Influenza Pneumonia Surveillance among Hospitalized Adults May Underestimate the Burden of Severe Influenza Disease

Ortiz, Justin R.; Neuzil, Kathleen M.; Cooke, Colin R.; Neradilek, Moni B.; Goss, Christopher H.; Shay, David K.

doi:10.1371/journal.pone.0113903

Cited by 25 publications

(28 citation statements)

References 31 publications

(24 reference statements)

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“…However, in hospitalized patients, guidelines for most of the ICD‐10 codes require identification of influenza virus and tests for influenza are easily available with no restrictions on use. Studies indicate that the ICD‐codes tend to underestimate the number of influenza cases, however, the specificity of the ICD‐codes is shown to be high, indicating that the ICD‐codes of influenza are likely to reflect true influenza infection. In addition, many patients with influenza might not be tested for influenza or tested too late to confirm the diagnosis and may therefore be registered with other diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Burden of medically attended influenza in Norway 2008‐2017

Hauge

Bakken

Blasio

et al. 2019

Influenza Resp Viruses

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Background The burden of influenza in Norway remains uncertain, and data on seasonal variations and differences by age groups are needed. Objective To describe number of patients diagnosed with influenza in Norway each season and the number treated in primary or specialist health care by age. Further, to compare the burden of seasonal influenza with the 2009‐2010 pandemic outbreak. Methods We used Norwegian national health registries and identified all patients diagnosed with influenza from 2008 to 2017. We calculated seasonal rates, compared hospitalized patients with patients in primary care and compared seasonal influenza with the 2009‐2010 pandemic outbreak. Results Each season, on average 1.7% of the population were diagnosed with influenza in primary care, the average rate of hospitalization was 48 per 100 000 population while the average number of hospitalized patients each season was nearly 2500. The number of hospitalized influenza patients ranged from 579 in 2008‐2009 to 4973 in 2016‐2017. Rates in primary care were highest among young adults while hospitalization rates were highest in patients 80 years and older and in children below 5 years. The majority of in‐hospital deaths were in patients 70 years and older. Fewer patients were hospitalized during the 2009‐2010 pandemic than in seasonal outbreaks, but during the pandemic, more people in the younger age groups were hospitalized and fatal cases were younger. Conclusion Influenza causes a substantial burden in primary care and hospitals. In non‐pandemic seasons, people above 80 years have the highest risk of influenza hospitalization and death.

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Section: Discussionmentioning

confidence: 99%

Burden of medically attended influenza in Norway 2008‐2017

Hauge

Bakken

Blasio

et al. 2019

Influenza Resp Viruses

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“…The above findings and our approach to estimating the state‐level burden of influenza apply to broader public health prevention and response efforts in several ways. First, we demonstrated that it is feasible to calculate state‐level estimates of influenza burden using methods established for national public health purposes . Second, the approach accounted for the known under‐detection of influenza inherent to surveillance based on laboratory diagnosis or direct review of influenza diagnoses in administrative records .…”

Section: Discussionmentioning

confidence: 99%

“…The application of similar estimation methods to state‐level data has the potential to provide local burden estimates that complement existing influenza surveillance. We, therefore, adapted CDC’s methods and analogous methods from similar studies to estimate influenza excess hospitalizations and deaths in Colorado . We demonstrate that periodic disease burden estimates are feasible and provide additional information about serious influenza outcomes not routinely available in a state.…”

Section: Introductionmentioning

confidence: 99%

State‐level estimates of excess hospitalizations and deaths associated with influenza

Czaja

Miller

Colborn

et al. 2019

Influenza Resp Viruses

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Background National estimates of influenza burden may not reflect state‐level influenza activity, and local surveillance may not capture the full burden of influenza. Methods To provide state‐level information about influenza burden, we estimated excess pneumonia and influenza (P&I) and respiratory and circulatory (R&C) hospitalizations and deaths in Colorado from local hospital discharge records, death certificates, and influenza virus surveillance using negative binomial models. Results From July 2007 to June 2016, influenza was associated with an excess of 17 911 P&I hospitalizations (95%CI: 15 227, 20 354), 30 811 R&C hospitalizations (95%CI: 24 344, 37 176), 1,064 P&I deaths (95%CI: 757, 1298), and 3828 R&C deaths (95%CI: 2060, 5433). There was a large burden of influenza A(H1N1) among persons aged 0‐64 years, with high median seasonal rates of excess hospitalization among persons aged 0‐4 years. Persons aged ≥65 years experienced the largest numbers and highest median seasonal rates of excess hospitalization and death associated with influenza A (H3N2). The burden of influenza B was generally lower, with elevated median seasonal rates of excess hospitalization among persons aged 0‐4 years and ≥65 years. Conclusions These findings complement existing influenza surveillance. Periodic state‐level estimates of influenza disease burden may be useful for setting state public health priorities and planning prevention and control initiatives.

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“…When studies of influenza-associated critical illness do apply standardized laboratory testing criteria, case definitions often require documentation of fever or a radiographic infiltrate for study entry (2, 3, 9, 10). These criteria will lead to underestimates of influenza disease, as they will not capture non-pneumonia processes such as exacerbations of chronic underlying illnesses like congestive heart failure or asthma (11, 12). …”

Section: Introductionmentioning

confidence: 99%

The Burden of Influenza-Associated Critical Illness Hospitalizations*

Ortiz

Neuzil

Shay

et al. 2014

Critical Care Medicine

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Objective Influenza is the most common vaccine-preventable disease in the United States; however, little is known about the burden of critical illness due to influenza virus infection. Our primary objective was to estimate the proportion of all critical illness hospitalizations that are attributable to seasonal influenza. Design Retrospective cohort study Setting Arizona, California, and Washington from January 2003 through March 2009 Patients All adults hospitalized with critical illness, defined by ICD-9-CM diagnosis and procedure codes for acute respiratory failure, severe sepsis, or in-hospital death Measurements We combined the complete hospitalization discharge databases for three US states, regional influenza virus surveillance, and state census data. Using negative binomial regression models, we estimated the incidence rates of adult influenza-associated critical illness hospitalizations and compared them to all-cause event rates. We also compared modeled outcomes to ICD-9-CM-coded influenza hospitalizations to assess potential under-recognition of severe influenza disease. Main Results During the study period, we estimated that 26,760 influenza-associated critical illness hospitalizations (95% CI: 14,541, 47,464) occurred. The population-based incidence estimate for influenza-associated critical illness was 12.0 per 100,000 person-years (95% CI: 6.6, 21.6), or 1.3% (95%CI:0.7%, 2.3%) of all critical illness hospitalizations. During the influenza season, 3.4% (95%CI:1.9%, 5.8%) of all critical illness hospitalizations were attributable to influenza. There were only 2,612 critical illness hospitalizations with ICD-9-CM-coded influenza diagnoses, suggesting influenza is either undiagnosed or under-coded in a substantial proportion of critical illness. Conclusions Extrapolating our data to the 2010 US population, we estimate about 28,000 adults are hospitalized for influenza-associated critical illness annually. Influenza in many of these critically ill patients may be undiagnosed. Critical care physicians should have a high index of suspicion for influenza in the ICU, particularly when influenza is known to be circulating in their communities.

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Influenza Pneumonia Surveillance among Hospitalized Adults May Underestimate the Burden of Severe Influenza Disease

Cited by 25 publications

References 31 publications

Burden of medically attended influenza in Norway 2008‐2017

Burden of medically attended influenza in Norway 2008‐2017

State‐level estimates of excess hospitalizations and deaths associated with influenza

The Burden of Influenza-Associated Critical Illness Hospitalizations*

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