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Using clinical research networks to assess severity of an emerging influenza pandemic
journal contribution
posted on 2023-06-09, 13:59 authored by Lone Simonsen, Elizabeth Higgs, Robert J Taylor, Deborah Wentworth, Al Cozzi-Lepri, Sarah Pett, Dominic E Dwyer, Richard Davey, Ruth Lynfield, Marcelo Losso, Kathleen Morales, Marshall J Glesby, Jozef Weckx, Dianne Carey, Cliff Lane, Jens Lundgren, Melanie NewportMelanie Newport, INSIGHT FLU002 and FLU003 Study GroupsBACKGROUND: Early clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from the International Network for Strategic Initiatives in Global HIV Trials, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic, an essential part of pandemic response. METHODS: We estimated the CFR of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza for the pandemic (2009-2011) and post-pandemic (2012-2015) periods. We used literature survey results on health-seeking behavior to convert that estimate to CFR among all infected persons (CFRAR). RESULTS: During the pandemic period, 5.0% (3.1%-6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%-12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%-0.6%) in the pandemic period 2009-2011 but declined 5-fold in young adults during the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012-2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA. CONCLUSIONS: Data from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, clinical research networks with a global presence and standardized protocols would substantially aid rapid assessment of clinical severity.
History
Publication status
- Published
Journal
Clinical Infectious DiseasesISSN
1058-4838Publisher
Oxford University PressExternal DOI
Issue
3Volume
67Page range
341-349Department affiliated with
- Global Health and Infection Publications
Research groups affiliated with
- Wellcome Trust Brighton and Sussex Centre for Global Health Research Publications
Full text available
- No
Peer reviewed?
- Yes
Legacy Posted Date
2018-06-28First Compliant Deposit (FCD) Date
2018-06-27Usage metrics
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