2009 Pandemic Influenza A (H1N1)
Open accessAbstract
In the spring of 2009, a novel influenza A (H1N1) virus emerged in North America and spread worldwide to cause the first influenza pandemic since 1968. During the first 4 months, over 500 deaths in the United States had been associated with confirmed 2009 pandemic influenza A (H1N1) [2009 H1N1] virus infection. Pathological evaluation of respiratory specimens from initial influenza-associated deaths suggested marked differences in viral tropism and tissue damage compared with seasonal influenza and prompted further investigation. Available autopsy tissue samples were obtained from 100 US deaths with laboratory-confirmed 2009 H1N1 virus infection. Demographic and clinical data of these case-patients were collected, and the tissues were evaluated by multiple laboratory methods, including histopathological evaluation, special stains, molecular and immunohistochemical assays, viral culture, and electron microscopy. The most prominent histopathological feature observed was diffuse alveolar damage in the lung in all case-patients examined. Alveolar lining cells, including type I and type II pneumocytes, were the primary infected cells. Bacterial co-infections were identified in >25% of the case-patients. Viral pneumonia and immunolocalization of viral antigen in association with diffuse alveolar damage are prominent features of infection with 2009 pandemic influenza A (H1N1) virus. Underlying medical conditions and bacterial co-infections contributed to the fatal outcome of this infection. More studies are needed to understand the multifactorial pathogenesis of this infection.
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Of the eight autopsy case series, three studies tested lung tissue specimens for evidence of bacterial infection in all included subjects and identified bacterial co-infection in between 29 and 43% of fatal cases.
“Of the eight autopsy case series, 3 studies tested lung tissue specimens for evidence of bacterial infection in all included subjects [16–18] and identified bacterial co-infection diagnosed either before or after death in between 29 and 43% of fatal cases [16–18].”
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 [18]
Bacterial co-infection was detected in ~30% of cases in the 2009 H1N1 pandemic, with high mortality rates despite administration of appropriate antibiotics.
“Bacterial co-infection was also detected in ~30% of cases in the 2009 H1N1 pandemic, with high mortality rates despite administration of appropriate antibiotics”
From Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia. (2018) · cites this paper as [17]
Historical and contemporary descriptions of influenza pathology have focused predominantly or exclusively on disease caused by seasonal or pandemic influenza A viruses.
“Historical and contemporary descriptions of influenza pathology have characteristically focused, predominantly or exclusively, on disease caused by seasonal or pandemic influenza A viruses [2,3,[10][11][12][13][14][15].”
From Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection (2012) · cites this paper as [15]
The few studies to describe in vivo distribution of influenza virus antigens in respiratory tissues from deceased patients have focused specifically on influenza A viruses.
“The few studies to describe in vivo distribution of influenza virus antigens in respiratory tissues from deceased patients have focused specifically on influenza A viruses [14,15]”
From Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection (2012) · cites this paper as [15]
A study of 100 fatal cases of H1N1 influenza in the United States showed 26% overall were due to bacterial co-infection, mainly caused by S. pneumoniae.
“A study of 100 fatal cases of H1N1 influenza in the United States showed 26% overall were due to bacterial co‐infection, mainly caused by S. pneumoniae.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [37]
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Assessment of human influenza pandemic scenarios in Europe
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Safaeyan, F., Nahaei, M. R., Seifi, S. J., Kafil, H. S., & Sadeghi, J. (2015) · German Medical Science GMS Publishing House · doi:10.3205/dgkh000249 · Cited by 13 · see citing works
- Authors
- Shieh, W.-J., Blau, D. M., Denison, A. M., DeLeon-Carnes, M., Adem, P., Bhatnagar, J., Sumner, J., Liu, L., Patel, M., Batten, B., Greer, P., Jones, T., Smith, C., Bartlett, J., Montague, J., White, E., Rollin, D., Gao, R., Seales, C., Jost, H., Metcalfe, M., Goldsmith, C. S., Humphrey, C., Schmitz, A., Drew, C., Paddock, C., Uyeki, T. M., & Zaki, S. R.
- Affiliations
- Centers for Disease Control and Prevention (US)
- National Institute for Viral Disease Control and Prevention (CN)
- Corresponding author
- Shieh, Wun-Ju
- ORCID
- Venue
- The American Journal of Pathology
- Publisher
- Elsevier BV
- Published
- 2010-07
- Volume
- 177
- Issue
- 1
- Pages
- 166-175
- ISSN
- 0002-9440 (ISSN-L)
- PMC
- PMC2893660
- OpenAlex
- W1869071094
- Cited by
- 429
- References
- 57
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 10 · 2023: 13 · 2022: 17 · 2021: 40 · 2020: 35 · 2019: 22 · 2018: 17 · 2017: 23 · 2016: 25 · 2015: 28 · 2014: 25 · 2013: 37 · 2012: 52
- FWCI
- 34.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal Of Pathology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
- Keywords
- 2009 H1N1 pandemic, influenza A (H1N1) virus, influenza-associated deaths, autopsy findings, diffuse alveolar damage, viral pneumonia, bacterial co-infection, viral tropism, pathogenesis, immunohistochemistry
- MeSH terms
- Adolescent, Adult, Autopsy, Child, Child, Preschool, Humans, Infant, Infant, Newborn, Influenza, Human, Lung, Male, Middle Aged, United States, Influenza A Virus, H1N1 Subtype, Young Adult, Pandemics
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