51
|
Grohskopf LA, Alyanak E, Ferdinands JM, Broder KR, Blanton LH, Talbot HK, Fry AM. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021-22 Influenza Season. MMWR Recomm Rep 2021; 70:1-28. [PMID: 34448800 PMCID: PMC8407757 DOI: 10.15585/mmwr.rr7005a1] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This report updates the 2020-21 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2020;69[No. RR-8]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. ACIP makes no preferential recommendation for a specific vaccine when more than one licensed, recommended, and age-appropriate vaccine is available. During the 2021-22 influenza season, the following types of vaccines are expected to be available: inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4).The 2021-22 influenza season is expected to coincide with continued circulation of SARS-CoV-2, the virus that causes COVID-19. Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient visits, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html. Recommendations for the use of COVID-19 vaccines are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.html, and additional clinical guidance is available at https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html.Updates described in this report reflect discussions during public meetings of ACIP that were held on October 28, 2020; February 25, 2021; and June 24, 2021. Primary updates to this report include the following six items. First, all seasonal influenza vaccines available in the United States for the 2021-22 season are expected to be quadrivalent. Second, the composition of 2021-22 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components. U.S.-licensed influenza vaccines will contain hemagglutinin derived from an influenza A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture-based and recombinant vaccines), an influenza A/Cambodia/e0826360/2020 (H3N2)-like virus, an influenza B/Washington/02/2019 (Victoria lineage)-like virus, and an influenza B/Phuket/3073/2013 (Yamagata lineage)-like virus. Third, the approved age indication for the cell culture-based inactivated influenza vaccine, Flucelvax Quadrivalent (ccIIV4), has been expanded from ages ≥4 years to ages ≥2 years. Fourth, discussion of administration of influenza vaccines with other vaccines includes considerations for coadministration of influenza vaccines and COVID-19 vaccines. Providers should also consult current ACIP COVID-19 vaccine recommendations and CDC guidance concerning coadministration of these vaccines with influenza vaccines. Vaccines that are given at the same time should be administered in separate anatomic sites. Fifth, guidance concerning timing of influenza vaccination now states that vaccination soon after vaccine becomes available can be considered for pregnant women in the third trimester. As previously recommended, children who need 2 doses (children aged 6 months through 8 years who have never received influenza vaccine or who have not previously received a lifetime total of ≥2 doses) should receive their first dose as soon as possible after vaccine becomes available to allow the second dose (which must be administered ≥4 weeks later) to be received by the end of October. For nonpregnant adults, vaccination in July and August should be avoided unless there is concern that later vaccination might not be possible. Sixth, contraindications and precautions to the use of ccIIV4 and RIV4 have been modified, specifically with regard to persons with a history of severe allergic reaction (e.g., anaphylaxis) to an influenza vaccine. A history of a severe allergic reaction to a previous dose of any egg-based IIV, LAIV, or RIV of any valency is a precaution to use of ccIIV4. A history of a severe allergic reaction to a previous dose of any egg-based IIV, ccIIV, or LAIV of any valency is a precaution to use of RIV4. Use of ccIIV4 and RIV4 in such instances should occur in an inpatient or outpatient medical setting under supervision of a provider who can recognize and manage a severe allergic reaction; providers can also consider consulting with an allergist to help identify the vaccine component responsible for the reaction. For ccIIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any ccIIV of any valency or any component of ccIIV4 is a contraindication to future use of ccIIV4. For RIV4, history of a severe allergic reaction (e.g., anaphylaxis) to any RIV of any valency or any component of RIV4 is a contraindication to future use of RIV4. This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2021-22 influenza season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used according to Food and Drug Administration-licensed indications. Updates and other information are available from CDC's influenza website (https://www.cdc.gov/flu); vaccination and health care providers should check this site periodically for additional information.
Collapse
|
52
|
Sakala IG, Honda-Okubo Y, Li L, Baldwin J, Petrovsky N. A M2 protein-based universal influenza vaccine containing Advax-SM adjuvant provides newborn protection via maternal or neonatal immunization. Vaccine 2021; 39:5162-5172. [PMID: 34362601 DOI: 10.1016/j.vaccine.2021.07.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/10/2021] [Accepted: 07/14/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite newborns being at increased risk of serious influenza infection, influenza vaccines are currently not recommended for use in infants under 6 months of age. We therefore sought to evaluate the protective efficacy in mice of an M2-based influenza vaccine (CapM2e) formulated with Advax-SM adjuvant. Vaccine protection was assessed via both passive maternal immunization and direct neonatal immunization. METHODS For maternal transfer studies, female mice were immunized 1 week before and after mating. Blood was collected from both mother and offspring during weaning and pups were challenged when they reached 3 weeks of age with lethal doses of H1N1 and homologous reassortment influenza strain H3N2 with conserved M2. For direct immunization studies, newborns were immunized at 1 and 3 weeks of age and blood was collected prior to challenge at 4 weeks of age. RESULTS Maternal immunization with CapM2e + Advax-SM vaccine induced high maternal M2e antibody levels that were passively transferred to their offspring and provided them with protection against both H1N1 and H3N2 influenza strains when challenged at 3 weeks of age. When used for direct immunization of neonatal mice, CapM2e + Advax-SM vaccine similarly induced high serum M2e antibody levels and protected against H1N1 and H3N2 influenza challenges with protection associated with inhibition of virus replication with a significant reduction in lung virus load in immunized pups. CONCLUSION CapM2e + Advax-SM vaccine could be useful for protecting newborns against diverse influenza A strains, with opportunities to achieve protection by passive maternal immunization or active neonatal immunization. This data supports further development of this promising M2e-based vaccine candidate.
Collapse
Affiliation(s)
- Isaac G Sakala
- Vaxine Pty Ltd, 11 Walkley Avenue, Adelaide 5046, Australia; College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Yoshikazu Honda-Okubo
- Vaxine Pty Ltd, 11 Walkley Avenue, Adelaide 5046, Australia; College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Lei Li
- Vaxine Pty Ltd, 11 Walkley Avenue, Adelaide 5046, Australia; College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia
| | - Jeremy Baldwin
- Vaxine Pty Ltd, 11 Walkley Avenue, Adelaide 5046, Australia
| | - Nikolai Petrovsky
- Vaxine Pty Ltd, 11 Walkley Avenue, Adelaide 5046, Australia; College of Medicine and Public Health, Flinders University, Adelaide 5042, Australia.
| |
Collapse
|
53
|
Clemens EA, Alexander-Miller MA. Understanding Antibody Responses in Early Life: Baby Steps towards Developing an Effective Influenza Vaccine. Viruses 2021; 13:v13071392. [PMID: 34372597 PMCID: PMC8310046 DOI: 10.3390/v13071392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 01/01/2023] Open
Abstract
The immune system of young infants is both quantitatively and qualitatively distinct from that of adults, with diminished responsiveness leaving these individuals vulnerable to infection. Because of this, young infants suffer increased morbidity and mortality from respiratory pathogens such as influenza viruses. The impaired generation of robust and persistent antibody responses in these individuals makes overcoming this increased vulnerability through vaccination challenging. Because of this, an effective vaccine against influenza viruses in infants under 6 months is not available. Furthermore, vaccination against influenza viruses is challenging even in adults due to the high antigenic variability across viral strains, allowing immune evasion even after induction of robust immune responses. This has led to substantial interest in understanding how specific antibody responses are formed to variable and conserved components of influenza viruses, as immune responses tend to strongly favor recognition of variable epitopes. Elicitation of broadly protective antibody in young infants, therefore, requires that both the unique characteristics of young infant immunity as well as the antibody immunodominance present among epitopes be effectively addressed. Here, we review our current understanding of the antibody response in newborns and young infants and discuss recent developments in vaccination strategies that can modulate both magnitude and epitope specificity of IAV-specific antibody.
Collapse
|
54
|
Clemens EA, Holbrook BC, Kanekiyo M, Yewdell JW, Graham BS, Alexander-Miller MA. An R848-Conjugated Influenza Virus Vaccine Elicits Robust Immunoglobulin G to Hemagglutinin Stem in a Newborn Nonhuman Primate Model. J Infect Dis 2021; 224:351-359. [PMID: 33245745 PMCID: PMC8280492 DOI: 10.1093/infdis/jiaa728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022] Open
Abstract
Eliciting broadly protective antibodies is a critical goal for the development of more effective vaccines against influenza. Optimizing protection is of particular importance in newborns, who are highly vulnerable to severe disease following infection. An effective vaccination strategy for this population must surmount the challenges associated with the neonatal immune system as well as mitigate the inherent immune subdominance of conserved influenza virus epitopes, responses to which can provide broader protection. Here, we show that prime-boost vaccination with a TLR7/8 agonist (R848)-conjugated influenza A virus vaccine elicits antibody responses to the highly conserved hemagglutinin stem and promotes rapid induction of virus neutralizing stem-specific antibodies following viral challenge. These findings support the efficacy of R848 as an effective adjuvant for newborns and demonstrate its ability to enhance antibody responses to subdominant antigenic sites in this at-risk population.
Collapse
Affiliation(s)
- Elene A Clemens
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Beth C Holbrook
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Masaru Kanekiyo
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jonathan W Yewdell
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Martha A Alexander-Miller
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
55
|
Haddadin Z, Rankin DA, Lipworth L, Suh M, McHenry R, Blozinski A, George SS, Fernandez KN, Varjabedian R, Spieker AJ, Shepard DS, Halasa NB. Respiratory Virus Surveillance in Infants across Different Clinical Settings. J Pediatr 2021; 234:164-171.e2. [PMID: 33774057 DOI: 10.1016/j.jpeds.2021.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We aimed to evaluate the distribution, clinical presentations and severity of common acute respiratory infections (ARI) viruses in infants across 3 clinical settings. STUDY DESIGN In a prospective virus surveillance study, infants under 1 year with fever and/or respiratory symptoms were enrolled from outpatient, emergency department, and inpatient settings from December 16, 2019 through April 30, 2020. Demographic and clinical characteristics were collected through parent/guardian interviews, medical chart abstractions, and follow-up surveys. Nasal swabs were collected and tested for viruses using quantitative reverse-transcription polymerase chain reaction. RESULTS We enrolled 366 infants and tested nasal swabs on 360 (98%); median age was 6.3 months, 50% male. In total, 295 (82%) had at least 1 virus detected; rhinovirus/enterovirus (RV/EV; 42%), respiratory syncytial virus (RSV; 34%), and influenza (15%) were the most common. RSV was the most frequently detected virus in the inpatient (63%) and emergency department (37%) settings, and RV/EV was most frequently detected virus in the outpatient setting (54%). RSV-positive infants had a lower median age (4.9 months) and were more likely to have respiratory distress, and RV/EV-positive infants were less likely to have respiratory distress. Influenza-positive infants had a higher median age (8 months) and were more likely to have systemic symptoms. RSV infection and younger age were associated with higher odds of hospitalization in multivariable logistic regression. CONCLUSIONS Across 3 clinical settings, and combining virologic, patient, and health-system information, our results highlight the burden of viral ARI among infants. Overall, RSV, RV/EV, and influenza were most commonly detected, with RSV having the highest disease severity.
Collapse
Affiliation(s)
- Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
| | - Danielle A Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN
| | - Loren Lipworth
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Rendie McHenry
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Anna Blozinski
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Kailee N Fernandez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Donald S Shepard
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA
| | - Natasha B Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
56
|
Christensen H, Reynolds R, Kwiatkowska R, Brooks-Pollock E, Dominey M, Finn A, Gjini A, Hickman M, Roderick M, Yates J. Influence of commissioned provider type and deprivation score on uptake of the childhood flu immunization. J Public Health (Oxf) 2021; 42:618-624. [PMID: 31188441 DOI: 10.1093/pubmed/fdz060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/10/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Since 2015/16 the UK seasonal influenza immunization programme has included children aged 5 and 6 years. In the South West of England school-based providers, GPs or community pharmacies were commissioned to deliver the vaccine depending on the locality. We aimed to assess variation in vaccine uptake in relation to the type of commissioned provider, and levels of socioeconomic deprivation. METHODS Data from the South West of England (2015-16 season) were analysed using multilevel logistic regression to assess variation in vaccine uptake by type of commissioned provider, allowing for clustering of children within delivery sites. RESULTS Overall uptake in 5 and 6 year olds was 34.3% (37 555/109 404). Vaccine uptake was highest when commissioned through school-based programmes 50.2% (9983/19 867) and lowest when commissioned through pharmacies, 23.1% (4269/18 479). Delivery through schools resulted in less variation by site and equal uptake across age groups, in contrast to GP and pharmacy delivery for which uptake was lower among 6 year olds. Vaccine uptake decreased with increasing levels of deprivation across all types of commissioned provider. CONCLUSION School-based programmes achieve the highest and most consistent rates of childhood influenza vaccination. Interventions are still needed to promote more equitable uptake of the childhood influenza vaccine.
Collapse
Affiliation(s)
- Hannah Christensen
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road Bristol, UK
| | - Rosy Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road Bristol, UK.,NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Rachel Kwiatkowska
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road Bristol, UK.,NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.,Field Services, National Infection Service, Public Health England South West, 2 Rivergate Bristol, UK
| | - Ellen Brooks-Pollock
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road Bristol, UK.,Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, UK
| | - Matthew Dominey
- Screening and Immunisation Team, Public Health England South West, 2 Rivergate Bristol, UK.,NHS England-South (South West), South Plaza, Marlborough Street, Bristol, UK
| | - Adam Finn
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road Bristol, UK.,Department of Paediatric Immunology, Bristol Children's Hospital, Upper Maudlin St, Bristol, UK
| | - Ardiana Gjini
- Screening and Immunisation Team, Public Health England South West, 2 Rivergate Bristol, UK.,NHS England-South (South West), South Plaza, Marlborough Street, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road Bristol, UK.,NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Marion Roderick
- NHS England-South (South West), South Plaza, Marlborough Street, Bristol, UK
| | - Julie Yates
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, UK.,Screening and Immunisation Team, Public Health England South West, 2 Rivergate Bristol, UK
| |
Collapse
|
57
|
Howard LM, Liu Y, Zhu Y, Liu D, Willams JV, Gil AI, Griffin MR, Edwards KM, Lanata CF, Grijalva CG. Assessing the impact of acute respiratory illnesses on the risk of subsequent respiratory illness. J Infect Dis 2021; 225:42-49. [PMID: 34120189 DOI: 10.1093/infdis/jiab313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Whether acute respiratory illnesses (ARIs), often associated with virus detection, are associated with lower risk for subsequent ARI remains unclear. We assessed the association between symptomatic ARI and subsequent ARI in young children. METHODS In a prospective cohort of Peruvian children <3 years, we examined the impact of index ARI on subsequent ARI risk. Index ARI were matched with ≤3 asymptomatic observations and followed over 28 days. We compared risk of subsequent ARI between groups using conditional logistic regression adjusting for several covariates, accounting for repeat observations from individual children. RESULTS Among 983 index ARI, 339 (34%) had an ARI event during follow-up, compared with 876/2826 (31%) matched asymptomatic observations. We found no significant association of index ARI and subsequent ARI risk during follow-up overall (aOR 1.10, 95% CI 0.98, 1.23) or when limited to index ARI with respiratory viruses detected (aOR 1.03, 95% CI 0.86, 1.24). Similarly, when the outcome was limited to ARI in which viruses were detected, no significant association was seen (aOR 1.05, 95% CI 0.87, 1.27). DISCUSSION ARIs were not associated with short-term protection against subsequent ARI in these children. Additional longitudinal studies are needed to understand drivers of recurrent ARI in young children.
Collapse
Affiliation(s)
- Leigh M Howard
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuhan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John V Willams
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ana I Gil
- Instituto de Investigación Nutricional, Lima, Peru
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
58
|
The burden of Respiratory Syncytial Virus (RSV) infection in the Middle East and North Africa (MENA) region across age groups: A systematic review. Vaccine 2021; 39:3803-3813. [PMID: 34099329 DOI: 10.1016/j.vaccine.2021.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/02/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022]
Abstract
Respiratory Syncytial Virus (RSV) is a common respiratory virus that generally causes a mild illness in children and adults or severe symptoms with complications in infants and the elderly, particularly in the presence of underlying comorbidities. While epidemiological data about this virus are available globally, data from the Middle East and North Africa (MENA) region are still scarce. For this reason, we conducted a systematic review to determine the burden of RSV disease in the MENA region by searching the available literature up until September 2018. A total of 1242 studies were retrieved of which 90 were included in the review. Most of the included studies were conducted in subjects aged 0-18 years with the majority being in children below 3 years of age, while only 2 studies included exclusively adults above 18 years of age. RSV infection rates varied greatly between different studies on hospitalized subjects and ranged between 4% and 82%, while the range was smaller in studies on outpatient subjects (between 6% and 36%). When calculating the RSV infection rates in the hospitalized subjects with different inclusion criteria, we found that it was 19%, 70%, and 33% among subjects admitted with Acute Respiratory Infections (ARIs), Acute Lower Respiratory Infections (ALRIs), and bronchiolitis, respectively. RSV infections were most common during the winter season. With regards to complications, intensive care unit admissions ranged between 1% and 15%, while the need for mechanical ventilation ranged between 1% and 10%. The overall RSV related mortality rate across all age groups in studies included in our review was 1.9%. This review identifies several limitations in the existing data and under-representation of the adult population. Future studies should be providing more evidence on the RSV burden in adults and children with comorbidities in order to better assess the potential impact of future preventive strategies in the MENA region.
Collapse
|
59
|
San Román Montero J, Gil-Prieto R, Martín RJ, de Lejarazu RO, Gallardo-Pino C, Gil de Miguel A. Influenza hospitalizations in children under 1 year old in Spain: the importance of maternal immunization. Hum Vaccin Immunother 2021; 17:1853-1857. [PMID: 33351678 PMCID: PMC8115588 DOI: 10.1080/21645515.2020.1845523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
This study estimates the burden of influenza in infants up to 12 months of age in Spain over 8 seasons (2009/10-2016/17). The survey was conducted by reviewing the Spanish Surveillance System for Hospital Data. Over the eight seasons, 5,618 hospital admissions were recorded for patients younger than 12 months that included codes related to influenza in any diagnostic position (487-488 ICD-9-CM and J9, J10 and J11 CIE 10). In total, 2,363 admissions (42.1%) were female patients whose median age was 3.05 months. Patients younger than 6 months accounted for 3,856 admissions (68.6%). Among them, 59.2% were male, and 40.8% were female (p < .05). Overall, 37.1% (2,084 patients) were younger than 2 months. The hospitalization rate for the entire period studied was 156.09 admissions per 100,000 children under 12 months of age (95% CI: 152.4-160.6). The average duration of hospitalization was 6.6 days (95% CI: 6.4-6.8). Eighteen deaths were recorded for hospitalized patients over the entire period. Of these, 12 patients (66.7%) were younger than 6 months. There is a significant burden of influenza disease in children under 1 year of age in Spain, mainly in children under 6 months of age. Improvements to prevention strategies through increased vaccination coverage in family environments and vaccination strategies involving pregnant woman can contribute decisively and effectively to reducing these hospitalizations.
Collapse
Affiliation(s)
| | - Ruth Gil-Prieto
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Rubén Jiménez Martín
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | | | - Carmen Gallardo-Pino
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| | - Angel Gil de Miguel
- Area of Preventive Medicine & Public Health, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
60
|
Mattila JM, Vuorinen T, Waris M, Antikainen P, Heikkinen T. Oseltamivir treatment of influenza A and B infections in infants. Influenza Other Respir Viruses 2021; 15:618-624. [PMID: 33939270 PMCID: PMC8404048 DOI: 10.1111/irv.12862] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background Oseltamivir treatment is currently the only way of managing influenza in young infants for whom influenza vaccines are not licensed, but little data exist on the effectiveness of the treatment in this age group. Methods In a prospective study, we enrolled 431 newborn infants and followed them up for 10 months during their first respiratory season (September 2017‐June 2018). During each respiratory illness, we examined the infants and obtained nasopharyngeal specimens for determination of the viral etiology. Infants with influenza were re‐examined at short intervals, and additional nasopharyngeal specimens were obtained at each visit for measuring the viral load. All infants with symptoms <48 hours received oseltamivir treatment. The parents filled out daily symptom diaries. Results Among 23 infants with influenza A, the mean total duration of illness in oseltamivir recipients was 82.1 hours, compared with 253.5 hours in infants without treatment (P = .0003). For infants with influenza B, the corresponding durations were 110.0 and 173.9 hours, respectively (P = .03). In infants with influenza A, total symptom scores were significantly lower in oseltamivir‐treated infants at all time points between days 3 and 11 after the onset of therapy. In most children with either influenza A or B, viral antigen concentrations declined rapidly within 1‐2 days after the initiation of oseltamivir treatment. Conclusions Oseltamivir treatment of infants with influenza rapidly decreased the viral load in nasopharyngeal secretions and shortened the duration and severity of symptoms. The clinical effectiveness of oseltamivir appeared to be greater against influenza A than against influenza B infections.
Collapse
Affiliation(s)
- Janna-Maija Mattila
- Department of Pediatrics, University of Turku, Turku University Hospital, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Institute of Biomedicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Matti Waris
- Department of Clinical Microbiology, Institute of Biomedicine, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Terho Heikkinen
- Department of Pediatrics, University of Turku, Turku University Hospital, Turku, Finland
| |
Collapse
|
61
|
Sutton SS, Magagnoli J, Cummings T, Hardin J. Association Between the Use of Antibiotics, Antivirals, and Hospitalizations Among Patients With Laboratory-confirmed Influenza. Clin Infect Dis 2021; 72:566-573. [PMID: 31974543 DOI: 10.1093/cid/ciaa074] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/22/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Clinicians may prescribe antibiotics to influenza patients at high risk for bacterial complications. We explored the association between antibiotics, antivirals, and hospitalization among people with influenza. METHODS A retrospective cohort study of patients with confirmed influenza with encounters during January 2011-January 2019 was conducted using data from the Veterans Affairs Informatics and Computing Infrastructure (VINCI). We compared inpatient hospitalizations (all-cause and respiratory) within 30 days of influenza diagnosis between 4 patient cohorts: (1) no treatment (n = 4228); (2) antibiotic only (n = 671); (3) antiviral only (n = 6492); and (4) antibiotic plus antiviral (n = 1415). We estimated relative risk for hospitalization using Poisson generalized linear model and robust standard errors. RESULTS Among 12 806 influenza cases, most were white men (mean age, 57-60 years). Those with antivirals only, antibiotic plus antiviral, and antibiotics only all had a statistically significant lower risk of all-cause and respiratory hospitalization compared to those without treatment. Comparing the antibiotic plus antiviral cohort to those who were prescribed an antiviral alone, there was a 47% lower risk for respiratory hospitalization (relative risk, 0.53 [95% confidence interval, .31-.94]), and no other statistical differences were detected. CONCLUSIONS Those prescribed an antiviral, antibiotic, or both had a lower risk of hospitalization within 30 days compared to those without therapy. Furthermore, intervention with both an antibiotic and antiviral had a lower risk of respiratory hospitalization within 30 days compared to those with an antiviral alone. Importantly, the absolute magnitude of decreased risk with antibiotic plus antiviral therapy is small and must be interpreted within the context of the overall risk of antibiotic usage.
Collapse
Affiliation(s)
- S Scott Sutton
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, Columbia, South Carolina, USA
| | - Joseph Magagnoli
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, College of Pharmacy, Columbia, South Carolina, USA
| | - Tammy Cummings
- Wm Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, South Carolina, USA
| | - James Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| |
Collapse
|
62
|
Tran N, Cortright L, Buckman C, Tumin D, Syed S. Association between asthma and influenza vaccine uptake among US adolescents: a retrospective survey study. J Asthma 2021; 59:1256-1262. [PMID: 33761306 DOI: 10.1080/02770903.2021.1908349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Despite longstanding recommendations for children with asthma to receive the influenza vaccine, vaccine uptake in this population remains low. We used the nationally representative National Immunization Survey-Teen to analyze the impact of asthma on adolescent influenza vaccination rates. METHODS Adolescents ages 13-17 years with provider-reported data on vaccine coverage were included in the analysis. The primary outcome was being up-to-date on influenza vaccination, defined as receiving the seasonal influenza vaccine in at least one of the past 3 years, and was analyzed using logistic regression. Asthma was defined by parent report of whether the adolescent has ever been told by a health professional that he or she has asthma. Data were collected in 2016-2017 and analyzed in 2020. RESULTS Of 36,655 adolescents in the analytic sample (mean age 15 years, 49% female), 55% were up-to-date on influenza vaccination, and 21% had been diagnosed with asthma. On bivariate analysis, vaccination was more common among adolescents who had been diagnosed with asthma compared to those who were not (60% vs. 53%, P < 0.001). On multivariable analysis, asthma diagnosis was associated with greater likelihood of being up-to-date on seasonal influenza vaccination (adjusted odds ratio: 1.29; 95% confidence interval: 1.22, 1.36; P < 0.001). CONCLUSIONS Seasonal influenza vaccination rates remain low among adolescents. Despite concerns about vaccine effectiveness in children with asthma, this diagnosis was associated with increased likelihood of influenza vaccination, possibly in relation to increased health care use (and exposure to vaccine encouragement) among adolescents with asthma.
Collapse
Affiliation(s)
- Nga Tran
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA.,Vidant Medical Center, Greenville, NC, USA
| | - Lindsay Cortright
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Cierra Buckman
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| | - Salma Syed
- Department of Pediatrics, Brody School of Medicine at East, Carolina University, Greenville, NC, USA
| |
Collapse
|
63
|
Vajo Z, Balaton G, Vajo P, Torzsa P. A Reduced Dose Whole Virion Aluminum Adjuvanted Seasonal Influenza Vaccine Is Immunogenic, Safe, and Well Tolerated in Pediatric Patients. Viruses 2021; 13:500. [PMID: 33803680 PMCID: PMC8003037 DOI: 10.3390/v13030500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Data suggest that pediatric patients might react differently to influenza vaccination, both in terms of immunity and side effects. We have recently shown that using a whole virion vaccine with aluminum phosphate adjuvants, reduced dose vaccines containing 6 µg of viral hemagglutinin (HA) per strain are immunogenic, and well tolerated in adult and elderly patients. Here we show the results of a multicenter clinical trial of pediatric patients, using reduced doses of a new, whole virion, aluminum phosphate adjuvanted vaccine (FluArt, Budapest, Hungary). METHODS A total of 120 healthy volunteers were included in two age groups (3-11 years, receiving 3 µg of HA per strain, and 12-18 years, receiving 6 µg of HA per strain). We used hemagglutination inhibition testing to assess immunogenicity, based on EMA and FDA licensing criteria, including post/pre-vaccination geometric mean titer ratios, seroconversion and seropositivity rates. Safety and tolerability were assessed using CHMP guidelines. RESULTS All subjects entered the study and were vaccinated (ITT population). All 120 subjects attended the control visit on Day 21 (PP population). All immunogenicity licensing criteria were met in both age groups for all three vaccine virus strains. No serious adverse events were detected and the vaccine was well tolerated by both age groups. DISCUSSION Using a whole virion vaccine and aluminum phosphate adjuvants, a reduction in the amount of the viral hemmaglutinin is possible while maintaining immunogenicity, safety and tolerability in pediatric and adolescent patients.
Collapse
Affiliation(s)
- Zoltan Vajo
- Department of Family Medicine, Semmelweis University Medical School, 1125 Budapest, Hungary;
| | - Gergely Balaton
- Department of Pediatric Dentistry, Semmelweis University Medical School, 1088 Budapest, Hungary;
| | - Peter Vajo
- Clinical Center, University of Debrecen, 4032 Debrecen, Hungary;
| | - Peter Torzsa
- Department of Family Medicine, Semmelweis University Medical School, 1125 Budapest, Hungary;
| |
Collapse
|
64
|
Okoli GN, Reddy VK, Al-Yousif Y, Neilson CJ, Mahmud SM, Abou-Setta AM. Sociodemographic and health-related determinants of seasonal influenza vaccination in pregnancy: A systematic review and meta-analysis of the evidence since 2000. Acta Obstet Gynecol Scand 2021; 100:997-1009. [PMID: 33420724 DOI: 10.1111/aogs.14079] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/12/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Vaccination is considered to be the most practical and effective preventative measure against influenza. It is highly recommended for population subgroups most at risk of developing complications, including pregnant women. However, seasonal influenza vaccine uptake remains suboptimal among pregnant women, even in jurisdictions with universal vaccination. We summarized the evidence on the determinants of seasonal influenza vaccine uptake during pregnancy to better understand factors that influence vaccine uptake among pregnant women. MATERIAL AND METHODS We systematically searched MEDLINE, Embase and CINAHL from January 2000 to February 2020 for publications in English reporting on sociodemographic and/or health-related determinants of seasonal influenza vaccine uptake during pregnancy. Two reviewers independently included studies. One reviewer extracted data and assessed study quality, and another reviewer checked extracted data and study quality assessments for errors. Disagreements were resolved through consensus, or a third reviewer. We meta-analyzed using the inverse variance, random-effects method, and reported the odds ratios (OR) and 95% confidence intervals (CI). RESULTS From 1663 retrieved citations, we included 36 studies. The following factors were associated with increased seasonal influenza vaccine uptake: Older age (20 studies: OR 1.13, 95% CI 1.07-1.20), being nulliparous (13 studies: OR 1.26, 95% CI 1.15-1.38), married (8 studies: OR 1.11, 95% CI 1.07-1.15), employed (4 studies: OR 1.13, 95% CI 1.02-1.24), a non-smoker (8 studies: OR 1.25, 95% CI 1.04-1.51) and having prenatal care (3 studies: OR 3.36, 95% CI 2.25-5.02), a chronic condition (6 studies: OR 1.30, 95% CI 1.17-1.44), been previously vaccinated (9 studies: OR 4.88, 95% CI 3.14-7.57) and living in a rural area (9 studies: OR 1.09, 95% CI 1.05-1.14). Compared with being black, being white was also associated with increased seasonal influenza vaccine uptake (11 studies: OR 1.30, 95% CI 1.20-1.41). CONCLUSIONS The evidence suggests that several sociodemographic and health-related factors may determine seasonal influenza vaccination in pregnancy, and that parity, history of influenza vaccination, prenatal care and comorbidity status may be influential.
Collapse
Affiliation(s)
- George N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.,Vaccine and Drug Evaluation Center, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Viraj K Reddy
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yahya Al-Yousif
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine J Neilson
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Salaheddin M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Vaccine and Drug Evaluation Center, University of Manitoba, Winnipeg, Manitoba, Canada.,Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.,Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
65
|
Shuai W, Chen X, Shan Y, Li W, Ma W, Lu Q, Li D. Clinical Characteristics and CT Findings in 148 Non-COVID-19 Influenza-Like Illness Cases: A Retrospective Control Study. Front Public Health 2021; 9:616963. [PMID: 33634067 PMCID: PMC7900189 DOI: 10.3389/fpubh.2021.616963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study was to collect clinical features and computed tomography (CT) findings of Influenza-Like Illness (ILI) cases, and to evaluate the correlation between clinical data and the abnormal chest CT in patients with the Influenza-Like Illness symptoms. Methods: Patients with the Influenza-Like Illness symptoms who attended the emergency department of The Six Medical Center of The PLA General Hospital from February 10 to April 1, 2020 were enrolled. Clinical and imaging data of the enrolled patients were collected and analyzed. The association between clinical characteristics and abnormal chest CT was also analyzed. Results: A total of 148 cases were enrolled in this study. Abnormalities on chest CT were detected in 61/148 (41.2%) patients. The most common abnormal CT features were as follows: patchy consolidation 22/61(36.1%), ground-glass opacities 21/61(34.4%), multifocal consolidations 17/61(27.9%). The advanced age and underlying diseases were significantly associated with abnormal chest CT. Conclusions: Abnormal chest CT is a common condition in Influenza-Like Illness cases. The presence of advanced age and concurrent underlying diseases is significantly associated with abnormal chest CT findings in patients with ILI symptoms. The chest CT characteristic of ILI is different from the manifestation of COVID-19 infection, which is helpful for differential diagnosis.
Collapse
Affiliation(s)
- Weizheng Shuai
- Department of Critical Care Medicine, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xuxin Chen
- Department of Respiratory and Critical Care Medicine, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yi Shan
- Department of Emergency Medicine, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wenping Li
- Radiology Department, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Ma
- Basic Medical Research Center, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qiaohui Lu
- Radiology Department, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Dawei Li
- Department of Critical Care Medicine, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
66
|
McMorrow ML, Rossi L, Meiring S, Bishop K, Itzikowitz R, Isaacs W, Stellenboom F, Walaza S, Hellferscee O, Treurnicht FK, Zar HJ, Tempia S, Cohen C. A Retrospective observational cohort study of the effect of antenatal influenza vaccination on birth outcomes in Cape Town, South Africa, 2015-2016. Influenza Other Respir Viruses 2021; 15:446-456. [PMID: 33452708 PMCID: PMC8189187 DOI: 10.1111/irv.12836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background There are conflicting data concerning the impact of antenatal influenza vaccination on birth outcomes including low birthweight (LBW), preterm birth, small for gestational age (SGA), and stillbirth. Methods We conducted a retrospective observational cohort study of infants born to women residing in Mitchells Plain, Cape Town. Infants were born at 4 health facilities during May 28 – December 31, 2015 and April 15 – December 31, 2016. We performed crude and multivariable logistic regression, propensity score (PS) matching logistic regression, and inverse probability of treatment weighted (IPTW) regression to assess vaccine effectiveness (VE) against LBW, preterm birth, SGA, and stillbirth adjusting for measured confounders. Results Maternal vaccination status, antenatal history, and ≥1 birth outcome(s) were available for 4084/5333 (76.6%) pregnancies, 2109 (51.6%) vaccinated, and 1975 (48.4%) unvaccinated. The proportion LBW was lower in vaccinated (6.9%) vs. unvaccinated (12.5%) in multivariable [VE 0.27 (95% CI 0.07‐0.42)], PS [VE 0.30 (95% CI 0.09‐0.51)], and IPTW [VE 0.24 (95% CI 0.04‐0.45)]. Preterm birth was less frequent in vaccinated (8.6%) than unvaccinated (16.4%) in multivariable [VE 0.26 (0.09‐0.40)], PS [VE 0.25 (95% CI 0.09‐0.41)], and IPTW [VE 0.34 (95% CI 0.18‐0.51)]. The proportion SGA was lower in vaccinated (6.0%) than unvaccinated (8.8%) but not in adjusted models. There were few stillbirths in our study population, 30/4084 (0.7%). Conclusions Using multiple analytic approaches, we found that influenza vaccination was associated with lower prevalence of LBW (24‐30%) and preterm birth (25‐34%) in Cape Town during 2015‐2016.
Collapse
Affiliation(s)
- Meredith L McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,United States Public Health Service, Rockville, Maryland, USA
| | - Liza Rossi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Susan Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Katherine Bishop
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Raphaela Itzikowitz
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Washiefa Isaacs
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Faakhiera Stellenboom
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,MassGenics, Duluth, Georgia, USA
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
67
|
de la Cruz Conty ML, Encinas Pardilla MB, Garcia Sanchez M, Gonzalez Rodriguez L, Muner-Hernando ML, Royuela Vicente A, Pintado Recarte P, Martinez Varea A, Martinez Diago C, Cruz Melguizo S, Martinez-Perez O. Impact of Recommended Maternal Vaccination Programs on the Clinical Presentation of SARS-CoV-2 Infection: A Prospective Observational Study. Vaccines (Basel) 2021; 9:31. [PMID: 33429912 PMCID: PMC7826802 DOI: 10.3390/vaccines9010031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has raised questions about the possible cross immunity resulting from common vaccination programs and SARS-CoV-2 infection. Therefore, the Spanish Obstetric Emergency group performed a multicenter prospective study on the vaccination status of Influenza and Tdap (diphtheria, tetanus and pertussis vaccine boost administered in adulthood) in consecutive cases of SARS-CoV-2 infection in a pregnancy cohort, in order to assess its possible association with the clinical presentation and severity of symptoms of SARS-CoV-2 infection, as well as to determine the factors that may affect vaccination adherence. A total of 1150 SARS-CoV-2 positive pregnant women from 78 Spanish hospitals were analyzed: 183 had not received either vaccine, 23 had been vaccinated for Influenza only, 529 for Tdap only and 415 received both vaccines. No association was observed between the vaccination status and the clinical presentation of SARS-CoV-2 infection and/or the severity of symptoms. However, a lower adherence to the administration of both vaccines was observed in the Latin-American subgroup. Based on the results above, we reinforce the importance of maternal vaccination programs in the actual pandemic. Health education campaigns should be specially targeted to groups less likely to participate in these programs, as well as for a future SARS-CoV-2 vaccination campaign.
Collapse
Affiliation(s)
| | - Maria Begoña Encinas Pardilla
- Department of Gynecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, 28222 Madrid, Spain; (M.B.E.P.) ; (S.C.M.); (O.M.-P.)
| | - Marta Garcia Sanchez
- Department of Gynecology and Obstetrics, Quironsalud Malaga University Hospital, 29004 Malaga, Spain
| | - Laura Gonzalez Rodriguez
- Department of Gynecology and Obstetrics, Alvaro Cunqueiro Hospital of Vigo, 36213 Pontevedra, Spain;
| | | | - Ana Royuela Vicente
- *Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA-CIBERESP), 28222 Madrid, Spain;
| | - Pilar Pintado Recarte
- Department of Gynecology and Obstetrics, Gregorio Marañon University Hospital, 28007 Madrid, Spain;
| | - Alicia Martinez Varea
- Department of Gynecology and Obstetrics, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Clara Martinez Diago
- Department of Gynecology and Obstetrics, Doctor Josep Trueta University Hospital of Girona, 17007 Girona, Spain;
| | - Sara Cruz Melguizo
- Department of Gynecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, 28222 Madrid, Spain; (M.B.E.P.) ; (S.C.M.); (O.M.-P.)
| | - Oscar Martinez-Perez
- Department of Gynecology and Obstetrics, Puerta de Hierro University Hospital of Majadahonda, 28222 Madrid, Spain; (M.B.E.P.) ; (S.C.M.); (O.M.-P.)
- Departamento de Obstetricia y Ginecología, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | | |
Collapse
|
68
|
Abstract
Influenza poses a significant disease burden on children worldwide, with high rates of hospitalization and substantial morbidity and mortality. Although the clinical presentation of influenza in children has similarities to that seen in adults, there are unique aspects to how children present with infection that are important to recognize. In addition, children play a significant role in viral transmission within communities. Growing evidence supports the idea that early influenza infection can uniquely establish lasting immunologic memory, making an understanding of how viral immunity develops in this population critical to better protect children from infection and to facilitate efforts to develop a more universally protective influenza vaccine.
Collapse
Affiliation(s)
- Jennifer Nayak
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Rochester Medical Center, Rochester, New York 14642-0001, USA
| | - Gregory Hoy
- Medical Scientist Training Program, Medical School, University of Michigan, Ann Arbor, Michigan 48109-2029, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109-2029, USA
| |
Collapse
|
69
|
McLaughlin JM, Khan F, Schmitt HJ, Agosti Y, Jodar L, Simões EAF, Swerdlow DL. Respiratory Syncytial Virus-Associated Hospitalization Rates among US Infants: A Systematic Review and Meta-Analysis. J Infect Dis 2020; 225:1100-1111. [PMID: 33346360 PMCID: PMC8921994 DOI: 10.1093/infdis/jiaa752] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/24/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although global reviews of infant RSV burden exist, none have summarized data from the United States or evaluated how RSV burden estimates are influenced by variations in study design. METHODS We performed a systematic literature review and meta-analysis of studies describing RSV-associated hospitalization rates among US infants and examined the impact of key study characteristics on these estimates. RESULTS We reviewed 3328 articles through August 14, 2020 and identified 25 studies with 31 unique estimates of RSV-associated hospitalization rates. Among US infants <1 year of age, annual rates ranged from 8.4 to 40.8 per 1000 with a pooled rate= 19.4 (95%CI: 17.9-20.9). Study type influenced RSV-associated hospitalization rates (P=.003), with active surveillance studies having pooled rates (11.0; 95%CI: 9.8-12.2) that were half that of studies based on administrative claims (21.4; 95%CI: 19.5-23.3) or modeling approaches (23.2; 95%CI: 20.2-26.2). CONCLUSIONS Applying our pooled rates to the 2020 US birth cohort suggests that 79,850 (95%CI: 73,680-86,020) RSV-associated infant hospitalizations occur each year. The full range of RSV-associated hospitalization rates identified in our review can better inform future evaluations of RSV prevention strategies. More research is needed to better understand differences in estimated RSV burden across study design.
Collapse
Affiliation(s)
| | | | | | | | | | - Eric A F Simões
- University of Colorado, School of Medicine, Aurora, CO.,Children's Hospital Colorado, Aurora, CO
| | | |
Collapse
|
70
|
Shultz PK, Crofts KF, Holbrook BC, Alexander-Miller MA. Neuraminidase-specific antibody responses are generated in naive and vaccinated newborn nonhuman primates following virus infection. JCI Insight 2020; 5:141655. [PMID: 33264104 PMCID: PMC7819742 DOI: 10.1172/jci.insight.141655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/11/2020] [Indexed: 01/30/2023] Open
Abstract
Individuals younger than 6 months of age are at significant risk from influenza virus infection; however, there is currently no vaccine approved for this age group. Influenza virus neuraminidase (NA) has emerged as a potential additional target for vaccine strategies. In this study, we sought to understand the ability of newborns to mount an antibody response to NA. Here we employed a nonhuman primate model, given the similarities to humans in immune system and development. We measured antibody to NA following infection with an H1N1 virus or following vaccination and challenge. Administration of an inactivated virus vaccine was not capable of eliciting detectable NA-specific antibody, even in the presence of adjuvants previously shown to increase total virus-specific IgG. However, both naive and vaccinated newborns generated a NA-specific antibody response following virus infection. Interestingly, the presence of the vaccine-induced response did not prevent generation of systemic antibody to NA following challenge, although the respiratory response was reduced in a significant portion of newborns. These findings are the first, to our knowledge, to evaluate the newborn response to the influenza NA protein as well as the impact of previous vaccination on generation of these antibodies following virus infection.
Collapse
|
71
|
Rolsma SL, Rankin DA, Haddadin Z, Hamdan L, Rahman HK, Faouri S, Shehabi A, Williams JV, Khuri-Bulos N, Halasa NB. Assessing the epidemiology and seasonality of influenza among children under two hospitalized in Amman, Jordan, 2010-2013. Influenza Other Respir Viruses 2020; 15:284-292. [PMID: 33175456 PMCID: PMC7902256 DOI: 10.1111/irv.12813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background The disease burden of influenza‐associated hospitalizations among children in Jordan is not well established. We aimed to characterize hospitalizations attributed to influenza in a pediatric population. Methods We conducted a cross‐sectional study from our viral surveillance cohort in children under 2 years hospitalized with acute respiratory symptoms and/or fever from March 2010 to March 2013. We collected demographic and clinical characteristics, and calculated the frequency of children who met the severe acute respiratory illness (SARI) criteria. Nasal specimens were tested using real‐time reverse transcriptase polymerase chain reaction to detect influenza A, B, or C. Further subtyping for influenza A‐positive isolates was conducted. Results Of the 3168 children enrolled in our study, 119 (4%) were influenza‐positive. Influenza types and subtypes varied by season but were predominantly detected between December and February. Codetection of multiple respiratory pathogens was identified in 58% of children with the majority occurring among those <6 months. Bronchopneumonia and rule‐out sepsis were the most common admission diagnoses, with influenza A accounting for over 2/3 of children with a rule‐out sepsis admission status. One‐third of children under 6 months compared to 3/4 of children 6‐23 months met the SARI criteria. Conclusions Influenza was an important cause of acute respiratory illness in children under 2 years. Children <6 months had the highest burden of influenza‐associated hospitalizations and were less likely to meet the SARI global surveillance case definition. Additional surveillance is needed in the Middle East to determine the true influenza burden on a global scale.
Collapse
Affiliation(s)
- Stephanie L Rolsma
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danielle A Rankin
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zaid Haddadin
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lubna Hamdan
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Herdi K Rahman
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samir Faouri
- Department of Pediatrics, Al Bashir Hospital, Amman, Jordan
| | - Asem Shehabi
- Department Pathology and Microbiology and Forensic Medicine, Jordan University, Amman, Jordan
| | - John V Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Natasha B Halasa
- Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
| |
Collapse
|
72
|
Mattila JM, Thomas E, Lehtinen P, Vuorinen T, Waris M, Heikkinen T. Burden of influenza during the first year of life. Influenza Other Respir Viruses 2020; 15:506-512. [PMID: 33073478 PMCID: PMC8189221 DOI: 10.1111/irv.12820] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 01/18/2023] Open
Abstract
Background Every year, influenza viruses infect millions of children and cause an enormous burden of disease. Young children are at the highest risk for influenza‐attributable hospitalizations. Nevertheless, most young children are treated as outpatients, and limited data are available on the burden of influenza in these children. Methods We carried out a prospective cohort study and followed 431 infants born in June‐August 2017 for 10 months from September 1, 2017, to June 30, 2018. The parents filled out daily symptom diaries and were instructed to bring their child for clinical examination at our study clinic each time the child had fever or any signs or symptoms of respiratory tract infection. During each visit, we obtained nasopharyngeal swab specimens for determination of the viral etiology of the illness. Results A total of 55 episodes of laboratory‐confirmed influenza were diagnosed among the 408 actively participating children, which corresponds to an annual incidence rate of 135/1000 children (95% Cl, 102‐175). Excluding five children with double viral infection, acute otitis media developed as a complication of influenza in 23 (46%) children. One (2%) child with influenza was hospitalized because of febrile convulsion. The effectiveness of influenza vaccination was 48% (95% CI, −29%‐80%). Conclusions The burden of influenza during the first year of life is heavy in the outpatient setting where most infants with influenza are managed. Effective strategies for the prevention of influenza particularly in infants under 6 months of age are needed to diminish the burden of disease in this age group.
Collapse
Affiliation(s)
- Janna-Maija Mattila
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Emilia Thomas
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Pasi Lehtinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital, and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Matti Waris
- Department of Clinical Microbiology, Turku University Hospital, and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
73
|
Hoshi SL, Shono A, Seposo X, Okubo I, Kondo M. Cost-effectiveness analysis of influenza vaccination during pregnancy in Japan. Vaccine 2020; 38:7363-7371. [PMID: 33020012 DOI: 10.1016/j.vaccine.2020.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pregnant women and infants are known as high risk groups for influenza. WHO recommend pregnant women be vaccinated with inactivated influenza vaccine. In Japan, some municipalities started to give subsidy to encourage pregnant women to receive a shot on their own accord, which has made the introduction of seasonal antepartum maternal vaccination program (AMVP) into the routine vaccination list a current topic in health policy and has raised the need to evaluate the value for money of such possibility. METHODS We conducted a cost-effectiveness analysis to evaluate the efficiency of conducting AMVP in Japan. A decision tree model was adopted taking into consideration the duration of single-year vaccine effectiveness for infants and for mothers. The program targeted pregnant women aged 20-49 years old at or over 12 weeks gestation during October 1 through March 30. Estimated probabilities of treatments received due to influenza for pregnant/postpartum women or their infants varied by calendar time, vaccination status, and/or gestational age. Incremental cost-effectiveness ratio (ICER) compared with current no-AMVP from societal perspective was calculated. Transition probabilities, utility weights to estimate quality-adjusted life year (QALY), and disease treatment costs were either calculated or extracted from literature. Costs per vaccination was assumed at ¥3,529/US$32.1. RESULTS AMVP reduces disease treatment costs, while the reduction cannot offset the vaccination cost. Incremental QALYs were at 0.00009, among them 84.2% were from infants. ICER was ¥7,779,356/US$70,721 per QALY gained. One-way sensitivity analyses revealed that vaccine effectiveness for infant and costs per shot were the two main key variables affecting the ICER. CONCLUSION We found that vaccinating pregnant women with influenza vaccine to prevent unvaccinated infants and pregnant/postpartum women from influenza-associated disease in Japan can be cost-effective from societal perspective, under the WHO-suggested "cost-effective" criteria (1-3 times of GDP).
Collapse
Affiliation(s)
- Shu-Ling Hoshi
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 3058577, Japan
| | - Aiko Shono
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 2048588, Japan; Social Pharmacy and Regulatory Science, Showa Pharmaceutical University, 3-3165, Higashi-Tamagawagakuen, Machidashi, Tokyo 194-8543, Japan.
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 8528523, Japan
| | - Ichiro Okubo
- Yokohama City Institute of Public Health, 7-1, Tomiokahigashi 2-chom, Kanazawa-ku, Yokohama City 2360051, Japan
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 3058577, Japan
| |
Collapse
|
74
|
Rioux M, McNeil M, Francis ME, Dawe N, Foley M, Langley JM, Kelvin AA. The Power of First Impressions: Can Influenza Imprinting during Infancy Inform Vaccine Design? Vaccines (Basel) 2020; 8:E546. [PMID: 32961707 PMCID: PMC7563765 DOI: 10.3390/vaccines8030546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022] Open
Abstract
Influenza virus infection causes severe respiratory illness in people worldwide, disproportionately affecting infants. The immature respiratory tract coupled with the developing immune system, and lack of previous exposure to the virus is thought to synergistically play a role in the increased disease severity in younger age groups. No influenza vaccines are available for those under six months, although maternal influenza immunization is recommended. In children aged six months to two years, vaccine immunogenicity is dampened compared to older children and adults. Unlike older children and adults, the infant immune system has fewer antigen-presenting cells and soluble immune factors. Paradoxically, we know that a person's first infection with the influenza virus during infancy or childhood leads to the establishment of life-long immunity toward that particular virus strain. This is called influenza imprinting. We contend that by understanding the influenza imprinting event in the context of the infant immune system, we will be able to design more effective influenza vaccines for both infants and adults. Working through the lens of imprinting, using infant influenza animal models such as mice and ferrets which have proven useful for infant immunity studies, we will gain a better understanding of imprinting and its implications regarding vaccine design. This review examines literature regarding infant immune and respiratory development, current vaccine strategies, and highlights the importance of research into the imprinting event in infant animal models to develop more effective and protective vaccines for all including young children.
Collapse
Affiliation(s)
- Melissa Rioux
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.R.); (M.M.); (M.E.F.); (N.D.); (M.F.)
| | - Mara McNeil
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.R.); (M.M.); (M.E.F.); (N.D.); (M.F.)
| | - Magen E. Francis
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.R.); (M.M.); (M.E.F.); (N.D.); (M.F.)
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), Saskatoon, SK S7N 5E3, Canada
| | - Nicholas Dawe
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.R.); (M.M.); (M.E.F.); (N.D.); (M.F.)
| | - Mary Foley
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.R.); (M.M.); (M.E.F.); (N.D.); (M.F.)
| | - Joanne M. Langley
- Department of Pediatrics, Division of Infectious Disease, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada;
- The Canadian Center for Vaccinology (IWK Health Centre, Dalhousie University and the Nova Scotia Health Authority), Halifax, NS B3K 6R8, Canada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada
| | - Alyson A. Kelvin
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (M.R.); (M.M.); (M.E.F.); (N.D.); (M.F.)
- Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), Saskatoon, SK S7N 5E3, Canada
- Department of Pediatrics, Division of Infectious Disease, Faculty of Medicine, Dalhousie University, Halifax, NS B3K 6R8, Canada;
- The Canadian Center for Vaccinology (IWK Health Centre, Dalhousie University and the Nova Scotia Health Authority), Halifax, NS B3K 6R8, Canada
| |
Collapse
|
75
|
Grohskopf LA, Alyanak E, Broder KR, Blanton LH, Fry AM, Jernigan DB, Atmar RL. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2020-21 Influenza Season. MMWR Recomm Rep 2020; 69:1-24. [PMID: 32820746 PMCID: PMC7439976 DOI: 10.15585/mmwr.rr6908a1] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This report updates the 2019–20 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2019;68[No. RR-3]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. For each recipient, a licensed and age-appropriate vaccine should be used. Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. Most influenza vaccines available for the 2020–21 season will be quadrivalent, with the exception of MF59-adjuvanted IIV, which is expected to be available in both quadrivalent and trivalent formulations. Updates to the recommendations described in this report reflect discussions during public meetings of ACIP held on October 23, 2019; February 26, 2020; and June 24, 2020. Primary updates to this report include the following two items. First, the composition of 2020–21 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. Second, recent licensures of two new influenza vaccines, Fluzone High-Dose Quadrivalent and Fluad Quadrivalent, are discussed. Both new vaccines are licensed for persons aged ≥65 years. Additional changes include updated discussion of contraindications and precautions to influenza vaccination and the accompanying Table, updated discussion concerning use of LAIV4 in the setting of influenza antiviral medication use, and updated recommendations concerning vaccination of persons with egg allergy who receive either cell culture–based IIV4 (ccIIV4) or RIV4. The 2020–21 influenza season will coincide with the continued or recurrent circulation of SARS-CoV-2 (the novel coronavirus associated with coronavirus disease 2019 [COVID-19]). Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient illnesses, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at https://www.cdc.gov/vaccines/pandemic-guidance/index.html. This report focuses on recommendations for the use of vaccines for the prevention and control of seasonal influenza during the 2020–21 season in the United States. A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used within Food and Drug Administration (FDA)–licensed indications. Updates and other information are available from CDC’s influenza website (https://www.cdc.gov/flu). Vaccination and health care providers should check this site periodically for additional information.
Collapse
|
76
|
Implementation of the United Kingdom's childhood influenza national vaccination programme: A review of clinical impact and lessons learned over six influenza seasons. Vaccine 2020; 38:5747-5758. [PMID: 32703747 DOI: 10.1016/j.vaccine.2020.06.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/22/2022]
Abstract
In 2012, the Joint Committee on Vaccination and Immunisation recommended that the United Kingdom's (UK) National Vaccination Programme (NVP) for influenza was extended to include healthy children and adolescents aged 2 to <17 years. Previously, the UK's NVP focused on seasonal vaccination of the elderly and people (including children) with underlying health conditions that put them at high risk of hospitalisation if they contracted influenza. The extension of the UK's programme began in the 2013/14 influenza season through the vaccination of children aged 2-3 years in primary care across England and the devolved administrations of Scotland, Wales, and Northern Ireland. School-aged children were generally vaccinated in a school setting, with several implementation pilots in England and Scotland. Due to the scale of the programme, it has been phased in over several years and expanded to include broader childhood age groups. This article reviews the experiences from the implementation of the UK's childhood influenza NVP over the first six influenza seasons (between 2013/14 and 2018/19) from the perspectives of England, Scotland, Wales, and Northern Ireland. The processes used to deliver the vaccination programme in general practice and the school-based setting are described in terms of governance, contracting, workforce management, communication, administrative tasks, vaccination sessions, vaccine supply and distribution, and surveillance. In addition, the available evidence regarding the clinical impact of the UK's childhood influenza NVP over the first six influenza seasons is reviewed. We also share lessons learned from the programme and recommendations to provide guidance to other countries looking to implement childhood influenza vaccination programmes.
Collapse
|
77
|
McCarthy Z, Athar S, Alavinejad M, Chow C, Moyles I, Nah K, Kong JD, Agrawal N, Jaber A, Keane L, Liu S, Nahirniak M, Jean DS, Romanescu R, Stockdale J, Seet BT, Coudeville L, Thommes E, Taurel AF, Lee J, Shin T, Arino J, Heffernan J, Chit A, Wu J. Quantifying the annual incidence and underestimation of seasonal influenza: A modelling approach. Theor Biol Med Model 2020; 17:11. [PMID: 32646444 PMCID: PMC7347407 DOI: 10.1186/s12976-020-00129-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal influenza poses a significant public health and economic burden, associated with the outcome of infection and resulting complications. The true burden of the disease is difficult to capture due to the wide range of presentation, from asymptomatic cases to non-respiratory complications such as cardiovascular events, and its seasonal variability. An understanding of the magnitude of the true annual incidence of influenza is important to support prevention and control policy development and to evaluate the impact of preventative measures such as vaccination. METHODS We use a dynamic disease transmission model, laboratory-confirmed influenza surveillance data, and randomized-controlled trial (RCT) data to quantify the underestimation factor, expansion factor, and symptomatic influenza illnesses in the US and Canada during the 2011-2012 and 2012-2013 influenza seasons. RESULTS Based on 2 case definitions, we estimate between 0.42-3.2% and 0.33-1.2% of symptomatic influenza illnesses were laboratory-confirmed in Canada during the 2011-2012 and 2012-2013 seasons, respectively. In the US, we estimate between 0.08-0.61% and 0.07-0.33% of symptomatic influenza illnesses were laboratory-confirmed in the 2011-2012 and 2012-2013 seasons, respectively. We estimated the symptomatic influenza illnesses in Canada to be 0.32-2.4 million in 2011-2012 and 1.8-8.2 million in 2012-2013. In the US, we estimate the number of symptomatic influenza illnesses to be 4.4-34 million in 2011-2012 and 23-102 million in 2012-2013. CONCLUSIONS We illustrate that monitoring a representative group within a population may aid in effectively modelling the transmission of infectious diseases such as influenza. In particular, the utilization of RCTs in models may enhance the accuracy of epidemiological parameter estimation.
Collapse
Affiliation(s)
- Zachary McCarthy
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Safia Athar
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Mahnaz Alavinejad
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Christopher Chow
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Iain Moyles
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada
| | - Kyeongah Nah
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Jude D Kong
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | | | - Ahmed Jaber
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Laura Keane
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada
| | - Sam Liu
- McMaster University, Hamilton, L8S 4L8, ON, Canada
| | - Myles Nahirniak
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Danielle St Jean
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Razvan Romanescu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, M5G 1X5, ON, Canada
| | - Jessica Stockdale
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Bruce T Seet
- Sanofi Pasteur, Toronto, M2R 3T4, Canada.,Department of Molecular Genetics, Toronto, M5S 1A8, ON, Canada
| | | | - Edward Thommes
- Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada.,Sanofi Pasteur, Toronto, M2R 3T4, Canada
| | | | - Jason Lee
- Sanofi Pasteur, Toronto, M2R 3T4, Canada
| | | | - Julien Arino
- University of Manitoba, Department of Mathematics, Winnipeg, R3T 2N2, MB, Canada
| | - Jane Heffernan
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Ayman Chit
- Leslie Dan School of Pharmacy, University of Toronto, Toronto, M5S 3M2, ON, Canada.,Sanofi Pasteur, Swiftwater, 18370, PA, USA
| | - Jianhong Wu
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada. .,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada. .,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada. .,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada.
| |
Collapse
|
78
|
Kovacevic P, Matijasevic J, Dragic S, Zlojutro B, Gavrilovic S, Jandric M, Andrijevic A, Kovacevic T, Carapic V, Travar M, Preradovic L, Momcicevic D. Characteristics and outcomes of critically ill patients with influenza A (H1N1) in the Western Balkans during the 2019 post-pandemic season. Indian J Med Microbiol 2020; 38:415-420. [PMID: 33154256 DOI: 10.4103/ijmm.ijmm_20_169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background This study looked at the characteristics and outcomes of critically ill patients with confirmed influenza A (H1N1) pdm09 infection in the Western Balkans in the post-pandemic period. Materials and Methods This retrospective observational study of medical records and associated data collected during the post-pandemic period included all mechanically ventilated adult patients of two university-affiliated hospitals of the Western Balkans between 1 January and 31 March 2019 who had influenza A (H1N1) pdm09 infection confirmed by real-time reverse transcriptase-polymerase chain reaction from nasopharyngeal swab specimens and respiratory secretions. Results The study included 89 patients, 49 males (55.1%), aged 56.09 ± 12.64 years. The median time from shift from hospital time to intensive care unit was 1 day (range: 1-2). In the post-pandemic period, cases observed in this study were found to have the following comorbidities: cardiovascular diseases in 44 (49.4%) patients and diabetes in 21 (23.6%) patients. Thirty-one patients (34.8%) in this study were obese. All 89 patients (100%) experienced some degree of acute respiratory distress syndrome, and 39 (44%) had multiorgan failure. Eighty-three patients (93%) were intubated and mechanically ventilated, 6 (7%) received non-invasive mechanical ventilation, 12 (13%) were treated with vvECMO and 36 (40%) received renal replacement therapy. Vasoactive support was needed by 56 (63%) patients. The median duration of mechanical ventilation was 9 (6-15.5) days. The hospital mortality rate was 44%. Conclusion Critically ill patients with confirmed influenza A (H1N1) pdm09 infection in the post-pandemic season were older, required vasoactive drugs more often, and there was a trend of higher survival compared to H1N1 infection patients in the previous pandemic seasons.
Collapse
Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska; Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina, Novi Sad, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Srdjan Gavrilovic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Milka Jandric
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Ana Andrijevic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Tijana Kovacevic
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina; Department of Pharmacy, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Vladimir Carapic
- Institute for Pulmonary Diseases, Medical School University of Novi Sad, Novi Sad, Serbia
| | - Maja Travar
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina; Department of Microbiology, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| | - Ljubisa Preradovic
- Faculty of Medicine, University of Banja Luka, Bosnia and Herzegovina, Novi Sad, Serbia
| | - Danica Momcicevic
- Medical Intensive Care Unit, University Clinical Center of Republika Srpska, Novi Sad, Serbia
| |
Collapse
|
79
|
Kempe A, Saville AW, Albertin C, Zimet G, Breck A, Helmkamp L, Vangala S, Dickinson LM, Rand C, Humiston S, Szilagyi PG. Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey. Pediatrics 2020; 146:e20193852. [PMID: 32540985 PMCID: PMC7329256 DOI: 10.1542/peds.2019-3852] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The World Health Organization has designated vaccine hesitancy as 1 of the 10 leading threats to global health, yet there is limited current national data on prevalence of hesitancy among US parents. Among a nationally representative sample of US parents, we aimed to (1) assess and compare prevalence of hesitancy and factors driving hesitancy for routine childhood and influenza vaccination and (2) examine associations between sociodemographic characteristics and hesitancy for routine childhood or influenza vaccination. METHODS In February 2019, we surveyed families with children using the largest online panel generating representative US samples. After weighting, we assessed hesitancy using a modified 5-point Vaccine Hesitancy Scale and labeled parents as hesitant if they scored >3. RESULTS A total of 2176 of 4445 parents sampled completed the survey (response rate 49%). Hesitancy prevalence was 6.1% for routine childhood and 25.8% for influenza vaccines; 12% strongly and 27% somewhat agreed they had concerns about serious side effects of both routine childhood and influenza vaccines. A total of 70% strongly agreed that routine childhood vaccines are effective versus 26% for influenza vaccine (P < .001). In multivariable models, an educational level lower than a bachelor's degree and household income <400% of the federal poverty level predicted hesitancy about both routine childhood and influenza vaccines. CONCLUSIONS Almost 1 in 15 US parents are hesitant about routine childhood vaccines, whereas >1 in 4 are hesitant about influenza vaccine. Furthermore, 1 in 8 parents are concerned about vaccine safety for both routine childhood and influenza vaccines, and only 1 in 4 believe influenza vaccine is effective. Vaccine hesitancy, particularly for influenza vaccine, is prevalent in the United States.
Collapse
Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado;
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Christina Albertin
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| | - Gregory Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Abigail Breck
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Cindy Rand
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York; and
| | - Sharon Humiston
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Peter G Szilagyi
- Department of Pediatrics, University of California at Los Angeles Mattel Children's Hospital and University of California at Los Angeles, Los Angeles, California
| |
Collapse
|
80
|
Abu-Raya B, Maertens K, Edwards KM, Omer SB, Englund JA, Flanagan KL, Snape MD, Amirthalingam G, Leuridan E, Damme PV, Papaevangelou V, Launay O, Dagan R, Campins M, Cavaliere AF, Frusca T, Guidi S, O'Ryan M, Heininger U, Tan T, Alsuwaidi AR, Safadi MA, Vilca LM, Wanlapakorn N, Madhi SA, Giles ML, Prymula R, Ladhani S, Martinón-Torres F, Tan L, Michelin L, Scambia G, Principi N, Esposito S. Global Perspectives on Immunization During Pregnancy and Priorities for Future Research and Development: An International Consensus Statement. Front Immunol 2020; 11:1282. [PMID: 32670282 PMCID: PMC7326941 DOI: 10.3389/fimmu.2020.01282] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
Immunization during pregnancy has been recommended in an increasing number of countries. The aim of this strategy is to protect pregnant women and infants from severe infectious disease, morbidity and mortality and is currently limited to tetanus, inactivated influenza, and pertussis-containing vaccines. There have been recent advancements in the development of vaccines designed primarily for use in pregnant women (respiratory syncytial virus and group B Streptococcus vaccines). Although there is increasing evidence to support vaccination in pregnancy, important gaps in knowledge still exist and need to be addressed by future studies. This collaborative consensus paper provides a review of the current literature on immunization during pregnancy and highlights the gaps in knowledge and a consensus of priorities for future research initiatives, in order to optimize protection for both the mother and the infant.
Collapse
Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kirsten Maertens
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Kathryn M. Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Department of Epidemiology of Microbial Diseases, Yale School of Medicine, Yale School of Public Health, New Haven, CT, United States
| | - Janet A. Englund
- Department of Pediatrics, Seattle Children's Research Institute, University of Washington, Seattle, WA, United States
| | - Katie L. Flanagan
- Faculty of Health Sciences, School of Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, RMIT University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
| | - Matthew D. Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Elke Leuridan
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Faculty of Medicine and Health Sciences, Centre for the Evaluation of Vaccination, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
| | - Vana Papaevangelou
- Third Department of Pediatrics, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens, Greece
| | - Odile Launay
- Université de Paris, Inserm, CIC 1417, F-CRIN I REIVAC, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Magda Campins
- Preventive Medicine and Epidemiology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Anna Franca Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sofia Guidi
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel O'Ryan
- Microbiology and Mycology Program, Faculty of Medicine, Institute of Biomedical Sciences and Associate Researcher, Millennium Institute of Immunology and Immunotherapy, University of Chile, Santiago, Chile
| | - Ulrich Heininger
- Pediatric Infectious Diseases, University of Basel Children's Hospital, Basel, Switzerland
| | - Tina Tan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Marco. A. Safadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Luz M. Vilca
- Unit of Obstetrics and Gynecology, Buzzi Hospital - ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Roman Prymula
- School of Medicine Hradec Kralove, Institute of Social Medicine, Charles University Prague, Prague, Czechia
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, University of Santiago, Santiago de Compostela, Spain
| | - Litjen Tan
- Immunization Action Coalition, St. Paul, MN, United States
| | - Lessandra Michelin
- Infectious Diseases and Vaccinology Division, Health Sciences Post Graduation Program, University of Caxias Do Sul, Caxias Do Sul, Brazil
| | - Giovanni Scambia
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario “A. Gemelli” IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| |
Collapse
|
81
|
Abstract
BACKGROUND Influenza A viruses are conventionally thought to cause more severe illnesses than B viruses, but few studies with long observation periods have compared the clinical severity of A and B infections in hospitalized children. METHODS We analyzed the clinical presentation, outcomes and management of all children <16 years of age admitted to Turku University Hospital, Finland, with virologically confirmed influenza A or B infection during the 14-year period of 1 July 2004 to 30 June 2018. All comparisons between influenza A and B were performed both within predefined age groups (0-2, 3-9 and 10-15 years) and in all age groups combined. RESULTS Among 391 children hospitalized with influenza A or B infection, influenza A was diagnosed in 279 (71.4%) and influenza B in 112 (28.6%) children. Overall, there were no significant differences in any clinical features or outcomes, management, treatment at intensive care unit or length of stay between children with influenza A and B, whether analyzed by age group or among all children. As indicators of the most severe clinical presentations, blood cultures were obtained from 101 (36.2%) children with influenza A and 39 (34.8%) with influenza B (P = 0.80), and lumbar puncture was performed to 16 (5.7%) children with influenza A and 11 (9.8%) children with influenza B (P = 0.15). CONCLUSIONS The clinical severity of influenza A and B infections is similar in children. For optimal protection against severe influenza illnesses, the use of quadrivalent vaccines containing both lineages of B viruses seems warranted in children.
Collapse
|
82
|
Li J, Jie X, Liang X, Chen Z, Xie P, Pan X, Zhou B, Li J. Sinensetin suppresses influenza a virus-triggered inflammation through inhibition of NF-κB and MAPKs signalings. BMC Complement Med Ther 2020; 20:135. [PMID: 32370749 PMCID: PMC7200050 DOI: 10.1186/s12906-020-02918-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
Background Human respiratory system infected with influenza A virus (IAV) elicited a robust pro-inflammatory response that resulted in severe illness and even death. Currently, limited immunomodulator is available to counteract IAV-associated pneumonia in the clinic. Sinensetin, a polymethoxylated flavone with five methoxy groups, has been found to possess anti-agiogenesis, anti-inflammatory and anti-diabetic activities. However, the effects of sinensetin on IAV-triggered pro-inflammatory response remain unclear. In the present study, the anti-inflammatory effects and corresponding possible mechanism of sinensetin in IAV-infected A549 cells were subjected to investigations. Methods The cytotoxic effects of sinensetin towards A549 cells was detected by MTT and LDH assays. The antiviral activity of sinensetin against influenza A virus was assayed in A549 cells with an engineered replication-competent influenza A virus carrying Gaussia luciferase reporter gene infection. The effect of sinensetin on influenza A virus-triggered inflammatory reaction was determined by qRT-PCR, Luminex assays, ELISA and Western blot. Results Our results showed that sinensetin did not exhibit antiviral activity against A/PR/8/34 (H1N1). Meanwhile, sinensetin treatment significantly decreased IAV-induced expression of pro-inflammatory mediators at mRNA and protein levels, including IL-6, TNF-α, IP-10, IL-8 and MCP-1. Additionally, levels of cyclooxygenase (COX)-2 and the downstream product prostaglandin E2 (PGE2) up-regulated by IAV infection were dramatically suppressed by sinensetin. The mechanistic investigation revealed that sinensetin treatment suppressed the NF-κB transcriptional activity using the NF-κB reporter stable HEK293 cell line stimulated with TNF-α (20 ng/mL) or influenza H1N1 virus. Furthermore, sinensetin abrogated influenza H1N1 virus-induced activation of NF-κB, ERK1/2 MAPK and p38 MAPK signalings. Conclusion Collectively, our results indicated that sinensetin has potential capacity to attenuate IAV-triggered pro-inflammatory response via inactivation of NF-κB, ERK1/2 MAPK and p38 MAPK signalings, which implied that sinensetin may be a promising candidate drug for influenza H1N1 virus infection therapeutics.
Collapse
Affiliation(s)
- Jiashun Li
- Department of Respiratory, Affiliated Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), Huadu, Guangzhou, Guangdong, 510800, P.R. China
| | - Xiang Jie
- Huizhou third people's hospital, Guangzhou Medical University, Guangdong, 516002, China
| | - Xiaoli Liang
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, National Clinical Centre of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510120, P.R. China
| | - Ziyu Chen
- Institute of Respiratory Diseases, Department of Respiratory, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Peifang Xie
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, National Clinical Centre of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510120, P.R. China
| | - Xiping Pan
- Institute of Chinese Integrative Medicine, Guangzhou Medical University, Guangzhou, Guangdong, 511436, P.R. China
| | - Beixian Zhou
- Department of Pharmacy, The People's hospital of Gaozhou, Gaozhou, 525200, Guangdong, China.
| | - Jing Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, National Clinical Centre of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510120, P.R. China.
| |
Collapse
|
83
|
O'Leary ST, Cataldi JR, Lindley MC, Hurley LP, Riley LE, Brtnikova M, Crane LA, Beaty B, Stokley S, Fisher A, Kempe A. Impact of media reports regarding influenza vaccine on obstetricians' vaccination practices. Vaccine 2020; 38:3474-3479. [PMID: 32204941 PMCID: PMC9987339 DOI: 10.1016/j.vaccine.2020.02.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2017, three media stories regarding influenza vaccine may have impacted obstetricians' (OB) influenza vaccination practices: reports of reduced influenza vaccine effectiveness, a severe influenza season, and a possible increased risk of miscarriage among pregnant women receiving 2009 H1N1 vaccine in the 1st trimester who had received H1N1 vaccine the previous season (later disproven). OBJECTIVE Describe OB's: (1) awareness of; (2) attitudes and experiences related to; and (3) reported alterations in practice as a result of these reports. METHODS A survey among a nationally representative sample of OBs April to June 2018. RESULTS Response rate was 65% (302/468). 88% of OBs were "very aware" of the severe season, 74% of lower effectiveness, and 25% of the miscarriage study (47% "completely unaware" of miscarriage study). Among those aware, 58%, 57%, and 16% reported ≥10% of pregnant patients initiated discussions about the severe season, lower effectiveness, and miscarriage study, respectively. Most (83%) agreed reports about increased severity increased their enthusiasm for recommending influenza vaccine; fewer agreed reports about the miscarriage study (18%) and lower vaccine effectiveness (12%) decreased their enthusiasm for recommending influenza vaccine. Providers were more likely to initiate discussion with patients about increased severity of the season than the other reports. However, 35% agreed the miscarriage study reports increased their concerns about influenza vaccine safety; 18% (n = 48) reported changing the way they recommended influenza vaccine. Of those, 17 (6% of all respondents) reported not recommending influenza vaccine to women during the 1st trimester and 26 (10% of all respondents) recommended it but were willing to delay until the 2nd trimester. CONCLUSIONS During a season in which media stories could have influenced OB influenza vaccination behaviors in different directions, reports underscoring importance of influenza vaccine may have had more impact on OBs' recommendations than reports questioning vaccine safety or effectiveness.
Collapse
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, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
| | - Jessica R Cataldi
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Megan C Lindley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - 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, CO, United States; Division of General Internal Medicine, Denver Health, Denver, CO, United States
| | - Laura E Riley
- The American College of Obstetricians and Gynecologists, Washington, DC, United States
| | - 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, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - 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, CO, United States; Department of Community and Behavioral Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Brenda Beaty
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, United States
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison Fisher
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - 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, CO, United States; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| |
Collapse
|
84
|
Colucci ME, Affanni P, Cantarelli A, Caruso L, Bracchi MT, Capobianco E, Zoni R, Paini G, Odone A, Mohieldin Mahgoub Ibrahim MM, Veronesi L. Influenza vaccine effectiveness in children: a retrospective study on eight post-pandemic seasons with trivalent inactivated vaccine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:63-70. [PMID: 32275269 PMCID: PMC7975907 DOI: 10.23750/abm.v91i3-s.9424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 01/12/2023]
Abstract
Background and aim of the work: The global burden of disease attributable to seasonal influenza virus in children is difficult to quantify. Children with chronic medical conditions and healthy children may experience severe or fatal complications. Aim of the study was to estimate the influenza vaccine effectiveness (VE) in a cohort of outpatient children. Methods: From 2010 to 2018, a Pediatrician of Parma from the InfluNet network of Emilia-Romagna Region, performed nasal/throat swabs on every child with Influenza-like illness at least 14 days from the vaccination with trivalent vaccine. VE estimates against influenza season, virus type and subtype and age group were evaluated using a test-negative design. Results: 2,480 swabs were performed. The 57.6% of the analyzed swabs were positive for influenza viruses. Type A (57%) and type B viruses (43%) co-circulated. The 37.1% of type A viruses belonged to subtype A(H3N2), 19.4% to subtype A(H1N1)pdm09. The subtype A(H3N2) was prevalent among children up to 23 months (42.4%) while the type B in the 2-4 (40.7%) and 5-16 year old age groups (49.4%). Overall, 19.9% of the children were vaccinated. The highest prevalence of vaccinated subjects was found in children aged 5-16 (30.5%). The VE against subtype A(H1N1)pdm09 was 63% (95%CI 42.6-76.0), against type B 27.5% (95%CI 7.9-42.9) and against subtype A(H3N2) -14.3% (95%CI - 46.0-10.7). Conclusions: Our findings represent a useful contribution to the ongoing debate about the appropriateness of including influenza vaccination for healthy children, 6 months and older, in the updating National Vaccine Prevention Plan (PNPV).
Collapse
Affiliation(s)
| | - Paola Affanni
- Department of Medicine and Surgery, University of Parma.
| | | | - Luca Caruso
- Department of Medicine and Surgery, University of Parma.
| | | | | | - Roberta Zoni
- Department of Medicine and Surgery, University of Parma.
| | - Giulia Paini
- Department of Medicine and Surgery, University of Parma.
| | - Anna Odone
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, Milan.
| | | | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma.
| |
Collapse
|
85
|
Yu J, Qian S, Liu C, Xiao Y, Xu T, Wang Y, Su H, Chen L, Yuan B, Wang X, Xu B, Yang Y, Shen K, Xie Z, Ren L, Wang J. Viral etiology of life-threatening pediatric pneumonia: A matched case-control study. Influenza Other Respir Viruses 2020; 14:452-459. [PMID: 32267084 PMCID: PMC7262399 DOI: 10.1111/irv.12738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background Pediatric pneumonia remains a significant health challenge, while the viral risk factors for adverse outcomes in pediatric pneumonia are not yet fully clear. Methods A matched case‐control study of pediatric patients with pneumonia was carried out in Beijing, China, between 2007 and 2015. The study enrolled 334 intensive care unit patients who developed life‐threatening diseases and 522 controls matched to the sex, age, ethnicity, admission dates, and residing district of the cases suffered from pneumonia. Nasopharyngeal aspirates were taken from all participants and tested by PCR for 18 common respiratory viruses. Results At least, one virus was detected in 257 (77%) of the cases and 409 (78%) of the controls. We observed no difference in the prevalence of 17 respiratory viruses between cases and controls but found a higher frequency of influenza A virus (IFV‐A) in the cases than in the controls (7% vs 4%, P = .036). After adjusting for comorbid conditions and a history of reactive airway diseases, IFV‐A was associated with an increase in life‐threatening pneumonia (adjusted odds ratio = 2.55, 95% CI = 1.24‐5.24). Young age and congenital heart disease (aOR = 10.16‐10.27, P < .001) were also independent risk factors. Conclusions The prevention of IFV infection is critical in decreasing the risk of life‐threatening pneumonia in children.
Collapse
Affiliation(s)
- Jianxing Yu
- National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Suyun Qian
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Chunyan Liu
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Xiao
- National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Teng Xu
- Vision Medicals, Guangzhou, China
| | - Ying Wang
- National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hang Su
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lan Chen
- National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bin Yuan
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Xinming Wang
- National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Baoping Xu
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yan Yang
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Kunling Shen
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhengde Xie
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lili Ren
- National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jianwei Wang
- National Health Commission Key Laboratory of Systems Biology of Pathogens and Christophe Merieux Laboratory, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
86
|
Howard LM, Zhu Y, Griffin MR, Edwards KM, Williams JV, Gil AI, Vidal JE, Klugman KP, Lanata CF, Grijalva CG. Nasopharyngeal Pneumococcal Density during Asymptomatic Respiratory Virus Infection and Risk for Subsequent Acute Respiratory Illness. Emerg Infect Dis 2020; 25:2040-2047. [PMID: 31625844 PMCID: PMC6810199 DOI: 10.3201/eid2511.190157] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Increased nasopharyngeal pneumococcal (Streptococcus pneumoniae) colonization density has been associated with invasive pneumococcal disease, but factors that increase pneumococcal density are poorly understood. We evaluated pneumococcal densities in nasopharyngeal samples from asymptomatic young children from Peru and their association with subsequent acute respiratory illness (ARI). Total pneumococcal densities (encompassing all present serotypes) during asymptomatic periods were significantly higher when a respiratory virus was detected versus when no virus was detected (p<0.001). In adjusted analyses, increased pneumococcal density was significantly associated with the risk for a subsequent ARI (p<0.001), whereas asymptomatic viral detection alone was associated with lower risk for subsequent ARI. These findings suggest that interactions between viruses and pneumococci in the nasopharynx during asymptomatic periods might have a role in onset of subsequent ARI. The mechanisms for these interactions, along with other potentially associated host and environmental factors, and their role in ARI pathogenesis and pneumococcal transmission require further elucidation.
Collapse
|
87
|
Buchy P, Badur S. Who and when to vaccinate against influenza. Int J Infect Dis 2020; 93:375-387. [DOI: 10.1016/j.ijid.2020.02.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022] Open
|
88
|
Kempe A, Saville AW, Albertin C, Helmkamp L, Zhou X, Vangela S, Dickinson LM, Tseng CH, Campbell JD, Whittington M, Gurfinkel D, Roth H, Hoefer D, Szilagyi P. Centralized Reminder/Recall to Increase Influenza Vaccination Rates: A Two-State Pragmatic Randomized Trial. Acad Pediatr 2020; 20:374-383. [PMID: 31698085 PMCID: PMC7477488 DOI: 10.1016/j.acap.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Centralized reminder/recall (C-R/R) by health departments using immunization information systems is more effective and cost effective than practice-based approaches for increasing childhood vaccines but has not been studied for influenza vaccination. We assessed effectiveness and cost of C-R/R for increasing childhood influenza vaccination compared with usual care. METHODS Within Colorado (CO) and New York (NY), random samples of primary care practices (pediatric, family medicine, and health center) were selected proportionate to where children are served-65 practices (N = 54,353 children) in CO; 101 practices (N = 65,777) in NY. We conducted 4-arm RCTs per state (1, 2, or 3 autodial reminders vs usual care), with randomization at the patient level within practices from 10/2016 to 1/2017. RESULTS In CO, the maximum absolute difference in receipt of ≥1 influenza vaccine was 1.7% between the 2 R/R group and control (adjusted risk ratio [ARR] of 1.06 [1.01, 1.10]); other R/R arms did not differ significantly. In NY, ARRs for the study arms versus control varied from 1.05 (1.01, 1.10) for 3 R/R to 1.06 (1.01, 1.11) for 1-2 R/R groups and maximum absolute increase in vaccination was 0.6%. In time-to-event analyses, study arm was a significant predictor of vaccination in CO (P = .001) but not in NY. Costs/child randomized to one message were $.17 in CO and $.23 in NY. CONCLUSIONS C-R/R for influenza vaccine using autodial had low-level effects on increasing influenza rates in 2 states. Given the feasibility and low cost of C-R/R in previous trials, its utility for influenza should be re-examined using different modalities.
Collapse
Affiliation(s)
- Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (A Kempe), Aurora, Colo.
| | - Alison W Saville
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Xinkai Zhou
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Sitaram Vangela
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo; Department of Family Medicine, University of Colorado School of Medicine (LM Dickinson), Aurora, Colo
| | - Chi-Hong Tseng
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California (X Zhou, S Vangela, and C-H Tseng), Los Angeles, Calif
| | - Jonathan D Campbell
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Melanie Whittington
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus (JD Campbell and M Whittington), Aurora, Colo
| | - Dennis Gurfinkel
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, AW Saville, L Helmkamp, LM Dickinson, and D Gurfinkel), Aurora, Colo
| | - Heather Roth
- Colorado Immunization Information System, Colorado Department of Public Health and Environment (H Roth), Denver, Colo
| | - Dina Hoefer
- New York State Immunization Information System, New York State Department of Health (D Hoefer), Albany, NY
| | - Peter Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (C Albertin and P Szilagyi), Los Angeles, Calif
| |
Collapse
|
89
|
Gandhi CK, Patel J, Zhan X. Trend of influenza vaccine Facebook posts in last 4 years: a content analysis. Am J Infect Control 2020; 48:361-367. [PMID: 32098695 DOI: 10.1016/j.ajic.2020.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/05/2020] [Accepted: 01/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Decreasing immunization rates may be partly due to antivaccine campaigns and other sources of misinformation available on social media, particularly on Facebook. Given the potential impact of this medium for communicating vaccine-related information, it is important to analyze the trend of information available on Facebook. METHODS We searched Facebook on August 15, 2018 to obtain posts containing relevant health information on influenza vaccine in years 2015-2018. We collected information regarding nature of the post (eg, pro-, antivaccine, and informational), number of shares and likes received, and ease of reading for each post. We evaluated these characteristics by year and type of post in our exploratory analyses. RESULTS The proportion of pro-vaccine posts has increased compared to antivaccine and informational posts since 2016. There was no correlation between ease of reading and popularity of posts. Although the language of antivaccine posts was complex, they were shared and liked more than pro-vaccine posts. The pro-vaccine personal post by a nurse was the most popular in our study (shared over 46,000 times) in 2018. CONCLUSIONS Though the number of pro-vaccine posts increased, antivaccine posts remained more popular. The government agency may use an emotive personal family-oriented message to promote vaccination.
Collapse
|
90
|
Affiliation(s)
- Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, UR Golisano Children's Hospital, Rochester, New York, USA
| |
Collapse
|
91
|
Weinberg GA. Nontraditional Uses of Live Attenuated Influenza Vaccine: School-Located Influenza Vaccination. J Pediatric Infect Dis Soc 2020; 9:S19-S23. [PMID: 32191311 DOI: 10.1093/jpids/piaa007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Immunization against influenza continues to be the best method of preventing influenza infection in children, and additionally, indirectly helping to lower disease in adults, given the role of children as "spreaders" of influenza to the community at large. An increasing evidence base exists for the use of school-located influenza vaccination (SLIV) programs to increase the influenza vaccination rates among children. Live, attenuated influenza vaccine (LAIV) has unique characteristics that make it useful for SLIV programs, including ease of immunization without needles, faster delivery, and in many (but not all) years, good vaccine effectiveness. Reviewed herein are results of selected published trials as well as guidance on planning a successful SLIV program.
Collapse
Affiliation(s)
- Geoffrey A Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, University of Rochester Golisano Children's Hospital, Rochester, New York, USA
| |
Collapse
|
92
|
Affiliation(s)
- John Treanor
- Department of Medicine, University of Rochester School of Medicine and Dentistry
| |
Collapse
|
93
|
Bordi L, Nicastri E, Scorzolini L, Di Caro A, Capobianchi MR, Castilletti C, Lalle E, On Behalf Of Inmi Covid-Study Group And Collaborating Centers. Differential diagnosis of illness in patients under investigation for the novel coronavirus (SARS-CoV-2), Italy, February 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32127123 PMCID: PMC7055037 DOI: 10.2807/1560-7917.es.2020.25.8.2000170] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A novel coronavirus (SARS-CoV-2) has been identified as the causative pathogen of an ongoing outbreak of respiratory disease, now named COVID-19. Most cases and sustained transmission occurred in China, but travel-associated cases have been reported in other countries, including Europe and Italy. Since the symptoms are similar to other respiratory infections, differential diagnosis in travellers arriving from countries with wide-spread COVID-19 must include other more common infections such as influenza and other respiratory tract diseases.
Collapse
Affiliation(s)
- Licia Bordi
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Laura Scorzolini
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Antonino Di Caro
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | | - Concetta Castilletti
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Eleonora Lalle
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | | |
Collapse
|
94
|
Clemens E, Angeletti D, Holbrook BC, Kanekiyo M, Jorgensen MJ, Graham BS, Yewdell J, Alexander-Miller MA. Influenza-infected newborn and adult monkeys exhibit a strong primary antibody response to hemagglutinin stem. JCI Insight 2020; 5:135449. [PMID: 32078584 DOI: 10.1172/jci.insight.135449] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/12/2020] [Indexed: 01/06/2023] Open
Abstract
The specificity of antibodies (Abs) generated against influenza A virus (IAV) infection can significantly alter protection and viral clearance. At present, the impact of age upon this process is relatively unexplored. Here, we evaluated the Ab response in newborn and adult African green monkeys following infection with IAV using a strain that enables us to determine the immunodominance (ID) hierarchy of the Ab response to hemagglutinin (HA), the principal target of protective Abs. This revealed altered ID patterns in the early IgM anti-HA response in newborns versus adults that converged over time. While the IgG ID profiles for HA in newborn and adult monkeys were similar, this was not the case for IgA. Importantly, HA stem-specific Abs were generated robustly and similarly in newborns and adults in terms of quality and quantity. Together, these results demonstrate that newborns and adults can differ in the Ab ID pattern established following infection and that the ID pattern can vary across isotypes. In addition, newborns have the ability to generate potent HA stem-specific Ab responses. Our findings further the understanding of the newborn response to IAV antigens and inform the development of improved vaccines for this at-risk population.
Collapse
Affiliation(s)
- Elene Clemens
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Davide Angeletti
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden
| | - Beth C Holbrook
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Matthew J Jorgensen
- Section on Comparative Medicine, Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jonathan Yewdell
- Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Martha A Alexander-Miller
- Department of Microbiology and Immunology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
95
|
Murthy NC, Black C, Kahn KE, Ding H, Ball S, Fink RV, Devlin R, D'Angelo D, Fiebelkorn AP. Tetanus, Diphtheria, and Acellular Pertussis and Influenza Vaccinations among Women With a Live Birth, Internet Panel Survey, 2017-2018. Infect Dis (Lond) 2020; 13:1178633720904099. [PMID: 32095076 PMCID: PMC7011328 DOI: 10.1177/1178633720904099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 01/11/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives Pregnant women are at increased risk of complications from influenza, and infants are at increased risk of pertussis. Maternal influenza and Tdap (tetanus, diphtheria, and acellular pertussis) vaccination can reduce risk of these infections and related complications. Our objective was to estimate vaccination coverage with influenza and Tdap vaccines during pregnancy among women with a recent live birth. Methods An opt-in Internet panel survey was conducted from March 28 to April 10, 2018 among pregnant and recently pregnant women. Respondents with a live birth from August 1, 2017 through the date in which the participant completed the survey were included in the analysis. Receipt of influenza vaccination since July 1, 2017 and Tdap vaccination during pregnancy were assessed by sociodemographic characteristics, receipt of a health care provider (HCP) recommendation and/or offer of vaccination, and vaccination-related knowledge, attitudes, and beliefs. Results Less than a third (30.3%) of women with a live birth were unvaccinated during their pregnancy with both Tdap and influenza vaccines. Almost a third (32.8%) of the women reported being vaccinated with both vaccines. The majority (73.0%) of women reported receiving an HCP recommendation for both vaccines, and 54.2% of women were offered both vaccines by an HCP. Reasons for nonvaccination included negative attitudes toward influenza vaccine and lack of awareness about Tdap vaccination during pregnancy. Conclusions Maternal Tdap and influenza vaccinations can prevent morbidity and mortality among infants and their mothers, yet many pregnant women are unvaccinated with either Tdap or influenza vaccines. Clinic-based education, along with interventions, such as standing orders and provider reminders, are strategies to increase maternal vaccination.
Collapse
Affiliation(s)
- Neil Chandra Murthy
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Carla Black
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Katherine E Kahn
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.,Leidos, Atlanta, GA, USA
| | - Helen Ding
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | | | | - Denise D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Amy Parker Fiebelkorn
- Immunization Services Division (ISD), National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| |
Collapse
|
96
|
Kohlmaier B, Svendova V, Walcher T, Pilch H, Krenn L, Kurz H, Zwiauer K, Zenz W. A severe influenza season in Austria and its impact on the paediatric population: mortality and hospital admission rates, november 2017 - march 2018. BMC Public Health 2020; 20:178. [PMID: 32019542 PMCID: PMC7001220 DOI: 10.1186/s12889-020-8239-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/20/2020] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In Austria paediatric influenza-associated hospitalisations and deaths have never been systematically monitored. We examined the influenza season 2017/18 in terms of hospitalisation and mortality in the Austrian paediatric population and put the results into perspective of the available data from the last 15 years. METHODS Cases of influenza-associated hospitalisations and deaths for season 2017/18 in children below 18 years were retrospectively collected from 12 and 33 Austrian hospitals, respectively. Hospitalisation and mortality rates for the whole Austrian paediatric population were estimated, adjusting for the population in each catchment area. Two Austrian databases were queried for hospitalisations and deaths associated with influenza during 2002-2016. Rough estimate of the vaccination coverage was calculated from a survey on 100 inpatients. RESULTS Influenza-related paediatric hospitalisation rate in season 2017/18 was estimated as 128 (CI: 122-135) per 100,000 children, much higher than the national average of 40 per 100,000 over the years 2002-2016. There were nine reported influenza-associated deaths among children, resulting in mortality rate of 0.67 (CI: 0.32-1.21) per 100,000 children. CONCLUSIONS Reported influenza-associated hospitalisations and fatalities demonstrate a high burden of influenza in the Austrian paediatric population corresponding with very low vaccination coverage.
Collapse
Affiliation(s)
- Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Vendula Svendova
- Department of General Paediatrics, Medical University of Graz, Graz, Austria.,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Thomas Walcher
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Heidemarie Pilch
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Larissa Krenn
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Kurz
- Department of Paediatrics and Adolescent Medicine, Social Medical Center East - Danube Hospital (SMZ-Ost), Vienna, Austria
| | - Karl Zwiauer
- Department of Paediatrics and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria.
| | | |
Collapse
|
97
|
Dabaniyasti D, Eksi F, Keskin Ö, Özkars MY, Karsligil T, Balci I. An investigation into respiratory tract viruses in children with acute lower respiratory tract infection or wheezing. Minerva Pediatr 2020; 72:45-54. [PMID: 27854115 DOI: 10.23736/s0026-4946.16.04322-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to determine the frequencies of respiratory tract viruses in patient (acute lower respiratory tract infection [LRTI] or wheezing) and control (history of asthma without symptoms) groups. METHODS Using multiplex-polymerase chain reaction (PCR), respiratory tract viruses were investigated in the respiratory tract specimens from patient and control groups followed in the Pediatric Clinic. RESULTS The viruses detected in the patient and control groups (P=0.013) were as follows, respectively: rhinoviruses A, B, C (25.6% and 36.7%), influenza virus A (21.1% and 0.0%), parainfluenza virus type 1 (7.8% and 1.7%), parainfluenza virus type 4 (5.6% and 0.0%), adenoviruses A, B, C, D, E (4.4% and 1.7%), parainfluenza virus type 3 (4.4% and 1.7%), coronaviruses 229E and NL63 (4.4% and 1.7%), coronavirus OC43 (3.3% and 0.0%), respiratory syncytial virus A (3.3% and 0.0%), parainfluenza virus type 2 (2.2% and 0.0%), influenza virus B (2.2% and 0.0%), and respiratory syncytial virus B (1.1% and 1.7%). No bocavirus, metapneumovirus or enterovirus was found in any specimen. Statistically significant differences in the detection of influenza virus A (P=0.000), the total detection of parainfluenza viruses (P=0.008) and coinfection (P=0.004) were observed between the patient and control groups. CONCLUSIONS The advantage of our study compared with other studies is the inclusion of not only wheezing patients but also children with asthma without symptom. The higher detection of rhinoviruses both in patient and control groups give rise to thought that these viruses may be responsible for asthma exacerbations and may be related with long duration of virus shedding.
Collapse
Affiliation(s)
- Demet Dabaniyasti
- Department of Medical Microbiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Fahriye Eksi
- Department of Medical Microbiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey -
| | - Özlem Keskin
- Unit of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Y Özkars
- Unit of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Tekin Karsligil
- Department of Medical Microbiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Iclal Balci
- Department of Medical Microbiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
98
|
Zhang Y, Muscatello DJ, Cao Z, Chughtai AA, Costantino V, Zhang D, Yang P, Wang Q, MacIntyre CR. A model of influenza infection and vaccination in children aged under 5 years in Beijing, China. Hum Vaccin Immunother 2020; 16:1685-1690. [PMID: 31995439 DOI: 10.1080/21645515.2019.1705692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Children aged under 5 years are particularly vulnerable to influenza infection. In this study, we aim to estimate the number and incidence of influenza among young children and estimate the impact of childhood vaccination in different scenarios from 2013/14 to 2016/17 seasons. METHODS The number and incidence rate of influenza infections among children aged under 5 years in Beijing was estimated by scaling up observed surveillance data. Then, we used a susceptible-exposed-infected-recovery (SEIR) model to reproduce the weekly number of influenza infections estimated in Beijing during the study seasons, and to estimate the number and proportion of influenza-attributed medically attended acute respiratory infections (I-MAARI) averted by vaccination in each season. Finally, we evaluated the impact of alternative childhood vaccination programs with different coverage and speed of vaccine distribution. RESULTS The estimated average annual incidence of influenza in children aged under 5 years was 33.9% (95% confidence interval (CI): 27.5%, 47.2%) during the study period. With the actual coverage during the included seasons at around 2.9%, an average of 3.9% (95%CI: 3.5%, 4.4%) I-MAARI was reduced compared to a no-vaccination scenario. Reaching 20%, 40%, 50%, 60%, 80% and 100% vaccine coverage would lead to an overall I-MAARI reduction of 25.3%, 42.7%, 51.9%, 57.0%, 65.3% and 71.2%. At 20% coverage scenario, an average of 28.8% I-MAARI will be prevented if intensive vaccination implemented in 2 months since the vaccine released. CONCLUSION In Beijing, the introduction of a program for vaccinating young children, even at relatively low vaccine coverage rates, would considerably reduce I-MAARI, particularly if the vaccines can be quickly delivered.
Collapse
Affiliation(s)
- Yi Zhang
- Institute for Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine , Beijing, China.,School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia
| | - David J Muscatello
- School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia
| | - Zhidong Cao
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences , Beijing, China
| | - Abrar A Chughtai
- School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia
| | - Valentina Costantino
- School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia
| | - Daitao Zhang
- Institute for Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine , Beijing, China
| | - Peng Yang
- Institute for Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine , Beijing, China
| | - Quanyi Wang
- Institute for Infectious Diseases and Endemic Diseases Control, Beijing Municipal Center for Disease Prevention and Control & Beijing Research Center for Preventive Medicine , Beijing, China
| | - C Raina MacIntyre
- Kirby Institute, Faculty of Medicine, The University of New South Wales , Sydney, Australia.,College of Public Service & Community Solutions and College of Health Solutions, Arizona State University , Phoenix, AZ, USA
| |
Collapse
|
99
|
McLean HQ, Hanson KE, Foster AD, Olson SC, Kemble SK, Belongia EA. Serious outcomes of medically attended, laboratory-confirmed influenza illness among school-aged children with and without asthma, 2007-2018. Influenza Other Respir Viruses 2020; 14:173-181. [PMID: 31944583 PMCID: PMC7040974 DOI: 10.1111/irv.12710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 11/27/2022] Open
Abstract
Background Asthma was associated with influenza hospitalizations in children during the 2009 pandemic, but it is unclear if asthma is associated with serious illness during seasonal epidemics. Little is known regarding the effect of vaccination on influenza severity in children with asthma. Methods Children aged 5‐17 years in a community cohort presenting with acute respiratory illness were prospectively enrolled and tested for influenza from 2007‐08 through 2017‐18 (excluding the 2009‐10 pandemic season). Data from the electronic health record were extracted to determine asthma status and serious outcomes associated with influenza infection. A serious outcome was defined as hospitalization, emergency department visit, and/or pneumonia diagnosis within 30 days of symptom onset. Multivariable logistic regression models were used to assess asthma status and effect of vaccination on odds of a serious outcome. Results One thousand seven hundred and sixty four medically‐attended influenza infections among school‐aged children were included. Asthma was confirmed in 287 (16%) children. A serious influenza‐associated outcome occurred in 104 (6%) children. The odds of a serious outcome did not differ between those with confirmed asthma and those without asthma [adjusted odds ratio (aOR): 1.35, 95% confidence interval (CI): (0.77‐2.35), P = .3]. The effect of vaccination on serious outcomes was not modified by asthma status [aOR for children without asthma: 0.55 (95% CI: 0.28‐1.07), children with asthma: 1.39 (95% CI: 0.53‐3.69); interaction P‐value = .12]. Conclusions Asthma was not a risk factor for serious illness among children with influenza. Additional studies are needed to better understand the role of influenza vaccination in preventing serious outcomes among children with asthma.
Collapse
Affiliation(s)
- Huong Q McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Kayla E Hanson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Allison D Foster
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Scott C Olson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | | | - Edward A Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| |
Collapse
|
100
|
Cohen C, Nunes MC. Vaccinating Mothers to Protect Their Babies Against Influenza. J Infect Dis 2020; 221:5-7. [PMID: 31671176 DOI: 10.1093/infdis/jiz387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health and, Johannesburg, South Africa
| | - Marta C Nunes
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa.,National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|