Mortality from Pandemic A/H1N1 2009 Influenza in England: Public Health Surveillance Study

Overview

Journal BMJ

Specialty General Medicine

Date 2009 Dec 17

PMID 20007665

Citations 165

Authors

Liam J Donaldson

Paul D Rutter

Benjamin M Ellis

Felix E C Greaves

Oliver T Mytton

Richard G Pebody

Iain E Yardley

Affiliations

Soon will be listed here.

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 >or=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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References

Vaillant L, La Ruche G, Tarantola A, Barboza P . Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009. Euro Surveill. 2009; 14(33). DOI: 10.2807/ese.14.33.19309-en. View

Dawood F, Jain S, Finelli L, Shaw M, Lindstrom S, Garten R . Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009; 360(25):2605-15. DOI: 10.1056/NEJMoa0903810. View

Echevarria-Zuno S, Mejia-Arangure J, Mar-Obeso A, Grajales-Muniz C, Robles-Perez E, Gonzalez-Leon M . Infection and death from influenza A H1N1 virus in Mexico: a retrospective analysis. Lancet. 2009; 374(9707):2072-2079. DOI: 10.1016/S0140-6736(09)61638-X. View

Perez-Padilla R, Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E . Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009; 361(7):680-9. DOI: 10.1056/NEJMoa0904252. View

Fraser C, Donnelly C, Cauchemez S, Hanage W, Van Kerkhove M, Hollingsworth T . Pandemic potential of a strain of influenza A (H1N1): early findings. Science. 2009; 324(5934):1557-61. PMC: 3735127. DOI: 10.1126/science.1176062. View

Luk J, Gross P, Thompson W . Observations on mortality during the 1918 influenza pandemic. Clin Infect Dis. 2001; 33(8):1375-8. DOI: 10.1086/322662. View

Payne A . Some aspects of the epidemiology of the 1957 influenza pandemic. Proc R Soc Med. 1958; 51(12):1009-15. PMC: 1889515. View

Taubenberger J, Morens D . 1918 Influenza: the mother of all pandemics. Emerg Infect Dis. 2006; 12(1):15-22. PMC: 3291398. DOI: 10.3201/eid1201.050979. View

Webb S, Pettila V, Seppelt I, Bellomo R, Bailey M, Cooper D . Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med. 2009; 361(20):1925-34. DOI: 10.1056/NEJMoa0908481. View

10.

Louie J, Acosta M, Winter K, Jean C, Gavali S, Schechter R . Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA. 2009; 302(17):1896-902. DOI: 10.1001/jama.2009.1583. View

11.

Kumar A, Zarychanski R, Pinto R, Cook D, Marshall J, Lacroix J . Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA. 2009; 302(17):1872-9. DOI: 10.1001/jama.2009.1496. View

12.

Dominguez-Cherit G, Lapinsky S, Macias A, Pinto R, Espinosa-Perez L, De La Torre A . Critically Ill patients with 2009 influenza A(H1N1) in Mexico. JAMA. 2009; 302(17):1880-7. DOI: 10.1001/jama.2009.1536. View

13.

Maudsley G, Williams E . "Inaccuracy' in death certification--where are we now?. J Public Health Med. 1996; 18(1):59-66. DOI: 10.1093/oxfordjournals.pubmed.a024463. View

14.

Woodall J, ROWSON K, McDonald J . Age and Asian influenza, 1957. Br Med J. 1958; 2(5108):1316-8. PMC: 2027356. DOI: 10.1136/bmj.2.5108.1316. View

15.

Jain S, Kamimoto L, Bramley A, Schmitz A, Benoit S, Louie J . Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009; 361(20):1935-44. DOI: 10.1056/NEJMoa0906695. View

16.

. Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection - United States, April-August 2009. MMWR Morb Mortal Wkly Rep. 2009; 58(34):941-7. View

17.

Garske T, Legrand J, Donnelly C, Ward H, Cauchemez S, Fraser C . Assessing the severity of the novel influenza A/H1N1 pandemic. BMJ. 2009; 339:b2840. DOI: 10.1136/bmj.b2840. View

18.

Serfling R . Methods for current statistical analysis of excess pneumonia-influenza deaths. Public Health Rep (1896). 2009; 78(6):494-506. PMC: 1915276. View

19.

Mathers C, Fat D, Inoue M, Rao C, Lopez A . Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ. 2005; 83(3):171-7. PMC: 2624200. DOI: /S0042-96862005000300009. View

20.

Baker M, Kelly H, Wilson N . Pandemic H1N1 influenza lessons from the southern hemisphere. Euro Surveill. 2009; 14(42). DOI: 10.2807/ese.14.42.19370-en. View