1
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Kumova OK, Galani IE, Rao A, Johnson H, Triantafyllia V, Matt SM, Pascasio J, Gaskill PJ, Andreakos E, Katsikis PD, Carey AJ. Severity of neonatal influenza infection is driven by type I interferon and oxidative stress. Mucosal Immunol 2022; 15:1309-1320. [PMID: 36352099 PMCID: PMC9724789 DOI: 10.1038/s41385-022-00576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/26/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
Neonates exhibit increased susceptibility to respiratory viral infections, attributed to inflammation at the developing pulmonary air-blood interface. IFN I are antiviral cytokines critical to control viral replication, but also promote inflammation. Previously, we established a neonatal murine influenza virus (IV) model, which demonstrates increased mortality. Here, we sought to determine the role of IFN I in this increased mortality. We found that three-day-old IFNAR-deficient mice are highly protected from IV-induced mortality. In addition, exposure to IFNβ 24 h post IV infection accelerated death in WT neonatal animals but did not impact adult mortality. In contrast, IFN IIIs are protective to neonatal mice. IFNβ induced an oxidative stress imbalance specifically in primary neonatal IV-infected pulmonary type II epithelial cells (TIIEC), not in adult TIIECs. Moreover, neonates did not have an infection-induced increase in antioxidants, including a key antioxidant, superoxide dismutase 3, as compared to adults. Importantly, antioxidant treatment rescued IV-infected neonatal mice, but had no impact on adult morbidity. We propose that IFN I exacerbate an oxidative stress imbalance in the neonate because of IFN I-induced pulmonary TIIEC ROS production coupled with developmentally regulated, defective antioxidant production in response to IV infection. This age-specific imbalance contributes to mortality after respiratory infections in this vulnerable population.
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Affiliation(s)
- Ogan K. Kumova
- Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Ioanna-Evdokia Galani
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Abhishek Rao
- Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Hannah Johnson
- Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Vasiliki Triantafyllia
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Stephanie M. Matt
- Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Judy Pascasio
- Pathology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Peter J. Gaskill
- Pharmacology and Physiology, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Evangelos Andreakos
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation Academy of Athens, Athens, Greece
| | - Peter D. Katsikis
- Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alison J. Carey
- Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, United States.,Pediatrics, Drexel University College of Medicine, Philadelphia, PA, United States
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2
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Hamdan L, Probst V, Haddadin Z, Rahman H, Spieker AJ, Vandekar S, Stewart LS, Williams JV, Boom JA, Munoz F, Englund JA, Selvarangan R, Staat MA, Weinberg GA, Azimi PH, Klein EJ, McNeal M, Sahni LC, Singer MN, Szilagyi PG, Harrison CJ, Patel M, Campbell AP, Halasa NB. Influenza clinical testing and oseltamivir treatment in hospitalized children with acute respiratory illness, 2015-2016. Influenza Other Respir Viruses 2022; 16:289-297. [PMID: 34704375 PMCID: PMC8818823 DOI: 10.1111/irv.12927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Antiviral treatment is recommended for all hospitalized children with suspected or confirmed influenza, regardless of their risk profile. Few data exist on adherence to these recommendations, so we sought to determine factors associated with influenza testing and antiviral treatment in children. METHODS Hospitalized children <18 years of age with acute respiratory illness (ARI) were enrolled through active surveillance at pediatric medical centers in seven cities between 11/1/2015 and 6/30/2016; clinical information was obtained from parent interview and chart review. We used generalized linear mixed-effects models to identify factors associated with influenza testing and antiviral treatment. RESULTS Of the 2299 hospitalized children with ARI enrolled during one influenza season, 51% (n = 1183) were tested clinically for influenza. Clinicians provided antiviral treatment for 61 of 117 (52%) patients with a positive influenza test versus 66 of 1066 (6%) with a negative or unknown test result. In multivariable analyses, factors associated with testing included neuromuscular disease (aOR = 5.35, 95% CI [3.58-8.01]), immunocompromised status (aOR = 2.88, 95% CI [1.66-5.01]), age (aOR = 0.93, 95% CI [0.91-0.96]), private only versus public only insurance (aOR = 0.78, 95% CI [0.63-0.98]), and chronic lung disease (aOR = 0.64, 95% CI [0.51-0.81]). Factors associated with antiviral treatment included neuromuscular disease (aOR = 1.86, 95% CI [1.04, 3.31]), immunocompromised state (aOR = 2.63, 95% CI [1.38, 4.99]), duration of illness (aOR = 0.92, 95% CI [0.84, 0.99]), and chronic lung disease (aOR = 0.60, 95% CI [0.38, 0.95]). CONCLUSION Approximately half of children hospitalized with influenza during the 2015-2016 influenza season were treated with antivirals. Because antiviral treatment for influenza is associated with better health outcomes, further studies of subsequent seasons would help evaluate current use of antivirals among children and better understand barriers for treatment.
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Affiliation(s)
- Lubna Hamdan
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Varvara Probst
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zaid Haddadin
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Herdi Rahman
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Andrew J. Spieker
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Simon Vandekar
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Laura S. Stewart
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - John V. Williams
- Pediatric Infectious Diseases, Institute for Infection, Inflammation, and Immunity in Children, University of Pittsburgh School of MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Julie A. Boom
- Primary Care Practice at Palm Center, Immunization Project, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Flor Munoz
- Pediatrics and Molecular Virology and Microbiology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Janet A. Englund
- Department of Pediatrics, Division of Infectious DiseasesSeattle Children's HospitalSeattleWashingtonUSA
| | | | - Mary A. Staat
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Geoffrey A. Weinberg
- Pediatric Infectious DiseasesUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Parvin H. Azimi
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Eileen J. Klein
- Department of Pediatrics, Division of Emergency MedicineSeattle Children's HospitalSeattleWashingtonUSA
| | - Monica McNeal
- Pediatric Infectious Diseases, University of Cincinnati College of MedicineCincinnati Children's Hospital and Medical CenterCincinnatiOhioUSA
| | - Leila C. Sahni
- Department of Pediatrics, Section of Hematology‐Oncology, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Monica N. Singer
- Pediatric Infectious DiseasesChildren's Hospital and Research CenterOaklandCaliforniaUSA
| | - Peter G. Szilagyi
- Department of PediatricsUniversity of California at Los Angeles Mattel Children's HospitalLos AngelesCaliforniaUSA
| | | | - Manish Patel
- National Center for Immunization and Respiratory Diseases, Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Angela P. Campbell
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Natasha B. Halasa
- Department of Pediatrics, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
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3
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Devrim İ, Böncüoğlu E, Kıymet E, Şahinkaya Ş, Çelebi MY, Cem E, Düzgöl M, Arıkan KÖ, Kara AA, Devrim F, Ağın H, Bayram N. Comparison of the pediatric hospitalizations due to COVID-19 and H1N1pdm09 virus infections during the pandemic period. J Med Virol 2022; 94:2055-2059. [PMID: 35023188 PMCID: PMC9015540 DOI: 10.1002/jmv.27589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/18/2021] [Accepted: 01/10/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND There are two major pandemics in the new millennium, including the pandemic of swine influenza, and the COVID-19 pandemic. These two pandemics affected children as well as the adult population. In this case-control study, we compared children with COVID-19 infection and those with H1N1pdm09 virus infection. METHODS In this case-control study, we compared the demographic factors, underlying disease, and the requirement for intensive care admission between the hospitalized children with COVID-19 infection and children with H1N1pdm09 virus infection who were hospitalized during the 2009 H1N1 pandemic. RESULTS In this study, we evaluated 103 patients with H1N1pdm09 virus infection and 392 patients with COVID-19 infection. The age was significantly higher in the COVID-19 patients' group compared to the pandemic influenza group (p<0.001). The ratio of the children ≥ 12 years was 10.7% (n = 11) in the H1N1pdm09 virus infection and 36.2% (n = 142) in the COVID-19 group. The rate of underlying disease was significantly higher in the patients with H1N1pdm09 virus infections (p = 0.02). The prevalence of underlying disease in patients requiring PICU hospitalization was 69.2% (n = 9/13) compared to 25.7% (n = 124/482) in patients who did not require PICU hospitalization. The rate of underlying disease was significantly higher in the PICU group regardless of COVID-19 or H1N1pdm09 virus (p = 0.002). CONCLUSION Our results suggest that older children were more hospitalized for COVID-19 infections compared to pandemic influenza. In addition, regardless of the type of pandemic infection, the underlying disease is an important factor for pediatric intensive care unit admission. This finding is important for developing strategies for the protection of children with the underlying disease in the upcoming pandemics. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- İlker Devrim
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Elif Böncüoğlu
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Elif Kıymet
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Şahika Şahinkaya
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Miray Yılmaz Çelebi
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Ela Cem
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey.,Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, Izmir, Turkey.,Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Intensive Care, Izmir, Turkey
| | - Mine Düzgöl
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Kamile Ötiken Arıkan
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Aybüke Akaslan Kara
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
| | - Fatma Devrim
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatrics, Izmir, Turkey
| | - Hasan Ağın
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Intensive Care, Izmir, Turkey
| | - Nuri Bayram
- Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Department of Pediatric Infectious Diseases, Izmir, Turkey
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4
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Öztelcan Gündüz B, Ataş E, Ünay B, Halil H. Evaluation of Influenza Patients Admitted in 2019–2020 Flu Season. J PEDIAT INF DIS-GER 2022. [DOI: 10.1055/s-0041-1741003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Objective Influenza viruses are among the most common respiratory pathogens for all age groups, and may cause seasonal outbreaks. The aim of our study was to describe the clinical characteristics of influenza cases in the 2019–2020 flu season and to study the risk factors for hospital admission and complications.
Methods This was a retrospective study in 251 children (group 1: nonhospitalized; group 2: hospitalized) with influenza in the 2019–2020 flu season. Data on demographic features, influenza type, complaints, complications, and hospitalization length were collected and recorded.
Results Influenza A was detected in 199 (79.3%) patients, and influenza B was detected in 52 (20.7%); 43.4% of patients were girls and 56.6% were boys. The mean age of the patients was 3.91 ± 3.3 years (16 days to 18 years). A total of 52 (20.7%) patients were hospitalized. The age of the patients in group 2 was lower than that in group 1 (3.1 vs. 4.2 years, p = 0.03). Group 2 patients were more likely to have creatine kinase (CK) elevation, febrile seizures, and physical examination abnormalities. Group 2 patients were also more likely to have influenza A. Patients with febrile seizures, chronic diseases, abnormal physical examination findings, developed complications, and additional drug use apart from oseltamivir in the treatment were also more likely to require hospitalization.
Conclusion Infants and children with chronic diseases, history of febrile seizures, complications, and the use of drugs other than antiviral drugs should be carefully evaluated in case they need hospitalization. Increasing vaccination rates, initiation of antiviral treatment for selected patients, and close monitoring of patients in risk groups can decrease morbidity and mortality. Myalgias are a common complaint in patients with acute influenza infection. Previous studies suggest CK measurement be part of the work-up for the hospitalized patient with acute influenza infection.
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Affiliation(s)
- Bahar Öztelcan Gündüz
- Department of Pediatrics, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erman Ataş
- Deparment of Pediatrics, Division of Pediatric Hematology and Oncology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Bülent Ünay
- Deparment of Pediatrics, Division of Pediatric Neurology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Halit Halil
- Deparment of Pediatrics, Division of Pediatric Emergency Medicine, University of Health Sciences, Dr Sami Ulus Training and Research Hospital, Ankara, Turkey
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5
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Althaqafi A, Farahat F, Alsaedi A, Alshamrani M, Alsaeed MS, AlhajHussein B, El-Kafrawy SA, Azhar EI. Molecular Detection of Influenza A and B Viruses in Four Consecutive Influenza Seasons 2015-16 to 2018-19 in a Tertiary Center in Western Saudi Arabia. J Epidemiol Glob Health 2021; 11:208-215. [PMID: 33969948 PMCID: PMC8242120 DOI: 10.2991/jegh.k.210427.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/02/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Influenza infection poses a significant public health threat. The core for disease prevention and control relies on strengthened surveillance activities, particularly in Saudi Arabia, the country that hosts the largest annual mass gathering event worldwide. This study aimed to assess the molecular and seasonal pattern of influenza virus subtypes in western Saudi Arabia to inform policy decisions on influenza vaccine. Methods: This cross-sectional study was conducted at King Abdulaziz Medical City, western Saudi Arabia. Medical records and surveillance database of laboratory-confirmed influenza cases were reviewed from October 2015 to 2019. A panel of real-time polymerase chain reactions was performed to detect influenza A and B. Extracted RNA from a subset of positive samples was used to determine influenza A subtypes and influenza B lineages. Results: This study included a total of 1928 patients with laboratory-confirmed influenza infections. Influenza peaks were observed in October each season, with variant predominant strains. Influenza virus subtypes co-circulate with no reports of co-infection. Influenza A(H3N2) was reported in 42% of the cases, then influenza B (30.7%) and influenza A(H1N1)pdm09 (27.3%). Healthcare workers represented 9.4% of the cases. One-third of the cases (30.4%) were admitted to the hospital with a median admission duration of 4 days. The influenza B viruses were subtyped in 218 cases. Victoria lineage was predominant (64.1%) in 2015 and 2016; however, Yamagata was predominant in the next two consecutive seasons (94.4% and 85.4%, respectively). Conclusion: The burden due to influenza B may be underestimated with an observed vaccine mismatch. A quadrivalent influenza vaccine is recommended to reduce the health impact associated with influenza B infections. Molecular surveillance of the influenza viruses should be enhanced continuously for a better understanding of the influenza activity and assessment of vaccine effectiveness.
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Affiliation(s)
- Abdulhakeem Althaqafi
- Department of Medicine, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Fayssal Farahat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Infection Prevention and Control, Ministry of National Guard - Health Affairs, Saudi Arabia
| | - Asim Alsaedi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Infection Prevention and Control, Ministry of National Guard - Health Affairs, Saudi Arabia
| | - Majid Alshamrani
- Department of Infection Prevention and Control, Ministry of National Guard - Health Affairs, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Moneerah S Alsaeed
- Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Baraa AlhajHussein
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Laboratory Medicine, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Sherif A El-Kafrawy
- Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
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6
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Teutsch SM, Zurynski YA, Nunez C, Lester-Smith D, Festa M, Booy R, Elliott EJ. Ten Years of National Seasonal Surveillance for Severe Complications of Influenza in Australian Children. Pediatr Infect Dis J 2021; 40:191-198. [PMID: 33093432 DOI: 10.1097/inf.0000000000002961] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Severe complications of influenza in children are uncommon but may result in admission to hospital or an intensive care unit (ICU) and death. METHODS Active prospective surveillance using the Australian Paediatric Surveillance Unit with monthly reporting by pediatricians of national demographic and clinical data on children with <15 years of age hospitalized with severe complications of laboratory-confirmed influenza during ten influenza seasons 2008-2017. RESULTS Of 722 children notified, 613 had laboratory-confirmed influenza and at least one severe complication. Most (60%) were <5 years of age; 10% were <6 months, hence ineligible for vaccination. Almost half of all cases were admitted to ICU and 30 died. Most children were previously healthy: 40.3% had at least one underlying medical condition. Sixty-five different severe complications were reported; pneumonia was the most common, occurring in over half of all cases. Influenza A accounted for 68.6% hospitalizations; however, influenza B was more often associated with acute renal failure (P = 0.014), rhabdomyolysis (P = 0.019), myocarditis (P = 0.015), pericarditis (P = 0.013), and cardiomyopathy (P = 0.035). Children who died were more likely to be older (5-14 years), have underlying medical conditions, be admitted to ICU, and have encephalitis, acute renal failure, or myocarditis. Only 36.1% of all children reported received antiviral medications, and 8.5% were known to be vaccinated for seasonal influenza. CONCLUSIONS Severe influenza complications cause morbidity and mortality in children, which may increase if coinfection with COVID-19 occurs in the 2020 season and beyond. Increased vaccination rates, even in healthy children, early diagnosis and timely antiviral treatment are needed to reduce severe complications and death.
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Affiliation(s)
- Suzy M Teutsch
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
| | - Yvonne A Zurynski
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
- NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University
| | - Carlos Nunez
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
| | - David Lester-Smith
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
| | - Marino Festa
- Kids Critical Care Research, The Children's Hospital at Westmead
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, Sydney, NSW, Australia
| | - Elizabeth J Elliott
- From the The Australian Paediatric Surveillance Unit, Kid's Research, Sydney Children's Hospitals Network, Westmead
- Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney
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7
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The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies. Int J Infect Dis 2021; 105:567-578. [PMID: 33647509 DOI: 10.1016/j.ijid.2021.02.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcomes are risk factors for neonatal mortality and morbidity. While some studies have demonstrated notable associations between influenza and adverse pregnancy outcomes, the findings have contrasted with other studies. This meta-analysis was conducted to assess the effect of influenza infection on pregnancy outcomes. METHODS We searched PubMed, Embase, Cochrane Library and Web of Science from inception to 4 November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects or fixed-effects models. RESULTS A total of 17 studies involving 2,351,204 participants were included. Influenza infection increased the risk of stillbirth (RR = 3.62, 95% CI: 1.60-8.20), with no significant effect on preterm birth (RR = 1.17, 95%CI: 0.95-1.45), fetal death (RR = 0.93, 95%CI: 0.73-1.18), small for gestational age (SGA) (RR = 1.10, 95%CI: 0.98-1.24) and low birth weight (LBW) (RR = 1.88, 95%CI: 0.46-7.66). In a subgroup analysis of LBW, the association was evident in studies conducted during the 2009 H1N1 pandemic (RR = 2.28, 95%CI: 1.81-2.87), with no evidence of an association in pre-pandemic or post-pandemic studies. CONCLUSIONS Influenza virus infection was associated with an increased risk of stillbirth, but its effect on preterm birth, fetal death, SGA and LBW is still uncertain.
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8
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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.
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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
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9
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Böncüoğlu E, Kıymet E, Çağlar İ, Tahta N, Bayram N, Ayhan FY, Genel F, Ecevit ÇÖ, Apa H, Çelik T, Devrim İ. Influenza-related hospitalizations due to acute lower respiratory tract infections in a tertiary care children's hospital in Turkey. J Clin Virol 2020; 128:104355. [PMID: 32464308 DOI: 10.1016/j.jcv.2020.104355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/28/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The influenza virus is a significant cause of acute lower respiratory tract infections (LRTI) requiring hospitalization in childhood and leads to severe morbidity and mortality, especially in certain risk groups. OBJECTIVES The study aims to evaluate acute LRTI due to influenza in a tertiary care hospital and the risk factors for hospitalization among Turkish children. STUDY DESIGN Children between 1 month and 18 years of age who were hospitalized at Dr. Behçet Uz Children's Hospital between January 2016 and March 2018 with lower respiratory tract infection that tested positive for influenza by PCR were included. Children with viral coinfections were excluded. Patient files were retrospectively scanned from the hospital computerized system in terms of age, underlying diseases, whether antiviral therapy was used, and length of hospital stay. Statistical analysis was performed using SPSS statistical software. RESULTS The study included 131 patients with a median age of 2 years (1 month-15 years). Sixty-seven (51,1%) patients were younger than two years. Influenza A was isolated in 129 patients and B in 2 patients. Fifty-two patients (39,7%) had underlying medical conditions, and the most common one was malignancies (12/52, 23%). This was followed by neurodevelopmental diseases (9/52, 17,3%), prematurity (9/52 patients, 17,3%), primary immunodeficiency (8/52, 15,4%), asthma (7/52, 13,4%), Down syndrome (4/52, 7,7%), chronic renal disease (2/52, 3,8%) and congenital heart diseases (1/52, 1,9%). The mean length of stay (LOS) was 12,3 ± 9,5 days (2-60 days). The LOS was found to be statistically longer (15,2 ± 12,1 days, 3-60 days) in patients with an underlying disease compared to previously healthy patients (10,4 ± 6,7 days, 2-35 days) (p = 0.01). CONCLUSIONS Hospitalization due to influenza-related acute LRTI is not an issue only for patients with an underlying medical condition. Vaccination should be considered not only for those with underlying medical conditions but also for healthy children.
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Affiliation(s)
- Elif Böncüoğlu
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey.
| | - Elif Kıymet
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - İlknur Çağlar
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Neryal Tahta
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Hematology and Oncology, İzmir, Turkey
| | - Nuri Bayram
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Fahri Yüce Ayhan
- Dr. Behçet Uz Children's Hospital, Department of Microbiology, İzmir, Turkey
| | - Ferah Genel
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Immunology, İzmir, Turkey
| | - Çiğdem Ömür Ecevit
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Gastroenterology, İzmir, Turkey
| | - Hurşit Apa
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Emergency Medicine, İzmir, Turkey
| | - Tanju Çelik
- Dr. Behçet Uz Children's Hospital, Department of Pediatrics, İzmir, Turkey
| | - İlker Devrim
- Dr. Behçet Uz Children's Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
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10
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Kohlmaier B, Svendova V, Walcher T, Pilch H, Krenn L, Kurz H, Zwiauer K, Zenz W. A severe influenza season in Austria and its impact on the paediatric population: mortality and hospital admission rates, november 2017 - march 2018. BMC Public Health 2020; 20:178. [PMID: 32019542 PMCID: PMC7001220 DOI: 10.1186/s12889-020-8239-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/20/2020] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In Austria paediatric influenza-associated hospitalisations and deaths have never been systematically monitored. We examined the influenza season 2017/18 in terms of hospitalisation and mortality in the Austrian paediatric population and put the results into perspective of the available data from the last 15 years. METHODS Cases of influenza-associated hospitalisations and deaths for season 2017/18 in children below 18 years were retrospectively collected from 12 and 33 Austrian hospitals, respectively. Hospitalisation and mortality rates for the whole Austrian paediatric population were estimated, adjusting for the population in each catchment area. Two Austrian databases were queried for hospitalisations and deaths associated with influenza during 2002-2016. Rough estimate of the vaccination coverage was calculated from a survey on 100 inpatients. RESULTS Influenza-related paediatric hospitalisation rate in season 2017/18 was estimated as 128 (CI: 122-135) per 100,000 children, much higher than the national average of 40 per 100,000 over the years 2002-2016. There were nine reported influenza-associated deaths among children, resulting in mortality rate of 0.67 (CI: 0.32-1.21) per 100,000 children. CONCLUSIONS Reported influenza-associated hospitalisations and fatalities demonstrate a high burden of influenza in the Austrian paediatric population corresponding with very low vaccination coverage.
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Affiliation(s)
- Benno Kohlmaier
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Vendula Svendova
- Department of General Paediatrics, Medical University of Graz, Graz, Austria.,Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Thomas Walcher
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Heidemarie Pilch
- Department of General Paediatrics, Medical University of Graz, Graz, Austria
| | - Larissa Krenn
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Kurz
- Department of Paediatrics and Adolescent Medicine, Social Medical Center East - Danube Hospital (SMZ-Ost), Vienna, Austria
| | - Karl Zwiauer
- Department of Paediatrics and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria
| | - Werner Zenz
- Department of General Paediatrics, Medical University of Graz, Graz, Austria.
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11
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Collins JP, Campbell AP, Openo K, Farley MM, Cummings CN, Kirley PD, Herlihy R, Yousey-Hindes K, Monroe ML, Ladisky M, Lynfield R, Baumbach J, Spina N, Bennett N, Billing L, Thomas A, Schaffner W, Price A, Garg S, Anderson EJ. Clinical Features and Outcomes of Immunocompromised Children Hospitalized With Laboratory-Confirmed Influenza in the United States, 2011-2015. J Pediatric Infect Dis Soc 2019; 8:539-549. [PMID: 30358877 DOI: 10.1093/jpids/piy101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Existing data on the clinical features and outcomes of immunocompromised children with influenza are limited. METHODS Data from the 2011-2012 through 2014-2015 influenza seasons were collected as part of the Centers for Disease Control and Prevention (CDC) Influenza Hospitalization Surveillance Network (FluSurv-NET). We compared clinical features and outcomes between immunocompromised and nonimmunocompromised children (<18 years old) hospitalized with laboratory-confirmed community-acquired influenza. Immunocompromised children were defined as those for whom ≥1 of the following applies: human immunodeficiency virus/acquired immunodeficiency syndrome, cancer, stem cell or solid organ transplantation, nonsteroidal immunosuppressive therapy, immunoglobulin deficiency, complement deficiency, asplenia, and/or another rare condition. The primary outcomes were intensive care admission, duration of hospitalization, and in-hospital death. RESULTS Among 5262 hospitalized children, 242 (4.6%) were immunocompromised; receipt of nonsteroidal immunosuppressive therapy (60%), cancer (39%), and solid organ transplantation (14%) were most common. Immunocompromised children were older than the nonimmunocompromised children (median, 8.8 vs 2.8 years, respectively; P < .001), more likely to have another comorbidity (58% vs 49%, respectively; P = .007), and more likely to have received an influenza vaccination (58% vs 39%, respectively; P < .001) and early antiviral treatment (35% vs 27%, respectively; P = .013). In multivariable analyses, immunocompromised children were less likely to receive intensive care (adjusted odds ratio [95% confidence interval], 0.31 [0.20-0.49]) and had a slightly longer duration of hospitalization (adjusted hazard ratio of hospital discharge [95% confidence interval], 0.89 [0.80-0.99]). Death was uncommon in both groups. CONCLUSIONS Immunocompromised children hospitalized with influenza received intensive care less frequently but had a longer hospitalization duration than nonimmunocompromised children. Vaccination and early antiviral use could be improved substantially. Data are needed to determine whether immunocompromised children are more commonly admitted with milder influenza severity than are nonimmunocompromised children.
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Affiliation(s)
- Jennifer P Collins
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Angela P Campbell
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kyle Openo
- Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
| | | | | | - Rachel Herlihy
- Colorado Department of Public Health and Environment, Denver
| | | | - Maya L Monroe
- Maryland Department of Health and Mental Hygiene, Baltimore
| | - Macey Ladisky
- Michigan Department of Health and Human Services, Lansing
| | | | | | | | | | | | | | | | - Andrea Price
- Salt Lake Valley Health Department, Salt Lake City, Utah
| | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Emerging Infections Program, Atlanta VA Medical Center, Atlanta, Georgia
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12
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Age-Stratified Risk of Critical Illness in Young Children Presenting to the Emergency Department with Suspected Influenza. J Pediatr 2019; 215:132-138.e2. [PMID: 31561954 DOI: 10.1016/j.jpeds.2019.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the risk of critical illness by age group among young children without a chronic condition presenting to the emergency department (ED) with suspected influenza. STUDY DESIGN Retrospective study of patients aged <2 years presenting to the ED with suspected influenza (defined by diagnostic codes for influenza or influenza-like illness) from 2009 to 2017 in 49 hospitals in the Pediatric Health Information System. Patients with chronic conditions were excluded. The main clinical outcomes were intensive care unit (ICU) admission, ventilatory support, vasopressor administration, and mortality, which were compared independently by age group (<3 months, 3 to <6 months, 6 to <12 months, and 12 to <24 months). To compare outcomes by age, we estimated the prevalence of each outcome by age group after fitting logistic regression models to control for demographic differences between groups. RESULTS A total of 55 986 children were studied. Overall admission and ICU admission rates were 20% and 2%, respectively. After adjustment for demographic variables, infants aged <3 months had higher rates of ICU admission (2.7%; 95% CI, 2.0%-3.3%; P < .001 compared with other age groups) and ventilatory support (2.5%; 95% CI, 1.9%-3.2%; P < .001 compared with other age groups); however, there were no differences in vasopressor administration. The overall case fatality rate was low (0.007%) and thus could not be compared across age groups. CONCLUSIONS Infants aged <3 months with suspected influenza are at greatest risk for critical illness. Although critical illness is uncommon, these findings should be incorporated into acute management decisions, including the need for specified outpatient follow-up or hospitalization, and public health efforts should focus on prevention and disease-modifying interventions in this high-risk population.
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13
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Rao S, Yanni E, Moss A, Lamb MM, Schuind A, Bekkat-Berkani R, Innis BL, Cotter J, Mistry RD, Asturias EJ. Evaluation of a New Clinical Endpoint for Moderate to Severe Influenza Disease in Children: A Prospective Cohort Study. J Pediatric Infect Dis Soc 2019; 9:460-467. [PMID: 31724050 PMCID: PMC7495912 DOI: 10.1093/jpids/piz075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/07/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND A moderate to severe (M/S) influenza clinical endpoint has been proposed in children, defined as fever >39°C, otitis media, lower respiratory tract infection, or serious extrapulmonary manifestations. The objective of the study was to evaluate the M/S measure against clinically relevant outcomes including hospitalization, emergency room visits, antimicrobial use, and child/parental absenteeism. METHODS We conducted a prospective observational study of children aged 6 months-8 years at the Children's Hospital Colorado emergency department (ED) and urgent care site during 2016-2017 and 2017-2018. Children with influenza-like illness (ILI) underwent influenza testing by polymerase chain reaction (PCR); children who tested positive and a subset of matched test-negative controls underwent follow-up at 2 weeks. The primary outcome was the proportion of children who were hospitalized. Secondary outcomes included recurrent ED visits, antimicrobial use, hospital charges, and child/parental absenteeism within 14 days. RESULTS Among 1478 children enrolled with ILI, 411 (28%) tested positive for influenza by PCR. Of children with influenza illness, 313 (76%) met the M/S definition. Children with M/S influenza were younger (3.8 years vs 4.8 years), infected with influenza A (59% vs 44%), and more frequently hospitalized (unadjusted risk difference [RD], 6.3%; 95% confidence interval [CI], 2.1-10.4; P = .03) and treated with antibiotics (unadjusted RD, 13.3%; 95% CI, 4.3-22.4; P < .01) compared to those with mild disease. CONCLUSIONS Children with M/S influenza have a higher risk of hospitalization and antibiotic use compared with mild disease. This proposed definition may be a useful clinical endpoint to study the public health and clinical impact of influenza interventions in children. CLINICAL TRIALS REGISTRATION NCT02979626.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics (Infectious Diseases, Hospital Medicine and Epidemiology), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA,Corresponding Author: Suchitra Rao, MBBS, MSCS, Department of Pediatrics (Infectious Diseases, Hospital Medicine, Epidemiology), University of Colorado School of Medicine and Children’s Hospital Colorado, Box 055, 13123 E 16th Ave, Aurora, CO 80045.
| | | | - Angela Moss
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado and Adult and Child Center for Health Outcomes Research and Delivery Science, Aurora, Colorado, USA
| | - Molly M Lamb
- Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA
| | | | | | - Bruce L Innis
- GSK, Rockville, Maryland, USA,Present affiliation: PATH, Washington, District of Columbia, USA
| | - Jillian Cotter
- Department of Pediatrics (Hospital Medicine), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Rakesh D Mistry
- Department of Pediatrics (Emergency Medicine), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado School of Medicine, Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, Colorado, USA
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14
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Clinical Characteristics and Prognosis of Influenza B Virus-Related Hospitalizations in Northern China during the 2017-18 Influenza Season: A Multicenter Case Series. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8756563. [PMID: 31828141 PMCID: PMC6885173 DOI: 10.1155/2019/8756563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/16/2019] [Accepted: 10/11/2019] [Indexed: 01/20/2023]
Abstract
Background By weekly monitoring of China's influenza situation, Chinese National Influenza Center observed that the 2017-18 season was predominated by influenza B virus (IBV)/Yamagata. No studies regarding hospitalizations in adults with IBV infections have been performed. We aimed to describe the clinical characteristics of hospitalized patients with IBV infection in northern China. Methods In this multicenter and retrospective study, we reviewed all consecutive adult patients with confirmed IBV infections at two level A tertiary teaching hospitals in northern China during the 2017-18 influenza season. Patients' clinical and diagnostic findings, as well as administered treatments and mortality data, were analyzed. Results A total of 573 patients with a confirmed diagnosis of IBV infection were identified, of whom 22 cases were analyzed because of IBV-related hospitalization. Most patients were admitted to the intensive care unit (ICU) and had at least one underlying disease. The total in-hospital mortality was 27.3%. An elevated initial pneumonia severity index score, elevated direct bilirubin values, and lower platelet levels were associated with mortality (p=0.020, 0.013, and 0.049, respectively). The quick development of bilateral diffuse alveolar infiltrates was the most common imaging characteristics, following consolidation and pleural effusion(s). Risk factors such as HIV infection, pregnancy, underlying medical conditions, coinfections, and treatment delays were not associated with mortality. Conclusions IBV should not be neglected because of its significant mortality. The elderly and patients with comorbidities, such as hypertension, diabetes, and connective tissue diseases, are more likely to have severe IBV-related pneumonia. Higher heart rates, direct bilirubin levels, initial PSI scores, and lower platelet levels are correlated with hospital mortality. Increased uptake in tetravalent influenza vaccine should be very helpful in preventing future cases of IBV hospitalizations.
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15
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Goldstein E, Finelli L, O’Halloran A, Liu P, Karaca Z, Steiner CA, Viboud C, Lipsitch M. Hospitalizations Associated with Respiratory Syncytial Virus and Influenza in Children, Including Children Diagnosed with Asthma. Epidemiology 2019; 30:918-926. [PMID: 31469696 PMCID: PMC6768705 DOI: 10.1097/ede.0000000000001092] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is uncertainty about the burden of hospitalization associated with respiratory syncytial virus (RSV) and influenza in children, including those with underlying medical conditions. METHODS We applied previously developed methodology to Health Care Cost and Utilization Project hospitalization data and additional data related to asthma diagnosis/previous history in hospitalized children to estimate RSV and influenza-associated hospitalization rates in different subpopulations of US children between 2003 and 2010. RESULTS The estimated average annual rates (per 100,000 children) of RSV-associated hospitalization with a respiratory cause (ICD-9 codes 460-519) present anywhere in the discharge diagnosis were 2,381 (95% CI(2252,2515)) in children <1 year of age; 710.6 (609.1, 809.2) (1 y old); 395 (327.7, 462.4) (2 y old); 211.3 (154.6, 266.8) (3 y old); 111.1 (62.4, 160.1) (4 y old); 72.3 (29.3, 116.4) (5-6 y of age); 35.6 (9.9,62.2) (7-11 y of age); and 39 (17.5, 60.6) (12-17 y of age). The corresponding rates of influenza-associated hospitalization were lower, ranging from 181 (142.5, 220.3) in <1 year old to 17.9 (11.7, 24.2) in 12-17 years of age. The relative risks for RSV-related hospitalization associated with a prior diagnosis of asthma in age groups <5 y ranged between 3.1 (2.1, 4.7) (<1 y old) and 6.7 (4.2, 11.8) (2 y old; the corresponding risks for influenza-related hospitalization ranged from 2.8 (2.1, 4) (<1y old) to 4.9 (3.8, 6.4) (3 y old). CONCLUSION RSV-associated hospitalization rates in young children are high and decline rapidly with age. There are additional risks for both RSV and influenza hospitalization associated with a prior diagnosis of asthma, with the rates of RSV-related hospitalization in the youngest children diagnosed with asthma being particularly high.
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Affiliation(s)
- Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
| | | | - Alissa O’Halloran
- Influenza Division, National Center for Immunization and Respiratory Diseases, US CDC, Atlanta, GA 30329 USA
| | - Patrick Liu
- Yale School of Medicine, New Haven, CT 06510 USA
| | - Zeynal Karaca
- Agency for HealthCare Research and Quality, U.S. Department of Health & Human Services, Rockville, MD 20850 USA
| | - Claudia A. Steiner
- Agency for HealthCare Research and Quality, U.S. Department of Health & Human Services, Rockville, MD 20850 USA (work performed in that capacity; currently works at Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80231 USA)
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
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16
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Emukule GO, Otiato F, Nyawanda BO, Otieno NA, Ochieng CA, Ndegwa LK, Muturi P, Bigogo G, Verani JR, Muthoka PM, Hunsperger E, Chaves SS. The Epidemiology and Burden of Influenza B/Victoria and B/Yamagata Lineages in Kenya, 2012-2016. Open Forum Infect Dis 2019; 6:ofz421. [PMID: 31660376 PMCID: PMC6804754 DOI: 10.1093/ofid/ofz421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/27/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The impact of influenza B virus circulation in Sub-Saharan Africa is not well described. METHODS We analyzed data from acute respiratory illness (ARI) in Kenya. We assessed clinical features and age-specific hospitalization and outpatient visit rates by person-years for influenza B/Victoria and B/Yamagata and the extent to which circulating influenza B lineages in Kenya matched the vaccine strain component of the corresponding season (based on Northern Hemisphere [October-March] and Southern Hemisphere [April-September] vaccine availability). RESULTS From 2012 to 2016, influenza B represented 31% of all influenza-associated ARIs detected (annual range, 13-61%). Rates of influenza B hospitalization and outpatient visits were higher for <5 vs ≥5 years. Among <5 years, B/Victoria was associated with pneumonia hospitalization (64% vs 44%; P = .010) and in-hospital mortality (6% vs 0%; P = .042) compared with B/Yamagata, although the mean annual hospitalization rate for B/Victoria was comparable to that estimated for B/Yamagata. The 2 lineages co-circulated, and there were mismatches with available trivalent influenza vaccines in 2/9 seasons assessed. CONCLUSIONS Influenza B causes substantial burden in Kenya, particularly among children aged <5 years, in whom B/Victoria may be associated with increased severity. Our findings suggest a benefit from including both lineages when considering influenza vaccination in Kenya.
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Affiliation(s)
- Gideon O Emukule
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | | | | | - Nancy A Otieno
- Kenya Medical Research Institute, Kisumu and Nairobi, Kenya
| | | | - Linus K Ndegwa
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | | | - Godfrey Bigogo
- Kenya Medical Research Institute, Kisumu and Nairobi, Kenya
| | - Jennifer R Verani
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | | | - Elizabeth Hunsperger
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
| | - Sandra S Chaves
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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17
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Palekar RS, Rolfes MA, Arriola CS, Acosta BO, Guidos PA, Vargas XB, Bancej C, Ramirez JB, Baumeister E, Bruno A, Cabello MA, Chen J, Couto P, Junior FJDP, Fasce R, Ferreira de Almeida W, Solorzano VEF, Ramírez CF, Goñi N, Isaza de Moltó Y, Lara J, Malo DC, Medina Osis JL, Mejía H, Castillo LM, Mustaquim D, Nwosu A, Ojeda J, Samoya AP, Pulido PA, Ramos Hernandez HM, Lopez RR, Rodriguez A, Saboui M, Bolanos HS, Santoro A, Silvera JE, Sosa P, Sotomayor V, Suarez L, Von Horoch M, Azziz-Baumgartner E. Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015. PLoS One 2019; 14:e0221479. [PMID: 31490961 PMCID: PMC6730873 DOI: 10.1371/journal.pone.0221479] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/07/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas. METHODS Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates. RESULTS Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000). CONCLUSIONS Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.
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Affiliation(s)
- Rakhee S. Palekar
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
- * E-mail:
| | - Melissa A. Rolfes
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - C. Sofia Arriola
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Belsy O. Acosta
- Department of Virology, “Pedro Kouri” Institute of Tropical Medicine, Havana, Cuba
| | | | | | | | | | - Elsa Baumeister
- National Reference Laboratory for Viral Respiratory Infections and National Influenza Center, Buenos Aires, Argentina
| | - Alfredo Bruno
- National Institute of Public Health Research, Guayaquil, Ecuador
| | | | - Jufu Chen
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Battelle Memorial Institute, Atlanta, GA, United States of America
| | - Paula Couto
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | | | | | | | | | | | - Natalia Goñi
- Department of Public Health Laboratories, Montevideo, Uruguay
| | | | - Jenny Lara
- Costa Rican Institute of Research and Education in Nutrition and Health, Cartago, Costa Rica
| | | | - José L. Medina Osis
- National Center of Epidemiology, Prevention, and Control of Diseases, Lima, Peru
| | | | | | - Desiree Mustaquim
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | | | | | | | | | | | - Angel Rodriguez
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | | | | | - Adrián Santoro
- Directorate of Statistics and Health Information, Buenos Aires, Argentina
| | | | - Paulina Sosa
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | | | | | - Marta Von Horoch
- Ministry of Public Health and Social Welfare, Asuncion, Paraguay
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Influenza in Children With Special Risk Medical Conditions: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2019; 38:912-919. [PMID: 31274833 DOI: 10.1097/inf.0000000000002405] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Children with special risk medical conditions (SRMC) are over-represented in influenza hospitalizations. A systematic review was undertaken to determine whether children with SRMCs experience greater complications or severity following influenza infection. METHODS Bibliographies of pertinent articles were searched in MEDLINE and EMBASE (1990 to March 2018) and contact made with the investigators of unpublished studies containing relevant data. Studies of children (aged ≤18 years) with a SRMC hospitalized with influenza were included. Outcomes were pneumonia, intensive care unit (ICU) admission, mechanical ventilation, neurologic outcomes (seizures, encephalopathy), death and length of stay in hospital or ICU. RESULTS Twenty-two studies met inclusion criteria. Compared with healthy peers, children with SRMC had higher odds of ICU admission [pooled odds ratio (OR) 1.66 (95% confidence interval (CI): 1.25-2.21)], for mechanical ventilation [pooled OR 1.53 (95% CI: 0.93-2.52)] and death [pooled OR 1.34 (95% CI: 0.74-2.41)]. Additionally, children with SRMC were more likely to develop bacterial pneumonia (crude OR 1.7; 95% CI: 1.1-2.6) or experience prolonged hospital length of stay [adjusted rate ratio 1.75 (95% CI: 1.44-2.11)]. The level of GRADE evidence was low for all outcomes considered in this review. CONCLUSIONS While there was evidence that ICU management and bacterial pneumonia increases in children with SRMC, evidence showing an increase in the probability of death or need for mechanical ventilation was inconsistent. Further research using large datasets should evaluate the impact of complications and associated morbidity from influenza in SRMC children.
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Chavez D, Gonzales‐Armayo V, Mendoza E, Palekar R, Rivera R, Rodriguez A, Salazar C, Veizaga A, Añez A. Estimation of influenza and respiratory syncytial virus hospitalizations using sentinel surveillance data-La Paz, Bolivia. 2012-2017. Influenza Other Respir Viruses 2019; 13:477-483. [PMID: 31206257 PMCID: PMC6692540 DOI: 10.1111/irv.12663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The objective was to estimate the number of hospitalizations associated with influenza and RSV using data from severe acute respiratory infection (SARI) sentinel surveillance from El Alto-La Paz. Bolivia. METHODS All persons who met the case definition for SARI at one sentinel hospital had a clinical sample collected and analyzed by rRT-PCR for influenza and by indirect immunofluorescence for RSV. The SARI-influenza and SARI-RSV case counts were stratified by six age groups. The proportion of cases captured in the sentinel hospital in relation to the non-sentinel hospitals of area was multiplied by the age-specific census population, to build the denominators. The annual incidence and a 95% confidence interval (CI) were estimated. RESULTS During 2012-2017, n = 2606 SARI cases were reported (average incidence 120/100 000 inhabitants [95% CI: 116-124]); the average incidence of influenza-associated SARI hospitalization was 15.3/100 000 (95% CI: 14.1-16.7), and the average incidence of RSV-associated SARI hospitalization was 9/100 000 inhabitants (95% CI: 8.1-10.1). The highest incidence of influenza was among those less than one year of age (average 174.7/100 000 [range: 89.1-299.5]), followed by those one to four years of age (average 51.8/100 000 [range: 19.8-115.4]) and then those 65 years of age and older (average 47.7/100 000 [range: 18.8-117]). For RSV, the highest incidence was highest among those less than one year of age (231/100 000 [range: 119.9-322.9]). CONCLUSION Influenza and RSV represent major causes of hospitalization in La Paz, Bolivia-with the highest burden among children under one year of age. Our estimates support current prevention strategies in this age group.
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Emukule GO, Namagambo B, Owor N, Bakamutumaho B, Kayiwa JT, Namulondo J, Byaruhanga T, Tempia S, Chaves SS, Lutwama JJ. Influenza-associated pneumonia hospitalizations in Uganda, 2013-2016. PLoS One 2019; 14:e0219012. [PMID: 31306466 PMCID: PMC6629074 DOI: 10.1371/journal.pone.0219012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Influenza is an important contributor to acute respiratory illness, including pneumonia, and results in substantial morbidity and mortality globally. Understanding the local burden of influenza-associated severe disease can inform decisions on allocation of resources toward influenza control programs. Currently, there is no national influenza vaccination program in Uganda. METHODS In this study, we used data on pneumonia hospitalizations that were collected and reported through the Health Management Information System (HMIS) of the Ministry of Health, Uganda, and the laboratory-confirmed influenza positivity data from severe acute respiratory illness (SARI) surveillance in three districts (Wakiso, Mbarara, and Tororo) to estimate the age-specific incidence of influenza-associated pneumonia hospitalizations from January 2013 through December 2016. RESULTS The overall estimated mean annual rate of pneumonia hospitalizations in the three districts was 371 (95% confidence interval [CI] 323-434) per 100,000 persons, and was highest among children aged <5 years (1,524 [95% CI 1,286-1,849]) compared to persons aged ≥5 years (123 [95% CI 105-144]) per 100,000 persons. The estimated mean annual rate of influenza-associated pneumonia hospitalization was 34 (95% CI 23-48) per 100,000 persons (116 [95% CI 78-165] and 16 [95% CI 6-28] per 100,000 persons among children aged <5 years and those ≥5 years, respectively). Among children aged <5 years, the rate of hospitalized influenza-associated pneumonia was highest among those who were <2 years old (178 [95% CI 109-265] per 100,000 persons). Over the period of analysis, the estimated mean annual number of hospitalized influenza-associated pneumonia cases in the three districts ranged between 672 and 1,436, of which over 70% represent children aged <5 years. CONCLUSIONS The burden of influenza-associated pneumonia hospitalizations was substantial in Uganda, and was highest among young children aged <5 years. Influenza vaccination may be considered, especially for very young children.
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Affiliation(s)
- Gideon O. Emukule
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
| | - Barbara Namagambo
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Nicholas Owor
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Barnabas Bakamutumaho
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - John T. Kayiwa
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Joyce Namulondo
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Timothy Byaruhanga
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
| | - Stefano Tempia
- Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sandra S. Chaves
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julius J. Lutwama
- Uganda Virus Research Institute, National Influenza Centre (UVRI-NIC), Entebbe, Uganda
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Singh M, Tanvir T, Nagoji D, Madan A, Gattem S, Singh H. Influenza vaccine: A viable option to protect pregnant women and infants from seasonal flu: A retrospective hospital-based study in India. Int J Clin Pract 2019; 73:e13361. [PMID: 31074182 DOI: 10.1111/ijcp.13361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/14/2019] [Accepted: 05/04/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Influenza is a highly contagious disease with global annual outbreaks of 3-5 million severe cases and 0.25-0.5 million deaths. The risk is greater in pregnant women that results in high morbidity and mortality. OBJECTIVE The objective of this study was to see the efficacy of influenza vaccine on pregnant women and their newborn upto 6 months. METHOD This was a retrospective study (January 2016-March 2018). Records of 346 pregnant women were included in this study (vaccinated: 288; unvaccinated: 58). Women and infants were categorised into Category A, B or C according to the guidelines issued by the Ministry of Health and Family Welfare, India on influenza. RESULTS The groups were comparable with respect to baseline characteristics. Greater number of women received influenza vaccine during the first trimester (n = 117). During the gestation period, majority of the women in the vaccinated group were symptom-free compared with the unvaccinated (92% vs 70.7%). Also, none of the vaccinated women were categorised into category C compared with one who was laboratory tested positive for influenza in the unvaccinated group. Similar results were seen postpartum and more number of infants remained symptom-free in the vaccinated group compared with unvaccinated (69.3% vs 25.9%). More number of infants were born pre-term in the unvaccinated group compared with vaccinated (15.5% vs 8.6%). CONCLUSIONS Immunisation with influenza vaccine in any trimester during pregnancy was found to protect the mother and infants upto 6 months of age against seasonal influenza without significant maternal adverse effects. In order to improve vaccination rates, there must be a national vaccination policy and incorporation of maternal immunisation in standard antenatal care.
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Affiliation(s)
- Meeta Singh
- Tanvir Hospital, Hyderabad, Telangana, India
| | | | - Dharani Nagoji
- SVS Medical College & Hospital, Mahbubnagar, Telangana, India
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Schwarze J, Openshaw P, Jha A, Giacco SR, Firinu D, Tsilochristou O, Roberts G, Selby A, Akdis C, Agache I, Custovic A, Heffler E, Pinna G, Khaitov M, Nikonova A, Papadopoulos N, Akhlaq A, Nurmatov U, Renz H, Sheikh A, Skevaki C. Influenza burden, prevention, and treatment in asthma-A scoping review by the EAACI Influenza in asthma task force. Allergy 2018; 73:1151-1181. [PMID: 29105786 DOI: 10.1111/all.13333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma. The strongest evidence of an association was seen in studies of children. Countries in the European Union currently recommend influenza vaccination of adults with asthma; however, coverage varied between regions. Coverage was lower among children with asthma. Limited data suggest that good seroprotection and seroconversion can be achieved in both children and adults with asthma and that vaccination confers a degree of protection against influenza illness and asthma-related morbidity to children with asthma. There were insufficient data to determine efficacy in adults. Overall, influenza vaccines appeared to be safe for people with asthma. We identify knowledge gaps and make recommendations on future research needs in relation to influenza in patients with asthma.
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Affiliation(s)
- J. Schwarze
- Centre for Inflammation Research The Queens Medical Research Institute University of Edinburgh Edinburgh UK
| | - P. Openshaw
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - A. Jha
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - S. R. Giacco
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | - D. Firinu
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | | | - G. Roberts
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - A. Selby
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | - I. Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - A. Custovic
- Department of Paediatrics Imperial College London London UK
| | - E. Heffler
- Personalized Medicine Asthma and Allergy Clinic Department of Biomedical Sciences Humanitas University Milan Italy
| | - G. Pinna
- Department of Medical Microbiology National Kapodistrian University of Athens Athens Greece
| | - M. Khaitov
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - A. Nikonova
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - N. Papadopoulos
- Division of Infection, Inflammation & Respiratory Medicine The University of Manchester Manchester UK
- Allergy Department 2nd Paediatric Clinic National Kapodistrian University of Athens Athens Greece
| | - A. Akhlaq
- Department of Health and Hospital Management Institute of Business Management Korangi Creek Karachi 75190 Pakistan
| | - U. Nurmatov
- Division of Population Medicine School of Medicine Cardiff University the National Centre for Population Health and Wellbeing Research Wales UK
| | - H. Renz
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
| | - A. Sheikh
- Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - C. Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
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Comparison of incidence and cost of influenza between healthy and high-risk children <60 months old in Thailand, 2011-2015. PLoS One 2018; 13:e0197207. [PMID: 29771945 PMCID: PMC5957403 DOI: 10.1371/journal.pone.0197207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/27/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Thailand recommends influenza vaccination for children aged 6 months to <36 months, but investment in vaccine purchase is limited. To inform policy decision with respect to influenza disease burden and associated cost in young children and to support the continued inclusion of children as the recommended group for influenza vaccination, we conducted a prospective cohort study of children in Bangkok hospital to estimate and compare influenza incidence and cost between healthy and high-risk children. Methods Caregivers of healthy children and children with medical conditions (‘high-risk’) aged <36 months were called weekly for two years to identify acute respiratory illness (ARI) episodes and collect illness-associated costs. Children with ARI were tested for influenza viruses by polymerase chain reaction. Illnesses were categorized as mild or severe depending on whether children were hospitalized. Population-averaged Poisson models were used to compare influenza incidence by risk group. Quantile regression was used to examine differences in the median illness expenses. Results During August 2011-September 2015, 659 healthy and 490 high-risk children were enrolled; median age was 10 months. Incidence of mild influenza-associated ARI was higher among healthy than high-risk children (incidence rate ratio [IRR]: 1.67; 95% confidence interval [CI]: 1.13–2.48). Incidence of severe influenza-associated ARI did not differ (IRR: 0.40; 95% CI: 0.11–1.38). The median cost per mild influenza-associated ARI episode was $22 among healthy and $25 among high-risk children (3–4% of monthly household income; difference in medians: -$1; 95% CI for difference in medians: -$9 to $6). The median cost per severe influenza-associated ARI episode was $232 among healthy and $318 among high-risk children (26–40% and 36–54% of monthly household income, respectively; difference in medians: 110; 95% CI for difference in medians: -$352 to $571). Conclusions Compared to high-risk children, healthy children had higher incidence of mild influenza-associated ARI but not severe influenza-associated ARI. Costs of severe influenza-associated ARI were substantial. These findings support the benefit of annual influenza vaccination in reducing the burden of influenza and associated cost in young children.
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Uyeki TM. Oseltamivir Treatment of Influenza in Children. Clin Infect Dis 2018; 66:1501-1503. [PMID: 29315362 PMCID: PMC6669028 DOI: 10.1093/cid/cix1150] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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Shang M, Blanton L, Brammer L, Olsen SJ, Fry AM. Influenza-Associated Pediatric Deaths in the United States, 2010-2016. Pediatrics 2018; 141:peds.2017-2918. [PMID: 29440502 DOI: 10.1542/peds.2017-2918] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Influenza-associated pediatric deaths became a notifiable condition in the United States in 2004. METHODS We analyzed deaths in children aged <18 years with laboratory-confirmed influenza virus infection reported to the Centers for Disease Control and Prevention during the 2010-2011 to 2015-2016 influenza seasons. Data were collected with a standard case report form that included demographics, medical conditions, and clinical diagnoses. RESULTS Overall, 675 deaths were reported. The median age was 6 years (interquartile range: 2-12). The average annual incidence was 0.15 per 100 000 children (95% confidence interval: 0.14-0.16) and was highest among children aged <6 months (incidence: 0.66; 95% confidence interval: 0.53-0.82), followed by children aged 6-23 months (incidence: 0.33; 95% confidence interval: 0.27-0.39). Only 31% (n = 149 of 477) of children aged ≥6 months had received any influenza vaccination. Overall, 65% (n = 410 of 628) of children died within 7 days after symptom onset. Half of the children (n = 327 of 654) had no preexisting medical conditions. Compared with children with preexisting medical conditions, children with none were younger (median: 5 vs 8 years old), less vaccinated (27% vs 36%), more likely to die before hospital admission (77% vs 48%), and had a shorter illness duration (4 vs 7 days; P < .05 for all). CONCLUSIONS Each year, influenza-associated pediatric deaths are reported. Young children have the highest death rates, especially infants aged <6 months. Increasing vaccination among children, pregnant women, and caregivers of infants may reduce influenza-associated pediatric deaths.
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Affiliation(s)
- Mei Shang
- Epidemic Intelligence Service and.,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lenee Blanton
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lynnette Brammer
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sonja J Olsen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Zhou H, Thompson WW, Belongia EA, Fowlkes A, Baxter R, Jacobsen SJ, Jackson ML, Glanz JM, Naleway AL, Ford DC, Weintraub E, Shay DK. Estimated rates of influenza-associated outpatient visits during 2001-2010 in 6 US integrated healthcare delivery organizations. Influenza Other Respir Viruses 2018; 12:122-131. [PMID: 28960732 PMCID: PMC5818343 DOI: 10.1111/irv.12495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 12/01/2022] Open
Abstract
Background Population‐based estimates of influenza‐associated outpatient visits including both pandemic and interpandemic seasons are uncommon. Comparisons of such estimates with laboratory‐confirmed rates of outpatient influenza are rare. Objective To estimate influenza‐associated outpatient visits in 6 US integrated healthcare delivery organizations enrolling ~7.7 million persons. Methods Using negative binomial regression methods, we modeled rates of influenza‐associated visits with ICD‐9‐CM‐coded pneumonia or acute respiratory outpatient visits during 2001‐10. These estimated counts were added to visits coded specifically for influenza to derive estimated rates. We compared these rates with those observed in 2 contemporaneous studies recording RT‐PCR‐confirmed influenza outpatient visits. Results Outpatient rates estimated with pneumonia visits were 39 (95% confidence interval [CI], 30‐70) and 203 (95% CI, 180‐240) per 10 000 person‐years, respectively, for interpandemic and pandemic seasons. Corresponding rates estimated with respiratory visits were 185 (95% CI, 161‐255) and 542 (95% CI, 441‐823) per 10 000 person‐years. During the pandemic, children aged 2‐17 years had the largest increase in rates (when estimated with pneumonia visits, from 64 [95% CI, 50‐121] to 381 [95% CI, 366‐481]). Rates estimated with pneumonia visits were consistent with rates of RT‐PCR‐confirmed influenza visits during 4 of 5 seasons in 1 comparison study. In another, rates estimated with pneumonia visits during the pandemic for children and adults were consistent in timing, peak, and magnitude. Conclusions Estimated rates of influenza‐associated outpatient visits were higher in children than adults during pre‐pandemic and pandemic seasons. Rates estimated with pneumonia visits plus influenza‐coded visits were similar to rates from studies using RT‐PCR‐confirmed influenza.
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Affiliation(s)
- Hong Zhou
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | | | | | - Ashley Fowlkes
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Roger Baxter
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Derek C Ford
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Eric Weintraub
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - David K Shay
- Centers for Disease Control & Prevention, Atlanta, GA, USA
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Sotomayor V, Fasce RA, Vergara N, De la Fuente F, Loayza S, Palekar R. Estimating the burden of influenza-associated hospitalizations and deaths in Chile during 2012-2014. Influenza Other Respir Viruses 2018; 12:138-145. [PMID: 29446231 PMCID: PMC5818356 DOI: 10.1111/irv.12502] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 12/24/2022] Open
Abstract
Background Influenza is a vaccine preventable disease that causes important morbidity and mortality worldwide. Estimating the burden of influenza disease is difficult. However, there are some methods based in surveillance data and laboratory testing that can be used for this purpose. Objectives Estimating the burden of serious illness from influenza by means of hospitalization and death records during the period between 2012 and 2014, and using information from Severe Acute Respiratory Illness (SARI) surveillance. Methods To estimate the Chilean rate of influenza‐associated hospitalizations and deaths, we applied the influenza positivity of respiratory samples tested in six SARI surveillance sentinel hospitals to the hospitalizations and deaths from the records with ICD‐10 codes from influenza and pneumonia. Results Annually, 5320 people are hospitalized for influenza and 447 die for this cause. The annual influenza‐associated hospitalization rate for the period was 71.5/100 000 person‐year for <5 years old, 11.8/100 000 person‐year for people between 5 and 64 years old; and 156.0/100 000 person‐year for ≥65 years. The annual mortality rate for the period was 0.08/100 000 person‐year for <5 years; 0.3/100 000 person‐year for people between 5 and 64 years; and 22.8/100 000 person‐year for ≥65 years. Conclusions This is the first study of influenza burden in Chile. Every year an important quantity of hospitalizations and deaths result from influenza infection. In countries in temperate zones, it is important to know the burden of influenza in order to prepare the health care network and to assess preventive intervention currently in practice and the new ones to implementing.
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Affiliation(s)
- Viviana Sotomayor
- Department of Epidemiology, Ministry of Health of Chile, Santiago, Chile
| | - Rodrigo A Fasce
- Sub-Department of Viral Diseases, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Natalia Vergara
- Department of Epidemiology, Ministry of Health of Chile, Santiago, Chile
| | | | - Sergio Loayza
- Department of Epidemiology, Ministry of Health of Chile, Santiago, Chile
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Nunes MC, Madhi SA. Prevention of influenza-related illness in young infants by maternal vaccination during pregnancy. F1000Res 2018; 7:122. [PMID: 29445450 PMCID: PMC5791002 DOI: 10.12688/f1000research.12473.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/15/2022] Open
Abstract
The influenza virus circulates yearly and causes global epidemics. Influenza infection affects all age groups and causes mild to severe illness, and young infants are at particular risk for serious disease. The most effective measure to prevent influenza disease is vaccination; however, no vaccine is licensed for use in infants younger than 6 months old. Thus, there is a crucial need for other preventive strategies in this high-risk age group. Influenza vaccination during pregnancy protects both the mothers and the young infants against influenza infection. Vaccination during pregnancy boosts the maternal antibodies and increases the transfer of immunoglobulin G from the mother to the fetus through the placenta, which confers protection against infection in infants too young to be vaccinated. Data from clinical trials and observational studies did not demonstrate adverse effects to the mother, the fetus, or the infant after maternal influenza vaccination. We present the current data on the effectiveness and safety of influenza vaccination during pregnancy in preventing disease in the young infant.
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Affiliation(s)
- Marta C Nunes
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
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Hart RJ, Stevenson MD, Smith MJ, LaJoie AS, Cross K. Cost-effectiveness of Strategies for Offering Influenza Vaccine in the Pediatric Emergency Department. JAMA Pediatr 2018; 172:e173879. [PMID: 29114729 PMCID: PMC6583269 DOI: 10.1001/jamapediatrics.2017.3879] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Influenza is a significant public health burden, causing morbidity and mortality in children, yet vaccination rates remain low. Vaccination in the pediatric emergency department (PED) setting may be beneficial but, to date, has not been proven to be cost-effective. OBJECTIVE To compare the cost-effectiveness of 4 strategies for PED-based influenza vaccine: offering vaccine to all patients, only to patients younger than 5 years, only to high-risk patients (all ages), or to no patients. DESIGN, SETTING, AND PARTICIPANTS Using commercial decision analysis software, a cost-effectiveness analysis was performed from January 1, 2016, to June 1, 2017, to compare influenza vaccine strategies at a tertiary, urban, freestanding PED with an estimated 60 000 visits per year among a hypothetical cohort of children visiting the above PED during influenza season. Sensitivity analyses estimated the effect of uncertainties across a variety of input variables (eg, influenza prevalence, vaccine price and effectiveness, and costs of complications). MAIN OUTCOMES AND MEASURES The primary outcomes were cost and incremental cost-effectiveness ratio in dollars per influenza case averted. Secondary outcomes included total societal costs, hospitalizations and deaths averted, and quality-adjusted life-years gained. RESULTS Offering influenza vaccine to all eligible patients has the lowest cost, at $114.45 (95% CI, $55.48-$245.45) per case of influenza averted. This strategy saves $33.51 (95% CI, $18-$62) per case averted compared with no vaccination, and averages 27 fewer cases of influenza per 1000 patients. Offering vaccine to all patients resulted in 0.72 days (95% CI, 0.18-1.78 days) of quality-adjusted life-years lost, whereas offering to none resulted in 0.91 days (95% CI, 0.25-2.2 days) of quality-adjusted life-years lost. In sensitivity analyses, this strategy remains robustly cost-effective across a wide range of assumptions. In addition to being the most cost-effective strategy regardless of age or risk status, routine vaccination in the PED results in a net societal monetary benefit under many circumstances. In Monte Carlo analysis, offering vaccine to all patients was superior to other strategies in at least 99.8% of cases. CONCLUSIONS AND RELEVANCE Although few PEDs routinely offer influenza vaccination, doing so appears to be cost-effective, with the potential to significantly reduce the economic (and patient) burden of pediatric influenza.
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Affiliation(s)
- Rebecca J. Hart
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michelle D. Stevenson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Michael J. Smith
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - A. Scott LaJoie
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky
| | - Keith Cross
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky
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Teros-Jaakkola T, Toivonen L, Schuez-Havupalo L, Karppinen S, Julkunen I, Waris M, Peltola V. Influenza virus infections from 0 to 2 years of age: A birth cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:526-533. [PMID: 29254653 DOI: 10.1016/j.jmii.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/14/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Influenza vaccine has been recommended in Finland since 2007 for all children of 6-35 months of age and in 2009 for those ≥6 months against pandemic influenza. We investigated the incidence of influenza and vaccine effectiveness in a birth cohort of children in 2008-2011. METHODS We followed 923 children from birth to 2 years of age for respiratory tract infections. A nasal swab sample for PCR for influenza A and B viruses was taken at the onset of acute respiratory infections. Samples were collected either at the study clinic or at home by parents. Vaccination data was retrieved from the health registries. RESULTS Vaccination coverage of children aged 6-23 months was 22-47% against seasonal influenza and 80% against the A(H1N1)pdm09 virus in the pandemic season 2009-2010. During 3 influenza seasons, 1607 nasal swab samples were collected. Influenza was confirmed in 56 (6.1%) of 923 children (16 A(H1N1), 14 A(H3N2), and 26 B viruses). The incidence of influenza was 5.1% in 2008-2009, 2.7% in 2009-2010, and 5.0% in 2010-2011. Effectiveness of the adjuvanted vaccine against the pandemic influenza A(H1N1)pdm09 was 97% (95% confidence interval, 76-100%). Three children with influenza were hospitalized. CONCLUSION The yearly incidence of seasonal influenza was 5% in this cohort of very young children with variable influenza vaccine coverage. Adjuvanted vaccine against the pandemic influenza was highly effective. Both seasonal and pandemic influenza cases were mostly non-severe.
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Affiliation(s)
- Tamara Teros-Jaakkola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Laura Toivonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Linnea Schuez-Havupalo
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Sinikka Karppinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Julkunen
- Department of Virology, University of Turku, Turku, Finland
| | - Matti Waris
- Department of Virology, University of Turku, Turku, Finland
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
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Fell DB, Johnson J, Mor Z, Katz MA, Skidmore B, Neuzil KM, Ortiz JR, Bhat N. Incidence of laboratory-confirmed influenza disease among infants under 6 months of age: a systematic review. BMJ Open 2017; 7:e016526. [PMID: 28882916 PMCID: PMC5595206 DOI: 10.1136/bmjopen-2017-016526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aim of this systematic review was to assess incidence rates of laboratory-confirmed influenza (LCI) outcomes among infants under 6 months of age. DESIGN Systematic literature search and review of indexed studies in PubMed, EMBASE, the Cochrane Library and CINAHL Plus from inception to 19 April 2017. SETTING Population-based estimates from community or hospital settings. PARTICIPANTS Infants under 6 months of age. PRIMARY AND SECONDARY OUTCOME MEASURES LCI illness in ambulatory care settings, LCI hospitalisation, LCI intensive care unit admission and LCI death. Only studies with population-based incidence data were included. RESULTS We identified 27 primary studies, 11 of which were from the USA, four were from other non-US high-income settings and the remaining were from lower-middle-income or upper-middle-income countries. Most studies (n=23) assessed incidence of LCI hospitalisation, but meta-analysis to pool study-specific rates was not possible due to high statistical and methodological heterogeneity. Among US studies, the reported incidence of LCI hospitalisation ranged from 9.3 to 91.2 per 10 000 infants under 6 months for seasonal influenza, while the only US-based estimate for pandemic H1N1 influenza was 20.2 per 10 000 infants. Reported rates for LCI hospitalisation for seasonal influenza from other countries ranged from 6.2 to 73.0 per 10 000 infants under 6 months, with the exception of one study with an estimated rate of 250 per 10 000 infants. No events were reported in five of the nine studies that evaluated LCI death among infants under 6 months. CONCLUSION Our review of published studies found limited data on LCI outcomes for infants under 6 months, particularly from non-US settings. Globally representative and reliable incidence data are necessary to fully evaluate influenza disease burden and the potential impact of maternal influenza immunisation programme on morbidity and mortality in young infants.
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Affiliation(s)
- Deshayne B Fell
- University of Ottawa and Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Jeanene Johnson
- Independent Epidemiology Consultant, Los Gatos, California, USA
| | - Zohar Mor
- Tel Aviv Department of Health, Ministry of Health, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Katz
- Medical School for International Health and Department of Health Systems Management, Ben Gurion University in the Negev, Beersheba, Israel
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Kathleen M Neuzil
- Department of Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Justin R Ortiz
- Initiative for Vaccine Research, WHO, Geneva, Switzerland
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
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Abstract
Influenza is a common respiratory illness in children and accounts for substantial morbidity and mortality on an annual basis. Inactivated and live influenza vaccines are approved for children and are safe and efficacious. The absolute effectiveness of vaccines varies by year and is influenced by several factors. The reason for recent reduced performance of live-attenuated influenza vaccines is poorly understood, and active research is ongoing. Vaccination programs are less common in tropical and subtropical countries, where unique logistical and feasibility challenges exist. Antiviral medications for prevention and treatment of influenza in children are an important adjunct to vaccines.
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Affiliation(s)
- Elizabeth T Rotrosen
- Center for Vaccine Development, University of Maryland, School of Medicine, 685 West Baltimore Street, Room 480, Baltimore, MD 21201, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development, University of Maryland, School of Medicine, 685 West Baltimore Street, Room 480, Baltimore, MD 21201, USA.
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Tempia S, Walaza S, Moyes J, Cohen AL, von Mollendorf C, Treurnicht FK, Venter M, Pretorius M, Hellferscee O, Mtshali S, Seleka M, Tshangela A, Nguweneza A, McAnerney JM, Wolter N, von Gottberg A, Dawood H, Variava E, Madhi SA, Cohen C. Risk Factors for Influenza-Associated Severe Acute Respiratory Illness Hospitalization in South Africa, 2012-2015. Open Forum Infect Dis 2017; 4:ofw262. [PMID: 28480255 PMCID: PMC5414019 DOI: 10.1093/ofid/ofw262] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/09/2017] [Indexed: 11/29/2022] Open
Abstract
Background Data on risk factors for influenza-associated hospitalizations in low- and middle-income countries are limited. Methods We conducted active syndromic surveillance for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) in 2 provinces of South Africa during 2012–2015. We compared the characteristics of influenza-positive patients with SARI to those with ILI to identify factors associated with severe disease requiring hospitalization, using unconditional logistic regression. Results During the study period, influenza virus was detected in 5.9% (110 of 1861) and 15.8% (577 of 3652) of SARI and ILI cases, respectively. On multivariable analysis factors significantly associated with increased risk of influenza-associated SARI hospitalization were as follows: younger and older age (<6 months [adjusted odds ratio {aOR}, 37.6], 6–11 months [aOR, 31.9], 12–23 months [aOR, 22.1], 24–59 months [aOR, 7.1], and ≥65 years [aOR, 40.7] compared with 5–24 years of age), underlying medical conditions (aOR, 4.5), human immunodeficiency virus infection (aOR, 4.3), and Streptococcus pneumoniae colonization density ≥1000 deoxyribonucleic acid copies/mL (aOR, 4.8). Underlying medical conditions in children aged <5 years included asthma (aOR, 22.7), malnutrition (aOR, 2.4), and prematurity (aOR, 4.8); in persons aged ≥5 years, conditions included asthma (aOR, 3.6), diabetes (aOR, 7.1), chronic lung diseases (aOR, 10.7), chronic heart diseases (aOR, 9.6), and obesity (aOR, 21.3). Mine workers (aOR, 13.8) and pregnant women (aOR, 12.5) were also at increased risk for influenza-associated hospitalization. Conclusions The risk groups identified in this study may benefit most from annual influenza immunization, and children <6 months of age may be protected through vaccination of their mothers during pregnancy.
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Affiliation(s)
- Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.,Strategic Information Group, Expanded Programme on Immunization, Department of Immunization, Vaccines and Biological, World Health Organization, Geneva, Switzerland
| | - Claire von Mollendorf
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florette K Treurnicht
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Marietjie Venter
- Global Disease Detection Center, Division of Global Health Protection, Centers for Disease Control and Prevention, Pretoria, South Africa.,Zoonoses Research Program, Department of Medical Virology, University of Pretoria, South Africa
| | - Marthi Pretorius
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Zoonoses Research Program, Department of Medical Virology, University of Pretoria, South Africa.,Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Orienka Hellferscee
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Senzo Mtshali
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mpho Seleka
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Akhona Tshangela
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Athermon Nguweneza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Johanna M McAnerney
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Halima Dawood
- Department of Medicine, Pietermaritzburg Metropolitan Hospital, South Africa.,Department of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp-Tshepong Hospital Complex, South Africa.,Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Oboho IK, Bramley A, Finelli L, Fry A, Ampofo K, Arnold SR, Self WH, Williams DJ, Courtney DM, Zhu Y, Anderson EJ, Grijalva CG, McCullers JA, Wunderink RG, Pavia AT, Edwards KM, Jain S. Oseltamivir Use Among Children and Adults Hospitalized With Community-Acquired Pneumonia. Open Forum Infect Dis 2016; 4:ofw254. [PMID: 28480248 DOI: 10.1093/ofid/ofw254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/04/2016] [Accepted: 11/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Data on oseltamivir treatment among hospitalized community-acquired pneumonia (CAP) patients are limited. METHODS Patients hospitalized with CAP at 6 hospitals during the 2010-2012 influenza seasons were included. We assessed factors associated with oseltamivir treatment using logistic regression. RESULTS Oseltamivir treatment was provided to 89 of 1627 (5%) children (<18 years) and 143 of 1051 (14%) adults. Among those with positive clinician-ordered influenza tests, 39 of 61 (64%) children and 37 of 48 (77%) adults received oseltamivir. Among children, oseltamivir treatment was associated with hospital A (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.36-4.88), clinician-ordered testing performed (aOR, 2.44; 95% CI, 1.47-5.19), intensive care unit (ICU) admission (aOR, 2.09; 95% CI, 1.27-3.45), and age ≥2 years (aOR, 1.43; 95% CI, 1.16-1.76). Among adults, oseltamivir treatment was associated with clinician-ordered testing performed (aOR, 8.38; 95% CI, 4.64-15.12), hospitals D and E (aOR, 3.46-5.11; 95% CI, 1.75-11.01), Hispanic ethnicity (aOR, 2.06; 95% CI, 1.18-3.59), and ICU admission (aOR, 2.05; 95% CI, 1.34-3.13). CONCLUSIONS Among patients hospitalized with CAP during influenza season, oseltamivir treatment was moderate overall and associated with clinician-ordered testing, severe illness, and specific hospitals. Increased clinician education is needed to include influenza in the differential diagnosis for hospitalized CAP patients and to test and treat patients empirically if influenza is suspected.
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Affiliation(s)
- Ikwo K Oboho
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Bramley
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake City
| | - Sandra R Arnold
- Le Bonheur Children's Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis
| | - Wesley H Self
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - D Mark Courtney
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yuwei Zhu
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | - Jonathan A McCullers
- Le Bonheur Children's Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis
| | | | - Andrew T Pavia
- University of Utah Health Sciences Center, Salt Lake City
| | | | - Seema Jain
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Smith MR, Burman P, Sadahiro M, Kidd BA, Dudley JT, Morishita H. Integrative Analysis of Disease Signatures Shows Inflammation Disrupts Juvenile Experience-Dependent Cortical Plasticity. eNeuro 2016; 3:ENEURO.0240-16.2016. [PMID: 28101530 PMCID: PMC5241709 DOI: 10.1523/eneuro.0240-16.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/01/2016] [Accepted: 11/12/2016] [Indexed: 01/04/2023] Open
Abstract
Throughout childhood and adolescence, periods of heightened neuroplasticity are critical for the development of healthy brain function and behavior. Given the high prevalence of neurodevelopmental disorders, such as autism, identifying disruptors of developmental plasticity represents an essential step for developing strategies for prevention and intervention. Applying a novel computational approach that systematically assessed connections between 436 transcriptional signatures of disease and multiple signatures of neuroplasticity, we identified inflammation as a common pathological process central to a diverse set of diseases predicted to dysregulate plasticity signatures. We tested the hypothesis that inflammation disrupts developmental cortical plasticity in vivo using the mouse ocular dominance model of experience-dependent plasticity in primary visual cortex. We found that the administration of systemic lipopolysaccharide suppressed plasticity during juvenile critical period with accompanying transcriptional changes in a particular set of molecular regulators within primary visual cortex. These findings suggest that inflammation may have unrecognized adverse consequences on the postnatal developmental trajectory and indicate that treating inflammation may reduce the burden of neurodevelopmental disorders.
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Affiliation(s)
- Milo R. Smith
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Poromendro Burman
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Masato Sadahiro
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Brian A. Kidd
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Joel T. Dudley
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Hirofumi Morishita
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029
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Antiviral activity of KR-23502 targeting nuclear export of influenza B virus ribonucleoproteins. Antiviral Res 2016; 134:77-88. [DOI: 10.1016/j.antiviral.2016.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022]
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Principi N, Esposito S. Severe influenza in children: incidence and risk factors. Expert Rev Anti Infect Ther 2016; 14:961-8. [PMID: 27560100 DOI: 10.1080/14787210.2016.1227701] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/19/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The identification of factors that can predispose to the development of severe influenza is essential to enable the implementation of optimal prevention and control measures for vulnerable populations. AREAS COVERED Unfortunately, data in the pediatric age group remain difficult to interpret. However, epidemiological data seem to suggest that the most severe influenza cases, those who are hospitalized, those who are admitted to the intensive care unit, and those who died, occur in children in the first 2 years of life and in school age patients. Expert commentary: Immaturity of the immune system, and in particular of the mechanisms that usually recognize influenza viruses and activate cytokine and chemokine responses to reduce viral replication, might explain the high hospitalization rate observed in the youngest patients. Some underlying chronic conditions favour the development of the severe cases, sometime leading to death, although both admission to the intensive care unit and death can occur in otherwise healthy subjects.
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Affiliation(s)
- Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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Dawood FS, Jara J, Gonzalez R, Castillo JM, De León T, Estripeaut D, Luciani K, Sujey Brizuela Y, Barahona A, Cazares RA, Lawson AM, Rodriguez M, de Viana D, Franco D, Castillo M, Fry AM, Gubareva L, Tamura D, Hughes M, Gargiullo P, Clara W, Azziz-Baumgartner E, Widdowson MA. A randomized, double-blind, placebo-controlled trial evaluating the safety of early oseltamivir treatment among children 0–9 years of age hospitalized with influenza in El Salvador and Panama. Antiviral Res 2016; 133:85-94. [DOI: 10.1016/j.antiviral.2016.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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Millman AJ, Reed C, Kirley PD, Aragon D, Meek J, Farley MM, Ryan P, Collins J, Lynfield R, Baumbach J, Zansky S, Bennett NM, Fowler B, Thomas A, Lindegren ML, Atkinson A, Finelli L, Chaves SS. Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates. Emerg Infect Dis 2016; 21:1595-601. [PMID: 26292017 PMCID: PMC4550134 DOI: 10.3201/eid2109.141665] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Adjusting for diagnostic test sensitivity enables more accurate and timely comparisons over time. Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from <10% during 2003–2008 to ≈70% during 2009–2013. Observed hospitalization rates per 100,000 persons varied by season: 7.3–50.5 for children <18 years of age, 3.0–30.3 for adults 18–64 years, and 13.6–181.8 for adults >65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children <18 years, ≈20% higher for adults 18–64 years, and ≈55% for adults >65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates.
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Bennet R, Hamrin J, Wirgart BZ, Östlund MR, Örtqvist Å, Eriksson M. Influenza epidemiology among hospitalized children in Stockholm, Sweden 1998-2014. Vaccine 2016; 34:3298-302. [PMID: 27155498 PMCID: PMC7115574 DOI: 10.1016/j.vaccine.2016.04.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 01/25/2023]
Abstract
Background Influenza remains a common reason for the hospitalization of children. There is a need for long term studies that are also population based. We describe the epidemiology of severe influenza in a defined population 1998–2014. Method Retrospective study of annually collected data of virologically confirmed influenza in hospitalized children 0–17 years living in the catchment area (230,000 children). We gathered information about comorbidity and complications from case records, and compared Influenza A, B and A(H1N1)pdm09 with respect to these factors. Results A total of 922 children with influenza were hospitalized. The mean rate remained unchanged at 22.5–24.2 per 100,000 children per year. There were two major outbreaks: influenza A(H3N2) in 2003–2004 and the A(H1N1) pandemic in 2009–2010. The proportion of children with influenza B increased from 8% during the first half of the study period to 28% during the second half. The highest admission rate was found in children <3 months of age, 169 per 100,000. Children with influenza B were older than those with influenza A. Comorbidity was found in 34%, complications in 41%, and 11% needed intensive care management. The mortality rate was 0.17/100,000 children. Conclusion Influenza remains an important reason for the hospitalization of children, especially during the first years of life. The increasing proportion of influenza B may have to be considered when recommending influenza vaccines.
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Affiliation(s)
- Rutger Bennet
- Astrid Lindgren Children's Hospital, SE-171 76 Stockholm, Sweden.
| | - Johan Hamrin
- Astrid Lindgren Children's Hospital, SE-171 76 Stockholm, Sweden
| | | | - Maria Rotzén Östlund
- Clinical Microbiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Åke Örtqvist
- Department of Communicable Disease Control and Prevention, Stockholm County Council, SE-118 91 Stockholm, Sweden; Department of Medicine, Unit of Infectious Diseases, Karolinska University Hospital, SE-171 76 Solna, Sweden
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Kaczmarek MC, Ware RS, Coulthard MG, McEniery J, Lambert SB. Epidemiology of Australian Influenza-Related Paediatric Intensive Care Unit Admissions, 1997-2013. PLoS One 2016; 11:e0152305. [PMID: 27023740 PMCID: PMC4811543 DOI: 10.1371/journal.pone.0152305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/11/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Influenza virus predictably causes an annual epidemic resulting in a considerable burden of illness in Australia. Children are disproportionately affected and can experience severe illness and complications, which occasionally result in death. METHODS We conducted a retrospective descriptive study using data collated in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry of influenza-related intensive care unit (ICU) admissions over a 17-year period (1997-2013, inclusive) in children <16 years old. National laboratory-confirmed influenza notifications were used for comparison. RESULTS Between 1997 and 2013, a total of 704 influenza-related ICU admissions were recorded, at a rate of 6.2 per 1,000 all-cause ICU admissions. Age at admission ranged from 0 days and 15.9 years (median = 2.1 years), with 135 (19.2%) aged <6 months. Pneumonia/pneumonitis and bronchiolitis were the most common primary diagnoses among influenza-related admissions (21.9% and 13.6%, respectively). More than half of total cases (59.2%) were previously healthy (no co-morbidities recorded), and in the remainder, chronic lung disease (16.7%) and asthma (12.5%) were the most common co-morbidities recorded. Pathogen co-detection occurred in 24.7% of cases, most commonly with respiratory syncytial virus or a staphylococcal species. Median length of all ICU admissions was 3.2 days (range 2.0 hours- 107.4 days) and 361 (51.3%) admissions required invasive respiratory support for a median duration of 4.3 days (range 0.2 hours- 107.5 days). There were 27 deaths recorded, 14 (51.9%) in children without a recorded co-morbidity. CONCLUSION Influenza causes a substantial number of ICU admissions in Australian children each year with the majority occurring in previously healthy children.
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Affiliation(s)
- Marlena C Kaczmarek
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.,The University of Queensland, School of Public Health, Brisbane, Australia.,Queensland Children's Medical Research Institute, Brisbane, Australia
| | - Robert S Ware
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.,The University of Queensland, School of Public Health, Brisbane, Australia.,Queensland Children's Medical Research Institute, Brisbane, Australia
| | - Mark G Coulthard
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia.,Academic Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Julie McEniery
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Stephen B Lambert
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.,Queensland Children's Medical Research Institute, Brisbane, Australia.,Communicable Diseases Unit, Queensland Health, Brisbane, Australia
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Han SB, Rhim JW, Shin HJ, Lee SY, Kim HH, Kim JH, Lee KY, Ma SH, Park JS, Kim HM, Kim CS, Kim DH, Choi YY, Cha SH, Hong YJ, Kang JH. Immunogenicity and safety assessment of a trivalent, inactivated split influenza vaccine in Korean children: Double-blind, randomized, active-controlled multicenter phase III clinical trial. Hum Vaccin Immunother 2016; 11:1094-102. [PMID: 25875868 PMCID: PMC4514431 DOI: 10.1080/21645515.2015.1017693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A multicenter, double-blind, randomized, active-control phase III clinical trial was performed to assess the immunogenicity and safety of a trivalent, inactivated split influenza vaccine. Korean children between the ages of 6 months and 18 y were enrolled and randomized into a study (study vaccine) or a control vaccine group (commercially available trivalent, inactivated split influenza vaccine) in a 5:1 ratio. Antibody responses were determined using hemagglutination inhibition assay, and post-vaccination immunogenicity was assessed based on seroconversion and seroprotection rates. For safety assessment, solicited local and systemic adverse events up to 28 d after vaccination and unsolicited adverse events up to 6 months after vaccination were evaluated. Immunogenicity was assessed in 337 and 68 children of the study and control groups. In the study vaccine group, seroconversion rates against influenza A/H1N1, A/H3N2, and B strains were 62.0% (95% CI: 56.8–67.2), 53.4% (95% CI: 48.1–58.7), and 54.9% (95% CI: 48.1–60.2), respectively. The corresponding seroprotection rates were 95.0% (95% CI: 92.6–97.3), 93.8% (95% CI: 91.2–96.4), and 95.3% (95% CI: 93.0–97.5). The lower 95% CI limits of the seroconversion and seroprotection rates were over 40% and 70%, respectively, against all strains. Seroconversion and seroprotection rates were not significantly different between the study and control vaccine groups. Furthermore, the frequencies of adverse events were not significantly different between the 2 vaccine groups, and no serious vaccination-related adverse events were noted. In conclusion, the study vaccine exhibited substantial immunogenicity and safety in Korean children and is expected to be clinically effective.
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Affiliation(s)
- Seung Beom Han
- a Department of Pediatrics; The Catholic University of Korea College of Medicine ; Seoul , Republic of Korea
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Huang QS, Turner N, Baker MG, Williamson DA, Wong C, Webby R, Widdowson MA. Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance. Influenza Other Respir Viruses 2016; 9:179-90. [PMID: 25912617 PMCID: PMC4474494 DOI: 10.1111/irv.12315] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/29/2022] Open
Abstract
The 2009 influenza A(H1N1)pdm09 pandemic highlighted the need for improved scientific knowledge to support better pandemic preparedness and seasonal influenza control. The Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance (SHIVERS) project, a 5-year (2012–2016) multiagency and multidisciplinary collaboration, aimed to measure disease burden, epidemiology, aetiology, risk factors, immunology, effectiveness of vaccination and other prevention strategies for influenza and other respiratory infectious diseases of public health importance. Two active, prospective, population-based surveillance systems were established for monitoring influenza and other respiratory pathogens among those hospitalized patients with acute respiratory illness and those enrolled patients seeking consultations at sentinel general practices. In 2015, a sero-epidemiological study will use a sample of patients from the same practices. These data will provide a full picture of the disease burden and risk factors from asymptomatic infections to severe hospitalized disease and deaths and related economic burden. The results during the first 2 years (2012–2013) provided scientific evidence to (a) support a change to NZ's vaccination policy for young children due to high influenza hospitalizations in these children; (b) contribute to the revision of the World Health Organization's case definition for severe acute respiratory illness for global influenza surveillance; and (c) contribute in part to vaccine strain selection using vaccine effectiveness assessment in the prevention of influenza-related consultations and hospitalizations. In summary, SHIVERS provides valuable international platforms for supporting seasonal influenza control and pandemic preparedness, and responding to other emerging/endemic respiratory-related infections.
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Affiliation(s)
- Qiu Sue Huang
- Institute of Environmental Science and Research, Wellington, New Zealand
| | | | | | - Deborah A Williamson
- Institute of Environmental Science and Research, Wellington, New Zealand.,University of Otago, Wellington, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Conroy Wong
- Counties Manakau District Health Board, Auckland, New Zealand
| | - Richard Webby
- WHO Collaborating Centre, St Jude Children's Research Hospital, Memphis, TN, USA
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Williams JTB, Cunningham MA, Wilson KM, Rao S. Rising Oseltamivir Use Among Hospitalized Children in a Postpandemic Era. Hosp Pediatr 2016; 6:172-8. [PMID: 26908818 DOI: 10.1542/hpeds.2015-0126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oseltamivir prescribing among pediatric inpatients with influenza varied from 2% to 48% prior to the 2009 H1N1 pandemic. After the pandemic, prescribing guidelines were expanded, and studies reported benefits for hospitalized children. Post-pandemic prescribing practices among children are unclear. OBJECTIVES To report the rate of oseltamivir use and to identify factors associated with its use among inpatients with confirmed influenza infection from 2010 to 2014 at a tertiary children's hospital. METHODS We conducted a retrospective cohort study of inpatients with polymerase chain reaction-confirmed influenza from December 2010 to April 2014 at Children's Hospital Colorado. The primary outcome was oseltamivir use. Variables regarding demographics, underlying medical conditions, diagnoses, and hospital course were also explored. Univariate and multivariate logistic regression analyses were performed. RESULTS Among 395 inpatients with influenza, 323 (82%) received oseltamivir. In univariate analyses, oseltamivir use was associated with admission within 48 hours of symptom onset (89% vs 77%), ICU admission (88% vs 79%), longer length of stay (90% for >6 days vs 77% for ≤2 days), and influenza A H1N1 infection (P < .05 for all). In multivariate logistic regression analysis, longer length of stay, illness during the 2013-2014 season, and admission within 48 hours of symptom onset were associated with higher odds of oseltamivir use. CONCLUSIONS Oseltamivir use for children with influenza in the postpandemic era is increasing at our institution, aligning with official recommendations and reported benefits. We report highest use for patients in the 2013-2014 season, those who present early in their illness, and those requiring a prolonged hospital stay.
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Affiliation(s)
- Joshua T B Williams
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; and
| | | | | | - Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; and Department of Pediatrics (Hospital Medicine and Infectious Diseases), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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Lee GE, Fisher BT, Xiao R, Coffin SE, Feemster K, Seif AE, Bagatell R, Li Y, Huang YSV, Aplenc R. Burden of Influenza-Related Hospitalizations and Attributable Mortality in Pediatric Acute Lymphoblastic Leukemia. J Pediatric Infect Dis Soc 2015; 4:290-6. [PMID: 26582867 PMCID: PMC4681386 DOI: 10.1093/jpids/piu066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/05/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Influenza can be severe in patients with underlying malignancy; however, the rate of influenza hospitalizations and attributable mortality in children with cancer is unknown. METHODS We performed a retrospective cohort study among 10 698 children with new-onset acute lymphoblastic leukemia (ALL) from 41 US children's hospitals between January 1999 and September 2011. Influenza-related hospitalizations were identified using ICD-9 discharge diagnosis codes, excluding hospitalizations during low-prevalence influenza periods. Follow-up was censored at the earliest of 5 events: end of study period, expected end of chemotherapy, last known hospitalization, hematopoietic stem cell transplant, or death. Data were collected on hospitalization characteristics and resource utilization. Hospitalization rates were calculated using season-adjusted person-time. Crude attributable in-hospital mortality was calculated using baseline mortality for noninfluenza hospitalizations during the same period. Subgroup analysis was performed by time from ALL diagnosis and by age category. RESULTS The rate of influenza-related hospitalizations was 618.3 per 100 000 person-months. Rates were similar by time from ALL diagnosis and across age categories. Overall attributable in-hospital mortality was 1.0% (95% confidence interval [CI], 0.3%-2.3%) and was highest for children <6 months from diagnosis (1.6%; 95% CI, 0.4%-4.5%) and children <2 years of age (6.7%; 95% CI, 1.3%-22.7%). Total length of stay, days of broad-spectrum antibiotic exposure, and duration of intensive care were significantly greater for influenza-related hospitalizations compared with noninfluenza hospitalizations. CONCLUSIONS The burden of influenza-related hospitalizations in children with ALL is high and associated with significantly increased resource utilization and attributable mortality.
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Affiliation(s)
- Grace E. Lee
- Division of Infectious Diseases,Department of Pediatrics
| | - Brian T. Fisher
- Division of Infectious Diseases,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics,Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics,Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan E. Coffin
- Division of Infectious Diseases,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics
| | - Kristen Feemster
- Division of Infectious Diseases,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics
| | | | | | - Yimei Li
- Oncology,Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yuan-Shung V. Huang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania
| | - Richard Aplenc
- Oncology,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics,Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Emukule GO, Paget J, van der Velden K, Mott JA. Influenza-Associated Disease Burden in Kenya: A Systematic Review of Literature. PLoS One 2015; 10:e0138708. [PMID: 26398196 PMCID: PMC4580615 DOI: 10.1371/journal.pone.0138708] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 09/02/2015] [Indexed: 02/03/2023] Open
Abstract
Background In Kenya data on the burden of influenza disease are needed to inform influenza control policies. Methods We conducted a systematic review of published data describing the influenza disease burden in Kenya using surveillance data collected until December 2013. We included studies with laboratory confirmation of influenza, well-defined catchment populations, case definitions used to sample patients for testing and a description of the laboratory methods used for influenza testing. Studies with or without any adjustments on the incidence rates were included. Results Ten studies reporting the incidence of medically-attended and non-medically attended influenza were reviewed. For all age groups, the influenza positive proportion ranged from 5–10% among hospitalized patients, and 5–27% among all medically-attended patients (a combination of in- and outpatients). The adjusted incidence rate of hospitalizations with influenza among children <5 years ranged from 2.7–4.7 per 1,000 [5.7 per 1,000 in children <6 months old], and were 7–10 times higher compared to persons aged ≥5 years. The adjusted incidence of all medically-attended influenza among children aged <5 years ranged from 13.0–58.0 per 1,000 compared to 4.3–26.0 per 1,000 among persons aged ≥5 years. Conclusions Our review shows an expanding set of literature on disease burden associated with influenza in Kenya, with a substantial burden in children under five years of age. Hospitalizations with influenza in these children were 2–3 times higher than reported in the United States. These findings highlight the possible value of an influenza vaccination program in Kenya, with children <5 years and pregnant women being potentially important targets.
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Affiliation(s)
- Gideon O. Emukule
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
- * E-mail:
| | - John Paget
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Koos van der Velden
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Joshua A. Mott
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- US Public Health Service, Rockville, Maryland, United States of America
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McMorrow ML, Emukule GO, Njuguna HN, Bigogo G, Montgomery JM, Nyawanda B, Audi A, Breiman RF, Katz MA, Cosmas L, Waiboci LW, Duque J, Widdowson MA, Mott JA. The Unrecognized Burden of Influenza in Young Kenyan Children, 2008-2012. PLoS One 2015; 10:e0138272. [PMID: 26379030 PMCID: PMC4574572 DOI: 10.1371/journal.pone.0138272] [Citation(s) in RCA: 17] [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: 05/13/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022] Open
Abstract
Influenza-associated disease burden among children in tropical sub-Saharan Africa is not well established, particularly outside of the 2009 pandemic period. We estimated the burden of influenza in children aged 0–4 years through population-based surveillance for influenza-like illness (ILI) and acute lower respiratory tract illness (ALRI). Household members meeting ILI or ALRI case definitions were referred to health facilities for evaluation and collection of nasopharyngeal and oropharyngeal swabs for influenza testing by real-time reverse transcription polymerase chain reaction. Estimates were adjusted for health-seeking behavior and those with ILI and ALRI who were not tested. During 2008–2012, there were 9,652 person-years of surveillance among children aged 0–4 years. The average adjusted rate of influenza-associated hospitalization was 4.3 (95% CI 3.0–6.0) per 1,000 person-years in children aged 0–4 years. Hospitalization rates were highest in the 0–5 month and 6–23 month age groups, at 7.6 (95% CI 3.2–18.2) and 8.4 (95% CI 5.4–13.0) per 1,000 person-years, respectively. The average adjusted rate of influenza-associated medically attended (inpatient or outpatient) ALRI in children aged 0–4 years was 17.4 (95% CI 14.2–19.7) per 1,000 person-years. Few children who had severe laboratory-confirmed influenza were clinically diagnosed with influenza by the treating clinician in the inpatient (0/33, 0%) or outpatient (1/109, 0.9%) settings. Influenza-associated hospitalization rates from 2008–2012 were 5–10 times higher than contemporaneous U.S. estimates. Many children with danger signs were not hospitalized; thus, influenza-associated severe disease rates in Kenyan children are likely higher than hospital-based estimates suggest.
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Affiliation(s)
- Meredith L. McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Gideon O. Emukule
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Henry N. Njuguna
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya
| | - Joel M. Montgomery
- United States Public Health Service, Rockville, Maryland, United States of America
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bryan Nyawanda
- Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya
| | - Allan Audi
- Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya
| | - Robert F. Breiman
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Mark A. Katz
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Leonard Cosmas
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Lilian W. Waiboci
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- Battelle, Atlanta, Georgia, United States of America
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Joshua A. Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
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Ang LW, Lim C, Lee VJM, Ma S, Tiong WW, Ooi PL, Lin RTP, James L, Cutter J. Influenza-associated hospitalizations, Singapore, 2004-2008 and 2010-2012. Emerg Infect Dis 2015; 20:1652-60. [PMID: 25275710 PMCID: PMC4193272 DOI: 10.3201/eid2010.131768] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Studies of influenza-associated hospitalizations in tropical settings are lacking. To increase understanding of the effect of influenza in Singapore, we estimated the age-specific influenza-associated hospitalizations for pneumonia and influenza during 2004-2008 and 2010-2012. The rate of hospitalization was 28.3/100,000 person-years during 2004-2008 and 29.6/100,000 person-years during 2010-2012. The age-specific influenza-associated hospitalization rates followed a J-shaped pattern: rates in persons >75 years of age and in children <6 months of age were >47 times and >26 times higher, respectively, than those for persons 25-44 years of age. Across all ages during these 2 study periods, ≈12% of the hospitalizations for pneumonia and influenza were attributable to influenza. The rates and proportions of hospitalizations for influenza, particularly among the very young and the elderly, are considerable in Singapore and highlight the importance of vaccination in protecting populations at risk.
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Hospitalizations associated with influenza and respiratory syncytial virus among patients attending a network of private hospitals in South Africa, 2007-2012. BMC Infect Dis 2014; 14:694. [PMID: 25510622 PMCID: PMC4278267 DOI: 10.1186/s12879-014-0694-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/10/2014] [Indexed: 11/20/2022] Open
Abstract
Background Influenza and respiratory syncytial virus (RSV) infection are common causes of lower respiratory tract illness. Data on their burden in low and middle-income settings and from Africa are scarce. We aimed to estimate age-specific rates of hospitalization attributable to influenza and RSV among patients attending private hospitals in South Africa during 2007–2012. Methods We estimated annual age-specific rates of influenza- and RSV-associated hospitalization (that is respiratory hospitalizations likely due to influenza or RSV infection) by applying regression models to monthly administrative hospitalization data from a national private hospital group, using influenza and RSV surveillance data as covariates. Results Estimated mean hospitalization rates associated with seasonal influenza were 75 (95% confidence interval (CI), 41–108) and 3 (95% CI, 2–5) per 100,000 person-years for all-respiratory and all-circulatory causes, respectively. Children <1 year and adults ≥75 years were the most affected, with influenza-associated all-respiratory hospitalization rates estimated at 255 (95% CI, 143–358) and 380 (95% CI, 227–506) per 100,000 person-years, respectively. Excess all-circulatory hospitalizations associated with seasonal influenza were only observed in adults ≥65 years. Annual hospitalization rates associated with RSV averaged an estimate of 223 (95% CI, 128–317) per 100,000 person-years for all-respiratory causes. Among children <1 year, RSV-associated all-respiratory hospitalization rate of 7,601 (95% CI, 4,312-10,817) per 100,000 person-years was estimated. Conclusions Influenza and RSV substantially contributed to hospitalizations over the study period. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0694-x) contains supplementary material, which is available to authorized users.
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Kotloff KL, Halasa NB, Harrison CJ, Englund JA, Walter EB, King JC, Creech CB, Healy SA, Dolor RJ, Stephens I, Edwards KM, Noah DL, Hill H, Wolff M. Clinical and immune responses to inactivated influenza A(H1N1)pdm09 vaccine in children. Pediatr Infect Dis J 2014; 33:865-71. [PMID: 25222307 PMCID: PMC4166548 DOI: 10.1097/inf.0000000000000329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As the influenza A H1N1 pandemic emerged in 2009, children were found to experience high morbidity and mortality and were prioritized for vaccination. This multicenter, randomized, double-blind, age-stratified trial assessed the safety and immunogenicity of inactivated influenza A(H1N1)pdm09 vaccine in healthy children aged 6 months to 17 years. METHODS Children received 2 doses of approximately 15 or 30 µg hemagglutin antigen 21 days apart. Reactogenicity was assessed for 8 days after each dose, adverse events through day 42, and serious adverse events or new-onset chronic illnesses through day 201. Serum hemagglutination inhibition titers were measured on days 0 (prevaccination), 8, 21, 29 and 42. RESULTS A total of 583 children received the first dose and 571 received the second dose of vaccine. Vaccinations were generally well-tolerated and no related serious adverse events were observed. The 15 µg dosage elicited a seroprotective hemagglutination inhibition (≥ 1:40) in 20%, 47% and 93% of children in the 6-35 month, 3-9 year and 10-17 year age strata 21 days after dose 1 and in 78%, 82% and 98% of children 21 days after dose 2, respectively. The 30 µg vaccine dosage induced similar responses. CONCLUSIONS The inactivated influenza A(H1N1)pdm09 vaccine exhibited a favorable safety profile at both dosage levels. While a single 15 or 30 µg dose induced seroprotective antibody responses in most children 10-17 years of age, younger children required 2 doses, even when receiving dosages 4- to 6-fold higher than recommended. Well-tolerated vaccines are needed that induce immunity after a single dose for use in young children during influenza pandemics.
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Affiliation(s)
- Karen L. Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD
| | - Natasha B. Halasa
- Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, TN
| | - Christopher J. Harrison
- Pediatric Infectious Diseases Section, Children's Mercy Hospital and Clinics, and the University of Missouri-Kansas City, Kansas City, MO
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Emmanuel B. Walter
- Department of Pediatrics, Duke Clinical Vaccine Unit, Duke University School of Medicine, Durham, NC
| | - James C. King
- Division of General Pediatrics, Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD
| | - C. Buddy Creech
- Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, TN
| | - Sara A. Healy
- Division of Pediatric Infectious Diseases, University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Rowena J. Dolor
- Department of Pediatrics, Duke Clinical Vaccine Unit, Duke University School of Medicine, Durham, NC
| | - Ina Stephens
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD
| | - Kathryn M. Edwards
- Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, TN
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