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The impact of influenza A(H1N1)pdm09 compared with seasonal influenza on intensive care admissions in New South Wales, Australia, 2007 to 2010: a time series analysis.

Schaffer A, Muscatello D, Cretikos M, Gilmour R, Tobin S, Ward J - BMC Public Health (2012)

Bottom Line: The estimated excess rate of influenza-associated respiratory ICU admissions per 100,000 inhabitants was more than three times higher in 2007 (2.6/100,000, 95% CI 2.0 to 3.1) than the pandemic year, 2009 (0.76/100,000, 95% CI 0.04 to 1.48).In 2009, high ICU use among young to middle aged adults was offset by relatively low use among older adults, and Aboriginal people and pregnant women were substantially over-represented in ICUs.Greater emphasis on prevention of serious illness in Aboriginal people and pregnant women should be a priority in pandemic planning.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Epidemiology and Research, NSW Ministry of Health, North Sydney, NSW, Australia. andrea.schaffer@sydney.edu.au

ABSTRACT

Background: In Australia, the 2009 epidemic of influenza A(H1N1)pdm09 resulted in increased admissions to intensive care. The annual contribution of influenza to use of intensive care is difficult to estimate, as many people with influenza present without a classic influenza syndrome and laboratory testing may not be performed. We used a population-based approach to estimate and compare the impact of recent epidemics of seasonal and pandemic influenza.

Methods: For 2007 to 2010, time series describing health outcomes in various population groups were prepared from a database of all intensive care unit (ICU) admissions in the state of New South Wales, Australia. The Serfling approach, a time series method, was used to estimate seasonal patterns in health outcomes in the absence of influenza epidemics. The contribution of influenza was estimated by subtracting expected seasonal use from observed use during each epidemic period.

Results: The estimated excess rate of influenza-associated respiratory ICU admissions per 100,000 inhabitants was more than three times higher in 2007 (2.6/100,000, 95% CI 2.0 to 3.1) than the pandemic year, 2009 (0.76/100,000, 95% CI 0.04 to 1.48). In 2009, the highest excess respiratory ICU admission rate was in 17 to 64 year olds (2.9/100,000, 95% CI 2.2 to 3.6), while in 2007, the highest excess rate was in those aged 65 years or older (9.5/100,000, 95% CI 6.2 to 12.8). In 2009, the excess rate was 17/100,000 (95% CI 14 to 20) in Aboriginal people and 14/100,000 (95% CI 13 to 16) in pregnant women.

Conclusion: While influenza was diagnosed more frequently and peak use of intensive care was higher during the epidemic of pandemic influenza in 2009, overall excess admissions to intensive care for respiratory illness was much greater during the influenza season in 2007. Thus, the impact of seasonal influenza on intensive care use may have previously been under-recognised. In 2009, high ICU use among young to middle aged adults was offset by relatively low use among older adults, and Aboriginal people and pregnant women were substantially over-represented in ICUs. Greater emphasis on prevention of serious illness in Aboriginal people and pregnant women should be a priority in pandemic planning.

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Rates of intensive care admission in Aboriginal people. Weekly observed (blue) and predicted (green) rates of intensive care admission per 100,000 among Aboriginal people of respiratory, influenza or pneumonia, or influenza illness, New South Wales, Australia, 2007 to 2010. Respiratory diagnoses include a primary diagnosis of any respiratory illness or a primary or other diagnosis of influenza or pneumonia. Each influenza period is marked with vertical reference lines.
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Figure 5: Rates of intensive care admission in Aboriginal people. Weekly observed (blue) and predicted (green) rates of intensive care admission per 100,000 among Aboriginal people of respiratory, influenza or pneumonia, or influenza illness, New South Wales, Australia, 2007 to 2010. Respiratory diagnoses include a primary diagnosis of any respiratory illness or a primary or other diagnosis of influenza or pneumonia. Each influenza period is marked with vertical reference lines.

Mentions: Considering all respiratory intensive care admissions, pregnant/postpartum women were markedly more affected in 2009 (Table2, Figure4) with a rate of respiratory admission per 100,000 of 14.4 (95% CI 12.5 to 16.2), as were Aboriginal people with a rate of respiratory admission per 100,000 of 17.0 (95% CI 14.4 to 19.6) (Table2, Figure5). These compare to rates of 8.5 per 100,000 (95% CI 7.0 to 9.9) and 3.1 per 100,000 (95% CI 1.1 to 5.2) respectively for pregnant women and Aboriginal people in 2007. Both pregnant women and Aboriginal people have a younger age distribution than the general population, and when compared to the excess respiratory rate in 17 to 64 year olds, the excess rate in pregnant women was nearly 5 times larger, while the excess rate in Aboriginal people was nearly 6 times larger. This compares to differences of 6 times and 2 times, respectively, in 2007 (Table2).


The impact of influenza A(H1N1)pdm09 compared with seasonal influenza on intensive care admissions in New South Wales, Australia, 2007 to 2010: a time series analysis.

Schaffer A, Muscatello D, Cretikos M, Gilmour R, Tobin S, Ward J - BMC Public Health (2012)

Rates of intensive care admission in Aboriginal people. Weekly observed (blue) and predicted (green) rates of intensive care admission per 100,000 among Aboriginal people of respiratory, influenza or pneumonia, or influenza illness, New South Wales, Australia, 2007 to 2010. Respiratory diagnoses include a primary diagnosis of any respiratory illness or a primary or other diagnosis of influenza or pneumonia. Each influenza period is marked with vertical reference lines.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539885&req=5

Figure 5: Rates of intensive care admission in Aboriginal people. Weekly observed (blue) and predicted (green) rates of intensive care admission per 100,000 among Aboriginal people of respiratory, influenza or pneumonia, or influenza illness, New South Wales, Australia, 2007 to 2010. Respiratory diagnoses include a primary diagnosis of any respiratory illness or a primary or other diagnosis of influenza or pneumonia. Each influenza period is marked with vertical reference lines.
Mentions: Considering all respiratory intensive care admissions, pregnant/postpartum women were markedly more affected in 2009 (Table2, Figure4) with a rate of respiratory admission per 100,000 of 14.4 (95% CI 12.5 to 16.2), as were Aboriginal people with a rate of respiratory admission per 100,000 of 17.0 (95% CI 14.4 to 19.6) (Table2, Figure5). These compare to rates of 8.5 per 100,000 (95% CI 7.0 to 9.9) and 3.1 per 100,000 (95% CI 1.1 to 5.2) respectively for pregnant women and Aboriginal people in 2007. Both pregnant women and Aboriginal people have a younger age distribution than the general population, and when compared to the excess respiratory rate in 17 to 64 year olds, the excess rate in pregnant women was nearly 5 times larger, while the excess rate in Aboriginal people was nearly 6 times larger. This compares to differences of 6 times and 2 times, respectively, in 2007 (Table2).

Bottom Line: The estimated excess rate of influenza-associated respiratory ICU admissions per 100,000 inhabitants was more than three times higher in 2007 (2.6/100,000, 95% CI 2.0 to 3.1) than the pandemic year, 2009 (0.76/100,000, 95% CI 0.04 to 1.48).In 2009, high ICU use among young to middle aged adults was offset by relatively low use among older adults, and Aboriginal people and pregnant women were substantially over-represented in ICUs.Greater emphasis on prevention of serious illness in Aboriginal people and pregnant women should be a priority in pandemic planning.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Epidemiology and Research, NSW Ministry of Health, North Sydney, NSW, Australia. andrea.schaffer@sydney.edu.au

ABSTRACT

Background: In Australia, the 2009 epidemic of influenza A(H1N1)pdm09 resulted in increased admissions to intensive care. The annual contribution of influenza to use of intensive care is difficult to estimate, as many people with influenza present without a classic influenza syndrome and laboratory testing may not be performed. We used a population-based approach to estimate and compare the impact of recent epidemics of seasonal and pandemic influenza.

Methods: For 2007 to 2010, time series describing health outcomes in various population groups were prepared from a database of all intensive care unit (ICU) admissions in the state of New South Wales, Australia. The Serfling approach, a time series method, was used to estimate seasonal patterns in health outcomes in the absence of influenza epidemics. The contribution of influenza was estimated by subtracting expected seasonal use from observed use during each epidemic period.

Results: The estimated excess rate of influenza-associated respiratory ICU admissions per 100,000 inhabitants was more than three times higher in 2007 (2.6/100,000, 95% CI 2.0 to 3.1) than the pandemic year, 2009 (0.76/100,000, 95% CI 0.04 to 1.48). In 2009, the highest excess respiratory ICU admission rate was in 17 to 64 year olds (2.9/100,000, 95% CI 2.2 to 3.6), while in 2007, the highest excess rate was in those aged 65 years or older (9.5/100,000, 95% CI 6.2 to 12.8). In 2009, the excess rate was 17/100,000 (95% CI 14 to 20) in Aboriginal people and 14/100,000 (95% CI 13 to 16) in pregnant women.

Conclusion: While influenza was diagnosed more frequently and peak use of intensive care was higher during the epidemic of pandemic influenza in 2009, overall excess admissions to intensive care for respiratory illness was much greater during the influenza season in 2007. Thus, the impact of seasonal influenza on intensive care use may have previously been under-recognised. In 2009, high ICU use among young to middle aged adults was offset by relatively low use among older adults, and Aboriginal people and pregnant women were substantially over-represented in ICUs. Greater emphasis on prevention of serious illness in Aboriginal people and pregnant women should be a priority in pandemic planning.

Show MeSH
Related in: MedlinePlus