Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Lancet Infect Dis. 2012 Sep;12(9):687-95. doi: 10.1016/S1473-3099(12)70121-4. Epub 2012 Jun 26.
18,500 laboratory-confirmed deaths caused by the 2009 pandemic influenza A H1N1 were reported worldwide for the period April, 2009, to August, 2010. This number is likely to be only a fraction of the true number of the deaths associated with 2009 pandemic influenza A H1N1. We aimed to estimate the global number of deaths during the first 12 months of virus circulation in each country.
We calculated crude respiratory mortality rates associated with the 2009 pandemic influenza A H1N1 strain by age (0-17 years, 18-64 years, and >64 years) using the cumulative (12 months) virus-associated symptomatic attack rates from 12 countries and symptomatic case fatality ratios (sCFR) from five high-income countries. To adjust crude mortality rates for differences between countries in risk of death from influenza, we developed a respiratory mortality multiplier equal to the ratio of the median lower respiratory tract infection mortality rate in each WHO region mortality stratum to the median in countries with very low mortality. We calculated cardiovascular disease mortality rates associated with 2009 pandemic influenza A H1N1 infection with the ratio of excess deaths from cardiovascular and respiratory diseases during the pandemic in five countries and multiplied these values by the crude respiratory disease mortality rate associated with the virus. Respiratory and cardiovascular mortality rates associated with 2009 pandemic influenza A H1N1 were multiplied by age to calculate the number of associated deaths.
We estimate that globally there were 201,200 respiratory deaths (range 105,700-395,600) with an additional 83,300 cardiovascular deaths (46,000-179,900) associated with 2009 pandemic influenza A H1N1. 80% of the respiratory and cardiovascular deaths were in people younger than 65 years and 51% occurred in southeast Asia and Africa.
Our estimate of respiratory and cardiovascular mortality associated with the 2009 pandemic influenza A H1N1 was 15 times higher than reported laboratory-confirmed deaths. Although no estimates of sCFRs were available from Africa and southeast Asia, a disproportionate number of estimated pandemic deaths might have occurred in these regions. Therefore, efforts to prevent influenza need to effectively target these regions in future pandemics.
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2009 年甲型 H1N1 大流行流感在全球范围内报告了 18500 例实验室确诊死亡，时间为 2009 年 4 月至 2010 年 8 月。这个数字可能只是与 2009 年甲型 H1N1 大流行流感相关的实际死亡人数的一小部分。我们的目的是估计每个国家在病毒传播的前 12 个月内的全球死亡人数。
我们根据年龄（0-17 岁、18-64 岁和>64 岁）计算了与 2009 年甲型 H1N1 大流行相关的粗呼吸死亡率，使用了 12 个国家的累积（12 个月）病毒相关症状性攻击率和 5 个高收入国家的症状性病死率（sCFR）。为了调整各国因流感死亡风险不同而导致的粗死亡率，我们开发了一个呼吸死亡率乘数，等于每个世卫组织区域死亡率阶层的下呼吸道感染死亡率中位数与死亡率非常低的国家的中位数之比。我们使用五个国家大流行期间心血管和呼吸道疾病超额死亡的比例计算了与 2009 年甲型 H1N1 感染相关的心血管疾病死亡率，并将这些值乘以与病毒相关的粗呼吸疾病死亡率。将与 2009 年甲型 H1N1 大流行相关的呼吸和心血管死亡率乘以年龄，以计算相关死亡人数。
我们估计，全球有 201200 例呼吸死亡（范围 105700-395600），另外有 83300 例心血管死亡（46000-179900）与 2009 年甲型 H1N1 大流行相关。80%的呼吸和心血管死亡发生在 65 岁以下的人群中，51%发生在东南亚和非洲。
我们对与 2009 年甲型 H1N1 大流行相关的呼吸和心血管死亡率的估计是报告的实验室确诊死亡人数的 15 倍。尽管无法获得非洲和东南亚的 sCFR 估计值，但这些地区可能发生了不成比例的大流行死亡人数。因此，未来大流行流感的预防工作需要有效地针对这些地区。
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