Household Transmission of Influenza A(H1N1)pdm09 in the Pandemic and Post-Pandemic Seasons
Household Transmission of Influenza A(H1N1)pdm09 in the Pandemic and Post-Pandemic Seasons
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DOI：
10.1371/journal.pone.0108485
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发表时间：
2014-09-25
期刊：
影响因子：
3.7
通讯作者：
Castilla, Jesus
中科院分区：
文献类型：
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作者：
Casado, Itziar;Martinez-Baz, Ivan;Castilla, Jesus
背景：流感病毒的传播发生在人与人之间，并因家庭等封闭环境内的接触而容易传播。本研究的目的是评估在大流行和大流行后季节实验室确认的甲型H1N1流感pdm09的继发发病率和与家庭传播相关的因素。方法：在2009-2010年和2010-2011年流感季节，西班牙纳瓦拉76名哨点医生采集诊断为流感样疾病患者的鼻咽拭子和咽拭子。一名训练有素的护士给实验室确诊为甲型H1N1流感pdm09的患者的家庭打电话，询问每个家庭成员的症状、危险因素和疫苗接种情况。结果：在405户有甲型H1N1流感pdm09实验室确诊患者的家庭中，鉴定出977名易感接触者；其中16% （95% CI 14-19%）出现流感样疾病，被认为是继发性病例。2009-2010年和2010-2011年的二次发作率分别为14%和19% (p = 0.049)，主要发生在患有严重慢性疾病的人群中。在多因素logistic回归分析中，2010-2011年流行季发生继发病例的风险高于2009-2010年流行季（校正优势比：1.72;95% CI 1.17-2.54）， 5岁以下儿童发生继发病例的风险高于2009-2010年流行季，年龄较大的接触者发生继发病例的风险降低。流感疫苗接种与流感样疾病发生率较低相关，接近统计学显著性（校正优势比：0.29;95% CI 0.08-1.03）。结论：第二季家庭二次发病率高于第一季。儿童感染的风险更大。在第二个大流行季节应保持预防措施，特别是对高危人群。
Background: The transmission of influenza viruses occurs person to person and is facilitated by contacts within enclosed environments such as households. The aim of this study was to evaluate secondary attack rates and factors associated with household transmission of laboratory-confirmed influenza A(H1N1)pdm09 in the pandemic and post-pandemic seasons.Methods: During the 2009-2010 and 2010-2011 influenza seasons, 76 sentinel physicians in Navarra, Spain, took nasopharyngeal and pharyngeal swabs from patients diagnosed with influenza-like illness. A trained nurse telephoned households of those patients who were laboratory-confirmed for influenza A(H1N1) pdm09 to ask about the symptoms, risk factors and vaccination status of each household member.Results: In the 405 households with a patient laboratory-confirmed for influenza A(H1N1) pdm09, 977 susceptible contacts were identified; 16% of them (95% CI 14-19%) presented influenza-like illness and were considered as secondary cases. The secondary attack rate was 14% in 2009-2010 and 19% in the 2010-2011 season (p = 0.049), an increase that mainly affected persons with major chronic conditions. In the multivariate logistic regression analysis, the risk of being a secondary case was higher in the 2010-2011 season than in the 2009-2010 season (adjusted odds ratio: 1.72; 95% CI 1.17-2.54), and in children under 5 years, with a decreasing risk in older contacts. Influenza vaccination was associated with lesser incidence of influenza-like illness near to statistical significance (adjusted odds ratio: 0.29; 95% CI 0.08-1.03).Conclusion: The secondary attack rate in households was higher in the second season than in the first pandemic season. Children had a greater risk of infection. Preventive measures should be maintained in the second pandemic season, especially in high-risk persons.