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Antonelli Incalzi R, Consoli A, Lopalco P, Maggi S, Sesti G, Veronese N, Volpe M. Influenza vaccination for elderly, vulnerable and high-risk subjects: a narrative review and expert opinion. Intern Emerg Med 2024; 19:619-640. [PMID: 37891453 PMCID: PMC11039544 DOI: 10.1007/s11739-023-03456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Influenza is associated with a substantial health burden, especially in high-risk subjects such as older adults, frail individuals and those with underlying chronic diseases. In this review, we summarized clinical findings regarding the impact of influenza in vulnerable populations, highlighted the benefits of influenza vaccination in preventing severe illness and complications and reviewed the main evidence on the efficacy, effectiveness and safety of the vaccines that are best suited to older adults among those available in Italy. The adverse outcomes associated with influenza infection in elderly and frail subjects and those with underlying chronic diseases are well documented in the literature, as are the benefits of vaccination (mostly in older adults and in patients with cardiovascular diseases, diabetes and chronic lung disease). High-dose and adjuvanted inactivated influenza vaccines were specifically developed to provide enhanced immune responses in older adults, who generally have low responses mainly due to immunosenescence, comorbidities and frailty. These vaccines have been evaluated in clinical studies and systematic reviews by international immunization advisory boards, including the European Centre for Disease Prevention and Control. The high-dose vaccine is the only licensed influenza vaccine to have demonstrated greater efficacy versus a standard-dose vaccine in preventing laboratory-confirmed influenza in a randomized controlled trial. Despite global recommendations, the vaccination coverage in high-risk populations is still suboptimal. All healthcare professionals (including specialists) have an important role in increasing vaccination rates.
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Affiliation(s)
- Raffaele Antonelli Incalzi
- Gerontology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Pierluigi Lopalco
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Stefania Maggi
- Institute of Neuroscience-Aging Branch, National Research Council, Padua, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Rome, Italy.
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome and IRCCS San Raffaele, Rome, Italy
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Aleem MA, Macintyre CR, Rahman B, Islam AKMM, Akhtar Z, Chowdhury F, Qadri F, Chughtai AA. Association of recent respiratory illness and influenza with acute myocardial infarction among the Bangladeshi population: A case-control study. Epidemiol Infect 2023; 151:e204. [PMID: 38031480 PMCID: PMC10753452 DOI: 10.1017/s0950268823001863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/25/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023] Open
Abstract
Current evidence suggests that recent acute respiratory infections and seasonal influenza may precipitate acute myocardial infarction (AMI). This study examined the potential link between recent clinical respiratory illness (CRI) and influenza, and AMI in Bangladesh. Conducted during the 2018 influenza season at a Dhaka tertiary-level cardiovascular (CV) hospital, it included 150 AMI cases and two control groups: 44 hospitalized cardiac patients without AMI and 90 healthy individuals. Participants were matched by gender and age groups. The study focused on self-reported CRI and laboratory-confirmed influenza ascertained via quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) within the preceding week, analyzed using multivariable logistic regression. Results showed that cases reported CRI, significantly more frequently than healthy controls (27.3% vs. 13.3%, adjusted odds ratio (aOR): 2.21; 95% confidence interval (CI): 1.05-4.06), although this was not significantly different from all controls (27.3% vs. 22.4%; aOR: 1.19; 95% CI: 0.65-2.18). Influenza rates were insignificantly higher among cases than controls. The study suggests that recent respiratory illnesses may precede AMI onset among Bangladeshi patients. Infection prevention and control practices, as well as the uptake of the influenza vaccine, may be advocated for patients at high risk of acute CV events.
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Affiliation(s)
- Mohammad Abdul Aleem
- School of Population Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
- Program for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - C. Raina Macintyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Bayzidur Rahman
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - A. K. M. Monwarul Islam
- Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh
| | - Zubair Akhtar
- Program for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Fahmida Chowdhury
- Program for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Firdausi Qadri
- Respiratory and Enteric Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Abrar Ahmad Chughtai
- School of Population Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
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Bednarz K, Goniewicz K, Al-Wathinani AM, Goniewicz M. Emergency Medicine Perspectives: The Importance of Bystanders and Their Impact on On-Site Resuscitation Measures and Immediate Outcomes of Out-of-Hospital Cardiac Arrest. J Clin Med 2023; 12:6815. [PMID: 37959280 PMCID: PMC10650602 DOI: 10.3390/jcm12216815] [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: 08/31/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrests (OHCAs) represent critical medical emergencies in which timely interventions can make a significant difference in patient outcomes. Despite their importance, the role of on-scene witnesses during such events remains relatively unexplored. AIM OF THE STUDY This research seeks to shed light on the influence of witnesses, especially family members, during OHCAs and the effect of their interventions, or the absence thereof, on outcomes. Drawing from existing literature, our working hypothesis suggests that the presence of a witness, particularly one who is knowledgeable about CPR, can increase the likelihood of obtaining the return of spontaneous circulation (ROSC), potentially enhancing overall survival rates. METHODS Using a retrospective analytical method, we thoroughly reviewed medical records from the Lublin Voivodeship between 2014-2017. Out of 5111 events identified using ICD-10 diagnosis codes and ICD-9 medical procedure codes, 4361 cases specifically related to sudden cardiac arrest were chosen. Concurrently, 750 events were excluded based on predefined criteria. RESULTS Both basic and advanced EMS teams showed higher rates of CPR initiation and an increased likelihood of obtaining ROSC. Notably, the presence of a trained EMS professional as a witness significantly increased the chances of CPR initiation. The presenting rhythms most often detected were ventricular tachycardia (VT) and ventricular fibrillation (VF). Different urgency codes were directly linked to varying ROSC outcomes. When witnesses, especially family members, began chest compressions, the use of amiodarone was notably higher. A significant finding was that 46.85% of OHCA patients died without witnesses, while family members were present in 23.87% of cases. Actions taken by witnesses, especially chest compressions, generally extended the overall duration of patient care. CONCLUSION The crucial influence of witnesses, particularly family members, on OHCA outcomes is evident. Therefore, it is essential to increase public awareness of CPR techniques and rapid intervention strategies to improve outcomes in emergency situations.
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Affiliation(s)
- Kamil Bednarz
- Department of Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland;
| | | | - Ahmed M. Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland;
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Williams N. Prehospital Cardiac Arrest Should be Considered When Evaluating Coronavirus Disease 2019 Mortality in the United States. Methods Inf Med 2023; 62:100-109. [PMID: 36652957 PMCID: PMC10462431 DOI: 10.1055/a-2015-1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Public health emergencies leave little time to develop novel surveillance efforts. Understanding which preexisting clinical datasets are fit for surveillance use is of high value. Coronavirus disease 2019 (COVID-19) offers a natural applied informatics experiment to understand the fitness of clinical datasets for use in disease surveillance. OBJECTIVES This study evaluates the agreement between legacy surveillance time series data and discovers their relative fitness for use in understanding the severity of the COVID-19 emergency. Here fitness for use means the statistical agreement between events across series. METHODS Thirteen weekly clinical event series from before and during the COVID-19 era for the United States were collected and integrated into a (multi) time series event data model. The Centers for Disease Control and Prevention (CDC) COVID-19 attributable mortality, CDC's excess mortality model, national Emergency Medical Services (EMS) calls, and Medicare encounter level claims were the data sources considered in this study. Cases were indexed by week from January 2015 through June of 2021 and fit to Distributed Random Forest models. Models returned the variable importance when predicting the series of interest from the remaining time series. RESULTS Model r2 statistics ranged from 0.78 to 0.99 for the share of the volumes predicted correctly. Prehospital data were of high value, and cardiac arrest (CA) prior to EMS arrival was on average the best predictor (tied with study week). COVID-19 Medicare claims volumes can predict COVID-19 death certificates (agreement), while viral respiratory Medicare claim volumes cannot predict Medicare COVID-19 claims (disagreement). CONCLUSION Prehospital EMS data should be considered when evaluating the severity of COVID-19 because prehospital CA known to EMS was the strongest predictor on average across indices.
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Affiliation(s)
- Nick Williams
- National Library of Medicine, Lister Hill National Center for Biomedical Communications, Bethesda, Maryland, United States
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Kim P, Coleman B, Kwong JC, Plevneshi A, Hassan K, Green K, McNeil SA, Armstrong I, Gold WL, Gubbay J, Katz K, Kuster SP, Lovinsky R, Matukas L, Ostrowska K, Richardson D, McGeer A. Burden of Severe Illness Associated With Laboratory-Confirmed Influenza in Adults Aged 50-64 Years, 2010-2011 to 2016-2017. Open Forum Infect Dis 2022; 10:ofac664. [PMID: 36632417 PMCID: PMC9830541 DOI: 10.1093/ofid/ofac664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background Understanding the burden of influenza is necessary to optimize recommendations for influenza vaccination. We describe the epidemiology of severe influenza in 50- to 64-year-old residents of metropolitan Toronto and Peel region, Canada, over 7 influenza seasons. Methods Prospective population-based surveillance for hospitalization associated with laboratory-confirmed influenza was conducted from September 2010 to August 2017. Conditions increasing risk of influenza complications were as defined by Canada's National Advisory Committee on Immunization. Age-specific prevalence of medical conditions was estimated using Ontario health administrative data. Population rates were estimated using Statistics Canada data. Results Over 7 seasons, 1228 hospitalizations occurred in patients aged 50-64 years: 40% due to A(H3N2), 30% A(H1N1), and 22% influenza B. The average annual hospitalization rate was 15.6, 20.9, and 33.2 per 100 000 in patients aged 50-54, 55-59, and 60-64 years, respectively; average annual mortality was 0.9/100 000. Overall, 33% of patients had received current season influenza vaccine; 963 (86%) had ≥1 underlying condition increasing influenza complication risk. The most common underlying medical conditions were chronic lung disease (38%) and diabetes mellitus (31%); 25% of patients were immunocompromised. The average annual hospitalization rate was 6.1/100 000 in those without and 41/100 000 in those with any underlying condition, and highest in those with renal disease or immunocompromise (138 and 281 per 100 000, respectively). The case fatality rate in hospitalized patients was 4.4%; median length of stay was 4 days (interquartile range, 2-8 days). Conclusions The burden of severe influenza in 50- to 64-year-olds remains significant despite our universal publicly funded vaccination program. These data may assist in improving estimates of the cost-effectiveness of new strategies to reduce this burden.
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Affiliation(s)
- Philip Kim
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Brenda Coleman
- Department of Microbiology, Sinai Health System, Toronto, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Canada,ICES, Toronto, Canada,Public Health Ontario, Toronto, Canada
| | - Agron Plevneshi
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Kazi Hassan
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Karen Green
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Shelly A McNeil
- Department of Medicine, Dalhousie University, Halifax, Canada
| | | | - Wayne L Gold
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada,Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Larissa Matukas
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada,Division of Microbiology, Unity Health, Toronto, Canada
| | | | - David Richardson
- Department of Medical Microbiology and Infectious Diseases, William Osler Health System, Brampton, Canada
| | - Allison McGeer
- Correspondence: Allison McGeer, Mount Sinai Hospital, 600 University Ave, Room 171, Toronto, ON, Canada M5G 1X5 ()
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Influenza virus and cardiovascular death: Looking through and beyond myocardial injury. Int J Cardiol 2022; 368:70-71. [PMID: 35988672 DOI: 10.1016/j.ijcard.2022.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022]
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