Pett, S;
Simonsen, L;
Higgs, E;
Robert.J, T;
Wentworth, D;
Cozzi-Lepri, A;
Dwyer, DE;
... Lundgren, J; + view all
(2018)
Using Clinical Research Networks to Assess Severity of an Emerging Influenza Pandemic.
pp. 341-349.
10.1093/cid/ciy088.
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Abstract
Background. Early clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from INSIGHT, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic. Such assessments are now an integral part of the WHO pandemic definition and an essential part of pandemic response. Methods. We estimated the case fatality ratio of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza, for the pandemic (2009-2011) and post-pandemic (2012-2015) periods. We used literature survey results on health seeking behavior to convert that estimate to CFR among all infected persons (CFRAR). Results. During the pandemic period, 5.0% (3.1-6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%-12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%-0.6%) in the pandemic period 2009-2011, but declined 5-fold in young adults the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012-2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA. Conclusion. Data from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, already-operating research networks with global presence would substantially aid rapid assessment of clinical severity, both in absolute terms and relative to recent influenza seasons.
| Type: | Article |
|---|---|
| Title: | Using Clinical Research Networks to Assess Severity of an Emerging Influenza Pandemic |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/cid/ciy088 |
| Publisher version: | https://academic.oup.com/cid/article/67/3/341/4993... |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10042773 |
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