Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria

Lum, Martin; McMillan, Alison; Brook, Chris; Lester, Rosemary; Piers, Leonard S.

doi:10.5694/j.1326-5377.2009.tb02914.x

Cited by 60 publications

(59 citation statements)

References 3 publications

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“…EDs in Victoria, Australia, experienced a 30% increase in demand for services during their “containment” phase 28 . This declined to seasonal baseline rates within a few weeks with the help of community diversion influenza clinics, even as hospital and ICU admissions increased 27 . While GP consultation rates did not exceed previous years in Australia, visits to ED due to ILI slightly exceeded the 2007 influenza season in Western Australia 34 …”

Section: Resultsmentioning

confidence: 95%

“…The proportion of hospitalized patients requiring admission to an ICU ranged from 4% in Chile to 11–14% in Australia, Argentina and New Zealand (Table 1). In Victoria, Australia, the proportion was 21% (92/433) 27 . Data on hospitalizations and ICU admission were not available for South Africa.…”

Section: Resultsmentioning

confidence: 99%

“…By the end of August 2009, 71% of ECMO patients in Australia and New Zealand had survived to ICU discharge and 21% had died 40 . In Victoria, Australia, 72% of ICU admissions received mechanical ventilation and 7% required ECMO 27 …”

Section: Resultsmentioning

confidence: 99%

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Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa

Kerkhove

Mounts

Mall

et al. 2011

Influenza and Other Respiratory Viruses

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Please cite this paper as: Van Kerkhove et al. (2011) Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa. Influenza and Other Respiratory Viruses 5(6), e487–e498. Introduction and Setting Our analysis compares the most comprehensive epidemiologic and virologic surveillance data compiled to date for laboratory‐confirmed H1N1pdm patients between 1 April 2009 ‐ 31 January 2010 from five temperate countries in the Southern Hemisphere–Argentina, Australia, Chile, New Zealand, and South Africa. Objective We evaluate transmission dynamics, indicators of severity, and describe the co‐circulation of H1N1pdm with seasonal influenza viruses. Results In the five countries, H1N1pdm became the predominant influenza strain within weeks of initial detection. South Africa was unique, first experiencing a seasonal H3N2 wave, followed by a distinct H1N1pdm wave. Compared with the 2007 and 2008 influenza seasons, the peak of influenza‐like illness (ILI) activity in four of the five countries was 3‐6 times higher with peak ILI consultation rates ranging from 35/1,000 consultations/week in Australia to 275/100,000 population/week in New Zealand. Transmission was similar in all countries with the reproductive rate ranging from 1.2–1.6. The median age of patients in all countries increased with increasing severity of disease, 4–14% of all hospitalized cases required critical care, and 26–68% of fatal patients were reported to have ≥1 chronic medical condition. Compared with seasonal influenza, there was a notable downward shift in age among severe cases with the highest population‐based hospitalization rates among children <5 years old. National population‐based mortality rates ranged from 0.8–1.5/100,000. Conclusions The difficulty experienced in tracking the progress of the pandemic globally, estimating its severity early on, and comparing information across countries argues for improved routine surveillance and standardization of investigative approaches and data reporting methods.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

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Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa

Kerkhove

Mounts

Mall

et al. 2011

Influenza and Other Respiratory Viruses

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“…The pandemic paradox is that, while disease in the community appears to be mild, and the risk of hospitalisation low (reported as 0.3% for the first 10 weeks of the pandemic in Victoria 11 ), 20% of hospitalised patients required intensive care 11 . People with underlying respiratory, cardiovascular and other chronic diseases are known to have worse outcomes from influenza infection, and this has been evident with confirmed swine flu infections 11 . However, with swine flu we also see a high rate of serious disease among pregnant women 2 , 11 , 12 and people who are very overweight 11 , 13 .…”

Section: Hospitalisations: the Pandemic Paradoxmentioning

confidence: 99%

A pandemic response to a disease of predominantly seasonal intensity

Kelly

2010

Medical Journal of Australia

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From the recognition of the swine flu pandemic in late April 2009, health professionals, politicians and the public needed to know how serious pandemic (H1N1) 2009 influenza (swine flu) was in relation to other seasonal strains of influenza. The Victorian experience suggests that the circulation of pandemic (H1N1) 2009 influenza in the community was at most like influenza circulation in a season of moderate seasonal activity. We have no estimate of the total case count, but we know most infections have been mild. However, while disease in the community appears mild, and the risk of hospitalisation is low, a high proportion of patients hospitalised with swine flu required intensive care. Deaths from swine flu have not been as numerous as the modelled deaths from seasonal influenza, although people dying from swine flu are younger. Because we do not understand the laboratory‐confirmed burden of disease due to seasonal influenza (as opposed to the modelled burden of disease), we could not base our response to the pandemic on an informed comparison of seasonal and pandemic influenza. We may not have needed a pandemic response to a disease that, although it has a different footprint, has been predominantly of seasonal intensity. It is critical to accumulate quality evidence about laboratory‐confirmed influenza to guide our intervention policies for both seasonal and pandemic influenza.

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“…The magnitude of a pandemic and its consequences on the organization of a health-care system depend on several parameters and are notoriously difficult to predict [21,22]. Therefore, experiences reported during the first waves throughout the world were useful to better elaborate forecasts taking into account different attack rates and epidemic wave durations [23,24]. Data gathered in Canada during the first wave were applied to a variety of second-wave models to determine its impact on ICU and ventilator demand [21,25].…”

Section: Discussionmentioning

confidence: 99%

Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic

et al. 2012

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IntroductionThe specific burden imposed on Intensive Care Units (ICUs) during the A/H1N1 influenza 2009 pandemic has been poorly explored. An on-line screening registry allowed a daily report of ICU beds occupancy rate by flu infected patients (Flu-OR) admitted in French ICUs.MethodsWe conducted a prospective inception cohort study with results of an on-line screening registry designed for daily assessment of ICU burden.ResultsAmong the 108 centers participating to the French H1N1 research network on mechanical ventilation (REVA) - French Society of Intensive Care (SRLF) registry, 69 ICUs belonging to seven large geographical areas voluntarily participated in a website screening-registry. The aim was to daily assess the ICU beds occupancy rate by influenza-infected and non-infected patients for at least three weeks. Three hundred ninety-one critically ill infected patients were enrolled in the cohort, representing a subset of 35% of the whole French 2009 pandemic cohort; 73% were mechanically ventilated, 13% required extra corporal membrane oxygenation (ECMO) and 22% died. The global Flu-OR in these ICUs was only 7.6%, but it exceeded a predefined 15% critical threshold in 32 ICUs for a total of 103 weeks. Flu-ORs were significantly higher in University than in non-University hospitals. The peak ICU burden was poorly predicted by observations obtained at the level of large geographical areas.ConclusionsThe peak Flu-OR during the pandemic significantly exceeded a 15% critical threshold in almost half of the ICUs, with an uneven distribution with time, geographical areas and between University and non-University hospitals. An on-line assessment of Flu-OR via a simple dedicated registry may contribute to better match resources and needs.

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Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria

Cited by 60 publications

References 3 publications

Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa

Epidemiologic and virologic assessment of the 2009 influenza A (H1N1) pandemic on selected temperate countries in the Southern Hemisphere: Argentina, Australia, Chile, New Zealand and South Africa

A pandemic response to a disease of predominantly seasonal intensity

Interest of a simple on-line screening registry for measuring ICU burden related to an influenza pandemic

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