Estimated epidemiologic parameters and morbidity associated with pandemic H1N1 influenza.
BACKGROUND
In the face of an influenza pandemic, accurate estimates of epidemiologic parameters are required to help guide decision-making. We sought to estimate epidemiologic parameters for pandemic H1N1 influenza using data from initial reports of laboratory-confirmed cases.


METHODS
We obtained data on laboratory-confirmed cases of pandemic H1N1 influenza reported in the province of Ontario, Canada, with dates of symptom onset between Apr. 13 and June 20, 2009. Incubation periods and duration of symptoms were estimated and fit to parametric distributions. We used competing-risk models to estimate risk of hospital admission and case-fatality rates. We used a Markov Chain Monte Carlo model to simulate disease transmission.


RESULTS
The median incubation period was 4 days and the duration of symptoms was 7 days. Recovery was faster among patients less than 18 years old than among older patients (hazard ratio 1.23, 95% confidence interval 1.06-1.44). The risk of hospital admission was 4.5% (95% CI 3.8%-5.2%) and the case-fatality rate was 0.3% (95% CI 0.1%-0.5%). The risk of hospital admission was highest among patients less than 1 year old and those 65 years or older. Adults more than 50 years old comprised 7% of cases but accounted for 7 of 10 initial deaths (odds ratio 28.6, 95% confidence interval 7.3-111.2). From the simulation models, we estimated the following values (and 95% credible intervals): a mean basic reproductive number (R0, the number of new cases created by a single primary case in a susceptible population) of 1.31 (1.25-1.38), a mean latent period of 2.62 (2.28-3.12) days and a mean duration of infectiousness of 3.38 (2.06-4.69) days. From these values we estimated a serial interval (the average time from onset of infectiousness in a case to the onset of infectiousness in a person infected by that case) of 4-5 days.


CONCLUSIONS
The low estimates for R0 indicate that effective mitigation strategies may reduce the final epidemic impact of pandemic H1N1 influenza.
Tuite
Ashleigh R
AR
Research Institute of The Hospital for Sick Children, and the Dalla Lana School of Public Health, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
Greer
Amy L
AL
Whelan
Michael
M
Winter
Anne-Luise
AL
Lee
Brenda
B
Yan
Ping
P
Wu
Jianhong
J
Moghadas
Seyed
S
Buckeridge
David
D
Pourbohloul
Babak
B
Fisman
David N
DN
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055256:Infectious Disease Incubation Period; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000635:transmission; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012306:Risk; D055815:Young Adult