Influenza estacional en adultos y niños—Diagnóstico, tratamiento, quimioprofilaxis y control de brotes institucionales: Guías de práctica clínica de la Sociedad de Enfermedades Infecciosas de Estados Unidos de América

No association between inactivated influenza vaccination and influenza viral load at diagnosis among young Japanese children: An observational study of the 2013/2014 through 2017/2018 influenza seasons

BACKGROUND

The association between inactivated influenza vaccination and viral load in young children remains unclear.

METHODS

During the 2013/2014 to 2017/2018 influenza seasons in Japan, children under 6 years of age with pre-defined influenza-like illness and influenza-positive status by real-time RT-PCR were recruited at pediatric clinics for this observational study. Influenza viral load was measured for the most predominant subtype/lineage in each season. Using median dichotomized viral load as an outcome, a multilevel logistic regression model was applied to estimate the multivariable adjusted odds ratio (MOR) and 95% confidence interval (CI) for higher viral load.

RESULTS

A total of 1,185 influenza-positive children were analyzed. The median log10 viral load copy number (copies per milliliter) was 5.5 (interquartile range, 4.6 to 6.1) and did not differ by vaccination status: 5.5 for unvaccinated, 5.7 for one dose, and 5.5 for two doses (p = 0.67). The MOR of vaccinated (one or two doses) versus unvaccinated children was 1.19 (95% CI: 0.86-1.64). Other factors showing significant associations with higher viral load were positive results for A(H1N1)pdm09 and A(H3N2) in comparison with B/Yamagata. The respective MORs were 3.25 (95% CI: 2.28-4.64) and 1.81 (95% CI: 1.32-2.49). Significantly elevated MORs against higher viral load were also observed for higher body temperature at influenza diagnosis and shorter duration from fever onset to specimen collection.

CONCLUSION

No association was observed between inactivated-influenza vaccination and viral load at influenza-positive diagnosis. Influenza subtype/lineage, body temperature, and time elapsed since fever onset were significantly associated with viral load.

Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6-59 Months: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis summarises the literature on parental acceptance, parental hesitancy, uptake, and the associated factors of seasonal influenza vaccination (SIV) among children aged 6-59 months. Studies were sourced from the following platforms: PubMed, Web of Science, MEDLINE, and EMBASE databases. A random-effects model was used to evaluate the prevalence and 95% confidence intervals (CI) of parental acceptance, parental hesitancy, and SIV uptake in the last flu season and lifetime among children. A total of 36 studies were included for analysis. The overall prevalence was 64% for parental acceptance (95% CI: 51-75%), 34% for parental hesitancy (95% CI: 22-48%), 41% for SIV uptake in the last flu season (95% CI: 33-50%), and 46% for SIV uptake in a lifetime (95% CI: 20-74%). Associated factors of parental acceptance/hesitancy and uptake included the age of the children or parents, parental education level, household income level, ethnicity, and other modifiable factors, including perceived benefits, perceived barriers, perceived severity, perceived susceptibility, and cues to action related to SIV. Meta-regression analyses revealed regional differences in parental acceptance (Americas: 79% vs. Asia: 60%). The results provided implications informing us of the development of intervention programs targeting parents to improve SIV coverage among young children.

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa

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.

A Narrative Review of Influenza: A Seasonal and Pandemic Disease

Influenza is an acute respiratory disease caused by the influenza A or B virus. It often occurs in outbreaks and epidemics worldwide, mainly during the winter season. Significant numbers of influenza virus particles are present in the respiratory secretions of infected persons, so infection can be transmitted by sneezing and coughing via large particle droplets. The mean duration of influenza virus shedding in immunocompetent adult patients is around 5 days but may continue for up to 10 days or more-particularly in children, elderly adults, patients with chronic illnesses, and immunocompromised hosts. Influenza typically begins with the abrupt onset of high-grade fever, myalgia, headache, and malaise. These manifestations are accompanied by symptoms of respiratory tract illnesses such as nonproductive cough, sore throat, and nasal discharge. After a typical course, influenza can affect other organs such as the lungs, brain, and heart more than it can affect the respiratory tract and cause hospitalization. The best way to prevent influenza is to administer annual vaccinations. Among severely ill patients, an early commencement of antiviral treatment (<2 d from illness onset) is associated with reduced morbidity and mortality, with greater benefits allied to an earlier initiation of treatment. Given the significance of the disease burden, we reviewed the latest findings in the diagnosis and management of influenza.

Available influenza vaccines: immunization strategies, history and new tools for fighting the disease

The main public health strategy for containing influenza-related disease is annual vaccination, which is recommended for the elderly and others belonging to risk-factor categories, who present the highest morbidity and mortality, as reported by the World Health Organization (WHO) Recommendations. The availability of different influenza vaccine formulations makes the choice of the best immunization strategy a challenge for stakeholders and public health experts. Heterogeneity in at-risk categories included in national influenza vaccine recommendations still exists, in particular among European countries. Broader consensus is expected, which should positively impact on influenza vaccination coverage. The availability of quadrivalent vaccines, containing both influenza B lineages, offers the potential to improve protection by overcoming the drawbacks of wrongly predicting which B lineage will predominate in a given year.

Effect of mass media on influenza vaccine coverage in the season 2014/2015: a regional survey in Lazio, Italy

INTRODUCTION

Adherence to vaccination program for Influenza virus is an important issue of Public Health in presence of many no-vaccine tendencies. The media event about some deaths, occurring after MF59 adjuvanted vaccine administration, has characterized the season 2014/15 vaccination program in Italy. Aim of the study is vaccination adherence assessment of the current season with regards to local health units (LHU) coordinators's perceptions in Lazio Region (IT).

METHODS

LHU coordinators's perceptions were collected from a questionnaire that was send via email to the all 12 LHU coordinators. The questionnaire was built with 4 questions concerning the impression about the vaccination adherence of elderly people in the current season. Data from questionnaire was compared with the official coverage rate obtained by the Regional Authority. Severe adverse events were collected by 1 LHU.

RESULTS

All the 12 LHU coordinators answered to our questionnaire: 7/12 (50%) predicted a coverage rate of at least 50%; 3/12 (25%) referred a coverage rate around 40-45%; 2/12 (17%) predicted a reduction of 5-10% less than the previous season. Indeed, a mean 49.1% vaccination coverage in the elderly has been reported by the Regional Authority highlighting a reduction of 10% less than the 2013/14 season coverage. No severe adverse events were observed.

DISCUSSION

In our survey an important effect of media event on anti-flu vaccination program adherence has been evidenced, with a failure in communication and joint management of Public Health Institutions in Italy about efficacy and safety information of flu vaccine.

Pandemic influenza A (H1N1) vaccination among libyan health care personnel: A cross-sectional retrospective study

CONTEXT

Vaccination rate among health-care personnel's (HCPs) are not promising notwithstanding the World Health Organization campaigns over three decades resulting in compromising patient safety. The H1N1 virus, which caused a world-wide pandemic earlier has now transformed into a seasonal flu virus.

AIMS

The aim of this study was to analyze the incidence of 2009-10 pandemic influenza A (H1N1) vaccination among Libyan HCPs in four hospitals of Al-Zawia, Libya.

MATERIALS AND METHODS

A questionnaire, which listed eight sections of parameters distributed among 310 HCPs to assess the vaccination rate and resulting adverse effects.

STATISTICAL ANALYSIS

The data were analyzed using descriptive statistics, Pearson's χ(2)-test and Student's t-test where appropriate.

RESULTS

The overall pandemic A (H1N1) vaccination among all HCPs was only 107 (39.9%) out of 268 respondents. The distribution of respondents based on physicians, other staff and sex were found significant (P < 0.05). The common barriers of H1N1 vaccination being lack of awareness fear of adverse effects, allergies and religious beliefs. The major adverse effect observed was erythema in 95.56% of physicians and 87.1% in other staff. About 2% of HCPs have reported arthralgia. No significant differences existed between the responses of general variables and adverse effects. The glycoprotein 120 and squalene were found responsible for the reported adverse effects. 37 (82.22%) vaccinated medical HCPs have advised their patients to get vaccinated.

CONCLUSIONS

Due to recurrence of H1N1 influenza in recent times, vaccination campaigns should be promoted immediately to address the knowledge gap of HCPs for intervention by regulatory and health organizations in Libya. The health belief model could be applied to improve vaccination among HCPs.

Reducing inappropriate antibiotic use among children with influenza infection

QUESTION

With the influenza season reaching a peak, I see numerous children in my clinic with fever and influenza-like illnesses. Parents are concerned and at times ask for antibiotic treatment in hopes that the treatment will shorten the duration of illness. What strategies can I use in order to minimize inappropriate prescription of antibiotics during the influenza season?

ANSWER

Use of antibiotics for treatment of viral infections such as influenza contributes to the emergence of resistant bacteria strains. Misuse and overuse of antibiotics can be reduced by preventing the infection and its complications through vaccination, point-of-care rapid influenza testing, and early antiviral treatment when appropriate, as well as constantly increasing the knowledge of both physicians and families regarding the appropriate use of antibiotics.

Hospitalised patients with Influenza A (H1N1) in the Royal Hospital, Oman: Experience of a tertiary care hospital, July-December 2009

OBJECTIVES

The aim of this study was to describe the clinical characteristics, risk factors, laboratory investigations and outcome of hospitalised patients with positive Influenza A (H1N1) at the Royal Hospital in Oman.

METHODS

We extracted data from the retrospective medical charts, radiological and laboratory findings of 131 patients who were confirmed as positive for Influenza A (H1N1) by real-time reverse-transcriptase-polymerase- chain-reaction from 21 July to 23 December 2009.

RESULTS

The median age was 24 years with 34.4% in the paediatric age group. Most (63%) of hospitalised patients were female. Symptoms at presentation included mainly fever (93.9%) and respiratory symptoms (89.3%). 83% of the patients had at least one risk factor and pregnancy was the most common associated condition (22.9%). Most of the patients had reduced lymphocytic count (57.3%) and high levels of serum C-reactive protein, aspartate transaminase and lactate dehydrogenase (75.7%, 75% and 70.8% respectively). The majority of the patients (64.5%) had evidence of pneumonia and radiological findings constituted mainly bi-lateral infiltrates (60.6%). Antiviral therapy was administered to 95.4% of the patients who mostly received it 48 hours after disease onset. Death occurred in 6.9% of patients. Out of these, 88.9% required Intensive Care Unit (ICU) care and mechanical ventilation.

CONCLUSION

Influenza A (H1N1) infection mainly affected those of younger age and females. Associated medical conditions were common, with pregnancy being interestingly the commonest risk factor. The infection caused severe illness that required ICU admission and led to death in 6.9% of patients.

Finding a new drug and vaccine for emerging swine flu: what is the concept?

Influenza is a well known infection of the respiratory system. The main clinical manifestations of influenza include fever, sore throat, headache, cough, coryza, and malaise. Apart from the well known classical influenza, there are also groups of influenza virus infections that are called "atypical infection". These infections are usually due to a novel influenza virus infection. In early 2009, an emerging novel influenza originating from Mexico called swine flu was reported. The World Health Organization noted a level VI precaution, the highest level precaution possible, for this newest influenza virus infection. As of June 2009, it is not known if this disease will be successfully controlled. Finding new drugs and vaccine for the emerging swine flu is still required to cope with this emerging worldwide problem.