Donaldson Liam J, Rutter Paul D, Ellis Benjamin M, Greaves Felix E C, Mytton Oliver T, Pebody Richard G, Yardley Iain E
Department of Health, Richmond House, London SW1A 2NS.
BMJ. 2009 Dec 10;339:b5213. doi: 10.1136/bmj.b5213.
To establish mortality from pandemic A/H1N1 2009 influenza up to 8 November 2009.
Investigation of all reported deaths related to pandemic A/H1N1 in England.
Mandatory reporting systems established in acute hospitals and primary care.
Physicians responsible for the patient.
Numbers of deaths from influenza combined with mid-range estimates of numbers of cases of influenza to calculate age specific case fatality rates. Underlying conditions, time course of illness, and antiviral treatment.
With the official mid-range estimate for incidence of pandemic A/H1N1, the overall estimated case fatality rate was 26 (range 11-66) per 100 000. It was lowest for children aged 5-14 (11 (range 3-36) per 100 000) and highest for those aged >or=65 (980 (range 300-3200) per 100 000). In the 138 people in whom the confirmed cause of death was pandemic A/H1N1, the median age was 39 (interquartile range 17-57). Two thirds of patients who died (92, 67%) would now be eligible for the first phase of vaccination in England. Fifty (36%) had no, or only mild, pre-existing illness. Most patients (108, 78%) had been prescribed antiviral drugs, but of these, 82 (76%) did not receive them within the first 48 hours of illness.
Viewed statistically, mortality in this pandemic compares favourably with 20th century influenza pandemics. A lower population impact than previous pandemics, however, is not a justification for public health inaction. Our data support the priority vaccination of high risk groups. We observed delayed antiviral use in most fatal cases, which suggests an opportunity to reduce deaths by making timely antiviral treatment available, although the lack of a control group limits the ability to extrapolate from this observation. Given that a substantial minority of deaths occur in previously healthy people, there is a case for extending the vaccination programme and for continuing to make early antiviral treatment widely available.
确定截至2009年11月8日2009年甲型H1N1流感大流行的死亡率。
对英格兰所有报告的与甲型H1N1流感大流行相关的死亡病例进行调查。
在急症医院和初级保健机构建立的强制报告系统。
负责患者的医生。
流感死亡人数结合流感病例数的中等范围估计值，以计算特定年龄组的病死率。基础疾病、病程及抗病毒治疗情况。
根据甲型H1N1流感大流行发病率的官方中等范围估计值，总体估计病死率为每10万人26例（范围为11 - 66例）。5 - 14岁儿童的病死率最低（每10万人11例（范围为3 - 36例）），65岁及以上人群的病死率最高（每10万人980例（范围为300 - 3200例））。在确诊死因是甲型H1N1流感大流行的138人中，中位年龄为39岁（四分位间距为17 - 57岁）。死亡患者中有三分之二（92例，67%）现在符合英格兰第一阶段疫苗接种条件。50例（36%）没有或仅有轻微的基础疾病。大多数患者（108例，78%）曾开具抗病毒药物，但其中82例（76%）在发病的头48小时内未接受药物治疗。
从统计学角度看，此次大流行的死亡率与20世纪流感大流行相比情况较好。然而，与以往大流行相比对人群影响较小，这并不能成为公共卫生不作为的理由。我们的数据支持对高危人群进行优先接种疫苗。我们观察到在大多数致命病例中抗病毒药物使用延迟，这表明通过及时提供抗病毒治疗有机会降低死亡率，尽管缺乏对照组限制了从这一观察结果进行推断的能力。鉴于相当一部分死亡发生在原本健康的人群中，有理由扩大疫苗接种计划并继续广泛提供早期抗病毒治疗。
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