Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study
Identifieur interne : 001245 ( Istex/Corpus ); précédent : 001244; suivant : 001246Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study
Auteurs : Liam J. Donaldson ; Paul D. Rutter ; Benjamin M. Ellis ; Felix E C. Greaves ; Oliver T. Mytton ; Richard G. Pebody ; Iain E. YardleySource :
- BMJ [ 0959-8138 ] ; 2009.
English descriptors
- Teeft :
- Acute care, Acute hospitals, Antigenic shift, Antiviral, Antiviral drugs, Case definition, Case fatality, Case fatality rate, Case fatality rates, Case numbers, Causal chain, Century influenza pandemics, Clinical information, Commercial entities, Confidence interval, Confidence limit, Consultation rates, Cumulative incidence, Cumulative number, Current pandemic, Death certificate, Death certificates, Death certification, Denominator, Direct cause, Disease control, Exact test, Fatal cases, Fatality, First phase, General practitioner, Health protection, Health protection agency, Healthy people, High risk groups, Highest case fatality rate, Hour window, Incidence rate, Influenza, Influenza infection, Influenza pandemic, Influenza virus infection, Influenza viruses, Intensive care units, International classification, Interquartile range, Interquartile range days, Laboratory testing, Large numbers, Long term conditions, Lower population impact, Median, Medical attention, Mexican study, Mortality data, National statistics, Novel influenza, November, Older people, Online, Other analyses, Pandemic, Pandemic infection, Pandemic influenza, Population estimates, Population risk, Positivity rates, Previous exposure, Previous pandemics, Primary care, Primary care trusts, Public health, Public health inaction, Risk factors, Risk group, Risk groups, Seasonal influenza, Southern hemisphere, Specific case fatality rates, Substantial minority, Surveillance system, Symptomatic cases, Symptomatic pandemic, Time distribution, Vaccination, Vaccination programme, Weekly estimate, World health organization.
Abstract
Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009. Design Investigation of all reported deaths related to pandemic A/H1N1 in England. Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient. Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment. Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness. Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.
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DOI: 10.1136/bmj.b5213
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ISTEX:3ABD4D6DB7A4F2ABC0C4F3714E5E5686A9E14905Le document en format XML
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Design Investigation of all reported deaths related to pandemic A/H1N1 in England. Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient. Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment. Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness. Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</div></front></TEI><istex><corpusName>bmj</corpusName><keywords><teeft><json:string>pandemic</json:string><json:string>antiviral</json:string><json:string>fatality</json:string><json:string>antiviral drugs</json:string><json:string>case fatality rate</json:string><json:string>influenza</json:string><json:string>denominator</json:string><json:string>online</json:string><json:string>case fatality rates</json:string><json:string>november</json:string><json:string>health protection agency</json:string><json:string>acute hospitals</json:string><json:string>death certificate</json:string><json:string>death certification</json:string><json:string>death certificates</json:string><json:string>median</json:string><json:string>vaccination</json:string><json:string>case 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London SW1A 2NS</json:string></affiliations></json:item><json:item><name>Richard G Pebody</name><affiliations><json:string>Health Protection Agency, Colindale, London</json:string></affiliations></json:item><json:item><name>Iain E Yardley</name><affiliations><json:string>Department of Health, Richmond House, London SW1A 2NS</json:string></affiliations></json:item></author><articleId><json:string>donl729848</json:string></articleId><arkIstex>ark:/67375/NVC-J7433C84-3</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009. Design Investigation of all reported deaths related to pandemic A/H1N1 in England. Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient. Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment. Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness. Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</abstract><qualityIndicators><score>10</score><pdfWordCount>5758</pdfWordCount><pdfCharCount>37083</pdfCharCount><pdfVersion>1.6</pdfVersion><pdfPageCount>8</pdfPageCount><pdfPageSize>595 x 794 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>307</abstractWordCount><abstractCharCount>2024</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</title><pmid><json:string>20007665</json:string></pmid><genre><json:string>research-article</json:string></genre><host><title>BMJ</title><language><json:string>unknown</json:string></language><issn><json:string>0959-8138</json:string></issn><eissn><json:string>1468-5833</json:string></eissn><publisherId><json:string>bmj</json:string></publisherId><volume>339</volume><genre><json:string>journal</json:string></genre><subject><json:item><value>Infectious diseases</value></json:item><json:item><value>Epidemiologic studies</value></json:item><json:item><value>Vaccination programs</value></json:item><json:item><value>General practice / family medicine</value></json:item><json:item><value>Immunology (including allergy)</value></json:item><json:item><value>Child health</value></json:item></subject></host><namedEntities><unitex><date><json:string>2009</json:string><json:string>1957</json:string><json:string>2009-12-10</json:string><json:string>1918</json:string><json:string>14 and 15-24</json:string><json:string>the 20th century</json:string><json:string>1000s</json:string><json:string>20th century</json:string><json:string>2007</json:string><json:string>April-June 2009</json:string><json:string>2008</json:string><json:string>June-July 2009</json:string><json:string>April-August 2009</json:string></date><geogName></geogName><orgName><json:string>RESEARCH Week</json:string><json:string>The Health Protection Agency</json:string><json:string>Department of Health, Richmond House, London SW</json:string><json:string>NHS</json:string><json:string>Department of Health</json:string><json:string>Australia and New Zealand</json:string><json:string>England’s National Health Service</json:string><json:string>ASA</json:string><json:string>UK, England and Wales</json:string><json:string>National Surveillance System</json:string><json:string>NPFS</json:string><json:string>American Society of Anesthesiologists</json:string><json:string>National Statistics</json:string><json:string>National Pandemic Flu Service</json:string><json:string>Health Protection Agency</json:string><json:string>World Health Organization</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Ma Fat</json:string><json:string>Tara Fajeyisan</json:string><json:string>Initial</json:string><json:string>Andre Charlett</json:string><json:string>Information</json:string><json:string>Gillian Perkins</json:string><json:string>P. 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Group</publisher><availability status="free"><p>Open Access</p></availability><date>2009-12-10</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</title><author xml:id="author-0000" corresp="yes"><persName><forename type="first">Liam J</forename><surname>Donaldson</surname></persName><email>liam.donaldson@dh.gsi.gov.uk</email><note type="biography">chief medical officer for England</note><affiliation>chief medical officer for England</affiliation><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Paul D</forename><surname>Rutter</surname></persName><note type="biography">clinical adviser</note><affiliation>clinical adviser</affiliation><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Benjamin M</forename><surname>Ellis</surname></persName><note type="biography">clinical adviser</note><affiliation>clinical adviser</affiliation><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Felix E C</forename><surname>Greaves</surname></persName><note type="biography">clinical adviser</note><affiliation>clinical adviser</affiliation><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Oliver T</forename><surname>Mytton</surname></persName><note type="biography">clinical adviser</note><affiliation>clinical adviser</affiliation><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Richard G</forename><surname>Pebody</surname></persName><note type="biography">consultant medical epidemiologist</note><affiliation>consultant medical epidemiologist</affiliation><affiliation>Health Protection Agency, Colindale, London</affiliation></author><author xml:id="author-0006"><persName><forename type="first">Iain E</forename><surname>Yardley</surname></persName><note type="biography">clinical adviser</note><affiliation>clinical adviser</affiliation><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation></author><idno type="istex">3ABD4D6DB7A4F2ABC0C4F3714E5E5686A9E14905</idno><idno type="ark">ark:/67375/NVC-J7433C84-3</idno><idno type="DOI">10.1136/bmj.b5213</idno><idno type="href">bmj-339-bmj-b5213.pdf</idno><idno type="article-id">donl729848</idno><idno type="PMID">20007665</idno><idno type="local">bmj;339/dec10_1/b5213</idno></analytic><monogr><title level="j">BMJ</title><title level="j" type="abbrev">BMJ</title><idno type="pISSN">0959-8138</idno><idno type="eISSN">1468-5833</idno><idno type="publisher-id">bmj</idno><idno type="PublisherID-hwp">bmj</idno><idno type="PublisherID-nlm-ta">BMJ</idno><imprint><publisher>British Medical Journal Publishing Group</publisher><date type="published" when="2009"></date><biblScope unit="volume">339</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009-12-10</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009. Design Investigation of all reported deaths related to pandemic A/H1N1 in England. Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient. Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment. Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness. Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Infectious diseases</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Epidemiologic studies</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Vaccination programs</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>General practice / family medicine</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Immunology (including allergy)</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>hwp-journal-coll</head><item><term>Child health</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-12-10">Created</change><change when="2009">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/NVC-J7433C84-3/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">bmj</journal-id><journal-id journal-id-type="nlm-ta">BMJ</journal-id><journal-id journal-id-type="publisher-id">bmj</journal-id><journal-title>BMJ</journal-title><abbrev-journal-title abbrev-type="publisher">BMJ</abbrev-journal-title><issn pub-type="ppub">0959-8138</issn><issn pub-type="epub">1468-5833</issn><publisher><publisher-name>British Medical Journal Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">donl729848</article-id><article-id pub-id-type="doi">10.1136/bmj.b5213</article-id><article-id pub-id-type="other">bmj;339/dec10_1/b5213</article-id><article-id pub-id-type="other">bmj;bmj.b5213</article-id><article-id pub-id-type="other">dec10_1</article-id><article-id pub-id-type="pmid">20007665</article-id><article-id pub-id-type="other">bmj.b5213</article-id><article-id pub-id-type="other">bmj.b5213</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Infectious diseases</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Epidemiologic studies</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Vaccination programs</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>General practice / family medicine</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Immunology (including allergy)</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Child health</subject></subj-group></article-categories><title-group><article-title>Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Donaldson</surname><given-names>Liam J</given-names></name><role>chief medical officer for England</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Rutter</surname><given-names>Paul D</given-names></name><role>clinical adviser</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Ellis</surname><given-names>Benjamin M</given-names></name><role>clinical adviser</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Greaves</surname><given-names>Felix E C</given-names></name><role>clinical adviser</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Mytton</surname><given-names>Oliver T</given-names></name><role>clinical adviser</role><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Pebody</surname><given-names>Richard G</given-names></name><role>consultant medical epidemiologist</role><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author" corresp="no"><name><surname>Yardley</surname><given-names>Iain E</given-names></name><role>clinical adviser</role><xref ref-type="aff" rid="aff1">1</xref></contrib><aff id="aff1"><label>1</label>Department of Health, Richmond House, London SW1A 2NS</aff><aff id="aff2"><label>2</label>Health Protection Agency, Colindale, London</aff></contrib-group><author-notes><corresp>Correspondence to: L Donaldson <email>liam.donaldson@dh.gsi.gov.uk</email></corresp></author-notes><pub-date pub-type="collection"><year>2009</year></pub-date><pub-date pub-type="ppub"><year>2009</year></pub-date><pub-date pub-type="epub-original"><year>2009</year></pub-date><pub-date pub-type="epub"><day>10</day><month>12</month><year>2009</year></pub-date><volume>339</volume><volume-id pub-id-type="other">339</volume-id><volume-id pub-id-type="other">339</volume-id><elocation-id>b5213</elocation-id><history><date date-type="accepted"><day>30</day><month>November</month><year>2009</year></date></history><permissions><copyright-statement>© Donaldson et al 2009</copyright-statement><copyright-year>2009</copyright-year><copyright-holder>Donaldson et al</copyright-holder><license license-type="open-access"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/</ext-link> and <ext-link xlink:href="http://creativecommons.org/licenses/by-nc/2.0/legalcode" ext-link-type="uri">http://creativecommons.org/licenses/by-nc/2.0/legalcode</ext-link>.</p></license></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="bmj-339-bmj-b5213.pdf"></self-uri><abstract><p><bold>Objective</bold> To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009.</p><p><bold>Design</bold> Investigation of all reported deaths related to pandemic A/H1N1 in England.</p><p><bold>Setting</bold> Mandatory reporting systems established in acute hospitals and primary care. </p><p><bold>Participants </bold>Physicians responsible for the patient.</p><p><bold>Main outcome measures </bold>Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment.</p><p><bold>Results</bold> With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness.</p><p><bold>Conclusions</bold> Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Liam J</namePart><namePart type="family">Donaldson</namePart><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation><affiliation>E-mail: liam.donaldson@dh.gsi.gov.uk</affiliation><description>chief medical officer for England</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Paul D</namePart><namePart type="family">Rutter</namePart><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation><description>clinical adviser</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Benjamin M</namePart><namePart type="family">Ellis</namePart><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation><description>clinical adviser</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Felix E C</namePart><namePart type="family">Greaves</namePart><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation><description>clinical adviser</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Oliver T</namePart><namePart type="family">Mytton</namePart><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation><description>clinical adviser</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Richard G</namePart><namePart type="family">Pebody</namePart><affiliation>Health Protection Agency, Colindale, London</affiliation><description>consultant medical epidemiologist</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Iain E</namePart><namePart type="family">Yardley</namePart><affiliation>Department of Health, Richmond House, London SW1A 2NS</affiliation><description>clinical adviser</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>British Medical Journal Publishing Group</publisher><dateIssued encoding="w3cdtf">2009</dateIssued><dateCreated encoding="w3cdtf">2009-12-10</dateCreated><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract>Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009. Design Investigation of all reported deaths related to pandemic A/H1N1 in England. Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient. Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment. Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness. Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</abstract><relatedItem type="host"><titleInfo><title>BMJ</title></titleInfo><titleInfo type="abbreviated"><title>BMJ</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>hwp-journal-coll</genre><topic>Infectious diseases</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Epidemiologic studies</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Vaccination programs</topic></subject><subject><genre>hwp-journal-coll</genre><topic>General practice / family medicine</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Immunology (including allergy)</topic></subject><subject><genre>hwp-journal-coll</genre><topic>Child health</topic></subject><identifier type="ISSN">0959-8138</identifier><identifier type="eISSN">1468-5833</identifier><identifier type="PublisherID">bmj</identifier><identifier type="PublisherID-hwp">bmj</identifier><identifier type="PublisherID-nlm-ta">BMJ</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>339</number></detail></part></relatedItem><identifier type="istex">3ABD4D6DB7A4F2ABC0C4F3714E5E5686A9E14905</identifier><identifier type="ark">ark:/67375/NVC-J7433C84-3</identifier><identifier type="DOI">10.1136/bmj.b5213</identifier><identifier type="href">bmj-339-bmj-b5213.pdf</identifier><identifier type="ArticleID">donl729848</identifier><identifier type="PMID">20007665</identifier><identifier type="local">bmj;339/dec10_1/b5213</identifier><accessCondition type="use and reproduction" contentType="open-access">This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. 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