1
|
Vitoratou DI, Milas GP, Korovessi P, Kostaridou S, Koletsi P. Obesity as a risk factor for severe influenza infection in children and adolescents: a systematic review and meta-analysis. Eur J Pediatr 2023; 182:363-374. [PMID: 36369400 PMCID: PMC9652042 DOI: 10.1007/s00431-022-04689-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022]
Abstract
Obesity has been recently identified as a predisposing factor for a worse prognosis in viral illnesses such as SARS-CoV-2; however, its role in children with influenza is not yet clarified. The current systematic review and meta-analysis aims to assess whether obesity is a risk factor for either hospitalization or a worse prognosis when hospitalized among children infected by influenza. We systematically searched the following databases using a structured algorithm: MEDLINE, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). Statistical meta-analysis was performed using the "meta" package in R software, and included studies were evaluated using the Newcastle-Ottawa scale. Among children with influenza, obesity increased the odds of hospitalization with a pooled OR of 1.89 (95% CI [1.23, 2.9], I2 = 0, p = 0.003). When hospitalized, children with obesity were also more likely to have a worse outcome than their healthy-weight counterparts, with a pooled OR of 1.24 (95% Cl [1.02; 1.51], I2 = 11, p = 0.03). In an effort to lower heterogeneity, a leave-one-out meta-analysis was conducted. Publication bias was assessed with the visual inspection of funnel plots and the trim-and-fill method. Certainty assessment was evaluated using the GRADE score. CONCLUSIONS The findings of our meta-analysis suggest that obesity in children with influenza is associated with a worse prognosis, both hospitalization and ICU admission/death. WHAT IS KNOWN • Obesity has been identified as a risk factor for non-communicable as well as communicable diseases. • A previous meta-analysis failed to demonstrate a statistically significant association between obesity and influenza infection severity. WHAT IS NEW • Children with high BMI and influenza infection are more likely to get hospitalized. • Pediatric inpatients with increased BMI and influenza infection may have a worse prognosis.
Collapse
Affiliation(s)
| | | | | | | | - Patra Koletsi
- Pediatric Department, Penteli Children's Hospital, Athens, Greece
| |
Collapse
|
2
|
Wang J, Zhu L, Liu L, Yan X, Xue L, Huang S, Zhang B, Xu T, Ji F, Li C, Ming F, Zhao Y, Cheng J, Chen K, Zhao XA, Sang D, Guan X, Chen X, Yan X, Zhang Z, Liu J, Huang R, Zhu C, Wu C. Clinical features and prognosis of COVID-19 patients with metabolic syndrome: A multicenter, retrospective study. MEDICINA CLINICA (ENGLISH ED.) 2022; 158:458-465. [PMID: 35702719 PMCID: PMC9181760 DOI: 10.1016/j.medcle.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023]
Abstract
Background Few studies have investigated the impacts of metabolic syndrome (MS) on coronavirus disease 2019 (COVID-19). We described the clinical features and prognosis of confirmed COVID-19 patients with MS during hospitalization and after discharge. Methods Two hundred and thirty-three COVID-19 patients from the hospitals in 8 cities of Jiangsu, China were retrospectively included. Clinical characteristics of COVID-19 patients were described and risk factors of severe illness were analyzed by logistic regression analysis. Results Forty-five (19.3%) of 233 COVID-19 patients had MS. The median age of COVID-19 patients with MS was significantly higher than non-MS patients (53.0 years vs. 46.0 years, P = 0.004). There were no significant differences of clinical symptoms, abnormal chest CT images, and treatment drugs between two groups. More patients with MS had severe illness (33.3% vs. 6.4%, P < 0.001) and critical illness (4.4% vs. 0.5%, P = 0.037) than non-MS patients. The proportions of respiratory failure and acute respiratory distress syndrome in MS patients were also higher than non-MS patients during hospitalization. Multivariate analysis showed that concurrent MS (odds ratio [OR] 7.668, 95% confidence interval [CI] 3.062–19.201, P < 0.001) and lymphopenia (OR 3.315, 95% CI 1.306–8.411, P = 0.012) were independent risk factors of severe illness of COVID-19. At a median follow-up of 28 days after discharge, bilateral pneumonia was found in 95.2% of MS patients, while only 54.7% of non-MS patients presented bilateral pneumonia. Conclusions 19.3% of COVID-19 patients had MS in our study. COVID-19 patients with MS are more likely to develop severe complications and have worse prognosis. More attention should be paid to COVID-19 patients with MS.
Collapse
Key Words
- ARDS, acute respiratory distress syndrome
- BMI, body mass index
- COVID-19, coronavirus disease 2019
- Coronavirus disease 2019
- FBG, fasting blood glucose
- ICU, intensive care units
- IQR, interquartile range
- MS, metabolic syndrome
- Metabolic syndrome
- Prognosis
- SARS, severe acute respiratory syndrome
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- TC, total cholesterol
- TG, triglycerides
- WHO, world Health Organization
Collapse
Affiliation(s)
- Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Li Zhu
- Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Longgen Liu
- Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, China
| | - Xuebing Yan
- Department of Infectious Diseases, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Leyang Xue
- Department of Critical Medicine, Huai'an No. 4 People's Hospital, Huai'an, China
| | - Songping Huang
- Department of Infectious Diseases, Nantong Third People's Hospital, Nantong University, Nantong, China
| | - Biao Zhang
- Department of Quality Control Office, Huai'an No. 4 People's Hospital, Huai'an, China
| | - Tianmin Xu
- Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, China
| | - Fang Ji
- Department of Infectious Diseases, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunyang Li
- Department of Infectious Diseases, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Fang Ming
- Department of Infectious Diseases, Nantong Third People's Hospital, Nantong University, Nantong, China
| | - Yun Zhao
- Department of Infectious Diseases, The Third People's Hospital of Yangzhou, Yangzhou, China
| | - Juan Cheng
- Department of Infectious Diseases, Yancheng Second People's Hospital, Yancheng, China
| | - Kang Chen
- Department of Tuberculosis, The Third People's Hospital of Changzhou, Changzhou, China
| | - Xiang-An Zhao
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dawen Sang
- Department of Infectious Diseases, Yancheng Second People's Hospital, Yancheng, China
| | - Xinying Guan
- Department of Neurology, The Affiliated Hospital of Kangda College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaobing Chen
- Department of Emergency, The Affiliated Hospital of Kangda College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaomin Yan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhaoping Zhang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiacheng Liu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chuanwu Zhu
- Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
3
|
Wang J, Zhu L, Liu L, Yan X, Xue L, Huang S, Zhang B, Xu T, Ji F, Li C, Ming F, Zhao Y, Cheng J, Chen K, Zhao XA, Sang D, Guan X, Chen X, Yan X, Zhang Z, Liu J, Huang R, Zhu C, Wu C. Clinical features and prognosis of COVID-19 patients with metabolic syndrome: A multicenter, retrospective study. Med Clin (Barc) 2022; 158:458-465. [PMID: 34243955 PMCID: PMC8213355 DOI: 10.1016/j.medcli.2021.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Few studies have investigated the impacts of metabolic syndrome (MS) on coronavirus disease 2019 (COVID-19). We described the clinical features and prognosis of confirmed COVID-19 patients with MS during hospitalization and after discharge. METHODS Two hundred and thirty-three COVID-19 patients from the hospitals in 8 cities of Jiangsu, China were retrospectively included. Clinical characteristics of COVID-19 patients were described and risk factors of severe illness were analyzed by logistic regression analysis. RESULTS Forty-five (19.3%) of 233 COVID-19 patients had MS. The median age of COVID-19 patients with MS was significantly higher than non-MS patients (53.0 years vs. 46.0 years, P=0.004). There were no significant differences of clinical symptoms, abnormal chest CT images, and treatment drugs between two groups. More patients with MS had severe illness (33.3% vs. 6.4%, P<0.001) and critical illness (4.4% vs. 0.5%, P=0.037) than non-MS patients. The proportions of respiratory failure and acute respiratory distress syndrome in MS patients were also higher than non-MS patients during hospitalization. Multivariate analysis showed that concurrent MS (odds ratio [OR] 7.668, 95% confidence interval [CI] 3.062-19.201, P<0.001) and lymphopenia (OR 3.315, 95% CI 1.306-8.411, P=0.012) were independent risk factors of severe illness of COVID-19. At a median follow-up of 28 days after discharge, bilateral pneumonia was found in 95.2% of MS patients, while only 54.7% of non-MS patients presented bilateral pneumonia. CONCLUSIONS 19.3% of COVID-19 patients had MS in our study. COVID-19 patients with MS are more likely to develop severe complications and have worse prognosis. More attention should be paid to COVID-19 patients with MS.
Collapse
Affiliation(s)
- Jian Wang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Li Zhu
- Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China
| | - Longgen Liu
- Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, China
| | - Xuebing Yan
- Department of Infectious Diseases, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Leyang Xue
- Department of Critical Medicine, Huai'an No. 4 People's Hospital, Huai'an, China
| | - Songping Huang
- Department of Infectious Diseases, Nantong Third People's Hospital, Nantong University, Nantong, China
| | - Biao Zhang
- Department of Quality Control Office, Huai'an No. 4 People's Hospital, Huai'an, China
| | - Tianmin Xu
- Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, China
| | - Fang Ji
- Department of Infectious Diseases, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunyang Li
- Department of Infectious Diseases, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Fang Ming
- Department of Infectious Diseases, Nantong Third People's Hospital, Nantong University, Nantong, China
| | - Yun Zhao
- Department of Infectious Diseases, The Third People's Hospital of Yangzhou, Yangzhou, China
| | - Juan Cheng
- Department of Infectious Diseases, Yancheng Second People's Hospital, Yancheng, China
| | - Kang Chen
- Department of Tuberculosis, The Third People's Hospital of Changzhou, Changzhou, China
| | - Xiang-An Zhao
- Department of Gastroenterology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dawen Sang
- Department of Infectious Diseases, Yancheng Second People's Hospital, Yancheng, China
| | - Xinying Guan
- Department of Neurology, The Affiliated Hospital of Kangda College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaobing Chen
- Department of Emergency, The Affiliated Hospital of Kangda College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Xiaomin Yan
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhaoping Zhang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiacheng Liu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Rui Huang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Chuanwu Zhu
- Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, China.
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| |
Collapse
|
4
|
Huang PY, Su CP, Liu SW, Kao KC, Hsieh YC, Huang CT. Correlation between Negative Rapid Influenza Diagnostic Test and Severe Disease in Hospitalized Adults with Laboratory-Confirmed Influenza Virus Infection. Am J Trop Med Hyg 2020; 103:1642-1648. [PMID: 32876004 PMCID: PMC7543834 DOI: 10.4269/ajtmh.19-0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
False-negative rapid influenza diagnostic test (RIDT) results could mislead physicians to exclude an influenza diagnosis. We sought to evaluate the association between negative RIDT and intensive care unit (ICU) admission. We reviewed data from hospitalized adults with laboratory-confirmed influenza virus infections in a tertiary referral hospital in Taiwan from July 2009 to February 2011. The diagnosis was documented by real-time PCR or virus culture. Of 134 hospitalized adults infected with influenza virus, 38 (28%) were admitted to the ICU. Compared with RIDT-positive patients, the percentage of ICU admission was significantly higher among RIDT-negative patients (46% versus 13%, P < 0.001). The RIDT-negative patients had higher percentages of lower respiratory symptoms and more chest radiograph infiltrates. The time interval between the RIDT and antiviral treatment was longer in RIDT-negative than RIDT-positive patients (1.94 days versus 0.03 days, P < 0.001). Among patients presenting with mild illness, only a negative RIDT and delayed antiviral treatment were associated with ICU admission after adjusting for potential confounding factors. To conclude, patients with a negative RIDT were more likely to have severe disease and a delay in initiating antiviral treatment. Our findings should help improve treatment outcomes of hospitalized patients with influenza infection.
Collapse
Affiliation(s)
- Po-Yen Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Ping Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Shi-Wei Liu
- Division of Infectious Diseases, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Chia Hsieh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| |
Collapse
|
5
|
Flick H. [Fatality and risk factors for severe courses of COVID-19 pneumonia]. DER PNEUMOLOGE 2020; 17:385-393. [PMID: 33132796 PMCID: PMC7585743 DOI: 10.1007/s10405-020-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, the course, fatality and mortality are multifactorial and attributable to the immediate parenchymal damage in the region of the lungs (including pulmonary vessels), pre-existing comorbidities, extrapulmonary complications, secondary infections and the quality of the available medical care. In this respect, coronavirus disease 2019 (COVID-19) is comparable with other severe community-acquired forms of pneumonia caused by conventional pathogens, even if the pathogenesis is different. The fatality of hospitalized COVID-19 patients is approximately 20% (and therefore higher than for other pneumonia pathogens), in intensive care patients 30-40% and in invasively ventilated patients ca. 50%. Risk factors that are decisive for the fatality are old age, overweight, male gender and typical age-related cardiopulmonary underlying diseases. The clinical risk estimation in hospital should essentially be carried out in accordance with the valid guidelines on pneumonia. The value of laboratory surrogate markers specific for COVID-19 for risk estimation and treatment optimization cannot yet be adequately assessed.
Collapse
Affiliation(s)
- Holger Flick
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Pulmonologie, LKH-Univ. Klinikum Graz, Augenbruggerplatz 15, 8036 Graz, Österreich
| |
Collapse
|
6
|
Hauge SH, Bakken IJ, de Blasio BF, Håberg SE. Risk conditions in children hospitalized with influenza in Norway, 2017-2019. BMC Infect Dis 2020; 20:769. [PMID: 33076855 PMCID: PMC7569759 DOI: 10.1186/s12879-020-05486-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/07/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Norwegian children are more frequently hospitalized with influenza than adults. Little is known about the characteristics of these children. Our aim was to investigate the presence of pre-existing risk conditions and to determine the duration of influenza hospitalizations in children during two influenza seasons. METHODS The Norwegian Patient Registry holds data on all hospitalized patients in Norway. We included all patients younger than 18 years hospitalized with a diagnosis of influenza during the influenza seasons 2017-18 and 2018-19. Pre-existing risk conditions for influenza were identified by ICD-10 diagnoses in the Norwegian Patient Registry. In addition, information on asthma diagnoses were also retrieved from the Norwegian Registry for Primary Health Care. To estimate the prevalence of risk conditions in the child population, we obtained diagnoses on all Norwegian children in a two-year period prior to each influenza season. We calculated age-specific rates for hospitalization and risk for being hospitalized with influenza in children with risk conditions. RESULTS In total, 1013 children were hospitalized with influenza during the two influenza seasons. Children younger than 6 months had the highest rate of hospitalization, accounting for 13.5% of all admissions (137 children). Hospitalization rates decreased with increasing age. Among children hospitalized with influenza, 25% had one or more pre-existing risk conditions for severe influenza, compared to 5% in the general population under 18 years. Having one or more risk conditions significantly increased the risk of hospitalization, (Odds Ratio (OR) 6.1, 95% confidence interval (CI) 5.0-7.4 in the 2017-18 season, and OR 6.8, 95% CI 5.4-8.4 in the 2018-19 season). Immunocompromised children and children with epilepsy had the highest risk of hospitalization with influenza, followed by children with heart disease and lung disease. The average length of stay in hospital were 4.6 days, and this did not differ with age. CONCLUSION Children with pre-existing risk conditions for influenza had a higher risk of hospitalization for influenza. However, most children (75%) admitted to hospital with influenza in Norway during 2017-2019 did not have pre-existing risk conditions. Influenza vaccination should be promoted in particular for children with risk conditions and pregnant women to protect new-borns.
Collapse
Affiliation(s)
- Siri Helene Hauge
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Inger Johanne Bakken
- Department of Health Registries, Norwegian Directorate of Health, Trondheim, Norway
| | - Birgitte Freiesleben de Blasio
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Siri Eldevik Håberg
- Norwegian Institute of Public Health, Centre for Fertility and Health, Oslo, Norway
| |
Collapse
|
7
|
Flick H, Arns BM, Bolitschek J, Bucher B, Cima K, Gingrich E, Handzhiev S, Hochmair M, Horak F, Idzko M, Jaksch P, Kovacs G, Kropfmüller R, Lamprecht B, Löffler-Ragg J, Meilinger M, Olschewski H, Pfleger A, Puchner B, Puelacher C, Prior C, Rodriguez P, Salzer H, Schenk P, Schindler O, Stelzmüller I, Strenger V, Täubl H, Urban M, Wagner M, Wimberger F, Zacharasiewicz A, Zwick RH, Eber E. Management of patients with SARS-CoV-2 infections and of patients with chronic lung diseases during the COVID-19 pandemic (as of 9 May 2020) : Statement of the Austrian Society of Pneumology (ASP). Wien Klin Wochenschr 2020; 132:365-386. [PMID: 32533443 PMCID: PMC7291190 DOI: 10.1007/s00508-020-01691-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is currently a challenge worldwide. In Austria, a crisis within the healthcare system has so far been prevented. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic; however, COVID-19 specific adjustments are useful. The treatment of patients with chronic lung diseases has to be adapted during the pandemic but must still be guaranteed.
Collapse
Affiliation(s)
- Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Brigitte Bucher
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | - Katharina Cima
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | | | - Sabin Handzhiev
- Department of Pulmonology, University Hospital Krems, Krems, Austria
| | - Maximilian Hochmair
- Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | | | - Marco Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Roland Kropfmüller
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II (Infectious Diseases, Pneumology, Rheumatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Meilinger
- Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Andreas Pfleger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | | | | | | | - Patricia Rodriguez
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Helmut Salzer
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Peter Schenk
- Department of Pulmonology, Landesklinikum Hochegg, Grimmenstein, Austria
| | - Otmar Schindler
- Department of Internal, Respiratory and Critical Care Medicine, State Hospital II, Location Enzenbach, Gratwein-Straßengel, Austria
| | | | - Volker Strenger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Helmut Täubl
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | - Matthias Urban
- Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Marlies Wagner
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | | | - Angela Zacharasiewicz
- Department of Paediatrics, Teaching Hospital of the Medical University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | | | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
| |
Collapse
|
8
|
Flick H, Arns BM, Bolitschek J, Bucher B, Cima K, Gingrich E, Handzhiev S, Hochmair M, Horak F, Idzko M, Jaksch P, Kovacs G, Kropfmüller R, Lamprecht B, Löffler-Ragg J, Meilinger M, Olschewski H, Pfleger A, Puchner B, Puelacher C, Prior C, Rodriguez P, Salzer H, Schenk P, Schindler O, Stelzmüller I, Strenger V, Täubl H, Urban M, Wagner M, Wimberger F, Zacharasiewicz A, Zwick RH, Eber E. [Statement of the Austrian Society of Pneumology (ASP)]. WIENER KLINISCHES MAGAZIN : BEILAGE ZUR WIENER KLINISCHEN WOCHENSCHRIFT 2020; 23:92-115. [PMID: 32427192 PMCID: PMC7232599 DOI: 10.1007/s00740-020-00350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic is currently a challenge worldwide. In Austria, a crisis within the health care system has so far been avoided. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic. However, COVID-19-specific adjustments are useful. The treatment of patients with chronic lung diseases must be adapted during the pandemic, but must still be guaranteed.
Collapse
Affiliation(s)
- H. Flick
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
| | - B. M. Arns
- 1. Medizinische Abteilung, Hanusch Krankenhaus, Wien, Österreich
| | | | - B. Bucher
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - K. Cima
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - E. Gingrich
- Lungenfachärztliche Ordination, Wien, Österreich
| | - S. Handzhiev
- Klinische Abteilung für Pneumologie, Universitätsklinikum Krems, Krems, Österreich
| | - M. Hochmair
- Karl Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - F. Horak
- Allergiezentrum Wien West, Wien, Österreich
| | - M. Idzko
- Klinische Abteilung für Pulmologie, Univ. Klinik für Innere Medizin II, Medizinische Universität Wien/AKH Wien, Wien, Österreich
| | - P. Jaksch
- Klinische Abteilung für Thoraxchirurgie, Univ. Klinik für Chirurgie, Medizinische Universität Wien/AKH Wien, Wien, Österreich
| | - G. Kovacs
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung Graz, Graz, Österreich
| | - R. Kropfmüller
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - B. Lamprecht
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - J. Löffler-Ragg
- Pneumologische Ambulanz, Univ. Klinik für Innere Medizin II, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M. Meilinger
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - H. Olschewski
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung Graz, Graz, Österreich
| | - A. Pfleger
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - B. Puchner
- Department für Pneumologie, Reha Zentrum Münster, Münster, Österreich
| | - C. Puelacher
- Interdisziplinäres Schlaflabor, Telfs, Österreich
| | - C. Prior
- Lungenfachärztliche Ordination, Innsbruck, Österreich
| | - P. Rodriguez
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - H. Salzer
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - P. Schenk
- Abteilung Pulmologie, Landesklinikum Hochegg, Grimmenstein, Österreich
| | - O. Schindler
- Abteilung für Innere Medizin und Pneumologie, LKH Graz II, Standort Enzenbach, Gratwein, Österreich
| | | | - V. Strenger
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - H. Täubl
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - M. Urban
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - M. Wagner
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - F. Wimberger
- Ordensklinikum Elisabethinen Linz, Linz, Österreich
| | - A. Zacharasiewicz
- Abteilung für Kinder- und Jugendheilkunde, Wilhelminenspital der Stadt Wien, Lehrkrankenhaus der Medizinischen Universität Wien, Wien, Österreich
| | - R. H. Zwick
- Ambulante Pneumologische Rehabilitation, Therme Wien Med, Wien, Österreich
| | - E. Eber
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| |
Collapse
|
9
|
Jiang C, Yao X, Zhao Y, Wu J, Huang P, Pan C, Liu S, Pan C. Comparative review of respiratory diseases caused by coronaviruses and influenza A viruses during epidemic season. Microbes Infect 2020; 22:236-244. [PMID: 32405236 PMCID: PMC7217786 DOI: 10.1016/j.micinf.2020.05.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to sweep the world, causing infection of millions and death of hundreds of thousands. The respiratory disease that it caused, COVID-19 (stands for coronavirus disease in 2019), has similar clinical symptoms with other two CoV diseases, severe acute respiratory syndrome and Middle East respiratory syndrome (SARS and MERS), of which causative viruses are SARS-CoV and MERS-CoV, respectively. These three CoVs resulting diseases also share many clinical symptoms with other respiratory diseases caused by influenza A viruses (IAVs). Since both CoVs and IAVs are general pathogens responsible for seasonal cold, in the next few months, during the changing of seasons, clinicians and public heath may have to distinguish COVID-19 pneumonia from other kinds of viral pneumonia. This is a discussion and comparison of the virus structures, transmission characteristics, clinical symptoms, diagnosis, pathological changes, treatment and prevention of the two kinds of viruses, CoVs and IAVs. It hopes to provide information for practitioners in the medical field during the epidemic season.
Collapse
Affiliation(s)
- Chao Jiang
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China; School of Life Sciences, Bengbu Medical College, Bengbu, Anhui, 233030, China
| | - Xingang Yao
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yulin Zhao
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China
| | - Jianmin Wu
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China
| | - Pan Huang
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China
| | - Chunhua Pan
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, 510000, China.
| | - Shuwen Liu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Chungen Pan
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China.
| |
Collapse
|
10
|
Mertz D, Lo CKF, Lytvyn L, Ortiz JR, Loeb M. Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis. BMC Infect Dis 2019; 19:683. [PMID: 31375073 PMCID: PMC6679491 DOI: 10.1186/s12879-019-4318-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. METHODS We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). RESULTS A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02-7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48-0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75-1.34). CONCLUSIONS Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.
Collapse
Affiliation(s)
- Dominik Mertz
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Departments of Pathology and Molecular Medicine & Clinical Epidemiology and Biostatistics, McMaster University, MDCL 3203, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.,Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, ON, Canada
| | - Calvin Ka-Fung Lo
- Departments of Pathology and Molecular Medicine & Clinical Epidemiology and Biostatistics, McMaster University, MDCL 3203, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. .,Departments of Pathology and Molecular Medicine & Clinical Epidemiology and Biostatistics, McMaster University, MDCL 3203, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada. .,Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, ON, Canada.
| | | |
Collapse
|
11
|
Dandachi D, Rodriguez-Barradas MC. Viral pneumonia: etiologies and treatment. J Investig Med 2018; 66:957-965. [PMID: 29680828 DOI: 10.1136/jim-2018-000712] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2018] [Indexed: 12/16/2022]
Abstract
Viral pathogens are increasingly recognized as a cause of pneumonia, in immunocompetent patients and more commonly among immunocompromised. Viral pneumonia in adults could present as community-acquired pneumonia (CAP), ranging from mild disease to severe disease requiring hospital admission and mechanical ventilation. Moreover, the role of viruses in hospital-acquired pneumonia and ventilator-associated pneumonia as causative agents or as co-pathogens and the effect of virus detection on clinical outcome are being investigated.More than 20 viruses have been linked to CAP. Clinical presentation, laboratory findings, biomarkers, and radiographic patterns are not characteristic to specific viral etiology. Currently, laboratory confirmation is most commonly done by detection of viral nucleic acid by reverse transcription-PCR of respiratory secretions.Apart from the US Food and Drug Administration-approved medications for treatment of influenza pneumonia, the treatment of non-influenza respiratory viruses is limited. Moreover, the evidence supporting the use of available antivirals to treat immunocompromised patients is modest at best. With the widespread use of molecular diagnostics, an aging population, and advancement in cancer therapy, physicians will face a bigger challenge in managing viral respiratory tract infections. Emphasis on infection control measures to prevent the spread of respiratory viruses especially in healthcare settings is extremely important.
Collapse
Affiliation(s)
- Dima Dandachi
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Infectious Diseases Section (MS 111G), Michael E. DeBakey VAMC, Houston, Texas, USA
| |
Collapse
|
12
|
Heneghan CJ, Onakpoya I, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Spencer EA, Mahtani KR, Nunan D, Howick J, Jefferson T. Neuraminidase inhibitors for influenza: a systematic review and meta-analysis of regulatory and mortality data. Health Technol Assess 2018; 20:1-242. [PMID: 27246259 DOI: 10.3310/hta20420] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Neuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide. OBJECTIVES To (1) describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports (CSRs) of published and unpublished randomised, placebo-controlled trials and regulatory comments; and (2) determine the effect of oseltamivir (Tamiflu(®), Roche) treatment on mortality in patients with 2009A/H1N1 influenza. METHODS We searched trial registries, electronic databases and corresponded with regulators and sponsors to identify randomised trials of NIs. We requested full CSRs and accessed regulators' comments. We included only those trials for which we had CSRs. To examine the effects of oseltamivir on 2009A/H1N1 influenza mortality, we requested individual patient data (IPD) from corresponding authors of all included observational studies. RESULTS Effect of oseltamivir and zanamivir (Relenza®, GlaxoSmithKline) in the prevention and treatment of influenza: Oseltamivir reduced the time to first alleviation of symptoms in adults by 16.8 hours [95% confidence interval (CI) 8.4 to 25.1 hours]. Zanamivir reduced the time to first alleviation of symptoms in adults by 0.60 days (95% CI 0.39 to 0.81 days). Oseltamivir reduced unverified pneumonia in adult treatment [risk difference (RD) 1.00%, 95% CI 0.22% to 1.49%]; similar findings were observed with zanamivir prophylaxis in adults (RD 0.32%, 95% CI 0.09% to 0.41%). Oseltamivir treatment of adults increased the risk of nausea (RD 3.66%, 95% CI 0.90% to 7.39%) and vomiting (RD 4.56%, 95% CI 2.39% to 7.58%). In the treatment of children, oseltamivir induced vomiting (RD 5.34%, 95% CI 1.75% to 10.29%). Both oseltamivir and zanamivir prophylaxis reduced the risk of symptomatic influenza in individuals (oseltamivir RD 3.05%, 95% CI 1.83% to 3.88%; zanamivir RD 1.98%, 95% CI 0.98% to 2.54%) and in households (oseltamivir RD 13.6%, 95% CI 9.52% to 15.47%; zanamivir RD 14.84%, 95% CI 12.18% to 16.55%). Oseltamivir increased psychiatric adverse events in the combined on- and off-treatment periods (RD 1.06%, 95% CI 0.07% to 2.76%) and the risk of headaches while on treatment (RD 3.15%, 95% CI 0.88% to 5.78%). Effect of oseltamivir on mortality in patients with 2009A/H1N1 influenza: Analysis of summary data of 30 studies as well as IPD of four studies showed evidence of time-dependent bias. After adjusting for time-dependent bias and potential confounding variables, competing risks analysis of the IPD showed insufficient evidence that oseltamivir reduced the risk of mortality (hazard ratio 1.03, 95% CI 0.64 to 1.65). CONCLUSIONS Oseltamivir and zanamivir cause small reductions in the time to first alleviation of influenza symptoms in adults. The use of oseltamivir increases the risk of nausea, vomiting, psychiatric events in adults and vomiting in children. Oseltamivir has no protective effect on mortality among patients with 2009A/H1N1 influenza. Prophylaxis with either NI may reduce symptomatic influenza in individuals and in households. The balance between benefits and harms should be considered when making decisions about use of NIs for either prophylaxis or treatment of influenza. STUDY REGISTRATION This study is registered as PROSPERO CRD42012002245. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Carl J Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igho Onakpoya
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark A Jones
- School of Population Health, The University of Queensland, Brisbane, QLD, Australia
| | - Peter Doshi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Chris B Del Mar
- Centre for Research in Evidence-Based Practice (CREBP), Bond University, Robina, QLD, Australia
| | - Rokuro Hama
- Japan Institute of Pharmacovigilance, Osaka, Japan
| | - Matthew J Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Elizabeth A Spencer
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Nunan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeremy Howick
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | |
Collapse
|
13
|
Coleman BL, Fadel SA, Fitzpatrick T, Thomas SM. Risk factors for serious outcomes associated with influenza illness in high- versus low- and middle-income countries: Systematic literature review and meta-analysis. Influenza Other Respir Viruses 2017; 12:22-29. [PMID: 29197154 PMCID: PMC5818335 DOI: 10.1111/irv.12504] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 11/29/2022] Open
Abstract
Aim To determine factors associated with a serious outcome (hospital admission or severe outcome: critical care or death) and associated with illness caused by laboratory‐confirmed influenza, with a specific interest in low‐ and middle‐income countries (LMIC). Method Databases were searched on 11 March 2016 for reports of influenza and factors associated with mortality or morbidity in humans, with no language restrictions. Pooled risks were estimated using random‐effects models. Results Despite the heterogeneity of results across studies, known risk factors for serious disease were associated with both hospital admission and severe outcomes (critical care and/or death). In LMIC, but not in high income countries (HIC), pregnant women, people with HIV/AIDS and children < 5 years old (compared with older children) were at increased risk of a severe outcome. Also, although all patients with neurological conditions were at higher risk of severe outcomes than those without, children were at higher risk than adults and children who lived in a LMIC were at significantly higher risk than those living in HIC. Adults were more likely than children to suffer a severe outcome if they had diabetes or a hematologic condition, were obese or had liver disease. Asthma is a risk factor for hospital admission but not for severe outcomes. Conclusion Known risk factors for serious disease remain important predictors of hospital admission and severe outcomes with few differences between HIC and LMIC countries. These differences likely reflect differences in health‐seeking behaviours and health services, but high heterogeneity between studies limits conclusions about the effect size.
Collapse
Affiliation(s)
- Brenda L Coleman
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| | - Shaza A Fadel
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| | - Tiffany Fitzpatrick
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| | - Sera-Melisa Thomas
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
14
|
Boikos C, Caya C, Doll MK, Kraicer-Melamed H, Dolph M, Delisle G, Winters N, Gore G, Quach C. Safety and effectiveness of neuraminidase inhibitors in situations of pandemic and/or novel/variant influenza: a systematic review of the literature, 2009-15. J Antimicrob Chemother 2017; 72:1556-1573. [PMID: 28204554 DOI: 10.1093/jac/dkx013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/05/2017] [Indexed: 01/02/2023] Open
Abstract
Objectives To review systematically the published literature evaluating neuraminidase inhibitor (NI) safety and effectiveness in situations of pandemic and novel/variant influenza. Methods We searched six online databases using comprehensive search criteria for observational studies and randomized controlled trials investigating the effects of NI treatment, prophylaxis or outbreak control in patients of all ages. Results Overall, 165 studies were included (95% observational), which were generally of low methodological quality due to lack of adjustment for confounding variables. In studies reporting adjusted estimates in general populations, NI treatment appeared likely to be effective against mortality (primarily if administered within 48 h of symptom onset) and potentially effective in reducing pneumonia. NIs appeared effective in reducing secondary transmission when indicated for prophylaxis. Limited, low-quality data suggest NIs are likely safe in general populations and may be safe in pregnant women and children. Data are scarce regarding safety of NIs in adults and high-risk individuals. Conclusions Most included studies were observational, statistically underpowered and at high risk of reporting biased and/or confounded effect estimates. NI treatment appeared likely effective in reducing mortality (cause unspecified) and pneumonia in general populations, with increasing benefit when administered with 48 h of symptom onset. NI pre- or post-exposure prophylaxis is likely effective in reducing secondary transmission of influenza in a general population. Our evidence suggests NIs are likely safe to use in the general population; however, data for children and pregnant women are limited. Knowledge gaps persist in specific populations such as Aboriginals, high-risk individuals and the elderly.
Collapse
Affiliation(s)
- C Boikos
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - C Caya
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - M K Doll
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - H Kraicer-Melamed
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - M Dolph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | | | - N Winters
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - G Gore
- Life Sciences Library, McGill University, Montreal, QC, Canada
| | - C Quach
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada.,Department of Pediatrics, Division of Infectious Diseases, The Montreal Children's Hospital, Montreal, QC, Canada.,Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, QC, Canada
| |
Collapse
|
15
|
Morales KF, Paget J, Spreeuwenberg P. Possible explanations for why some countries were harder hit by the pandemic influenza virus in 2009 - a global mortality impact modeling study. BMC Infect Dis 2017; 17:642. [PMID: 28946870 PMCID: PMC5613504 DOI: 10.1186/s12879-017-2730-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A global pandemic mortality study found prominent regional mortality variations in 2009 for Influenza A(H1N1)pdm09. Our study attempts to identify factors that explain why the pandemic mortality burden was high in some countries and low in others. METHODS As a starting point, we identified possible risk factors worth investigating for Influenza A(H1N1)pdm09 mortality through a targeted literature search. We then used a modeling procedure (data simulations and regression models) to identify factors that could explain differences in respiratory mortality due to Influenza A(H1N1)pdm09. We ran sixteen models to produce robust results and draw conclusions. In order to assess the role of each factor in explaining differences in excess pandemic mortality, we calculated the reduction in between country variance, which can be viewed as an effect-size for each factor. RESULTS The literature search identified 124 publications and 48 possible risk factors, of which we were able to identify 27 factors with appropriate global datasets. The modelling procedure indicated that age structure (explaining 40% of the mean between country variance), latitude (8%), influenza A and B viruses circulating during the pandemic (3-8%), influenza A and B viruses circulating during the preceding influenza season (2-6%), air pollution (pm10; 4%) and the prevalence of other infections (HIV and TB) (4-6%) were factors that explained differences in mortality around the world. Healthcare expenditure, levels of obesity, the distribution of antivirals, and air travel did not explain global pandemic mortality differences. CONCLUSIONS Our study found that countries with a large proportion of young persons had higher pandemic mortality rates in 2009. The co-circulation of influenza viruses during the pandemic and the circulation of influenza viruses during the preceding season were also associated with pandemic mortality rates. We found that real time assessments of 2009 pandemic mortality risk factors (e.g. obesity) probably led to a number of false positive findings.
Collapse
Affiliation(s)
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| |
Collapse
|
16
|
Rath B, Conrad T, Myles P, Alchikh M, Ma X, Hoppe C, Tief F, Chen X, Obermeier P, Kisler B, Schweiger B. Influenza and other respiratory viruses: standardizing disease severity in surveillance and clinical trials. Expert Rev Anti Infect Ther 2017; 15:545-568. [PMID: 28277820 PMCID: PMC7103706 DOI: 10.1080/14787210.2017.1295847] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Influenza-Like Illness is a leading cause of hospitalization in children. Disease burden due to influenza and other respiratory viral infections is reported on a population level, but clinical scores measuring individual changes in disease severity are urgently needed. Areas covered: We present a composite clinical score allowing individual patient data analyses of disease severity based on systematic literature review and WHO-criteria for uncomplicated and complicated disease. The 22-item ViVI Disease Severity Score showed a normal distribution in a pediatric cohort of 6073 children aged 0-18 years (mean age 3.13; S.D. 3.89; range: 0 to 18.79). Expert commentary: The ViVI Score was correlated with risk of antibiotic use as well as need for hospitalization and intensive care. The ViVI Score was used to track children with influenza, respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus infections and is fully compliant with regulatory data standards. The ViVI Disease Severity Score mobile application allows physicians to measure disease severity at the point-of care thereby taking clinical trials to the next level.
Collapse
Affiliation(s)
- Barbara Rath
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Tim Conrad
- d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Puja Myles
- c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Maren Alchikh
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xiaolin Ma
- b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
| | - Christian Hoppe
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Franziska Tief
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xi Chen
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Patrick Obermeier
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Bron Kisler
- f Clinical Data Standards Interchange Consortium (CDISC) , Austin , TX , USA
| | - Brunhilde Schweiger
- e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
| |
Collapse
|
17
|
Summary of the National Advisory Committee on Immunization (NACI) Statement on Seasonal Influenza Vaccine for 2016-2017. ACTA ACUST UNITED AC 2016; 42:188-192. [PMID: 29770030 DOI: 10.14745/ccdr.v42i09a06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Influenza is a respiratory infection caused primarily by influenza A and B viruses. Vaccination is the most effective way to prevent influenza and its complications. The National Advisory Committee on Immunization (NACI) provides recommendations regarding seasonal influenza vaccines annually to the Public Health Agency of Canada (the Agency). Objective To summarize the NACI recommendations regarding the use of seasonal influenza vaccines for the 2016-2017 influenza season. Methods Annual influenza vaccine recommendations are developed by NACI's Influenza Working Group for consideration and approval by NACI, based on NACI's evidence-based process for developing recommendations, and include a consideration of the burden of influenza illness and the target populations for vaccination; efficacy and effectiveness, immunogenicity and safety of influenza vaccines; vaccine schedules; and other aspects of influenza immunization. These recommendations are published annually on the Agency's website in the NACI Advisory Committee Statement: Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine (the Statement). Results The annual NACI seasonal influenza vaccine recommendations have been updated for the 2016-2017 influenza season to include adults with neurologic or neurodevelopment conditions among the groups for whom influenza vaccination is particularly recommended; to include the new high-dose, trivalent inactivated influenza vaccine for use in adults 65 years of age and over; to recommend that egg-allergic individuals may also be vaccinated against influenza using the low ovalbumin-containing live attenuated influenza vaccine (LAIV) licensed for use in Canada (NACI has previously recommended that egg-allergic individuals may be vaccinated using inactivated influenza vaccines); and to remove the preferential recommendation for the use of LAIV in children 2-17 years of age. Two addenda to the 2016-2017 Statement address these new LAIV recommendations. Conclusion NACI continues to recommend annual influenza vaccination for all individuals aged six months and older, with particular focus on people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk and others as indicated.
Collapse
|
18
|
Basile K, Dwyer DE, Kok J. Fat and flu: fact or fiction? Future Virol 2016. [DOI: 10.2217/fvl-2016-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Novel risk factors for severe influenza infection were described during the early phases of the influenza pandemic of 2009. Worldwide, the rate of severe influenza in the obese and morbidly obese population was disproportionate to that of the general population. This risk factor has now been recognized presumably due to the increasing prevalence of obesity. The cause behind this trend may extend beyond the known deleterious effects of obesity on respiratory physiology, as emerging evidence in animal models demonstrate A(H1N1)pdm09 itself confers worse outcomes compared with seasonal influenza subtypes. Currently, uncertainty remains regarding the optimal antiviral regimen and vaccination strategies in obese individuals. Therefore, further studies on the effects of obesity on influenza infection need to be prioritized.
Collapse
Affiliation(s)
- Kerri Basile
- Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases & Biosecurity, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
- Centre for Research Excellence in Critical Infections, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
| | - Dominic E Dwyer
- Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases & Biosecurity, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
- Centre for Research Excellence in Critical Infections, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
| | - Jen Kok
- Centre for Infectious Diseases & Microbiology Laboratory Services, Institute of Clinical Pathology & Medical Research, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases & Biosecurity, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
- Centre for Research Excellence in Critical Infections, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
| |
Collapse
|
19
|
Sheu SM, Tsai CF, Yang HY, Pai HW, Chen SCC. Comparison of age-specific hospitalization during pandemic and seasonal influenza periods from 2009 to 2012 in Taiwan: a nationwide population-based study. BMC Infect Dis 2016; 16:88. [PMID: 26911158 PMCID: PMC4765149 DOI: 10.1186/s12879-016-1438-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Background Determining the age-specific hospitalization burden associated with seasonal influenza and the (H1N1) 2009 pandemic is important for the development of effective vaccine strategies and clinical management. The aim of this study was to investigate age-specific differences in hospitalization rates during the pandemic and seasonal periods. Methods Using the Taiwan National Health Insurance Research Database (NHIRD), we identified hospitalized patients with a principle discharge diagnosis of influenza-related infection (ICD-9-CM 487) between 2009 and 2012. Results Based on the time distribution of influenza-related hospitalizations and previously reported epidemic periods, the first and second waves of the (H1N1) 2009 pandemic (p1 is known as 2009.07-2010.01, and p2 is known as 2010.12-2011.03) and three seasonal periods (s1 is known as 2010.03-2010.11, s2 is known as 2011.10-2012.03, and s3 is known as 2012.04-2012.10) were found. During these five periods, children younger than 7 years of age consistently had the highest hospitalization rate of the studied age groups. In individuals younger than 50 years of age, the seasonal periods were associated with a significantly lower risk of hospitalization than that of p1 (Relative risk (RR) range = 0.18–0.85); however, they had a significantly higher hospitalization risk for adults over 50 years of age (RR = 1.51–3.22). Individuals over 50 years of age also had a higher intensive care unit admission rate and case fatality ratio than individuals under than 50 years of age during the seasonal periods and especially during the pandemic periods. Conclusions In both pandemic and seasonal periods, the highest hospitalization rate was observed for children younger than 7 years of age. Adults over 50 years of age had a higher hospitalization risk during the seasonal periods and a higher clinical severity during the pandemic periods. Those results emphasize that the importance of influenza-related prevention strategies in the younger and older age groups, either seasonal or pandemic periods.
Collapse
Affiliation(s)
- Shew-Meei Sheu
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hsin-Yi Yang
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hui-Wen Pai
- Department of Geriatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan. .,Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
20
|
Nermin KG, Remzi I, Zeynep A, Ilker C, Meltem OT, Guven O, Ferda K, Halis A. A retrospective evaluation of critically ill patients infected with H1N1 influenza A virus in Bursa, Turkey, during the 2009-2010 pandemic. Afr Health Sci 2015; 15:352-9. [PMID: 26124779 DOI: 10.4314/ahs.v15i2.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey. METHODS Demographic characteristics, clinical features, and outcome relating to H1N1 infection were retrospectively analysed in patients treated in the ICU. RESULTS Twenty-three cases of H1N1 infection were treated in the ICU. The mean age of patients was 37 years range: (17-82). Fifteen patients were female (65.2%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 range: (5-39). The most common symptoms were dyspnea (73.9%), fever (69.6%), and cough (60.9%). Mechanical ventilation was required for all patients. Oseltamivir and antibiotics were administered to all patients. Six (26.1%) patients died. APACHE II scores were higher in the deceased 28.5 range: [16-39] vs. 14 range: [5-28] in survivors; p = 0.013). CONCLUSION When compared to the literature, the demographic, epidemiological, and clinical characteristics were similar in the cases we encountered. The mortality rate was high despite the use of appropriate treatment. We believe that the high mortality is related to higher APACHE II scores. The H1N1 virus should be considered in community acquired pneumonia, especially in younger patients presenting with severe pneumonia.
Collapse
Affiliation(s)
- Kelebek Girgin Nermin
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Iscimen Remzi
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Akogul Zeynep
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Cimen Ilker
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Oner Torlar Meltem
- Uludag University, School of Medicine, Department of Microbiology and Infectious Disease
| | - Ozkaya Guven
- Uludag University, School of Medicine, Department of Biostatistics
| | - Kahveci Ferda
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Akalin Halis
- Uludag University, School of Medicine, Department of Microbiology and Infectious Disease
| |
Collapse
|
21
|
H1N1 Status Cannot Be Reliably Predicted by Chest X-ray and Complete Blood Count Findings. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Cárdenas G, Soto-Hernández JL, Díaz-Alba A, Ugalde Y, Mérida-Puga J, Rosetti M, Sciutto E. Neurological events related to influenza A (H1N1) pdm09. Influenza Other Respir Viruses 2014; 8:339-46. [PMID: 24895698 PMCID: PMC4181482 DOI: 10.1111/irv.12241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To review neurological complications after the influenza A (H1N1) pdm09, highlighting the clinical differences between patients with post-vaccine or viral infection. DESIGN A search on Medline, Ovid, EMBASE, and PubMed databases using the keywords “neurological complications of Influenza AH1N1” or “post-vaccine Influenza AH1N1.” SETTING Only papers written in English, Spanish, German, French, Portuguese, and Italian published from March 2009 to December 2012 were included. SAMPLE We included 104 articles presenting a total of 1636 patient cases. In addition, two cases of influenza vaccine-related neurological events from our neurological care center, arising during the period of study, were also included. MAIN OUTCOME MEASURES Demographic data and clinical diagnosis of neurological complications and outcomes: death, neurological sequelae or recovery after influenza A (H1N1) pdm09 vaccine or infection. RESULTS The retrieved cases were divided into two groups: the postvaccination group, with 287 patients, and the viral infection group, with 1349 patients. Most patients in the first group were adults. The main neurological complications were Guillain-Barre syndrome (GBS) or polyneuropathy (125), and seizures (23). All patients survived. Pediatric patients were predominant in the viral infection group. In this group, 60 patients (4.7%) died and 52 (30.1%) developed permanent sequelae. A wide spectrum of neurological complications was observed. CONCLUSIONS Fatal cases and severe, permanent, neurological sequelae were observed in the infection group only. Clinical outcome was more favorable in the post-vaccination group. In this context, the relevance of an accurate neurological evaluation is demonstrated for all suspicious cases, as well as the need of an appropriate long-term clinical and imaging follow-up of infection and post-vaccination events related to influenza A (H1N1) pdm09, to clearly estimate the magnitude of neurological complications leading to permanent disability.
Collapse
Affiliation(s)
- Graciela Cárdenas
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - José Luis Soto-Hernández
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Alexandra Díaz-Alba
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Yair Ugalde
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Jorge Mérida-Puga
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Marcos Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de MéxicoMexico City, Mexico
| | - Edda Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de MéxicoMexico City, Mexico
| |
Collapse
|
23
|
Brogan TV, Hall M, Sills MR, Fieldston ES, Simon HK, Mundorff MB, Fagbuyi DB, Shah SS. Hospital Readmissions Among Children With H1N1 Influenza Infection. Hosp Pediatr 2014; 4:348-58. [PMID: 25362076 DOI: 10.1542/hpeds.2014-0045] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe readmissions among children hospitalized with H1N1 (influenza subtype, hemagglutinin1, neuraminidase 1) pandemic influenza and secondarily to determine the association of oseltamivir during index hospitalization with readmission. METHODS We reviewed data from 42 freestanding children's hospitals contributing to the Pediatric Health Information System from May through December 2009 when H1N1 was the predominant influenza strain. Children were divided into 2 groups by whether they experienced complications of influenza during index hospitalization. Primary outcome was readmission at 3, 7, and 30 days among both patient groups. Secondary outcome was the association of oseltamivir treatment with readmission. RESULTS The study included 8899 children; 6162 patients had uncomplicated index hospitalization, of whom 3808 (61.8%) received oseltamivir during hospitalization, and 2737 children had complicated influenza, of whom 1055 (38.5%) received oseltamivir. Median 3-, 7-, and 30-day readmission rates were 1.6%, 2.5%, and 4.7% for patients with uncomplicated index hospitalizations and 4.3%, 5.8%, and 10.3% among patients with complicated influenza. The 30-day readmission rates did not differ by treatment group among patients with uncomplicated influenza; however, patients with complicated index hospitalizations who received oseltamivir had lower all-cause 30-day readmissions than untreated patients. The most common causes of readmission were pneumonia and asthma exacerbations. CONCLUSIONS Oseltamivir use for hospitalized children did not decrease 30-day readmission rates in children after uncomplicated index hospitalization but was associated with a lower 30-day readmission rate among children with complicated infections during the 2009 H1N1 pandemic. Readmission rates for children who had complicated influenza infection during index hospitalizations are high.
Collapse
Affiliation(s)
- Thomas V Brogan
- Seattle Children's Hospital, and Department of Pediatrics, Division of Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Matthew Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Marion R Sills
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Evan S Fieldston
- Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harold K Simon
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michael B Mundorff
- Department of Systems Improvement, Children's Primary Hospital, Salt Lake City, Utah
| | - Daniel B Fagbuyi
- The George Washington University School of Medicine, and Children's National Medical Center, Washington, District of Columbia
| | - Samir S Shah
- Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio Department of Pediatrics and Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
24
|
Ergönül Ö, Alan S, Ak Ö, Sargın F, Kantürk A, Gündüz A, Engin D, Öncül O, Balkan II, Ceylan B, Benzonana N, Yazıcı S, Şimşek F, Uzun N, Inan A, Gulhan E, Ciblak M, Midilli K, Ozyurt M, Badur S, Gencer S, Nazlıcan O, Özer S, Özgüneş N, Yıldırmak T, Aslan T, Göktaş P, Saltoğlu N, Fincancı M, Dokucu AI, Eraksoy H. Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults. BMC Infect Dis 2014; 14:317. [PMID: 24916566 PMCID: PMC4080987 DOI: 10.1186/1471-2334-14-317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/03/2014] [Indexed: 11/22/2022] Open
Abstract
Background The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. Methods This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. Results In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality. Conclusions Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.
Collapse
Affiliation(s)
- Önder Ergönül
- Department of Infectious Diseases and Clinical Microbiology, Koç University, School of Medicine, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Redlberger-Fritz M, Hirk S, Buchinger D, Haberl R, Hell M, Perkmann-Nagele N, Kundi M, Popow-Kraupp T. Distinct differences in clinical manifestation and viral laboratory parameters between children and adults with influenza A(H1N1)pdm09 infection--a retrospective comparative analysis. J Med Virol 2014; 86:1048-55. [PMID: 24615722 DOI: 10.1002/jmv.23912] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 01/24/2023]
Abstract
During the influenza pandemic 2009 children and adults differed in the clinical course of the influenza disease. In following the question arose, if the case definitions used within the national and international organizations are an adequate tool for the clinical diagnosis of influenza in children as well as in adults. Therefore medical charts from 146 children and 229 adults were retrospectively analyzed. In addition, the initial viral loads of all 375 patients and the duration of virus shedding of a subset of 79 patients were also investigated. Children show a wider clinical spectrum including gastro enteric symptoms and also a different spectrum of laboratory parameters like elevated CRP-levels, leucocytosis, and higher viral loads. Further, children show significantly more often complications, for example, myositis that may be underdiagnosed. In patients receiving antiviral-therapy complications occurred significantly less often and the presence of symptoms was significantly shorter compared to the untreated group (2.3 days vs. 6.0 days). In summary, the differences in the clinical picture between children and adults should be taken into consideration for the clinical diagnosis of influenza and also for a future discussion on age specific influenza case definitions.
Collapse
|
26
|
Sheng Z, Ran Z, Wang D, Hoppe AD, Simonson R, Chakravarty S, Hause BM, Li F. Genomic and evolutionary characterization of a novel influenza-C-like virus from swine. Arch Virol 2014; 159:249-55. [PMID: 23942954 PMCID: PMC5714291 DOI: 10.1007/s00705-013-1815-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
Abstract
We recently described the isolation of a novel influenza virus from swine exhibiting respiratory disease in the United States that is distantly related to human influenza C virus. Based on genetic, biochemical and morphological analysis, the virus was provisionally classified as C/swine/Oklahoma/1334/2011 (C/OK). To further understand the genetics and evolution of this novel pathogen, we performed a comprehensive analysis of its sequence and phylogeny. The results demonstrated that C/OK and human influenza C viruses share a conserved array of predicted functional domains in the viral RNA genome replication and viral entry machinery but vary at key functional sites. Furthermore, our evolutionary analysis showed that homologous genes of C/OK and human influenza C viruses diverged from each other an estimated several hundred to several thousand years ago. Taken together, the findings described in this study support and extend our previous observations that C/OK is a genetically and evolutionarily distinct influenza virus in the family Orthomyxoviridae.
Collapse
Affiliation(s)
- Zizhang Sheng
- Department of Chemistry and Biochemistry, South Dakota State University, Brookings, SD, 57007, USA
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Purakayastha DR, Gupta V, Broor S, Sullender W, Fowler K, Widdowson MA, Lal RB, Krishnan A. Clinical differences between influenza A (H1N1) pdm09 & influenza B infections identified through active community surveillance in North India. Indian J Med Res 2013; 138:962-8. [PMID: 24521643 PMCID: PMC3978989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND & OBJECTIVES Most studies on the clinical presentation with influenza viruses have been conducted in outpatient or inpatient medical facilities with only a few studies in community settings. Clinical differences between influenza A (H1N1) pdm 09 and influenza B virus infections have importance for community-based public health surveillance. An active community surveillance at the time of emergence of pandemic influenza provided us with an opportunity to compare the clinical features among patients infected with influenza A (H1N1) pdm09 virus and those with influenza B virus co-circulating in an active community-based weekly surveillance in three villages in Faridabad, Haryana, north India. METHODS Active surveillance for febrile acute respiratory infection (FARI) was carried out in a rural community (n=16,182) in the context of an inactivated trivalent influenza vaccine trial (among children <11 yr). Individuals with FARI were assessed clinically by nurses and respiratory samples collected and tested for influenza viruses by real time RT-PCR from November 2009 to August 2010. Clinical symptoms of patients with influenza A (H1N1) pdm 09 and influenza B infection were compared. RESULTS Of the 4796 samples tested, 822 (17%) were positive for influenza virus. Of these, 443 (54%) were influenza A (H1N1) pdm09, 373 (45%) were influenza B and six were other subtypes/mixed infections. The mean age was lower for patients with influenza B (16.4 yr) than influenza A (H1N1) pdm09 infection (18.7 yr; P=0.04). Among children aged 5-18 yr, chills/rigours (OR 4.0; CI 2.2, 7.4), sore throat (OR 6.8; CI 2.3, 27.3) and headache (OR2.0; CI 1.3, 3.3) were more common in influenza A (H1N1) pdm09 infection than in influenza B cases. Chills/rigours (OR 2.4; CI 1.4, 4.0) and headache (OR 1.7; CI 1.0, 2.7) were associated with influenza A (H1N1) pdm09 infection in those >18 yr. No significant differences were seen in children <5 yr. CONCLUSION Our findings show that the differences in the clinical presentation of influenza A(H1N1)pdm09 and influenza B infections are not likely to be of clinical or public health significance.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Anand Krishnan
- Department of Microbiology, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
28
|
Adverse event analysis in fatal cases of influenza A (H1N1) - a lesson from Poland. J Forensic Leg Med 2013; 20:1131-4. [PMID: 24237836 DOI: 10.1016/j.jflm.2013.09.012] [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: 03/07/2013] [Revised: 09/16/2013] [Accepted: 09/23/2013] [Indexed: 11/21/2022]
Abstract
During pandemic of influenza A (H1N1) in 2009 the relationship between mortality and medical errors, especially delayed antiviral treatment initiation, was highlighted in many studies. Our study was based on 5 fatal cases of pandemic influenza A (H1N1) hospitalized in Poland between November 2009 and February 2011. The material included data from medical documentation as well as testimonies from medical personnel and patients' families recorded during on-going lawsuits alleging medical malpractice. The risk factors of adverse events were: lack of typical symptoms, lack of detailed medical history, clinical masking of a "trivial" illness, doctors' ignorance and insufficient knowledge, several physicians treating the same patient during hospitalization. Recommendations for improving management of pandemic infectious disease include: an effective, quick and detailed system of information about the epidemiological threat, clear indication of units with diagnostic and medical possibilities, rational health policy and national system of closed claims and adverse event analysis.
Collapse
|
29
|
Hoenigl M, Prattes J, Drescher M, Tovilo K, Seeber K, Kessler HH, Vander K, Palfner M, Meilinger M, Avian A, Valentin T, Zollner-Schwetz I, Strenger V, Krause R, Flick H. Comparison of clinical presentation and laboratory values at admission between PCR-confirmed influenza A H1N1 infection and influenza-like disease, South-East Austria. Infection 2013; 42:317-24. [PMID: 24190398 DOI: 10.1007/s15010-013-0549-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 10/24/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Reliable and rapid diagnosis of influenza A H1N1 is essential to initiate the appropriate antiviral therapy and preventive measures. As PCR assays are time-consuming and rapid antigen tests have a limited sensitivity, official influenza case definitions are used in many clinical settings. These, however, are based exclusively on clinical criteria and have only a moderate potential to differentiate between influenza and other febrile diseases. Only limited data on the differences in clinical and laboratory parameters between influenza and non-influenza febrile diseases are available to date. METHODS This was a retrospective case-negative control series that was conducted in Styria, southeast Austria. We analyzed the differences in clinical presentation and laboratory admission parameters between patients with PCR-confirmed H1N1 influenza infection (n = 199) and those with influenza-like disease and negative influenza PCR results (ILD group; n = 252). RESULTS In the multivariable analysis lower C-reactive protein (CRP) level, lower white blood cell (WBC) count, fever, wheezing, cough, and the absence of nausea or sudden onset remained significant predictors of H1N1 influenza in adult patients (n = 263). Lower CRP level, lower WBC count, and cough remained significant predictors in pediatric patients (<16 years; n = 188). CONCLUSION Lower CRP level, lower WBC count, and cough were significant predictors of H1N1 in both the adult and pediatric patient group. These data may help to develop an improved case definition for suspected H1N1 infection which combines clinical findings and easily available laboratory parameters.
Collapse
Affiliation(s)
- M Hoenigl
- Division of Pulmonology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Reuss A, Dehnert M, Buda S, Haas W. Differential use of antivirals for treatment of patients with influenza A(H1N1)pdm09 in Germany. Influenza Other Respir Viruses 2013; 7:1427-32. [PMID: 23957666 PMCID: PMC4634277 DOI: 10.1111/irv.12152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization recommends early antiviral treatment for patients with severe influenza illness or those at increased risk for severe illness. Objectives The aim of this study was to determine the proportion of cases with laboratory‐confirmed A(H1N1)pdm09 infection that have been treated with antivirals in Germany during the pandemic (H1N1) 2009 and to investigate factors associated with the use of antivirals. Methods We analyzed cases with laboratory‐confirmed A(H1N1)pdm09 infection notified to national health authorities in Germany between week 29/2009 and week 17/2010 using multivariable logistic regression. Severity of disease was defined by pneumonia or death. Results and conclusions Of 160 804 cases with laboratory‐confirmed A(H1N1)pdm09 infection, 22% were treated with antivirals. Cases with severe disease were more likely to be treated with antivirals than cases without severe disease (odds ratio = 1·66; 95% confidence interval: 1·46–1·89). In the group with at least one underlying medical condition, only children aged between 1 and 4 years had significant lower odds for receiving antiviral treatment compared with cases in the age group 15 to 49 years (odds ratio = 0·75; 95% confidence interval: 0·6–0·94). In conclusion, the implementation of international recommendations on use of antivirals differed according to the age of patients in Germany during the pandemic (H1N1) 2009. This indicates that the potential of antivirals to prevent severe influenza might not have been fully exhausted. The reasons leading to the observed differences in patient management need to be investigated.
Collapse
Affiliation(s)
- Annicka Reuss
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | | |
Collapse
|
31
|
Poeppl W, Poeppl G, Hunger M, Tobudic S, Winkler H, Faas A, Mooseder G, Burgmann H. Pre- and post-pandemic prevalence of antibodies to the 2009 pandemic influenza A (H1N1) virus in Austrian adults. J Med Virol 2012; 84:1331-4. [PMID: 22825809 DOI: 10.1002/jmv.23337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antibody prevalence to the 2009 pandemic influenza A (H1N1) virus was determined in a sample of the Austrian population to assess the post-pandemic seropositivity rate, the infection attack rate, and the proportion of subclinical infections during the 2009/2010 influenza pandemic in Austrian adults. A total of 480 sera from individuals aged between 18 and 57 years from all nine federal states of Austria were collected between April and June 2010. Information on demographic characteristics, vaccination history, and history of suspected or verified influenza virus infection was ascertained. Antibodies were determined using a commercial ELISA and compared with 80 age-matched adult sera collected before the pandemic began. The overall seropositivity rate was 28% and was highest among young adults aged 18-29 years, followed by adults aged 50-57 years. Among seropositive unvaccinated individuals, infection was asymptomatic in more than 80%. Extrapolation to the overall Austrian adult population indicates that more than 1.3 million persons aged 18-57 years became infected in 2009. Compared with the pre-pandemic seropositivity rate, the infection rate was highest among young adults but low in those aged 30-57 years. Among 69 individuals previously vaccinated with the 2009 pandemic influenza A (H1N1) virus, 71% had specific antibodies. The study demonstrates that infection rates based on surveillance of clinical cases considerably underestimated the infection attack rate during the 2009 H1N1 pandemic in Austria and that vaccination against this virus elicited long-lasting seropositivity in more than 70% of adults.
Collapse
Affiliation(s)
- W Poeppl
- Department of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Carbonara S, Bruno G, Ciaula GD, Pantaleo AD, Angarano G, Monno L. Limiting severe outcomes and impact on intensive care units of moderate-intermediate 2009 pandemic influenza: role of infectious diseases units. PLoS One 2012; 7:e42940. [PMID: 22905188 PMCID: PMC3419232 DOI: 10.1371/journal.pone.0042940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 07/16/2012] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The rate of severe outcomes of patients with 2009 pandemic (A/H1N1) influenza (2009pI) hospitalized in non-intensive care units (ICUs) has not been defined thus far. This study aims to assess the efficacy of the management of patients with influenza-like illness (ILI) of moderate intermediate severity in an infectious diseases unit (IDU) during the first wave of 2009pI and its influence on the burden of ICUs. METHODS All patients hospitalized from October 27, 2009, to February 5, 2010, with ILI were included in this prospective observational study. The IDU was organized and the staff was trained to provide intermediate care; patients were transferred to the ICU only if they required invasive ventilation, extracorporeal membrane oxygenation, or advanced cardiovascular support. Demographic data, clinical presentation, coexisting medical conditions, and laboratory and radiological findings were recorded and analyzed, as well as treatment and outcome data. RESULTS Overall, 108 patients (median age 36 years [IQR 27-54], 57.4% males) including 66.7% with ≥ 1 risk factor for severe influenza, 47.2% with confirmed 2009pI by RT-PCR and 63.9% with pneumonia, were enrolled in the study. All subjects received intravenous fluids and 83.3% were administered oseltamivir, 96.3% antibacterials, 19.4% oxygen therapy without ventilatory support, and 10.2% non-invasive ventilation. A total of 106 (98.1%) subjects were discharged after a 6-day median hospital stay [IQR 4-9]. Two patients (1.9%) were transferred to the ICU. There were no deaths. CONCLUSIONS These results suggest that the aggressive treatment of patients with moderate intermediate severity 2009 pandemic ILI in non-ICU wards may result in a low rate of severe outcomes and brief hospitalization. IDUs, if properly organized for intermediate care, may efficiently provide correct disease management, in addition to complying with infection control requirements, thus reducing the burden of the pandemic on ICUs. Further studies are warranted to evaluate the outcome of patients with moderate intermediate 2009pI in different non-ICU settings.
Collapse
Affiliation(s)
- Sergio Carbonara
- Clinic of Infectious Diseases, School of Medicine and Surgery, University of Bari, Bari, Italy.
| | | | | | | | | | | |
Collapse
|
33
|
Pandemic and post-pandemic influenza A (H1N1) seasons in a tertiary care university hospital-high rate of complications compared to previous influenza seasons. Infection 2012; 41:145-50. [PMID: 22886772 DOI: 10.1007/s15010-012-0310-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 07/20/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The aim was to study the characteristics and case severity of patients hospitalized for influenza with a pandemic strain at a German tertiary care university hospital in 2009/10 and 2010/11 and to compare them to two previous influenza seasons. METHODS An observational study of all patients hospitalized for laboratory-confirmed influenza during the last four influenza seasons at Regensburg University Hospital was undertaken. RESULTS During the last four seasons, a rising number of patients were admitted due to influenza (4 in 2007/8, 16 in 2008/9, 27 in 2009/10, and 55 in 2010/11). Patients seen in the last two seasons were younger (median age 63 years in 2007/8, 52 years in 2008/9, 42 years in 2009/10, and 48 years in 2010/11) (p = 0.046) and presented with a lower rate of major comorbidities (75 % in 2007/8, 62.5 % in 2008/9, 37 % in 2009/10, and 47.3 % in 2010/11). The pandemic and post-pandemic seasons were characterized by a high rate of seriously ill patients with longer hospitalizations (11 days in 2007/8, 7 days in 2008/9, 22 days in 2009/10 and 2010/11) (p = 0.004) and higher rates of intensive care unit (ICU) admission (25 % in 2007/8, 18.8 % in 2008/9, 66.7 % in 2009/10, and 52.7 % in 2010/11) (p = 0.003) and mechanical ventilation (25 % in 2007/8, 6.3 % in 2008/9, 63 % in 2009/10, and 49.1 % in 2010/11) (p < 0.001). Extracorporeal membrane oxygenation (ECMO) was necessary in 33.3 % of patients in 2009/10 and 25.5 % in 2010/11. We had six fatalities in both pandemic and post-pandemic seasons. CONCLUSION Compared to seasonal influenza, we observed even more so in the post-pandemic than the pandemic season a higher number of younger patients, with less serious comorbidities often showing a very severe course.
Collapse
|
34
|
Wieching A, Benser J, Kohlhauser-Vollmuth C, Weissbrich B, Streng A, Liese JG. Clinical characteristics of pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Northern Bavaria, Germany. BMC Res Notes 2012; 5:304. [PMID: 22713762 PMCID: PMC3438061 DOI: 10.1186/1756-0500-5-304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/18/2012] [Indexed: 11/24/2022] Open
Abstract
Background The 2009 pandemic influenza A (H1N1) (PIA) virus infected large parts of the pediatric population with a wide clinical spectrum and an initially unknown complication rate. The aims of our study were to define clinical characteristics and outcome of pandemic influenza A (H1N1) 2009-associated hospitalizations (PIAH) in children <18 years of age. All hospitalized cases of children <18 years of age with laboratory-confirmed pandemic influenza A (H1N1) 2009 in the region of Wuerzburg (Northern Bavaria, Germany) between July 2009 and March 2010 were identified. For these children a medical chart review was performed to determine their clinical characteristics and complications. Results Between July 2009 and March 2010, 94 PIAH (62% males) occurred in children <18 years of age, with a median age of 7 years (IQR: 3–12 years). Underlying diseases and predisposing factors were documented in 40 (43%) children; obesity (n = 12, 30%), asthma (n = 10, 25%) and neurologic disorders (n = 8, 20%) were most frequently reported. Sixteen (17%) children received oxygen supplementation; three (3%) children required mechanical ventilation. Six (6%) children were admitted to an intensive care unit, four of them with underlying chronic diseases. Conclusions Most PIAH demonstrated a benign course of disease. However, six children (6%) needed treatment at an intensive care unit for severe complications.
Collapse
Affiliation(s)
- Anna Wieching
- University Children's Hospital, Pediatric Infectiology and Immunology, Julius-Maximilians-University of Wuerzburg, Josef-Schneider-Str, 2, 97080, Wuerzburg, Germany
| | | | | | | | | | | |
Collapse
|
35
|
Al-Mahrezi A, Samir N, Al-Zakwani I, Al-Muharmi Z, Balkhair A, Al-Shafaee M. Clinical characteristics of influenza A H1N1 versus other influenza-like illnesses amongst outpatients attending a university health center in Oman. Int J Infect Dis 2012; 16:e504-7. [PMID: 22521779 DOI: 10.1016/j.ijid.2012.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 02/21/2012] [Accepted: 02/29/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify the clinical characteristics of outpatients with flu-like illnesses stratified by influenza A H1N1 status. METHODS The study was conducted at the H1N1 staff clinic of Sultan Qaboos University Hospital in Muscat, Oman. The population consisted of university students and university/hospital staff and their family members. All adult patients who presented to the H1N1 clinic with an influenza-like illness over a 4-month period (from August until the end of November 2009) were included. Real-time reverse transcriptase (rRT) PCR was used for the diagnosis of H1N1 influenza. Demographic data, clinical signs and symptoms, history of exposure to H1N1, history of recent travel, and co-morbid conditions were documented. Analyses were conducted using univariate and multivariate statistical techniques. RESULTS Out of the 2318 patients identified, 27% (n=616) were positive for H1N1 influenza. The mean temperature in the H1N1-positive group was significantly higher than in the negative group (38.3 °C vs. 37.2 °C; p<0.001). Proportions of patients who reported cough, sore throat, headache, myalgia, gastrointestinal symptoms, exposure to a confirmed case of H1N1, and a history of travel were significantly higher in the H1N1-positive group as compared to the swab-negative group. However, the multivariable logistic model identified only the following significant predictor variables of H1N1 infection: younger age, fever (≥ 37.8 °C), sore throat, myalgia, diarrhea, and exposure to a confirmed H1N1 case within the last 7 days. CONCLUSIONS This study provides useful data on the clinical characteristics of H1N1 influenza in a large outpatient population from the Middle East. Patients who tested positive for H1N1 were more likely to have fever, sore throat, diarrhea, and myalgia compared to those with other influenza-like illnesses.
Collapse
Affiliation(s)
- Abdulaziz Al-Mahrezi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, PO Box 38, PC 123, Al-Khod, Muscat, Oman.
| | | | | | | | | | | |
Collapse
|
36
|
Nachtnebel M, Greutelaers B, Falkenhorst G, Jorgensen P, Dehnert M, Schweiger B, Träder C, Buda S, Eckmanns T, Wichmann O, Hellenbrand W. Lessons from a one-year hospital-based surveillance of acute respiratory infections in Berlin- comparing case definitions to monitor influenza. BMC Public Health 2012; 12:245. [PMID: 22452874 PMCID: PMC3362781 DOI: 10.1186/1471-2458-12-245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 03/27/2012] [Indexed: 12/19/2022] Open
Abstract
Background Surveillance of severe acute respiratory infections (SARI) in sentinel hospitals is recommended to estimate the burden of severe influenza-cases. Therefore, we monitored patients admitted with respiratory infections (RI) in 9 Berlin hospitals from 7.12.2009 to 12.12.2010 according to different case definitions (CD) and determined the proportion of cases with influenza A(H1N1)pdm09 (pH1N1). We compared the sensitivity and specificity of CD for capturing pandemic pH1N1 cases. Methods We established an RI-surveillance restricted to adults aged ≤ 65 years within the framework of a pH1N1 vaccine effectiveness study, which required active identification of RI-cases. The hospital information-system was screened daily for newly admitted RI-patients. Nasopharyngeal swabs from consenting patients were tested by PCR for influenza-virus subtypes. Four clinical CD were compared in terms of capturing pH1N1-positives among hospitalized RI-patients by applying sensitivity and specificity analyses. The broadest case definition (CD1) was used for inclusion of RI-cases; the narrowest case definition (CD4) was identical to the SARI case definition recommended by ECDC/WHO. Results Over the study period, we identified 1,025 RI-cases, of which 283 (28%) met the ECDC/WHO SARI case definition. The percentage of SARI-cases among internal medicine admissions decreased from 3.2% (calendar-week 50-2009) to 0.2% (week 25-2010). Of 354 patients tested by PCR, 20 (6%) were pH1N1-positive. Two case definitions narrower than CD1 but -in contrast to SARI- not requiring shortness of breath yielded the largest areas under the Receiver-Operator-Curve. Heterogeneity of proportions of patients admitted with RI between hospitals was significant. Conclusions Comprehensive surveillance of RI cases was feasible in a network of community hospitals. In most settings, several hospitals should be included to ensure representativeness. Although misclassification resulting from failure to obtain symptoms in the hospital information-system cannot be ruled out, a high proportion of hospitalized PCR-positive pH1N1-patients (45%) did not fulfil the SARI case-definition that included shortness of breath or difficulty breathing. Thus, to assess influenza-related disease burden in hospitals, broader, alternative case definitions should be considered.
Collapse
Affiliation(s)
- Matthias Nachtnebel
- Department of Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, Berlin 13086, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Stupica D, Lusa L, Petrovec M, Zigon N, Jevšnik M, Bogovič P, Strle F. Respiratory viruses in patients and employees in an intensive care unit. Infection 2012; 40:381-8. [PMID: 22350959 PMCID: PMC7099890 DOI: 10.1007/s15010-012-0245-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 02/04/2012] [Indexed: 01/16/2023]
Abstract
Purpose To evaluate the frequency of respiratory viruses in a nonselected population of intensive care unit patients and employees and to investigate the clinical as well as the epidemiological association with virological findings. Methods Between 12 January and 5 March 2009, nasopharyngeal swabs were collected from 55 intensive care unit (ICU) patients and 41 medical personnel at 16 different time-points and tested for 11 respiratory viruses by single real-time PCR using TaqMan or MGB probes. Results Among the 55 ICU patients tested, there were 30 virus-positive respiratory specimens (30/173, 17.3%) and 23 patients who tested positive at least once for respiratory viruses (23/55, 41.8%). Only the time from admission to the ICU was associated with the probability of testing positive, with the probability of testing positive decreasing with increasing length of stay (P < 0.001). Of the 418 respiratory specimens collected from the healthcare personnel, 27 (6.5%) tested positive. Seventeen employees tested positive at least once for respiratory viruses (17/41, 41.5%). Among the employees, calendar time (P = 0.03) and having sick contacts at home (P = 0.006) were significantly associated with swab positivity. Among the study population, patients had a significantly higher probability of having a positive swab result than employees. The distribution of viruses differed between the two groups. Conclusions Our results suggest that when hygiene precautions are adopted, the possibility of transmitting selected respiratory viruses between patients and personnel is limited. They also point to a greater importance of the community over the hospital environment for acquisition of viral respiratory infections by ICU patients and employees. Electronic supplementary material The online version of this article (doi:10.1007/s15010-012-0245-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- D Stupica
- Department of Infectious Diseases, University Medical Center Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia.
| | | | | | | | | | | | | |
Collapse
|
38
|
Shin DH, Han SK, Choi PC, Woo HY. Conventional blood tests in predicting influenza A (H1N1) rapidly. Scandinavian Journal of Clinical and Laboratory Investigation 2011; 72:197-203. [DOI: 10.3109/00365513.2011.634022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Hee-Yeon Woo
- Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine,
Seoul, Korea
| |
Collapse
|
39
|
Yang JR, Huang YP, Chang FY, Hsu LC, Lin YC, Su CH, Chen PJ, Wu HS, Liu MT. New variants and age shift to high fatality groups contribute to severe successive waves in the 2009 influenza pandemic in Taiwan. PLoS One 2011; 6:e28288. [PMID: 22140569 PMCID: PMC3227656 DOI: 10.1371/journal.pone.0028288] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/04/2011] [Indexed: 01/26/2023] Open
Abstract
Past influenza pandemics have been characterized by the signature feature of multiple waves. However, the reasons for multiple waves in a pandemic are not understood. Successive waves in the 2009 influenza pandemic, with a sharp increase in hospitalized and fatal cases, occurred in Taiwan during the winter of 2010. In this study, we sought to discover possible contributors to the multiple waves in this influenza pandemic. We conducted a large-scale analysis of 4703 isolates in an unbiased manner to monitor the emergence, dominance and replacement of various variants. Based on the data from influenza surveillance and epidemic curves of each variant clade, we defined virologically and temporally distinct waves of the 2009 pandemic in Taiwan from May 2009 to April 2011 as waves 1 and 2, an interwave period and wave 3. Except for wave 3, each wave was dominated by one distinct variant. In wave 3, three variants emerged and co-circulated, and formed distinct phylogenetic clades, based on the hemagglutinin (HA) genes and other segments. The severity of influenza was represented as the case fatality ratio (CFR) in the hospitalized cases. The CFRs in waves 1 and 2, the interwave period and wave 3 were 6.4%, 5.1%, 15.2% and 9.8%, respectively. The results highlight the association of virus evolution and variable influenza severity. Further analysis revealed that the major affected groups were shifted in the waves to older individuals, who had higher age-specific CFRs. The successive pandemic waves create challenges for the strategic preparedness of health authorities and make the pandemic uncertain and variable. Our findings indicate that the emergence of new variants and age shift to high fatality groups might contribute potentially to the occurrence of successive severe pandemic waves and offer insights into the adjustment of national responses to mitigate influenza pandemics.
Collapse
Affiliation(s)
- Ji-Rong Yang
- Centers for Disease Control, Taipei, Taiwan, ROC
| | | | | | - Li-Ching Hsu
- Centers for Disease Control, Taipei, Taiwan, ROC
| | - Yu-Cheng Lin
- Centers for Disease Control, Taipei, Taiwan, ROC
| | - Chun-Hui Su
- Centers for Disease Control, Taipei, Taiwan, ROC
| | - Pei-Jer Chen
- College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Ho-Sheng Wu
- Centers for Disease Control, Taipei, Taiwan, ROC
- School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan, ROC
- * E-mail: (HSW); (MTL)
| | - Ming-Tsan Liu
- Centers for Disease Control, Taipei, Taiwan, ROC
- * E-mail: (HSW); (MTL)
| |
Collapse
|