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Hayward, Andrew C; Fragaszy, Ellen B; Bermingham, Alison; Wang, Lili; Copas, Andrew; Edmunds, W John; Ferguson, Neil; Goonetilleke, Nilu; Harvey, Gabrielle; Kovar, Jana; Lim, Megan S C; McMichael, Andrew; Millett, Elizabeth R C; Nguyen-Van-Tam, Jonathan S; Nazareth, Irwin; Pebody, Richard; Tabassum, Faiza; Watson, John M; Wurie, Fatima B; Johnson, Anne M; Zambon, Maria (2014)
Publisher: Elsevier BV
Journal: The Lancet Respiratory Medicine
Languages: English
Types: Article
BACKGROUND: Assessment of the effect of influenza on populations, including risk of infection, illness if infected, illness severity, and consultation rates, is essential to inform future control and prevention. We aimed to compare the community burden and severity of seasonal and pandemic influenza across different age groups and study years and gain insight into the extent to which traditional surveillance underestimates this burden.
METHODS: Using preseason and postseason serology, weekly illness reporting, and RT-PCR identification of influenza from nasal swabs, we tracked the course of seasonal and pandemic influenza over five successive cohorts (England 2006-11; 5448 person-seasons' follow-up). We compared burden and severity of seasonal and pandemic strains. We weighted analyses to the age and regional structure of England to give nationally representative estimates. We compared symptom profiles over the first week of illness for different strains of PCR-confirmed influenza and non-influenza viruses using ordinal logistic regression with symptom severity grade as the outcome variable.
FINDINGS: Based on four-fold titre rises in strain-specific serology, on average influenza infected 18% (95% CI 16-22) of unvaccinated people each winter. Of those infected there were 69 respiratory illnesses per 100 person-influenza-seasons compared with 44 per 100 in those not infected with influenza. The age-adjusted attributable rate of illness if infected was 23 illnesses per 100 person-seasons (13-34), suggesting most influenza infections are asymptomatic. 25% (18-35) of all people with serologically confirmed infections had PCR-confirmed disease. 17% (10-26) of people with PCR-confirmed influenza had medically attended illness. These figures did not differ significantly when comparing pandemic with seasonal influenza. Of PCR-confirmed cases, people infected with the 2009 pandemic strain had markedly less severe symptoms than those infected with seasonal H3N2.
INTERPRETATION: Seasonal influenza and the 2009 pandemic strain were characterised by similar high rates of mainly asymptomatic infection with most symptomatic cases self-managing without medical consultation. In the community the 2009 pandemic strain caused milder symptoms than seasonal H3N2.
FUNDING: Medical Research Council and the Wellcome Trust.
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    • 1 WHO. Influenza (seasonal): fact sheet number 211, April 2009. http:// www.who.int/mediacentre/factsheets/fs211/en/ (accessed July 1, 2013).
    • 2 Nguyen-Van-Tam JS, Hampson AW. The epidemiology and clinical impact of pandemic influenza. Vaccine 2003; 21: 1762-68.
    • 3 Luk J, Gross P, Thompson WW. Observations on mortality during the 1918 influenza pandemic. Clin Infect Dis 2001; 33: 1375-78.
    • 4 Oxford JS. Influenza A pandemics in the 20th century with special reference to 1918: virology, pathology and epidemiology. Rev Med Virol 2000; 10: 119-33.
    • 5 WHO. World now at the start of 2009 influenza pandemic: statement to the press by WHO Director-General Dr Margaret Chan (June 11, 2009). http://www.who.int/mediacentre/news/statements/2009/h1n1_ pandemic_phase6_20090611/en/index.html (accessed July 1, 2013).
    • 6 WHO. Swine influenza: statement by WHO Director-General, Dr Margaret Chan (April 25, 2009). http://www.who.int/mediacentre/ news/statements/2009/h1n1_20090425/en/index.html (accessed July 1, 2013).
    • 7 Dawood FS, Iuliano AD, Reed C, et al. Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study. Lancet Infect Dis 2012; 12: 687-95.
    • 8 WHO. H1N1 in post-pandemic period: Director-General's opening statement at virtual press conference (Aug 10, 2010). http:// www.who.int/mediacentre/news/statements/2010/h1n1_ vpc_20100810/en/index.html (accessed July 1, 2013).
    • 9 WHO. Review of the 2010-2011 winter influenza season, northern hemisphere. Wkly Epidemiol Rec 2011; 86: 222-27.
    • 10 Mytton OT, Rutter PD, Donaldson LJ. Influenza A(H1N1)pdm09 in England, 2009 to 2011: a greater burden of severe illness in the year after the pandemic than in the pandemic year. Euro Surveill 2012; 17: 11-19.
    • 11 WHO. WHO global technical consultation: global standards and tools for influenza surveillance (WHO/HSE/GIP/2011.1). Geneva: World Health Organization, 2011. http://www.who.int/influenza/resources/ documents/technical_consultation/en/index.html (accessed July 1, 2013).
    • 12 Garske T, Legrand J, Donnelly CA, et al. Assessing the severity of the novel influenza A/H1N1 pandemic. BMJ 2009; 339: b2840.
    • 13 Laurie KL, Huston P, Riley S, et al. Influenza serological studies to inform public health action: best practices to optimise timing, quality and reporting. Influenza Other Respir Viruses 2013; 7: 211-24.
    • 14 Brooks-Pollock E, Tilston N, Edmunds WJ, Eames KTD. Using an online survey of healthcare-seeking behaviour to estimate the magnitude and severity of the 2009 H1N1v influenza epidemic in England. BMC Infect Dis 2011; 11: 68.
    • 15 Fiore AE, Uyeki TM, Broder K, et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep 2010; 59: 1-62.
    • 16 Dingle JH, Badger GF, Feller AE, Hodges RG, Jordan WS, Rammelkamp CH. A study of illness in a group of Cleveland families. 1. Plan of study and certain general observations. Am J Hyg 1953; 58: 16-30.
    • 17 Elveback LR, Fox JP, Ketler A, Brandt CD, Wassermann FE, Hall CE. The Virus Watch program: a continuing surveillance of viral infections in metropolitan New York families. 3. Preliminary report on association of infections with disease. Am J Epidemiol 1966; 83: 436-54.
    • 18 Monto AS, Kioumehr F. The Tecumseh Study of Respiratory Illness. IX. Occurrence of influenza in the community, 1966-1971. Am J Epidemiol 1975; 102: 553-63.
    • 19 Monto AS. Studies of the community and family: acute respiratory illness and infection. Epidemiol Rev 1994; 16: 351-73.
    • 20 Horby P, Mai LQ, Fox A, et al. The epidemiology of interpandemic and pandemic influenza in Vietnam, 2007-2010: the Ha Nam household cohort study I. Am J Epidemiol 2012; 175: 1062-74.
    • 21 Riley S, Kwok KO, Wu KM, et al. Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study. PLoS Med 2011; 8: e1000442.
    • 22 Kieffer A, Paboriboune P, Crepey P, et al. 2009 A(H1N1) seroconversion rates and risk factors among the general population in Vientiane Capital, Laos. PLoS One 2013; 8: e61909.
    • 23 Chen MI, Lee VJ, Lim WY, et al. 2009 influenza A(H1N1) seroconversion rates and risk factors among distinct adult cohorts in Singapore. JAMA 2010; 303: 1383-91.
    • 24 Khuntirat B, Yoon IK, Krueger W, et al. Pandemic influenza A (H1N1) virus infections among villagers living in rural Thailand. 15th International Congress on Infectious Diseases; Bankok, Thailand; June 13-16, 2012.
    • 25 Koita OA, Sangare L, Poudiougou B, et al. A seroepidemiological study of pandemic A/H1N1(2009) influenza in a rural population of Mali. Clin Microbiol Infect 2012; 18: 976-81.
    • 26 Van Kerkhove MD, Hirve S, Koukounari A, Mounts AW. Estimating age-specific cumulative incidence for the 2009 influenza pandemic: a meta-analysis of A(H1N1)pdm09 serological studies from 19 countries. Influenza Other Respir Viruses 2013; 7: 872-86.
    • 27 Klick B, Leung GM, Cowling BJ. Optimal design of studies of influenza transmission in households. I: case-ascertained studies. Epidemiol Infect 2012; 140: 106-14.
    • 28 Klick B, Nishiura H, Leung GM, Cowling BJ. Optimal design of studies of influenza transmission in households. II: comparison between cohort and case-ascertained studies. Epidemiol Infect 2013; published online July 5. http://dx.doi.org/10.1017/ S0950268813001623.
    • 29 Gregory S. General Practice in England: an overview. Briefing. London: Kings Fund; 2009. http://www.kingsfund.org.uk/sites/files/ kf/General-practice-in-England-an-overview-Sarah-Gregory-TheKings-Fund-September-2009.pdf (accessed July 1, 2013).
    • 30 Ellis J, Iturriza M, Allen R, et al. Evaluation of four real-time PCR assays for detection of influenza A(H1N1)v viruses. Euro Surveill 2009; 14:19230.
    • 31 Stephenson I, Democratis J, Lackenby A, et al. Neuraminidase inhibitor resistance after oseltamivir treatment of acute influenza A and B in children. Clin Infect Dis 2009; 48: 389-96.
    • 32 Zambon M, Hays J, Webster A, Newman R, Keene O. Diagnosis of influenza in the community: relationship of clinical diagnosis to confirmed virological, serologic, or molecular detection of influenza. Arch Intern Med 2001; 161: 2116-22.
    • 33 Miller E, Hoschler K, Hardelid P, Stanford E, Andrews N, Zambon M. Incidence of 2009 pandemic influenza A H1N1 infection in England: a cross-sectional serological study. Lancet 2010; 375: 1100-08.
    • 34 CDC. Overview of influenza surveillance in the United States. http:// www.cdc.gov/flu/weekly/overview.htm (accessed July 1, 2013).
    • 35 Monto AS, Koopman JS, Longini IM. Tecumseh study of illness. XIII. Influenza infection and disease, 1976-1981. Am J Epidemiol 1985; 121: 811-22.
    • 36 Health Protection Agency. Sources of UK flu data: influenza surveillance in the United Kingdom-sentinel surveillance schemes based on networks of general practitioners. http://www.hpa.org.uk/ web/HPAweb&HPAwebStandard/HPAweb_C/1195733821514#GP (accessed July 1, 2013).
    • 37 Spyridaki IS, Christodoulou I, de Beer L, et al. Comparison of four nasal sampling methods for the detection of viral pathogens by RT-PCR-A GA(2)LEN project. J Virol Methods 2009; 156: 102-06.
    • 38 Heikkinen T, Salmi AA, Ruuskanen O. Comparative study of nasopharyngeal aspirate and nasal swab specimens for detection of influenza. BMJ 2001; 322: 138.
    • 39 Dhiman N, Miller RM, Finley JL, et al. Effectiveness of patient-collected swabs for influenza testing. Mayo Clinic Proc 2012; 87: 548-54.
    • 40 Cooper DL, Smith GE, Chinemana F, et al. Linking syndromic surveillance with virological self-sampling. Epidemiol Infect 2008; 136: 222-24.
    • 41 Lackenby A, Elliot AJ, Powers C, et al. Virological self-sampling to monitor influenza antiviral susceptibility in a community cohort. J Antimicrob Chemother 2013; 68: 2324-31.
    • 42 Cowling BJ, Fang VJ, Nishiura H, et al. Increased risk of noninfluenza respiratory virus infections associated with receipt of inactivated influenza vaccine. Clin Infect Dis 2012; 54: 1778-83.
    • 43 Ellis J, Galiano M, Pebody R, et al. Virological analysis of fatal influenza cases in the United Kingdom during the early wave of influenza in winter 2010/11. Euro Surveill 2011; 16: 2-7.
    • 44 Birrell PJ, Ketsetzis G, Gay NJ, et al. Bayesian modeling to unmask and predict influenza A/H1N1pdm dynamics in London. Proc Natl Acad Sci USA 2011; 108: 18238-43.
    • 45 Carrat F, Vergu E, Ferguson NM, et al. Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol 2008; 167: 775-85.
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