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Article: The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis
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TitleThe severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis
 
AuthorsPresanis, AM2
De Angelis, D2 4
Hagy, A
Reed, C5
Riley, S3
Cooper, BS4
Finelli, L5
Biedrzycki, P
Lipsitch, M1
Ackelsberg, J
Adamski, A
Adman, G
AgborTabi, E
Aston, C
Atamian, J
Backman, P
Balter, S
Barbot, O
Beatrice, ST
Beaudry, G
Begier, E
Bell, G
Berg, D
Berger, M
Betz, J
Blank, S
Bornschlegel, K
Bregman, B
Burke, M
Butts, B
Cai, L
Cajigal, A
Campbell, M
Camurati, L
Chamany, S
Cimini, D
Cone, J
Cook, H
Cook, D
Corey, C
Costarella, R
Coyle, C
Crouch, B
Da Costa, CA
Daniels, A
Darkins, B
DeGrasse, A
DeGrechie, S
Del Cid, O
Deocharan, B
Diaz, L
DiCaprio, K
DiGrande, L
Duquaine, D
Durrah, J
Eavey, J
Edghill, Z
Edwin, B
Egger, J
Eisenhower, D
Evans, M
Farley, S
Feliciano, R
Fernandez, M
FilsAime, C
Fine, A
Fireteanu, AM
Fitzgerald, K
France, AM
Frieden, T
Friedman, S
Fu, J
Fung, L
Girdharrie, L
Glaser, M
Goranson, C
Griffing, F
Gupta, L
Hamilton, C
Hanson, H
Harper, S
HartmanO'Connell, I
Hasnain, Q
Hedge, S
Heller, M
Hendrickson, D
Herskovitz, A
Hinterland, K
Holmes, R
Hom, J
Hon, J
Hopke, T
Hsieh, J
Hughes, S
Immerwahr, S
Incalicchio, AM
Jasek, J
Jimenez, J
Johns, M
Jones, L
Jordan, H
Kambili, C
Kang, J
Kapell, D
Karpati, A
Kerker, B
Konty, K
Kornblum, J
Krigsman, G
Laraque, F
Layton, M
Lee, E
Lee, L
Lee, S
Lim, S
Marx, M
McGibbon, E
Mahoney, K
Marin, G
Matte, T
McAnanama, R
McKay, R
McKay, C
McVeigh, K
Medina, E
Medina, W
Michelangelo, D
Milhofer, J
Milyavskaya, I
Misener, M
Mizrahi, J
Moskin, L
Motherwell, M
Myers, C
Nair, HP
Nguyen, T
Nilsen, D
Nival, J
Norton, J
Oleszko, W
Olson, C
Paladini, M
Palumbo, L
Papadopoulos, P
Parton, H
Paternostro, J
Paynter, L
Perkins, K
Perlman, S
Persaud, H
Peters, C
Pfeiffer, M
Platt, R
Pool, L
Punsalang, A
Rasul, Z
Rawlins, V
Reddy, V
Rinchiuso, A
Rodriguez, T
Rosal, R
Ryan, M
Sanderson, M
Scaccia, A
Seligson, AL
Seupersad, J
SevereDildy, J
Siddiqi, A
Siemetzki, U
Singh, T
Slavinski, S
Slopen, M
Snuggs, T
Starr, D
Stayton, C
Stoute, A
Terlonge, J
Ternier, A
Thorpe, L
Travers, C
Tsoi, B
Turner, K
Tzou, J
Vines, S
Waddell, EN
Walker, D
Warner, C
Weisfuse, I
Weiss, D
WilliamsAkita, A
Wilson, E
Wilson, E
Wong, M
Wu, C
Yang, D
Younis, M
Yusuff, S
Zimmerman, C
Zucker, J
 
Issue Date2009
 
PublisherPublic Library of Science. The Journal's web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676
 
CitationPlos Medicine, 2009, v. 6 n. 12 [How to Cite?]
DOI: http://dx.doi.org/10.1371/journal.pmed.1000207
 
AbstractBackground: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.
 
ISSN1549-1277
2012 SCImago Journal Rankings: 4.105
 
DOIhttp://dx.doi.org/10.1371/journal.pmed.1000207
 
PubMed Central IDPMC2784967
 
ISI Accession Number IDWOS:000273060600018
Funding AgencyGrant Number
UK Medical Research CouncilG0600675
U.1052.00.007
UK Health Protection Agency
Cooperative Agreements1U54GM088558
5U01GM076497
US National Institutes of Health (US NIH)
US NIH3R01TW008246-01S1
US Department of Homeland Security
Funding Information:

AMP and DDA were funded by the UK Medical Research Council (grants G0600675 and U.1052.00.007). DDA was funded also by the UK Health Protection Agency. ML and SR were supported by Cooperative Agreements 1U54GM088558 and 5U01GM076497 of the Models of Infectious Disease Agent Study program of the US National Institutes of Health (US NIH). SR also received funding from grant 3R01TW008246-01S1 from the US NIH from the RAPIDD program of the Fogarty International Center of the US NIH and the Science and Technology Directorate of the US Department of Homeland Security. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorPresanis, AM
 
dc.contributor.authorDe Angelis, D
 
dc.contributor.authorHagy, A
 
dc.contributor.authorReed, C
 
dc.contributor.authorRiley, S
 
dc.contributor.authorCooper, BS
 
dc.contributor.authorFinelli, L
 
dc.contributor.authorBiedrzycki, P
 
dc.contributor.authorLipsitch, M
 
dc.contributor.authorAckelsberg, J
 
dc.contributor.authorAdamski, A
 
dc.contributor.authorAdman, G
 
dc.contributor.authorAgborTabi, E
 
dc.contributor.authorAston, C
 
dc.contributor.authorAtamian, J
 
dc.contributor.authorBackman, P
 
dc.contributor.authorBalter, S
 
dc.contributor.authorBarbot, O
 
dc.contributor.authorBeatrice, ST
 
dc.contributor.authorBeaudry, G
 
dc.contributor.authorBegier, E
 
dc.contributor.authorBell, G
 
dc.contributor.authorBerg, D
 
dc.contributor.authorBerger, M
 
dc.contributor.authorBetz, J
 
dc.contributor.authorBlank, S
 
dc.contributor.authorBornschlegel, K
 
dc.contributor.authorBregman, B
 
dc.contributor.authorBurke, M
 
dc.contributor.authorButts, B
 
dc.contributor.authorCai, L
 
dc.contributor.authorCajigal, A
 
dc.contributor.authorCampbell, M
 
dc.contributor.authorCamurati, L
 
dc.contributor.authorChamany, S
 
dc.contributor.authorCimini, D
 
dc.contributor.authorCone, J
 
dc.contributor.authorCook, H
 
dc.contributor.authorCook, D
 
dc.contributor.authorCorey, C
 
dc.contributor.authorCostarella, R
 
dc.contributor.authorCoyle, C
 
dc.contributor.authorCrouch, B
 
dc.contributor.authorDa Costa, CA
 
dc.contributor.authorDaniels, A
 
dc.contributor.authorDarkins, B
 
dc.contributor.authorDeGrasse, A
 
dc.contributor.authorDeGrechie, S
 
dc.contributor.authorDel Cid, O
 
dc.contributor.authorDeocharan, B
 
dc.contributor.authorDiaz, L
 
dc.contributor.authorDiCaprio, K
 
dc.contributor.authorDiGrande, L
 
dc.contributor.authorDuquaine, D
 
dc.contributor.authorDurrah, J
 
dc.contributor.authorEavey, J
 
dc.contributor.authorEdghill, Z
 
dc.contributor.authorEdwin, B
 
dc.contributor.authorEgger, J
 
dc.contributor.authorEisenhower, D
 
dc.contributor.authorEvans, M
 
dc.contributor.authorFarley, S
 
dc.contributor.authorFeliciano, R
 
dc.contributor.authorFernandez, M
 
dc.contributor.authorFilsAime, C
 
dc.contributor.authorFine, A
 
dc.contributor.authorFireteanu, AM
 
dc.contributor.authorFitzgerald, K
 
dc.contributor.authorFrance, AM
 
dc.contributor.authorFrieden, T
 
dc.contributor.authorFriedman, S
 
dc.contributor.authorFu, J
 
dc.contributor.authorFung, L
 
dc.contributor.authorGirdharrie, L
 
dc.contributor.authorGlaser, M
 
dc.contributor.authorGoranson, C
 
dc.contributor.authorGriffing, F
 
dc.contributor.authorGupta, L
 
dc.contributor.authorHamilton, C
 
dc.contributor.authorHanson, H
 
dc.contributor.authorHarper, S
 
dc.contributor.authorHartmanO'Connell, I
 
dc.contributor.authorHasnain, Q
 
dc.contributor.authorHedge, S
 
dc.contributor.authorHeller, M
 
dc.contributor.authorHendrickson, D
 
dc.contributor.authorHerskovitz, A
 
dc.contributor.authorHinterland, K
 
dc.contributor.authorHolmes, R
 
dc.contributor.authorHom, J
 
dc.contributor.authorHon, J
 
dc.contributor.authorHopke, T
 
dc.contributor.authorHsieh, J
 
dc.contributor.authorHughes, S
 
dc.contributor.authorImmerwahr, S
 
dc.contributor.authorIncalicchio, AM
 
dc.contributor.authorJasek, J
 
dc.contributor.authorJimenez, J
 
dc.contributor.authorJohns, M
 
dc.contributor.authorJones, L
 
dc.contributor.authorJordan, H
 
dc.contributor.authorKambili, C
 
dc.contributor.authorKang, J
 
dc.contributor.authorKapell, D
 
dc.contributor.authorKarpati, A
 
dc.contributor.authorKerker, B
 
dc.contributor.authorKonty, K
 
dc.contributor.authorKornblum, J
 
dc.contributor.authorKrigsman, G
 
dc.contributor.authorLaraque, F
 
dc.contributor.authorLayton, M
 
dc.contributor.authorLee, E
 
dc.contributor.authorLee, L
 
dc.contributor.authorLee, S
 
dc.contributor.authorLim, S
 
dc.contributor.authorMarx, M
 
dc.contributor.authorMcGibbon, E
 
dc.contributor.authorMahoney, K
 
dc.contributor.authorMarin, G
 
dc.contributor.authorMatte, T
 
dc.contributor.authorMcAnanama, R
 
dc.contributor.authorMcKay, R
 
dc.contributor.authorMcKay, C
 
dc.contributor.authorMcVeigh, K
 
dc.contributor.authorMedina, E
 
dc.contributor.authorMedina, W
 
dc.contributor.authorMichelangelo, D
 
dc.contributor.authorMilhofer, J
 
dc.contributor.authorMilyavskaya, I
 
dc.contributor.authorMisener, M
 
dc.contributor.authorMizrahi, J
 
dc.contributor.authorMoskin, L
 
dc.contributor.authorMotherwell, M
 
dc.contributor.authorMyers, C
 
dc.contributor.authorNair, HP
 
dc.contributor.authorNguyen, T
 
dc.contributor.authorNilsen, D
 
dc.contributor.authorNival, J
 
dc.contributor.authorNorton, J
 
dc.contributor.authorOleszko, W
 
dc.contributor.authorOlson, C
 
dc.contributor.authorPaladini, M
 
dc.contributor.authorPalumbo, L
 
dc.contributor.authorPapadopoulos, P
 
dc.contributor.authorParton, H
 
dc.contributor.authorPaternostro, J
 
dc.contributor.authorPaynter, L
 
dc.contributor.authorPerkins, K
 
dc.contributor.authorPerlman, S
 
dc.contributor.authorPersaud, H
 
dc.contributor.authorPeters, C
 
dc.contributor.authorPfeiffer, M
 
dc.contributor.authorPlatt, R
 
dc.contributor.authorPool, L
 
dc.contributor.authorPunsalang, A
 
dc.contributor.authorRasul, Z
 
dc.contributor.authorRawlins, V
 
dc.contributor.authorReddy, V
 
dc.contributor.authorRinchiuso, A
 
dc.contributor.authorRodriguez, T
 
dc.contributor.authorRosal, R
 
dc.contributor.authorRyan, M
 
dc.contributor.authorSanderson, M
 
dc.contributor.authorScaccia, A
 
dc.contributor.authorSeligson, AL
 
dc.contributor.authorSeupersad, J
 
dc.contributor.authorSevereDildy, J
 
dc.contributor.authorSiddiqi, A
 
dc.contributor.authorSiemetzki, U
 
dc.contributor.authorSingh, T
 
dc.contributor.authorSlavinski, S
 
dc.contributor.authorSlopen, M
 
dc.contributor.authorSnuggs, T
 
dc.contributor.authorStarr, D
 
dc.contributor.authorStayton, C
 
dc.contributor.authorStoute, A
 
dc.contributor.authorTerlonge, J
 
dc.contributor.authorTernier, A
 
dc.contributor.authorThorpe, L
 
dc.contributor.authorTravers, C
 
dc.contributor.authorTsoi, B
 
dc.contributor.authorTurner, K
 
dc.contributor.authorTzou, J
 
dc.contributor.authorVines, S
 
dc.contributor.authorWaddell, EN
 
dc.contributor.authorWalker, D
 
dc.contributor.authorWarner, C
 
dc.contributor.authorWeisfuse, I
 
dc.contributor.authorWeiss, D
 
dc.contributor.authorWilliamsAkita, A
 
dc.contributor.authorWilson, E
 
dc.contributor.authorWilson, E
 
dc.contributor.authorWong, M
 
dc.contributor.authorWu, C
 
dc.contributor.authorYang, D
 
dc.contributor.authorYounis, M
 
dc.contributor.authorYusuff, S
 
dc.contributor.authorZimmerman, C
 
dc.contributor.authorZucker, J
 
dc.date.accessioned2010-09-06T09:17:08Z
 
dc.date.available2010-09-06T09:17:08Z
 
dc.date.issued2009
 
dc.description.abstractBackground: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.
 
dc.description.naturepublished_or_final_version
 
dc.identifier.citationPlos Medicine, 2009, v. 6 n. 12 [How to Cite?]
DOI: http://dx.doi.org/10.1371/journal.pmed.1000207
 
dc.identifier.citeulike6345977
 
dc.identifier.doihttp://dx.doi.org/10.1371/journal.pmed.1000207
 
dc.identifier.hkuros168609
 
dc.identifier.isiWOS:000273060600018
Funding AgencyGrant Number
UK Medical Research CouncilG0600675
U.1052.00.007
UK Health Protection Agency
Cooperative Agreements1U54GM088558
5U01GM076497
US National Institutes of Health (US NIH)
US NIH3R01TW008246-01S1
US Department of Homeland Security
Funding Information:

AMP and DDA were funded by the UK Medical Research Council (grants G0600675 and U.1052.00.007). DDA was funded also by the UK Health Protection Agency. ML and SR were supported by Cooperative Agreements 1U54GM088558 and 5U01GM076497 of the Models of Infectious Disease Agent Study program of the US National Institutes of Health (US NIH). SR also received funding from grant 3R01TW008246-01S1 from the US NIH from the RAPIDD program of the Fogarty International Center of the US NIH and the Science and Technology Directorate of the US Department of Homeland Security. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

 
dc.identifier.issn1549-1277
2012 SCImago Journal Rankings: 4.105
 
dc.identifier.issue12
 
dc.identifier.openurl
 
dc.identifier.pmcidPMC2784967
 
dc.identifier.pmid19997612
 
dc.identifier.scopuseid_2-s2.0-74049092311
 
dc.identifier.urihttp://hdl.handle.net/10722/86446
 
dc.identifier.volume6
 
dc.languageeng
 
dc.publisherPublic Library of Science. The Journal's web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&issn=1549-1676
 
dc.publisher.placeUnited States
 
dc.relation.ispartofPLoS Medicine
 
dc.relation.referencesReferences in Scopus
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.subject.meshBayes Theorem
 
dc.subject.meshDisease Outbreaks
 
dc.subject.meshHospitalization - statistics and numerical data
 
dc.subject.meshInfluenza A Virus, H1N1 Subtype
 
dc.subject.meshInfluenza, Human - classification - epidemiology
 
dc.titleThe severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis
 
dc.typeArticle
 
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<contributor.author>Griffing, F</contributor.author>
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<contributor.author>Herskovitz, A</contributor.author>
<contributor.author>Hinterland, K</contributor.author>
<contributor.author>Holmes, R</contributor.author>
<contributor.author>Hom, J</contributor.author>
<contributor.author>Hon, J</contributor.author>
<contributor.author>Hopke, T</contributor.author>
<contributor.author>Hsieh, J</contributor.author>
<contributor.author>Hughes, S</contributor.author>
<contributor.author>Immerwahr, S</contributor.author>
<contributor.author>Incalicchio, AM</contributor.author>
<contributor.author>Jasek, J</contributor.author>
<contributor.author>Jimenez, J</contributor.author>
<contributor.author>Johns, M</contributor.author>
<contributor.author>Jones, L</contributor.author>
<contributor.author>Jordan, H</contributor.author>
<contributor.author>Kambili, C</contributor.author>
<contributor.author>Kang, J</contributor.author>
<contributor.author>Kapell, D</contributor.author>
<contributor.author>Karpati, A</contributor.author>
<contributor.author>Kerker, B</contributor.author>
<contributor.author>Konty, K</contributor.author>
<contributor.author>Kornblum, J</contributor.author>
<contributor.author>Krigsman, G</contributor.author>
<contributor.author>Laraque, F</contributor.author>
<contributor.author>Layton, M</contributor.author>
<contributor.author>Lee, E</contributor.author>
<contributor.author>Lee, L</contributor.author>
<contributor.author>Lee, S</contributor.author>
<contributor.author>Lim, S</contributor.author>
<contributor.author>Marx, M</contributor.author>
<contributor.author>McGibbon, E</contributor.author>
<contributor.author>Mahoney, K</contributor.author>
<contributor.author>Marin, G</contributor.author>
<contributor.author>Matte, T</contributor.author>
<contributor.author>McAnanama, R</contributor.author>
<contributor.author>McKay, R</contributor.author>
<contributor.author>McKay, C</contributor.author>
<contributor.author>McVeigh, K</contributor.author>
<contributor.author>Medina, E</contributor.author>
<contributor.author>Medina, W</contributor.author>
<contributor.author>Michelangelo, D</contributor.author>
<contributor.author>Milhofer, J</contributor.author>
<contributor.author>Milyavskaya, I</contributor.author>
<contributor.author>Misener, M</contributor.author>
<contributor.author>Mizrahi, J</contributor.author>
<contributor.author>Moskin, L</contributor.author>
<contributor.author>Motherwell, M</contributor.author>
<contributor.author>Myers, C</contributor.author>
<contributor.author>Nair, HP</contributor.author>
<contributor.author>Nguyen, T</contributor.author>
<contributor.author>Nilsen, D</contributor.author>
<contributor.author>Nival, J</contributor.author>
<contributor.author>Norton, J</contributor.author>
<contributor.author>Oleszko, W</contributor.author>
<contributor.author>Olson, C</contributor.author>
<contributor.author>Paladini, M</contributor.author>
<contributor.author>Palumbo, L</contributor.author>
<contributor.author>Papadopoulos, P</contributor.author>
<contributor.author>Parton, H</contributor.author>
<contributor.author>Paternostro, J</contributor.author>
<contributor.author>Paynter, L</contributor.author>
<contributor.author>Perkins, K</contributor.author>
<contributor.author>Perlman, S</contributor.author>
<contributor.author>Persaud, H</contributor.author>
<contributor.author>Peters, C</contributor.author>
<contributor.author>Pfeiffer, M</contributor.author>
<contributor.author>Platt, R</contributor.author>
<contributor.author>Pool, L</contributor.author>
<contributor.author>Punsalang, A</contributor.author>
<contributor.author>Rasul, Z</contributor.author>
<contributor.author>Rawlins, V</contributor.author>
<contributor.author>Reddy, V</contributor.author>
<contributor.author>Rinchiuso, A</contributor.author>
<contributor.author>Rodriguez, T</contributor.author>
<contributor.author>Rosal, R</contributor.author>
<contributor.author>Ryan, M</contributor.author>
<contributor.author>Sanderson, M</contributor.author>
<contributor.author>Scaccia, A</contributor.author>
<contributor.author>Seligson, AL</contributor.author>
<contributor.author>Seupersad, J</contributor.author>
<contributor.author>SevereDildy, J</contributor.author>
<contributor.author>Siddiqi, A</contributor.author>
<contributor.author>Siemetzki, U</contributor.author>
<contributor.author>Singh, T</contributor.author>
<contributor.author>Slavinski, S</contributor.author>
<contributor.author>Slopen, M</contributor.author>
<contributor.author>Snuggs, T</contributor.author>
<contributor.author>Starr, D</contributor.author>
<contributor.author>Stayton, C</contributor.author>
<contributor.author>Stoute, A</contributor.author>
<contributor.author>Terlonge, J</contributor.author>
<contributor.author>Ternier, A</contributor.author>
<contributor.author>Thorpe, L</contributor.author>
<contributor.author>Travers, C</contributor.author>
<contributor.author>Tsoi, B</contributor.author>
<contributor.author>Turner, K</contributor.author>
<contributor.author>Tzou, J</contributor.author>
<contributor.author>Vines, S</contributor.author>
<contributor.author>Waddell, EN</contributor.author>
<contributor.author>Walker, D</contributor.author>
<contributor.author>Warner, C</contributor.author>
<contributor.author>Weisfuse, I</contributor.author>
<contributor.author>Weiss, D</contributor.author>
<contributor.author>WilliamsAkita, A</contributor.author>
<contributor.author>Wilson, E</contributor.author>
<contributor.author>Wilson, E</contributor.author>
<contributor.author>Wong, M</contributor.author>
<contributor.author>Wu, C</contributor.author>
<contributor.author>Yang, D</contributor.author>
<contributor.author>Younis, M</contributor.author>
<contributor.author>Yusuff, S</contributor.author>
<contributor.author>Zimmerman, C</contributor.author>
<contributor.author>Zucker, J</contributor.author>
<date.accessioned>2010-09-06T09:17:08Z</date.accessioned>
<date.available>2010-09-06T09:17:08Z</date.available>
<date.issued>2009</date.issued>
<identifier.citation>Plos Medicine, 2009, v. 6 n. 12</identifier.citation>
<identifier.issn>1549-1277</identifier.issn>
<identifier.uri>http://hdl.handle.net/10722/86446</identifier.uri>
<description.abstract>Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.</description.abstract>
<language>eng</language>
<publisher>Public Library of Science. The Journal&apos;s web site is located at http://medicine.plosjournals.org/perlserv/?request=index-html&amp;issn=1549-1676</publisher>
<relation.ispartof>PLoS Medicine</relation.ispartof>
<rights>Creative Commons: Attribution 3.0 Hong Kong License</rights>
<subject.mesh>Bayes Theorem</subject.mesh>
<subject.mesh>Disease Outbreaks</subject.mesh>
<subject.mesh>Hospitalization - statistics and numerical data</subject.mesh>
<subject.mesh>Influenza A Virus, H1N1 Subtype</subject.mesh>
<subject.mesh>Influenza, Human - classification - epidemiology</subject.mesh>
<title>The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis</title>
<type>Article</type>
<identifier.openurl>http://library.hku.hk:4550/resserv?sid=HKU:IR&amp;issn=1549-1277&amp;volume=6&amp;issue=12, article no. e1000207&amp;spage=&amp;epage=&amp;date=2009&amp;atitle=The+severity+of+pandemic+H1N1+influenza+in+the+United+States,+from+April+to+July+2009:+a+Bayesian+analysis</identifier.openurl>
<description.nature>published_or_final_version</description.nature>
<identifier.doi>10.1371/journal.pmed.1000207</identifier.doi>
<identifier.pmid>19997612</identifier.pmid>
<identifier.pmcid>PMC2784967</identifier.pmcid>
<identifier.scopus>eid_2-s2.0-74049092311</identifier.scopus>
<identifier.hkuros>168609</identifier.hkuros>
<relation.references>http://www.scopus.com/mlt/select.url?eid=2-s2.0-74049092311&amp;selection=ref&amp;src=s&amp;origin=recordpage</relation.references>
<identifier.volume>6</identifier.volume>
<identifier.issue>12</identifier.issue>
<identifier.isi>WOS:000273060600018</identifier.isi>
<publisher.place>United States</publisher.place>
<identifier.citeulike>6345977</identifier.citeulike>
<bitstream.url>http://hub.hku.hk/bitstream/10722/86446/1/pmed.1000207.pdf</bitstream.url>
</item>
Author Affiliations
  1. Harvard School of Public Health
  2. Medical Research Council
  3. The University of Hong Kong
  4. Health Protection Agency
  5. Centers for Disease Control and Prevention