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Comparative Analysis of Clinical and Epidemiological Characteristics in Patients with SARI Confirmed as Influenza or COVID-19 Admitted in a Tertiary Care Hospital in Bucharest, Romania. Processes (Basel) 2022. [DOI: 10.3390/pr10020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The COVID-19 pandemic has influenced the epidemiology of other respiratory pathogens, and this was most evident in the 2020–2021 season, which was characterized by a low circulation of influenza viruses. We aim to present a comparative analysis of clinical and epidemiological characteristics of 2018–2019 influenza cases and 2020–2021 COVID-19 cases, hospitalized at a tertiary infectious diseases hospital in Bucharest. We used data collected from patients admitted for severe acute respiratory infection (SARI) and subsequently confirmed with either influenza or COVID-19. During the 2018–2019 season, 208 patients over 18 years of age were confirmed with influenza (median age = 53 years, 59.6% were female) and 6.7% had been vaccinated against influenza. The most frequent symptoms were fever (97.1%) and cough (94.7%), and 77.4% had at least one chronic condition. 90.4% received influenza antiviral therapy. During the 2020–2021 season, 191 patients were confirmed with COVID-19 (median age = 56 years, 67% were male). The most frequent symptoms were cough (85.9%) and fever (80.6%), and 75.9% had at least one chronic condition. This analysis highlights the main similarities and differences between influenza and COVID-19 and could help to optimize the management of cases.
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Drăgănescu AC, Miron VD, Streinu-Cercel A, Florea D, Vlaicu O, Bilaşco A, Oţelea D, Luminos ML, Piţigoi D, Streinu-Cercel A, Săndulescu O. Circulation of influenza A viruses among patients hospitalized for severe acute respiratory infection in a tertiary care hospital in Romania in the 2018/19 season: Results from an observational descriptive epidemiological study. Medicine (Baltimore) 2021; 100:e28460. [PMID: 34967388 PMCID: PMC8718231 DOI: 10.1097/md.0000000000028460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/09/2021] [Indexed: 01/05/2023] Open
Abstract
The seasonal circulation of influenza viruses and the impact that this infection has on the population varies from year to year. We have prospectively captured hospital-based surveillance data describing the circulation of influenza viruses and characterizing patients with influenza admitted to a tertiary hospital in Bucharest, Romania in the 2018/19 season.We have conducted an observational descriptive epidemiological study analyzing all consecutive patients hospitalized for influenza like illness or severe acute respiratory infection at the National Institute for Infectious Diseases "Prof. Dr. Matei Balş", Bucharest, Romania, from November 2018 to April 2019. For all patients we actively collected standardized clinical information and performed real-time reverse transcription polymerase chain reaction testing of respiratory samples to identify the presence of influenza viruses and to determine the subtype/lineage.A total of 1128 hospitalized patients were tested in this study, with an influenza positivity rate of 41.2% (n = 465). We identified an exclusive circulation of influenza A viruses (A/H1 - 57.2%, A/H3 - 29.3%, A not subtyped - 13.3%), with only 1 case of influenza B detected at the end of the season (week 18/2019). Children under 5 years of age accounted for the majority of cases (40%, n = 186), and all cases had a favorable evolution. Females were more likely to test positive for influenza (53.3%) compared to males (46.7%), P = .048, and presence of asthma or chronic obstructive pulmonary disease increased the risk of influenza 4.4-fold and 2-fold, respectively (P < .001 and P = .034). Thirteen influenza patients required hospitalization in intensive care and 5 deaths were recorded (1.1%). The vaccination rate for all patients included in the study was low (4.6%). The existence of chronic conditions or age over 65 years prolonged the hospitalization period with 2 days (P < .001 each).In the 2018/19 season, we identified an important circulation of influenza A viruses among patients hospitalized for influenza like illness/severe acute respiratory infection in a tertiary care hospital in Romania, with a higher likelihood of affecting females and patients with pre-existing lung conditions. Monitoring of the clinical and epidemiological characteristics of influenza virus infection is of great interest and should be done carefully each season to better inform on the necessary measures to limit the impact that this infection may have on risk groups.
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Affiliation(s)
| | | | - Anca Streinu-Cercel
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Dragoş Florea
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Vlaicu
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
| | - Anuţa Bilaşco
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
| | - Dan Oţelea
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
| | - Monica Luminiţa Luminos
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniela Piţigoi
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Adrian Streinu-Cercel
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Oana Săndulescu
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Simionescu AA, Streinu-Cercel A, Popescu FD, Stanescu AMA, Vieru M, Danciu BM, Miron VD, Săndulescu O. Comprehensive Overview of Vaccination during Pregnancy in Europe. J Pers Med 2021; 11:jpm11111196. [PMID: 34834548 PMCID: PMC8623700 DOI: 10.3390/jpm11111196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 12/18/2022] Open
Abstract
Vaccinations during pregnancy can protect the mother from several infections, thus blocking vertical transmission. Furthermore, through passive antibody transfer, the newborn can be protected against some infections in the first months of life until their own vaccination regimen is initiated and completed at the appropriate age. Pregnancy can be considered a high-risk condition that increases vulnerability to infectious diseases with potentially unfavorable evolution. We present the current knowledge on vaccination during pregnancy in Europe as a useful information source for different health workers involved in prenatal care. Many European countries implement vaccination policies specifically designed for pregnant women, but there is great heterogeneity among programs. Recommendations on vaccination during pregnancy must be based on current high-quality scientific data. The decisions must be made for each individual case, depending on the associated conditions or special circumstances, with a concomitant assessment of the potential benefits and risks to both the pregnant patient and the fetus. Many vaccines are well-tolerated in pregnant women, with no clinically meaningful injection site reactions, systemic symptoms, or vaccine-related serious adverse events.
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Affiliation(s)
- Anca Angela Simionescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Florin-Dan Popescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- Department of Allergology and Clinical Immunology, Nicolae Malaxa Clinical Hospital, 022441 Bucharest, Romania
- Correspondence: or
| | - Ana Maria Alexandra Stanescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
| | - Mariana Vieru
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- Department of Allergology and Clinical Immunology, Nicolae Malaxa Clinical Hospital, 022441 Bucharest, Romania
| | - Bianca Mihaela Danciu
- National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 127715 Bucharest, Romania;
| | - Victor Daniel Miron
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 127715 Bucharest, Romania;
| | - Oana Săndulescu
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.A.S.); (A.S.-C.); (A.M.A.S.); (M.V.); (V.D.M.); (O.S.)
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
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Clinical and molecular epidemiology of influenza viruses from Romanian patients hospitalized during the 2019/20 season. PLoS One 2021; 16:e0258798. [PMID: 34767579 PMCID: PMC8589178 DOI: 10.1371/journal.pone.0258798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Two main mechanisms contribute to the continuous evolution of influenza viruses: accumulation of mutations in the hemagglutinin and neuraminidase genes (antigenic drift) and genetic re-assortments (antigenic shift). Epidemiological surveillance is important in identifying new genetic variants of influenza viruses with potentially increased pathogenicity and transmissibility. In order to characterize the 2019/20 influenza epidemic in Romania, 1042 respiratory samples were collected from consecutive patients hospitalized with acute respiratory infections in the National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest Romania and tested for influenza A virus, influenza B virus and respiratory syncytial virus (RSV) by real-time PCR. Out of them, 516 cases were positive for influenza, with relatively equal distribution of influenza A and B. Two patients had influenza A and B co-infection and 8 patients had influenza-RSV co-infection. The most severe cases, requiring supplemental oxygen administration or intensive care, and the most deaths were reported in patients aged 65 years and over. Subtyping showed the predominance of A(H3N2) compared to A(H1N1)pdm09 pdm09 (60.4% and 39.6% of all subtyped influenza A isolates, respectively), and the circulation of Victoria B lineage only. Influenza B started to circulate first (week 47/2019), with influenza A appearing slightly later (week 50/2019), followed by continued co-circulation of A and B viruses throughout the season. Sixty-eight samples, selected to cover the entire influenza season and all circulating viral types, were analysed by next generation sequencing (NGS). All A(H1N1)pdm09 sequences identified during this season in Romania were clustered in the 6b1.A clade (sub-clades: 6b1.A.183P -5a and 6b1.A.187A). For most A(H1N1)pdm09 sequences, the dominant epitope was Sb (pepitope = 0.25), reducing the vaccine efficacy by approximately 60%. According to phylogenetic analysis, influenza A(H3N2) strains circulating in this season belonged predominantly to clade 3C.3A, with only few sequences in clade 3C.2A1b. These 3C.2A1b sequences, two of which belonged to vaccinated patients, harbored mutations in antigenic sites leading to potential reduction of vaccine efficacy. Phylogenetic analysis of influenza B, lineage Victoria, sequences showed that the circulating strains belonged to clade V1A3. As compared to the other viral types, fewer mutations were observed in B/Victoria strains, with limited impact on vaccine efficiency based on estimations.
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Pițigoi D, Streinu-Cercel A, Ivanciuc AE, Lazãr M, Cherciu CM, Mihai ME, Nițescu M, Aramă V, Crăciun MD, Streinu-Cercel A, Săndulescu O. Surveillance of medically-attended influenza in elderly patients from Romania-data from three consecutive influenza seasons (2015/16, 2016/17, and 2017/18). Influenza Other Respir Viruses 2020; 14:530-540. [PMID: 32410402 PMCID: PMC7431641 DOI: 10.1111/irv.12752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background Influenza is an acute infection affecting all age groups; however, elderly patients are at an increased risk. We aim to describe the clinical characteristics and the circulation of influenza virus types in elderly patients admitted for severe acute respiratory infection (SARI) to a tertiary care hospital in Bucharest, Romania, part of the I‐MOVE+ hospital network. Methods We conducted an active surveillance study at the National Institute for Infectious Diseases “Prof. Dr Matei Balș,” Bucharest, Romania, during three consecutive influenza seasons: 2015/16, 2016/17, and 2017/18. All patients aged 65 and older admitted to our hospital for SARI were tested for influenza by PCR. Results A total of 349 eligible patients were tested during the study period, and 149 (42.7%) were confirmed with influenza. Most patients, 321 (92.5%) presented at least one underlying condition at the time of hospital admission, the most frequent being cardiovascular disease, 270 (78.3%). The main influenza viral subtype circulating in 2015/16 was A(H1N1)pdm09, followed by A(H3N2) in 2016/17 and B influenza in 2017/18. Case fatality was highest in the 2015/16 season (3.7%), 0% in 2016/17, and 1.0% in 2017/18. Vaccination coverage in elderly patients with SARI from our study population was 22 (6.3%) over the three seasons. Conclusions Our study has highlighted a high burden of comorbidities in elderly patients presenting with SARI during winter season in Romania. The influenza vaccine coverage rate needs to be substantially increased in the elderly population, through targeted interventions.
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Affiliation(s)
- Daniela Pițigoi
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Alina Elena Ivanciuc
- "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Mihaela Lazãr
- "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Carmen Maria Cherciu
- "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Maria Elena Mihai
- "Cantacuzino" National Medico-Military Institute for Research and Development, Bucharest, Romania
| | - Maria Nițescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Victoria Aramă
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Maria Dorina Crăciun
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Grigore Alexandrescu Clinical Children's Emergency Hospital, Bucharest, Romania
| | - Adrian Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Oana Săndulescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
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