Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis.
Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis.
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DOI：
10.1371/journal.pmed.1001053
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发表时间：
2011-07
期刊：
影响因子：
15.8
通讯作者：
WHO Working Group for Risk Factors for Severe H1N1pdm Infection
中科院分区：
文献类型：
--
作者：
Van Kerkhove MD;Vandemaele KA;Shinde V;Jaramillo-Gutierrez G;Koukounari A;Donnelly CA;Carlino LO;Owen R;Paterson B;Pelletier L;Vachon J;Gonzalez C;Hongjie Y;Zijian F;Chuang SK;Au A;Buda S;Krause G;Haas W;Bonmarin I;Taniguichi K;Nakajima K;Shobayashi T;Takayama Y;Sunagawa T;Heraud JM;Orelle A;Palacios E;van der Sande MA;Wielders CC;Hunt D;Cutter J;Lee VJ;Thomas J;Santa-Olalla P;Sierra-Moros MJ;Hanshaoworakul W;Ungchusak K;Pebody R;Jain S;Mounts AW;WHO Working Group for Risk Factors for Severe H1N1pdm Infection
这项研究分析了19个国家（2009年4月至2010年1月）的数据，包括约70,000名重症H1N1感染住院患者，以揭示严重大流行性流感的危险因素，包括慢性疾病、心脏病、慢性呼吸道疾病和糖尿病。自 2009 年甲型流感大流行 (H1N1pdm) 开始以来，世界卫生组织及其成员国收集了信息来描述 H1N1pdm 感染的临床严重程度，并协助政策制定者确定风险群体，以采取有针对性的控制措施。数据收集于 2009 年 4 月 1 日至 2010 年 1 月 1 日期间，来自 19 个国家或行政区（阿根廷、澳大利亚、加拿大、智利、中国、法国、德国、香港特别行政区、日本、马达加斯加、墨西哥、荷兰、新西兰、澳大利亚）的约 70,000 名实验室确诊的 H1N1pdm 住院患者、9,700 名入住重症监护病房 (ICU) 的患者以及 2,500 例死亡报告。新加坡、南非、西班牙、泰国、美国和英国——描述和比较 H1N1pdm 患者在三个严重程度级别（住院、入住 ICU 和死亡）的危险因素分布。患者的中位年龄随着疾病的严重程度而增加。人均住院风险最高的是<5岁和5-14岁的患者（与一般人群相比，相对风险[RR] 分别= 3.3和3.2），而人均死亡风险最高的是50-64岁和≥65岁的年龄组（与一般人群相比，RR 分别= 1.5和1.6）。同样，H1N1pdm 死亡与住院治疗的比率随着年龄的增长而增加，并且在≥65 岁年龄组中最高，这表明虽然观察到最年长年龄组的感染率非常低，但 64 岁以上感染者的死亡风险高于年轻群体。报告患有一种或多种慢性疾病的 H1N1pdm 患者的比例随着严重程度的增加而增加（住院、入住 ICU 和致命 H1N1pdm 病例的中位数分别为 31.1%、52.3% 和 61.8%）。除哮喘、妊娠和肥胖等危险因素外，具有每种危险因素的患者比例随着严重程度的增加而增加。对于所有严重程度而言，妊娠晚期的孕妇始终占孕妇总数的大多数。我们的研究结果表明，病态肥胖可能是入住 ICU 和致命结果的危险因素 (RR = 36.3)。我们的研究结果表明，严重 H1N1pdm 感染的危险因素与季节性流感相似，但存在一些显着差异，例如年轻群体和肥胖，并强调需要识别和保护严重后果风险最高的群体。 请参阅文章后面的编者摘要 2009 年 4 月，一种新的甲型 H1N1 流感病毒首次在墨西哥和美国被发现，随后在世界各地传播。 2009 年 6 月，世界卫生组织 (WHO) 宣布进入大流行警报第 6 阶段，该警报持续到 2010 年 8 月。在整个大流行期间，世卫组织和成员国收集信息来描述与新型甲型 H1N1 流感病毒感染相关的风险模式，并评估临床情况。尽管许多国家已经详细记录了季节性流感感染后发生严重疾病的危险因素（例如，怀孕；慢性疾病，如肺部、心血管、肾脏、肝脏、神经肌肉、血液和代谢疾病；一些认知问题；以及免疫缺陷），但在 2009 年 H1N1 大流行初期感染后发生严重疾病的危险因素在很大程度上尚不清楚。许多国家最近报告了严重H1N1流感与各种潜在危险因素之间关联的数据，但由于这些数据以不同的格式呈现，因此很难在各国之间进行直接比较，对某些情况还没有明确的共识。因此，为了评估严重H1N1感染的已知和新的潜在危险因素的频率和分布，本研究收集了19个国家卫生部或国家公共卫生研究所监测项目的数据（2009年4月1日至2010年1月1日）——阿根廷、澳大利亚、加拿大、智利、中国、法国、德国、香港（特别行政区）、日本、马达加斯加、墨西哥、荷兰、新西兰、新加坡、南非、西班牙、泰国、美国和英国。作为常规监测的一部分，各国被要求使用标准化格式提供入院、入住重症监护病房 (ICU) 或因感染而死亡的患者经实验室确诊的 H1N1 流感的危险因素数据。研究人员将潜在的风险状况分为四类：年龄、慢性疾病、怀孕（到三个月）以及以前不被认为是严重流感结果风险状况的其他状况，例如肥胖。对于每个危险因素（妊娠除外），研究人员使用每个严重类别（住院、入住 ICU 和死亡）报告的病例总数计算了每组患者的百分比。为了评估与怀孕相关的风险，研究人员使用每个严重级别的孕妇与所有育龄女性（15-49岁）的比率来描述级别之间的差异。研究人员收集了大约 70,000 名需要住院治疗的患者、9,700 名入住 ICU 的患者以及 2,500 名死于 H1N1 感染的患者的数据。患有一种或多种慢性疾病的 H1N1 患者比例随严重程度的增加而增加，住院患者中的中位数为 31.1%，入住 ICU 的患者中为 52.3%，死亡患者中为 61.8%。对于所有严重程度而言，妊娠晚期的孕妇始终占孕妇总数的大多数。随着疾病严重程度的增加，肥胖患者的比例也随之增加——占住院患者的中位数为 6%，入住 ICU 的患者为 11.3%，占所有 H1N1 死亡人数的 12.0%。这些研究结果表明，严重H1N1感染的危险因素与季节性流感相似，但也有一些显着差异：相当一部分患有严重和致命H1N1病例的人先前患有慢性病，这表明慢性病的存在会增加死亡的可能性。心脏病、慢性呼吸道疾病和糖尿病是严重疾病的重要危险因素，对于这些疾病高发国家尤其重要。大约 2/3 的住院患者和 40% 的 H1N1 感染死亡患者没有任何已知的既往慢性病，但这项研究无法全面评估这些病例中有多少人存在其他危险因素，如怀孕、肥胖、吸烟和酗酒。由于国家之间存在巨大差异，肥胖和怀孕等危险因素的作用还需要进一步研究——尽管有足够的证据支持孕妇接种疫苗和早期干预。总体而言，这项研究的结果强调了识别和针对高危人群进行免疫接种、早期医疗建议和使用抗病毒药物等干预措施的必要性。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.1001053。世卫组织提供全球警报和响应 (GAR)，其中包含许多流感相关主题的最新信息 美国疾病控制和预防中心提供有关危险因素和 H1N1 的信息
This study analyzes data from 19 countries (from April 2009 to Jan 2010), comprising some 70,000 hospitalized patients with severe H1N1 infection, to reveal risk factors for severe pandemic influenza, which include chronic illness, cardiac disease, chronic respiratory disease, and diabetes. 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 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. Please see later in the article for the Editors' Summary In April 2009, a new strain of influenza A H1N1 was first identified in Mexico and the United States and subsequently spread around the world. In June 2009, the World Health Organization (WHO) declared a pandemic alert phase 6, which continued until August 2010. Throughout the pandemic, WHO and member states gathered information to characterize the patterns of risk associated with the new influenza A H1N1 virus infection and to assess the clinical picture. Although risk factors for severe disease following seasonal influenza infection have been well documented in many countries (for example, pregnancy; chronic medical conditions such as pulmonary, cardiovascular, renal, hepatic, neuromuscular, hematologic, and metabolic disorders; some cognitive conditions; and immunodeficiency), risk factors for severe disease following infection early in the 2009 H1N1 pandemic were largely unknown. Many countries have recently reported data on the association between severe H1N1 influenza and a variety of underlying risk factors, but because these data are presented in different formats, making direct comparisons across countries is difficult, with no clear consensus for some conditions. Therefore, to assess the frequency and distribution of known and new potential risk factors for severe H1N1 infection, this study was conducted to collect data (from 1 April 2009 to 1 January 2010) from surveillance programs of the Ministries of Health or National Public Health Institutes in 19 countries―Argentina, Australia, Canada, Chile, China, France, Germany, Hong Kong (special administrative region), Japan, Madagascar, Mexico, the Netherlands, New Zealand, Singapore, South Africa, Spain, Thailand, the United States, and the United Kingdom. As part of routine surveillance, countries were asked to provide risk factor data on laboratory-confirmed H1N1 in patients who were admitted to hospital, admitted to the intensive care unit (ICU), or had died because of their infection, using a standardized format. The researchers grouped potential risk conditions into four categories: age, chronic medical illnesses, pregnancy (by trimester), and other conditions that were not previously considered as risk conditions for severe influenza outcomes, such as obesity. For each risk factor (except pregnancy), the researchers calculated the percentage of each group of patients using the total number of cases reported in each severity category (hospitalization, admission to ICU, and death). To evaluate the risk associated with pregnancy, the researchers used the ratio of pregnant women to all women of childbearing age (age 15–49 years) at each level of severity to describe the differences between levels. The researchers were able to collect data on approximately 70,000 patients requiring hospitalization, 9,700 patients admitted to the ICU, and 2,500 patients who died from H1N1 infection. The proportion of patients with H1N1 with one or more reported chronic conditions increased with severity—the median was 31.1% of hospitalized patients, 52.3% of patients admitted to the ICU, and 61.8% of patients who died. For all levels of severity, pregnant women in their third trimester consistently accounted for the majority of the total of pregnant women. The proportion of patients with obesity increased with increasing disease severity—median of 6% of hospitalized patients, 11.3% of patients admitted to the ICU, and 12.0% of all deaths from H1N1. These findings show that risk factors for severe H1N1 infection are similar to those for seasonal influenza, with some notable differences: a substantial proportion of people with severe and fatal cases of H1N1 had pre-existing chronic illness, which indicates that the presence of chronic illness increases the likelihood of death. Cardiac disease, chronic respiratory disease, and diabetes are important risk factors for severe disease that will be especially relevant for countries with high rates of these illnesses. Approximately 2/3 of hospitalized people and 40% of people who died from H1N1 infection did not have any identified pre-existing chronic illness, but this study was not able to comprehensively assess how many of these cases had other risk factors, such as pregnancy, obesity, smoking, and alcohol misuse. Because of large differences between countries, the role of risk factors such as obesity and pregnancy need further study—although there is sufficient evidence to support vaccination and early intervention for pregnant women. Overall, the findings of this study reinforce the need to identify and target high-risk groups for interventions such as immunization, early medical advice, and use of antiviral medications. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001053. WHO provides a Global Alert and Response (GAR) with updates on a number of influenza-related topics The US Centers for Disease Control and Prevention provides information on risk factors and H1N1
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影响因子：
5.5
作者：
Bettinger, Julie A.;Sauve, Laura J.;Pelletier, Louise
通讯作者：
Pelletier, Louise
影响因子：
14.6
作者：
Campbell, Alexia;Rodin, Rachel;Pelletier, Louise
通讯作者：
Pelletier, Louise
DOI：
10.1136/bmj.b5213
发表时间：
2009-12-10
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Donaldson LJ;Rutter PD;Ellis BM;Greaves FE;Mytton OT;Pebody RG;Yardley IE
通讯作者：
Yardley IE
DOI：
10.1016/0002-9378(59)90570-8
发表时间：
1959-01-01
影响因子：
9.8
作者：
FREEMAN, DW
通讯作者：
FREEMAN, DW
影响因子：
14.6
作者：
Dodds, Linda;McNeil, Shelly A.;MacDonald, Noni
通讯作者：
MacDonald, Noni