Severe, critical and fatal cases of 2009 H1N1 influenza in China

Yang, Peng; Deng, Ying; Pang, Xinghuo; Shi, Weixian; Li, Xinyu; Tian, Lili; Zhang, Yi; Wang, Xiaoli; Huang, Fang; Raina, MacIntyre C; Wang, Quanyi

doi:10.1016/j.jinf.2010.07.010

Cited by 39 publications

(31 citation statements)

References 19 publications

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“…Finally, treatment factors may have contributed to different pandemic mortality rates in the United States and Beijing. Due to limited supply of antiviral drugs in Beijing, most patients with mild influenza illness did not take neuraminidase inhibitors within 48 hours of illness onset, increasing the likelihood of severe or fatal outcomes 7. In addition, although approximately 80% of patients with severe illness from influenza A(H1N1)pdm09 in Beijing were treated with neuraminidase inhibitors at some point during the course of their illness, in most cases, treatment was not initiated within 48 hours of illness onset 7…”

Section: Discussionmentioning

confidence: 99%

“…With a resident population of nearly 20 million in 2010, it is one of the most populous cities in the world. During the 2009 H1N1 pandemic, only 10 844 laboratory‐confirmed cases of influenza A(H1N1)pdm09 and 69 deaths were reported in Beijing 7. These numbers solely represent laboratory‐confirmed influenza deaths and not decedents who might have died because of pandemic influenza but were never tested 3.…”

Section: Introductionmentioning

confidence: 99%

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Mortality burden from seasonal influenza and 2009 H1N1 pandemic influenza in Beijing, China, 2007‐2013

Wei

Greene

et al. 2017

Influenza Resp Viruses

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BackgroundData about influenza mortality burden in northern China are limited. This study estimated mortality burden in Beijing associated with seasonal influenza from 2007 to 2013 and the 2009 H1N1 pandemic.MethodsWe estimated influenza‐associated excess mortality by fitting a negative binomial model using weekly mortality data as the outcome of interest with the percent of influenza‐positive samples by type/subtype as predictor variables.ResultsFrom 2007 to 2013, an average of 2375 (CI 1002‐8688) deaths was attributed to influenza per season, accounting for 3% of all deaths. Overall, 81% of the deaths attributed to influenza occurred in adults aged ≥65 years, and the influenza‐associated mortality rate in this age group was higher than the rate among those aged <65 years (113.6 [CI 49.5‐397.4] versus 4.4 [CI 1.7‐18.6] per 100 000, P < .05). The mortality rate associated with the 2009 H1N1 pandemic in 2009/2010 was comparable to that of seasonal influenza during the seasonal years (19.9 [CI 10.4‐33.1] vs 17.2 [CI 7.2‐67.5] per 100 000). People aged <65 years represented a greater proportion of all deaths during the influenza A(H1N1)pdm09 pandemic period than during the seasonal epidemics (27.0% vs 17.7%, P < .05).ConclusionsInfluenza is an important contributor to mortality in Beijing, especially among those aged ≥65 years. These results support current policies to give priority to older adults for seasonal influenza vaccination and help to define the populations at highest risk for death that could be targeted for pandemic influenza vaccination.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mortality burden from seasonal influenza and 2009 H1N1 pandemic influenza in Beijing, China, 2007‐2013

Wei

Greene

et al. 2017

Influenza Resp Viruses

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“…The fatality rate among the patients over 65 years of age were not found to be higher, although many authors reported that being older than 65 years of age was associated with fatality [8]. According to a systematic analysis which included 44 articles on A (H1N1) pdm09, early in the pandemic the disease occurred overwhelmingly in children and younger adults, and the case fatality rate was 2.9% among confirmed patients [9].…”

Section: Discussionmentioning

confidence: 99%

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

Ergönül

Alan

et al. 2014

BMC Infect Dis

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BackgroundThe fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients.MethodsThis is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality.ResultsIn the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality.ConclusionsEarly detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

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“…The percentages of missing data were smaller for the deaths than the survivors (0.4% vs. 36% for time to death/discharge for example), suggesting that data collection was more thorough for patients who died. 210 Poeppl 2011 198 Blumental 2011 202 Yung 2011 195 Altmann 2011 185 Enstone 2011 192 del Rosal 2011 205 Nguyen-Van-Tam 2010 186 Thompson 2011 188 Miranda-Choque 2011 197 Yokota 2011 200 Moretti 2011 208 Yang 2010 191 Mickienė 2011 Results show that when the time-dependent nature of treatment is taken into account appropriately the treatment effects change direction, although none of the results is statistically significant. Adjusting for potential confounders and imputing missing data made little difference to the results.…”

Section: Meta-analysis Of Individual Patient Datamentioning

confidence: 99%

Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

Heneghan

Onakpoya

Jones

et al. 2016

Health Technol Assess

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BackgroundNeuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide.ObjectivesTo (1) describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports (CSRs) of published and unpublished randomised, placebo-controlled trials and regulatory comments; and (2) determine the effect of oseltamivir (Tamiflu®, Roche) treatment on mortality in patients with 2009A/H1N1 influenza.MethodsWe searched trial registries, electronic databases and corresponded with regulators and sponsors to identify randomised trials of NIs. We requested full CSRs and accessed regulators’ comments. We included only those trials for which we had CSRs. To examine the effects of oseltamivir on 2009A/H1N1 influenza mortality, we requested individual patient data (IPD) from corresponding authors of all included observational studies.ResultsEffect of oseltamivir and zanamivir (Relenza®, GlaxoSmithKline) in the prevention and treatment of influenza: Oseltamivir reduced the time to first alleviation of symptoms in adults by 16.8 hours [95% confidence interval (CI) 8.4 to 25.1 hours]. Zanamivir reduced the time to first alleviation of symptoms in adults by 0.60 days (95% CI 0.39 to 0.81 days). Oseltamivir reduced unverified pneumonia in adult treatment [risk difference (RD) 1.00%, 95% CI 0.22% to 1.49%]; similar findings were observed with zanamivir prophylaxis in adults (RD 0.32%, 95% CI 0.09% to 0.41%). Oseltamivir treatment of adults increased the risk of nausea (RD 3.66%, 95% CI 0.90% to 7.39%) and vomiting (RD 4.56%, 95% CI 2.39% to 7.58%). In the treatment of children, oseltamivir induced vomiting (RD 5.34%, 95% CI 1.75% to 10.29%). Both oseltamivir and zanamivir prophylaxis reduced the risk of symptomatic influenza in individuals (oseltamivir RD 3.05%, 95% CI 1.83% to 3.88%; zanamivir RD 1.98%, 95% CI 0.98% to 2.54%) and in households (oseltamivir RD 13.6%, 95% CI 9.52% to 15.47%; zanamivir RD 14.84%, 95% CI 12.18% to 16.55%). Oseltamivir increased psychiatric adverse events in the combined on- and off-treatment periods (RD 1.06%, 95% CI 0.07% to 2.76%) and the risk of headaches while on treatment (RD 3.15%, 95% CI 0.88% to 5.78%).Effect of oseltamivir on mortality in patients with 2009A/H1N1 influenza: Analysis of summary data of 30 studies as well as IPD of four studies showed evidence of time-dependent bias. After adjusting for time-dependent bias and potential confounding variables, competing risks analysis of the IPD showed insufficient evidence that oseltamivir reduced the risk of mortality (hazard ratio 1.03, 95% CI 0.64 to 1.65).ConclusionsOseltamivir and zanamivir cause small reductions in the time to first alleviation of influenza symptoms in adults. The use of oseltamivir increases the risk of nausea, vomiting, psychiatric events in adults and vomiting in children. Oseltamivir has no protective effect on mortality among patients with 2009A/H1N1 influenza. Prophylaxis with either NI may reduce symptomatic influenza in individuals and in households. The balance between benefits and harms should be considered when making decisions about use of NIs for either prophylaxis or treatment of influenza.Study registrationThis study is registered as PROSPERO CRD42012002245.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Severe, critical and fatal cases of 2009 H1N1 influenza in China

Cited by 39 publications

References 19 publications

Mortality burden from seasonal influenza and 2009 H1N1 pandemic influenza in Beijing, China, 2007‐2013

Mortality burden from seasonal influenza and 2009 H1N1 pandemic influenza in Beijing, China, 2007‐2013

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

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