Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
复制标题
DOI：
10.1371/journal.pone.0041069
复制
发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Borja-Aburto VH
中科院分区：
文献类型：
--
作者：
Chowell G;Echevarría-Zuno S;Viboud C;Simonsen L;Miller MA;Fernández-Gárate I;González-Bonilla C;Borja-Aburto VH
阐明2009年甲型H1N1流感大流行严重后果的潜在风险因素的作用，对于在未来大流行中确定资源有限环境中的优先风险群体至关重要。我们使用来自墨西哥社会保障医疗系统前瞻性监测系统的大量ARI（急性呼吸道感染）住院患者的个体水平临床数据，分析临床特征，入院延迟，选定的合并症和接受季节性疫苗对A/H1N1相关死亡风险的影响。我们考虑了2009年8月至12月期间ARI住院和住院死亡患者，并记录了个体患者的人口统计学、地理和医学信息。在调整了年龄、性别、地理、抗病毒治疗、入院延迟、合并症和医疗条件后，季节性流感疫苗接种与甲型H1N1住院患者死亡风险降低相关（OR =0.43（95%CI：0.25，0.74））。 然而，这一结果应谨慎解释，因为它可能受到我们研究中未直接测量的因素的影响。抗病毒治疗对甲型H1N1流感住院患者死亡的影响没有达到统计学意义（OR = 0.56（95%CI：0.29，1.10）），可能是因为只有8.9%的甲型H1N1流感住院患者接受了抗病毒治疗。 此外，糖尿病（OR = 1.6）和免疫抑制（OR = 2.3）是统计学上显著的死亡危险因素，而哮喘患者（OR = 0.3）或孕妇（OR = 0.4）在甲型H1N1流感住院患者中的死亡率降低。 我们还观察到症状出现后入院延迟>2天的甲型H1N1流感住院患者死亡风险增加（OR = 2.7）。 在甲型H1N1流感阴性住院患者中也观察到类似的关联。已确定的医疗风险因素（包括糖尿病患病率和免疫抑制）的地理差异可能部分解释了国家间流行病死亡率负担的差异。此外，获得护理，包括立即住院和抗病毒治疗，以及2008-09年三价灭活流感疫苗的接种覆盖率也是重要因素。
Elucidating the role of the underlying risk factors for severe outcomes of the 2009 A/H1N1 influenza pandemic could be crucial to define priority risk groups in resource-limited settings in future pandemics. We use individual-level clinical data on a large series of ARI (acute respiratory infection) hospitalizations from a prospective surveillance system of the Mexican Social Security medical system to analyze clinical features at presentation, admission delays, selected comorbidities and receipt of seasonal vaccine on the risk of A/H1N1-related death. We considered ARI hospitalizations and inpatient-deaths, and recorded demographic, geographic, and medical information on individual patients during August-December, 2009. Seasonal influenza vaccination was associated with a reduced risk of death among A/H1N1 inpatients (OR = 0.43 (95% CI: 0.25, 0.74)) after adjustment for age, gender, geography, antiviral treatment, admission delays, comorbidities and medical conditions. However, this result should be interpreted with caution as it could have been affected by factors not directly measured in our study. Moreover, the effect of antiviral treatment against A/H1N1 inpatient death did not reach statistical significance (OR = 0.56 (95% CI: 0.29, 1.10)) probably because only 8.9% of A/H1N1 inpatients received antiviral treatment. Moreover, diabetes (OR = 1.6) and immune suppression (OR = 2.3) were statistically significant risk factors for death whereas asthmatic persons (OR = 0.3) or pregnant women (OR = 0.4) experienced a reduced fatality rate among A/H1N1 inpatients. We also observed an increased risk of death among A/H1N1 inpatients with admission delays >2 days after symptom onset (OR = 2.7). Similar associations were also observed for A/H1N1-negative inpatients. Geographical variation in identified medical risk factors including prevalence of diabetes and immune suppression may in part explain between-country differences in pandemic mortality burden. Furthermore, access to care including hospitalization without delay and antiviral treatment and are also important factors, as well as vaccination coverage with the 2008–09 trivalent inactivated influenza vaccine.
登录
查看更多内容
DOI：
10.1136/bmj.b3928
发表时间：
2009-10-06
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Garcia-Garcia L;Valdespino-Gómez JL;Lazcano-Ponce E;Jimenez-Corona A;Higuera-Iglesias A;Cruz-Hervert P;Cano-Arellano B;Garcia-Anaya A;Ferreira-Guerrero E;Baez-Saldaña R;Ferreyra-Reyes L;Ponce-de-León-Rosales S;Alpuche-Aranda C;Rodriguez-López MH;Perez-Padilla R;Hernandez-Avila M
通讯作者：
Hernandez-Avila M
影响因子：
3.7
作者：
Chowell G;Echevarría-Zuno S;Viboud C;Simonsen L;Miller MA;Fernández-Gárate I;González-Bonilla C;Borja-Aburto VH
通讯作者：
Borja-Aburto VH
影响因子：
14.6
作者：
Campbell, Alexia;Rodin, Rachel;Pelletier, Louise
通讯作者：
Pelletier, Louise
影响因子：
168.9
作者：
Echevarria-Zuno, Santiago;Manuel Mejia-Arangure, Juan;Hugo Borja-Aburto, Victor
通讯作者：
Hugo Borja-Aburto, Victor
影响因子：
28.2
作者：
Cortes Garcia, Marta;Sierra Moros, Maria Jose;Pachon, Isabel
通讯作者：
Pachon, Isabel