Assessing severity & outcomes of SARI - PowerPoint Presentation

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Assessing severity & outcomes of SARI

Dr Gail Carson

www.isaric.tghn.org

#ISARIC1

ERS PREPARE Amsterdam

November, 2017

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Over the next 20 mins…

Definition

Flu pandemic 2009/2010 reflection

WHO Framework how to measure severity

Outcomes to consider

SPRINT SARI observational study

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What are we talking about

SARI

An acute respiratory infection with:

history of fever or measured fever of ≥ 38 °C;

and cough;

with onset within the last 10 days;

and requires hospitalization

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Definitions

Pandemic

An epidemic occurring worldwide or over a wide area crossing international borders and usually affecting a large number of people.

(A Dictionary of Epidemiology. Oxford. 2014

)

The worldwide spread of a new disease.

WHO, 2010

Epidemic

The occurrence in a community or region of cases of illness or health-related events clearly in excess of normal expectancy

(

A Dictionary of Epidemiology. Oxford. 2014

)

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AlexLMX

/

iStock

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How big a problem is it ?

SARI is a major public health problem. There have been multiple outbreaks of severe acute respiratory infection (SARI) over recent decades. The commonest cause of SARI is influenza.

Between pandemics, SARI is still one of the leading causes of death worldwide and places a major financial burden on health systems, given the substantial hospitalization requirements for affected patients.

There is a lack of information about the epidemiology and management of SARI patients globally, and a stated need from international bodies to establish the research infrastructure to gather this information rapidly during a time of acute need, or in an emergency such as the emergence of a new cause of SARI with epidemic potential

.

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GlaMOR

project

WHO estimated

18,631

laboratory-confirmed

pandemic H1N1 deaths

Estimated that 2009 global pandemic respiratory mortality was ~10-fold higher than the WHO’s laboratory-confirmed mortality count.

Although the pandemic mortality estimate was similar in magnitude to that of seasonal influenza, a marked shift toward mortality among persons < 65 y of age occurred, so that many more life-years were lost.

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Going back to 2009

Data for phase changes:

Phase 4 > 5: Is there evidence of sustained P2P transmission in ≥2 countries in 1WHO region

Phase 5 > 6: Is there evidence of sustained community transmission in multiple WHO regions?

Transmission:

How fast and far has this/will this spread?

Severity

: How bad is this? What can we expect?

What is the CFR? How can we best estimate this with limited data?

What are the age specific attack rates?

Who is most at risk?

What will the impact be on health services be... ...due to illness? ...due to fear or panic?

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Some of the questions

Presentation and symptoms

How accurate were the case definitions? Were symptoms typical vs. atypical?

Time of onset of symptoms to time of admission and severity of presentation and outcome?

How many admitted patients received antivirals before admission?

Data needed to prepare health services

What was the availability of essential elements of medical care for these patients? e.g., antibiotics, IV fluids, O2, mechanical ventilators, ECMO equipment

What were H1N1pdm patients dying from?

Viral pneumonia, secondary bacterial infections,

etc

What are risk factors for severe infection and death? Known seasonal risk factors vs. potential new risk factors vs. no “identifiable risk factors”

Pregnancy, obesity, HIV, vulnerable/ethnic populations

Rates of infection/severe illness in HCWs

Virus information

Incubation period, duration of infectiousness, relation of virus shedding to patterns of transmission/ in different settings (e.g., hospitals with different infection control practices)

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What is the shape of the severity pyramid ?

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The impact of interventions

How effective are pharmaceutical interventions?

Vaccines and Antivirals: questions about efficacy & dosing for adult and

pediatric

patients, stockpiles, deployment plans, want vs. need vs. access

How effective are non-pharmaceutical interventions?

School closures – more data available, but only from a small number of industrialized countries

Data made available from more countries of different economic levels were needed for timely public health policy decision making

anecdotal info from other places

E.g. Mass gatherings – Masks - Social distancing - Hand washing

Importance of identifying effective and appropriate

prevention strategies in the global context when not all countries have access to pharmaceuticals

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Pandemic Influenza Severity Assessment

(PISA)

Describe severity of an epidemic or pandemic and describe what to expect.

In 2011, the IHR review committee on the 2009 pandemic noted:

• The absence of a consistent, measurable and understandable depiction of severity of the pandemic.

• Influenza pandemics will continue to occur and influenza is grossly unpredictable.

• There needs to be a distinction between defining a pandemic and describing what to expect in a pandemic.

• … and recommended WHO should develop and apply measures that can be used to assess the

severity of every influenza epidemic.

By applying, evaluating and refining tools to measure severity every year, WHO and Member

States can be better prepared to assess severity in the next pandemic.

Inform risk management.

– The degree of severity informs risk assessments, policy decisions on planning and response, interventions and personal interest.

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PISA Indicators

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Proposed parameters

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What Endpoints make sense

in Clinical Trials of Severe Influenza?

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Harmonisation

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Institut

Pasteur

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SPRINT SARI

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Acknowledgments

Maria Van

Kerkhove

, WHO

Kaat

Vandemaele

, WHO Menno de Jong, AMC

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