Regional Variation in Mortality Impact of the 2009 A(H1N1) Influenza Pandemic in China

Overview

Journal Influenza Other Respir Viruses

Publisher Wiley

Specialty Microbiology

Date 2013 May 15

PMID 23668477

Citations 30

Authors

Hongjie Yu

Luzhao Feng

Cecile G Viboud

David K Shay

Yong Jiang

Hong Zhou

Maigeng Zhou

Zhen Xu

Nan Hu

Weizhong Yang

Shaofa Nie

Affiliations

Soon will be listed here.

Abstract

Background: Laboratory-confirmed deaths grossly underestimate influenza mortality burden, so that reliable burden estimates are derived from indirect statistical studies, which are scarce in low- and middle-income settings.

Objectives: Here, we used statistical excess mortality models to estimate the burden of seasonal and pandemic influenza in China.

Methods: We modeled data from a nationally representative population-based death registration system, combined with influenza virological surveillance data, to estimate influenza-associated excess mortality for the 2004-2005 through 2009-2010 seasons, by age and region.

Results: The A(H1N1) pandemic was associated with 11·4-12·1 excess respiratory and circulatory (R&C) deaths per 100,000 population in rural sites of northern and southern China during 2009-2010; these rates were 2·2-2·8 times higher than those of urban sites (P<0·01). Influenza B accounted for a larger proportion of deaths than pandemic A(H1N1) in 2009-2010 in some regions. Nationally, we attribute 126,200 (95% CI, 61,000-248,400) excess R&C deaths (rate of 9·4/100,000) and 2,323,000 (1,166,000-4,533,000) years of life lost (YLL) to the first year of A(H1N1)pdm circulation.

Conclusions: The A(H1N1) pandemic posed a mortality and YLL burden comparable to that of interpandemic influenza in China. Our high burden estimates in rural areas highlight the need to enhance epidemiological surveillance and healthcare services, in underdeveloped and remote areas.

Citing Articles

Influenza-Associated Excess Mortality by Age, Sex, and Subtype/Lineage: Population-Based Time-Series Study With a Distributed-Lag Nonlinear Model.

Li L, Yan Z, Luo L, Liu W, Yang Z, Shi C JMIR Public Health Surveill. 2023; 9:e42530.

PMID: 36630176 PMC: 9878364. DOI: 10.2196/42530.

One Hundred Years of Influenza Since the 1918 Pandemic - Is China Prepared Today?.

Zhang R, Dong X, Wang D, Feng L, Zhou L, Ren R China CDC Wkly. 2021; 1(4):56-61.

PMID: 34594605 PMC: 8422199.

Influenza-associated disease burden in mainland China: a systematic review and meta-analysis.

Li J, Chen Y, Wang X, Yu H Sci Rep. 2021; 11(1):2886.

PMID: 33536462 PMC: 7859194. DOI: 10.1038/s41598-021-82161-z.

Characterization of Influenza A and B Viruses Circulating in Southern China During the 2017-2018 Season.

Yan Y, Ou J, Zhao S, Ma K, Lan W, Guan W Front Microbiol. 2020; 11:1079.

PMID: 32547518 PMC: 7272714. DOI: 10.3389/fmicb.2020.01079.

Years of potential life lost and productivity costs due to premature mortality from six priority diseases in Tanzania, 2006-2015.

Rumisha S, George J, Bwana V, Mboera L PLoS One. 2020; 15(6):e0234300.

PMID: 32516340 PMC: 7282655. DOI: 10.1371/journal.pone.0234300.

References

Simonsen L, Reichert T, Viboud C, Blackwelder W, Taylor R, Miller M . Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med. 2005; 165(3):265-72. DOI: 10.1001/archinte.165.3.265. View

Viboud C, Simonsen L . Global mortality of 2009 pandemic influenza A H1N1. Lancet Infect Dis. 2012; 12(9):651-3. DOI: 10.1016/S1473-3099(12)70152-4. View

Viboud C, Miller M, Olson D, Osterholm M, Simonsen L . Preliminary Estimates of Mortality and Years of Life Lost Associated with the 2009 A/H1N1 Pandemic in the US and Comparison with Past Influenza Seasons. PLoS Curr. 2010; 2:RRN1153. PMC: 2843747. DOI: 10.1371/currents.rrn1153. View

Viboud C, Grais R, Lafont B, Miller M, Simonsen L . Multinational impact of the 1968 Hong Kong influenza pandemic: evidence for a smoldering pandemic. J Infect Dis. 2005; 192(2):233-48. DOI: 10.1086/431150. View

Schuck-Paim C, Viboud C, Simonsen L, Miller M, Moura F, Fernandes R . Were equatorial regions less affected by the 2009 influenza pandemic? The Brazilian experience. PLoS One. 2012; 7(8):e41918. PMC: 3411570. DOI: 10.1371/journal.pone.0041918. View

Feng L, Shay D, Jiang Y, Zhou H, Chen X, Zheng Y . Influenza-associated mortality in temperate and subtropical Chinese cities, 2003-2008. Bull World Health Organ. 2012; 90(4):279-288B. PMC: 3324869. DOI: 10.2471/BLT.11.096958. View

Yang L, Chan K, Cowling B, Chiu S, Chan K, Peiris J . Excess mortality associated with the 2009 pandemic of influenza A(H1N1) in Hong Kong. Epidemiol Infect. 2011; 140(9):1542-50. DOI: 10.1017/S0950268811002238. View

Shrestha S, Swerdlow D, Borse R, Prabhu V, Finelli L, Atkins C . Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009-April 2010). Clin Infect Dis. 2011; 52 Suppl 1:S75-82. DOI: 10.1093/cid/ciq012. View

Simonsen L . The global impact of influenza on morbidity and mortality. Vaccine. 1999; 17 Suppl 1:S3-10. DOI: 10.1016/s0264-410x(99)00099-7. View

10.

Hardelid P, Andrews N, Pebody R . Excess mortality monitoring in England and Wales during the influenza A(H1N1) 2009 pandemic. Epidemiol Infect. 2011; 139(9):1431-9. DOI: 10.1017/S0950268811000410. View

11.

Paddock C, Liu L, Denison A, Bartlett J, Holman R, DeLeon-Carnes M . Myocardial injury and bacterial pneumonia contribute to the pathogenesis of fatal influenza B virus infection. J Infect Dis. 2012; 205(6):895-905. DOI: 10.1093/infdis/jir861. View

12.

Liang W, Feng L, Xu C, Xiang N, Zhang Y, Shu Y . Response to the first wave of pandemic (H1N1) 2009: experiences and lessons learnt from China. Public Health. 2012; 126(5):427-36. PMC: 7111655. DOI: 10.1016/j.puhe.2012.02.008. View

13.

Muscatello D, Cretikos M, MacIntyre C . All-cause mortality during first wave of pandemic (H1N1) 2009, New South Wales, Australia, 2009. Emerg Infect Dis. 2010; 16(9):1396-402. PMC: 3294965. DOI: 10.3201/eid1609.091723. View

14.

Yu H, Feng Z, Uyeki T, Liao Q, Zhou L, Feng L . Risk factors for severe illness with 2009 pandemic influenza A (H1N1) virus infection in China. Clin Infect Dis. 2011; 52(4):457-65. PMC: 3060897. DOI: 10.1093/cid/ciq144. View

15.

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

16.

Chow A, Ma S, Ling A, Chew S . Influenza-associated deaths in tropical Singapore. Emerg Infect Dis. 2006; 12(1):114-21. PMC: 3293465. DOI: 10.3201/eid1201.050826. View

17.

Yu H, Cauchemez S, Donnelly C, Zhou L, Feng L, Xiang N . Transmission dynamics, border entry screening, and school holidays during the 2009 influenza A (H1N1) pandemic, China. Emerg Infect Dis. 2012; 18(5):758-66. PMC: 3358060. DOI: 10.3201/eid1805.110356. View

18.

Nielsen J, Mazick A, Glismann S, Molbak K . Excess mortality related to seasonal influenza and extreme temperatures in Denmark, 1994-2010. BMC Infect Dis. 2011; 11:350. PMC: 3264536. DOI: 10.1186/1471-2334-11-350. View

19.

van den Wijngaard C, van Asten L, Koopmans M, van Pelt W, Nagelkerke N, Wielders C . Comparing pandemic to seasonal influenza mortality: moderate impact overall but high mortality in young children. PLoS One. 2012; 7(2):e31197. PMC: 3272034. DOI: 10.1371/journal.pone.0031197. View

20.

Charu V, Simonsen L, Lustig R, Steiner C, Viboud C . Mortality burden of the 2009-10 influenza pandemic in the United States: improving the timeliness of influenza severity estimates using inpatient mortality records. Influenza Other Respir Viruses. 2013; 7(5):863-71. PMC: 3674131. DOI: 10.1111/irv.12096. View