The first, second and third wave of pandemic influenza A (H1N1)pdm09 in North Denmark Region 2009-2011: a population-based study of hospitalizations

Influenza Other Respir Viruses. 2013 Sep;7(5):776-82. doi: 10.1111/irv.12093. Epub 2013 Feb 9.

Abstract

Background and objectives: Denmark experienced three waves of the new pandemic influenza A (H1N1)pdm09 from July 2009 to February 2011. The aim of the study was to describe the epidemiology and clinical characteristics of hospitalized patients in a defined population of North Denmark Region with a mixed urban and rural community of 579,000 inhabitants.

Methods: Review of medical records of all hospitalized patients with confirmed influenza A from July 2009 to February 2011.

Results: Two hundred and seventy-three patients were admitted to hospital. The age-related population incidences of hospitalization were as follows: 0-14 years: 111/100,000, 15-64 years: 39/100,000, and ≥ 65 years: 17/100,000. During the first wave (July 2009-August 2009), three patients were admitted - none received treatment in intensive care units (ICUs), during the second wave (October 2009-January 2010), 158 patients were admitted - nine received treatment in ICUs, and during the third wave (December 2010-February 2011), 112 patients were admitted - 25 received treatment in ICUs. Fourteen patients (5%) died within 30 days of diagnosis (median 55 years; range 14-76 years) and additional seven patients (2.6%) died within 365 days (median 25 years; range 1-86 years).

Conclusions: Patients hospitalized with pandemic influenza A (H1N1)pdm09 were predominantly children and younger adults, and only a few patients were >65 years. The third wave was the most severe taking the number and percentage of patients admitted to ICUs and 30-day mortality into consideration. We observed that the incidence of hospitalizations as well as clinical severity among younger adults did not decline from the second to the third wave.

Keywords: Epidemiology; ICU; hospitalization; influenza; outcome; pandemic.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Denmark / epidemiology
  • Female
  • Hospitalization
  • Humans
  • Incidence
  • Infant
  • Influenza A Virus, H1N1 Subtype / genetics
  • Influenza A Virus, H1N1 Subtype / isolation & purification*
  • Influenza, Human / epidemiology*
  • Influenza, Human / mortality
  • Influenza, Human / therapy
  • Influenza, Human / virology
  • Intensive Care Units
  • Male
  • Middle Aged
  • Pandemics
  • Young Adult