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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 involving ARDS, respiratory failure, mechanical ventilation, or ECMO. Weekly observed (blue) and predicted (green) rates per 100,000 persons of intensive care admissions for acute respiratory distress syndrome, respiratory failure, where mechanical ventilation was used, and where extracorporeal membrane ventilation was used, New South Wales, Australia, 2007 to 2010. Each influenza period is marked with vertical reference lines.
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Figure 6: Rates of intensive care admission involving ARDS, respiratory failure, mechanical ventilation, or ECMO. Weekly observed (blue) and predicted (green) rates per 100,000 persons of intensive care admissions for acute respiratory distress syndrome, respiratory failure, where mechanical ventilation was used, and where extracorporeal membrane ventilation was used, New South Wales, Australia, 2007 to 2010. Each influenza period is marked with vertical reference lines.

Mentions: In terms of severity, while respiratory failure and mechanical ventilation were more common in 2007, 2009 saw the greatest number of diagnoses of ARDS and the greatest number of admissions where the patient required ECMO, with an excess of 34 diagnoses (95% CI 21 to 46) and 21 admissions (95% CI 20 to 23) respectively (Table3, Figure6). No other year experienced an excess of ARDS diagnoses, while the next highest excess number of admissions where the patient required ECMO was observed in 2010, with an excess of 3 admissions (95% CI 2 to 4). Overall, in 2009 the median time spent in ICU in patients with respiratory illness and influenza/pneumonia were 77 hours and 96 hours respectively, which are similar to other years (Table4). People under 65 years with influenza/pneumonia tended to have a longer stay in intensive care on average in 2009, while people 65 years and older had shorter stays (Table4). In 2009 the percentage of respiratory patients who died while in intensive care was the lowest of all 4 years (16%) (Table5).


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 involving ARDS, respiratory failure, mechanical ventilation, or ECMO. Weekly observed (blue) and predicted (green) rates per 100,000 persons of intensive care admissions for acute respiratory distress syndrome, respiratory failure, where mechanical ventilation was used, and where extracorporeal membrane ventilation was used, New South Wales, Australia, 2007 to 2010. 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 6: Rates of intensive care admission involving ARDS, respiratory failure, mechanical ventilation, or ECMO. Weekly observed (blue) and predicted (green) rates per 100,000 persons of intensive care admissions for acute respiratory distress syndrome, respiratory failure, where mechanical ventilation was used, and where extracorporeal membrane ventilation was used, New South Wales, Australia, 2007 to 2010. Each influenza period is marked with vertical reference lines.
Mentions: In terms of severity, while respiratory failure and mechanical ventilation were more common in 2007, 2009 saw the greatest number of diagnoses of ARDS and the greatest number of admissions where the patient required ECMO, with an excess of 34 diagnoses (95% CI 21 to 46) and 21 admissions (95% CI 20 to 23) respectively (Table3, Figure6). No other year experienced an excess of ARDS diagnoses, while the next highest excess number of admissions where the patient required ECMO was observed in 2010, with an excess of 3 admissions (95% CI 2 to 4). Overall, in 2009 the median time spent in ICU in patients with respiratory illness and influenza/pneumonia were 77 hours and 96 hours respectively, which are similar to other years (Table4). People under 65 years with influenza/pneumonia tended to have a longer stay in intensive care on average in 2009, while people 65 years and older had shorter stays (Table4). In 2009 the percentage of respiratory patients who died while in intensive care was the lowest of all 4 years (16%) (Table5).

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