Post on 22-Jul-2020
Impactofinfluenzastrainandpatientcharacteristicsontheriskofadmissionswithinfluenza.GlobalInfluenzaHospitalSurveillanceNetworkResults,2014-
2015influenzaseason
ThestudywasfundedbySanofiPasteur
Methods
Joan Puig-Barberà1, Elena Burtseva2, Hongjie Yu3, Selim Badur4, Jan Kyncl5, F. Xavier López-Labrador1,6, Maria Pisareva7,Svetlana Trushakova2, Benjamin J. Cowling8, Tulay Bagci9, Ainara Mira-Iglesias1, Elizaveta Smorodintseva7, Lidiya Kisteneva2,Luzhao Feng3, Sevim Mese4, Angels Natividad-Miralles1, Kirill Stolyarov7, Lyudmila Kolobukhina2, Peng Wu8, Kubra Yurtcu4,Lubov Voloshchuk7, Veronika Afanasieva2 , Qin Ying3, Anna Sominina7 for the Global Influenza Hospital Surveillance Study Group(GIHSN).
1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain. 2 D.I. Ivanovsky Institute of Virology FSBI (Federal State BudgetaryInstitution). “N.F. Gamaleya FRCEM” Ministry of Health of Russian Federation, Moscow, Russian Federation. 3 Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning onInfectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. 4 National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 5Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic. 6 Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP),Instituto de Salud Carlos III, Madrid, Spain. 7 Research Institute of Influenza, Saint Petersburg, Russian Federation. 8 School of Public Health, Li Ka Shing Faculty of Medicine, The University of HongKong, Hong Kong Special Administrative Region, China. 9 Hacettepe Medicine Faculty – Ankara, Turkey
Abstract:P42
ResultsIntroductionThe Global Influenza Hospital SurveillanceNetwork (GIHSN) is a public-privatepartnership between various Public Healthinstitutions and Sanofi Pasteur. The maingoal of the GIHSN is to study influenzaepidemiology. During the 2014-2015 influenzaseason, in 24 hospitals in Russia Federation,Czech Republic, Turkey, China and Spain (Figure1), we screened consecutive admissionsfollowing a common protocol.
FundaciónparaelFomentodelaInvestigaciónBiomédicaySanitaria(FISABIO),Valencia,SpainPhone:+34961925968;e-mail:puig_joa@gva.es
http://gihsn.org
Figure 2. Studymethods flowchart
DiscussionInfluenza was a significant threat for all agegroups. Comorbidity increased the risk ofinfluenza and this was observed for allinfluenza strains. Pregnancy was an risk factorregardless of involved strain.A(H1N1)pdm09 was associated with a graterrisk of ICU admission and B/Yamagata-lineagewith an increased risk of respiratory failure.
Figure1.GlobalInfluenzaHospitalSurveillanceNetwork(GIHSN)
Eligible'patients'considered'for'inclusion:
All#consecutive#admissions#for#an#acute#processAdmitted#in#the#previous#48#hours
Chief#complaints#for#admission#possibly#related#to#a#previous#influenza#infection
Residents#in#the#predefined#study’s#catchment#area#(study#population#or#study#base)
Complies'with'inclusion'criteria:
Able#to#communicateInformed#consent#to#participate
Is#a#permanent#resident#(as#defined#in#the#site#protocol)
Not#institutionalizedNot#discharged#from#a#hospital#in#the#last#30#daysILI#symptoms#within#7#days#to#admission#(≥5#y#old)Admission#symptoms#within#7#days#to#admission#
(<5#y#old)
Study'procedures:
Common#standardized#questionnaire#Combined#respiratory#swabs
Site’s'reference'laboratorySemi;quantitative'real;time'reverse'
transcription'PCR
Influenza)positive
Influenza)subtype)or)lineage
Influenza)negative
Eligible:17,469
Excluded: 6,357 (36%)Noconsent:1,727(10%)
NoILI:3,189(20%)
Symptoms>7days:1,327(11%)
Included:9,589(55%)
Negative:7,413(77%)
Influenza:2,176(23%)
Recruitedoutsideseason:1,176(10%)
Records:21,611
Southernhemisphere:338
Noresident:256
Institutionalized:870
Previousadmission≤30days:3,016(15%)
Figure 3. FlowchartofadmissionsGIHSN2014-2015influenzaseason
0
50
100
150
200
250
Adm
issio
ns p
ositiv
e fo
r infl
uenz
a (n
umbe
r by
stra
in)
2014
-47
2014
-48
2014
-49
2014
-50
2014
-51
2014
-52
2014
-53
2015
-01
2015
-02
2015
-03
2015
-04
2015
-05
2015
-06
2015
-07
2015
-08
2015
-09
2015
-10
2015
-11
2015
-12
2015
-13
2015
-14
2015
-15
2015
-16
2015
-17
2015
-18
2015
-19
2015
-20
Epidemiological week
A(H1N1)pdm09 (n=121; 6%)A(H3N2) (n=1,243; 57%)A not subtyped (n=106; 5%) B/Yamagata-lineage (n=665; 30%)B/Victoria-lineage (n=11; 0.5%)B not subtyped (n=54; 2%)
Figure4. Numberofadmissionswithinfluenza,byvirusstrainandweek
CVD
COPD
Asthma
Immunosupression
Diabetes
Renal disease
Neuromuscular
Neoplasm
Cirrhosis
Autoinmune
Pregnancy
Obesity
factors
Strain/Risk
1.69 (1.45, 1.97)
1.56 (1.31, 1.86)
1.48 (1.11, 1.96)
0.69 (0.33, 1.43)
1.76 (1.46, 2.12)
1.84 (1.46, 2.32)
0.69 (0.43, 1.12)
1.26 (0.88, 1.81)
0.88 (0.54, 1.43)
2.18 (1.48, 3.19)
2.35 (1.51, 3.68)
1.52 (1.25, 1.86)
aOR (95% CI)
319
222
65
8
180
108
19
38
19
36
64
148
Influenza
admissions with
Number of
1.69 (1.45, 1.97)
1.56 (1.31, 1.86)
1.48 (1.11, 1.96)
0.69 (0.33, 1.43)
1.76 (1.46, 2.12)
1.84 (1.46, 2.32)
0.69 (0.43, 1.12)
1.26 (0.88, 1.81)
0.88 (0.54, 1.43)
2.18 (1.48, 3.19)
2.35 (1.51, 3.68)
1.52 (1.25, 1.86)
aOR (95% CI)
319
222
65
8
180
108
19
38
19
36
64
148
Influenza
admissions with
Number of
1.25 .75 1 2 5Adjusted odds ratio
Adjusted odds ratio (aOR)* of admission with A(H3N2)
CVD
COPD
Asthma
Diabetes
Renal disease
Neuromuscular
Neoplasm
Autoinmune
Pregnancy
Obesity
factors
Strain/Risk
0.77 (0.45, 1.32)
0.40 (0.18, 0.88)
0.96 (0.38, 2.43)
0.62 (0.29, 1.31)
0.28 (0.07, 1.16)
2.49 (1.15, 5.40)
1.11 (0.39, 3.15)
0.52 (0.07, 3.80)
3.31 (1.07, 10.21)
0.60 (0.27, 1.33)
aOR (95% CI)
18
7
5
8
2
8
4
1
11
7
Influenza
admissions with
Number of
0.77 (0.45, 1.32)
0.40 (0.18, 0.88)
0.96 (0.38, 2.43)
0.62 (0.29, 1.31)
0.28 (0.07, 1.16)
2.49 (1.15, 5.40)
1.11 (0.39, 3.15)
0.52 (0.07, 3.80)
3.31 (1.07, 10.21)
0.60 (0.27, 1.33)
aOR (95% CI)
18
7
5
8
2
8
4
1
11
7
Influenza
admissions with
Number of
1.25 .75 1 2 5Adjusted odds ratio
Adjusted odds ratio* of admission with A(H1N1)pdm
CVD
COPD
Asthma
Immunosupression
Diabetes
Renal disease
Neuromuscular
Neoplasm
Cirrhosis
Autoinmune
Pregnancy
Obesity
factors
Strain/Risk
0.87 (0.69, 1.10)
0.63 (0.47, 0.84)
0.83 (0.54, 1.27)
0.78 (0.34, 1.81)
0.50 (0.35, 0.72)
0.70 (0.47, 1.06)
1.22 (0.77, 1.94)
0.88 (0.53, 1.47)
0.79 (0.43, 1.48)
0.76 (0.37, 1.56)
3.74 (2.27, 6.16)
0.79 (0.58, 1.07)
ratio (95% CI)
Adjusted odds
109
60
24
6
34
27
22
17
11
8
69
50
Influenza
admissions with
Number of
0.87 (0.69, 1.10)
0.63 (0.47, 0.84)
0.83 (0.54, 1.27)
0.78 (0.34, 1.81)
0.50 (0.35, 0.72)
0.70 (0.47, 1.06)
1.22 (0.77, 1.94)
0.88 (0.53, 1.47)
0.79 (0.43, 1.48)
0.76 (0.37, 1.56)
3.74 (2.27, 6.16)
0.79 (0.58, 1.07)
ratio (95% CI)
Adjusted odds
109
60
24
6
34
27
22
17
11
8
69
50
Influenza
admissions with
Number of
1.25 .75 1 2 5Adjusted odds ratio
Adjusted odds ratio* of admission with B/Yamagata
0
20
40
60
80
100
Adm
issi
ons
posi
tive
for i
nflue
nza
(pro
porti
on b
y st
rain
)
0-1
1-4
5-17
18-4
9
50-6
4
65-7
4
75-8
4
>=85
Age group (years of age)
A(H1N1)pdm09 (n=121; 6%) A(H3N2) (n=1,243; 57%) A not subtyped (n=106; 5%) B/Yamagata-lineage (n=665; 30%) B/Victoria-lineage (n=11; 0.5%) B not subtyped (n=54; 2%)
Figure 5. Proportion of admissionswith influenza, by strain and age
0
.02
.04
.06
Pre
dict
ed p
roba
bilit
y of
ICU
adm
issi
on
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H1N1)pdm
A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
-.2
0
.2
.4
.6
Pre
dict
ed p
roba
bilit
y of
in h
ospi
tal d
eath
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H1N1)pdm
A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
-.005
0
.005
.01
.015
Pre
dict
ed p
roba
bilit
y of
AR
DS
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H3N2)
RT-PCR result
Predicted probailities by RT-PCR result
-.05
0
.05
.1
.15
Pre
dict
ed p
roba
bilit
y of
res
pira
tory
failu
re
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
0
.02
.04
.06
Pred
icte
d pr
obab
ility
of IC
U a
dmis
sion
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H1N1)pdm
A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
-.2
0
.2
.4
.6
Pred
icte
d pr
obab
ility
of in
hos
pita
l dea
th
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H1N1)pdm
A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
-.005
0
.005
.01
.015
Pred
icte
d pr
obab
ility
of A
RD
S
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H3N2)
RT-PCR result
Predicted probailities by RT-PCR result
-.05
0
.05
.1
.15
Pred
icte
d pr
obab
ility
of r
espi
rato
ry fa
ilure
0 10 20 30 40 50 60 70 80 90 100 110Age group
No influenza A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
Figure 6. Adjusted risk of admission with influenza, by strain,related to underlyingchronic conditions or risk factors.
Figure 7. Predicted probability of severe outcomes (intensive careunit (ICU) admission and respiratory failure) by age and strain
Theadjustedoddsratio(aOR)foradmissionwithinfluenzawasestimatedbylogisticregressionusingascomparisongroupinfluenzanegativeadmissionswithoutunderlyingconditions.Allestimateswereadjustedasbysex,site,numberofadmissionsinprevioustwelvemonths,smokinghabits,timetoswabandcalendartime.