Global mortality estimates for the 2009 influenza pandemic from the GLAMOR Project: A modeling study
Document Type
Journal Article
Publication Date
11-26-2013
Journal
PLoS Medicine
Volume
Volume 10, Issue 11
Inclusive Pages
Article number e1001558
DOI
10.1371/journal.pmed.1001558
Keywords
Cause of Death; Influenza A Virus, H1N1 Subtype,; Influenza, Human--mortality; Pandemics
Abstract
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(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 personsoccurred, 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.
Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.
APA Citation
Simonsen, L., Spreeuwenberg, P., Lustig, R., Taylor, R.J., Fleming, D.M., Kroneman, M., Van Kerkhove, M.D., Mounts, A.W., Paget, W.J. (2013) Global Mortality Estimates for the 2009 Influenza Pandemic from the GLaMOR Project: A Modeling Study. PLoS Med 10(11): e1001558.
Peer Reviewed
1
Open Access
1
Comments
Reproduced with permission of PLoS Medicine.