Distinguishing viruses responsible for influenza-like illness

Point of Care Nucleic Acid Testing for Influenza-Like Illness: A Cost-Consequence Analysis for High-Risk Patients in Primary Care in Germany

INTRODUCTION

Influenza A/B virus, severe acute respiratory coronavirus 2 (SARS-CoV-2), and respiratory syncytial virus (RSV) cause similar symptoms, often referred to as influenza-like illness, but require different treatments which must be administered within a short timeframe after symptom onset. This necessitates rapid detection and accurate differentiation by primary care providers, ideally at point of care (POC). POC nucleic acid tests such as the multiplex, real-time polymerase chain reaction (PCR) Xpert® Xpress CoV-2/Flu/RSV plus (Xpert Xpress) offer a faster, more accurate alternative compared to antigen testing, clinical judgement alone, or send-out PCR. This cost-consequence analysis evaluated Xpert Xpress versus conventional testing methods, from a German statutory health insurance (SHI) perspective.

METHODS

A 1-year decision tree was developed to compare Xpert Xpress with antigen testing, send-out PCR, and empiric diagnosis, for influenza A/B virus, SARS-CoV-2, and RSV. The model accounted for diagnostic accuracy and projected the share of patients receiving results within guideline-recommended treatment windows. Data on test accuracy, treatment effects, and costs were sourced from literature and German databases. The main outcome was total cost to the SHI for the 2023/24 respiratory illness season.

RESULTS

Xpert Xpress was associated with the highest number of net correct treatment courses (n = 443,600) versus empiric diagnosis (n = 239,250), antigen testing (n = 347,218), and send-out PCR (n = 280,527). Acquisition costs were highest for Xpert Xpress (EUR 38.4 million versus EUR 27.4 million for antigen testing and EUR 33.5 million for send-out PCR) but were offset by reduced hospitalization and intensive care costs. Overall, Xpert Xpress was associated with cost savings of EUR 1.97 million versus empiric diagnosis, EUR 10.1 million versus antigen testing, and EUR 20.8 million versus send-out PCR.

CONCLUSIONS

Using Xpert Xpress at POC combined fast turnaround with high diagnostic accuracy, thereby increasing correct treatment courses while reducing total costs for influenza, COVID-19, and RSV, offering substantial savings to the German SHI.

Community-based pathogen-specific incidence of influenza-like illness due to respiratory viruses in South-central Vietnam in 2009-2012: after a pandemic of influenza A viruses

BACKGROUND

Influenza-like illness (ILI) is one of the most common illnesses caused by various respiratory viruses and directly or indirectly incurs high expenses to households. However, the pathogen-specific incidence and health-seeking behaviour in communities have not been well described.

METHODS

A longitudinal cohort study using a self-recorded health calendar among 1000 households was performed in South-central Vietnam from October 2009 to September 2012. Endemic respiratory viruses in the community were monitored using random sampling in public health clinics (polyclinics). The monthly incidence of specific pathogens was calculated using the Bayesian method.

FINDINGS

Among 5,016 household members, 3,687 ILI episodes were reported during the study period. The incidence rate of ILI was 21.7 (95% confidence interval 21.0-22.4) per 1,000 person-months for all ages and highest in children under 2 years with 71.6 (64.7-81.8) followed by 2-4 years with 71.3 (65.8-78.2). Rhinovirus had the highest incidence with 22.5 among the age under 2 years, followed by adenovirus and respiratory syncytial virus (RSV) with 12.5 and 9.9, respectively. Most young children sought treatment from clinics and hospitals, whereas most schoolchildren and adults sought treatment from drugstores. RSV outbreaks significantly increase the number of healthcare visits among children under 2 years, but not in older age groups.

INTERPRETATION

Several surges of ILI were attributed by multiple respiratory viruses. Healthcare seeking patterns were varied among pathogens. Highly transmissible viruses, such as rhinovirus and adenovirus, pose the potential risk of the next pandemic.

Hidden in plain sight: the impact of human rhinovirus infection in adults

BACKGROUND

Human rhinovirus (HRV), a non-enveloped RNA virus, was first identified more than 70 years ago. It is highly infectious and easily transmitted through aerosols and direct contact. The advent of multiplex PCR has enhanced the detection of a diverse range of respiratory viruses, and HRV consistently ranks among the most prevalent respiratory pathogens globally. Circulation occurs throughout the year, with peak incidence in autumn and spring in temperate climates. Remarkably, during the SARS-CoV-2 pandemic, HRV transmission persisted, demonstrating its resistance to stringent public health measures aimed at curbing viral transmission.

MAIN BODY

HRV is characterised by its extensive genetic diversity, comprising three species and more than 170 genotypes. This diversity and substantial number of concurrently circulating strains allows HRVs to frequently escape the adaptive immune system and poses formidable challenges for the development of effective vaccines and antiviral therapies. There is currently a lack of specific treatments. Historically, HRV has been associated with self-limiting upper respiratory infection. However, there is now extensive evidence highlighting its significant role in severe lower respiratory disease in adults, including exacerbations of chronic airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), as well as pneumonia. These severe manifestations can occur even in immunocompetent individuals, broadening the clinical impact of this ubiquitous virus. Consequently, the burden of rhinovirus infections extends across various healthcare settings, from primary care to general hospital wards and intensive care units. The impact of HRV in adults, in terms of morbidity and healthcare utilisation, rivals that of the other major respiratory viruses, including influenza and respiratory syncytial virus. Recognition of this substantial burden underscores the critical need for novel treatment strategies and effective management protocols to mitigate the impact of HRV infections on public health.

CONCLUSION

This review examines the epidemiology, clinical manifestations, and risk factors associated with severe HRV infection in adults. By drawing on contemporary literature, we aim to provide a comprehensive overview of the virus's significant health implications. Understanding the scope of this impact is essential for developing new, targeted interventions and improving patient outcomes in the face of this persistent and adaptable pathogen.

Nationwide spatial epidemiological dataset of over 100,000 influenza-like illness notifications in Iran by county (2015-2019)

OBJECTIVES

This data note documents influenza-like illness (ILI) notifications in Iran by county from 2015 to 2019 as a pre-COVID-19 dataset, providing individual and spatial data for further comprehensive spatiotemporal analysis. Due to the high contagion rate of ILI and global health impact, precise geographic mapping serves as a critical tool for public health officials and researchers to monitor, mitigate, and predict epidemics. By utilizing advanced spatial-temporal epidemiological analysis to study disease occurrence patterns, this geodatabase can enable a better understanding and more effective management of ILIs in the future.

DATA DESCRIPTION

This is the most comprehensive dataset of all individual ILI notifications in Iran between 2015 and 2019 by date of notification and county (398 counties). The database includes two data files, a help file, and a data usage agreement: Data File 1 is an Excel (.xlsx) file detailing demographic and clinical information from 109,919 ILI notifications nationwide, covering county and date of notification, patient demographics, admission details, sample types, differential diagnosis, medical history, mortality details, test results, and symptoms. Data File 2 contains spatiotemporal information in polygon shapefiles (.shp), mapping ILI notification locations by county with data on case counts for each year, total population, gender distribution, and geographic coordinates.

Increased Risk of Influenza-Like Illness Clusters in Schools, Taiwan from 2011 to 2020: A Retrospective Study

Acute influenza-like illnesses (ILIs) are primarily caused by influenza type A or type B viruses. Several factors influence the risk of the spread of ILIs. The present study investigated the epidemiological characteristics, differences, and epidemiological trends of influenza viruses, noninfluenza respiratory pathogens, and locations where clusters occurred in Taiwan between 2011 and 2020. The study analyzed publicly available data on 1,545 confirmed ILI clusters, with the data obtained from the Taiwan Centers for Disease Control. In total, 1,334 ILI clusters were caused by influenza virus infection, 11 ILI clusters were caused by noninfluenza respiratory pathogens, and 78 ILI clusters were caused by pathogens not detected in routine testing. Additionally, for 122 ILI clusters, no pathogen detection was initiated. Significant differences were observed (p < 0.001) in the number of ILI clusters between influenza and noninfluenza respiratory pathogens in 2011-2020. In addition, significant differences were observed (p < 0.001) in the number of ILI clusters between locations in 2011-2020. In terms of specific pathogens within ILI clusters, single infections with influenza A virus accounted for the highest number of cases (69.6%, 1076/1358, odds ratio: 1.740-2.957, p < 0.001-0.012), followed by adenovirus infections among noninfluenza respiratory pathogens (58.3%, 7/12). Schools had the highest number of ILI clusters (47.3%, 731/1545) among the investigated institutions (odds ratio: 1.438-1.556, p < 0.001-0.012). This study provides valuable insights into ILI cluster transmission patterns in Taiwan over a 10-year period and highlights the importance of long-term studies covering a wide geographic area as a means of understanding the implications of such patterns.

Impact of RSVpreF vaccination on reducing the burden of respiratory syncytial virus in infants and older adults

Respiratory syncytial virus (RSV) causes a substantial health burden among infants and older adults. Prefusion F protein-based vaccines have shown high efficacy against RSV disease in clinical trials, offering promise for mitigating this burden through maternal and older adult immunization. Employing an individual-based model, we evaluated the impact of RSV vaccination on hospitalizations and deaths in 13 high-income countries, assuming that the vaccine does not prevent infection or transmission. Using country-specific vaccine uptake rates for seasonal influenza, we found that vaccination of older adults would prevent hospitalizations by a median of 35-64% across the countries studied here. Vaccination of pregnant women could avert infant hospitalizations by 5-50%. Reductions in RSV-related mortality mirrored those estimated for hospitalizations. While substantial hospitalization costs could be averted, the impact of vaccination depends critically on uptake rates. Enhancing uptake and accessibility is crucial for maximizing the real-world impact of vaccination on reducing RSV burden among vulnerable populations.

Biases in Routine Influenza Surveillance Indicators Used to Monitor Infection Incidence and Recommendations for Improvement

BACKGROUND

Monitoring how the incidence of influenza infections changes over time is important for quantifying the transmission dynamics and clinical severity of influenza. Infection incidence is difficult to measure directly, and hence, other quantities which are more amenable to surveillance are used to monitor trends in infection levels, with the implicit assumption that they correlate with infection incidence.

METHODS

Here, we demonstrate, through mathematical reasoning using fundamental mathematical principles, the relationship between the incidence of influenza infections and three commonly reported surveillance indicators: (1) the rate per unit time of influenza-like illness reported through sentinel healthcare sites, (2) the rate per unit time of laboratory-confirmed influenza infections and (3) the proportion of laboratory tests positive for influenza ('test-positive proportion').

RESULTS

Our analysis suggests that none of these ubiquitously reported surveillance indicators are a reliable tool for monitoring influenza incidence. In particular, we highlight how these surveillance indicators can be heavily biassed by the following: the dynamics of circulating pathogens (other than influenza) with similar symptom profiles, changes in testing rates and differences in infection rates, symptom rates and healthcare-seeking behaviour between age-groups and through time. We make six practical recommendations to improve the monitoring of influenza infection incidence. The implementation of our recommendations would enable the construction of more interpretable surveillance indicator(s) for influenza from which underlying patterns of infection incidence could be readily monitored.

CONCLUSIONS

The implementation of all (or a subset) of our recommendations would greatly improve understanding of the transmission dynamics, infection burden and clinical severity of influenza, improving our ability to respond effectively to seasonal epidemics and future pandemics.

Comparison of Three Influenza Surveillance Data Sources for Timely Detection of Epidemic Onset - Chengdu City, Sichuan Province and Beijing Municipality, China, 2017-2023

What is already known about this topic?

The syndromic surveillance system, exemplified by the influenza-like illness (ILI) surveillance system, has long been crucial in providing early warnings of influenza epidemics.

What is added by this report?

The analysis revealed that employing reported influenza case data from the nationwide Notifiable Infectious Diseases Reporting Information System (NIDRIS) enhanced the early detection of influenza epidemics, particularly within the context of multiple respiratory pathogens circulating concurrently.

What are the implications for public health practice?

The NIDRIS, characterized by its extensive coverage, obligatory reporting, high specificity, and real-time data transmission, offers a valuable tool for the effective early detection of influenza epidemics. Utilizing this system could enhance preparedness and responses to such health crises, potentially mitigating their impact on public health.

Epidemiology of Viral Infectious Diseases Reported in Saudi Arabia

INTRODUCTION

Efficient epidemiological monitoring of virus diseases is crucial in evaluating general public health, the prevalence of specific diseases, the pattern of spread, and implementing preventative and control strategies into action.

METHODS

This study analyzed data obtained from the Field Epidemiology Program (FETP) which is part of the Ministry of Health (MOH) in Saudi Arabia, which contained reported cases of infectious diseases over four years, from January 2018 to December 2021, to investigate and highlight the significant trend and incidence rate for each viral infectious disease.

RESULTS

Of the reported viral infectious diseases, hepatitis B and C, dengue fever (DF), influenza, chickenpox, and measles were the highest reported viral cases over four years. For the aforementioned diseases, males were often more susceptible to viral infections than females. Except for DF, this viral infection was more common in Saudi citizens. Viral illnesses like hand, foot, and mouth disease were less prevalent, while neurological viral disorders such as acute flaccid paralysis were rarely detected. There was an overall reduction in viral cases recorded during 2020-2021, which may be attributed to the implementation of preventive measures during the Coronavirus Disease 2019 (COVID-19) pandemic or an underreporting of cases during the lockdown of that time.

CONCLUSION

The prevalence of these common viral infections in the Saudi population suggests that understanding the mechanisms influencing changes in these viruses, methods of transmission, and the burden of these diseases is a priority for health policy. This understanding is necessary to develop effective intervention and preventive strategies.

Incidence and prevalence of headache in influenza: A 2010-2021 surveillance-based study

BACKGROUND AND PURPOSE

Influenza is a common cause of acute respiratory infection, with headache being one of the symptoms included in the European Commission case definition. The prevalence of headache as a symptom of influenza remains unknown. We aimed to describe the incidence and prevalence of headache in patients with influenza.

METHODS

All consecutive patients who met the definition criteria of influenza-like illness during the influenza seasons 2010-2011 through 2021-2022 were included. The seasonal cumulative incidence of influenza per 1000 patients at risk and the prevalence of headache as an influenza symptom were calculated, including the 95% confidence intervals (CIs). Subgroup analyses were done based on patients' sex, age group, microbiological confirmation, vaccination status, and influenza type/subtype/lineage.

RESULTS

During the study period, 8171 patients were eligible. The incidence of headache in the context of influenza varied between 0.24 cases per 1000 patients (season 2020-2021) and 21.69 cases per 1000 patients (season 2017-2018). The prevalence of headache was 66.1% (95% CI = 65.1%-67.1%), varying between 49.6% (season 2021-2022) and 80.1% (season 2010-2011). The prevalence of headache was higher in women (67.9% vs. 65.7%, p = 0.03) and higher in patients between 15 and 65 years old. Headache was more prevalent in patients infected with B subtypes than A subtypes (68.7% vs. 56.9%, p < 0.001). There were no notable differences regarding vaccination status or microbiological confirmation of the infection.

CONCLUSIONS

Headache is a common symptom in patients with influenza, with a prevalence higher than that observed in other viral infections.

Epidemiologic and clinical updates on viral infections in Saudi Arabia

In the past two decades, the world has witnessed devastating pandemics affecting the global healthcare infrastructure and disrupting society and the economy worldwide. Among all pathogens, viruses play a critical role that is associated with outbreaks due to their wide range of species, involvement of animal hosts, easily transmitted to humans, and increased rates of infectivity. Viral disease outbreaks threaten public health globally due to the challenges associated with controlling and eradicating them. Implementing effective viral disease control programs starts with ongoing surveillance data collection and analyses to detect infectious disease trends and patterns, which is critical for maintaining public health. Viral disease control strategies include improved hygiene and sanitation facilities, eliminating arthropod vectors, vaccinations, and quarantine. The Saudi Ministry of Health (MOH) and the Public Health Authority (also known as Weqayah) in Saudi Arabia are responsible for public health surveillance to control and prevent infectious diseases. The notifiable viral diseases based on the Saudi MOH include hepatitis diseases, viral hemorrhagic fevers, respiratory viral diseases, exanthematous viral diseases, neurological viral diseases, and conjunctivitis. Monitoring trends and detecting changes in these viral diseases is essential to provide proper interventions, evaluate the established prevention programs, and develop better prevention strategies. Therefore, this review aims to highlight the epidemiological updates of the recently reported viral infections in Saudi Arabia and to provide insights into the recent clinical treatment and prevention strategies.

Long-Term Regional Influenza-Like-Illness Forecasting Using Exogenous Data

Disease forecasting is a longstanding problem for the research community, which aims at informing and improving decisions with the best available evidence. Specifically, the interest in respiratory disease forecasting has dramatically increased since the beginning of the coronavirus pandemic, rendering the accurate prediction of influenza-like-illness (ILI) a critical task. Although methods for short-term ILI forecasting and nowcasting have achieved good accuracy, their performance worsens at long-term ILI forecasts. Machine learning models have outperformed conventional forecasting approaches enabling to utilize diverse exogenous data sources, such as social media, internet users' search query logs, and climate data. However, the most recent deep learning ILI forecasting models use only historical occurrence data achieving state-of-the-art results. Inspired by recent deep neural network architectures in time series forecasting, this work proposes the Regional Influenza-Like-Illness Forecasting (ReILIF) method for regional long-term ILI prediction. The proposed architecture takes advantage of diverse exogenous data, that are, meteorological and population data, introducing an efficient intermediate fusion mechanism to combine the different types of information with the aim to capture the variations of ILI from various views. The efficacy of the proposed approach compared to state-of-the-art ILI forecasting methods is confirmed by an extensive experimental study following standard evaluation measures.

Clinical profile of children with influenza like illness during pre-monsoon at coastal Karaikal, Puducherry, India

Influenza infections in developing countries are under reported and WHO estimates that nearly 99% of influenza deaths worldwide occur in children under-five years of age in Asian and African countries. Consequently, this study aims to analyze the use of clinical profile and easily available laboratory parameters to aid identification of the possible viral etiology in the setting of pre-monsoon ILI. A cross-sectional study was carried out for three months among children with ILI attending fever clinic of a tertiary care hospital in Karaikal, South India. In the study population the prevalence of ILI was highest in the age group four to five years followed by school aged children. Adolescents were affected the least. Influenza B was most common virus causing ILI in this region, followed by covid-19 infection. Laboratory parameters depicted a significantly high ESR in COVID-19 infected ILI children. They also exhibited leucopenia and normal platelet counts. Clinical symptoms and laboratory parameters which are easily available and cheaper can be used in resource poor settings of healthcare to identify possible influenza and COVID-19 infected children amongst cases presenting with ILI.

Identify future epidemic threshold and intensity for influenza-like illness in Iraq by using the moving epidemic method

Objectives

Influenza-like illness (ILI) entered the Iraq surveillance system in 2021. The alert threshold was determined using the cumulative sum 2 method, which did not provide other characteristics. This study uses the moving epidemic method (MEM) to describe duration and estimate alert thresholds for ILI in Iraq for 2023-2024.

Methods

MEM default package was used to estimate influenza 2023-2024 epidemic thresholds. Analysis was repeated using optimum parameter of epidemic timing for fixed criteria method, which is 3.3. Arithmetic means and 95% confidence interval upper limit were used to estimate threshold. Geometric mean and 40%, 90%, and 97.3% confidence interval upper limits were used to estimate intensity levels. Aggregated Centers for Disease Control and Prevention surveillance data were used to detect epidemic thresholds, length, sensitivity, and predictive values.

Results

ILI activity starts at week 30 and lasts 7 weeks. Optimized epidemic threshold is 4513 cases, lower than default (4540 cases). Optimized medium-intensity level was higher than default, and high and very high-intensity levels were lower.

Conclusions

MEM is essential to determine an influenza epidemic's threshold and intensity levels. Despite requiring 3-5 years of data, using it on data for 2.5 years has resulted in an epidemic threshold slightly higher than the threshold calculated using the cumulative sum 2 method.

Residential exposure to mold, dampness, and indoor air pollution and risk of respiratory tract infections: a study among children ages 11 and 12 in the Danish National Birth Cohort

BACKGROUND

The burden of respiratory tract infections (RTIs) is high in childhood. Several residential exposures may affect relative rates.

OBJECTIVES

To determine risk of RTIs in children ages 11 and 12 by residential exposures.

METHODS

We included children in the Danish National Birth Cohort (DNBC) at ages 11 and 12. We estimated incidence risk ratios (IRR) and 95% confidence intervals (CI) for counts of RTIs within the last year by exposure to mold/dampness, gas stove usage, summer and winter candle-burning, fireplace usage, cats and dogs indoors, and farmhouse living. We also estimated IRR and 95% CI for RTIs for predicted scores of four extracted factors ('owned house', 'mold and dampness', 'candles', and 'density') from exploratory factor analyses (EFA).

RESULTS

We included 42 720 children with complete data. Mold/dampness was associated with all RTIs (common cold: IRRadj 1.09[1.07, 1.12]; influenza: IRRadj 1.10 [1.05, 1.15]; tonsillitis: IRRadj 1.19 [1.10, 1.28]; conjunctivitis: IRRadj 1.16 [1.02, 1.32]; and doctor-diagnosed pneumonia: IRRadj 1.05 [0.90, 1.21]), as was the EFA factor 'mold/dampness' for several outcomes. Gas stove usage was associated with conjunctivitis (IRRadj 1.25 [1.05, 1.49]) and with doctor-diagnosed pneumonia (IRRadj 1.14 [0.93, 1.39]). Candle-burning during summer, but not winter, was associated with several RTIs, for tonsillitis in a dose-dependent fashion (increasing weekly frequencies vs. none: [IRRadj 1.06 [0.98, 1.14], IRRadj 1.16 [1.04, 1.30], IRRadj 1.23 [1.06, 1.43], IRRadj 1.29 [1.00, 1.67], and IRRadj 1.41 [1.12, 1.78]).

CONCLUSION

Residential exposures, in particular to mold and dampness and to a lesser degree to indoor combustion sources, are related to the occurrence of RTIs in children.

A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses

AIMS

Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies.

METHODS

A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course.

RESULTS

The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies.

LIMITATIONS

Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic.

CONCLUSION

The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.

Clinical use of ketoprofen lysine salt: a reappraisal in adolescents with acute respiratory infections

Upper respiratory infections are widespread, and they are mainly of viral etiology. It has to be remarked that every infection is always associated with an inflammatory response. Inflammation implicates a cascade of bothersome symptoms, including fever, pain (headache, myalgia, and arthralgia), malaise, and respiratory complaints. As a result, anti-inflammatory medications could be beneficial as they act on different pathogenetic pathways. The ketoprofen lysine salt (KLS) has a potent anti-inflammatory activity associated with effective analgesic and antipyretic effects and has a valuable safety profile. However, adolescents present peculiar psychological characteristics that determine their difficulty to be managed. In this regard, an adolescent with a respiratory infection requires a prompt and adequate cure. KLS, thanks to its pharmacologic profile, could be favorably used in this regard. A recent primary-care experience outlined its effectiveness in this issue.

Sobrerol: New Perspectives to Manage Patients with Frequent Respiratory Infections

Respiratory tract infections (RTIs) are usually characterized by mucus hypersecretion. This condition may worsen and prolong symptoms and signs. For this reason, reducing mucus production and improving mucus removal represent relevant aspects of managing patients with RTIs. In this regard, mucoactive drugs may be effective. Mucoactive agents constitute a large class of compounds characterized by different mechanisms of action. Sobrerol is a monoterpene able to fluidify mucus, increase mucociliary clearance, and exert antioxidant activity. Sobrerol is available in various formulations (granules, syrup, nebulized, and suppository). Sobrerol has been on the market for over 50 years. Therefore, the present article revised the evidence concerning this compound and proposed new possible strategies. The literature analysis showed that several studies investigated the efficacy and safety of sobrerol in acute and chronic RTIs characterized by mucus hyperproduction. Seven pediatric studies have been conducted with favorable outcomes. However, the regulatory agencies recently reduced the treatment duration to three days. Therefore, a future study will test the hypothesis that a combination of oral and topical sobrerol could benefit children and adults with frequent respiratory tract infections. The rationale of this new approach is based on the concept that mucus accumulation could be a risk factor for increased susceptibility to infections.

Wastewater concentrations of human influenza, metapneumovirus, parainfluenza, respiratory syncytial virus, rhinovirus, and seasonal coronavirus nucleic-acids during the COVID-19 pandemic: a surveillance study

BACKGROUND

Respiratory disease is a major cause of morbidity and mortality; however, surveillance for circulating respiratory viruses is passive and biased. Wastewater-based epidemiology has been used to understand SARS-CoV-2, influenza A, and respiratory syncytial virus (RSV) infection rates at a community level but has not been used to investigate other respiratory viruses. We aimed to use wastewater-based epidemiology to understand community viral respiratory infection occurrence.

METHODS

A retrospective wastewater-based epidemiology surveillance study was carried out at a large wastewater treatment plant located in California, USA. Using droplet digital RT-PCR, we measured RNA concentrations of influenza A and influenza B viruses, RSV A and RSV B, parainfluenza (1-4) viruses, rhinovirus, seasonal coronaviruses, and metapneumovirus in wastewater solids three times per week for 17 months (216 samples) between Feb 1, 2021, and June 21, 2022. Novel probe-based RT-PCR assays for non-influenza viral targets were developed and validated. We compared viral RNA concentrations to positivity rates for viral infections from clinical specimens submitted to California Sentinel Clinical Laboratories (sentinel laboratories) to assess concordance between the two datasets.

FINDINGS

We detected RNA from all tested viruses in wastewater solids. Human rhinovirus (median concentration 4300 [0-9500] copies per gram dry weight) and seasonal human coronaviruses (35 000 [17 000-56 000]) were found at the highest concentrations. Concentrations of viral RNA correlated significantly and positively with positivity rates of associated viral diseases from sentinel laboratories (tau 0·32-0·57, p<0·0009); the only exceptions were influenza B and RSV A, which were rarely detected in wastewater solids. Measurements from wastewater indicated coronavirus OC43 dominated the seasonal human coronavirus infections whereas parainfluenza 3 dominated among parainfluenza infections during the study period. Concentrations of all tested viral RNA decreased noticeably after the omicron BA.1 surge suggesting a connection between changes in human behaviour during the surge and transmission of all respiratory viruses.

INTERPRETATION

Wastewater-based epidemiology can be used to obtain information on circulation of respiratory viruses at a localised, community level without the need to test many individuals because a single sample of wastewater represents the entire contributing community. Results from wastewater can be available within 24 h of sample collection, generating real time information to inform public health responses, clinical decision making, and individual behaviour modifications.

FUNDING

CDC Foundation.

Wastewater Levels of Respiratory Syncytial Virus Associated with Influenza-like Illness Rates in Children-A Case Study in Larissa, Greece (October 2022-January 2023)

The emergence of the COVID-19 pandemic has led to significant progress in the field of wastewater-based surveillance (WBS) of respiratory pathogens and highlighted its potential for a wider application in public health surveillance. This study aimed to evaluate whether monitoring of respiratory syncytial virus (RSV) in wastewater can provide a comprehensive picture of disease transmission at the community level. The study was conducted in Larissa (Central Greece) between October 2022 and January 2023. Forty-six wastewater samples were collected from the inlet of the wastewater treatment plant of Larissa and analyzed with a real-time reverse transcription polymerase chain reaction (RT-PCR) based method. RSV and SARS-CoV-2 wastewater viral loads (genome copies/100,000 inhabitants) were analyzed against sentinel surveillance data on influenza-like illness (ILI) to identify potential associations. Univariate linear regression analysis revealed that RSV wastewater viral load (lagged by one week) and ILI notification rates in children up to 14 years old were strongly associated (std. Beta: 0.73 (95% CI: 0.31-1.14), p = 0.002, R2 = 0.308). A weaker association was found between SARS-CoV-2 viral load and ILI rates in the 15+ age group (std. Beta: 0.56 (95% CI: 0.06-1.05), p = 0.032, R2 = 0.527). The results support the incorporation of RSV monitoring into existing wastewater-based surveillance systems.

Effects of ambient temperature on influenza-like illness: A multicity analysis in Shandong Province, China, 2014-2017

Background

The associations between ambient temperature and influenza-like illness (ILI) have been investigated in previous studies. However, they have inconsistent results. The purpose of this study was to estimate the effect of ambient temperature on ILI in Shandong Province, China.

Methods

Weekly ILI surveillance and meteorological data over 2014-2017 of the Shandong Province were collected from the Shandong Center for Disease Control and Prevention and the China Meteorological Data Service Center, respectively. A distributed lag non-linear model was adopted to estimate the city-specific temperature-ILI relationships, which were used to pool the regional-level and provincial-level estimates through a multivariate meta-analysis.

Results

There were 911,743 ILI cases reported in the study area between 2014 and 2017. The risk of ILI increased with decreasing weekly ambient temperature at the provincial level, and the effect was statistically significant when the temperature was <-1.5°C (RR = 1.24, 95% CI: 1.00-1.54). We found that the relationship between temperature and ILI showed an L-shaped curve at the regional level, except for Southern Shandong (S-shaped). The risk of ILI was influenced by cold, with significant lags from 2.5 to 3 weeks, and no significant effect of heat on ILI was found.

Conclusion

Our findings confirm that low temperatures significantly increased the risk of ILI in the study area. In addition, the cold effect of ambient temperature may cause more risk of ILI than the hot effect. The findings have significant implications for developing strategies to control ILI and respond to climate change.

Respiratory illness virus infections with special emphasis on COVID-19

Viruses that emerge pose challenges for treatment options as their uniqueness would not know completely. Hence, many viruses are causing high morbidity and mortality for a long time. Despite large diversity, viruses share common characteristics for infection. At least 12 different respiratory-borne viruses are reported belonging to various virus taxonomic families. Many of these viruses multiply and cause damage to the upper and lower respiratory tracts. The description of these viruses in comparison with each other concerning their epidemiology, molecular characteristics, disease manifestations, diagnosis and treatment is lacking. Such information helps diagnose, differentiate, and formulate the control measures faster. The leading cause of acute illness worldwide is acute respiratory infections (ARIs) and are responsible for nearly 4 million deaths every year, mostly in young children and infants. Lower respiratory tract infections are the fourth most common cause of death globally, after non-infectious chronic conditions. This review aims to present the characteristics of different viruses causing respiratory infections, highlighting the uniqueness of SARS-CoV-2. We expect this review to help understand the similarities and differences among the closely related viruses causing respiratory infections and formulate specific preventive or control measures.