A(H1N1)pdm CVD COPD Asthma Immunosupression Diabetes Renal disease Rhematologic dis Neuromuscular Neoplasm Cirrhosis Autoinmune Pregnancy Obesity A(H3N2) CVD COPD Asthma Immunosupression Diabetes Renal disease Rhematologic dis Neuromuscular Neoplasm Cirrhosis Autoinmune Pregnancy Obesity B/Yamagata CVD COPD Asthma Diabetes Renal disease Rhematologic dis Neuromuscular Cirrhosis Autoinmune Pregnancy Obesity factors Strain/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 80 79 31 3 67 28 1 3 15 11 6 18 67 90 44 35 13 29 24 5 14 13 10 7 100 47 13 13 10 5 4 4 2 1 2 33 5 Influenza admissions with Number 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 80 79 31 3 67 28 1 3 15 11 6 18 67 90 44 35 13 29 24 5 14 13 10 7 100 47 13 13 10 5 4 4 2 1 2 33 5 Influenza admissions with Number of Less risk More risk 0.25 0.75 2 5 Adjusted odds ratio 1 Epidemiology of admissions with influenza and the impact of underlying patient characteristicson the risk of admission with influenza during the 2013/14 season in the GIHSN participating sites The study was funded by Sanofi Pasteur Joan PuigBarberà 1 , Angels NatividadSancho 1 , Svetlana Trushakova 2 , AnnaSominina 3 , MariaPisareva 3 , Meral A.Ciblak 4 , Selim Badur 4 , Hongjie Yu 5 , BenjaminJ. Cowling 6 , Clotilde El GuercheSéblain 7 , Ainara MiraIglesias 1 , Lidiya Kisteneva 2 , Kirill Stolyarov 3 , Kubra Yurctu 4 , LuzhaoFeng 5 , Elena Burtseva 2 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 ofVirology FGBC “N.F. Gamaleya FRCEM”Ministry ofHealth ofRussian Federation,Moscow,RussianFederation3 Research Institute of Influenza,Saint Petersburg,Russian Federation4 NationalInfluenza Reference Laboratory,IstanbulFaculty ofMedicine,IstanbulUniversity,Istanbul,Turkey5 Division ofInfectious Disease,Key LaboratoryofSurveillance and EarlyWarning on Infectious Disease,Chinese Center for Disease Controland Prevention,Beijing,China6 SchoolofPublic Health, LiKa Shing Faculty ofMedicine,The University ofHong Kong,Hong Kong SpecialAdministrative Region,China7 SanofiPasteur,Lyon,France Abstract : 492 Influenza was associated with disease needing admi ssi on in per s on with a nd wit hout ri sk factors. Underlying com orbidity increased the risk of infl ue nza and preg na nc y was an out sta ndi ng risk factor. Our results support influenza vaccination as a risk re du ci ng measure. Results Background This was a multicentric study performed by the Global Influenza Hospital Surveillance Network (GI HSN). A total of 9,507 consecutive eligible admissions were screen ed for inclusion in 19 hospitals in Russia, Turkey, China and Spain, following a prospective, active surveillance, approach aimed to describe the epidemiology of admissions with influenza. Sixty percent of influenza admissions were in patients with no comorbidity. Fundación para el Fomento de la Investigación Biomédica y Sanitaria (FISABIO),Valencia,Spain Phone: +34 961 925 968; email: [email protected] Methods Keywords: Epidemiology, Hospitalization and Immune response Conclusions Epidemiological data was collected in consecutive admissions using a common case definition. Influenza was confirmed by R TPCR. We used multivariate logistic 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 of influenza virus. For chronic obstructive pulmonary disease, 2.6(1.9 to 3.6), diabetes, 3.7(2.6 to 5.3), and obesity, 3.1 (2.24.4), the risk of severe diseas e was preferentially related to A(H1N1)pdm We included 5,303 admissions, 1086 were influenza positive: 534, A(H3N2), 362, A(H1N1), 130, B Yamagata 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 process Admitted 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 communicate Informed consent to participate Is a permanent resident (as defined in the site protocol) Not institutionalized Not discharged from a hospital in the last 30 days ILI 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 laboratory Semi;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%) 0 5 10 15 20 25 30 35 40 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 0 5 10 15 20 25 30 35 0 5 10 15 20 25 Number of cases Epidemiological week St. Petersburg 0 5 10 15 20 25 30 35 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 Percent positive Epidemiological week Turkey 0 5 10 15 20 25 30 35 40 0 2 4 6 8 10 12 14 16 Number of cases Epidemiological week Beijing 0 5 10 15 20 25 30 35 0 10 20 30 40 50 60 70 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)pdm to increase the need of intensive care and for A(H3N2) the risk of inhospital death. Respiratory failure w as more common in admissions with A(H3N2). Influenza vaccination, 0.6(0.40.8) lowered the risk of confirmed influenza. 0.00 0.02 0.04 0.06 0.08 0.10 Probability of death during admission 1 - 4 y 5 - 17y 18 - 49y 50 - 64y 65 - 74y 75 - 84y ≥ 85y 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 Probability of ICU admission during admission 0 - 5 mo 6- 11 mo 1 - 4y 5 - 17y 18 - 49y 50 - 64y 65 - 74y 75 - 84y ≥ 85 y Age group Negative A(H1N1)pdm09 A(H3N2) Any ICU admission Death in hospital Pneumonia COPD Respiratory failure Asthma Bronchiolitis ARDS Renal failure Fluid electrolite imbalance Upper respiratory infection A(H1N1)p ICU admission Death in hospital Pneumonia COPD Respiratory failure Asthma Bronchiolitis ARDS Renal failure Fluid electrolite imbalance Upper respiratory infection A(H3N2) ICU admission Death in hospital Pneumonia COPD Respiratory failure Asthma Bronchiolitis ARDS Renal failure Fluid electrolite imbalance Upper respiratory infection B/Yamagata Pneumonia COPD Bronchiolitis Uri 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 31 15 194 42 25 16 41 10 10 8 261 14 7 95 31 15 12 5 8 6 5 42 17 8 79 6 10 4 24 2 4 3 176 20 5 12 43 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 31 15 194 42 25 16 41 10 10 8 261 14 7 95 31 15 12 5 8 6 5 42 17 8 79 6 10 4 24 2 4 3 176 20 5 12 43 Positive Less risk More risk .25 .75 1 2 5 AdMusted odds ratio 0 20 40 60 80 100 Number of admissions 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)