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Article: Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study

TitleEpidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study
Authors
Issue Date2011
PublisherPublic 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?
AbstractBackground: 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.
Persistent Identifierhttp://hdl.handle.net/10722/135660
ISSN
2014 Impact Factor: 14.429
2014 SCImago Journal Rankings: 4.438
PubMed Central ID
ISI Accession Number ID
Funding AgencyGrant Number
Research Fund for the Control of Infectious Disease, Food and Health Bureau, Government of the Hong Kong SARPHE-21
Fogarty International Centre with the Science & Technology Directorate, Department of Homeland Security
Fogarty International CentreR01 TW008246-01
Hong Kong University Grants CommitteeAoE/M-12/06
US National Institutes of Health
Wellcome Trust093488/Z/10/Z
MedImmune Inc.
GlaxoSmithKline
Baxter
Cruxell
Combinatorix
DIVA Solutions
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.

References
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DC FieldValueLanguage
dc.contributor.authorRiley, Sen_HK
dc.contributor.authorKwok, KOen_HK
dc.contributor.authorWu, KMen_HK
dc.contributor.authorNing, DYen_HK
dc.contributor.authorCowling, BJen_HK
dc.contributor.authorWu, JTen_HK
dc.contributor.authorHo, LMen_HK
dc.contributor.authorTsang, Ten_HK
dc.contributor.authorLo, SVen_HK
dc.contributor.authorChu, DKWen_HK
dc.contributor.authorMa, ESKen_HK
dc.contributor.authorPeiris, JSMen_HK
dc.date.accessioned2011-07-27T01:38:55Z-
dc.date.available2011-07-27T01:38:55Z-
dc.date.issued2011en_HK
dc.identifier.citationPlos Medicine, 2011, v. 8 n. 6en_HK
dc.identifier.issn1549-1277en_HK
dc.identifier.urihttp://hdl.handle.net/10722/135660-
dc.description.abstractBackground: 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.en_HK
dc.languageengen_US
dc.publisherPublic Library of Science. The Journal's web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676en_HK
dc.relation.ispartofPLoS Medicineen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshHong Kong - epidemiology-
dc.subject.meshInfluenza A Virus, H1N1 Subtype - physiology-
dc.subject.meshInfluenza, Human - blood - epidemiology - virology-
dc.subject.meshPandemics - statistics and numerical data-
dc.subject.meshResidence Characteristics - statistics and numerical data-
dc.titleEpidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort studyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1549-1277&volume=8&issue=6, article no. e1000442&spage=&epage=&date=2011&atitle=Epidemiological+characteristics+of+2009+(H1N1)+pandemic+influenza+based+on+paired+sera+from+a+longitudinal+community+cohort+study-
dc.identifier.emailRiley, S: steven.riley@hku.hken_HK
dc.identifier.emailCowling, BJ: bcowling@hku.hken_HK
dc.identifier.emailWu, JT: joewu@hkucc.hku.hken_HK
dc.identifier.emailHo, LM: lmho@hkucc.hku.hken_HK
dc.identifier.emailPeiris, JSM: malik@hkucc.hku.hken_HK
dc.identifier.authorityRiley, S=rp00511en_HK
dc.identifier.authorityCowling, BJ=rp01326en_HK
dc.identifier.authorityWu, JT=rp00517en_HK
dc.identifier.authorityHo, LM=rp00360en_HK
dc.identifier.authorityPeiris, JSM=rp00410en_HK
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1371/journal.pmed.1000442en_HK
dc.identifier.pmid21713000-
dc.identifier.pmcidPMC3119689-
dc.identifier.scopuseid_2-s2.0-79959809606en_HK
dc.identifier.hkuros186375en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-79959809606&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume8en_HK
dc.identifier.issue6en_HK
dc.identifier.eissn1549-1676-
dc.identifier.isiWOS:000292136800003-
dc.publisher.placeUnited Statesen_HK
dc.relation.projectControl of Pandemic and Inter-pandemic Influenza-
dc.relation.projectA longitudinal community study of influenza virus infections in Hong Kong-
dc.identifier.scopusauthoridRiley, S=7102619416en_HK
dc.identifier.scopusauthoridKwok, KO=44161211700en_HK
dc.identifier.scopusauthoridWu, KM=36151664200en_HK
dc.identifier.scopusauthoridNing, DY=44161461200en_HK
dc.identifier.scopusauthoridCowling, BJ=8644765500en_HK
dc.identifier.scopusauthoridWu, JT=7409256423en_HK
dc.identifier.scopusauthoridHo, LM=7402955625en_HK
dc.identifier.scopusauthoridTsang, T=7101832378en_HK
dc.identifier.scopusauthoridLo, SV=8426498400en_HK
dc.identifier.scopusauthoridChu, DKW=7201734326en_HK
dc.identifier.scopusauthoridMa, ESK=24725277400en_HK
dc.identifier.scopusauthoridPeiris, JSM=7005486823en_HK

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