Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.

<h4>Background</h4>Elucidating the role of the underlying risk factors for severe outcomes of the 2009 A/H1N1 influenza pandemic could be crucial to define priority risk groups in resource-limited settings in future pandemics.<h4>Methods</h4>We use individual-level clinical d...

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Autores principales:	Gerardo Chowell, Santiago Echevarría-Zuno, Cécile Viboud, Lone Simonsen, Mark A Miller, Irma Fernández-Gárate, Cesar González-Bonilla, Víctor H Borja-Aburto
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/26fb4315b01445798f1352e4d2aa5b05
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spelling	oai:doaj.org-article:26fb4315b01445798f1352e4d2aa5b052021-11-18T07:12:19ZEpidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.1932-620310.1371/journal.pone.0041069https://doaj.org/article/26fb4315b01445798f1352e4d2aa5b052012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22815917/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Elucidating the role of the underlying risk factors for severe outcomes of the 2009 A/H1N1 influenza pandemic could be crucial to define priority risk groups in resource-limited settings in future pandemics.<h4>Methods</h4>We use individual-level clinical data on a large series of ARI (acute respiratory infection) hospitalizations from a prospective surveillance system of the Mexican Social Security medical system to analyze clinical features at presentation, admission delays, selected comorbidities and receipt of seasonal vaccine on the risk of A/H1N1-related death. We considered ARI hospitalizations and inpatient-deaths, and recorded demographic, geographic, and medical information on individual patients during August-December, 2009.<h4>Results</h4>Seasonal influenza vaccination was associated with a reduced risk of death among A/H1N1 inpatients (OR = 0.43 (95% CI: 0.25, 0.74)) after adjustment for age, gender, geography, antiviral treatment, admission delays, comorbidities and medical conditions. However, this result should be interpreted with caution as it could have been affected by factors not directly measured in our study. Moreover, the effect of antiviral treatment against A/H1N1 inpatient death did not reach statistical significance (OR = 0.56 (95% CI: 0.29, 1.10)) probably because only 8.9% of A/H1N1 inpatients received antiviral treatment. Moreover, diabetes (OR = 1.6) and immune suppression (OR = 2.3) were statistically significant risk factors for death whereas asthmatic persons (OR = 0.3) or pregnant women (OR = 0.4) experienced a reduced fatality rate among A/H1N1 inpatients. We also observed an increased risk of death among A/H1N1 inpatients with admission delays >2 days after symptom onset (OR = 2.7). Similar associations were also observed for A/H1N1-negative inpatients.<h4>Conclusions</h4>Geographical variation in identified medical risk factors including prevalence of diabetes and immune suppression may in part explain between-country differences in pandemic mortality burden. Furthermore, access to care including hospitalization without delay and antiviral treatment and are also important factors, as well as vaccination coverage with the 2008-09 trivalent inactivated influenza vaccine.Gerardo ChowellSantiago Echevarría-ZunoCécile ViboudLone SimonsenMark A MillerIrma Fernández-GárateCesar González-BonillaVíctor H Borja-AburtoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 7, p e41069 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Gerardo Chowell Santiago Echevarría-Zuno Cécile Viboud Lone Simonsen Mark A Miller Irma Fernández-Gárate Cesar González-Bonilla Víctor H Borja-Aburto Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
description	<h4>Background</h4>Elucidating the role of the underlying risk factors for severe outcomes of the 2009 A/H1N1 influenza pandemic could be crucial to define priority risk groups in resource-limited settings in future pandemics.<h4>Methods</h4>We use individual-level clinical data on a large series of ARI (acute respiratory infection) hospitalizations from a prospective surveillance system of the Mexican Social Security medical system to analyze clinical features at presentation, admission delays, selected comorbidities and receipt of seasonal vaccine on the risk of A/H1N1-related death. We considered ARI hospitalizations and inpatient-deaths, and recorded demographic, geographic, and medical information on individual patients during August-December, 2009.<h4>Results</h4>Seasonal influenza vaccination was associated with a reduced risk of death among A/H1N1 inpatients (OR = 0.43 (95% CI: 0.25, 0.74)) after adjustment for age, gender, geography, antiviral treatment, admission delays, comorbidities and medical conditions. However, this result should be interpreted with caution as it could have been affected by factors not directly measured in our study. Moreover, the effect of antiviral treatment against A/H1N1 inpatient death did not reach statistical significance (OR = 0.56 (95% CI: 0.29, 1.10)) probably because only 8.9% of A/H1N1 inpatients received antiviral treatment. Moreover, diabetes (OR = 1.6) and immune suppression (OR = 2.3) were statistically significant risk factors for death whereas asthmatic persons (OR = 0.3) or pregnant women (OR = 0.4) experienced a reduced fatality rate among A/H1N1 inpatients. We also observed an increased risk of death among A/H1N1 inpatients with admission delays >2 days after symptom onset (OR = 2.7). Similar associations were also observed for A/H1N1-negative inpatients.<h4>Conclusions</h4>Geographical variation in identified medical risk factors including prevalence of diabetes and immune suppression may in part explain between-country differences in pandemic mortality burden. Furthermore, access to care including hospitalization without delay and antiviral treatment and are also important factors, as well as vaccination coverage with the 2008-09 trivalent inactivated influenza vaccine.
format	article
author	Gerardo Chowell Santiago Echevarría-Zuno Cécile Viboud Lone Simonsen Mark A Miller Irma Fernández-Gárate Cesar González-Bonilla Víctor H Borja-Aburto
author_facet	Gerardo Chowell Santiago Echevarría-Zuno Cécile Viboud Lone Simonsen Mark A Miller Irma Fernández-Gárate Cesar González-Bonilla Víctor H Borja-Aburto
author_sort	Gerardo Chowell
title	Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
title_short	Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
title_full	Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
title_fullStr	Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
title_full_unstemmed	Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.
title_sort	epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in mexico.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/26fb4315b01445798f1352e4d2aa5b05
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Epidemiological characteristics and underlying risk factors for mortality during the autumn 2009 pandemic wave in Mexico.

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