Comparative epidemiology of pandemic and seasonal influenza A in households

Abstract

Background: There are few data on the comparative epidemiology and virology of the pandemic 2009 influenza A (H1N1) virus and cocirculating seasonal influenza A viruses in community settings.

Methods: We recruited 348 index patients with acute respiratory illness from 14 outpatient clinics in Hong Kong in July and August 2009. We then prospectively followed household members of 99 patients who tested positive for influenza A virus on rapid diagnostic testing. We collected nasal and throat swabs from all household members at three home visits within 7 days for testing by means of quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay and viral culture. Using hemagglutination-inhibition and viral-neutralization assays, we tested baseline and convalescent serum samples from a subgroup of patients for antibody responses to the pandemic and seasonal influenza A viruses.

Results: Secondary attack rates (as confirmed on RT-PCR assay) among household contacts of index patients were similar for the pandemic influenza virus (8%; 95% confidence interval [CI], 3 to 14) and seasonal influenza viruses (9%; 95% CI, 5 to 15). The patterns of viral shedding and the course of illness among index patients were also similar for the pandemic and seasonal influenza viruses. In a subgroup of patients for whom baseline and convalescent serum samples were available, 36% of household contacts who had serologic evidence of pandemic influenza virus infection did not shed detectable virus or report illness.

Conclusions: Pandemic 2009 H1N1 virus has characteristics that are broadly similar to those of seasonal influenza A viruses in terms of rates of viral shedding, clinical illness, and transmissibility in the household setting.

Figure 1. Enrollment and Outcomes

Figure 2. Patterns of Viral Shedding and Course of Illness in Index Patients, According to the Onset of Acute Respiratory Illness

Panels A and B show the geometric mean viral load on reverse-transcriptase—polymerase-chain-reaction (RTPCR) assay for index patients with pandemic influenza and those with seasonal influenza, respectively. The lower limit of detection for the RT-PCR assay was approximately 900 copies per milliliter (horizontal lines). Panels C and D show the geometric mean tissue-culture infectious dose (TCID₅₀) (the quantity of virus required for a cytopathic effect in 50% of inoculated cultures) for index patients with pandemic influenza and those with seasonal influenza, respectively. The lower limit of detection of the quantitative culture assay was approximately 0.3 log₁₀ TCID₅₀ (horizontal lines). Panels E and F show the mean scores for lower respiratory, upper respiratory, and systemic symptoms in index patients with pandemic influenza and those with seasonal influenza, respectively. Symptom scores were calculated from a composite of three groups of signs and symptoms of influenza and ranged from 0 to 1, with higher scores indicating a greater severity of symptoms. In all panels, the onset of acute respiratory illness was defined as the self-reported day of illness onset before recruitment to the study.