• Open Access

Epidemiology of influenza A (H1N1)pdm09-associated deaths in the United States, September–October 2009


Matthew Biggerstaff, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A-32, Atlanta, GA, USA 30333. E-mail: zmo2@cdc.gov


Please cite this paper as: Regan et al. (2012) Epidemiology of influenza A (H1N1)pdm09-associated deaths in the United States, September–October 2009. Influenza and Other Respiratory Viruses 6(601), e169–e177.

Background  From April to July 2009, the United States experienced a wave of influenza A (H1N1)pdm09 virus (H1N1pdm09) infection. The majority of the deaths during that period occurred in persons <65 years of age with underlying medical conditions.

Objective  To describe the epidemiology of H1N1pdm09-associated deaths in the US during the fall of 2009.

Methods  We collected demographic, medical history, and cause of death information on a nationally representative, stratified random sample of 323 H1N1pdm09-associated deaths that occurred during September 1–October 31, 2009.

Results  Data were available for 302/323 (93%) deaths. Most cases (74%) were 18–64 years of age and had ≥1 underlying medical condition (72%). Among cases aged <18 years, 16/43 (37%) had a chronic lung disease, and 15/43 (35%) a neurological disorder; among cases aged ≥18 years, 94/254 (37%) had a chronic lung disease and 84/254 (33%) had a metabolic disorder. The median number of days between symptom onset and death was six among children (range, 1–48) and 12 among adults (range, 0–109). Influenza antiviral agents were prescribed for 187/268 (70%) of cases, but only 48/153 (31%) received treatment within 2 days of illness onset.

Conclusions  The characteristics of H1N1pdm09 deaths identified during the fall of 2009 were similar to those occurring April–July 2009. While most cases had conditions that were known to increase the risk for severe outcomes and were recommended to receive antiviral therapy, a minority of cases received antivirals early in the course of illness.