title: The burden of 2009 pandemic influenza A(H1N1) in the Netherlands.
abstract: BACKGROUND
  The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands.
  
  
  METHODS
  The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters.
  
  
  RESULTS
  The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza.
  
  
  CONCLUSIONS
  This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands.
authors.affiliation: National Institute for Public Health and the Environment, RIVM, Centre for Infectious Disease Control Netherlands, Bilthoven, The Netherlands.
authors.forename: C C H
authors.initials: CC
authors.lastname: Wielders
authors.forename: E A
authors.initials: EA
authors.lastname: van Lier
authors.forename: T M
authors.initials: TM
authors.lastname: van 't Klooster
authors.forename: A B
authors.initials: AB
authors.lastname: van Gageldonk-Lafeber
authors.forename: C C
authors.initials: CC
authors.lastname: van den Wijngaard
authors.forename: J A
authors.initials: JA
authors.lastname: Haagsma
authors.forename: G A
authors.initials: GA
authors.lastname: Donker
authors.forename: A
authors.initials: A
authors.lastname: Meijer
authors.forename: W
authors.initials: W
authors.lastname: van der Hoek
authors.forename: A K
authors.initials: AK
authors.lastname: Lugnér
authors.forename: M E E
authors.initials: ME
authors.lastname: Kretzschmar
authors.forename: M A B
authors.initials: MA
authors.lastname: van der Sande
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000150:complications* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D058873:Pandemics; D012042:Registries; D012720:Severity of Illness Index; D055815:Young Adult