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Affiliation(s)
- Seema Jain
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, USA.
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102
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Lucero MG, Inobaya MT, Nillos LT, Tan AG, Arguelles VLF, Dureza CJC, Mercado ES, Bautista AN, Tallo VL, Barrientos AV, Rodriguez T, Olveda RM. National Influenza Surveillance in the Philippines from 2006 to 2012: seasonality and circulating strains. BMC Infect Dis 2016; 16:762. [PMID: 27993136 PMCID: PMC5168815 DOI: 10.1186/s12879-016-2087-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/01/2016] [Indexed: 11/15/2022] Open
Abstract
Background The results of routine influenza surveillance in 13 regions in the Philippines from 2006 to 2012 are presented, describing the annual seasonal epidemics of confirmed influenza virus infection, seasonal and alert thresholds, epidemic curve, and circulating influenza strains. Methods Retrospective analysis of Philippine influenza surveillance data from 2006 to 2012 was conducted to determine seasonality with the use of weekly influenza positivity rates and calculating epidemic curves and seasonal and alert thresholds using the World Health Organization (WHO) global epidemiological surveillance standards for influenza. Results Increased weekly influenza positive rates were observed from June to November, coinciding with the rainy season and school opening. Two or more peaks of influenza activity were observed with different dominant influenza types associated with each peak. A-H1N1, A-H3N2, and two types of B viruses circulated during the influenza season in varying proportions every year. Increased influenza activity for 2012 occurred 8 weeks late in week 29, rather than the expected week of rise of cases in week 21 as depicted in the established average epidemic curve and seasonal threshold. The intensity was severe going above the alert threshold but of short duration. Southern Hemisphere vaccine strains matched circulating influenza virus for more surveillance years than Northern Hemisphere vaccine strains. Conclusions Influenza seasonality in the Philippines is from June to November. The ideal time to administer Southern Hemisphere influenza vaccine should be from April to May. With two lineages of influenza B circulating annually, quadrivalent vaccine might have more impact on influenza control than trivalent vaccine. Establishment of thresholds and average epidemic curve provide a tool for policy-makers to assess the intensity or severity of the current influenza epidemic even early in its course, to help plan more precisely resources necessary to control the outbreak. Influenza surveillance activities should be continued in the Philippines and funding for such activities should already be incorporated into the Philippine health budget. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2087-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marilla G Lucero
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines.
| | - Marianette T Inobaya
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Leilani T Nillos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Alvin G Tan
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Vina Lea F Arguelles
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Christine Joy C Dureza
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Edelwisa S Mercado
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Analisa N Bautista
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Veronica L Tallo
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Agnes V Barrientos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Tomas Rodriguez
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
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Young B, Zhao X, Cook AR, Parry CM, Wilder-Smith A, I-Cheng MC. Do antibody responses to the influenza vaccine persist year-round in the elderly? A systematic review and meta-analysis. Vaccine 2016; 35:212-221. [PMID: 27939013 DOI: 10.1016/j.vaccine.2016.11.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/19/2016] [Accepted: 11/04/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The influenza vaccine is less immunogenic in older than younger adults, and the duration of protection is unclear. Determining if protection persists beyond a typical seasonal epidemic is important for climates where influenza virus activity is year-round. METHODS A systematic review protocol was developed and registered with PROSPERO [CRD42015023847]. Electronic databases were searched systematically for studies reporting haemagglutination-inhibition (HI) titres 180-360days following vaccination with inactivated trivalent seasonal influenza vaccine, in adults aged ⩾65years. Geometric mean titre (GMT) and seroprotection (HI titre ⩾1:40) at each time point was extracted. A Bayesian model was developed of titre trajectories from pre-vaccination to Day 360. In the meta-analysis, studies were aggregated using a random-effects model to compare pre-vaccination with post-vaccination HI titres at Day 21-42 ('seroconversion'), Day 180 and Day 360. Potential sources of bias were systematically assessed, and heterogeneity explored. RESULTS 2864 articles were identified in the literature search, of which nineteen met study inclusion/exclusion criteria. Sixteen studies contained analysable data from 2565 subjects. In the Bayesian model, the proportion of subjects seroprotected increased from 41-51% pre-vaccination to 75-78% at seroconversion. Seroprotection subsequently fell below 60% for all serotypes by Day 360: A/H1 42% (95% CI 38-46), A/H3 59% (54-63), B 47% (42-52). The Bayesian model of GMT trajectories revealed a similar pattern. By Day 360, titres were similar to pre-vaccination levels. In the meta-analysis, no significant difference in proportion of subjects seroprotected, 0 (-0.11, 0.11) or in log2GMT 0.30 (-0.02, 0.63) was identified by Day 360 compared with pre-vaccination. The quality of this evidence was limited to moderate on account of significant participant dropout. CONCLUSIONS The review found consistent evidence that HI antibody responses following influenza vaccination do not reliably persist year-round in older adults. Alternative vaccination strategies could provide clinical benefits in regions where year-round protection is important.
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Affiliation(s)
- Barnaby Young
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore, Singapore.
| | - Xiahong Zhao
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #09-01, 117549 Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #09-01, 117549 Singapore, Singapore; Yale-NUS College, National University of Singapore, 16 College Avenue West #01-220, 138527 Singapore, Singapore
| | - Christopher M Parry
- School of Tropical Medicine and Global Health, Nagasaki University Institute of Tropical Medicine, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Annelies Wilder-Smith
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore, Singapore; Lee Kong Chian School of Medicine, 11 Mandalay Road, 308232 Singapore, Singapore
| | - Mark Chen I-Cheng
- Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433 Singapore, Singapore; Saw Swee Hock School of Public Health, Tahir Foundation Building, National University of Singapore, 12 Science Drive 2, #09-01, 117549 Singapore, Singapore
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Phadke VK, Steinhoff MC, Omer SB, MacDonald NE. Maternal Influenza Immunization and Adverse Birth Outcomes: Using Data and Practice to Inform Theory and Research Design. Am J Epidemiol 2016; 184:789-792. [PMID: 27784657 PMCID: PMC5152664 DOI: 10.1093/aje/kww110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/03/2016] [Indexed: 01/02/2023] Open
Abstract
Maternal influenza immunization can reduce influenza-attributable morbidity and mortality among pregnant women and infants who are too young to be vaccinated. Data from empirical studies also support the hypothesis that immunization can protect the fetus against adverse outcomes if the mother is exposed to influenza. In their theoretical analysis in the Journal, Hutcheon et al. (Am J Epidemiol 2016;184(3):227-232) critiqued the existing evidence of the fetal benefits of maternal influenza immunization by calculating the sample sizes needed to demonstrate hypothetical reductions in risk and concluded that the benefits observed in empirical studies are likely implausible. However, in their analysis, they did not take into account multiple fundamental characteristics of influenza epidemiology, including the time-variable effects of influenza illness and vaccination during pregnancy, or well-known differences in disease epidemiology between seasons, populations, and geographic regions. Although these and other factors might affect the magnitude of fetal benefit conferred by maternal influenza immunization, studies in which investigators have accounted for influenza circulation have demonstrated a consistent protective effect against a variety of adverse birth outcomes; those studies include the only randomized controlled trial designed a priori and adequately powered to do so. Only a comprehensive and nuanced assessment of the evidence base will allow for effective translation of these data into a global immunization policy.
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Affiliation(s)
- Varun K. Phadke
- Correspondence to Dr. Varun K. Phadke, Division of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303 (e-mail: )
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Nkwembe E, Cintron R, Sessions W, Kavunga H, Babakazo P, Manya L, Muyembe JJ. Molecular Analysis of Influenza A(H3N2) and A(H1N1)pdm09 Viruses circulating in the Democratic Republic of Congo, 2014. JOURNAL OF HARMONIZED RESEARCH IN MEDICAL AND HEALTH SCIENCES 2016; 3:247-264. [PMID: 29569652 PMCID: PMC5858567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Very little is known about influenza viruses circulating in the Democratic Republic of Congo (DRC). We aim to characterize genetically and antigenically Influenza A(H3N2) and A(H1N1)pdm09 viruses circulating in the country. METHODS From August to December 2014, specimens were collected from patients with influenza like-illness (ILI) or severe acute respiratory infection (SARI) in various surveillance sites. Specimens were tested using real time reverse transcription polymerase chain reaction (RT-PCR) method for the detection of influenza viruses. Positive influenza samples with a cycle threshold (Ct) <30 were genetically and antigenically characterized. RESULTS 32 samples tested were found positive to influenza A with Ct <30. At CDC Atlanta, 28 out of 32 samples (88%) were tested positive for influenza A virus, including 26 seasonal influenza A viruses subtype H3N2 and 2 pandemic influenza A viruses subtype H1N1pdm 2009. The majority of influenza A(H3N2) viruses were antigenically related to the A/Switzerland/9715293/2013 vaccine virus, while two influenza A(H1N1)pdm09 isolates were antigenically characterized as A/California/07/2009-like. All A(H3N2) and A(H1N1)pdm09 virus isolates characterized were sensitive to oseltamivir and zanamivir. CONCLUSION Two genetically distinct influenza subtypes were co-circulating in the DRCongo. Effective measures against influenza have been suggested.
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Affiliation(s)
| | - Roxana Cintron
- Influenza Division, Centers for Disease Control and Prevention,
Atlanta, USA
- Battelle Memorial Institute, TOPS Atlanta, USA
| | - Wendy Sessions
- Influenza Division, Centers for Disease Control and Prevention,
Atlanta, USA
| | - Hugo Kavunga
- Institut National de recherches Biomédicales, INRB
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Yoshimura Y, Miyata N, Miyajima M, Sakamoto Y, Amano Y, Tachikawa N. Diseases affecting patients returning from abroad: Experience of a travel clinic in Japan from 2004 to 2014. J Infect Chemother 2016; 23:35-39. [PMID: 27780680 PMCID: PMC7128327 DOI: 10.1016/j.jiac.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/11/2016] [Accepted: 09/15/2016] [Indexed: 11/17/2022]
Abstract
The number of patients returning from or staying abroad is likely to increase in the future. We performed a retrospective study of patients returning from abroad in our travel clinic in Japan. All patients presenting within 6 months of traveling abroad between 2004 and 2014 were included in the present study. A total of 2374 (mean age, 35 years) patients were seen by doctors specializing in treating infectious diseases. Of these, 918 were females and 87 of them lived abroad. Diagnoses and exposure regions were recorded for all patients. The most frequent region visited before attending our clinic was Southeast Asia (n = 1050, 44%), with a median duration for staying abroad of 8 days. The major purposes for overseas travel were tourism (n = 1302, 55%) and business (n = 684, 29%). Of the 2399 individual diagnoses made, the most frequent were diseases of the gastrointestinal system (n = 1083, 45%), skin and soft tissue (n = 440, 18%), systemic febrile disease without specific systems (419, 18%), and the respiratory system (353, 15%). The relative incidences of specific diseases changed drastically due to significant disease outbreaks, such as pandemic influenza in 2009. Exposure regions remained relatively constant throughout the study period, except for Japan. Vaccine-preventable diseases accounted for 5.3% of all the diseases, and 402 (26%) patients received pre-travel consultation and prophylaxis with vaccines and/or anti-malarial drug. We should make an effort to make more people notice the risk of travel and properly perform prophylaxis.
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Affiliation(s)
- Yukihiro Yoshimura
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
| | - Nobuyuki Miyata
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Makiko Miyajima
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yohei Sakamoto
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Yuichiro Amano
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Natsuo Tachikawa
- Department of Infectious Diseases, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
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Kittikraisak W, Suntarattiwong P, Ditsungnoen D, Klungthong C, Fernandez S, Yoon IK, Lindblade K, Dawood FS, Olsen SJ, Chotpitayasunondh T. Effectiveness of the 2013 and 2014 Southern Hemisphere Influenza Vaccines Against Laboratory-confirmed Influenza in Young Children Using a Test-negative Design, Bangkok, Thailand. Pediatr Infect Dis J 2016; 35:e318-25. [PMID: 27307102 PMCID: PMC5021558 DOI: 10.1097/inf.0000000000001280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Thai Advisory Committee on Immunization Practices recommends annual influenza vaccination for children 6 months through 2 years of age, although older children may be vaccinated on request. We evaluated the effectiveness of the 2013 and 2014 inactivated influenza vaccines to reduce medically attended, laboratory-confirmed influenza illness among Thai children aged 7-60 months. METHODS From September 2013-May 2015, children with influenza-like illness were screened with a rapid influenza diagnostic test. Enrolled children had nasal and throat swabs tested for influenza viruses using polymerase chain reaction. Cases and controls were subjects testing positive and negative, respectively, for influenza viruses by polymerase chain reaction. Vaccination status was ascertained from vaccination cards. Vaccine effectiveness (VE) was calculated as 100% × (1 - odds ratio of vaccination among cases vs. controls). RESULTS Of the 1377 children enrolled, cases (n = 490) and controls (n = 887) were similar in demographic characteristics. Cases were less likely to receive influenza vaccine than controls in 2013 (6% vs. 14%; P = 0.02), but not in 2014 (6% vs. 7%; P = 0.57). Among cases, 126 (26%) were positive for influenza A(H1N1)pdm09 virus, 239 (49%) for influenza A(H3N2) and 124 (25%) for influenza B. One specimen was positive for both influenza A(H3N2) and B viruses. VE for full vaccination against all viruses was 64% (95% confidence interval: 21% to 84%) in 2013 and 26% (95% confidence interval: -47% to 63%) in 2014. CONCLUSIONS Influenza vaccination was low among Thai children in this study, and VE varied by year, highlighting the need for annual monitoring of VE to better understand vaccine program effectiveness.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Piyarat Suntarattiwong
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Darunee Ditsungnoen
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Stefan Fernandez
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - In-Kyu Yoon
- International Vaccine Institute, Seoul, Korea
| | - Kim Lindblade
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fatimah S. Dawood
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sonja J. Olsen
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
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Anh DD, Thiem VD, Anh NTH, Huong VM, Nga NT, Thang TC, Thai DH, Chien VC, Holt R, Wahid R, Flores J, Berlanda Scorza F, Taylor DN. Randomized safety and immunogenicity trial of a seasonal trivalent inactivated split virion influenza vaccine (IVACFLU-S) in healthy young Vietnamese adults. Vaccine 2016; 34:5457-5462. [PMID: 27567493 DOI: 10.1016/j.vaccine.2016.08.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Under the auspices of the World Health Organization (WHO) Global Action Plan, PATH supported evaluation of a trivalent, seasonal inactivated influenza vaccine candidate produced by the Institute of Vaccines and Medical Biologicals (IVAC), a Vietnamese manufacturer. METHODS In 2015, 60 healthy adult subjects 18-45years of age were enrolled in a Phase 1, single center, double blind, randomized, placebo-controlled study conducted at a district health center in Thai Binh Province, Vietnam. The study evaluated the overall safety and immunogenicity of a seasonal, trivalent inactivated split virion influenza vaccine. Volunteers were given either vaccine or placebo in a randomized 1:1 ratio. After undergoing screening, eligible volunteers provided their signed consent and were enrolled in the study. On the first day of immunization, randomly chosen volunteers received IVACFLU-S 15μg (mcg) hemagglutinin of each of the three strains in 0.5mL or placebo by intramuscular injection. All volunteers were monitored for adverse events and underwent blood testing at screening and Day 8 to assess the vaccine candidate's safety. Sera obtained before and 21days after immunization were tested for influenza antibody titers using the hemagglutination-inhibition (HAI) and microneutralization tests (MNT). RESULTS Vaccine was well tolerated, and there were no serious adverse events reported. HAI and MNT identified serum antibody responses against the three influenza strains in nearly all volunteers who received the vaccine. Overall, serum HAI responses of fourfold or greater were observed in 93 percent, 83 percent, and 77 percent of H1, H3, and B strains, respectively. Seroprotection rates were also very high. CONCLUSIONS IVAC's seasonal, trivalent influenza vaccine was safe and well tolerated and induced high levels of seroconversion and seroprotection rates. These clinical data are a first step towards demonstrating the feasibility of producing the vaccine locally and that seasonal vaccine production in Vietnam may be an effective strategy for enhancing the global influenza vaccine supply. ClinicalTrials.gov number NCT02598089, October 15, 2015.
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Affiliation(s)
- Dang Duc Anh
- National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Viet Nam
| | - Vu Dinh Thiem
- National Institute of Hygiene and Epidemiology (NIHE), Hanoi, Viet Nam
| | | | - Vu Minh Huong
- PATH VN, 11th Floor, Hanoi Towers, 49 Hai Ba Trung Street, Hanoi, Viet Nam
| | - Nguyen Tuyet Nga
- PATH VN, 11th Floor, Hanoi Towers, 49 Hai Ba Trung Street, Hanoi, Viet Nam
| | - Tran Cong Thang
- PATH VN, 11th Floor, Hanoi Towers, 49 Hai Ba Trung Street, Hanoi, Viet Nam
| | - Duong Huu Thai
- Institute of Vaccines and Medical Biologicals (IVAC), Nha Trang, Viet Nam
| | - Vien Chinh Chien
- Institute of Vaccines and Medical Biologicals (IVAC), Nha Trang, Viet Nam
| | - Renee Holt
- PATH US, Seattle, WA 98121, United States
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Ansari WK, Parvej MS, El Zowalaty ME, Jackson S, Bustin SA, Ibrahim AK, El Zowalaty AE, Rahman MT, Zhang H, Khan MFR, Ahamed MM, Rahman MF, Rahman M, Nazir KHMNH, Ahmed S, Hossen ML, Kafi MA, Yamage M, Debnath NC, Ahmed G, Ashour HM, Masudur Rahman M, Noreddin A, Rahman MB. Surveillance, epidemiological, and virological detection of highly pathogenic H5N1 avian influenza viruses in duck and poultry from Bangladesh. Vet Microbiol 2016; 193:49-59. [PMID: 27599930 DOI: 10.1016/j.vetmic.2016.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/31/2016] [Indexed: 12/09/2022]
Abstract
Avian influenza viruses (AIVs) continue to pose a global threat. Waterfowl are the main reservoir and are responsible for the spillover of AIVs to other hosts. This study was conducted as part of routine surveillance activities in Bangladesh and it reports on the serological and molecular detection of H5N1 AIV subtype. A total of 2169 cloacal and 2191 oropharyngeal swabs as well as 1725 sera samples were collected from live birds including duck and chicken in different locations in Bangladesh between the years of 2013 and 2014. Samples were tested using virus isolation, serological tests and molecular methods of RT-PCR. Influenza A viruses were detected using reverse transcription PCR targeting the virus matrix (M) gene in 41/4360 (0.94%) samples including both cloacal and oropharyngeal swab samples, 31 of which were subtyped as H5N1 using subtype-specific primers. Twenty-one live H5N1 virus isolates were recovered from those 31 samples. Screening of 1,868 blood samples collected from the same birds using H5-specific ELISA identified 545/1603 (34%) positive samples. Disconcertingly, an analysis of 221 serum samples collected from vaccinated layer chicken in four districts revealed that only 18 samples (8.1%) were seropositive for anti H5 antibodies, compared to unvaccinated birds (n=105), where 8 samples (7.6%) were seropositive. Our result indicates that the vaccination program as currently implemented should be reviewed and updated. In addition, surveillance programs are crucial for monitoring the efficacy of the current poultry vaccinations programs, and to monitor the circulating AIV strains and emergence of AIV subtypes in Bangladesh.
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Affiliation(s)
- Wahedul Karim Ansari
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Shafiullah Parvej
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Mohamed E El Zowalaty
- School of Health Sciences, KwaZulu Natal University, Durban 4000, South Africa; Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, 30322, USA.
| | - Sally Jackson
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Stephen A Bustin
- Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
| | - Adel K Ibrahim
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Cairo University, Egypt
| | - Ahmed E El Zowalaty
- Department of Physiology & Pharmacology, College of Veterinary Medicine, University of Georgia, Athens, Georgia 30602, USA
| | - Md Tanvir Rahman
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Han Zhang
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, 30322, USA
| | | | - Md Mostakin Ahamed
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | | | - Marzia Rahman
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | | | - Sultan Ahmed
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Liakot Hossen
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Md Abdul Kafi
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Mat Yamage
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization (FAO) of the United Nations, Bangladesh
| | - Nitish C Debnath
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization (FAO) of the United Nations, Bangladesh
| | - Graba Ahmed
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization (FAO) of the United Nations, Bangladesh
| | - Hossam M Ashour
- Department of Biological Sciences, College of Arts and Sciences, University of South Florida St. Petersburg, Florida, USA; Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Egypt
| | - Md Masudur Rahman
- Department of Pathology, Faculty of Veterinary and Animal Science, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Ayman Noreddin
- School of Pharmacy, Chapman University, Irvine, California, 92618, USA
| | - Md Bahanur Rahman
- Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh.
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Hirve S, Lambach P, Paget J, Vandemaele K, Fitzner J, Zhang W. Seasonal influenza vaccine policy, use and effectiveness in the tropics and subtropics - a systematic literature review. Influenza Other Respir Viruses 2016; 10:254-67. [PMID: 26842617 PMCID: PMC4910173 DOI: 10.1111/irv.12374] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 12/20/2022] Open
Abstract
AIM The evidence needed for tropical countries to take informed decisions on influenza vaccination is scarce. This article reviews policy, availability, use and effectiveness of seasonal influenza vaccine in tropical and subtropical countries. METHOD Global health databases were searched in three thematic areas - policy, availability and protective benefits in the context of human seasonal influenza vaccine in the tropics and subtropics. We excluded studies on monovalent pandemic influenza vaccine, vaccine safety, immunogenicity and uptake, and disease burden. RESULTS Seventy-four countries in the tropics and subtropics representing 60% of the world's population did not have a national vaccination policy against seasonal influenza. Thirty-eight countries used the Northern Hemisphere and 21 countries the Southern Hemisphere formulation. Forty-six countries targeted children and 57 targeted the elderly; though, the age cut-offs varied. Influenza vaccine supply increased twofold in recent years. However, coverage remained lower than five per 1000 population. Vaccine protection against laboratory-confirmed influenza in the tropics ranged from 0% to 42% in the elderly, 20-77% in children and 50-59% in healthy adults. Vaccinating pregnant women against seasonal influenza prevented laboratory-confirmed influenza in both mothers (50%) and their infants <6 months (49-63%). CONCLUSION Guidelines on vaccine composition, priority risk groups and vaccine availability varied widely. The evidence on vaccine protection was scarce. Countries in the tropics and subtropics need to strengthen and expand their evidence-base required for making informed decisions on influenza vaccine introduction and expansion, and how much benefit to expect.
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Affiliation(s)
| | - Philipp Lambach
- Initiative for Vaccine ResearchWorld Health OrganizationGenevaSwitzerland
| | | | | | - Julia Fitzner
- Global Influenza ProgramWorld Health OrganizationGenevaSwitzerland
| | - Wenqing Zhang
- Global Influenza ProgramWorld Health OrganizationGenevaSwitzerland
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Caini S, Huang QS, Ciblak MA, Kusznierz G, Owen R, Wangchuk S, Henriques CMP, Njouom R, Fasce RA, Yu H, Feng L, Zambon M, Clara AW, Kosasih H, Puzelli S, Kadjo HA, Emukule G, Heraud JM, Ang LW, Venter M, Mironenko A, Brammer L, Mai LTQ, Schellevis F, Plotkin S, Paget J. Epidemiological and virological characteristics of influenza B: results of the Global Influenza B Study. Influenza Other Respir Viruses 2016; 9 Suppl 1:3-12. [PMID: 26256290 PMCID: PMC4549097 DOI: 10.1111/irv.12319] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Literature on influenza focuses on influenza A, despite influenza B having a large public health impact. The Global Influenza B Study aims to collect information on global epidemiology and burden of disease of influenza B since 2000. METHODS Twenty-six countries in the Southern (n = 5) and Northern (n = 7) hemispheres and intertropical belt (n = 14) provided virological and epidemiological data. We calculated the proportion of influenza cases due to type B and Victoria and Yamagata lineages in each country and season; tested the correlation between proportion of influenza B and maximum weekly influenza-like illness (ILI) rate during the same season; determined the frequency of vaccine mismatches; and described the age distribution of cases by virus type. RESULTS The database included 935 673 influenza cases (2000-2013). Overall median proportion of influenza B was 22·6%, with no statistically significant differences across seasons. During seasons where influenza B was dominant or co-circulated (>20% of total detections), Victoria and Yamagata lineages predominated during 64% and 36% of seasons, respectively, and a vaccine mismatch was observed in ≈25% of seasons. Proportion of influenza B was inversely correlated with maximum ILI rate in the same season in the Northern and (with borderline significance) Southern hemispheres. Patients infected with influenza B were usually younger (5-17 years) than patients infected with influenza A. CONCLUSION Influenza B is a common disease with some epidemiological differences from influenza A. This should be considered when optimizing control/prevention strategies in different regions and reducing the global burden of disease due to influenza.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Q Sue Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | | | - Gabriela Kusznierz
- Instituto Nacional de Enfermedades Respiratorias Dr. Emilio Coni, Santa Fe, Argentina
| | - Rhonda Owen
- Department of Health and Ageing, Influenza Surveillance Section, Surveillance Branch, Office of Health Protection, Woden, ACT, Australia
| | - Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | | | - Richard Njouom
- Service de Virologie, Centre Pasteur du Cameroun, Yaounde, Cameroon
| | - Rodrigo A Fasce
- Sección de Virus Respiratorios y Exantemáticos, Instituto de Salud Pública de Chile, Santiago de Chile, Chile
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Luzhao Feng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maria Zambon
- Respiratory Virus Unit, Public Health England, Colindale, UK
| | - Alexey W Clara
- US Centers for Disease Control, Central American Region, Guatemala City, Guatemala
| | - Herman Kosasih
- US Naval Medical Research Unit No. 2, Jakarta, Indonesia
| | - Simona Puzelli
- National Influenza Center, Istituto Superiore Sanità, Rome, Italy
| | - Herve A Kadjo
- Respiratory Viruses Unit, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Gideon Emukule
- US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jean-Michel Heraud
- National Influenza Center, Virology Unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore, Singapore
| | - Marietjie Venter
- Global Disease Detection, US-CDC, Pretoria, South Africa.,Zoonoses Research Unit, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Alla Mironenko
- L.V.Gromashevsky Institute of Epidemiology and Infectious Diseases National Academy of Medical Science of Ukraine, Kiev, Ukraine
| | - Lynnette Brammer
- Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - François Schellevis
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Affiliation(s)
- Anwar M Hashem
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia E-mail:
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Ang LW, Tien WS, Lin RTP, Cui L, Cutter J, James L, Goh KT. Characterization of influenza activity based on virological surveillance of influenza-like illness in tropical Singapore, 2010-2014. J Med Virol 2016; 88:2069-2077. [PMID: 27152935 DOI: 10.1002/jmv.24566] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/10/2022]
Abstract
Singapore is situated in the tropics where the seasonality of influenza is not as well defined as that of temperate countries. We examined the circulation of influenza viruses in the community in terms of the characteristics of influenza activity. We reviewed laboratory-confirmed virological data collected between 2010 and 2014 under the national influenza surveillance programme. Influenza activity was measured by the proportion of specimens from outpatients with influenza-like illness tested positive for influenza virus based on 4-weekly moving interval. Seasonal epidemics occurred around the end of previous year or the beginning and middle of the year. Increases in influenza positivity were more pronounced when there was a change in the predominant circulating influenza virus type/subtype to influenza A(H3N2). Influenza epidemics lasted about 12 weeks on average, with longer duration when there was a change in the predominant influenza type/subtype and especially when it was associated with influenza A(H3N2). Continuous influenza surveillance is important as it could provide early warning of imminent surges in virus transmission, and allow for timely implementation of public health prevention and control interventions to minimize influenza-associated disease burden. J. Med. Virol. 88:2069-2077, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore.
| | - Wee Siong Tien
- Communicable Diseases Division, Ministry of Health, Singapore
| | | | - Lin Cui
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Jeffery Cutter
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Lyn James
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
| | - Kee Tai Goh
- Communicable Diseases Division, Ministry of Health, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Kittikraisak W, Chittaganpitch M, Gregory CJ, Laosiritaworn Y, Thantithaveewat T, Dawood FS, Lindblade KA. Assessment of potential public health impact of a quadrivalent inactivated influenza vaccine in Thailand. Influenza Other Respir Viruses 2016; 10:211-9. [PMID: 26588892 PMCID: PMC4814859 DOI: 10.1111/irv.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Each year, an influenza B strain representing only one influenza B lineage is included in the trivalent inactivated influenza vaccine (IIV3); a mismatch between the selected lineage and circulating viruses can result in suboptimal vaccine effectiveness. We modeled the added potential public health impact of a quadrivalent inactivated influenza vaccine (IIV4) that includes strains from both influenza B lineages compared to IIV3 on influenza-associated morbidity and mortality in Thailand. METHODS Using data on the incidence of influenza-associated hospitalizations and deaths, vaccine effectiveness, and vaccine coverage from the 2007-2012 influenza seasons in Thailand, we estimated rates of influenza-associated outcomes that might be averted using IIV4 instead of IIV3. We then applied these rates to national population estimates to calculate averted illnesses, hospitalizations, and deaths for each season. We assumed that the influenza B lineage included in IIV3 would provide a relative vaccine effectiveness of 75% against the other B lineage. RESULTS Compared to use of IIV3, use of IIV4 might have led to an additional reduction ranging from 0·4 to 14·3 influenza-associated illnesses per 100 000 population/year, <0·1 to 0·5 hospitalizations per 100 000/year, and <0·1 to 0·4 deaths per 1000/year. Based on extrapolation to national population estimates, replacement of IIV3 with IIV4 might have averted an additional 267-9784 influenza-associated illnesses, 9-320 hospitalizations, and 0-3 deaths. CONCLUSION Compared to use of IIV3, IIV4 has the potential to further reduce the burden of influenza-associated morbidity and mortality in Thailand.
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Affiliation(s)
- Wanitchaya Kittikraisak
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
| | | | - Christopher J. Gregory
- International Emerging Infections ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Division of Global Health ProtectionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | | | | | - Fatimah S. Dawood
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
| | - Kim A. Lindblade
- Influenza ProgramThailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention CollaborationNonthaburiThailand
- Influenza DivisionU.S. Centers for Disease Control and PreventionAtlantaGAUSA
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Hirve S, Newman LP, Paget J, Azziz-Baumgartner E, Fitzner J, Bhat N, Vandemaele K, Zhang W. Influenza Seasonality in the Tropics and Subtropics - When to Vaccinate? PLoS One 2016; 11:e0153003. [PMID: 27119988 PMCID: PMC4847850 DOI: 10.1371/journal.pone.0153003] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The timing of the biannual WHO influenza vaccine composition selection and production cycle has been historically directed to the influenza seasonality patterns in the temperate regions of the northern and southern hemispheres. Influenza activity, however, is poorly understood in the tropics with multiple peaks and identifiable year-round activity. The evidence-base needed to take informed decisions on vaccination timing and vaccine formulation is often lacking for the tropics and subtropics. This paper aims to assess influenza seasonality in the tropics and subtropics. It explores geographical grouping of countries into vaccination zones based on optimal timing of influenza vaccination. METHODS Influenza seasonality was assessed by different analytic approaches (weekly proportion of positive cases, time series analysis, etc.) using FluNet and national surveillance data. In case of discordance in the seasonality assessment, consensus was built through discussions with in-country experts. Countries with similar onset periods of their primary influenza season were grouped into geographical zones. RESULTS The number and period of peak activity was ascertained for 70 of the 138 countries in the tropics and subtropics. Thirty-seven countries had one and seventeen countries had two distinct peaks. Countries near the equator had secondary peaks or even identifiable year-round activity. The main influenza season in most of South America and Asia started between April and June. The start of the main season varied widely in Africa (October and December in northern Africa, April and June in Southern Africa and a mixed pattern in tropical Africa). Eight "influenza vaccination zones" (two each in America and Asia, and four in Africa and Middle East) were defined with recommendations for vaccination timing and vaccine formulation. The main limitation of our study is that FluNet and national surveillance data may lack the granularity to detect sub-national variability in seasonality patterns. CONCLUSION Distinct influenza seasonality patterns, though complex, could be ascertained for most countries in the tropics and subtropics using national surveillance data. It may be possible to group countries into zones based on similar recommendations for vaccine timing and formulation.
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Affiliation(s)
| | - Laura P. Newman
- University of Washington, Seattle, Washington, United States of America
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | | | - Julia Fitzner
- Global Influenza Program, World Health Organization, Geneva, Switzerland
| | - Niranjan Bhat
- Program for Appropriate Technology, Seattle, Washington, United States of America
| | | | - Wenqing Zhang
- Global Influenza Program, World Health Organization, Geneva, Switzerland
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Ditsungnoen D, Greenbaum A, Praphasiri P, Dawood FS, Thompson MG, Yoocharoen P, Lindblade KA, Olsen SJ, Muangchana C. Knowledge, attitudes and beliefs related to seasonal influenza vaccine among pregnant women in Thailand. Vaccine 2016; 34:2141-6. [PMID: 26854910 PMCID: PMC4811693 DOI: 10.1016/j.vaccine.2016.01.056] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2009, Thailand recommended pregnant women be prioritized for influenza vaccination. Vaccine uptake among Thai pregnant women is lower than other high-risk groups. METHODS During December 2012-April 2013, we conducted a cross-sectional survey of a convenience sample of Thai pregnant women aged ≥ 15 years attending antenatal clinics at public hospitals in 8 of 77 provinces. A self-administered questionnaire covered knowledge, attitudes, and beliefs related to influenza vaccination using the Health Belief Model. We examined factors associated with willingness to be vaccinated using log-binomial regression models. RESULTS The survey was completed by 1031 (96%) of 1072 pregnant women approached. A total of 627 (61%) women had heard about influenza vaccine and were included in the analysis, of whom 262 (42%) were willing to be vaccinated, 155 (25%) had received a healthcare provider recommendation for influenza vaccination and 25 (4%) had received the influenza vaccine during the current pregnancy. In unadjusted models, high levels of perceptions of susceptibility (prevalence ratio [PR] 1.5, 95% CI 1.2-2.0), high levels of belief in the benefits of vaccination (PR 2.3, 95% CI 1.7-3.1), moderate (PR 1.7, 95% CI 1.2-2.3) and high (PR 3.4, 95% CI 2.6-4.5) levels of encouragement by others to be vaccinated (i.e., cues to action) were positively associated with willingness to be vaccinated. Moderate (PR 0.5, 95% CI 0.4-0.7) and high levels of (PR 0.5, 95% CI 0.4-0.8) perceived barriers were negatively associated with willingness to be vaccinated. In the final adjusted model, only moderate (PR 1.5, 95% CI 1.1-2.0) and high levels of cues to action (PR 2.7, 95% CI 2.0-3.6) were statistically associated with willingness to be vaccinated. CONCLUSION Cues to action were associated with willingness to be vaccinated and can be used to inform communication strategies during the vaccine campaign to increase influenza vaccination among Thai pregnant women.
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Affiliation(s)
- Darunee Ditsungnoen
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Adena Greenbaum
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Prabda Praphasiri
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Pornsak Yoocharoen
- Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Kim A Lindblade
- Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Charung Muangchana
- National Vaccine Institute, Ministry of Public Health, Nonthaburi, Thailand.
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Waiboci LW, Mott JA, Kikwai G, Arunga G, Xu X, Mayieka L, Emukule GO, Muthoka P, Njenga MK, Fields BS, Katz MA. Which influenza vaccine formulation should be used in Kenya? A comparison of influenza isolates from Kenya to vaccine strains, 2007-2013. Vaccine 2016; 34:2593-601. [PMID: 27079931 DOI: 10.1016/j.vaccine.2016.03.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Every year the World Health Organization (WHO) recommends which influenza virus strains should be included in a northern hemisphere (NH) and a southern hemisphere (SH) influenza vaccine. To determine the best vaccine formulation for Kenya, we compared influenza viruses collected in Kenya from April 2007 to May 2013 to WHO vaccine strains. METHODS We collected nasopharyngeal and oropharyngeal (NP/OP) specimens from patients with respiratory illness, tested them for influenza, isolated influenza viruses from a proportion of positive specimens, tested the isolates for antigenic relatedness to vaccine strains, and determined the percentage match between circulating viruses and SH or NH influenza vaccine composition and schedule. RESULTS During the six years, 7.336 of the 60,072 (12.2%) NP/OP specimens we collected were positive for influenza: 30,167 specimens were collected during the SH seasons and 3717 (12.3%) were positive for influenza; 2903 (78.1%) influenza A, 902 (24.2%) influenza B, and 88 (2.4%) influenza A and B positive specimens. We collected 30,131 specimens during the NH seasons and 3978 (13.2%) were positive for influenza; 3181 (80.0%) influenza A, 851 (21.4%) influenza B, and 54 (1.4%) influenza A and B positive specimens. Overall, 362/460 (78.7%) isolates from the SH seasons and 316/338 (93.5%) isolates from the NH seasons were matched to the SH and the NH vaccine strains, respectively (p<0.001). Overall, 53.6% and 46.4% SH and NH vaccines, respectively, matched circulating strains in terms of vaccine strains and timing. CONCLUSION In six years of surveillance in Kenya, influenza circulated at nearly equal levels during the SH and the NH influenza seasons. Circulating viruses were matched to vaccine strains. The vaccine match decreased when both vaccine strains and timing were taken into consideration. Either vaccine formulation could be suitable for use in Kenya but the optimal timing for influenza vaccination needs to be determined.
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Affiliation(s)
- Lilian W Waiboci
- US Centers for Disease Control and Prevention-Kenya, P.O. Box 606-00621, Nairobi, Kenya; Department of Biochemistry, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya.
| | - Joshua A Mott
- US Centers for Disease Control and Prevention-Kenya, P.O. Box 606-00621, Nairobi, Kenya; US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, USA
| | - Gilbert Kikwai
- Kenya Medical Research Institute/Centers for Diseases Control and Prevention, P.O. Box 54840-00200, Nairobi, Kenya
| | - Geoffrey Arunga
- Kenya Medical Research Institute/Centers for Diseases Control and Prevention, P.O. Box 54840-00200, Nairobi, Kenya
| | - Xiyan Xu
- US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, USA
| | - Lilian Mayieka
- Kenya Medical Research Institute/Centers for Diseases Control and Prevention, P.O. Box 54840-00200, Nairobi, Kenya
| | - Gideon O Emukule
- US Centers for Disease Control and Prevention-Kenya, P.O. Box 606-00621, Nairobi, Kenya
| | - Phillip Muthoka
- Kenya Ministry of Health, Afya House, P.O. Box 30016-00100, Nairobi, Kenya
| | - M Kariuki Njenga
- US Centers for Disease Control and Prevention-Kenya, P.O. Box 606-00621, Nairobi, Kenya; Kenya Medical Research Institute/Centers for Diseases Control and Prevention, P.O. Box 54840-00200, Nairobi, Kenya
| | - Barry S Fields
- US Centers for Disease Control and Prevention-Kenya, P.O. Box 606-00621, Nairobi, Kenya; US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, USA
| | - Mark A Katz
- US Centers for Disease Control and Prevention-Kenya, P.O. Box 606-00621, Nairobi, Kenya; US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4027, USA
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Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination? PLoS One 2016; 11:e0152310. [PMID: 27031105 PMCID: PMC4816507 DOI: 10.1371/journal.pone.0152310] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/11/2016] [Indexed: 12/28/2022] Open
Abstract
Introduction Determining the optimal time to vaccinate is important for influenza vaccination programmes. Here, we assessed the temporal characteristics of influenza epidemics in the Northern and Southern hemispheres and in the tropics, and discuss their implications for vaccination programmes. Methods This was a retrospective analysis of surveillance data between 2000 and 2014 from the Global Influenza B Study database. The seasonal peak of influenza was defined as the week with the most reported cases (overall, A, and B) in the season. The duration of seasonal activity was assessed using the maximum proportion of influenza cases during three consecutive months and the minimum number of months with ≥80% of cases in the season. We also assessed whether co-circulation of A and B virus types affected the duration of influenza epidemics. Results 212 influenza seasons and 571,907 cases were included from 30 countries. In tropical countries, the seasonal influenza activity lasted longer and the peaks of influenza A and B coincided less frequently than in temperate countries. Temporal characteristics of influenza epidemics were heterogeneous in the tropics, with distinct seasonal epidemics observed only in some countries. Seasons with co-circulation of influenza A and B were longer than influenza A seasons, especially in the tropics. Discussion Our findings show that influenza seasonality is less well defined in the tropics than in temperate regions. This has important implications for vaccination programmes in these countries. High-quality influenza surveillance systems are needed in the tropics to enable decisions about when to vaccinate.
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Timmermans A, Melendrez MC, Se Y, Chuang I, Samon N, Uthaimongkol N, Klungthong C, Manasatienkij W, Thaisomboonsuk B, Tyner SD, Rith S, Horm VS, Jarman RG, Bethell D, Chanarat N, Pavlin J, Wongstitwilairoong T, Saingam P, El BS, Fukuda MM, Touch S, Sovann L, Fernandez S, Buchy P, Chanthap L, Saunders D. Human Sentinel Surveillance of Influenza and Other Respiratory Viral Pathogens in Border Areas of Western Cambodia. PLoS One 2016; 11:e0152529. [PMID: 27028323 PMCID: PMC4814059 DOI: 10.1371/journal.pone.0152529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/15/2016] [Indexed: 01/16/2023] Open
Abstract
Little is known about circulation of influenza and other respiratory viruses in remote populations along the Thai-Cambodia border in western Cambodia. We screened 586 outpatients (median age 5, range 1–77) presenting with influenza-like-illness (ILI) at 4 sentinel sites in western Cambodia between May 2010 and December 2012. Real-time reverse transcriptase (rRT) PCR for influenza was performed on combined nasal and throat specimens followed by viral culture, antigenic analysis, antiviral susceptibility testing and full genome sequencing for phylogenetic analysis. ILI-specimens negative for influenza were cultured, followed by rRT-PCR for enterovirus and rhinovirus (EV/RV) and EV71. Influenza was found in 168 cases (29%) and occurred almost exclusively in the rainy season from June to November. Isolated influenza strains had close antigenic and phylogenetic relationships, matching vaccine and circulating strains found elsewhere in Cambodia. Influenza vaccination coverage was low (<20%). Western Cambodian H1N1(2009) isolate genomes were more closely related to 10 earlier Cambodia isolates (94.4% genome conservation) than to 13 Thai isolates (75.9% genome conservation), despite sharing the majority of the amino acid changes with the Thai references. Most genes showed signatures of purifying selection. Viral culture detected only adenovirus (5.7%) and parainfluenza virus (3.8%), while non-polio enteroviruses (10.3%) were detected among 164 culture-negative samples including coxsackievirus A4, A6, A8, A9, A12, B3, B4 and echovirus E6 and E9 using nested RT-PCR methods. A single specimen of EV71 was found. Despite proximity to Thailand, influenza epidemiology of these western Cambodian isolates followed patterns observed elsewhere in Cambodia, continuing to support current vaccine and treatment recommendations from the Cambodian National Influenza Center. Amino acid mutations at non-epitope sites, particularly hemagglutinin genes, require further investigation in light of an increasingly important role of permissive mutations in influenza virus evolution. Further research about the burden of adenovirus and non-polio enteroviruses as etiologic agents in acute respiratory infections in Cambodia is also needed.
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Affiliation(s)
- Ans Timmermans
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Melanie C. Melendrez
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * E-mail:
| | - Youry Se
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Battambang, Cambodia
| | - Ilin Chuang
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nou Samon
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Battambang, Cambodia
| | - Nichapat Uthaimongkol
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Wudtichai Manasatienkij
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stuart D. Tyner
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sareth Rith
- Virology Department, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Viseth Srey Horm
- Virology Department, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Richard G. Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Delia Bethell
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Nitima Chanarat
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Julie Pavlin
- Deputy Director, Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
| | | | - Piyaporn Saingam
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - But Sam El
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Battambang, Cambodia
| | - Mark M. Fukuda
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sok Touch
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Ly Sovann
- Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia
| | - Stefan Fernandez
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Philippe Buchy
- Virology Department, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Lon Chanthap
- Department of Immunology, Armed Forces Research Institute of Medical Sciences, Phnom Penh, Cambodia
| | - David Saunders
- Department of Immunology, US Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Barasheed O, Alfelali M, Mushta S, Bokhary H, Alshehri J, Attar AA, Booy R, Rashid H. Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review. Int J Infect Dis 2016; 47:105-11. [PMID: 27044522 PMCID: PMC7110449 DOI: 10.1016/j.ijid.2016.03.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/18/2016] [Accepted: 03/24/2016] [Indexed: 11/25/2022] Open
Abstract
Approximately half of the attendees of mass gatherings use facemask Facemask seems to be effective against respiratory infections at Hajj Effectiveness of facemask against specific respiratory infections is not proven
Objectives The risk of acquisition and transmission of respiratory infections is high among attendees of mass gatherings (MGs). Currently used interventions have limitations yet the role of facemask in preventing those infections at MG has not been systematically reviewed. We have conducted a systematic review to synthesise evidence about the uptake and effectiveness of facemask against respiratory infections in MGs. Methods A comprehensive literature search was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines using major electronic databases such as, Medline, EMBASE, SCOPUS and CINAHL. Results Of 25 studies included, the pooled sample size was 12710 participants from 55 countries aged 11 to 89 years, 37% were female. The overall uptake of facemask ranged from 0.02% to 92.8% with an average of about 50%. Only 13 studies examined the effectiveness of facemask, and their pooled estimate revealed significant protectiveness against respiratory infections (relative risk [RR] = 0.89, 95% CI: 0.84-0.94, p < 0.01), but the study end points varied widely. Conclusion A modest proportion of attendees of MGs use facemask, the practice is more widespread among health care workers. Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven.
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Affiliation(s)
- Osamah Barasheed
- Research Center, King Abdullah Medical City (KAMC), Makkah, P.O. Box: 57657, Saudi Arabia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia.
| | - Mohammad Alfelali
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Department of Family and Community Medicine, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | | | - Hamid Bokhary
- Umm Al-Qura University Medical Center, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jassir Alshehri
- Research Center, King Abdullah Medical City (KAMC), Makkah, P.O. Box: 57657, Saudi Arabia
| | - Ammar A Attar
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia; Science and technology Unit, General Presidency for the Holy Mosque & Prophet Holy Mosque affairs, Makkah, Saudi Arabia; Department of Innovation & Corporate Integration, King Abdullah Medical City (KAMC), Makkah, Saudi Arabia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Australia
| | - Harunor Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), The Children's Hospital at Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Biological Sciences and Sydney Medical School, The University of Sydney, Australia
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Saha S, Chadha M, Shu Y. Divergent seasonal patterns of influenza types A and B across latitude gradient in Tropical Asia. Influenza Other Respir Viruses 2016; 10:176-84. [PMID: 26781162 PMCID: PMC4814861 DOI: 10.1111/irv.12372] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Influenza circulation in tropics and subtropics reveals a complex seasonal pattern with year‐round circulation in some areas and biannual peaks in others. Methods We analyzed influenza surveillance data from nine countries around southern and southeastern Asia spanning latitudinal gradient from equatorial to temperate zones to further characterize influenza type‐specific seasonality in the region. We calculated proportion of positives by month out of positives during that year and adjust for variation in samples tested and positivity in these countries. Results Influenza A epidemics were identified between November and March during winters in areas lying above 30°N latitude, during monsoon months of June–November in areas between 10° and 30°N latitude, and no specific seasonality for influenza A virus circulation in areas lying closer to the equator. Influenza B circulation coincided with influenza A circulation in areas lying above 30°N latitude; however, in areas south of 30°N Asia, influenza B circulated year round at 3–8% of annual influenza B positives during most months with less pronounced peaks during post‐monsoon period. Conclusion Even though influenza B circulates round the year in most areas of the tropical regions of southern and southeastern Asia, the most appropriate time for influenza vaccination using the most recent WHO recommended vaccine would be prior to the monsoon season conferring protection against influenza A and B peaks.
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Affiliation(s)
| | | | - Yuelong Shu
- Chinese National Influenza Center, Beijing, China
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Regression approaches in the test-negative study design for assessment of influenza vaccine effectiveness. Epidemiol Infect 2016; 144:1601-11. [PMID: 26732691 DOI: 10.1017/s095026881500309x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Influenza vaccination is the most practical means available for preventing influenza virus infection and is widely used in many countries. Because vaccine components and circulating strains frequently change, it is important to continually monitor vaccine effectiveness (VE). The test-negative design is frequently used to estimate VE. In this design, patients meeting the same clinical case definition are recruited and tested for influenza; those who test positive are the cases and those who test negative form the comparison group. When determining VE in these studies, the typical approach has been to use logistic regression, adjusting for potential confounders. Because vaccine coverage and influenza incidence change throughout the season, time is included among these confounders. While most studies use unconditional logistic regression, adjusting for time, an alternative approach is to use conditional logistic regression, matching on time. Here, we used simulation data to examine the potential for both regression approaches to permit accurate and robust estimates of VE. In situations where vaccine coverage changed during the influenza season, the conditional model and unconditional models adjusting for categorical week and using a spline function for week provided more accurate estimates. We illustrated the two approaches on data from a test-negative study of influenza VE against hospitalization in children in Hong Kong which resulted in the conditional logistic regression model providing the best fit to the data.
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Zeitouni MO, Al Barrak AM, Al-Moamary MS, Alharbi NS, Idrees MM, Al Shimemeri AA, Al-Hajjaj MS. The Saudi Thoracic Society guidelines for influenza vaccinations. Ann Thorac Med 2015; 10:223-30. [PMID: 26664559 PMCID: PMC4652287 DOI: 10.4103/1817-1737.167065] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Influenza viruses are responsible for the influenza outbreaks that lead to significant burden and cause significant morbidity and mortality worldwide. Based on the core proteins, influenza viruses are classified into three types, A, B, and C, of which only A and B cause significant human disease and so the vaccine is directed against these two subtypes only. The effectiveness of the vaccine depends on boosting the immune system against the serotypes included within it. As influenza viruses undergo periodic changes in their antigen, the vaccine is modified annually to ensure susceptibility. In contrast to other countries, Saudi Arabia faces a unique and challenging situation due to Hajj and Umrah seasons, when millions of people gather at the holy places in Mecca and Madinah, during which influenza outbreaks are commonly found. Such challenges making the adoption of strict vaccination strategy in Saudi Arabia is of great importance. All efforts were made to develop this guideline in an easy-to-read form, making it very handy and easy to use by health care workers. The guideline was designed to provide recommendations for problems frequently encountered in real life, with special consideration for special situations such as Hajj and Umrah seasons and pregnancy.
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Affiliation(s)
- Mohammed O Zeitouni
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali M Al Barrak
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohamed S Al-Moamary
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nasser S Alharbi
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Majdy M Idrees
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah A Al Shimemeri
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed S Al-Hajjaj
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Alonso WJ, Yu C, Viboud C, Richard SA, Schuck-Paim C, Simonsen L, Mello WA, Miller MA. A global map of hemispheric influenza vaccine recommendations based on local patterns of viral circulation. Sci Rep 2015; 5:17214. [PMID: 26621769 PMCID: PMC4664865 DOI: 10.1038/srep17214] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/27/2015] [Indexed: 11/28/2022] Open
Abstract
Both the Northern and the Southern Hemisphere annual WHO influenza vaccine recommendations are designed to ensure vaccine delivery before the winter-time peak of viral circulation in each hemisphere. However, influenza seasonal patterns are highly diverse in tropical countries and may be out of phase with the WHO recommendations for their respective hemisphere. We modelled the peak timing of influenza activity for 125 countries using laboratory-based surveillance data from the WHO's FLUNET database and compared it with the influenza hemispheric recommendations in place. Influenza vaccine recommendations for respectively 25% and 39% of the Northern and Southern Hemisphere countries were out of phase with peak influenza circulation in their corresponding hemisphere (62% and 53%, respectively, when the analysis was limited to the 52 countries in the tropical belt). These results indicate that routine influenza immunization efforts should be closely tailored to local patterns of viral circulation, rather than a country's hemispheric position.
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Affiliation(s)
- Wladimir J. Alonso
- National Institutes of Health, Fogarty International Center, Bethesda, MD, 20892, USA
| | - Christine Yu
- George Washington University, Milken Institute School of Public Health, Washington, DC 20052, USA
| | - Cecile Viboud
- National Institutes of Health, Fogarty International Center, Bethesda, MD, 20892, USA
| | - Stephanie A. Richard
- National Institutes of Health, Fogarty International Center, Bethesda, MD, 20892, USA
| | | | - Lone Simonsen
- George Washington University, Milken Institute School of Public Health, Washington, DC 20052, USA
| | - Wyller A. Mello
- Evandro Chagas Institute, WHO Global Influenza Surveillance Network, Para, Brazil
| | - Mark A. Miller
- National Institutes of Health, Fogarty International Center, Bethesda, MD, 20892, USA
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Cox NJ, Hickling J, Jones R, Rimmelzwaan GF, Lambert LC, Boslego J, Rudenko L, Yeolekar L, Robertson JS, Hombach J, Ortiz JR. Report on the second WHO integrated meeting on development and clinical trials of influenza vaccines that induce broadly protective and long-lasting immune responses: Geneva, Switzerland, 5-7 May 2014. Vaccine 2015; 33:6503-10. [PMID: 26478203 PMCID: PMC8218335 DOI: 10.1016/j.vaccine.2015.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/02/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022]
Abstract
On 5-7 May 2014, the World Health Organization (WHO) convened the second integrated meeting on "influenza vaccines that induce broadly protective and long-lasting immune responses". Around 100 invited experts from academia, the vaccine industry, research and development funders, and regulatory and public health agencies attended the meeting. Areas covered included mechanisms of protection in natural influenza-virus infection and vaccine-induced immunity, new approaches to influenza-vaccine design and production, and novel routes of vaccine administration. A timely focus was on how this knowledge could be applied to both seasonal influenza and emerging viruses with pandemic potential such as influenza A (H7N9), currently circulating in China. Special attention was given to the development of possible universal influenza vaccines, given that the Global Vaccine Action Plan calls for at least one licensed universal influenza vaccine by 2020. This report highlights some of the topics discussed and provides an update on studies published since the report of the previous meeting.
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Affiliation(s)
- Nancy J Cox
- Influenza Division, National Center for Infectious Diseases, 1600 Clifton Road NE, Atlanta, GA 30333, United States
| | | | - Rebecca Jones
- Working in Tandem Ltd, Cambridge CB1 7AB, United Kingdom
| | - Guus F Rimmelzwaan
- Department of Virology, Erasmus Medical Center, Dr Molewaterplein 50, Rotterdam CE 3015, The Netherlands
| | - Linda C Lambert
- Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases, NIAID/NIH/DHHS, 5601 Fishers Lane, Bethesda, MD 20892, United States
| | - John Boslego
- PATH, 445 Massachusetts Avenue, NW Suite 1000, Washington, DC 20001, United States
| | - Larisa Rudenko
- Institute of Experimental Medicine, Russian Academy of Medical Sciences, 12 Acad. Pavlov Street, St Petersburg 197376, Russian Federation
| | - Leena Yeolekar
- Vaccine Production, Serum Institute of India, 212/2 Hadapsar, Pune, India
| | | | - Joachim Hombach
- Initiative for Vaccine Research (IVR), Immunization, Vaccines and Biologicals (IVB), World Health Organization, Switzerland
| | - Justin R Ortiz
- Initiative for Vaccine Research (IVR), Immunization, Vaccines and Biologicals (IVB), World Health Organization, Switzerland
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Lambach P, Alvarez AMR, Hirve S, Ortiz JR, Hombach J, Verweij M, Hendriks J, Palkonyay L, Pfleiderer M. Considerations of strategies to provide influenza vaccine year round. Vaccine 2015; 33:6493-8. [PMID: 26319745 PMCID: PMC8218336 DOI: 10.1016/j.vaccine.2015.08.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/27/2015] [Accepted: 08/11/2015] [Indexed: 11/20/2022]
Abstract
There is potential for influenza vaccine programmes to make a substantial impact on severe disease in low-resource settings, however questions around vaccine composition and programmatic issues will require special attention. Some countries may benefit from immunization programmes that provide year-round supply of vaccine; however the best way to ensure adequate vaccine supply has yet to be determined. In this report, we discuss vaccine composition, availability, and programmatic issues that must be considered when developing year-round influenza immunization programmes. We then explore how these considerations have influenced immunization practices in the Latin American region as a case study. We identify three different approaches to achieve year-round supply: (1) alternating between Northern Hemisphere and Southern Hemisphere formulations, (2) extending the expiration date to permit extended use of a single hemisphere formulation, and (3) local vaccine manufacture with production timelines that align with local epidemiology. Each approach has its challenges and opportunities. The growing data suggesting high influenza disease burden in low resource countries underscores the compelling public health need to determine the best strategies for vaccine delivery.
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Affiliation(s)
- Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
| | - Alba Maria Ropero Alvarez
- Immunization Unit, Pan American Health Organization, 525 Twenty Third St., NW, Washington, DC 20037, USA
| | | | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Marcel Verweij
- Department of Social Sciences, Subdepartment Communication, Philosophy, and Technology, Wageningen University, Wageningen, The Netherlands
| | - Jan Hendriks
- Essential Medicines Department, World Health Organization, Geneva, Switzerland
| | - Laszlo Palkonyay
- Essential Medicines Department, World Health Organization, Geneva, Switzerland
| | - Michael Pfleiderer
- Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Institut, Langen, Germany
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Intention to receive influenza vaccination prior to the summer influenza season in adults of Hong Kong, 2015. Vaccine 2015; 33:6525-8. [DOI: 10.1016/j.vaccine.2015.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/23/2015] [Accepted: 10/06/2015] [Indexed: 11/21/2022]
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Le TT, Pham TH, Pham TH, Nguyen LKH, Nguyen CT, Hoang VMP, Tran TH, Nguyen VS, Ngo HG, Le QM. Circulation of influenza B lineages in northern Viet Nam, 2007-2014. Western Pac Surveill Response J 2015; 6:17-23. [PMID: 26798557 PMCID: PMC4712529 DOI: 10.5365/wpsar.2015.6.1.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Influenza B viruses circulate throughout Viet Nam, and their activities vary by region. There have been two antigenically distinct lineages of influenza B viruses co-circulating in the past 20 years; however, only one lineage is selected as a component of contemporary trivalent seasonal influenza vaccines. To improve the understanding of circulating influenza B lineages and influenza vaccine mismatches, we report the virus lineages circulating in northern Viet Nam over an eight-year period (2007-2014). METHODS Lineages of 331 influenza B viruses were characterized by haemagglutination inhibition assay against standard reference ferret (Yamagata) and sheep (Victoria) antisera. Sequence analysis of the haemagglutinin gene was performed in 64 selected influenza B isolates. RESULTS The proportion of influenza B lineages changed by year. The Yamagata lineage predominated in 2007, 2008 and 2012; the Victoria lineage predominated in 2009-2014 except 2012. The two lineages showed continuous evolution over time. The Northern Hemisphere's influenza vaccine components were mismatched with the predominant circulating viruses in 2007, 2009 and 2014. DISCUSSION The seasonality of influenza B activity is more variable in tropical and subtropical regions than in temperate zones. Our data showed a common co-circulation of both influenza B lineages in northern Viet Nam, and it was difficult to predict which one was the predominant lineage. Quadrivalent influenza vaccines containing both lineages may improve the effectiveness of influenza vaccine programmes in the future.
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Affiliation(s)
- Thi Thanh Le
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Thu Hang Pham
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Thi Hien Pham
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | | | | | | | - Thu Huong Tran
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Vu Son Nguyen
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Huong Giang Ngo
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Quynh Mai Le
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
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Affiliation(s)
- Nancy Cox
- Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States of America
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Mosnier A, Caini S, Daviaud I, Bensoussan JL, Stoll-Keller F, Bui TT, Lina B, Van der Werf S, Cohen JM. Ten influenza seasons in France: distribution and timing of influenza A and B circulation, 2003-2013. BMC Infect Dis 2015; 15:357. [PMID: 26289794 PMCID: PMC4545988 DOI: 10.1186/s12879-015-1056-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Describing the circulation of influenza viruses and the characteristics of seasonal epidemics remains an essential tool to optimize the strategies of influenza prevention and control. Special attention has been recently paid to influenza B in the context of the availability of a quadrivalent vaccine, containing two influenza B strains. METHODS We used data from a practitioners-based influenza surveillance network to describe the circulation of influenza viruses in France from 2003-2004 to 2012-2013. Nasopharyngeal swabs taken from acute respiratory infection (ARI) patients between October and April were tested for influenza. We reported the number of influenza cases by virus type (A, B), subtype (A(H1), A(H3)) and B lineage (Yamagata, Victoria) in each season and determined the frequency of influenza B vaccine mismatch. We estimated weekly incidence of influenza by extrapolating reported influenza cases to the French population. We compared the temporal characteristics of the epidemics caused by influenza A(H1), A(H3) and B. RESULTS Overall, 49,919 ARI patients were tested, of which 16,287 (32.6 %) were positive for influenza. Type B virus caused 23.7 % of all influenza cases. Virus subtypes A(H1) and A(H3) caused 51.6 % and 48.4 % of influenza A cases, respectively. Viruses of the B-Yamagata and B-Victoria lineage caused 62.8 % and 37.2 % of influenza B cases, respectively. There was an influenza B vaccine mismatch in three of the five seasons where influenza B caused 10 % or more of all influenza cases. Influenza A(H3) had the highest average value of estimated weekly incidence during the study period. Influenza B peaked an average 3.8 weeks later than influenza A when both virus types were circulating. No differences in the duration of influenza A and B epidemics were observed. CONCLUSIONS Influenza A(H3) was the most prevalent influenza type during the study period. Influenza B caused around one fourth of all influenza cases and tended to circulate later than influenza A. The frequency of influenza B vaccine mismatches was substantial. Timely data on the circulation of influenza viruses collected within influenza surveillance systems are essential to optimize influenza prevention and control strategies.
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Affiliation(s)
- Anne Mosnier
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
- Réseau des GROG, 67 rue du Poteau, 75018, Paris, France.
| | - Saverio Caini
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
| | - Isabelle Daviaud
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
- Réseau des GROG, 67 rue du Poteau, 75018, Paris, France.
| | | | | | - Tan Tai Bui
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
| | - Bruno Lina
- CNR des virus influenzae, CBPE, HCL & Virpath, UCBL, Université de Lyon, Lyon, France.
| | - Sylvie Van der Werf
- CNR des virus influenzae, GMVR Institut Pasteur, CNRS UMR3569, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Jean Marie Cohen
- Open Rome (Organize and Promote Epidemiological Network), 67 rue du Poteau, 75018, Paris, France.
- Réseau des GROG, 67 rue du Poteau, 75018, Paris, France.
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Sainato RJ, Ottolini MG, Hickey PW, Rajnik M. Preparing Families With Children for International Travel. Curr Probl Pediatr Adolesc Health Care 2015; 45:215-30. [PMID: 26253890 DOI: 10.1016/j.cppeds.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca J Sainato
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Martin G Ottolini
- Office of Curriculum, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.
| | - Patrick W Hickey
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Michael Rajnik
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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Ampofo WK, Azziz-Baumgartner E, Bashir U, Cox NJ, Fasce R, Giovanni M, Grohmann G, Huang S, Katz J, Mironenko A, Mokhtari-Azad T, Sasono PM, Rahman M, Sawanpanyalert P, Siqueira M, Waddell AL, Waiboci L, Wood J, Zhang W, Ziegler T. Strengthening the influenza vaccine virus selection and development process: Report of the 3rd WHO Informal Consultation for Improving Influenza Vaccine Virus Selection held at WHO headquarters, Geneva, Switzerland, 1-3 April 2014. Vaccine 2015; 33:4368-82. [PMID: 26148877 DOI: 10.1016/j.vaccine.2015.06.090] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
Despite long-recognized challenges and constraints associated with their updating and manufacture, influenza vaccines remain at the heart of public health preparedness and response efforts against both seasonal and potentially pandemic influenza viruses. Globally coordinated virological and epidemiological surveillance is the foundation of the influenza vaccine virus selection and development process. Although national influenza surveillance and reporting capabilities are being strengthened and expanded, sustaining and building upon recent gains has become a major challenge. Strengthening the vaccine virus selection process additionally requires the continuation of initiatives to improve the timeliness and representativeness of influenza viruses shared by countries for detailed analysis by the WHO Global Influenza Surveillance and Response System (GISRS). Efforts are also continuing at the national, regional, and global levels to better understand the dynamics of influenza transmission in both temperate and tropical regions. Improved understanding of the degree of influenza seasonality in tropical countries of the world should allow for the strengthening of national vaccination policies and use of the most appropriate available vaccines. There remain a number of limitations and difficulties associated with the use of HAI assays for the antigenic characterization and selection of influenza vaccine viruses by WHOCCs. Current approaches to improving the situation include the more-optimal use of HAI and other assays; improved understanding of the data produced by neutralization assays; and increased standardization of serological testing methods. A number of new technologies and associated tools have the potential to revolutionize influenza surveillance and response activities. These include the increasingly routine use of whole genome next-generation sequencing and other high-throughput approaches. Such approaches could not only become key elements in outbreak investigations but could drive a new surveillance paradigm. However, despite the advances made, significant challenges will need to be addressed before next-generation technologies become routine, particularly in low-resource settings. Emerging approaches and techniques such as synthetic genomics, systems genetics, systems biology and mathematical modelling are capable of generating potentially huge volumes of highly complex and diverse datasets. Harnessing the currently theoretical benefits of such bioinformatics ("big data") concepts for the influenza vaccine virus selection and development process will depend upon further advances in data generation, integration, analysis and dissemination. Over the last decade, growing awareness of influenza as an important global public health issue has been coupled to ever-increasing demands from the global community for more-equitable access to effective and affordable influenza vaccines. The current influenza vaccine landscape continues to be dominated by egg-based inactivated and live attenuated vaccines, with a small number of cell-based and recombinant vaccines. Successfully completing each step in the annual influenza vaccine manufacturing cycle will continue to rely upon timely and regular communication between the WHO GISRS, manufacturers and regulatory authorities. While the pipeline of influenza vaccines appears to be moving towards a variety of niche products in the near term, it is apparent that the ultimate aim remains the development of effective "universal" influenza vaccines that offer longer-lasting immunity against a broad range of influenza A subtypes.
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Affiliation(s)
| | | | - Uzma Bashir
- National Institute of Health, Islamabad, Pakistan
| | - Nancy J Cox
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Rodrigo Fasce
- Public Health Institute of Chile, National Influenza Center, Chile
| | | | - Gary Grohmann
- Therapeutics Goods Administration, Symonston, Australia
| | - Sue Huang
- National Influenza Center, Upper Hutt, New Zealand
| | - Jackie Katz
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | | | | | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | | | | | | | - John Wood
- Formerly National Institute for Biological Standards and Control (NIBSC), Potters Bar, UK
| | - Wenqing Zhang
- World Health Organization (WHO), Geneva, Switzerland.
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Koul PA, Broor S, Saha S, Barnes J, Smith C, Shaw M, Chadha M, Lal RB. Differences in influenza seasonality by latitude, northern India. Emerg Infect Dis 2015; 20:1723-6. [PMID: 25279651 PMCID: PMC4193176 DOI: 10.3201/eid2010.140431] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The seasonality of influenza in the tropics complicates vaccination timing. We investigated influenza seasonality in northern India and found influenza positivity peaked in Srinagar (34.09°N) in January–March but peaked in New Delhi (28.66°N) in July–September. Srinagar should consider influenza vaccination in October–November, but New Delhi should vaccinate in May–June.
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Abstract
Each year, influenza causes substantial mortality and morbidity worldwide. It is important to understand influenza in the tropics because of the significant burden in the region and its relevance to global influenza circulation. In this review, influenza burden, transmission dynamics, and their determinants in the tropics are discussed. Environmental, cultural, and social conditions in the tropics are very diverse and often differ from those of temperate regions. Theories that account for and predict influenza dynamics in temperate regions do not fully explain influenza epidemic patterns observed in the tropics. Routine surveillance and household studies have been useful in understanding influenza dynamics in the tropics, but these studies have been limited to only some regions; there is still a lack of information regarding influenza burden and transmission dynamics in many tropical countries. Further studies in the tropics will provide useful insight on many questions that remain.
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Affiliation(s)
- Sophia Ng
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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135
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Chadha MS, Potdar VA, Saha S, Koul PA, Broor S, Dar L, Chawla-Sarkar M, Biswas D, Gunasekaran P, Abraham AM, Shrikhande S, Jain A, Anukumar B, Lal RB, Mishra AC. Dynamics of influenza seasonality at sub-regional levels in India and implications for vaccination timing. PLoS One 2015; 10:e0124122. [PMID: 25938466 PMCID: PMC4418715 DOI: 10.1371/journal.pone.0124122] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/26/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Influenza surveillance is an important tool to identify emerging/reemerging strains, and defining seasonality. We describe the distinct patterns of circulating strains of the virus in different areas in India from 2009 to 2013. METHODS Patients in ten cities presenting with influenza like illness in out-patient departments of dispensaries/hospitals and hospitalized patients with severe acute respiratory infections were enrolled. Nasopharangeal swabs were tested for influenza viruses by real-time RT-PCR, and subtyping; antigenic and genetic analysis were carried out using standard assays. RESULTS Of the 44,127 ILI/SARI cases, 6,193 (14.0%) were positive for influenza virus. Peaks of influenza were observed during July-September coinciding with monsoon in cities Delhi and Lucknow (north), Pune (west), Allaphuza (southwest), Nagpur (central), Kolkata (east) and Dibrugarh (northeast), whereas Chennai and Vellore (southeast) revealed peaks in October-November, coinciding with the monsoon months in these cities. In Srinagar (Northern most city at 34°N latitude) influenza circulation peaked in January-March in winter months. The patterns of circulating strains varied over the years: whereas A/H1N1pdm09 and type B co-circulated in 2009 and 2010, H3N2 was the predominant circulating strain in 2011, followed by circulation of A/H1N1pdm09 and influenza B in 2012 and return of A/H3N2 in 2013. Antigenic analysis revealed that most circulating viruses were close to vaccine selected viral strains. CONCLUSIONS Our data shows that India, though physically located in northern hemisphere, has distinct seasonality that might be related to latitude and environmental factors. While cities with temperate seasonality will benefit from vaccination in September-October, cities with peaks in the monsoon season in July-September will benefit from vaccination in April-May. Continued surveillance is critical to understand regional differences in influenza seasonality at regional and sub-regional level, especially in countries with large latitude span.
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Affiliation(s)
| | | | | | - Parvaiz A. Koul
- Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Shobha Broor
- All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Dar
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Amita Jain
- King George Medical University (KGMU), Lucknow, India
| | | | - Renu B. Lal
- Centers for Disease Control and Prevention, Atlanta, USA
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136
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Meeyai A, Praditsitthikorn N, Kotirum S, Kulpeng W, Putthasri W, Cooper BS, Teerawattananon Y. Seasonal influenza vaccination for children in Thailand: a cost-effectiveness analysis. PLoS Med 2015; 12:e1001829; discussion e1001829. [PMID: 26011712 PMCID: PMC4444096 DOI: 10.1371/journal.pmed.1001829] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/13/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Seasonal influenza is a major cause of mortality worldwide. Routine immunization of children has the potential to reduce this mortality through both direct and indirect protection, but has not been adopted by any low- or middle-income countries. We developed a framework to evaluate the cost-effectiveness of influenza vaccination policies in developing countries and used it to consider annual vaccination of school- and preschool-aged children with either trivalent inactivated influenza vaccine (TIV) or trivalent live-attenuated influenza vaccine (LAIV) in Thailand. We also compared these approaches with a policy of expanding TIV coverage in the elderly. METHODS AND FINDINGS We developed an age-structured model to evaluate the cost-effectiveness of eight vaccination policies parameterized using country-level data from Thailand. For policies using LAIV, we considered five different age groups of children to vaccinate. We adopted a Bayesian evidence-synthesis framework, expressing uncertainty in parameters through probability distributions derived by fitting the model to prospectively collected laboratory-confirmed influenza data from 2005-2009, by meta-analysis of clinical trial data, and by using prior probability distributions derived from literature review and elicitation of expert opinion. We performed sensitivity analyses using alternative assumptions about prior immunity, contact patterns between age groups, the proportion of infections that are symptomatic, cost per unit vaccine, and vaccine effectiveness. Vaccination of children with LAIV was found to be highly cost-effective, with incremental cost-effectiveness ratios between about 2,000 and 5,000 international dollars per disability-adjusted life year averted, and was consistently preferred to TIV-based policies. These findings were robust to extensive sensitivity analyses. The optimal age group to vaccinate with LAIV, however, was sensitive both to the willingness to pay for health benefits and to assumptions about contact patterns between age groups. CONCLUSIONS Vaccinating school-aged children with LAIV is likely to be cost-effective in Thailand in the short term, though the long-term consequences of such a policy cannot be reliably predicted given current knowledge of influenza epidemiology and immunology. Our work provides a coherent framework that can be used for similar analyses in other low- and middle-income countries.
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Affiliation(s)
- Aronrag Meeyai
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Naiyana Praditsitthikorn
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
- Bureau of AIDS, TB, and STI, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Surachai Kotirum
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Wantanee Kulpeng
- Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
| | - Weerasak Putthasri
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Ben S. Cooper
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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137
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Vinh DN, Boni MF. Statistical identifiability and sample size calculations for serial seroepidemiology. Epidemics 2015; 12:30-9. [PMID: 26342240 PMCID: PMC4558460 DOI: 10.1016/j.epidem.2015.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 02/12/2015] [Accepted: 02/24/2015] [Indexed: 11/30/2022] Open
Abstract
We investigate whether disease dynamics can be inferred by repeated serum collections. Measuring antibody waning is critical for inference in serological time series. Collecting 200 samples every 2 months allows for inference of transmission parameters. Low-level seasonality is difficult to detect statistically.
Inference on disease dynamics is typically performed using case reporting time series of symptomatic disease. The inferred dynamics will vary depending on the reporting patterns and surveillance system for the disease in question, and the inference will miss mild or underreported epidemics. To eliminate the variation introduced by differing reporting patterns and to capture asymptomatic or subclinical infection, inferential methods can be applied to serological data sets instead of case reporting data. To reconstruct complete disease dynamics, one would need to collect a serological time series. In the statistical analysis presented here, we consider a particular kind of serological time series with repeated, periodic collections of population-representative serum. We refer to this study design as a serial seroepidemiology (SSE) design, and we base the analysis on our epidemiological knowledge of influenza. We consider a study duration of three to four years, during which a single antigenic type of influenza would be circulating, and we evaluate our ability to reconstruct disease dynamics based on serological data alone. We show that the processes of reinfection, antibody generation, and antibody waning confound each other and are not always statistically identifiable, especially when dynamics resemble a non-oscillating endemic equilibrium behavior. We introduce some constraints to partially resolve this confounding, and we show that transmission rates and basic reproduction numbers can be accurately estimated in SSE study designs. Seasonal forcing is more difficult to identify as serology-based studies only detect oscillations in antibody titers of recovered individuals, and these oscillations are typically weaker than those observed for infected individuals. To accurately estimate the magnitude and timing of seasonal forcing, serum samples should be collected every two months and 200 or more samples should be included in each collection; this sample size estimate is sensitive to the antibody waning rate and the assumed level of seasonal forcing.
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Affiliation(s)
- Dao Nguyen Vinh
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam
| | - Maciej F Boni
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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138
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Tran DN, Pham TMH, Ha MT, Hayakawa S, Mizuguchi M, Ushijima H. Molecular epidemiology of influenza A virus infection among hospitalized children in Vietnam during post-pandemic period. J Med Virol 2015; 87:904-12. [PMID: 25648607 PMCID: PMC7166353 DOI: 10.1002/jmv.24143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 12/11/2022]
Abstract
Genetic variability makes influenza virus to escape the immunity and causes yearly epidemics. Monitoring those changes is necessary for vaccine selection. In addition, H3N2 viruses were considered to be seeded from Southeast Asia before spreading globally. This study described the molecular epidemiology of influenza A during the post‐pandemic season 2010–2011 in Vietnam. Nasopharyngeal samples were collected from children with respiratory infections at Children's Hospital 2, Ho Chi Minh City. The HA, NA, M genes were amplified, sequenced and analyzed. Thirty‐five of 1,082 (3.2%) patients were positive for influenza A, including 14 pandemic H1N1 2009 (H1N1pdm09) and 21 H3N2 infections. H3N2 was dominant in the rainy season (May–October 2010) while H1N1pdm09 was dominant in the dry season (November 2010–April 2011). Phylogenetic analysis showed that Vietnamese H1N1pdm09 sequences in 2010–2011 formed the distinct cluster, with other contemporary Asian and 2012‐American sequences, suggesting a possible common ancestor. All were oseltamivir‐sensitive except two strains carrying S247N and D199N in NA which reduced the neuraminidase inhibitor susceptibility. The Vietnamese H3N2 viruses in mid‐2010 belonged to the emerging subclade Perth10/2010, which then spread worldwide in 2011. The Vietnamese influenza viruses were well matched with the Southern Hemisphere vaccine formulation. Mutations at antigenic sites were also identified in these viruses. Surveillance of influenza viruses in tropical countries is important not only for development of their prevention and control strategies but also for earlier identification of the newly emerged strains that may be selected for future vaccine. J. Med. Virol. 87:904–912, 2015. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Dinh Nguyen Tran
- Department of Developmental Medical Sciences, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Pediatrics, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
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139
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Gellin BG, Ampofo WK. Seasonal and pandemic influenza vaccine: demand, supply and vaccine availability. Vaccine 2014; 32:7037-9. [PMID: 25444824 DOI: 10.1016/j.vaccine.2014.10.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Bruce G Gellin
- National Vaccine Program Office, US Department of Health and Human Services, Washington, DC 20201, United States.
| | - William K Ampofo
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
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140
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Co MDT, Terajima M, Thomas SJ, Jarman RG, Rungrojcharoenkit K, Fernandez S, Yoon IK, Buddhari D, Cruz J, Ennis FA. Relationship of preexisting influenza hemagglutination inhibition, complement-dependent lytic, and antibody-dependent cellular cytotoxicity antibodies to the development of clinical illness in a prospective study of A(H1N1)pdm09 Influenza in children. Viral Immunol 2014; 27:375-82. [PMID: 25141276 DOI: 10.1089/vim.2014.0061] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The hemagglutination inhibition (HAI) antibody titer is considered the primary immune correlate of protection for influenza. However, recent studies have highlighted the limitations on the use of the HAI titer as a correlate in at-risk populations such as children and older adults. In addition to the neutralization of cell-free virus by antibodies to hemagglutinin and interference of virus release from infected cells by antibodies to neuraminidase, influenza virus-specific antibodies specifically can bind to infected cells and lyse virus-infected cells through the activation of complement or natural killer (NK) cells, via antibody-dependent cellular cytotoxicity (ADCC) or complement-dependent lysis (CDL). We evaluated preexisting HAI, CDL, and ADCC antibodies in young children enrolled in a prospective cohort study of dengue during the epidemic with influenza A(H1N1)pdm09 virus to determine associations between preexisting antibodies and the occurrence of clinical or subclinical influenza virus infection. Though both preexisting HAI and CDL antibodies were associated with protection against clinical influenza, our data suggested that CDL was not a better correlate than HAI. We found that ADCC antibodies behaved differently from HAI and CDL antibodies. Unlike HAI and CDL antibodies, preexisting ADCC antibodies did not correlate with protection against clinical influenza. In fact, ADCC antibodies were detected more frequently in the clinical influenza group than the subclinical group. In addition, in contrast to HAI and CDL antibodies, HAI and the ADCC antibodies titers did not correlate. We also found that ADCC, but not CDL or HAI antibodies, positively correlated with the ages of the children.
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Affiliation(s)
- Mary Dawn T Co
- 1 Department of Medicine, University of Massachusetts Medical School , Worcester, Massachusetts
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