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Amodio E, Belluzzo M, Genovese D, Palermo M, Pisciotta V, Vitale F. What 'case definition' for respiratory syncytial virus infection? Results of a systematic literature review to improve surveillance among the adults. J Public Health (Oxf) 2024:fdae066. [PMID: 38705841 DOI: 10.1093/pubmed/fdae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/27/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Human respiratory syncytial virus (hRSV) is a leading cause of acute lower respiratory tract infection in frail individuals, including children, the elderly and immunocompromised people, with mild to severe symptoms. World Health Organization claims hRSV causes most elderly influenza-like illnesses (ILI) and severe acute respiratory infections (SARI). In this study, different case definitions for hRSV surveillance were examined for accuracy. METHODS The following search query ('Respiratory Syncytial Virus' OR 'RSV' OR 'hRSV' AND 'case definition') was used on PubMed/MEDLINE and Scopus with a 15-year-old baseline age restriction to conduct a systematic literature review. RESULTS Of 12 records, 58% employed the SARI definition, 50% the ILI definition and 42% the acute respiratory infection (ARI) definition, with some overlap. In young adults (18-64 years old), most studies show RSV prevalence between 6.25 and 72.54 cases per 1000 per year, and 19.23 to 98.5 in older adults. The outpatient ARI and hospitalized SARI criteria are particularly sensitive and specific. CONCLUSIONS Disease burden measurement requires a clear case definition; however, current literature is questionable. Currently, hRSV surveillance uses numerous case definitions with debatable accuracy. The epidemiology, clinical characteristics, and disease burden of hRSV are difficult to characterize without a standard surveillance case definition.
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Affiliation(s)
- Emanuele Amodio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Miriam Belluzzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Dario Genovese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Martina Palermo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Vincenzo Pisciotta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties 'G. D'Alessandro', University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
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Tang L, Rhoads WJ, Eichelberg A, Hamilton KA, Julian TR. Applications of Quantitative Microbial Risk Assessment to Respiratory Pathogens and Implications for Uptake in Policy: A State-of-the-Science Review. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:56001. [PMID: 38728217 PMCID: PMC11086748 DOI: 10.1289/ehp12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Respiratory tract infections are major contributors to the global disease burden. Quantitative microbial risk assessment (QMRA) holds potential as a rapidly deployable framework to understand respiratory pathogen transmission and inform policy on infection control. OBJECTIVES The goal of this paper was to evaluate, motivate, and inform further development of the use of QMRA as a rapid tool to understand the transmission of respiratory pathogens and improve the evidence base for infection control policies. METHODS We conducted a literature review to identify peer-reviewed studies of complete QMRA frameworks on aerosol inhalation or contact transmission of respiratory pathogens. From each of the identified studies, we extracted and summarized information on the applied exposure model approaches, dose-response models, and parameter values, including risk characterization. Finally, we reviewed linkages between model outcomes and policy. RESULTS We identified 93 studies conducted in 16 different countries with complete QMRA frameworks for diverse respiratory pathogens, including SARS-CoV-2, Legionella spp., Staphylococcus aureus, influenza, and Bacillus anthracis. Six distinct exposure models were identified across diverse and complex transmission pathways. In 57 studies, exposure model frameworks were informed by their ability to model the efficacy of potential interventions. Among interventions, masking, ventilation, social distancing, and other environmental source controls were commonly assessed. Pathogen concentration, aerosol concentration, and partitioning coefficient were influential exposure parameters as identified by sensitivity analysis. Most (84%, n = 78 ) studies presented policy-relevant content including a) determining disease burden to call for policy intervention, b) determining risk-based threshold values for regulations, c) informing intervention and control strategies, and d) making recommendations and suggestions for QMRA application in policy. CONCLUSIONS We identified needs to further the development of QMRA frameworks for respiratory pathogens that prioritize appropriate aerosol exposure modeling approaches, consider trade-offs between model validity and complexity, and incorporate research that strengthens confidence in QMRA results. https://doi.org/10.1289/EHP12695.
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Affiliation(s)
- Lizhan Tang
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - William J. Rhoads
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Antonia Eichelberg
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
| | - Kerry A. Hamilton
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona, USA
- Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona, USA
| | - Timothy R. Julian
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dübendorf, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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3
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Martin BE, Garrett MR. Race and Sex Differences in Vital Signs Associated with COVID-19 and Flu Diagnoses in Mississippi. J Racial Ethn Health Disparities 2023; 10:228-236. [PMID: 35066856 PMCID: PMC8783800 DOI: 10.1007/s40615-021-01213-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 02/03/2023]
Abstract
Early detection of viral infections, such as COVID-19 and flu, have potential to reduce risk of morbidity, mortality, and disease transmission through earlier intervention strategies. For example, detecting changes in vital signs have the potential to more rapidly diagnose respiratory virus diseases. The objective of this study was to utilize the University of Mississippi Medical Center's extensive clinical database (EPIC) to investigate associations between temperature, pulse rate, blood pressure (BP), and respiration rate in COVID-19 and flu diagnosed patients. Data from 1,363 COVID-19 (March 3, 2020, to February 27, 2021) and 507 flu (October 1, 2017, to September 30, 2018) diagnosed patients with reported demographic dimensions (age, first race, and sex) and office visit dimensions (BMI, diastolic BP, pulse rate, respiration rate, systolic BP, and temperature) was obtained, including day of diagnosis and additional encounter visits 60 days before and after first unique diagnosis. Patients with COVID-19 or flu were disproportionately obese, with 93% of COVID-19 and 79% of flu patients with BMI ≥ 30. Most striking, Black women 50-64 years of age disproportionately carried the burden of disease. At the time of diagnosis, temperature was significantly increased for all patients, yet pulse rate was only significantly increased for flu diagnosis, and BP was not significantly different in either. Our findings show the need for more complete demographic and office visit dimension data from patients during epidemic and pandemic events and support further studies needed to understand association between vital signs and predicting respiratory disease.
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Affiliation(s)
- Brigitte E Martin
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Michael R Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
- Department of Medicine (Nephrology), University of Mississippi Medical Center, Jackson, MS, USA.
- Department of Pediatrics (Genetics), University of Mississippi Medical Center, Jackson, MS, USA.
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4
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Martin BE, Taylor EB, Attipoe EM, Wu W, Stec DE, Showmaker KC, Garrett MR. Sex and molecular differences in cardiovascular parameters at peak influenza disease in mice. Physiol Genomics 2023; 55:79-89. [PMID: 36645670 PMCID: PMC9925171 DOI: 10.1152/physiolgenomics.00146.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 01/17/2023] Open
Abstract
There is a growing interest in the detection of subtle changes in cardiovascular physiology in response to viral infection to develop better disease surveillance strategies. This is not only important for earlier diagnosis and better prognosis of symptomatic carriers but also useful to diagnose asymptomatic carriers of the virus. Previous studies provide strong evidence of an association between inflammatory biomarker levels and both blood pressure (BP) and heart rate (HR) during infection. The identification of novel biomarkers during an inflammatory event could significantly improve predictions for cardiovascular events. Thus, we evaluated changes in cardiovascular physiology induced in A/Puerto Rico/8/34 (PR8) influenza infections in female and male C57BL/6J mice and compared them with the traditional method of influenza disease detection using body weight (BW). Using radiotelemetry, changes in BP, HR, and activity were studied. Change in BW of infected females was significantly decreased from 5 to 13 days postinfection (dpi), yet alterations in normal physiology including loss of diurnal rhythm and reduced activity was observed starting at about 3 dpi for HR and 4 dpi for activity and BP; continuing until about 13 dpi. In contrast, males had significantly decreased BW 8 to 12 dpi and demonstrated altered physiological measurements for a shorter period compared with females with a reduction starting at 5 dpi for activity, 6 dpi for BP, and 7 dpi for HR until about 12 dpi, 10 dpi, and 9 dpi, respectively. Finally, females and males exhibited different patterns of inflammatory maker expression in lungs at peak disease by analyzing bulk RNA-sequencing data for lungs and Bio-plex cytokine assay for blood collected from influenza-infected and naïve C57BL/6J female and male mice at 7 dpi. In total, this study provides insight into cardiovascular changes and molecular markers to distinguish sex differences in peak disease caused by influenza virus infection.NEW & NOTEWORTHY This study performed longitudinal cardiovascular measurements of influenza viral infection and identified sex difference in both physiological and molecular markers at peak disease.
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Affiliation(s)
- Brigitte E Martin
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Erin B Taylor
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Esinam M Attipoe
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Wenjie Wu
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
| | - David E Stec
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Michael R Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
- Division of Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
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5
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Montgomery AS, Lustik MB, Reichert-Scrivner SA, Woodbury RL, Jones MU, Horseman TS. Respiratory Viral Pathogens Among U.S. Military Personnel at a Medical Treatment Facility in Hawaii From 2014 to 2019. Mil Med 2021; 187:182-188. [PMID: 34008030 DOI: 10.1093/milmed/usab191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/16/2021] [Accepted: 05/06/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Acute respiratory diseases account for a substantial number of outpatient visits and hospitalizations among U.S. military personnel, significantly affecting mission readiness and military operations. We conducted a retrospective analysis of respiratory viral pathogen (RVP) samples collected from U.S. military personnel stationed in Hawaii and tested at Tripler Army Medical Center from January 2014 to May 2019 in order to describe the etiology, distribution, and seasonality of RVP exposure in a military population. MATERIALS AND METHODS Samples were analyzed by viral culture or multiplex PCR. Distribution of respiratory viruses over time was analyzed as well as subject demographic and encounter data. Presenting signs and symptoms were evaluated with each RVP. RESULTS A total of 2,576 military personnel were tested, of which 726 (28.2%) were positive for one or more RVP. Among positive tests, the three most common viral pathogens detected were influenza A (43.0%), rhinovirus (24.5%), and parainfluenza (7.6%). Symptoms were generally mild and most frequently included cough, fever, and body aches. CONCLUSION Our study evaluated respiratory virus prevalence, seasonality, and association with clinical symptoms for military personnel in an urban tropical setting in Oahu, HI, over a 5-year period. We show that viral prevalence and seasonality in Hawaii are distinct from those of the CONUS. Results contribute to the broader understanding of seasonality, clinical manifestation, and demographics of RVP among active duty military personnel stationed in Hawaii.
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Affiliation(s)
- Agnes S Montgomery
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Michael B Lustik
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | | | - Ronald L Woodbury
- Department of Pathology, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Milissa U Jones
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Timothy S Horseman
- Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI 96859, USA
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6
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Santos RKO, Borges IC, Souza ML, Bouzas ML, Nascimento-Carvalho CM. Seasonality of distinct respiratory viruses in a tropical city: implications for prophylaxis. Trop Med Int Health 2021; 26:672-679. [PMID: 33666303 DOI: 10.1111/tmi.13571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The frequency and seasonality of viruses in tropical regions are scarcely reported. We estimated the frequency of seven respiratory viruses and assessed seasonality of respiratory syncytial virus (RSV) and influenza viruses in a tropical city. METHODS Children (age ≤ 18 years) with acute respiratory infection were investigated in Salvador, Brazil, between July 2014 and June 2017. Respiratory viruses were searched by direct immunofluorescence and real-time polymerase chain reaction for detection of RSV, influenza A virus, influenza B virus, adenovirus (ADV) and parainfluenza viruses (PIV) 1, 2 and 3. Seasonal distribution was evaluated by Prais-Winsten regression. Due to similar distribution, influenza A and influenza B viruses were grouped to analyse seasonality. RESULTS The study group comprised 387 cases whose median (IQR) age was 26.4 (10.5-50.1) months. Respiratory viruses were detected in 106 (27.4%) cases. RSV (n = 76; 19.6%), influenza A virus (n = 11; 2.8%), influenza B virus (n = 7; 1.8%), ADV (n = 5; 1.3%), PIV 1 (n = 5; 1.3%), PIV 3 (n = 3; 0.8%) and PIV 2 (n = 1; 0.3%) were identified. Monthly count of RSV cases demonstrated seasonal distribution (b3 = 0.626; P = 0.003). More than half (42/76 [55.3%]) of all RSV cases were detected from April to June. Monthly count of influenza cases also showed seasonal distribution (b3 = -0.264; P = 0.032). Influenza cases peaked from November to January with 44.4% (8/18) of all influenza cases. CONCLUSIONS RSV was the most frequently detected virus. RSV and influenza viruses showed seasonal distribution. These data may be useful to plan the best time to carry out prophylaxis and to increase the number of hospital beds.
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Affiliation(s)
- Ruth-Kelly O Santos
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.,Epidemiology Unit, Health Secretariat, Salvador, Brazil
| | - Igor C Borges
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
| | | | - Maiara L Bouzas
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil
| | - Cristiana M Nascimento-Carvalho
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.,Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil
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7
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Wang Y, Wang L, Zhao X, Zhang J, Ma W, Zhao H, Han X. A Semi-Quantitative Risk Assessment and Management Strategies on COVID-19 Infection to Outpatient Health Care Workers in the Post-Pandemic Period. Risk Manag Healthc Policy 2021; 14:815-825. [PMID: 33658877 PMCID: PMC7920612 DOI: 10.2147/rmhp.s293198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/27/2021] [Indexed: 12/21/2022] Open
Abstract
Background In the pandemic of COVID-19, due to asymptomatic patients and high personnel fluidity in outpatient clinics, health care workers (HCWs) in outpatients were facing severe threat from infection. There is an urgent need for a risk assessment to recognize and prevent infection risks. Purpose To establish a semi-quantitative risk assessment model on COVID-19 infections for HCWs in outpatient departments, and apply it to practices. Further to provide infection risk management strategies to reduce infection threats in the post-pandemic of COVID-19. Methods We used the method of Brainstorm, Literature study and Analytic Hierarchy Process (AHP) for risk factors selection and model construction, we also created corresponding indicators for each risk factors, in order to collect data in assessment practice. Results Eighteen risk factors were recognized and selected for model construction, by scatter plot, these risk factors had been classified into four parts, spanned the scopes of diagnosis and treatment, environment, personal protection and emergency handling, with specific management suggestions provided. In the practice, outpatient clinics were divided into three risk levels, 5 clinics in high risk level, 9 in medium risk level and 11 in low risk level. Conclusion A proper comprehensive risk assessment model for COVID-19 infections has been successfully established. With the model, the ability to COVID-19 prevention in outpatients can be easily evaluated. The strategies on disinfection, surveillance and personal protection were also valuable references in the post-pandemic of COVID-19.
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Affiliation(s)
- Yuncong Wang
- Hospital Infection Management Division, Xuan Wu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Lihong Wang
- Hospital Infection Management Division, Xuan Wu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Xia Zhao
- Hospital Infection Management Division, Xuan Wu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Jingli Zhang
- Hospital Infection Management Division, Xuan Wu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Wenhui Ma
- Hospital Infection Management Division, Xuan Wu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Huijie Zhao
- Hospital Infection Management Division, Xuan Wu Hospital Capital Medical University, Beijing, People's Republic of China
| | - Xu Han
- Hospital Infection Management Division, Xuan Wu Hospital Capital Medical University, Beijing, People's Republic of China
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8
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The Seasonality of Peripheral Venous Catheter-Related Bloodstream Infections. Infect Dis Ther 2021; 10:495-506. [PMID: 33548036 PMCID: PMC7954888 DOI: 10.1007/s40121-021-00407-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/20/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Although the seasonality of infectious diseases has been widely reported, the seasonality of peripheral venous catheter-related bloodstream infection (PV-CRBSI) has not been investigated. This study investigated the seasonality of PV-CRBSI and its relationship with meteorological conditions. Methods A retrospective cohort study of PV-CRBSI at Tokyo Medical University Hospital (Tokyo, Japan), from 2009 to 2019, provided the data for descriptive and time series analyses used to evaluate the number of PV-CRBSI cases per 1000 admissions that occurred each month for each causative organism. By performing univariate and multivariate analyses, the researchers investigated the seasonality of cases and the relationships between meteorological conditions, other external factors, and PV-CRBSIs. Results This study included a total of 184 PV-CRBSI cases. The mean numbers of PV-CRBSI cases per 1000 admissions caused by all organisms, Bacillus cereus, Gram-positive cocci, and Gram-negative rods were 0.67, 0.15, 0.37, and 0.16 per month, respectively, during the study period. The time series analysis showed that the incidences of PV-CRBSI cases associated with B. cereus and Gram-negative rods were significantly different in the winter/spring from those in the summer/autumn (P < 0.05). The incidence of PV-CRBSI cases caused by B. cereus peaked during summer. The incidence of PV-CRBSI cases caused by B. cereus was significantly positively associated with average monthly temperature, whereas the incidence of PV-CRBSIs caused by Gram-negative rods was significantly negatively associated with average daylight hours. Conclusion The incidence of PV-CRBSIs caused by B. cereus showed seasonality, peaking during the summer, and a significant correlation was found between PV-CRBSIs caused by B. cereus and average monthly temperature. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00407-9.
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Niya MHK, Jeda AS, Tavakoli A, Sohani H, Tameshkel FS, Panahi M, Izadi M, Zamani F, Keyvani H. Molecular epidemiology of human respiratory syncytial virus (HRSV) in Iranian military trainees with acute respiratory symptoms in 2017. IRANIAN JOURNAL OF MICROBIOLOGY 2020; 12:495-502. [PMID: 33604006 PMCID: PMC7867691 DOI: 10.18502/ijm.v12i5.4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in many populations, including military recruits receiving basic training. Therefore, this study was set out to determine the molecular epidemiology, genotype and phylogenetic features of RSVs in patients with respiratory infection as a case study. Materials and Methods In this study, military barracks of Tehran, Iran, between January to March 2017 exposed to respiratory diseases were used for sampling. Throat swabs were taken, a reverse transcriptase-polymerase chain reaction (RTPCR) assay was performed to identify RSV and then the genotyping and phylogenetic analyses of RSVs in patients with a respiratory infection. Results Among 400 Iranian military trainees with respiratory symptoms, RSV infection was identified in 2.75% (11/400) using RT-PCR. Sequencing showed the incidence of type A (2.5%, n=10) to be much higher than type B (0.25%, n=1); Sore throat was the most common symptom among RSV patients. Phylogenetic analysis revealed that the majority of strains from the studied samples were more consistent with those from the Philippines and the US strains. Conclusion This study is the first to document RSV as a major cause of acute respiratory illness among military trainees in Iran. The prevalence of RSV is substantial in the cold season and the prevalence of genotype A is dominant in the country, leading to take essential steps in preparing a preventive vaccine against this viral infection.
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Affiliation(s)
- Mohammad Hadi Karbalaie Niya
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Salimi Jeda
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Tavakoli
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Sohani
- Department of Microbiology, Faculty of Biology, College of Sciences, University of Sciences and Research, Tehran, Iran
| | | | - Mahshid Panahi
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Keyvani
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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10
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Matienzo N, Youssef MM, Comito D, Lane B, Ligon C, Morita H, Winchester A, Decker ME, Dayan P, Shopsin B, Shaman J. Respiratory viruses in pediatric emergency department patients and their family members. Influenza Other Respir Viruses 2020; 15:91-98. [PMID: 33210476 PMCID: PMC7767945 DOI: 10.1111/irv.12789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 01/09/2023] Open
Abstract
Background Respiratory viral infections account for a substantial fraction of pediatric emergency department (ED) visits. We examined the epidemiological patterns of seven common respiratory viruses in children presenting to EDs with influenza‐like illness (ILI). Additionally, we examined the co‐occurrence of viral infections in the accompanying adults and risk factors associated with the acquisition of these viruses. Methods Nasopharyngeal swab were collected from children seeking medical care for ILI and their accompanying adults (Total N = 1315). Study sites included New York Presbyterian, Bellevue, and Tisch hospitals in New York City. PCR using a respiratory viral panel was conducted, and data on symptoms and medical history were collected. Results Respiratory viruses were detected in 399 children (62.25%) and 118 (17.5%) accompanying adults. The most frequent pathogen detected was human rhinovirus (HRV) (28.81%). Co‐infection rates were 14.79% in children and 8.47% in adults. Respiratory syncytial virus (RSV) and parainfluenza infections occurred more often in younger children. Influenza and HRV occurred more often in older children. Influenza and coronavirus were mostly isolated in winter and spring, RSV in fall and winter and HRV in fall and spring. Children with HRV were more likely to have history of asthma. Adults with the same virus as their child often accompanied ≤ 2‐year‐old‐positive children and were more likely to be symptomatic compared to adults with different viruses. Conclusions Respiratory viruses, while presenting the same suite of symptoms, possess distinct seasonal cycles and affect individuals differently based on a number of identifiable factors, including age and history of asthma.
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Affiliation(s)
- Nelsa Matienzo
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mariam M Youssef
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Devon Comito
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Benjamin Lane
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Chanel Ligon
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Haruka Morita
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Arianna Winchester
- Division of Infectious Diseases, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Mary E Decker
- Division of Infectious Diseases, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Peter Dayan
- Department of Pediatrics, Columbia University Irving Medical center, New York, NY, USA
| | - Bo Shopsin
- Division of Infectious Diseases, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Jeffrey Shaman
- Environmental Health Sciences Department, Mailman School of Public Health, Columbia University, New York, NY, USA
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11
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Clemmons NS, Jordan NN, Brown AD, Kough EM, Pacha LA, Varner SM, Hawksworth AW, Myers CA, Gaydos JC. Outbreak of Chlamydia pneumoniae Infections and X-ray-Confirmed Pneumonia in Army Trainees at Fort Leonard Wood, Missouri, 2014. Mil Med 2020; 184:e196-e199. [PMID: 30690452 DOI: 10.1093/milmed/usy402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/11/2018] [Accepted: 11/28/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Chlamydia pneumoniae (Cp) is a bacterium that causes pneumonia and other respiratory diseases. Fever may be present early but absent by time of presentation to clinic. Increases in X-ray-confirmed pneumonia (XCP) and laboratory-confirmed Cp infections were observed in new soldiers in training at Fort Leonard Wood (FLW), Missouri, early in 2014. These findings prompted a site assistance visit from the U.S. Army Public Health Command, Aberdeen Proving Ground, Maryland, with a review of available data and information to describe the outbreak, and inspections of barracks and training facilities and review of training practices to identify opportunities for interventions to reduce the risk of respiratory disease agent transmission. MATERIALS AND METHODS The study population was trainee soldiers at FLW in 2013-2014. Data from two acute respiratory disease surveillance systems were studied. A local surveillance system operated by the FLW General Leonard Wood Army Community Hospital Preventive Medicine Department tracked weekly chest X-rays taken and the numbers positive for pneumonia. A Naval Health Research Center, San Diego, California, laboratory-based Febrile Respiratory Illness Surveillance Program collected clinical data and nasal, or nasal and pharyngeal swabs, for nucleic acid amplification testing from up to 15 trainees/week with fever and either cough or sore throat. Up to 4 of the 15 specimens could be from afebrile patients with XCP. Specimens were tested for a variety of agents. RESULTS Monthly rates of XCP rose quickly in 2014 and peaked at 0.9/100 trainees in May. The percentage of the San Diego surveillance system specimens that were positive for Cp also increased quickly in 2014, peaking at 54% in May. During the first half of 2014, the San Diego program studied specimens from 141 ill trainees; 37% (52/141) were positive for Cp, making it the most common organism identified, followed by rhinoviruses (8%), influenza viruses (4%), Mycoplasma pneumoniae (2%), and adenoviruses (1%). The remaining specimens (48%) were negative for all respiratory pathogens. Only 12% (6/52) of Cp positive patients were febrile. Facilities inspections and review of training practices failed to identify variables that might be contributing to an increased risk of respiratory agent transmission. CONCLUSION The XCP rate and the percentage of specimens positive for Cp increased in early 2014, peaking in May. Only 12% of trainees with laboratory-confirmed Cp were febrile. Historically, acute respiratory disease surveillance at military training centers focused on febrile diseases, particularly those caused by adenoviruses. With introduction of an adenovirus vaccine in late 2011, respiratory disease rates dropped with only sporadic occurrences of adenovirus-associated disease. In 2012, the San Diego surveillance program began providing data on multiple respiratory disease agents, in addition to adenoviruses and influenza viruses. Since then, Cp, rhinoviruses and Mycoplasma pneumoniae have frequently been detected in trainees with acute respiratory disease. Respiratory surveillance programs supporting Army training centers should be re-evaluated in this post-adenovirus vaccine era, to include assessment of the fever criterion for selecting patients for study, the value of chest X-ray surveillance and the value of rapidly providing laboratory results to inform provider decisions regarding antibiotic use.
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Affiliation(s)
- Nakia S Clemmons
- Centers for Disease Control and Prevention, Atlanta, GA.,Commissioned Corps, U.S. Public Health Service, Rockville, MD.,US Army Public Health Center, Aberdeen Proving Ground, MD
| | - Nikki N Jordan
- US Army Public Health Center, Aberdeen Proving Ground, MD
| | | | - Erin M Kough
- US Army Public Health Center, Aberdeen Proving Ground, MD
| | - Laura A Pacha
- US Army Public Health Center, Aberdeen Proving Ground, MD
| | - Susan M Varner
- General Leonard Wood Army Community Hospital, Fort Leonard Wood, MO
| | - Anthony W Hawksworth
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | | | - Joel C Gaydos
- US Army Public Health Center, Aberdeen Proving Ground, MD
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12
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Harnessing wearable device data to improve state-level real-time surveillance of influenza-like illness in the USA: a population-based study. LANCET DIGITAL HEALTH 2020; 2:e85-e93. [PMID: 33334565 DOI: 10.1016/s2589-7500(19)30222-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Acute infections can cause an individual to have an elevated resting heart rate (RHR) and change their routine daily activities due to the physiological response to the inflammatory insult. Consequently, we aimed to evaluate if population trends of seasonal respiratory infections, such as influenza, could be identified through wearable sensors that collect RHR and sleep data. METHODS We obtained de-identified sensor data from 200 000 individuals who used a Fitbit wearable device from March 1, 2016, to March 1, 2018, in the USA. We included users who wore a Fitbit for at least 60 days and used the same wearable throughout the entire period, and focused on the top five states with the most Fitbit users in the dataset: California, Texas, New York, Illinois, and Pennsylvania. Inclusion criteria included having a self-reported birth year between 1930 and 2004, height greater than 1 m, and weight greater than 20 kg. We excluded daily measurements with missing RHR, missing wear time, and wear time less than 1000 min per day. We compared sensor data with weekly estimates of influenza-like illness (ILI) rates at the state level, as reported by the US Centers for Disease Control and Prevention (CDC), by identifying weeks in which Fitbit users displayed elevated RHRs and increased sleep levels. For each state, we modelled ILI case counts with a negative binomial model that included 3-week lagged CDC ILI rate data (null model) and the proportion of weekly Fitbit users with elevated RHR and increased sleep duration above a specified threshold (full model). We also evaluated weekly change in ILI rate by linear regression using change in proportion of elevated Fitbit data. Pearson correlation was used to compare predicted versus CDC reported ILI rates. FINDINGS We identified 47 249 users in the top five states who wore a Fitbit consistently during the study period, including more than 13·3 million total RHR and sleep measures. We found the Fitbit data significantly improved ILI predictions in all five states, with an average increase in Pearson correlation of 0·12 (SD 0·07) over baseline models, corresponding to an improvement of 6·3-32·9%. Correlations of the final models with the CDC ILI rates ranged from 0·84 to 0·97. Week-to-week changes in the proportion of Fitbit users with abnormal data were associated with week-to-week changes in ILI rates in most cases. INTERPRETATION Activity and physiological trackers are increasingly used in the USA and globally to monitor individual health. By accessing these data, it could be possible to improve real-time and geographically refined influenza surveillance. This information could be vital to enact timely outbreak response measures to prevent further transmission of influenza cases during outbreaks. FUNDING Partly supported by the US National Institutes of Health National Center for Advancing Translational Sciences.
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13
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Tavakoli A, Karbalaie Niya MH, Bokharaei-Salim F, Farahmand M, Izadi M, Dorostkar R, Keyvani H. The molecular epidemiology of respiratory viruses in military trainees in Iran. Med J Islam Repub Iran 2019; 33:40. [PMID: 31456964 PMCID: PMC6708098 DOI: 10.34171/mjiri.33.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Military populations are more prone to respiratory infections worldwide. There is a dearth of research about the role of viral pathogens in the etiology of respiratory infections in military trainees in Iran. Hence, we aimed to investigate the molecular epidemiology and clinical symptoms of respiratory viruses among this population.
Methods: This cross-sectional study was performed on 400 military trainees with symptoms of respiratory infection, referred to the military medical clinic center in the basic military training camp of the General Staff of the Armed Forces of the Islamic Republic of Iran. Nucleic acid extraction from the throat or nasopharyngeal swab samples was performed by an automated extraction system. The extracts were then analyzed by the CLART® PneumoVir array system for the detection of respiratory viruses.
Results: All military trainees were male, aged between 18 and 57 years (mean: 21.69 years). Sore throat (75.5%), rhinorrhea (63.2%), cough (59.2%), fever (59.2%), and nasal congestion (50.5%) were amongst the most common symptoms. Overall, viral pathogens were detected in a total count of 124 (31%). The most commonly detected viruses were rhinovirus (7.2%), respiratory syncytial virus A (7.2%) and influenza B virus (6%).
Conclusion: This study was an important first step for understanding the etiological role of viral pathogens in respiratory infection among military trainees population in Iran. Our results indicated that rhinovirus, respiratory syncytial virus A and influenza B virus are important viral pathogens causing respiratory infection in military trainees, respectively. However, further multi-center studies with larger sample size are strongly recommended to confirm our findings.
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Affiliation(s)
- Ahmad Tavakoli
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Farah Bokharaei-Salim
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farahmand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ruhollah Dorostkar
- Applied Virology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Keyvani
- Department of Medical Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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14
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Webber BJ, Kieffer JW, White BK, Hawksworth AW, Graf PCF, Yun HC. Chemoprophylaxis against group A streptococcus during military training. Prev Med 2019; 118:142-149. [PMID: 30393152 DOI: 10.1016/j.ypmed.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/27/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
Chemoprophylaxis with intramuscular benzathine penicillin G has been used widely by the U.S. military to prevent epidemics of group A streptococcus infections during basic training. The recent global shortage of benzathine penicillin prompted a detailed analysis of this issue in 2017 by military preventive medicine and infectious disease authorities in San Antonio, Texas, and San Diego, California, USA. This paper explores the history of group A streptococcus and chemoprophylaxis in the U.S. military training environment, current policy and practice, and challenges associated with widespread chemoprophylaxis. In light of the history presented, preventive medicine authorities at basic training centers should be extremely cautious about discontinuing benzathine penicillin chemoprophylaxis.
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Affiliation(s)
- Bryant J Webber
- Epidemiology Consult Service, U.S. Air Force School of Aerospace Medicine, 2510 Fifth Street, Bldg 840, Rm W318.23, Wright-Patterson Air Force Base, OH 45433, USA.
| | - John W Kieffer
- 559th Medical Group, Wilford Hall Ambulatory Surgical Center, 1440 McGuire Street, Bldg 7206, Joint Base San Antonio-Lackland, TX 78235, USA.
| | - Brian K White
- 559th Medical Group, Wilford Hall Ambulatory Surgical Center, 1440 McGuire Street, Bldg 7206, Joint Base San Antonio-Lackland, TX 78235, USA.
| | - Anthony W Hawksworth
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., 6720A Rockledge Drive, Bethesda, MD 20817, USA
| | - Paul C F Graf
- Operational Infectious Diseases Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA.
| | - Heather C Yun
- Department of Infectious Diseases, San Antonio Military Medical Center, 3351 Roger Brooke Drive, MCHE-ZDM, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.
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15
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Ruzin A, Pastula ST, Levin-Sparenberg E, Jiang X, Fryzek J, Tovchigrechko A, Lu B, Qi Y, Liu H, Jin H, Yu L, Hackett J, Villafana T, Esser MT. Characterization of circulating RSV strains among subjects in the OUTSMART-RSV surveillance program during the 2016-17 winter viral season in the United States. PLoS One 2018; 13:e0200319. [PMID: 30040837 PMCID: PMC6057637 DOI: 10.1371/journal.pone.0200319] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/22/2018] [Indexed: 01/10/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is an established cause of serious lower respiratory disease in infants, elderly and high-risk populations. The OUTSMART surveillance program aims to characterize patient populations and currently circulating RSV strains, and monitor temporal and geographic evolution of RSV F and G proteins in the U.S. Methods The OUTSMART 2016–17 study collected RSV-positive samples from 25 RSVAlert® laboratories from 4 U.S. regions and Puerto Rico during November 2016 through March 2017. Frequencies of A and B subtypes and genotypes were determined for several demographic and geographic variables. To gauge the representativeness of the OUTSMART patients, results were compared to discharge data from the NEDS and NIS databases. Results A total of 1,041 RSV-positive samples with associated demographic data were obtained and the RSV F gene and second variable region of the G gene were sequenced. The majority of samples (76.0%) came from children under 2 years old: <1 year (48.4%), 1–2 years (27.6%). The OUTSMART patient sample was similar to NEDS and NIS for age, gender, and geographic location. Both OUTSMART and national RSV cases peaked in January. Of OUTSMART samples, 45.3% were subtype A, 53.7% were subtype B and 1.0% were mixed A and B. The percentage of RSV B cases increased with increasing age. Hospitalization (length of hospital stay, LOS, >24 hrs) occurred in 29.0% of patients of which 52.0% had RSV B. Outpatients (LOS <24 hrs) were 64.4% of total of which 73.3% were diagnosed in the ER and discharged, while only 6% were diagnosed in other outpatient settings. Conclusions The OUTSMART 2016–17 study was representative of the U.S. RSV experience. Geographic and temporal information from the RSV surveillance program will be used to establish a molecular baseline of RSV F and G sequence variability and to help inform development of novel agents for RSV prophylaxis and treatment.
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Affiliation(s)
- Alexey Ruzin
- AstraZeneca/MedImmune, Gaithersburg, Maryland, United States of America
- * E-mail:
| | - Susan T. Pastula
- Epidstat Institute, Ann Arbor, Michigan, United States of America
| | | | - Xiaohui Jiang
- Epidstat Institute, Ann Arbor, Michigan, United States of America
| | - Jon Fryzek
- Epidstat Institute, Ann Arbor, Michigan, United States of America
| | | | - Bin Lu
- AstraZeneca/MedImmune, Mountain View, California, United States of America
| | - Yanping Qi
- AstraZeneca/MedImmune, Mountain View, California, United States of America
| | - Hui Liu
- AstraZeneca/MedImmune, Mountain View, California, United States of America
| | - Hong Jin
- AstraZeneca/MedImmune, Mountain View, California, United States of America
| | - Li Yu
- AstraZeneca/MedImmune, Gaithersburg, Maryland, United States of America
| | - Judith Hackett
- AstraZeneca/MedImmune, Gaithersburg, Maryland, United States of America
| | - Tonya Villafana
- AstraZeneca/MedImmune, Gaithersburg, Maryland, United States of America
| | - Mark T. Esser
- AstraZeneca/MedImmune, Gaithersburg, Maryland, United States of America
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16
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Underlying Diseases and Causative Microorganisms of Recurrent Pneumonia in Children: A 13-Year Study in a University Hospital. J Trop Pediatr 2018; 65:224-230. [PMID: 30011014 PMCID: PMC7107262 DOI: 10.1093/tropej/fmy037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Pneumonia is a significant cause of death for children, particularly those in developing countries. The records of children who were hospitalized because of pneumonia between January 2003 and December 2015 were retrospectively reviewed, and patients who met the recurrent pneumonia criteria were included in this study. During this 13-year period, 1395 patients were hospitalized with pneumonia; of these, 129 (9.2%) met the criteria for recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients, with aspiration syndrome (21.7%) being the most common. Rhinovirus (30.5%), adenovirus (17.2%) and respiratory syncytial virus (13.9%) were the most frequent infectious agents. These results demonstrate that underlying diseases can cause recurrent pneumonia in children. Viruses are also commonly seen in recurrent pneumonia. Appropriate treatments should be chosen based on an analysis of the underlying disease, the patient's clinical condition and the laboratory and radiological data.
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17
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Meyers L, Ginocchio CC, Faucett AN, Nolte FS, Gesteland PH, Leber A, Janowiak D, Donovan V, Dien Bard J, Spitzer S, Stellrecht KA, Salimnia H, Selvarangan R, Juretschko S, Daly JA, Wallentine JC, Lindsey K, Moore F, Reed SL, Aguero-Rosenfeld M, Fey PD, Storch GA, Melnick SJ, Robinson CC, Meredith JF, Cook CV, Nelson RK, Jones JD, Scarpino SV, Althouse BM, Ririe KM, Malin BA, Poritz MA. Automated Real-Time Collection of Pathogen-Specific Diagnostic Data: Syndromic Infectious Disease Epidemiology. JMIR Public Health Surveill 2018; 4:e59. [PMID: 29980501 PMCID: PMC6054708 DOI: 10.2196/publichealth.9876] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background Health care and public health professionals rely on accurate, real-time monitoring of infectious diseases for outbreak preparedness and response. Early detection of outbreaks is improved by systems that are comprehensive and specific with respect to the pathogen but are rapid in reporting the data. It has proven difficult to implement these requirements on a large scale while maintaining patient privacy. Objective The aim of this study was to demonstrate the automated export, aggregation, and analysis of infectious disease diagnostic test results from clinical laboratories across the United States in a manner that protects patient confidentiality. We hypothesized that such a system could aid in monitoring the seasonal occurrence of respiratory pathogens and may have advantages with regard to scope and ease of reporting compared with existing surveillance systems. Methods We describe a system, BioFire Syndromic Trends, for rapid disease reporting that is syndrome-based but pathogen-specific. Deidentified patient test results from the BioFire FilmArray multiplex molecular diagnostic system are sent directly to a cloud database. Summaries of these data are displayed in near real time on the Syndromic Trends public website. We studied this dataset for the prevalence, seasonality, and coinfections of the 20 respiratory pathogens detected in over 362,000 patient samples acquired as a standard-of-care testing over the last 4 years from 20 clinical laboratories in the United States. Results The majority of pathogens show influenza-like seasonality, rhinovirus has fall and spring peaks, and adenovirus and the bacterial pathogens show constant detection over the year. The dataset can also be considered in an ecological framework; the viruses and bacteria detected by this test are parasites of a host (the human patient). Interestingly, the rate of pathogen codetections, on average 7.94% (28,741/362,101), matches predictions based on the relative abundance of organisms present. Conclusions Syndromic Trends preserves patient privacy by removing or obfuscating patient identifiers while still collecting much useful information about the bacterial and viral pathogens that they harbor. Test results are uploaded to the database within a few hours of completion compared with delays of up to 10 days for other diagnostic-based reporting systems. This work shows that the barriers to establishing epidemiology systems are no longer scientific and technical but rather administrative, involving questions of patient privacy and data ownership. We have demonstrated here that these barriers can be overcome. This first look at the resulting data stream suggests that Syndromic Trends will be able to provide high-resolution analysis of circulating respiratory pathogens and may aid in the detection of new outbreaks.
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Affiliation(s)
| | - Christine C Ginocchio
- BioFire Diagnostics, Salt Lake City, UT, United States.,bioMérieux USA, Durham, NC, United States.,Hofstra Northwell School of Medicine, Hempstead, NY, United States
| | | | - Frederick S Nolte
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Per H Gesteland
- Departments of Pediatrics and Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Amy Leber
- Laboratory of Microbiology and Immunoserology, Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Diane Janowiak
- Department of Lab Operations, South Bend Medical Foundation, South Bend, IN, United States
| | - Virginia Donovan
- Department of Pathology, New York University Winthrop Hospital, Mineola, NY, United States
| | - Jennifer Dien Bard
- Clinical Microbiology and Virology Laboratory, Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA, United States.,Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Silvia Spitzer
- Molecular Genetics Laboratory, Stony Brook University Medical Center, Stony Brook, NY, United States
| | - Kathleen A Stellrecht
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, United States
| | - Hossein Salimnia
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, United States
| | - Rangaraj Selvarangan
- Clinical Microbiology, Virology and Molecular Infectious Diseases Laboratory, Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States
| | - Stefan Juretschko
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease Diagnostics, Northwell Health, Lake Success, NY, United States
| | - Judy A Daly
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jeremy C Wallentine
- Department of Pathology, Intermountain Medical Center, Murray, UT, United States
| | - Kristy Lindsey
- Laboratory of Microbiology, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Franklin Moore
- Laboratory of Microbiology, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Sharon L Reed
- Department of Pathology and Medicine, Divisions of Clinical Pathology and Infectious Diseases, UC San Diego, San Diego, CA, United States
| | - Maria Aguero-Rosenfeld
- Department of Clinical Laboratories, New York University Langone Health, New York, NY, United States
| | - Paul D Fey
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Gregory A Storch
- Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Steve J Melnick
- Department of Pathology and Clinical Laboratories, Nicklaus Children's Hospital, Miami, FL, United States
| | - Christine C Robinson
- Department of Pathology and Laboratory Medicine, Microbiology/Virology Laboratory Section, Children's Hospital Colorado, Aurora, CO, United States
| | - Jennifer F Meredith
- Department of Laboratory Services, Microbiology Section, Greenville Health System, Greenville, SC, United States
| | | | | | - Jay D Jones
- BioFire Diagnostics, Salt Lake City, UT, United States
| | | | - Benjamin M Althouse
- University of Washington, Seattle, WA, United States.,New Mexico State University, Las Cruces, NM, United States
| | | | - Bradley A Malin
- Department of Biomedical Informatics, School of Medicine, Vanderbilt University, Nashville, TN, United States
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18
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Weinberger R, Riffelmann M, Kennerknecht N, Hülße C, Littmann M, O'Brien J, von Kries R, von König CHW. Long-lasting cough in an adult German population: incidence, symptoms, and related pathogens. Eur J Clin Microbiol Infect Dis 2018; 37:665-672. [PMID: 29302815 PMCID: PMC7088169 DOI: 10.1007/s10096-017-3158-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022]
Abstract
Studies of the incidence of pertussis in adults have shown that it accounts for only 5–15% cases of prolonged coughing. We assessed the burden of suffering related to prolonged coughing and tried to identify further causative agents. Based on a sentinel study with 35 general practitioners in two German cities (Krefeld, Rostock), with 3,946 patients fulfilling the inclusion criteria, we estimated the incidence of prolonged coughing in adults. In 975 of these outpatients, PCR and/or serology for adenovirus, Bordetella pertussis and B. parapertussis, human metapneumovirus, influenza virus A and rhinovirus, parainfluenza virus, Mycoplasma pneumonia, and respiratory syncytial virus (RSV) were performed. Treatment data were extracted for a subgroup of 138 patients. Descriptive statistics, including Kaplan–Maier curves were generated. Yearly incidence ranged between 1.4 and 2.1% per population in the two cities. Adult patients sought medical attention only after a median of 3 weeks of coughing. Irrespective of smoking and unrelated to the identified pathogens, the median duration of coughing was 6 weeks, with an interquartile range of 4–11 weeks. In 48.3% of patients, possible pathogens were identified, among which adenovirus (15.1%), RSV (7.5%), B. pertussis (5.6%), and influenza viruses (4.0%) were most often found. Symptoms were not indicative of a specific agent and a total of 64% of patients received antibiotics. Prolonged adult coughing requiring medical attention prompts substantial healthcare use. Apart from B. pertussis, a broad range of pathogens was associated with the symptoms. However, patients sought medical attention too late to guide efficacious therapeutic interventions using the diagnostic tests.
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Affiliation(s)
- Raphael Weinberger
- Institut für Soziale Pädiatrie, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marion Riffelmann
- Labor: Medizin Krefeld MVZ GmbH, Krefeld, Germany.,Institut für Hygiene und Labormedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Nicole Kennerknecht
- Institut für Hygiene und Labormedizin, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Christel Hülße
- Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern, Rostock, Germany
| | - Martina Littmann
- Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern, Rostock, Germany
| | - Judith O'Brien
- Institut für Soziale Pädiatrie, Ludwig-Maximilians-Universität, Munich, Germany.,Labor: Medizin Krefeld MVZ GmbH, Krefeld, Germany.,Institut für Hygiene und Labormedizin, HELIOS Klinikum Krefeld, Krefeld, Germany.,Landesamt für Gesundheit und Soziales des Landes Mecklenburg Vorpommern, Rostock, Germany
| | - Rüdiger von Kries
- Institut für Soziale Pädiatrie, Ludwig-Maximilians-Universität, Munich, Germany
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19
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Duchemann B, Annesi-Maesano I, Jacobe de Naurois C, Sanyal S, Brillet PY, Brauner M, Kambouchner M, Huynh S, Naccache JM, Borie R, Piquet J, Mekinian A, Virally J, Uzunhan Y, Cadranel J, Crestani B, Fain O, Lhote F, Dhote R, Saidenberg-Kermanac'h N, Rosental PA, Valeyre D, Nunes H. Prevalence and incidence of interstitial lung diseases in a multi-ethnic county of Greater Paris. Eur Respir J 2017; 50:50/2/1602419. [PMID: 28775045 DOI: 10.1183/13993003.02419-2016] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
Abstract
The objective of the study was to estimate the prevalence and incidence of interstitial lung diseases (ILDs) in Seine-Saint-Denis, a multi-ethnic county of Greater Paris, France.Patients with ILDs were identified between January and December 2012 by using several sources; all potentially involved medical specialists from public and private hospitals, community-based pulmonologists and general practitioners, and the Social Security system. Diagnoses were validated centrally by an expert multidisciplinary discussion.1170 ILD cases were reported (crude overall prevalence: 97.9/105 and incidence: 19.4/105/year). In the 848 reviewed cases, the most prevalent diagnoses were sarcoidosis (42.6%), connective tissue diseases associated ILDs (CTDs-ILDs) (16%), idiopathic pulmonary fibrosis (IPF) (11.6%), and occupational ILDs (5.0%), which corresponded to a crude prevalence of 30.2/105 for sarcoidosis, 12.1/105 for CTDs-ILDs and 8.2/105 for IPF. The prevalence of fibrotic idiopathic interstitial pneumonias, merging IPF, nonspecific interstitial pneumonia and cases registered with code J84.1 was 16.34/105 An adjusted multinomial model demonstrated an increased risk of sarcoidosis in North Africans and Afro-Caribbeans and of CTDs-ILDs in Afro-Caribbeans, compared to that in Europeans.This study, with a comprehensive recruitment and stringent diagnostic criteria, emphasises the importance of secondary ILDs, particularly CTDs-ILDs and the relatively low prevalence of IPF, and confirms that sarcoidosis is a rare disease in France.
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Affiliation(s)
- Boris Duchemann
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
| | - Isabella Annesi-Maesano
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris, France
| | | | - Shreosi Sanyal
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris, France
| | - Pierre-Yves Brillet
- Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France.,Assistance Publique - Hôpitaux de Paris, Service de Radiologie, Hôpital Avicenne, Bobigny, France
| | - Michel Brauner
- Assistance Publique - Hôpitaux de Paris, Service de Radiologie, Hôpital Avicenne, Bobigny, France
| | - Marianne Kambouchner
- Assistance Publique - Hôpitaux de Paris, Service d'Anatomie Pathologique, Hôpital Avicenne, Bobigny, France
| | - Sophie Huynh
- Service de Pneumologie, Hôpital Robert Ballanger, Aulnay sous-bois, France
| | - Jean Marc Naccache
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Tenon, Paris, France
| | - Raphael Borie
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie A, Hôpital Bichat, Paris, France
| | - Jacques Piquet
- Service de Pneumologie, Hôpital de Monfermeil, Montfermeil, France
| | - Arsène Mekinian
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne, Hôpital Jean Verdier, Bondy, France
| | - Jerôme Virally
- Service de Pneumologie, Hôpital Robert Ballanger, Aulnay sous-bois, France
| | - Yurdagul Uzunhan
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
| | - Jacques Cadranel
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Tenon, Paris, France
| | - Bruno Crestani
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie A, Hôpital Bichat, Paris, France
| | - Olivier Fain
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne, Hôpital Jean Verdier, Bondy, France
| | - Francois Lhote
- Service de Médecine Interne, Hôpital de Saint-Denis, Saint-Denis, France
| | - Robin Dhote
- Assistance Publique - Hôpitaux de Paris, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
| | | | | | - Dominique Valeyre
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
| | - Hilario Nunes
- Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France .,Université Paris 13, Sorbonne Paris Cité, EA2363 'hypoxie et poumon', Paris, France
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20
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Leotte J, Trombetta H, Faggion HZ, Almeida BM, Nogueira MB, Vidal LR, Raboni SM. Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years. J Pediatr (Rio J) 2017; 93:294-300. [PMID: 27916571 PMCID: PMC7094701 DOI: 10.1016/j.jped.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To report epidemiological features, clinical characteristics, and outcomes of human rhinovirus (HRV) infections in comparison with other community acquired respiratory virus (CRV) infections in patients hospitalized for two consecutive years. METHODS This was a cross-sectional study. Clinical, epidemiological, and laboratory data of patients hospitalized with acute respiratory syndrome in a tertiary care hospital from 2012 to 2013 were reviewed. RESULTS HRV was the most common CRV observed (36%, 162/444) and was present in the majority of viral co-detections (69%, 88/128), mainly in association with human enterovirus (45%). Most HRV-infected patients were younger than 2 years (57%). Overall, patients infected with HRV had a lower frequency of severe acute respiratory infection than those infected with other CRVs (60% and 84%, respectively, p=0.006), but had more comorbidities (40% and 27%, respectively; p=0.043). However, in the adjusted analysis this association was not significant. The mortality rate within the HRV group was 3%. Detection of HRV was more prevalent during autumn and winter, with a moderately negative correlation between viral infection frequency and temperature (r=-0.636, p<0.001) but no correlation with rainfall (r=-0.036, p=0.866). CONCLUSION HRV is usually detected in hospitalized children with respiratory infections and is often present in viral co-detections. Comorbidities are closely associated with HRV infections. These infections show seasonal variation, with predominance during colder seasons.
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Affiliation(s)
- Jaqueline Leotte
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brazil
| | - Hygor Trombetta
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brazil
| | - Heloisa Z Faggion
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brazil
| | - Bernardo M Almeida
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Epidemiologia Hospitalar, Curitiba, PR, Brazil
| | - Meri B Nogueira
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brazil
| | - Luine R Vidal
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brazil
| | - Sonia M Raboni
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brazil; Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brazil.
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21
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Leotte J, Trombetta H, Faggion HZ, Almeida BM, Nogueira MB, Vidal LR, Raboni SM. Impact and seasonality of human rhinovirus infection in hospitalized patients for two consecutive years. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2017. [PMCID: PMC7153728 DOI: 10.1016/j.jpedp.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objetivos Relatar as características epidemiológicas, as características clínicas e os resultados das infecções por rinovírus humano (RVH) em comparação a outras infecções por vírus respiratórios adquiridos na comunidade (VRCs) em pacientes internados por dois anos consecutivos. Métodos Este foi um estudo transversal. Foram revisados os dados clínicos, epidemiológicos e laboratoriais de pacientes internados com síndrome respiratória aguda em um hospital terciário de 2012 a 2013. Resultados O RVH foi o VRC mais comum observado (36%, 162/444) e esteve presente na maior parte das codetecções virais (69%, 88/128), principalmente em associação ao enterovírus humano (45%). A maioria dos pacientes infectados por RVH possuía menos de 2 anos (57%). De modo geral, os pacientes com RVH apresentaram uma menor frequência de infecção respiratória aguda grave que os pacientes infectados por outros VRCs (60% e 84%, respectivamente, p = 0,006), porém mais comorbidades (40% e 27%, respectivamente; p = 0,043). Contudo, em uma análise ajustada, essa associação não foi significativa. A taxa de mortalidade no grupo RVH foi 3%. A detecção de RVH foi mais prevalente durante o outono e inverno, com uma correlação negativa moderada entre a frequência de infecção viral e a temperatura (r = ‐0,636, p < 0,001), porém nenhuma correlação com a precipitação (r = −0,036, p = 0,866). Conclusão O RVH é normalmente detectado em crianças internadas com infecções respiratórias e normalmente está presente em codetecções virais. As comorbidades estão estreitamente associadas a infecções por RVH. Essas infecçõesmostram variação sazonal, com predominância durante as estações mais frias.
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Affiliation(s)
- Jaqueline Leotte
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brasil
| | - Hygor Trombetta
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brasil
| | - Heloisa Z. Faggion
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brasil
| | - Bernardo M. Almeida
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Epidemiologia Hospitalar, Curitiba, PR, Brasil
| | - Meri B. Nogueira
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brasil
| | - Luine R. Vidal
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brasil
| | - Sonia M. Raboni
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Divisão de Doenças Infecciosas, Curitiba, PR, Brasil
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Laboratório de Virologia, Curitiba, PR, Brasil
- Autor para correspondência.
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22
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Nguyen HKL, Nguyen SV, Nguyen AP, Hoang PMV, Le TT, Nguyen TC, Hoang HT, Vuong CD, Tran LTT, Le MQ. Surveillance of Severe Acute Respiratory Infection (SARI) for Hospitalized Patients in Northern Vietnam, 2011-2014. Jpn J Infect Dis 2017; 70:522-527. [PMID: 28367882 DOI: 10.7883/yoken.jjid.2016.463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe acute respiratory infections (SARI) are leading causes of hospitalization, morbidity, and mortality in children worldwide. The aim of this study was to identify viral pathogens responsible for SARI in northern Vietnam in the period from 2011 to 2014. Throat swabs and tracheal aspirates were collected from SARI patients according to WHO guidelines. The presence of 13 different viral pathogens (influenza A[H1N1]pdm09; A/H3N2; A/H5; A/H7 and B; para influenza 1,2,3; RSV; HMPV; adeno; severe acute respiratory syndrome-CoV and rhino) was tested by conventional/real-time reverse transcription-polymerase chain reaction. During the study period, 975 samples were collected and tested. More than 30% (32.1%, 313 samples) of the samples showed evidence of infection with influenza viruses, including A/H3N2 (48 samples), A (H1N1) pdm09 (221 samples), influenza B (42 samples), and co-infection of A (H1N1) pdm09 or A/H3N2 and influenza B (2 samples). Other respiratory pathogens were detected in 101 samples, including rhinovirus (73 samples), adenovirus (10 samples), hMPV (9 samples), parainfluenza 3 (5 samples), parainfluenza 2 (3 samples), and RSV (1 sample). Influenza A/H5, A/H7, or SARS-CoV were not detected. Respiratory viral infection, particularly infection of influenza and rhinoviruses, were associated with high rates of SARI hospitalization, and future studies correlating the clinical aspects are needed to design interventions, including targeted vaccination.
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Affiliation(s)
| | - Son Vu Nguyen
- Virology Department, National Institute of Hygiene and Epidemiology
| | | | | | - Thanh Thi Le
- Virology Department, National Institute of Hygiene and Epidemiology
| | - Thach Co Nguyen
- Virology Department, National Institute of Hygiene and Epidemiology
| | - Huong Thu Hoang
- Virology Department, National Institute of Hygiene and Epidemiology
| | - Cuong Duc Vuong
- Virology Department, National Institute of Hygiene and Epidemiology
| | | | - Mai Quynh Le
- Virology Department, National Institute of Hygiene and Epidemiology
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23
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Cilloniz C, Ewig S, Gabarrus A, Ferrer M, Puig de la Bella Casa J, Mensa J, Torres A. Seasonality of pathogens causing community-acquired pneumonia. Respirology 2017; 22:778-785. [DOI: 10.1111/resp.12978] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona; University of Barcelona (UB); Barcelona Spain
- Biomedical Research Institute “August Pi Sunyer” (IDIBAPS); Biomedical Research Networking Centres on Respiratory Diseases (CIBERES); Barcelona Spain
| | - Santiago Ewig
- Department of Respiratory Medicine and Infectious Diseases; Evangelic Hospital in Herne and Augusta Hospital in Bochum; Bochum Germany
| | - Albert Gabarrus
- Department of Pneumology, Hospital Clinic of Barcelona; University of Barcelona (UB); Barcelona Spain
- Biomedical Research Institute “August Pi Sunyer” (IDIBAPS); Biomedical Research Networking Centres on Respiratory Diseases (CIBERES); Barcelona Spain
| | - Miquel Ferrer
- Department of Pneumology, Hospital Clinic of Barcelona; University of Barcelona (UB); Barcelona Spain
- Biomedical Research Institute “August Pi Sunyer” (IDIBAPS); Biomedical Research Networking Centres on Respiratory Diseases (CIBERES); Barcelona Spain
| | | | - Josep Mensa
- Department of Infectious Diseases; Hospital Clinic of Barcelona; Barcelona Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona; University of Barcelona (UB); Barcelona Spain
- Biomedical Research Institute “August Pi Sunyer” (IDIBAPS); Biomedical Research Networking Centres on Respiratory Diseases (CIBERES); Barcelona Spain
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24
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Wansaula Z, Olsen SJ, Casal MG, Golenko C, Erhart LM, Kammerer P, Whitfield N, McCotter OZ. Surveillance for severe acute respiratory infections in Southern Arizona, 2010-2014. Influenza Other Respir Viruses 2016; 10:161-9. [PMID: 26590069 PMCID: PMC4814863 DOI: 10.1111/irv.12360] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/28/2022] Open
Abstract
Background The Binational Border Infectious Disease Surveillance program began surveillance for severe acute respiratory infections (SARI) on the US–Mexico border in 2009. Here, we describe patients in Southern Arizona. Methods Patients admitted to five acute care hospitals that met the SARI case definition (temperature ≥37·8°C or reported fever or chills with history of cough, sore throat, or shortness of breath in a hospitalized person) were enrolled. Staff completed a standard form and collected a nasopharyngeal swab which was tested for selected respiratory viruses by reverse transcription polymerase chain reaction. Results From October 2010–September 2014, we enrolled 332 SARI patients. Fifty‐two percent were male and 48% were white non‐Hispanic. The median age was 63 years (47% ≥65 years and 5·2% <5 years). During hospitalization, 51 of 230 (22%) patients required intubation, 120 of 297 (40%) were admitted to intensive care unit, and 28 of 278 (10%) died. Influenza vaccination was 56%. Of 309 cases tested, 49 (16%) were positive for influenza viruses, 25 (8·1%) for human metapneumovirus, 20 (6·5%) for parainfluenza viruses, 16 (5·2%) for coronavirus, 11 (3·6%) for respiratory syncytial virus, 10 (3·2%) for rhinovirus, 4 (1·3%) for rhinovirus/enterovirus, 3 (1·0%) for enteroviruses, and 3 (1·0%) for adenovirus. Among the 49 influenza‐positive specimens, 76% were influenza A (19 H3N2, 17 H1N1pdm09, and 1 not subtyped), and 24% were influenza B. Conclusion Influenza viruses were a frequent cause of SARI in hospitalized patients in Southern Arizona. Monitoring respiratory illness in border populations will help better understand the etiologies. Improving influenza vaccination coverage may help prevent some SARI cases.
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Affiliation(s)
- Zimy Wansaula
- Arizona Department of Health Services, Office of Border Health, Tucson, AZ, USA
| | - Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mariana G Casal
- Arizona Department of Health Services, Office of Border Health, Tucson, AZ, USA
| | - Catherine Golenko
- Arizona Department of Health Services, Office of Infectious Disease Services, Phoenix, AZ, USA
| | - Laura M Erhart
- Arizona Department of Health Services, Office of Infectious Disease Services, Phoenix, AZ, USA
| | | | - Natalie Whitfield
- Clinical and Molecular Microbiology, University of Arizona, Tucson, AZ, USA
| | - Orion Z McCotter
- Arizona Department of Health Services, Office of Border Health, Tucson, AZ, USA.,Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
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25
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Houtsma A, Bedenice D, Pusterla N, Pugliese B, Mapes S, Hoffman AM, Paxson J, Rozanski E, Mukherjee J, Wigley M, Mazan MR. Association between inflammatory airway disease of horses and exposure to respiratory viruses: a case control study. Multidiscip Respir Med 2015; 10:33. [PMID: 26535117 PMCID: PMC4630835 DOI: 10.1186/s40248-015-0030-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/14/2015] [Indexed: 11/10/2022] Open
Abstract
Background Inflammatory airway disease (IAD) in horses, similar to asthma in humans, is a common cause of chronic poor respiratory health and exercise intolerance due to airway inflammation and exaggerated airway constrictive responses. Human rhinovirus is an important trigger for the development of asthma; a similar role for viral respiratory disease in equine IAD has not been established yet. Methods In a case–control study, horses with IAD (n = 24) were compared to control animals from comparable stabling environments (n = 14). Horses were classified using pulmonary function testing and bronchoalveolar lavage. PCR for equine rhinitis virus A and B (ERAV, ERBV), influenza virus (EIV), and herpesviruses 2, 4, and 5 (EHV-2, EHV-4, EHV-5) was performed on nasal swab, buffy coat from whole blood, and cells from BAL fluid (BALF), and serology were performed. Categorical variables were compared between IAD and control using Fisher’s exact test; continuous variables were compared with an independent t-test. For all analyses, a value of P <0.05 was considered significant. Results There was a significant association between diagnosis of IAD and history of cough (P = 0.001) and exercise intolerance (P = 0.003) but not between nasal discharge and IAD. Horses with IAD were significantly more likely to have a positive titer to ERAV (68 %) vs. control horses (32 %). Horses with IAD had higher log-transformed titers to ERAV than did controls (2.28 ± 0.18 v.1.50 ± 0.25, P = 0.038). There was a significant association between nasal shedding (positive PCR) of EHV-2 and diagnosis of IAD (P = 0.002). Conclusions IAD remains a persistent problem in the equine population and has strong similarities to the human disease, asthma, for which viral infection is an important trigger. The association between viral respiratory infection and development or exacerbation of IAD in this study suggests that viral infection may contribute to IAD susceptibility; there is, therefore, merit in further investigation into the relationship between respiratory virus exposure and development of IAD.
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Affiliation(s)
- Ashley Houtsma
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
| | - Daniela Bedenice
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
| | | | - Brenna Pugliese
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
| | | | - Andrew M Hoffman
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
| | | | - Elizabeth Rozanski
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
| | - Jean Mukherjee
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
| | - Margaret Wigley
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
| | - Melissa R Mazan
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA USA
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26
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Pang J, Jin J, Loh JP, Tan BH, Koh WHV, Ng SH, Ho ZJM, Gao Q, Cook AR, Hsu LY, Lee VJ, Chen MIC. Risk factors for febrile respiratory illness and mono-viral infections in a semi-closed military environment: a case-control study. BMC Infect Dis 2015. [PMID: 26208494 PMCID: PMC4514976 DOI: 10.1186/s12879-015-1024-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Febrile respiratory illness (FRI) results in substantial burden in semi-closed environments. Tackling risk factors may reduce transmission and infection. However, risk factors involved in one setting may not be generalizable in all settings due to differences in climate, residential environment, population genetic and cultural backgrounds. This study aims to identify risk factors of FRI and mono-viral infections in a tropical military environment. Methods From year 2009 to 2012, military personnel with temperature ≥37.5 °C, cough and/or sore throat, and personnel with no fever or no respiratory symptoms were recruited as cases and controls, respectively. Subjects provided nasal wash specimens and answered a standardized questionnaire. Resplex assays were used to determine the viral etiologies. Descriptive, univariate and multivariate analyses of the variables were performed using appropriate descriptive tests and logistic regression modelling, respectively, with R program. Results A total of 7,743 FRI cases and 1,247 non-FRI study controls were recruited. Increasing age [adjusted odds ratio (AOR) = 1.03; 95 % confidence interval (CI) = 1.01-1.05], recruit camp (AOR = 4.67; 95 % CI = 3.99-5.46) and smoker (AOR = 1.31; 95 % CI = 1.13-1.52) were independent risk factors of FRI. Malay ethnicity was positively associated with influenza A(H1N1)pdm09 (AOR = 1.50; 95 % CI = 1.04-2.15) and coxsackie/echovirus (AOR = 1.67; 95 % CI = 1.19-2.36) mono-infection. Significant contact risk factors were stay-out personnel with ill household member (AOR = 4.96; 95 % CI = 3.39-7.24), and stay-in personnel with ill bunkmate and household member (AOR = 3.55; 95 % CI = 2.57-4.91). Staying in camp with none ill in bunk and at home was a protective factor against FRI (AOR = 0.80; 95 % CI = 0.64-0.99). These contact risk factors were similarly observed for the five most common viruses detected, namely adenovirus, rhinoviruses, influenza A and B, and coxsackie/echovirus. Conclusion Increasing age, smoker, recruit-camp, stay-out personnel with ill household members and stay-in personnel with ill bunkmates were independent risk factors of FRI in a semi-closed military environment. Early identification and isolation of ill personnel from their bunk may be effective to prevent and reduce transmission and disease burden.
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Affiliation(s)
- Junxiong Pang
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Jing Jin
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Jin Phang Loh
- Defence Medical and Environmental Research Institute, Singapore, Singapore.
| | - Boon Huan Tan
- Defence Medical and Environmental Research Institute, Singapore, Singapore.
| | | | - Sock Hoon Ng
- Defence Medical and Environmental Research Institute, Singapore, Singapore.
| | | | - Qiuhan Gao
- Biodefence Centre, Ministry of Defence, Singapore, Singapore.
| | - Alex R Cook
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Yale-NUS College, National University of Singapore, Singapore, Singapore. .,Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore. .,Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore.
| | - Li Yang Hsu
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Department of Medicine, National University of Singapore, Singapore, Singapore.
| | - Vernon J Lee
- Biodefence Centre, Ministry of Defence, Singapore, Singapore.
| | - Mark I Cheng Chen
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
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27
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Sanchez JL, Cooper MJ, Myers CA, Cummings JF, Vest KG, Russell KL, Sanchez JL, Hiser MJ, Gaydos CA. Respiratory Infections in the U.S. Military: Recent Experience and Control. Clin Microbiol Rev 2015; 28:743-800. [PMID: 26085551 PMCID: PMC4475643 DOI: 10.1128/cmr.00039-14] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This comprehensive review outlines the impact of military-relevant respiratory infections, with special attention to recruit training environments, influenza pandemics in 1918 to 1919 and 2009 to 2010, and peacetime operations and conflicts in the past 25 years. Outbreaks and epidemiologic investigations of viral and bacterial infections among high-risk groups are presented, including (i) experience by recruits at training centers, (ii) impact on advanced trainees in special settings, (iii) morbidity sustained by shipboard personnel at sea, and (iv) experience of deployed personnel. Utilizing a pathogen-by-pathogen approach, we examine (i) epidemiology, (ii) impact in terms of morbidity and operational readiness, (iii) clinical presentation and outbreak potential, (iv) diagnostic modalities, (v) treatment approaches, and (vi) vaccine and other control measures. We also outline military-specific initiatives in (i) surveillance, (ii) vaccine development and policy, (iii) novel influenza and coronavirus diagnostic test development and surveillance methods, (iv) influenza virus transmission and severity prediction modeling efforts, and (v) evaluation and implementation of nonvaccine, nonpharmacologic interventions.
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Affiliation(s)
- Jose L Sanchez
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Michael J Cooper
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | | | - James F Cummings
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kelly G Vest
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Kevin L Russell
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA
| | - Joyce L Sanchez
- Mayo Clinic, Division of General Internal Medicine, Rochester, Minnesota, USA
| | - Michelle J Hiser
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, USA Oak Ridge Institute for Science and Education, Postgraduate Research Participation Program, U.S. Army Public Health Command, Aberdeen Proving Ground, Aberdeen, Maryland, USA
| | - Charlotte A Gaydos
- International STD, Respiratory, and Biothreat Research Laboratory, Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
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28
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Abstract
Antiviral therapy has an important role in the treatment and chemoprophylaxis of influenza. At present, two classes of antiviral agents, adamantanes and neuraminidase inhibitors, are available for the treatment and chemoprophylaxis of influenza in Korea. Because of the widespread resistance against adamantanes, neuraminidase inhibitors are mainly used. Because each country has a unique epidemiology of influenza, the proper use of antiviral agents should be determined based on local data. Decisions on the clinical practice in the treatment of influenza in South Korea are guided by the local surveillance data, practice guidelines, health insurance system and the resistance patterns of the circulating influenza viruses. This review highlights the role of antiviral agents in the treatment and outcome of influenza in Korea by providing comprehensive information of their clinical usage in Korea.
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Affiliation(s)
- Young June Choe
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
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