Impact of the 2009 H1N1 Pandemic on Age-Specific Epidemic Curves of Other Respiratory Viruses: A Comparison of Pre-Pandemic, Pandemic and Post-Pandemic Periods in a Subtropical City

Abstract

Background: The 2009 H1N1 influenza pandemic caused offseason peaks in temperate regions but coincided with the summer epidemic of seasonal influenza and other common respiratory viruses in subtropical Hong Kong. This study was aimed to investigate the impact of the pandemic on age-specific epidemic curves of other respiratory viruses.

Methods: Weekly laboratory-confirmed cases of influenza A (subtypes seasonal A(H1N1), A(H3N2), pandemic virus A(H1N1)pdm09), influenza B, respiratory syncytial virus (RSV), adenovirus and parainfluenza were obtained from 2004 to 2013. Age-specific epidemic curves of viruses other than A(H1N1)pdm09 were compared between the pre-pandemic (May 2004-April 2009), pandemic (May 2009-April 2010) and post-pandemic periods (May 2010-April 2013).

Results: There were two peaks of A(H1N1)pdm09 in Hong Kong, the first in September 2009 and the second in February 2011. The infection rate was found highest in young children in both waves, but markedly fewer cases in school children were recorded in the second wave than in the first wave. Positive proportions of viruses other than A(H1N1)pdm09 markedly decreased in all age groups during the first pandemic wave. After the first wave of the pandemic, the positive proportion of A(H3N2) increased, but those of B and RSV remained slightly lower than their pre-pandemic proportions. Changes in seasonal pattern and epidemic peak time were also observed, but inconsistent across virus-age groups.

Conclusion: Our findings provide some evidence that age distribution, seasonal pattern and peak time of other respiratory viruses have changed since the pandemic. These changes could be the result of immune interference and changing health seeking behavior, but the mechanism behind still needs further investigations.

Fig 1. Weekly numbers of laboratory confirmed cases with influenza A (subtypes A(H1N1), A(H3N2) and A(H1N1)pdm09), influenza B, respiratory syncytial virus (RSV), adenovirus or parainfluenza by age group, Hong Kong, 2004–2010.

The pandemic period of 26 April 2009–24 April 2010 is highlighted in gray band.

Fig 2. Wavelet spectrum of age- and virus-specific positive numbers.

The black contour lines show the regions of power significant at the 5% level computed based on 1,000 Monte Carlo simulations. The cone of influence (black curve) indicated the region without edge effects. The power values were coded from dark blue for low power to dark red for high power, as shown in the right panel.

Fig 3. Comparison of the mean week of the epidemics (MWE) during the pre- and post-pandemic periods, for influenza A(H3N2), B, respiratory syncytial virus (RSV), adenovirus and parainfluenza.

Red and blue dots represent MWE in warm season (week 19 to week 50) and cool season (week 51 to week 18 of next year) of the pre-pandemic period. Pink and light blue dots represent MWE in warm and cool season of the post-pandemic period. The vertical bars indicate ± one standard error.