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. 2014 Jul 8;9(7):e101785.
doi: 10.1371/journal.pone.0101785. eCollection 2014.

Outcomes of influenza A(H1N1)pdm09 virus infection: results from two international cohort studies

Ruth Lynfield  1 , Richard Davey  2 , Dominic E Dwyer  3 , Marcelo H Losso  4 , Deborah Wentworth  5 , Alessandro Cozzi-Lepri  6 , Kathy Herman-Lamin  5 , Grazyna Cholewinska  7 , Daniel David  8 , Stefan Kuetter  9 , Zelalem Ternesgen  10 , Timothy M Uyeki  11 , H Clifford Lane  2 , Jens Lundgren  12 , James D Neaton  5 ; INSIGHT Influenza Study Group
Collaborators, Affiliations

Outcomes of influenza A(H1N1)pdm09 virus infection: results from two international cohort studies

Ruth Lynfield et al. PLoS One. .

Abstract

Background: Data from prospectively planned cohort studies on risk of major clinical outcomes and prognostic factors for patients with influenza A(H1N1)pdm09 virus are limited. In 2009, in order to assess outcomes and evaluate risk factors for progression of illness, two cohort studies were initiated: FLU 002 in outpatients and FLU 003 in hospitalized patients.

Methods and findings: Between October 2009 and December 2012, adults with influenza-like illness (ILI) were enrolled; outpatients were followed for 14 days and inpatients for 60 days. Disease progression was defined as hospitalization and/or death for outpatients, and hospitalization for >28 days, transfer to intensive care unit (ICU) if enrolled from general ward, and/or death for inpatients. Infection was confirmed by RT-PCR. 590 FLU 002 and 392 FLU 003 patients with influenza A (H1N1)pdm09 were enrolled from 81 sites in 17 countries at 2 days (IQR 1-3) and 6 days (IQR 4-10) following ILI onset, respectively. Disease progression was experienced by 29 (1 death) outpatients (5.1%; 95% CI: 3.4-7.2%) and 80 inpatients [death (32), hospitalization >28 days (43) or ICU transfer (20)] (21.6%; 95% CI: 17.5-26.2%). Disease progression (death) for hospitalized patients was 53.1% (26.6%) and 12.8% (3.8%), respectively, for those enrolled in the ICU and general ward. In pooled analyses for both studies, predictors of disease progression were age, longer duration of symptoms at enrollment and immunosuppression. Patients hospitalized during the pandemic period had a poorer prognosis than in subsequent seasons.

Conclusions: Patients with influenza A(H1N1)pdm09, particularly when requiring hospital admission, are at high risk for disease progression, especially if they are older, immunodeficient, or admitted late in infection. These data reinforce the need for international trials of novel treatment strategies for influenza infection and serve as a reminder of the need to monitor the severity of seasonal and pandemic influenza epidemics globally.

Trial registration: ClinicalTrials.gov Identifiers: FLU 002--NCT01056354, FLU 003--NCT01056185.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. FLU 002 flow diagram.
Figure 2
Figure 2. FLU 003 flow diagram.
Figure 3
Figure 3. Cumulative percentage of patients with death from any cause in FLU 003 according to location of enrollment.
The number of patients at risk at each timepoint are given below the graph.
Figure 4
Figure 4. Frequency distribution of number of days between onset of ILI symptoms and enrollment for patients in FLU 002 and FLU 003.
See this image and copyright information in PMC

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