Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study.
Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study.
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DOI：
10.1371/journal.pmed.1000442
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发表时间：
2011-06
期刊：
影响因子：
15.8
通讯作者：
Peiris JS
中科院分区：
文献类型：
--
作者：
Riley S;Kwok KO;Wu KM;Ning DY;Cowling BJ;Wu JT;Ho LM;Tsang T;Lo SV;Chu DK;Ma ES;Peiris JS
Steven Riley 及其同事分析了 2009 年香港 H1N1 流感大流行的一项社区队列研究，发现感染 H1N1 流感的儿童多于成人，但儿童发展为严重疾病的可能性低于成人。虽然临床流感的发病模式已得到很好的描述，但感染的发病模式仍然存在很大的不确定性。 2009 年的大流行提供了利用血清学技术研究轻度和无症状感染模式的动力和机会。然而，迄今为止，仅基于具有便利抽样框架的横截面研究设计来定义广泛的流行病学模式。我们对香港的一组家庭进行了配对血清学调查，通过随机数字拨号的方式招募，并收集了公立医院系统重症确诊病例的数据（住院天数>90%）。从 770 名年龄在 3 岁至 103 岁之间的个体中获得了配对血清，以及详细的个人水平和家庭水平的感染风险因素。此外，我们使用严重病例的时间序列推断出研究期间之外的情况，并使用从我们的数据获得的流行病学参数模拟了替代研究设计。我们研究期间的感染率随着年龄的增长而大幅下降：3-19岁，发病率为39%（31%-49%）； 20-39岁，8.9%（5.3%-14.7%）； 40-59岁，5.3%（3.5%-8.0%）； 60 岁或以上，0.77% (0.18%–4.2%)。我们估计了感染的简约模型的参数，其中使用线性年龄项和家庭中是否有儿童来预测感染的对数几率。症状报告模式表明儿童比成人更容易出现症状。已确诊的 2009 年 H1N1 流感大流行 (H1N1pdm) 总体死亡率为每 100,000 名感染者 7.6 人 (6.2–9.5 人)。然而，随着年龄的增加，每 100,000 名感染者的死亡人数大幅增加，从 3-19 岁的 0.66 (0.65-0.86) 上升到 60 岁及以上的 220 (50-4,000)。使用严重疾病发生率来推断我们研究期间之外的情况，我们估计截至 2010 年 1 月底，56% (43%–69%) 的 3-19 岁儿童和 16% (13%–18%) 的总体人口感染了大流行毒株。通过模拟，我们发现，在 2009 年期间，较大的队列和较短的随访时间可以迅速提供与此处提供的数据类似的数据。如果 H1N1pdm 在老年人中变得更具传染性，那么在未来的浪潮中，每次感染的严重疾病的平均发生率可能会更高：衡量严重程度的这种变化需要与此处描述的类似的研究。对于老年人来说，有效接种 H1N1pdm 感染疫苗的好处可能很大。修订后的大流行性流感防范计划应包括前瞻性血清学队列研究。在香港 2009 年的主要流感浪潮之后，许多各个年龄段的人仍然容易感染 H1N1pdm。 请参阅本文后面的编辑摘要 从 2009 年 6 月到 2010 年 8 月，世界正式（根据世界卫生组织的具体标准——世界卫生组织第 6 阶段大流行警报）陷入了由新的 H1N1 病毒株引发的甲型流感大流行。在此期间，超过 214 个国家和海外领土报告了 2009 年 H1N1 流感大流行实验室确诊病例，造成近 20,000 人死亡。虽然人们对临床流感的发病模式已经了解很多，但感染发病模式却更加不确定，因为许多流感感染要么无症状，要么仅引起轻微症状。这意味着仅使用临床监测很难准确估计感染的危险因素和总体疾病负担。然而，如果不能准确估计不同风险人群的感染发生率，就不可能确定导致重症的感染人数（重症的人均感染率）。因此，很难向个人、团体和人群提供有关可能降低流感感染风险的药物和疫苗等干预措施的潜在益处的循证建议。 2009年大流行期间，一些国家和地区，例如香港，能够利用血清学技术调查轻度和无症状感染的模式，从而提供可能有助于填补这一知识空白的信息。鉴于高水平的聚合酶链反应 (PCR) 检测和医院事件的可靠报告，香港的 H1N1 流感大流行（2009 年 9 月期间）为实施前瞻性队列研究以调查感染发生率提供了机会。 研究人员做了什么并发现了什么？研究人员通过随机选择参与研究的家庭来收集有关流感无症状症状的数据。每个愿意参与的家庭成员都在大流行的主波（2009年7月至2009年9月）之前采集了基线血样，然后，当临床监测表明传播的主峰已经过去时，在主波之后（2009年11月至2010年2月）。在研究期间，参与者被要求通过三种方式报告任何流感样症状：给研究团队打电话并实时报告症状；填写纸质日记，注明日期和症状；并在后续访谈中报告症状。与此同时，研究人员监测了每位入住重症监护病房或在医院死亡的 H1N1 患者的数据。然后，研究人员通过开发基于可能性的框架来估计每个重症病例的 H1N1 感染人数（感染发生率）。他们使用模拟模型来调查替代研究设计，并验证他们对每次感染的严重疾病发生率的估计。利用这些方法，研究人员发现，研究期间H1N1感染率随着年龄的增长而大幅下降：3-19岁，发病率为39%； 20-39岁，8.9%； 40-59岁，5.3%； 60岁或以上，0.77%。此外，症状报告模式表明儿童比成人更容易出现症状。确诊的 H1N1 流感总体死亡率为每 10 万人中有 7.6 人死亡。然而，随着年龄的增加，每 10 万感染者的死亡人数不断大幅增加，从 3-19 岁的 0.66 人增加到 60 岁及以上的 220 人。统计模型表明，截至 2010 年 1 月底，56% 的 3-19 岁儿童和 16% 的人口感染了这一大流行毒株。这项研究的结果表明，感染 H1N1 流感的儿童多于成人，但大多数儿童并未发展为严重疾病。相反，虽然感染 H1N1 流感的老年人较少，但这一群体患严重疾病的可能性要大得多。因此，如果 H1N1 流感在老年人中的感染率不断增加，例如，该群体的传染性变得更强，那么每次感染的平均重症率可能会比 2009 年大流行时高得多。修订后的大流行防范计划应包括前瞻性血清学队列研究，例如本研究，以便能够估计每次感染的严重疾病发生率。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.1000442。世卫组织掌握了全球应对 2009 年 H1N1 流感大流行的信息 世卫组织还提供了 H1N1 流感大流行后时期的建议 香港政府卫生防护中心提供了有关香港 H1N1 流感的信息
Steven Riley and colleagues analyze a community cohort study from the 2009 (H1N1) influenza pandemic in Hong Kong, and found that more children than adults were infected with H1N1, but children were less likely to progress to severe disease than adults. While patterns of incidence of clinical influenza have been well described, much uncertainty remains over patterns of incidence of infection. The 2009 pandemic provided both the motivation and opportunity to investigate patterns of mild and asymptomatic infection using serological techniques. However, to date, only broad epidemiological patterns have been defined, based on largely cross-sectional study designs with convenience sampling frameworks. We conducted a paired serological survey of a cohort of households in Hong Kong, recruited using random digit dialing, and gathered data on severe confirmed cases from the public hospital system (>90% inpatient days). Paired sera were obtained from 770 individuals, aged 3 to 103, along with detailed individual-level and household-level risk factors for infection. Also, we extrapolated beyond the period of our study using time series of severe cases and we simulated alternate study designs using epidemiological parameters obtained from our data. Rates of infection during the period of our study decreased substantially with age: for 3–19 years, the attack rate was 39% (31%–49%); 20–39 years, 8.9% (5.3%–14.7%); 40–59 years, 5.3% (3.5%–8.0%); and 60 years or older, 0.77% (0.18%–4.2%). We estimated parameters for a parsimonious model of infection in which a linear age term and the presence of a child in the household were used to predict the log odds of infection. Patterns of symptom reporting suggested that children experienced symptoms more often than adults. The overall rate of confirmed pandemic (H1N1) 2009 influenza (H1N1pdm) deaths was 7.6 (6.2–9.5) per 100,000 infections. However, there was substantial and progressive increase in deaths per 100,000 infections with increasing age from 0.66 (0.65–0.86) for 3–19 years up to 220 (50–4,000) for 60 years and older. Extrapolating beyond the period of our study using rates of severe disease, we estimated that 56% (43%–69%) of 3–19 year olds and 16% (13%–18%) of people overall were infected by the pandemic strain up to the end of January 2010. Using simulation, we found that, during 2009, larger cohorts with shorter follow-up times could have rapidly provided similar data to those presented here. Should H1N1pdm evolve to be more infectious in older adults, average rates of severe disease per infection could be higher in future waves: measuring such changes in severity requires studies similar to that described here. The benefit of effective vaccination against H1N1pdm infection is likely to be substantial for older individuals. Revised pandemic influenza preparedness plans should include prospective serological cohort studies. Many individuals, of all ages, remained susceptible to H1N1pdm after the main 2009 wave in Hong Kong. Please see later in the article for the Editors' Summary From June 2009 to August 2010, the world was officially (according to specific WHO criteria—WHO phase 6 pandemic alert) in the grip of an Influenza A pandemic with a new strain of the H1N1 virus. During this time, more than 214 countries and overseas territories reported laboratory confirmed cases of pandemic influenza H1N1 2009 with almost 20,000 deaths. While much is already known about patterns of incidence of clinical influenza, the patterns of infection incidence are much more uncertain, because many influenza infections are either asymptomatic or cause only mild symptoms. This means that it is difficult to obtain accurate estimates of risk factors for infection and the overall burden of disease using only clinical surveillance. However, without accurate estimates of infection incidence across different risk groups, it is not possible to establish the number of infections that give rise to severe disease (the per infection rate of severe disease). Consequently, it is difficult to give evidence-based advice for individuals, groups, and populations about the potential benefits of interventions including drugs and vaccines that might reduce the risk of influenza infection. During the 2009 pandemic, some countries and territories, such as Hong Kong, were able to investigate patterns of mild and asymptomatic infection using serological techniques, thus providing information that may help to fill this knowledge gap. Given the high levels of polymerase chain reaction (PCR) testing and the robust reporting of hospital episodes, the main H1N1 pandemic wave in Hong Kong (during September 2009) provided an opportunity to implement a prospective cohort study to investigate the incidence of infection. What Did the Researchers Do and Find? The researchers collected data on the asymptomatic symptoms of influenza by randomly selecting households to participate in the study. Each member of the household willing to participate had a baseline blood sample taken before the main wave of the pandemic (July to September 2009), then, when clinical surveillance suggested that the main peak in transmission had passed, after the main wave (November 2009 to February 2010). During the study period, participants were asked to report any flu-like symptoms in three ways: to phone the study team and report symptoms in real time; to fill out a paper diary with the day and symptoms; and to report symptoms during a follow-up interview. In parallel, the researchers monitored data on every patient with H1N1 admitted to intensive care units or who died while in the hospital. The researchers then estimated the number of H1N1 infections (infection incidence) per severe case by developing a likelihood-based framework. They used a simulation model to investigate alternate study designs and to validate their estimates of the rate of severe disease per infection. Using these methods, the researchers found that rates of H1N1 infection during the study period decreased substantially with age: for 3–19 years, the attack rate was 39%; 20–39 years, 8.9%; 40–59 years, 5.3%; and 60 years or older, 0.77%. In addition, patterns of symptom reporting indicated that children experienced symptoms more often than adults. The overall rate of confirmed H1N1 deaths was 7.6 per 100,000 infections. However, there was a substantial and progressive increase in deaths per 100,000 infections with increasing age from 0.66 for 3–19 years up to 220 for 60 years and older. Statistical modeling suggested that 56% of 3–19 year olds and 16% of people overall were infected by the pandemic strain up to the end of January 2010. The results of this study suggest that more children were infected with H1N1 than adults but most of them did not progress to severe disease. Conversely, although fewer older adults were infected with H1N1, this group was much more likely to experience severe disease. Therefore, should H1N1 infection incidence ever increase in older adults, for example by evolving to become more infectious to this group, average rates of severe disease per infection could be much higher than for the 2009 pandemic. Revised pandemic preparedness plans should include prospective serological cohort studies, such as this one, in order to be able to estimate rates of severe disease per infection. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000442. WHO has information about the global response to the 2009 H1N1 pandemic WHO also provides recommendations for the H1N1 post-pandemic period The government of Hong Kong's Centre for Health Protection provides information about H1N1 in Hong Kong
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DOI：
10.1073/pnas.0510873103
发表时间：
2006-08-15
影响因子：
11.1
作者：
Riley, Steven;Ferguson, Neil M.
通讯作者：
Ferguson, Neil M.
影响因子：
15.8
作者：
Van Kerkhove MD;Asikainen T;Becker NG;Bjorge S;Desenclos JC;dos Santos T;Fraser C;Leung GM;Lipsitch M;Longini IM Jr;McBryde ES;Roth CE;Shay DK;Smith DJ;Wallinga J;White PJ;Ferguson NM;Riley S;WHO Informal Network for Mathematical Modelling for Pandemic Influenza H1N1 2009 (Working Group on Data Needs)
通讯作者：
WHO Informal Network for Mathematical Modelling for Pandemic Influenza H1N1 2009 (Working Group on Data Needs)
DOI：
10.3329/jhpn.v28i6.6601
发表时间：
2010-12
期刊：
Journal of health, population, and nutrition
影响因子：
--
作者：
Prachayangprecha S;Makkoch J;Payungporn S;Chieochansin T;Vuthitanachot C;Vuthitanachot V;Theamboonlers A;Poovorawan Y
通讯作者：
Poovorawan Y
DOI：
10.1086/656740
发表时间：
2010-11-15
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Wu JT;Ma ES;Lee CK;Chu DK;Ho PL;Shen AL;Ho A;Hung IF;Riley S;Ho LM;Lin CK;Tsang T;Lo SV;Lau YL;Leung GM;Cowling BJ;Malik Peiris JS
通讯作者：
Malik Peiris JS
影响因子：
5
作者：
FOX, JP;COONEY, MK;FOY, HM
通讯作者：
FOY, HM