelation>
<tutelles>
<tutelle active="#struct-548010" type="direct">
<org type="institution" xml:id="struct-548010" status="VALID">
<orgName>Organisation Mondiale de la Santé / World Health Organization Office</orgName>
<orgName type="acronym">OMS / WHO</orgName>
<desc>
<address>
<addrLine>Genève</addrLine>
<country key="CH"></country>
</address>
<ref type="url">https://www.who.int/</ref>
</desc>
</org>
</tutelle>
</tutelles>
</hal:affiliation>
<country>Suisse</country>
</affiliation>
</author>
</analytic>
<idno type="DOI">10.1371/journal.pmed.1001053</idno>
<series>
<title level="j">PLoS Medicine</title>
<idno type="ISSN">1549-1277</idno>
<imprint>
<date type="datePub">2011-07-05</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
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<profileDesc>
<textClass></textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">
<p>Background: Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its memberstates have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers todetermine risk groups for targeted control measures.Methods and Findings: Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdmpatients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1January 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, theUnited States, and the United Kingdom—to characterize and compare the distribution of risk factors among H1N1pdmpatients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased withseverity of disease. The highest per capita risk of hospitalization was among patients ,5 y and 5–14 y (relative risk [RR] = 3.3and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the agegroups 50–64 y and $65 y (RR = 1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio ofH1N1pdm deaths to hospitalizations increased with age and was the highest in the $65-y-old age group, indicating thatwhile infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 ywho became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reportedchronic conditions increased with severity (median = 31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatalH1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion ofpatients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimesterconsistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might bea risk factor for ICU admission and fatal outcome (RR = 36.3).Conclusions: Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonalinfluenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify andprotect groups at highest risk of severe outcomes.</p>
</div>
</front>
</TEI>
<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>Géorgie</li>
<li>Japon</li>
<li>Madagascar</li>
<li>Mexique</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>République populaire de Chine</li>
<li>Singapour</li>
<li>Suisse</li>
<li>Thaïlande</li>
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<name sortKey="Koukounari, Artemis" sort="Koukounari, Artemis" uniqKey="Koukounari A" first="Artemis" last="Koukounari">Artemis Koukounari</name>
<name sortKey="Pebody, Richard" sort="Pebody, Richard" uniqKey="Pebody R" first="Richard" last="Pebody">Richard Pebody</name>
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<name sortKey="Vandemaele, Katelijn" sort="Vandemaele, Katelijn" uniqKey="Vandemaele K" first="Katelijn" last="Vandemaele">Katelijn Vandemaele</name>
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<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. Mounts</name>
<name sortKey="Shinde, Vivek" sort="Shinde, Vivek" uniqKey="Shinde V" first="Vivek" last="Shinde">Vivek Shinde</name>
</country>
<country name="Argentine">
<noRegion>
<name sortKey="Carlino, Luis" sort="Carlino, Luis" uniqKey="Carlino L" first="Luis" last="Carlino">Luis Carlino</name>
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<noRegion>
<name sortKey="Owen, Rhonda" sort="Owen, Rhonda" uniqKey="Owen R" first="Rhonda" last="Owen">Rhonda Owen</name>
</noRegion>
<name sortKey="Paterson, Beverly" sort="Paterson, Beverly" uniqKey="Paterson B" first="Beverly" last="Paterson">Beverly Paterson</name>
</country>
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<name sortKey="Pelletier, Louise" sort="Pelletier, Louise" uniqKey="Pelletier L" first="Louise" last="Pelletier">Louise Pelletier</name>
</noRegion>
<name sortKey="Vachon, Julie" sort="Vachon, Julie" uniqKey="Vachon J" first="Julie" last="Vachon">Julie Vachon</name>
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<name sortKey="Gonzalez, Claudia" sort="Gonzalez, Claudia" uniqKey="Gonzalez C" first="Claudia" last="Gonzalez">Claudia Gonzalez</name>
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<noRegion>
<name sortKey="Hongjie, Yu" sort="Hongjie, Yu" uniqKey="Hongjie Y" first="Yu" last="Hongjie">Yu Hongjie</name>
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<name sortKey="Au, Albert" sort="Au, Albert" uniqKey="Au A" first="Albert" last="Au">Albert Au</name>
<name sortKey="Kwan Chuang, Shuk" sort="Kwan Chuang, Shuk" uniqKey="Kwan Chuang S" first="Shuk" last="Kwan Chuang">Shuk Kwan Chuang</name>
<name sortKey="Zijian, Feng" sort="Zijian, Feng" uniqKey="Zijian F" first="Feng" last="Zijian">Feng Zijian</name>
</country>
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<name sortKey="Buda, Silke" sort="Buda, Silke" uniqKey="Buda S" first="Silke" last="Buda">Silke Buda</name>
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<name sortKey="Haas, Walter" sort="Haas, Walter" uniqKey="Haas W" first="Walter" last="Haas">Walter Haas</name>
<name sortKey="Krause, Gerard" sort="Krause, Gerard" uniqKey="Krause G" first="Gerard" last="Krause">Gerard Krause</name>
</country>
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<noRegion>
<name sortKey="Bonmarin, Isabelle" sort="Bonmarin, Isabelle" uniqKey="Bonmarin I" first="Isabelle" last="Bonmarin">Isabelle Bonmarin</name>
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<name sortKey="Taniguichi, Kiyosu" sort="Taniguichi, Kiyosu" uniqKey="Taniguichi K" first="Kiyosu" last="Taniguichi">Kiyosu Taniguichi</name>
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<name sortKey="Nakajima, Kensuke" sort="Nakajima, Kensuke" uniqKey="Nakajima K" first="Kensuke" last="Nakajima">Kensuke Nakajima</name>
<name sortKey="Shobayashi, Tokuaki" sort="Shobayashi, Tokuaki" uniqKey="Shobayashi T" first="Tokuaki" last="Shobayashi">Tokuaki Shobayashi</name>
<name sortKey="Sunagawa, Tomi" sort="Sunagawa, Tomi" uniqKey="Sunagawa T" first="Tomi" last="Sunagawa">Tomi Sunagawa</name>
<name sortKey="Takayama, Yoshihiro" sort="Takayama, Yoshihiro" uniqKey="Takayama Y" first="Yoshihiro" last="Takayama">Yoshihiro Takayama</name>
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<name sortKey="Heraud, Jean Michel" sort="Heraud, Jean Michel" uniqKey="Heraud J" first="Jean-Michel" last="Heraud">Jean-Michel Heraud</name>
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<name sortKey="Palacios, Ethel" sort="Palacios, Ethel" uniqKey="Palacios E" first="Ethel" last="Palacios">Ethel Palacios</name>
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<name sortKey="Thomas, Juno" sort="Thomas, Juno" uniqKey="Thomas J" first="Juno" last="Thomas">Juno Thomas</name>
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<noRegion>
<name sortKey="Santa Olalla, Patricia" sort="Santa Olalla, Patricia" uniqKey="Santa Olalla P" first="Patricia" last="Santa-Olalla">Patricia Santa-Olalla</name>
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<name sortKey="Hanshaoworakul, Wanna" sort="Hanshaoworakul, Wanna" uniqKey="Hanshaoworakul W" first="Wanna" last="Hanshaoworakul">Wanna Hanshaoworakul</name>
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<name sortKey="Jain, Seema" sort="Jain, Seema" uniqKey="Jain S" first="Seema" last="Jain">Seema Jain</name>
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