Systematic Reviews and Meta- and Pooled Analyses Hospitalization Fatality Risk of Influenza A(H1N1)pdm09: A Systematic Reviewand Meta-Analysis

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 es-timates 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 do-mestic product. Early in the next pandemic, estimation of a standardizedHFRmay 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. hospitalization; influenza; public health; severity Abbreviations: GDP, gross domestic product; HFR, hospitalization fatality risk; ICU, intensive care unit. The first influenza pandemic of the 21st century was rec-ognized in April 2009, when the United States reported th