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Takayama I, Nguyen BG, Dao CX, Pham TT, Dang TQ, Truong PT, Do TV, Pham TTP, Fujisaki S, Odagiri T, Hasegawa H, Nakajima N. Next-Generation Sequencing Analysis of the Within-Host Genetic Diversity of Influenza A(H1N1)pdm09 Viruses in the Upper and Lower Respiratory Tracts of Patients with Severe Influenza. mSphere 2021; 6:e01043-20. [PMID: 33408229 PMCID: PMC7845592 DOI: 10.1128/msphere.01043-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/16/2020] [Indexed: 01/22/2023] Open
Abstract
The influenza A(H1N1)pdm09 virus emerged in April 2009 with an unusual incidence of severe disease and mortality, and currently circulates as a seasonal influenza virus. Previous studies using consensus viral genome sequencing data have overlooked the viral genomic and phenotypic diversity. Next-generation sequencing (NGS) may instead be used to characterize viral populations in an unbiased manner and to measure within-host genetic diversity. In this study, we used NGS analysis to investigate the within-host genetic diversity of influenza A(H1N1)pdm09 virus in the upper and lower respiratory samples from nine patients who were admitted to the intensive care unit (ICU). A total of 47 amino acid substitution positions were found to differ between the upper and lower respiratory tract samples from all patients. However, the D222G/N substitution in hemagglutinin (HA) protein was the only amino acid substitution common to multiple patients. Furthermore, the substitution was detected only in the six samples from the lower respiratory tract. Therefore, it is important to investigate influenza A(H1N1)pdm09 virus populations using multiple paired samples from the upper and lower respiratory tract to avoid overlooking potentially important substitutions, especially in patients with severe disease.IMPORTANCE The D222G/N substitution in the hemagglutinin (HA) protein of influenza A(H1N1)pdm09 virus has been reported to be associated with disease severity and mortality in numerous previous studies. In the present study, 75% of lower respiratory samples contained heterogeneous influenza populations that carried different amino acids at position 222 of the HA protein, whereas all upper respiratory samples only contained the wild-type 222D. These results suggest the influenza A(H1N1)pdm09 virus has diversified inside the host owing to differences in tissue specificity. In this study, the within-host genetic diversity of influenza A(H1N1)pdm09 virus was investigated for the first time using next-generation sequencing analysis of the viral whole-genome in samples extracted from the upper and lower respiratory tracts of patients with severe disease.
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Affiliation(s)
- Ikuyo Takayama
- Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | | | | | | | | | | | - Seiichiro Fujisaki
- Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Takato Odagiri
- Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hideki Hasegawa
- Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Noriko Nakajima
- Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan
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DeFelice T. Relationship between temporal anomalies in PM 2.5 concentrations and reported influenza/influenza-like illness activity. Heliyon 2020; 6:e04726. [PMID: 32835121 PMCID: PMC7428445 DOI: 10.1016/j.heliyon.2020.e04726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/06/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022] Open
Abstract
A small number of studies suggest atmospheric particulate matter with diameters 2.5 micron and smaller (PM2.5) may possibly play a role in the transmission of influenza and influenza-like illness (ILI) symptoms. Those studies were predominantly conducted under moderately to highly polluted outdoor atmospheres. The purpose of this study was to extend the data set to include a less polluted atmospheric environment. A relationship between PM2.5 and ILI activity extended to include lightly to moderately polluted atmospheres could imply a more complicated mechanism than that suggested by existing studies. We obtained concurrent PM2.5 mass concentration data, meteorological data and reported Influenza and influenza-like illness (ILI) activity for the light to moderately polluted atmospheres over the Tucson, AZ region. We found no relation between PM2.5 mass concentration and ILI activity. There was an expected relation between ILI, activity, temperature, and relative humidity. There was a possible relation between PM2.5 mass concentration anomalies and ILI activity. These results might be due to the small dataset size and to the technological limitations of the PM measurements. Further study is recommended since it would improve the understanding of ILI transmission and thereby improve ILI activity/outbreak forecasts and transmission model accuracies.
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Oda H, Wakabayashi H, Tanaka M, Yamauchi K, Sugita C, Yoshida H, Abe F, Sonoda T, Kurokawa M. Effects of lactoferrin on infectious diseases in Japanese summer: A randomized, double-blinded, placebo-controlled trial. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:566-574. [PMID: 32151562 DOI: 10.1016/j.jmii.2020.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate the effects of lactoferrin (LF) on infectious diseases in Japanese summer. METHODS An intake of placebo, 200 mg, or 600 mg of LF were administered to healthy adults in Kyushu University of Health and Welfare for 12 weeks in a randomized, double-blinded, placebo-controlled parallel-group comparative trial. The primary endpoints were the prevalence and duration of infectious diseases and changes in immune parameters. RESULTS Three hundred and ten subjects were randomized (placebo, n = 104; 200 mg, n = 103; 600 mg, n = 103). Twenty subjects were lost to the follow-up, leaving 290 for a full analysis set (n = 99; n = 95; n = 96). The duration (day) of total infectious diseases was shorter in the 200 mg group (2.0, p = 0.045) and 600 mg group (2.0, p = 0.010) than in the placebo group (3.0). The duration of summer colds was shorter in the 600 mg group (2.0, p = 0.036) than in the placebo group (3.0). No significant differences were observed in the prevalence of infectious diseases or changes in immune parameters. In exploratory investigations, changes in the neutrophil phagocytic capacity, cortisol concentrations, and T score of "Vigor/Activity" in the Profile of Mood States 2 were greater in the 600 mg group than in the placebo group, when analysis was done on the lower half groups at the baseline. Adverse events were similar in each group and none had a causal relationship with the intake of the test foods. CONCLUSIONS In summer, the intake of LF attenuates infectious diseases, including summer colds.
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Affiliation(s)
- Hirotsugu Oda
- Food Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., 5-1-83, Zama, Kanagawa, 252-8583, Japan.
| | - Hiroyuki Wakabayashi
- Food Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., 5-1-83, Zama, Kanagawa, 252-8583, Japan
| | - Miyuki Tanaka
- Food Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., 5-1-83, Zama, Kanagawa, 252-8583, Japan
| | - Koji Yamauchi
- Food Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., 5-1-83, Zama, Kanagawa, 252-8583, Japan
| | - Chihiro Sugita
- Department of Biochemistry, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1, Nobeoka, Miyazaki, 882-8508, Japan
| | - Hiroki Yoshida
- Department of Biochemistry, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1, Nobeoka, Miyazaki, 882-8508, Japan
| | - Fumiaki Abe
- Food Ingredients and Technology Institute, Morinaga Milk Industry Co., Ltd., 5-1-83, Zama, Kanagawa, 252-8583, Japan
| | - Tohru Sonoda
- Department of Occupational Therapy, School of Health and Science, Kyushu University of Health and Welfare, 1714-1, Nobeoka, Miyazaki, 882-8508, Japan
| | - Masahiko Kurokawa
- Department of Biochemistry, Graduate School of Clinical Pharmacy, Kyushu University of Health and Welfare, 1714-1, Nobeoka, Miyazaki, 882-8508, Japan
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Le Thi N, Ikuyo T, Nguyen Gia B, Truong Thai P, Vu Thi TV, Bui Minh V, Dao Xuan C, Le Trung D, Phan Thu P, Do Duy C, Pham The T, Do VT, Pham Thi PT, Ngo Quy C, Dang Quoc T, Jin T, Shohei S, Takato O, Noriko N, Tsutomu K. A clinic-based direct real-time fluorescent reverse transcription loop-mediated isothermal amplification assay for influenza virus. J Virol Methods 2019; 277:113801. [PMID: 31838003 DOI: 10.1016/j.jviromet.2019.113801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 02/08/2023]
Abstract
Seasonal influenza virus causes acute respiratory tract infections, which can be severe in children and the elderly. At present, rapid influenza diagnostic tests (RIDTs) are popular at clinical sites because they enable early diagnosis and avoid unnecessary use of antibiotics; in addition, high risk patients with underlying disease can be given antiviral drugs. However, the sensitivity and specificity of some of those tests are relatively poor. To overcome these problems, nucleic acid-based molecular point-of-care tests have been developed; however, they are significantly more expensive than RIDTs. Previously, the authors developed real-time reverse transcription loop-mediated isothermal amplification (rRT-LAMP) assays using a quenching primer to detect influenza viruses. However, the assay is limited to laboratory use because it requires a nucleic acid purification step and preparation of reaction mixtures on ice. Therefore, the authors developed and validated direct rRT-LAMP assays that require no nucleic acid purification steps using commercial RNA isolation kits, and no storage and handling of reagents on ice. These assays can be performed within 10-30 min and require only mixing a clinical specimen with extraction reagent followed by addition of a lyophilized detection reagent. The established assay showed high sensitivity and specificity when validated using 310 clinical specimens. Thus, the assay is a powerful tool for molecular diagnosis of seasonal influenza virus infection in the clinic.
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Affiliation(s)
- Ngan Le Thi
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Takayama Ikuyo
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
| | - Binh Nguyen Gia
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Phuong Truong Thai
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Tuong Van Vu Thi
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Vuong Bui Minh
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Co Dao Xuan
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Dung Le Trung
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Phuong Phan Thu
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Cuong Do Duy
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Thach Pham The
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Van Thanh Do
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Phuong Thuy Pham Thi
- NCGM-Bach Mai Hospital Medical Collaboration Center, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Chau Ngo Quy
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Tuan Dang Quoc
- Bach Mai Hospital, 78 Giai Phong Street, Dong Da District, Hanoi, Viet Nam
| | - Takasaki Jin
- National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Semba Shohei
- Eiken Chemical Co., Ltd, 4-19-9 Taito, Taito-ku, Tokyo, 110-8408, Japan
| | - Odagiri Takato
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
| | - Nakajima Noriko
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan.
| | - Kageyama Tsutomu
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan
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Takayama I, Nakauchi M, Takahashi H, Oba K, Semba S, Kaida A, Kubo H, Saito S, Nagata S, Odagiri T, Kageyama T. Development of real-time fluorescent reverse transcription loop-mediated isothermal amplification assay with quenching primer for influenza virus and respiratory syncytial virus. J Virol Methods 2019; 267:53-58. [PMID: 30831121 PMCID: PMC7113748 DOI: 10.1016/j.jviromet.2019.02.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/31/2019] [Accepted: 02/28/2019] [Indexed: 12/20/2022]
Abstract
Influenza virus and respiratory syncytial virus cause acute upper and lower respiratory tract infections, especially in children and the elderly. Early treatment for these infections is thought to be important, so simple and sensitive detection methods are needed for use at clinical sites. Therefore, in this study, real-time reverse transcription loop-mediated isothermal amplification assays with quenching primer for influenza virus and respiratory syncytial virus were developed. Evaluation of a total of 113 clinical specimens compared to real-time RT-PCR assays showed that the novel assays could distinguish between the types and subtypes of influenza virus and respiratory syncytial virus and had 100% diagnostic specificity. The diagnostic sensitivity of each assay exceeded 85.0% and the assays showed sufficient clinical accuracy. Furthermore, positive results could be obtained in around 15 min using the novel assays in cases with high concentrations of virus. The developed assays should be useful for identifying influenza virus and respiratory syncytial virus cases not only in experimental laboratories but also in hospital and quarantine laboratories.
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Affiliation(s)
- Ikuyo Takayama
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Mina Nakauchi
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Hitoshi Takahashi
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira-shi, Tokyo 187-0002, Japan
| | - Shohei Semba
- Eiken Chemical Co. Ltd., 4-19-9 Taito, Taito-ku, Tokyo 110-8408, Japan
| | - Atsushi Kaida
- Division of Microbiology, Osaka Institute of Public Health, 8-34 Tojo-cho, Tennoji-ku, Osaka 543-0026, Japan
| | - Hideyuki Kubo
- Division of Microbiology, Osaka Institute of Public Health, 8-34 Tojo-cho, Tennoji-ku, Osaka 543-0026, Japan
| | - Shinji Saito
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Shiho Nagata
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Takato Odagiri
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Tsutomu Kageyama
- Influenza Virus Research Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.
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Sruamsiri R, Ferchichi S, Jamotte A, Toumi M, Kubo H, Mahlich J. Impact of patient characteristics and treatment procedures on hospitalization cost and length of stay in Japanese patients with influenza: A structural equation modelling approach. Influenza Other Respir Viruses 2017; 11:543-555. [PMID: 28987034 PMCID: PMC5705683 DOI: 10.1111/irv.12505] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Little is known about the economic burden of influenza-related hospitalizations in Japan. This study sought to identify the factors that contribute to the total healthcare costs (THCs) associated with hospitalizations due to influenza in the Japanese population. STUDY DESIGN A retrospective cross-sectional database analysis study. METHODS A structural equation modelling approach was used to analyse a nationwide Japanese hospital claims data. This study included inpatients with at least 1 confirmed diagnosis of influenza and with a hospital stay of at least 2 days, who were admitted between April 2014 and March 2015. RESULTS A total of 5261 Japanese inpatients with a diagnosis of influenza were included in the final analysis. The elderly (≥65 years) and the young (≤15 years) comprised more than 85% of patients. The average length of stay (LOS) was 12.5 days, and the mean THC was 5402 US dollars (US$) per hospitalization. One additional hospital day increased the THC by 314 US$. Intensive care unit hospitalizations were linked to higher costs (+4957 US$) compared to regular hospitalizations. The biggest procedure-related cost drivers, which were also impacted by LOS, were blood transfusions (+6477 US$), tube feedings (+3501 US$) and dialysis (+2992 US$). CONCLUSIONS In Japan, the economic burden due to influenza-related hospitalizations for both children and the elderly is considerable and is further impacted by associated comorbidities, diagnostic tests and procedures that prolong the LOS.
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Affiliation(s)
- Rosarin Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan.,Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
| | | | | | - Mondher Toumi
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Hiroshi Kubo
- Research & Development Department, Janssen Pharmaceutical KK, Tokyo, Japan
| | - Jörg Mahlich
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan.,Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany
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Kim WJ, Lee JS, Lee CK, Cheong HJ, Kim M, Monegal JS, Carneiro R, Kyaw MH, Haguinet F, Ray R, Matias G. Clinical Features of Influenza and Acute Respiratory Illness in Older Adults at Least 50 Years of Age in an Outpatient Setting in the Republic of Korea: a Prospective, Observational, Cohort Study. J Korean Med Sci 2017; 32:407-414. [PMID: 28145642 PMCID: PMC5290098 DOI: 10.3346/jkms.2017.32.3.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/20/2016] [Indexed: 11/20/2022] Open
Abstract
Two prospective, multi-centre, observational studies (GlaxoSmithKline [GSK] identifier No. 110938 and 112519) were performed over 2 influenza seasons (2007-2008 and 2008-2009) in the Republic of Korea (ROK) with the aim to evaluate the burden of laboratory-confirmed influenza (LCI) in patients ≥ 50 years of age seeking medical attention for acute respiratory illness (ARI). The median participant age was 58 years in the 2007-2008 season and 60 years in the 2008-2009 season. LCI was observed in 101/346 (29.2%) of ARI patients in the 2007-2008 season and in 166/443 (37.5%) of ARI patients in the 2008-2009 season. Compared to patients with non-influenza ARI, those with LCI had higher rates of decreased daily activities (60.4% vs. 32.9% in 2007-2008 and 46.4% vs. 25.8% in 2008-2009), work absenteeism (51.1% vs. 25.6% and 14.4% vs. 7.7%), and longer duration of illness. These results indicated that influenza is an important cause of ARI in adults aged 50 and older causing more severe illness than non-influenza related ARI.
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Affiliation(s)
- Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
| | - Jin Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University Inha Hospital, Incheon, Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Mijeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
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Sugaya N. A review of the indirect protection of younger children and the elderly through a mass influenza vaccination program in Japan. Expert Rev Vaccines 2014; 13:1563-70. [PMID: 25138431 DOI: 10.1586/14760584.2014.951036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the past, Japan's strategy for controlling influenza was to vaccinate schoolchildren based on the theory that this could reduce influenza epidemics in the community, and a special program to vaccinate schoolchildren against influenza was begun in 1962. However, the program was discontinued in 1994 because of lack of evidence that it had limited the spread of influenza in the community. In 2001, it was reported that a clear decrease in excess mortality had coincided with the timing of the schoolchild vaccination program. This decrease could have potentially occurred because elderly people were protected by herd immunity generated by the program. Moreover, the program protected the younger siblings of schoolchildren against influenza-associated encephalopathy. Finally, the program was effective in reducing the number of class cancellations and absenteeism from school. During the period when the program was in effect, Japanese schoolchildren served as a barrier against influenza in the community.
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Affiliation(s)
- Norio Sugaya
- Department of Pediatrics, Keiyu Hospital, Yokohama, Japan
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Paul Glezen W, Schmier JK, Kuehn CM, Ryan KJ, Oxford J. The burden of influenza B: a structured literature review. Am J Public Health 2013; 103:e43-51. [PMID: 23327249 PMCID: PMC3673513 DOI: 10.2105/ajph.2012.301137] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2012] [Indexed: 01/14/2023]
Abstract
We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010. Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B-specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant. The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disease and assist in vaccine development.
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Affiliation(s)
- W Paul Glezen
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
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10
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Sakudo A, Baba K, Ikuta K. Discrimination of influenza virus-infected nasal fluids by Vis-NIR spectroscopy. Clin Chim Acta 2012; 414:130-4. [PMID: 22959922 DOI: 10.1016/j.cca.2012.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Influenza patients show a severe condition of the respiratory tract with high temperature. Efficient treatment of influenza requires early use of oseltamivir, and thus rapid diagnosis is needed. Recently, rapid diagnostic methods such as immunochromatography have been developed; however, immunochromatography is not an optimal technique because it is relatively expensive and has low sensitivity. METHODS Visible and near-infrared (Vis-NIR) spectroscopy in the region 600-1100 nm, combined with chemometrics analysis such as principal component analysis (PCA) or soft modeling of class analogy (SIMCA), was used to develop a potential diagnostic method for influenza based on nasal aspirates from infected patients. RESULTS The Vis-NIR spectra of nasal aspirates from 33 non-influenza patients and 34 influenza patients were subjected to PCA and SIMCA to develop multivariate models to discriminate between influenza and non-influenza patients. These models were further assessed by the prediction of 126 masked measurements [30 from non-influenza patients, 30 from influenza patients and 66 from patients infected with respiratory syncytial virus (RSV)]. The PCA model showed some discrimination of the masked samples. The SIMCA model correctly predicted 29 of 30 (96.7%) non-influenza patients, and 30 of 30 (100%) influenza patients from the Vis-NIR spectra of masked nasal aspirate samples. Nasal aspirates of RSV-infected patients were predicted as 50% non-influenza and 50% influenza by the SIMCA model, suggesting that discrimination between patients infected with influenza virus and those infected with RSV was difficult. CONCLUSIONS Although the study sample was small and there was difficulty in discriminating between influenza virus and RSV infection, these results suggest that Vis-NIR spectroscopy of nasal aspirates, combined with chemometrics analysis, might be a potential tool for diagnosis of influenza.
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Affiliation(s)
- Akikazu Sakudo
- Department of Virology, Center for Infectious Disease Control, Research Institute for Microbial Diseases, Osaka University, Yamadaoka, Suita, Osaka 565-0871, Japan.
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11
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Very low pandemic influenza A (H1N1) 2009 mortality associated with early neuraminidase inhibitor treatment in Japan: analysis of 1000 hospitalized children. J Infect 2011; 63:288-94. [PMID: 21722665 DOI: 10.1016/j.jinf.2011.06.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 05/07/2011] [Accepted: 06/16/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE There were many cases of pandemic influenza A (H1N1) 2009 (H1N1/09) in Japan during the 2009-2010 epidemic. They accounted for 16% of the total population (20.7 million/128 million), and 59% of the patients were children 15 years of age and under (12.2 million/20.7million). However, there were only 38 paediatric deaths. We analyzed the clinical manifestations and treatment of children hospitalized because of H1N1/09 infection in order to clarify the association between treatment with neuraminidase inhibitors and the low mortality rate. METHODS A retrospective chart review was performed on a total of 1000 paediatric inpatients. RESULTS The causes of the hospitalizations were respiratory complications in 651 cases (65.1%), neurological complications in 255 cases (25.5%) and other complications in 94 cases. Neuraminidase inhibitors, primarily oseltamivir, had been used to treat 984 (98.4%) of the 1000 patients, and in 88.9% of the patients, treatment with neuraminidase inhibitors was initiated within 48 h after the onset of illness. Only 12 (1.2%) of the 1000 patients underwent mechanical ventilation, and one patient died of H1N1/09 infection. CONCLUSIONS Although a high proportion of the patients in this study had severe respiratory complications, the case fatality rate was only 0.1%. The low mortality rate of children due to the H1N1/09 epidemic in Japan was probably attributable to the universal implementation of early treatment with neuraminidase inhibitors.
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Sánchez-Yebra W, Ávila-Carrillo JA, Giménez-Sánchez F, Reyes-Bertos A, Sánchez-Forte M, Morales-Torres M, Rojas A, Mendoza J. Viral agents causing lower respiratory tract infections in hospitalized children: evaluation of the Speed-Oligo® RSV assay for the detection of respiratory syncytial virus. Eur J Clin Microbiol Infect Dis 2011; 31:243-50. [PMID: 21647616 PMCID: PMC7088155 DOI: 10.1007/s10096-011-1300-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 05/15/2011] [Indexed: 11/01/2022]
Abstract
Respiratory syncytial virus (RSV) is the viral agent which is more frequently involved in lower respiratory tract infections (LRTIs) in infants under 1 year of age in developed countries. A new oligochromatographic assay, Speed-Oligo® RSV, was designed and optimized for the specific detection and identification of RSV subtypes A and B. The test was evaluated in 289 clinical samples from 169 hospitalized children using an immunochromatography (IC) test, virus isolation by culture, and an in-house real-time polymerase chain reaction (RT-PCR). Other viruses causing LRTIs were investigated by cell culture or PCR-based tests. Sixty-two patients were infected by RSV (36.7%). In addition, adenovirus, influenza B, parainfluenza 2, and human metapneumovirus were detected in rates ranging from 5 to 8%. A proportion of 10.1% of the patients had mixed infections. The sensitivity, specificity, and positive and negative predictive values were, respectively, 94.9, 99.4, 98.9, and 97.4% for Speed-Oligo® RSV, 92.9, 96.3, 92.9, and 96.3% for RT-PCR/RSV, and 58.4, 98.1, 93.3, and 82.6% for IC. Our rates of viral detection and co-infection were similar to those of previously reported series. Finally, we find that Speed-Oligo® RSV is a rapid and easy-to-perform technique for the detection of RSV and the identification of subtypes A and B.
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Affiliation(s)
- W Sánchez-Yebra
- Department of Microbiology, CH Torrecárdenas, 04009, Almería, Spain.
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13
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Long-acting neuraminidase inhibitor laninamivir octanoate (CS-8958) versus oseltamivir as treatment for children with influenza virus infection. Antimicrob Agents Chemother 2010; 54:2575-82. [PMID: 20368393 DOI: 10.1128/aac.01755-09] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We conducted a double-blind, randomized controlled trial to compare a long-acting neuraminidase inhibitor, laninamivir octanoate, with oseltamivir. Eligible patients were children 9 years of age and under who had febrile influenza symptoms of no more than 36-h duration. Patients were randomized to 1 of 3 treatment groups: a group given 40 mg laninamivir (40-mg group), a group given 20 mg laninamivir (20-mg group), and an oseltamivir group. Laninamivir octanoate was administered as a single inhalation. Oseltamivir (2 mg/kg of body weight) was administered orally twice daily for 5 days. The primary end point was the time to alleviation of influenza illness. The primary analysis included 184 patients (61, 61, and 62 in the 40-mg group, 20-mg group, and oseltamivir group, respectively). Laninamivir octanoate markedly reduced the median time to illness alleviation in comparison with oseltamivir in patients infected with oseltamivir-resistant influenza A (H1N1) virus, and the reductions were 60.9 h for the 40-mg group and 66.2 h for the 20-mg group. On the other hand, there were no significant differences in the times to alleviation of illness between the laninamivir groups and oseltamivir group for patients with influenza A (H3N2) or B virus infection. Laninamivir octanoate was well tolerated. The most common adverse events were gastrointestinal events. Laninamivir octanoate was an effective and well-tolerated treatment for children with oseltamivir-resistant influenza A (H1N1) virus infection. Further study will be needed to confirm clinical efficacy against influenza A (H3N2) or B virus infection. Its ease of administration is noteworthy, because a single inhalation is required during the course of illness.
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Simmerman JM, Uyeki TM. The burden of influenza in East and South-East Asia: a review of the English language literature. Influenza Other Respir Viruses 2009; 2:81-92. [PMID: 19453467 PMCID: PMC4634698 DOI: 10.1111/j.1750-2659.2008.00045.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Abstract While human infections with avian influenza A (H5NI) viruses in Asia have prompted concerns about an influenza pandemic, the burden of human influenza in East and Southeast Asia has received far less attention. We conducted a review of English language articles on influenza in 18 countries in East and Southeast Asia published from 1980 to 2006 that were indexed on PubMed. Articles that described human influenza‐associated illnesses among outpatients or hospitalized patients, influenza‐associated deaths, or influenza‐associated socioeconomic costs were reviewed. We found 35 articles from 9 countries that met criteria for inclusion in the review. The quality of articles varied substantially. Significant heterogeneity was noted in case definitions, sampling schemes and laboratory methods. Early studies relied on cell culture, had difficulties with specimen collection and handling, and reported a low burden of disease. The recent addition of PCR testing has greatly improved the proportion of respiratory illnesses diagnosed with influenza. These more recent studies reported that 11–26% of outpatient febrile illness and 6‐14% of hospitalized pneumonia cases had laboratory‐confirmed influenza infection. The influenza disease burden literature from East and Southeast Asia is limited but expanding. Recent studies using improved laboratory testing methods and indirect statistical approaches report a substantial burden of disease, similar to that of Europe and North America. Current increased international focus on influenza, coupled with unprecedented funding for surveillance and research, provide a unique opportunity to more comprehensively describe the burden of human influenza in the region.
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Affiliation(s)
- James M Simmerman
- Thailand MOPH-U.S. CDC Collaboration, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
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15
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Ajayi-Obe EK, Coen PG, Handa R, Hawrami K, Aitken C, McIntosh EDG, Booy R. Influenza A and respiratory syncytial virus hospital burden in young children in East London. Epidemiol Infect 2008; 136:1046-58. [PMID: 17903316 PMCID: PMC2870908 DOI: 10.1017/s0950268807009557] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2007] [Indexed: 11/07/2022] Open
Abstract
Epidemiological studies have demonstrated high hospitalization rates attributable to influenza and RSV in children aged 6 months and those aged <12 months, respectively (43 and 92.5/10 000 person-months, respectively). In conclusion, these high paediatric RSV and influenza incidence rates can be used to inform UK policy on childhood influenza immunization and subsequent RSV immunization in the future.
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Affiliation(s)
- E K Ajayi-Obe
- Centre for Child Health, Queen Mary University of London, Barts and the London NHS Trust, London, UK.
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16
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Medina DC, Findley SE, Guindo B, Doumbia S. Forecasting non-stationary diarrhea, acute respiratory infection, and malaria time-series in Niono, Mali. PLoS One 2007; 2:e1181. [PMID: 18030322 PMCID: PMC2077810 DOI: 10.1371/journal.pone.0001181] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 10/18/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Much of the developing world, particularly sub-Saharan Africa, exhibits high levels of morbidity and mortality associated with diarrhea, acute respiratory infection, and malaria. With the increasing awareness that the aforementioned infectious diseases impose an enormous burden on developing countries, public health programs therein could benefit from parsimonious general-purpose forecasting methods to enhance infectious disease intervention. Unfortunately, these disease time-series often i) suffer from non-stationarity; ii) exhibit large inter-annual plus seasonal fluctuations; and, iii) require disease-specific tailoring of forecasting methods. METHODOLOGY/PRINCIPAL FINDINGS In this longitudinal retrospective (01/1996-06/2004) investigation, diarrhea, acute respiratory infection of the lower tract, and malaria consultation time-series are fitted with a general-purpose econometric method, namely the multiplicative Holt-Winters, to produce contemporaneous on-line forecasts for the district of Niono, Mali. This method accommodates seasonal, as well as inter-annual, fluctuations and produces reasonably accurate median 2- and 3-month horizon forecasts for these non-stationary time-series, i.e., 92% of the 24 time-series forecasts generated (2 forecast horizons, 3 diseases, and 4 age categories = 24 time-series forecasts) have mean absolute percentage errors circa 25%. CONCLUSIONS/SIGNIFICANCE The multiplicative Holt-Winters forecasting method: i) performs well across diseases with dramatically distinct transmission modes and hence it is a strong general-purpose forecasting method candidate for non-stationary epidemiological time-series; ii) obliquely captures prior non-linear interactions between climate and the aforementioned disease dynamics thus, obviating the need for more complex disease-specific climate-based parametric forecasting methods in the district of Niono; furthermore, iii) readily decomposes time-series into seasonal components thereby potentially assisting with programming of public health interventions, as well as monitoring of disease dynamics modification. Therefore, these forecasts could improve infectious diseases management in the district of Niono, Mali, and elsewhere in the Sahel.
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Affiliation(s)
- Daniel C. Medina
- College of Physicians and Surgeons, Columbia University, New York, New York, United States of America
- Malaria Research and Training Center, Faculté de Médecine de Pharmacie et d'Odonto-Stomatologie (FMPOS), Université de Bamako, Bamako, Mali
| | - Sally E. Findley
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * To whom correspondence should be addressed. E-mail:
| | - Boubacar Guindo
- Malaria Research and Training Center, Faculté de Médecine de Pharmacie et d'Odonto-Stomatologie (FMPOS), Université de Bamako, Bamako, Mali
| | - Seydou Doumbia
- Malaria Research and Training Center, Faculté de Médecine de Pharmacie et d'Odonto-Stomatologie (FMPOS), Université de Bamako, Bamako, Mali
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van Esso Arbolave DL, Estabanell Buxó A, Fernández García I, Pérez Cifuentes M, Besora Anglerill R, Casanovas Gordó JM, Pumarola Suñé T, Marcos Maeso MA, Martínez Mateo A, Domínguez García A. [Clinical and epidemiological characteristics of influenza A virus infection in children aged less than 7 years old in primary care]. An Pediatr (Barc) 2006; 65:211-8. [PMID: 16956499 DOI: 10.1157/13092156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The aim of this study was to describe the clinical and epidemiological features of confirmed influenza A virus infection in patients aged less than 7 years old. PATIENTS AND METHODS We performed a retrospective, descriptive study of the clinical and epidemiological features of influenza A virus infection in patients aged less than 7 years old attending three primary care centers during the 2003-2004 influenza season. Patients with influenza A infection confirmed by immunofluorescence, cell culture, or polymerase chain reaction were interviewed to obtain clinical and epidemiological data on their disease. RESULTS Influenza A virus was detected in 47 patients aged between 5 months and 7 years (mean: 37.3 +/- 5.7 months). Of these, 35 children (74.4 %) were aged between 0 and 4 years. The most frequent symptoms were fever (100 %), cough (95.7 %), and rhinorrhea (76.6 %). Gastrointestinal symptoms were present in 40.4 % of the patients. The mean duration of fever was 5.2 +/- 1.8 days (range 2-8). Complications occurred in nine patients (19.2 %). The frequency of influenza-like disease in parents was 9.1 % (8/88) at diagnosis of the index case and was 23.9 % (21/88) immediately after the episode in the child (p 5 0.01). The mean number of days of absence from school was 7.5 +/- 3.6 days. CONCLUSIONS The mean age of our patients confirms that influenza is a frequent disease in infancy and childhood. The results demonstrate that the infection is transmitted from children to parents in the household setting, since the frequency of influenza-like symptoms in adults increases after influenza episodes in children.
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Nicholson KG, McNally T, Silverman M, Simons P, Stockton JD, Zambon MC. Rates of hospitalisation for influenza, respiratory syncytial virus and human metapneumovirus among infants and young children. Vaccine 2006; 24:102-8. [PMID: 16310899 DOI: 10.1016/j.vaccine.2005.02.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/19/2005] [Accepted: 02/07/2005] [Indexed: 10/25/2022]
Abstract
To inform the development of a national influenza immunisation programme and the potential role of antiviral drugs in young children, we studied 613 children aged 71 months or younger who attended Leicester Childrens' Hospital during winter 2001-2002. During periods of respiratory syncytial virus (RSV), influenza, and human metapneumovirus activity, an estimated 12.2% (95% CI: 11.4-13.1), 7.1% (6.3-7.9), and 2.5% (2.1-2.9), respectively, of all medical cases assessed in the hospital were associated with these infections. The respective rates of hospital assessments for RSV, influenza, and human metapneumovirus (HMPV) were 1042 (95% CI: 967-1021), 394 (348-443), and 223 (189-262) per 100,000 children, and for admissions were 517 (465-574), 144 (117-175), and 126 (101-156) per 100,000. Few children with influenza had a prior risk factor. Children with influenza were admitted a median of 4 days after onset of illness and none was coded at discharge as influenza. We conclude that antivirals have little role in the hospital management of children with influenza. Our data provide health economists with information to evaluate the place of universal immunisation of young children against influenza. Hospitalisation rates decreased markedly with referral age, so vaccine would need to be given in early infancy for maximum benefit.
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Affiliation(s)
- Karl G Nicholson
- Infectious Diseases Unit, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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19
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Esposito S, Gasparini R, Bosis S, Marchisio P, Tagliabue C, Tosi S, Bianchi C, Crovari P, Principi N. Clinical and socio-economic impact of influenza and respiratory syncytial virus infection on healthy children and their households. Clin Microbiol Infect 2005; 11:933-6. [PMID: 16216113 DOI: 10.1111/j.1469-0691.2005.01270.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This prospective study compared the clinical and socio-economic impact of laboratory-confirmed influenza and respiratory syncytial virus (RSV) infection on healthy children and their families. Among 1,520 otherwise healthy children aged< 15 years attending the Emergency Department for acute conditions other than trauma, influenza viruses and RSV were found in 234 (15.4%) and 116 (7.6%; p<0.0001) patients, respectively. The fact that influenza has a similar global clinical impact on the community to that of RSV infection, but represents a greater socio-economic burden, may contribute to broadening the acceptance of influenza vaccination.
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Affiliation(s)
- S Esposito
- Institute of Pediatrics, Fondazione IRCCS 'Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena', University of Milan, Milan, Italy
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20
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Sugaya N, Takeuchi Y. Mass Vaccination of Schoolchildren against Influenza and Its Impact on the Influenza-Associated Mortality Rate among Children in Japan. Clin Infect Dis 2005; 41:939-47. [PMID: 16142657 DOI: 10.1086/432938] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2005] [Accepted: 06/01/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Influenza control based on mass vaccination of schoolchildren was implemented in Japan in the 1960s and was associated with a decrease in the overall mortality rate. The program was discontinued in 1994. The discontinuation was followed by a seasonal increase in the mortality rate. Lately, young children and elderly persons have been receiving influenza vaccines. The purpose of this study was to investigate changes in influenza-related mortality among young children before and after discontinuation of mass vaccination of schoolchildren. METHODS We calculated the monthly all-cause mortality rates during 1972-2003 and the pneumonia and influenza (P&I) mortality rates during 1972-1999 for young children (age, 1-4 years). We estimated the excess mortality rates attributable to influenza by computing the baseline annual mortality rate as a centered, 3-year moving average of the number of deaths reported during the 2 preceding and the following Decembers. RESULTS Prominent winter peaks in monthly all-cause mortality rates among young children occurred in the 1990s. They coincided with the winter peaks in monthly P&I mortality rates among young children and were very similar to the winter peaks observed among elderly persons. The number of excess deaths of young children was estimated to be 783 in the 11 winter seasons from 1990 to 2000, whereas no winter peaks in the number of deaths were seen after 2000. CONCLUSIONS It is likely that discontinuation of mass vaccination of schoolchildren was responsible for the increase in influenza-associated deaths among young children in the 1990s. The recent increase in influenza vaccinations among young children, together with the routine therapeutic use of neuraminidase inhibitors, has led to a decrease in the influenza-associated mortality rate.
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Affiliation(s)
- Norio Sugaya
- Department of Pediatrics, Keiyu Hospital, Yokohama, Kanagawa, Japan.
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Piedra PA, Gaglani MJ, Riggs M, Herschler G, Fewlass C, Watts M, Kozinetz C, Hessel C, Glezen WP. Live attenuated influenza vaccine, trivalent, is safe in healthy children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a community-based, nonrandomized, open-label trial. Pediatrics 2005; 116:e397-407. [PMID: 16140685 PMCID: PMC1361119 DOI: 10.1542/peds.2004-2258] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Influenza-associated deaths in healthy children that were reported during the 2003-2004 influenza season heightened the public awareness of the seriousness of influenza in children. In 1996-1998, a pivotal phase III trial was conducted in children who were 15 to 71 months of age. Live attenuated influenza vaccine, trivalent (LAIV-T), was shown to be safe and efficacious. In a subsequent randomized, double-blind, placebo-controlled LAIV-T trial in children who were 1 to 17 years of age, a statistically significant increase in asthma encounters was observed for children who were younger than 59 months. LAIV-T was not licensed to children who were younger than 5 years because of the concern for asthma. We report on the largest safety study to date of the recently licensed LAIV-T in children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a 4-year (1998-2002) community-based trial that was conducted at Scott & White Memorial Hospital and Clinic (Temple, TX). METHODS An open-label, nonrandomized, community-based trial of LAIV-T was conducted before its licensure. Medical records of all children were surveyed for serious adverse events (SAEs) 6 weeks after vaccination. Health care utilization was evaluated by determining the relative risk (RR) of medically attended acute respiratory illness (MAARI) and asthma rates at 0 to 14 and 15 to 42 days after vaccination compared with the rates before vaccination. Medical charts of all visits coded as asthma were reviewed for appropriate classification of events: acute asthma or other. We evaluated the risk for MAARI (health care utilization for acute respiratory illness) 0 to 14 and 15 to 42 days after LAIV-T by a method similar to the postlicensure safety analysis conducted on measles, mumps, and rubella and on diphtheria, tetanus, and whole-cell pertussis vaccines. RESULTS All children regardless of age were administered a single intranasal dose of LAIV-T in each vaccine year. In the 4 years of the study, we administered 18780 doses of LAIV-T to 11096 children. A total of 4529, 7036, and 7215 doses of LAIV-T were administered to children who were 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age, respectively. In vaccination years 1, 2, 3, and 4, we identified 10, 15, 11, and 6 SAEs, respectively. None of the SAEs was attributed to LAIV-T. In vaccination years 1, 2, 3, and 4, we identified 3, 2, 1, and 0 pregnancies, respectively, among adolescents. All delivered healthy infants. The RR for MAARI from 0 to 14 and 15 to 42 days after LAIV-T was assessed in vaccinees during the 4 vaccine years. Compared with the prevaccination period, there was no significant increase in risk in health care utilization attributed to MAARI from 0 to 14 and 15 to 42 days after vaccination in children who were 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in the 4 vaccine years. In children who were 18 months to 4 years of age, there was no significant increase in the risk in health care utilization for MAARI, MAARI subcategories (otitis media/sinusitis, upper respiratory tract illness, and lower respiratory tract illness), and asthma during the 0 to 14 days after vaccination compared with the prevaccination period. No significant increase in the risk in health care utilization for MAARI, MAARI subcategories, and asthma was detected when the risk period was extended to 15 to 42 days after vaccination, except for asthma events in vaccine year 1. A RR of 2.85 (95% confidence interval [CI]: 1.01-8.03) for asthma events was detected in children who were 18 months to 4 years of age but was not significantly increased for the other 3 vaccine years (vaccine year 2, RR: 1.42 [95% CI: 0.59-3.42]; vaccine year 3, RR: 0.47 [95% CI: 0.12-1.83]; vaccine year 4, RR: 0.20 [95% CI: 0.03-1.54]). No significant increase in the risk in health care utilization for MAARI or asthma was observed in children who were 18 months to 18 years of age and received 1, 2, 3, or 4 annual sequential doses of LAIV-T. Children who were 18 months to 4 years of age and received 1, 2, 3, or 4 annual doses of LAIV-T did not experience a significant increase in the RR for MAARI 0 to 14 days after vaccination; this was also true for children who were 5 to 9 and 10 to 18 years of age. CONCLUSIONS We observed no increased risk for asthma events 0 to 14 days after vaccination in children who were 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age, In vaccine year 1, children who were 18 months to 4 years of age did have a significantly higher RR (2.85; 95% CI: 1.01-8.03) for asthma events 15 to 42 days after vaccination. In vaccine year 2, the formulation of LAIV-T was identical to the vaccine formulation used in vaccine year 1; however, in children who were 18 months to 4 years of age, no statistically significant increased risk was detected for asthma events 15 to 42 days after vaccination. Similarly, in vaccine years 3 and 4, children who were 18 months to 4 years of age did not have a statistically significant increased risk for asthma events 15 to 42 days after vaccination. Also, LAIV-T did not increase the risk for asthma in children who received 1, 2, 3, or 4 annual doses of LAIV-T. Although the possibility for a true increased risk for asthma was observed in 1 of 4 years in children who were 18 months to 4 years at 15 to 42 days after vaccination, it is more likely that the association is a chance effect because of the 190 comparisons made without adjustment for multiple comparisons. We conclude that LAIV-T is safe in children who are 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age. The hypothesis that LAIV-T is associated with an increase in asthma events in children who are younger than 5 years is not supported by our data. Reassessment of the lower age limit for use of LAIV-T in children is indicated.
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Key Words
- asthma exacerbation
- children and adolescents
- health service utilization
- influenza vaccine
- outcome assessment
- rsv, respiratory syncytial virus
- laiv-t, live attenuated influenza vaccine, trivalent
- maari, medically attended acute respiratory illness
- fda, food and drug administration
- sae, serious adverse event
- swhp, scott & white health plan
- rr, relative risk
- icd-9, international classification of diseases, ninth revision
- ci, confidence interval
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Affiliation(s)
- Pedro A Piedra
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas 77030, USA.
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Arostegi Kareaga N, Montes M, Pérez-Yarza EG, Sardón O, Vicente D, Cilla G. Características clínicas de los niños hospitalizados por infección por virus Influenza. An Pediatr (Barc) 2005; 62:5-12. [PMID: 15642235 DOI: 10.1157/13070174] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The clinical manifestations of influenza virus are fairly nonspecific and are similar to those of other viral infections, respiratory processes due to other causes and even septic disease in neonates. Few studies have been performed of the clinical characteristics of influenza virus infection in hospitalized children. OBJECTIVE To evaluate the clinical characteristics of children hospitalized for influenza virus infection in four consecutive epidemic waves (2000-2004). MATERIAL AND METHODS We retrospectively reviewed the medical records of children hospitalized for influenza A and B virus infection confirmed by cell culture and polymerase chain reaction. Age, sex, symptoms on admission, complementary investigations, diagnosis and outcome were evaluated. RESULTS Eighty-four children were hospitalized, of which 74 had influenza virus type AH3, five had influenza virus type AH1 and five had influenza B virus. A total of 42.8 % were aged less than 6 months. The main symptoms were fever (75 patients), cough (56 patients) and ENT involvement (53 patients). The most frequent causes of admission were febrile syndrome (75 patients), bronchiolitis (19 patients), pneumonia (13 patients) and bronchitis (8 patients). In 21 patients viral or bacterial coinfection was found, the most frequent of which was respiratory syncytial virus (10 patients). Few differences were found among age groups except for pneumonia and prolonged fever (more frequent in children older than 6 months) and lymphocytosis (in children younger than 6 months). The greatest number of complementary investigations in younger children was performed for acute febrile syndrome in neonates aged less than 6 months. Risk factors for hospitalization were found in only three children, all of whom were older than 6 months. Outcome was favorable in all children. CONCLUSIONS Influenza virus infection in hospitalized children is most frequent in previously healthy neonates with fever and nonspecific signs and symptoms that are similar to those of other infectious processes. Specific microbiological diagnostic techniques are required for an early diagnosis. Healthy infants aged less than 24 months are most at risk for hospitalization for influenza virus infection.
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Infección por el virus influenza en la infancia. ¿Deberían ampliarse las indicaciones de la vacuna antigripal? Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75510-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Navarro-Marí JM, Palacios Del Valle E, Pérez-Ruiz M, De La Rosa M. The impact of influenza viruses on hospitalizations in infants younger than two years old during epidemics of respiratory syncytial virus infection. Clin Microbiol Infect 2003; 9:959-63. [PMID: 14616686 DOI: 10.1046/j.1469-0691.2003.00672.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In order to evaluate the association of influenza viruses with hospitalizations for acute respiratory infection in infants younger than two years old during epidemics of respiratory syncytial virus infection, we studied 512 nasal washes from this population. The samples were obtained from 1997 to 2000. A total of 337 viruses were isolated: 264 respiratory syncytial viruses, 62 influenza viruses, eight parainfluenza viruses, two adenovirus and one rhinovirus. Hospitalizations for acute respiratory infection were owing to influenza and respiratory syncytial viruses in 18.3% vs. 78.3% of all cases, and 32.5% vs. 65.8%, respectively, in the group of infants between 6 months and 2 years old.
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Affiliation(s)
- J M Navarro-Marí
- The Microbiology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain.
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Peltola V, Ziegler T, Ruuskanen O. Influenza A and B virus infections in children. Clin Infect Dis 2003; 36:299-305. [PMID: 12539071 DOI: 10.1086/345909] [Citation(s) in RCA: 194] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2002] [Accepted: 10/22/2002] [Indexed: 12/15/2022] Open
Abstract
To obtain data on the clinical manifestations of infection, the age distribution, and the underlying conditions of children with influenza severe enough to lead to hospital referral, we performed a retrospective study of children treated at Turku University Hospital (Turku, Finland) in 1980-1999. Influenza A or B antigen was detected in the nasopharyngeal aspirates of 683 of the 15,420 children studied. The median age of children with influenza A was 2.0 years (n=544), and that of children with influenza B was 4.2 years (n=139) (P<.001). One-fourth of the children had an underlying medical condition. High fever, cough, and rhinorrhea were the most frequently recorded symptoms. Acute otitis media developed in 24% of the children, and pneumonia developed in 9% of the children. The study shows that the majority of patient hospitalizations for pediatric influenza involve previously healthy infants and young children. Laboratory confirmation of influenza is particularly important for children because the clinical presentation of the infection is less characteristic than that seen in adults.
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Affiliation(s)
- Ville Peltola
- Department of Pediatrics, Turku University Hospital, Turku, Finland.
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Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics: the ups and downs of a seasonal virus. Pediatr Infect Dis J 2003; 22:S21-32. [PMID: 12671449 DOI: 10.1097/01.inf.0000053882.70365.c9] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Respiratory syncytial virus (RSV) is the most common pathogen causing lower respiratory tract infections in infants worldwide. Lower respiratory tract infections caused by RSV occur epidemically, and the appearance of epidemics seems to vary with latitude, altitude and climate. This study uses a review of the literature on RSV seasonality to investigate whether a global pattern in RSV epidemics can be found. A comparison of morbidity and mortality caused by RSV in developed vs. developing countries is also presented. The seasons in which RSV epidemics occur typically depend on geographic location and altitude. During these seasons the epidemics tend to appear in clusters. Although the appearance pattern of these epidemics varies from one continent to another, they usually begin in coastal areas. RSV is the cause of one-fifth of lower respiratory infections worldwide. Generally RSV mortality is low, with a median value of zero. However, RSV mortality in developing countries is significantly higher than RSV mortality in developed countries.
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Affiliation(s)
- Lone Graff Stensballe
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Copenhagen, Denmark
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Poehling KA, Griffin MR, Dittus RS, Tang YW, Holland K, Li H, Edwards KM. Bedside diagnosis of influenzavirus infections in hospitalized children. Pediatrics 2002; 110:83-8. [PMID: 12093950 DOI: 10.1542/peds.110.1.83] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE For preventing nosocomial influenza infections and to facilitate prompt antiviral therapy, an accessible, rapid diagnostic method for influenzavirus is needed. We evaluated the performance of a lateral-flow immunoassay (QuickVue Influenza Test) completed at the bedside of hospitalized children during the influenza season. METHODS All children who were evaluated at a large teaching hospital during the 1999 to 2000 influenza season were eligible if they were 1) younger than 19 years and hospitalized with respiratory symptoms or 2) younger than 3 years and hospitalized with fever. Each study child had 2 nasal swabs obtained--1 for influenzavirus culture and polymerase chain reaction (PCR) and the other for the QuickVue Influenza Test. The performance of the rapid diagnostic test was compared with the results of culture or PCR for influenza A or B. RESULTS Of 303 eligible children, 233 (77%) were enrolled. In this population, 19 children had culture- and/or PCR-confirmed influenza A infection, prevalence of 8%. The QuickVue Influenza Test had a sensitivity of 74%, specificity of 98%, positive predictive value of 74%, and negative predictive value of 98%. CONCLUSIONS Among children hospitalized with fever/respiratory symptoms during the influenza season, negative bedside QuickVue Influenza Tests indicated very low likelihood of influenza infection, whereas positive tests greatly increased the probability of influenza-associated illness.
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Affiliation(s)
- Katherine A Poehling
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Abstract
The highest infection rates with influenza virus occur in young children because of their lack of prior immunity and prior exposure to the virus. Most children with influenza virus infection are healthy otherwise. Previously healthy children who have influenza in their first year of life have a substantial risk for developing serious disease. An underlying chronic medical condition further increases this risk. Infants, young children, and children with underlying conditions have the highest rates of outpatient medical visits and hospitalizations for acute respiratory disease during influenza epidemics. Secondary bacterial infections, antibiotic use, and other complications of influenza are consequences of influenza virus infection in children of all ages. Annual immunization with influenza vaccine is recommended for any child older than 6 months of age in whom prevention of disease is desirable, and particularly in those with underlying medical conditions. The consequences of infection in infants younger than 6 months of age can be modified by maternal immunization currently recommended for women in the second or third trimester of pregnancy during the influenza season. Family members, including siblings, and all other close contacts should receive influenza vaccine to reduce the possibility of transmission to children at risk. Immunization of all children has a positive impact on the occurrence of influenza infection and its complications, both in those at greater risk and in the entire population.
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Affiliation(s)
- Flor M Munoz
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Rm 221-D, MC-BCM-280, Houston, TX 77030, USA.
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Piedra PA. Safety of the trivalent, cold-adapted influenza vaccine (CAIV-T) in children. SEMINARS IN PEDIATRIC INFECTIOUS DISEASES 2002; 13:90-6. [PMID: 12122958 DOI: 10.1053/spid.2002.122995] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The trivalent, cold-adapted influenza vaccine (CAIV-T, FluMist, Aviron, Mountain View, CA) is a live attenuated influenza virus vaccine that is administered by nasal spray. CAIV-T is efficacious in preventing influenza virus infection. The vaccine was submitted to the Food and Drug Administration for licensure in healthy children and adults. Universal immunization is being considered in children, and an effective vaccine with minimal adverse reactions is thus required. The published studies on the safety of CAIV-T in children reviewed in this article were clinical trials sponsored by the National Institutes of Health (NIH) conducted in children from 1975 to 1991, clinical trials from 1991 to 1993 sponsored by a cooperative agreement between NIH and Wyeth-Ayerst Research, and clinical trials from 1995 to the present sponsored by a cooperative agreement between NIH and Aviron. Safety assessments included the occurrence of: 1) specific influenza-like symptoms, unexpected symptoms, and use of medications within the first 10 days after vaccination; 2) acute illness and use of medication within 11 to 42 days postvaccination; 3) serious adverse events and rare events within 42 days after vaccination; 4) healthcare utilization within 14 days after vaccination; and 5) acute respiratory symptoms with annual sequential vaccine doses. CAIV-T was safe and well-tolerated. Transient, mild respiratory symptoms were observed in a minority (10%-15%) of children and primarily with the first CAIV-T dose. Vomiting and abdominal pain occurred in fewer than 2 percent of CAIV-T recipients. The gastrointestinal symptoms were mild and of short duration. An excess of illness or use of medication was not observed after the 10th day of vaccination. Sequential annual doses of CAIV-T were well-tolerated and not associated with increased reactogenicity. CAIV-T did not cause an increase in healthcare utilization. Thus CAIV-T is safe in healthy children and should complement the use of inactivated influenza vaccine, trivalent (IIV-T) in children with underlying chronic conditions.
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Affiliation(s)
- Pedro A Piedra
- Department of Molecular Virology and Microbiology, Rm 248E, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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Reichert T, Sugaya N, Fedson D, Glezen W, Simonsen L, Tashiro M. Measuring the effect of influenza vaccination programs—the Japanese schoolchildren experience revisited. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0531-5131(01)00407-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pyhälä R, Haanpää M, Kleemola M, Tervahauta R, Visakorpi R, Kinnunen L. Acceptable protective efficacy of influenza vaccination in young military conscripts under circumstances of incomplete antigenic and genetic match. Vaccine 2001; 19:3253-60. [PMID: 11312022 DOI: 10.1016/s0264-410x(01)00010-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Commercial inactivated parenteral influenza vaccines reduced febrile (> or = 38 degrees C) respiratory illness by 53% (95% CL: 41-63%) during a 3 week outbreak in 1998 when A/Sydney/5/97(H3N2)-like influenza viruses were shown to be the predominant etiological agents and an older antigenic variant, A/Nanchang/933/95, served as the vaccine virus. The calculatory efficacy for preventing virologically diagnosed influenza infections was 57% (95% CL: 40-68%). The study population consisted of 1374 young male military conscripts. Vaccination coverage on a voluntary basis was 67%. Vaccination was ineffective in preventing febrile illness during a second epidemic wave lasting 2 weeks when mainly adenoviruses were shown to have been circulating in the garrison. Out of the 36 nasopharyngeal aspirates positive for influenza A by antigen detection, 18 A/Sydney/5/97-like strains (10 from non-vaccinated and eight from vaccinated subjects) and two A/Nanchang/933/95-like strains (both from non-vaccinated subjects) were isolated in MDCK cell cultures. Intraepidemic variation was detected among the A/Sydney/5/97-like field strains in their HA1 sequences and reactivity in HI tests, but no evidence was obtained that this variation would have been of significance to the virus in breaking through the vaccination-induced immunity.
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Affiliation(s)
- R Pyhälä
- National Public Health Institute, Helsinki, Finland.
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Reichert TA, Sugaya N, Fedson DS, Glezen WP, Simonsen L, Tashiro M. The Japanese experience with vaccinating schoolchildren against influenza. N Engl J Med 2001; 344:889-96. [PMID: 11259722 DOI: 10.1056/nejm200103223441204] [Citation(s) in RCA: 578] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Influenza epidemics lead to increased mortality, principally among elderly persons and others at high risk, and in most developed countries, influenza-control efforts focus on the vaccination of this group. Japan, however, once based its policy for the control of influenza on the vaccination of schoolchildren. From 1962 to 1987, most Japanese schoolchildren were vaccinated against influenza. For more than a decade, vaccination was mandatory, but the laws were relaxed in 1987 and repealed in 1994; subsequently, vaccination rates dropped to low levels. When most schoolchildren were vaccinated, it is possible that herd immunity against influenza was achieved in Japan. If this was the case, both the incidence of influenza and mortality attributed to influenza should have been reduced among older persons. METHODS We analyzed the monthly rates of death from all causes and death attributed to pneumonia and influenza, as well as census data and statistics on the rates of vaccination for both Japan and the United States from 1949 through 1998. For each winter, we estimated the number of deaths per month in excess of a base-line level, defined as the average death rate in November. RESULTS The excess mortality from pneumonia and influenza and that from all causes were highly correlated in each country. In the United States, these rates were nearly constant over time. With the initiation of the vaccination program for schoolchildren in Japan, excess mortality rates dropped from values three to four times those in the United States to values similar to those in the United States. The vaccination of Japanese children prevented about 37,000 to 49,000 deaths per year, or about 1 death for every 420 children vaccinated. As the vaccination of schoolchildren was discontinued, the excess mortality rates in Japan increased. CONCLUSIONS The effect of influenza on mortality is much greater in Japan than in the United States and can be measured about equally well in terms of deaths from all causes and deaths attributed to pneumonia or influenza. Vaccinating schoolchildren against influenza provides protection and reduces mortality from influenza among older persons.
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Affiliation(s)
- T A Reichert
- Becton Dickinson and Entropy Limited, Upper Saddle River, NJ, USA.
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Abstract
Because influenza significantly affects the health of children, this review describes the current and future options for preventing, diagnosing, and treating influenza infections. Currently, the inactivated influenza vaccine is recommended for prevention of influenza; however, the live, attenuated, intranasal influenza vaccine is a potential future option. For diagnosis, viral culture is the gold standard, although four rapid diagnostic tests are available for more immediate results. The impetus for rapid results is the availability of effective antiviral agents indicated for early influenza infection. The four currently approved antiviral agents are amantadine, rimantadine, zanamivir [Relenza, Glaxo Wellcome, Inc., Research Triangle Park, NC] and oseltamivir [Tamiflu, Roche Pharmaceuticals, Nutley, NJ]. The indications, benefits, side effects and ages for which each drug is approved are reviewed.
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Affiliation(s)
- K A Poehling
- Department of Pediatrics, Vanderbilt Medical Center, Nashville, Tennessee 37232, USA.
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Affiliation(s)
- M Valette
- Centre national de référence Grippe France-Sud, laboratoire de virologie, CHU Lyon, France
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