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Most people killed by swine flu 'had no underlying health problems.

Ronan Kelly

Retired 2020
Most people killed by swine flu 'had no underlying health problems.


Published Date: 13 July 2010
By ANDREW WHITAKER
MORE than half of those killed by swine flu or admitted to hospital with the disease were previously considered to be healthy, new figures have revealed.
A total of 59 per cent of the in-patient deaths from the virus were people with no underlying health conditions, according to the UK-wide study.

Research taken from the first wave of the swine flu pandemic also showed 55 per cent of patients hospitalised by swine flu were not previously living with health problems, such as asthma or breathing difficulties.

The study said more needed to be done to monitor the conditions of swine flu victims once they had been admitted to hospital, such as ensuring those with an illness comparable to flu had a chest X-ray.

The researchers, from Imperial College London, focused on the period between 27 April and 30 September last year, when statistics were collected on 631 people hospitalised with swine flu across the UK. Their ages ranged from three months to 90 years, with 36 per cent under 16 and one in 20 aged 65 and older. Those from black and minority ethnic backgrounds made up more than 60 per cent of admissions.

The figures also showed a total of 27 patients were pregnant, representing 4 per cent of admissions and 18 per cent of all women patients aged between 16 and 44 - suggesting pregnant women were about three times as likely as those not expecting a baby to need hospital admission once infected with swine flu.

Another key finding was that two days normally went by before the onset of swine flu symptoms and then patient's admission to hospital.

The most commonly recorded symptoms were fever and cough, in both adults and children, according to the study.

But about one in four adults and children did not have a fever on admission, and more than half did not have a high fever, prompting the researchers to question the wisdom of using a high fever as a key symptom of swine flu infection.

The figures, published in the journal Thorax, were released after it emerged the UK spent ?587 million on drugs to tackle the swine flu pandemic.

Contracts were signed with pharmaceutical firms such as GlaxoSmithKline to supply the vaccines across the country though large numbers remained unused after the virus turned out to be less serious than initially feared.

Jabs against the potentially deadly virus were given to people in the priority groups such as asthma sufferers, heart attack victims, pregnant women, children under five and those with serious long-term respiratory conditions.

The Scottish Government claimed the new study backed prioritising groups such as pregnant women for the vaccine.

Ministers also said their vaccination programme against swine flu had been a success and that the majority of people who died from swine flu in Scotland during the six month period covered by the study had been living with underlying health conditions,

A Scottish Government spokeswoman said: "Scotland's vaccination programme was based on advice from the Joint Committee on Vaccination and Immunisation - the experts who advise all four UK countries on all vaccination-related matters.

"Decisions were made on the best available clinical evidence and, as new information emerged, the programme was adapted - right up to and after vaccinations started.

"This study backs the policy of prioritising pregnant women, under fives and those with long-term respiratory problems for vaccination. Of the nine confirmed H1N1 deaths in Scotland between May and September last year, seven were of people who were known to have underlying health conditions."

There were 457 deaths linked to swine flu in the UK, with 69 of them coming in Scotland, where a further 1,542 people were hospitalised.

? Case Study: Tragedy struck young mother only weeks after she gave birth


AT-RISK GROUPS

THE study said that those people classed as having underlying health problems were mainly asthma sufferers.

Others placed in that category included people who were "obese or with any underlying serious breathing and respiratory conditions".

Heart attack and stroke victims were included in the list of the groups at risk, as were people with cancer and other life-threatening conditions.

Patients with high blood pressure and those with temperature problems were also included, along with people who had a history of suffering from serious flu viruses

http://news.scotsman.com/news/Most-people-killed-by-swine.6415404.jp

findings from India; People without prior diseases prone to H1N1
http://www.flutrackers.com/forum/showthread.php?t=147029
 
Re: Most people killed by swine flu 'had no underlying health problems.

According to Eurosurveillance, Volume 15, Issue 20, 20 May 2010:
Pandemic Influenza A (H1N1) 2009 and mortality in the United Kingdom: risk factors for death, April 2009 to March 2010

"...Across the UK, 440 fatal cases were identified. In England, fatal cases were mainly seen in young adults (median age 43 years, 85% under 65 years), unlike for seasonal influenza. The majority (77%) of cases for whom data were available (n=308) had underlying risk factors for severe disease...."
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19571

In USA (April 2009-Feb 2010):
Hospitalizations with underlying conditions: 58% children; 85% adult
Deaths in children with underlying conditions: 65%
AZ: At least 1 Underlying Medical Condition: (62%)hospitalizations; (87%)deaths http://www.azdhs.gov/phs/oids/epi/flu/pdf/weeklyflureport.pdf
CO: 69 deaths (12 pediatric and 57 adult) have been reported this season. Of the 69 deaths 84% had underlying condition http://www.cdphe.state.co.us/dc/Influenza/Colorado Flu Report.pdf
FL: About 20 percent of deaths due to H1N1 are in persons with no underlying conditions. http://www.doh.state.fl.us/Disease_ctrl/epi/htopics/flu/2010/Week-20-2009-2010.pdf
ID: Detailed clinical information was available for 51.9% of hospitalized cases and of those, 84% had some kind of underlying medical condition: cardiovascular disease, chronic metabolic disease (such as diabetes) and asthma were the top three reported. 12 of the 23 deaths had underlying health conditions.http://healthandwelfare.idaho.gov/Health/PanFluHome/IdahoCaseCounts/tabid/890/Default.aspx#hosp

Asthma most common underlying condition in hospitalizations.
Neurological disorders most common among pediatric deaths.
Pregnancy is high risk for severe outcome.
http://www.cdc.gov/vaccines/recs/aci...-2-flu-vac.pdf

http://www.cdc.gov/H1N1flu/eip_under...conditions.htm

In Greece (May 2009-Feb 2010):
Admitted to ICU: 68.4% had underlying conditions; obesity most common in adults and neurological disorders most common in 19 and under.
82.1% of deaths had underlying conditions with obesity the most common.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5922a2.htm

".. .in Mexico and Peru...underlying comorbidities were present in approximately 60 to 77% of hospitalized cases."
http://new.paho.org/hq/index.php?opt...d=2295&lang=en
 
Re: Most people killed by swine flu 'had no underlying health problems.

Thorax 2010;65:645-651 doi:10.1136/thx.2010.135210

* Respiratory infection

Risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza: United Kingdom first wave (May?September 2009)
This article has been UnlockedEditor's Choice

1. J S Nguyen-Van-Tam1,
2. P J M Openshaw2,
3. A Hashim1,
4. E M Gadd3,
5. W S Lim4,
6. M G Semple5,
7. R C Read6,
8. B L Taylor7,
9. S J Brett8,
10. J McMenamin9,
11. J E Enstone1,
12. C Armstrong3,
13. K G Nicholson10 on behalf of the Influenza Clinical Information Network (FLU-CIN)

Abstract

Background During the first wave of pandemic H1N1 influenza in 2009, most cases outside North America occurred in the UK. The clinical characteristics of UK patients hospitalised with pandemic H1N1 infection and risk factors for severe outcome are described.

Methods A case note-based investigation was performed of patients admitted with confirmed pandemic H1N1 infection.

Results From 27 April to 30 September 2009, 631 cases from 55 hospitals were investigated. 13% were admitted to a high dependency or intensive care unit and 5% died; 36% were aged <16 years and 5% were aged ≥65 years. Non-white and pregnant patients were over-represented. 45% of patients had at least one underlying condition, mainly asthma, and 13% received antiviral drugs before admission. Of 349 with documented chest x-rays on admission, 29% had evidence of pneumonia, but bacterial co-infection was uncommon. Multivariate analyses showed that physician-recorded obesity on admission and pulmonary conditions other than asthma or chronic obstructive pulmonary disease (COPD) were associated with a severe outcome, as were radiologically-confirmed pneumonia and a raised C-reactive protein (CRP) level (≥100 mg/l). 59% of all in-hospital deaths occurred in previously healthy people.

Conclusions Pandemic H1N1 infection causes disease requiring hospitalisation of previously fit individuals as well as those with underlying conditions. An abnormal chest x-ray or a raised CRP level, especially in patients who are recorded as obese or who have pulmonary conditions other than asthma or COPD, indicate a potentially serious outcome. These findings support the use of pandemic vaccine in pregnant women, children <5 years of age and those with chronic lung disease.


FULL ARTICLE

http://thorax.bmj.com/content/65/7/645.full
 
Re: Most people killed by swine flu 'had no underlying health problems.

Seventeen of the 29 fatalities (59%) were previously healthy

In Uk total deaths were more than 400
 
Re: Most people killed by swine flu 'had no underlying health problems.

According to this paper, 45% of patients admitted to hospital (284/631) had a risk factor, and only 41% of fatal cases had a risk factor. In other words risk factors made death less likely!

Looking at Table 2;

The comorbidities most likely to be associated with hospitalization are;

cardiovascular disease by a factor of 3 compared to the general population
COPD by a factor of 2
Asthma by a factor of 4
Diabetes by a factor of 2

Obesity and pregnancy seem to reduce the likelihood of hospitalization!

However, if obesity were recorded, this increased the likelihood of a severe outcome.

The authors themselves indicate that obesity as a comorbidity may have been underrecorded. If this is the case, then it would be enough to at least negate the headline article.

Comparing risk factor of cases to the general population by age such as in table two should probably try to take into account that H1N1 does not equally affect all age groups.
 
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