Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis
Publication Date
July 05, 2011
Journal
PLOS Medicine
Authors
Maria D. Van Kerkhove, Katelijn A. H. Vandemaele, Vivek Shinde, Giovanna Jaramillo Gutierrez, et al
Volume
8
Issue
7
Pages
e1001053
DOI
https://dx.plos.org/10.1371/journal.pmed.1001053
Publisher URL
http://journals.plos.org/plosmedicine/article?id=10.1371%2Fjournal.pmed.1001053
PubMed
http://www.ncbi.nlm.nih.gov/pubmed/21750667
PubMed Central
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130021
Europe PMC
http://europepmc.org/abstract/MED/21750667
Web of Science
000293169700003
Scopus
79960936455
Mendeley
http://www.mendeley.com/research/risk-factors-severe-outcomes-following-2009-influenza-h1n1-infection-global-pooled-analysis-11
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Mendeley | Further Information

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H.", "last_name"=>"Vandemaele"}, {"first_name"=>"Vivek", "last_name"=>"Shinde"}, {"first_name"=>"Giovanna", "last_name"=>"Jaramillo-Gutierrez"}, {"first_name"=>"Artemis", "last_name"=>"Koukounari"}, {"first_name"=>"Christl A.", "last_name"=>"Donnelly"}, {"first_name"=>"Luis O.", "last_name"=>"Carlino"}, {"first_name"=>"Rhonda", "last_name"=>"Owen"}, {"first_name"=>"Beverly", "last_name"=>"Paterson"}, {"first_name"=>"Louise", "last_name"=>"Pelletier"}, {"first_name"=>"Julie", "last_name"=>"Vachon"}, {"first_name"=>"Claudia", "last_name"=>"Gonzalez"}, {"first_name"=>"Yu", "last_name"=>"Hongjie"}, {"first_name"=>"Feng", "last_name"=>"Zijian"}, {"first_name"=>"Shuk Kwan", "last_name"=>"Chuang"}, {"first_name"=>"Albert", "last_name"=>"Au"}, {"first_name"=>"Silke", "last_name"=>"Buda"}, {"first_name"=>"Gerard", "last_name"=>"Krause"}, {"first_name"=>"Walter", "last_name"=>"Haas"}, {"first_name"=>"Isabelle", "last_name"=>"Bonmarin"}, {"first_name"=>"Kiyosu", "last_name"=>"Taniguichi"}, {"first_name"=>"Kensuke", "last_name"=>"Nakajima"}, {"first_name"=>"Tokuaki", "last_name"=>"Shobayashi"}, {"first_name"=>"Yoshihiro", "last_name"=>"Takayama"}, {"first_name"=>"Tomi", "last_name"=>"Sunagawa"}, {"first_name"=>"Jean Michel", "last_name"=>"Heraud"}, {"first_name"=>"Arnaud", "last_name"=>"Orelle"}, {"first_name"=>"Ethel", "last_name"=>"Palacios"}, {"first_name"=>"Marianne A. B.", "last_name"=>"van der Sande"}, {"first_name"=>"C. C. H. Lieke", "last_name"=>"Wielders"}, {"first_name"=>"Darren", "last_name"=>"Hunt"}, {"first_name"=>"Jeffrey", "last_name"=>"Cutter"}, {"first_name"=>"Vernon J.", "last_name"=>"Lee"}, {"first_name"=>"Juno", "last_name"=>"Thomas"}, {"first_name"=>"Patricia", "last_name"=>"Santa-Olalla"}, {"first_name"=>"Maria J.", "last_name"=>"Sierra-Moros"}, {"first_name"=>"Wanna", "last_name"=>"Hanshaoworakul"}, {"first_name"=>"Kumnuan", "last_name"=>"Ungchusak"}, {"first_name"=>"Richard", "last_name"=>"Pebody"}, {"first_name"=>"Seema", "last_name"=>"Jain"}, {"first_name"=>"Anthony W.", "last_name"=>"Mounts"}], "year"=>2011, "source"=>"PLoS Medicine", "identifiers"=>{"scopus"=>"2-s2.0-79960936455", "sgr"=>"79960936455", "issn"=>"1549-1676", "doi"=>"10.1371/journal.pmed.1001053", "pmid"=>"21750667", "isbn"=>"1549-1277", "pui"=>"362242032"}, "id"=>"a0aa1175-c24b-3d04-8c55-e5d21837507b", "abstract"=>"Background: Abstract MethodsandFindings: Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its member states have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers to determine risk groups for targeted control measures. Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdm patients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1 January 2010 from 19 countries or administrative regions—Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong SAR, Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom—to characterize and compare the distribution of risk factors among H1N1pdm patients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased with severity of disease. The highest per capita risk of hospitalization was among patients,5 y and 5–14 y (relative risk [RR]=3.3 and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the age groups 50–64 y and $65 y (RR=1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio of H1N1pdm deaths to hospitalizations increased with age and was the highest in the $65-y-old age group, indicating that while infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 y who became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reported chronic conditions increased with severity (median=31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatal H1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion of patients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might be Conclusions: a risk factor for ICU admission and fatal outcome (RR=36.3). Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonal influenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify and protect groups at highest risk of severe outcomes", "link"=>"http://www.mendeley.com/research/risk-factors-severe-outcomes-following-2009-influenza-h1n1-infection-global-pooled-analysis-11", "reader_count"=>122, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>7, "Librarian"=>2, "Student > Doctoral Student"=>7, "Researcher"=>20, "Student > Ph. D. 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Scopus | Further Information

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  • {"files"=>["https://ndownloader.figshare.com/files/759561"], "description"=>"<p>See <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001053#pmed.1001053.s001\" target=\"_blank\">Text S1</a> for countries included in the pooled risk factor ORs.</p>", "links"=>[], "tags"=>["cis", "hospitalization"], "article_id"=>429888, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Maria D. Van Kerkhove", "Katelijn A. H. Vandemaele", "Vivek Shinde", "Giovanna Jaramillo-Gutierrez", "Artemis Koukounari", "Christl A. Donnelly", "Luis O. Carlino", "Rhonda Owen", "Beverly Paterson", "Louise Pelletier", "Julie Vachon", "Claudia González", "Yu Hongjie", "Feng Zijian", "Shuk Kwan Chuang", "Albert Au", "Silke Buda", "Gérard Krause", "Walter Haas", "Isabelle Bonmarin", "Kiyosu Taniguichi", "Kensuke Nakajima", "Tokuaki Shobayashi", "Yoshihiro Takayama", "Tomi Sunagawa", "Jean Michel Heraud", "Arnaud Orelle", "Ethel Palacios", "Marianne A. B. van der Sande", "C. C. H. Lieke Wielders", "Darren Hunt", "Jeffrey Cutter", "Vernon J. Lee", "Juno Thomas", "Patricia Santa-Olalla", "Maria J. Sierra-Moros", "Wanna Hanshaoworakul", "Kumnuan Ungchusak", "Richard Pebody", "Seema Jain", "Anthony W. Mounts"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001053.g003", "stats"=>{"downloads"=>0, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Pooled_odds_ratio_and_95_CIs_of_risk_of_death_given_hospitalization_for_selected_countries_/429888", "title"=>"Pooled odds ratio and 95% CIs of risk of death given hospitalization for selected countries.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-07-05 02:44:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/381827"], "description"=>"<div><h3>Background</h3><p>Since the start of the 2009 influenza A pandemic (H1N1pdm), the World Health Organization and its member states have gathered information to characterize the clinical severity of H1N1pdm infection and to assist policy makers to determine risk groups for targeted control measures.</p> <h3>Methods and Findings</h3><p>Data were collected on approximately 70,000 laboratory-confirmed hospitalized H1N1pdm patients, 9,700 patients admitted to intensive care units (ICUs), and 2,500 deaths reported between 1 April 2009 and 1 January 2010 from 19 countries or administrative regions—Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong SAR, Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom—to characterize and compare the distribution of risk factors among H1N1pdm patients at three levels of severity: hospitalizations, ICU admissions, and deaths. The median age of patients increased with severity of disease. The highest per capita risk of hospitalization was among patients <5 y and 5–14 y (relative risk [RR] = 3.3 and 3.2, respectively, compared to the general population), whereas the highest risk of death per capita was in the age groups 50–64 y and ≥65 y (RR = 1.5 and 1.6, respectively, compared to the general population). Similarly, the ratio of H1N1pdm deaths to hospitalizations increased with age and was the highest in the ≥65-y-old age group, indicating that while infection rates have been observed to be very low in the oldest age group, risk of death in those over the age of 64 y who became infected was higher than in younger groups. The proportion of H1N1pdm patients with one or more reported chronic conditions increased with severity (median = 31.1%, 52.3%, and 61.8% of hospitalized, ICU-admitted, and fatal H1N1pdm cases, respectively). With the exception of the risk factors asthma, pregnancy, and obesity, the proportion of patients with each risk factor increased with severity level. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. Our findings suggest that morbid obesity might be a risk factor for ICU admission and fatal outcome (RR = 36.3).</p> <h3>Conclusions</h3><p>Our results demonstrate that risk factors for severe H1N1pdm infection are similar to those for seasonal influenza, with some notable differences, such as younger age groups and obesity, and reinforce the need to identify and protect groups at highest risk of severe outcomes.</p> <h3></h3><p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["factors", "outcomes", "2009", "influenza", "pooled"], "article_id"=>135405, "categories"=>["Cancer", "Biotechnology"], "users"=>["Maria D. Van Kerkhove", "Katelijn A. H. Vandemaele", "Vivek Shinde", "Giovanna Jaramillo-Gutierrez", "Artemis Koukounari", "Christl A. Donnelly", "Luis O. Carlino", "Rhonda Owen", "Beverly Paterson", "Louise Pelletier", "Julie Vachon", "Claudia González", "Yu Hongjie", "Feng Zijian", "Shuk Kwan Chuang", "Albert Au", "Silke Buda", "Gérard Krause", "Walter Haas", "Isabelle Bonmarin", "Kiyosu Taniguichi", "Kensuke Nakajima", "Tokuaki Shobayashi", "Yoshihiro Takayama", "Tomi Sunagawa", "Jean Michel Heraud", "Arnaud Orelle", "Ethel Palacios", "Marianne A. B. van der Sande", "C. C. H. Lieke Wielders", "Darren Hunt", "Jeffrey Cutter", "Vernon J. Lee", "Juno Thomas", "Patricia Santa-Olalla", "Maria J. Sierra-Moros", "Wanna Hanshaoworakul", "Kumnuan Ungchusak", "Richard Pebody", "Seema Jain", "Anthony W. Mounts"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001053", "stats"=>{"downloads"=>8, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Risk_Factors_for_Severe_Outcomes_following_2009_Influenza_A_H1N1_Infection_A_Global_Pooled_Analysis/135405", "title"=>"Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-07-05 01:30:05"}
  • {"files"=>["https://ndownloader.figshare.com/files/759756"], "description"=>"a<p>See <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001053#pmed.1001053.s001\" target=\"_blank\">Text S1</a> for definitions of risk factors.</p>b<p>All data given as median percent (IQR), except for age, which is median (in years) (IQR).</p>c<p>RR<sub>hosp</sub> is the unadjusted RR of hospitalization among H1N1pdm patients with the risk factor compared to the risk of hospitalization among H1N1pdm patients without the risk factor, and RR<sub>death</sub> is the unadjusted RR of death among H1N1pdm patients with the risk factor compared to the risk of death among H1N1pdm patients without the risk factor; range of RR provided if ≥2 countries provided data.</p>d<p>The number of countries providing data for cell directly to the right; the full list of countries that provided data for each risk factor is provided in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001053#pmed.1001053.s001\" target=\"_blank\">Text S1</a>.</p>e<p>RR<sub>hosp</sub> and RR<sub>death</sub> calculated by age group and shown in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001053#pmed-1001053-g001\" target=\"_blank\">Figure 1</a>.</p>f<p>Denominator is women of childbearing age in each level of severity.</p><p>NA, not assessed.</p>", "links"=>[], "tags"=>["factors", "severity", "countries"], "article_id"=>430074, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Maria D. Van Kerkhove", "Katelijn A. H. Vandemaele", "Vivek Shinde", "Giovanna Jaramillo-Gutierrez", "Artemis Koukounari", "Christl A. Donnelly", "Luis O. Carlino", "Rhonda Owen", "Beverly Paterson", "Louise Pelletier", "Julie Vachon", "Claudia González", "Yu Hongjie", "Feng Zijian", "Shuk Kwan Chuang", "Albert Au", "Silke Buda", "Gérard Krause", "Walter Haas", "Isabelle Bonmarin", "Kiyosu Taniguichi", "Kensuke Nakajima", "Tokuaki Shobayashi", "Yoshihiro Takayama", "Tomi Sunagawa", "Jean Michel Heraud", "Arnaud Orelle", "Ethel Palacios", "Marianne A. B. van der Sande", "C. C. H. Lieke Wielders", "Darren Hunt", "Jeffrey Cutter", "Vernon J. Lee", "Juno Thomas", "Patricia Santa-Olalla", "Maria J. Sierra-Moros", "Wanna Hanshaoworakul", "Kumnuan Ungchusak", "Richard Pebody", "Seema Jain", "Anthony W. Mounts"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001053.t001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_factors_by_severity_level_for_select_countries_and_risk_of_severe_disease_/430074", "title"=>"Risk factors by severity level for select countries and risk of severe disease.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2011-07-05 00:01:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/759447"], "description"=>"<p>Countries included in figure: Spain, Singapore, China, Hong Kong SAR, Canada, the Netherlands, Thailand, Chile, Germany, Japan, US, and New Zealand. Bars represent maximum country ratio.</p>", "links"=>[], "tags"=>["confirmed", "h1n1pdm", "deaths", "hospitalizations"], "article_id"=>429765, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Maria D. Van Kerkhove", "Katelijn A. H. Vandemaele", "Vivek Shinde", "Giovanna Jaramillo-Gutierrez", "Artemis Koukounari", "Christl A. Donnelly", "Luis O. Carlino", "Rhonda Owen", "Beverly Paterson", "Louise Pelletier", "Julie Vachon", "Claudia González", "Yu Hongjie", "Feng Zijian", "Shuk Kwan Chuang", "Albert Au", "Silke Buda", "Gérard Krause", "Walter Haas", "Isabelle Bonmarin", "Kiyosu Taniguichi", "Kensuke Nakajima", "Tokuaki Shobayashi", "Yoshihiro Takayama", "Tomi Sunagawa", "Jean Michel Heraud", "Arnaud Orelle", "Ethel Palacios", "Marianne A. B. van der Sande", "C. C. H. Lieke Wielders", "Darren Hunt", "Jeffrey Cutter", "Vernon J. Lee", "Juno Thomas", "Patricia Santa-Olalla", "Maria J. Sierra-Moros", "Wanna Hanshaoworakul", "Kumnuan Ungchusak", "Richard Pebody", "Seema Jain", "Anthony W. Mounts"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001053.g002", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Ratio_of_confirmed_H1N1pdm_deaths_to_hospitalizations_for_selected_countries_/429765", "title"=>"Ratio of confirmed H1N1pdm deaths to hospitalizations for selected countries.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-07-05 02:42:45"}
  • {"files"=>["https://ndownloader.figshare.com/files/759289"], "description"=>"<p>Countries included in hospitalization (A) and mortality (C) RRs: Japan, Hong Kong SAR, China, Singapore, Thailand, Chile, Germany, the Netherlands, Spain, New Zealand, Canada, US, Madagascar (hospitalizations only), and France (deaths only). Countries included in ICU admission RR (B): Japan, Hong Kong SAR, China, Singapore, Canada, Spain, the Netherlands, US, New Zealand, and South Africa. Dark line represents pooled RR; shaded lines are individual country RR.</p>", "links"=>[], "tags"=>["icu", "compared"], "article_id"=>429623, "categories"=>["Biotechnology", "Infectious Diseases"], "users"=>["Maria D. Van Kerkhove", "Katelijn A. H. Vandemaele", "Vivek Shinde", "Giovanna Jaramillo-Gutierrez", "Artemis Koukounari", "Christl A. Donnelly", "Luis O. Carlino", "Rhonda Owen", "Beverly Paterson", "Louise Pelletier", "Julie Vachon", "Claudia González", "Yu Hongjie", "Feng Zijian", "Shuk Kwan Chuang", "Albert Au", "Silke Buda", "Gérard Krause", "Walter Haas", "Isabelle Bonmarin", "Kiyosu Taniguichi", "Kensuke Nakajima", "Tokuaki Shobayashi", "Yoshihiro Takayama", "Tomi Sunagawa", "Jean Michel Heraud", "Arnaud Orelle", "Ethel Palacios", "Marianne A. B. van der Sande", "C. C. H. Lieke Wielders", "Darren Hunt", "Jeffrey Cutter", "Vernon J. Lee", "Juno Thomas", "Patricia Santa-Olalla", "Maria J. Sierra-Moros", "Wanna Hanshaoworakul", "Kumnuan Ungchusak", "Richard Pebody", "Seema Jain", "Anthony W. Mounts"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001053.g001", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Relative_risk_of_hospitalization_ICU_admission_and_death_by_age_group_compared_to_the_general_population_/429623", "title"=>"Relative risk of hospitalization, ICU admission, and death by age group compared to the general population.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2011-07-05 02:40:23"}

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Relative Metric

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