Giuseppe
Emeritus
[Source: PLoS ONE, full page: (LINK). Abstract, edited.]
Open Access / Peer-Reviewed / Research Article
Populations at Risk for Severe or Complicated Avian Influenza H5N1: A Systematic Review and Meta-Analysis
Dominik Mertz, Tae Hyong Kim, Jennie Johnstone, Po-Po Lam, Michelle Science, Stefan P. Kuster, Shaza A. Fadel, Dat Tran, Eduardo Fernandez, Neera Bhatnagar, Mark Loeb
Published: March 06, 2014 / DOI: 10.1371/journal.pone.0089697
Abstract
Background
Little is known about risk factors for severe outcomes in patients infected with H5N1 and no systematic review has been conducted. Understanding risk factors is an important step for prioritizing prophylaxis or treatment in the event of a pandemic.
Objectives
To systematically evaluate risk factors for severe outcomes in patients with avian influenza H5N1 infection.
Data sources
MEDLINE, EMBASE, CINAHL, GlobalHealth, and CENTRAL through March 2011
Eligibility criteria for selecting studies
Observational studies of any design published in English, French, Spanish, German or Korean that reported on risk factor-outcome combinations of interest in participants with confirmed H5N1 infections. Outcomes considered included death, ventilator support, hospital and ICU admission, pneumonia, and composite outcomes.
Study appraisal
Risk of bias was assessed using the Newcastle-Ottawa scale (NOS).
Results
We identified 20 studies reporting on 999 patients infected with H5N1. The majority of studies (n = 14, 70%) were at intermediate risk of bias, i.e. 4?6 points on the NOS. Females were at increased risk of death (OR 1.75, 95% CI 1.27?2.44), while young age, in particular <5 years of age (OR 0.44, 95% CI 0.25?0.79 for death), was protective. Data on traditional risk factors was scarce and requires further studies. Another major limitation in the published literature was lack of adjustment for confounders.
Interpretation
Females were at increased risk for complications following H5N1 infection while young age protected against severe outcomes. Research on traditional risk factors was limited and is required.
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Citation: Mertz D, Kim TH, Johnstone J, Lam P-P, Science M, et al. (2014) Populations at Risk for Severe or Complicated Avian Influenza H5N1: A Systematic Review and Meta-Analysis. PLoS ONE 9(3): e89697. doi:10.1371/journal.pone.0089697
Editor: Paul Robert Cleary, Health Protection Agency, United Kingdom
Received: December 2, 2013; Accepted: January 21, 2014; Published: March 6, 2014
Copyright: ? 2014 Mertz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The World Health Organization (WHO) funded the study. The protocol was reviewed by the WHO and the WHO's suggestions were incorporated into the protocol. DM was partly supported by a research scholarship from the Swiss National Science Foundation (PASMP3-132571) and the Lichtenstein-Stiftung, and is a recipient of a Research Early Career Award from Hamilton Health Sciences Foundation (Jack Hirsh Fellowship); ML holds the Michael G. DeGroote Chair in Infectious Diseases at McMaster University; JJ receives salary support from the Canadian Institutes of Health Research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: Mark Loeb has been a paid consultant for GSK, Novartis, and Sanofi Pasteur (vaccine manufacturers). There are no other competing interests to be declared. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
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