Estimation of the Burden of Pandemic(H1N1)2009 in Developing Countries: Experience from a Tertiary Care Center in South India

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Moorthy, Mahesh ; Samuel, Prasanna ; Peter, John Victor ; Vijayakumar, Saranya ; Sekhar, Dipika ; Verghese, Valsan P. ; Agarwal, Indira ; Moses, Prabhakar D. ; Ebenezer, Kala ; Abraham, Ooriapadickal Cherian ; Thomas, Kurien ; Mathews, Prasad ; Mishra, Akhilesh C. ; Lal, Renu ; Muliyil, Jayaprakash ; Abraham, Asha Mary
• Description:
  Background
  
  The burden of the pandemic (H1N1) 2009 influenza might be underestimated if detection of the virus is mandated to diagnose infection. Using an alternate approach, we propose that a much higher pandemic burden was experienced in our institution.
  
  Methodology/Principal Findings
  
  Consecutive patients (n = 2588) presenting to our hospital with influenza like illness (ILI) or severe acute respiratory infection (SARI) during a 1-year period (May 2009–April 2010) were prospectively recruited and tested for influenza A by real-time RT-PCR. Analysis of weekly trends showed an 11-fold increase in patients presenting with ILI/SARI during the peak pandemic period when compared with the pre-pandemic period and a significant (P<0.001) increase in SARI admissions during the pandemic period (30±15.9 admissions/week) when compared with pre-pandemic (7±2.5) and post-pandemic periods (5±3.8). However, Influenza A was detected in less than one-third of patients with ILI/SARI [699 (27.0%)]; a majority of these (557/699, 79.7%) were Pandemic (H1N1)2009 virus [A/H1N1/09]. An A/H1N1/09 positive test was correlated with shorter symptom duration prior to presentation (p = 0.03). More ILI cases tested positive for A/H1N1/09 when compared with SARI (27.4% vs. 14.6%, P = 0.037). When the entire study population was considered, A/H1N1/09 positivity was associated with lower risk of hospitalization (p<0.0001) and ICU admission (p = 0.013) suggesting mild self-limiting illness in a majority.
  
  Conclusion/Significance
  
  Analysis of weekly trends of ILI/SARI suggest a higher burden of the pandemic attributable to A/H1N1/09 than estimates assessed by a positive PCR test alone. The study highlights methodological consideration in the estimation of burden of pandemic influenza in developing countries using hospital-based data that may help assess the impact of future outbreaks of respiratory illnesses.
  
  
• Subjects:
  Adolescent Adult Aged Child Child, Preschool Communicable Disease Control Developing Countries Female Hospitalization Humans Infant Infant, Newborn Influenza, Human Influenza A Virus, H1N1 Subtype Intensive Care Units Male Middle Aged Pandemics Real-Time Polymerase Chain Reaction Tertiary Care Centers Time Factors

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• Source:
  PLoS One. 2012; 7(9).
• Pubmed ID:
  22957015
• Pubmed Central ID:
  PMC3434194
• Document Type:
  Journal Article
• Funding:
  5U50/CI024407-05/CI/NCPDCID CDC HHS/United States
• Place as Subject:
  India
• Volume:
  7
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ca5fab506ce4e1e0fd98939b5c21b127992db5c0f570325ae577dd6b57652d0c
• Download URL:
  https://stacks.cdc.gov/view/cdc/10928/cdc_10928_DS1.pdf
• File Type:
  [PDF - 694.44 KB ]