Predictors of clinical outcome in a national hospitalised cohort across both waves of the influenza A/H1N1 pandemic 2009–2010 in the UK
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BACKGROUND: Although generally mild, the 2009-2010 influenza A/H1N1 pandemic caused two major surges in hospital admissions in the UK. The characteristics of patients admitted during successive waves are described. METHODS: Data were systematically obtained on 1520 patients admitted to 75 UK hospitals between May 2009 and January 2010. Multivariable analyses identified factors predictive of severe outcome. RESULTS: Patients aged 5-54 years were over-represented compared with winter seasonal admissions for acute respiratory infection, as were non-white ethnic groups (first wave only). In the second wave patients were less likely to be school age than in the first wave, but their condition was more likely to be severe on presentation to hospital and they were more likely to have delayed admission. Overall, 45% had comorbid conditions, 16.5% required high dependency (level 2) or critical (level 3) care and 5.3% died. As in 1918-1919, the likelihood of severe outcome by age followed a W-shaped distribution. Pre-admission antiviral drug use decreased from 13.3% to 10% between the first and second waves (p=0.048), while antibiotic prescribing increased from 13.6% to 21.6% (p<0.001). Independent predictors of severe outcome were age 55-64 years, chronic lung disease (non-asthma, non-chronic obstructive pulmonary disease), neurological disease, recorded obesity, delayed admission (≥5 days after illness onset), pneumonia, C-reactive protein ≥100 mg/litre, and the need for supplemental oxygen or intravenous fluid replacement on admission. CONCLUSIONS: There were demographic, ethnic and clinical differences between patients admitted with pandemic H1N1 infection and those hospitalised during seasonal influenza activity. Despite national policies favouring use of antiviral drugs, few patients received these before admission and many were given antibiotics.
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A UK study showed a "w" shaped morbidity curve with a peak in young adults.
“a UK study showed a “w” shaped morbidity curve with a peak in young adults [46]”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [46]
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- Authors
- Myles, P. R., Semple, M. G., Lim, W. S., Openshaw, P. J. M., Gadd, E. M., Read, R. C., Taylor, B. L., Brett, S. J., McMenamin, J., Enstone, J. E., Armstrong, C., Bannister, B., Nicholson, K. G., Nguyen-Van-Tam, J. S., & on behalf of the Influenza Clinical Information Network (FLU-CIN)
- Affiliations
- University of Nottingham (GB)
- University of Liverpool (GB)
- Nottingham University Hospitals NHS Trust (GB)
- Imperial College London (GB)
- Royal Hallamshire Hospital (GB)
- Portsmouth Hospitals NHS Trust (GB)
- Imperial College Healthcare NHS Trust (GB)
- Health Protection Scotland (GB)
- Leicester Royal Infirmary (GB)
- ORCID
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2012-03-10
- Volume
- 67
- Issue
- 8
- Pages
- 709-717
- ISSN
- 0040-6376 (ISSN-L)
- 1468-3296
- PMC
- PMC3402749
- OpenAlex
- W2127341698
- Cited by
- 82
- References
- 31
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 6 · 2020: 10 · 2019: 5 · 2018: 5 · 2017: 7 · 2016: 4 · 2015: 3 · 2014: 12 · 2013: 13 · 2012: 6
- FWCI
- 8.11
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Thorax (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Pfizer
- GlaxoSmithKline
- Sanofi
- F. Hoffmann-La Roche
- Alder Hey Children's NHS Foundation Trust
- Nottingham University Hospitals NHS Trust
- University Hospitals of Leicester NHS Trust
- National Institute for Health and Care Research (NF-SI-0508-10212)
- Imperial College London
- Imperial College Healthcare NHS Trust
- University College London
- University of Nottingham
- Public Health Agency
- University of South Australia
- University College London Hospitals NHS Foundation Trust
- Medical Research Council (MC_G1001212)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Keywords
- hospitalized patients, clinical outcomes, pandemic waves, age distribution, ethnic differences, comorbidities, delayed admission, antiviral prescribing, antibiotic prescribing, C-reactive protein, obesity, chronic lung disease, pneumonia, mortality, seasonal influenza comparison
- MeSH terms
- Adolescent, Adult, Aged, Anti-Bacterial Agents, Antiviral Agents, Child, Child, Preschool, Drug Utilization, Female, United Kingdom, Hospitalization, Humans, Infant, Influenza, Human, Male, Middle Aged, Prognosis, Risk Factors, Cohort Studies, Comorbidity, Treatment Outcome, Age Distribution, Sex Distribution, Influenza A Virus, H1N1 Subtype, Young Adult, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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