An outbreak of influenza A(H3N2) in Alappuzha district, Kerala, India, in 2011

Towards adult vaccination in India: a narrative literature review

Despite vast improvements in childhood vaccination coverage in India, adult vaccination coverage is negligible. Our aim was, therefore, to create awareness about the importance of adult immunization. Although the true burden of vaccine-preventable diseases (VPDs) among Indian adults is unknown, adults are particularly vulnerable during outbreaks, due to a lack of immunization, waning immunity, age-related factors (e.g. chronic conditions and immunosenescence), and epidemiological shift. There are no national adult immunization guidelines in India, and although several medical societies have published adult immunization guidelines, these vary, making it unclear who should receive which vaccines (based on age, underlying conditions, etc.). Other barriers to adult immunization include vaccine hesitancy, missed opportunities, and cost. Steps to improve adult vaccination could include: adoption of national guidelines, education of healthcare providers and the public, and promotion of life-course immunization. Improving adult vaccine coverage could help reduce the burden of VPDs, particularly among older adults.

Assessing the reporting quality of influenza outbreaks in the community

BACKGROUND

High-quality reporting of outbreak characteristics is fundamental to understand the behaviour of various strains of influenza virus and the impact of outbreak management strategies. However, few studies have systematically evaluated the quality of outbreak reporting.

OBJECTIVES

To conduct a systematic analysis and assessment for reporting quality of influenza outbreaks based on a modified version of the STROBE statement, and to examine characteristics associated with reporting quality.

METHODS

A literature search was conducted across 3 online databases (PubMed, Web of Science, MEDLINE) for reports of influenza outbreaks (pandemic H1N1, avian, seasonal). The quality of reports meeting our eligibility criteria was assessed using the Modified STROBE criteria and assigned a score of 30. Mean differences (MD) and 95% confidence intervals (CI) were reported for comparisons of study characteristics.

RESULTS

Sixty-four outbreak reports were available for analyses. The average Modified STROBE score was 20/30. Peer-reviewed articles were associated with a better quality of reporting (MD 2.79, 95% CI 0.79-4.78). Likewise, reports from authors affiliated with public health agencies were associated with better quality than those from academic institutions (MD 1.65, 95% CI-0.27-3.56).

CONCLUSIONS

The development of explicit reporting guidelines specifically geared towards reporting of outbreak investigations proved to be useful. Providing information on patient characteristics, investigation details in introduction and results, as well as addressing limitations that could have biased the findings, were frequently missing in the published reports.

Haemagglutinin and neuraminidase sequencing delineate nosocomial influenza outbreaks with accuracy equivalent to whole genome sequencing

OBJECTIVES

We describe haemagglutinin (HA) and neuraminidase (NA) sequencing in an apparent cross-site influenza A(H1N1) outbreak in renal transplant and haemodialysis patients, confirmed with whole genome sequencing (WGS).

METHODS

Isolates were sequenced from influenza positive individuals. Phylogenetic trees were constructed using HA and NA sequencing and subsequently WGS. Sequence data was analysed to determine genetic relatedness of viruses obtained from inpatient and outpatient cohorts and compared with epidemiological outbreak information.

RESULTS

There were 6 patient cases of influenza in the inpatient renal ward cohort (associated with 3 deaths) and 9 patient cases in the outpatient haemodialysis unit cohort (no deaths). WGS confirmed clustered transmission of two genetically different influenza A(H1N1)pdm09 strains initially identified by analysis of HA and NA genes. WGS took longer, and in this case was not required to determine whether or not the two seemingly linked outbreaks were related.

CONCLUSION

Rapid sequencing of HA and NA genes may be sufficient to aid early influenza outbreak investigation making it appealing for future outbreak investigation. However, as next generation sequencing becomes cheaper and more widely available and bioinformatics software is now freely accessible next generation whole genome analysis may increasingly become a valuable tool for real-time Influenza outbreak investigation.