BMJ Global Health (Feb 2019)
Using research to prepare for outbreaks of severe acute respiratory infection
- Andrew Bentley,
- John Marshall,
- Allen C Cheng,
- Anthony G Charles,
- Jordi Rello,
- Li Yang Hsu,
- David J Wallace,
- Shidasp Siami,
- Cédric Bruel,
- Sotharith Bory,
- Mich Vann,
- Bunlor Teav,
- Leakhann Som,
- Mikko J Jarrvisalo,
- Anni Pulkkinen,
- Tero Ala-kokko,
- Sari Melto,
- Thomas DAIX,
- Francois Philippart,
- Marchalot Antoine,
- Kelly Tiercelet,
- BRUYERE Remi,
- Sedillot Nicholas,
- Taimon Fabienne,
- Raomi Bruyere,
- Xavier Forceville,
- Simon Erickson,
- Lewis Campbell,
- Ravikiran Sonawane,
- John Santamaria,
- Mark Kol,
- Jeff Powis,
- Richard Hall,
- Anne E McCarthy,
- Philippe Jouvet,
- Mary Anne Opavsky,
- Elaine Gilfoyle,
- Nataly Farshait,
- Dori-Ann Martin,
- Donald Griesdale,
- John Muscedere,
- Asgar Rishu,
- Wai Ching Sin,
- Wallace Chun Wai Ngai,
- Paul Young,
- Annette Forrest,
- Alex Kazemi,
- Seton Henderson,
- Troy Browne,
- Anusha Ganeshalingham,
- Rachael McConnochie,
- Jae Hwa Cho,
- Tai Sun Park,
- Yun Su Sim,
- Youjin Chang,
- Heung Bum Lee,
- Seung Yong Park,
- Wai Ming Chan,
- Won-Yeon Lee,
- Derek C Angus,
- H Rogier van Doorn,
- Nguyen Van Kinh,
- Nguyen Vu Trung,
- Meghan Prin,
- Theogene Twagirumugabe,
- Olivier Felix UMUHIRE,
- HABARUREMA Sylvain,
- Eman Al Qasim,
- Jean-Michel Heraud,
- Mihaja Raberahona,
- Joelinotahiana Hasina RABARISON,
- Santiago Perez Patrigeon,
- Alejandra Ramirez-Venegas,
- Javier Araujo Meléndez,
- M Lourdes Guerrero,
- Ivan Mambule,
- Otieno George Ochieng,
- Behzad Nadjm,
- Iris Wai Sum Li,
- Won-Il Choi,
- KOMURIAN-PRADEL Florence,
- Yaseen M Arabi,
- T Eoin West,
- Elisabeth D Riviello,
- Rachael Parke,
- AnnaneE Djillali,
- Robert Fowler,
- Srinivas Murthy,
- Alistair Nichol,
- Calum Semple,
- Maya George,
- Miia Valkonen,
- Colin McArthur,
- Gail Carson,
- Genevieve O'Neill,
- J Perren Cobb,
- Jake Dunning,
- Jean-Daniel Chiche,
- Jin-Won Huh,
- Julia GUILLEBAUD,
- Norosoa Razanazatovo,
- Juilett Wambura Otieno,
- Karen Green,
- Kathy Rowan,
- John Kenneth Baillie,
- Laura Merson,
- Michael D Christian,
- Moritoki Egi,
- Nahoko Shindo,
- Peter Horby,
- Raul Pardinaz-Solis,
- Sebastián Ugarte Ubiergo,
- Steve AR Webb,
- Timothy M Uyeki,
- Anthony C Gordon,
- David L Paterson,
- Dean Everett,
- Evangelos J Giamarellos-Bourboulis,
- Kajsa-Stina Longuere,
- David Maslove,
- Gloria Crowl,
- Theresa Pedutem Humber,
- Edward Ellazar Humber,
- Ilona Bahinskaya,
- Joan Osbourne-Townsend,
- Ingeborg Welters,
- Nadia Malik,
- T S Browne,
- Jennifer Goodson,
- Vinaya Mahesh
Affiliations
- Andrew Bentley
- Respiratory Medicine Research Group, School of Translational Medicine, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- John Marshall
- 11 Ruesch Center for the Cure of Gastrointestinal Cancers, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
- Allen C Cheng
- Infectious Disease Epidemiology Unit – School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Anthony G Charles
- Jordi Rello
- Centro de Investigación Biomédica en Red – Enfermedades Respiratorias (CIBERES), Hospital Universitari Vall dHebron, Barcelona, Spain
- Li Yang Hsu
- 1 National University Singapore Saw Swee Hock School of Public Health, Singapore
- David J Wallace
- 2 Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Shidasp Siami
- 11 Intensive Care Unit, Centre Hospitalier Sud-Essonne Dourdan-Etampes, Etampes, France
- Cédric Bruel
- Service de réanimation, Groupe hospitalier Paris Saint Joseph, Paris, France
- Sotharith Bory
- Mich Vann
- Bunlor Teav
- Leakhann Som
- Mikko J Jarrvisalo
- Anni Pulkkinen
- Tero Ala-kokko
- 4 Department of intensive care, Oulu University Hospital, Oulu, Finland
- Sari Melto
- Thomas DAIX
- Francois Philippart
- 5 Intensive Care Unit, Fondation Hopital Saint Joseph, Paris, France
- Marchalot Antoine
- Kelly Tiercelet
- BRUYERE Remi
- Sedillot Nicholas
- Taimon Fabienne
- Raomi Bruyere
- Xavier Forceville
- Simon Erickson
- Paediatric Intensive Care Unit, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- Lewis Campbell
- Intensive Care Unit, Royal Darwin Hospital, Casuarina, Darwin, Australia
- Ravikiran Sonawane
- John Santamaria
- Mark Kol
- Jeff Powis
- Richard Hall
- 13 South East Genomic Laboratory Hub, London, UK
- Anne E McCarthy
- Philippe Jouvet
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Mary Anne Opavsky
- Elaine Gilfoyle
- Nataly Farshait
- Dori-Ann Martin
- Pediatric Critical Care, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
- Donald Griesdale
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
- John Muscedere
- Department of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada
- Asgar Rishu
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Wai Ching Sin
- Wallace Chun Wai Ngai
- Paul Young
- 15 Intensive Care Department, Wellington Hospital, London, UK
- Annette Forrest
- Alex Kazemi
- Seton Henderson
- Troy Browne
- Anusha Ganeshalingham
- Rachael McConnochie
- Jae Hwa Cho
- Tai Sun Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea (the Republic of)
- Yun Su Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
- Youjin Chang
- Heung Bum Lee
- Seung Yong Park
- Wai Ming Chan
- Won-Yeon Lee
- Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- H Rogier van Doorn
- Oxford University Clinical Research Unit, Ha Noi, Viet Nam
- Nguyen Van Kinh
- National Hospital of Tropical Diseases, Hanoi, Viet Nam
- Nguyen Vu Trung
- Meghan Prin
- Theogene Twagirumugabe
- Olivier Felix UMUHIRE
- HABARUREMA Sylvain
- Eman Al Qasim
- Jean-Michel Heraud
- 1 National Influenza Center, Virology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Mihaja Raberahona
- Faculté de Médecine, Université d’Antananarivo, Antananarivo, Analamanga, Madagascar
- Joelinotahiana Hasina RABARISON
- Institut Pasteur de Madagascar, Antananarivo, Madagascar
- Santiago Perez Patrigeon
- Alejandra Ramirez-Venegas
- Tobacco Smoking and COPD Research Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
- Javier Araujo Meléndez
- M Lourdes Guerrero
- Ivan Mambule
- Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi
- Otieno George Ochieng
- Behzad Nadjm
- clinical lecturer
- Iris Wai Sum Li
- Won-Il Choi
- KOMURIAN-PRADEL Florence
- Yaseen M Arabi
- professor of critical care
- T Eoin West
- Elisabeth D Riviello
- Rachael Parke
- 3 School of Nursing, The University of Auckland, Auckland, New Zealand
- AnnaneE Djillali
- Robert Fowler
- Sunnybrook Health Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Srinivas Murthy
- University of British Columbia, Vancouver, British Columbia, Canada
- Alistair Nichol
- Monash University, Melbourne, Victoria, Australia, Melbourne, Ireland
- Calum Semple
- International Severe Acute Respiratory and emerging Infection Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, UK
- Maya George
- Miia Valkonen
- Colin McArthur
- director of intensive care
- Gail Carson
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Heatlh, University of Oxford, Oxford, UK
- Genevieve O'Neill
- J Perren Cobb
- Jake Dunning
- Jean-Daniel Chiche
- Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center/University of Ulsan College of Medicine, Seoul, South Korea
- Julia GUILLEBAUD
- Norosoa Razanazatovo
- Juilett Wambura Otieno
- Karen Green
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Kathy Rowan
- 3 ICNARC, London, UK
- John Kenneth Baillie
- Roslin Institute, University of Edinburgh, Midlothian, UK
- Laura Merson
- ISARIC Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Michael D Christian
- 1 London`s Air Ambulance, London, UK
- Moritoki Egi
- Nahoko Shindo
- Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Raul Pardinaz-Solis
- Sebastián Ugarte Ubiergo
- Steve AR Webb
- Timothy M Uyeki
- Anthony C Gordon
- Department of Surgery and Cancer, Imperial College London, London, UK
- David L Paterson
- 5 The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
- Dean Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Evangelos J Giamarellos-Bourboulis
- Kajsa-Stina Longuere
- David Maslove
- Gloria Crowl
- Theresa Pedutem Humber
- Edward Ellazar Humber
- Ilona Bahinskaya
- Joan Osbourne-Townsend
- Ingeborg Welters
- Institute of Life Course and Medical Science, University of Liverpool, Liverpool, UK
- Nadia Malik
- T S Browne
- Jennifer Goodson
- Vinaya Mahesh
- DOI
- https://doi.org/10.1136/bmjgh-2018-001061
- Journal volume & issue
-
Vol. 4,
no. 1
Abstract
Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.