1
|
Lii A, Temte J, Barlow S, Goss M, Temte E, Zaborek J, Uzicanin A. Assessment and comparison of the ILI case definition in clinical and school-based community settings: ORCHARDS/IISP. Ann Fam Med 2024; 21:4842. [PMID: 38271207 PMCID: PMC10983225 DOI: 10.1370/afm.22.s1.4842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Context: Influenza-like illness (ILI) is commonly used in clinical and public health settings to identify influenza cases. CDC defines ILI as fever and either cough or sore throat, with symptom onset within 7 days. Objective: Assess performance of ILI criteria in two settings (clinical and community), comparing symptom profiles and laboratory detection of influenza in children. Study Design and Analysis: Retrospective analyses of data from medically attended influenza (MAI) surveillance and a communitybased study. Datasets were analyzed separately to assess predictors of influenza cases. Analyses were limited to specimens collected within 7 days of symptom onset. Relationships between influenza and each categorical variable were described by the confusion matrix, sensitivity, and specificity. Associations were tested using chi-square tests. Unadjusted and adjusted logistic regression models were used for all variables with RT-PCR result as the outcome. Setting or Dataset: The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) is a respiratory infection study based in the Oregon School District (Dane County, WI). The Wisconsin Influenza Incidence Surveillance Project (IISP) is a MAI surveillance system operating in five family medicine clinics in Dane County. Population Studied: Children aged 4-18 years with acute respiratory infections. Intervention/Instrument: Oropharyngeal specimens, collected by research staff (ORCHARDS) or clinicians (IISP), were tested for influenza via RT-PCR and for multiple respiratory viruses at the Wisconsin State Laboratory of Hygiene. Extensive demographic and symptoms data were collected from all participants. Outcome Measures: Influenza(+)PCR. Results: From 9/7/2010-3/12/2020, 1,338 and 2,359 specimens meeting inclusion criteria were collected for IISP and ORCHARDS, respectively. Cough, fever, and ILI classification were significantly associated with influenza (sensitivity ≥92.8%, ≥85.9%, and ≥84.5%, respectively). Receiver operator curve analysis confirmed ILI had high predictive ability in both settings, improved by the inclusion of seasonality and influenza vaccination status (IISP: 0.61 vs 0.76, ORCHARDS: 0.68 vs 0.78). Conclusions: ILI performed well in both clinical and community contexts. Factors most highly associated with increased odds of RT-PCR(+) results were cough, fever, and ILI. Inclusion of seasonality and influenza vaccination status improved the predictive value of ILI in both datasets.
Collapse
|
2
|
Temte J, Barlow S, Temte E, Goss M. Rapid Antigen Testing in School Health Offices for Surveillance of SARS-CoV-2 and Influenza A. Ann Fam Med 2024; 21:4841. [PMID: 38271206 PMCID: PMC10983375 DOI: 10.1370/afm.22.s1.4841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Context: Evaluation of acute respiratory infections (ARIs) has been disrupted by the SARS-CoV-2 (SC2) pandemic, limiting comprehensive surveillance for respiratory pathogens in clinical settings. Alternatives to using medically attended ARI for public health surveillance are needed. A potential approach involves assessing children and school personnel in school health offices (SHOs) as pandemic-related responses enhanced innovative approaches for SC2 testing in novel settings. Objective: Evaluate the comparability of SC2 and influenza A (FLuA) detection based on rapid antigen testing in SHOs to traditional surveillance systems. Study Design: Prospective evaluation of results from rapid antigen testing for SC2 and FluA in SHOs of a suburban/rural school district compared to large-scale, countywide detection of SC2 and clinic-based surveillance of FluA using cross correlation analyses. Setting: Oregon School District (OSD) in Dane County (DC: southcentral Wisconsin) over two academic years (September 2021-April 2023). Population Studied: School-aged children (4-18 years) and school staff/teachers reporting to SHOs with ARI symptoms. Comparator data included all PCR-based testing for SC2 reported to Public Health Madison & Dane County and PCR-based testing for influenza at five family medicine clinics in DC. Intervention/Instrument: Quidel Sofia SARS/Influenza Fluorescent Immunoassay with wireless transmission of anonymous results to a cloud-based server with availability to the study team. Outcome Measures: Cross correlation and lag estimates for weekly counts of SC2 and FLuA cases comparing school-based and community-based results. Results: The SHOs at the 7 OSD schools performed 1,508 tests with few invalid tests (n=7; 0.46%). Participants had a wide age range [1-71 years] with a median age of 13 years, and included 1,145 (76%) students. SC2: 118 and 119,630 cases were identified in OSD and DC, respectively. The maximum cross correlation (r=0.82) occurred with no time lag. FluA: 61 and 75 cases were identified in OSD and DC, respectively. The maximum cross correlation (r=0.69) occurred with DC lagging OSD by 1 week. Conclusions: Surveillance for significant respiratory pathogens can be based on rapid antigen testing within SHOs, is highly comparable with larger scale surveillance programs, and demonstrates either advanced (FluA) or concurrent detections (SC2). Performance of similar programs are needed in other geographical areas and for other pathogens.
Collapse
|
3
|
Santos DJAD, Oliveira TRD, Araújo GMD, Pott-Junior H, Melendez ME, Sabino EC, Leite OD, Faria RC. An electrochemical genomagnetic assay for detection of SARS-CoV-2 and Influenza A viruses in saliva. Biosens Bioelectron 2024; 255:116210. [PMID: 38537427 DOI: 10.1016/j.bios.2024.116210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/15/2024]
Abstract
Viral respiratory infections represent a major threat to the population's health globally. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 disease and in some cases the symptoms can be confused with Influenza disease caused by the Influenza A viruses. A simple, fast, and selective assay capable of identifying the etiological agent and differentiating the diseases is essential to provide the correct clinical management to the patient. Herein, we described the development of a genomagnetic assay for the selective capture of viral RNA from SARS-CoV-2 and Influenza A viruses in saliva samples and employing a simple disposable electrochemical device for gene detection and quantification. The proposed method showed excellent performance detecting RNA of SARS-CoV-2 and Influenza A viruses, with a limit of detection (LoD) and limit of quantification (LoQ) of 5.0 fmol L-1 and 8.6 fmol L-1 for SARS-CoV-2, and 1.0 fmol L-1 and 108.9 fmol L-1 for Influenza, respectively. The genomagnetic assay was employed to evaluate the presence of the viruses in 36 saliva samples and the results presented similar responses to those obtained by the real-time reverse transcription-polymerase chain reaction (RT-PCR), demonstrating the reliability and capability of a method as an alternative for the diagnosis of COVID-19 and Influenza with point-of-care capabilities.
Collapse
Affiliation(s)
| | | | | | - Henrique Pott-Junior
- Department of Medicine, Federal University of São Carlos, São Carlos, SP, 13565-905, Brazil
| | | | - Ester Cerdeira Sabino
- Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, SP, 05403-000, Brazil
| | - Oldair Donizeti Leite
- Department of Chemistry, Federal University of São Carlos, São Carlos, SP, 13565-905, Brazil; Federal Technological University of Paraná, Campus Medianeira, Medianeira, PR, 85884-000, Brazil.
| | - Ronaldo Censi Faria
- Department of Chemistry, Federal University of São Carlos, São Carlos, SP, 13565-905, Brazil.
| |
Collapse
|
4
|
Juárez X, García Causarano MF, Burundarena C, Dondoglio P, Montoto Piazza L, Wenk G, Haleblian E, Rial MJ, Cancellara A. Children with influenza admitted at a children's hospital in Argentina in the 2019-2022 period: What has changed after the COVID-19 pandemic? ARCH ARGENT PEDIATR 2024; 122:e202310130. [PMID: 37917026 DOI: 10.5546/aap.2023-10130.eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Introduction. During 2020 and 2021, the circulation of influenza virus remained below expectations worldwide. In Argentina, in 2022, we observed an uninterrupted circulation of influenza all year round. Our objectives were to describe the circulation patterns and clinical characteristics of hospitalized children with influenza. Population and methods. Retrospective, analytical, observational study. All children with influenza virus admitted to a children's hospital during the 2019-2022 period were included. Results. A total of 138 patients were admitted over 4 years; in 2019, the rate of hospital discharges was 4.5/1000, compared to 15.1/1000 in 2022. No cases were recorded in 2020 and 2021. In 2019, most cases were observed in the winter; in 79%, the cause was acute lower respiratory tract infection (ALRTI); influenza A was detected in 92%. In 2022, most cases occurred in the spring; 62% developed ALRTI; and influenza A was detected in 56%. Similar rates of vaccination and comorbidities were observed in both periods. Conclusions. In 2022, more hospitalizations due to influenza were recorded, which may have correlated with the use of more sensitive molecular diagnostic testing and a change in seasonality, with more cases observed in the spring. In 2019, influenza A predominated in lower respiratory tract infections, while in 2022, cases of influenza A and B were similar, with more extra-pulmonary forms.
Collapse
Affiliation(s)
- Ximena Juárez
- Department of Infectious Diseases; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - María F García Causarano
- Department of Infectious Diseases; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - Carmen Burundarena
- Department of Infectious Diseases; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - Patricia Dondoglio
- Department of Infectious Diseases; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - Luciana Montoto Piazza
- Laboratory; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - Gretel Wenk
- Laboratory; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - Emilce Haleblian
- Laboratory; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - María J Rial
- Laboratory; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| | - Aldo Cancellara
- Department of Infectious Diseases; Hospital General de Niños Pedro de Elizalde, City of Buenos Aires, Argentina
| |
Collapse
|
5
|
Liu G, Wang J, Wang J, Cui X, Wang K, Chen M, Yang Z, Gao A, Shen Y, Zhang Q, Gao G, Cui D. Deep-learning assisted zwitterionic magnetic immunochromatographic assays for multiplex diagnosis of biomarkers. Talanta 2024; 273:125868. [PMID: 38458085 DOI: 10.1016/j.talanta.2024.125868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
Magnetic nanoparticle (MNP)-based immunochromatographic tests (ICTs) display long-term stability and an enhanced capability for multiplex biomarker detection, surpassing conventional gold nanoparticles (AuNPs) and fluorescence-based ICTs. In this study, we innovatively developed zwitterionic silica-coated MNPs (MNP@Si-Zwit/COOH) with outstanding antifouling capabilities and effectively utilised them for the simultaneous identification of the nucleocapsid protein (N protein) of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) and influenza A/B. The carboxyl-functionalised MNPs with 10% zwitterionic ligands (MNP@Si-Zwit 10/COOH) exhibited a wide linear dynamic detection range and the most pronounced signal-to-noise ratio when used as probes in the ICT. The relative limit of detection (LOD) values were achieved in 12 min by using a magnetic assay reader (MAR), with values of 0.0062 ng/mL for SARS-CoV-2 and 0.0051 and 0.0147 ng/mL, respectively, for the N protein of influenza A and influenza B. By integrating computer vision and deep learning to enhance the image processing of immunoassay results for multiplex detection, a classification accuracy in the range of 0.9672-0.9936 was achieved for evaluating the three proteins at concentrations of 0, 0.1, 1, and 10 ng/mL. The proposed MNP-based ICT for the multiplex diagnosis of biomarkers holds substantial promise for applications in both medical institutions and self-administered diagnostic settings.
Collapse
Affiliation(s)
- Guan Liu
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China
| | - Junhao Wang
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China
| | - Jiulin Wang
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China
| | - Xinyuan Cui
- Radiology Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Second Road, Shanghai, 200025, PR China
| | - Kan Wang
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China
| | - Mingrui Chen
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China
| | - Ziyang Yang
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China
| | - Ang Gao
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China
| | - Yulan Shen
- Department of Radiology, Huashan Hospital Affiliated to Fudan University, PR China.
| | - Qian Zhang
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China.
| | - Guo Gao
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China.
| | - Daxiang Cui
- Institute of Nano Biomedicine and Engineering, School of Sensing Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, 800 Dongchuan RD, Shanghai, 200240, PR China; National Engineering Research Center for Nanotechnology, Shanghai, 200241, PR China; Henan Medical School, Henan University, Henan, 475004, PR China.
| |
Collapse
|
6
|
Kurz H, Sever-Yildiz G, Kocsisek CV, Resch E, Großschädl C, Totschnig L, Resch B. Respiratory Syncytial Virus and Influenza During the COVID-19 Pandemic: A Two-center Experience. Pediatr Infect Dis J 2024; 43:410-414. [PMID: 38266234 PMCID: PMC11003405 DOI: 10.1097/inf.0000000000004260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The aim of the study was to determine the burden of respiratory syncytial virus (RSV) and influenza disease during the COVID-19 pandemic at 2 Austrian urban pediatric centers between October 1, 2019 and April 30, 2022. METHODS We performed a retrospective observational 2-center study on RSV- and influenza virus-associated hospitalizations in infants and children up to 18 years at the University Hospital of Graz and the Clinic Donaustadt of Vienna from October 1, 2019 to April 30, 2022. Hospitalization had to be associated with the infectious disease, proven by polymerase chain reaction, including presence of respiratory symptoms. Demographic data including underlying diseases and treatment strategies were compared between centers and diseases, respectively. RESULTS There were 826 cases in Graz and 379 in Vienna with significant more RSV cases in Graz and more influenza cases in Vienna (RSV: 76% vs. 59%, influenza: 24% vs. 41%; both P < 0.001). One death occurred in Graz due to RSV and another due to influenza in Vienna. Seasonality only slightly differed between centers and severity of diseases was not aggravated when measured by pediatric intensive care unit admission rates, need for supplemental oxygen and respiratory support between first and last seasons. Treatment regimen differed regarding higher use of antibiotics and rates of intravenous fluids in Vienna compared to higher rates of bronchodilators, corticosteroids and nose drops in Graz. CONCLUSIONS We observed higher numbers of hospitalizations due to both viruses after the lockdown but not increased severity of the diseases; and mortality remained extremely low. Preventive measures should be implemented with high priority especially focused on infants with underlying diseases.
Collapse
Affiliation(s)
- Herbert Kurz
- From the Department of Pediatrics and Adolescents, Clinic Donaustadt, Vienna, Austria
| | - Gulsen Sever-Yildiz
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Corinna V. Kocsisek
- From the Department of Pediatrics and Adolescents, Clinic Donaustadt, Vienna, Austria
| | - Elisabeth Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Clara Großschädl
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Leonie Totschnig
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
| | - Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
7
|
Okubo Y, Uda K. Structural and organizational determinants of the capacity for COVID-19 testing and diagnoses in children: Insights from the 2009 influenza and COVID-19 pandemics. Respir Investig 2024; 62:426-430. [PMID: 38492332 DOI: 10.1016/j.resinv.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND This study explored factors associated with testing and diagnoses for children with COVID-19 at the hospital level and investigated whether the capacity of testing and diagnoses during the 2009 influenza pandemic was associated with that during COVID-19 pandemic. METHODS In this observational study, we analyzed data obtained from the Japan Medical Data Center database, comprising 4906 medical facilities and 1.7 million infectious disease-related visits among children aged <20 years in 2020-2021. Multivariable generalized linear models were used to explore determinants of testing and diagnoses capacity for COVID-19 and investigate the association between the capacity during the 2009 influenza and COVID-19 pandemics. RESULTS Public hospitals (adjusted incidence rate ratio [aIRR], 1.52; 95%CI, 1.26-1.82) and university hospitals (aIRR, 1.44; 95%CI, 1.14-1.80) were more likely to perform testing for COVID-19 among children, compared to clinics. The highest testing rate was observed in the department of internal medicine (aIRR, 1.64; 95%CI, 1.32-2.04), followed by pediatrics (aIRR, 1.40; 95%CI, 1.10-1.78) and otolaryngology (aIRR, 1.21; 95%CI, 0.89-1.64). Cubic spline models demonstrated the dose-response relationships between testing rate for influenza in 2009 and testing rates for COVID-19. Compared to the medical facilities in the lowest quartile of testing rate for influenza in 2009, those in the highest quartile were more likely to perform testing for COVID-19 (aIRR, 1.62; 95%CI, 1.43-1.83). CONCLUSIONS Our study provides insights into the capacity of testing and diagnoses for children, highlighting the dose-response relationship between the 2009 influenza and COVID-19 pandemics, which could be valuable in preparing healthcare systems for future pandemics.
Collapse
Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Kazuhiro Uda
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 1-1-1 Tsushima-Naka, Kita-ku, Okayama City, 700-8530, Japan; Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| |
Collapse
|
8
|
Serafin B, Kamen A, de Crescenzo G, Henry O. Antibody-independent surface plasmon resonance assays for influenza vaccine quality control. Appl Microbiol Biotechnol 2024; 108:307. [PMID: 38656587 PMCID: PMC11043112 DOI: 10.1007/s00253-024-13145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
Surface plasmon resonance (SPR)-based biosensors have emerged as a powerful platform for bioprocess monitoring due to their ability to detect biointeractions in real time, without the need for labeling. Paramount for the development of a robust detection platform is the immobilization of a ligand with high specificity and affinity for the in-solution species of interest. Following the 2009 H1N1 pandemic, much effort has been made toward the development of quality control platforms for influenza A vaccine productions, many of which have employed SPR for detection. Due to the rapid antigenic drift of influenza's principal surface protein, hemagglutinin, antibodies used for immunoassays need to be produced seasonally. The production of these antibodies represents a 6-8-week delay in immunoassay and, thus, vaccine availability. This review focuses on SPR-based assays that do not rely on anti-HA antibodies for the detection, characterization, and quantification of influenza A in bioproductions and biological samples. KEY POINTS: • The single radial immunodiffusion assay (SRID) has been the gold standard for the quantification of influenza vaccines since 1979. Due to antigenic drift of influenza's hemagglutinin protein, new antibody reagents for the SRID assay must be produced each year, requiring 6-8 weeks. The resulting delay in immunoassay availability is a major bottleneck in the influenza vaccine pipeline. This review highlights ligand options for the detection and quantification of influenza viruses using surface plasmon resonance biosensors.
Collapse
Affiliation(s)
- Benjamin Serafin
- Department of Chemical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Amine Kamen
- Department of Bioengineering, McGill University, Montreal, QC, Canada
| | - Gregory de Crescenzo
- Department of Chemical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Olivier Henry
- Department of Chemical Engineering, Polytechnique Montreal, Montreal, QC, Canada.
| |
Collapse
|
9
|
de Havenon A, Callaghan BC, Xu Y, Connor M, Hill CE, Ney J, Esper GJ. Burden of Neurologic Health Care and Incident Neurologic Diagnoses in the Year After COVID-19 or Influenza Hospitalization. Neurology 2024; 102:e209248. [PMID: 38507675 DOI: 10.1212/wnl.0000000000209248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/02/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Following the outbreak of viral infections from the severe acute respiratory syndrome coronavirus 2 virus in 2019 (coronavirus disease 2019 [COVID-19]), reports emerged of long-term neurologic sequelae in survivors. To better understand the burden of neurologic health care and incident neurologic diagnoses in the year after COVID-19 vs influenza, we performed an analysis of patient-level data from a large collection of electronic health records (EMR). METHODS We acquired deidentified data from TriNetX, a global health research network providing access to EMR data. We included individuals aged 18 years or older during index event, defined as hospital-based care for COVID-19 (from April 1, 2020, until November 15, 2021) or influenza (from 2016 to 2019). The study outcomes were subsequent health care encounters over the following year for 6 neurologic diagnoses including migraine, epilepsy, stroke, neuropathy, movement disorders, and dementia. We also created a composite of the 6 diagnoses as an incident event, which we call "incident neurologic diagnoses." We performed a 1:1 complete case nearest-neighbor propensity score match on age, sex, race/ethnicity, marital status, US census region patient residence, preindex years of available data, and Elixhauser comorbidity score. We fit time-to-event models and reported hazard ratios for COVID-19 vs influenza infection. RESULTS After propensity score matching, we had a balanced cohort of 77,272 individuals with COVID-19 and 77,272 individuals with influenza. The mean age was 51.0 ± 19.7 years, 57.7% were female, and 41.5% were White. Compared with patients with influenza, patients with COVID-19 had a lower risk of subsequent care for migraine (HR 0.645, 95% CI 0.604-0.687), epilepsy (HR 0.783, 95% CI 0.727-0.843), neuropathies (HR 0.567, 95% CI 0.532-0.604), movement disorders (HR 0.644, 95% CI 0.598-0.693), stroke (HR 0.904, 95% CI 0.845-0.967), or dementia (HR 0.931, 95% CI 0.870-0.996). Postinfection incident neurologic diagnoses were observed in 2.79% of the COVID-19 cohort vs 4.91% of the influenza cohort (HR 0.618, 95% CI 0.582-0.657). DISCUSSION Compared with a matched cohort of adults with a hospitalization or emergency department visit for influenza infection, those with COVID-19 had significantly fewer health care encounters for 6 major neurologic diagnoses over a year of follow-up. Furthermore, we found that COVID-19 infection was associated with a lower risk of an incident neurologic diagnosis in the year after infection.
Collapse
Affiliation(s)
- Adam de Havenon
- From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA
| | - Brian C Callaghan
- From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA
| | - Yunshan Xu
- From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA
| | - Maria Connor
- From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA
| | - Chloe E Hill
- From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA
| | - John Ney
- From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA
| | - Gregory J Esper
- From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA
| |
Collapse
|
10
|
May F, Ginige S, Firman E, Li YS, Soonarane YK, Smoll N, Hunter I, Pery B, Macfarlane B, Bladen T, Allen T, Green T, Walker J, Slinko V, Stickley M, Khandaker G, Anuradha S, Wattiaux A. Estimating the incidence of COVID-19, influenza and respiratory syncytial virus infection in three regions of Queensland, Australia, winter 2022: findings from a novel longitudinal testing-based sentinel surveillance programme. BMJ Open 2024; 14:e081793. [PMID: 38653507 PMCID: PMC11043701 DOI: 10.1136/bmjopen-2023-081793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The 2022 Australian winter was the first time that COVID-19, influenza and respiratory syncytial virus (RSV) were circulating in the population together, after two winters of physical distancing, quarantine and borders closed to international travellers. We developed a novel surveillance system to estimate the incidence of COVID-19, influenza and RSV in three regions of Queensland, Australia. DESIGN We implemented a longitudinal testing-based sentinel surveillance programme. Participants were provided with self-collection nasal swabs to be dropped off at a safe location at their workplace each week. Swabs were tested for SARS-CoV-2 by PCR. Symptomatic participants attended COVID-19 respiratory clinics to be tested by multiplex PCR for SARS-CoV-2, influenza A and B and RSV. Rapid antigen test (RAT) results reported by participants were included in the analysis. SETTING AND PARTICIPANTS Between 4 April 2022 and 3 October 2022, 578 adults were recruited via their workplace. Due to rolling recruitment, withdrawals and completion due to positive COVID-19 results, the maximum number enrolled in any week was 423 people. RESULTS A total of 4290 tests were included. Participation rates varied across the period ranging from 25.9% to 72.1% of enrolled participants. The total positivity of COVID-19 was 3.3%, with few influenza or RSV cases detected. Widespread use of RAT may have resulted in few symptomatic participants attending respiratory clinics. The weekly positivity rate of SARS-CoV-2 detected during the programme correlated with the incidence of notified cases in the corresponding communities. CONCLUSION This testing-based surveillance programme could estimate disease trends and be a useful tool in settings where testing is less common or accessible. Difficulties with recruitment meant the study was underpowered. The frontline sentinel nature of workplaces meant participants were not representative of the general population but were high-risk groups providing early warning of disease.
Collapse
Affiliation(s)
- Fiona May
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Shamila Ginige
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Elise Firman
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Yee Sum Li
- Metro South Public Health Unit, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Yudish Kumar Soonarane
- Metro South Public Health Unit, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Nicolas Smoll
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Ian Hunter
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Brielle Pery
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Bonnie Macfarlane
- Metro South Public Health Unit, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Tracy Bladen
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Terresa Allen
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Trevor Green
- Metro South Public Health Unit, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Vicki Slinko
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Mark Stickley
- Metro South Public Health Unit, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Gulam Khandaker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Satyamurthy Anuradha
- Metro South Public Health Unit, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Andre Wattiaux
- Gold Coast Public Health Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| |
Collapse
|
11
|
Ebell MH, Dale A, Merenstein DJ, Barrett B, Hulme C, Walters S, Sabry A, Bentivegna M. Prospective external validation of the FluScore risk score for influenza in outpatients. Fam Pract 2024; 41:207-211. [PMID: 38466150 DOI: 10.1093/fampra/cmae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Testing for influenza in patients with acute lower respiratory tract infection (LRTI) is common and in some cases is performed for all patients with LRTI. A more selective approach to testing could be more efficient. METHODS We used data from two prospective studies in the US primary and urgent care settings that enrolled patients with acute LRTI or influenza-like illness. Data were collected in the 2016, 2019, 2021, and 2022 flu seasons. All patients underwent polymerase chain reaction (PCR) testing for influenza and the FluScore was calculated based on patient-reported symptoms at their initial visit. The probability of influenza in each risk group was reported, as well as stratum-specific likelihood ratios (SSLRs) for each risk level. RESULTS The prevalence of influenza within risk groups varied based on overall differences in flu seasons and populations. However, the FluScore exhibited consistent performance across various seasons and populations based on the SSLRs. The FluScore had a consistent SSLR range of 0.20 to 0.23 for the low-risk group, 0.63 to 0.99 for the moderate-risk group, and 1.46 to 1.67 for the high-risk group. The diagnostic odds ratio based on the midpoints of these ranges was 7.25. CONCLUSIONS The FluScore could streamline patient categorization, identifying patients who could be exempted from testing, while identifying candidates for rapid influenza tests. This has the potential to be more efficient than a "one size fits all" test strategy, as it strategically targets the use of tests on patients most likely to benefit. It is potentially usable in a telehealth setting.
Collapse
Affiliation(s)
- Mark H Ebell
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Ariella Dale
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Dan J Merenstein
- Department of Family Medicine, Georgetown University, Washington, DC, United States
| | - Bruce Barrett
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, United States
| | - Cassie Hulme
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Sarah Walters
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, United States
| | - Alea Sabry
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, WI, United States
| | - Michelle Bentivegna
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| |
Collapse
|
12
|
Sim JK, Lee HS, Yang J, Gwack J, Kim BI, Cha JO, Min KH, Lee YS. Comparative Analysis of Clinical Outcomes Using Propensity Score Matching: Coronavirus Disease 2019 vs. Seasonal Influenza in Korea. J Korean Med Sci 2024; 39:e128. [PMID: 38622937 PMCID: PMC11018986 DOI: 10.3346/jkms.2024.39.e128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The advent of the omicron variant and the formulation of diverse therapeutic strategies marked a new epoch in the realm of coronavirus disease 2019 (COVID-19). Studies have compared the clinical outcomes between COVID-19 and seasonal influenza, but such studies were conducted during the early stages of the pandemic when effective treatment strategies had not yet been developed, which limits the generalizability of the findings. Therefore, an updated evaluation of the comparative analysis of clinical outcomes between COVID-19 and seasonal influenza is requisite. METHODS This study used data from the severe acute respiratory infection surveillance system of South Korea. We extracted data for influenza patients who were infected between 2018 and 2019 and COVID-19 patients who were infected in 2021 (pre-omicron period) and 2022 (omicron period). Comparisons of outcomes were conducted among the pre-omicron, omicron, and influenza cohorts utilizing propensity score matching. The adjusted covariates in the propensity score matching included age, sex, smoking, and comorbidities. RESULTS The study incorporated 1,227 patients in the pre-omicron cohort, 1,948 patients in the omicron cohort, and 920 patients in the influenza cohort. Following propensity score matching, 491 patients were included in each respective group. Clinical presentations exhibited similarities between the pre-omicron and omicron cohorts; however, COVID-19 patients demonstrated a higher prevalence of dyspnea and pulmonary infiltrates compared to their influenza counterparts. Both COVID-19 groups exhibited higher in-hospital mortality and longer hospital length of stay than the influenza group. The omicron group showed no significant improvement in clinical outcomes compared to the pre-omicron group. CONCLUSION The omicron group did not demonstrate better clinical outcomes than the pre-omicron group, and exhibited significant disease severity compared to the influenza group. Considering the likely persistence of COVID-19 infections, it is imperative to sustain comprehensive studies and ongoing policy support for the virus to enhance the prognosis for individuals affected by COVID-19.
Collapse
Affiliation(s)
- Jae Kyeom Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Gwack
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Bryan Inho Kim
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Jeong-Ok Cha
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency (KDCA), Cheongju, Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Seok Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
| |
Collapse
|
13
|
Liu HF, Hu XZ, Huang RW, Guo ZH, Gao JR, Xiang M, Lu R, Ban D, Liu CY, Wang YY, Li W, Li Y, Guo YJ, Lu Q, Fu HM. Evaluation of disease severity and prediction of severe cases in children hospitalized with influenza A (H1N1) infection during the post-COVID-19 era: a multicenter retrospective study. BMC Pediatr 2024; 24:234. [PMID: 38566022 PMCID: PMC10985932 DOI: 10.1186/s12887-024-04645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The rebound of influenza A (H1N1) infection in post-COVID-19 era recently attracted enormous attention due the rapidly increased number of pediatric hospitalizations and the changed characteristics compared to classical H1N1 infection in pre-COVID-19 era. This study aimed to evaluate the clinical characteristics and severity of children hospitalized with H1N1 infection during post-COVID-19 period, and to construct a novel prediction model for severe H1N1 infection. METHODS A total of 757 pediatric H1N1 inpatients from nine tertiary public hospitals in Yunnan and Shanghai, China, were retrospectively included, of which 431 patients diagnosed between February 2023 and July 2023 were divided into post-COVID-19 group, while the remaining 326 patients diagnosed between November 2018 and April 2019 were divided into pre-COVID-19 group. A 1:1 propensity-score matching (PSM) was adopted to balance demographic differences between pre- and post-COVID-19 groups, and then compared the severity across these two groups based on clinical and laboratory indicators. Additionally, a subgroup analysis in the original post-COVID-19 group (without PSM) was performed to investigate the independent risk factors for severe H1N1 infection in post-COIVD-19 era. Specifically, Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select candidate predictors, and logistic regression was used to further identify independent risk factors, thus establishing a prediction model. Receiver operating characteristic (ROC) curve and calibration curve were utilized to assess discriminative capability and accuracy of the model, while decision curve analysis (DCA) was used to determine the clinical usefulness of the model. RESULTS After PSM, the post-COVID-19 group showed longer fever duration, higher fever peak, more frequent cough and seizures, as well as higher levels of C-reactive protein (CRP), interleukin 6 (IL-6), IL-10, creatine kinase-MB (CK-MB) and fibrinogen, higher mechanical ventilation rate, longer length of hospital stay (LOS), as well as higher proportion of severe H1N1 infection (all P < 0.05), compared to the pre-COVID-19 group. Moreover, age, BMI, fever duration, leucocyte count, lymphocyte proportion, proportion of CD3+ T cells, tumor necrosis factor α (TNF-α), and IL-10 were confirmed to be independently associated with severe H1N1 infection in post-COVID-19 era. A prediction model integrating these above eight variables was established, and this model had good discrimination, accuracy, and clinical practicability. CONCLUSIONS Pediatric H1N1 infection during post-COVID-19 era showed a higher overall disease severity than the classical H1N1 infection in pre-COVID-19 period. Meanwhile, cough and seizures were more prominent in children with H1N1 infection during post-COVID-19 era. Clinicians should be aware of these changes in such patients in clinical work. Furthermore, a simple and practical prediction model was constructed and internally validated here, which showed a good performance for predicting severe H1N1 infection in post-COVID-19 era.
Collapse
Affiliation(s)
- Hai-Feng Liu
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Xiao-Zhong Hu
- Department of Pediatrics, The People's Hospital of Lincang, Lincang, 677000, China
| | - Rong-Wei Huang
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Zheng-Hong Guo
- Department of Pediatrics, Zhaotong Hospital Affiliated to Kunming Medical University, Zhaotong, 657000, China
| | - Jin-Rong Gao
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Mei Xiang
- Department of Pediatrics, The First People's Hospital of Honghe, Honghe, 651400, China
| | - Rui Lu
- Department of Pediatrics, The People's Hospital of Wenshan, Wenshan, 663000, China
| | - Deng Ban
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Cong-Yun Liu
- Department of Pediatrics, The People's Hospital of Baoshan, Baoshan, 678000, China
| | - Ya-Yu Wang
- Department of Pediatrics, The Third Affiliated Hospital of Dali University, Dali, 671000, China
| | - Wang Li
- Department of Pediatrics, The Fifth People's Hospital of Kunming, Kunming, 650200, China
| | - Yin Li
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Yun-Jie Guo
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China
| | - Quan Lu
- Department of Pulmonary Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 1400 West Beijing Road, Jinan District, Shanghai, 200040, China.
| | - Hong-Min Fu
- Department of Pulmonary and Critical Care Medicine, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming Medical University, No. 28, Shulin Street, Xishan District, Kunming, 650034, China.
| |
Collapse
|
14
|
Moso MA, Taiaroa G, Steinig E, Zhanduisenov M, Butel-Simoes G, Savic I, Taouk ML, Chea S, Moselen J, O'Keefe J, Prestedge J, Pollock GL, Khan M, Soloczynskyj K, Fernando J, Martin GE, Caly L, Barr IG, Tran T, Druce J, Lim CK, Williamson DA. Non-SARS-CoV-2 respiratory viral detection and whole genome sequencing from COVID-19 rapid antigen test devices: a laboratory evaluation study. Lancet Microbe 2024; 5:e317-e325. [PMID: 38359857 DOI: 10.1016/s2666-5247(23)00375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND There has been high uptake of rapid antigen test device use for point-of-care COVID-19 diagnosis. Individuals who are symptomatic but test negative on COVID-19 rapid antigen test devices might have a different respiratory viral infection. We aimed to detect and sequence non-SARS-CoV-2 respiratory viruses from rapid antigen test devices, which could assist in the characterisation and surveillance of circulating respiratory viruses in the community. METHODS We applied archival clinical nose and throat swabs collected between Jan 1, 2015, and Dec 31, 2022, that previously tested positive for a common respiratory virus (adenovirus, influenza, metapneumovirus, parainfluenza, rhinovirus, respiratory syncytial virus [RSV], or seasonal coronavirus; 132 swabs and 140 viral targets) on PCR to two commercially available COVID-19 rapid antigen test devices, the Panbio COVID-19 Ag Rapid Test Device and Roche SARS-CoV-2 Antigen Self-Test. In addition, we collected 31 COVID-19 rapid antigen test devices used to test patients who were symptomatic at The Royal Melbourne Hospital emergency department in Melbourne, Australia. We extracted total nucleic acid from the device paper test strips and assessed viral recovery using multiplex real-time PCR (rtPCR) and capture-based whole genome sequencing. Sequence and genome data were analysed through custom computational pipelines, including subtyping. FINDINGS Of the 140 respiratory viral targets from archival samples, 89 (64%) and 88 (63%) were positive on rtPCR for the relevant taxa following extraction from Panbio or Roche rapid antigen test devices, respectively. Recovery was variable across taxa: we detected influenza A in nine of 18 samples from Panbio and seven of 18 from Roche devices; parainfluenza in 11 of 20 samples from Panbio and 12 of 20 from Roche devices; human metapneumovirus in 11 of 16 from Panbio and 14 of 16 from Roche devices; seasonal coronavirus in eight of 19 from Panbio and two of 19 from Roche devices; rhinovirus in 24 of 28 from Panbio and 27 of 28 from Roche devices; influenza B in four of 15 in both devices; and RSV in 16 of 18 in both devices. Of the 31 COVID-19 devices collected from The Royal Melbourne Hospital emergency department, 11 tested positive for a respiratory virus on rtPCR, including one device positive for influenza A virus, one positive for RSV, four positive for rhinovirus, and five positive for SARS-CoV-2. Sequences of target respiratory viruses from archival samples were detected in 55 (98·2%) of 56 samples from Panbio and 48 (85·7%) of 56 from Roche rapid antigen test devices. 98 (87·5%) of 112 viral genomes were completely assembled from these data, enabling subtyping for RSV and influenza viruses. All 11 samples collected from the emergency department had viral sequences detected, with near-complete genomes assembled for influenza A and RSV. INTERPRETATION Non-SARS-CoV-2 respiratory viruses can be detected and sequenced from COVID-19 rapid antigen devices. Recovery of near full-length viral sequences from these devices provides a valuable opportunity to expand genomic surveillance programmes for public health monitoring of circulating respiratory viruses. FUNDING Australian Government Medical Research Future Fund and Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Michael A Moso
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - George Taiaroa
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eike Steinig
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Madiyar Zhanduisenov
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Grace Butel-Simoes
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Ivana Savic
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Mona L Taouk
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Socheata Chea
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jean Moselen
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jacinta O'Keefe
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Jacqueline Prestedge
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Georgina L Pollock
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Mohammad Khan
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Katherine Soloczynskyj
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Janath Fernando
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Genevieve E Martin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Leon Caly
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Ian G Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, VIC, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Chuan K Lim
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Deborah A Williamson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
| |
Collapse
|
15
|
Domnich A, Orsi A, Ogliastro M, Ferrari A, Bruzzone B, Panatto D, Icardi G. Influenza-like illness surveillance may underestimate the incidence of respiratory syncytial virus in adult outpatients. Int J Infect Dis 2024; 141:106968. [PMID: 38368926 DOI: 10.1016/j.ijid.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024] Open
Abstract
OBJECTIVES Although respiratory syncytial virus (RSV) is a leading cause of acute respiratory infections (ARIs), it is unclear which of the case definitions that prompt swab collection predicts RSV best. We aimed to profile RSV-positive adults and to identify possible RSV case definitions. METHODS This individual-based pooled analysis was based on influenza-like illness (ILI) surveillance conducted among Italian outpatient adults. All samples were tested for influenza, RSV and other respiratory viruses. RESULTS RSV was detected in 5.2% of the 1240 ILI adults tested. The prevalence of fever/feverishness was significantly lower (83.3%) in individuals positive for RSV and those negative for both viruses (79.4%) than in influenza-positive subjects (96.2%). Conversely, 98.3% of RSV-positive adults reported cough. Compared with subjects who tested negative, the adjusted relative risk ratio of cough in RSV-positive subjects was much higher than in influenza-positive subjects (6.89 vs 2.79). Using ARI with cough as the RSV case definition increased specificity. CONCLUSION As fever/feverishness is more common among influenza than RSV cases, ILI-based surveillance may underestimate RSV incidence in adult outpatients. While broad ARI definitions are useful for routine RSV surveillance, their low specificity may hamper vaccine effectiveness studies. The use of further ARI qualifiers like cough increases specificity.
Collapse
Affiliation(s)
- Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy.
| | - Andrea Orsi
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Interuniversity Research Centre on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Matilde Ogliastro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Allegra Ferrari
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Donatella Panatto
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Interuniversity Research Centre on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Giancarlo Icardi
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Interuniversity Research Centre on Influenza and Other Transmissible Infections (CIRI-IT), Genoa, Italy
| |
Collapse
|
16
|
Cilloniz C, Dy-Agra G, Pagcatipunan RS, Torres A. Viral Pneumonia: From Influenza to COVID-19. Semin Respir Crit Care Med 2024; 45:207-224. [PMID: 38228165 DOI: 10.1055/s-0043-1777796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.
Collapse
Affiliation(s)
- Catia Cilloniz
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Guinevere Dy-Agra
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Rodolfo S Pagcatipunan
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Antoni Torres
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Antoon JW, Stopczynski T, Amarin JZ, Stewart LS, Boom JA, Sahni LC, Michaels MG, Williams JV, Englund JA, Klein EJ, Staat MA, Schlaudecker EP, Selvarangan R, Schuster JE, Weinberg GA, Szilagyi PG, Perez A, Moline HL, Spieker AJ, Grijalva CG, Olson SM, Halasa NB. Accuracy of Influenza ICD-10 Diagnosis Codes in Identifying Influenza Illness in Children. JAMA Netw Open 2024; 7:e248255. [PMID: 38656577 PMCID: PMC11043895 DOI: 10.1001/jamanetworkopen.2024.8255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Importance Studies of influenza in children commonly rely on coded diagnoses, yet the ability of International Classification of Diseases, Ninth Revision codes to identify influenza in the emergency department (ED) and hospital is highly variable. The accuracy of newer International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes to identify influenza in children is unknown. Objective To determine the accuracy of ICD-10 influenza discharge diagnosis codes in the pediatric ED and inpatient settings. Design, Setting, and Participants Children younger than 18 years presenting to the ED or inpatient settings with fever and/or respiratory symptoms at 7 US pediatric medical centers affiliated with the Centers for Disease Control and Prevention-sponsored New Vaccine Surveillance Network from December 1, 2016, to March 31, 2020, were included in this cohort study. Nasal and/or throat swabs were collected for research molecular testing for influenza, regardless of clinical testing. Data, including ICD-10 discharge diagnoses and clinical testing for influenza, were obtained through medical record review. Data analysis was performed in August 2023. Main Outcomes and Measures The accuracy of ICD-10-coded discharge diagnoses was characterized using molecular clinical or research laboratory test results as reference. Measures included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Estimates were stratified by setting (ED vs inpatient) and age (0-1, 2-4, and 5-17 years). Results A total of 16 867 children in the ED (median [IQR] age, 2.0 [0.0-4.0] years; 9304 boys [55.2%]) and 17 060 inpatients (median [IQR] age, 1.0 [0.0-4.0] years; 9798 boys [57.4%]) were included. In the ED, ICD-10 influenza diagnoses were highly specific (98.0%; 95% CI, 97.8%-98.3%), with high PPV (88.6%; 95% CI, 88.0%-89.2%) and high NPV (85.9%; 95% CI, 85.3%-86.6%), but sensitivity was lower (48.6%; 95% CI, 47.6%-49.5%). Among inpatients, specificity was 98.2% (95% CI, 98.0%-98.5%), PPV was 82.8% (95% CI, 82.1%-83.5%), sensitivity was 70.7% (95% CI, 69.8%-71.5%), and NPV was 96.5% (95% CI, 96.2%-96.9%). Accuracy of ICD-10 diagnoses varied by patient age, influenza season definition, time between disease onset and testing, and clinical setting. Conclusions and Relevance In this large cohort study, influenza ICD-10 discharge diagnoses were highly specific but moderately sensitive in identifying laboratory-confirmed influenza; the accuracy of influenza diagnoses varied by clinical and epidemiological factors. In the ED and inpatient settings, an ICD-10 diagnosis likely represents a true-positive influenza case.
Collapse
Affiliation(s)
- James W Antoon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tess Stopczynski
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Justin Z Amarin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Leila C Sahni
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Marian G Michaels
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John V Williams
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, Washington
| | - Eileen J Klein
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, Washington
| | - Mary A Staat
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elizabeth P Schlaudecker
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Jennifer E Schuster
- Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Ariana Perez
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Heidi L Moline
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samantha M Olson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
18
|
Benack K, Nyandege A, Nonnenmacher E, Jan S, Setoguchi S, Gerhard T, Strom BL, Horton DB. Validity of ICD-10-based algorithms to identify patients with influenza in inpatient and outpatient settings. Pharmacoepidemiol Drug Saf 2024; 33:e5788. [PMID: 38556924 PMCID: PMC11022168 DOI: 10.1002/pds.5788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 02/08/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To evaluate the validity of ICD-10-CM code-based algorithms as proxies for influenza in inpatient and outpatient settings in the USA. METHODS Administrative claims data (2015-2018) from the largest commercial insurer in New Jersey (NJ), USA, were probabilistically linked to outpatient and inpatient electronic health record (EHR) data containing influenza test results from a large NJ health system. The primary claims-based algorithms defined influenza as presence of an ICD-10-CM code for influenza, stratified by setting (inpatient/outpatient) and code position for inpatient encounters. Test characteristics and 95% confidence intervals (CIs) were calculated using test-positive influenza as a reference standard. Test characteristics of alternative outpatient algorithms incorporating CPT/HCPCS testing codes and anti-influenza medication pharmacy claims were also calculated. RESULTS There were 430 documented influenza test results within the study period (295 inpatient, 135 outpatient). The claims-based influenza definition had a sensitivity of 84.9% (95% CI 72.9%-92.1%), specificity of 96.3% (95% CI 93.1%-98.0%), and PPV of 83.3% (95% CI 71.3%-91.0%) in the inpatient setting, and a sensitivity of 76.7% (95% CI 59.1%-88.2%), specificity of 96.2% (95% CI 90.6%-98.5%), PPV of 85.2% (95% CI 67.5%-94.1%) in the outpatient setting. Primary inpatient discharge diagnoses had a sensitivity of 54.7% (95% CI 41.5%-67.3%), specificity of 99.6% (95% CI 97.7%-99.9%), and PPV of 96.7% (95% CI 83.3%-99.4%). CPT/HCPCS codes and anti-influenza medication claims were present for few outpatient encounters (sensitivity 3%-10%). CONCLUSIONS In a large US healthcare system, inpatient ICD-10-CM codes for influenza, particularly primary inpatient diagnoses, had high predictive value for test-positive influenza. Outpatient ICD-10-CM codes were moderately predictive of test-positive influenza.
Collapse
Affiliation(s)
- Kirk Benack
- Montefiore Medical Center
- Rutgers Robert Wood Johnson Medical School
| | - Abner Nyandege
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research
| | - Edward Nonnenmacher
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research
- Bayshore Analytics and Integrated Solutions LLC
| | - Saira Jan
- Horizon Blue Cross Blue Shield of New Jersey
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research
- Department of Medicine, Rutgers Robert Wood Johnson Medical School
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy
| | - Brian L. Strom
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research
- Rutgers Biomedical and Health Sciences
| | - Daniel B. Horton
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School
| |
Collapse
|
19
|
Hardt M, Kaiser F, Voss T, Oelmüller U, Zatloukal K. Pre-analytical properties of different respiratory viruses for PCR-based detection: Comparative analysis of sampling devices and sample stabilization solutions. N Biotechnol 2024; 79:60-70. [PMID: 38145650 DOI: 10.1016/j.nbt.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
After the decline of the COVID-19 pandemic, health systems were challenged by the simultaneous prevalence of different respiratory viruses causing a wide overlap in symptoms. This increased the demand for multi-virus diagnostic tests which require suitable pre-analytical workflow solutions in order to receive valid diagnostic results. In this context, the effects of specimen storage duration and temperature on the RNA/DNA copy number stability of influenza A/B, RSV A/B, SARS-CoV-2 and adenovirus were examined for four commercially available transport swab systems and saliva collection devices. The respiratory viruses were more stable in the saliva collection devices than in the transport swab systems when stored at RT or 37 °C for up to 96 h. Moreover, no differences between viral nucleic acid stability of enveloped and non-enveloped viruses were observed. The infectivity of all enveloped viruses could be inactivated by the saliva collection device from PreAnalytiX. The Norgen saliva device completely inactivated influenza A/B, while RSV A/B were partially inactivated. The non-enveloped adenovirus was inactivated by a reduction factor of 10E+ 4 in both saliva collection devices. All respiratory viruses remained infectious in the transport swab systems. Two possible transport medium additives were tested which inactivated or strongly reduced viral replication of tested enveloped viruses but had no effect on the non-enveloped adenovirus. Finally the implementation of multi-target detection procedures involving a direct amplification approach was successfully tested by spike-in of all enveloped viruses simultaneously into transport swab systems. This fast and reproducible setup presents a valuable solution for future implementations in multi-virus testing strategies.
Collapse
Affiliation(s)
- Melina Hardt
- Diagnostic, and Research Center for Molecular Biomedicine, Diagnostic, and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | | | | | - Kurt Zatloukal
- Diagnostic, and Research Center for Molecular Biomedicine, Diagnostic, and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
| |
Collapse
|
20
|
Ocaña Gutiérrez VR, González Ramírez RA, Ocaña Aguilar VA, Ocaña Aguilar NG, Holguín Mauricci CE. The weekly P25 of the age of the influenza-like illness shows a higher correlation with COVID-19 mortality than rapid tests and could predict the evolution of COVID-19 pandemics in sentinel surveillance, Piura, Perú, 2021. PLoS One 2024; 19:e0295309. [PMID: 38452053 PMCID: PMC10919873 DOI: 10.1371/journal.pone.0295309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/20/2023] [Indexed: 03/09/2024] Open
Abstract
GOAL To describe the dynamics of syndromic surveillance of ILI cases in seasonal and COVID-19 pandemic scenarios. METHODOLOGY A descriptive study of the epidemiological behavior of ILI in the seasonal and COVID-19 pandemic scenarios. Of a sample of 16,231 cases of ILI from 2013 to 2021, the features of cases from 68 weeks before and during the pandemic were selected and compared; weekly endemic channels were built; data fluctuations on the trend of ILI cases were analyzed; and estimated weekly correlations between weekly P25 age, cases confirmed by rapid tests, and mortality from COVID-19. To analyze clinical-epidemiological and mortality data, Student's t test, Mann-Whitney U, Chi2, Spearman's Ro, polynomial, and multinomial regression with a 95% confidence interval were used. RESULTS During the COVID-19 pandemic, those most affected with ILI were: adults and the elderly; higher median age; autochthonous cases predominated; a lower proportion of other syndromes; delays in seeking care; and a higher rate of pneumonia attack than in the seasonal period (p< 0.01). Rapid tests (serological and antigenic) confirmed 52.7% as COVID-19. Two ILI pandemic waves were seasonally consistent with confirmed COVID-19 cases and district mortality with robust correlation (p<0.01) before and during the pandemic, especially the ILI weekly P25 age, which has a more robust correlation with mortality than ILI and rapid tests (p<0.01) whose endemic channels describe and could predict the evolution of the pandemic (p<0.01). CONCLUSIONS The pandemic changed the clinical and epidemiological behavior of ILI, and the weekly P25 of age is a more robust indicator to monitor the COVID-19 pandemic than a rapid test and could predict its evolution.
Collapse
Affiliation(s)
| | - Rodolfo Arturo González Ramírez
- School of Medicine, Cesar Vallejo University, Piura, Perú
- Department of Public Health, School of Medicine, National University of Cajamarca, Cajamarca, Perú
| | - Víctor Alexander Ocaña Aguilar
- School of Medicine, Cesar Vallejo University, Piura, Perú
- Department of Public Health, School of Medicine, National University of Cajamarca, Cajamarca, Perú
| | | | | |
Collapse
|
21
|
Chung E, Leem AY, Chung KS, Kang YA, Park MS, Kim YS, Jang HJ, Lee SH. Differences of respiratory mechanics in mechanical ventilation of acute respiratory distress syndrome between patients with COVID-19 and Influenza A. Respir Res 2024; 25:112. [PMID: 38448933 PMCID: PMC10919012 DOI: 10.1186/s12931-024-02730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Whether COVID-19-induced acute respiratory distress syndrome (ARDS) should be approached differently in terms of mechanical ventilation therapy compared to other virus-induced ARDS is debatable. Therefore, we aimed to ascertain whether the respiratory mechanical characteristics of COVID-19-induced ARDS differ from those of influenza A induced ARDS, in order to establish a rationale for mechanical ventilation therapy in COVID-19-induced ARDS. METHODS This was a retrospective cohort study comparing patients with COVID-19-induced ARDS and influenza A induced ARDS. We included intensive care unit (ICU) patients with COVID-19 or Influenza A aged ≥ 19, who were diagnosed with ARDS according to the Berlin definition between January 2015 and July 2021. Ventilation parameters for respiratory mechanics were collected at specific times on days one, three, and seven after intubation. RESULTS The median age of the 87 participants was 71.0 (62.0-78.0) years old, and 63.2% were male. The ratio of partial pressure of oxygen in arterial blood to the fractional of inspiratory oxygen concentration in COVID-19-induced ARDS was lower than that in influenza A induced ARDS during the initial stages of mechanical ventilation (influenza A induced ARDS 216.1 vs. COVID-19-induced ARDS 167.9, p = 0.009, day 1). The positive end expiratory pressure remained consistently higher in the COVID-19 group throughout the follow-up period (7.0 vs. 10.0, p < 0.001, day 1). COVID-19 and influenza A initially showed different directions for peak inspiratory pressure and dynamic compliance; however, after day 3, both groups exhibited similar directions. Dynamic driving pressure exhibited opposite trends between the two groups during mechanical ventilation. CONCLUSIONS Respiratory mechanics show clear differences between COVID-19-induced ARDS and influenza A induced ARDS. Based on these findings, we can consider future treatment strategies for COVID-19-induced ARDS.
Collapse
Affiliation(s)
- Eunki Chung
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hye Jin Jang
- Division of Pulmonary, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea.
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
22
|
Deng J, Zhu H, An S, Huang H, Wang R, Chen Y, Chen P, Yu X. Accurate detection of influenza A virus by use of a novel cross-priming isothermal amplification-based point-of-care assay. Microbiol Spectr 2024; 12:e0307423. [PMID: 38349165 PMCID: PMC10913471 DOI: 10.1128/spectrum.03074-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/16/2024] [Indexed: 03/06/2024] Open
Abstract
Influenza virus is known to cause respiratory tract infections of varying severity in individuals of all ages. The EasyNAT Rapid Flu assay is a newly developed in vitro diagnostic test that employs cross-priming isothermal amplification (CPA) to detect and differentiate influenza A and B viruses in human nasopharyngeal (NP) swabs. The aim of this study is to determine the performance characteristics of the EasyNAT Rapid Flu assay for rapid detection of influenza virus. The limit of detection (LOD) and cross-reactivity of the EasyNAT Rapid Flu assay were assessed. The clinical performance of the assay was evaluated using NP swab samples that were tested with real-time reverse-transcription polymerase chain reaction (RT-PCR) and Xpert Xpress Flu/RSV assay. The LOD for the detection of influenza A and B using the EasyNAT Rapid Flu assay was found to be 500 copies/mL. Furthermore, the assay exhibited no cross-reactivity with other common respiratory viruses tested. For the 114 NP swab samples tested for influenza A using both the EasyNAT Rapid Flu assay and real-time RT-PCR, the two assays demonstrated a high level of agreement (κ = 0.963, P < 0.001), with a positive percentage agreement (PPA) of 97.7% and a negative percentage agreement (NPA) of 98.6%. Similarly, for the 43 NP swab samples tested for influenza A and B using both the EasyNAT Rapid Flu assay and Xpert Xpress Flu/RSV assay, the two assays showed a high level of agreement (κ = 0.933, P < 0.001), with the overall rate of agreement (ORA) of 97.7% for influenza A and 100% for influenza B. The EasyNAT Rapid Flu assay demonstrates excellent performance in the detection of influenza A, highlighted by its strong agreement with RT-PCR-based assays.IMPORTANCEThe newly developed EasyNAT Rapid Flu assay is an innovative cross-priming isothermal amplification-based method designed for detecting influenza A and B viruses at point-of-care settings. This study aims to thoroughly assess the analytical and clinical performance of the assay, offering valuable insights into its potential advantages and limitations. The findings of this research hold significant implications for clinical practice.
Collapse
Affiliation(s)
- Jiankai Deng
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongji Zhu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shu An
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Huang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruizhi Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaoming Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peisong Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuegao Yu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
23
|
Sechan F, Edridge AWD, van Rijswijk J, Jebbink MF, Deijs M, Bakker M, Matser A, Prins M, van der Hoek L. Influenza-like illness symptoms due to endemic human coronavirus reinfections are not influenced by the length of the interval separating reinfections. Microbiol Spectr 2024; 12:e0391223. [PMID: 38329364 PMCID: PMC10913438 DOI: 10.1128/spectrum.03912-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
After 3 years of its introduction to humans, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been declared as endemic. Little is known about the severity of the disease manifestation that future infections may cause, especially when reinfections occur after humoral immunity from a previous infection or vaccination has waned. Such knowledge could inform policymakers regarding the frequency of vaccination. Reinfections by endemic human coronaviruses (HCoVs) can serve as a model system for SARS-CoV-2 endemicity. We monitored 44 immunocompetent male adults with blood sampling every 6 months (for 17 years), for the frequency of HCoV (re-)infections, using rises in N-antibodies of HCoV-NL63, HCoV-29E, HCoV-OC43, and HCoV-HKU1 as markers of infection. Disease associations during (re-)infections were examined by comparison of self-reporting records of influenza-like illness (ILI) symptoms, every 6 months, by all participants. During 8,549 follow-up months, we found 364 infections by any HCoV with a median of eight infections per person. Symptoms more frequently reported during HCoV infection were cough, sore throat, and myalgia. Two hundred fifty-one of the 364 infections were species-specific HCoV-reinfections, with a median interval of 3.58 (interquartile range 1.92-5.67) years. The length of the interval between reinfections-being either short or long-had no influence on the frequency of reporting ILI symptoms. All HCoV-NL63, HCoV-229E, HCoV-OC43, and HCoV-HKU1 (re-)infections are associated with the reporting of ILIs. Importantly, in immunocompetent males, these symptoms are not influenced by the length of the interval between reinfections. IMPORTANCE Little is known about the disease following human coronavirus (HCoV) reinfection occurring years after the previous infection, once humoral immunity has waned. We monitored endemic HCoV reinfection in immunocompetent male adults for up to 17 years. We found no influence of reinfection interval length in the disease manifestation, suggesting that immunocompetent male adults are adequately protected against future HCoV infections.
Collapse
Affiliation(s)
- Ferdyansyah Sechan
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Arthur W. D. Edridge
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Jacqueline van Rijswijk
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Maarten F. Jebbink
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Martin Deijs
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Amy Matser
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Maria Prins
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Lia van der Hoek
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| |
Collapse
|
24
|
Cui J, Jia W, Li P, Zhang X, Li Z, Song C. Influenza a H1N1 infection complicated with encephalopathy and acute pancreatitis: a case report. BMC Pediatr 2024; 24:156. [PMID: 38443804 PMCID: PMC10916310 DOI: 10.1186/s12887-024-04651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
This paper reports a case of influenza complicated with influenza associated encephalopathy complicated with acute pancreatitis. This kind of disease is relatively rare, we hope to draw people's attention to it in order to improve early detection and prognosis.
Collapse
Affiliation(s)
- Junhao Cui
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, No. 1, University South Road, Erqi District, Zhengzhou, Henan Province, 450000, China
| | - Wanyu Jia
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, No. 1, University South Road, Erqi District, Zhengzhou, Henan Province, 450000, China
| | - Peng Li
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, No. 1, University South Road, Erqi District, Zhengzhou, Henan Province, 450000, China
| | - Xue Zhang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, No. 1, University South Road, Erqi District, Zhengzhou, Henan Province, 450000, China
| | - Zheng Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100000, China
| | - Chunlan Song
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, No. 1, University South Road, Erqi District, Zhengzhou, Henan Province, 450000, China.
| |
Collapse
|
25
|
Yahyavi I, Edalat F, Pirbonyeh N, Letafati A, Sattarahmady N, Heli H, Moattari A. Nucleic acid-based electrochemical biosensor for detection of influenza B by gold nanoparticles. J Mol Recognit 2024; 37:e3073. [PMID: 38126612 DOI: 10.1002/jmr.3073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
The influenza virus is a pervasive pathogen that exhibits increased prevalence during colder seasons, resulting in a significant annual occurrence of infections. Notably, pharmaceutical interventions effective against influenza A strains often exhibit limited efficacy against influenza B variants. Against this backdrop, the need for innovative approaches to accurately and swiftly differentiate and detect influenza B becomes evident. Biosensors play a pivotal role in this detection process, offering rapid, specific, and sensitive identification of the virus, facilitating timely intervention and containment efforts. Oligonucleotide sequences targeting the conserved B/Victoria/2/87 influenza virus NP region were designed. Nasopharyngeal swabs were collected from patients suspected of influenza virus infection, and viral RNA was extracted. RNA quality was assessed through one-step PCR. cDNA synthesis was performed using random hexamers, and real-time PCR quantified the influenza genome. Gold nanoparticles were immobilized on a surface to immobilize the specific DNA probe, and electrochemical hybridization was electrochemically followed. The biosensor exhibited high selectivity and effective distinction of complementary sequences from mismatches and influenza virus cDNA genome. The biosensor successfully detected the influenza B virus genome in real samples. Non-influenza samples yielded no significant hybridization signals. The comparison between the results obtained from the biosensor and real-time PCR revealed full agreement of these methods. The biosensor utilized electrochemical detection of hybridization and proved effective in detecting the influenza B virus genome with high specificity, sensitivity, and selectivity. Comparative analysis with real-time PCR underscored the accuracy and potential applicability of the biosensor in rapid and specific virus detection. This innovative approach holds promise for future diagnostic and epidemiological applications in detecting influenza B virus and other pathogens.
Collapse
Affiliation(s)
- Isar Yahyavi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Ceinge Biotechnologie Avanzate, Naples, Italy
| | - Fahime Edalat
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pirbonyeh
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Microbiology, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Letafati
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Naghmeh Sattarahmady
- Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Heli
- Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afagh Moattari
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
26
|
Cavallazzi R, Ramirez JA. Influenza and Viral Pneumonia. Infect Dis Clin North Am 2024; 38:183-212. [PMID: 38280763 DOI: 10.1016/j.idc.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are in general nonspecific. The advent of polymerase chain reaction testing has enormously facilitated the identification of respiratory viruses, which has important implications for infection control measures and treatment. Currently, treatment options for patients with viral infection are limited but there is ongoing research on the development and clinical testing of new treatment regimens and strategies.
Collapse
Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Disorders, University of Louisville, Louisville, KY, USA.
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
| |
Collapse
|
27
|
Kang T, Cha JH, Kim J, Kim KJ, Nam M, Nam MH, Kim DW, Cho Y, Lee CK, Yun SG. Evaluation of Multiplex Rapid Antigen Test for the Detection of SARS-CoV-2 and Influenza A/B in Respiratory Samples. Clin Lab 2024; 70. [PMID: 38469788 DOI: 10.7754/clin.lab.2023.231003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND There is little data about the performance of multiplex rapid antigen tests (RATs) on the detection of SARS-CoV-2, influenza A (Flu A), and influenza B (Flu B). This study is to evaluate the performance of Panbio COVID-19/Flu A&B rapid panel (Abbott Diagnostics, Korea) and analyze the factors influencing its sensitivity. METHODS Nasopharyngeal swabs were collected and stored at the Korea University Anam hospital. In total, 400 residual samples from nasopharyngeal swabs were examined. The diagnostic accuracy of RAT was compared to that of RT-qPCR using the Allplex SARS-CoV-2/FluA/FluB/RSV Assay (Seegene, Seoul, South Korea). RESULTS Panbio COVID-19/Flu A&B rapid panel showed the sensitivities of 88.0%, 92.0%, and 100% for SARS-CoV-2, Flu A, and Flu B, respectively, and specificities of 100% for all. The agreements with previously licensed single-plex RATs were shown to be high. In the analysis of variables affecting sensitivity, inappropriate sampling time after symptom onset (STASO) and high cycle threshold (Ct value) were shown to negatively affect the sensi-tivity. CONCLUSIONS In conclusion, the multiplex RAT is useful for diagnosing SARS-CoV-2 and Flu A/B, but more clinical studies are needed.
Collapse
|
28
|
Fanshawe TR, Tonner S, Turner PJ, Cogdale J, Glogowska M, de Lusignan S, Okusi C, Perera R, Sebastianpillai P, Williams A, Zambon M, Nicholson BD, Hobbs FDR, Hayward GN. Diagnostic accuracy of a point-of-care antigen test for SARS-CoV-2 and influenza in a primary care population (RAPTOR-C19). Clin Microbiol Infect 2024; 30:380-386. [PMID: 38103638 DOI: 10.1016/j.cmi.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Limited evidence exists for the diagnostic performance of point-of-care tests for SARS-CoV-2 and influenza in community healthcare. We carried out a prospective diagnostic accuracy study of the LumiraDx™ SARS-CoV-2 and influenza A or B assay in primary care. METHODS Total of 913 adults and children with symptoms of current SARS-CoV-2 infection were recruited from 18 UK primary care practices during a period when Omicron was the predominant COVID variant of concern (June 2022 to December 2022). Trained health care staff performed the index test, with diagnostic accuracy parameters estimated for SARS-CoV-2 and influenza against real-time reverse-transcription PCR (rtRT-PCR). RESULTS 151/887 participants were SARS-CoV-2 rtRT-PCR positive, 109 positive for Influenza A, 6 for Influenza B. Index test sensitivity for SARS-CoV-2 was 80.8% (122 of the 151, 95% CI, 73.6-86.7%) and specificity 98.9% (728 of the 736, 95% CI, 97.9-99.5%). For influenza A, sensitivity was 61.5% (67 of the 109, 95% CI, 51.7-70.6%) and specificity 99.4% (771 of the 776, 95% CI, 98.5-99.8%). Sensitivity to detect SARS-CoV-2 and influenza dropped sharply at rtRT-PCR cycle thresholds (Ct) > 30. DISCUSSIONS The LumiraDx™ SARS-CoV-2 and influenza A/B assay had moderate sensitivity for SARS-CoV-2 in symptomatic patients in primary care, with lower performance with high rtRT-PCR Ct. Negative results in this patient group cannot definitively rule out SARS-CoV-2 or influenza.
Collapse
Affiliation(s)
- Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Sharon Tonner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jade Cogdale
- Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Praveen Sebastianpillai
- Immunization and Vaccine Preventable Diseases Division and Public Health Programmes, UK Health Security Agency, UK
| | - Alice Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Maria Zambon
- Influenza and Respiratory Virology and Polio Reference Service, UK Health Security Agency, UK; NIHR Health Protection Research Unit, Imperial College London, UK
| | - Brian D Nicholson
- Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
| |
Collapse
|
29
|
Tomassini L, Ferretti F, Uvelli A, Fedeli D, Gualtieri G. Fatal Viral and Bacterial Septicemia in a Seventeen-Year-Old Woman with Immunodepressive Influenza A H1N1: An Autopsy Case. Clin Ter 2024; 175:95-100. [PMID: 38571465 DOI: 10.7417/ct.2024.5039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Abstract The Influenza A H1N1 subtype can present with a wide spectrum of severity, from mild symptoms of influenza to severe respiratory distress. The morbidity and mortality connected to influenza are mostly associated with secondary bacterial infections. The influenza syndrome alone can cause a massive release of cytokines with dysregulation of the immune system, and it can act in synergy with other bacteria which can enhance cytokines secretion. This article deals with a case of severe pneumonia of H1N1 in a 17-year-old woman with bacterial superinfection with Staphylococcus aureus characterized by a high level of interleukine-6 (105900 pg/mL) and the appearance of severe leukopenia with immuno-suppression, such that HIV infection and hematological diseases were included in the initial differential diagnosis. After death, the autopsy confirmed the presence of severe pneumonia, in addition to an hepatic steatosis in absence of other risk factors. This case reports the rapid and lethal course of influenza A /H1N1 in a young and healthy subject without comorbidities, in an age group in which mortality is about 0.3 deaths per 100,000. The case underlines the importance of quickly diagnosis of viral infections and the differential diagnoses with other immunosuppressive diseases, which can be fatal even in adolescent and healthy subjects.
Collapse
Affiliation(s)
- L Tomassini
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - F Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - A Uvelli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - D Fedeli
- Forensic Pathologist and Clinical Forensic Medicine Specialist, Castel San Pietro Terme, Italy
| | - G Gualtieri
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| |
Collapse
|
30
|
Frediani JK, Parsons R, McLendon KB, Westbrook AL, Lam W, Martin G, Pollock NR. The New Normal: Delayed Peak SARS-CoV-2 Viral Loads Relative to Symptom Onset and Implications for COVID-19 Testing Programs. Clin Infect Dis 2024; 78:301-307. [PMID: 37768707 PMCID: PMC10874267 DOI: 10.1093/cid/ciad582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Early in the coronavirus disease 2019 (COVID-19) pandemic, peak viral loads coincided with symptom onset. We hypothesized that in a highly immune population, symptom onset might occur earlier in infection, coinciding with lower viral loads. METHODS We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A viral loads relative to symptom duration in symptomatic adults (≥16 years) presenting for testing in Georgia (4/2022-4/2023; Omicron variant predominant). Participants provided symptom duration and recent testing history. Nasal swabs were tested by Xpert Xpress SARS-CoV-2/Flu/RSV assay and cycle threshold (Ct) values recorded. Nucleoprotein concentrations in SARS-CoV-2 polymerase chain reaction (PCR)-positive samples were measured by single molecule array. To estimate hypothetical antigen rapid diagnostic test (Ag RDT) sensitivity on each day after symptom onset, percentages of individuals with Ct value ≤30 or ≤25 were calculated. RESULTS Of 348 newly-diagnosed SARS-CoV-2 PCR-positive individuals (65.5% women, median 39.2 years), 317/348 (91.1%) had a history of vaccination, natural infection, or both. By both Ct value and antigen concentration measurements, median viral loads rose from the day of symptom onset and peaked on the fourth/fifth day. Ag RDT sensitivity estimates were 30.0%-60.0% on the first day, 59.2%-74.8% on the third day, and 80.0%-93.3% on the fourth day of symptoms.In 74 influenza A PCR-positive individuals (55.4% women; median 35.0 years), median influenza viral loads peaked on the second day of symptoms. CONCLUSIONS In a highly immune adult population, median SARS-CoV-2 viral loads peaked around the fourth day of symptoms. Influenza A viral loads peaked soon after symptom onset. These findings have implications for ongoing use of Ag RDTs for COVID-19 and influenza.
Collapse
Affiliation(s)
- Jennifer K Frediani
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Richard Parsons
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kaleb B McLendon
- Emory/Children's Laboratory for Innovative Assay Development, Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Adrianna L Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Wilbur Lam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Greg Martin
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
31
|
Qi JF, Guo ML, Lin L, Fu S, Chen LL. An exploration of the value of NLR, PLR, LMR, and WBC × CRP for the diagnosis and treatment of influenza B in adults. Medicine (Baltimore) 2024; 103:e37046. [PMID: 38306568 PMCID: PMC10843311 DOI: 10.1097/md.0000000000037046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/03/2024] [Indexed: 02/04/2024] Open
Abstract
The aim of the study was to study the diagnostic and therapeutic utility of NLR (neutrophil-to-lymphocyte ratio), LWR (lymphocyte-to-monocyte ratio), PLR (platelet-to-lymphocyte ratio), and WBC × CRP (WBC: white cell count, CRP: C-reactive protein) in patients with influenza B. This retrospective study included 122 adult patients with influenza B, 176 adult patients with bacterial infection, and 119 adult healthy physical examinees for routine blood examination and CRP testing, calculation of NLR, LMR, PLR, and WBC × CRP for relevant statistical analysis, monitoring of NLR, LMR, PLR and WBC × CRP in patients with influenza B during relevant treatment. All indicators, except for WBC and NLR, had no statistical differences between the influenza B group, the normal control group, and the influenza B group and bacterial infection group, respectively, and showed no statistical significance for the differences between the groups. The diagnostic effect of LMR and WBC × CRP was deemed good or excellent in patients with influenza B, healthy people, and patients with a bacterial infection. Conversely, NLR and PLR could only distinguish patients with influenza B from healthy people but remained unable to identify different pathogens. Moreover, many false negatives were noted for WBC and CRP during the diagnosis of influenza B. Also, NLR, LMR, PLR, and WBC × CRP exerted a good effect in evaluating curative effect and conditions for influenza B. LMR and WBC × CRP have a relatively high value in the early diagnosis of adults suffering from influenza B. Also, NLR and PLR excelled at differentiating adult patients with influenza B from healthy people. Therefore, NLR, PLR, LMR, and WBC × CRP can all be used for disease course monitoring and efficacy evaluation.
Collapse
Affiliation(s)
- Juan-Fei Qi
- Department of Clinical Laboratory, Xinchang Hospital of traditional Chinese (MD) Medicine, Shaoxing, Zhejiang Province, People’s Republic of China
| | - Mei-Li Guo
- Department of Clinical Laboratory, The People’s Hospital of Cangnan Zhejiang, Wenzhou, Zhejiang Province, People’s Republic of China
| | - Li Lin
- Department of Rehabilitation, Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang province, People’s Republic of China
| | - Shui Fu
- Department of Clinical Laboratory, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, People’s Republic of China
| | - Liu-Ling Chen
- Department of Clinical Laboratory, Xinchang Hospital of traditional Chinese (MD) Medicine, Shaoxing, Zhejiang Province, People’s Republic of China
| |
Collapse
|
32
|
Losa-Martin O, Frisuelos-Garcia A, Delgado-Iribarren A, Martin-deCabo MR, Martin-Segarra O, Vegas-Serrano A, Hervas-Gomez R, Moreno-Nuñez L, Velasco-Arribas M, Losa-Garcia JE. Respiratory syncytial virus infection in adults: Differences with influenza. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:62-68. [PMID: 36624032 DOI: 10.1016/j.eimce.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes an acute respiratory illness similar to influenza, although there are few data comparing both of them in adults. The existence of clinical differences between these two infections could have implications for their management. MATERIALS AND METHODS Retrospective observational cohort study including 63 adults with positive PCR for RSV and 221 for influenza during winter 2018-2019. Epidemiological, clinical characteristics and outcomes were contrasted between both groups. RESULTS Compared to influenza, RSV-positive patients presented a higher association with active neoplasia (OR=2.9; 95% CI: 1.2-6.9), dependence for basic activities of daily living (OR=3.4; 95% CI: 1.4-8.2) and immunosuppression due to chronic glucocorticoid administration (OR=7.6; 95% CI: 1.6-36.1). At diagnosis, fever was less common (OR=0.3; 95% CI: 0.2-0.7), and C-reactive protein level ≥100mg/l was more frequent (OR=2.1; 95% CI: 1.0-4.5). They developed bacterial co-infection by Staphylococcus aureus in a higher proportion (OR=8.3; 95% CI: 1.5-46.9) and presented a greater need for admission to the intensive care unit (OR=5.4; 95% CI: 1.4-19.2). CONCLUSION RSV is an important cause of respiratory illness in adults during the influenza season. It especially affects vulnerable patients with chronic underlying diseases, and has a higher morbidity than influenza. For all these reasons, specific detection, prevention and treatment of RSV is necessary in order to reduce the consumption of health care resources due to RSV disease in adults.
Collapse
Affiliation(s)
- Oscar Losa-Martin
- Facultad de Medicina, Universidad Rey Juan Carlos, Madrid, Spain; Cirugía Plástica Estética y Reparadora, Hospital Universitario La Paz, Madrid, Spain.
| | | | - Alberto Delgado-Iribarren
- Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | - Oriol Martin-Segarra
- Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Ana Vegas-Serrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Rafael Hervas-Gomez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Leonor Moreno-Nuñez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Maria Velasco-Arribas
- Facultad de Medicina, Universidad Rey Juan Carlos, Madrid, Spain; Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Juan E Losa-Garcia
- Facultad de Medicina, Universidad Rey Juan Carlos, Madrid, Spain; Unidad de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| |
Collapse
|
33
|
Pulscher LA, Webby RJ, Gray GC. An algorithm for the characterization of influenza A viruses from various host species and environments. Influenza Other Respir Viruses 2024; 18:e13258. [PMID: 38385997 PMCID: PMC10883340 DOI: 10.1111/irv.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Due to the extensive host range of influenza A viruses, it is difficult to determine the best diagnostic algorithm to efficiently screen samples from a variety of host species for influenza A viruses. While there are some influenza diagnostic algorithms that are specific to host species, to our knowledge, no single algorithm exists for the characterization of influenza A viruses across multiple host species. In this paper, we propose an algorithm that can serve as a guide for screening human, animal, and environmental samples for influenza A viruses of high human and animal health importance.
Collapse
Affiliation(s)
- Laura A Pulscher
- Department of Medicine (Infectious Diseases), University of Texas Medical Branch, Galveston, Texas, USA
| | - Richard J Webby
- Department of Infectious Disease, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gregory C Gray
- Department of Medicine (Infectious Diseases), University of Texas Medical Branch, Galveston, Texas, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, Texas, USA
- Center for Tropical Diseases, University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
34
|
Çiçek Y, Sarı H, İmre Yetkin D, Özel M. Clinical and epidemiological evaluation of influenza and SARS-CoV-2 coinfected cases. J Infect Dev Ctries 2024; 18:21-26. [PMID: 38377085 DOI: 10.3855/jidc.18143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/17/2023] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Coinfection of COVID-19 with influenza pathogens, may complicate the diagnosis, treatment, and prognosis, which is a new concern. This study aims to evaluate COVID-19 and influenza coinfected cases during the flu season, while the SARS-CoV-2 pandemic continues. METHODOLOGY The study was conducted between November 2021 and January 2022. A total of 1987 (1752 outpatients, 235 inpatients) patients were included, and 44 simultaneous COVID-19 and influenza laboratory-confirmed diagnoses. RESULTS During the study period, 1553 patients were diagnosed with COVID-19, 390 influenza, and 44 were diagnosed with coinfection. The incidence of coinfected cases was 2.2% (n = 44) in all patients, When coinfected cases were examined, there was a statistically significant difference between the disease duration in the inpatients (19.86 ± 10.78 days) and the disease duration in the outpatients (7.63 ± 2.25 days) (p < 0.05). 31.8% (n = 14) of coinfected cases were hospitalized, and the mortality rate was 50.0% (n = 7) in hospitalized patients. CONCLUSIONS Coinfection with SARS-CoV-2 and İnfluenza was not uncommon. Data on coinfected cases are limited in the literature. The coinfection with SARS-CoV-2 and influenza A should be considered in patients with complaints such as fever, myalgia, weakness, shortness of breath, and cough during the flu season. Using the diagnostic test showing two diseases in a single sample may contribute to protecting patient and community health in follow-up and treatment.
Collapse
Affiliation(s)
- Yeliz Çiçek
- Bingöl Public Hospital, Department of Infectious Diseases and Clinical Microbiology, Bingöl, Turkey
| | - Hıdır Sarı
- Dicle University Faculty of Medicine, Department of Public Health, Diyarbakır, Turkey
| | | | - Mehmet Özel
- Diyarbakır Gazi Yasargil Training and Research Hospital, University of Health Sciences, Department of Emergency Medicine, Diyarbakır, Turkey
| |
Collapse
|
35
|
Pott H, J LeBlanc J, S ElSherif M, Hatchette TF, McNeil SA, Andrew MK. Clinical features and outcomes of influenza and RSV coinfections: a report from Canadian immunization research network serious outcomes surveillance network. BMC Infect Dis 2024; 24:147. [PMID: 38291361 PMCID: PMC10826021 DOI: 10.1186/s12879-024-09033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Influenza and RSV coinfections are not commonly seen but are concerning as they can lead to serious illness and adverse clinical outcomes among vulnerable populations. Here we describe the clinical features and outcomes of influenza and RSV coinfections in hospitalized adults. METHODS A cohort study was performed with pooled active surveillance in hospitalized adults ≥ 50 years from the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN SOS) during the 2012/13, 2013/14, and 2014/15 influenza seasons. Descriptive statistics summarized the characteristics of influenza/RSV coinfections. Kaplan-Meier estimated the probability of survival over the first 30 days of hospitalization. RESULTS Over three influenza seasons, we identified 33 cases of RSV and influenza coinfection, accounting for 2.39 cases per 1,000 hospitalizations of patients with acute respiratory illnesses. Adults aged 50 + years commonly reported cough (81.8%), shortness of breath (66.7%), sputum production (45.5%), weakness (33.3%), fever (27.3%), and nasal congestion (24.2%) as constitutional and lower respiratory tract infection symptoms. The mortality rate was substantial (12.1%), and age, comorbidity burden, and frailty were associated with a higher risk for adverse clinical outcomes. CONCLUSIONS Older adults are at higher risk for complications from influenza and RSV coinfections, especially those over 65 with a high comorbidity burden and frailty.
Collapse
Affiliation(s)
- Henrique Pott
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada.
- Department of Medicine, Universidade Federal de São Carlos, Rod. Washington Luis, km 235. São Carlos, São Carlos, 13656-905, Brazil.
| | - Jason J LeBlanc
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - May S ElSherif
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Canada
| |
Collapse
|
36
|
Kim J, Baek S, Nam J, Park J, Kim K, Kang J, Yeom G. Simultaneous Detection of Infectious Diseases Using Aptamer-Conjugated Gold Nanoparticles in the Lateral Flow Immunoassay-Based Signal Amplification Platform. Anal Chem 2024; 96:1725-1732. [PMID: 38240676 DOI: 10.1021/acs.analchem.3c04870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Various platforms for the accurate diagnosis of infectious diseases have been studied because of the emergence of coronavirus disease (COVID-19) in 2019. Recently, it has become difficult to distinguish viruses with similar symptoms due to the continuous mutation of viruses, and there is an increasing need for a diagnostic method to detect them simultaneously. Therefore, we developed a paper-based rapid antigen diagnostic test using DNA aptamers for the simultaneous detection of influenza A, influenza B, and COVID-19. Aptamers specific for each target viral antigen were selected and attached to AuNPs for application in a rapid antigen diagnosis kit using our company's heterogeneous sandwich-type aptamer screening method (H-SELEX). We confirmed that the three viruses could be detected on the same membrane without cross-reactivity based on the high stability, specificity, and binding affinity of the selected aptamers. Further, the limit of detection was 2.89 pg·mL-1 when applied to develop signal amplification technology; each virus antigen was detected successfully in diluted nasopharyngeal samples. We believe that the developed simultaneous diagnostic kit, based on such high accuracy, can distinguish various infectious diseases, thereby increasing the therapeutic effect and contributing to the clinical field.
Collapse
Affiliation(s)
- Jinwoo Kim
- SB BIOSCIENCE Inc., Room 120, Venture Building, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Sowon Baek
- SB BIOSCIENCE Inc., Room 120, Venture Building, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Jungmin Nam
- SB BIOSCIENCE Inc., Room 120, Venture Building, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Jeongeun Park
- SB BIOSCIENCE Inc., Room 120, Venture Building, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Kihyeun Kim
- Advanced Photonics Research Institute (APRI), Gwangju Institute of Science and Technology (GIST), 123 Cheomdan-gwagiro, Buk-gu, Gwangju 61005, Republic of Korea
| | - Juyoung Kang
- SB BIOSCIENCE Inc., Room 120, Venture Building, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Gyuho Yeom
- SB BIOSCIENCE Inc., Room 120, Venture Building, 125 Gwahak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| |
Collapse
|
37
|
Kang SK, Son WS, Kim BI. Application of the Time Derivative (TD) Method for Early Alert of Influenza Epidemics. J Korean Med Sci 2024; 39:e40. [PMID: 38288541 PMCID: PMC10825455 DOI: 10.3346/jkms.2024.39.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/13/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND In order to minimize the spread of seasonal influenza epidemic to communities worldwide, the Korea Disease Control and Prevention Agency has issued an influenza epidemic alert using the influenza epidemic threshold formula based on the results of the influenza-like illness (ILI) rate. However, unusual changes have occurred in the pattern of respiratory infectious diseases, including seasonal influenza, after the coronavirus disease 2019 (COVID-19) pandemic. As a result, the importance of detecting the onset of an epidemic earlier than the existing epidemic alert system is increasing. Accordingly, in this study, the Time Derivative (TD) method was suggested as a supplementary approach to the existing influenza alert system for the early detection of seasonal influenza epidemics. METHODS The usefulness of the TD method as an early epidemic alert system was evaluated by applying the ILI rate for each week during past seasons when seasonal influenza epidemics occurred, ranging from the 2013-2014 season to the 2022-2023 season to compare it with the issued time of the actual influenza epidemic alert. RESULTS As a result of applying the TD method, except for the two seasons (2020-2021 season and 2021-2022 season) that had no influenza epidemic, an influenza early epidemic alert was suggested during the remaining seasons, excluding the 2017-2018 and 2022-2023 seasons. CONCLUSION The TD method is a time series analysis that enables early epidemic alert in real-time without relying on past epidemic information. It can be considered as an alternative approach when it is challenging to set an epidemic threshold based on past period information. This situation may arise when there has been a change in the typical seasonal epidemic pattern of various respiratory viruses, including influenza, following the COVID-19 pandemic.
Collapse
Affiliation(s)
- Seul-Ki Kang
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Woo-Sik Son
- Research Team for Transmission Dynamics of Infectious Disease, Division of Fundamental Research on Public Agenda, National Institute for Mathematical Sciences, Daejeon, Korea
| | - Bryan Inho Kim
- Division of Infectious Disease Control, Bureau of Infectious Disease Policy, Korea Disease Control and Prevention Agency, Cheongju, Korea.
| |
Collapse
|
38
|
Alqaissi E, Alotaibi F, Sher Ramzan M, Algarni A. Novel graph-based machine-learning technique for viral infectious diseases: application to influenza and hepatitis diseases. Ann Med 2024; 55:2304108. [PMID: 38242107 PMCID: PMC10802812 DOI: 10.1080/07853890.2024.2304108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Most infectious diseases are caused by viruses, fungi, bacteria and parasites. Their ability to easily infect humans and trigger large-scale epidemics makes them a public health concern. Methods for early detection of these diseases have been developed; however, they are hindered by the absence of a unified, interoperable and reusable model. This study seeks to create a holistic and real-time model for swift, preliminary detection of infectious diseases using symptoms and additional clinical data. MATERIALS AND METHODS In this study, we present a medical knowledge graph (MKG) that leverages multiple data sources to analyse connections between different nodes. Medical ontologies were used to enhance the MKG. We applied various graph algorithms to extract key features. The performance of multiple machine-learning (ML) techniques for influenza and hepatitis detection was assessed, selecting multi-layer perceptron (MLP) and random forest (RF) models due to their superior outcomes. The hyperparameters of both graph-based ML models were automatically fine-tuned. RESULTS Both the graph-based MLP and RF models showcased the least loss and error rates, along with the most specific, accurate recall, precision and F1 scores. Their Matthews correlation coefficients were also optimal. When compared with existing ML techniques and findings from the literature, these graph-based ML models manifested superior detection accuracy. CONCLUSIONS The graph-based MLP and RF models effectively diagnosed influenza and hepatitis, respectively. This underlines the potential of graph data science in enhancing ML model performance and uncovering concealed relationships in the MKG.
Collapse
Affiliation(s)
- Eman Alqaissi
- Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
- Computer Science and Information Systems, The Applied College, King Khalid University, Abha, Saudi Arabia
| | - Fahd Alotaibi
- Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhammad Sher Ramzan
- Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | |
Collapse
|
39
|
Chao S, Wang Y, Wu B, Li R, Dong J, Ji L, Li X, Li R, Yin X, Zhao X, Liang W. Characterization of viral infections in children with influenza-like-illness during December 2018-January 2019. Front Cell Infect Microbiol 2024; 13:1351814. [PMID: 38304460 PMCID: PMC10830827 DOI: 10.3389/fcimb.2023.1351814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
Introduction Respiratory viral infection (RVI) is of very concern after the outbreak of COVID-19, especially in pediatric departments. Learning pathogen spectrum of RVI in children previous the epidemic of COVID-19 could provide another perspective for understanding RVI under current situation and help to prepare for the post COVID-19 infection control. Methods A nucleic acid sequence-based amplification (NASBA) assay, with 19 pairs of primers targeting various respiratory viruses, was used for multi-pathogen screening of viral infections in children presenting influenza-like illness (ILI) symptoms. Children with ILI at the outpatient department of Beijing Tsinghua Changgung Hospital during the influenza epidemic from 12/2018 to 01/2019 were included. Throat swabs were obtained for both the influenza rapid diagnostic test (IRDT) based on the colloidal gold immunochromatographic assay and the NASBA assay, targeting various respiratory viruses with an integrated chip technology. Results and discussion Of 519 patients, 430 (82.9%) were positive in the NASBA assay. The predominant viral pathogens were influenza A H1N1 pdm1/2009 (pH1N1) (48.4%) and influenza A (H3N2) (18.1%), followed by human metapneumovirus (hMPV) (8.8%) and respiratory syncytial virus (RSV) (6.1%). Of the 320 cases identified with influenza A by NASBA, only 128 (40.0%) were positive in the IRDT. The IRDT missed pH1N1 significantly more frequently than A (H3N2) (P<0.01). Influenza A pH1N1 and A (H3N2) were the major pathogens in <6 years and 6-15 years old individuals respectively (P<0.05). In summary, influenza viruses were the major pathogens in children with ILI during the 2018-2019 winter influenza epidemic, while hMPV and RSV were non-negligible. The coexistence of multiple pathogen leading to respiratory infections is the normalcy in winter ILI cases.
Collapse
Affiliation(s)
- Shuang Chao
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuejiao Wang
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Baolei Wu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Runqing Li
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingxiao Dong
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lina Ji
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xuejun Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ran Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaomei Yin
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiuying Zhao
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| |
Collapse
|
40
|
Hernández-Bou S, Trenchs V, Guirado C, Castrillón I, Luaces C. Procalcitonin as Point-of-Care Testing Modality for the Diagnosis of Pneumonia in Children With Influenza-like Illness. Indian Pediatr 2024; 61:57-61. [PMID: 38183254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
OBJECTIVE To evaluate the usefulness of procalcitonin (PCT) as a point-of-care testing to screen for radiographic pneumonia among children with influenza-like illness (ILI) and prolonged fever. METHODS A prospective cohort study conducted at the pediatric emergency department of a tertiary hospital. Point-of-care testing for PCT was determined for 185 children aged 3 months to < 18 years with ILI and fever lasting > 4 days seen during the flu season in 2020. A chest radiograph (CXR) was performed for patients with PCT > 0.5 ng/mL. RESULTS PCT value was > 0.5 ng/mL in 46 (24.9%) patients; a CXR was ordered in all cases except one and 14 (31.1%) of them had radiographic pneumonia (all had a PCT value > 0.7 ng/mL). Among the 139 (75.1%) patients with a PCT value ≤ 0.5 ng/mL, 137 (98.6%) were managed in the outpatient with symptomatic treatment; the remaining two cases warranted a CXR which was unremarkable in both. At evolution, no radiographic pneumonia was diagnosted in any of them. CONCLUSION PCT is a useful tool for point-of-care testing in patients with ILI and fever > 4 days to guide the indication for CXR to rule out radiographic pneumonia and helps in avoiding unnecessary radiation exposure.
Collapse
Affiliation(s)
- Susanna Hernández-Bou
- Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Victoria Trenchs
- Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain. Correspondence to: Dr. Victoria Trenchs, Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu 2, 08940 Esplugues de Llobregat (Barcelona), Spain.
| | - Cristina Guirado
- Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Ignacio Castrillón
- Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Carles Luaces
- Pediatric Emergency Department, Hospital Sant Joan de Déu Barcelona, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| |
Collapse
|
41
|
Harris E. Program Offering Free COVID-19 and Flu Services Expands Nationwide. JAMA 2024; 331:101. [PMID: 38117506 DOI: 10.1001/jama.2023.25268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
|
42
|
Hsu PC, Lin YT, Kao KC, Peng CK, Sheu CC, Liang SJ, Chan MC, Wang HC, Chen YM, Chen WC, Yang KY. Risk factors for prolonged mechanical ventilation in critically ill patients with influenza-related acute respiratory distress syndrome. Respir Res 2024; 25:9. [PMID: 38178147 PMCID: PMC10765923 DOI: 10.1186/s12931-023-02648-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Patients with influenza-related acute respiratory distress syndrome (ARDS) are critically ill and require mechanical ventilation (MV) support. Prolonged mechanical ventilation (PMV) is often seen in these cases and the optimal management strategy is not established. This study aimed to investigate risk factors for PMV and factors related to weaning failure in these patients. METHODS This retrospective cohort study was conducted by eight medical centers in Taiwan. All patients in the intensive care unit with virology-proven influenza-related ARDS requiring invasive MV from January 1 to March 31, 2016, were included. Demographic data, critical illness data and clinical outcomes were collected and analyzed. PMV is defined as mechanical ventilation use for more than 21 days. RESULTS There were 263 patients with influenza-related ARDS requiring invasive MV enrolled during the study period. Seventy-eight patients had PMV. The final weaning rate was 68.8% during 60 days of observation. The mortality rate in PMV group was 39.7%. Risk factors for PMV were body mass index (BMI) > 25 (kg/m2) [odds ratio (OR) 2.087; 95% confidence interval (CI) 1.006-4.329], extracorporeal membrane oxygenation (ECMO) use (OR 6.181; 95% CI 2.338-16.336), combined bacterial pneumonia (OR 4.115; 95% CI 2.002-8.456) and neuromuscular blockade use over 48 h (OR 2.8; 95% CI 1.334-5.879). In addition, risk factors for weaning failure in PMV patients were ECMO (OR 5.05; 95% CI 1.75-14.58) use and bacteremia (OR 3.91; 95% CI 1.20-12.69). CONCLUSIONS Patients with influenza-related ARDS and PMV have a high mortality rate. Risk factors for PMV include BMI > 25, ECMO use, combined bacterial pneumonia and neuromuscular blockade use over 48 h. In addition, ECMO use and bacteremia predict unsuccessful weaning in PMV patients.
Collapse
Affiliation(s)
- Pai-Chi Hsu
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Respiratory Therapy, Sijhih Cathay General Hospital, New Taipei, Taiwan
| | - Yi-Tsung Lin
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kuo-Chin Kao
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shinn-Jye Liang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Cheng Chan
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hao-Chien Wang
- Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
- Department of Chest Medicine, Taipei Veterans General Hospital, # 201 Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan
| | - Kuang-Yao Yang
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan.
- Department of Chest Medicine, Taipei Veterans General Hospital, # 201 Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.
- Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
43
|
Zou S, Mohtar SH, Othman R, Hassan RM, Liang K, Lei D, Xu B. Platelet distribution width as an useful indicator of influenza severity in children. BMC Infect Dis 2024; 24:9. [PMID: 38166827 PMCID: PMC10759456 DOI: 10.1186/s12879-023-08890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The present study aims to investigate the potential of platelet distribution width as an useful parameter to assess the severity of influenza in children. METHODS Baseline characteristics and laboratory results were collected and analyzed. Receiver operating characteristic (ROC) curve analysis was used to joint detection of inflammatory markers for influenza positive children, and the scatter-dot plots were used to compare the differences between severe and non-severe group. RESULTS Influenza B positive children had more bronchitis and pneumonia (P < 0.05), influenza A infected children had more other serious symptoms (P = 0.007). Neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), and platelet parameters performed differently among < 4 years and ≥ 4 years children with influenza. Combined detection of platelet parameters and other indicators could better separate healthy children from influenza infected children than single indicator detection. The levels of platelet distribution width of children with severe influenza (A and B) infection was significantly dropped, compared with non-severe group (P < 0.05). CONCLUSIONS Platelet distribution width could be a very useful and economic indicator in distinction and severity assessment for children with influenza.
Collapse
Affiliation(s)
- Seyin Zou
- Department of Laboratory Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China.
- Department of Science and Biotechnology, Faculty of Engineering and Life Sciences, Universiti Selangor, Bestari Jaya Campus, Bestari Jaya, Selangor Darul Ehsan, 45600, Malaysia.
| | - Siti Hasmah Mohtar
- Department of Science and Biotechnology, Faculty of Engineering and Life Sciences, Universiti Selangor, Bestari Jaya Campus, Bestari Jaya, Selangor Darul Ehsan, 45600, Malaysia.
| | - Roshani Othman
- Department of Science and Biotechnology, Faculty of Engineering and Life Sciences, Universiti Selangor, Bestari Jaya Campus, Bestari Jaya, Selangor Darul Ehsan, 45600, Malaysia
| | - Rodiah Mohd Hassan
- Department of Science and Biotechnology, Faculty of Engineering and Life Sciences, Universiti Selangor, Bestari Jaya Campus, Bestari Jaya, Selangor Darul Ehsan, 45600, Malaysia
| | - Kun Liang
- Guangdong Medical University, Dongguan, 523000, China
| | - Da Lei
- Department of Laboratory Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| | - Bangming Xu
- Department of Laboratory Medicine, Guangdong Second Provincial General Hospital, Guangzhou, 510317, China
| |
Collapse
|
44
|
Bernasconi C, Katugampola L, Wildum S. Comparison of influenza viral load in nasopharyngeal and midturbinate swabs. Influenza Other Respir Viruses 2024; 18:e13253. [PMID: 38260724 PMCID: PMC10800293 DOI: 10.1111/irv.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024] Open
Abstract
Different specimen types are used for influenza diagnosis but comparative data for viral loads from different swab types are limited. We compared influenza viral loads (determined by quantitative reverse transcription polymerase chain reaction [RT-PCR]) in 93 paired midturbinate and nasopharyngeal swab aliquots from influenza infected patients enrolled in a phase 3 randomized-controlled study with the objective of maximizing the number of swabs available for sequence analysis. Midturbinate swabs yielded a 53% lower viral load versus nasopharyngeal swabs, and this difference was similar for influenza A and B. These data suggest that nasopharyngeal swabs might be preferred in diagnostic settings when obtaining higher viral load is important.
Collapse
Affiliation(s)
- Corrado Bernasconi
- F. Hoffmann‐La Roche Ltd.BaselSwitzerland
- Present address:
Limites Medical Research Ltd.VacalloSwitzerland
| | | | | |
Collapse
|
45
|
Brendish NJ, Davis C, Chapman ME, Borca F, Waddington D, Hill C, White N, Clark TW. Emergency Department point-of-care antiviral host response testing is accurate during periods of multiple respiratory virus co-circulation. J Infect 2024; 88:41-47. [PMID: 37977337 DOI: 10.1016/j.jinf.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES FebriDx is a CE-marked, FDA-approved point-of-care test that detects the antiviral host response protein Myxovirus Resistance Protein A (MxA), in addition to C-reactive protein, using finger-prick blood. FebriDx MxA detection had a high negative predictive value for COVID-19 in symptomatic adults presenting to hospital in the first waves of the pandemic and was used subsequently as a 'rule out' triage tool in Emergency departments. The diagnostic accuracy of FebriDx MxA in the current context of co-circulation of influenza, SARS-CoV-2, and Respiratory Syncytial Virus (RSV), and in the era of COVID-19 vaccination, is unknown. METHODS We retrospectively evaluated the diagnostic performance of FebriDx MxA in adults with acute respiratory symptoms presenting to the Emergency Department (ED) of a large UK teaching hospital using Reverse Transcription Polymerase Chain Reaction (RT-PCR) as the reference standard (Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV). RESULTS Between March 9th 2022 and March 8th 2023, 5426 patients had both FebriDx and RT-PCR testing with valid results. 999 (18.4%) of patients had influenza detected, 520 (9.6%) SARS-CoV-2, and 190 (3.5%) RSV. Negative Predictive Value (NPV) of MxA detection by FebriDx was 97.5% (96.9-98.0) for influenza, 97.1% (96.4-97.7) for SARS-CoV-2, 98.1% (97.5-98.6) for RSV, and 92.8% (91.8-93.7) for all viruses combined. CONCLUSIONS In symptomatic adults, FebriDx MxA had a high NPV for influenza and RSV, and retained a high NPV for SARS-CoV-2, in the context of virus co-circulation and widespread COVID-19 vaccination. FebriDx continues to be a useful 'rule out' triage tool in the ED and could potentially be scaled to provide a national triage solution for future viral pandemics.
Collapse
Affiliation(s)
- Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Cai Davis
- Clinical Informatics Research Unit, NHS Blood and Transplant Southampton, Southampton, UK
| | - Mary E Chapman
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Florina Borca
- Clinical Informatics Research Unit, NHS Blood and Transplant Southampton, Southampton, UK
| | - Daniel Waddington
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christopher Hill
- Department of Emergency Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicola White
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
46
|
Brouwer CWE, Russcher A, Rezek Y, Nijhuis RHT. Evaluation of the fully automated, sample-to-result Seegene STARlet-AIOS platform for detection of SARS-CoV-2, influenza virus A, influenza virus B, and RSV. Eur J Clin Microbiol Infect Dis 2024; 43:87-93. [PMID: 37966626 DOI: 10.1007/s10096-023-04703-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023]
Abstract
Early, accurate, and bulk detection of respiratory pathogens is essential for patient management and infection control. STARlet-All-in-One System (AIOS) (Seegene) is a new, fully automated, sample-to-result, molecular diagnostic platform. This study describes the first evaluation of STARlet-AIOS, by testing the Allplex™ SARS-CoV-2 (AS) and Allplex™ SARS-CoV-2/FluA/FluB/RSV combination (AC) assays in comparison to the SARS-CoV-2 assays used at our institute. Over a 3-week period, all naso-/oropharyngeal specimens tested for SARS-CoV-2 using either GeneXpert, Panther, or in-house developed test (LDT) were tested on the AIOS using the AS or AC assays. In addition, retrospective cohorts of specimens containing SARS-CoV-2, influenza virus A, influenza virus B, and RSV were tested. Discrepant results were re-tested with another assay used in this study. Hands-on time (HOT) and turn-around time (TAT) of the different systems were monitored and compared. A total of 738 specimens were tested on the AIOS using the AS assay. In addition, 210 specimens were tested using the AC assay. Overall agreement for SARS-CoV-2 detection was established as 98.5% and 95.2% for the AS and AC assay, respectively. Retrospective testing revealed high agreements for all targets, except for influenza virus A (agreement of 87.5%). HOT of the system was comparable to the HOT of GeneXpert and Panther and TAT comparable to Panther and LDT. The AIOS proved to be a robust sample-to-result system with low HOT and moderate TAT. This study showed reliable detection of SARS-CoV-2, influenza virus B, and RSV, whereas detection of influenza virus A using the AC assay appeared to be suboptimal.
Collapse
Affiliation(s)
- C W E Brouwer
- Laboratory for Medical Microbiology and Medical Immunology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - A Russcher
- Laboratory for Medical Microbiology and Medical Immunology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - Y Rezek
- Laboratory for Medical Microbiology and Medical Immunology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
| | - R H T Nijhuis
- Laboratory for Medical Microbiology and Medical Immunology, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
| |
Collapse
|
47
|
Walls T, Bowen E, Elsmore A, Lucas N. Rapid PCR Testing Reduces Antibiotic Prescribing in Children Presenting to Hospital With Lower Respiratory Tract Infections due to Influenza. Influenza Other Respir Viruses 2024; 18:e13265. [PMID: 38420686 PMCID: PMC10902685 DOI: 10.1111/irv.13265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/27/2024] [Indexed: 03/02/2024] Open
Affiliation(s)
- Tony Walls
- Department of PaediatricsUniversity of OtagoChristchurchUK
- Paediatric DepartmentTe Whatu Ora (HealthNZ) WaitahaCanterburyUK
| | - Emily Bowen
- Department of PaediatricsUniversity of OtagoChristchurchUK
| | - Ava Elsmore
- Department of PaediatricsUniversity of OtagoChristchurchUK
| | - Nathanael Lucas
- Paediatric DepartmentTe Whatu Ora (HealthNZ) WaitahaCanterburyUK
| |
Collapse
|
48
|
Cogdale J, Kele B, Myers R, Harvey R, Lofts A, Mikaiel T, Hoschler K, Banyard AC, James J, Mollett BC, Byrne AM, Lopez-Bernal J, Watson CH, Chand M, Welfare W, Williamson DA, Oliver I, Padfield S, Lee A, Calvert S, Bewley MA, Wallace L, deLusignan S, Lewis NS, Brown IH, Zambon M. A case of swine influenza A(H1N2)v in England, November 2023. Euro Surveill 2024; 29:2400002. [PMID: 38240057 PMCID: PMC10797662 DOI: 10.2807/1560-7917.es.2024.29.3.2400002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 01/22/2024] Open
Abstract
Under International Health Regulations from 2005, a human infection caused by a novel influenza A virus variant is considered an event that has potential for high public health impact and is immediately notifiable to the World Health Organisation. We here describe the clinical, epidemiological and virological features of a confirmed human case of swine influenza A(H1N2)v in England detected through community respiratory virus surveillance. Swabbing and contact tracing helped refine public health risk assessment, following this unusual and unexpected finding.
Collapse
Affiliation(s)
- Jade Cogdale
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Beatrix Kele
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Richard Myers
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Ruth Harvey
- The Francis Crick Institute, London, United Kingdom
| | - Abi Lofts
- The Francis Crick Institute, London, United Kingdom
| | | | - Katja Hoschler
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Ashley C Banyard
- Animal and Plant Health Agency (APHA), Weybridge, United Kingdom
| | - Joe James
- Animal and Plant Health Agency (APHA), Weybridge, United Kingdom
| | - Benjamin C Mollett
- Animal and Plant Health Agency (APHA), Weybridge, United Kingdom
- Royal Veterinary College, London, United Kingdom
| | | | | | - Conall H Watson
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Meera Chand
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - William Welfare
- United Kingdom Health Security Agency (UKHSA), Manchester, United Kingdom
| | | | - Isabel Oliver
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| | - Simon Padfield
- United Kingdom Health Security Agency (UKHSA), Leeds, United Kingdom
| | - Andrew Lee
- United Kingdom Health Security Agency (UKHSA), Leeds, United Kingdom
| | - Suzanne Calvert
- United Kingdom Health Security Agency (UKHSA), Leeds, United Kingdom
| | - Martin A Bewley
- United Kingdom Health Security Agency (UKHSA), Leeds, United Kingdom
| | - Louise Wallace
- Yorkshire and Humber Public Health Network (YHPHN), Yorkshire, United Kingdom
| | - Simon deLusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford United Kingdom
- Royal College of General Practice (RCGP) Research and Surveillance Centre (RSC), Oxford, United Kingdom
| | - Nicola S Lewis
- The Francis Crick Institute, London, United Kingdom
- Royal Veterinary College, London, United Kingdom
| | - Ian H Brown
- Animal and Plant Health Agency (APHA), Weybridge, United Kingdom
| | - Maria Zambon
- United Kingdom Health Security Agency (UKHSA), London, United Kingdom
| |
Collapse
|
49
|
Shan N, Zheng Z. A Case of Nosocomial Coinfection of SARS-CoV-2 and Influenza A Virus in a Hospitalized Patient with Acute Myocardial Infarction. Clin Lab 2024; 70. [PMID: 38213216 DOI: 10.7754/clin.lab.2023.230735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Inpatients in cardiovascular medicine departments often have complicated conditions, long hospital stays, and a high risk of nosocomial infection. Good infection control is of great importance for the treatment and rehabilitation of inpatients in cardiovascular medicine departments. METHODS We report a case of coinfection with the 2019 novel coronavirus (SARS-CoV-2) and influenza A virus in a hospitalized patient with acute myocardial infarction. We used reverse transcription real-time fluorescence quantitative PCR to detect SARS-CoV-2 and influenza A virus and used the Ct value to represent the relative concentration of the above two viruses. RESULTS The patient was tested for SARS-CoV-2 nucleic acid and influenza A and B virus nucleic acid in the early stage of hospitalization, and the results were negative. On the 39th day of admission, the nucleic acid test result for SARS-CoV-2 was positive (ORF1ab gene, Ct value 24.63; N gene, Ct value 24.55); on the 48th day of admission, the nucleic acid test result for influenza A virus was positive (Ct value, 21.32), indicating hospital-acquired respiratory virus coinfection. CONCLUSIONS Clinicians should be highly cognizant that SARS-CoV-2 may become a new high-incidence pathogen of nosocomial infection. In-hospital monitoring of common respiratory viruses should be considered to detect infected patients early and prevent common respiratory viruses from spreading in hospitals.
Collapse
|
50
|
Davies S, Boller E, Chase J, Beaubrun A, Miller C, Jensen I. A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses. J Med Econ 2024; 27:430-441. [PMID: 38328858 DOI: 10.1080/13696998.2024.2313391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
AIMS Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies. METHODS A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course. RESULTS The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies. LIMITATIONS Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic. CONCLUSION The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.
Collapse
Affiliation(s)
- Shawn Davies
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | - Emily Boller
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | | | | | - Cynthia Miller
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | - Ivar Jensen
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| |
Collapse
|