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Post-pandemic influenza A/H1N1pdm09 is associated with more severe outcomes than A/H3N2 and other respiratory viruses in adult hospitalisations

  • C. A. Minney-Smith (a1) (a2), L. A. Selvey (a3), A. Levy (a2) (a4) and D. W. Smith (a2) (a4)

Abstract

This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2–5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6–5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47–0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.

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      Post-pandemic influenza A/H1N1pdm09 is associated with more severe outcomes than A/H3N2 and other respiratory viruses in adult hospitalisations
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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: C. A. Minney-Smith, E-mail: cara.minney-smith@health.wa.gov.au

References

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1.Iuliano, AD et al. (2018) Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet 391, 12851300.
2.Australian Government DoH (2017) 2017 Influenza Season in Australia: A summary from the National Influenza Surveillance Committee.
3.Lee, N et al. (2011) Complications and outcomes of pandemic 2009 influenza A (H1N1) virus infection in hospitalized adults: how do they differ from those in seasonal influenza? Journal of Infectious Diseases 203, 17391747.
4.Reed, C et al. (2014) Complications among adults hospitalized with influenza: a comparison of seasonal influenza and the 2009 H1N1 pandemic. Clinical Infectious Diseases 59, 166174.
5.Minchole, E et al. (2016) Seasonal influenza A H1N1pdm09 virus and severe outcomes: a reason for broader vaccination in non-elderly, at-risk people. PLOS ONE 11, e0165711.
6.Kusznierz, G et al. (2017) Impact of influenza in the post-pandemic phase: clinical features in hospitalized patients with influenza A (H1N1) pdm09 and H3N2 viruses, during 2013 in Santa Fe, Argentina. Journal of Medical Virology 89, 11861191.
7.Jain, S et al. (2015) Community-acquired pneumonia requiring hospitalization among US adults. New England Journal of Medicine 373, 415427.
8.Jain, S et al. (2015) Community-acquired pneumonia requiring hospitalization among US children. New England Journal of Medicine 372, 835845.
9.Jorquera, PA, Anderson, L and Tripp, RA (2016) Understanding respiratory syncytial virus (RSV) vaccine development and aspects of disease pathogenesis. Expert Review of Vaccines 15, 173187.
10.Ren, J, Phan, T and Bao, X (2015) Recent vaccine development for human metapneumovirus. Journal of General Virology 96, 15151520.
11.Minosse, C et al. (2008) Frequency of detection of respiratory viruses in the lower respiratory tract of hospitalized adults. Journal of Clinical Virology 42, 215220.
12.Wu, X et al. (2015) Incidence of respiratory viral infections detected by PCR and real-time PCR in adult patients with community-acquired pneumonia: a meta-analysis. Respiration; International Review of Thoracic Diseases 89, 343352.
13.Walker, E and Ison, MG (2014) Respiratory viral infections among hospitalized adults: experience of a single tertiary healthcare hospital. Influenza & Other Respiratory Viruses 8, 282292.
14.Lee, N et al. (2013) High morbidity and mortality in adults hospitalized for respiratory syncytial virus infections. Clinical Infectious Diseases 57, 10691077.
15.Lowery, EM et al. (2013) The aging lung. Clinical Interventions in Aging 8, 14891496.
16.Department of Health (2016) SCGH: For Patients and Visitors. Available at http://www.scgh.health.wa.gov.au/Patients_Visitors/ (Accessed 10 November 2016).
17.Chidlow, GR et al. (2009) An economical tandem multiplex real-time PCR technique for the detection of a comprehensive range of respiratory pathogens. Viruses 1, 4256.
18.Chidlow, GR et al. (2012) Respiratory viral pathogens associated with lower respiratory tract disease among young children in the highlands of Papua New Guinea. Journal of Clinical Virology 54, 235239.
19.Australian Government Department of Health (2019) Influenza. Available at https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu (Accessed 18 June 2019).
20.Cheng, AC et al. (2017) Influenza epidemiology in patients admitted to sentinel Australian hospitals in 2016: the Influenza Complications Alert Network (FluCAN). Communicable Diseases Intelligence 41, E337E347.
21.Clark, TW et al. (2014) Adults hospitalised with acute respiratory illness rarely have detectable bacteria in the absence of COPD or pneumonia; viral infection predominates in a large prospective UK sample. Journal of Infection 69, 507515.
22.Jennings, LC et al. (2008) Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 63, 4248.
23.Sundaram, ME et al. (2014) Medically attended respiratory syncytial virus infections in adults aged ≥50 years: clinical characteristics and outcomes. Clinical Infectious Diseases 58, 342349.
24.Kaye, M et al. (2006) Surveillance of respiratory virus infections in adult hospital admissions using rapid methods. Epidemiology & Infection 134, 792798.
25.Falsey, AR et al. (2005) Respiratory syncytial virus infection in elderly and high-risk adults. New England Journal of Medicine 352, 17491759.
26.Widmer, K et al. (2012) Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. Journal of Infectious Diseases 206, 5662.
27.Choi, S-H et al. (2012) Viral infection in patients with severe pneumonia requiring intensive care unit admission. American Journal of Respiratory and Critical Care Medicine 186, 325332.
28.van Asten, L et al. (2016) Early occurrence of influenza A epidemics coincided with changes in occurrence of other respiratory virus infections. Influenza and Other Respiratory Viruses 10, 1426.
29.Lee, N and Ison, MG (2012) Diagnosis, management and outcomes of adults hospitalized with influenza. Antiviral Therapy 17, 143.
30.Simonsen, L et al. (1998) Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. Journal of Infectious Diseases 178, 5360.
31.Kwok, KO et al. (2017) Relative incidence and individual-level severity of seasonal influenza A H3N2 compared with 2009 pandemic H1N1. BMC Infectious Diseases 17, 337.
32.Huang, S-Y et al. (2017) Increased mortality in seasonal H3N2 patients compared with those with pandemic 2009 H1N1 in Taiwan, 2009–2010. The American Journal of Tropical Medicine and Hygiene 97, 19451951.
33.Goh, EH et al. (2017) Epidemiology and relative severity of influenza subtypes in Singapore in the post-pandemic period from 2009 to 2010. Clinical Infectious Diseases 65, 19051913.
34.Shiley, KT et al. (2015) Differences in the epidemiological characteristics and clinical outcomes of pandemic (H1N1) 2009 influenza, compared with seasonal influenza. Infection Control & Hospital Epidemiology 31, 676682.
35.To, KKW et al. (2010) Concurrent comparison of epidemiology, clinical presentation and outcome between adult patients suffering from the pandemic influenza A (H1N1) 2009 virus and the seasonal influenza A virus infection. Postgraduate Medical Journal 86, 515521.
36.Kraft, CS et al. (2012) Severity of human rhinovirus infection in immunocompromised adults is similar to that of 2009 H1N1 influenza. Journal of Clinical Microbiology 50, 10611063.
37.Cheng, AC et al. (2016) Influenza epidemiology in patients admitted to sentinel Australian hospitals in 2015: the Influenza Complications Alert Network. Communicable Diseases Intelligence Quarterly Report 40, E521E526.
38.Belongia, EA et al. (2016) Variable influenza vaccine effectiveness by subtype: a systematic review and meta-analysis of test-negative design studies. The Lancet Infectious Diseases 16, 942951.
39.Desmond, LA et al. (2019) Respiratory viruses in adults hospitalised with community-acquired pneumonia during the non-winter months in Melbourne: routine diagnostic practice may miss large numbers of influenza and respiratory syncytial virus infections. Communicable Diseases Intelligence 43.

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Post-pandemic influenza A/H1N1pdm09 is associated with more severe outcomes than A/H3N2 and other respiratory viruses in adult hospitalisations

  • C. A. Minney-Smith (a1) (a2), L. A. Selvey (a3), A. Levy (a2) (a4) and D. W. Smith (a2) (a4)

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