Perez-Flores Eusebio, Izquierdo-Puente Juan Carlos, Castillo-Perez Jose Juan, Ramírez-Rosales Gustavo, Grijalva-Otero Israel, Lopez-Macias Constantino, Garcia-Ramirez Roman Alejandro, Grajales-Muñiz Concepción, Mejia-Arangure Juan Manuel
Coordination of Health Research, Mexican Social Security Institute (IMSS), Mexico City, Mexico.
J Infect Dev Ctries. 2014 Jun 11;8(6):742-8. doi: 10.3855/jidc.3622.
The frequency and mortality of the pandemic caused by influenza A(H1N1)pdm09 might have been underestimated, especially in developing countries. This study was designed to quantify the possible underestimation of pandemic influenza mortality and evaluate the concordance between the data reported for A(H1N1)pdm09 mortality and the causes of death reported during the pandemic period of April 2009 to February 2010.
The death certificates of 754 confirmed cases of A(H1N1)pdm09 infection were included in the study. Data was analyzed using the United States Centers for Disease Control and Prevention's statistical model accounts for the variability in the proportion at each step using the Monte Carlo probabilistic model sampled from a uniform probability distribution.
A total of 1,969 deaths were estimated, with an estimated lethality of 5.53 per 100,000 (range, 3.5-8.76 per 100,000) in contrast with the 754 deaths and a lethality of 1.98 per 100,000 infected patients officially reported. In 631 of 754 (83.7%) death certificates from A(H1N1)pdm09 influenza-positive patients, influenza was not mentioned as a cause of death.
It is possible that the mortality of the pandemic was three times higher than officially reported in Mexico. One source of error that could explain this underestimation is in the completion of death certificates, because in > 80% of confirmed cases of infection with influenza virus, it was not reported as the cause of death.
甲型H1N1流感大流行的频率和死亡率可能被低估了，尤其是在发展中国家。本研究旨在量化大流行性流感死亡率可能被低估的程度，并评估2009年4月至2010年2月大流行期间报告的甲型H1N1流感死亡率数据与死亡原因之间的一致性。
本研究纳入了754例确诊的甲型H1N1流感感染病例的死亡证明。使用美国疾病控制与预防中心的统计模型对数据进行分析，该模型使用从均匀概率分布中采样的蒙特卡洛概率模型来考虑每一步骤中比例的变异性。
估计共有1969人死亡，估计致死率为每10万人中5.53人（范围为每10万人中3.5 - 8.76人），相比之下，官方报告的754例死亡病例的致死率为每10万感染患者中1.98人。在754份甲型H1N1流感阳性患者的死亡证明中，有631份（83.7%）未提及流感作为死亡原因。
墨西哥大流行的死亡率可能比官方报告的高三倍。死亡证明填写方面的一个误差来源可以解释这种低估情况，因为在超过80%的确诊流感病毒感染病例中，流感未被报告为死亡原因。
