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O'Leary ST, Narwaney KJ, Wagner NM, Kraus CR, Omer SB, Glanz JM. Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT. Am J Prev Med 2019; 57:e125-e133. [PMID: 31471001 DOI: 10.1016/j.amepre.2019.05.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women. STUDY DESIGN RCT. SETTING/PARTICIPANTS This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013-July 2016, with data analysis in 2017-2018. INTERVENTION Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and "Ask a Question" portal. MAIN OUTCOME MEASURES Tdap and influenza vaccination. These outcomes were analyzed separately. RESULTS For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. CONCLUSIONS Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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Hong K, Sohn S, Chun BC. Estimating Influenza-associated Mortality in Korea: The 2009-2016 Seasons. J Prev Med Public Health 2019; 52:308-315. [PMID: 31588700 PMCID: PMC6780294 DOI: 10.3961/jpmph.19.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes. METHODS Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype. RESULTS Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus-associated influenza or pneumonia deaths were more common in those under 65 years old. CONCLUSIONS Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.
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Affiliation(s)
- Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sangho Sohn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Jeong S, Jang EJ, Jo J, Jang S. Effects of maternal influenza vaccination on adverse birth outcomes: A systematic review and Bayesian meta-analysis. PLoS One 2019; 14:e0220910. [PMID: 31412058 PMCID: PMC6693758 DOI: 10.1371/journal.pone.0220910] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/25/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although pregnant women are a priority group for influenza vaccination, its effect on birth outcomes has long been debated. Numerous observational studies and a few randomized controlled studies have been conducted, with inconsistent results. OBJECTIVES To evaluate the association of influenza vaccination in pregnancy with adverse birth outcomes. DATA SOURCE The Cochrane Library, PubMed, EMBASE, Web of Science, and Scopus were searched. STUDY ELIGIBILITY CRITERIA This analysis included randomized placebo-controlled studies, cohort studies, and case-control studies, in which inactivated influenza vaccination was given during pregnancy and fetal adverse birth outcomes were assessed. PARTICIPANTS & INTERVENTION Women who received inactivated influenza vaccine during pregnancy and their offspring. STUDY APPRAISAL AND SYNTHESIS Two independent reviewers and a third reviewer collaborated in study selection and data extraction. A Bayesian 3-level random-effects model was utilized to assess the impact of maternal influenza vaccination on birth outcomes, which were presented as odds ratios (ORs) with 95% credible interval (CrIs). Bayesian outcome probabilities (P) of an OR<1 were calculated, and values of at least 90% (0.9) were deemed to indicate a significant result. RESULTS Among the 6,249 identified publications, 48 studies were eligible for the meta-analysis, including 2 randomized controlled trials, 41 cohort studies, and 5 case-control studies. The risk of none of the following adverse birth outcomes decreased significantly: preterm birth (OR = 0.945, 95% CrI: 0.736-1.345, P = 73.3%), low birth weight (OR = 0.928, 95% CrI: 0.432-2.112, P = 76.7%), small for gestational age (OR = 0.971, 95% CrI: 0.249-4.217,P = 63.3%), congenital malformation (OR = 1.026, 95% CrI: 0.687-1.600, P = 38.0%), and fetal death (OR = 0.942, 95% CrI: 0.560-1.954, P = 61.6%). Summary estimates including only cohort studies showed significantly decreased risks for preterm birth, small for gestational age and fetal death. However, after adjusting for season at the time of vaccination and countries' income level, only fetal death remained significant. CONCLUSION This Bayesian meta-analysis did not find a protective effect of maternal influenza vaccination against adverse birth outcomes, as reported in previous studies. In fact, our results showed evidence of null associations between maternal influenza vaccination and adverse birth outcomes.
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Affiliation(s)
- Sohyun Jeong
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts, United States of America
- School of Pharmacy, Sungkyunkwan University, Jangan-gu, Suwon, Gyeonggi-do, Korea
| | - Eun Jin Jang
- Department of Information Statistics, Andong National University, Gyeongsangbuk-do, Korea
| | - Junwoo Jo
- Department of Statistics, Kyungpook National University, Bukgu, Daegu, Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Korea
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Clinical Presentation of Influenza in Children 6 to 35 Months of Age: Findings From a Randomized Clinical Trial of Inactivated Quadrivalent Influenza Vaccine. Pediatr Infect Dis J 2019; 38:866-872. [PMID: 31306399 DOI: 10.1097/inf.0000000000002387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In an exploratory analysis of an inactivated quadrivalent influenza vaccine (IIV4) trial in children 6-35 months without risk factors for influenza, we evaluated clinical presentation of influenza illness and vaccine impact on health outcomes. METHODS This phase III trial was conducted in 13 geographically diverse countries across 5 influenza seasons (2011-2014). Children were randomized 1:1 to IIV4 or control. Active surveillance was performed for influenza-like episodes (ILE); influenza was confirmed by reverse transcription polymerase chain reaction (RT-PCR). The total vaccinated cohort was evaluated (N = 12,018). RESULTS 5702 children experienced ≥1 ILE; 356 (IIV4 group) and 693 (control group) children had RT-PCR-confirmed influenza. Prevalence of ILE was similar in RT-PCR-positive and RT-PCR-negative cases regardless of vaccination. Breakthrough influenza illness was attenuated in children vaccinated with IIV4; moderate-to-severe illness was 41% less likely to be reported in the IIV4 group than the control group [crude odds ratio: 0.59 (95% confidence intervals: 0.44-0.77)]. Furthermore, fever >39°C was 46% less frequent following vaccination with IIV4 than with control [crude odds ratio: 0.54 (95% confidence intervals: 0.39-0.75)] in children with breakthrough illness. Health outcome analysis showed that, each year, IIV4 would prevent 54 influenza cases per 1000 children and 19 children would need to be vaccinated to prevent 1 new influenza case. CONCLUSIONS In addition to preventing influenza in 50% of participants, IIV4 attenuated illness severity and disease burden in children who had a breakthrough influenza episode despite vaccination.
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Cumulative clinical experience with MF59-adjuvanted trivalent seasonal influenza vaccine in young children. Int J Infect Dis 2019; 85S:S26-S38. [DOI: 10.1016/j.ijid.2019.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 01/05/2023] Open
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Akpalu Y, Karaye I, Anderson J, Mgbere O, Horney JA. Demographic Determinants of Influenza Vaccination and Infection, Brazos County, Texas, 2017. Infect Dis (Lond) 2019; 12:1178633719863815. [PMID: 31320802 PMCID: PMC6630077 DOI: 10.1177/1178633719863815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/25/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Seasonal influenza constitutes an enormous public health burden. The 2017-2018 influenza season was the most severe since the 2009 novel Influenza A (H1N1) pandemic. The State of Texas, like other states, experienced unusually high and persistent influenza activity. METHODS Data on confirmed cases of influenza and influenza-like illness (ILI) in Brazos County during December 2017 were collected by the Brazos County Health Department (BCHD) from medical records. Records of vaccine administered between January 1 and December 31, 2017 were collected from vaccination providers. The total number of influenza cases for 2017 was compiled from regular weekly influenza counts reported to BCHD by healthcare providers. RESULTS A total of 1651 cases of laboratory-confirmed influenza were reported in Brazos County residents in December 2017, 10 times more than that reported in December 2016. The highest rates of infection were in 2 ZIP codes where vaccination rates were also high. A total of 16 027 influenza vaccinations were given to individuals reporting a residential address in Brazos County in 2017. Vaccination coverage was lowest among adults aged 18 to 49, whereas those aged 65 or older and Hispanics were most likely to be hospitalized. DISCUSSION Overall, vaccination coverage in Brazos County, Texas is low, less than half of the Healthy People 2020 target. The development of health education materials and an increased use of social media, local television and radio, and communication methods that can reach parents, younger adults, and Hispanic residents are needed.
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Affiliation(s)
- Yao Akpalu
- Brazos County Health Department, Bryan, TX, USA
| | - Ibraheem Karaye
- Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, TX, USA
| | | | | | - Jennifer A Horney
- Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, TX, USA
- Department of Epidemiology, College of Health Sciences, University of Delaware, Newark, DE, USA
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O'Leary ST, Pyrzanowski J, Brewer SE, Sevick C, Miriam Dickinson L, Dempsey AF. Effectiveness of a multimodal intervention to increase vaccination in obstetrics/gynecology settings. Vaccine 2019; 37:3409-3418. [DOI: 10.1016/j.vaccine.2019.05.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 01/05/2023]
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Estimating age-stratified influenza-associated invasive pneumococcal disease in England: A time-series model based on population surveillance data. PLoS Med 2019; 16:e1002829. [PMID: 31246954 PMCID: PMC6597037 DOI: 10.1371/journal.pmed.1002829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/17/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Measures of the contribution of influenza to Streptococcus pneumoniae infections, both in the seasonal and pandemic setting, are needed to predict the burden of secondary bacterial infections in future pandemics to inform stockpiling. The magnitude of the interaction between these two pathogens has been difficult to quantify because both infections are mainly clinically diagnosed based on signs and symptoms; a combined viral-bacterial testing is rarely performed in routine clinical practice; and surveillance data suffer from confounding problems common to all ecological studies. We proposed a novel multivariate model for age-stratified disease incidence, incorporating contact patterns and estimating disease transmission within and across groups. METHODS AND FINDINGS We used surveillance data from England over the years 2009 to 2017. Influenza infections were identified through the virological testing of samples taken from patients diagnosed with influenza-like illness (ILI) within the sentinel scheme run by the Royal College of General Practitioners (RCGP). Invasive pneumococcal disease (IPD) cases were routinely reported to Public Health England (PHE) by all the microbiology laboratories included in the national surveillance system. IPD counts at week t, conditional on the previous time point t-1, were assumed to be negative binomially distributed. Influenza counts were linearly included in the model for the mean IPD counts along with an endemic component describing some seasonal background and an autoregressive component mimicking pneumococcal transmission. Using age-specific counts, Akaike information criterion (AIC)-based model selection suggested that the best fit was obtained when the endemic component was expressed as a function of observed temperature and rainfall. Pneumococcal transmission within the same age group was estimated to explain 33.0% (confidence interval [CI] 24.9%-39.9%) of new cases in the elderly, whereas 50.7% (CI 38.8%-63.2%) of incidence in adults aged 15-44 years was attributed to transmission from another age group. The contribution of influenza on IPD during the 2009 pandemic also appeared to vary greatly across subgroups, being highest in school-age children and adults (18.3%, CI 9.4%-28.2%, and 6.07%, CI 2.83%-9.76%, respectively). Other viral infections, such as respiratory syncytial virus (RSV) and rhinovirus, also seemed to have an impact on IPD: RSV contributed 1.87% (CI 0.89%-3.08%) to pneumococcal infections in the 65+ group, whereas 2.14% (CI 0.87%-3.57%) of cases in the group of 45- to 64-year-olds were attributed to rhinovirus. The validity of this modelling strategy relies on the assumption that viral surveillance adequately represents the true incidence of influenza in the population, whereas the small numbers of IPD cases observed in the younger age groups led to significant uncertainty around some parameter estimates. CONCLUSIONS Our estimates suggested that a pandemic wave of influenza A/H1N1 with comparable severity to the 2009 pandemic could have a modest impact on school-age children and adults in terms of IPD and a small to negligible impact on infants and the elderly. The seasonal impact of other viruses such as RSV and rhinovirus was instead more important in the older population groups.
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59
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Buchan SA, Chung H, Karnauchow T, McNally JD, Campitelli MA, Gubbay JB, Katz K, McGeer AJ, Richardson DC, Richardson SE, Simor A, Smieja M, Zahariadis G, Tran D, Crowcroft NS, Rosella LC, Kwong JC. Characteristics and Outcomes of Young Children Hospitalized With Laboratory-confirmed Influenza or Respiratory Syncytial Virus in Ontario, Canada, 2009-2014. Pediatr Infect Dis J 2019; 38:362-369. [PMID: 30882725 DOI: 10.1097/inf.0000000000002164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Respiratory illnesses are a major contributor to pediatric hospitalizations, with influenza and respiratory syncytial virus (RSV) causing substantial morbidity and cost each season. We compared the characteristics and outcomes of children 0-59 months of age who were hospitalized with laboratory-confirmed influenza or RSV between 2009 and 2014 in Ontario, Canada. METHODS We included hospitalized children who were tested for influenza A, influenza B and RSV and were positive for a single virus. We characterized individuals by their demographics and healthcare utilization patterns and compared their hospital outcomes, in-hospital cost and postdischarge healthcare use by virus type and by presence of underlying comorbidities. RESULTS We identified and analyzed 7659 hospitalizations during which a specimen tested positive for influenza or RSV. Children with RSV were the youngest whereas children with influenza B were the oldest [median ages 6 months (interquartile range: 2-17 months) and 25 months (interquartile range: 10-45 months), respectively]. Complex chronic conditions were more prevalent among children with all influenza (sub)types than RSV (31%-34% versus 20%). In-hospital outcomes were similar by virus type, but in children with comorbidities, postdischarge outcomes varied. We observed no differences in in-hospital cost between viruses or by presence of comorbidities [overall median cost: $4150 Canadian dollars (interquartile range: $3710-$4948)]. CONCLUSIONS Influenza and RSV account for large numbers of pediatric hospitalizations. RSV and influenza were similar in terms of severity and cost in hospitalized children. Influenza vaccination should be promoted in pregnant women and young children, and a vaccine against RSV would mitigate the high burden of RSV.
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Affiliation(s)
- Sarah A Buchan
- From the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Hannah Chung
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Timothy Karnauchow
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Allison J McGeer
- From the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | | | - Susan E Richardson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew Simor
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - George Zahariadis
- London Health Sciences Centre, London, ON, Canada
- Newfoundland & Labrador Public Health Laboratory, St. John's, NF&L, Canada
| | - Dat Tran
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Paediatrics
| | - Natasha S Crowcroft
- From the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Laura C Rosella
- From the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Jeffrey C Kwong
- From the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
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Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, Gravenstein S, Hayden FG, Harper SA, Hirshon JM, Ison MG, Johnston BL, Knight SL, McGeer A, Riley LE, Wolfe CR, Alexander PE, Pavia AT. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis 2019; 68:e1-e47. [PMID: 30566567 PMCID: PMC6653685 DOI: 10.1093/cid/ciy866] [Citation(s) in RCA: 332] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 12/19/2022] Open
Abstract
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry H Bernstein
- Division of General Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - John S Bradley
- Division of Infectious Diseases, Rady Children's Hospital
- University of California, San Diego
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital
| | - Thomas M File
- Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan Gravenstein
- Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville
| | - Scott A Harper
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon Mark Hirshon
- Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Lynn Johnston
- Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Allison McGeer
- Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada
| | - Laura E Riley
- Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Paul E Alexander
- McMaster University, Hamilton, Ontario, Canada
- Infectious Diseases Society of America, Arlington, Virginia
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City
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61
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Uyeki TM, Bernstein HH, Bradley JS, Englund JA, File TM, Fry AM, Gravenstein S, Hayden FG, Harper SA, Hirshon JM, Ison MG, Johnston BL, Knight SL, McGeer A, Riley LE, Wolfe CR, Alexander PE, Pavia AT. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa. Clin Infect Dis 2019; 68. [PMID: 30566567 PMCID: PMC6653685 DOI: 10.1093/cid/ciy866 10.1093/cid/ciz044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.
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Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Henry H Bernstein
- Division of General Pediatrics, Cohen Children's Medical Center, New Hyde Park, New York
| | - John S Bradley
- Division of Infectious Diseases, Rady Children's Hospital
- University of California, San Diego
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Hospital
| | - Thomas M File
- Division of Infectious Diseases Summa Health, Northeast Ohio Medical University, Rootstown
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stefan Gravenstein
- Providence Veterans Affairs Medical Center and Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville
| | - Scott A Harper
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jon Mark Hirshon
- Department of Emergency Medicine, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - B Lynn Johnston
- Department of Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada
| | - Shandra L Knight
- Library and Knowledge Services, National Jewish Health, Denver, Colorado
| | - Allison McGeer
- Division of Infection Prevention and Control, Sinai Health System, University of Toronto, Ontario, Canada
| | - Laura E Riley
- Department of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston
| | - Cameron R Wolfe
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Paul E Alexander
- McMaster University, Hamilton, Ontario, Canada
- Infectious Diseases Society of America, Arlington, Virginia
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City
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Homaira N, Briggs N, Oei JL, Hilder L, Bajuk B, Snelling T, Chambers GM, Jaffe A. Impact of influenza on hospitalization rates in children with a range of chronic lung diseases. Influenza Other Respir Viruses 2019; 13:233-239. [PMID: 30701672 PMCID: PMC6468072 DOI: 10.1111/irv.12633] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Data on burden of severe influenza in children with a range of chronic lung diseases (CLDs) remain limited. METHOD We performed a cohort study to estimate burden of influenza-associated hospitalization in children with CLDs using population-based linked data. The cohort comprised all children in New South Wales, Australia, born between 2001 and 2010 and was divided into five groups, children with: (a) severe asthma; (b) bronchopulmonary dysplasia (BPD); (c) cystic fibrosis (CF); (d) other congenital/chronic lung conditions; and (e) children without CLDs. Incidence rates and rate ratios for influenza-associated hospitalization were calculated for 2001-2011. Average cost/episode of hospitalization was estimated using public hospital cost weights. RESULTS Our cohort comprised 888 157 children; 11 058 (1.2%) had one of the CLDs. The adjusted incidence/1000 child-years of influenza-associated hospitalization in children with CLDs was 3.9 (95% CI: 2.6-5.2) and 0.7 (95% CI: 0.5-0.9) for children without. The rate ratio was 5.4 in children with CLDs compared to children without. The adjusted incidence/1000 child-years (95% CI) in children with severe asthma was 1.1 (0.6-1.6), with BPD was 6.0 (3.7-8.3), with CF was 7.4 (2.6-12.1), and with other congenital/chronic lung conditions was 6.9 (4.9-8.9). The cost/episode (95% CI) of influenza-associated hospitalization was AUD 19 704 (95% CI: 11 715-27 693) for children with CLDs compared to 4557 (95% CI: 4129-4984) for children without. DISCUSSION This large population-based study suggests a significant healthcare burden associated with influenza in children with a range of CLDs.
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Affiliation(s)
- Nusrat Homaira
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Nancy Briggs
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ju-Lee Oei
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lisa Hilder
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health UNSW Sydney, Sydney, New South Wales, Australia
| | - Barbara Bajuk
- NSW Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Tom Snelling
- Princess Margaret Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Georgina M Chambers
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Big Data Research in Health UNSW Sydney, Sydney, New South Wales, Australia.,National Perinatal Epidemiology and Statistics Unit (NPESU), Kensington, New South Wales, Australia
| | - Adam Jaffe
- Faculty of Medicine, Discipline of Pediatrics, School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
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63
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Loeb M, Dang AD, Thiem VD, Thanabalan V, Wang B, Nguyen NB, Tran HTM, Luong TM, Singh P, Smieja M, Maguire J, Pullenayegum E. Effect of Vitamin D supplementation to reduce respiratory infections in children and adolescents in Vietnam: A randomized controlled trial. Influenza Other Respir Viruses 2019; 13:176-183. [PMID: 30328294 PMCID: PMC6379634 DOI: 10.1111/irv.12615] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/11/2018] [Accepted: 10/15/2018] [Indexed: 11/28/2022] Open
Abstract
Background It is uncertain whether vitamin D can reduce respiratory infection. Objective To determine whether vitamin D supplementation reduces influenza and other upper viral respiratory tract infections. Methods A total of 1300 healthy children and adolescents between the ages of 3 and 17 years were randomized to vitamin D (14 000 U weekly) or placebo for 8 months in Vietnam. The primary outcome was reverse transcriptase (RT)‐PCR–confirmed influenza infection, and the coprimary outcome was multiplex PCR–confirmed non‐influenza respiratory viruses. Participants, caregivers, and those assessing outcomes were blinded to group assignment. Results A total of 650 children and adolescents were randomly assigned to vitamin D and 650 to placebo. The mean baseline serum 25‐hydroxyvitamin D levels were 65.7 nmol/L and 65.2 nmol/L in the intervention and placebo groups, respectively, with an increase to 91.8 nmol/L in the vitamin D group and no increase, 64.5 nmol/L, in the placebo group. All 1300 participants randomized contributed to the analysis. We observed RT‐PCR–confirmed influenza A or B occurred in 50 children (7.7%) in the vitamin D group and in 43 (6.6%) in the placebo group (hazard ratio [HR]: 1.18, 95% CI: 0.79‐1.78). RT‐PCR–confirmed non‐influenza respiratory virus infection occurred in 146 (22.5%) in the vitamin D group and in 185 (28.5%) in the placebo group (hazard ratio [HR]: 0.76, 95% CI: 0.61‐0.94). When considering all respiratory viruses, including influenza, the effect of vitamin D in reducing infection was significant, HR: 0.81, 95% CI: 0.66‐0.99. Conclusion Vitamin D supplementation did not reduce the incidence of influenza but moderately reduced non‐influenza respiratory viral infection.
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Affiliation(s)
- Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Vu Dinh Thiem
- Department of Epidemiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Vitheya Thanabalan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Biao Wang
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nguyen Binh Nguyen
- Department of Epidemiology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Hung Thi Mai Tran
- Department of International Cooperation, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tan Minh Luong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Pardeep Singh
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathon Maguire
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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64
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Zhong Z, Haltalli M, Holder B, Rice T, Donaldson B, O'Driscoll M, Le-Doare K, Kampmann B, Tregoning JS. The impact of timing of maternal influenza immunization on infant antibody levels at birth. Clin Exp Immunol 2018; 195:139-152. [PMID: 30422307 DOI: 10.1111/cei.13234] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2018] [Indexed: 01/27/2023] Open
Abstract
Pregnant women and infants are at an increased risk of severe disease after influenza infection. Maternal immunization is a potent tool to protect both these at-risk groups. While the primary aim of maternal influenza vaccination is to protect the mother, a secondary benefit is the transfer of protective antibodies to the infant. A recent study using the tetanus, diphtheria and acellular pertussis (Tdap) vaccine indicated that children born to mothers immunized in the second trimester of pregnancy had the highest antibody titres compared to children immunized in the third trimester. The aim of the current study was to investigate how the timing of maternal influenza immunization impacts infant antibody levels at birth. Antibody titres were assessed in maternal and cord blood samples by both immunoglobulin (Ig)G-binding enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition assay (HAI). Antibody titres to the H1N1 component were significantly higher in infants born to mothers vaccinated in either the second or third trimesters than infants born to unvaccinated mothers. HAI levels in the infant were significantly lower when maternal immunization was performed less than 4 weeks before birth. These studies confirm that immunization during pregnancy increases the antibody titre in infants. Importantly, antibody levels in cord blood were significantly higher when the mother was vaccinated in either trimesters 2 or 3, although titres were significantly lower if the mother was immunized less than 4 weeks before birth. Based on these data, seasonal influenza vaccination should continue to be given in pregnancy as soon as it becomes available.
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Affiliation(s)
- Z Zhong
- Mucosal Infection and Immunity Group, Section of Virology, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - M Haltalli
- Mucosal Infection and Immunity Group, Section of Virology, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - B Holder
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - T Rice
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - B Donaldson
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - M O'Driscoll
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK
| | - K Le-Doare
- Infection and Immunity Theme, St George's University of London, Tooting, UK
| | - B Kampmann
- Centre for International Child Health, Section of Paediatrics, Department of Medicine, St Mary's Campus, Imperial College London, UK.,Vaccines and Immunity Theme, MRC Unit The Gambia, at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia.,The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - J S Tregoning
- Mucosal Infection and Immunity Group, Section of Virology, Department of Medicine, St Mary's Campus, Imperial College London, UK
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65
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Houser KV, Yamshchikov GV, Bellamy AR, May J, Enama ME, Sarwar U, Larkin B, Bailer RT, Koup R, Paskel M, Subbarao K, Anderson E, Bernstein DI, Creech B, Keyserling H, Spearman P, Wright PF, Graham BS, Ledgerwood JE. DNA vaccine priming for seasonal influenza vaccine in children and adolescents 6 to 17 years of age: A phase 1 randomized clinical trial. PLoS One 2018; 13:e0206837. [PMID: 30388160 PMCID: PMC6214651 DOI: 10.1371/journal.pone.0206837] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children are susceptible to severe influenza infections and facilitate community transmission. One potential strategy to improve vaccine immunogenicity in children against seasonal influenza involves a trivalent hemagglutinin DNA prime-trivalent inactivated influenza vaccine (IIV3) boost regimen. METHODS Sites enrolled adolescents, followed by younger children, to receive DNA prime (1 mg or 4 mg) intramuscularly by needle-free jet injector (Biojector), followed by split virus 2012/13 seasonal IIV3 boost by needle and syringe approximately 18 weeks later. A comparator group received IIV3 prime and boost at similar intervals. Primary study objectives included evaluation of the safety and tolerability of the vaccine regimens, with secondary objectives of measuring antibody responses at four weeks post boost by hemagglutination inhibition (HAI) and neutralization assays. RESULTS Seventy-five children ≥6 to ≤17 years old enrolled. Local reactogenicity was higher after DNA prime compared to IIV3 prime (p<0.001 for pain/tenderness, redness, or swelling), but symptoms were mild to moderate in severity. Systemic reactogenicity was similar between vaccines. Overall, antibody responses were similar among groups, although HAI antibodies revealed a trend towards higher responses following 4 mg DNA-IIV3 compared to IIV3-IIV3. The fold increase of HAI antibodies to A/California/07/2009 [A(H1N1)pdm09] was significantly greater following 4 mg DNA-IIV3 (10.12 fold, 5.60-18.27 95%CI) compared to IIV3-IIV3 (3.86 fold, 2.32-6.44 95%CI). Similar neutralizing titers were observed between regimens, with a trend towards increased response frequencies in 4 mg DNA-IIV3. However, significant differences in fold increase, reported as geometric mean fold ratios, were detected against the H1N1 viruses within the neutralization panel: A/New Caledonia/20/1999 (1.41 fold, 1.10-1.81 95%CI) and A/South Carolina/1/1918 (1.55 fold, 1.27-1.89 95%CI). CONCLUSIONS In this first pediatric DNA vaccine study conducted in the U.S., the DNA prime-IIV3 boost regimen was safe and well tolerated. In children, the 4 mg DNA-IIV3 regimen resulted in antibody responses comparable to the IIV3-IIV3 regimen.
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MESH Headings
- Adolescent
- Antibodies, Viral/administration & dosage
- Antibodies, Viral/immunology
- Child
- Female
- Hemagglutination Inhibition Tests
- Humans
- Immunogenicity, Vaccine/drug effects
- Immunogenicity, Vaccine/immunology
- Influenza A Virus, H1N1 Subtype/drug effects
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Influenza Vaccines/administration & dosage
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Seasons
- Vaccines, DNA/administration & dosage
- Vaccines, Inactivated/administration & dosage
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Affiliation(s)
- Katherine V. Houser
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Galina V. Yamshchikov
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | | | - Jeanine May
- The Emmes Corporation, Rockville, MD, United States of America
| | - Mary E. Enama
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Uzma Sarwar
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Brenda Larkin
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Robert T. Bailer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Richard Koup
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Myeisha Paskel
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Kanta Subbarao
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Edwin Anderson
- Department of Internal Medicine, Saint Louis University, Saint Louis, MO, United States of America
| | - David I. Bernstein
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
| | - Buddy Creech
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Harry Keyserling
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Paul Spearman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Peter F. Wright
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States of America
| | - Barney S. Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Julie E. Ledgerwood
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States of America
- * E-mail:
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66
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Krefis AC, Fischereit J, Hoffmann P, Pinnschmidt H, Sorbe C, Augustin M, Augustin J. Temporal analysis of determinants for respiratory emergency department visits in a large German hospital. BMJ Open Respir Res 2018; 5:e000338. [PMID: 30487970 PMCID: PMC6241969 DOI: 10.1136/bmjresp-2018-000338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Associations between air pollutants, meteorological conditions and respiratory diseases have been extensively shown. The aim of this study was to investigate associations between daily meteorological data, data on air pollution and emergency department (ED) visits depending on the day of the week, season and year (study period from 2013 to 2015). METHODS Highly correlated environmental data entered a categorical principal components analysis (CATPCA). We analysed cross-correlation functions between the time series of the respective daily environmental factors and daily ED visits. Time lags with peak correlations of environmental variables obtained by the CATPCA on ED visits together with day of the week, year, running day (linear, quadratic and cubic), season and interaction terms entered the univariate analysis of variance (UNIANOVA) model. RESULTS The analyses demonstrated main effects on ED visits for the day of the week with highest admission rates on Mondays (B=10.69; ƞ2=0.333; p<0.001). A significant time trend could be observed showing increasing numbers of ED visits per each year (p<0.001). The variable 'running day' (linear, quadratic and cubic) indicated a significant non-linear effect over time. The variable season showed significant results with winter, spring and summer recording fewer ED visits compared with the reference season autumn. Environmental variables showed no direct associations with respiratory ED visits. DISCUSSION ED visits were significantly associated with temporal variables. Our data did not show direct associations between environmental variables and ED visits.In times of rapid urbanisation, increases in respiratory diseases, temperature and air pollution, our analyses can help focus future studies and enhance strategies to reduce increasing numbers of respiratory diseases and ED visits. Because the potential costs of medical care in hospitals can be high compared with physicians, public health recommendations for reducing the increasing ED visits should be promoted and evaluated.
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Affiliation(s)
- Anne Caroline Krefis
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jana Fischereit
- Meteorological Institute, University of Hamburg, Hamburg, Germany
| | - Peter Hoffmann
- Meteorological Institute, University of Hamburg, Hamburg, Germany
| | - Hans Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Sorbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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67
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Lin GL, McGinley JP, Drysdale SB, Pollard AJ. Epidemiology and Immune Pathogenesis of Viral Sepsis. Front Immunol 2018; 9:2147. [PMID: 30319615 PMCID: PMC6170629 DOI: 10.3389/fimmu.2018.02147] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/30/2018] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis can be caused by a broad range of pathogens; however, bacterial infections represent the majority of sepsis cases. Up to 42% of sepsis presentations are culture negative, suggesting a non-bacterial cause. Despite this, diagnosis of viral sepsis remains very rare. Almost any virus can cause sepsis in vulnerable patients (e.g., neonates, infants, and other immunosuppressed groups). The prevalence of viral sepsis is not known, nor is there enough information to make an accurate estimate. The initial standard of care for all cases of sepsis, even those that are subsequently proven to be culture negative, is the immediate use of broad-spectrum antibiotics. In the absence of definite diagnostic criteria for viral sepsis, or at least to exclude bacterial sepsis, this inevitably leads to unnecessary antimicrobial use, with associated consequences for antimicrobial resistance, effects on the host microbiome and excess healthcare costs. It is important to understand non-bacterial causes of sepsis so that inappropriate treatment can be minimised, and appropriate treatments can be developed to improve outcomes. In this review, we summarise what is known about viral sepsis, its most common causes, and how the immune responses to severe viral infections can contribute to sepsis. We also discuss strategies to improve our understanding of viral sepsis, and ways we can integrate this new information into effective treatment.
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Affiliation(s)
- Gu-Lung Lin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Joseph P McGinley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Simon B Drysdale
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom.,Department of Paediatrics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
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68
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Li Y, Wang XL, Zheng X. Impact of weather factors on influenza hospitalization across different age groups in subtropical Hong Kong. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1615-1624. [PMID: 29804235 DOI: 10.1007/s00484-018-1561-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 04/18/2018] [Accepted: 05/09/2018] [Indexed: 05/19/2023]
Abstract
Accumulating evidence demonstrates the significant influence of weather factors, especially temperature and humidity, on influenza seasonality. However, it is still unclear whether temperature variation within the same day, that is diurnal temperature range (DTR), is related to influenza seasonality. In addition, the different effects of weather factors on influenza seasonality across age groups have not been well documented in previous studies. Our study aims to explore the effects of DTR and humidity on influenza seasonality, and the differences in the association between weather factors and influenza seasonality among different age groups in Hong Kong, China. Generalized additive models were conducted to flexibly assess the impact of DTR, absolute humidity (vapor pressure, VP), and relative humidity on influenza seasonality in Hong Kong, China, from January 2012 to December 2016. Stratified analyses were performed to determine if the effects of weather factors differ across age groups (< 5, 5-9, 10-64, and > 64 years). The results suggested that DTR, absolute humidity, and relative humidity were significantly related to influenza seasonality in dry period (when VP is less than 20 mb), while no significant association was found in humid period (when VP is greater than 20 mb). The percentage changes of hospitalization rates due to influenza associated with per unit increase of weather factors in the very young children (age 0-4) and the elderly (age 65+) were higher than that in the adults (age 10-64). Diurnal temperature range is significantly associated with influenza seasonality in dry period, and the effects of weather factors differ across age groups in Hong Kong, China.
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Affiliation(s)
- Yapeng Li
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, 200032, China
| | - Xi-Ling Wang
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, 200032, China
| | - Xueying Zheng
- Department of Biostatistics, School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, 200032, China.
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69
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Zhou F, Trieu MC, Davies R, Cox RJ. Improving influenza vaccines: challenges to effective implementation. Curr Opin Immunol 2018; 53:88-95. [DOI: 10.1016/j.coi.2018.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/08/2018] [Accepted: 04/13/2018] [Indexed: 12/15/2022]
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70
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Schwarze J, Openshaw P, Jha A, Giacco SR, Firinu D, Tsilochristou O, Roberts G, Selby A, Akdis C, Agache I, Custovic A, Heffler E, Pinna G, Khaitov M, Nikonova A, Papadopoulos N, Akhlaq A, Nurmatov U, Renz H, Sheikh A, Skevaki C. Influenza burden, prevention, and treatment in asthma-A scoping review by the EAACI Influenza in asthma task force. Allergy 2018; 73:1151-1181. [PMID: 29105786 DOI: 10.1111/all.13333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma. The strongest evidence of an association was seen in studies of children. Countries in the European Union currently recommend influenza vaccination of adults with asthma; however, coverage varied between regions. Coverage was lower among children with asthma. Limited data suggest that good seroprotection and seroconversion can be achieved in both children and adults with asthma and that vaccination confers a degree of protection against influenza illness and asthma-related morbidity to children with asthma. There were insufficient data to determine efficacy in adults. Overall, influenza vaccines appeared to be safe for people with asthma. We identify knowledge gaps and make recommendations on future research needs in relation to influenza in patients with asthma.
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Affiliation(s)
- J. Schwarze
- Centre for Inflammation Research The Queens Medical Research Institute University of Edinburgh Edinburgh UK
| | - P. Openshaw
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - A. Jha
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - S. R. Giacco
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | - D. Firinu
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | | | - G. Roberts
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - A. Selby
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | - I. Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - A. Custovic
- Department of Paediatrics Imperial College London London UK
| | - E. Heffler
- Personalized Medicine Asthma and Allergy Clinic Department of Biomedical Sciences Humanitas University Milan Italy
| | - G. Pinna
- Department of Medical Microbiology National Kapodistrian University of Athens Athens Greece
| | - M. Khaitov
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - A. Nikonova
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - N. Papadopoulos
- Division of Infection, Inflammation & Respiratory Medicine The University of Manchester Manchester UK
- Allergy Department 2nd Paediatric Clinic National Kapodistrian University of Athens Athens Greece
| | - A. Akhlaq
- Department of Health and Hospital Management Institute of Business Management Korangi Creek Karachi 75190 Pakistan
| | - U. Nurmatov
- Division of Population Medicine School of Medicine Cardiff University the National Centre for Population Health and Wellbeing Research Wales UK
| | - H. Renz
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
| | - A. Sheikh
- Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - C. Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
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Abstract
PURPOSE OF REVIEW Influenza virus can cause severe or life-threatening infection in children. This review provides an update on antiviral medications available to treat and prevent influenza in both healthy children and children with underlying medical conditions, and recommendations on their appropriate use in the outpatient and inpatient settings. RECENT FINDINGS Despite the significant morbidity and mortality associated with influenza infection, a large number of children hospitalized with influenza do not receive specific antiviral treatment with a neuraminidase inhibitor. Although the effectiveness of this intervention has been debated, several recent observational studies have shown the potential benefits conferred by early antiviral treatment. Oral oseltamivir and inhaled zanamivir remain the best studied antiviral agents for influenza treatment and prevention. In addition, the US Food and Drug Administration recently approved peramivir, a novel neuraminidase inhibitor available for intravenous administration. SUMMARY Children with suspected or documented influenza infection benefit from early antiviral treatment with neuraminidase inhibitors that can shorten illness duration, decrease symptom severity, and lower the risk of complications leading to hospitalization and death. Unless contraindicated, all hospitalized children, children with underlying medical conditions, and those with severe or progressive symptoms of influenza should receive specific antiviral treatment for influenza with a neuraminidase inhibitor. Additionally, antiviral treatment of influenza-infected children in the outpatient setting should be strongly considered.
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An Evidence Synthesis Approach to Estimating the Proportion of Influenza Among Influenza-like Illness Patients. Epidemiology 2018; 28:484-491. [PMID: 28252453 DOI: 10.1097/ede.0000000000000646] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Estimation of the national-level incidence of seasonal influenza is notoriously challenging. Surveillance of influenza-like illness is carried out in many countries using a variety of data sources, and several methods have been developed to estimate influenza incidence. Our aim was to obtain maximally informed estimates of the proportion of influenza-like illness that is true influenza using all available data. METHODS We combined data on weekly general practice sentinel surveillance consultation rates for influenza-like illness, virologic testing of sampled patients with influenza-like illness, and positive laboratory tests for influenza and other pathogens, applying Bayesian evidence synthesis to estimate the positive predictive value (PPV) of influenza-like illness as a test for influenza virus infection. We estimated the weekly number of influenza-like illness consultations attributable to influenza for nine influenza seasons, and for four age groups. RESULTS The estimated PPV for influenza in influenza-like illness patients was highest in the weeks surrounding seasonal peaks in influenza-like illness rates, dropping to near zero in between-peak periods. Overall, 14.1% (95% credible interval [CrI]: 13.5%, 14.8%) of influenza-like illness consultations were attributed to influenza infection; the estimated PPV was 50% (95% CrI: 48%, 53%) for the peak weeks and 5.8% during the summer periods. CONCLUSIONS The model quantifies the correspondence between influenza-like illness consultations and influenza at a weekly granularity. Even during peak periods, a substantial proportion of influenza-like illness-61%-was not attributed to influenza. The much lower proportion of influenza outside the peak periods reflects the greater circulation of other respiratory pathogens relative to influenza.
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Shang M, Blanton L, Brammer L, Olsen SJ, Fry AM. Influenza-Associated Pediatric Deaths in the United States, 2010-2016. Pediatrics 2018; 141:peds.2017-2918. [PMID: 29440502 DOI: 10.1542/peds.2017-2918] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Influenza-associated pediatric deaths became a notifiable condition in the United States in 2004. METHODS We analyzed deaths in children aged <18 years with laboratory-confirmed influenza virus infection reported to the Centers for Disease Control and Prevention during the 2010-2011 to 2015-2016 influenza seasons. Data were collected with a standard case report form that included demographics, medical conditions, and clinical diagnoses. RESULTS Overall, 675 deaths were reported. The median age was 6 years (interquartile range: 2-12). The average annual incidence was 0.15 per 100 000 children (95% confidence interval: 0.14-0.16) and was highest among children aged <6 months (incidence: 0.66; 95% confidence interval: 0.53-0.82), followed by children aged 6-23 months (incidence: 0.33; 95% confidence interval: 0.27-0.39). Only 31% (n = 149 of 477) of children aged ≥6 months had received any influenza vaccination. Overall, 65% (n = 410 of 628) of children died within 7 days after symptom onset. Half of the children (n = 327 of 654) had no preexisting medical conditions. Compared with children with preexisting medical conditions, children with none were younger (median: 5 vs 8 years old), less vaccinated (27% vs 36%), more likely to die before hospital admission (77% vs 48%), and had a shorter illness duration (4 vs 7 days; P < .05 for all). CONCLUSIONS Each year, influenza-associated pediatric deaths are reported. Young children have the highest death rates, especially infants aged <6 months. Increasing vaccination among children, pregnant women, and caregivers of infants may reduce influenza-associated pediatric deaths.
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Affiliation(s)
- Mei Shang
- Epidemic Intelligence Service and.,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lynnette Brammer
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sonja J Olsen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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O'Leary ST, Riley LE, Lindley MC, Allison MA, Crane LA, Hurley LP, Beaty BL, Brtnikova M, Collins M, Albert AP, Fisher AK, Jiles AJ, Kempe A. Immunization Practices of U.S. Obstetrician/Gynecologists for Pregnant Patients. Am J Prev Med 2018; 54:205-213. [PMID: 29246674 PMCID: PMC5783738 DOI: 10.1016/j.amepre.2017.10.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/14/2017] [Accepted: 10/20/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION U.S. obstetrician/gynecologists play a critical role as vaccinators of pregnant women. However, little is known about their current immunization practices. Thus, study objectives were to determine (1) practices related to assessment of vaccination status and vaccine delivery for pregnant patients; (2) barriers to stocking and administering vaccines; and (3) factors associated with administering both influenza and tetanus, diphtheria, and acellular pertussis (Tdap) vaccines. METHODS An e-mail and mail survey among a national sample of obstetrician/gynecologists conducted July-October 2015 (analysis August 2016-August 2017). RESULTS The response rate was 73.2% (353/482). Among obstetrician/gynecologists caring for pregnant women (n=324), vaccination status was most commonly assessed for influenza (97%), Tdap (92%), and measles, mumps, and rubella vaccines (88%). Vaccines most commonly administered included influenza (85%) and Tdap (76%). Few respondents reported administering other vaccines to pregnant patients. More physicians reported using standing orders for influenza (66%) than Tdap (39%). Other evidence-based strategies for increasing vaccine uptake were less frequently used (electronic decision support, 42%; immunization information system to record [13%] or assess vaccination status [11%]; reminder/recall, 7%). Barriers most commonly reported were provider financial barriers, yet provider attitudinal barriers were rare. Providers who administered both influenza and Tdap vaccines were more likely to be female, perceive fewer financial and practice barriers, less likely to be in private practice, and perceive more patient barriers. CONCLUSIONS Although most obstetrician/gynecologists administer some vaccines to pregnant women, the focus remains on influenza and Tdap. Financial barriers and infrequent use of evidence-based strategies for increasing vaccination uptake may be hindering delivery of a broader complement of adult vaccines in obstetrician/gynecologist offices.
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Affiliation(s)
- Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Laura E Riley
- The American Congress of Obstetricians and Gynecologists, Washington, District of Columbia
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mandy A Allison
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lori A Crane
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura P Hurley
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Division of General Internal Medicine, Denver Health, Denver, Colorado
| | - Brenda L Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Michaela Brtnikova
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Margaret Collins
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Alison P Albert
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison K Fisher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela J Jiles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev 2018; 2:CD004879. [PMID: 29388195 PMCID: PMC6491174 DOI: 10.1002/14651858.cd004879.pub5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The consequences of influenza in children and adults are mainly absenteeism from school and work. However, the risk of complications is greatest in children and people over 65 years of age. This is an update of a review published in 2011. Future updates of this review will be made only when new trials or vaccines become available. Observational data included in previous versions of the review have been retained for historical reasons but have not been updated because of their lack of influence on the review conclusions. OBJECTIVES To assess the effects (efficacy, effectiveness, and harm) of vaccines against influenza in healthy children. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 12), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (1966 to 31 December 2016), Embase (1974 to 31 December 2016), WHO International Clinical Trials Registry Platform (ICTRP; 1 July 2017), and ClinicalTrials.gov (1 July 2017). SELECTION CRITERIA Randomised controlled trials comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy children under 16 years. Previous versions of this review included 19 cohort and 11 case-control studies. We are no longer updating the searches for these study designs but have retained the observational studies for historical purposes. DATA COLLECTION AND ANALYSIS Review authors independently assessed risk of bias and extracted data. We used GRADE to rate the certainty of evidence for the key outcomes of influenza, influenza-like illness (ILI), complications (hospitalisation, ear infection), and adverse events. Due to variation in control group risks for influenza and ILI, absolute effects are reported as the median control group risk, and numbers needed to vaccinate (NNVs) are reported accordingly. For other outcomes aggregate control group risks are used. MAIN RESULTS We included 41 clinical trials (> 200,000 children). Most of the studies were conducted in children over the age of two and compared live attenuated or inactivated vaccines with placebo or no vaccine. Studies were conducted over single influenza seasons in the USA, Western Europe, Russia, and Bangladesh between 1984 and 2013. Restricting analyses to studies at low risk of bias showed that influenza and otitis media were the only outcomes where the impact of bias was negligible. Variability in study design and reporting impeded meta-analysis of harms outcomes.Live attenuated vaccinesCompared with placebo or do nothing, live attenuated influenza vaccines probably reduce the risk of influenza infection in children aged 3 to 16 years from 18% to 4% (risk ratio (RR) 0.22, 95% confidence interval (CI) 0.11 to 0.41; 7718 children; moderate-certainty evidence), and they may reduce ILI by a smaller degree, from 17% to 12% (RR 0.69, 95% CI 0.60 to 0.80; 124,606 children; low-certainty evidence). Seven children would need to be vaccinated to prevent one case of influenza, and 20 children would need to be vaccinated to prevent one child experiencing an ILI. Acute otitis media is probably similar following vaccine or placebo during seasonal influenza, but this result comes from a single study with particularly high rates of acute otitis media (RR 0.98, 95% CI 0.95 to 1.01; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. Vaccinating children may lead to fewer parents taking time off work, although the CI includes no effect (RR 0.69, 95% CI 0.46 to 1.03; low-certainty evidence). Data on the most serious consequences of influenza complications leading to hospitalisation were not available. Data from four studies measuring fever following vaccination varied considerably, from 0.16% to 15% in children who had live vaccines, while in the placebo groups the proportions ranged from 0.71% to 22% (very low-certainty evidence). Data on nausea were not reported.Inactivated vaccinesCompared with placebo or no vaccination, inactivated vaccines reduce the risk of influenza in children aged 2 to 16 years from 30% to 11% (RR 0.36, 95% CI 0.28 to 0.48; 1628 children; high-certainty evidence), and they probably reduce ILI from 28% to 20% (RR 0.72, 95% CI 0.65 to 0.79; 19,044 children; moderate-certainty evidence). Five children would need to be vaccinated to prevent one case of influenza, and 12 children would need to be vaccinated to avoid one case of ILI. The risk of otitis media is probably similar between vaccinated children and unvaccinated children (31% versus 27%), although the CI does not exclude a meaningful increase in otitis media following vaccination (RR 1.15, 95% CI 0.95 to 1.40; 884 participants; moderate-certainty evidence). There was insufficient information available to determine the effect of vaccines on school absenteeism due to very low-certainty evidence from one study. We identified no data on parental working time lost, hospitalisation, fever, or nausea.We found limited evidence on secondary cases, requirement for treatment of lower respiratory tract disease, and drug prescriptions. One brand of monovalent pandemic vaccine was associated with a sudden loss of muscle tone triggered by the experience of an intense emotion (cataplexy) and a sleep disorder (narcolepsy) in children. Evidence of serious harms (such as febrile fits) was sparse. AUTHORS' CONCLUSIONS In children aged between 3 and 16 years, live influenza vaccines probably reduce influenza (moderate-certainty evidence) and may reduce ILI (low-certainty evidence) over a single influenza season. In this population inactivated vaccines also reduce influenza (high-certainty evidence) and may reduce ILI (low-certainty evidence). For both vaccine types, the absolute reduction in influenza and ILI varied considerably across the study populations, making it difficult to predict how these findings translate to different settings. We found very few randomised controlled trials in children under two years of age. Adverse event data were not well described in the available studies. Standardised approaches to the definition, ascertainment, and reporting of adverse events are needed. Identification of all global cases of potential harms is beyond the scope of this review.
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Affiliation(s)
- Tom Jefferson
- University of OxfordCentre for Evidence Based MedicineOxfordUKOX2 6GG
| | - Alessandro Rivetti
- ASL CN2 Alba BraDipartimento di Prevenzione ‐ S.Pre.S.A.LVia Vida 10AlbaPiemonteItaly12051
| | - Carlo Di Pietrantonj
- Local Health Unit Alessandria‐ ASL ALRegional Epidemiology Unit SeREMIVia Venezia 6AlessandriaAlessandriaItaly15121
| | - Vittorio Demicheli
- Azienda Sanitaria Locale ASL ALServizio Regionale di Riferimento per l'Epidemiologia, SSEpi‐SeREMIVia Venezia 6AlessandriaPiemonteItaly15121
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Hart RJ, Stevenson MD, Smith MJ, LaJoie AS, Cross K. Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. JAMA Pediatr 2018; 172:e173879. [PMID: 29114729 PMCID: PMC6583269 DOI: 10.1001/jamapediatrics.2017.3879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Influenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective. OBJECTIVE To compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients. DESIGN, SETTING, AND PARTICIPANTS Using commercial decision analysis software, a cost-effectiveness analysis was performed from January 1, 2016, to June 1, 2017, to compare influenza vaccine strategies at a tertiary, urban, freestanding PED with an estimated 60 000 visits per year among a hypothetical cohort of children visiting the above PED during influenza season. Sensitivity analyses estimated the effect of uncertainties across a variety of input variables (eg, influenza prevalence, vaccine price and effectiveness, and costs of complications). MAIN OUTCOMES AND MEASURES The primary outcomes were cost and incremental cost-effectiveness ratio in dollars per influenza case averted. Secondary outcomes included total societal costs, hospitalizations and deaths averted, and quality-adjusted life-years gained. RESULTS Offering influenza vaccine to all eligible patients has the lowest cost, at $114.45 (95% CI, $55.48-$245.45) per case of influenza averted. This strategy saves $33.51 (95% CI, $18-$62) per case averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients. Offering vaccine to all patients resulted in 0.72 days (95% CI, 0.18-1.78 days) of quality-adjusted life-years lost, whereas offering to none resulted in 0.91 days (95% CI, 0.25-2.2 days) of quality-adjusted life-years lost. In sensitivity analyses, this strategy remains robustly cost-effective across a wide range of assumptions. In addition to being the most cost-effective strategy regardless of age or risk status, routine vaccination in the PED results in a net societal monetary benefit under many circumstances. In Monte Carlo analysis, offering vaccine to all patients was superior to other strategies in at least 99.8% of cases. CONCLUSIONS AND RELEVANCE Although few PEDs routinely offer influenza vaccination, doing so appears to be cost-effective, with the potential to significantly reduce the economic (and patient) burden of pediatric influenza.
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Affiliation(s)
- Rebecca J. Hart
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michelle D. Stevenson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michael J. Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - A. Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky
| | - Keith Cross
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
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77
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Fouda GG, Martinez DR, Swamy GK, Permar SR. The Impact of IgG transplacental transfer on early life immunity. Immunohorizons 2018; 2:14-25. [PMID: 29457151 PMCID: PMC5812294 DOI: 10.4049/immunohorizons.1700057] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pediatric vaccines have significantly reduced infectious disease-related infant mortality, but as protective immunity often require several infant vaccine doses; maternally-acquired antibodies are critical to protect infants during the first months of life. Consequently, immunization of pregnant women is an important strategy not only to protect mothers from infection, but also to provide immunity to young infants. Nevertheless, maternal immunization can also negatively impact early life immunity. In fact, maternal antibodies can interfere with the development of infant immune responses, though it is unclear if such interference is clinically significant. Moreover, the transplacental transfer of maternal immunoglobulin therapeutics can be harmful to the fetus. Thus, the risk/benefit of maternal immunization for both the mother and the fetus should be carefully weighed. In addition, it is critical to fully understand the mechanisms by which IgG is transferred across the placenta in order to develop optimal maternal and infant immunization strategies.
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Affiliation(s)
- Genevieve G. Fouda
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Pediatrics, Duke University Medical Center, Durham, NC, 27710
| | - David R. Martinez
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, 27710
| | - Geeta K. Swamy
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 27710
| | - Sallie R. Permar
- Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710
- Department of Pediatrics, Duke University Medical Center, Durham, NC, 27710
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Principi N, Camilloni B, Esposito S. Influenza immunization policies: Which could be the main reasons for differences among countries? Hum Vaccin Immunother 2017; 14:684-692. [PMID: 29227734 PMCID: PMC5861803 DOI: 10.1080/21645515.2017.1405188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Despite the availability of effective prophylactic and therapeutic measures, influenza remains one of the most important infectious disease threats to the human population. Every year, seasonal influenza epidemics infect up to 30% of the population; a relevant portion of the ill are hospitalized, and more than a marginal number die. In an attempt to reduce the medical, social and economic burden of influenza, vaccines are recommended by many health authorities worldwide. However, not all countries have a national program for influenza immunization. The main aim of this paper is to list the differences among influenza immunization policies of various countries, highlighting the most important scientific reasons that may have led health authorities to make different decisions. The manuscript highlights that national influenza immunization policies can vary significantly from country to country. These differences arise from insufficient evidence of the relevance of influenza infection from a clinical, social and economic point of view. The lack of precise data on the true frequency and clinical relevance of influenza infection makes it nearly impossible to establish the economic burden of influenza. Moreover, it remains very difficult to evaluate the efficacy of the different influenza vaccines and whether their use is cost-effective considering the various types of people receiving them and the indirect advantages. Disparities among countries will be overcome only when more reliable data regarding all these aspects of influenza infection, particularly those related to the true impact of the disease, are precisely defined.
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Affiliation(s)
- Nicola Principi
- a Emeritus Professor of Pediatrics, Università degli Studi di Milano , Milano , Italy
| | - Barbara Camilloni
- b Department of Experimental Medicine , Università degli Studi di Perugia , Perugia , Italy
| | - Susanna Esposito
- c Pediatric Clinic , Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia , Perugia , Italy
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Teros-Jaakkola T, Toivonen L, Schuez-Havupalo L, Karppinen S, Julkunen I, Waris M, Peltola V. Influenza virus infections from 0 to 2 years of age: A birth cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:526-533. [PMID: 29254653 DOI: 10.1016/j.jmii.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/14/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Influenza vaccine has been recommended in Finland since 2007 for all children of 6-35 months of age and in 2009 for those ≥6 months against pandemic influenza. We investigated the incidence of influenza and vaccine effectiveness in a birth cohort of children in 2008-2011. METHODS We followed 923 children from birth to 2 years of age for respiratory tract infections. A nasal swab sample for PCR for influenza A and B viruses was taken at the onset of acute respiratory infections. Samples were collected either at the study clinic or at home by parents. Vaccination data was retrieved from the health registries. RESULTS Vaccination coverage of children aged 6-23 months was 22-47% against seasonal influenza and 80% against the A(H1N1)pdm09 virus in the pandemic season 2009-2010. During 3 influenza seasons, 1607 nasal swab samples were collected. Influenza was confirmed in 56 (6.1%) of 923 children (16 A(H1N1), 14 A(H3N2), and 26 B viruses). The incidence of influenza was 5.1% in 2008-2009, 2.7% in 2009-2010, and 5.0% in 2010-2011. Effectiveness of the adjuvanted vaccine against the pandemic influenza A(H1N1)pdm09 was 97% (95% confidence interval, 76-100%). Three children with influenza were hospitalized. CONCLUSION The yearly incidence of seasonal influenza was 5% in this cohort of very young children with variable influenza vaccine coverage. Adjuvanted vaccine against the pandemic influenza was highly effective. Both seasonal and pandemic influenza cases were mostly non-severe.
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Affiliation(s)
- Tamara Teros-Jaakkola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Laura Toivonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Linnea Schuez-Havupalo
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Sinikka Karppinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Julkunen
- Department of Virology, University of Turku, Turku, Finland
| | - Matti Waris
- Department of Virology, University of Turku, Turku, Finland
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
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Malosh RE, Martin ET, Ortiz JR, Monto AS. The risk of lower respiratory tract infection following influenza virus infection: A systematic and narrative review. Vaccine 2017; 36:141-147. [PMID: 29157959 PMCID: PMC5736984 DOI: 10.1016/j.vaccine.2017.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/07/2017] [Indexed: 01/18/2023]
Abstract
Background Lower respiratory tract infections (LRTI) are a major cause of morbidity and mortality worldwide, particularly in young children and older adults. Influenza is known to cause severe disease but the risk of developing LRTI following influenza virus infection in various populations has not been systematically reviewed. Such data are important for estimating the impact specific influenza vaccine programs would have on LRTI outcomes in a community. We sought to review the published literature to determine the risk of developing LRTI following an influenza virus infection in individuals of any age. Methods and findings We conducted a systematic review to identify prospective studies that estimated the incidence of LRTI following laboratory-confirmed influenza virus infection. We searched PubMed, Medline, and Embase databases for relevant literature. We supplemented this search with a narrative review of influenza and LRTI. The systematic review identified two prospective studies that both followed children less than 5 years. We also identified one additional pediatric study from our narrative review meeting the study inclusion criteria. Finally, we summarized recent case-control studies on the etiology of pneumonia in both adults and children. Conclusions There is a dearth of prospective studies evaluating the risk of developing LRTI following influenza virus infection. Determining the burden of severe LRTI that is attributable to influenza is necessary to estimate the benefits of influenza vaccine on this important public health outcome. Vaccine probe studies are an efficient way to evaluate these questions and should be encouraged going forward.
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Affiliation(s)
- Ryan E Malosh
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | | | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor, MI, United States.
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Choi JG, Jin YH, Lee H, Oh TW, Yim NH, Cho WK, Ma JY. Protective Effect of Panax notoginseng Root Water Extract against Influenza A Virus Infection by Enhancing Antiviral Interferon-Mediated Immune Responses and Natural Killer Cell Activity. Front Immunol 2017; 8:1542. [PMID: 29181006 PMCID: PMC5693858 DOI: 10.3389/fimmu.2017.01542] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/30/2017] [Indexed: 01/27/2023] Open
Abstract
Influenza is an acute respiratory illness caused by the influenza A virus, which causes economic losses and social disruption mainly by increasing hospitalization and mortality rates among the elderly and people with chronic diseases. Influenza vaccines are the most effective means of preventing seasonal influenza, but can be completely ineffective if there is an antigenic mismatch between the seasonal vaccine virus and the virus circulating in the community. In addition, influenza viruses resistant to antiviral drugs are emerging worldwide. Thus, there is an urgent need to develop new vaccines and antiviral drugs against these viruses. In this study, we conducted in vitro and in vivo analyses of the antiviral effect of Panax notoginseng root (PNR), which is used as an herbal medicine and nutritional supplement in Korea and China. We confirmed that PNR significantly prevented influenza virus infection in a concentration-dependent manner in mouse macrophages. In addition, PNR pretreatment inhibited viral protein (PB1, PB2, HA, NA, M1, PA, M2, and NP) and viral mRNA (NS1, HA, PB2, PA, NP, M1, and M2) expression. PNR pretreatment also increased the secretion of pro-inflammatory cytokines [tumor necrosis factor alpha and interleukin 6] and interferon (IFN)-beta and the phosphorylation of type-I IFN-related proteins (TANK-binding kinase 1, STAT1, and IRF3) in vitro. In mice exposed to the influenza A H1N1 virus, PNR treatment decreased mortality by 90% and prevented weight loss (by approximately 10%) compared with the findings in untreated animals. In addition, splenocytes from PNR-administered mice displayed significantly enhanced natural killer (NK) cell activity against YAC-1 cells. Taking these findings together, PNR stimulates an antiviral response in murine macrophages and mice that protects against viral infection, which may be attributable to its ability to stimulate NK cell activity. Further investigations are needed to reveal the molecular mechanisms underlying the protective effects of PNR and its components against influenza virus A infection.
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Affiliation(s)
- Jang-Gi Choi
- Korean Medicine (KM) Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu, South Korea
| | - Young-Hee Jin
- Korean Medicine (KM) Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu, South Korea
| | - Heeeun Lee
- Korean Medicine (KM) Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu, South Korea
| | - Tae Woo Oh
- Korean Medicine (KM) Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu, South Korea
| | - Nam-Hui Yim
- Korean Medicine (KM) Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu, South Korea
| | - Won-Kyung Cho
- Korean Medicine (KM) Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu, South Korea
| | - Jin Yeul Ma
- Korean Medicine (KM) Application Center, Korea Institute of Oriental Medicine (KIOM), Daegu, South Korea
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Abstract
BACKGROUND Influenza is a major cause of respiratory morbidity worldwide. It poses a risk of complications in children with cardiac disease. Influenza vaccine is considered the most effective and safe means of preventing the disease. The aims of this study were to determine the rate of influenza vaccination in children with cardiac disease and to identify the reasons for failure to vaccinate in this patient population. METHODS The study group included 186 children and their parents who attended the cardiology institute of a tertiary pediatric medical center between September and October 2012. Parents were asked to complete a questionnaire covering demographics, clinical features, influenza vaccination, receipt of advice from medical professionals regarding vaccination and personal knowledge about and attitude toward the influenza vaccine. RESULTS Median age of the children was 7.6 years. Thirty-six percent had been vaccinated in the previous influenza season. Vaccination was unrelated to the child's age or sex or the parents' education. Factors significantly affecting the decision of the parents to have their child vaccinated were their knowledge, beliefs and conceptions about the vaccine and their receipt of a recommendation to do so from the pediatrician or cardiologist (P < 0.001). CONCLUSIONS The rate of vaccination against influenza is low in children with heart disease. Major factors encouraging vaccination are proper parental knowledge and the recommendation of the primary physician or cardiologist. Medical professionals caring for this patient population should be alerted to the need to routinely counsel parents on the importance of influenza vaccination.
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83
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Influenza vaccine use to protect healthy children: A debated topic. Vaccine 2017; 36:5391-5396. [PMID: 28928077 DOI: 10.1016/j.vaccine.2017.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 08/19/2017] [Accepted: 09/01/2017] [Indexed: 11/20/2022]
Abstract
At the beginning of this century, a number of studies suggested that in healthy children, particularly those <2years of age, influenza could have a serious and complicated course, as it frequently led to hospitalization and sometimes, albeit rarely, to death. Moreover, pre-schoolers and school-age children were found to be among the most important causes of influenza transmission to the community, as they shed the virus for a longer time than adults and had frequent contact with greater numbers of individuals through day-care and school. These findings led a number of health authorities to modify the official recommendations regarding the use of influenza vaccine in healthy children. Several factors seem to indicate that vaccination against influenza in healthy children of any age and in pregnant women could be effective in preventing the disease in the entire paediatric population and in providing herd immunity in adults and old people as well. The direct advantages of the vaccine seem greater in younger subjects, particularly those <2-3years of age. Vaccination of older children is considered effective by most experts, but high vaccination coverage of these subjects has been difficult to attain. Similar difficulties have been identified for the vaccination of pregnant women. These challenges can be overcome, at least in part, by appropriate information and accurate evaluations of available data. In addition, further studies specifically designed to clarify unresolved problems regarding vaccine use in paediatric and pregnant populations are needed to convince reluctant health authorities. More effective vaccines for younger children as well as improved availability of data regarding the optimal time period for vaccine administration in pregnant women appear relevant in this regard.
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84
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Fell DB, Johnson J, Mor Z, Katz MA, Skidmore B, Neuzil KM, Ortiz JR, Bhat N. Incidence of laboratory-confirmed influenza disease among infants under 6 months of age: a systematic review. BMJ Open 2017; 7:e016526. [PMID: 28882916 PMCID: PMC5595206 DOI: 10.1136/bmjopen-2017-016526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to assess incidence rates of laboratory-confirmed influenza (LCI) outcomes among infants under 6 months of age. DESIGN Systematic literature search and review of indexed studies in PubMed, EMBASE, the Cochrane Library and CINAHL Plus from inception to 19 April 2017. SETTING Population-based estimates from community or hospital settings. PARTICIPANTS Infants under 6 months of age. PRIMARY AND SECONDARY OUTCOME MEASURES LCI illness in ambulatory care settings, LCI hospitalisation, LCI intensive care unit admission and LCI death. Only studies with population-based incidence data were included. RESULTS We identified 27 primary studies, 11 of which were from the USA, four were from other non-US high-income settings and the remaining were from lower-middle-income or upper-middle-income countries. Most studies (n=23) assessed incidence of LCI hospitalisation, but meta-analysis to pool study-specific rates was not possible due to high statistical and methodological heterogeneity. Among US studies, the reported incidence of LCI hospitalisation ranged from 9.3 to 91.2 per 10 000 infants under 6 months for seasonal influenza, while the only US-based estimate for pandemic H1N1 influenza was 20.2 per 10 000 infants. Reported rates for LCI hospitalisation for seasonal influenza from other countries ranged from 6.2 to 73.0 per 10 000 infants under 6 months, with the exception of one study with an estimated rate of 250 per 10 000 infants. No events were reported in five of the nine studies that evaluated LCI death among infants under 6 months. CONCLUSION Our review of published studies found limited data on LCI outcomes for infants under 6 months, particularly from non-US settings. Globally representative and reliable incidence data are necessary to fully evaluate influenza disease burden and the potential impact of maternal influenza immunisation programme on morbidity and mortality in young infants.
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Affiliation(s)
- Deshayne B Fell
- University of Ottawa and Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Jeanene Johnson
- Independent Epidemiology Consultant, Los Gatos, California, USA
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Katz
- Medical School for International Health and Department of Health Systems Management, Ben Gurion University in the Negev, Beersheba, Israel
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Kathleen M Neuzil
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Justin R Ortiz
- Initiative for Vaccine Research, WHO, Geneva, Switzerland
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
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85
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Wang X, Wu W, Zhang W, Leland Booth J, Duggan ES, Tian L, More S, Zhao YD, Sawh RN, Liu L, Zou MH, Metcalf JP. RIG-I overexpression decreases mortality of cigarette smoke exposed mice during influenza A virus infection. Respir Res 2017; 18:166. [PMID: 28865477 PMCID: PMC5581920 DOI: 10.1186/s12931-017-0649-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/25/2017] [Indexed: 12/22/2022] Open
Abstract
Background Retinoic acid-inducible gene I (RIG-I) is an important regulator of virus-induced antiviral interferons (IFNs) and proinflammatory cytokines which participate in clearing viral infections. Cigarette smoke (CS) exposure increases the frequency and severity of respiratory tract infections. Methods We generated a RIG-I transgenic (TG) mouse strain that expresses the RIG-I gene product under the control of the human lung specific surfactant protein C promoter. We compared the mortality and host immune responses of RIG-I TG mice and their litter-matched wild type (WT) mice following challenge with influenza A virus (IAV). Results RIG-I overexpression increased survival of IAV-infected mice. CS exposure increased mortality in WT mice infected with IAV. Remarkably, the effect of RIG-I overexpression on survival during IAV infection was enhanced in CS-exposed animals. CS-exposed IAV-infected WT mice had a suppressed innate response profile in the lung compared to sham-exposed IAV-infected WT mice in terms of the protein concentration, total cell count and inflammatory cell composition in the bronchoalveolar lavage fluid. RIG-I overexpression restored the innate immune response in CS-exposed mice to that seen in sham-exposed WT mice during IAV infection, and is likely responsible for enhanced survival in RIG-I TG mice as restoration preceded death of the animals. Conclusions Our results demonstrate that RIG-I overexpression in mice is protective for CS enhanced susceptibility of smokers to influenza infection, and that CS mediated RIG-I suppression may be partially responsible for the increased morbidity and mortality of the mice exposed to IAV. Thus, optimizing the RIG-I response may be an important treatment strategy for CS-enhanced lung infections, particularly those due to IAV.
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Affiliation(s)
- Xiaoqiu Wang
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wenxin Wu
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wei Zhang
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - J Leland Booth
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Elizabeth S Duggan
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lili Tian
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunil More
- The Lundberg-Kienlen Lung Biology and Toxicology Laboratory, Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Yan D Zhao
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ravindranauth N Sawh
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Lin Liu
- The Lundberg-Kienlen Lung Biology and Toxicology Laboratory, Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Ming-Hui Zou
- Center of Molecular and Translational Medicine, Georgia State University, Atlanta, GA, USA
| | - Jordan P Metcalf
- Pulmonary and Critical Care Division, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. .,Veterans Affairs Medical Center, Oklahoma City, OK, USA. .,Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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86
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Influenza epidemiology and immunization during pregnancy: Final report of a World Health Organization working group. Vaccine 2017; 35:5738-5750. [PMID: 28867508 PMCID: PMC8274347 DOI: 10.1016/j.vaccine.2017.08.037] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/17/2017] [Indexed: 12/05/2022]
Abstract
From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal influenza immunization reduces the risk of adverse birth outcomes was conflicting, and many observational studies were subject to substantial bias. The lack of scientific clarity regarding disease burden or magnitude of vaccine efficacy against severe illness poses challenges for robust estimation of the potential impact of maternal influenza immunization programs.
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87
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Abstract
Influenza is an acute respiratory illness, caused by influenza A, B, and C viruses, that occurs in local outbreaks or seasonal epidemics. Clinical illness follows a short incubation period and presentation ranges from asymptomatic to fulminant, depending on the characteristics of both the virus and the individual host. Influenza A viruses can also cause sporadic infections or spread worldwide in a pandemic when novel strains emerge in the human population from an animal host. New approaches to influenza prevention and treatment for management of both seasonal influenza epidemics and pandemics are desirable. In this Seminar, we discuss the clinical presentation, transmission, diagnosis, management, and prevention of seasonal influenza infection. We also review the animal-human interface of influenza, with a focus on current pandemic threats.
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Affiliation(s)
- Catharine Paules
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kanta Subbarao
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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88
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Alsuwaidi AR, Al-Mekaini LA, Kamal SM, Narchi H, Souid AK. Seroprevalence of influenza A and B viruses among unvaccinated children in the United Arab Emirates: a cross-sectional study. BMC Res Notes 2017; 10:379. [PMID: 28797306 PMCID: PMC5553759 DOI: 10.1186/s13104-017-2720-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/29/2017] [Indexed: 11/10/2022] Open
Abstract
Background Young children are at increased risk of severe influenza disease and, thus, are good candidates for receiving annual vaccination. Nevertheless, the influenza vaccine is infrequently given to children in our region. The primary objectives of this study are to monitor the serologic immunities against influenza A and B viruses, and provide pediatric data that support the need for influenza vaccination in the community. Methods Influenza A and B virus-specific IgG antibodies were measured in 294 children (median age 4.1 years; range 1.9–12.5 years) between July 2014 and September 2015. Results The percentage of children who were seropositive for influenza A IgG was 15.8%, equivocal 7.4%, and negative 76.8%. The corresponding values for influenza B IgG were 31.3, 9.6, and 59.1%, respectively. There was a higher seropositivity rate for influenza B than for influenza A in all age groups. The percentage of children who were seropositive for either influenza A or B IgG was 27.9% and for both was only 2.7%. Conclusions Most of the studied children are serologically naïve and, thus, are likely to acquire primary influenza disease. A national policy that endorses childhood influenza vaccination is highly advisable.
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Affiliation(s)
- Ahmed R Alsuwaidi
- Department of Pediatrics, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE.
| | - Lolowa A Al-Mekaini
- Department of Pediatrics, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - Salwa M Kamal
- Ambulatory Healthcare Services, Abu Dhabi Health Services Company (SEHA), Abu Dhabi, UAE
| | - Hassib Narchi
- Department of Pediatrics, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
| | - Abdul-Kader Souid
- Department of Pediatrics, United Arab Emirates University, P.O. Box 17666, Al Ain, UAE
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89
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Singanayagam A, Zambon M, Lalvani A, Barclay W. Urgent challenges in implementing live attenuated influenza vaccine. THE LANCET. INFECTIOUS DISEASES 2017; 18:e25-e32. [PMID: 28780285 DOI: 10.1016/s1473-3099(17)30360-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/10/2017] [Accepted: 05/25/2017] [Indexed: 12/26/2022]
Abstract
Conflicting reports have emerged about the effectiveness of the live attenuated influenza vaccine. The live attenuated influenza vaccine appears to protect particularly poorly against currently circulating H1N1 viruses that are derived from the 2009 pandemic H1N1 viruses. During the 2015-16 influenza season, when pandemic H1N1 was the predominant virus, studies from the USA reported a complete lack of effectiveness of the live vaccine in children. This finding led to a crucial decision in the USA to recommend that the live vaccine not be used in 2016-17 and to switch to the inactivated influenza vaccine. Other countries, including the UK, Canada, and Finland, however, have continued to recommend the use of the live vaccine. This policy divergence and uncertainty has far reaching implications for the entire global community, given the importance of the production capabilities of the live attenuated influenza vaccine for pandemic preparedness. In this Personal View, we discuss possible explanations for the observed reduced effectiveness of the live attenuated influenza vaccine and highlight the underpinning scientific questions. Further research to understand the reasons for these observations is essential to enable informed public health policy and commercial decisions about vaccine production and development in coming years.
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Affiliation(s)
- Anika Singanayagam
- Department of Medicine, Imperial College, London, UK; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College, London, UK
| | - Maria Zambon
- Virus Reference Department, National Infection Service, Public Health England, Colindale, London, UK; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College, London, UK
| | - Ajit Lalvani
- National Heart and Lung Institute, Imperial College, London, UK; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College, London, UK
| | - Wendy Barclay
- Department of Medicine, Imperial College, London, UK; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College, London, UK.
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90
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van der Lubbe JEM, Vreugdenhil J, Damman S, Vaneman J, Klap J, Goudsmit J, Radošević K, Roozendaal R. Maternal antibodies protect offspring from severe influenza infection and do not lead to detectable interference with subsequent offspring immunization. Virol J 2017. [PMID: 28651593 PMCID: PMC5485558 DOI: 10.1186/s12985-017-0787-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Various studies have shown that infants under the age of 6 months are especially vulnerable for complications due to influenza. Currently there are no vaccines licensed for use in this age group. Vaccination of pregnant women during the last trimester, recommended by the WHO as protective measure for this vulnerable female population, may provide protection of newborns at this early age. Although it has been observed that maternal vaccination can passively transfer protection, maternal antibodies could possibly also interfere with subsequent active vaccination of the offspring. METHODS Using a mouse model, we evaluated in depth the ability of maternal influenza vaccination to protect offspring and the effect of maternal immunization on the subsequent influenza vaccination of the offspring. By varying the regimen of maternal immunization we explored the impact of different levels of maternal antibodies on the longevity of these antibodies in their progeny. We subsequently assessed to what extent maternal antibodies can mediate direct protection against influenza in their offspring, and whether these antibodies interfere with protection induced by active vaccination of the offspring. RESULTS The number of immunizations of pregnant mice correlates to the level and longevity of maternal antibodies in the offspring. When these antibodies are present at time of influenza challenge they protect offspring against lethal influenza challenge, even in the absence of detectable HAI titers. Moreover, no detectable interference of passively-transferred maternal antibodies on the subsequent vaccination of the offspring was observed. CONCLUSION In the absence of a licensed influenza vaccine for young children, vaccination of pregnant women is a promising measure to provide protection of young infants against severe influenza infection.
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Affiliation(s)
- Joan E M van der Lubbe
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Archimedesweg 4-6, 2333CN, Leiden, The Netherlands.
| | - Jessica Vreugdenhil
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Archimedesweg 4-6, 2333CN, Leiden, The Netherlands
| | - Sarra Damman
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Archimedesweg 4-6, 2333CN, Leiden, The Netherlands
| | - Joost Vaneman
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Archimedesweg 4-6, 2333CN, Leiden, The Netherlands
| | - Jaco Klap
- Janssen Prevention Center, Center of Excellence of Janssen Research & Development, Pharmaceutical companies of Johnson and Johnson, Leiden, The Netherlands
| | - Jaap Goudsmit
- Janssen Prevention Center, Center of Excellence of Janssen Research & Development, Pharmaceutical companies of Johnson and Johnson, Leiden, The Netherlands
| | | | - Ramon Roozendaal
- Janssen Vaccines and Prevention, Pharmaceutical Companies of Johnson and Johnson, Archimedesweg 4-6, 2333CN, Leiden, The Netherlands
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91
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Increased risk of influenza among vaccinated adults who are obese. Int J Obes (Lond) 2017; 41:1324-1330. [PMID: 28584297 PMCID: PMC5585026 DOI: 10.1038/ijo.2017.131] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/16/2017] [Accepted: 04/16/2017] [Indexed: 12/19/2022]
Abstract
Background Influenza infects 5–15% of the global population each year, and obesity has been shown to be an independent risk factor for increased influenza-related complications including hospitalization and death. However, the risk of developing influenza or ILI in a vaccinated obese adult population has not been addressed. Objective This study evaluated whether obesity was associated with increased risk of influenza and influenza-like illness among vaccinated adults. Subjects and Methods During the 2013–2014 and 2014–2015 influenza seasons, we recruited 1042 subjects to a prospective observational study of trivalent inactivated influenza vaccine (IIV3) in adults.1022 subjects completed the study. Assessments of relative risk for laboratory confirmed influenza and influenza-like illness were determined based on BMI. Seroconversion and seroprotection rates were determined using pre-vaccination and 26–35 days post-vaccination serum samples. Recruitment criteria for this study were adults 18 years of age and older receiving the seasonal trivalent inactivated influenza vaccine (IIV3) for the years 2013–2014 and 2014–2015. Exclusion criteria were immunosuppressive diseases, use of immunomodulatory or immunosuppressive drugs, acute febrile illness, history of Guillain-Barre syndrome, use of theophylline preparations, or use of warfarin. Results Among obese, 9.8% had either confirmed influenza or influenza-like-illness compared with 5.1% of healthy weight participants. Compared with vaccinated healthy weight, obese participants had double the risk of developing influenza or influenza-like illness (relative risk= 2.01, 95% CI 1.12, 3.60, p=0.020). Seroconversion or seroprotection rates were not different between healthy weight and obese adults with influenza or ILI. Conclusions Despite robust serological responses, vaccinated obese adults are twice as likely to develop influenza and influenza-like illness compared to healthy weight adults. This finding challenges the current standard for correlates of protection, suggesting use of antibody titers to determine vaccine effectiveness in an obese population may provide misleading information.
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92
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Lu CY, Huang LM, Fan TY, Cheng AL, Chang LY. Incidence of respiratory viral infections and associated factors among children attending a public kindergarten in Taipei City. J Formos Med Assoc 2017; 117:132-140. [PMID: 28420553 DOI: 10.1016/j.jfma.2017.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/04/2017] [Accepted: 02/07/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Kindergarteners frequently encounter various infectious diseases, so surveillance of viral infectious diseases would provide information for their health promotion. METHODS We enrolled kindergarten attendees, age 2-5 years, during the academic years of 2006 and 2007 in a Taipei City kindergarten. Daily monitoring of illness and regular biweekly physical examinations were undertaken. Multiple infections were defined as one child having two or more laboratory-confirmed viral infections with different viruses or different serotypes during one academic year. RESULTS The overall laboratory-confirmed incidence rate of respiratory viral infection was 239 per 100 person-years in the 2006 academic year and 136 per 100 person-years in the 2007 academic year. The attack rate for seasonal influenza was 17% in the 2006 academic year and 27% in the 2007 academic year. Boys and children with allergies had significantly higher risks to get multiple viral infections [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.20-2.75; OR 1.56, 95% CI 1.00-2.39, respectively]. Boys also tended to get enterovirus infections (OR 1.56, 95% CI 1.02-2.38) while children with allergies tended to acquire adenovirus infections (OR 1.71, 95% CI 1.12-2.66). CONCLUSION Boys and children with allergies were more susceptible to multiple viral infections, so they should be more cautious about viral infections.
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Affiliation(s)
- Chun-Yi Lu
- Departments of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Departments of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsui-Yien Fan
- Departments of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - A-Ling Cheng
- Departments of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Departments of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
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93
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Kang EK, Eun BW, Kim NH, Kim YK, Lim JS, Kim DH. Hemagglutination inhibiting antibody persistence 1 year after influenza vaccination in Korean children and adolescents. Hum Vaccin Immunother 2017; 13:895-902. [PMID: 27905835 DOI: 10.1080/21645515.2016.1259044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This study aimed to assess the 1-y immunogenicity of influenza vaccines and the association between immunogenicity at 1 m and further influenza infections in children aged 6 m to 18 y. Serum hemagglutination inhibition (HI) antibody titers and GMTs were determined for the recommended influenza strains 0, 1, 6, and 12 m post-vaccination. The serological evidence of influenza infections were defined as the increase of HI titer (HI ≥1:40 and 4-fold rise). The seroprotection rates for strains A(H1N1), A(H3N2), and B were 91.2%, 87.6%, and 87.6%, respectively, at 1 month (n = 174). These rates were 76.5%, 64.7%, and 54.6%, respectively, at 12 m. The seroprotection rates and GMTs for influenza A(H1N1) and A(H3N2) were higher at 12 m than at 0 m (p < 0.05) but not for B. There were 39 subjects (42 cases) of serological influenza infections. Subjects with seroprotection at 1 m post-vaccination had showed fewer serologic A(H1N1) (10.1 vs 54.5%) and A(H3N2) (7.2 vs 38.1%) infections than the ones with HI titer <1:40 during follow-up (P < 0.01). In conclusion, influenza vaccines used during the 2008-09 season induced adequate 1-y immunogenicity for A(H1N1) and A(H3N2). The immunogenicity at one month after vaccination influenced further serological influenza infections.
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Affiliation(s)
- Eun Kyeong Kang
- a Department of Pediatrics , Dongguk University Ilsan Hospital , Goyang , South Korea
| | - Byung Wook Eun
- b Department of Pediatrics , Eulji General Hospitl , Seoul , South Korea
| | - Nam Hee Kim
- c Department of Pediatrics , Inje University Ilsan Paik Hospital , Goyang , South Korea
| | - Yun Kyung Kim
- d Department of Pediatrics , Korea University Ansan Hospital , Ansan , South Korea
| | - Jung Sub Lim
- e Department of Pediatrics , Korea Cancer Center Hospital , Seoul , South Korea
| | - Dong Ho Kim
- e Department of Pediatrics , Korea Cancer Center Hospital , Seoul , South Korea
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94
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Jain VK, Domachowske JB, Wang L, Ofori-Anyinam O, Rodríguez-Weber MA, Leonardi ML, Klein NP, Schlichter G, Jeanfreau R, Haney BL, Chu L, Harris JAS, Sarpong KO, Micucio AC, Soni J, Chandrasekaran V, Li P, Innis BL. Time to Change Dosing of Inactivated Quadrivalent Influenza Vaccine in Young Children: Evidence From a Phase III, Randomized, Controlled Trial. J Pediatric Infect Dis Soc 2017; 6:9-19. [PMID: 28062552 PMCID: PMC5907868 DOI: 10.1093/jpids/piw068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND. Children under 3 years of age may benefit from a double-dose of inactivated quadrivalent influenza vaccine (IIV4) instead of the standard-dose. METHODS. We compared the only United States-licensed standard-dose IIV4 (0.25 mL, 7.5 µg hemagglutinin per influenza strain) versus double-dose IIV4 manufactured by a different process (0.5 mL, 15 µg per strain) in a phase III, randomized, observer-blind trial in children 6-35 months of age (NCT02242643). The primary objective was to demonstrate immunogenic noninferiority of the double-dose for all vaccine strains 28 days after last vaccination. Immunogenic superiority of the double-dose was evaluated post hoc. Immunogenicity was assessed in the per-protocol cohort (N = 2041), and safety was assessed in the intent-to-treat cohort (N = 2424). RESULTS. Immunogenic noninferiority of double-dose versus standard-dose IIV4 was demonstrated in terms of geometric mean titer (GMT) ratio and seroconversion rate difference. Superior immunogenicity against both vaccine B strains was observed with double-dose IIV4 in children 6-17 months of age (GMT ratio = 1.89, 95% confidence interval [CI] = 1.64-2.17, B/Yamagata; GMT ratio = 2.13, 95% CI = 1.82-2.50, B/Victoria) and in unprimed children of any age (GMT ratio = 1.85, 95% CI = 1.59-2.13, B/Yamagata; GMT ratio = 2.04, 95% CI = 1.79-2.33, B/Victoria). Safety and reactogenicity, including fever, were similar despite the higher antigen content and volume of the double-dose IIV4. There were no attributable serious adverse events. CONCLUSIONS. Double-dose IIV4 may improve protection against influenza B in some young children and simplifies annual influenza vaccination by allowing the same vaccine dose to be used for all eligible children and adults.
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Affiliation(s)
| | | | - Long Wang
- GSK Vaccines, King of Prussia, Pennsylvania
| | | | | | | | | | | | | | - Byron L. Haney
- Family Health Care of Ellensburg, Ellensburg and Pacific Northwest University, Yakima, Washington
| | | | | | - Kwabena O. Sarpong
- Sealy Center for Vaccine Development University of Texas Medical Branch, Galveston
| | - Amanda C. Micucio
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jyoti Soni
- GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, India
| | | | - Ping Li
- GSK Vaccines, King of Prussia, Pennsylvania
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95
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Sánchez-Ramos EL, Monárrez-Espino J, Noyola DE. Impact of vaccination on influenza mortality in children <5years old in Mexico. Vaccine 2017; 35:1287-1292. [PMID: 28162824 DOI: 10.1016/j.vaccine.2017.01.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/14/2017] [Accepted: 01/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Influenza is a leading cause of respiratory tract infections among children. In Mexico, influenza vaccination was included in the National Immunization Program since 2004. However, the population health effects of the vaccine on children have not been fully described. Thus, we estimated the impact of influenza immunization in terms of mortality associated with this virus among children younger than 5years of age in Mexico. METHODS Mortality rates and years of life lost associated with influenza were estimated using national mortality register data for the period 1998-2012. Age-stratified and cause-specific mortality rates were estimated for all-cause, respiratory and cardiovascular events. Influenza-associated mortality was compared between the period prior to introduction of the influenza vaccine as part of the National Immunization Program (1998-2004) and the period thereafter (2004-2012). RESULTS During the 1998-2012 winter seasons, the average number of all-cause, respiratory and cardiovascular deaths attributable to influenza were 1186, 794 and 21, respectively. Influenza-associated mortality was higher prior to the vaccination period than after influenza was included in the immunization program for all-cause (mean 1660 vs. 780) and respiratory (mean 1063 vs. 563) mortality, but no reduction was seen for cardiovascular mortality. The proportion of all-cause and respiratory deaths attributable to influenza was significantly lower in the post-vaccine period compared with the pre-vaccine period (P<0.001), but no reduction was seen in the proportion of cardiovascular deaths. There was an average annual reduction of 66,558years of life lost in the post-vaccine compared with the pre-vaccine period. CONCLUSION The introduction of influenza vaccination within the Mexican Immunization Program was associated with a reduction in mortality rates attributable to this virus among children younger than 5years of age.
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Affiliation(s)
- Evelyn L Sánchez-Ramos
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - Daniel E Noyola
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
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96
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Nakano T, Ishiwada N, Sumitani T, Uemori M, Isobe K. Inhaled Laninamivir Octanoate as Prophylaxis for Influenza in Children. Pediatrics 2016; 138:peds.2016-0109. [PMID: 27940664 DOI: 10.1542/peds.2016-0109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A single 20-mg dose of inhaled laninamivir octanoate is an effective treatment of influenza. However, the efficacy of laninamivir octanoate for the prevention of influenza in children <10 years of age has not yet been established. METHODS We conducted a double-blind, multicenter, randomized, placebo-controlled study to determine whether the efficacy of a single 20-mg dose of inhaled laninamivir octanoate to prevent the development of influenza was superior to that of placebo as prophylaxis for influenza in pediatric (<10 years) household members of index cases. Eligible subjects without influenza, in contact with an influenza-infected index case living in the same household, were blindly randomly assigned in a 1:1 ratio to receive 20 mg of laninamivir octanoate or placebo. The primary end point was the proportion of subjects who developed clinical influenza during a 10-day period. RESULTS A total of 343 subjects were randomly assigned, with 341 subjects included in the full analysis set for the primary analysis. The proportions of subjects who developed clinical influenza were 11% (18/171) in the laninamivir octanoate group and 19% (33/170) in the placebo group (P = .02). The relative risk reduction was 45.8% (95% confidence interval, 7.5% to 68.2%). The incidence of adverse events was similar in both groups. CONCLUSIONS A single 20-mg dose of inhaled laninamivir octanoate was effective and well tolerated as prophylaxis for influenza.
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Affiliation(s)
- Takashi Nakano
- Department of Pediatrics, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan
| | - Naruhiko Ishiwada
- Department of Infectious Diseases Medical Mycology Research Center, Chiba University, Chiba, Japan; and
| | | | - Mitsutoshi Uemori
- Clinical Data and Biostatistics Department, Daiichi Sankyo Co, Ltd, Tokyo, Japan
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97
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Principi N, Esposito S. Severe influenza in children: incidence and risk factors. Expert Rev Anti Infect Ther 2016; 14:961-8. [PMID: 27560100 DOI: 10.1080/14787210.2016.1227701] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/19/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The identification of factors that can predispose to the development of severe influenza is essential to enable the implementation of optimal prevention and control measures for vulnerable populations. AREAS COVERED Unfortunately, data in the pediatric age group remain difficult to interpret. However, epidemiological data seem to suggest that the most severe influenza cases, those who are hospitalized, those who are admitted to the intensive care unit, and those who died, occur in children in the first 2 years of life and in school age patients. Expert commentary: Immaturity of the immune system, and in particular of the mechanisms that usually recognize influenza viruses and activate cytokine and chemokine responses to reduce viral replication, might explain the high hospitalization rate observed in the youngest patients. Some underlying chronic conditions favour the development of the severe cases, sometime leading to death, although both admission to the intensive care unit and death can occur in otherwise healthy subjects.
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Affiliation(s)
- Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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98
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Grohskopf LA, Sokolow LZ, Broder KR, Olsen SJ, Karron RA, Jernigan DB, Bresee JS. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep 2016; 65:1-54. [PMID: 27560619 DOI: 10.15585/mmwr.rr6505a1] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This report updates the 2015-16 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines (Grohskopf LA, Sokolow LZ, Olsen SJ, Bresee JS, Broder KR, Karron RA. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2015-16 influenza season. MMWR Morb Mortal Wkly Rep 2015;64:818-25). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For the 2016-17 influenza season, inactivated influenza vaccines (IIVs) will be available in both trivalent (IIV3) and quadrivalent (IIV4) formulations. Recombinant influenza vaccine (RIV) will be available in a trivalent formulation (RIV3). In light of concerns regarding low effectiveness against influenza A(H1N1)pdm09 in the United States during the 2013-14 and 2015-16 seasons, for the 2016-17 season, ACIP makes the interim recommendation that live attenuated influenza vaccine (LAIV4) should not be used. Vaccine virus strains included in the 2016-17 U.S. trivalent influenza vaccines will be an A/California/7/2009 (H1N1)-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent vaccines will include an additional influenza B virus strain, a B/Phuket/3073/2013-like virus (Yamagata lineage).Recommendations for use of different vaccine types and specific populations are discussed. A licensed, age-appropriate vaccine should be used. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is otherwise appropriate. This information is intended for vaccination providers, immunization program personnel, and public health personnel. Information in this report reflects discussions during public meetings of ACIP held on October 21, 2015; February 24, 2016; and June 22, 2016. These recommendations apply to all licensed influenza vaccines used within Food and Drug Administration-licensed indications, including those licensed after the publication date of this report. Updates and other information are available at CDC's influenza website (http://www.cdc.gov/flu). Vaccination and health care providers should check CDC's influenza website periodically for additional information.
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Affiliation(s)
- Lisa A Grohskopf
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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99
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Buchan SA, Hottes TS, Rosella LC, Crowcroft NS, Tran D, Kwong JC. Contribution of influenza viruses to medically attended acute respiratory illnesses in children in high-income countries: a meta-analysis. Influenza Other Respir Viruses 2016; 10:444-454. [PMID: 27311404 PMCID: PMC5059948 DOI: 10.1111/irv.12400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 01/11/2023] Open
Abstract
AIM The burden of disease in children attributable to influenza viruses is difficult to quantify given the similarity of symptoms caused by infection due to influenza and other viruses. This uncertainty impacts clinical decision-making and estimates of burden. We aimed to systematically review the literature to determine the proportion of healthy children presenting for health care with an acute respiratory illness (ARI) who have laboratory-confirmed seasonal influenza (PROSPERO ID#CRD42014013896). METHOD We searched Ovid MEDLINE, EMBASE, Scopus, and references of included articles. We included studies that used polymerase chain reaction methods to test for influenza in healthy children aged ≤5 years who presented for health care in high-income countries with an influenza-like or ARI. A standardized form was used to collect data on positivity and other relevant study elements. RESULTS Seventeen studies covering 12 different influenza seasons were included. The proportion of influenza positivity ranged from 11% to 56%. Subgroup analyses were performed by influenza season, continent, healthcare setting, age group, and vaccination status. Higher influenza positivity was reported among children aged 3-5 years compared with children aged ≤2 years, and for unvaccinated children. CONCLUSION The minority of healthy patients aged ≤5 years with medically attended influenza-like or acute respiratory symptoms have laboratory-confirmed influenza virus infection, although this varied by influenza season. Prevention efforts should be targeted accordingly. STATEMENT Most influenza-like illnesses are not laboratory-confirmed and have similar clinical presentations. Consequently, the true contribution of influenza to acute respiratory infections in children remains uncertain. Our systematic review estimates that this proportion ranges from 11% to 56%. This finding can help both clinicians and public health professionals target prevention.
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Affiliation(s)
- Sarah A Buchan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Travis S Hottes
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Dat Tran
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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100
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Lakhan N, Clarke M, Mathew SM, Marshall H. Retrospective review of factors associated with severe hospitalised community-acquired influenza in a tertiary paediatric hospital in South Australia. Influenza Other Respir Viruses 2016; 10:479-485. [PMID: 27381474 PMCID: PMC5059954 DOI: 10.1111/irv.12403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 11/29/2022] Open
Abstract
Background Influenza infection can result in severe disease with debilitating complications. Young children have the highest rate of influenza hospitalisations with various factors influencing influenza susceptibility and severity. Objectives This study aimed to determine the disease burden and assess risk factors for severe hospitalised influenza in South Australian children under 5 years of age. Methods Influenza admissions to the tertiary paediatric hospital in South Australia from 2008 to 2012 were identified. Data from laboratory‐confirmed influenza cases were collected, including infecting influenza strain, co‐infections, prematurity, pre‐existing medical comorbidities and other potential risk factors. Predictors of high‐level care were assessed using logistic regression. Results A total of 267 children with laboratory‐confirmed influenza were hospitalised. Of these, 147 admissions (53%) occurred in children without underlying medical risk factors. Eighteen children (7%) required high‐level care, of which 11 (61%) had no underlying medical risk factors. No deaths were reported. The majority of children were unimmunised against influenza. Co‐infections were identified in 40% of children (n = 107). Influenza B was associated with a requirement for higher care (OR 3.7, CI 1.3–10.9, P = .02) as was a history of food allergies (OR 9.7, CI 1.5–61.4, P = .02) and iron deficiency anaemia (OR 4.8, CI 1.4–16.1, P = .01). Conclusions Influenza can be a severe illness, even in children without underlying medical conditions. The identification of Influenza B strain, history of food allergies and iron deficiency anaemia as predictors of severity in hospitalised cases warrants further investigation and may have important implications for preventative strategies to reduce the burden of childhood influenza.
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Affiliation(s)
- Nerissa Lakhan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Michelle Clarke
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Suja M Mathew
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, SA, Australia.,Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, SA, Australia. .,School of Medicine, University of Adelaide, Adelaide, SA, Australia. .,School of Public Health, University of Adelaide, Adelaide, SA, Australia. .,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia.
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