Project Details

Report now available.
View the executive summary (pdf format)
You can view the full text from the H1N1 influenza and pandemic flu themed issue 1 publication details page on the HTA website

The question: what precisely are H1N1-infected patients in the UK dying of? How much is due to the infection, how much to secondary infections in the lung, how much to the effects of treatment, and - critically - what are the contributions of pre-existing diseases (co-morbidities) in patients who die? If this information is made available quickly as the epidemic develops, then clinicians can better evaluate and treat H1N1-infected patients, and consider new therapies. The only way to obtain this information is from autopsy, so that all the pre-mortem and post-mortem examination clinical and pathology data can be collated and synthesised.

To obtain this autopsy information, all available autopsy reports on patients who died with H1N1 infection will be collected centrally and entered on a database. A certain amount of data-cleaning will be necessary to make the results comparable and meaningful; this will be done by the Lead Applicant who has long practical experience in autopsy and autopsy data interpretation. All UK pathologists who undertake these autopsies over a period of 6 months will be approached to submit their autopsy case reports. The autopsies should be mostly consented procedures, but the coroner-requested cases (medico-legal autopsies) will also be collected.

The data will be collected in a central London office manned by a research assistant coordinator. After data-cleaning and anonymisation, the case results (ie detailed causes of death) will be posted on a website accessible to health care workers on a daily basis. As the data accumulate, there will be periodic summaries, and at the end of the project there will be summary peer-reviewed publication in medical journal.

To rapidly gather all the available clinical pathology information from autopsies performed on patients – adults and children - dying with known or suspected influenza A/H1N1 infection, across the United Kingdom.

To evaluate co-morbidities present in these deceased patients; correlate them with the H1N1-related pathology and treatment-associated pathology, determine their relative contributions, and estimate the significant features associated with death; identify pre-mortem diagnostic confusions contributing to death.

To evaluate the effects of treatment in these patients, including any adverse events following mass H1N1 vaccination.

To post this information, anonymised, in real time, on a website available to health care workers, followed by formal peer-reviewed publication.