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

INSIGHT FLU002 and FLU003 Study Groups

doi:10.1093/cid/ciy088

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

INSIGHT FLU002 and FLU003 Study Groups

Institut for Klinisk Medicin

6 Citationer (Scopus)

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.

Clinical Trials Registration: NCT01056354 and NCT010561.

Originalsprog	Engelsk
Tidsskrift	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Vol/bind	67
Udgave nummer	3
Sider (fra-til)	341-349
Antal sider	9
ISSN	1058-4838
DOI	https://doi.org/10.1093/cid/ciy088
Status	Udgivet - 18 jul. 2018

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title = "Using Clinical Research Networks to Assess 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.Clinical Trials Registration: NCT01056354 and NCT010561.",

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 Jozef Weckx and Dianne Carey and Cliff Lane and Jens Lundgren and {INSIGHT FLU002 and FLU003 Study Groups}",

year = "2018",

month = jul,

day = "18",

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",

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TY - JOUR

T1 - Using Clinical Research Networks to Assess 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, Jozef

AU - Carey, Dianne

AU - Lane, Cliff

AU - Lundgren, Jens

AU - INSIGHT FLU002 and FLU003 Study Groups

PY - 2018/7/18

Y1 - 2018/7/18

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.Clinical Trials Registration: NCT01056354 and NCT010561.

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.Clinical Trials Registration: NCT01056354 and NCT010561.

U2 - 10.1093/cid/ciy088

DO - 10.1093/cid/ciy088

M3 - Journal article

C2 - 29746631

SN - 1058-4838

VL - 67

SP - 341

EP - 349

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 3

ER -

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

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