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Shaukat H, Wang S, Kim D, Koutroulis I, Berkowitz D, Breslin K. Practice patterns and perceptions of influenza testing amongst pediatric urgent care providers. Diagn Microbiol Infect Dis 2023; 105:115818. [PMID: 36241541 DOI: 10.1016/j.diagmicrobio.2022.115818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Despite a sensitivity of 50% to 70% the rapid influenza diagnostic test (RIDT) continues to play an important role in clinical decision-making due to its quick turn-around time, high specificity, relative simplicity of use, and low cost. METHODS A quantitative study using a web-based survey was distributed to 110 members of the Society of Pediatric Urgent Care aimed to assess RIDT use for diagnosis and management of influenza in outpatient pediatric patients. RESULTS Responses from 61 providers were received. Forty-two percent (95% CI 29.5-54.5%) of respondents report higher confidence in their diagnosis of influenza with the aid of a positive RIDT. 28% of respondents (95% CI 16.6-39.4%) report a higher likelihood of prescribing antiviral medications to low-risk patients if an RIDT is positive than without laboratory confirmation. CONCLUSION Most pediatric urgent care respondents reported higher confidence in their diagnosis and higher likelihood of prescribing antivirals with a positive RIDT rather than by clinical symptoms alone.
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Affiliation(s)
- Haroon Shaukat
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Sophia Wang
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA
| | - Dana Kim
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA
| | - Ioannis Koutroulis
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Deena Berkowitz
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kristen Breslin
- Division of Emergency Medicine, Children's National Health System, Wshington, DC, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Ratre YK, Vishvakarma NK, Bhaskar LVKS, Verma HK. Dynamic Propagation and Impact of Pandemic Influenza A (2009 H1N1) in Children: A Detailed Review. Curr Microbiol 2020; 77:3809-3820. [PMID: 32959089 PMCID: PMC7505219 DOI: 10.1007/s00284-020-02213-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/13/2020] [Indexed: 12/18/2022]
Abstract
Influenza is a highly contagious respiratory infection caused by the circulating Swine flu virus. According to the World Health Organization (WHO), the unique blending strain of influenza A H1N1 2009 (Swine Flu) is a pandemic affecting several geographical regions, including India. Previous literature indicates that children are "drivers" of influenza pandemics. At present, satisfactory data were not available to accurately estimate the role of children in the spread of influenza (in particular 2009 pandemic influenza). However, the role of children in the spread of pandemics influenza is unclear. Several studies in children have indicated that the immunization program decreased the occurrence of influenza, emphasizing the significance of communities impacted by global immunization programs. This article provides a brief overview on how children are a key contributor to pandemic Influenza A (2009 H1N1) and we would like to draw your attention to the need for a new vaccine for children to improve disease prevention and a positive impact on the community.
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Affiliation(s)
| | | | - L V K S Bhaskar
- Department of Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur, India
| | - Henu Kumar Verma
- Institute of Experimental Endocrinology and Oncology CNR, Naples, Italy.
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Tagarro A, Cruz-Cañete M, Otheo E, Launes C, Couceiro JA, Pérez C, Alfayate S, Calvo C, de Liria CRG. Oseltamivir for the treatment of influenza in children and adolescents. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Comerlato Scotta M, Greff Machado D, Goecks Oliveira S, de Moura A, Rhoden Estorgato G, de Souza APD, Nery Porto B, de Araújo PD, Sarria EE, Pitrez PM, Jones MH, Araújo Pinto L, Tetelbom Stein R, Polack FP, Mattiello R. Evaluation of nasal levels of interferon and clinical severity of influenza in children. J Clin Virol 2019; 114:37-42. [PMID: 30913521 DOI: 10.1016/j.jcv.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/04/2019] [Accepted: 02/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Experimental data show that type I interferon has a key role in innate immune response against influenza infection. OBJECTIVE We compared nasal levels of interferon-α2 and β among inpatients and outpatients with influenza. STUDY DESIGN Children younger than 5 years of age with influenza-like illness seeking care at the emergency department within the first 72 h of disease onset were prospectively included. Clinical and demographic data and secretions through nasal wash were obtained. Influenza infection was assessed through reverse-transcription polymerase chain reaction and nasal levels of interferon-α2 and β were measured by enzyme-linked immunosorbent assay. All patients followed until the end of the disease. RESULTS One hundred patients were included, of which 24 had confirmed influenza infection, and 5 of them were hospitalized. Subtypes A (H3N2) and B were confirmed in 10 and 14 patients, respectively. Seventy-six patients without influenza, including 48% of outpatients, were recruited as controls. All hospitalized patients were significantly younger regardless of influenza status (age <6 months in 59% vs. 23.2%, p < 0.001). All other data were similar among the groups. Comparing median levels of interferon-α2 among children with influenza, levels were significantly higher in outpatients than in hospitalized patients and were 263.2 pg/mL (25-75 interquartile range: 58.3-634) and detectable in only one patient (90 pg/mL), respectively. The levels of interferon-α2 in controls and those of interferon-β in all groups were not detected. CONCLUSIONS Higher levels of interferon-α2 in patients with less severe influenza reinforce experimental evidence about the protective role of interferon-α2 against influenza infection.
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Affiliation(s)
| | - Denise Greff Machado
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Centro Universitário Ritter dos Reis, Porto Alegre, Brazil
| | - Suelen Goecks Oliveira
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angela de Moura
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Barbara Nery Porto
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Edgar Enrique Sarria
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Universidade de Santa Cruz do Sul (UNISC), School of Medicine, Department of Biology and Pharmacy, Brazil
| | - Paulo Marcio Pitrez
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Marcus Herbert Jones
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Araújo Pinto
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Renato Tetelbom Stein
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rita Mattiello
- Centro Infant, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
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[Oseltamivir for the treatment of influenza in children and adolescents]. An Pediatr (Barc) 2019; 90:317.e1-317.e8. [PMID: 30797703 DOI: 10.1016/j.anpedi.2019.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Influenza is a generally a benign disease, but occasionally it can cause serious complications. There is controversy about the benefits of antiviral treatment. OBJECTIVES To provide some recommendations on the treatment with oseltamivir in paediatric patients with influenza, based on the best data available and valid in our environment. METHODS The Respiratory Infections Group of the Spanish Society of Paediatric Infectious Diseases carried out a review of the literature. The findings were analysed using the GRADE methodology, and recommendations were made. RESULTS The systematic use of diagnostic tests for influenza in the outpatient setting, or in the emergency room, in immunocompetent patients with a compatible clinical picture is not recommended. If the aim is to prevent serious events, the use of antivirals is not recommended for the vast majority of healthy and asthmatic patients with influenza or suspected seasonal flu. The systematic use of oseltamivir in patients admitted to hospital with influenza is not recommended. Oseltamivir treatment is recommended in any patients with influenza and pneumonia or severe illness, and critically ill patients, especially during the first 48hours of illness. The treatment of patients with risk factors is recommended, considering their underlying disease. Influenza vaccination, together with basic isolation measures, continue to be the main tool in the prevention of influenza. CONCLUSION In some situations, there are sufficient data to issue clear recommendations. In other situations, the data are incomplete, and only allows weak recommendations.
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Li T, Qi N, Gao X, Yu H. Rescue of four pediatric patients with severe influenza A (H3N2) in Weifang, China. J Int Med Res 2018; 46:4800-4805. [PMID: 30213216 PMCID: PMC6259391 DOI: 10.1177/0300060518792795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/15/2018] [Indexed: 11/24/2022] Open
Abstract
In this report, we summarize our experience of rescuing four children with severe type A H3N2 influenza from January to February 2017 in Weifang People's Hospital, Shandong Province, China for reference in clinical treatment. Two boys and two girls, ranging in age from 3 months to 6 years, with fever, cough, and asthma, were admitted to the pediatric intensive care unit. All children had severe pulmonary infection with respiratory distress. Three children had myocardial damage, two had liver damage, and one had encephalitis. One child had a history of bronchial asthma and one had severe spinal muscular atrophy. After all four children were admitted to the pediatric intensive care unit, they were provided active and effective organ function support and ventilator-assisted respiration. They were treated with gamma globulin, methylprednisolone, and antibiotics. Three children were treated with anti-influenza drugs and recovered from influenza; one child died even before antiviral treatment intervention on the first day. Definite diagnosis of the cases was through clinical manifestations, supplemented by laboratory tests, such as influenza virus H3N2 rapid antigen detection and nucleic acid detection. Early antiviral therapy, high-dose glucocorticoids and immunoglobulins, and systemic comprehensive rescue might be important for rescuing children with severe influenza A (H3N2).
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Affiliation(s)
- Tianhua Li
- Department of Paediatrics, Weifang People’s Hospital, Weifang City, Shandong Province, China
| | - Ningning Qi
- Department of Paediatrics, Weifang People’s Hospital, Weifang City, Shandong Province, China
| | - Xiaona Gao
- Department of Paediatrics, Weifang People’s Hospital, Weifang City, Shandong Province, China
| | - Haili Yu
- Department of Paediatrics, Weifang People’s Hospital, Weifang City, Shandong Province, China
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Oda K, Nishimura H, Watanabe O, Kubo T, Shindo S. A case report on parainfluenza virus type 4a infection in a 1-year-old boy with biphasic fever. J Thorac Dis 2018; 10:S2305-S2308. [PMID: 30116609 DOI: 10.21037/jtd.2018.05.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 1-year-old boy was infected with parainfluenza virus type 4a (PIV4a) during an influenza epidemic in January 2016. His body temperature was 38.2 °C on day 1 of the illness followed by an intermittent phase of 36.5 °C on days 2 and 3, and it rose again on day 3 and peaked at 39.6 °C on day 4, of which the fever pattern was reminiscent of an influenza case with biphasic fever. However, results of rapid influenza virus (IFV) antigen tests performed at the first clinical visit and during the second fever phase on day 4 were both negative. The PIV4a was isolated from all the nasal aspirate specimens on days 1, 4, and 7. Other common respiratory viruses were negative in all the specimens in the viral isolation trials using the multiplex cell culture system and RT-PCR tests. The fever disappeared within 5 days after the onset without any antibiotic treatment, which strongly suggested the PIV4a as the causative agent of the patient's illness. On the basis of the incubation period required for the appearance of the cytopathic effect (CPE) in the infected cells, from specimen inoculation to the cells, the viral load in the nasal cavity was speculated to be greatest on day 4. His cough started on day 1 and persisted until day 9, and the viral isolation indicated that the shedding of the active virus continued with the coughing even after the termination of fever.
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Affiliation(s)
- Keiko Oda
- Department of Health Management, College of Healthcare Management, Miyama, Japan.,Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan
| | - Hidekazu Nishimura
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan
| | - Ohshi Watanabe
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan
| | - Toru Kubo
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai, Japan.,Nagasaki Genbaku Isahaya Hospital, Isahaya, Nagasaki, Japan.,Department of Virology, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Nagasaki, Japan
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Uyeki TM. Oseltamivir Treatment of Influenza in Children. Clin Infect Dis 2018; 66:1501-1503. [PMID: 29315362 PMCID: PMC6669028 DOI: 10.1093/cid/cix1150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sykes A, Gerhardt E, Tang L, Adderson EE. The Effectiveness of Trivalent Inactivated Influenza Vaccine in Children with Acute Leukemia. J Pediatr 2017; 191:218-224.e1. [PMID: 29173310 PMCID: PMC5726795 DOI: 10.1016/j.jpeds.2017.08.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/17/2017] [Accepted: 08/25/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to determine the effectiveness of trivalent inactivated influenza vaccine (TIV) for the prevention of laboratory-confirmed influenza and influenza-like illnesses (ILI) among children and adolescents receiving therapy for acute leukemia. STUDY DESIGN A retrospective review of the demographic and clinical characteristics of 498 patients at a pediatric cancer center who received therapy for acute leukemia during 3 successive influenza seasons (2010-2011 through 2012-2013). RESULTS In 498 patient seasons with a known immunization history (median age, 6 years; range, 1-21), 354 patients (71.1%) were immunized with TIV and 98 (19.7%) received a booster dose of vaccine. Vaccinated and unvaccinated patients had generally similar demographic characteristics. There were no differences in the overall rates of influenza or ILI between vaccinated and unvaccinated patients overall, or in any individual season. There was no difference in the rates of influenza or ILI between patients who received 1 dose of vaccine and those who received 2 doses. Time to first influenza infection and time to first ILI in vaccinated and unvaccinated patients were not different. CONCLUSION TIV did not protect children and adolescents with acute leukemia against laboratory-confirmed influenza or ILI. Future prospective studies should assess TIV effectiveness in high-risk subpopulations and alternative strategies to prevent influenza should be considered in this population.
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Affiliation(s)
- April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Elsie Gerhardt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Li Tang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Elisabeth E Adderson
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Carmel, IN; Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN.
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Huang L, Zhang L, Liu Y, Luo R, Zeng L, Telegina I, Vlassov VV. Arbidol for preventing and treating influenza in adults and children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd011489.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Liang Huang
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
- Ministry of Education; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University; Chengdu Sichuan China 610041
- West China Second University Hospital, Sichuan University; Evidence-Based Pharmacy Center; Chengdu China
| | - Lingli Zhang
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
| | - Yantao Liu
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
- Ministry of Education; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University; Chengdu Sichuan China 610041
- West China Second University Hospital, Sichuan University; Evidence-Based Pharmacy Center; Chengdu China
| | - Rong Luo
- West China Second University Hospital, Sichuan University; Department of Pediatrics; Chengdu Sichuan China
| | - Linan Zeng
- West China Second University Hospital, Sichuan University; Department of Pharmacy; Chengdu Sichuan China 610041
- Ministry of Education; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University; Chengdu Sichuan China 610041
- West China Second University Hospital, Sichuan University; Evidence-Based Pharmacy Center; Chengdu China
| | - Irina Telegina
- Stavropol State Medical Academy; Department of Obstetrics and Gynaecology, Faculty of Post-Graduate Education; Marshala Zhukova street 42, flat 40 Stavropol Russian Federation 355035
| | - Vasiliy V Vlassov
- State Research University Higher School of Economics; Health Policy Institute; PO Box 13 Moscow Russian Federation 109451
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Fairchok MP, Chen WJ, Arnold JC, Schofield C, Danaher PJ, McDonough EA, Ottolini M, Mor D, Ridore M, Burgess TH, Millar EV. Neuraminidase inhibitor therapy in a military population. J Clin Virol 2015; 67:17-22. [PMID: 25959151 DOI: 10.1016/j.jcv.2015.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/17/2015] [Accepted: 03/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although neuraminidase inhibitors (NI) are the mainstay of treatment for influenza infection, prescribing practice for these agents is not well described. Additionally, benefit is contested. OBJECTIVES We examined provider prescriptions of NI during the 2009 pandemic and post-pandemic periods. We also evaluated the effectiveness of NI in reducing severity of influenza infection. STUDY DESIGN Data on NI prescription and severity of influenza infection were compiled in healthy pediatric and adult beneficiaries enrolled in a prospective study of influenza like illness conducted at five military medical centers over five years. Subjects underwent nasal swabs to determine viral etiology of their infection. Demographic, medication and severity data were collected. Subjects with positive influenza were included. RESULTS Two hundred sixty three subjects were influenza positive [38% [H1N1] pdm09, 38.4% H3N2, and 20.5% B); 23.9% were treated with NI. NI were initiated within 48h in 63% of treated subjects. Although NI use increased over the five years of the study, early use declined. Most measures for severity of illness were not significantly reduced with NI; adults treated within 48h had only a modest reduction in duration and severity of some of their symptoms. CONCLUSIONS NI use in our population is increasing, but early use is not. NI use resulted in no reduction in complications of illness. Resolution of symptoms and reduction in severity of some symptoms were slightly better in adults who were treated early. These modest benefits do not support routine treatment with NI in otherwise healthy individuals with influenza.
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Affiliation(s)
- Mary P Fairchok
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States; Madigan Army Medical Center, Tacoma, WA, United States.
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States
| | | | | | | | | | - Martin Ottolini
- Office of Curriculum, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Deepika Mor
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States
| | - Michelande Ridore
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States
| | - Timothy H Burgess
- Office of Curriculum, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States
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Blanchon T, Geffrier F, Turbelin C, Daviaud I, Laouénan C, Duval X, Lambert B, Hanslik T, Mosnier A, Leport C. Use of neuraminidase inhibitors in primary health care during pandemic and seasonal influenza between 2009 and 2013. Antivir Ther 2015; 20:753-61. [PMID: 25687219 DOI: 10.3851/imp2945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND In a context of controversy about influenza antiviral treatments, this study assessed primary health-care physicians' prescription of neuraminidase inhibitors (NIs) in France during pandemic and seasonal influenza between 2009 and 2013. METHODS This observational study, using data recorded in three national databases, estimated the rate of NI prescription among influenza-like illness (ILI) patients seen in GP and paediatrician consultations, and determined factors associated with this prescription according to a multivariate analysis. NI delivery by pharmacists was also evaluated. RESULTS Rates of NI prescription were estimated to be 61.1% among ILI patients with a severe influenza risk factor seen in GP consultation during the A(H1N1)pdm2009 pandemic versus an average rate of 25.9% during the three following seasonal influenza epidemics. Factors associated with NI prescription were a chronic disease in patients under 65 years (OR 14.85; 95% CI 13.00, 16.97) and in those aged 65 and older (OR 7.54; 5.86, 9.70), an age ≥65 years in patients without chronic disease (OR 1.35; 1.04, 1.74), a pregnancy (OR 10.63; 7.67, 15.76), obesity (OR 4.67; 3.50, 6.22) and a consultation during the pandemic A(H1N1)pdm2009 (OR 3.19; 2.93, 3.48). The number of antiviral treatments delivered by pharmacists during the A(H1N1)pdm2009 pandemic was 835 per 100,000 inhabitants, and an average of 275 per 100,000 inhabitants during the three following seasonal influenza epidemics. CONCLUSIONS Although physicians seem to follow the recommended indications for NIs in primary health-care practice, this study confirms the low rate of NI prescription to ILI patients with a severe influenza risk factor, especially during seasonal epidemics.
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Affiliation(s)
- Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Paris, France.
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Huang L, Zhang L, Liu Y, Luo R, Zeng L, Telegina I, Vlassov VV. Arbidol for preventing and treating influenza in adults and children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mathie RT, Frye J, Fisher P. Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness. Cochrane Database Syst Rev 2015; 1:CD001957. [PMID: 25629583 PMCID: PMC6726585 DOI: 10.1002/14651858.cd001957.pub6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Influenza is a highly infectious viral disease that is particularly common in the winter months. Oscillococcinum® is a patented homeopathic medicine that is made from a 1% solution of wild duck heart and liver extract, which is then serially diluted 200 times with water and alcohol. OBJECTIVES To determine whether homeopathic Oscillococcinum® is more effective than placebo in the prevention and/or treatment of influenza and influenza-like illness in adults or children. SEARCH METHODS We searched CENTRAL (2014, Issue 8), MEDLINE (1966 to August week 4, 2014), MEDLINE In-Process & Other Non-Indexed Citations (4 September 2014), AMED (2006 to September 2014), Web of Science (1985 to September 2014), LILACS (1985 to September 2014) and EMBASE (1980 to September 2014). We contacted the manufacturers of Oscillococcinum® for information on further trials. SELECTION CRITERIA Randomised, placebo-controlled trials of Oscillococcinum® in the prevention and/or treatment of influenza and influenza-like illness in adults or children. DATA COLLECTION AND ANALYSIS Three review authors independently extracted data and assessed risk of bias in the eligible trials. MAIN RESULTS No new trials were included in this 2014 update. We included six studies: two prophylaxis trials (327 young to middle-aged adults in Russia) and four treatment trials (1196 teenagers and adults in France and Germany). The overall standard of trial reporting was poor and hence many important methodological aspects of the trials had unclear risk of bias. There was no statistically significant difference between the effects of Oscillococcinum® and placebo in the prevention of influenza-like illness: risk ratio (RR) 0.48, 95% confidence interval (CI) 0.17 to 1.34, P value = 0.16. Two treatment trials (judged as 'low quality') reported sufficient information to allow full data extraction: 48 hours after commencing treatment, there was an absolute risk reduction of 7.7% in the frequency of symptom relief with Oscillococcinum® compared with that of placebo (risk difference (RD) 0.077, 95% CI 0.03 to 0.12); the RR was 1.86 (95% CI 1.27 to 2.73; P value = 0.001). A significant but lesser effect was observed at three days (RR 1.27, 95% CI 1.03 to 1.56; P value = 0.03), and no significant difference between the groups was noted at four days (RR 1.11, 95% CI 0.98 to 1.27; P value = 0.10) or at five days (RR 1.06, 95% CI 0.96 to 1.16; P value = 0.25). One of the six studies reported one patient who suffered an adverse effect (headache) from taking Oscillococcinum®. AUTHORS' CONCLUSIONS There is insufficient good evidence to enable robust conclusions to be made about Oscillococcinum® in the prevention or treatment of influenza and influenza-like illness. Our findings do not rule out the possibility that Oscillococcinum® could have a clinically useful treatment effect but, given the low quality of the eligible studies, the evidence is not compelling. There was no evidence of clinically important harms due to Oscillococcinum®.
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Affiliation(s)
| | - Joyce Frye
- Homeopathic Pharmacopoeia Convention of the United StatesPharmacopoeia Revision CommitteeBaltimoreMarylandUSAMD 21201
| | - Peter Fisher
- Royal London Hospital for Integrated Medicine60 Great Ormond StreetLondonUKWC1N 3HR
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Okoli GN, Otete HE, Beck CR, Nguyen-Van-Tam JS. Use of neuraminidase inhibitors for rapid containment of influenza: a systematic review and meta-analysis of individual and household transmission studies. PLoS One 2014; 9:e113633. [PMID: 25490762 PMCID: PMC4260958 DOI: 10.1371/journal.pone.0113633] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/29/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of neuraminidase inhibitors for use in rapid containment of influenza. METHOD We conducted a systematic review and meta-analysis in accordance with the PRISMA statement. Healthcare databases and sources of grey literature were searched up to 2012 and records screened against protocol eligibility criteria. Data extraction and risk of bias assessments were performed using a piloted form. Results were synthesised narratively and we undertook meta-analyses to calculate pooled estimates of effect, statistical heterogeneity and assessed publication bias. FINDINGS Nine randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. Neuraminidase inhibitors provided 67 to 89% protection for individuals following prophylaxis. Meta-analysis of individual protection showed a significantly lower pooled odds of laboratory confirmed seasonal or influenza A(H1N1)pdm09 infection following oseltamivir usage compared to placebo or no therapy (n = 8 studies; odds ratio (OR) = 0.11; 95% confidence interval (CI) = 0.06 to 0.20; p<0.001; I2 = 58.7%). This result was comparable to the pooled odds ratio for individual protection with zanamivir (OR = 0.23; 95% CI 0.16 to 0.35). Similar point estimates were obtained with widely overlapping 95% CIs for household protection with oseltamivir or zanamivir. We found no studies of neuraminidase inhibitors to prevent population-wide community transmission of influenza. CONCLUSION Oseltamivir and zanamivir are effective for prophylaxis of individuals and households irrespective of treatment of the index case. There are no data which directly support an effect on wider community transmission. PROTOCOL REGISTRY PROSPERO registration number: CRD42013003880.
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Affiliation(s)
- George N. Okoli
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England, United Kingdom
| | - Harmony E. Otete
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England, United Kingdom
| | - Charles R. Beck
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England, United Kingdom
| | - Jonathan S. Nguyen-Van-Tam
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, England, United Kingdom
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Hata A, Akashi-Ueda R, Takamatsu K, Matsumura T. Safety and efficacy of peramivir for influenza treatment. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2017-38. [PMID: 25368514 PMCID: PMC4216046 DOI: 10.2147/dddt.s46654] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective This report presents a review of the efficacy and safety of peramivir, a neuraminidase inhibitor that was granted Emergency Use Authorization by the US Food and Drug Administration (FDA) from October 23, 2009 to June 23, 2010 during the 2009 H1N1 pandemic. Methods Literature was accessed via PubMed (January 2000–April 2014) using several search terms: peramivir; BCX-1812; RWJ 270201; H1N1, influenza; antivirals; and neuraminidase inhibitors. The peramivir manufacturers, Shionogi and Co Ltd and BioCryst Pharmaceuticals, were contacted to obtain unpublished data and information presented at recent scientific meetings. Information was obtained from the Centers for Disease Control and Prevention (CDC) and from US FDA websites. English-language and Japanese-language reports in the literature were reviewed and selected based on relevance, along with information from the CDC, US FDA, and the drug manufacturers. Results We obtained eleven clinical trial reports of intravenous peramivir, two of which described comparisons with oseltamivir. Seven of nine other recently reported published studies was a dose–response study. Clinical reports of critically ill patients and pediatric patients infected with pandemic H1N1 described that early treatment significantly decreased mortality. Peramivir administered at 300 mg once daily in adult patients with influenza significantly reduces the time to alleviation of symptoms or fever compared to placebo. It is likely to be as effective as other neuraminidase inhibitors. Conclusion Although peramivir shows efficacy for the treatment of seasonal and pH1N1 influenza, it has not received US FDA approval. Peramivir is used safely and efficiently in hospitalized adult and pediatric patients with suspected or laboratory-confirmed influenza. Peramivir might be a beneficial alternative antiviral treatment for many patients, including those unable to receive inhaled or oral neuraminidase inhibitors, or those requiring nonintravenous drug delivery.
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Affiliation(s)
- Atsuko Hata
- Department of Pediatrics, Division of Respiratory Medicine, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan ; Department of Infectious Diseases, Division of Respiratory Medicine, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Ryoko Akashi-Ueda
- Department of Pediatrics, Division of Respiratory Medicine, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Kazufumi Takamatsu
- Respiratory Disease Center, Division of Respiratory Medicine, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Takuro Matsumura
- Department of Infectious Diseases, Division of Respiratory Medicine, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan
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Haffizulla J, Hartman A, Hoppers M, Resnick H, Samudrala S, Ginocchio C, Bardin M, Rossignol JF. Effect of nitazoxanide in adults and adolescents with acute uncomplicated influenza: a double-blind, randomised, placebo-controlled, phase 2b/3 trial. THE LANCET. INFECTIOUS DISEASES 2014; 14:609-18. [PMID: 24852376 PMCID: PMC7164783 DOI: 10.1016/s1473-3099(14)70717-0] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Influenza is an important cause of morbidity and mortality worldwide. Treatment options are scarce, and new drugs with novel mechanisms of action are needed. We aimed to assess the efficacy and safety of nitazoxanide, a thiazolide anti-infective, for treatment of acute uncomplicated influenza. Methods We did a double-blind, randomised, placebo-controlled, phase 2b/3 trial in 74 primary care clinics in the USA between Dec 27, 2010, and April 30, 2011. We enrolled participants aged 12–65 years with fever, at least one respiratory symptom, and one constitutional symptom of influenza within 48 h of symptom onset. We randomly assigned participants to receive either nitazoxanide 600 mg, nitazoxanide 300 mg, or placebo twice daily for 5 days, (ratio 1:1:1) and followed them up for 28 days. Randomisation lists were computer generated and done in blocks of three. Sponsor, investigators, study monitors, patients, and laboratory personnel were all masked to treatment allocation in the study. The primary endpoint was the time from first dose to alleviation of symptoms. The primary analysis was by intention-to-treat for participants with influenza infection confirmed by RT-PCR or culture at baseline. This trial is registered with ClinicalTrials.gov, number NCT01227421. Findings Of 650 participants screened, 624 (96%) were enrolled. Of these, 212 were randomly assigned to receive placebo twice a day, 201 to receive nitazoxanide 300 mg twice a day, and 211 to receive nitazoxanide 600 mg a day. The median duration of symptoms for participants receiving placebo was 116·7 h (95% CI 108·1–122·1) compared with 95·5 h (84·0–108·0; p=0·0084) for those receiving 600 mg nitazoxanide and 109·1 h (96·1–129·5, p=0·52) for those receiving 300 mg nitazoxanide. Adverse events were similar between the three groups, the most common being headache reported by 24 (11%) of 212 patients enrolled in placebo group, 12 (6%) of 201 patients in the low-dose group, and 17 (8%) of 211 patients in the high-dose group, or diarrhoea, reported by seven (3%) patients in the placebo group, four (2%) patients enrolled in the low-dose group, and 17 (8%) patients in the high-dose group. Interpretation Treatment with nitazoxanide 600 mg twice daily for 5 days was associated with a reduction of the duration of symptoms in participants with acute uncomplicated influenza. Further studies are warranted to confirm these findings and to assess efficacy of the drug alone or in combination with existing drugs in seriously ill patients and those at risk of influenza complications. Funding Romark Laboratories LC.
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Rutter P, Mytton O, Ellis B, Donaldson L. Access to the NHS by telephone and Internet during an influenza pandemic: an observational study. BMJ Open 2014; 4:e004174. [PMID: 24491382 PMCID: PMC3918981 DOI: 10.1136/bmjopen-2013-004174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/23/2013] [Accepted: 01/10/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine use of a novel telephone and Internet service-the National Pandemic Flu Service (NPFS)-by the population of England during the 2009-2010 influenza pandemic. SETTING National telephone and Internet-based service. PARTICIPANTS Service available to population of England (n=51.8 million). PRIMARY AND SECONDARY OUTCOME MEASURES Primary: service use rate, by week. Numbers and age-specific and sex-specific rates of population who: accessed service; were authorised to collect antiviral medication; collected antiviral medication; were advised to seek further face-to-face assessment. Secondary: daily mean contacts by hour; proportion using service by telephone/Internet. RESULTS The NPFS was activated on 23 July 2009, operated for 204 days and assessed 2.7 million patients (5200 consultations/100 000 population). This was six times the number of people who consulted their general practitioner with influenza-like illness during the same period (823 consultations/100 000 population, rate ratio (RR)=6.30, 95% CI 6.28 to 6.32). Women used the service more than men (52.6 vs 43.4 assessments/1000 population, RR1 21, 95% CI 1.21 to 1.22). Among adults, use of the service declined with age (16-29 years: 74.4 vs 65 years+: 9.9 assessments/1000 population (RR 7.46 95% CI 7.41 to 7.52). Almost three-quarters of those assessed met the criteria to receive antiviral medication (1 807 866/2 488 510; 72.6%). Most of the people subsequently collected this medication, although more than one-third did not (n=646 709; 35.8%). Just over one-third of those assessed were advised to seek further face-to-face assessment with a practitioner (951 332/2 488 504; 38.2%). CONCLUSIONS This innovative healthcare service operated at large scale and achieved its aim of relieving considerable pressure from mainstream health services, while providing appropriate initial assessment and management for patients. This offers proof-of-concept for such a service that, with further refinement, England can use in future pandemics. Other countries may wish to adopt a similar system as part of their pandemic emergency planning.
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Affiliation(s)
| | - Oliver Mytton
- Department of Public Health, University of Oxford, Oxford, UK
| | - Benjamin Ellis
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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19
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Scotta MC, Mattiello R, Marostica PJC, Jones MH, Martins LG, Fischer GB. Risk factors for need of mechanical ventilation in children with influenza A(H1N1)pdm09. J Pediatr (Rio J) 2013; 89:444-9. [PMID: 23845706 DOI: 10.1016/j.jped.2013.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/30/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The pandemic caused by influenza A(H1N1)pdm09 virus peaked between July and August of 2009 in southern Brazil, with the highest incidence in children and young adults. In the post-pandemic period, there was an increase in the incidence of cases during the winter months of 2011 and 2012 in Brazil, similar to seasonal influenza virus. Since infections due to pandemic influenza are still occurring, the present study aimed to investigate the risk factors for worse outcome in children. METHODS A retrospective cohort study was performed by reviewing the charts of hospitalized patients younger than 14 years with reverse transcription-polymerase chain reaction (RT-PCR) positive for influenza A(H1N1)pdm09 during the first pandemic wave in six Brazilian tertiary centers. Need for mechanical ventilation was defined as the severity of outcome; age, chronic diseases, bacterial and viral co-detection, chest radiograph findings, and use of oseltamivir were possible predictors. RESULTS In the present study, 120 patients were included. In a multivariate analysis, chronic diseases (prevalence ratio: 2.613, 95% CI: 1.267-5.386) and viral co-detection (prevalence ratio: 2.43, 95% CI: 1.203-4.905) were statistically associated with worse outcome (p<0.05). CONCLUSIONS The presence of chronic diseases as predictors reinforces previous finding. Furthermore, viral co-detection was found to be a risk factor. Further studies are necessary to confirm this association.
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Affiliation(s)
- Marcelo C Scotta
- MSc Candidate in Child and Adolescent Health, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Pediatric Infectious Disease's Specialist, Hospital da Criança Santo Antonio, Departamento de Pediatria, Porto Alegre, RS, Brazil.
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Michiels B, Van Puyenbroeck K, Verhoeven V, Vermeire E, Coenen S. The value of neuraminidase inhibitors for the prevention and treatment of seasonal influenza: a systematic review of systematic reviews. PLoS One 2013; 8:e60348. [PMID: 23565231 PMCID: PMC3614893 DOI: 10.1371/journal.pone.0060348] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
Controversy has arisen regarding the effectiveness of neuraminidase inhibitors (NIs), especially against influenza-related complications. A literature search was performed to critically assess the evidence collected by the available systematic reviews (SRs) regarding the benefits and disadvantages of NIs (oseltamivir, zanamivir) compared to placebos in healthy and at-risk individuals of all ages for prophylaxis and treatment of seasonal influenza. A SR was done using the Cochrane Database of Systematic Reviews, Health Technology Assessment Database, Database of Abstracts of Reviews of Effects, and Medline (January 2006-July 2012). Two reviewers selected SRs based on randomized clinical trials, which were restricted to intention-to-treat results, and they assessed review (AMSTAR) and study quality indicators (GRADE). The SRs included (N = 9) were of high quality. The efficacy of NIs in prophylaxis ranged from 64% (16-85) to 92% (37-99); the absolute risk reduction ranged from 1.2% to 12.1% (GRADE moderate to low). Clinically relevant treatment benefits of NIs were small in healthy adults and children suffering from influenza-like illness (GRADE high to moderate). Oseltamivir reduced antibiotic usage in healthy adults according to one SR, but this was not confirmed by other reviews (GRADE low). Zanamivir showed a preventive effect on antibiotic usage in children (95% (77-99);GRADE moderate) and on the occurrence of bronchitis in at-risk individuals (59% (30-76);GRADE moderate). No evidence was available on the treatment benefits of NIs in elderly and at-risk groups and their effects on hospitalization and mortality. In oseltamivir trials, nausea, vomiting and diarrhea were significant side-effects. For zanamivir trials, no adverse effects have been reported. The combination of diagnostic uncertainty, the risk for virus strain resistance, possible side effects and financial cost outweigh the small benefits of oseltamivir or zanamivir for the prophylaxis and treatment of healthy individuals. No relevant benefits of these NIs on complications in at-risk individuals have been established.
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Affiliation(s)
- Barbara Michiels
- Department of Primary and Interdisciplinary Care Antwerp, Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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Launes C, García-García J, Martínez-Planas A, Moraga F, Soldevila N, Astigarraga I, Arístegui J, Korta J, Quintana J, Torner N, Domínguez A. Clinical features of influenza disease in admitted children during the first postpandemic season and risk factors for hospitalization: a multicentre Spanish experience. Clin Microbiol Infect 2013; 19:E157-62. [DOI: 10.1111/1469-0691.12106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/11/2012] [Accepted: 11/12/2012] [Indexed: 01/16/2023]
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Poehling KA, Edwards KM, Griffin MR, Szilagyi PG, Staat MA, Iwane MK, Snively BM, Suerken CK, Hall CB, Weinberg GA, Chaves SS, Zhu Y, McNeal MM, Bridges CB. The burden of influenza in young children, 2004-2009. Pediatrics 2013; 131:207-16. [PMID: 23296444 PMCID: PMC3557405 DOI: 10.1542/peds.2012-1255] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To characterize the health care burden of influenza from 2004 through 2009, years when influenza vaccine recommendations were expanded to all children aged ≥6 months. METHODS Population-based surveillance for laboratory-confirmed influenza was performed among children aged <5 years presenting with fever and/or acute respiratory illness to inpatient and outpatient settings during 5 influenza seasons in 3 US counties. Enrolled children had nasal/throat swabs tested for influenza by reverse transcriptase-polymerase chain reaction and their medical records reviewed. Rates of influenza hospitalizations per 1000 population and proportions of outpatients (emergency department and clinic) with influenza were computed. RESULTS The study population comprised 2970, 2698, and 2920 children from inpatient, emergency department, and clinic settings, respectively. The single-season influenza hospitalization rates were 0.4 to 1.0 per 1000 children aged <5 years and highest for infants <6 months. The proportion of outpatient children with influenza ranged from 10% to 25% annually. Among children hospitalized with influenza, 58% had physician-ordered influenza testing, 35% had discharge diagnoses of influenza, and 2% received antiviral medication. Among outpatients with influenza, 7% were tested for influenza, 7% were diagnosed with influenza, and <1% had antiviral treatment. Throughout the 5 study seasons, <45% of influenza-negative children ≥6 months were fully vaccinated against influenza. CONCLUSIONS Despite expanded vaccination recommendations, many children are insufficiently vaccinated, and substantial influenza burden remains. Antiviral use was low. Future studies need to evaluate trends in use of vaccine and antiviral agents and their impact on disease burden and identify strategies to prevent influenza in young infants.
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Affiliation(s)
| | | | | | | | - Mary A. Staat
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Marika K. Iwane
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Beverly M. Snively
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cynthia K. Suerken
- Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caroline B. Hall
- Departments of Pediatrics and,Medicine, University of Rochester Schools of Medicine and Dentistry, Rochester, New York
| | | | - Sandra S. Chaves
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuwei Zhu
- Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Monica M. McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and
| | - Carolyn B. Bridges
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sanderson SD, Thoman ML, Kis K, Virts EL, Herrera EB, Widmann S, Sepulveda H, Phillips JA. Innate immune induction and influenza protection elicited by a response-selective agonist of human C5a. PLoS One 2012; 7:e40303. [PMID: 22792270 PMCID: PMC3391237 DOI: 10.1371/journal.pone.0040303] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 06/04/2012] [Indexed: 12/20/2022] Open
Abstract
The anaphylatoxin C5a is an especially potent mediator of both local and systemic inflammation. However, C5a also plays an essential role in mucosal host defense against bacterial, viral, and fungal infection. We have developed a response-selective agonist of human C5a, termed EP67, which retains the immunoenhancing activity of C5a at the expense of its inflammatory, anaphylagenic properties. EP67 insufflation results in the rapid induction of pulmonary cytokines and chemokines. This is followed by an influx of innate immune effector cells, including neutrophils, NK cells, and dendritic cells. EP67 exhibits both prophylactic and therapeutic protection when tested in a murine model of influenza A infection. Mice treated with EP67 within a twenty-four hour window of non-lethal infection were significantly protected from influenza-induced weight loss. Furthermore, EP67 delivered twenty-four hours after lethal infection completely blocked influenza-induced mortality (0% vs. 100% survival). Since protection based on innate immune induction is not restricted to any specific pathogen, EP67 may well prove equally efficacious against a wide variety of possible viral, bacterial, and fungal pathogens. Such a strategy could be used to stop the worldwide spread of emergent respiratory diseases, including but not limited to novel strains of influenza.
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Affiliation(s)
- Sam D. Sanderson
- School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Marilyn L. Thoman
- Sidney Kimmel Cancer Center, San Diego, California, United States of America
- Biosciences Center, San Diego State University, San Diego, California, United States of America
| | - Kornelia Kis
- Biosciences Center, San Diego State University, San Diego, California, United States of America
| | - Elizabeth L. Virts
- Sidney Kimmel Cancer Center, San Diego, California, United States of America
- Biosciences Center, San Diego State University, San Diego, California, United States of America
| | - Edgar B. Herrera
- Biosciences Center, San Diego State University, San Diego, California, United States of America
| | | | | | - Joy A. Phillips
- Sidney Kimmel Cancer Center, San Diego, California, United States of America
- Biosciences Center, San Diego State University, San Diego, California, United States of America
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Hsu J, Santesso N, Mustafa R, Brozek J, Chen YL, Hopkins JP, Cheung A, Hovhannisyan G, Ivanova L, Flottorp SA, Saeterdal I, Wong AD, Tian J, Uyeki TM, Akl EA, Alonso-Coello P, Smaill F, Schünemann HJ. Antivirals for treatment of influenza: a systematic review and meta-analysis of observational studies. Ann Intern Med 2012; 156:512-24. [PMID: 22371849 PMCID: PMC6679687 DOI: 10.7326/0003-4819-156-7-201204030-00411] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systematic reviews of randomized, controlled trials in patients with influenza suggest a lack of evidence about the effects of antiviral therapy on several patient-important outcomes of influenza. PURPOSE To systematically review observational studies for benefits and harms of oseltamivir, zanamivir, amantadine, or rimantadine in the treatment of influenza. DATA SOURCES MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, SIGLE, the Chinese Biomedical Literature Database, Panteleimon, and LILACS up to November 2010; contact with pharmaceutical companies; and reference lists. STUDY SELECTION Observational studies in any language that compared single antiviral therapy with no therapy or other antiviral therapy, or that had no comparator, for influenza or influenza-like illness. DATA EXTRACTION Two independent investigators extracted data. Confidence in the estimates of the obtained effects (quality of evidence) was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS 74 studies fulfilled the inclusion criteria. Meta-analyses of the few studies providing effects with adjustment for confounders suggest that, in high-risk populations, oral oseltamivir may reduce mortality (odds ratio, 0.23 [95% CI, 0.13 to 0.43]; low-quality evidence), hospitalization (odds ratio, 0.75 [CI, 0.66 to 0.89]; low-quality evidence), and duration of symptoms (33 hours [CI, 21 to 45 hours]; very low-quality evidence) compared with no treatment. Earlier treatment with oseltamivir was generally associated with better outcomes. Inhaled zanamivir may lead to shorter symptom duration (23 hours [CI, 17 to 28 hours]; moderate-quality evidence) and fewer hospitalizations (odds ratio, 0.66 [CI, 0.37 to 1.18]) but more complications than no treatment. Direct comparison of oral oseltamivir and inhaled zanamivir suggests no important differences in key outcomes. Data from 1 study suggest that oral amantadine may reduce mortality and pneumonia associated with influenza A. No included study evaluated rimantadine. LIMITATIONS Mortality was assessed in high-risk patients, and generalizability is limited. The overall body of evidence is limited by risk for confounding and selection, reporting, and publication bias. CONCLUSION Therapy with oral oseltamivir and inhaled zanamivir may provide a net benefit over no treatment of influenza. However, as with the randomized trials, the confidence in the estimates of the effects for decision making is low to very low. PRIMARY FUNDING SOURCES: World Health Organization and McMaster University.
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