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

被引:520
作者
Van Kerkhove, Maria D. [1 ,2 ]
Vandemaele, Katelijn A. H. [1 ]
Shinde, Vivek [1 ]
Jaramillo-Gutierrez, Giovanna [1 ]
Koukounari, Artemis [2 ]
Donnelly, Christl A. [2 ]
Carlino, Luis O. [3 ]
Owen, Rhonda [4 ]
Paterson, Beverly [4 ]
Pelletier, Louise [5 ]
Vachon, Julie [5 ]
Gonzalez, Claudia [6 ]
Yu Hongjie [7 ]
Feng Zijian [7 ]
Chuang, Shuk Kwan [8 ]
Au, Albert [8 ]
Buda, Silke [9 ]
Krause, Gerard [9 ]
Haas, Walter [9 ]
Bonmarin, Isabelle [10 ]
Taniguichi, Kiyosu [11 ]
Nakajima, Kensuke [12 ]
Shobayashi, Tokuaki [12 ]
Takayama, Yoshihiro [12 ]
Sunagawa, Tomi [11 ]
Heraud, Jean Michel [13 ]
Orelle, Arnaud [13 ]
Palacios, Ethel [14 ]
van der Sande, Marianne A. B. [15 ]
Wielders, C. C. H. Lieke [15 ]
Hunt, Darren [16 ]
Cutter, Jeffrey [17 ]
Lee, Vernon J. [18 ,19 ]
Thomas, Juno [20 ]
Santa-Olalla, Patricia [21 ]
Sierra-Moros, Maria J. [21 ]
Hanshaoworakul, Wanna [22 ]
Ungchusak, Kumnuan [22 ]
Pebody, Richard [23 ]
Jain, Seema [24 ]
Mounts, Anthony W. [1 ]
机构
[1] WHO, Global Influenza Programme, London, England
[2] Univ London Imperial Coll Sci Technol & Med, Dept Infect Dis Epidemiol, Med Res Council Ctr Outbreak Anal & Modelling, London, England
[3] Minist Salud Nac, Buenos Aires, DF, Argentina
[4] Dept Hlth & Ageing, Off Hlth Protect, Surveillance Branch, Influenza Surveillance Sect, Woden, ACT, Australia
[5] Publ Hlth Agcy Canada, Influenza Surveillance Sect, Toronto, ON, Canada
[6] Minist Salud Chile, Div Planificac Sanitaria, Dept Epidemiol, Santiago, Chile
[7] Chinese Ctr Dis Control & Prevent Beijing, Off Dis Control & Emergency Response, Beijing, Peoples R China
[8] Ctr Hlth Protect, Surveillance & Epidemiol Branch, Dept Hlth, Hong Kong, Hong Kong, Peoples R China
[9] Robert Koch Inst, Dept Infect Dis Epidemiol, D-1000 Berlin, Germany
[10] Inst Veille, Dept Malad Infect, Sanitaire, Saint Maurice, France
[11] Natl Inst Infect Dis, Infect Dis Surveillance Ctr, Tokyo, Japan
[12] Minist Hlth Labour & Welf, Tokyo, Japan
[13] Inst Pasteur Madagascar, Virol Unit, Antananarivo, Madagascar
[14] Directorate Gen Epidemiol, Mexico City, DF, Mexico
[15] Natl Inst Publ Hlth & Environm, Ctr Infect Dis Control, Epidemiol & Surveillance Unit, NL-3720 BA Bilthoven, Netherlands
[16] New Zealand Minist Hlth, Wellington, New Zealand
[17] Minist Hlth, Communicable Dis Div, Singapore, Singapore
[18] Minist Def, Biodef Ctr, Singapore, Singapore
[19] Natl Univ Singapore, Yong Loo Lin Sch Med, Dept Epidemiol & Publ Hlth, Singapore 117595, Singapore
[20] Natl Hlth Lab Serv, Natl Inst Communicable Dis, Resp Virus Unit, Epidemiol & Surveillance Unit, Johannesburg, South Africa
[21] Minist Sanidad & Polit Social, Direcc Gen Salud Publ & Sanidad Exterior, Coordinating Ctr Hlth Alerts & Emergencies, Madrid, Spain
[22] Minist Publ Hlth, Dept Dis Control, Nonthaburi, Thailand
[23] Hlth Protect Agcy, London, England
[24] Ctr Dis Control & Prevent, Epidemiol & Prevent Branch, Influenza Div, Atlanta, GA USA
基金
英国医学研究理事会;
关键词
CRITICALLY-ILL PATIENTS; PANDEMIC INFLUENZA; VIRUS-INFECTION; HOSPITALIZED-PATIENTS; A(H1N1) INFECTION; PREGNANT-WOMEN; ADULT PATIENTS; UNITED-STATES; MORTALITY; SURVEILLANCE;
D O I
10.1371/journal.pmed.1001053
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: 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. Methods and Findings: 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). Conclusions: 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.
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页数:12
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