A global pandemic mortality study found prominent regional mortality variations in 2009 for Influenza A(H1N1)pdm09. The study by Morales, et al. (2017) attempts to identify factors that explain why the pandemic mortality burden was high in some countries and low in others.
As a starting point, the researchers identified possible risk factors worth investigating for Influenza A(H1N1)pdm09 mortality through a targeted literature search. We then used a modeling procedure (data simulations and regression models) to identify factors that could explain differences in respiratory mortality due to Influenza A(H1N1)pdm09. They ran 16 models to produce robust results and draw conclusions. In order to assess the role of each factor in explaining differences in excess pandemic mortality, they calculated the reduction in between country variance, which can be viewed as an effect-size for each factor.
The literature search identified 124 publications and 48 possible risk factors, of which the researchers were able to identify 27 factors with appropriate global datasets. The modeling procedure indicated that age structure (explaining 40% of the mean between country variance), latitude (8%), influenza A and B viruses circulating during the pandemic (3–8%), influenza A and B viruses circulating during the preceding influenza season (2–6%), air pollution (pm10; 4%) and the prevalence of other infections (HIV and TB) (4–6%) were factors that explained differences in mortality around the world. Healthcare expenditure, levels of obesity, the distribution of antivirals, and air travel did not explain global pandemic mortality differences.
The researchers conclude that their study found that countries with a large proportion of young persons had higher pandemic mortality rates in 2009. The co-circulation of influenza viruses during the pandemic and the circulation of influenza viruses during the preceding season were also associated with pandemic mortality rates. They found that real-time assessments of 2009 pandemic mortality risk factors (e.g., obesity) probably led to a number of false positive findings.
Reference: Morales KF, Paget J and Spreeuwenberg P. Possible explanations for why some countries were harder hit by the pandemic influenza virus in 2009 – a global mortality impact modeling study. BMC Infectious Diseases. 2017; 17:642
CDC Urges Vigilance: New Recommendations for Monitoring and Testing H5N1 Exposures
July 11th 2025With avian influenza A(H5N1) infections surfacing in both animals and humans, the CDC has issued updated guidance calling for aggressive monitoring and targeted testing to contain the virus and protect public health.
IP LifeLine: Layoffs and the Evolving Job Market Landscape for Infection Preventionists
July 11th 2025Infection preventionists, once hailed as indispensable during the pandemic, now face a sobering reality: budget pressures, hiring freezes, and layoffs are reshaping the field, leaving many IPs worried about their future and questioning their value within health care organizations.
A Helping Hand: Innovative Approaches to Expanding Hand Hygiene Programs in Acute Care Settings
July 9th 2025Who knew candy, UV lights, and a college kid in scrubs could double hand hygiene adherence? A Pennsylvania hospital’s creative shake-up of its infection prevention program shows that sometimes it takes more than soap to get hands clean—and keep them that way.