Dataset Information

Severe mortality impact of the 1957 influenza pandemic in Chile.

ABSTRACT:

Introduction

Epidemiological studies of the 1957 influenza pandemic are scarce, particularly from lower-income settings.

Methods

We analyzed the spatial-temporal mortality patterns of the 1957 influenza pandemic in Chile, including detailed age-specific mortality data from a large city, and investigated risk factors for severe mortality impact across regions.

Results

Chile exhibited two waves of excess mortality in winter 1957 and 1959 with a cumulative excess mortality rate of 12 per 10 000, and a ~10-fold mortality difference across provinces. High excess mortality rates were associated with high baseline mortality (R² =41.8%; P=.02), but not with latitude (P>.7). Excess mortality rates increased sharply with age. Transmissibility declined from R=1.4-2.1 to R=1.2-1.4 between the two pandemic waves.

Conclusions

The estimated A/H2N2 mortality burden in Chile is the highest on record for this pandemic-about three to five times as severe as that experienced in wealthier nations. The global impact of this pandemic may be substantially underestimated from previous studies based on high-income countries.

SUBMITTER: Chowell G

PROVIDER: S-EPMC5410718 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Publications

Severe mortality impact of the 1957 influenza pandemic in Chile.

Chowell Gerardo G Simonsen Lone L Fuentes Rodrigo R Flores Jose J Miller Mark A MA Viboud Cécile C

Influenza and other respiratory viruses 20170331 3

<h4>Introduction</h4>Epidemiological studies of the 1957 influenza pandemic are scarce, particularly from lower-income settings.<h4>Methods</h4>We analyzed the spatial-temporal mortality patterns of the 1957 influenza pandemic in Chile, including detailed age-specific mortality data from a large city, and investigated risk factors for severe mortality impact across regions.<h4>Results</h4>Chile exhibited two waves of excess mortality in winter 1957 and 1959 with a cumulative excess mortality rat ...[more]

PMID: 27883281

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Project description:BackgroundWe assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality.Methods and findingsWe used data on all-cause mortality (1999-2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266-958) influenza-attributed deaths; for seasonal influenza 1,956 (range 0-3,990). 15,845 years-of-life-lost were estimated for the pandemic; for an average seasonal epidemic 17,908. For 0-4 yrs of age the number of influenza-attributed deaths during the pandemic were higher than in any seasonal epidemic; 77 deaths (range 61-93) compared to 16 deaths (range 0-45). The ?75 yrs of age showed a far below average number of deaths. Using pneumonia/influenza and respiratory/cardiovascular instead of all-cause deaths consistently resulted in relatively low total pandemic mortality, combined with high impact in the youngest age category.ConclusionThe pandemic had an overall moderate impact on mortality compared to 10 preceding seasonal epidemics, with higher mortality in young children and low mortality in the elderly. This resulted in a total number of pandemic deaths far below the average for seasonal influenza, and a total number of years-of-life-lost somewhat below average. Comparing pandemic and seasonal influenza mortality as in our study will help assessing the worldwide impact of the 2009 pandemic.

Project description:PURPOSE: The rate of severe outcomes of patients with 2009 pandemic (A/H1N1) influenza (2009pI) hospitalized in non-intensive care units (ICUs) has not been defined thus far. This study aims to assess the efficacy of the management of patients with influenza-like illness (ILI) of moderate intermediate severity in an infectious diseases unit (IDU) during the first wave of 2009pI and its influence on the burden of ICUs. METHODS: All patients hospitalized from October 27, 2009, to February 5, 2010, with ILI were included in this prospective observational study. The IDU was organized and the staff was trained to provide intermediate care; patients were transferred to the ICU only if they required invasive ventilation, extracorporeal membrane oxygenation, or advanced cardiovascular support. Demographic data, clinical presentation, coexisting medical conditions, and laboratory and radiological findings were recorded and analyzed, as well as treatment and outcome data. RESULTS: Overall, 108 patients (median age 36 years [IQR 27-54], 57.4% males) including 66.7% with ≥ 1 risk factor for severe influenza, 47.2% with confirmed 2009pI by RT-PCR and 63.9% with pneumonia, were enrolled in the study. All subjects received intravenous fluids and 83.3% were administered oseltamivir, 96.3% antibacterials, 19.4% oxygen therapy without ventilatory support, and 10.2% non-invasive ventilation. A total of 106 (98.1%) subjects were discharged after a 6-day median hospital stay [IQR 4-9]. Two patients (1.9%) were transferred to the ICU. There were no deaths. CONCLUSIONS: These results suggest that the aggressive treatment of patients with moderate intermediate severity 2009 pandemic ILI in non-ICU wards may result in a low rate of severe outcomes and brief hospitalization. IDUs, if properly organized for intermediate care, may efficiently provide correct disease management, in addition to complying with infection control requirements, thus reducing the burden of the pandemic on ICUs. Further studies are warranted to evaluate the outcome of patients with moderate intermediate 2009pI in different non-ICU settings.

Dataset Information

Severe mortality impact of the 1957 influenza pandemic in Chile.

Introduction

Methods

Results

Conclusions

Publications

Severe mortality impact of the 1957 influenza pandemic in Chile.

Similar Datasets

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