Article: Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study
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- Publisher Website: 10.1371/journal.pmed.1000442
- Scopus: eid_2-s2.0-79959809606
- PMID: 21713000
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| Title | Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study | ||||||||||||||||||||||||||
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| Authors | Riley, S3 4 Kwok, KO3 Wu, KM3 Ning, DY3 Cowling, BJ3 Wu, JT3 Ho, LM3 Tsang, T6 Lo, SV1 Chu, DKW2 Ma, ESK1 Peiris, JSM2 5 | ||||||||||||||||||||||||||
| Issue Date | 2011 | ||||||||||||||||||||||||||
| Publisher | Public Library of Science. The Journal's web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676 | ||||||||||||||||||||||||||
| Citation | Plos Medicine, 2011, v. 8 n. 6 [How to Cite?] DOI: http://dx.doi.org/10.1371/journal.pmed.1000442 | ||||||||||||||||||||||||||
| Abstract | Background: 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. Methods and Findings: 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. Conclusions: 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. © 2011 Riley et al. | ||||||||||||||||||||||||||
| ISSN | 1549-1277 2011 Impact Factor: 16.269 2011 SCImago Journal Rankings: 1.041 | ||||||||||||||||||||||||||
| DOI | http://dx.doi.org/10.1371/journal.pmed.1000442 | ||||||||||||||||||||||||||
| ISI Accession Number ID | WOS:000292136800003
Funding Information: This project was supported by: the Research Fund for the Control of Infectious Disease, Food and Health Bureau, Government of the Hong Kong SAR (PHE-21); the RAPIDD program from Fogarty International Centre with the Science & Technology Directorate, Department of Homeland Security; R01 TW008246-01 from Fogarty International Centre; the Area of Excellence Scheme of the Hong Kong University Grants Committee (AoE/M-12/06); US National Institutes of Health Models of Infectious Disease Agent Study program; and a Wellcome Trust University Award 093488/Z/10/Z. The funding bodies had no role in study design, data collection and analysis, preparation of the manuscript, or the decision to publish. | ||||||||||||||||||||||||||
| PubMed Central ID | PMC3119689 | ||||||||||||||||||||||||||
| References | References in Scopus | ||||||||||||||||||||||||||
| Grants | Control of Pandemic and Inter-pandemic Influenza A longitudinal community study of influenza virus infections in Hong Kong |
| dc.contributor.author | Riley, S | ||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| dc.contributor.author | Kwok, KO | ||||||||||||||||||||||||||
| dc.contributor.author | Wu, KM | ||||||||||||||||||||||||||
| dc.contributor.author | Ning, DY | ||||||||||||||||||||||||||
| dc.contributor.author | Cowling, BJ | ||||||||||||||||||||||||||
| dc.contributor.author | Wu, JT | ||||||||||||||||||||||||||
| dc.contributor.author | Ho, LM | ||||||||||||||||||||||||||
| dc.contributor.author | Tsang, T | ||||||||||||||||||||||||||
| dc.contributor.author | Lo, SV | ||||||||||||||||||||||||||
| dc.contributor.author | Chu, DKW | ||||||||||||||||||||||||||
| dc.contributor.author | Ma, ESK | ||||||||||||||||||||||||||
| dc.contributor.author | Peiris, JSM | ||||||||||||||||||||||||||
| dc.date.accessioned | 2011-07-27T01:38:55Z | ||||||||||||||||||||||||||
| dc.date.available | 2011-07-27T01:38:55Z | ||||||||||||||||||||||||||
| dc.date.issued | 2011 | ||||||||||||||||||||||||||
| dc.description.abstract | Background: 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. Methods and Findings: 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. Conclusions: 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. © 2011 Riley et al. | ||||||||||||||||||||||||||
| dc.description.grant | Control of Pandemic and Inter-pandemic Influenza | ||||||||||||||||||||||||||
| dc.description.grant | A longitudinal community study of influenza virus infections in Hong Kong | ||||||||||||||||||||||||||
| dc.description.grantcode | 97655 | ||||||||||||||||||||||||||
| dc.description.grantcode | 100778 | ||||||||||||||||||||||||||
| dc.description.nature | published_or_final_version | ||||||||||||||||||||||||||
| dc.identifier.citation | Plos Medicine, 2011, v. 8 n. 6 [How to Cite?] DOI: http://dx.doi.org/10.1371/journal.pmed.1000442 | ||||||||||||||||||||||||||
| dc.identifier.doi | http://dx.doi.org/10.1371/journal.pmed.1000442 | ||||||||||||||||||||||||||
| dc.identifier.hkuros | 186375 | ||||||||||||||||||||||||||
| dc.identifier.isi | WOS:000292136800003
Funding Information: This project was supported by: the Research Fund for the Control of Infectious Disease, Food and Health Bureau, Government of the Hong Kong SAR (PHE-21); the RAPIDD program from Fogarty International Centre with the Science & Technology Directorate, Department of Homeland Security; R01 TW008246-01 from Fogarty International Centre; the Area of Excellence Scheme of the Hong Kong University Grants Committee (AoE/M-12/06); US National Institutes of Health Models of Infectious Disease Agent Study program; and a Wellcome Trust University Award 093488/Z/10/Z. The funding bodies had no role in study design, data collection and analysis, preparation of the manuscript, or the decision to publish. | ||||||||||||||||||||||||||
| dc.identifier.issn | 1549-1277 2011 Impact Factor: 16.269 2011 SCImago Journal Rankings: 1.041 | ||||||||||||||||||||||||||
| dc.identifier.issue | 6 | ||||||||||||||||||||||||||
| dc.identifier.openurl | | ||||||||||||||||||||||||||
| dc.identifier.pmcid | PMC3119689 | ||||||||||||||||||||||||||
| dc.identifier.pmid | 21713000 | ||||||||||||||||||||||||||
| dc.identifier.scopus | eid_2-s2.0-79959809606 | ||||||||||||||||||||||||||
| dc.identifier.uri | http://hdl.handle.net/10722/135660 | ||||||||||||||||||||||||||
| dc.identifier.volume | 8 | ||||||||||||||||||||||||||
| dc.language | eng | ||||||||||||||||||||||||||
| dc.publisher | Public Library of Science. The Journal's web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676 | ||||||||||||||||||||||||||
| dc.publisher.place | United States | ||||||||||||||||||||||||||
| dc.relation.ispartof | PLoS Medicine | ||||||||||||||||||||||||||
| dc.relation.references | References in Scopus | ||||||||||||||||||||||||||
| dc.rights | Creative Commons: Attribution 3.0 Hong Kong License | ||||||||||||||||||||||||||
| dc.subject.mesh | Hong Kong - epidemiology | ||||||||||||||||||||||||||
| dc.subject.mesh | Influenza A Virus, H1N1 Subtype - physiology | ||||||||||||||||||||||||||
| dc.subject.mesh | Influenza, Human - blood - epidemiology - virology | ||||||||||||||||||||||||||
| dc.subject.mesh | Pandemics - statistics and numerical data | ||||||||||||||||||||||||||
| dc.subject.mesh | Residence Characteristics - statistics and numerical data | ||||||||||||||||||||||||||
| dc.title | Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study | ||||||||||||||||||||||||||
| dc.type | Article |
Author Affiliations
- Hong Kong Hospital Authority
- The University of Hong Kong Li Ka Shing Faculty of Medicine
- The University of Hong Kong
- Imperial College London
- HKU-Pasteur Research Centre
- Centre for Health Protection