P42 gihsn isrv epi1415 v1 rjpb · Joan Puig-Barberà1, Elena Burtseva2, Hongjie Yu3, Selim Badur4,...
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Impact of influenza strain and patient characteristics on the risk of admissions with influenza. Global Influenza Hospital Surveillance Network Results, 2014- 2015 influenza season The study was funded by Sanofi Pasteur Methods Joan Puig-Barberà 1 , Elena Burtseva 2 , Hongjie Yu 3 , Selim Badur 4 , Jan Kyncl 5 , F. Xavier López-Labrador 1,6 , Maria Pisareva 7 , Svetlana Trushakova 2 , Benjamin J. Cowling 8 , Tulay Bagci 9 , Ainara Mira-Iglesias 1 , Elizaveta Smorodintseva 7 , Lidiya Kisteneva 2 , Luzhao Feng 3 , Sevim Mese 4 , Angels Natividad-Miralles 1 , Kirill Stolyarov 7 , Lyudmila Kolobukhina 2 , Peng Wu 8 , Kubra Yurtcu 4 , Lubov Voloshchuk 7 , Veronika Afanasieva 2 , Qin Ying 3 , Anna Sominina 7 for the Global Influenza Hospital Surveillance Study Group (GIHSN). 1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain. 2 D.I. Ivanovsky Institute of Virology FSBI (Federal State Budgetary Institution). “N.F. Gamaleya FRCEM” Ministry of Health of Russian Federation, Moscow, Russian Federation. 3 Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. 4 National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 5 Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic. 6 Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain. 7 Research Institute of Influenza, Saint Petersburg, Russian Federation. 8 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. 9 Hacettepe Medicine Faculty – Ankara, Turkey Abstract : P42 Results Introduction The Global Influenza Hospital Surveillance Network (GIHSN) is a public-private partnership between various Public Health institutions and Sanofi Pasteur. The main goal of the GIHSN is to study influenza epidemiology. During the 2014-2015 influenza season, in 24 hospitals in Russia Federation, Czech Republic, Turkey, China and Spain (Figure 1), we screened consecutive admissions following a common protocol. Fundación para el Fomento de la Investigación Biomédica y Sanitaria (FISABIO), Valencia, Spain Phone: +34 961 925 968; e-mail: [email protected] http://gihsn.org Figure 2. Study methods flowchart Discussion Influenza was a significant threat for all age groups. Comorbidity increased the risk of influenza and this was observed for all influenza strains. Pregnancy was an risk factor regardless of involved strain. A(H1N1)pdm09 was associated with a grater risk of ICU admission and B/Yamagata-lineage with an increased risk of respiratory failure. Figure 1. Global Influenza Hospital Surveillance Network (GIHSN) Eligible patients considered for inclusion: All consecutive admissions for an acute process Admitted in the previous 48 hours Chief complaints for admission possibly related to a previous influenza infection Residents in the predefined study’s catchment area (study population or study base) Complies with inclusion criteria: Able to communicate Informed consent to participate Is a permanent resident (as defined in the site protocol) Not institutionalized Not discharged from a hospital in the last 30 days ILI symptoms within 7 days to admission (≥5 y old) Admission symptoms within 7 days to admission (<5 y old) Study procedures: Common standardized questionnaire Combined respiratory swabs Site’s reference laboratory Semi;quantitative real;time reverse transcription PCR Influenza positive Influenza subtype or lineage Influenza negative Eligible: 17,469 Excluded: 6,357 (36%) No consent: 1,727 (10%) No ILI: 3,189 (20%) Symptoms >7 days: 1,327 (11%) Included: 9,589 (55%) Negative: 7,413 (77%) Influenza: 2,176 (23%) Recruited outside season: 1,176 (10%) Records: 21,611 Southern hemisphere: 338 No resident: 256 Institutionalized: 870 Previous admission ≤ 30 days: 3,016 (15%) Figure 3. Flowchart of admissions GIHSN 2014-2015 influenza season 0 50 100 150 200 250 Admissions positive for influenza (number by strain) 2014-47 2014-48 2014-49 2014-50 2014-51 2014-52 2014-53 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06 2015-07 2015-08 2015-09 2015-10 2015-11 2015-12 2015-13 2015-14 2015-15 2015-16 2015-17 2015-18 2015-19 2015-20 Epidemiological week A(H1N1)pdm09 (n=121; 6%) A(H3N2) (n=1,243; 57%) A not subtyped (n=106; 5%) B/Yamagata-lineage (n=665; 30%) B/Victoria-lineage (n=11; 0.5%) B not subtyped (n=54; 2%) Figure 4. Number of admissions with influenza, by virus strain and week CVD COPD Asthma Immunosupression Diabetes Renal disease Neuromuscular Neoplasm Cirrhosis Autoinmune Pregnancy Obesity factors Strain/Risk 1.69 (1.45, 1.97) 1.56 (1.31, 1.86) 1.48 (1.11, 1.96) 0.69 (0.33, 1.43) 1.76 (1.46, 2.12) 1.84 (1.46, 2.32) 0.69 (0.43, 1.12) 1.26 (0.88, 1.81) 0.88 (0.54, 1.43) 2.18 (1.48, 3.19) 2.35 (1.51, 3.68) 1.52 (1.25, 1.86) aOR (95% CI) 319 222 65 8 180 108 19 38 19 36 64 148 Influenza admissions with Number of 1.69 (1.45, 1.97) 1.56 (1.31, 1.86) 1.48 (1.11, 1.96) 0.69 (0.33, 1.43) 1.76 (1.46, 2.12) 1.84 (1.46, 2.32) 0.69 (0.43, 1.12) 1.26 (0.88, 1.81) 0.88 (0.54, 1.43) 2.18 (1.48, 3.19) 2.35 (1.51, 3.68) 1.52 (1.25, 1.86) aOR (95% CI) 319 222 65 8 180 108 19 38 19 36 64 148 Influenza admissions with Number of 1 .25 .75 1 2 5 Adjusted odds ratio Adjusted odds ratio (aOR)* of admission with A(H3N2) CVD COPD Asthma Diabetes Renal disease Neuromuscular Neoplasm Autoinmune Pregnancy Obesity factors Strain/Risk 0.77 (0.45, 1.32) 0.40 (0.18, 0.88) 0.96 (0.38, 2.43) 0.62 (0.29, 1.31) 0.28 (0.07, 1.16) 2.49 (1.15, 5.40) 1.11 (0.39, 3.15) 0.52 (0.07, 3.80) 3.31 (1.07, 10.21) 0.60 (0.27, 1.33) aOR (95% CI) 18 7 5 8 2 8 4 1 11 7 Influenza admissions with Number of 0.77 (0.45, 1.32) 0.40 (0.18, 0.88) 0.96 (0.38, 2.43) 0.62 (0.29, 1.31) 0.28 (0.07, 1.16) 2.49 (1.15, 5.40) 1.11 (0.39, 3.15) 0.52 (0.07, 3.80) 3.31 (1.07, 10.21) 0.60 (0.27, 1.33) aOR (95% CI) 18 7 5 8 2 8 4 1 11 7 Influenza admissions with Number of 1 .25 .75 1 2 5 Adjusted odds ratio Adjusted odds ratio* of admission with A(H1N1)pdm CVD COPD Asthma Immunosupression Diabetes Renal disease Neuromuscular Neoplasm Cirrhosis Autoinmune Pregnancy Obesity factors Strain/Risk 0.87 (0.69, 1.10) 0.63 (0.47, 0.84) 0.83 (0.54, 1.27) 0.78 (0.34, 1.81) 0.50 (0.35, 0.72) 0.70 (0.47, 1.06) 1.22 (0.77, 1.94) 0.88 (0.53, 1.47) 0.79 (0.43, 1.48) 0.76 (0.37, 1.56) 3.74 (2.27, 6.16) 0.79 (0.58, 1.07) ratio (95% CI) Adjusted odds 109 60 24 6 34 27 22 17 11 8 69 50 Influenza admissions with Number of 0.87 (0.69, 1.10) 0.63 (0.47, 0.84) 0.83 (0.54, 1.27) 0.78 (0.34, 1.81) 0.50 (0.35, 0.72) 0.70 (0.47, 1.06) 1.22 (0.77, 1.94) 0.88 (0.53, 1.47) 0.79 (0.43, 1.48) 0.76 (0.37, 1.56) 3.74 (2.27, 6.16) 0.79 (0.58, 1.07) ratio (95% CI) Adjusted odds 109 60 24 6 34 27 22 17 11 8 69 50 Influenza admissions with Number of 1 .25 .75 1 2 5 Adjusted odds ratio Adjusted odds ratio* of admission with B/Yamagata 0 20 40 60 80 100 Admissions positive for influenza (proportion by strain) 0-1 1-4 5-17 18-49 50-64 65-74 75-84 >=85 Age group (years of age) A(H1N1)pdm09 (n=121; 6%) A(H3N2) (n=1,243; 57%) A not subtyped (n=106; 5%) B/Yamagata-lineage (n=665; 30%) B/Victoria-lineage (n=11; 0.5%) B not subtyped (n=54; 2%) Figure 5. Proportion ofadmissions with influenza,bystrain and age 0 .02 .04 .06 Predicted probability of ICU admission 0 10 20 30 40 50 60 70 80 90 100 110 Age group No influenza A(H1N1)pdm A(H3N2) B/Yamagata RT-PCR result Predicted probailities by RT-PCR result -.05 0 .05 .1 .15 Predicted probability of respiratory failure 0 10 20 30 40 50 60 70 80 90 100 110 Age group No influenza A(H3N2) B/Yamagata RT-PCR result Predicted probailities by RT-PCR result Figure 6. Adjusted risk of admission with influenza, by strain, related to underlyingchronicconditions or risk factors. Figure 7. Predicted probability of severe outcomes (intensive care unit (ICU) admission and respiratory failure) by age and strain The adjusted odds ratio (aOR) for admission with influenza was estimated by logistic regression using as comparison group influenza negative admissions without underlying conditions. All estimates were adjusted as by sex, site, number of admissions in previous twelve months, smoking habits, time to swab and calendar time.
Transcript of P42 gihsn isrv epi1415 v1 rjpb · Joan Puig-Barberà1, Elena Burtseva2, Hongjie Yu3, Selim Badur4,...
Impactofinfluenzastrainandpatientcharacteristicsontheriskofadmissionswithinfluenza.GlobalInfluenzaHospitalSurveillanceNetworkResults,2014-
2015influenzaseason
ThestudywasfundedbySanofiPasteur
Methods
Joan Puig-Barberà1, Elena Burtseva2, Hongjie Yu3, Selim Badur4, Jan Kyncl5, F. Xavier López-Labrador1,6, Maria Pisareva7,Svetlana Trushakova2, Benjamin J. Cowling8, Tulay Bagci9, Ainara Mira-Iglesias1, Elizaveta Smorodintseva7, Lidiya Kisteneva2,Luzhao Feng3, Sevim Mese4, Angels Natividad-Miralles1, Kirill Stolyarov7, Lyudmila Kolobukhina2, Peng Wu8, Kubra Yurtcu4,Lubov Voloshchuk7, Veronika Afanasieva2 , Qin Ying3, Anna Sominina7 for the Global Influenza Hospital Surveillance Study Group(GIHSN).
1 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain. 2 D.I. Ivanovsky Institute of Virology FSBI (Federal State BudgetaryInstitution). “N.F. Gamaleya FRCEM” Ministry of Health of Russian Federation, Moscow, Russian Federation. 3 Division of Infectious Disease, Key Laboratory of Surveillance and Early-Warning onInfectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. 4 National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 5Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic. 6 Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP),Instituto de Salud Carlos III, Madrid, Spain. 7 Research Institute of Influenza, Saint Petersburg, Russian Federation. 8 School of Public Health, Li Ka Shing Faculty of Medicine, The University of HongKong, Hong Kong Special Administrative Region, China. 9 Hacettepe Medicine Faculty – Ankara, Turkey
Abstract:P42
ResultsIntroductionThe Global Influenza Hospital SurveillanceNetwork (GIHSN) is a public-privatepartnership between various Public Healthinstitutions and Sanofi Pasteur. The maingoal of the GIHSN is to study influenzaepidemiology. During the 2014-2015 influenzaseason, in 24 hospitals in Russia Federation,Czech Republic, Turkey, China and Spain (Figure1), we screened consecutive admissionsfollowing a common protocol.
FundaciónparaelFomentodelaInvestigaciónBiomédicaySanitaria(FISABIO),Valencia,SpainPhone:+34961925968;e-mail:[email protected]
http://gihsn.org
Figure 2. Studymethods flowchart
DiscussionInfluenza was a significant threat for all agegroups. Comorbidity increased the risk ofinfluenza and this was observed for allinfluenza strains. Pregnancy was an risk factorregardless of involved strain.A(H1N1)pdm09 was associated with a graterrisk of ICU admission and B/Yamagata-lineagewith an increased risk of respiratory failure.
Figure1.GlobalInfluenzaHospitalSurveillanceNetwork(GIHSN)
Eligible'patients'considered'for'inclusion:
All#consecutive#admissions#for#an#acute#processAdmitted#in#the#previous#48#hours
Chief#complaints#for#admission#possibly#related#to#a#previous#influenza#infection
Residents#in#the#predefined#study’s#catchment#area#(study#population#or#study#base)
Complies'with'inclusion'criteria:
Able#to#communicateInformed#consent#to#participate
Is#a#permanent#resident#(as#defined#in#the#site#protocol)
Not#institutionalizedNot#discharged#from#a#hospital#in#the#last#30#daysILI#symptoms#within#7#days#to#admission#(≥5#y#old)Admission#symptoms#within#7#days#to#admission#
(<5#y#old)
Study'procedures:
Common#standardized#questionnaire#Combined#respiratory#swabs
Site’s'reference'laboratorySemi;quantitative'real;time'reverse'
transcription'PCR
Influenza)positive
Influenza)subtype)or)lineage
Influenza)negative
Eligible:17,469
Excluded: 6,357 (36%)Noconsent:1,727(10%)
NoILI:3,189(20%)
Symptoms>7days:1,327(11%)
Included:9,589(55%)
Negative:7,413(77%)
Influenza:2,176(23%)
Recruitedoutsideseason:1,176(10%)
Records:21,611
Southernhemisphere:338
Noresident:256
Institutionalized:870
Previousadmission≤30days:3,016(15%)
Figure 3. FlowchartofadmissionsGIHSN2014-2015influenzaseason
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A(H1N1)pdm09 (n=121; 6%)A(H3N2) (n=1,243; 57%)A not subtyped (n=106; 5%) B/Yamagata-lineage (n=665; 30%)B/Victoria-lineage (n=11; 0.5%)B not subtyped (n=54; 2%)
Figure4. Numberofadmissionswithinfluenza,byvirusstrainandweek
CVD
COPD
Asthma
Immunosupression
Diabetes
Renal disease
Neuromuscular
Neoplasm
Cirrhosis
Autoinmune
Pregnancy
Obesity
factors
Strain/Risk
1.69 (1.45, 1.97)
1.56 (1.31, 1.86)
1.48 (1.11, 1.96)
0.69 (0.33, 1.43)
1.76 (1.46, 2.12)
1.84 (1.46, 2.32)
0.69 (0.43, 1.12)
1.26 (0.88, 1.81)
0.88 (0.54, 1.43)
2.18 (1.48, 3.19)
2.35 (1.51, 3.68)
1.52 (1.25, 1.86)
aOR (95% CI)
319
222
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108
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148
Influenza
admissions with
Number of
1.69 (1.45, 1.97)
1.56 (1.31, 1.86)
1.48 (1.11, 1.96)
0.69 (0.33, 1.43)
1.76 (1.46, 2.12)
1.84 (1.46, 2.32)
0.69 (0.43, 1.12)
1.26 (0.88, 1.81)
0.88 (0.54, 1.43)
2.18 (1.48, 3.19)
2.35 (1.51, 3.68)
1.52 (1.25, 1.86)
aOR (95% CI)
319
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108
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148
Influenza
admissions with
Number of
1.25 .75 1 2 5Adjusted odds ratio
Adjusted odds ratio (aOR)* of admission with A(H3N2)
CVD
COPD
Asthma
Diabetes
Renal disease
Neuromuscular
Neoplasm
Autoinmune
Pregnancy
Obesity
factors
Strain/Risk
0.77 (0.45, 1.32)
0.40 (0.18, 0.88)
0.96 (0.38, 2.43)
0.62 (0.29, 1.31)
0.28 (0.07, 1.16)
2.49 (1.15, 5.40)
1.11 (0.39, 3.15)
0.52 (0.07, 3.80)
3.31 (1.07, 10.21)
0.60 (0.27, 1.33)
aOR (95% CI)
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Influenza
admissions with
Number of
0.77 (0.45, 1.32)
0.40 (0.18, 0.88)
0.96 (0.38, 2.43)
0.62 (0.29, 1.31)
0.28 (0.07, 1.16)
2.49 (1.15, 5.40)
1.11 (0.39, 3.15)
0.52 (0.07, 3.80)
3.31 (1.07, 10.21)
0.60 (0.27, 1.33)
aOR (95% CI)
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Influenza
admissions with
Number of
1.25 .75 1 2 5Adjusted odds ratio
Adjusted odds ratio* of admission with A(H1N1)pdm
CVD
COPD
Asthma
Immunosupression
Diabetes
Renal disease
Neuromuscular
Neoplasm
Cirrhosis
Autoinmune
Pregnancy
Obesity
factors
Strain/Risk
0.87 (0.69, 1.10)
0.63 (0.47, 0.84)
0.83 (0.54, 1.27)
0.78 (0.34, 1.81)
0.50 (0.35, 0.72)
0.70 (0.47, 1.06)
1.22 (0.77, 1.94)
0.88 (0.53, 1.47)
0.79 (0.43, 1.48)
0.76 (0.37, 1.56)
3.74 (2.27, 6.16)
0.79 (0.58, 1.07)
ratio (95% CI)
Adjusted odds
109
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Influenza
admissions with
Number of
0.87 (0.69, 1.10)
0.63 (0.47, 0.84)
0.83 (0.54, 1.27)
0.78 (0.34, 1.81)
0.50 (0.35, 0.72)
0.70 (0.47, 1.06)
1.22 (0.77, 1.94)
0.88 (0.53, 1.47)
0.79 (0.43, 1.48)
0.76 (0.37, 1.56)
3.74 (2.27, 6.16)
0.79 (0.58, 1.07)
ratio (95% CI)
Adjusted odds
109
60
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Influenza
admissions with
Number of
1.25 .75 1 2 5Adjusted odds ratio
Adjusted odds ratio* of admission with B/Yamagata
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A(H1N1)pdm09 (n=121; 6%) A(H3N2) (n=1,243; 57%) A not subtyped (n=106; 5%) B/Yamagata-lineage (n=665; 30%) B/Victoria-lineage (n=11; 0.5%) B not subtyped (n=54; 2%)
Figure 5. Proportion of admissionswith influenza, by strain and age
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No influenza A(H1N1)pdm
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RT-PCR result
Predicted probailities by RT-PCR result
-.2
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eath
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No influenza A(H1N1)pdm
A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
-.005
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.015
Pre
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No influenza A(H3N2)
RT-PCR result
Predicted probailities by RT-PCR result
-.05
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Pre
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No influenza A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
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RT-PCR result
Predicted probailities by RT-PCR result
-.2
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No influenza A(H1N1)pdm
A(H3N2) B/Yamagata
RT-PCR result
Predicted probailities by RT-PCR result
-.005
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Predicted probailities by RT-PCR result
-.05
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No influenza A(H3N2) B/Yamagata
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Predicted probailities by RT-PCR result
Figure 6. Adjusted risk of admission with influenza, by strain,related to underlyingchronic conditions or risk factors.
Figure 7. Predicted probability of severe outcomes (intensive careunit (ICU) admission and respiratory failure) by age and strain
Theadjustedoddsratio(aOR)foradmissionwithinfluenzawasestimatedbylogisticregressionusingascomparisongroupinfluenzanegativeadmissionswithoutunderlyingconditions.Allestimateswereadjustedasbysex,site,numberofadmissionsinprevioustwelvemonths,smokinghabits,timetoswabandcalendartime.
