Infect Chemother.  2011 Oct;43(5):390-395. 10.3947/ic.2011.43.5.390.

Variations in Number of Hospitalized Patients with Cardiopulmonary Diseases Associated with 2009 H1N1 Pandemic Influenza in a Tertiary Teaching Hospital - Comparison with Seasonal Influenza

• Nah SY
• Hong JT
• Im JH
• Lee JH
• Durey A
• Kim M
• Lee HJ
• Park SK
• Chung MH
• Baek JH
• Lee JS

• KMID: 2285011
• DOI: http://doi.org/10.3947/ic.2011.43.5.390

Abstract

BACKGROUND
The world encountered the global outbreak of an H1N1 influenza pandemic in 2009. Influenza has accounted for grave outcomes, not only through infectious complications, but also through the exacerbation of underlying chronic diseases. A substantial number of confirmed or probable cases of influenza had been reported during the 2009 H1N1 pandemic in South Korea, but a review of the development of influenza-related complications or the exacerbation of underlying chronic diseases has been absent. This study aims to understand the influence of the 2009 pandemic on the exacerbation of existing cardiopulmonary diseases.
MATERIALS AND METHODS
We surveyed the number of hospitalized patients with a diagnosis of pneumonia, asthma, chronic obstructive pulmonary disease, acute myocardial infarctions, and heart failure during the period of the 2009 H1N1 influenza pandemic in a 950-bed teaching hospital in Korea. Three influenza seasons from 2007 to 2009 were compared via a medical records review. Data collection included the number of hospitalizations, patient age, number of deaths from all causes, and underlying medical conditions of fatal patients.
RESULTS
The weekly number of cardiopulmonary hospitalizations showed no differences between the 2009 pandemic influenza period and seasonal influenza epidemics (53 and 56 on average, respectively), but the total number of hospitalized patients during the pandemic influenza period was 1481, whereas there were 625 on average for seasonal influenza. The hospitalization rate for patients under five years of age exceeded that of the patients sixty years of age or older in pandemic influenza, and the hospitalization rate of patients twentyfive to fifty-nine during pandemic influenza was significantly higher than that of seasonal influenza outbreaks (P=0.012). On the other hand, the hospitalization rate of the patients sixty years of age or older during the pandemic influenza period significantly fell short of that in past seasonal influenza periods (P<0.001). However, the patients sixty years of age or older had the highest case fatality rate during both periods. The total number of deaths among hospitalized patients with cardiopulmonary diseases in pandemic influenza and seasonal influenza epidemics was 87 and 46 on average, respectively. Weekly fatal cases were 3 and 4.
CONCLUSIONS
The cardiopulmonary hospitalization rate during the pandemic period outnumbered that of preceding seasonal influenza epidemics by its extended length. But, the virulence or disease severity of the 2009 H1N1 and seasonal influenza seems to be little different. A larger-scale epidemiological investigation is necessary.

Keyword

Pandemic influenza (H1N1); Disease burden; Complication; Cardiopulmonary disease

MeSH Terms

Asthma
Chronic Disease
Data Collection
Disease Outbreaks
Hand
Heart Failure
Hospitalization
Hospitals, Teaching
Humans
Influenza, Human
Korea
Medical Records
Myocardial Infarction
Pandemics
Pneumonia
Pulmonary Disease, Chronic Obstructive
Republic of Korea
Seasons

Figure

• 

  Figure 1 Age distribution of hospitalization according to the study periods.

Reference

1. Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, Vugia D, Harriman K, Matyas B, Glaser CA, Samuel MC, Rosenberg J, Talarico J, Hatch D. California Pandemic (H1N1) Working Group. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA. 2009. 302:1896–1902.

2. Jamieson DJ, Honein MA, Rasmussen SA, Williams JL, Swerdlow DL, Biggerstaff MS, Lindstrom S, Louie JK, Christ CM, Bohm SR, Fonseca VP, Ritger KA, Kuhles DJ, Eggers P, Bruce H, Davidson HA, Lutterloh E, Harris ML, Burke C, Cocoros N, Finelli L, MacFarlane KF, Shu B, Olsen SJ. Novel Influenza A (H1N1) Pregnancy Working Group. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet. 2009. 374:451–458.

3. Falagas ME, Koletsi PK, Baskouta E, Rafailidis PI, Dimopoulos G, Karageorgopoulos DE. Pandemic A(H1N1) 2009 influenza: review of the Southern Hemisphere experience. Epidemiol Infect. 2011. 139:27–40.

4. Falagas ME, Cholevas NV, Kapaskelis AM, Vouloumanou EK, Michalopoulos A, Rafailidis PI. Epidemiological aspects of 2009 H1N1 influenza: the accumulating experience from the Northern Hemisphere. Eur J Clin Microbiol Infect Dis. 2010. 29:1327–1347.

5. Infulenza sentinel surveillance report, number 36-2009. Korea Center for Disease Control and Prevention. Accessed on 22 March 2011. Available at: http://www.cdc.go.kr.

6. Transcript of statement by Margaret Chan, Director-General of the World Health Organization, 11 June 2009. World Health Organization. Available at: http://www.who.int/mediacentre/influenzaAH1N1_presstranscript_20090611.pdf.

7. Pandemic (H1N1) 2009 - update 76. World Health Organization. Available at: http://www.who.int/csr/don/2009_11_27a/en/index.html.

8. Pandemic (H1N1) 2009 - update 112. World Health Organization. Available at: http://www.who.int/csr/don/2010_08_06/en/index.html.

9. Infulenza weekly report, 17th week 2010. Korea Center for Disease Control and Prevention. Accessed on 22 March 2011. Available at: http://www.cdc.go.kr.

10. Kang YM, Song BM, Lee JS, Kim HS, Seo SH. Pandemic H1N1 influenza virus causes a stronger inflammatory response than seasonal H1N1 influenza virus in ferrets. Arch Virol. 2011. 156:759–767.

11. Carcione D, Giele C, Dowse GK, Mak DB, Goggin L, Kwan K, Williams S, Smith D, Effler P. Comparison of pandemic (H1N1) 2009 and seasonal influenza, Western Australia, 2009. Emerg Infect Dis. 2010. 16:1388–1395.

12. Chang YS, van Hal SJ, Spencer PM, Gosbell IB, Collett PW. Comparison of adult patients hospitalised with pandemic (H1N1) 2009 influenza and seasonal influenza during the "PROTECT" phase of the pandemic response. Med J Aust. 2010. 192:90–93.

13. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, Sugerman DE, Druckenmiller JK, Ritger KA, Chugh R, Jasuja S, Deutscher M, Chen S, Walker JD, Duchin JS, Lett S, Soliva S, Wells EV, Swerdlow D, Uyeki TM, Fiore AE, Olsen SJ, Fry AM, Bridges CB, Finelli L. 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009. 361:1935–1944.

14. Hancock K, Veguilla V, Lu X, Zhong W, Butler EN, Sun H, Liu F, Dong L, DeVos JR, Gargiullo PM, Brammer TL, Cox NJ, Tumpey TM, Katz JM. Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med. 2009. 361:1945–1952.

15. Serologic cross-reactivity of serum samples from different age groups in Korea against a novel influenza A(H1N1) virus. Korea Center for Disease Control and Prevention. Accessed on 22 March 2011. Available at:http://www.cdc.go.kr. .

16. Chowell G, Bertozzi SM, Colchero MA, Lopez-Gatell H, Alpuche-Aranda C, Hernandez M, Miller MA. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med. 2009. 361:674–679.

17. Luk J, Gross P, Thompson WW. Observations on mortality during the 1918 influenza pandemic. Clin Infect Dis. 2001. 33:1375–1378.

18. Simonsen L, Clarke MJ, Schonberger LB, Arden NH, Cox NJ, Fukuda K. Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. J Infect Dis. 1998. 178:53–60.

19. Pebody RG, McLean E, Zhao H, Cleary P, Bracebridge S, Foster K, Charlett A, Hardelid P, Waight P, Ellis J, Bermingham A, Zambon M, Evans B, Salmon R, McMenamin J, Smyth B, Catchpole M, Watson J. Pandemic Influenza A (H1N1) 2009 and mortality in the United Kingdom: risk factors for death, April 2009 to March 2010. Euro Surveill. 2010. 15:pii: 19571.

20. Donaldson LJ, Rutter PD, Ellis BM, Greaves FE, Mytton OT, Pebody RG, Yardley IE. Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study. BMJ. 2009. 339:b5213.

21. Viboud C, Miller M, Olson D, Osterholm M, Simonsen L. Preliminary Estimates of Mortality and Years of Life Lost Associated with the 2009 A/H1N1 Pandemic in the US and Comparison with Past Influenza Seasons. PLoS Curr. 2010. RRN1153.