Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand

Webb, Steven A R; Pettilä, Ville; Seppelt, Ian; Bellomo, Rinaldo; Bailey, Michael; Cooper, Jamie; Cretikos, Michelle; Davies, Andrew R.; Finfer, Simon; Harrigan, Peter; Hart, Graeme K; Howe, Belinda; Iredell, Jonathan R.; McArthur, Colin; Mitchell, Imogen; Morrison, Stephen; Nichol, Alistair; Paterson, David L.; Peake, Sandra; Richards, Brent; Stephens, Dianne P.; Turner, Andrew; Yung, Michael

doi:10.1056/nejmoa0908481

Cited by 840 publications

(268 citation statements)

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“…A majority of hospitalized patients requiring therapy in ICUs were adults <65 years who on admission had respiratory failure due mainly to primary influenza pneumonia in agreement with other observations,8, 15, 21, 22, 23, 24 and in clear contrast to seasonal influenza. The number of patients that are admitted to an ICU may vary related to criteria used by the institution.…”

Section: Discussionsupporting

confidence: 90%

“…The number of patients that are admitted to an ICU may vary related to criteria used by the institution. Consequently, the mortality in ICU differs has been reported from 11% to 25% 15, 21, 22, 23, 24, 25. Many patients with severe disease have co‐morbidities, but it is well described that fatalities from pandemic influenza may occur in previously healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

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The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

Ørsted

Mølvadgaard

Nielsen

et al. 2013

Influenza Resp Viruses

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Background and objectivesDenmark experienced three waves of the new pandemic influenza A (H1N1)pdm09 from July 2009 to February 2011. The aim of the study was to describe the epidemiology and clinical characteristics of hospitalized patients in a defined population of North Denmark Region with a mixed urban and rural community of 579 000 inhabitants.MethodsReview of medical records of all hospitalized patients with confirmed influenza A from July 2009 to February 2011.ResultsTwo hundred and seventy‐three patients were admitted to hospital. The age‐related population incidences of hospitalization were as follows: 0–14 years: 111/100 000, 15–64 years: 39/100 000, and ≥65 years: 17/100 000. During the first wave (July 2009–August 2009), three patients were admitted – none received treatment in intensive care units (ICUs), during the second wave (October 2009–January 2010), 158 patients were admitted – nine received treatment in ICUs, and during the third wave (December 2010–February 2011), 112 patients were admitted – 25 received treatment in ICUs. Fourteen patients (5%) died within 30 days of diagnosis (median 55 years; range 14–76 years) and additional seven patients (2·6%) died within 365 days (median 25 years; range 1–86 years).ConclusionsPatients hospitalized with pandemic influenza A (H1N1)pdm09 were predominantly children and younger adults, and only a few patients were >65 years. The third wave was the most severe taking the number and percentage of patients admitted to ICUs and 30‐day mortality into consideration. We observed that the incidence of hospitalizations as well as clinical severity among younger adults did not decline from the second to the third wave.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

Ørsted

Mølvadgaard

Nielsen

et al. 2013

Influenza Resp Viruses

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“…H1N1 virus infection is associated with a high fatality rate [1-4]; however, a potential explanation for such rates has not been totally elucidated. Patients who require ICU admission have frequently experienced rapidly progressive, serious lower respiratory tract disease.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

et al. 2011

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IntroductionLittle information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.MethodsWe conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria.ResultsA total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 ± 8.3 versus 12.6 ± 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 ± 4.2 versus 4.8 ± 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3%; P < 0.01, OR 5.1, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62).ConclusionsIn our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.

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“…After screening 787 titles and abstracts and 164 full‐text articles, 48 cohort studies plus 14 companion reports met eligibility criteria and were included 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73. These studies examined H1N1 between March 1, 2009 and October 24, 2010, and the most common factor of social disadvantage reported was ethnic minority status (36/48 studies), except in 12 studies that considered H1N1‐infected patients from LIC/LMIC, which were analyzed separately for each country (one study from Guatemala,57 two from Morocco,60, 61 one from Pakistan,73 and eight from India, plus four companion reports) 60, …”

Section: Resultsmentioning

confidence: 99%

“…Severe illness [defined as intensive care unit (ICU) admission, pneumonia, or respiratory failure] was reported in 19 studies 14, 16, 20, 21, 23, 25, 36, 37, 41, 42, 44, 45, 46, 52, 53, 54, 55. Ethnic minorities did not have a statistically significant increased risk of ICU admission in an Australian study (OR 0·24, 95% CI: 0·05–1·20),36 yet a Canadian study observed a significantly greater proportion of ICU admissions among ethnic minorities (OR 2·76, 95% CI: 1·45–5·23) 20.…”

Section: Resultsmentioning

confidence: 99%

Impact of H1N1 on socially disadvantaged populations: summary of a systematic review

Tricco

Lillie

Soobiah

et al. 2013

Influenza Resp Viruses

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BackgroundPrevious reviews found that the H1N1 pandemic was associated with a large proportion of hospitalizations, severe illness, workplace absenteeism, and high costs. However, the burden among socially disadvantaged groups of the population is unclear. This is a summary of a previously published systematic review commissioned by the World Health Organization on the burden of H1N1 pandemic (influenza A/Mexico/2009 (H1N1)) among socially disadvantaged populations.Methods MEDLINE and EMBASE were searched to identify studies reporting hospitalization, severe illness, and mortality attributable to the 2009 H1N1 pandemic among socially disadvantaged populations, including ethnic minorities and low‐income or lower‐middle‐income economy countries (LIC/LMIC). SAS and Review Manager were used to conduct random effects meta‐analysis.ResultsForty‐eight cohort studies and 14 companion reports including 44 777 patients were included after screening 787 citations and 164 full‐text articles. Twelve of the included studies provided data on LIC/LMIC, including one study from Guatemala, two from Morocco, one from Pakistan, and eight from India, plus four companion reports. The rest provided data on ethnic minorities living in high‐income economy countries (HIC). Significantly more hospitalizations were observed among ethnic minorities versus nonethnic minorities in two North American studies [1313 patients, odds ratio (OR) 2·26 (95% confidence interval: 1·53–3·32)]. Among hospitalized patients in HIC, statistically significant differences in intensive care unit admissions (n = 8 studies, 15 352 patients, OR 0·84 [0·69–1·02]) and deaths (n = 6 studies, 14 757 patients, OR 0·85 [95% CI: 0·73–1·01]) were not observed.ConclusionWe found significantly more hospitalizations among ethnic minorities versus nonethnic minorities in North America, yet no differences in intensive care unit admissions or deaths among H1N1‐infected hospitalized patients were observed in North America and Australia. Our results suggest a similar burden of H1N1 between ethnic minorities and nonethnic minorities living in HIC.

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Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand

Abstract: The 2009 H1N1 virus had a substantial effect on ICUs during the winter in Australia and New Zealand. Our data can assist planning for the treatment of patients during the winter in the Northern Hemisphere.

Cited by 840 publications

References 12 publications

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009–2011: a population‐based study of hospitalizations

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

Impact of H1N1 on socially disadvantaged populations: summary of a systematic review

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