intensive care surveillance of influenza, 11 countries, 2009-2016

Intensive care surveillance of influenza, 11 EU countries, 2009–2016

Cornelia AdlhochEuropean Centre for Disease Prevention and Control

Options IX for the control of influenza, 24–28 August 2016

Thank you for the tireless commitment in collecting and providing high-quality European influenza surveillance data

Finland: Outi Lyytikäinen, Niina Ikonen, Satu Murtopuro, Anu Haveri; France: Blanchon Thierry, Clement Turbelin, Emmanuel Belchior, Isabelle Bonmarin, Sylvie Behillil, Bruno Lina, Martine Valette, Sylvie van der Werf, Vincent Enouf; Ireland: Lisa Domegan, Allison Waters, Joan O’Donnell, Margaret Duffy, SuzieCoughlan, Derval Igoe; Malta: Christopher Barbara, Jackie Maistre Melillo, Tanya Melillo, Graziella Zahra; Netherlands: Mariette Hooiveld, Anne Teirlinck, Adam Meijer, Frederika Dijkstra, Gé Donker, GuusRimmelzwaan, Marit de Lange; Portugal: Ana Paula Rodrigues , Helena Rebelo De Andrade, RaquelMoreira Guiomar; Romania: Emilia Lupulescu, Florin Popovici; Slovak Republic: Edita Staronová; Spain:Amparo Larrauri, Francisco Pozo, Inmaculada Casas, Leonardo Raul Ortiz De Lejarazu, Tomas Pumarola,Tomas Vega.

All practitioners and hospitals providing samples and epidemiological data.

I have no potential conflict of interest to report

Rational for severe disease surveillance

• to monitor and assess the impact of influenza

• to identify high risk groups and risk factors

Objective of the study

To describe confirmed influenza cases admitted to intensivecare units (ICU) in order to identify risk factors for fataloutcome in EU/EEA countries

Methods

Data collection

Laboratory-confirmed influenza cases admitted to ICU

- age and gender

- influenza type and A subtype

- underlying conditions, complications and vaccination status

- outcome

11 EU/EEA countries

2009/10 – 2015/16 (weeks 40–20)

Data analysis

Descriptive analysis

Uni- and multivariable logistic regression

Reporting countries and number of cases

Variable number of countries reporting each season, 11 in total

Age 58; 0-97 54; 0-100(median, range) (median, range)


FatalN=621

RecoveredN=1 658

18% 19%

57% 55%


FatalN=621

RecoveredN=1 658

Cases by (sub)type, age-group and outcome

A(H1N1)pdm09 affects mostly 40–64 year-olds, A(H3N2) 65+ year-olds

Descriptive analysis – chronic conditions

Lung disease 15% 15%

Heart disease 14% 8%

Diabetes 11% 11%

HIV 11% 5%

Obesity 10% 13%

Cancer 5% 2%

Kidney disease 5% 3%

Liver disease 4% 3%

Morbid obesity 4% 5%

Asthma 2% 3%

Pregnancy 2% 4%

FatalN=621

RecoveredN=1 658

Descriptive analysis - complications

ARDS 56% 53%

Pneumonia 34% 36%

Sepsis 9% 3%

FatalN=621

RecoveredN=1 658

Risk factors for fatal outcome pooled data 2009/10–2015/16, EU/EEA

Factors Univariable analysis Multivariable analysis

Odds ratio (95%CI) Adjusted odds ratio* (95%CI)

0–9 years Ref.

10–19 years 1.2 (0.5-2.7) 1.0 (0.4-2.4)

20–29 years 1.8 (1.0-3.4) 1.6 (0.8-3.2)

30–39 years 2.4 (1.4-4.2) 1.9 (1.1-3.4)

40–49 years 2.0 (1.2-3.4) 1.4 (0.8-2.5)

50–59 years 3.3 (2.0-5.5) 2.6 (1.5-4.4)

60–69 years 3.2 (1.9-5.4) 2.5 (1.5-4.3)

70–79 years 3.7 (2.2-6.3) 3.1 (1.8-5.5)

80+ years 3.7 (2.0-6.8) 3.6 (1.9-7.0)

Increasing age is a risk factor for fatal outcome

*adjusted for gender, season and countryBold: p<0.05


Univariable analysis Multivariable analysis

Virus (sub)type Odds ratio (95%CI) Adjusted odds ratio* (95%CI)

B Ref. Ref.

A(H1N1)pdm09 1.8 (1.3-2.4) 2.1 (1.5-3.1)

A(H3N2) 1.4 (1.0-2.1) 1.5 (1.0-2.3)

Vaccination status

Vaccinated 1.1 (0.8-1.4) 1.0 (0.8-1.4)

Complications

Sepsis 5.8 (3.7-9.1) 5.5 (3.4-8.9)

ARDS 1.2 (0.9-1.6)

Pneumonia 0.8 (0.6-1.1)

Infection with influenza A(H1N1)pdm09 is a risk factor for fatal outcome



Underlying conditions

Univariable analysis Multivariable analysis

Odds ratio (95%CI) Adjusted odds ratio* (95%CI)

Cancer 2.8 (1.7-4.7) 2.7 (1.5-4.9)

HIV 2.5 (1.7-3.5) 2.7 (1.8-4.0)

Kidney disease 1.9 (1.2-3.1) 1.8 (1.1-3.1)

Liver disease 1.6 (0.9-2.6) 2.2 (1.2-3.9)

Heart disease 1.5 (1.1-2.1) 1.3 (0.9-1.9)

Pregnancy 0.6 (0.3-1.0) 0.9 (0.5-1.7)

Asthma 0.6 (0.3-1.2)

Diabetes 1.0 (0.8-1.4)

Lung disease 0.9 (0.7-1.2)

Obesity 0.8 (0.6-1.1)

Morbid obesity 1.1 (0.7-1.7)

Cancer, kidney and liver disease, and HIV are risk factors for fatal outcome


Limitations

• Small subset of reporting countries might introduce bias

• Inconsistent reporting over time

• Lack of denominator data

Conclusions

• Identified risk factors for fatal outcome:

• Increasing age

• Infection with influenza A virus

• Cancer

• HIV

• Kidney disease

• Liver disease

• Vaccination not protective in these severely ill patients

• Need for more countries in EU/EEA to perform severe influenza surveillance

ECDC team:

Pasi Penttinen

Eeva Broberg

Julien Beauté

René Snacken

Joana Gomes Dias

Adrian Prodan

Gaetan Guyodo

...and the influenza programme at WHO Regional Office for Europe

Thank you for your attention!

intensive care surveillance of influenza, 11 countries, 2009-2016

Health & Medicine