Risk Factors for 2009 Pandemic Influenza A (H1N1)–Related Hospitalization and Death Among Racial/Ethnic Groups in New Mexico

Thompson, Deborah; Jungk, Jessica; Hancock, Emily B.; Smelser, Chad; Landen, Michael; Nichols, Megin; Selvage, David; Baumbach, Joan; Sewell, Mack

doi:10.2105/ajph.2011.300223

Cited by 66 publications

(99 citation statements)

References 20 publications

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“…Hospitalization rates among Native Americans, non-Hispanic Blacks, and Hispanics were 2–6 times higher than those observed among non-Hispanic Whites, which is in agreement with an analysis of hospitalized patients during the 2009 A/H1N1 influenza pandemic in Wisconsin, New Mexico, and the US overall [9, 14, 15]. While Asians experienced the lowest A/H1N1 hospitalization rates among ethnic/race groups, this group showed a statistically significant increased risk of death in the hospital (OR = 23.3) after adjustment for other covariates.…”

Section: Discussionsupporting

confidence: 85%

Risk Factors for Mortality among 2009 A/H1N1 Influenza Hospitalizations in Maricopa County, Arizona, April 2009 to March 2010

Chowell

Ayala

Berisha

et al. 2012

Computational and Mathematical Methods in Medicine

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We analyzed individual-level data on pandemic influenza A/H1N1pdm hospitalizations from the enhanced surveillance system of the Maricopa County Department of Public Health, AZ, USA from April 1st, 2009 to March 31st, 2010. We also assessed the the risk of death among A/H1N1 hospitalizations using multivariate logistic regression. Hospitalization rates were significantly higher among Native Americans (risk ratio (RR) = 6.2; 95% CI: 6.15, 6.21), non-Hispanic Black (RR = 3.84; 95% CI: 3.8, 3.9), and Hispanics (RR = 2.0; 95% CI: 2.0, 2.01) compared to non-Hispanic Whites. Throughout the spring, 59.2% of hospitalized patients received antiviral treatment; the proportion of patients treated increased significantly during the fall to 74.4% (Chi-square test, P < 0.0001). In our best-fit logistic model, the adjusted risk of death among A/H1N1 inpatients was significantly higher during the fall wave (August 16, 2009 to March 31, 2010, OR = 3.94; 95% CI: 1.72, 9.03) compared to the spring wave (April 1, 2009 to August 15, 2009). Moreover, chronic lung disease (OR = 3.5; 95% CI: 1.7, 7.4), cancer within the last 12 months (OR = 4.3; 95%CI: 1.3, 14.8), immuno-suppression (OR = 4.0; 95% CI: 1.84, 8.9), and admission delays (OR = 4.6; 95% CI: 2.2, 9.5) were significantly associated with an increased the risk of death among A/H1N1 inpatients.

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Section: Discussionsupporting

confidence: 85%

Risk Factors for Mortality among 2009 A/H1N1 Influenza Hospitalizations in Maricopa County, Arizona, April 2009 to March 2010

Chowell

Ayala

Berisha

et al. 2012

Computational and Mathematical Methods in Medicine

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“…[185][186][187][188] One was a German study of 93 critically ill children; 185 another was a UK study of 1520 hospitalised patients of all ages; 186 another was a Canadian study 187 of 605 critically ill adults; and the last study 188 was a US study of 926 hospitalised patients of all ages. After removing data from patients who received zanamivir and patients with missing death status (n = 73, 2%), we had data for 3071 patients, of whom 242 (8%) died, 1803 (59%) were discharged, 140 (4%) remained in hospital and 886 (29%) had missing date of discharge.…”

Section: Meta-analysis Of Individual Patient Datamentioning

confidence: 99%

“…The percentages of missing data were smaller for the deaths than the survivors (0.4% vs. 36% for time to death/discharge for example), suggesting that data collection was more thorough for patients who died. 210 Poeppl 2011 198 Blumental 2011 202 Yung 2011 195 Altmann 2011 185 Enstone 2011 192 del Rosal 2011 205 Nguyen-Van-Tam 2010 186 Thompson 2011 188 Miranda-Choque 2011 197 Yokota 2011 200 Moretti 2011 208 Yang 2010 191 Mickienė 2011 Results show that when the time-dependent nature of treatment is taken into account appropriately the treatment effects change direction, although none of the results is statistically significant. Adjusting for potential confounders and imputing missing data made little difference to the results.…”

Section: Meta-analysis Of Individual Patient Datamentioning

confidence: 99%

Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

Heneghan

Onakpoya

Jones

et al. 2016

Health Technol Assess

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BackgroundNeuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide.ObjectivesTo (1) describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports (CSRs) of published and unpublished randomised, placebo-controlled trials and regulatory comments; and (2) determine the effect of oseltamivir (Tamiflu®, Roche) treatment on mortality in patients with 2009A/H1N1 influenza.MethodsWe searched trial registries, electronic databases and corresponded with regulators and sponsors to identify randomised trials of NIs. We requested full CSRs and accessed regulators’ comments. We included only those trials for which we had CSRs. To examine the effects of oseltamivir on 2009A/H1N1 influenza mortality, we requested individual patient data (IPD) from corresponding authors of all included observational studies.ResultsEffect of oseltamivir and zanamivir (Relenza®, GlaxoSmithKline) in the prevention and treatment of influenza: Oseltamivir reduced the time to first alleviation of symptoms in adults by 16.8 hours [95% confidence interval (CI) 8.4 to 25.1 hours]. Zanamivir reduced the time to first alleviation of symptoms in adults by 0.60 days (95% CI 0.39 to 0.81 days). Oseltamivir reduced unverified pneumonia in adult treatment [risk difference (RD) 1.00%, 95% CI 0.22% to 1.49%]; similar findings were observed with zanamivir prophylaxis in adults (RD 0.32%, 95% CI 0.09% to 0.41%). Oseltamivir treatment of adults increased the risk of nausea (RD 3.66%, 95% CI 0.90% to 7.39%) and vomiting (RD 4.56%, 95% CI 2.39% to 7.58%). In the treatment of children, oseltamivir induced vomiting (RD 5.34%, 95% CI 1.75% to 10.29%). Both oseltamivir and zanamivir prophylaxis reduced the risk of symptomatic influenza in individuals (oseltamivir RD 3.05%, 95% CI 1.83% to 3.88%; zanamivir RD 1.98%, 95% CI 0.98% to 2.54%) and in households (oseltamivir RD 13.6%, 95% CI 9.52% to 15.47%; zanamivir RD 14.84%, 95% CI 12.18% to 16.55%). Oseltamivir increased psychiatric adverse events in the combined on- and off-treatment periods (RD 1.06%, 95% CI 0.07% to 2.76%) and the risk of headaches while on treatment (RD 3.15%, 95% CI 0.88% to 5.78%).Effect of oseltamivir on mortality in patients with 2009A/H1N1 influenza: Analysis of summary data of 30 studies as well as IPD of four studies showed evidence of time-dependent bias. After adjusting for time-dependent bias and potential confounding variables, competing risks analysis of the IPD showed insufficient evidence that oseltamivir reduced the risk of mortality (hazard ratio 1.03, 95% CI 0.64 to 1.65).ConclusionsOseltamivir and zanamivir cause small reductions in the time to first alleviation of influenza symptoms in adults. The use of oseltamivir increases the risk of nausea, vomiting, psychiatric events in adults and vomiting in children. Oseltamivir has no protective effect on mortality among patients with 2009A/H1N1 influenza. Prophylaxis with either NI may reduce symptomatic influenza in individuals and in households. The balance between benefits and harms should be considered when making decisions about use of NIs for either prophylaxis or treatment of influenza.Study registrationThis study is registered as PROSPERO CRD42012002245.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Although the demographic profiles of patients pre and during the H1N1 were similar, our results reveal that significantly different patterns of clinical presentation (including chief complaint and level of acuity) emerged during the H1N1 epidemic. Published studies, which included adult ED encounters, demonstrated some differences in symptom patterns when comparing patients of pandemic novel H1N1 and seasonal influenza 21,22. Tang et al21 reported a lower incidence of fever and dyspnea in early H1N1 pandemic in Singapore, while Shiley et al22 documented cough and myalgias were more common in patients with a diagnosis of pandemic H1N1 at 2 medical centers in Philadelphia.…”

Section: Discussionmentioning

confidence: 99%

“…Published studies, which included adult ED encounters, demonstrated some differences in symptom patterns when comparing patients of pandemic novel H1N1 and seasonal influenza 21,22. Tang et al21 reported a lower incidence of fever and dyspnea in early H1N1 pandemic in Singapore, while Shiley et al22 documented cough and myalgias were more common in patients with a diagnosis of pandemic H1N1 at 2 medical centers in Philadelphia. Our findings that rates of hospital admission did not differ between the pre H1N1 and post H1N1 groups is consistent with U.S. CDC surveillance data, which do not show an increase in pneumonia and influenza mortality after the emergence of H1N1 21…”

Section: Discussionmentioning

confidence: 99%

Emergency Physicians’ Adherence to Center for Disease Control and Prevention Guidance During the 2009 Influenza A H1N1 Pandemic

Hsieh¹,

Kelen²,

Dugas³

et al. 2013

WestJEM

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Introduction:Little is known regarding compliance with management guidelines for epidemic influenza in adult emergency department (ED) settings during the 2009 novel influenza A (H1N1) epidemic, especially in relation to the Centers for Disease Control and Prevention (CDC) guidance.Methods:We investigated all patients with a clinical diagnosis of influenza at an inner-city tertiary academic adult ED with an annual census of approximately 60,000 visits from May 2008 to December 2009. We aimed to determine patterns of presentation and management for adult patients with an ED diagnosis of influenza during the H1N1 pandemic, using seasonal influenza (pre-H1N1) as reference and to determine the ED provider’s adherence to American College of Emergency Physicians and CDC guidance during the 2009 H1N1 influenza pandemic. Adherence to key elements of CDC 2009 H1N1 guidance was defined as (1) the proportion of admitted patients who were recommended to receive testing or treatment who actually received testing for influenza or treatment with antivirals; and (2) the proportion of high-risk patients who were supposed to be treated who actually were treated with antivirals.Results:Among 339 patients with clinically diagnosed influenza, 88% occurred during the H1N1 pandemic. Patients were similarly managed during both phases. Median length of visit (pre-H1N1: 385 min, H1N1: 355 min, P > 0.05) and admission rates (pre-H1N1: 8%, H1N1: 11%, P > 0.05) were similar between the 2 groups. 28% of patients in the pre-H1N1 group and 16% of patients in the H1N1 group were prescribed antibiotics during their ED visits (P > 0.05). There were 34 admitted patients during the pandemic;, 30 (88%) of them received influenza testing in the ED, and 22 (65%) were prescribed antivirals in the ED. Noticeably, 19 (56%) of the 34 admitted patients, including 6 with a positive influenza test, received antibiotic treatment during their ED stay.Conclusion:During the recent H1N1 pandemic, most admitted patients received ED diagnostic testing corresponding to the current recommended guidance. Antibiotic treatment for ED patients admitted with suspected influenza is not uncommon. However, less than 70% of admitted patients and less than 50% of high-risk patients were treated with antivirals during their ED visit, indicating a specific call for closer adherence to guidelines in future influenza pandemics.

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Risk Factors for 2009 Pandemic Influenza A (H1N1)–Related Hospitalization and Death Among Racial/Ethnic Groups in New Mexico

Abstract: This analysis supports recent national efforts to include American Indian/Alaska Native race as a group at high risk for complications of influenza with respect to vaccination and antiviral treatment recommendations.

Cited by 66 publications

References 20 publications

Risk Factors for Mortality among 2009 A/H1N1 Influenza Hospitalizations in Maricopa County, Arizona, April 2009 to March 2010

Risk Factors for Mortality among 2009 A/H1N1 Influenza Hospitalizations in Maricopa County, Arizona, April 2009 to March 2010

Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data

Emergency Physicians’ Adherence to Center for Disease Control and Prevention Guidance During the 2009 Influenza A H1N1 Pandemic

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