Severity of influenza-associated hospitalisations by influenza virus type and subtype in the USA, 2010-19: a repeated cross-sectional study.

Autor:	Sumner KM; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: rhq3@cdc.gov., Masalovich S; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA., O'Halloran A; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Holstein R; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Reingold A; School of Public Health, University of California Berkeley, Berkeley, CA, USA., Kirley PD; California Emerging Infections Program, Oakland, CA, USA., Alden NB; Colorado Department of Public Health and Environment, Denver, CA, USA., Herlihy RK; Colorado Department of Public Health and Environment, Denver, CA, USA., Meek J; Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA., Yousey-Hindes K; Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, USA., Anderson EJ; Department of Medicine and Depatment of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA; Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA; Veterans Affairs Medical Center, Atlanta, GA, USA., Openo KP; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, GA, USA; Veterans Affairs Medical Center, Atlanta, GA, USA., Monroe ML; Maryland Department of Health, Baltimore, MD, USA., Leegwater L; Michigan Department of Health and Human Services, Lansing, MI, USA., Henderson J; Michigan Department of Health and Human Services, Lansing, MI, USA., Lynfield R; Minnesota Department of Health, Saint Paul, MN, USA., McMahon M; Minnesota Department of Health, Saint Paul, MN, USA., McMullen C; New Mexico Department of Health, Santa Fe, NM, USA., Angeles KM; New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, NM, USA., Spina NL; New York State Department of Health, Albany, NY, USA., Engesser K; New York State Department of Health, Albany, NY, USA., Bennett NM; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA., Felsen CB; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA., Lung K; Ohio Department of Health, Columbus, OH, USA., Shiltz E; Ohio Department of Health, Columbus, OH, USA., Thomas A; Oregon Health Authority, Salem, OR, USA., Talbot HK; Vanderbilt University Medical Center, Nashville, TN, USA., Schaffner W; Vanderbilt University Medical Center, Nashville, TN, USA., Swain A; Salt Lake County Health Department, Salt Lake City, UT, USA., George A; Salt Lake County Health Department, Salt Lake City, UT, USA., Rolfes MA; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Reed C; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA., Garg S; Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
Jazyk:	angličtina
Zdroj:	The Lancet. Microbe [Lancet Microbe] 2023 Nov; Vol. 4 (11), pp. e903-e912. Date of Electronic Publication: 2023 Sep 25.
DOI:	10.1016/S2666-5247(23)00187-8
Abstrakt:	Background: Influenza burden varies across seasons, partly due to differences in circulating influenza virus types or subtypes. Using data from the US population-based surveillance system, Influenza Hospitalization Surveillance Network (FluSurv-NET), we aimed to assess the severity of influenza-associated outcomes in individuals hospitalised with laboratory-confirmed influenza virus infections during the 2010-11 to 2018-19 influenza seasons. Methods: To evaluate the association between influenza virus type or subtype causing the infection (influenza A H3N2, A H1N1pdm09, and B viruses) and in-hospital severity outcomes (intensive care unit [ICU] admission, use of mechanical ventilation or extracorporeal membrane oxygenation [ECMO], and death), we used FluSurv-NET to capture data for laboratory-confirmed influenza-associated hospitalisations from the 2010-11 to 2018-19 influenza seasons for individuals of all ages living in select counties in 13 US states. All individuals had to have an influenza virus test within 14 days before or during their hospital stay and an admission date between Oct 1 and April 30 of an influenza season. Exclusion criteria were individuals who did not have a complete chart review; cases from sites that contributed data for three or fewer seasons; hospital-onset cases; cases with unidentified influenza type; cases of multiple influenza virus type or subtype co-infection; or individuals younger than 6 months and ineligible for the influenza vaccine. Logistic regression models adjusted for influenza season, influenza vaccination status, age, and FluSurv-NET site compared odds of in-hospital severity by virus type or subtype. When missing, influenza A subtypes were imputed using chained equations of known subtypes by season. Findings: Data for 122 941 individuals hospitalised with influenza were captured in FluSurv-NET from the 2010-11 to 2018-19 seasons; after exclusions were applied, 107 941 individuals remained and underwent influenza A virus imputation when missing A subtype (43·4%). After imputation, data for 104 969 remained and were included in the final analytic sample. Averaging across imputed datasets, 57·7% (weighted percentage) had influenza A H3N2, 24·6% had influenza A H1N1pdm09, and 17·7% had influenza B virus infections; 16·7% required ICU admission, 6·5% received mechanical ventilation or ECMO, and 3·0% died (95% CIs had a range of less than 0·1% and are not displayed). Individuals with A H1N1pdm09 had higher odds of in-hospital severe outcomes than those with A H3N2: adjusted odds ratios (ORs) for A H1N1pdm09 versus A H3N2 were 1·42 (95% CI 1·32-1·52) for ICU admission; 1·79 (1·60-2·00) for mechanical ventilation or ECMO use; and 1·25 (1·07-1·46) for death. The adjusted ORs for individuals infected with influenza B versus influenza A H3N2 were 1·06 (95% CI 1·01-1·12) for ICU admission, 1·14 (1·05-1·24) for mechanical ventilation or ECMO use, and 1·18 (1·07-1·31) for death. Interpretation: Despite a higher burden of hospitalisations with influenza A H3N2, we found an increased likelihood of in-hospital severe outcomes in individuals hospitalised with influenza A H1N1pdm09 or influenza B virus. Thus, it is important for individuals to receive an annual influenza vaccine and for health-care providers to provide early antiviral treatment for patients with suspected influenza who are at increased risk of severe outcomes, not only when there is high influenza A H3N2 virus circulation but also when influenza A H1N1pdm09 and influenza B viruses are circulating. Funding: The US Centers for Disease Control and Prevention. Competing Interests: Declaration of interests EJA has consulted for Pfizer, Sanofi Pasteur, GlaxoSmithKline (GSK), Janssen, Moderna, and Medscape; serves on a safety monitoring board for Kentucky BioProcessing and Sanofi Pasteur; and serves on a data adjudication board for WCG and ACI Clinical. EJA's institution receives funds to conduct clinical research unrelated to this manuscript from MedImmune, Regeneron, PaxVax, Pfizer, GSK, Merck, Sanofi Pasteur, Janssen, and Micron, and has also received funding from the US National Institutes of Health to conduct clinical trials of COVID-19 vaccines. ES notes the agency grant funding supporting the data collection for this project, and agency grant funding from the US Centers for Disease Control and Prevention (CDC) to support other epidemiology projects. HKT, WS, NBA, JM, KY-H, RKH, and RL have received CDC grant funding. JH and LL have received grants from the Michigan Department of Health and Human Services. ES reports grants from the Council for State and Territorial Epidemiologists (CSTE) during the conduct of the study and grants from CDC outside the submitted work. AG reports grants from CSTE. All other authors declare no competing interests. (Copyright © 2023 Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu