The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis

Anne M. Presanis, Daniela De Angelis, Angela Hagy, Carrie Reed, Steven Riley, Ben S. Cooper, Lyn Finelli, Paul Biedrzycki, Marc Lipsitch, Joel Ackelsberg, Alys Adamski, Gail Adman, Elisabeth Agbor-Tabi, Christopher Aston, Josephine Atamian, Peter Backman, Sharon Balter, Oxiris Barbot, Sara T. Beatrice, Gary BeaudryElizabeth Begier, Geraldine Bell, Debra Berg, Magdalena Berger, James Betz, Susan Blank, Katherine Bornschlegel, Brooke Bregman, Meghan Burke, Barbara Butts, Liqun Cai, Alejandro Cajigal, Marilyn Campbell, Lorraine Camurati, Shadi Chamany, Dan Cimini, James Cone, Heather Cook, Debra Cook, Catherine Corey, Roseann Costarella, Christiana Coyle, Bindy Crouch, Cherry Ann Da Costa, Alexandria Daniels, Berta Darkins, Arlene DeGrasse, Susanne DeGrechie, Otto Del Cid, Bisram Deocharan, Luis Diaz, Kathleen DiCaprio, Laura DiGrande, Damon Duquaine, James Durrah, Joanna Eavey, Zadkijah Edghill, Barbara Edwin, Joseph Egger, Donna Eisenhower, Martin Evans, Shannon Farley, Richard Feliciano, Marcial Fernandez, Christine Fils-Aime, Anne Fine, Ana Maria Fireteanu, Kelly Fitzgerald, Anne Marie France, Thomas Frieden, Stephen Friedman, Jie Fu, Lawrence Fung, Latchmidat Girdharrie, Michelle Glaser, Christopher Goranson, Francine Griffing, Leena Gupta, Carol Hamilton, Heather Hanson, Scott Harper, Ian Hartman-O'Connell, Qazi Hasnain, Sonia Hedge, Michael Heller, Debra Hendrickson, Arnold Herskovitz, Kinjia Hinterland, Roosevelt Holmes, Jeanne Hom, Jeffrey Hon, Tana Hopke, Jennifer Hsieh, Scott Hughes, Stephen Immerwahr, Anne Marie Incalicchio, John Jasek, Julia Jimenez, Michael Johns, Lucretia Jones, Hannah Jordan, Chrispin Kambili, Jisuk Kang, Deborah Kapell, Adam Karpati, Bonnie Kerker, Kevin Konty, John Kornblum, Gary Krigsman, Fabienne Laraque, Marcelle Layton, Ellen Lee, Lillian Lee, Stephen Lee, Sungwoo Lim, Melissa Marx, Emily McGibbon, Kevin Mahoney, Gilbert Marin, Thomas Matte, Rene McAnanama, Ryan McKay, Carolyn McKay, Katherine McVeigh, Eric Medina, Wanda Medina, Danielle Michelangelo, Juliet Milhofer, Irina Milyavskaya, Mark Misener, Joseph Mizrahi, Linda Moskin, Matt Motherwell, Christa Myers, Hemanth P. Nair, Trang Nguyen, Diana Nilsen, Janet Nival, Jennifer Norton, William Oleszko, Carolyn Olson, Marc Paladini, Lucille Palumbo, Peter Papadopoulos, Hilary Parton, Jacob Paternostro, Lynn Paynter, Krystal Perkins, Sharon Perlman, Haresh Persaud, Charles Peters, Melissa Pfeiffer, Roger Platt, Lindsay Pool, Amado Punsalang, Zahedur Rasul, Valerie Rawlins, Vasudha Reddy, Anne Rinchiuso, Teresa Rodriguez, Ramon Rosal, Maureen Ryan, Michael Sanderson, Allison Scaccia, Amber Levanon Seligson, Jantee Seupersad, Joanne Severe-Dildy, Asma Siddiqi, Ulirike Siemetzki, Tejinder Singh, Sally Slavinski, Meredith Slopen, Timothy Snuggs, David Starr, Catherine Stayton, Alaina Stoute, Jacqueline Terlonge, Alexandra Ternier, Lorna Thorpe, Catherine Travers, Benjamin Tsoi, Kimberly Turner, Joan Tzou, Shameeka Vines, Elizabeth Waddell, Donald Walker, Connie Warner, Isaac Weisfuse, Don Weiss, Antoinette Williams-Akita, Elisha Wilson, Eliza Wilson, Marie Wong, Charles Wu, David Yang, Mohammad Younis, Sulaimon Yusuff, Christopher Zimmerman, Jane Zucker

Research output: Contribution to journalArticle

228 Citations (Scopus)

Abstract

Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.

Original languageEnglish (US)
Article number1000207
JournalPLoS Medicine
Volume6
Issue number12
DOIs
StatePublished - Dec 1 2009
Externally publishedYes

Fingerprint

Bayes Theorem
Pandemics
Human Influenza
Hospitalization
Information Storage and Retrieval
Infection
Incidence
Critical Care
Artificial Respiration
Uncertainty
Virulence
Delivery of Health Care
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Presanis, A. M., De Angelis, D., Hagy, A., Reed, C., Riley, S., Cooper, B. S., ... Zucker, J. (2009). The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis. PLoS Medicine, 6(12), [1000207]. https://doi.org/10.1371/journal.pmed.1000207

The severity of pandemic H1N1 influenza in the United States, from April to July 2009 : A Bayesian analysis. / Presanis, Anne M.; De Angelis, Daniela; Hagy, Angela; Reed, Carrie; Riley, Steven; Cooper, Ben S.; Finelli, Lyn; Biedrzycki, Paul; Lipsitch, Marc; Ackelsberg, Joel; Adamski, Alys; Adman, Gail; Agbor-Tabi, Elisabeth; Aston, Christopher; Atamian, Josephine; Backman, Peter; Balter, Sharon; Barbot, Oxiris; Beatrice, Sara T.; Beaudry, Gary; Begier, Elizabeth; Bell, Geraldine; Berg, Debra; Berger, Magdalena; Betz, James; Blank, Susan; Bornschlegel, Katherine; Bregman, Brooke; Burke, Meghan; Butts, Barbara; Cai, Liqun; Cajigal, Alejandro; Campbell, Marilyn; Camurati, Lorraine; Chamany, Shadi; Cimini, Dan; Cone, James; Cook, Heather; Cook, Debra; Corey, Catherine; Costarella, Roseann; Coyle, Christiana; Crouch, Bindy; Da Costa, Cherry Ann; Daniels, Alexandria; Darkins, Berta; DeGrasse, Arlene; DeGrechie, Susanne; Del Cid, Otto; Deocharan, Bisram; Diaz, Luis; DiCaprio, Kathleen; DiGrande, Laura; Duquaine, Damon; Durrah, James; Eavey, Joanna; Edghill, Zadkijah; Edwin, Barbara; Egger, Joseph; Eisenhower, Donna; Evans, Martin; Farley, Shannon; Feliciano, Richard; Fernandez, Marcial; Fils-Aime, Christine; Fine, Anne; Fireteanu, Ana Maria; Fitzgerald, Kelly; France, Anne Marie; Frieden, Thomas; Friedman, Stephen; Fu, Jie; Fung, Lawrence; Girdharrie, Latchmidat; Glaser, Michelle; Goranson, Christopher; Griffing, Francine; Gupta, Leena; Hamilton, Carol; Hanson, Heather; Harper, Scott; Hartman-O'Connell, Ian; Hasnain, Qazi; Hedge, Sonia; Heller, Michael; Hendrickson, Debra; Herskovitz, Arnold; Hinterland, Kinjia; Holmes, Roosevelt; Hom, Jeanne; Hon, Jeffrey; Hopke, Tana; Hsieh, Jennifer; Hughes, Scott; Immerwahr, Stephen; Incalicchio, Anne Marie; Jasek, John; Jimenez, Julia; Johns, Michael; Jones, Lucretia; Jordan, Hannah; Kambili, Chrispin; Kang, Jisuk; Kapell, Deborah; Karpati, Adam; Kerker, Bonnie; Konty, Kevin; Kornblum, John; Krigsman, Gary; Laraque, Fabienne; Layton, Marcelle; Lee, Ellen; Lee, Lillian; Lee, Stephen; Lim, Sungwoo; Marx, Melissa; McGibbon, Emily; Mahoney, Kevin; Marin, Gilbert; Matte, Thomas; McAnanama, Rene; McKay, Ryan; McKay, Carolyn; McVeigh, Katherine; Medina, Eric; Medina, Wanda; Michelangelo, Danielle; Milhofer, Juliet; Milyavskaya, Irina; Misener, Mark; Mizrahi, Joseph; Moskin, Linda; Motherwell, Matt; Myers, Christa; Nair, Hemanth P.; Nguyen, Trang; Nilsen, Diana; Nival, Janet; Norton, Jennifer; Oleszko, William; Olson, Carolyn; Paladini, Marc; Palumbo, Lucille; Papadopoulos, Peter; Parton, Hilary; Paternostro, Jacob; Paynter, Lynn; Perkins, Krystal; Perlman, Sharon; Persaud, Haresh; Peters, Charles; Pfeiffer, Melissa; Platt, Roger; Pool, Lindsay; Punsalang, Amado; Rasul, Zahedur; Rawlins, Valerie; Reddy, Vasudha; Rinchiuso, Anne; Rodriguez, Teresa; Rosal, Ramon; Ryan, Maureen; Sanderson, Michael; Scaccia, Allison; Seligson, Amber Levanon; Seupersad, Jantee; Severe-Dildy, Joanne; Siddiqi, Asma; Siemetzki, Ulirike; Singh, Tejinder; Slavinski, Sally; Slopen, Meredith; Snuggs, Timothy; Starr, David; Stayton, Catherine; Stoute, Alaina; Terlonge, Jacqueline; Ternier, Alexandra; Thorpe, Lorna; Travers, Catherine; Tsoi, Benjamin; Turner, Kimberly; Tzou, Joan; Vines, Shameeka; Waddell, Elizabeth; Walker, Donald; Warner, Connie; Weisfuse, Isaac; Weiss, Don; Williams-Akita, Antoinette; Wilson, Elisha; Wilson, Eliza; Wong, Marie; Wu, Charles; Yang, David; Younis, Mohammad; Yusuff, Sulaimon; Zimmerman, Christopher; Zucker, Jane.

In: PLoS Medicine, Vol. 6, No. 12, 1000207, 01.12.2009.

Research output: Contribution to journalArticle

Presanis, AM, De Angelis, D, Hagy, A, Reed, C, Riley, S, Cooper, BS, Finelli, L, Biedrzycki, P, Lipsitch, M, Ackelsberg, J, Adamski, A, Adman, G, Agbor-Tabi, E, Aston, C, Atamian, J, Backman, P, Balter, S, Barbot, O, Beatrice, ST, Beaudry, G, Begier, E, Bell, G, Berg, D, Berger, M, Betz, J, Blank, S, Bornschlegel, K, Bregman, B, Burke, M, Butts, B, Cai, L, Cajigal, A, Campbell, M, Camurati, L, Chamany, S, Cimini, D, Cone, J, Cook, H, Cook, D, Corey, C, Costarella, R, Coyle, C, Crouch, B, Da Costa, CA, Daniels, A, Darkins, B, DeGrasse, A, DeGrechie, S, Del Cid, O, Deocharan, B, Diaz, L, DiCaprio, K, DiGrande, L, Duquaine, D, Durrah, J, Eavey, J, Edghill, Z, Edwin, B, Egger, J, Eisenhower, D, Evans, M, Farley, S, Feliciano, R, Fernandez, M, Fils-Aime, C, Fine, A, Fireteanu, AM, Fitzgerald, K, France, AM, Frieden, T, Friedman, S, Fu, J, Fung, L, Girdharrie, L, Glaser, M, Goranson, C, Griffing, F, Gupta, L, Hamilton, C, Hanson, H, Harper, S, Hartman-O'Connell, I, Hasnain, Q, Hedge, S, Heller, M, Hendrickson, D, Herskovitz, A, Hinterland, K, Holmes, R, Hom, J, Hon, J, Hopke, T, Hsieh, J, Hughes, S, Immerwahr, S, Incalicchio, AM, Jasek, J, Jimenez, J, Johns, M, Jones, L, Jordan, H, Kambili, C, Kang, J, Kapell, D, Karpati, A, Kerker, B, Konty, K, Kornblum, J, Krigsman, G, Laraque, F, Layton, M, Lee, E, Lee, L, Lee, S, Lim, S, Marx, M, McGibbon, E, Mahoney, K, Marin, G, Matte, T, McAnanama, R, McKay, R, McKay, C, McVeigh, K, Medina, E, Medina, W, Michelangelo, D, Milhofer, J, Milyavskaya, I, Misener, M, Mizrahi, J, Moskin, L, Motherwell, M, Myers, C, Nair, HP, Nguyen, T, Nilsen, D, Nival, J, Norton, J, Oleszko, W, Olson, C, Paladini, M, Palumbo, L, Papadopoulos, P, Parton, H, Paternostro, J, Paynter, L, Perkins, K, Perlman, S, Persaud, H, Peters, C, Pfeiffer, M, Platt, R, Pool, L, Punsalang, A, Rasul, Z, Rawlins, V, Reddy, V, Rinchiuso, A, Rodriguez, T, Rosal, R, Ryan, M, Sanderson, M, Scaccia, A, Seligson, AL, Seupersad, J, Severe-Dildy, J, Siddiqi, A, Siemetzki, U, Singh, T, Slavinski, S, Slopen, M, Snuggs, T, Starr, D, Stayton, C, Stoute, A, Terlonge, J, Ternier, A, Thorpe, L, Travers, C, Tsoi, B, Turner, K, Tzou, J, Vines, S, Waddell, E, Walker, D, Warner, C, Weisfuse, I, Weiss, D, Williams-Akita, A, Wilson, E, Wilson, E, Wong, M, Wu, C, Yang, D, Younis, M, Yusuff, S, Zimmerman, C & Zucker, J 2009, 'The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis', PLoS Medicine, vol. 6, no. 12, 1000207. https://doi.org/10.1371/journal.pmed.1000207
Presanis, Anne M. ; De Angelis, Daniela ; Hagy, Angela ; Reed, Carrie ; Riley, Steven ; Cooper, Ben S. ; Finelli, Lyn ; Biedrzycki, Paul ; Lipsitch, Marc ; Ackelsberg, Joel ; Adamski, Alys ; Adman, Gail ; Agbor-Tabi, Elisabeth ; Aston, Christopher ; Atamian, Josephine ; Backman, Peter ; Balter, Sharon ; Barbot, Oxiris ; Beatrice, Sara T. ; Beaudry, Gary ; Begier, Elizabeth ; Bell, Geraldine ; Berg, Debra ; Berger, Magdalena ; Betz, James ; Blank, Susan ; Bornschlegel, Katherine ; Bregman, Brooke ; Burke, Meghan ; Butts, Barbara ; Cai, Liqun ; Cajigal, Alejandro ; Campbell, Marilyn ; Camurati, Lorraine ; Chamany, Shadi ; Cimini, Dan ; Cone, James ; Cook, Heather ; Cook, Debra ; Corey, Catherine ; Costarella, Roseann ; Coyle, Christiana ; Crouch, Bindy ; Da Costa, Cherry Ann ; Daniels, Alexandria ; Darkins, Berta ; DeGrasse, Arlene ; DeGrechie, Susanne ; Del Cid, Otto ; Deocharan, Bisram ; Diaz, Luis ; DiCaprio, Kathleen ; DiGrande, Laura ; Duquaine, Damon ; Durrah, James ; Eavey, Joanna ; Edghill, Zadkijah ; Edwin, Barbara ; Egger, Joseph ; Eisenhower, Donna ; Evans, Martin ; Farley, Shannon ; Feliciano, Richard ; Fernandez, Marcial ; Fils-Aime, Christine ; Fine, Anne ; Fireteanu, Ana Maria ; Fitzgerald, Kelly ; France, Anne Marie ; Frieden, Thomas ; Friedman, Stephen ; Fu, Jie ; Fung, Lawrence ; Girdharrie, Latchmidat ; Glaser, Michelle ; Goranson, Christopher ; Griffing, Francine ; Gupta, Leena ; Hamilton, Carol ; Hanson, Heather ; Harper, Scott ; Hartman-O'Connell, Ian ; Hasnain, Qazi ; Hedge, Sonia ; Heller, Michael ; Hendrickson, Debra ; Herskovitz, Arnold ; Hinterland, Kinjia ; Holmes, Roosevelt ; Hom, Jeanne ; Hon, Jeffrey ; Hopke, Tana ; Hsieh, Jennifer ; Hughes, Scott ; Immerwahr, Stephen ; Incalicchio, Anne Marie ; Jasek, John ; Jimenez, Julia ; Johns, Michael ; Jones, Lucretia ; Jordan, Hannah ; Kambili, Chrispin ; Kang, Jisuk ; Kapell, Deborah ; Karpati, Adam ; Kerker, Bonnie ; Konty, Kevin ; Kornblum, John ; Krigsman, Gary ; Laraque, Fabienne ; Layton, Marcelle ; Lee, Ellen ; Lee, Lillian ; Lee, Stephen ; Lim, Sungwoo ; Marx, Melissa ; McGibbon, Emily ; Mahoney, Kevin ; Marin, Gilbert ; Matte, Thomas ; McAnanama, Rene ; McKay, Ryan ; McKay, Carolyn ; McVeigh, Katherine ; Medina, Eric ; Medina, Wanda ; Michelangelo, Danielle ; Milhofer, Juliet ; Milyavskaya, Irina ; Misener, Mark ; Mizrahi, Joseph ; Moskin, Linda ; Motherwell, Matt ; Myers, Christa ; Nair, Hemanth P. ; Nguyen, Trang ; Nilsen, Diana ; Nival, Janet ; Norton, Jennifer ; Oleszko, William ; Olson, Carolyn ; Paladini, Marc ; Palumbo, Lucille ; Papadopoulos, Peter ; Parton, Hilary ; Paternostro, Jacob ; Paynter, Lynn ; Perkins, Krystal ; Perlman, Sharon ; Persaud, Haresh ; Peters, Charles ; Pfeiffer, Melissa ; Platt, Roger ; Pool, Lindsay ; Punsalang, Amado ; Rasul, Zahedur ; Rawlins, Valerie ; Reddy, Vasudha ; Rinchiuso, Anne ; Rodriguez, Teresa ; Rosal, Ramon ; Ryan, Maureen ; Sanderson, Michael ; Scaccia, Allison ; Seligson, Amber Levanon ; Seupersad, Jantee ; Severe-Dildy, Joanne ; Siddiqi, Asma ; Siemetzki, Ulirike ; Singh, Tejinder ; Slavinski, Sally ; Slopen, Meredith ; Snuggs, Timothy ; Starr, David ; Stayton, Catherine ; Stoute, Alaina ; Terlonge, Jacqueline ; Ternier, Alexandra ; Thorpe, Lorna ; Travers, Catherine ; Tsoi, Benjamin ; Turner, Kimberly ; Tzou, Joan ; Vines, Shameeka ; Waddell, Elizabeth ; Walker, Donald ; Warner, Connie ; Weisfuse, Isaac ; Weiss, Don ; Williams-Akita, Antoinette ; Wilson, Elisha ; Wilson, Eliza ; Wong, Marie ; Wu, Charles ; Yang, David ; Younis, Mohammad ; Yusuff, Sulaimon ; Zimmerman, Christopher ; Zucker, Jane. / The severity of pandemic H1N1 influenza in the United States, from April to July 2009 : A Bayesian analysis. In: PLoS Medicine. 2009 ; Vol. 6, No. 12.
@article{1e844c6afe4c4a1f9de08e69b7b173d3,
title = "The severity of pandemic H1N1 influenza in the United States, from April to July 2009: A Bayesian analysis",
abstract = "Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048{\%} (95{\%} credible interval [CI] 0.026{\%}-0.096{\%}), sCIR of 0.239{\%} (0.134{\%}-0.458{\%}), and sCHR of 1.44{\%} (0.83{\%}-2.64{\%}). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.",
author = "Presanis, {Anne M.} and {De Angelis}, Daniela and Angela Hagy and Carrie Reed and Steven Riley and Cooper, {Ben S.} and Lyn Finelli and Paul Biedrzycki and Marc Lipsitch and Joel Ackelsberg and Alys Adamski and Gail Adman and Elisabeth Agbor-Tabi and Christopher Aston and Josephine Atamian and Peter Backman and Sharon Balter and Oxiris Barbot and Beatrice, {Sara T.} and Gary Beaudry and Elizabeth Begier and Geraldine Bell and Debra Berg and Magdalena Berger and James Betz and Susan Blank and Katherine Bornschlegel and Brooke Bregman and Meghan Burke and Barbara Butts and Liqun Cai and Alejandro Cajigal and Marilyn Campbell and Lorraine Camurati and Shadi Chamany and Dan Cimini and James Cone and Heather Cook and Debra Cook and Catherine Corey and Roseann Costarella and Christiana Coyle and Bindy Crouch and {Da Costa}, {Cherry Ann} and Alexandria Daniels and Berta Darkins and Arlene DeGrasse and Susanne DeGrechie and {Del Cid}, Otto and Bisram Deocharan and Luis Diaz and Kathleen DiCaprio and Laura DiGrande and Damon Duquaine and James Durrah and Joanna Eavey and Zadkijah Edghill and Barbara Edwin and Joseph Egger and Donna Eisenhower and Martin Evans and Shannon Farley and Richard Feliciano and Marcial Fernandez and Christine Fils-Aime and Anne Fine and Fireteanu, {Ana Maria} and Kelly Fitzgerald and France, {Anne Marie} and Thomas Frieden and Stephen Friedman and Jie Fu and Lawrence Fung and Latchmidat Girdharrie and Michelle Glaser and Christopher Goranson and Francine Griffing and Leena Gupta and Carol Hamilton and Heather Hanson and Scott Harper and Ian Hartman-O'Connell and Qazi Hasnain and Sonia Hedge and Michael Heller and Debra Hendrickson and Arnold Herskovitz and Kinjia Hinterland and Roosevelt Holmes and Jeanne Hom and Jeffrey Hon and Tana Hopke and Jennifer Hsieh and Scott Hughes and Stephen Immerwahr and Incalicchio, {Anne Marie} and John Jasek and Julia Jimenez and Michael Johns and Lucretia Jones and Hannah Jordan and Chrispin Kambili and Jisuk Kang and Deborah Kapell and Adam Karpati and Bonnie Kerker and Kevin Konty and John Kornblum and Gary Krigsman and Fabienne Laraque and Marcelle Layton and Ellen Lee and Lillian Lee and Stephen Lee and Sungwoo Lim and Melissa Marx and Emily McGibbon and Kevin Mahoney and Gilbert Marin and Thomas Matte and Rene McAnanama and Ryan McKay and Carolyn McKay and Katherine McVeigh and Eric Medina and Wanda Medina and Danielle Michelangelo and Juliet Milhofer and Irina Milyavskaya and Mark Misener and Joseph Mizrahi and Linda Moskin and Matt Motherwell and Christa Myers and Nair, {Hemanth P.} and Trang Nguyen and Diana Nilsen and Janet Nival and Jennifer Norton and William Oleszko and Carolyn Olson and Marc Paladini and Lucille Palumbo and Peter Papadopoulos and Hilary Parton and Jacob Paternostro and Lynn Paynter and Krystal Perkins and Sharon Perlman and Haresh Persaud and Charles Peters and Melissa Pfeiffer and Roger Platt and Lindsay Pool and Amado Punsalang and Zahedur Rasul and Valerie Rawlins and Vasudha Reddy and Anne Rinchiuso and Teresa Rodriguez and Ramon Rosal and Maureen Ryan and Michael Sanderson and Allison Scaccia and Seligson, {Amber Levanon} and Jantee Seupersad and Joanne Severe-Dildy and Asma Siddiqi and Ulirike Siemetzki and Tejinder Singh and Sally Slavinski and Meredith Slopen and Timothy Snuggs and David Starr and Catherine Stayton and Alaina Stoute and Jacqueline Terlonge and Alexandra Ternier and Lorna Thorpe and Catherine Travers and Benjamin Tsoi and Kimberly Turner and Joan Tzou and Shameeka Vines and Elizabeth Waddell and Donald Walker and Connie Warner and Isaac Weisfuse and Don Weiss and Antoinette Williams-Akita and Elisha Wilson and Eliza Wilson and Marie Wong and Charles Wu and David Yang and Mohammad Younis and Sulaimon Yusuff and Christopher Zimmerman and Jane Zucker",
year = "2009",
month = "12",
day = "1",
doi = "10.1371/journal.pmed.1000207",
language = "English (US)",
volume = "6",
journal = "PLoS Medicine",
issn = "1549-1277",
publisher = "Nature Publishing Group",
number = "12",

}

TY - JOUR

T1 - The severity of pandemic H1N1 influenza in the United States, from April to July 2009

T2 - A Bayesian analysis

AU - Presanis, Anne M.

AU - De Angelis, Daniela

AU - Hagy, Angela

AU - Reed, Carrie

AU - Riley, Steven

AU - Cooper, Ben S.

AU - Finelli, Lyn

AU - Biedrzycki, Paul

AU - Lipsitch, Marc

AU - Ackelsberg, Joel

AU - Adamski, Alys

AU - Adman, Gail

AU - Agbor-Tabi, Elisabeth

AU - Aston, Christopher

AU - Atamian, Josephine

AU - Backman, Peter

AU - Balter, Sharon

AU - Barbot, Oxiris

AU - Beatrice, Sara T.

AU - Beaudry, Gary

AU - Begier, Elizabeth

AU - Bell, Geraldine

AU - Berg, Debra

AU - Berger, Magdalena

AU - Betz, James

AU - Blank, Susan

AU - Bornschlegel, Katherine

AU - Bregman, Brooke

AU - Burke, Meghan

AU - Butts, Barbara

AU - Cai, Liqun

AU - Cajigal, Alejandro

AU - Campbell, Marilyn

AU - Camurati, Lorraine

AU - Chamany, Shadi

AU - Cimini, Dan

AU - Cone, James

AU - Cook, Heather

AU - Cook, Debra

AU - Corey, Catherine

AU - Costarella, Roseann

AU - Coyle, Christiana

AU - Crouch, Bindy

AU - Da Costa, Cherry Ann

AU - Daniels, Alexandria

AU - Darkins, Berta

AU - DeGrasse, Arlene

AU - DeGrechie, Susanne

AU - Del Cid, Otto

AU - Deocharan, Bisram

AU - Diaz, Luis

AU - DiCaprio, Kathleen

AU - DiGrande, Laura

AU - Duquaine, Damon

AU - Durrah, James

AU - Eavey, Joanna

AU - Edghill, Zadkijah

AU - Edwin, Barbara

AU - Egger, Joseph

AU - Eisenhower, Donna

AU - Evans, Martin

AU - Farley, Shannon

AU - Feliciano, Richard

AU - Fernandez, Marcial

AU - Fils-Aime, Christine

AU - Fine, Anne

AU - Fireteanu, Ana Maria

AU - Fitzgerald, Kelly

AU - France, Anne Marie

AU - Frieden, Thomas

AU - Friedman, Stephen

AU - Fu, Jie

AU - Fung, Lawrence

AU - Girdharrie, Latchmidat

AU - Glaser, Michelle

AU - Goranson, Christopher

AU - Griffing, Francine

AU - Gupta, Leena

AU - Hamilton, Carol

AU - Hanson, Heather

AU - Harper, Scott

AU - Hartman-O'Connell, Ian

AU - Hasnain, Qazi

AU - Hedge, Sonia

AU - Heller, Michael

AU - Hendrickson, Debra

AU - Herskovitz, Arnold

AU - Hinterland, Kinjia

AU - Holmes, Roosevelt

AU - Hom, Jeanne

AU - Hon, Jeffrey

AU - Hopke, Tana

AU - Hsieh, Jennifer

AU - Hughes, Scott

AU - Immerwahr, Stephen

AU - Incalicchio, Anne Marie

AU - Jasek, John

AU - Jimenez, Julia

AU - Johns, Michael

AU - Jones, Lucretia

AU - Jordan, Hannah

AU - Kambili, Chrispin

AU - Kang, Jisuk

AU - Kapell, Deborah

AU - Karpati, Adam

AU - Kerker, Bonnie

AU - Konty, Kevin

AU - Kornblum, John

AU - Krigsman, Gary

AU - Laraque, Fabienne

AU - Layton, Marcelle

AU - Lee, Ellen

AU - Lee, Lillian

AU - Lee, Stephen

AU - Lim, Sungwoo

AU - Marx, Melissa

AU - McGibbon, Emily

AU - Mahoney, Kevin

AU - Marin, Gilbert

AU - Matte, Thomas

AU - McAnanama, Rene

AU - McKay, Ryan

AU - McKay, Carolyn

AU - McVeigh, Katherine

AU - Medina, Eric

AU - Medina, Wanda

AU - Michelangelo, Danielle

AU - Milhofer, Juliet

AU - Milyavskaya, Irina

AU - Misener, Mark

AU - Mizrahi, Joseph

AU - Moskin, Linda

AU - Motherwell, Matt

AU - Myers, Christa

AU - Nair, Hemanth P.

AU - Nguyen, Trang

AU - Nilsen, Diana

AU - Nival, Janet

AU - Norton, Jennifer

AU - Oleszko, William

AU - Olson, Carolyn

AU - Paladini, Marc

AU - Palumbo, Lucille

AU - Papadopoulos, Peter

AU - Parton, Hilary

AU - Paternostro, Jacob

AU - Paynter, Lynn

AU - Perkins, Krystal

AU - Perlman, Sharon

AU - Persaud, Haresh

AU - Peters, Charles

AU - Pfeiffer, Melissa

AU - Platt, Roger

AU - Pool, Lindsay

AU - Punsalang, Amado

AU - Rasul, Zahedur

AU - Rawlins, Valerie

AU - Reddy, Vasudha

AU - Rinchiuso, Anne

AU - Rodriguez, Teresa

AU - Rosal, Ramon

AU - Ryan, Maureen

AU - Sanderson, Michael

AU - Scaccia, Allison

AU - Seligson, Amber Levanon

AU - Seupersad, Jantee

AU - Severe-Dildy, Joanne

AU - Siddiqi, Asma

AU - Siemetzki, Ulirike

AU - Singh, Tejinder

AU - Slavinski, Sally

AU - Slopen, Meredith

AU - Snuggs, Timothy

AU - Starr, David

AU - Stayton, Catherine

AU - Stoute, Alaina

AU - Terlonge, Jacqueline

AU - Ternier, Alexandra

AU - Thorpe, Lorna

AU - Travers, Catherine

AU - Tsoi, Benjamin

AU - Turner, Kimberly

AU - Tzou, Joan

AU - Vines, Shameeka

AU - Waddell, Elizabeth

AU - Walker, Donald

AU - Warner, Connie

AU - Weisfuse, Isaac

AU - Weiss, Don

AU - Williams-Akita, Antoinette

AU - Wilson, Elisha

AU - Wilson, Eliza

AU - Wong, Marie

AU - Wu, Charles

AU - Yang, David

AU - Younis, Mohammad

AU - Yusuff, Sulaimon

AU - Zimmerman, Christopher

AU - Zucker, Jane

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.

AB - Background: Accurate measures of the severity of pandemic (H1N1) 2009 influenza (pH1N1) are needed to assess the likely impact of an anticipated resurgence in the autumn in the Northern Hemisphere. Severity has been difficult to measure because jurisdictions with large numbers of deaths and other severe outcomes have had too many cases to assess the total number with confidence. Also, detection of severe cases may be more likely, resulting in overestimation of the severity of an average case. We sought to estimate the probabilities that symptomatic infection would lead to hospitalization, ICU admission, and death by combining data from multiple sources. Methods and Findings: We used complementary data from two US cities: Milwaukee attempted to identify cases of medically attended infection whether or not they required hospitalization, while New York City focused on the identification of hospitalizations, intensive care admission or mechanical ventilation (hereafter, ICU), and deaths. New York data were used to estimate numerators for ICU and death, and two sources of data - medically attended cases in Milwaukee or self-reported influenza-like illness (ILI) in New York - were used to estimate ratios of symptomatic cases to hospitalizations. Combining these data with estimates of the fraction detected for each level of severity, we estimated the proportion of symptomatic patients who died (symptomatic case-fatality ratio, sCFR), required ICU (sCIR), and required hospitalization (sCHR), overall and by age category. Evidence, prior information, and associated uncertainty were analyzed in a Bayesian evidence synthesis framework. Using medically attended cases and estimates of the proportion of symptomatic cases medically attended, we estimated an sCFR of 0.048% (95% credible interval [CI] 0.026%-0.096%), sCIR of 0.239% (0.134%-0.458%), and sCHR of 1.44% (0.83%-2.64%). Using self-reported ILI, we obtained estimates approximately 7-96lower. sCFR and sCIR appear to be highest in persons aged 18 y and older, and lowest in children aged 5-17 y. sCHR appears to be lowest in persons aged 5-17; our data were too sparse to allow us to determine the group in which it was the highest. Conclusions: These estimates suggest that an autumn-winter pandemic wave of pH1N1 with comparable severity per case could lead to a number of deaths in the range from considerably below that associated with seasonal influenza to slightly higher, but with the greatest impact in children aged 0-4 and adults 18-64. These estimates of impact depend on assumptions about total incidence of infection and would be larger if incidence of symptomatic infection were higher or shifted toward adults, if viral virulence increased, or if suboptimal treatment resulted from stress on the health care system; numbers would decrease if the total proportion of the population symptomatically infected were lower than assumed.

UR - http://www.scopus.com/inward/record.url?scp=74049092311&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=74049092311&partnerID=8YFLogxK

U2 - 10.1371/journal.pmed.1000207

DO - 10.1371/journal.pmed.1000207

M3 - Article

C2 - 19997612

AN - SCOPUS:74049092311

VL - 6

JO - PLoS Medicine

JF - PLoS Medicine

SN - 1549-1277

IS - 12

M1 - 1000207

ER -