A(H1N1)pdmCVDCOPDAsthmaImmunosupressionDiabetesRenal diseaseRhematologic disNeuromuscularNeoplasmCirrhosisAutoinmunePregnancyObesity

A(H3N2)CVDCOPDAsthmaImmunosupressionDiabetesRenal diseaseRhematologic disNeuromuscularNeoplasmCirrhosisAutoinmunePregnancyObesity

B/YamagataCVDCOPDAsthmaDiabetesRenal diseaseRhematologic disNeuromuscularCirrhosisAutoinmunePregnancyObesity

factorsStrain/Risk

2.16 (1.56, 2.99)2.59 (1.85, 3.62)3.13 (2.01, 4.89)1.31 (0.39, 4.37)3.72 (2.58, 5.34)3.12 (1.87, 5.20)1.78 (0.23, 14.05)0.54 (0.16, 1.77)2.03 (1.10, 3.73)2.88 (1.44, 5.76)3.29 (1.28, 8.41)4.66 (1.74, 12.47)3.11 (2.18, 4.43)

1.57 (1.18, 2.09)0.73 (0.50, 1.08)1.99 (1.33, 3.00)3.47 (1.80, 6.70)0.86 (0.54, 1.35)1.75 (1.06, 2.88)4.80 (1.62, 14.22)1.67 (0.92, 3.04)0.93 (0.48, 1.79)1.63 (0.82, 3.27)2.56 (1.08, 6.07)3.76 (2.27, 6.22)1.47 (1.02, 2.11)

1.23 (0.65, 2.33)1.49 (0.77, 2.86)3.32 (1.63, 6.79)1.12 (0.43, 2.91)2.25 (0.77, 6.60)19.39 (5.71, 65.84)1.50 (0.35, 6.45)0.98 (0.13, 7.31)5.24 (1.14, 24.11)3.70 (1.09, 12.55)0.97 (0.38, 2.48)

ratio (95% CI)Adjusted odss

8079313672813151161867

9044351329245141310710047

131310544212335

Influenzaadmissions withNumber of

2.16 (1.56, 2.99)2.59 (1.85, 3.62)3.13 (2.01, 4.89)1.31 (0.39, 4.37)3.72 (2.58, 5.34)3.12 (1.87, 5.20)1.78 (0.23, 14.05)0.54 (0.16, 1.77)2.03 (1.10, 3.73)2.88 (1.44, 5.76)3.29 (1.28, 8.41)4.66 (1.74, 12.47)3.11 (2.18, 4.43)

1.57 (1.18, 2.09)0.73 (0.50, 1.08)1.99 (1.33, 3.00)3.47 (1.80, 6.70)0.86 (0.54, 1.35)1.75 (1.06, 2.88)4.80 (1.62, 14.22)1.67 (0.92, 3.04)0.93 (0.48, 1.79)1.63 (0.82, 3.27)2.56 (1.08, 6.07)3.76 (2.27, 6.22)1.47 (1.02, 2.11)

1.23 (0.65, 2.33)1.49 (0.77, 2.86)3.32 (1.63, 6.79)1.12 (0.43, 2.91)2.25 (0.77, 6.60)19.39 (5.71, 65.84)1.50 (0.35, 6.45)0.98 (0.13, 7.31)5.24 (1.14, 24.11)3.70 (1.09, 12.55)0.97 (0.38, 2.48)

ratio (95% CI)Adjusted odss

8079313672813151161867

9044351329245141310710047

131310544212335

Influenzaadmissions withNumber of

Less risk More risk0.25 0.75 2 5

Adjusted odds ratio

1

Epidemiology of admissions with influenza and the impact of underlying patient characteristics on the risk of admission with influenza during the 2013/14 season in the GIHSN participating sites

The study was funded by Sanofi Pasteur

Joan Puig-­Barberà1, Angels Natividad-­Sancho1, Svetlana Trushakova 2, Anna Sominina3, Maria Pisareva3, Meral A. Ciblak4, Selim Badur 4, Hongjie Yu5, Benjamin J. Cowling6, Clotilde El Guerche-­Séblain7, Ainara Mira-­Iglesias1, Lidiya Kisteneva2, Kirill Stolyarov3, Kubra Yurctu4, Luzhao Feng5, Elena Burtseva2 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 FGBC “N.F. Gamaleya FRCEM”Ministry of Health of Russian Federation, Moscow, Russian Federation;; 3 Research Institute of Influenza, Saint Petersburg, Russian Federation;; 4 National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey;; 5 Div is ion of Infectious Disease, Key Laboratory of Surveillance and Early-­Warning on Infectious Disease, Chinese

Center for Disease Control and Prevention, Beijing, China;; 6 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China;; 7 Sanofi Pasteur, Lyon, France

Abstract : 492

Influenza was associated wit h di sea se needingadmi ssion in per son with and wit hout ri skfactor s. Underlying com orbidity incr eased therisk of infl uenza and pregnancy was anout standing ri sk fa ctor. Our result s supportinfluenza vaccinat ion as a risk reducingmeasure.

ResultsBackgroundThis was a multicentric study performed by the GlobalInfluenza Hospital Surveillance Network (GI HSN). Atotal of 9,507 consecutive eligible admissions werescreen ed for inclusion in 19 hospitals in Russia, Turkey,China and Spain, following a prospective, activesurveillance, approach aimed to describe theepidemiology of admissions with influenza.

Sixty perc ent of influenza admissions were in patients

with no comorbidity.

Fundación para el Fomento de la Investigación Biomédica y Sanitaria (FISABIO), Valencia, SpainPhone: +34 961 925 968; e-­‐mail: puig_joa@gva.es

Methods

Keywords: Epidemiology, Hospitalization and Immune response

Conclusions

Epidemiological data was collected in consecutive

admissions using a common case definition. Influenzawas confirmed by R T-­‐PCR. We used multivariatelogistic regression models to estimate influenza

admission adjusted odds ratios (aOR).

Patients with cardiovascular disease aOR, 1.6 (95%CI,1.3 to 2), asthma, 2.3 (1.7 to 3.0),immunosuppression, 2.3 (1.2 to 4.1), renal disease,2.1 (1.5 to 3.0), liver disease, 1.9 (1.2 to 3.2),autoimmune disease, 3.9 (1.6 to 5.6), and pregnancy,3.8 (2.5 to 5.9) were at an increased risk regardless ofinfluenza virus. For chronic obstructive pulmonarydisease, 2.6(1.9 to 3.6), diabetes, 3.7(2.6 to 5.3), andobesity, 3.1 (2.2-­‐4.4), the risk of severe diseas e waspreferentially related to A(H1N1)pdm

We included 5,303 admissions, 1086 were influenzapositive: 534, A(H3N2), 362, A(H1N1), 130, BYamagata lineage, 3, B Victoria, 40 and 18, A and B,were not subtyped.

http://gihsn.org/

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:( 9,507

Excluded: 4,204 (44%)

No(consent:(591, (6%)

No(ILI:(1,781,(19%)

Symptoms(>(7(days:(1,006,,(11%)

Included:(5,303,(56%)

Negative:4,217,(80%)

Influenza:1,086,(20%)

Recruited(outside(season:(279, (3%)

0510152025303540

0

20

40

60

80

100

120

2013)50

2013)52

2014)02

2014)04

2014)06

2014)08

2014)10

2014)12

2014)14

2014)16

2014)18

2014)20

2014)22

Percent'positive

Epidemiological'week

All'sites

B_nosubty Victoria Yamagata A_nosubty H3N2 H1N1 %?positive

05101520253035

0

5

10

15

20

25

Num

ber'o

f'cases

Epidemiological'week

St.'Petersburg

05101520253035

0

5

10

15

20

25

30

2013

&50

2013

&52

2014

&02

2014

&04

2014

&06

2014

&08

2014

&10

2014

&12

2014

&14

2014

&16

2014

&18

2014

&20

2014

&22

Epidemiological'week

Moscow

0

10

20

30

40

50

60

0

5

10

15

20

25

Percen

t'positive

Epidemiological'week

Turkey

0510152025303540

0246810121416

Num

ber'o

f'cases

Epidemiological'week

Beijing

05101520253035

010203040506070

2013

&50

2013

&52

2014

&02

2014

&04

2014

&06

2014

&08

2014

&10

2014

&12

2014

&14

2014

&16

2014

&18

2014

&20

2014

&22

Epidemiological'week

Valencia

We observed a non significant trend for influenza A(H1N1)pdmto increase the need of intensive care and for A(H3N2) the riskof in-­‐hospital death.

Respiratory failure was more common inadmissions with A(H3N2).

Influenza vaccination, 0.6(0.4-­‐0.8) loweredthe risk of confirmed influenza.

0.00

0.02

0.04

0.06

0.08

0.10

Prob

ability

of IC

U ad

miss

ion du

ring a

dmiss

ion

0 - 5 mo

6- 11 mo

1 - 4 y

5 - 17 y

18 - 49 y

50 - 64 y

65 - 74 y

75 - 84 y

≥ 85 y

Age group

Negative

A(H1N1)pdm09

A(H3N2)

0.00

0.02

0.04

0.06

0.08

0.10

Prob

ability

of de

ath du

ring a

dmiss

ion

1 - 4 y

5 - 17 y

18 - 49y

50 - 64 y

65 - 74y

75 - 84 y

≥ 85 y

Age group

Negative

A(H1N1)pdm09

A(H3N2)

0 - 5 mo

6- 11 mo

0.00

0.02

0.04

0.06

0.08

0.10

Prob

ability

of IC

U ad

miss

ion du

ring a

dmiss

ion

0 - 5 mo

6- 11 mo

1 - 4 y

5 - 17 y

18 - 49 y

50 - 64 y

65 - 74 y

75 - 84 y

≥ 85 y

Age group

Negative

A(H1N1)pdm09

A(H3N2)

0.00

0.02

0.04

0.06

0.08

0.10

Prob

ability

of de

ath du

ring a

dmiss

ion

1 - 4 y

5 - 17 y

18 - 49y

50 - 64 y

65 - 74y

75 - 84 y

≥ 85 y

Age group

Negative

A(H1N1)pdm09

A(H3N2)

0 - 5 mo

6- 11 mo

AnyICU admissionDeath in hospitalPneumoniaCOPDRespiratory failureAsthmaBronchiolitisARDSRenal failureFluid electrolite imbalanceUpper respiratory infection

A(H1N1)pICU admissionDeath in hospitalPneumoniaCOPDRespiratory failureAsthmaBronchiolitisARDSRenal failureFluid electrolite imbalanceUpper respiratory infection

A(H3N2)ICU admissionDeath in hospitalPneumoniaCOPDRespiratory failureAsthmaBronchiolitisARDSRenal failureFluid electrolite imbalanceUpper respiratory infection

B/YamagataPneumoniaCOPDBronchiolitisUri

Complication

0.95 (0.60, 1.52)1.22 (0.60, 2.44)0.92 (0.76, 1.13)0.75 (0.51, 1.12)1.67 (0.99, 2.81)1.79 (0.90, 3.58)1.02 (0.70, 1.49)1.17 (0.55, 2.46)0.99 (0.47, 2.05)0.59 (0.26, 1.36)0.23 (0.19, 0.27)

1.40 (0.69, 2.83)1.15 (0.42, 3.15)0.96 (0.73, 1.26)1.03 (0.66, 1.59)1.27 (0.68, 2.37)1.90 (0.86, 4.19)0.30 (0.13, 0.72)1.22 (0.54, 2.74)1.00 (0.39, 2.61)0.40 (0.13, 1.19)0.57 (0.40, 0.80)

0.92 (0.49, 1.72)1.32 (0.53, 3.28)0.94 (0.69, 1.27)0.27 (0.10, 0.77)3.22 (1.45, 7.15)1.44 (0.46, 4.53)1.49 (0.91, 2.43)1.06 (0.23, 4.83)1.04 (0.38, 2.88)1.38 (0.39, 4.86)0.17 (0.13, 0.21)

0.73 (0.42, 1.25)0.39 (0.08, 1.91)1.96 (0.86, 4.44)0.21 (0.14, 0.32)

ratio (95% CI)Adjusted odds

31151944225164110108261

14795311512586542

17879610424243176

2051243

0.95 (0.60, 1.52)1.22 (0.60, 2.44)0.92 (0.76, 1.13)0.75 (0.51, 1.12)1.67 (0.99, 2.81)1.79 (0.90, 3.58)1.02 (0.70, 1.49)1.17 (0.55, 2.46)0.99 (0.47, 2.05)0.59 (0.26, 1.36)0.23 (0.19, 0.27)

1.40 (0.69, 2.83)1.15 (0.42, 3.15)0.96 (0.73, 1.26)1.03 (0.66, 1.59)1.27 (0.68, 2.37)1.90 (0.86, 4.19)0.30 (0.13, 0.72)1.22 (0.54, 2.74)1.00 (0.39, 2.61)0.40 (0.13, 1.19)0.57 (0.40, 0.80)

0.92 (0.49, 1.72)1.32 (0.53, 3.28)0.94 (0.69, 1.27)0.27 (0.10, 0.77)3.22 (1.45, 7.15)1.44 (0.46, 4.53)1.49 (0.91, 2.43)1.06 (0.23, 4.83)1.04 (0.38, 2.88)1.38 (0.39, 4.86)0.17 (0.13, 0.21)

0.73 (0.42, 1.25)0.39 (0.08, 1.91)1.96 (0.86, 4.44)0.21 (0.14, 0.32)

ratio (95% CI)Adjusted odds

31151944225164110108261

14795311512586542

17879610424243176

2051243

Positive

Less risk More risk .25 .75 1 2 5

Ad usted odds ratio

020

4060

8010

0

Num

ber o

f adm

issio

ns

2013

-49

2013

-50

2013

-51

2013

-52

2014

-01

2014

-02

2014

-03

2014

-04

2014

-05

2014

-06

2014

-07

2014

-08

2014

-09

2014

-10

2014

-11

2014

-12

2014

-13

2014

-14

2014

-15

2014

-16

2014

-17

2014

-18

2014

-19

2014

-20

2014

-21

2014

-22

2014

-23

Epidemioogical week

H1N1 (362) H3N2 (534) A nosubtyped (40) B Yamgata (130) B Victoria (3) B nosubtyped (18)