Trends in mortality from respiratory disease in Latin America since 1998 and the impact of the 2009 influenza pandemic

Souza, Maria de Fátima Marinho de; Widdowson, Marc‐Alain; Alencar, Airlane Pereira; Gawryszewski, Vilma Pinheiro; Aziz-Baumgartner, Eduardo; Palekar, Rakhee; Breese, Joseph; Cheng, Po‐Yung; Barbosa, Jarbas; Vicedo‐Cabrera, Ana M.; Olea, Andrea; Flores, Arturo Barranco; Shay, David K.; Mounts, Anthony W.; Oliva, Otávio Pinheiro

doi:10.2471/blt.12.116871

Cited by 13 publications

(7 citation statements)

References 21 publications

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“…Although the elderly are the most vulnerable group to viral respiratory infections, we found relative small excess of deaths in years of circulating AH1N1 pre pandemic (2002 and 2008). Study comparing excess deaths from respiratory diseases in the elderly in Latin America shows stable rates (mean of 89.4 per 100,000 inhabitants) in southern Brazil between 1998 and 2008 (pre-pandemic Flu A-H1N1), although higher in Brazil than in other countries ( 24 ). In the USA and in European countries, influenza seasons dominated by subtype AH3N2 are typically associated with mortality two to three times higher than in seasons with predominance of AH1N1 (prior to pandemic strain 2009) and of influenza B viruses ( 9 , 10 , 19 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

Excess of Mortality in Adults and Elderly and Circulation of Subtypes of Influenza Virus in Southern Brazil

Freitas

Donalísio

2018

Front. Immunol.

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PurposeIn the elderly population, the influenza infection and its clinical complications are important causes of hospitalization and death, particularly, in longer-lived age. The objective of this study is to analyze the impact of influenza virus circulation on mortality in the elderly and adults, in years with different predominant virus strains.MethodsWe performed a time trend study to evaluated excess of mortality for pneumonia and influenza, respiratory disease, and all-causes in southern region of Brazil, from 2002 to 2015. After considering other models, we opted for Serfling regression. Excess of death rates per 100,000 inhabitants were analyzed in specific age groups (24–59, 60–69, 70–79, ≥80 years) and by year of occurrence. Mortality information were taken from Brazilian Mortality Information System and etiological data were accessed in Sentinel Virological Surveillance database, getting the weekly positivity of the immunofluorescence tests for influenza A (H1N1, H3N2), and B.ResultsIn southern Brazil, there is an evident seasonal pattern of all death outcomes among different age groups in the dry and cold season (April–September). The highest excess mortality rates occurs among older, particularly in years of circulation of influenza AH3N2, especially among people ≥80 years, in 2003 and 2007—years of great severity of influenza activity. After 2009, with the introduction of the pandemic influenza AH1N1, we observed a lower impact on the mortality of the elderly compared to <60 years.DiscussionA cross reactivity antibody response from past exposure probably provided protection against disease in the elderly. Despite not controlling for comorbidities, climate, and vaccination, for the >70 years, ratio of respiratory diseases excess mortality rates between AH1N1 (2009) and severe year of H3N2 (2007) shows protection in the pandemic year and great vulnerability during AH3N2 virus predominance.ConclusionThe reduced immune response to infection, and to vaccination, and presence of comorbidities recommend a special attention to this age group in Brazil. Besides medical assistance, the timeliness of vaccine campaigns, its composition, and etiological surveillance of respiratory diseases are some of the preventive and public health measures.

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Section: Discussionmentioning

confidence: 99%

Excess of Mortality in Adults and Elderly and Circulation of Subtypes of Influenza Virus in Southern Brazil

Freitas

Donalísio

2018

Front. Immunol.

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“…6 No other studies from sub-Saharan Africa report on trends of case fatality rates for hospital admissions for pneumonia over such a long period. In a review 18 of trends in overall mortality from respiratory diseases in Latin America between 1998 and 2009, investigators reported that mortality in children younger than 5 years had also significantly decreased. The results of this study are in line with the progress documented by official country indicators of Malawi (appendix, p 31), showing an improvement in many socioeconomic and health indicators.…”

Section: Discussionmentioning

confidence: 99%

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study

Lazzerini

Seward

Lufesi³

et al. 2016

The Lancet Global Health

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Summary Background Few studies have reported long-term data on mortality rates for children admitted to hospital with pneumonia in Africa. We examined trends in case fatality rates for all-cause clinical pneumonia and its risk factors in Malawian children between 2001 and 2012. Methods Individual patient data for children (<5 years) with clinical pneumonia who were admitted to hospitals participating in Malawi’s Child Lung Health Programme between 2001 and 2012 were recorded prospectively on a standardised medical form. We analysed trends in pneumonia mortality and children’s clinical characteristics, and we estimated the association of risk factors with case fatality for children younger than 2 months, 2–11 months of age, and 12–59 months of age using separate multivariable mixed effects logistic regression models. Findings Between November, 2012, and May, 2013, we retrospectively collected all available hard copies of yellow forms from 40 of 41 participating hospitals. We examined 113 154 pneumonia cases, 104 932 (92.7%) of whom had mortality data and 6903 of whom died, and calculated an overall case fatality rate of 6.6% (95% CI 6.4–6.7). The case fatality rate significantly decreased between 2001 (15.2% [13.4–17.1]) and 2012 (4.5% [4.1–4.9]; ptrend<0.0001). Univariable analyses indicated that the decrease in case fatality rate was consistent across most subgroups. In multivariable analyses, the risk factors significantly associated with increased odds of mortality were female sex, young age, very severe pneumonia, clinically suspected Pneumocystis jirovecii infection, moderate or severe underweight, severe acute malnutrition, disease duration of more than 21 days, and referral from a health centre. Increasing year between 2001 and 2012 and increasing age (in months) were associated with reduced odds of mortality. Fast breathing was associated with reduced odds of mortality in children 2–11 months of age. However, case fatality rate in 2012 remained high for children with very severe pneumonia (11.8%), severe undernutrition (15.4%), severe acute malnutrition (34.8%), and symptom duration of more than 21 days (9.0%). Interpretation Pneumonia mortality and its risk factors have steadily improved in the past decade in Malawi; however, mortality remains high in specific subgroups. Improvements in hospital care may have reduced case fatality rates though a lack of sufficient data on quality of care indicators and the potential of socioeconomic and other improvements outside the hospital precludes adequate assessment of why case-fatality rates fell. Results from this study emphasise the importance of effective national systems for data collection. Further work combining this with data on trends in the incidence of pneumonia in the community are needed to estimate trends in the overall risk of mortality from pneumonia in children in Malawi.

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“…Esta tendencia a la reducción se revirtió en el año 2009, quizá como resultado de la pandemia de influenza A H1N1. 10 Nuestros resultados también mostraron que los grupos de edad con mayor mortalidad son los menores de un año y los de 65 y más años, tanto para hombres como para mujeres. En el primer grupo de edad se ha reportado de forma asidua la asociación entre la exposición al humo de leña y el incremento en la mortalidad por neumonías en los menores de cinco años a nivel global.…”

Section: Discussionunclassified

“…Este estudio también incluyó a México. 10 La mayor reducción en la tasa de mortalidad en menores de cinco años observada en América latina puede ser debido primero, a los años que se incluyeron en el estudio (1998-2008) y a la diferencia en el grupo de edad estudiado (menores de un año en nuestro estudio en comparación con menores de cinco años en el artículo de América Latina). Sin embargo, las tasas de mortalidad infantil en América Latina y en México siguen siendo elevadas y éstas pueden ser reducidas mediante la eliminación de los factores de riesgo respiratorios (tabaquismo activo, tabaquismo pasivo, exposición a humo de leña, entre otros).…”

Section: Discussionunclassified

Impacto de la epidemia de neumonía e influenza A H1N1 del 2009 en la tendencia de la mortalidad estandarizada por edad, y en las tasas de muerte específicas por grupos de edad y sexo en México, 2000-2010

Martínez-Briseño

Figueroa

Fernández-Plata

et al. 2016

NCT Neumología Y Cirugía De Tórax

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Trends in mortality from respiratory disease in Latin America since 1998 and the impact of the 2009 influenza pandemic

Cited by 13 publications

References 21 publications

Excess of Mortality in Adults and Elderly and Circulation of Subtypes of Influenza Virus in Southern Brazil

Excess of Mortality in Adults and Elderly and Circulation of Subtypes of Influenza Virus in Southern Brazil

Mortality and its risk factors in Malawian children admitted to hospital with clinical pneumonia, 2001–12: a retrospective observational study

Impacto de la epidemia de neumonía e influenza A H1N1 del 2009 en la tendencia de la mortalidad estandarizada por edad, y en las tasas de muerte específicas por grupos de edad y sexo en México, 2000-2010

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