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Nairz M, Todorovic T, Gehrer CM, Grubwieser P, Burkert F, Zimmermann M, Trattnig K, Klotz W, Theurl I, Bellmann-Weiler R, Weiss G. Single-Center Experience in Detecting Influenza Virus, RSV and SARS-CoV-2 at the Emergency Department. Viruses 2023; 15:v15020470. [PMID: 36851685 PMCID: PMC9958692 DOI: 10.3390/v15020470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
Reverse transcription polymerase chain reaction (RT-PCR) on respiratory tract swabs has become the gold standard for sensitive and specific detection of influenza virus, respiratory syncytial virus (RSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this retrospective analysis, we report on the successive implementation and routine use of multiplex RT-PCR testing for patients admitted to the Internal Medicine Emergency Department (ED) at a tertiary care center in Western Austria, one of the hotspots in the early coronavirus disease 2019 (COVID-19) pandemic in Europe. Our description focuses on the use of the Cepheid® Xpert® Xpress closed RT-PCR system in point-of-care testing (POCT). Our indications for RT-PCR testing changed during the observation period: From the cold season 2016/2017 until the cold season 2019/2020, we used RT-PCR to diagnose influenza or RSV infection in patients with fever and/or respiratory symptoms. Starting in March 2020, we used the RT-PCR for SARS-CoV-2 and a multiplex version for the combined detection of all these three respiratory viruses to also screen subjects who did not present with symptoms of infection but needed in-hospital medical treatment for other reasons. Expectedly, the switch to a more liberal RT-PCR test strategy resulted in a substantial increase in the number of tests. Nevertheless, we observed an immediate decline in influenza virus and RSV detections in early 2020 that coincided with public SARS-CoV-2 containment measures. In contrast, the extensive use of the combined RT-PCR test enabled us to monitor the re-emergence of influenza and RSV detections, including asymptomatic cases, at the end of 2022 when COVID-19 containment measures were no longer in place. Our analysis of PCR results for respiratory viruses from a real-life setting at an ED provides valuable information on the epidemiology of those infections over several years, their contribution to morbidity and need for hospital admission, the risk for nosocomial introduction of such infection into hospitals from asymptomatic carriers, and guidance as to how general precautions and prophylactic strategies affect the dynamics of those infections.
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Rodriguez R, Espinoza D, Junia C. If the Test Fits: Diagnosis to Aid in the Treatment of Influenza. Cureus 2022; 14:e27850. [PMID: 36110448 PMCID: PMC9462060 DOI: 10.7759/cureus.27850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/01/2022] [Indexed: 12/01/2022] Open
Abstract
Influenza is a significant cause of morbidity and mortality worldwide, presenting with lethal complications such as acute respiratory distress syndrome (ARDS). Multiple ways to diagnose influenza include rapid antigen tests, flu polymerase chain reaction (PCR), and respiratory viral panels or multiplex PCR. However, they have different sensitivities and specificities. We present a case of a 70-year-old female who was admitted to the ICU for ARDS and had a high pretest probability of influenza. She had an initial rapid flu antigen test that was negative and a negative flu PCR. However, she tested positive for influenza A (H1N1) with a respiratory viral panel. We as physicians should take into consideration the different sensitivities and specificities diagnostic tests have and consider retesting patients who have a negative test in the context of a high pretest probability. We should also remember to begin antiviral therapy early in a patient with high suspicion of influenza with a severe clinical presentation despite not having a confirmed diagnosis.
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3
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Havasi A, Visan S, Cainap C, Cainap SS, Mihaila AA, Pop LA. Influenza A, Influenza B, and SARS-CoV-2 Similarities and Differences – A Focus on Diagnosis. Front Microbiol 2022; 13:908525. [PMID: 35794916 PMCID: PMC9251468 DOI: 10.3389/fmicb.2022.908525] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/23/2022] [Indexed: 12/23/2022] Open
Abstract
In late December 2019, the first cases of viral pneumonia caused by an unidentified pathogen were reported in China. Two years later, SARS-CoV-2 was responsible for almost 450 million cases, claiming more than 6 million lives. The COVID-19 pandemic strained the limits of healthcare systems all across the world. Identifying viral RNA through real-time reverse transcription-polymerase chain reaction remains the gold standard in diagnosing SARS-CoV-2 infection. However, equipment cost, availability, and the need for trained personnel limited testing capacity. Through an unprecedented research effort, new diagnostic techniques such as rapid diagnostic testing, isothermal amplification techniques, and next-generation sequencing were developed, enabling accurate and accessible diagnosis. Influenza viruses are responsible for seasonal outbreaks infecting up to a quarter of the human population worldwide. Influenza and SARS-CoV-2 present with flu-like symptoms, making the differential diagnosis challenging solely on clinical presentation. Healthcare systems are likely to be faced with overlapping SARS-CoV-2 and Influenza outbreaks. This review aims to present the similarities and differences of both infections while focusing on the diagnosis. We discuss the clinical presentation of Influenza and SARS-CoV-2 and techniques available for diagnosis. Furthermore, we summarize available data regarding the multiplex diagnostic assay of both viral infections.
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Affiliation(s)
- Andrei Havasi
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Medical Oncology, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Simona Visan
- Department of Genetics, Genomics and Experimental Pathology, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Calin Cainap
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Medical Oncology, The Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania
| | - Simona Sorana Cainap
- Pediatric Clinic No. 2, Department of Pediatric Cardiology, Emergency County Hospital for Children, Cluj-Napoca, Romania
- Department of Mother and Child, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- *Correspondence: Simona Sorana Cainap, ;
| | - Alin Adrian Mihaila
- Faculty of Economics and Business Administration, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Laura-Ancuta Pop
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
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4
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Koesnoe S, Masjkuri N, Adisasmita A, Djauzi S, Kartasasmita C, Sundoro J, Nadjib M, Korib M, Muthia AN, Muzellina VN, Habibah U, Nursyirwan SA, Djaya KH, Bachtiar NS, Sari RM. A randomized controlled trial to evaluate the effect of influenza vaccination and probiotic supplementation on immune response and incidence of influenza-like illness in an elderly population in Indonesia. PLoS One 2021; 16:e0250234. [PMID: 34914726 PMCID: PMC8675694 DOI: 10.1371/journal.pone.0250234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/27/2021] [Indexed: 11/19/2022] Open
Abstract
AIM To investigate the effect of influenza vaccination with or without probiotic supplementation on the immune response and incidence of influenza-like illness (ILI) in the elderly. METHODS A randomized double-blind, placebo-controlled trial with a modified factorial design was conducted in 554 healthy elderly subjects aged 67 ± 5.6 (ranging from 60-90) years old in the Primary Health Care Center (Puskesmas area) of the Pulo Gadung District East Jakarta. Subjects received either a trivalent influenza vaccine or placebo at the start of the study, and a probiotic supplement (Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011) or a placebo for 6 months. Subjects were randomly assigned into four intervention groups: influenza vaccine and probiotics (n = 141), influenza vaccine and placebo (n = 136), placebo and probiotics (n = 140), and both placebo (n = 137). The primary outcome was ILI incidence within 6 months. The secondary outcomes were seroprotection and seroconversion rates at 1, 4, and 6 months after administering the interventions. RESULTS This study showed that the trivalent influenza vaccine increased seroprotection (RR 3.6 [95%CI 2.92-4.47]; p<0.010) and seroconversion (RR 29.8 [95%CI 11.1-79.5]; p<0.010) rates 1 month after vaccination in elderly people while the probiotic supplement did not alter influenza antibody titers (p = 1.000 and p = 0.210). The relative ILI incidence risk was similar between vaccinated and non-vaccinated groups, as well as in the probiotic group compared to the non-probiotic group. CONCLUSION The tested trivalent influenza vaccine significantly induced seroprotection and seroconversion in the vaccinated subjects, while probiotics administration did not influence these parameters. Vaccinated individuals displayed a similarly low ILI incidence as those in the Control Group. However, the observed trend towards a reduction of ILI incidence with probiotics supplementation warrants further assessments in a larger, at-risk population. CLINICAL TRIAL REGISTRY NUMBER NCT03695432.
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Affiliation(s)
- Sukamto Koesnoe
- Division of Allergy and Immunology, Department of Internal Medicine, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
- * E-mail:
| | - Nuning Masjkuri
- Department of Epidemiology, Faculty of Public Health University of Indonesia Jakarta, Jakarta, Indonesia
| | - Asri Adisasmita
- Department of Epidemiology, Faculty of Public Health University of Indonesia Jakarta, Jakarta, Indonesia
| | - Samsuridjal Djauzi
- Division of Allergy and Immunology, Department of Internal Medicine, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Cissy Kartasasmita
- Department of Child Health, Faculty of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - Mardiati Nadjib
- Department of Health Policy and Administration, Faculty of Public Health University of Indonesia, Jakarta, Indonesia
| | - Mondastri Korib
- Department of Epidemiology, Faculty of Public Health University of Indonesia Jakarta, Jakarta, Indonesia
| | | | - Virly Nanda Muzellina
- Division of Gastroenterology, Depertment of Internal Medicine, dr. Cipto Mangunkusomo Hospital, Jakarta, Indonesia
- Division of Gastroenterology, Depertment of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
| | - Ummu Habibah
- Indonesian Society of Internal Medicine, Jakarta, Indonesia
| | - Saskia Aziza Nursyirwan
- Division of Gastroenterology, Depertment of Internal Medicine, dr. Cipto Mangunkusomo Hospital, Jakarta, Indonesia
- Division of Gastroenterology, Depertment of Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, Indonesia
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5
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Beale S, Johnson AM, Zambon M, Hayward AC, Fragaszy EB. Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort. Wellcome Open Res 2021; 5:98. [PMID: 34250260 PMCID: PMC8243225 DOI: 10.12688/wellcomeopenres.15796.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants ( n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.
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Affiliation(s)
- Sarah Beale
- UCL Public Health Data Science Research Group, Institute of Health Informatics, UCL, London, NW1 2DA, UK
- UCL Institute of Epidemiology and Health Care, UCL, London, WC1E 7HB, UK
| | | | - Maria Zambon
- Public Health England, London, EC4Y 8AE, UK
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, W2 1PG, UK
| | - Flu Watch Group
- UCL Public Health Data Science Research Group, Institute of Health Informatics, UCL, London, NW1 2DA, UK
- UCL Institute of Epidemiology and Health Care, UCL, London, WC1E 7HB, UK
- UCL Institute of Global Health, UCL, London, WC1E 7HB, UK
- Public Health England, London, EC4Y 8AE, UK
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, W2 1PG, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew C. Hayward
- UCL Institute of Epidemiology and Health Care, UCL, London, WC1E 7HB, UK
| | - Ellen B. Fragaszy
- UCL Public Health Data Science Research Group, Institute of Health Informatics, UCL, London, NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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6
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Rothberg MB. Influenza, Like COVID-19, Needs Randomized Trials. J Gen Intern Med 2021; 36:1490-1491. [PMID: 33483821 PMCID: PMC7822583 DOI: 10.1007/s11606-020-06567-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA.
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7
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Quandelacy TM, Cummings DAT, Jiang CQ, Yang B, Kwok KO, Dai B, Shen R, Read JM, Zhu H, Guan Y, Riley S, Lessler J. Using serological measures to estimate influenza incidence in the presence of secular trends in exposure and immuno-modulation of antibody response. Influenza Other Respir Viruses 2021; 15:235-244. [PMID: 33108707 PMCID: PMC7902255 DOI: 10.1111/irv.12807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Influenza infection is often measured by a fourfold antibody titer increase over an influenza season (ie seroconversion). However, this approach may fail when influenza seasons are less distinct as it does not account for transient effects from recent infections. Here, we present a method to determine seroconversion for non-paired sera, adjusting for changes in individuals' antibody titers to influenza due to the transient impact of recent exposures, varied sampling times, and laboratory processes. METHODS We applied our method using data for five H3N2 strains collected from 942 individuals, aged 2-90 years, during the first two study visits of the Fluscape cohort study (2009-2012) in Guangzhou, China. RESULTS After adjustment, apparent seroconversion rates for non-circulating strains decreased while we observed a 20% increase in seroconversion rates to recently circulating strains. When examining seroconversion to the most recently circulating strain (A/Brisbane/20/2007) in our study, participants aged under 18, and over 64 had the highest seroconversion rates compared to other age groups. CONCLUSIONS Our results highlight the need for improved methods when using antibody titers as an endpoint in settings where there is no clear influenza "off" season. Methods, like those presented here, that use titers from circulating and non-circulating strains may be key.
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Affiliation(s)
- Talia M. Quandelacy
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Present address:
Centers for Disease Control and PreventionSan JuanPuerto Rico
| | - Derek A. T. Cummings
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Department of BiologyUniversity of FloridaGainesvilleFLUSA
| | | | - Bingyi Yang
- Department of BiologyUniversity of FloridaGainesvilleFLUSA
| | - Kin On Kwok
- The Jockey Club School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong Special Administrative RegionChina
- Stanley Ho Centre for Emerging Infectious DiseasesHong Kong Special Administrative RegionThe Chinese University of Hong KongShatin, Hong KongChina
- Shenzhen Research InstituteThe Chinese University of Hong KongShenzhenChina
| | - Byran Dai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Jonathan M. Read
- Center for Health Informatics Computing and StatisticsLancaster Medical SchoolLancaster UniversityLancasterUK
- Institute of Infection and Global HealthUniversity of LiverpoolLiverpoolUK
| | - Huachen Zhu
- State Key Laboratory of Emerging Infectious DiseasesSchool of Public HealthThe University of Hong KongHong KongChina
- Shantou University Medical CollegeShantouChina
| | - Yi Guan
- Shantou University Medical CollegeShantouChina
- School of Public HealthImperial College LondonLondonUK
| | - Steven Riley
- School of Public HealthImperial College LondonLondonUK
| | - Justin Lessler
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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8
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El Feghaly RE, Nolen JD, Lee BR, Abraham G, Nedved A, Hassan F, Selvarangan R. Impact of Rapid Influenza Molecular Testing on Management in Pediatric Acute Care Settings. J Pediatr 2021; 228:271-277.e1. [PMID: 32828881 DOI: 10.1016/j.jpeds.2020.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/01/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To measure the impact of rapid influenza real-time qualitative reverse transcriptase polymerase chain reaction (RT-PCR) on patient management in busy pediatric emergency department (ED) and urgent care clinic settings. STUDY DESIGN We developed a brief, elective survey that clinicians completed when an influenza RT-PCR order was placed in the ED or urgent care clinic between February 18, 2019, and March 13, 2019. We captured the clinical suspicion for influenza, intended management plans, and actual management plans once influenza RT-PCR results were available. RESULTS We evaluated 339 encounters, of which 164 (48.4%) had a positive influenza RT-PCR. Clinical suspicion for influenza was a nonsignificant predictor for influenza PT-PCR positivity (P = .126). After rapid influenza RT-PCR results were available, clinicians changed their original plans in 44.5% of influenza RT-PCR positive vs 92.6% of influenza RT-PCR negative cases (P < .0001). Change in plans for antiviral use was observed in 26% of influenza positive vs 77% of influenza negative cases (P < .0001). A total of 135 antiviral prescriptions were avoided in patients with negative influenza RT-PCR. CONCLUSIONS Implementation of a rapid and accurate influenza RT-PCR in the acute care setting is important to systematically diagnose influenza in children and improve outpatient management decisions, because clinical suspicion for influenza is inaccurate. A negative influenza RT-PCR decreases unnecessary antiviral use and has the potential for significant cost savings.
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Affiliation(s)
- Rana E El Feghaly
- Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO; University of Missouri Kansas City, Kansas City, MO
| | - John David Nolen
- University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Brian R Lee
- University of Missouri Kansas City, Kansas City, MO; Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO
| | - George Abraham
- University of Missouri Kansas City, Kansas City, MO; Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Amanda Nedved
- University of Missouri Kansas City, Kansas City, MO; Division of Urgent Care, Children's Mercy Kansas City, Kansas City, MO
| | - Ferdaus Hassan
- University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO
| | - Rangaraj Selvarangan
- Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO; University of Missouri Kansas City, Kansas City, MO; Division of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, MO.
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9
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Beale S, Johnson AM, Zambon M, Hayward AC, Fragaszy EB. Hand Hygiene Practices and the Risk of Human Coronavirus Infections in a UK Community Cohort. Wellcome Open Res 2020; 5:98. [PMID: 34250260 PMCID: PMC8243225 DOI: 10.12688/wellcomeopenres.15796.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand hygiene impacted the risk of acquiring seasonal coronavirus infections. Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants ( n=1633) provided baseline estimates of hand hygiene behaviour. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness, both unadjusted and adjusted for confounding by age and healthcare worker status. Results: Moderate-frequency handwashing (6-10 times per day) predicted a lower personal risk of coronavirus infection (adjusted incidence rate ratio (aIRR) =0.64, p=0.04). There was no evidence for a dose-response effect of handwashing, with results for higher levels of hand hygiene (>10 times per day) not significant (aIRR =0.83, p=0.42). Conclusions: This is the first empirical evidence that regular handwashing can reduce personal risk of acquiring seasonal coronavirus infection. These findings support clear public health messaging around the protective effects of hand washing in the context of the current COVID-19 pandemic.
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Affiliation(s)
- Sarah Beale
- UCL Public Health Data Science Research Group, Institute of Health Informatics, UCL, London, NW1 2DA, UK
- UCL Institute of Epidemiology and Health Care, UCL, London, WC1E 7HB, UK
| | | | - Maria Zambon
- Public Health England, London, EC4Y 8AE, UK
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, W2 1PG, UK
| | - Flu Watch Group
- UCL Public Health Data Science Research Group, Institute of Health Informatics, UCL, London, NW1 2DA, UK
- UCL Institute of Epidemiology and Health Care, UCL, London, WC1E 7HB, UK
- UCL Institute of Global Health, UCL, London, WC1E 7HB, UK
- Public Health England, London, EC4Y 8AE, UK
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, W2 1PG, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew C. Hayward
- UCL Institute of Epidemiology and Health Care, UCL, London, WC1E 7HB, UK
| | - Ellen B. Fragaszy
- UCL Public Health Data Science Research Group, Institute of Health Informatics, UCL, London, NW1 2DA, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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10
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Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, Gravenstein S, Hayden FG, Harper SA, Hirshon JM, Ison MG, Johnston BL, Knight SL, McGeer A, Riley LE, Wolfe CR, Alexander PE, Pavia AT. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis 2020; 68:e1-e47. [PMID: 30566567 DOI: 10.1093/cid/ciy866] [Citation(s) in RCA: 328] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022] Open
Abstract
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry H Bernstein
- Division of General Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - John S Bradley
- Division of Infectious Diseases, Rady Children's Hospital.,University of California, San Diego
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital
| | - Thomas M File
- Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan Gravenstein
- Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville
| | - Scott A Harper
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon Mark Hirshon
- Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Lynn Johnston
- Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Allison McGeer
- Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada
| | - Laura E Riley
- Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Paul E Alexander
- McMaster University, Hamilton, Ontario, Canada.,Infectious Diseases Society of America, Arlington, Virginia
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City
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11
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Diomidous M, Isaakidou M. Factors Influencing the Implementation of Flu Vaccination in Healthcare Professionals: Pros and Cons. Mater Sociomed 2020; 32:307-314. [PMID: 33628135 PMCID: PMC7879438 DOI: 10.5455/msm.2020.32.307-314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Vaccination is the best method for microbial and viral infections prevention. Especially for health professionals, flu vaccination is the best method to protect them, and the same applies for the patients and the general population from being infected. One of the most important preventive measure is vaccination and the main types of vaccines available, the limitations and side effects are briefly presented. Aim: The aim of this paper is to present the necessity of the healthcare professionals to conceptualize the importance of flu vaccination ifor themselves and the general population. Healthcare professionals are influenced by their knowledge, attitudes, and beliefs. Epidemiological surveys on this issue are presented for Greece, European Union, and the USA. Methods: A broad scope literature review was conducted based on a strict selection process of articles referring to the general population and the healthcare professionals with emphasis on the time period from the fall of 2018 until the spring of 2020 across Greece. The method used in this research obtained information through bibliographical references throughout Europe, USA, and relevant studies in Greece. Results: The results of this research indicated that influenza vaccination among healthcare professionals in Greece in the time period 2018-2019 was higher in primary health centers (PHCs) with a percentage of 43.8% than in Hospitals which was 30.6%. In addition, in the time period 2019-2020 flu vaccination among health professionals was higher in PHCs with a percentage of 57.9% rather than in Hospitals with a percentage of 38.8%. Specifically, flu vaccination rate which took place in hospitals was higher among physicians than in other healthcare personnel. Furthermore, the fundamental reasons for recommending flu vaccination in healthcare professionals are presented, and issues related to denial or acceptance of it are highlighted. Measures and strategies are proposed in order to increase flu vaccination coverage in healthcare facilities in Greece. Conclusions: Based on this research review healthcare professionals (HCPs) especially the ones working in ICUs, in ICUs for newborn children, in Departments for acute care infections, in Departments caring of persons with immunodeficiency or Units for transplantation, Oncology and Haematology Departments, and finally, in Emergency Care Units need directly to be vaccinated for the flu virus. Different measures have been undertaken to promote flu vaccination and the percentage of implementation has been highlighted.
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Affiliation(s)
- Marianna Diomidous
- Department of Public Health, Faculty of Nursing, National and Kapodistrian University of Athens, Greece
| | - Marianna Isaakidou
- Department of Public Health, Faculty of Nursing, National and Kapodistrian University of Athens, Greece
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Colunga‐Salas P, Sánchez‐Montes S, Grostieta E, Verde‐Arregoitia LD, Cabrera‐Garrido MY, Becker I, León‐Paniagua L. What do studies in wild mammals tell us about human emerging viral diseases in Mexico? Transbound Emerg Dis 2020; 67:33-45. [PMID: 31461573 PMCID: PMC7168564 DOI: 10.1111/tbed.13336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 01/01/2023]
Abstract
Multiple species of viruses circulate in wild mammals, some of them potentially causing zoonosis. Most of the suspected viral zoonotic diseases affecting human patients remain unidentified with regard to their aetiological agent. The aim of this study is to summarize the state of knowledge of the viral richness associated with wild mammals in Mexico throughout 1900-2018 and their relationship with human cases. We compiled two databases, one of them containing all available published studies on potentially zoonotic viruses in wild mammals and another with human cases related to zoonotic viruses. The database on wild mammals covers the period of 1900-2018; the human case database spans 2000-2013. We calculated the richness of viral potential zoonotic agents and evaluated their geographical distribution. We found 262 records of 42 potential zoonotic viral species associated with 92 wild mammal species in 28 states across Mexico. Records of human viral cases were only found in 29 states, which did not overlap with the reports in wild mammals. We detected 25.6% (42/164) of viral zoonotic agents reported worldwide. This analysis opens a relevant topic of discussion for public health attention.
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Affiliation(s)
- Pablo Colunga‐Salas
- Museo de Zoología “Alfonso L. Herrera”Facultad de CienciasUniversidad Nacional Autónoma de MéxicoCiudad de MéxicoMéxico
- Centro de Medicina TropicalFacultad de MedicinaUniversidad Nacional Autónoma de MéxicoCiudad de MéxicoMéxico
| | - Sokani Sánchez‐Montes
- Centro de Medicina TropicalFacultad de MedicinaUniversidad Nacional Autónoma de MéxicoCiudad de MéxicoMéxico
| | - Estefania Grostieta
- Centro de Medicina TropicalFacultad de MedicinaUniversidad Nacional Autónoma de MéxicoCiudad de MéxicoMéxico
| | | | - Martín Y. Cabrera‐Garrido
- Museo de Zoología “Alfonso L. Herrera”Facultad de CienciasUniversidad Nacional Autónoma de MéxicoCiudad de MéxicoMéxico
| | - Ingeborg Becker
- Centro de Medicina TropicalFacultad de MedicinaUniversidad Nacional Autónoma de MéxicoCiudad de MéxicoMéxico
| | - Livia León‐Paniagua
- Museo de Zoología “Alfonso L. Herrera”Facultad de CienciasUniversidad Nacional Autónoma de MéxicoCiudad de MéxicoMéxico
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The Prevalence of Respiratory Viruses Among Patients with Influenza-Like Illness in Zahedan, Southeastern Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.77089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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14
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Adisasmito W, Budayanti S, Aisyah DN, Coker R, Andayani AR, Smith GJD, Rudge JW. Surveillance and characterisation of influenza viruses among patients with influenza-like illness in Bali, Indonesia, July 2010-June 2014. BMC Infect Dis 2019; 19:231. [PMID: 30845930 PMCID: PMC6407202 DOI: 10.1186/s12879-019-3842-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/21/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although Indonesia has high fatality rate of human A/H5N1 cases, epidemiological and clinical data on influenza virus circulation among humans has been limited. Within Indonesia, Bali province is of interest due to high population densities of humans, pigs and poultry. This study aims to characterize and compare the epidemiological and clinical patterns of influenza viruses in humans through surveillance among patients with influenza-like illness (ILI) in Bali, Indonesia. METHODS ILI patients were recruited at 21 sentinel health facilities across all nine regencies in Bali, from July 2010 to June 2014. PCR-based assays were used for detection and subtyping of influenza viruses. Demographic, behavioural and clinical data were tested for associations with influenza using chi-squared tests and logistic regression. RESULTS Of 2077 ILI patients, 291 (14.0%) tested positive for influenza A, 152 (7.3%) for influenza B, and 16 (0.77%) for both influenza A and B. Of the influenza A isolates, the majority 61.2% were A/H3N2, followed by A/H1N1-pdm09 (80; 26.1%). Two A/H5N1 were identified. Influenza positive rates were significantly higher during wet season months (28.3%), compared with the dry season (13.8%; χ2 = 61.1; df = 1; p < 0.0001). Clinical predictors for infection varied by virus type, with measured fever (≥38 °C) more strongly associated with influenza B (AOR: 1.62; 95% CI: 1.10, 2.39). CONCLUSION Influenza circulates year-round among humans in Bali with higher activity during the wet season. High contact rates with poultry and pigs, along with influenza virus detection that could not be subtyped through conventional assays, highlight the need for molecular studies to characterize epidemiological and evolutionary dynamics of influenza in this setting.
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Affiliation(s)
- Wiku Adisasmito
- Faculty of Public Health, Universitas Indonesia, Depok, West Java 16424 Indonesia
| | | | - Dewi Nur Aisyah
- Faculty of Public Health, Universitas Indonesia, Depok, West Java 16424 Indonesia
| | - Richard Coker
- Communicable Diseases Policy Research Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | | | - James W. Rudge
- Communicable Diseases Policy Research Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, Gravenstein S, Hayden FG, Harper SA, Hirshon JM, Ison MG, Johnston BL, Knight SL, McGeer A, Riley LE, Wolfe CR, Alexander PE, Pavia AT. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis 2019; 68. [PMID: 30566567 PMCID: PMC6653685 DOI: 10.1093/cid/ciy866 10.1093/cid/ciz044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry H Bernstein
- Division of General Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - John S Bradley
- Division of Infectious Diseases, Rady Children's Hospital
- University of California, San Diego
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital
| | - Thomas M File
- Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan Gravenstein
- Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville
| | - Scott A Harper
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon Mark Hirshon
- Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Lynn Johnston
- Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Allison McGeer
- Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada
| | - Laura E Riley
- Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Paul E Alexander
- McMaster University, Hamilton, Ontario, Canada
- Infectious Diseases Society of America, Arlington, Virginia
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City
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Rastogi M, Singh SK. Advances in Molecular Diagnostic Approaches for Biothreat Agents. DEFENSE AGAINST BIOLOGICAL ATTACKS 2019. [PMCID: PMC7123646 DOI: 10.1007/978-3-030-03071-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The advancement in Molecular techniques has been implicated in the development of sophisticated, high-end diagnostic platform and point-of-care (POC) devices for the detection of biothreat agents. Different molecular and immunological approaches such as Immunochromatographic and lateral flow assays, Enzyme-linked Immunosorbent assays (ELISA), Biosensors, Isothermal amplification assays, Nucleic acid amplification tests (NAATs), Next Generation Sequencers (NGS), Microarrays and Microfluidics have been used for a long time as detection strategies of the biothreat agents. In addition, several point of care (POC) devices have been approved by FDA and commercialized in markets. The high-end molecular platforms like NGS and Microarray are time-consuming, costly, and produce huge amount of data. Therefore, the future prospects of molecular based technique should focus on developing quick, user-friendly, cost-effective and portable devices against biological attacks and surveillance programs.
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Odun-Ayo F, Odaibo G, Olaleye D. Influenza virus A (H1 and H3) and B co-circulation among patient presenting with acute respiratory tract infection in Ibadan, Nigeria. Afr Health Sci 2018; 18:1134-1143. [PMID: 30766579 PMCID: PMC6354865 DOI: 10.4314/ahs.v18i4.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Influenza is an acute respiratory disease that continues to cause global epidemics and pandemics in human with significant mortality and morbidity. Objectives This study was designed to identify the circulating influenza virus in Ibadan, Nigeria during the 2006/2007 season. Methods Throat swab samples were collected from patients presenting with acute respiratory tract infection at the Out-Patient Departments of major hospitals in Ibadan over a period of seven months from November 2006 to May 2007. Isolation of influenza virus was performed using Madin-Darby Canine Kidney cell line and 10 days old chicken embryonated egg. Isolates was identified by haemagglutination and haemagglutination-inhibition assays using selected CDC Influenza reference antisera (A, B, subtype H1 and H3). Results Out of 128 patients tested, 21(16.4%) yielded positive for virus isolation. Identification of the isolates showed that 19(14.8%) were positive for influenza virus out of which 11(8.6%) and 8(6.2%) were influenza A and B viruses respectively. Influenza A virus 6(4.7%) were subtype H1; 4(3.1%) were co-subtype H1 and H3; and 1(0.8%) was not inhibited by subtype H1 and H3. Conclusion The circulation of influenza virus A and B in this study is important to contributing knowledge and data to influenza epidemiology and surveillance in Nigeria.
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18
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Fragaszy EB, Warren-Gash C, Wang L, Copas A, Dukes O, Edmunds WJ, Goonetilleke N, Harvey G, Johnson AM, Kovar J, Lim MS, McMichael A, Millett ER, Nazareth I, Nguyen-Van-Tam JS, Tabassum F, Watson JM, Wurie F, Zambon M, Hayward AC. Cohort Profile: The Flu Watch Study. Int J Epidemiol 2018; 46:e18. [PMID: 26940466 PMCID: PMC5837336 DOI: 10.1093/ije/dyv370] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ellen B Fragaszy
- Institute of Health Informatics, University College London, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lili Wang
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Andrew Copas
- Research Department of Infection & Population Health, University College London, London, UK
| | - Oliver Dukes
- Institute of Health Informatics, University College London, London, UK
| | - W John Edmunds
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nilu Goonetilleke
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.,Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, CA, USA
| | - Gabrielle Harvey
- Research Department of Infection & Population Health, University College London, London, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, London, UK
| | - Jana Kovar
- Research Department of Infection & Population Health, University College London, London, UK
| | - Megan Sc Lim
- Research Department of Infection & Population Health, University College London, London, UK.,Burnet Institute, Centre for Population Health, Melbourne, VIC, Australia
| | - Andrew McMichael
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | | | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Faiza Tabassum
- Research Department of Infection & Population Health, University College London, London, UK
| | - John M Watson
- Chief Medical Officer's Private Office, Department of Health, London, UK and
| | - Fatima Wurie
- Institute of Health Informatics, University College London, London, UK
| | - Maria Zambon
- Public Health England Respiratory Virus Unit, Colindale, UK
| | - Andrew C Hayward
- Institute of Health Informatics, University College London, London, UK
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Imai C, Toizumi M, Hall L, Lambert S, Halton K, Merollini K. A systematic review and meta-analysis of the direct epidemiological and economic effects of seasonal influenza vaccination on healthcare workers. PLoS One 2018; 13:e0198685. [PMID: 29879206 PMCID: PMC5991711 DOI: 10.1371/journal.pone.0198685] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Influenza vaccination is a commonly used intervention to prevent influenza infection in healthcare workers (HCWs) and onward transmission to other staff and patients. We undertook a systematic review to synthesize the latest evidence of the direct epidemiological and economic effectiveness of seasonal influenza vaccination among HCW. METHODS We conducted a systematic search of MEDLINE/PubMed, Scopus, and Cochrane Central Register of Controlled Trials from 1980 through January 2018. All studies comparing vaccinated and non-vaccinated (i.e. placebo or non-intervention) groups of HCWs were included. Research articles that focused on only patient-related outcomes or monovalent A(H1N1)pdm09 vaccines were excluded. Two reviewers independently selected articles and extracted data. Pooled-analyses were conducted on morbidity outcomes including laboratory-confirmed influenza, influenza-like illnesses (ILI), and absenteeism. Economic studies were summarized for the characteristics of methods and findings. RESULTS Thirteen articles met eligibility criteria: three articles were randomized controlled studies and ten were cohort studies. Pooled results showed a significant effect on laboratory-confirmed influenza incidence but not ILI. While the overall incidence of absenteeism was not changed by vaccine, ILI absenteeism was significantly reduced. The duration of absenteeism was also shortened by vaccination. All published economic evaluations consistently found that the immunization of HCW was cost saving based on crude estimates of avoided absenteeism by vaccination. No studies, however, comprehensively evaluated both health outcomes and costs of vaccination programs to examine cost-effectiveness. DISCUSSION Our findings reinforced the influenza vaccine effects in reducing infection incidence and length of absenteeism. A better understanding of the incidence of absenteeism and comprehensive economic program evaluations are required to ensure the best possible management of ill HCWs and the investment in HCW immunization in increasingly constrained financial environments. These steps are fundamental to establish sustainability and cost-effectiveness of vaccination programs and underpin HCW immunization policy.
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MESH Headings
- Absenteeism
- Cost-Benefit Analysis
- Health Personnel/economics
- Health Personnel/statistics & numerical data
- Humans
- Incidence
- Infectious Disease Transmission, Patient-to-Professional/economics
- Infectious Disease Transmission, Patient-to-Professional/prevention & control
- Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data
- Infectious Disease Transmission, Professional-to-Patient/economics
- Infectious Disease Transmission, Professional-to-Patient/prevention & control
- Infectious Disease Transmission, Professional-to-Patient/statistics & numerical data
- Influenza Vaccines/therapeutic use
- Influenza, Human/economics
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Influenza, Human/transmission
- Seasons
- Vaccination/economics
- Vaccination/statistics & numerical data
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Affiliation(s)
- Chisato Imai
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail:
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lisa Hall
- Epidemiology and Biostatistics Division, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen Lambert
- UQ Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katharina Merollini
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
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Somes MP, Turner RM, Dwyer LJ, Newall AT. Estimating the annual attack rate of seasonal influenza among unvaccinated individuals: A systematic review and meta-analysis. Vaccine 2018; 36:3199-3207. [PMID: 29716771 DOI: 10.1016/j.vaccine.2018.04.063] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/12/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Seasonal influenza affects millions of people globally each year, causing significant morbidity and mortality. However, there remains substantial uncertainty about the attack rate (incidence) of influenza, particularly in unvaccinated individuals. METHODS We undertook a systematic review of vaccine randomised controlled trials (RCTs) that reported on laboratory-confirmed seasonal influenza in the placebo arm. We calculated the influenza attack rate from included studies as the number of laboratory-confirmed positive seasonal influenza cases in the placebo arm divided by the total number of subjects in this arm. A random effects meta-analysis was conducted to estimate the influenza attack rate among unvaccinated individuals (both symptomatic only as well as symptomatic and asymptomatic combined). RESULTS We included 32 RCTs that had a total of 13,329 participants. The pooled estimates for symptomatic influenza were 12.7% (95%CI 8.5%, 18.6%) for children (<18 years), 4.4% (95%CI 3.0%, 6.3%) for adults, and 7.2% (95%CI 4.3%, 12.0%) for older people (65 years and above). The pooled estimates for symptomatic and asymptomatic influenza combined for all influenza were 22.5% (95%CI 9.0%, 46.0%) for children and 10.7% (95%CI 4.5%, 23.2%) for adults. Only one study was identified for symptomatic and asymptomatic combined in older people which had a rate of 8.8% (95%CI 7.0%, 10.8%). There was substantial heterogeneity between studies. CONCLUSION Overall, we found that approximately 1 in 5 unvaccinated children and 1 in 10 unvaccinated adults were estimated to be infected by seasonal influenza annually, with rates of symptomatic influenza roughly half of these estimates. Our findings help to establish the background risk of seasonal influenza infection in unvaccinated individuals.
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Affiliation(s)
| | | | - Liam J Dwyer
- University of New South Wales, Sydney, NSW, Australia
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Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev 2018; 2:CD004876. [PMID: 29388197 PMCID: PMC6491101 DOI: 10.1002/14651858.cd004876.pub4] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The consequences of influenza in the elderly (those age 65 years or older) are complications, hospitalisations, and death. The primary goal of influenza vaccination in the elderly is to reduce the risk of death among people who are most vulnerable. This is an update of a review published in 2010. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions. OBJECTIVES To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in the elderly. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 11), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1966 to 31 December 2016); Embase (1974 to 31 December 2016); Web of Science (1974 to 31 December 2016); CINAHL (1981 to 31 December 2016); LILACS (1982 to 31 December 2016); WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017); and ClinicalTrials.gov (1 July 2017). SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs assessing efficacy against influenza (laboratory-confirmed cases) or effectiveness against influenza-like illness (ILI) or safety. We considered any influenza vaccine given independently, in any dose, preparation, or time schedule, compared with placebo or with no intervention. Previous versions of this review included 67 cohort and case-control studies. The searches for these trial designs are no longer updated. DATA COLLECTION AND ANALYSIS Review authors independently assessed risk of bias and extracted data. We rated the certainty of evidence with GRADE for the key outcomes of influenza, ILI, complications (hospitalisation, pneumonia), and adverse events. We have presented aggregate control group risks to illustrate the effect in absolute terms. We used them as the basis for calculating the number needed to vaccinate to prevent one case of each event for influenza and ILI outcomes. MAIN RESULTS We identified eight RCTs (over 5000 participants), of which four assessed harms. The studies were conducted in community and residential care settings in Europe and the USA between 1965 and 2000. Risk of bias reduced our certainty in the findings for influenza and ILI, but not for other outcomes.Older adults receiving the influenza vaccine may experience less influenza over a single season compared with placebo, from 6% to 2.4% (risk ratio (RR) 0.42, 95% confidence interval (CI) 0.27 to 0.66; low-certainty evidence). We rated the evidence as low certainty due to uncertainty over how influenza was diagnosed. Older adults probably experience less ILI compared with those who do not receive a vaccination over the course of a single influenza season (3.5% versus 6%; RR 0.59, 95% CI 0.47 to 0.73; moderate-certainty evidence). These results indicate that 30 people would need to be vaccinated to prevent one person experiencing influenza, and 42 would need to be vaccinated to prevent one person having an ILI.The study providing data for mortality and pneumonia was underpowered to detect differences in these outcomes. There were 3 deaths from 522 participants in the vaccination arm and 1 death from 177 participants in the placebo arm, providing very low-certainty evidence for the effect on mortality (RR 1.02, 95% CI 0.11 to 9.72). No cases of pneumonia occurred in one study that reported this outcome (very low-certainty evidence). No data on hospitalisations were reported. Confidence intervaIs around the effect of vaccines on fever and nausea were wide, and we do not have enough information about these harms in older people (fever: 1.6% with placebo compared with 2.5% after vaccination (RR 1.57, 0.92 to 2.71; moderate-certainty evidence)); nausea (2.4% with placebo compared with 4.2% after vaccination (RR 1.75, 95% CI 0.74 to 4.12; low-certainty evidence)). AUTHORS' CONCLUSIONS Older adults receiving the influenza vaccine may have a lower risk of influenza (from 6% to 2.4%), and probably have a lower risk of ILI compared with those who do not receive a vaccination over the course of a single influenza season (from 6% to 3.5%). We are uncertain how big a difference these vaccines will make across different seasons. Very few deaths occurred, and no data on hospitalisation were reported. No cases of pneumonia occurred in one study that reported this outcome. We do not have enough information to assess harms relating to fever and nausea in this population.The evidence for a lower risk of influenza and ILI with vaccination is limited by biases in the design or conduct of the studies. Lack of detail regarding the methods used to confirm the diagnosis of influenza limits the applicability of this result. The available evidence relating to complications is of poor quality, insufficient, or old and provides no clear guidance for public health regarding the safety, efficacy, or effectiveness of influenza vaccines for people aged 65 years or older. Society should invest in research on a new generation of influenza vaccines for the elderly.
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Affiliation(s)
- Vittorio Demicheli
- Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI, Azienda Sanitaria Locale ASL AL, Via Venezia 6, Alessandria, Piemonte, Italy, 15121
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Leibl M, Robinson C, Schuurmans MM. Comparison of diagnostic performance of rapid and standard polymerase chain reaction laboratory test for influenza and respiratory syncytial virus detection in nasopharyngeal swabs from symptomatic lung transplant recipients. Infect Dis (Lond) 2017; 50:476-478. [PMID: 29275668 DOI: 10.1080/23744235.2017.1420222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- M Leibl
- a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland.,b Division of Pulmonology , Zurcher RehaZentrum Wald , Zurich , Switzerland
| | - C Robinson
- a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland
| | - M M Schuurmans
- a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland
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Duration of viral shedding and factors associated with prolonged shedding among inpatients with influenza treated with oseltamivir: a prospective cohort study. Eur J Clin Microbiol Infect Dis 2017; 37:319-323. [PMID: 29143145 DOI: 10.1007/s10096-017-3135-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to determine the rate of decline in the diagnostic yield of influenza PCR assay after oseltamivir administration, and to identify risk factors for prolonged shedding. This was a prospective observational study. We included adult inpatients with clinical signs of influenza during the influenza seasons 2015 and 2016, who had positive influenza PCR tests and who were treated with oseltamivir. Clinical follow-up and repeat PCR testing were performed on days 2, 4 and 6 after the first positive test. We defined prolonged shedders as patients who still required hospitalization and had a positive PCR assay on day 4. Risk factors for prolonged shedding were assessed in univariate and multivariate analyses. A total of 215 patients were included in our study. The median age was 64 years and 49.3% were men. The main influenza type was H1N1 (50.1%). Rates of PCR positivity among evaluable patients on days 2, 4 and 6 were 142/215 (66%), 50/78 (64.1%) and 20/30 (66.6%), respectively. Independent risk factors for prolonged shedding (50 patients) included hypoxemia [odds ratio (OR) 2.55, 95% confidence interval (1.3-5.1)] and lower diastolic blood pressure [OR 0.94, 95% CI (0.92-0.97)] on admission. Negative PCR tests taken more than 48 h after initiation of treatment had low diagnostic yield. More severe disease, manifested by hypoxemia and lower blood pressure, is associated with prolonged shedding on oseltamivir treatment.
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Zhao X, Siegel K, Chen MIC, Cook AR. Rethinking thresholds for serological evidence of influenza virus infection. Influenza Other Respir Viruses 2017; 11:202-210. [PMID: 28294578 PMCID: PMC5410725 DOI: 10.1111/irv.12452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction For pathogens such as influenza that cause many subclinical cases, serologic data can be used to estimate attack rates and the severity of an epidemic in near real time. Current methods for analysing serologic data tend to rely on use of a simple threshold or comparison of titres between pre‐ and post‐epidemic, which may not accurately reflect actual infection rates. Methods We propose a method for quantifying infection rates using paired sera and bivariate probit models to evaluate the accuracy of thresholds currently used for influenza epidemics with low and high existing herd immunity levels, and a subsequent non‐influenza period. Pre‐ and post‐epidemic sera were taken from a cohort of adults in Singapore (n=838). Bivariate probit models with latent titre levels were fit to the joint distribution of haemagglutination‐inhibition assay‐determined antibody titres using Markov chain Monte Carlo simulation. Results Estimated attack rates were 15% (95% credible interval: 12%‐19%) for the first H1N1 pandemic wave. For a large outbreak due to a new strain, a threshold of 1:20 and a twofold rise (if pared sera is available) would result in a more accurate estimate of incidence. Conclusion The approach presented here offers the basis for a reconsideration of methods used to assess diagnostic tests by both reconsidering the thresholds used and by analysing serological data with a novel statistical model.
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Affiliation(s)
- Xiahong Zhao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Karen Siegel
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mark I-Cheng Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Abstract
Computer models can be useful in planning interventions against novel strains of influenza. However such models sometimes make unsubstantiated assumptions about the relative infectivity of asymptomatic and symptomatic cases, or conversely assume there is no impact at all. Using household-level data from known-index studies of virologically confirmed influenza A infection, the relationship between an individual's infectiousness and their symptoms was quantified using a discrete-generation transmission model and Bayesian Markov chain Monte Carlo methods. It was found that the presence of particular respiratory symptoms in an index case does not influence transmission probabilities, with the exception of child-to-child transmission where the donor has phlegm or a phlegmy cough.
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26
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Mese S, Akan H, Badur S, Uyanik A. Analytical performance of the BD veritor™ system for rapid detection of influenza virus A and B in a primary healthcare setting. BMC Infect Dis 2016; 16:481. [PMID: 27612949 PMCID: PMC5016879 DOI: 10.1186/s12879-016-1811-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
Background Infections with influenza A virus cannot be clinically differentiated from infections caused by influenza B virus or other respiratory viruses. Additionally, although antiviral treatment is available for influenza A virus, it is not effective for the other viruses and must be initiated early in the course of disease for it to be effective. For these reasons, there is a need for a rapid, accurate diagnostic test for use in physicians’ offices at the time patients are seen. We report the first field performance of BD Veritor™ System for Rapid Detection of Flu A + B test compared to real time PCR. The performance of this test was compared to real time PCR performed in the Istanbul University Influenza Reference Laboratory. Method A single-blinded cross sectional study was conducted in nine different family medicine centers in Istanbul, Turkey between 01 November 2014 and 01 May 2015. For every patient, two specimens were collected, one for real time PCR and one for the Veritor test. Specimens for the Veritor test were immediately tested at the participating clinic according to the manufacturer’s instructions. The specimens for real time PCR were transferred to the reference laboratory. Results A total of 238 persons were included in the study: 72 (30 %) of the patients included in the study were below 19 years old and accepted as childhood group. Mean age of adults was 42.4 and children 10.2 years. A total of 122 patients out of 238 were positive for influenza. The clinical sensitivity and specificity of the Veritor test in all age groups was determined to be 80 and 94 %, respectively. Positive predictive value was 93 % and the negative one was 81 %. Conclusion Field performance of the rapid influenza test was high and found to be useful with respect to rational antiviral use, avoiding unnecessary antibiotic usage and the management of cases by the family physicians.
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Affiliation(s)
- Sevim Mese
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Hulya Akan
- Department of Family Medicine, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Selim Badur
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysun Uyanik
- Department of Microbiology and Clinical Microbiology, Virology and Fundamental Immunology Unit, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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27
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Duong TN, Waldman SE. Importance of a Travel History in Evaluation of Respiratory Infections. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016; 4:141-152. [PMID: 32226655 PMCID: PMC7100244 DOI: 10.1007/s40138-016-0109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW International travel has increased at a fast pace and will continue to rapidly rise. Concomitantly, with this increase in travel is the increase in post travel-related diseases, such as respiratory illnesses. Identifying the cause of the posttravel respiratory illness is a complex challenge for many healthcare professionals because similar presentations occur for both infectious and noninfectious causes. Not only is diagnosis important but also transmission prevention. In the last two decades, there have been several severe infectious respiratory syndromes that have spread through international travel causing epidemics in many countries. RECENT FINDINGS A detailed travel history with the chronology of symptoms paired with the patient's medical risk factors and exposures along with some basic knowledge of infectious respiratory illnesses will help facilitate clinical decision making. This framework will help create a broad, but appropriate differential diagnosis to guide clinical workup, prevent delays in diagnosis, and implement the appropriate precautions to prevent transmission if appropriate. SUMMARY The foundation to diagnosing a travel-related respiratory illness lies within integrating the patient's travel history, comorbid conditions, clinical presentation, exposures, and mode of transmission. A timely and accurate diagnosis benefits not only the patient but also the surrounding community to prevent further individual transmission, epidemics, and pandemics.
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Affiliation(s)
- Theresa N. Duong
- Division of Hospital Medicine, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
| | - Sarah E. Waldman
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA USA
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28
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Falsey AR, Baran A, Walsh EE. Should clinical case definitions of influenza in hospitalized older adults include fever? Influenza Other Respir Viruses 2016; 9 Suppl 1:23-9. [PMID: 26256292 PMCID: PMC4549099 DOI: 10.1111/irv.12316] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Influenza is a major cause of morbidity and mortality in elderly persons. Fever is included in all standard definitions of influenza-like illness (ILI), yet older patients may have diminished febrile response to infection. Therefore, we examined the utility of various thresholds to define fever for case definitions of influenza in persons ≥65 years of age. Methods Data from two prospective surveillance studies for respiratory viral infection in adults hospitalized with acute cardiopulmonary illnesses with or without fever were examined. The highest temperature reported prior to admission or measured during the first 24 h after admission was recorded. The diagnosis of influenza was made by a combination of viral culture, reverse-transcription polymerase chain reaction, antigen testing, and serology. Results A total of 2410 subjects (66% ≥65 years of age) were enrolled; 281 had influenza (261 influenza A, 19 influenza B, and one mixed influenza A and B). The commonly used definition of ILI (fever ≥37·8°C and cough) resulted in 57% sensitivity and 71% specificity in older adults. Receiver operating characteristic curves examining the various temperature thresholds combined with cough and/or sore throat showed the optimal balance between sensitivity and specificity to be 37·9°C (AUC 0·71) and 37·3°C (AUC 0·66), in younger and older persons, respectively. Conclusion Clinical decision rules using the presence of cough and fever may be helpful when screening for influenza or empiric antiviral treatment when rapid influenza testing is not available; however, lower fever thresholds may be considered for elderly subjects.
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Affiliation(s)
- Ann R Falsey
- Department of Medicine, University of Rochester, Rochester, NY, USA.,Rochester General Hospital, Rochester, NY, USA
| | - Andrea Baran
- Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Edward E Walsh
- Department of Medicine, University of Rochester, Rochester, NY, USA.,Rochester General Hospital, Rochester, NY, USA
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29
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Jeong HW, Heo JY, Park JS, Kim WJ. Effect of the influenza virus rapid antigen test on a physician's decision to prescribe antibiotics and on patient length of stay in the emergency department. PLoS One 2014; 9:e110978. [PMID: 25375835 PMCID: PMC4222913 DOI: 10.1371/journal.pone.0110978] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/17/2014] [Indexed: 12/02/2022] Open
Abstract
Background Influenza virus infection is a common reason for visits to the emergency department (ED) during the influenza season. A rapid and accurate diagnosis of influenza virus infection is important to reduce unnecessary antibiotic prescription and to improve patient care. The aim of this study was to examine whether using the Influenza Virus Rapid Antigen Test (IVRAT) in the ED affects the decision to prescribe antibiotics or the length of hospital stay (LOS). Methods Data from patients suffering from an influenza-like illness (ILI) and who were discharged after visiting the ED at Chungbuk National University Hospital were reviewed over two influenza seasons: 2010–2011, when IVRAT was not used in the ED, and 2011–2012, when it was. The numbers of antibiotic prescriptions issued and the ED LOS during these two seasons were then compared. Results The number of antibiotic prescriptions was significantly lower in 2011–2012 (54/216, 25.0%) than in 2010–2011 (97/221, 43.9%; P<0.01). However, the median ED LOS for patients in 2011–2012 was much longer than that of patients in 2010–2011 (213 minutes vs. 257 minutes; P<0.01). During the 2011–2012 influenza season, 73 ILI patients showed a positive IVRAT result whereas 123 showed a negative result. Upon discharge, antibiotics were given to 42/123 (34.1%) ILI patients with a negative IVRAT result, but to only 7/73 (9.6%) patients with a positive IVRAT result (P<0.01). Conclusions Performing IVRAT in the ED reduced the prescription of antibiotics to ILI patients discharged after ED care. However, the ED LOS for patients who underwent IVRAT was longer than that for patients who did not. Thus, performing IVRAT in the ED reduces the unnecessary prescription of antibiotics to ILI patients during the influenza season.
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Affiliation(s)
- Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Heungduk-gu, Cheongju, Republic of Korea
- * E-mail:
| | - Jung Yeon Heo
- Department of Internal Medicine, Chungbuk National University College of Medicine, Heungduk-gu, Cheongju, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungbuk National University College of Medicine, Heungduk-gu, Cheongju, Republic of Korea
| | - Woo Joo Kim
- Division of Infections Disease, Department of Internal Medicine, Korea University College of Medicine, Guro-dong, Guro-gu, Seoul, Republic of Korea
- Transgovernmental Enterprise for Pandemic Influenza in Korea, Seoul, Republic of Korea
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30
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Khuntirat B, Yoon IK, Chittaganpitch M, Krueger WS, Supawat K, Blair PJ, Putnam SD, Gibbons RV, Buddhari D, Sawanpanyalert P, Heil GL, Friary JA, Gray GC. High rate of A(H1N1)pdm09 infections among rural Thai villagers, 2009-2010. PLoS One 2014; 9:e106751. [PMID: 25188434 PMCID: PMC4154756 DOI: 10.1371/journal.pone.0106751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background Pandemic influenza A(H1N1)pdm09 emerged in Thailand in 2009. A prospective longitudinal adult cohort and household transmission study of influenza-like illness (ILI) was ongoing in rural Thailand at the time of emergence. Symptomatic and subclinical A(H1N1)pdm09 infection rates in the cohort and among household members were evaluated. Methods A cohort of 800 Thai adults underwent active community-based surveillance for ILI from 2008–2010. Acute respiratory samples from ILI episodes were tested for A(H1N1)pdm09 by qRT-PCR; acute and 60-day convalescent blood samples were tested by A(H1N1)pdm09 hemagglutination inhibition assay (HI). Enrollment, 12-month and 24-month follow-up blood samples were tested for A(H1N1)pdm09 seroconversion by HI. Household members of influenza A-infected cohort subjects with ILI were enrolled in household transmission investigations in which day 0 and 60 blood samples and acute respiratory samples were tested by either qRT-PCR or HI for A(H1N1)pdm09. Seroconversion between annual blood samples without A(H1N1)pdm09-positive ILI was considered as subclinical infection. Results The 2-yr cumulative incidence of A(H1N1)pdm09 infection in the cohort in 2009/2010 was 10.8% (84/781) with an annual incidence of 1.2% in 2009 and 9.7% in 2010; 83.3% of infections were subclinical (50% in 2009 and 85.9% in 2010). The 2-yr cumulative incidence was lowest (5%) in adults born ≤1957. The A(H1N1)pdm09 secondary attack rate among household contacts was 47.2% (17/36); 47.1% of these infections were subclinical. The highest A(H1N1)pdm09 secondary attack rate among household contacts (70.6%, 12/17) occurred among children born between 1990 and 2003. Conclusion Subclinical A(H1N1)pdm09 infections in Thai adults occurred frequently and accounted for a greater proportion of all A(H1N1)pdm09 infections than previously estimated. The role of subclinical infections in A(H1N1)pdm09 transmission has important implications in formulating strategies to predict and prevent the spread of A(H1N1)pdm09 and other influenza virus strains.
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Affiliation(s)
- Benjawan Khuntirat
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - In-Kyu Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Whitney S. Krueger
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Krongkaew Supawat
- National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Shannon D. Putnam
- Naval Health Research Center, San Diego, California, United States of America
| | - Robert V. Gibbons
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Darunee Buddhari
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Gary L. Heil
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - John A. Friary
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Gregory C. Gray
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
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31
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Hayward AC, Fragaszy EB, Bermingham A, Wang L, Copas A, Edmunds WJ, Ferguson N, Goonetilleke N, Harvey G, Kovar J, Lim MSC, McMichael A, Millett ERC, Nguyen-Van-Tam JS, Nazareth I, Pebody R, Tabassum F, Watson JM, Wurie FB, Johnson AM, Zambon M. Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study. THE LANCET. RESPIRATORY MEDICINE 2014; 2:445-54. [PMID: 24717637 PMCID: PMC7164821 DOI: 10.1016/s2213-2600(14)70034-7] [Citation(s) in RCA: 278] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Assessment of the effect of influenza on populations, including risk of infection, illness if infected, illness severity, and consultation rates, is essential to inform future control and prevention. We aimed to compare the community burden and severity of seasonal and pandemic influenza across different age groups and study years and gain insight into the extent to which traditional surveillance underestimates this burden. METHODS Using preseason and postseason serology, weekly illness reporting, and RT-PCR identification of influenza from nasal swabs, we tracked the course of seasonal and pandemic influenza over five successive cohorts (England 2006-11; 5448 person-seasons' follow-up). We compared burden and severity of seasonal and pandemic strains. We weighted analyses to the age and regional structure of England to give nationally representative estimates. We compared symptom profiles over the first week of illness for different strains of PCR-confirmed influenza and non-influenza viruses using ordinal logistic regression with symptom severity grade as the outcome variable. FINDINGS Based on four-fold titre rises in strain-specific serology, on average influenza infected 18% (95% CI 16-22) of unvaccinated people each winter. Of those infected there were 69 respiratory illnesses per 100 person-influenza-seasons compared with 44 per 100 in those not infected with influenza. The age-adjusted attributable rate of illness if infected was 23 illnesses per 100 person-seasons (13-34), suggesting most influenza infections are asymptomatic. 25% (18-35) of all people with serologically confirmed infections had PCR-confirmed disease. 17% (10-26) of people with PCR-confirmed influenza had medically attended illness. These figures did not differ significantly when comparing pandemic with seasonal influenza. Of PCR-confirmed cases, people infected with the 2009 pandemic strain had markedly less severe symptoms than those infected with seasonal H3N2. INTERPRETATION Seasonal influenza and the 2009 pandemic strain were characterised by similar high rates of mainly asymptomatic infection with most symptomatic cases self-managing without medical consultation. In the community the 2009 pandemic strain caused milder symptoms than seasonal H3N2. FUNDING Medical Research Council and the Wellcome Trust.
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Affiliation(s)
- Andrew C Hayward
- UCL Research Department of Infection and Population Health, University College London, London, UK.
| | - Ellen B Fragaszy
- UCL Research Department of Infection and Population Health, University College London, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lili Wang
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Andrew Copas
- UCL Research Department of Infection and Population Health, University College London, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Neil Ferguson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Nilu Goonetilleke
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gabrielle Harvey
- UCL Research Department of Infection and Population Health, University College London, London, UK
| | - Jana Kovar
- UCL Research Department of Infection and Population Health, University College London, London, UK
| | - Megan S C Lim
- UCL Research Department of Infection and Population Health, University College London, London, UK; Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia
| | - Andrew McMichael
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Elizabeth R C Millett
- UCL Research Department of Infection and Population Health, University College London, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan S Nguyen-Van-Tam
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Irwin Nazareth
- UCL Department of Primary Care and Population Health, University College London, London, UK
| | - Richard Pebody
- Respiratory Diseases Department, Public Health England, Colindale, UK
| | - Faiza Tabassum
- UCL Research Department of Infection and Population Health, University College London, London, UK
| | - John M Watson
- Respiratory Diseases Department, Public Health England, Colindale, UK
| | - Fatima B Wurie
- UCL Research Department of Infection and Population Health, University College London, London, UK
| | - Anne M Johnson
- UCL Research Department of Infection and Population Health, University College London, London, UK
| | - Maria Zambon
- Respiratory Virus Unit, Public Health England, Colindale, UK
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32
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Koshio N, Hasegawa T, Suzuki K, Tanabe Y, Koya T, Sakagami T, Aoki N, Hoshino Y, Kagamu H, Tsukada H, Arakawa M, Gejyo F, Narita I, Suzuki E. Analysis of the influenza A (H1N1) 2009 pandemic infection in Japanese asthmatic patients: using a questionnaire-based survey. Allergol Int 2014; 63:67-74. [PMID: 24457814 DOI: 10.2332/allergolint.13-oa-0609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/09/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Influenza infection is known to be an exacerbating factor in the control of asthma, therfore its prevention is critical in managing asthma. The aim of this study was to investigate the influenza A H1N1 2009 pandemic virus (H1N1 pdm09) infection in adult asthmatic patients. METHODS Data were obtained from a questionnaire-based survey of asthmatic patients conducted from September to October 2010 in Niigata Prefecture. Patient background, H1N1 pdm09 infection, vaccination status, and asthma exacerbation due to influenza infection were analyzed. RESULTS In total, 2,555 cases were analyzed. The incidence of the infection was 6.7% (95% confidence interval [CI]: 5.7-7.6), and the rate of vaccination was 63.9% (95% CI: 62.1-65.8). The odds ratio (OR) for vaccination against the infection among adult patients and younger patients (≤ the median age) were 0.61 (95% CI: 0.45-0.84) and 0.62 (95% CI: 0.42-0.90), respectively. However, OR among the older patient (> median age) were 1.38 (95%CI: 0.66-2.89). The rate of infection-induced asthma exacerbation was 23.2% (95% CI: 18.6-29.6), and the OR for vaccination against the infection-induced asthma exacerbation was 1.42 (95% CI: 0.69-2.92). CONCLUSIONS The effectiveness of the vaccination against the H1N1 pdm09 virus was confirmed during the first pandemic season, but it was limited. Further investigation on H1N1 pdm09 virus infection in asthmatics will be required.
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Affiliation(s)
- Nao Koshio
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Hasegawa
- Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazuo Suzuki
- Department of Medicine, Prefectural Muikamachi Hospital, Niigata, Japan
| | - Yoshinari Tanabe
- Division of Infection Control and Prevention, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Toshiyuki Koya
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takuro Sakagami
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nobumasa Aoki
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshifumi Hoshino
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Kagamu
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroki Tsukada
- Department of Respiratory Disease, Niigata Citizen Hospital, Niigata, Japan
| | - Masaaki Arakawa
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Fumitake Gejyo
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ichiei Narita
- Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eiichi Suzuki
- Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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Luteijn JM, Brown MJ, Dolk H. Influenza and congenital anomalies: a systematic review and meta-analysis. Hum Reprod 2013; 29:809-23. [PMID: 24365800 DOI: 10.1093/humrep/det455] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does first trimester maternal influenza infection increase the risk of non-chromosomal congenital anomalies (CA)? SUMMARY ANSWER First trimester maternal influenza exposure is associated with raised risk of a number of non-chromosomal CA, including neural tube defects, hydrocephaly, congenital heart defects, cleft lip, digestive system defects and limb reduction defects. WHAT IS KNOWN ALREADY Hyperthermia is a well-established risk factor for neural tube defects. Previous studies suggest influenza may be a risk factor not only for neural tube defects, but also other CA. No systematic review has previously been undertaken. STUDY DESIGN, SIZE, DURATION Systematic review and meta-analysis. A search of EMBASE and PUBMED was performed for English and Dutch studies published up to July 2013. A total of 33 studies (15 case-control, 10 cohort and 8 ecological) were included in the systematic review of which 22 studies were included in the meta-analysis. PARTICIPANTS/MATERIALS, SETTINGS, METHODS A total of 29 542 babies with congenital anomaly (1112 exposed) from case-control studies and 1608 exposed pregnancies resulting in 56 babies with congenital anomaly from cohort studies were included in the meta-analysis. Maternal influenza exposure was defined as any reported influenza, influenza-like illness or fever with flu, with or without serological or clinical confirmation during the first trimester of pregnancy. Data for 24 (sub)groups with congenital anomaly available from ≥3 studies were analysed using the DerSimonian-Laird random effects model. The hypothesis of publication bias was assessed using funnel plots and risk of bias of included studies was assessed using a slightly modified version of the Newcastle-Ottawa scale. MAIN RESULTS AND THE ROLE OF CHANCE First trimester maternal influenza exposure was associated with an increased risk of any congenital anomaly [adjusted odds ratio (AOR) 2.00, 95% CI: 1.62-2.48], neural tube defects [odds ratio (OR) 3.33, 2.05-5.40], hydrocephaly (5.74, 1.10-30.00), congenital heart defects (1.56, 1.13-2.14), aortic valve atresia/stenosis (AOR 2.59, 1.21-5.54), ventricular septal defect (AOR 1.59, 1.24-2.14), cleft lip (3.12, 2.20-4.42), digestive system (1.72, 1.09-2.68) and limb reduction defects (2.03, 1.27-3.27). An increased risk for cleft lip (but not for cleft palate) was also reported by ecological studies not included in the meta-analysis. Study outcomes reported for 27 subgroups of congenital anomaly could not be included in the meta-analysis. Visual inspection of funnel plots did not suggest evidence for publication bias. LIMITATIONS, REASONS FOR CAUTION This study enrolled observational studies that can be subject to limitations such as confounding, retrospective maternal exposure reports and non-response of intended participants. Influenza exposed pregnancies can also have been exposed to influenza related medication. WIDER IMPLICATIONS OF THE FINDINGS Prevention of influenza in pregnant women may reduce congenital anomaly risk, and would be relevant to more than just neural tube defects. More research is needed to determine whether influenza and/or its related medication is teratogenic, to determine the role of hyperthermia in teratogenicity and the role of other environmental factors such as nutritional status in determining susceptibility.
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Affiliation(s)
- J M Luteijn
- Institute of Nursing Research/School of Nursing, University of Ulster, Jordanstown Campus, Shore Road, Newtownabbey BT37 0QB, UK
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Mikulska M, Del Bono V, Gandolfo N, Dini S, Dominietto A, Di Grazia C, Bregante S, Varaldo R, Orsi A, Ansaldi F, Bacigalupo A, Viscoli C. Epidemiology of viral respiratory tract infections in an outpatient haematology facility. Ann Hematol 2013; 93:669-76. [PMID: 24097084 PMCID: PMC7079995 DOI: 10.1007/s00277-013-1912-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/22/2013] [Indexed: 01/03/2023]
Abstract
Viral respiratory tract infections (VRTI) are an important cause of morbidity and mortality in haematology patients, particularly after haematopoietic stem cell transplantation (HSCT). The incidence, clinical presentation and outcome of symptomatic and asymptomatic VRTI in HSCT outpatient unit were prospectively evaluated during a single influenza season (January–March 2011). Pharyngeal swabs were performed at the first visit and if new symptoms were present. Molecular multiplex assay for 12 respiratory viruses was performed by the regional reference laboratory. Among 264 swabs from 193 outpatients, 58 (22 %) resulted positive for 61 viruses (influenza, n = 20; respiratory syncytial virus [RSV], n = 21; rhinovirus, n = 12; coronavirus, n = 4; adenovirus, n = 3; parainfluenza, n = 1). VRTI were detected more frequently in the presence of symptoms than in asymptomatic patients: 49 out of 162 (30 %) vs. 9 out of 102 (9 %), p < 0.001. Influenza-like illness syndrome (ILI) was significantly associated with a VRTI if compared to other presentations (42 %), while the European Centre for Disease Prevention and Control definition was not (30 %). Positive predictive value (PPV) of ILI for influenza was 17 %. Influenza and RSV peak periods were contemporary. Influenza prophylaxis was given to 25 patients following exposure. Low rate of progression from upper to lower respiratory tract infection (approximately 5 % for influenza and RSV), no nosocomial epidemics and no VRTI-related deaths were observed. VRTI are very frequent in high-risk haematology outpatients, but symptoms are aspecific and PPV of ILI is low. Symptoms of influenza and RSV overlap. Thus, microbiological diagnosis and contact preventive measures are crucial. Rather than universal influenza prophylaxis, prompt diagnosis and treatment of only documented infections could be pursued.
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Affiliation(s)
- Małgorzata Mikulska
- Division of Infectious Diseases, San Martino Hospital and University of Genoa, Largo R. Benzi, 10-16132, Genoa, Italy,
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Cellular immune correlates of protection against symptomatic pandemic influenza. Nat Med 2013; 19:1305-12. [PMID: 24056771 DOI: 10.1038/nm.3350] [Citation(s) in RCA: 637] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/19/2013] [Indexed: 12/13/2022]
Abstract
The role of T cells in mediating heterosubtypic protection against natural influenza illness in humans is uncertain. The 2009 H1N1 pandemic (pH1N1) provided a unique natural experiment to determine whether crossreactive cellular immunity limits symptomatic illness in antibody-naive individuals. We followed 342 healthy adults through the UK pandemic waves and correlated the responses of pre-existing T cells to the pH1N1 virus and conserved core protein epitopes with clinical outcomes after incident pH1N1 infection. Higher frequencies of pre-existing T cells to conserved CD8 epitopes were found in individuals who developed less severe illness, with total symptom score having the strongest inverse correlation with the frequency of interferon-γ (IFN-γ)(+) interleukin-2 (IL-2)(-) CD8(+) T cells (r = -0.6, P = 0.004). Within this functional CD8(+)IFN-γ(+)IL-2(-) population, cells with the CD45RA(+) chemokine (C-C) receptor 7 (CCR7)(-) phenotype inversely correlated with symptom score and had lung-homing and cytotoxic potential. In the absence of crossreactive neutralizing antibodies, CD8(+) T cells specific to conserved viral epitopes correlated with crossprotection against symptomatic influenza. This protective immune correlate could guide universal influenza vaccine development.
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Microdroplet sandwich real-time rt-PCR for detection of pandemic and seasonal influenza subtypes. PLoS One 2013; 8:e73497. [PMID: 24066051 PMCID: PMC3774678 DOI: 10.1371/journal.pone.0073497] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 07/23/2013] [Indexed: 12/16/2022] Open
Abstract
As demonstrated by the recent 2012/2013 flu epidemic, the continual emergence of new viral strains highlights the need for accurate medical diagnostics in multiple community settings. If rapid, robust, and sensitive diagnostics for influenza subtyping were available, it would help identify epidemics, facilitate appropriate antiviral usage, decrease inappropriate antibiotic usage, and eliminate the extra cost of unnecessary laboratory testing and treatment. Here, we describe a droplet sandwich platform that can detect influenza subtypes using real-time reverse-transcription polymerase chain reaction (rtRT-PCR). Using clinical samples collected during the 2010/11 season, we effectively differentiate between H1N1p (swine pandemic), H1N1s (seasonal), and H3N2 with an overall assay sensitivity was 96%, with 100% specificity for each subtype. Additionally, we demonstrate the ability to detect viral loads as low as 104 copies/mL, which is two orders of magnitude lower than viral loads in typical infected patients. This platform performs diagnostics in a miniaturized format without sacrificing any sensitivity, and can thus be easily developed into devices which are ideal for small clinics and pharmacies.
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Balinandi S, Bakamutumaho B, Kayiwa JT, Ongus J, Oundo J, Awor AC, Lutwama JJ. The viral aetiology of influenza-like illnesses in Kampala and Entebbe, Uganda, 2008. Afr J Lab Med 2013; 2:65. [PMID: 29043164 PMCID: PMC5637772 DOI: 10.4102/ajlm.v2i1.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 04/09/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As the threat of zoonoses and the emergence of pandemic-prone respiratory viruses increases, there is a need to establish baseline information on the incidence of endemic pathogens in countries worldwide. OBJECTIVES To investigate the presence of viruses associated with influenza-like illnesses (ILI) in Uganda. METHODS A cross-sectional study was conducted in which nasopharyngeal swab specimens were collected from patients diagnosed with ILI in Kampala and Entebbe between 14 August 2008 - 15 December 2008. A multiplex polymerase chain reaction assay for detecting 12 respiratory viruses was used. RESULTS A total of 369 patients (52.3% females) was enrolled; the median age was 6 years (range 1-70). One or more respiratory viruses were detected in 172 (46.6%) cases and their prevalence were influenza A virus (19.2%), adenovirus (8.7%), human rhinovirus A (7.9%), coronavirus OC43 (4.3%), parainfluenza virus 1 (2.7%), parainfluenza virus 3 (2.7%), influenza B virus (2.2%), respiratory syncytial virus B (2.2%), human metapneumovirus (1.4%), respiratory syncytial virus A (1.1%), parainfluenza virus 2 (0.5%) and coronavirus 229E (0.5%). There were 24 (14.0%) mixed infections. CONCLUSIONS This study identified some of the respiratory viruses associated with ILI in Uganda. The circulation of some of the viruses was previously unknown in the study population. These results are useful in order to guide future surveillance and case management strategies involving respiratory illnesses in Uganda.
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Affiliation(s)
- Stephen Balinandi
- Field Epidemiology and Laboratory Training Program, Kenya.,Uganda Virus Research Institute, Uganda
| | | | | | - Juliette Ongus
- Department of Medical Laboratory Sciences, Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Joseph Oundo
- Field Epidemiology and Laboratory Training Program, Kenya
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Bhandari R, Hartley TA, Lindsley WG, Fisher MA, Palmer JE. Assessing Healthcare Utilization for Influenza-like Illness at an Emergency Department and a Student Health Service during the 2009-2010 H1N1 Pandemic. Infect Dis (Lond) 2013; 6:15-23. [PMID: 24847173 PMCID: PMC3988625 DOI: 10.4137/idrt.s11315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Estimates of healthcare utilization during an influenza pandemic are needed in order to plan for the allocation of staff and resources. The aim of this study was to assess the number, age, and arrival time of patients with influenza-like-illness (ILI), and associations between their symptoms during the 2009-2010 H1N1 pandemic. We conducted a cross-sectional analysis of electronic health records from the student health service (SHS) and an emergency department (ED) in Morgantown, West Virginia, between January 2009 and December 2010. During the 2009-2010 H1N1 pandemic, patient arrivals at SHS and ED varied over the week. SHS patients arrived early in the week and primarily in the afternoon. ED patient arrivals were more evenly distributed, with busier evenings and weekends. Those with fever were more likely to experience cough, sore throat, vomiting/nausea, chills, congestion, headache, and body-ache. These results can assist health professionals in preparing for an influenza pandemic.
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Affiliation(s)
- Ruchi Bhandari
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Tara A. Hartley
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - William G. Lindsley
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Melanie A. Fisher
- Global Health Program, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Jan E. Palmer
- WELL WVU—The Students’ Center of Health, Student Health Service, West Virginia University, Morgantown, West Virginia, USA
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Paul Glezen W, Schmier JK, Kuehn CM, Ryan KJ, Oxford J. The burden of influenza B: a structured literature review. Am J Public Health 2013; 103:e43-51. [PMID: 23327249 PMCID: PMC3673513 DOI: 10.2105/ajph.2012.301137] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2012] [Indexed: 01/14/2023]
Abstract
We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010. Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B-specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant. The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disease and assist in vaccine development.
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Affiliation(s)
- W Paul Glezen
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
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Hartung HP, Keller-Stanislawski B, Hughes RA, Lehmann HC. [Guillain-Barré syndrome after exposure to influenza]. DER NERVENARZT 2012; 83:714-30. [PMID: 22528062 DOI: 10.1007/s00115-012-3479-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Guillain-Barré Syndrome (GBS) is an acquired, monophasic inflammatory polyradiculoneuritis of autoimmune origin, which occurs after infection and occasionally also after vaccination. Seasonal and pandemic influenza vaccines have in particular been implicated as triggers for GBS. However, a number of recent studies indicate that infection with influenza virus may also cause GBS. This review summarizes the epidemiological and experimental data of the association of GBS with exposure to influenza antigens by immunization (including vaccines against A/H1N1/2009) and infection. Vaccination against influenza is associated with a very low risk for the occurrence of GBS. In contrast infection with influenza may play a more important role as a triggering factor for GBS than previously assumed.
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Affiliation(s)
- H-P Hartung
- Neurologische Klinik, Heinrich-Heine-Universität, Moorenstr. 5, 40225 Düsseldorf, Deutschland.
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Kim WS, Lee GC, Yoo JH, Kim HY, Yun YP, Chong CK. Development and diagnostic application/evaluation of pandemic (H1N1) 2009 influenza virus-specific monoclonal antibodies. Microbiol Immunol 2012; 56:372-7. [PMID: 22686191 DOI: 10.1111/j.1348-0421.2012.00455.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We prepared mAb specific to the H1N1 2009 virus (H1N1 2009) to facilitate development of an RDT with enhanced sensitivity and specificity. Among these antibodies, we identified two clones--hybridomas 1H7E1 and 3A3H7-that specifically bound to H1N1 2009 (non-seasonal) and were very suitable for application to a diagnostic kit. The affinity constants (K(a)) of 1H7E1 and 3A3H7 were 1.10 × 10(10) and 2.35 × 10(10), respectively. To identify the antibodies, we performed ELISA and immunoblot analyses and found that 1H7E1 recognized a conformational epitope of HA while 3A3H7 recognized a linear epitope. In clinical evaluations using specimens from 215 patients, a lateral flow rapid testing kit comprising these mAb showed a sensitivity of 81.5% (75/92) and a specificity of 96.7% (119/123). Results using the RDT kit were well correlated with conventional RT-PCR methods as commonly and commercially used. Based on our findings, we believe that use of these mAb with a rapid evaluation kit could serve as a good diagnostic tool for H1N1 2009.
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Affiliation(s)
- Won-Shik Kim
- College of Pharmacy, Chungbuk National University, Chungbuk 361-763, Korea
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Tayo A, Ellis J, Linden Phillips L, Simpson S, Ward DJ. Emerging point of care tests for influenza: innovation or status quo. Influenza Other Respir Viruses 2012; 6:291-8. [PMID: 22103966 PMCID: PMC5779804 DOI: 10.1111/j.1750-2659.2011.00306.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Point of care tests (POCTs) for influenza potentially offer earlier diagnosis, enabling specific treatment, infection control measures and greater patient convenience and satisfaction. Current POCTs have limited sensitivity, some cannot distinguish influenza types, none differentiate subtypes and are relatively expensive. AIMS To identify and characterise influenza POCTs expected to be available for clinical use in the U.K. by mid-2013, highlighting those with potential benefits over existing tests. METHODS Potential developers of influenza POCTs were identified through known manufacturers' websites, Medical Technology trade associations, the EuroScan International Network, an expert advisory group and by searching relevant online sources. Identified companies were asked to provide standard information on relevant technologies. RESULTS Fifty-six companies were identified, and 29 (52%) responded, identifying 57 potentially relevant technologies. Of these, 40 (70%) were already available or had undetermined status and 5 (9%) were excluded as time to results took over 60 minutes. Of the remaining 12 emerging POCTs, 10 (83%) reportedly enabled differentiation of influenza types and eight differentiation of A subtypes. Nasopharyngeal swabs were the most commonly acceptable sample type; the sample volume ranging from 80 μl to 1.4 ml. DISCUSSION Most identified emerging influenza POCTs offered differentiation of influenza type and subtype. Tests claiming this capability include several incorporating reverse transcription polymerase chain reaction assays; though, these also had the longest time to result. However, whilst some identified POCTs exhibit high sensitivity and specificity, most lack published clinical data for assessment, and the overall costs of these technologies remains largely unknown.
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Affiliation(s)
- Adeoluwa Tayo
- National Horizon Scanning Centre, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Joanna Ellis
- Health Protection Agency Microbiology Services Colindale, Respiratory Virus Unit, Virus Reference Department, London, UK
| | - Luan Linden Phillips
- National Horizon Scanning Centre, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sue Simpson
- National Horizon Scanning Centre, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Derek J. Ward
- National Horizon Scanning Centre, School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Nakanishi M, Yoshida Y, Takeda N, Hirana H, Horita T, Shimizu K, Hiratani K, Toyoda S, Matsumura T, Shinno E, Hutamura A, Ota M, Natazuka T. Community-acquired pneumonia distinguished from influenza infection based on clinical signs and symptoms during a novel (swine) influenza A/H1N1 pandemic. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 20:421-6. [PMID: 21808939 DOI: 10.4104/pcrj.2011.00067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS The numbers of patients with influenza-like illnesses increase during influenza outbreaks. A study was undertaken to distinguish community-acquired pneumonia (CAP) from influenza based on clinical signs and symptoms. METHODS This retrospective study investigated patients with positive results in the rapid influenza antigen test and those diagnosed with CAP during an influenza A/H1N1 pandemic. Significant factors for predicting risk for CAP within 48 hrs from onset and at diagnosis were selected by multiple regression analysis. RESULTS Within 48 hrs of onset and at diagnosis, age and coarse crackles significantly increased the risk of CAP whereas sick contact, sore throat, and rhinorrhoea significantly decreased the risk of CAP. Duration of illness, sputum, dyspnoea, chest pain, and coarse crackles also significantly increased the risk of CAP at diagnosis. CONCLUSIONS CAP differed somewhat from influenza even within 48 hrs of onset and the differences became even more evident thereafter.
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Affiliation(s)
- Masanori Nakanishi
- Department of Respiratory Medicine, Shinseikai Toyama Hospital, Imizu, Japan.
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Klick B, Nishiura H, Cowling BJ. Optimal design of intervention studies to prevent influenza in healthy cohorts. PLoS One 2012; 7:e35166. [PMID: 22514718 PMCID: PMC3325991 DOI: 10.1371/journal.pone.0035166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 03/13/2012] [Indexed: 11/19/2022] Open
Abstract
Background Influenza cohort studies, in which participants are monitored for infection over an epidemic period, are invaluable in assessing the effectiveness of control measures such as vaccination, antiviral prophylaxis and non-pharmaceutical interventions (NPIs). Influenza infections and illnesses can be identified through a number of approaches with different costs and logistical requirements. Methodology and Principal Findings In the context of a randomized controlled trial of an NPI with a constrained budget, we used a simulation approach to examine which approaches to measuring outcomes could provide greater statistical power to identify an effective intervention against confirmed influenza. We found that for a short epidemic season, the optimal design was to collect respiratory specimens at biweekly intervals, as well as following report of acute respiratory illness (ARI), for virologic testing by reverse transcription polymerase chain reaction (RT-PCR). Collection of respiratory specimens only from individuals reporting ARI was also an efficient design particularly for studies in settings with longer periods of influenza activity. Collection of specimens only from individuals reporting a febrile ARI was less efficient. Collection and testing of sera before and after influenza activity appeared to be inferior to collection of respiratory specimens for RT-PCR confirmation of acute infections. The performance of RT-PCR was robust to uncertainty in the costs and diagnostic performance of RT-PCR and serological tests. Conclusions and Significance Our results suggest that unless the sensitivity or specificity of serology can be increased RT-PCR will remain as the preferable outcome measure in NPI studies. Routine collection of specimens for RT-PCR testing even when study participants do not report acute respiratory illness appears to be the most cost efficient design under most scenarios.
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Affiliation(s)
- Brendan Klick
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
| | - Hiroshi Nishiura
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
- PRESTO, Japan Science and Technology Agency, Saitama, Japan
| | - Benjamin J. Cowling
- Infectious Disease Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, People's Republic of China
- * E-mail:
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Mahony JB, Petrich A, Smieja M. Molecular diagnosis of respiratory virus infections. Crit Rev Clin Lab Sci 2012; 48:217-49. [PMID: 22185616 DOI: 10.3109/10408363.2011.640976] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The appearance of eight new respiratory viruses, including the SARS coronavirus in 2003 and swine-origin influenza A/H1N1 in 2009, in the human population in the past nine years has tested the ability of virology laboratories to develop diagnostic tests to identify these viruses. Nucleic acid based amplification tests (NATs) for respiratory viruses were first introduced two decades ago and today are utilized for the detection of both conventional and emerging viruses. These tests are more sensitive than other diagnostic approaches, including virus isolation in cell culture, shell vial culture (SVC), antigen detection by direct fluorescent antibody (DFA) staining, and rapid enzyme immunoassay (EIA), and now form the backbone of clinical virology laboratory testing around the world. NATs not only provide fast, accurate and sensitive detection of respiratory viruses in clinical specimens but also have increased our understanding of the epidemiology of both new emerging viruses such as the pandemic H1N1 influenza virus of 2009, and conventional viruses such as the common cold viruses, including rhinovirus and coronavirus. Multiplex polymerase chain reaction (PCR) assays introduced in the last five years detect up to 19 different viruses in a single test. Several multiplex PCR tests are now commercially available and tests are working their way into clinical laboratories. The final chapter in the evolution of respiratory virus diagnostics has been the addition of allelic discrimination and detection of single nucleotide polymorphisms associated with antiviral resistance. These assays are now being multiplexed with primary detection and subtyping assays, especially in the case of influenza virus. These resistance assays, together with viral load assays, will enable clinical laboratories to provide physicians with new and important information for optimal treatment of respiratory virus infections.
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Affiliation(s)
- James B Mahony
- M.G. DeGroote Institute for Infectious Disease Research, St. Joseph’s Healthcare, Hamilton, Canada.
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Vesikari T, Beran J, Durviaux S, Stainier I, El Idrissi M, Walravens K, Devaster JM. Use of real-time polymerase chain reaction (rtPCR) as a diagnostic tool for influenza infection in a vaccine efficacy trial. J Clin Virol 2011; 53:22-8. [PMID: 22079305 DOI: 10.1016/j.jcv.2011.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/10/2011] [Accepted: 10/14/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conventional techniques for diagnosing influenza based on viral cell culture or disease serology have limitations, and molecular assays, such as real-time polymerase chain reaction (rtPCR) are increasingly used. OBJECTIVES To evaluate the use of rtPCR as a diagnostic tool for the determination of influenza virus infection. STUDY DESIGN This prospective, double-blind, placebo-controlled, randomised efficacy study was conducted in persons aged 18-64 years. Cases of influenza-like-illness (ILI), defined as at least one systemic symptom [fever ≥37.8°C and/or myalgia] and at least one respiratory symptom [cough and/or sore throat] were identified by active and passive surveillance. For each case of suspected ILI, nasal and throat swabs were collected and analysed by viral culture and rtPCR. RESULTS 227 ILI cases were positive by rtPCR while 64% (145/227) were positive by both rtPCR and culture. For both assays, the maximum percentage of swabs that tested positive was on Day 0, thereafter positive samples by rtPCR remained constant until Day 5 but decreased progressively by culture. All rtPCR positive cases with a viral load of below 4.5log(10) copies/sample were negative by culture. There were however culture negative cases with high viral loads. Vaccine efficacy for influenza was estimated as 54.7% by rtPCR (culture positive or negative) and 61.6% by culture irrespective of match to vaccine strain. Clinical severity was not significantly different between culture positive cases and culture negative but rtPCR positive cases. CONCLUSIONS rtPCR is a sensitive and specific diagnostic tool for influenza vaccine efficacy studies.
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Affiliation(s)
- Timo Vesikari
- Vaccine Research Center, University of Tampere, Biokatu 10, Tampere, Finland.
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Park YJ, Jin JY, Yang HJ, Lee WR, Lee DH, Pyun BY, Suh ES. Clinical characteristics of 2009 pandemic influenza A (H1N1) infection in children and the performance of rapid antigen test. KOREAN JOURNAL OF PEDIATRICS 2011; 54:405-8. [PMID: 22232622 PMCID: PMC3250593 DOI: 10.3345/kjp.2011.54.10.405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/03/2011] [Accepted: 09/14/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE In autumn 2009, the swine-origin influenza A (H1N1) virus spread throughout South Korea. The aims of this study were to determine the clinical characteristics of children infected by the 2009 H1N1 influenza A virus, and to compare the rapid antigen and real-time polymerase chain reaction (PCR) tests. METHODS We conducted a retrospective review of patients ≥18 years of age who presented to Soonchunhyang University Hospital in Seoul with respiratory symptoms, including fever, between September 2009 and January 2010. A real-time PCR test was used to definitively diagnose 2009 H1N1 influenza A infection. Medical records of confirmed cases were reviewed for sex, age, and the time of infection. The decision to perform rapid antigen testing was not influenced by clinical conditions, but by individual factors such as economic conditions. Its sensitivity and specificity were evaluated compared to real-time PCR test results. RESULTS In total, 934 patients tested positive for H1N1 by real-time PCR. The highest number of patients (48.9%) was diagnosed in November. Most patients (48.2%) were aged between 6 and 10 years. Compared with the H1N1 real-time PCR test results, the rapid antigen test showed 22% sensitivity and 83% specificity. Seventy-eight patients were hospitalized for H1N1 influenza A virus infection, and fever was the most common symptom (97.4%). CONCLUSION For diagnosis of 2009 H1N1 influenza A virus infection, the rapid antigen test was inferior to the real-time PCR test in both sensitivity and specificity. This outcome suggests that the rapid antigen test is inappropriate for screening.
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Affiliation(s)
- Yong-Jae Park
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Goldstein E, Cowling BJ, Aiello AE, Takahashi S, King G, Lu Y, Lipsitch M. Estimating incidence curves of several infections using symptom surveillance data. PLoS One 2011; 6:e23380. [PMID: 21887246 PMCID: PMC3160845 DOI: 10.1371/journal.pone.0023380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 07/14/2011] [Indexed: 11/30/2022] Open
Abstract
We introduce a method for estimating incidence curves of several co-circulating infectious pathogens, where each infection has its own probabilities of particular symptom profiles. Our deconvolution method utilizes weekly surveillance data on symptoms from a defined population as well as additional data on symptoms from a sample of virologically confirmed infectious episodes. We illustrate this method by numerical simulations and by using data from a survey conducted on the University of Michigan campus. Last, we describe the data needs to make such estimates accurate.
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Affiliation(s)
- Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America.
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Lee VJ, Chen MI, Yap J, Ong J, Lim WY, Lin RTP, Barr I, Ong JBS, Mak TM, Goh LG, Leo YS, Kelly PM, Cook AR. Comparability of different methods for estimating influenza infection rates over a single epidemic wave. Am J Epidemiol 2011; 174:468-78. [PMID: 21719743 PMCID: PMC3148265 DOI: 10.1093/aje/kwr113] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Estimation of influenza infection rates is important for determination of the extent of epidemic spread and for calculation of severity indicators. The authors compared estimated infection rates from paired and cross-sectional serologic surveys, rates of influenza like illness (ILI) obtained from sentinel general practitioners (GPs), and ILI samples that tested positive for influenza using data from similar periods collected during the 2009 H1N1 epidemic in Singapore. The authors performed sensitivity analyses to assess the robustness of estimates to input parameter uncertainties, and they determined sample sizes required for differing levels of precision. Estimates from paired seroconversion were 17% (95% Bayesian credible interval (BCI): 14, 20), higher than those from cross-sectional serology (12%, 95% BCI: 9, 17). Adjusted ILI estimates were 15% (95% BCI: 10, 25), and estimates computed from ILI and laboratory data were 12% (95% BCI: 8, 18). Serologic estimates were least sensitive to the risk of input parameter misspecification. ILI-based estimates were more sensitive to parameter misspecification, though this was lessened by incorporation of laboratory data. Obtaining a 5-percentage-point spread for the 95% confidence interval in infection rates would require more than 1,000 participants per serologic study, a sentinel network of 90 GPs, or 50 GPs when combined with laboratory samples. The various types of estimates will provide comparable findings if accurate input parameters can be obtained.
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Affiliation(s)
- Vernon J Lee
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Osborne RH, Norquist JM, Elsworth GR, Busija L, Mehta V, Herring T, Gupta SB. Development and validation of the Influenza Intensity and Impact Questionnaire (FluiiQ™). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:687-699. [PMID: 21839407 DOI: 10.1016/j.jval.2010.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/25/2010] [Accepted: 12/16/2010] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Clinical trials of new agents to reduce the severity and impact of influenza require accurate assessment of the effect of influenza infection. Because there are limited high-quality adult influenza Patient Reported Outcomes (PRO) measures, the aim was to develop and validate a simple but comprehensive questionnaire for epidemiological research and clinical trials. METHODS Construct and item generation was guided by the literature, concept mapping, focus groups, and interviews with individuals with laboratory-confirmed influenza and expert physicians. Items were administered to 311 people with influenza-like illness (ILI) across 25 US sites. Analyses included classic psychometrics, structural equation modeling (SEM), and Rasch analyses. RESULTS Concept mapping generated 149 concepts covering the influenza experience and clustered into symptoms and impact on daily activities, emotions, and others. Items were drafted using simplicity and brevity criteria. Eleven symptoms from the literature underwent review by physicians and patients, and two were removed and one added. The symptoms domain factored into systemic and respiratory symptoms, whereas the impact domains were unidimensional. All domains displayed good internal consistency (Cronbach α ≥ 0.8) except the three-item respiratory domain (α = 0.48). A five-factor SEM indicated excellent fit where systemic, respiratory, and daily activities domains differentiated patients with ILI or confirmed influenza. All scales were responsive over time. CONCLUSIONS Patient and clinician consultations resulted in an influenza PRO measure with high validity and good overall evidence of reliability and responsiveness. The Influenza Intensity and Impact Questionnaire (FluiiQ™) will improve the evaluation of existing and future agents designed to prevent or control influenza infection by increasing the breadth and depth of measurement in this field.
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Affiliation(s)
- Richard H Osborne
- Public Health Innovation, Population Health Strategic Research Centre, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
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