Hospitalization Fatality Risk of Influenza A(H1N1)pdm09: A Systematic Review and Meta-Analysis

Am J Epidemiol. 2015 Aug 15;182(4):294-301. doi: 10.1093/aje/kwv054. Epub 2015 Jul 18.


During the 2009 influenza pandemic, uncertainty surrounding the severity of human infections with the influenza A(H1N1)pdm09 virus hindered the calibration of the early public health response. The case fatality risk was widely used to assess severity, but another underexplored and potentially more immediate measure is the hospitalization fatality risk (HFR), defined as the probability of death among H1N1pdm09 cases who required hospitalization for medical reasons. In this review, we searched for relevant studies published in MEDLINE (PubMed) and EMBASE between April 1, 2009, and January 9, 2014. Crude estimates of the HFR ranged from 0% to 52%, with higher estimates from tertiary-care referral hospitals in countries with a lower gross domestic product, but in wealthy countries the estimate was 1%-3% in all settings. Point estimates increased substantially with age and with lower gross domestic product. Early in the next pandemic, estimation of a standardized HFR may provide a picture of the severity of infection, particularly if it is presented in comparison with a similarly standardized HFR for seasonal influenza in the same setting.

Keywords: hospitalization; influenza; public health; severity.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Child
  • Databases, Bibliographic
  • Global Health / statistics & numerical data
  • Hospital Mortality*
  • Humans
  • Influenza A Virus, H1N1 Subtype*
  • Influenza, Human / epidemiology
  • Influenza, Human / mortality*
  • Influenza, Human / virology
  • Middle Aged
  • Pandemics
  • Risk Assessment
  • Severity of Illness Index
  • Young Adult