Global Mortality Estimates for the 2009 Influenza Pandemic from the GLaMOR Project: A Modeling Study

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Résumé

BACKGROUND: Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortality burden through statistical modeling of mortality data from multiple countries. METHODS AND FINDINGS: We obtained weekly virology and underlying cause-of-death mortality time series for 2005-2009 for 20 countries covering ∼35% of the world population. We applied a multivariate linear regression model to estimate pandemic respiratory mortality in each collaborating country. We then used these results plus ten country indicators in a multiple imputation model to project the mortality burden in all world countries. Between 123,000 and 203,000 pandemic respiratory deaths were estimated globally for the last 9 mo of 2009. The majority (62%-85%) were attributed to persons under 65 y of age. We observed a striking regional heterogeneity, with almost 20-fold higher mortality in some countries in the Americas than in Europe. The model attributed 148,000-249,000 respiratory deaths to influenza in an average pre-pandemic season, with only 19% in persons <65 y. Limitations include lack of representation of low-income countries among single-country estimates and an inability to study subsequent pandemic waves (2010-2012). CONCLUSIONS: We estimate that 2009 global pandemic respiratory mortality was ∼10-fold higher than the World Health Organization's laboratory-confirmed mortality count. Although the pandemic mortality estimate was similar in magnitude to that of seasonal influenza, a marked shift toward mortality among persons <65 y of age occurred, so that many more life-years were lost. The burden varied greatly among countries, corroborating early reports of far greater pandemic severity in the Americas than in Australia, New Zealand, and Europe. A collaborative network to collect and analyze mortality and hospitalization surveillance data is needed to rapidly establish the severity of future pandemics. Please see later in the article for the Editors' Summary.

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La notice

Revue

PLoS Medicine

Thématique

Influenza Virus Research Studies

Domaine

Medicine

Établissements canadiens

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Organismes subventionnaires

Fogarty International CenterStatens Serum InstitutRijksinstituut voor Volksgezondheid en MilieuMedical Research CouncilRobert Koch InstitutNational Institutes of HealthChinese Center for Disease Control and PreventionArizona State UniversityNSW Ministry of HealthNederlands Instituut voor Onderzoek van de GezondheidszorgPublic Health EnglandUniversity of New South WalesUniversity of OtagoKoch Institute for Integrative Cancer Research, Massachusetts Institute of TechnologyInstituto de Salud Carlos IIINational University of SingaporePublic Health Agency of CanadaPan American Health OrganizationCenters for Disease Control and PreventionKeiyu HospitalEuropean Centre for Disease Prevention and ControlNational Health Laboratory ServiceKorea Centers for Disease Control and PreventionInstitut National de la Santé et de la Recherche MédicaleBill and Melinda Gates FoundationAssistance publique-Hôpitaux de ParisGeorge Washington UniversityUniversity of Hong KongPublic Health AgencyScience and Technology DirectorateU.S. Department of Homeland Security

Mots-clés

PandemicDemographyMortality ratePopulationMedicinePublic healthGlobal healthInfluenza pandemicEnvironmental healthGeographyCoronavirus disease 2019 (COVID-19)Infectious disease (medical specialty)Disease

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