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Lemaitre M, Fouad F, Carrat F, Crépey P, Gaillat J, Gavazzi G, Launay O, Mosnier A, Levant MC, Uhart M. Estimating the burden of influenza-related and associated hospitalizations and deaths in France: An eight-season data study, 2010-2018. Influenza Other Respir Viruses 2022; 16:717-725. [PMID: 35014194 PMCID: PMC9178052 DOI: 10.1111/irv.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background In France, each year, influenza viruses are responsible for seasonal epidemics leading to 2–6 million cases. Influenza can cause severe disease that may lead to hospitalization or death. As severe disease may be due to the virus itself or to disease complications, estimating the burden of severe influenza is complex. The present study aimed at estimating the epidemiological and economic burden of severe influenza in France during eight consecutive influenza seasons (2010–2018). Methods Influenza‐related hospitalization and mortality data and patient characteristics were taken from the French hospital information database, PMSI. An ecological approach using cyclic regression models integrating the incidence of influenza syndrome from the Sentinelles network supplemented the PMSI data analysis in estimating excess hospitalization and mortality (CépiDc—2010–2015) and medical costs. Results Each season, the average number of influenza‐related hospitalizations was 18,979 (range: 8627–44,024), with an average length of stay of 8 days. The average number of respiratory hospitalizations indirectly related with influenza (i.e., influenza associated) was 31,490 (95% confidence interval [CI]: 24,542–39,012), with an average cost of €141 million (range: 54–217); 70% of these hospitalizations and 77% of their costs concerned individuals ≥65 years of age (65+). More than 90% of excess mortality was in 65+ subjects. Conclusions The combination of two complementary approaches allowed estimation of both influenza‐related and associated hospitalizations and deaths and their burden in France, showing the substantial impact of complications. The present study highlighted the major public health burden of influenza and its severe complications, especially in 65+ subjects.
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Affiliation(s)
| | | | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (Inserm), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Pascal Crépey
- Université de Rennes, EHESP, REPERES-EA 7449, Rennes, France
| | | | - Gaëtan Gavazzi
- CHU Grenoble Alpes, Clinique Universitaire de Gériatrie, Pavillon Elisée-Chatin, and GREPI EA 7408, Université Grenoble Alpes, Grenoble, France
| | - Odile Launay
- Faculté de Médecine Paris Descartes, Université de Paris, Paris, France.,Inserm, CIC 1417, F-CRIN I-REIVAC, Assistance Publique-Hôpitaux de Paris, CIC Cochin-Pasteur, Paris, France
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Budama-Kilinc Y, Cakir-Koc R, Ozdemir B, Kaya Z, Badur S. Production and characterization of a conserved M2e peptide-based specific IgY antibody: evaluation of the diagnostic potential via conjugation with latex nanoparticles. Prep Biochem Biotechnol 2018; 48:930-939. [PMID: 30388960 DOI: 10.1080/10826068.2018.1525564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Antibodies play an important role in combating and controlling viral diseases such as influenza. Immunoglobulin Y (IgY) antibodies have several advantages such as a less invasive manufacturing process, ease of isolation, higher affinity compared with IgG antibodies, and cost-effectiveness. To date, although specific IgY production has been performed for different strains of influenza A, to the best of our knowledge, an IgY against the M2e peptide has not been produced. In the current study, IgY antibodies are produced, purified, and characterized using the M2e peptide sequence for the first time with the intent to apply them for the diagnosis of influenza A virus. Anti-M2e IgY antibodies are obtained from eggs using a two-step purification method. The activity and characterization of the antibodies are determined using an enzyme-linked immunosorbent assay, a nano-spectrophotometer, an SDS-Page assay, and a Western Blot analysis. Finally, anti-M2e IgY antibodies are conjugated to the latex nanoparticles, and the reaction between the influenza A virus and the nanoparticles is demonstrated using light microscopy, transmission electron microscopy, and energy dispersive X-ray spectroscopy. In conclusion, this study shows that anti-M2e IgY antibodies can contribute to the diagnosis, treatment, and prevention of the influenza A virus.
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Affiliation(s)
| | - Rabia Cakir-Koc
- a Bioengineering Department , Yildiz Technical University , Istanbul , Turkey
| | - Burak Ozdemir
- b Graduate School of Natural and Applied Sciences , Yildiz Technical University , Istanbul , Turkey
| | - Zeynep Kaya
- b Graduate School of Natural and Applied Sciences , Yildiz Technical University , Istanbul , Turkey
| | - Selim Badur
- c GlaxoSmithKline-Vaccine , Istanbul , Turkey
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Martínez-Sobrido L, Peersen O, Nogales A. Temperature Sensitive Mutations in Influenza A Viral Ribonucleoprotein Complex Responsible for the Attenuation of the Live Attenuated Influenza Vaccine. Viruses 2018; 10:E560. [PMID: 30326610 PMCID: PMC6213772 DOI: 10.3390/v10100560] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/03/2018] [Accepted: 10/12/2018] [Indexed: 01/29/2023] Open
Abstract
Live attenuated influenza vaccines (LAIV) have prevented morbidity and mortality associated with influenza viral infections for many years and represent the best therapeutic option to protect against influenza viral infections in humans. However, the development of LAIV has traditionally relied on empirical methods, such as the adaptation of viruses to replicate at low temperatures. These approaches require an extensive investment of time and resources before identifying potential vaccine candidates that can be safely implemented as LAIV to protect humans. In addition, the mechanism of attenuation of these vaccines is poorly understood in some cases. Importantly, LAIV are more efficacious than inactivated vaccines because their ability to mount efficient innate and adaptive humoral and cellular immune responses. Therefore, the design of potential LAIV based on known properties of viral proteins appears to be a highly appropriate option for the treatment of influenza viral infections. For that, the viral RNA synthesis machinery has been a research focus to identify key amino acid substitutions that can lead to viral attenuation and their use in safe, immunogenic, and protective LAIV. In this review, we discuss the potential to manipulate the influenza viral RNA-dependent RNA polymerase (RdRp) complex to generate attenuated forms of the virus that can be used as LAIV for the treatment of influenza viral infections, one of the current and most effective prophylactic options for the control of influenza in humans.
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Affiliation(s)
- Luis Martínez-Sobrido
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, NY 14642, USA.
| | - Olve Peersen
- Department of Biochemistry and Molecular Biology, Colorado State University, Fort Collins, Colorado, CO 80523, USA.
| | - Aitor Nogales
- Department of Microbiology and Immunology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, New York, NY 14642, USA.
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Saha S, Gupta V, Dawood FS, Broor S, Lafond KE, Chadha MS, Rai SK, Krishnan A. Estimation of community-level influenza-associated illness in a low resource rural setting in India. PLoS One 2018; 13:e0196495. [PMID: 29698505 PMCID: PMC5919664 DOI: 10.1371/journal.pone.0196495] [Citation(s) in RCA: 2] [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: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. Methods During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. Findings The HUS of 69,369 residents during the year generated risk-time of 3945 person-years (p-y) and identified 150 (5%, 95%CI: 4–6) ILI episodes (38 ILI episodes/1,000 p-y; 95% CI 32–44). Among 1,372 ILI cases enrolled from clinics, 126 (9%; 95% CI 8–11) had laboratory-confirmed influenza (A (H3N2) = 72; B = 54). After adjusting for age, month, and clinic type, overall influenza-associated ILI rate was 4.8/1,000 p-y; rates were highest among children <5 years (13; 95% CI: 4–29) and persons≥60 years (11; 95%CI: 2–30). Conclusion We present a novel way to use HUS and CBS data to generate estimates of community burden of influenza. Although the confidence intervals overlapped considerably, higher point estimates for burden among young children and older adults shows the utility for exploring the value of influenza vaccination among target groups.
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Affiliation(s)
- Siddhartha Saha
- Influenza Program, US Center for Disease Control and Prevention-India office, New Delhi, India
- * E-mail:
| | - Vivek Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Fatimah S. Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shobha Broor
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kathryn E. Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Sanjay K. Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Incidence of medically attended influenza infection and cases averted by vaccination, 2011/2012 and 2012/2013 influenza seasons. Vaccine 2015; 33:5181-7. [PMID: 26271827 DOI: 10.1016/j.vaccine.2015.07.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND We estimated the burden of outpatient influenza and cases prevented by vaccination during the 2011/2012 and 2012/2013 influenza seasons using data from the United States Influenza Vaccine Effectiveness (US Flu VE) Network. METHODS We defined source populations of persons who could seek care for acute respiratory illness (ARI) at each of the five US Flu VE Network sites. We identified all members of the source population who were tested for influenza during US Flu VE influenza surveillance. Each influenza-positive subject received a sampling weight based on the proportion of source population members who were tested for influenza, stratified by site, age, and other factors. We used the sampling weights to estimate the cumulative incidence of medically attended influenza in the source populations. We estimated cases averted by vaccination using estimates of cumulative incidence, vaccine coverage, and vaccine effectiveness. RESULTS Cumulative incidence of medically attended influenza ranged from 0.8% to 2.8% across sites during 2011/2012 and from 2.6% to 6.5% during the 2012/2013 season. Stratified by age, incidence ranged from 1.2% among adults 50 years of age and older in 2011/2012 to 10.9% among children 6 months to 8 years of age in 2012/2013. Cases averted by vaccination ranged from 4 to 41 per 1000 vaccinees, depending on the study site and year. CONCLUSIONS The incidence of medically attended influenza varies greatly by year and even by geographic region within the same year. The number of cases averted by vaccination varies greatly based on overall incidence and on vaccine coverage.
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Chandler DP, Griesemer SB, Knickerbocker C, Golova JB, Lambarqui A, Perov AN, Zimmerman C, Wiles C, Rudy GB, St George K. Development and clinical testing of a simple, low-density gel element array for influenza identification, subtyping, and H275Y detection. J Virol Methods 2014; 208:152-9. [PMID: 25066276 PMCID: PMC4175443 DOI: 10.1016/j.jviromet.2014.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/09/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
The objectives of this study were to develop a user-friendly, gel element microarray test for influenza virus detection, subtyping, and neuraminidase inhibitor resistance detection, assess the performance characteristics of the assay, and perform a clinical evaluation on retrospective nasopharyngeal swab specimens. A streamlined microarray workflow enabled a single user to run up to 24 tests in an 8h shift. The most sensitive components of the test were the primers and probes targeting the A/H1 pdm09 HA gene with an analytical limit of detection (LoD) <100 gene copies (gc) per reaction. LoDs for all targets in nasopharyngeal swab samples were ≤1000 gc, with the exception of one target in the seasonal A/H1N1 subtype. Seasonal H275Y variants were detectable in a mixed population when present at >5% with wild type virus, while the 2009 pandemic H1N1 H275Y variant was detectable at ≤1% in a mixture with pandemic wild type virus. Influenza typing and subtyping results concurred with those obtained with real-time RT-PCR assays on more than 97% of the samples tested. The results demonstrate that a large panel of single-plex, real-time RT-PCR tests can be translated to an easy-to-use, sensitive, and specific microarray test for potential diagnostic use.
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Affiliation(s)
- Darrell P Chandler
- Akonni Biosystems, Inc., 400 Sagner Avenue, Suite 300, Frederick, MD 21701, United States.
| | - Sara B Griesemer
- Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY 12208, United States
| | | | - Julia B Golova
- Akonni Biosystems, Inc., 400 Sagner Avenue, Suite 300, Frederick, MD 21701, United States
| | - Amine Lambarqui
- Akonni Biosystems, Inc., 400 Sagner Avenue, Suite 300, Frederick, MD 21701, United States
| | - Alexander N Perov
- Akonni Biosystems, Inc., 400 Sagner Avenue, Suite 300, Frederick, MD 21701, United States
| | - Cynthia Zimmerman
- Akonni Biosystems, Inc., 400 Sagner Avenue, Suite 300, Frederick, MD 21701, United States
| | - Cory Wiles
- Akonni Biosystems, Inc., 400 Sagner Avenue, Suite 300, Frederick, MD 21701, United States
| | - George B Rudy
- Akonni Biosystems, Inc., 400 Sagner Avenue, Suite 300, Frederick, MD 21701, United States
| | - Kirsten St George
- Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY 12208, United States
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The Epidemiology of Upper Respiratory Infections at a Tertiary Care Center: Prevalence, Seasonality, and Clinical Symptoms. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/469393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Improved multiplex PCR detection methods are facilitating the correlation of the etiology of respiratory tract infections with specific symptoms or clinical manifestations. We conducted a retrospective analysis of the incidence of respiratory pathogens and initial symptoms in 1,286 patients at a tertiary care center tested by multiplex respiratory pathogen PCR from July 1, 2012, to June 30, 2013. Rhinovirus/enterovirus (Rhino/Entero) infections were the most prevalent (25.4%) followed by respiratory syncytial virus (RSV) (13.6%) and influenza A (6.2%). Eleven percent of patients were positive for multiple analytes with Rhino/Entero and RSV being the most common combination. Asthma or asthma exacerbation was the most common presenting symptom in patients positive for Rhino/Entero (38.4%) or positive for Rhino/Entero along with RSV or hMPV (34.8%). Of the patients positive for Rhino/Entero and presenting with asthma, 97% were ≤17 years of age. RSV positive patients most commonly presented with respiratory distress (40.3%) followed by asthma (18%) or pneumonia (18%). The most prevalent initial clinical manifestation for influenza was fever (27.4%) followed by respiratory distress (13%) or pneumonia (11.9%). The significant percentage of patients positive for Rhino/Entero virus presenting with asthma supports the role of rhinovirus as an important trigger for asthma exacerbation.
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Fowlkes A, Giorgi A, Erdman D, Temte J, Goodin K, Di Lonardo S, Sun Y, Martin K, Feist M, Linz R, Boulton R, Bancroft E, McHugh L, Lojo J, Filbert K, Finelli L. Viruses associated with acute respiratory infections and influenza-like illness among outpatients from the Influenza Incidence Surveillance Project, 2010-2011. J Infect Dis 2013; 209:1715-25. [PMID: 24338352 PMCID: PMC5749912 DOI: 10.1093/infdis/jit806] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background. The Influenza Incidence Surveillance Project (IISP) monitored outpatient acute respiratory infection (ARI; defined as the presence of ≥2 respiratory symptoms not meeting ILI criteria) and influenza-like illness (ILI) to determine the incidence and contribution of associated viral etiologies. Methods. From August 2010 through July 2011, 57 outpatient healthcare providers in 12 US sites reported weekly the number of visits for ILI and ARI and collected respiratory specimens on a subset for viral testing. The incidence was estimated using the number of patients in the practice as the denominator, and the virus-specific incidence of clinic visits was extrapolated from the proportion of patients testing positive. Results. The age-adjusted cumulative incidence of outpatient visits for ARI and ILI combined was 95/1000 persons, with a viral etiology identified in 58% of specimens. Most frequently detected were rhinoviruses/enteroviruses (RV/EV) (21%) and influenza viruses (21%); the resulting extrapolated incidence of outpatient visits was 20 and 19/1000 persons respectively. The incidence of influenza virus-associated clinic visits was highest among patients aged 2–17 years, whereas other viruses had varied patterns among age groups. Conclusions. The IISP provides a unique opportunity to estimate the outpatient respiratory illness burden by etiology. Influenza virus infection and RV/EV infection(s) represent a substantial burden of respiratory disease in the US outpatient setting, particularly among children.
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Fowlkes A, Dasgupta S, Chao E, Lemmings J, Goodin K, Harris M, Martin K, Feist M, Wu W, Boulton R, Temte J, Brammer L, Finelli L. Estimating influenza incidence and rates of influenza-like illness in the outpatient setting. Influenza Other Respir Viruses 2012; 7:694-700. [PMID: 22984820 PMCID: PMC5781202 DOI: 10.1111/irv.12014] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Please cite this paper as: Fowlkes et al. (2012) Estimating influenza incidence and rates of influenza‐like illness in the outpatient setting. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12014. Background: Estimating influenza incidence in outpatient settings is challenging. We used outpatient healthcare practice populations as a proxy to estimate community incidence of influenza‐like illness (ILI) and laboratory‐confirmed influenza‐associated ILI. Methods: From October 2009 to July 2010, 38 outpatient practices in seven jurisdictions conducted surveillance for ILI (fever with cough or sore throat for patients ≥2 years; fever with ≥1 respiratory symptom for patients <2 years). From a sample of patients with ILI, respiratory specimens were tested for influenza. Results: During the week of peak influenza activity (October 24, 2009), 13% of outpatient visits were for ILI and influenza was detected in 72% of specimens. For the 10‐month surveillance period, ILI and influenza‐associated ILI incidence were 20·0 (95% CI: 19·7, 20·4) and 8·7/1000 (95% CI: 8·2, 9·2) persons, respectively. Influenza‐associated ILI incidence was highest among children aged 2–17 years. Observed trends were highly correlated with national ILI and virologic surveillance. Conclusions: This is the first multistate surveillance system demonstrating the feasibility of using outpatient practices to estimate the incidence of medically attended influenza at the community level. Surveillance demonstrated the substantial burden of pandemic influenza in outpatient settings and especially in children aged 2–17 years. Observed trends were consistent with established syndromic and virologic systems.
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Affiliation(s)
- Ashley Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Lemaitre M, Leruez-Ville M, De Lamballerie XN, Salez N, Garrone P, Fluckiger AC, Klatzmann D, Carrat F. Seasonal H1N1 2007 influenza virus infection is associated with elevated pre-exposure antibody titers to the 2009 pandemic influenza A (H1N1) virus. Clin Microbiol Infect 2010; 17:732-7. [PMID: 20731679 DOI: 10.1111/j.1469-0691.2010.03352.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The new influenza strain detected in humans in April 2009 has caused the first influenza pandemic of the 21st century. A cross-reactive antibody response, in which antibodies against seasonal H1N1 viruses neutralized the 2009 pandemic influenza A (H1N1) virus (2009 pH1N1), was detected among individuals aged >60 years. However, factors other than age associated with such a cross-reactive antibody response are poorly documented. Our objective was to examine factors potentially associated with elevated pre-exposure viro-neutralization and hemagglutination-inhibition antibody titers against the 2009 pH1N1. We also studied factors associated with antibody titers against the 2007 seasonal H1N1 virus. One hundred subjects participating in an influenza cohort were selected. Sera collected in 2008 were analysed using hemagglutination inhibition and viro-neutralization assays for the 2009 pH1N1 virus and the 2007 seasonal H1N1 virus. Viro-neutralization results were explored using a linear mixed-effect model and hemagglutination-inhibition results using linear-regression models for interval-censored data. Elevated antibody titers against 2009 pH1N1 were associated with seasonal 2007 H1N1 infection (viro-neutralization, p 0.006; hemagglutination-inhibition, p 0.018). Elevated antibody titers were also associated with age in the viro-neutralization assay (p <0.0001). Seasonal 2007 H1N1 infection is an independent predictor of elevated pre-exposure antibody titers against 2009 pH1N1 and may have contributed to lowering the burden of the 2009 pH1N1 pandemic.
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Affiliation(s)
- M Lemaitre
- UPMC, Univ Paris 6, UMR-S 707, Paris, France
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Schwarzinger M, Lacombe K, Carrat F. Economic evaluations of neuraminidase inhibitors to control influenza. Expert Rev Pharmacoecon Outcomes Res 2010; 3:147-58. [PMID: 19807362 DOI: 10.1586/14737167.3.2.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Up to 10% of individuals present influenza-like illness each year. Neuraminidase inhibitors significantly reduce the median duration of influenza symptoms by 1.38 days and median time to return to normal activities by 0.9 days in adults. This review presents the economic evaluations of neuraminidase inhibitors in adults. The choice of key parameter estimates in cost-effectiveness and cost-benefit analysis is sensitive to the perspective of analysis: healthcare payer or societal, including productivity gains. This review discusses, among other key parameters, the proportion of influenza-like illness due to the influenza virus (targeted by neuraminidase inhibitors and influenza vaccine), and the measure of health benefits by either quality-adjusted life years gained or willingness-to-pay for a day of symptoms averted. Overall, neuraminidase inhibitors are worth their costs and do not challenge annual influenza vaccination but should be seen as a complementary option to reduce the burden of influenza.
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Affiliation(s)
- Michaël Schwarzinger
- Institut National de la Santé Et de la Recherche Médicale, INSERM Unit 444, Hôpital Saint-Antoine, 27 rue de Chaligny, 75012 Paris, France.
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Lemaitre M, Carrat F. Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic. BMC Infect Dis 2010; 10:162. [PMID: 20534113 PMCID: PMC2896934 DOI: 10.1186/1471-2334-10-162] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 06/09/2010] [Indexed: 12/21/2022] Open
Abstract
Background Several studies have shown a relatively high mortality rate among young people infected by the 2009 pandemic influenza A (H1N1) virus. Here we compared the age distributions of morbidity and mortality during two seasonal influenza epidemics (H1N1 and H3N2) in France and the United States with those of the 2009 H1N1 pandemic waves in the same countries. Methods Age-standardized ratios were used to compare the age distribution of morbidity and mortality due to influenza between the two countries and across the different years. Non parametric analysis of variance was used to compare these ratios between epidemic and pandemic influenza. Results Age distribution of morbidity was similar between the 2009 pandemic and seasonal epidemics due to H1N1 (p = 0.72) and H3N2 viruses (p = 0.68). In contrast, the proportion of under-60s among influenza deaths was markedly higher during the 2009 pandemic (peak <20 years) than during the seasonal epidemics (respectively p = 0.007 and p = 0.0008). Conclusions Young age was a principal mortality risk factor due to the 2009 H1N1 pandemic.
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Khiabanian H, Farrell GM, St George K, Rabadan R. Differences in patient age distribution between influenza A subtypes. PLoS One 2009; 4:e6832. [PMID: 19718262 PMCID: PMC2729409 DOI: 10.1371/journal.pone.0006832] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 08/02/2009] [Indexed: 11/18/2022] Open
Abstract
Since the spring of 1977, two subtypes of influenza A virus (H3N2 and H1N1) have been seasonally infecting the human population. In this work we study the distribution of patient ages within the populations that exhibit the symptomatic disease caused by each of the different subtypes of seasonal influenza viruses. When the publicly available extensive information is pooled across multiple geographical locations and seasons, striking differences emerge between these subtypes. We report that the symptomatic flu due to H1N1 is distributed mainly in a younger population relative to H3N2. (The median age of the H3N2 patients is 23 years while H1N1 patients are 9 years old.) These distinct characteristic spectra of age groups, possibly carried over from previous pandemics, are consistent with previous reports from various regional population studies and also findings on the evolutionary dynamics of each subtype. Moreover, they are relevant to age-related risk assessments, modeling of epidemiological networks for specific age groups, and age-specific vaccine design. Recently, a novel H1N1 virus has spread around the world. Preliminary reports suggest that this new strain causes symptomatic disease in the younger population in a similar fashion to the seasonal H1N1 strains.
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Affiliation(s)
- Hossein Khiabanian
- Department of Biomedical Informatics and Center for Computational Biology and Bioinformatics, Columbia University College of Physicians and Surgeons, New York, New York, United States of America.
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Maďarová L, Feiková S, Kissová R, Klement C, Blaškovičová H, Takáč B, Dluholucký S. Polymerase Chain Reaction (PCR) - an Efficient Tool for Diagnosis of Influenza and Acute Respiratory Illnesses During Influenza Season. Cent Eur J Public Health 2008; 16:59-64. [DOI: 10.21101/cejph.a3443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gioia C, Castilletti C, Tempestilli M, Piacentini P, Bordi L, Chiappini R, Agrati C, Squarcione S, Ippolito G, Puro V, Capobianchi MR, Poccia F. Cross-subtype immunity against avian influenza in persons recently vaccinated for influenza. Emerg Infect Dis 2008; 14:121-8. [PMID: 18258091 PMCID: PMC2600140 DOI: 10.3201/eid1401.061283] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Seasonal influenza vaccination may induce heterosubtypic immunity against avian influenza virus (H5N1). Avian influenza virus (H5N1) can be transmitted to humans, resulting in a severe or fatal disease. The aim of this study was to evaluate the immune cross-reactivity between human and avian influenza (H5N1) strains in healthy donors vaccinated for seasonal influenza A (H1N1)/(H3N2). A small frequency of CD4 T cells specific for subtype H5N1 was detected in several persons at baseline, and seasonal vaccine administration enhanced the frequency of such reactive CD4 T cells. We also observed that seasonal vaccination is able to raise neutralizing immunity against influenza (H5N1) in a large number of donors. No correlation between influenza-specific CD4 T cells and humoral responses was observed. N1 may possibly be a target for both cellular and humoral cross-type immunity, but additional experiments are needed to clarify this point. These findings highlight the possibility of boosting cross-type cellular and humoral immunity against highly pathogenic avian influenza A virus subtype H5N1 by seasonal influenza vaccination.
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Affiliation(s)
- Cristiana Gioia
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani, Istituti di Ricovero e Cura a Carattere Scientifico, Via Portuense 292, Rome, Italy
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16
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Roberts S, Hollier LM, Sheffield J, Laibl V, Wendel GD. Cost-effectiveness of universal influenza vaccination in a pregnant population. Obstet Gynecol 2006; 107:1323-9. [PMID: 16738159 DOI: 10.1097/01.aog.0000210225.45986.99] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to estimate whether universal influenza vaccination of pregnant women was cost-effective in the management of influenza-like illness during influenza season. METHODS A decision analysis model was developed to investigate the cost-effectiveness of providing inactivated trivalent influenza vaccine to all pregnant women. This scenario was compared with providing supportive care only on a case-by-case basis to the unvaccinated pregnant population. RESULTS Vaccination of 100% of pregnant women would save approximately 50 dollars per woman, resulting in a net gain of approximately 45 quality-adjusted hours relative to providing supportive care only. CONCLUSION Universal vaccination with inactivated trivalent influenza vaccine is cost-saving relative to providing supportive care alone in the pregnant population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Scott Roberts
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA
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17
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Lindsay L, Jackson LA, Savitz DA, Weber DJ, Koch GG, Kong L, Guess HA. Community influenza activity and risk of acute influenza-like illness episodes among healthy unvaccinated pregnant and postpartum women. Am J Epidemiol 2006; 163:838-48. [PMID: 16554352 DOI: 10.1093/aje/kwj095] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study investigated the relation between weekly levels of influenza activity and the risk of acute influenza-like illness episodes among 8,323 healthy pregnant and postpartum women enrolled in a Puget Sound region, Washington, health maintenance organization, Group Health Cooperative, between June 1991 and December 1997. The authors classified weeks between October and May for isolate activity level based on surveillance data for influenza, respiratory syncytial virus, parainfluenza, and adenovirus infection. Influenza-like illness episodes were identified from medical encounters assigned a diagnostic code consistent with a symptomatic influenza infection. The authors compared the occurrence of influenza-like illness episodes within each pregnancy stage for periods with varying levels of influenza isolate detection in the community. Repeated-measures logistic regression methods accounted for time-dependent factors. The adjusted strength of association between influenza exposure and influenza-like illness episodes increased as the pregnancy stage progressed (first trimester odds ratio = 1.12, 95% confidence interval: 0.79, 1.59; second trimester odds ratio = 1.30, 95% confidence interval: 0.97, 1.73; third trimester odds ratio = 1.84, 95% confidence interval: 1.31, 2.59; postpartum period odds ratio = 2.28, 95% confidence interval: 1.42, 3.68). Pregnancy stage modified the association between influenza activity and influenza-like illness episodes. Findings estimate that 20-43 pregnant/postpartum women would need to be vaccinated with an 80% effective vaccine to prevent one influenza-like illness episode.
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Affiliation(s)
- Lisa Lindsay
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA
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18
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Hindiyeh M, Levy V, Azar R, Varsano N, Regev L, Shalev Y, Grossman Z, Mendelson E. Evaluation of a multiplex real-time reverse transcriptase PCR assay for detection and differentiation of influenza viruses A and B during the 2001-2002 influenza season in Israel. J Clin Microbiol 2005; 43:589-95. [PMID: 15695650 PMCID: PMC548105 DOI: 10.1128/jcm.43.2.589-595.2005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2004] [Revised: 08/26/2004] [Accepted: 10/14/2004] [Indexed: 11/20/2022] Open
Abstract
The ability to rapidly diagnose influenza virus infections is of the utmost importance in the evaluation of patients with upper respiratory tract infections. It is also important for the influenza surveillance activities performed by national influenza centers. In the present study we modified a multiplex real-time reverse transcriptase PCR (RT-PCR) assay (which uses TaqMan chemistry) and evaluated it for its ability to detect and concomitantly differentiate influenza viruses A and B in 370 patient samples collected during the 2001-2002 influenza season in Israel. The performance of the TaqMan assay was compared to those of a multiplex one-step RT-PCR with gel detection, a shell vial immunofluorescence assay, and virus isolation in tissue culture. The TaqMan assay had an excellent sensitivity for the detection of influenza viruses compared to that of tissue culture. The overall sensitivity and specificity of the TaqMan assay compared to the results of culture were 98.4 and 85.5%, respectively. The sensitivity and specificity of the TaqMan assay for the detection of influenza virus A alone were 100 and 91.1%, respectively. On the other hand, the sensitivity and specificity for the detection of influenza virus B alone were 95.7 and 98.7%, respectively. The rapid turnaround time for the performance of the TaqMan assay (4.5 h) and the relatively low direct cost encourage the routine use of this assay in place of tissue culture. We conclude that the multiplex TaqMan assay is highly suitable for the rapid diagnosis of influenza virus infections both in well-established molecular biology laboratories and in reference clinical laboratories.
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Affiliation(s)
- Musa Hindiyeh
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Tel-Hashomer 52621, Israel
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Lavenu A, Valleron AJ, Carrat F. Exploring cross-protection between influenza strains by an epidemiological model. Virus Res 2004; 103:101-5. [PMID: 15163497 DOI: 10.1016/j.virusres.2004.02.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Almost all influenza surveillance systems of temperate countries report a single influenza illness peak each winter. Although several strains of different types or subtypes may co-circulate, they exceptionally lead to two distinct illness peaks during the same winter. We hypothesize that cross-protection between the different strains can, by itself, explain this absence of succeeding illness peaks. We used a dynamic population model to describe the spread of two influenza strains during one season. Cross-protection is included through a parameter defined as the reduction of host risk of infection to one strain after infection with another strain. Different scenarios are performed with two strains emerging with different time-lags, for different levels of cross-protection. We show that a cross-protection of 50% between the two strains is sufficient to explain why we observe a single influenza illness peak in temperate countries.
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Affiliation(s)
- Audrey Lavenu
- Institut National de la Santé Et de la Recherche Médicale INSERM Unité 444, Faculté de Médecine Saint-Antoine, 27 rue Chaligny, 75571 Paris Cedex 12, France.
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20
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Monto AS, Rotthoff J, Teich E, Herlocher ML, Truscon R, Yen HL, Elias S, Ohmit SE. Detection and control of influenza outbreaks in well-vaccinated nursing home populations. Clin Infect Dis 2004; 39:459-64. [PMID: 15356805 DOI: 10.1086/422646] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 03/07/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Influenza outbreaks continue to occur in nursing homes despite high vaccination coverage among residents. Recommendations for outbreak control in institutions such as nursing homes advises use of antiviral drugs to reduce influenza transmission. METHODS Influenza surveillance was performed among elderly residents of nursing homes in Michigan during 2 influenza seasons. The antiviral drug oseltamivir was used for outbreak control at the discretion of nursing home staff once influenza transmission was confirmed by virus isolation or rapid antigen detection. RESULTS During 2000-2001, influenza was not confirmed in any of the 28 participating homes, despite transmission of types A (H1N1) and B in the community. During 2001-2002, influenza type A (H3N2) transmission was confirmed in 8 (26%) of 31 participating homes; influenza vaccine coverage among residents was 57%- 98% in outbreak-associated homes. Oseltamivir was used in all homes with influenza transmission; outbreak control varied according to the rapidity of outbreak recognition and the extent of antiviral use. Reported adverse events were primarily gastrointestinal reactions and rashes. Analysis of the usefulness of rapid antigen detection tests for outbreak recognition indicated a sensitivity of only 77% (specificity, 92%). CONCLUSIONS Oseltamivir was reasonably well tolerated, and its use, along with continued promotion of vaccination coverage among nursing home residents and staff, should be a valuable addition to institutional outbreak-control strategies.
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Affiliation(s)
- Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Abstract
Although most influenza infections are self-limited, few other diseases exert such a huge toll of suffering and economic loss. Despite the importance of influenza, there had been, until recently, little advance in its control since amantadine was licensed almost 40 years ago. During the past decade, evidence has accrued on the protection afforded by inactivated vaccines and the safety and efficacy in children of live influenza-virus vaccines. There have been many new developments in vaccine technology. Moreover, work on viral neuraminidase has led to the licensing of potent selective antiviral drugs, and economic decision modelling provides further justification for annual vaccination and a framework for the use of neuraminidase inhibitors. Progress has also been made on developing near-patient testing for influenza that may assist individual diagnosis or the recognition of widespread virus circulation, and so optimise clinical management. Despite these advances, the occurrence of avian H5N1, H9N2, and H7N7 influenza in human beings and the rapid global spread of severe acute respiratory syndrome are reminders of our vulnerability to an emerging pandemic. The contrast between recent cases of H5N1 infection, associated with high mortality, and the typically mild, self-limiting nature of human infections with avian H7N7 and H9N2 influenza shows the gaps in our understanding of molecular correlates of pathogenicity and underlines the need for continuing international research into pandemic influenza. Improvements in animal and human surveillance, new approaches to vaccination, and increasing use of vaccines and antiviral drugs to combat annual influenza outbreaks are essential to reduce the global toll of pandemic and interpandemic influenza.
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Affiliation(s)
- Karl G Nicholson
- Infectious Diseases Unit, Leicester Royal Infirmary, Leicester, UK.
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22
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Toscani L, Gauthey L, Robert CF. The information network of senior citizens in Geneva, Switzerland, and progress in flu vaccination coverage between 1991 and 2000. Vaccine 2003; 21:393-8. [PMID: 12531637 DOI: 10.1016/s0264-410x(02)00411-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Switzerland has lagged behind other industrialized countries in increasing vaccination coverage against flu in the elderly population. The information campaign "United against Flu", started in Geneva in 1993, gradually extended to other French and Italian speaking cantons in Switzerland and indirectly affected German-speaking cantons. Activities developed include the production of TV spots, press conferences, information forwarded to health professionals, an Internet site and information material such as leaflets and posters to risk groups. The campaign is evaluated by repeated surveys that measure vaccination coverage as well as network of informants, knowledge and perceptions in the geriatric population. Vaccination coverage of the geriatric population in Geneva canton has increased from 29% in 1991 to 59% in the year 2000.
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Affiliation(s)
- Letizia Toscani
- Department of Community Medicine, Cantonal University Hospital, Geneva University Hospital, 24 r, Micheli-du-Crest, 1211 Pascal-Eric Gaberel Analyses, 4, Geneva, Switzerland.
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Schwarzinger M, Housset B, Carrat F. Bedside rapid flu test and zanamivir prescription in healthy working adults: a cost-benefit analysis. PHARMACOECONOMICS 2003; 21:215-224. [PMID: 12558471 DOI: 10.2165/00019053-200321030-00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Zanamivir, a neuraminidase inhibitor, reduces the number of days of illness in influenza-positive patients. New bedside rapid flu tests (RFT) should increase the number of influenza-positive patients whom receive zanamivir appropriately. OBJECTIVE To estimate the economic effects of implementing RFT and zanamivir among unvaccinated healthy working adults who consult within 2 days of the onset of influenza-like symptoms. METHODS We constructed a decision tree to perform a cost-benefit analysis from a societal perspective. Clinical outcome, i.e. number of influenza days averted, and societal costs were compared for three strategies: RFT and conditional zanamivir prescription;systematic zanamivir prescription; and no zanamivir. A two-way sensitivity analysis was performed including the proportion of influenza-positive patients. RESULTS During influenza epidemics, systematic zanamivir prescription provided the best health outcome (0.81 influenza days averted) and minimised societal costs (reduced by 29.80 US dollars per person compared with no zanamivir; 1999 values). RFT with conditional zanamivir averted 0.65 influenza days and saved 14.40 US dollars per person. When the proportion of influenza-positive patients was under 39%, the no zanamivir strategy yielded the greatest societal savings; otherwise, systematic zanamivir was the dominant strategy. Medical costs associated with no zanamivir were 88.70 US dollars per patient consulting with influenza-like illness, and increased to 125.50 US dollars with systematic zanamivir and to 127.60 US dollars with RFT and conditional zanamivir. CONCLUSIONS Due to poor sensitivity of current RFT, systematic zanamivir prescription without RFT for unvaccinated healthy working adults should be recommended during influenza epidemics.
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Affiliation(s)
- Michaël Schwarzinger
- Institut National de la Santé Et de la Recherche Médicale, u444, Hôpital Saint-Antoine, Paris, France.
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24
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Kyaw MH, Wayne B, Holmes EM, Jones IG, Campbell H. Influenza and pneumococcal vaccination in Scottish nursing homes: coverage, policies and reasons for receipt and non-receipt of vaccine. Vaccine 2002; 20:2516-22. [PMID: 12057607 DOI: 10.1016/s0264-410x(02)00177-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A national survey was carried out to determine the coverage of influenza and pneumococcal vaccines, policies, reasons for receipt, non-receipt of vaccine and strategies to improve vaccine coverage in Scottish nursing homes. Of the 550 nursing homes, 72% (394) participated in the study. Overall coverage was 85% for influenza vaccine in 2001-2002 season and 11% for pneumococcal vaccine in the last 5-year period. Only 6% (23/394) of homes were reported to have a systematic immunization record. The most frequently stated reasons for improved coverage of both vaccines were clear immunization policies (76%), awareness and education for staff and residents (68%), and consent on behalf of the incompetent residents (66%). The presence of vaccination policies was higher for influenza vaccine than pneumococcal vaccine expressed as verbal agreement (27% versus 3%), written policies with set target (24% versus 5%) and written policies without set target (17% versus 2%). Advice from the members of the community health care team was the principal reason for the receipt of both vaccines. The predominant reasons for non-receipt of vaccine were refusal by residents and family members (both vaccines) and lack of advice from general practitioners (pneumococcal vaccine). The substantial disparity in coverage of influenza and pneumococcal vaccine reflects the lack of national recommendations and policies for reimbursements for pneumococcal vaccination. These data suggest that greater efforts are needed to improve prevention behaviors of health care professionals and the public, organized vaccine delivery strategies and systematic vaccination documents to increase influenza and pneumococcal vaccination rates in nursing homes and other long-term care facilities.
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Affiliation(s)
- Moe H Kyaw
- Department of Public Health Sciences, University of Edinburgh, Edinburgh, UK.
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25
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Luce BR, Zangwill KM, Palmer CS, Mendelman PM, Yan L, Wolff MC, Cho I, Marcy SM, Iacuzio D, Belshe RB. Cost-effectiveness analysis of an intranasal influenza vaccine for the prevention of influenza in healthy children. Pediatrics 2001; 108:E24. [PMID: 11483834 DOI: 10.1542/peds.108.2.e24] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Intranasal influenza vaccine has proven clinical efficacy and may be better tolerated by young children and their families than an injectable vaccine. This study determined the potential cost-effectiveness (CE) of an intranasal influenza vaccine among healthy children. METHODS We conducted a CE analysis of data collected between 1996 and 1998 during a prospective 2-year efficacy trial of intranasal influenza vaccine, supplemented with data from the literature. The CE analysis included both direct and indirect costs. We enrolled 1602 healthy children aged 15 to 71 months in year 1, 1358 of whom were enrolled in year 2. One or 2 doses of intranasal influenza vaccine or placebo were administered to measure the cost per febrile influenza-like illness (ILI) day avoided. RESULTS During the 2-year study period, vaccinated children had an average of 1.2 fewer ILI fever days/child than unvaccinated children. In an individual-based vaccine delivery scenario with vaccine given twice in the first year and once each year thereafter at an assumed base case total cost of $20 for the vaccine and its administration (ie, per dose), CE was approximately $30/febrile ILI day avoided. CE ranged from $10 to $69/febrile ILI day avoided at $10 to $40/dose, respectively. In a group-based delivery scenario, vaccination was cost saving compared with placebo and remained so if vaccine cost was <$28 (the break-even price per dose). In the individual-based scenario, vaccination was cost saving if vaccine cost was <$5. In this scenario, nearly half of lost productivity in the vaccine group was attributable to vaccine visits, which overshadowed the relatively modest savings in ILI-associated costs averted. CONCLUSIONS Routine use of intranasal influenza vaccine among healthy children may be cost-effective and may be maximized by using group-based vaccination approaches. cost-effectiveness, influenza, vaccine, children.
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Affiliation(s)
- B R Luce
- MEDTAP International, Bethesda, Maryland 20814, USA.
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Nettleman MD, White T, Lavoie S, Chafin C. School absenteeism, parental work loss, and acceptance of childhood influenza vaccination. Am J Med Sci 2001; 321:178-80. [PMID: 11269793 DOI: 10.1097/00000441-200103000-00004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Influenza causes school absenteeism and may cause parents to miss work to care for sick children. However, it is not known whether these factors influence parental acceptance of childhood vaccination. METHODS A survey was mailed to parents of 1,805 children attending 3 elementary schools. It included questions about school absenteeism and employment status for adults who stayed home to care for an ill child. Parents were asked if they would consider vaccinating their child against a common wintertime respiratory virus. RESULTS Of the 972 surveys returned (54% return rate), 954 could be analyzed. Only 13% of respondents stated that they would not consider vaccination for their child. Sixty-nine percent of children had been absent from school because of a nonasthma respiratory illness, with an average of 2.54 days missed per child. Among respondents whose child had missed any school, 33% would definitely consider vaccination compared with 24% of respondents whose child had not missed school (P < 0.01). As children missed more school days, vaccine acceptance increased. In 53% of families, an adult had to miss work to care for the ill child. Vaccine acceptance was higher if an adult caretaker had to lose time from work because of a child's illness (35% versus 25% for non-working caretakers, P < 0.01). CONCLUSION Vaccine acceptance was closely linked with the amount of absenteeism caused by respiratory illness in the previous year. Parents who had to miss work to care for an ill child were more accepting of the vaccine than were other parents.
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Affiliation(s)
- M D Nettleman
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond 23298, USA.
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White T, Lavoie S, Nettleman MD. Potential cost savings attributable to influenza vaccination of school-aged children. Pediatrics 1999; 103:e73. [PMID: 10353970 DOI: 10.1542/peds.103.6.e73] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the costs and benefits of influenza vaccination of healthy school-aged children. DESIGN The analysis was based on data from the literature. Total costs included direct medical costs for vaccination, physician visits, and treatment as well as indirect costs. Indirect costs were in the form of lost productivity when working parents stayed home to care for ill children or to take children to an office for vaccination. The total costs of vaccination strategies were compared with the total cost of not vaccinating. For the base case, the vaccine was assumed to have no effect on rates of otitis media. SETTING Two hypothetical scenarios were investigated 1) individual-initiated vaccination and 2) vaccination in a group-based setting. The former scenario required the child to be accompanied to a clinic by a parent during usual work hours. RESULTS Vaccination resulted in a net savings per child vaccinated of $4 for individual-initiated vaccination and of $35 for group-based vaccination. The savings were caused primarily by averted indirect costs. Moderate increases in the cost of vaccination or reductions in the rate of influenza would eliminate the savings for individual-initiated vaccination but not for group-based vaccination. Alternatively, if influenza vaccination was effective in reducing rates of otitis media, the net savings from vaccination would be substantially higher than the base case. CONCLUSION Vaccination of school-aged children against influenza could have substantial financial benefits to society, especially if performed in a group-based setting. influenza, cost-effectiveness, vaccination, children, cost.
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Affiliation(s)
- T White
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA
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Fornaro P, Gandini F, Marin M, Pedrazzi C, Piccoli P, Tognetti D, Assael BM, Lucioni C, Mazzi S. Epidemiology and cost analysis of varicella in Italy: results of a sentinel study in the pediatric practice. Italian Sentinel Group on Pediatric Infectious Diseases. Pediatr Infect Dis J 1999; 18:414-9. [PMID: 10353513 DOI: 10.1097/00006454-199905000-00004] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Describing the epidemiology of varicella is relevant to the development of specific prevention strategies and to building up of economic models evaluating the cost:efficiency ratios of these strategies. AIM Our study was designed to describe the epidemiology of chickenpox among Italian children and to assess the resulting economic and health burden on the country. METHODS Thirty-nine Italian pediatricians participated in a sentinel network on pediatric infectious diseases representing a total pediatric population of 30 168 children. Each case of varicella observed from January through December, 1997, was recorded. Economic analysis was conducted from the societal point of view. All costs were broken down into two groups: direct and indirect costs. RESULTS A total of 1599 cases of varicella were reported among children 0 to 14 years old. There were 1266 primary cases (mean age, 4.5 +/- 2 years) and 333 secondary cases (mean age, 3.6 +/- 3.2 years). The global incidence of chickenpox was 51.01/1000/year. Complications were seen in 56 cases (3.5%). Drugs were prescribed in 672 cases. A group of adults (364 susceptible and 193 with uncertain status) were exposed to primary cases. Seventy (12.5%) were eventually infected among whom there were 4 pregnant women. For pediatric patients an average cost of $146.90 (250 400 lire) was estimated; this is largely accounted for by indirect costs. CONCLUSIONS The epidemiology of varicella in Italy is consistent with that found in previous studies in industrialized countries. Severe complications did not occur in our population. We believe that the health arguments in favor of universal vaccination of children > 18 months of age do not differ in our own country from those of other industrialized nations. Our data could now be incorporated into pharmacoeconomic models to establish cost-efficient strategies for Italy.
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Affiliation(s)
- P Fornaro
- Italian Sentinel Group on Pediatric Infectious Diseases, Milan
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29
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Ohmit SE, Arden NH, Monto AS. Effectiveness of inactivated influenza vaccine among nursing home residents during an influenza type A (H3N2) epidemic. J Am Geriatr Soc 1999; 47:165-71. [PMID: 9988287 DOI: 10.1111/j.1532-5415.1999.tb04574.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the use of influenza vaccine in nursing homes and its effectiveness in reducing the likelihood of influenza-like illness. DESIGN A retrospective case-control study with active identification of influenza infection. SETTING All nursing homes in a seven-county study area in southern lower Michigan were eligible for participation. Analyses were based on data collected from 23 homes with documented influenza transmission. PARTICIPANTS Persons aged 65 years or older who were residents of the nursing homes under study during the influenza type A(H3N2) outbreak in 1989-1990. MEASUREMENTS Residents were identified as cases or controls based on occurrence of febrile respiratory illness meeting a case definition. Demographic and underlying illness information were gathered as were data on the use of influenza vaccine, antibiotics, and antivirals. Characteristics of the nursing homes were also recorded. Logistic regression analyses were carried out to determine vaccine effectiveness. MAIN RESULTS Determinants of vaccine use were different from those observed in a parallel community-based study. In a multivariate model that considered the effects of resident and nursing home characteristics, vaccinated residents were significantly less likely than those who were not vaccinated to have an influenza-like illness (OR = .58 (95% CI, .43-.78), P < .001, imputed vaccine effectiveness estimate of 42%). Vaccination was more effective in younger residents (those aged 65 to 84) then in older residents (those older than 84 years). CONCLUSIONS Influenza vaccination was effective in reducing the likelihood of influenza-like illness in nursing home residents. Effectiveness appeared to be related to age, which may function as a surrogate for related immunologic factors. Older nursing home residents should be targeted for newer vaccines and/or potential prophylactic use of antivirals.
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Affiliation(s)
- S E Ohmit
- School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA
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30
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Cataldo DM, Van Nest G. The adjuvant MF59 increases the immunogenicity and protective efficacy of subunit influenza vaccine in mice. Vaccine 1997; 15:1710-5. [PMID: 9364672 DOI: 10.1016/s0264-410x(97)00115-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The immunogenicity and protective efficacy of influenza vaccine with and without the adjuvant MF59 was determined in mice. The addition of MF59 significantly increased the antibody response to the vaccine antigens over a wide dose range. Equivalent antibody titres were seen using 50- to 200-fold lower antigen concentrations when combined with MF59 compared with vaccine alone. The humoral response was sustained for at least 6 months after immunization. The addition of MF59 increased the protective efficacy of the vaccine: the amount of live virus detectable in the lungs of mice challenged with virus 1-6 months after immunization was reduced and the rate of survival was significantly increased. Influenza vaccine combined with MF59 gave full protection from viral challenge at antigen doses 65- to 80-fold lower than with vaccine alone.
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Affiliation(s)
- D M Cataldo
- Chiron Corporation, Emeryville, CA 94608, USA
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