Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in Mexico

Introduction: The frequency and mortality of the pandemic caused by influenza A(H1N1)pdm09 might have been underestimated, especially in developing countries. This study was designed to quantify the possible underestimation of pandemic influenza mortality and evaluate the concordance between the dat...

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Main Authors: Eusebio Perez-Flores, Juan Carlos Izquierdo-Puente, Jose Juan Castillo-Perez, Gustavo Ramírez-Rosales, Israel Grijalva-Otero, Constantino Lopez-Macias, Roman Alejandro Garcia-Ramirez, Concepción Grajales-Muñiz, Juan Manuel Mejia-Arangure
Format: Article
Language:English
Published: The Journal of Infection in Developing Countries 2014-06-01
Series:Journal of Infection in Developing Countries
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Online Access:https://jidc.org/index.php/journal/article/view/3622
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author Eusebio Perez-Flores
Juan Carlos Izquierdo-Puente
Jose Juan Castillo-Perez
Gustavo Ramírez-Rosales
Israel Grijalva-Otero
Constantino Lopez-Macias
Roman Alejandro Garcia-Ramirez
Concepción Grajales-Muñiz
Juan Manuel Mejia-Arangure
author_facet Eusebio Perez-Flores
Juan Carlos Izquierdo-Puente
Jose Juan Castillo-Perez
Gustavo Ramírez-Rosales
Israel Grijalva-Otero
Constantino Lopez-Macias
Roman Alejandro Garcia-Ramirez
Concepción Grajales-Muñiz
Juan Manuel Mejia-Arangure
author_sort Eusebio Perez-Flores
collection DOAJ
description Introduction: The frequency and mortality of the pandemic caused by influenza A(H1N1)pdm09 might have been underestimated, especially in developing countries. This study was designed to quantify the possible underestimation of pandemic influenza mortality and evaluate the concordance between the data reported for A(H1N1)pdm09 mortality and the causes of death reported during the pandemic period of April 2009 to February 2010. Methodology: The death certificates of 754 confirmed cases of A(H1N1)pdm09 infection were included in the study. Data was analyzed using the United States Centers for Disease Control and Prevention’s statistical model accounts for the variability in the proportion at each step using the Monte Carlo probabilistic model sampled from a uniform probability distribution. Results: A total of 1,969 deaths were estimated, with an estimated lethality of 5.53 per 100,000 (range, 3.5-8.76 per 100,000) in contrast with the 754 deaths and a lethality of 1.98 per 100,000 infected patients officially reported. In 631 of 754 (83.7%) death certificates from A(H1N1)pdm09 influenza-positive patients, influenza was not mentioned as a cause of death. Conclusions: It is possible that the mortality of the pandemic was three times higher than officially reported in Mexico. One source of error that could explain this underestimation is in the completion of death certificates, because in > 80% of confirmed cases of infection with influenza virus, it was not reported as the cause of death.
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spelling doaj-art-3e89b1378ece49e287bf63e45fa9aacd2025-08-20T03:52:38ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802014-06-0180610.3855/jidc.3622Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in MexicoEusebio Perez-Flores0Juan Carlos Izquierdo-Puente1Jose Juan Castillo-Perez2Gustavo Ramírez-Rosales3Israel Grijalva-Otero4Constantino Lopez-Macias5Roman Alejandro Garcia-Ramirez6Concepción Grajales-Muñiz7Juan Manuel Mejia-Arangure8Coordination of Health Research, Mexican Social Security Institute (IMSS), Mexico City, MexicoCoordination of Epidemiological Surveillance and Contingencies Support, IMSS, Mexico City, MexicoCoordination of Health Research, Mexican Social Security Institute (IMSS), Mexico City, MexicoCoordination of Epidemiological Surveillance and Contingencies Support, IMSS, Mexico City, MexicoCoordination of Health Research, Mexican Social Security Institute (IMSS), Mexico City, MexicoMedical Research Unit on Immunochemistry, Specialties Hospital of the National Medical Centre Siglo XXI, IMSS, Mexico City, MexicoResearch Unit on Clinical Epidemiology, Pediatric Hospital of the National Medical Centre Siglo XXI, IMSS, Mexico City, MexicoCoordination of Epidemiological Surveillance and Contingencies Support, IMSS, Mexico City, MexicoCoordination of Health Research, Mexican Social Security Institute (IMSS), Mexico City, MexicoIntroduction: The frequency and mortality of the pandemic caused by influenza A(H1N1)pdm09 might have been underestimated, especially in developing countries. This study was designed to quantify the possible underestimation of pandemic influenza mortality and evaluate the concordance between the data reported for A(H1N1)pdm09 mortality and the causes of death reported during the pandemic period of April 2009 to February 2010. Methodology: The death certificates of 754 confirmed cases of A(H1N1)pdm09 infection were included in the study. Data was analyzed using the United States Centers for Disease Control and Prevention’s statistical model accounts for the variability in the proportion at each step using the Monte Carlo probabilistic model sampled from a uniform probability distribution. Results: A total of 1,969 deaths were estimated, with an estimated lethality of 5.53 per 100,000 (range, 3.5-8.76 per 100,000) in contrast with the 754 deaths and a lethality of 1.98 per 100,000 infected patients officially reported. In 631 of 754 (83.7%) death certificates from A(H1N1)pdm09 influenza-positive patients, influenza was not mentioned as a cause of death. Conclusions: It is possible that the mortality of the pandemic was three times higher than officially reported in Mexico. One source of error that could explain this underestimation is in the completion of death certificates, because in > 80% of confirmed cases of infection with influenza virus, it was not reported as the cause of death. https://jidc.org/index.php/journal/article/view/3622influenza A virus H1N1 subtypepandemicspublic healthdisease outbreaksstatisticspopulation
spellingShingle Eusebio Perez-Flores
Juan Carlos Izquierdo-Puente
Jose Juan Castillo-Perez
Gustavo Ramírez-Rosales
Israel Grijalva-Otero
Constantino Lopez-Macias
Roman Alejandro Garcia-Ramirez
Concepción Grajales-Muñiz
Juan Manuel Mejia-Arangure
Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in Mexico
Journal of Infection in Developing Countries
influenza A virus H1N1 subtype
pandemics
public health
disease outbreaks
statistics
population
title Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in Mexico
title_full Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in Mexico
title_fullStr Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in Mexico
title_full_unstemmed Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in Mexico
title_short Quantifying the mortality caused by the H1N1 influenza virus during the 2009 pandemic in Mexico
title_sort quantifying the mortality caused by the h1n1 influenza virus during the 2009 pandemic in mexico
topic influenza A virus H1N1 subtype
pandemics
public health
disease outbreaks
statistics
population
url https://jidc.org/index.php/journal/article/view/3622
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