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FOR IMMEDIATE RELEASE

Marshfield Clinic research comparing the H1N1 influenza virus with seasonal influenza viruses has been published in this week’s Journal of the American Medical Association (JAMA).

This work, funded by the Centers for Disease Control and Prevention (CDC), took advantage of Marshfield Clinic Research Foundation (MCRF) expertise and infrastructure used to study the effectiveness of influenza vaccine over the past several seasons.

Edward A. Belongia, M.D., is lead author on the study, “Clinical Characteristics and 30-Day Outcomes for Influenza A 2009 (H1N1), 2008-2009 (H1N1), and 2007-2008 (H3N2) Infections.” Dr. Belongia is director of the Marshfield Epidemiology Research Center, MCRF. Additional authors are: Marshfield Clinic - Stephanie A. Irving, M.H.S., Stephen C. Waring, D.V.M., Ph.D., Laura A. Coleman, Ph.D., Jennifer K. Meece, Ph.D., Mary Vandermause, BSMT, Debra Kempf, B.S.N.; and Centers for Disease Control and Prevention (CDC) - David K. Shay, M.D., M.P.H., and Stephen Lindstrom, Ph.D.

Link to the JAMA news release: www.pubs.ama-assn.org

Link to JAMA video story and script: www.pubs.ama-assn.org

In the study, symptoms and risk of complications - pneumonia or hospital admission - were similar for patients with pandemic H1N1 influenza and those with seasonal influenza A strains. Pandemic and seasonal H1N1 infections occurred more often in children and H3N2 infections were more common in adults. In children and adolescents, the rate of clinic visits for pandemic H1N1 infection was greatly increased compared to rates for recent seasonal influenza A strains. This suggests children were more susceptible to infection with pandemic H1N1, although clinical features of the illness were similar to those of seasonal strains.

This research publication in JAMA “is huge for our team here,” Belongia said. “JAMA accepting the study for publication indicates it is thought to be of broad general interest in terms of implications for clinical and public health. It’s nice to know we’ve been able to discover something here that’s of great interest regarding epidemiology of the H1N1 pandemic.”

The research team “took advantage of the situation with our ability and infrastructure to look at this in a way that no one else in the United States could. We’re a small population and other research systems are bigger than us, but we had all the pieces in place to do comparisons,” he said.

“This also is a testament to the quality of the research team. This work required a large multidisciplinary team with many areas of expertise, especially since this study was implemented and completed in such a short time. Patients were enrolled right into November 2009 and we were able to analyze the data, submit a manuscript and have it accepted within just a few months, demonstrating the high caliber of expertise and hard work by everyone on the team.”

The team included MCRF’s Core Lab, Bioinformatics Research Center, Information Systems and an extensive group of research coordinators and interviewers led by Deb Kempf, Sandy Strey and Deb Johnson, “who were in clinics on weekdays, nights, weekends, going to people’s houses to do these enrollments.”

Belongia thanked Clinic physicians, their staff and Ministry Saint Joseph’s Hospital. “Our research coordinators established excellent relationships with physicians and medical assistants in primary care departments. We realize our presence complicated their lives since we were using their space to see patients, and it impacted their work flow. Everyone that we worked with in the clinical areas was helpful and supportive. Clinical support for this research was one of the keys to our success.”

During the pandemic nothing happened according to schedule, Belongia said. “The regular flu seasons are somewhat predictable, but no one expected the huge increase in patient volume that we saw in October and early November. The community was hit with a tidal wave of flu, especially in children and young adults. Everyone on the research team rose to the occasion and did what was necessary to meet the demand. We had to be ready or we would miss a one-time opportunity to understand what was happening.”

Research often proceeds slowly, he added. “It takes a long time to get work finished, written and published but this came together very quickly and very well. It’s great that we were able to contribute some general knowledge about different strains of influenza A that will facilitate public health planning in the future.”

The study included 1,398 cases of lab-confirmed flu identified from 6,874 Marshfield Clinic patients who consented to be tested. Uniform enrollment and testing procedures in Marshfield provided a chance to directly compare flu illness patterns and outcomes over several seasons. Patients were recruited and tested for flu during visits for acute respiratory illness, enrolled during three time periods when different influenza A viruses were circulating. All were tested for flu and medical records were reviewed to identify hospital admissions and pneumonia episodes within 30 days. Investigators compared illness characteristics and occurrence of complications in participants with 2009 pandemic H1N1 virus, 2008-09 H1N1 and 2007-08 H3N2.

The Marshfield Clinic system provides patient care, research and education with 52 locations in northern, central and western Wisconsin, making it one of the largest comprehensive medical systems in the United States.