Estimates of hospitalization attributable to influenza and RSV in the US during 1997-2009, by age and risk status

Gonçalo Matias, Robert Taylor, François Haguinet, Cynthia Schuck-Paim, Roger Lustig, Vivek Shinde, Gonçalo Matias, Robert Taylor, François Haguinet, Cynthia Schuck-Paim, Roger Lustig, Vivek Shinde

Abstract

Background: Estimates of influenza and respiratory syncytial virus (RSV) burden must be periodically updated to inform public health strategies. We estimated seasonal influenza- and RSV-attributable hospitalizations in the US from 1997 to 2009 according to age and risk status (NCT01599390).

Methods: Multiple linear regression modelling was used to attribute hospitalizations to influenza or RSV using virological surveillance and hospitalization data. Hospitalization data were obtained from the US Nationwide Inpatient Sample and virology data were obtained from FluView (Centers for Disease Control and Prevention). Outcomes included any mention of ICD-coded respiratory disease and cardiorespiratory disease diagnoses. We also explored a broader definition of respiratory disease that included mention of relevant respiratory sign/symptoms and viral infection ("respiratory broad").

Results: Applying the respiratory broad outcome, our model attributed ~300,000 and ~200,000 hospitalizations to influenza and RSV, respectively. Influenza A/H3N2 was the predominant cause of influenza-related hospitalizations in most seasons, except in three seasons when influenza B was dominant; likewise, A/H3N2 caused most influenza-related hospitalizations in all age segments, except in children <18 years where the relative contribution of A/H3N2 and B was similar. Most influenza A- and B-related hospitalizations occurred in seniors while approximately one half and one third of all RSV-related events occurred in children 0-4 years and seniors 65+ years, respectively. High-risk status was associated with higher risk of both influenza- and RSV-attributable hospitalizations in adults, but not in children.

Conclusions: Our study assessed the burden of influenza and RSV, information that is important for both cost effectiveness studies and for prioritization of the development of antivirals and vaccines. For seniors, we found that the burdens of influenza and RSV were both substantial. Among children <18 years, about half of all influenza hospitalizations were due to influenza B, most occurring in children without noted risk conditions. RSV hospitalizations among children were confined to those 0-4 years. Our study also demonstrated the importance of the outcome used to estimate hospitalization burden. Our findings highlight the burden of influenza among children regardless of risk status and underscore the prevalence of RSV infections among both young children and older adults.

Keywords: A/H3N2; Influenza; Mortality; Respiratory broad; Respiratory syncytial virus.

Figures

Fig. 1
Fig. 1
Proportion of total hospitalizations attributable to influenza and RSV by season in the US, 1997–2009 (respiratory broad outcome, any mention)
Fig. 2
Fig. 2
Proportion of total hospitalizations attributable to influenza and RSV by age in the US, 1997–2009 (respiratory broad outcome, any mention)

References

    1. Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, et al. Influenza-associated hospitalizations in the United States. JAMA. 2004;292:1333–1340. doi: 10.1001/jama.292.11.1333.
    1. Zhou H, Thompson WW, Viboud CG, Ringholz CM, Cheng PY, et al. Hospitalizations associated with influenza and respiratory syncytial virus in the United States, 1993-2008. Clin Infect Dis. 2012;54:1427–1436. doi: 10.1093/cid/cis211.
    1. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375:1545–1555. doi: 10.1016/S0140-6736(10)60206-1.
    1. Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360:588–598. doi: 10.1056/NEJMoa0804877.
    1. Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132:e341–e348. doi: 10.1542/peds.2013-0303.
    1. Nicholson KG, McNally T, Silverman M, Simons P, Zambon M. Influenza-related hospitalizations among young children in Leicestershire. Pediatr Infect Dis J. 2003;22:S228–S230. doi: 10.1097/01.inf.0000092193.91306.2f.
    1. Fleming DM, Cross KW, Pannell RS. Influenza and its relationship to circulatory disorders. Epidemiol Infect. 2005;133:255–262. doi: 10.1017/S0950268804003231.
    1. Mullooly JP, Bridges CB, Thompson WW, Chen J, Weintraub E, et al. Influenza- and RSV-associated hospitalizations among adults. Vaccine. 2007;25:846–855. doi: 10.1016/j.vaccine.2006.09.041.
    1. Widmer K, Zhu Y, Williams JV, Griffin MR, Edwards KM, et al. Rates of hospitalizations for respiratory syncytial virus, human metapneumovirus, and influenza virus in older adults. J Infect Dis. 2012;206:56–62. doi: 10.1093/infdis/jis309.
    1. Falsey AR, McElhaney JE, Beran J, van Essen GA, Duval X, et al. Respiratory syncytial virus and other respiratory viral infections in older adults with moderate to severe influenza-like illness. J Infect Dis. 2014;209:1873–1881. doi: 10.1093/infdis/jit839.
    1. Simonsen L, Reichert TA, Viboud C, Blackwelder WC, Taylor RJ, et al. Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med. 2005;165:265–272. doi: 10.1001/archinte.165.17.2039.
    1. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179–186. doi: 10.1001/jama.289.2.179.
    1. Pitman RJ, Melegaro A, Gelb D, Siddiqui MR, Gay NJ, et al. Assessing the burden of influenza and other respiratory infections in England and Wales. J Infect. 2007;54:530–538. doi: 10.1016/j.jinf.2006.09.017.
    1. Simonsen L, Taylor RJ, Young-Xu Y, Haber M, May L, et al. Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States. MBio. 2011;2:e00309–e00310. doi: 10.1128/mBio.00309-10.
    1. Fleming DM, Elliot AJ. Lessons from 40 years’ surveillance of influenza in England and Wales. Epidemiol Infect. 2008;136:866–875. doi: 10.1017/S0950268807009910.
    1. Finkelman BS, Viboud C, Koelle K, Ferrari MJ, Bharti N, et al. Global patterns in seasonal activity of influenza A/H3N2, A/H1N1, and B from 1997 to 2005: viral coexistence and latitudinal gradients. PLoS ONE. 2007;2:e1296. doi: 10.1371/journal.pone.0001296.
    1. Shaw MW, Xu X, Li Y, Normand S, Ueki RT, et al. Reappearance and global spread of variants of influenza B/Victoria/2/87 lineage viruses in the 2000-2001 and 2001-2002 seasons. Virology. 2002;303:1–8. doi: 10.1006/viro.2002.1719.
    1. Skowronski DM, Masaro C, Kwindt TL, Mak A, Petric M, et al. Estimating vaccine effectiveness against laboratory-confirmed influenza using a sentinel physician network: results from the 2005-2006 season of dual A and B vaccine mismatch in Canada. Vaccine. 2007;25:2842–2851. doi: 10.1016/j.vaccine.2006.10.002.
    1. Belongia EA, Kieke BA, Donahue JG, Greenlee RT, Balish A, et al. Effectiveness of inactivated influenza vaccines varied substantially with antigenic match from the 2004-2005 season to the 2006-2007 season. J Infect Dis. 2009;199:159–167. doi: 10.1086/595861.
    1. Grohskopf LA, Olsen SJ, Sokolow LZ, Bresee JS, Cox NJ, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) - United States, 2014-15 influenza season. MMWR Morb Mortal Wkly Rep. 2014;63:691–697.
    1. Matias G, Taylor R, Haguinet F, Schuck-Paim C, Lustig R, et al. Estimates of mortality attributable to influenza and RSV in the United States during 1997–2009 by influenza type or subtype, age, cause of death, and risk status. Influenza Other Respir Viruses. 2014;8:507–515. doi: 10.1111/irv.12258.
    1. Centers for Disease Control. Overview of influenza surveillance in the United States. 2013(a). Available: . Accessed 19 Feb 2013.
    1. Centers for Disease Control. Respiratory Syncytial Virus (RSV) Surveillance. 2013(b). Available: . Accessed 19 Feb 2013.
    1. Centers for Disease Control. Past Weekly Surveillance Reports. 2010. Available: . Accessed 27 Apr 2015.
    1. Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season. MMWR Morb Mortal Wkly Rep. 2015;64:818–825. doi: 10.15585/mmwr.mm6430a3.
    1. World Health Organization Vaccines against influenza WHO position paper – November 2012. Wkly Epidemiol Rec. 2012;87:461–476.
    1. Taylor S, Taylor RJ, Lustig RL, et al. Modelling estimates of the burden of respiratory syncytial virus infection in children in the UK. BMJ Open. 2016;6:e009337. doi: 10.1136/bmjopen-2015-009337.
    1. Janssen AGSC, Sanders EAM, Hoes AW, van Loon AM, Hak E. Influenza- and respiratory syncytial virus-associated mortality and hospitalisations. Eur Respir J. 2007;30:1158–1166. doi: 10.1183/09031936.00034407.
    1. Hall CB, Weinberg GA, Blumkin AK, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132:e341–e348. doi: 10.1542/peds.2013-0303.
    1. Lloyd PC, May L, Hoffman D, Riegelman R, Simonsen L. The effect of birth month on the risk of respiratory syncytial virus hospitalization in the first year of life in the United States. Pediatr Infect Dis J. 2014;33:e135–e140. doi: 10.1097/INF.0000000000000250.
    1. Gill PJ, Ashdown HF, Wang K, Heneghan C, Roberts NW, et al. Identification of children at risk of influenza-related complications in primary and ambulatory care: a systematic review and meta-analysis. Lancet Respir Med. 2015;3:139–149. doi: 10.1016/S2213-2600(14)70252-8.
    1. Wong KK, Jain S, Blanton L, Dhara R, Brammer L, et al. Influenza-associated pediatric deaths in the United States, 2004-2012. Pediatrics. 2013;132:796–804. doi: 10.1542/peds.2013-1493.
    1. Cromer D, van Hoek AJ, Jit M, Edmunds WJ, Fleming D, et al. The burden of influenza in England by age and clinical risk group: a statistical analysis to inform vaccine policy. J Infect. 2014;68:363–371. doi: 10.1016/j.jinf.2013.11.013.
    1. Viboud C, Charu V, Olson D, Ballesteros S, Gog J, et al. Demonstrating the use of high-volume electronic medical claims data to monitor local and regional influenza activity in the US. PLoS ONE. 2014;9:e102429. doi: 10.1371/journal.pone.0102429.
    1. Editorial For sepsis, the drugs don’t work. Lancet Infect Dis. 2012;12:89. doi: 10.1016/S1473-3099(12)70020-8.
    1. Thompson WW, Ridenhour BL, Barile JP, Shay DK. Time-series analyses of count data to estimate the burden of seasonal infectious diseases. Epidemiology. 2012;23:839–842. doi: 10.1097/EDE.0b013e31826cc1df.
    1. Gay NJ, Andrews NJ, Trotter CL, Edmunds WJ. Estimating deaths due to influenza and respiratory syncytial virus. JAMA. 2003;289:2499.
    1. Yang L, Chiu SS, Chan KP, Chan KH, Wong WH, et al. Validation of statistical models for estimating hospitalization associated with influenza and other respiratory viruses. PLoS ONE. 2011;6:e17882. doi: 10.1371/journal.pone.0017882.
    1. Goldstein E, Cobey S, Takahashi S, Miller JC, Lipsitch M. Predicting the epidemic sizes of influenza A/H1N1, A/H3N2, and B: a statistical method. PLoS Med. 2011;8:e1001051. doi: 10.1371/journal.pmed.1001051.
    1. Goldstein E, Viboud C, Charu V, Lipsitch M. Improving the estimation of influenza-related mortality over a seasonal baseline. Epidemiology. 2012;23:829–8. doi: 10.1097/EDE.0b013e31826c2dda.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj