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

DOI
https://doi.org/10.1136/bmjgh-2018-001061
Journal volume & issue
Vol. 4, no. 1

Abstract

Read online

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.