Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study
Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009.Design Investigation of all reported deaths related to pandemic A/H1N1 in England.Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for th...
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| Veröffentlicht in: | BMJ 2009-12, Vol.339 (7737), p.82-82 |
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| creator | Donaldson, Liam J Rutter, Paul D Ellis, Benjamin M Greaves, Felix E C Mytton, Oliver T Pebody, Richard G Yardley, Iain E |
| description | Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009.Design Investigation of all reported deaths related to pandemic A/H1N1 in England.Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient.Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment.Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness.Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available. |
| doi_str_mv | 10.1136/bmj.b5213 |
| format | Article |
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Participants Physicians responsible for the patient.Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment.Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness.Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</description><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 0959-535X</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.b5213</identifier><identifier>PMID: 20007665</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>Adolescent ; Adult ; Age ; Age Distribution ; Antiviral Agents - therapeutic use ; Cause of Death ; Child ; Child Health ; Child, Preschool ; Death ; Disease Outbreaks ; England ; England - epidemiology ; Epidemiologic Studies ; Estimates ; Family physicians ; Fatalities ; Female ; General Practice / Family Medicine ; Health surveillance ; Health Surveys ; Hospitals ; Humans ; Illnesses ; Immunology (Including Allergy) ; Incidence ; Infections ; Infectious Diseases ; Influenza ; Influenza A Virus, H1N1 Subtype ; Influenza, Human - drug therapy ; Influenza, Human - mortality ; Intensive care ; Male ; Middle Aged ; Mortality ; Pandemics ; Patients ; Population ; Primary care ; Public health ; Residence Characteristics ; Sex Distribution ; Surveillance ; Swine flu ; Vaccination Programs ; Young Adult</subject><ispartof>BMJ, 2009-12, Vol.339 (7737), p.82-82</ispartof><rights>Donaldson et al 2009</rights><rights>2010 BMJ Publishing Group Ltd</rights><rights>Copyright BMJ Publishing Group LTD Dec 10, 2009</rights><rights>Donaldson et al 2009 2009 Donaldson et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b658t-4f6478437fd89a9729de3212e1e02e969274646869cbf0cfb5d3e63322f47ffc3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/339/bmj.b5213.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmj.com/content/339/bmj.b5213.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>114,115,230,314,776,780,799,881,3183,23550,27901,27902,30977,57992,58225,77343,77374</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20007665$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Donaldson, Liam J</creatorcontrib><creatorcontrib>Rutter, Paul D</creatorcontrib><creatorcontrib>Ellis, Benjamin M</creatorcontrib><creatorcontrib>Greaves, Felix E C</creatorcontrib><creatorcontrib>Mytton, Oliver T</creatorcontrib><creatorcontrib>Pebody, Richard G</creatorcontrib><creatorcontrib>Yardley, Iain E</creatorcontrib><title>Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</title><title>BMJ</title><addtitle>BMJ</addtitle><description>Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009.Design Investigation of all reported deaths related to pandemic A/H1N1 in England.Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient.Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment.Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness.Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Age Distribution</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Cause of Death</subject><subject>Child</subject><subject>Child Health</subject><subject>Child, Preschool</subject><subject>Death</subject><subject>Disease Outbreaks</subject><subject>England</subject><subject>England - epidemiology</subject><subject>Epidemiologic Studies</subject><subject>Estimates</subject><subject>Family physicians</subject><subject>Fatalities</subject><subject>Female</subject><subject>General Practice / Family Medicine</subject><subject>Health surveillance</subject><subject>Health Surveys</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Immunology (Including Allergy)</subject><subject>Incidence</subject><subject>Infections</subject><subject>Infectious Diseases</subject><subject>Influenza</subject><subject>Influenza A Virus, H1N1 Subtype</subject><subject>Influenza, Human - drug therapy</subject><subject>Influenza, Human - mortality</subject><subject>Intensive care</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Population</subject><subject>Primary care</subject><subject>Public health</subject><subject>Residence Characteristics</subject><subject>Sex Distribution</subject><subject>Surveillance</subject><subject>Swine flu</subject><subject>Vaccination Programs</subject><subject>Young Adult</subject><issn>0959-8138</issn><issn>0959-535X</issn><issn>1468-5833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>7QJ</sourceid><recordid>eNp9kUtv1DAUhS0EoqOhC34AKBKoiEVavx8skKpRoaBSNsCCjeUkdsdDEg92UnX49TikDA8JVrZ1Pl2fcw8ADxE8Rojwk6rbHFcMI3IHLBDlsmSSkLtgARVTpUREHoDDlDYQQkyEVJzdBwc4vwTnbAE-vwtxMK0fdoWLoSu2pm9s5-vi9OQcXaIik6rwvWtH238z-Vac9Vdthl4U27FqM7i2ph3WRRrjtfVtlmpbpGFsdg_APWfaZA9vzyX4-Orsw-q8vHj_-s3q9KKsOJNDSR2nQlIiXCOVUQKrxhKMsEUWYqu4woLynIurunKwdhVriOWEYOyocK4mS_BynpsNdbapbT9E0-pt9J2JOx2M138qvV_rq3CtsVBI5q0swbPbATF8HW0adOdTbacsNoxJC0KRQlCoTB79l2SCEAohz-CTv8BNGGOf16CREBJyTuU07vlM1TGkFK3bm0ZQT-XqXK7-UW5mH_-eck_-rDIDj2Zgk4YQf-mMC8IZzXo56z4N9mavm_hFZ0Iwfflppd8KSshKUj19-HTmJw__9vUdqbbCJw</recordid><startdate>20091210</startdate><enddate>20091210</enddate><creator>Donaldson, Liam J</creator><creator>Rutter, Paul D</creator><creator>Ellis, Benjamin M</creator><creator>Greaves, Felix E C</creator><creator>Mytton, Oliver T</creator><creator>Pebody, Richard G</creator><creator>Yardley, Iain E</creator><general>British Medical Journal Publishing Group</general><general>British Medical Association</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7QJ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20091210</creationdate><title>Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</title><author>Donaldson, Liam J ; Rutter, Paul D ; Ellis, Benjamin M ; Greaves, Felix E C ; Mytton, Oliver T ; Pebody, Richard G ; Yardley, Iain E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b658t-4f6478437fd89a9729de3212e1e02e969274646869cbf0cfb5d3e63322f47ffc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age</topic><topic>Age Distribution</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Cause of Death</topic><topic>Child</topic><topic>Child Health</topic><topic>Child, Preschool</topic><topic>Death</topic><topic>Disease Outbreaks</topic><topic>England</topic><topic>England - epidemiology</topic><topic>Epidemiologic Studies</topic><topic>Estimates</topic><topic>Family physicians</topic><topic>Fatalities</topic><topic>Female</topic><topic>General Practice / Family Medicine</topic><topic>Health surveillance</topic><topic>Health Surveys</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Illnesses</topic><topic>Immunology (Including Allergy)</topic><topic>Incidence</topic><topic>Infections</topic><topic>Infectious Diseases</topic><topic>Influenza</topic><topic>Influenza A Virus, H1N1 Subtype</topic><topic>Influenza, Human - drug therapy</topic><topic>Influenza, Human - mortality</topic><topic>Intensive care</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Population</topic><topic>Primary care</topic><topic>Public health</topic><topic>Residence Characteristics</topic><topic>Sex Distribution</topic><topic>Surveillance</topic><topic>Swine flu</topic><topic>Vaccination Programs</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Donaldson, Liam J</creatorcontrib><creatorcontrib>Rutter, Paul D</creatorcontrib><creatorcontrib>Ellis, Benjamin M</creatorcontrib><creatorcontrib>Greaves, Felix E C</creatorcontrib><creatorcontrib>Mytton, Oliver T</creatorcontrib><creatorcontrib>Pebody, Richard G</creatorcontrib><creatorcontrib>Yardley, Iain E</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Donaldson, Liam J</au><au>Rutter, Paul D</au><au>Ellis, Benjamin M</au><au>Greaves, Felix E C</au><au>Mytton, Oliver T</au><au>Pebody, Richard G</au><au>Yardley, Iain E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study</atitle><jtitle>BMJ</jtitle><addtitle>BMJ</addtitle><date>2009-12-10</date><risdate>2009</risdate><volume>339</volume><issue>7737</issue><spage>82</spage><epage>82</epage><pages>82-82</pages><issn>0959-8138</issn><issn>0959-535X</issn><eissn>1468-5833</eissn><eissn>1756-1833</eissn><coden>BMJOAE</coden><abstract>Objective To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009.Design Investigation of all reported deaths related to pandemic A/H1N1 in England.Setting Mandatory reporting systems established in acute hospitals and primary care. Participants Physicians responsible for the patient.Main outcome measures Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment.Results With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged ≥65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness.Conclusions Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>20007665</pmid><doi>10.1136/bmj.b5213</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | BMJ, 2009-12, Vol.339 (7737), p.82-82 |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Jstor Complete Legacy; MEDLINE; BMJ Journals - NESLi2 |
| subjects | Adolescent Adult Age Age Distribution Antiviral Agents - therapeutic use Cause of Death Child Child Health Child, Preschool Death Disease Outbreaks England England - epidemiology Epidemiologic Studies Estimates Family physicians Fatalities Female General Practice / Family Medicine Health surveillance Health Surveys Hospitals Humans Illnesses Immunology (Including Allergy) Incidence Infections Infectious Diseases Influenza Influenza A Virus, H1N1 Subtype Influenza, Human - drug therapy Influenza, Human - mortality Intensive care Male Middle Aged Mortality Pandemics Patients Population Primary care Public health Residence Characteristics Sex Distribution Surveillance Swine flu Vaccination Programs Young Adult |
| title | Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study |
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