Using Research Networks to Assess Clinical Severity of an Emerging Influenza Pandemic

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, Josef Weckx, Dianne Carey, Cliff Lane, Jens Lundgren, INSIGHT Influenza FLU 002 study group, INSIGHT Influenza FLU 003 Study Group

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND:
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.
OriginalsprogEngelsk
TidsskriftClinical Infectious Diseases
Vol/bind67
Udgave nummer3
Sider (fra-til)341-349
Antal sider9
ISSN1058-4838
DOI
StatusUdgivet - 8 maj 2018

Bibliografisk note

This article has been found as a ’Free Version’ from the Publisher on January 30 2019. When access to the article closes, please notify rucforsk@ruc.dk

Citer dette

Simonsen, L., Higgs, E., Taylor, R. J., Wentworth , D., Cozzi-Lepri, A., Pett, S., ... INSIGHT Influenza FLU 003 Study Group (2018). Using Research Networks to Assess Clinical Severity of an Emerging Influenza Pandemic. Clinical Infectious Diseases, 67(3), 341-349. https://doi.org/10.1093/cid/ciy088
Simonsen, Lone ; Higgs, Elizabeth ; Taylor, Robert J ; Wentworth , Deborah ; Cozzi-Lepri, Al ; Pett, Sarah ; Dwyer, Dominic E. ; Davey, Richard ; Lynfield, Ruth ; Losso, Marcelo ; Morales, Kathleen ; Glesby, Marshall J. ; Weckx, Josef ; Carey, Dianne ; Lane, Cliff ; Lundgren, Jens ; INSIGHT Influenza FLU 002 study group ; INSIGHT Influenza FLU 003 Study Group. / Using Research Networks to Assess Clinical Severity of an Emerging Influenza Pandemic. I: Clinical Infectious Diseases. 2018 ; Bind 67, Nr. 3. s. 341-349.
@article{13799ff3d2fa4f13842579229c6163c2,
title = "Using Research Networks to Assess Clinical Severity of an Emerging Influenza Pandemic",
abstract = "BACKGROUND: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.",
author = "Lone Simonsen and Elizabeth Higgs and Taylor, {Robert J} and Deborah Wentworth and Al Cozzi-Lepri and Sarah Pett and Dwyer, {Dominic E.} and Richard Davey and Ruth Lynfield and Marcelo Losso and Kathleen Morales and Glesby, {Marshall J.} and Josef Weckx and Dianne Carey and Cliff Lane and Jens Lundgren and {INSIGHT Influenza FLU 002 study group} and {INSIGHT Influenza FLU 003 Study Group}",
note = "This article has been found as a ’Free Version’ from the Publisher on January 30 2019. When access to the article closes, please notify rucforsk@ruc.dk",
year = "2018",
month = "5",
day = "8",
doi = "10.1093/cid/ciy088",
language = "English",
volume = "67",
pages = "341--349",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "3",

}

Simonsen, L, Higgs, E, Taylor, RJ, Wentworth , D, Cozzi-Lepri, A, Pett, S, Dwyer, DE, Davey, R, Lynfield, R, Losso, M, Morales, K, Glesby, MJ, Weckx, J, Carey, D, Lane, C, Lundgren, J, INSIGHT Influenza FLU 002 study group & INSIGHT Influenza FLU 003 Study Group 2018, 'Using Research Networks to Assess Clinical Severity of an Emerging Influenza Pandemic', Clinical Infectious Diseases, bind 67, nr. 3, s. 341-349. https://doi.org/10.1093/cid/ciy088

Using Research Networks to Assess Clinical Severity of an Emerging Influenza Pandemic. / Simonsen, Lone; Higgs, Elizabeth; Taylor, Robert J; Wentworth , Deborah; Cozzi-Lepri, Al; Pett, Sarah; Dwyer, Dominic E.; Davey, Richard; Lynfield, Ruth; Losso, Marcelo; Morales, Kathleen; Glesby, Marshall J.; Weckx, Josef; Carey, Dianne; Lane, Cliff; Lundgren, Jens; INSIGHT Influenza FLU 002 study group; INSIGHT Influenza FLU 003 Study Group.

I: Clinical Infectious Diseases, Bind 67, Nr. 3, 08.05.2018, s. 341-349.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Using Research Networks to Assess Clinical Severity of an Emerging Influenza Pandemic

AU - Simonsen, Lone

AU - Higgs, Elizabeth

AU - Taylor, Robert J

AU - Wentworth , Deborah

AU - Cozzi-Lepri, Al

AU - Pett, Sarah

AU - Dwyer, Dominic E.

AU - Davey, Richard

AU - Lynfield, Ruth

AU - Losso, Marcelo

AU - Morales, Kathleen

AU - Glesby, Marshall J.

AU - Weckx, Josef

AU - Carey, Dianne

AU - Lane, Cliff

AU - Lundgren, Jens

AU - INSIGHT Influenza FLU 002 study group

AU - INSIGHT Influenza FLU 003 Study Group

N1 - This article has been found as a ’Free Version’ from the Publisher on January 30 2019. When access to the article closes, please notify rucforsk@ruc.dk

PY - 2018/5/8

Y1 - 2018/5/8

N2 - BACKGROUND: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.

AB - BACKGROUND: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.

UR - https://academic.oup.com/cid/article/67/3/341/4993975

U2 - 10.1093/cid/ciy088

DO - 10.1093/cid/ciy088

M3 - Journal article

VL - 67

SP - 341

EP - 349

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 3

ER -