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Hao YZ, Cen LF, Wang T, Yi T, Shi XL, Duan HJ, Dai Z, Zhu HY, Tang JG. The protective effect of 999 XiaoErGanMao granules on the lungs and intestines of influenza A virus-infected mice. PHARMACEUTICAL BIOLOGY 2023; 61:630-638. [PMID: 37036063 PMCID: PMC10088977 DOI: 10.1080/13880209.2023.2195884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/03/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
CONTEXT Gastrointestinal symptoms are a common complication of influenza virus infection in children, which the gut-lung axis become involved in its biological progress. The protective effect of 999 XiaoErGanMao granules (XEGMG) on multi-organ injury in viral pneumonia remains unclear. OBJECTIVE To investigate the therapeutic effect of XEGMG on lungs and intestines injury in A/FM/1/47 (H1N1) influenza virus-infected mice. MATERIALS AND METHODS Male BALB/c mice were infected with the 2LD50 H1N1 influenza virus and then treated with XEGMG (6 or 12 g/kg) intragastrically once a day for 4 days. The lung and colon samples were then collected for pathological observation, and assays for inflammatory cytokines and intestinal barrier. Mouse feces were collected to evaluate the intestinal microbiota. RESULTS Treating with XEGMG (12 g/kg) can mitigate body weight loss caused by 2LD50 H1N1 infection. It can also reduce lung index and pathological damage with the decreased inflammatory cytokines such as IL-6 and IL-1β. Furthermore, XEGMG (12 g/kg) can maintain the goblet cell number in the colons to protect the intestinal barrier and regulate the major flora such as Firmicutes, Bacteroidetes, and Muribaculaceae back to normal. Meanwhile, the expression of IL-17A in the colon tissues was significantly lower in the group of XEGMG (6, 12 g/kg) compared to H1N1 group. DISCUSSION AND CONCLUSIONS XEGMG can protect against H1N1 invasion involved in gut-lung axis regulation. The results provide new evidence for the protective effect of XEGMG, which is beneficial to vulnerable children.
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Affiliation(s)
- Yuan-zhen Hao
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, Shanghai, China
| | - Li-feng Cen
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, Shanghai, China
| | - Ting Wang
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, Shanghai, China
| | - Tong Yi
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, Shanghai, China
| | - Xun-long Shi
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, Shanghai, China
| | - Hui-juan Duan
- China Resources Sanjiu Medical & Pharmaceutical Co., Ltd, Shenzhen, China
| | - Zhi Dai
- China Resources Sanjiu Medical & Pharmaceutical Co., Ltd, Shenzhen, China
| | - Hai-yan Zhu
- Department of Biological Medicines & Shanghai Engineering Research Center of ImmunoTherapeutics, School of Pharmacy, Fudan University, Shanghai, China
| | - Jian-guo Tang
- Department of Trauma-Emergency & Critical Care Medicine, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
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Hussein I, Vänskä S, Sivelä J, Leino T, Nohynek H. Factors associated with parental intention to vaccinate their child against influenza, Finland, February to March, 2022: a web-based survey. Euro Surveill 2023; 28:2200828. [PMID: 38062946 PMCID: PMC10831410 DOI: 10.2807/1560-7917.es.2023.28.49.2200828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/04/2023] [Indexed: 12/18/2023] Open
Abstract
BackgroundInfluenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences.AimTo assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children.MethodsWe conducted a web-based survey among parents (n = 17,844) of randomly selected eligible children (aged 6 months-6 years) in February-March 2022 in five Finnish municipalities from regions of high and low coverage. Logistic regressions were used to determine associations between vaccination intention and e.g. sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study.ResultsParticipation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent's education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64%, and realised vaccination 51%.ConclusionDespite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating.
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Affiliation(s)
- Idil Hussein
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Doctoral Programme in Population Health, Faculty of Medicine, University of Helsinki, Finland
| | - Simopekka Vänskä
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jonas Sivelä
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tuija Leino
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Shi Y, Yang W, Li X, Chu K, Wang J, Tang R, Xu L, Li L, Hu Y, Zhao C, Pan H. Immunogenicity and Safety of One versus Two Doses of Quadrivalent Inactivated Influenza Vaccine (IIV4) in Vaccine-Unprimed Children and One Dose of IIV4 in Vaccine-Primed Children Aged 3-8 Years. Vaccines (Basel) 2023; 11:1586. [PMID: 37896989 PMCID: PMC10611167 DOI: 10.3390/vaccines11101586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Two doses of the inactivated influenza vaccine (IIV) are generally recommended for children under 9 years old. This study assessed the necessity for a second dose of quadrivalent IIV (IIV4) in children aged 3-8 years. In this randomized, open-label, paralleled-controlled study, 400 children aged 3-8 years who were vaccine-unprimed were randomly assigned at a 1:1 ratio to receive a two-dose (Group 1) or one-dose (Group 2) regimen of IIV4, and 200 who were vaccine-primed received one dose of IIV4 (Group 3). A serum sample was collected before and 28 days after the last dose to determine the hemagglutination inhibition (HI) antibody level. Adverse events were collected within 28 days after each dose. One-dose or two-doses of IIV4 were well tolerated and safe in children aged 3-8 years, and no serious adverse events related to the vaccine were reported. The seroconversion rates (SCRs) of HI antibody ranged from 61.86% to 95.86%, and the post-vaccination seroprotection rates (SPRs) were all >70% in three groups against the four virus strains. The two-dose regimen in vaccine-unprimed participants (Group 1) achieved similar SPRs in comparison with the one-dose in the vaccine-primed group (Group 3), and the SPRs in Group 1 and Group 3 were higher in vaccine-unprimed participants of the one-dose regimen (Group 2). The present study supports the recommendations of a two-dose regimen for IIV4 use in children aged 3-8 years.
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Affiliation(s)
- Yunfeng Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009,China
| | - Wanqi Yang
- Sinovac Biotech Co., Ltd., Beijing 100085, China
| | - Xiaoyu Li
- National Institutes for Food and Drug Control, Beijing 102629, China
| | - Kai Chu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009,China
| | | | - Rong Tang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009,China
| | - Li Xu
- Sinovac Biotech Co., Ltd., Beijing 100085, China
| | - Lanshu Li
- National Institutes for Food and Drug Control, Beijing 102629, China
| | - Yuansheng Hu
- Sinovac Biotech Co., Ltd., Beijing 100085, China
| | - Chenyan Zhao
- National Institutes for Food and Drug Control, Beijing 102629, China
| | - Hongxing Pan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009,China
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Rua IB, Diogo J, Januário G, Moinho R, Carvalho L, Mação P. Severe Influenza Virus and Respiratory Syncytial Virus Infections in Intensive Care Over the Last 15 Years. Cureus 2023; 15:e46966. [PMID: 38022179 PMCID: PMC10640910 DOI: 10.7759/cureus.46966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Influenza virus is a common agent of pediatric infections. Most cases are mild, but severe illness and death can occur. We aimed to analyze severe cases associated the influenza virus and compare it with respiratory syncytial virus (RSV). METHODS This is a retrospective study of 0-17-year-old patients admitted to the intensive care unit (ICU) of Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra (Pediatric Hospital, Coimbra Hospital and University Center), a tertiary pediatric hospital in Coimbra, Portugal, over the last 15 years (2008-2022) due to influenza virus infection. Clinical presentation, severity, and evolution were analyzed. A comparison of children with RSV infection admitted in the same period was performed. RESULTS We identified 47 cases of influenza virus infection (34% coinfection with other viruses), median age of 2.3 years (interquartile range (IQR) 6.1), and 38% had comorbidities. The median admissions were three/year (maximum 11 in 2019). Influenza A was identified in 96%. Ninety-six percent had respiratory symptoms, 38% had neurologic symptoms, and 28% had sepsis. The main reason for admission was respiratory failure (68%). The mean pediatric index of mortality 2 (PIM2) at admission was 9±15.9%. Ventilatory support was necessary in 66%, vasoactive support in 19%, and blood products in 17%. The median length of stay was four days (IQR 5). There were four (8.5%) deaths. During the same study period, there were 171 RSV-related admissions. When comparing influenza (group A, without RSV coinfection) and RSV (group B), the first had a higher PIM2 on admission, greater need of ventilatory support, more complications, and higher mortality (p=0.001). CONCLUSIONS The number of influenza virus infections admitted to ICU was much lower than RSV. However, influenza was more severe and associated with all deaths registered.
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Affiliation(s)
- Inês B Rua
- Pediatric Intensive Care Service, Pediatric Hospital, Coimbra Hospital and University Centre, Coimbra, PRT
| | - João Diogo
- Department of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, PRT
| | - Gustavo Januário
- Pediatric Ambulatory Service, Pediatric Hospital, Coimbra Hospital and University Centre, Coimbra, PRT
- Department of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, PRT
| | - Rita Moinho
- Pediatric Intensive Care Service, Pediatric Hospital, Coimbra Hospital and University Centre, Coimbra, PRT
| | - Leonor Carvalho
- Pediatric Intensive Care Service, Pediatric Hospital, Coimbra Hospital and University Centre, Coimbra, PRT
| | - Patrícia Mação
- Pediatric Emergency Service, Pediatric Hospital, Coimbra Hospital and University Centre, Coimbra, PRT
- Department of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, PRT
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Wei X, Tan X, Guan Q, Zhang R, Lei S, Wei S. Immunogenicity and safety of quadrivalent inactivated influenza vaccine in children aged 6 to 35 months: A systematic review and meta-analysis. Hum Vaccin Immunother 2023; 19:2256510. [PMID: 37794647 PMCID: PMC10557567 DOI: 10.1080/21645515.2023.2256510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Evidence of the immunogenicity and safety of quadrivalent inactivated influenza vaccine in children aged 6 to 35 months has been emerging. To evaluate the immunogenicity and safety of quadrivalent inactivated influenza vaccine in children aged 6 to 35 months in a systematic review and meta-analysis. This meta-analysis included 12 studies with 6722 participants receiving QIV, 3575 participants receiving TIV, 4249 participants receiving full-dose QIV (F-QIV), and 3722 participants receiving half-dose QIV (H-QIV). Among children aged 6 to 35 months, QIV produces a better Immunogenicity against influenza B vaccine strains not contained in TIV. However, injection site reaction was more common for QIV, F-QIV showed superior efficacy for the B lineage, but fever and injection site pain was more frequently reported for F-QIV than H-QIV. These data support the immunogenicity and safety of quadrivalent inactivated influenza vaccine among children aged 6 to 35 months.
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Affiliation(s)
- Xia Wei
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Xue Tan
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
| | - Qinghu Guan
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Ruizhi Zhang
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Shiguang Lei
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, Guizhou, China
| | - Shaofeng Wei
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou, China
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Kandeel A, Fahim M, Deghedy O, Roshdy WH, Khalifa MK, Shesheny RE, Kandeil A, Naguib A, Afifi S, Mohsen A, Abdelghaffar K. Resurgence of influenza and respiratory syncytial virus in Egypt following two years of decline during the COVID-19 pandemic: outpatient clinic survey of infants and children, October 2022. BMC Public Health 2023; 23:1067. [PMID: 37277781 DOI: 10.1186/s12889-023-15880-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Two years after unprecedented low rates of circulation of most common respiratory viruses (SARS-CoV-2), the Egyptian ARI surveillance system detected an increase in acute respiratory infections (ARIs) with a reduced circulation of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), especially among school children. A national survey was conducted to estimate the burden and identify the viral causes of ARIs among children < 16 years of age. METHODS A one-day survey was carried out in 98 governmental outpatient clinics distributed all over Egypt 26 governorates. The four largest referral hospitals in each governorate where most influenza-like illness (ILI) patients seek care were selected. Using the WHO case definition, the first five patients < 16 years of age with ILI symptoms visiting the selected outpatient clinics on the survey day were enrolled. Basic demographic and clinical data of patients were collected using a linelist. Patients were swabbed and tested for SARS-CoV-2, influenza, and Respiratory Syncytial virus (RSV) by RT-PCR at the Central Laboratory in Cairo. RESULTS Overall, 530 patients enrolled, their mean age was 5.8 ± 4.2, 57.1% were males, and 70.2% reside in rural or semi-rural areas. Of all patients, 134 (25.3%) had influenza, 111 (20.9%) RSV, and 14 (2.8%) coinfections. Influenza-positive children were older compared to RSV, (7.2 ± 4.1, 4.3 ± 4.1, p < 0.001), with more than half of them (53.0%) being school students. Dyspnea was reported in RSV more than in influenza (62.2% vs. 49.3%, p < 0.05). Among RSV patients, children < 2 years had a higher rate of dyspnea than others (86.7% vs. 53.1%, < 0.001). CONCLUSIONS A resurgence of influenza and RSV was detected in Egypt in the 2022-2023 winter season. Influenza caused a higher rate of infection than RSV, while RSV caused more severe symptoms than influenza. Monitoring a broader range of respiratory pathogens is recommended to estimate the ARI burden and risky groups for severe disease in Egypt.
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Affiliation(s)
- Amr Kandeel
- Ministry of Health and Population, Cairo, Egypt
| | - Manal Fahim
- Ministry of Health and Population, Cairo, Egypt
| | - Ola Deghedy
- Ministry of Health and Population, Cairo, Egypt
| | - Wael H Roshdy
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Mohamed K Khalifa
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622, Dokki, Giza, Egypt
| | - Rabeh El Shesheny
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622, Dokki, Giza, Egypt
| | - Ahmed Kandeil
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, 12622, Dokki, Giza, Egypt
| | - Amel Naguib
- Central Public Health Laboratory, Ministry of Health and Population, Cairo, Egypt
| | - Salma Afifi
- Consultant Ministry of Health and Population, Cairo, Egypt
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Üzüm Ö, Karadağ Öncel E, Demirçelik Y, Örsdemir Hortu H, Kanık A, Eliaçık K, Yılmaz Çiftdoğan D, Helvacı M. Characteristics and Results of Hospital Admission Caused by Influenza Virus Infections in Children under 5 Years Old. J Trop Pediatr 2022; 68:6617964. [PMID: 35751686 DOI: 10.1093/tropej/fmac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS The influenza virus is an infectious disease with acute respiratory tract infections, caused secondary bacterial infections and death. In this study, we aimed to determine which predictors were associated with the need for high-flow nasal cannula oxygen therapy (HFNC) and transition to intensive care for influenza virus and also to compare single viral pathogens with multiple ones. METHODS Inpatients under the age of 5 with influenza virus-related respiratory tract infections between November 2015 and March 2019 were included in the study. Demographic features, comorbidities, symptoms, secondary bacterial infection, need for HFNC and pediatric intensive care unit and respiratory support system, length of hospital stay, polymerase chain reaction tests were recorded. RESULTS A total of 93 patients were included in the study. It was determined that 53.8% of the cases were male and 84.9% were under the age of 2. Comorbidities were present in 50.5% of the cases. Secondary bacterial pneumonia developed in 56.9% of the cases. Patients with secondary bacterial pneumonia had higher PICU need, HFNC need and hospital stay (p = 0.014, p ≤ 0.001 and p ≤ 0.001, respectively). Patients with comorbidity had longer hospital stays and a higher need for HFNC (p ≤ 0.001 and p = 0.001, respectively). CONCLUSIONS In this study, it was determined that especially comorbidity and secondary bacterial infection aggravated the clinical treatment of hospitalized patients. Therefore, it was concluded that patients with comorbidity should be followed closely and secondary bacterial pneumonia should be recognized and treated early.
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Affiliation(s)
- Özlem Üzüm
- Department of Pediatric Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Eda Karadağ Öncel
- Department of Pediatric Infectious Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Yavuz Demirçelik
- Department of Pediatric Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Hacer Örsdemir Hortu
- Department of Pediatric Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Ali Kanık
- Department of Pediatric Diseases, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Kayı Eliaçık
- Department of Pediatric Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Dilek Yılmaz Çiftdoğan
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Katip Çelebi University, Izmir, Turkey
| | - Mehmet Helvacı
- Department of Pediatric Diseases, Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
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Hu S, Ma R, Shen K, Xin D, Li X, Xu B, Zhao X, Feng Z, Yan Y, Xue Z, Zhang B, Li X, Zheng Y, Zhou H, Wu L, Yang L, Xu H, Shao R, Yin Y, Zhong C, Li H, Cai Q, Xu Y. Efficacy and safety of Qinxiang Qingjie oral solution for the treatment of influenza in children: a randomized, double-blind, multicenter clinical trial. Transl Pediatr 2022; 11:987-1000. [PMID: 35800262 PMCID: PMC9253950 DOI: 10.21037/tp-22-201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Qinxiang Qingjie (QXQJ), an oral solution containing various Chinese herbs, is indicated for pediatric upper respiratory tract infections. The treatment of influenza also shows potential advantages in shortening the duration of illness and improving symptoms. However, there is still a lack of high-quality clinical evidence to support this. The trial was to explore the efficacy and safety of QXQJ for treating pediatric influenza and provide an evidence-based basis for expanding its applicability. METHODS A randomized, double-blind, double-dummy, positive-controlled, multicenter clinical trial was conducted in 14 hospitals in China. Children aged 1-13 years with influenza and "exterior and interior heat syndromes" as defined by traditional Chinese medicine (TCM) were randomly assigned to two groups with 1:1 radio. Children in the test group received QXQJ oral solution and oseltamivir simulant, while the control group received oseltamivir phosphate granules and QXQJ simulant. The duration of treatment was five days, followed by a two-day follow-up period. The primary endpoint was the clinical recovery time. Secondary endpoints included the time to defervescence, incidences of complications and severe or critical influenza, negative conversion rate, improvement of TCM syndromes, and safety profiles of the therapeutics, which mainly contained the adverse clinical events and adverse drug reactions. RESULTS A total of 231 children were randomized to either the QXQJ (n=117) or oseltamivir (n=114) group. The FAS and PPS results showed that both groups experienced a median clinical recovery time of three days (P>0.05). The median time to defervescence of both groups were 36 hours in FAS and PPS (P>0.05), and two groups did not differ in terms of the other secondary endpoints (P>0.05). 14 patients (12.39%) in the QXQJ group and 14 patients (12.50%) in the oseltamivir group reported at least one adverse event, respectively. One serious adverse event occurred in the QXQJ group. There was no significant difference in the incidence of adverse events or adverse drug reactions between the groups. CONCLUSIONS The efficacy of QXQJ oral solution was comparable to that of oseltamivir for treating influenza in children, with an acceptable safety profile. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900021060.
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Affiliation(s)
- Siyuan Hu
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Department of Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Rong Ma
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Kunling Shen
- Department of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children’s Health, Beijing, China
- Department of Pediatrics, Shenzhen Children’s Hospital, Shenzhen, China
| | - Deli Xin
- Department of Tropical Medicine Research, Beijing Friendship Hospital, Capital Medical University, Beijing Tropical Medicine Research Institute, Beijing, China
| | - Xinmin Li
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Baoping Xu
- Department of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children’s Health, Beijing, China
| | - Xiaobing Zhao
- Department of Medical Affairs, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Ziwei Feng
- Department of Pediatrics, Luohe Hospital of Traditional Chinese Medicine, Luohe, China
| | - Yongbin Yan
- Department of Pediatrics, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zheng Xue
- Department of Pediatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Baoqing Zhang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xueming Li
- Department of Pediatrics, Handan Hospital of Traditional Chinese Medicine, Handan, China
| | - Yanmei Zheng
- Department of Pediatrics, Taiyuan Maternity and Child Health Care Hospital, Taiyuan, China
| | - Hongxia Zhou
- Department of Pediatrics, Maternal and Child Health Care Hospital of Yuncheng, Yuncheng, China
| | - Liqun Wu
- Department of Pediatrics, Dongfang Hospital Beijing University of Chinese Medicine, Beijing, China
| | - Lili Yang
- Department of Pediatrics, Changzhi People’s Hospital, Changzhi, China
| | - Hua Xu
- Department of Pediatrics, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Rongchang Shao
- Department of Pediatrics, Ezhou Central Hospital, Ezhou, China
| | - Yong Yin
- Department of Respiratory, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengliang Zhong
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Department of Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Han Li
- Department of Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qiuhan Cai
- Department of Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yaqian Xu
- Department of Clinical Trial Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Wang JL, Chen T, Deng LL, Han YJ, Wang DY, Wang LP, He GX. Epidemiological characteristics of imported respiratory infectious diseases in China, 2014‒2018. Infect Dis Poverty 2022; 11:22. [PMID: 35246236 PMCID: PMC8895356 DOI: 10.1186/s40249-022-00944-6] [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: 09/26/2021] [Accepted: 02/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background With the progress of globalization, international mobility increases, greatly facilitating cross-border transmission of respiratory infectious diseases (RIDs). This study aimed to analyze the epidemiological characteristics and factors influencing imported RIDs, with the goal of providing evidence to support adoption of high-tech, intelligent methods to early find imported RIDs and prevent their spread in China. Methods We obtained data of imported RIDs cases from 2014 to 2018 from the Inbound Sentinel Network of Customs and the National Notifiable Diseases Reporting System in China. We analyzed spatial, temporal, and population distribution characteristics of the imported RIDs. We developed an index to describe seasonality. Pearson correlation coefficients were used to examine associations between independent variables and imported cases. Data analyses and visualizations were conducted with R software. Results From a total of 1 409 265 253 inbound travelers, 31 732 (2.25/100 000) imported RIDs cases were reported. RIDs cases were imported from 142 countries and five continents. The incidence of imported RIDs was nearly 5 times higher in 2018 (2.81/100 000) than in 2014 (0.58/100 000). Among foreigners, incidence rates were higher among males (5.32/100 000), 0–14-year-olds (15.15/100 000), and cases originating in Oceania (11.10/100 000). The vast majority (90.3%) of imported RIDs were influenza, with seasonality consistent with annual seasonality of influenza. The spatial distribution of imported RIDs was different between Chinese citizens and foreigners. Increases in inbound travel volume and the number of influenza cases in source countries were associated with the number of imported RIDs. Conclusions Our study documented importation of RIDs into China from 142 countries. Inbound travel poses a significant risks bringing important RIDs to China. It is urgent to strengthen surveillance at customs of inbound travelers and establish an intelligent surveillance and early warning system to prevent importation of RIDs to China for preventing further spread within China. Graphical Abstract ![]()
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Affiliation(s)
- Jin-Long Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tao Chen
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Le-Le Deng
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ya-Jun Han
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Da-Yan Wang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li-Ping Wang
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Guang-Xue He
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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10
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Wraith S, Balmaseda A, Carrillo FAB, Kuan G, Huddleston J, Kubale J, Lopez R, Ojeda S, Schiller A, Lopez B, Sanchez N, Webby R, Nelson MI, Harris E, Gordon A. Homotypic protection against influenza in a pediatric cohort in Managua, Nicaragua. Nat Commun 2022; 13:1190. [PMID: 35246548 PMCID: PMC8897407 DOI: 10.1038/s41467-022-28858-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
The period of protection from repeat infection following symptomatic influenza is not well established due to limited availability of longitudinal data. Using data from a pediatric cohort in Managua, Nicaragua, we examine the effects of natural influenza virus infection on subsequent infection with the same influenza virus subtype/lineage across multiple seasons, totaling 2,170 RT-PCR-confirmed symptomatic influenza infections. Logistic regression models assessed whether infection in the prior influenza season protected against homologous reinfection. We sequenced viruses from 2011-2019 identifying dominant clades and measuring antigenic distances between hemagglutinin clades. We observe homotypic protection from repeat infection in children infected with influenza A/H1N1pdm (OR 0.12, CI 0.02-0.88), A/H3N2 (OR 0.41, CI 0.24-0.73), and B/Victoria (OR 0.00, CI 0.00-0.14), but not with B/Yamagata viruses (OR 0.60, CI 0.09-2.10). Overall, protection wanes as time or antigenic distance increases. Individuals infected with one subtype or lineage of influenza virus have significantly lower odds of homologous reinfection for the following one to two years; after two years this protection wanes. This protection is demonstrated across multiple seasons, subtypes, and lineages among children.
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Affiliation(s)
- Steph Wraith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Fausto Andres Bustos Carrillo
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Guillermina Kuan
- Sustainable Sciences Institute, Managua, Nicaragua
- Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua
| | - John Huddleston
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - John Kubale
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Roger Lopez
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia, Ministry of Health, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Amy Schiller
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Brenda Lopez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Richard Webby
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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11
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Esposito S, Nauta J, Lapini G, Montomoli E, van de Witte S. Efficacy and safety of a quadrivalent influenza vaccine in children aged 6–35 months: A global, multiseasonal, controlled, randomized Phase III study. Vaccine 2022; 40:2626-2634. [DOI: 10.1016/j.vaccine.2022.02.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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12
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Rudolph H, Gress K, Weiss C, Schroten H, Adams O, Tenenbaum T. General Characteristics of Children with Single- and Co-Infections and Febrile Seizures with a Main Focus on Respiratory Pathogens: Preliminary Results. Pathogens 2021; 10:pathogens10081061. [PMID: 34451525 PMCID: PMC8399297 DOI: 10.3390/pathogens10081061] [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: 07/12/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 01/15/2023] Open
Abstract
Febrile seizures (FS) affect up to 5% of children. The pathogen etiology in regard of viral loads has never been investigated. In a prospective cohort study we investigated the correlation between virus type and quantity in nasopharyngeal aspirates (NPAs) and the clinical characteristics in pediatric patients with a FS. From January 2014 to April 2016, 184 children with a FS were prospectively enrolled. The mean age of all included children was 26.7 ± 18.3 months with a male to female ratio of 1.4:1. Males with an acute disease and a short duration or absence of prior symptoms had a higher risk for complex FS. The majority of patients with FS presented with a generalized convulsion (180; 98%) and was admitted to hospital (178; 97%). Overall, 79 (43%) single and in 59 (32%) co-infections were detected. Human herpes virus 6 (HHV6), influenza, adenovirus (AV) and rhinovirus (RV) were the dominant pathogens, all detected with clinically significant high viral loads. HHV6 positive cases were significantly younger and less likely to have a positive family/personal history for FS. Influenza positives showed a higher rate of complex seizures, lower leukocyte and higher monocyte counts. AV positive cases were more likely to have a positive family history for FS and showed higher C-reactive protein values. In conclusion, a high viral load may contribute to the development of a FS in respiratory tract infections.
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Affiliation(s)
- Henriette Rudolph
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
| | - Katharina Gress
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
| | - Christel Weiss
- Institute of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Horst Schroten
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
| | - Ortwin Adams
- Institute of Virology, University Children’s Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
| | - Tobias Tenenbaum
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
- Correspondence: or ; Tel.: +49-30-5518-5060
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13
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Roosenhoff R, Reed V, Kenwright A, Schutten M, Boucher CA, Monto A, Clinch B, Kumar D, Whitley R, Nguyen-Van-Tam JS, Osterhaus ADME, Fouchier RAM, Fraaij PLA. Viral Kinetics and Resistance Development in Children Treated with Neuraminidase Inhibitors: The Influenza Resistance Information Study (IRIS). Clin Infect Dis 2021; 71:1186-1194. [PMID: 31560055 PMCID: PMC7442852 DOI: 10.1093/cid/ciz939] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/19/2019] [Indexed: 01/17/2023] Open
Abstract
Background We studied the effect of age, baseline viral load, vaccination status, antiviral therapy, and emergence of drug resistance on viral shedding in children infected with influenza A or B virus. Methods Samples from children (aged ≤13 years) enrolled during the 7 years of the prospective Influenza Resistance Information Study were analyzed using polymerase chain reaction to determine the influenza virus (sub-)type, viral load, and resistance mutations. Disease severity was assessed; clinical symptoms were recorded. The association of age with viral load and viral clearance was examined by determining the area under the curve for viral RNA shedding using logistic regression and Kaplan-Meier analyses. Results A total of 2131 children infected with influenza (683, A/H1N1pdm09; 825, A/H3N2; 623, influenza B) were investigated. Age did not affect the mean baseline viral load. Children aged 1−5 years had prolonged viral RNA shedding (±1–2 days) compared with older children and up to 1.2-fold higher total viral burden. Besides, in older age (odds ratio [OR], 1.08; confidence interval [CI], 1.05–1.12), prior vaccination status (OR, 1.72; CI, 1.22–2.43) and antiviral treatment (OR, 1.74; CI, 1.43–2.12) increased the rate of viral clearance. Resistance mutations were detected in 49 children infected with influenza A virus (34, A/H1N1pdm09; 15, A/H3N2) treated with oseltamivir, most of whom were aged <5 years (n = 39). Conclusions Children aged 1−5 years had a higher total viral burden with prolonged virus shedding and had an increased risk of acquiring resistance mutations following antiviral treatment. Clinical Trials Registration NCT00884117.
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Affiliation(s)
| | | | | | | | - Charles A Boucher
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arnold Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Barry Clinch
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - Deepali Kumar
- Transplant Infectious Diseases and Multi Organ Transplant Program, University Health Network, Toronto, Ontario, Canada
| | - Richard Whitley
- Department of Pediatrics, Microbiology, Medicine, and Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jonathan S Nguyen-Van-Tam
- School of Medicine, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Albert D M E Osterhaus
- Research Institute for Infectious Diseases and Zoonosis, University of Veterinary Medicine, Hannover, Germany.,Artemis One Health Research Institute, Utrecht, The Netherlands
| | - Ron A M Fouchier
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pieter L A Fraaij
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Subdivision Infectious Diseases and Immunology, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
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14
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Tao YY, Li JX, Hu YM, Hu YS, Zeng G, Zhu FC. Quadrivalent influenza vaccine (Sinovac Biotech) for seasonal influenza prophylaxis. Expert Rev Vaccines 2021; 20:1-11. [PMID: 33434084 DOI: 10.1080/14760584.2021.1875823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Quadrivalent Influenza Vaccine (Sinovac Biotech) is a quadrivalent split-virion-inactivated influenza vaccine approved in China in June 2020 for individuals ≥3 years of age. It contains 15 µg hemagglutinin per strain including A/H1N1, A/H3N2, B/Victoria, and B/Yamagata, which could potentially improve protection against influenza B viruses. AREAS COVERED In this review, we summarize the development of quadrivalent influenza vaccines in China and foreign countries, and assess the immunogenicity and safety from the phase I and III clinical trials of Quadrivalent Influenza Vaccine in individuals ≥3 years of age. We also discuss the potential application of Quadrivalent Influenza Vaccine in young children 6-35 months of age according to the results of the phase III trial. EXPERT COMMENTARY The immunogenicity and safety profiles of Quadrivalent Influenza Vaccine containing two A and two B strains were comparable to the trivalent vaccines for the shared strains. The addition of a second B strain to the trivalent vaccine could induce superior immune responses for the alternate B strain. Since the two B strains co-circulated worldwide, the introduction of quadrivalent influenza vaccines has been expected to be a cost-effective strategy.
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Affiliation(s)
- Yan-Yang Tao
- School of Public Health, Southeast University; Nanjing, China
| | - Jing-Xin Li
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yue-Mei Hu
- NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yuan-Sheng Hu
- Clinical Research Department, Sinovac Biotech Co., LTD., Beijing, China
| | - Gang Zeng
- Clinical Research Department, Sinovac Biotech Co., LTD., Beijing, China
| | - Feng-Cai Zhu
- School of Public Health, Southeast University; Nanjing, China.,NHC Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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15
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Scholz SM, Weidemann F, Damm O, Ultsch B, Greiner W, Wichmann O. Cost-Effectiveness of Routine Childhood Vaccination Against Seasonal Influenza in Germany. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:32-40. [PMID: 33431151 DOI: 10.1016/j.jval.2020.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In Germany, routine influenza vaccination with quadrivalent influenza vaccines (QIV) is recommended and reimbursed for individuals ≥60 years of age and individuals with underlying chronic conditions. The present study examines the cost-effectiveness of a possible extension of the recommendation to include strategies of childhood vaccination against seasonal influenza using QIV. METHODS A dynamic transmission model was used to examine the epidemiological impact of different childhood vaccination strategies. The outputs were used in a health economic decision tree to calculate the costs per quality-adjusted life year (QALY) gained from a societal and a third-party payer (TPP) perspective. Strain-specific epidemiology, vaccine uptake, and vaccine efficacy data from the 10 non-pandemic seasons from 2003/2004 to 2013/2014 were used, and cost data were drawn mainly from a health insurance claims data analysis and supplemented by estimates from literature. Uncertainty is explored via scenario, deterministic, and probabilistic sensitivity analyses. RESULTS Vaccinating 2- to 9-year-olds with QIV assuming a vaccine uptake of 40% is cost-saving with a benefit-cost ratio of 1.66 from a societal perspective and an incremental cost-effectiveness ratio of €998/QALY from a TPP perspective. Lower and higher vaccine uptakes show marginal effects, while extending the target group to 2- to 17-year-olds further increases the health benefits while still being below the willingness-to-pay (WTP) threshold. Assuming no vaccine-induced herd protection has a negative effect on the cost-effectiveness ratio, but childhood vaccination remains cost-effective. CONCLUSION Routine childhood vaccination against seasonal influenza in Germany is most likely to be cost-saving from a societal perspective and highly cost-effective from a TPP perspective.
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Affiliation(s)
- Stefan M Scholz
- Immunization Unit, Robert Koch-Institute, Berlin, Germany; School of Public Health, Bielefeld University, Bielefeld, Germany.
| | | | - Oliver Damm
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Wolfgang Greiner
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
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16
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Bleser WK, Salmon DA, Miranda PY. A hidden vulnerable population: Young children up-to-date on vaccine series recommendations except influenza vaccines. PLoS One 2020; 15:e0234466. [PMID: 32555653 PMCID: PMC7302445 DOI: 10.1371/journal.pone.0234466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/14/2020] [Indexed: 12/04/2022] Open
Abstract
Very young children (under 2 years old) have high risk for influenza-related complications. Children 6 months or older in the US are recommended to receive influenza vaccination annually, yet uptake is substantially lower than other routinely-recommended vaccines. Existing nationally-representative studies on very young child influenza vaccine uptake has several limitations: few examine provider-verified influenza vaccination (relying on parental report), few contain parental vaccine attitudes variables (known to be crucial to vaccine uptake), and none to our knowledge consider intersectionality of social disadvantage nor how influenza vaccine determinants differ from those of other recommended vaccines. This nationally-representative study examines provider-verified data on 7,246 children aged 6–23 months from the most recent (2011) National Immunization Survey to include the restricted Parental Concerns module, focusing on children up-to-date on a series of vaccines (the 4:3:1:3:3:1:4 series) but not influenza vaccines (“hidden vulnerability to influenza”). About 71% of children were up-to-date on the series yet only 33% on influenza vaccine recommendations by their second birthday; 44% had hidden vulnerability to influenza. Independent of parental history of vaccine refusal and a myriad of health services use factors, no parental history of delaying vaccination was associated with 7.5% (2.6–12.5) higher probability of hidden vulnerability to influenza despite being associated with 15.5% (10.8–20.2) lower probability of being up-to-date on neither the series nor influenza vaccines. Thus, parental compliance with broad child vaccine recommendations and lack of vaccine hesitancy may not indicate choice to vaccinate children against influenza. Examination of intersectionality suggests that maternal college education may not confer improved vaccination among non-Hispanic Black and Hispanic children despite that it does for non-Hispanic White children. Policymakers and researchers from public health, sociology, and other sectors need to collaborate to further examine how vaccine hesitancy and intersectional social disadvantage interact to affect influenza vaccine uptake in young US children.
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Affiliation(s)
- William K. Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC, United States of America
- * E-mail:
| | - Daniel A. Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Patricia Y. Miranda
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, United States of America
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17
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Kong Z, Wang J, Li T, Zhang Z, Jian J. 2019 novel coronavirus pneumonia with onset of dizziness: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:506. [PMID: 32395550 PMCID: PMC7210151 DOI: 10.21037/atm.2020.03.89] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The 2019 novel coronavirus (2019-nCoV) epidemic continues, with the number of infections and deaths increasing. The respiratory tract is the main route of transmission of the virus, and the majority of symptoms are respiratory relative. Until now, there has been no reports concerning the nervous system onset. We present a 2019-nCoV patient with the onset of simple dizziness, accompanied by dry throat, no fever, no cough, no headache, no mental abnormality, and no obvious abnormality in the nuclear magnetic resonance imaging (MRI) of the head. Meanwhile, chest computed tomography (CT) scans showed multiple small spot shadows and interstitial changes in the early stage, especially in the extrapulmonary zone. There was a development of multiple ground-glass shadows and infiltrative shadows in both lungs with mild pleural effusion. The nucleic acid gene detection was positive, and thus the diagnosis of 2019-nCoV was confirmed. At last, the prognosis was good after active treatment. After antiviral and anti-infective treatment, the symptoms recovered. We presume that 2019-nCoV can also manifest in the nervous system alone, and lung CT, which has relative specificity, should be used as a routine screening method.
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Affiliation(s)
- Zhaohong Kong
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jingwei Wang
- Department of Medical Molecular Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Tao Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Zhaohui Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jiang Jian
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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18
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van Esso D, Vilà M, Andrés C, Iglesias S, Ferrer J, Losada L, Ricos G, Sanchez L, Morera P, Pérez M, Ferrandez MA, Hernando E, Rodrigo C, Pumarola T, Antón A. The Importance of Rapid Influenza Testing in Pediatric Primary Care: Experience During Three Consecutive Influenza Seasons (2016-2019) in Barcelona (Catalonia, Spain). Front Pediatr 2020; 8:565. [PMID: 33163462 PMCID: PMC7580502 DOI: 10.3389/fped.2020.00565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022] Open
Abstract
Clinical diagnosis of influenza has low sensitivity in infants and children. Signs and symptoms are non-specific and similar to those of other respiratory viruses. Rapid influenza diagnostic tests (RIDTs) with adequate sensitivity and specificity used at the point of care can be useful for an etiologic diagnosis of influenza in primary care. This should have an impact on better management of these patients. We conducted a study during three consecutive influenza seasons (2016-2017, 2017-2018, and 2018-2019) in pediatric primary care settings collecting data from influenza point-of-care tests (POCTs)-confirmed ≤ 6-year-old patients. During the first two influenza seasons, antibiotic prescriptions and additional visits from influenza POCT-confirmed patients (Group_1) were compared to patients with influenza-like illness (ILI) (Group_2), or fever (2016 ICD-10 code R50) with no other signs of influenza (Group_3). Group_1 had 0.19 (2016-2017) and 0.23 (2017-2018) additional visits compared to 0.48 (2016-2017) and 0.49 (2017-2018) Group_2 p < 0.001 and 1.01 (2016-2017) and 0.80 (2017-2018) Group_3 p < 0.001. Antibiotic prescription was lower in Group_1 (10.2%) vs. Group_3 (17.2%) p < 0.002, difference statistically significant only for the 2017-2018 season. During the third season (2018-2019), RIDTs results were transmitted in real time to the reference laboratory ia the cloud, which strengthens the monitoring of circulating influenza viruses in the community. In our experience, the use of POCTs has a great potential in primary care specially in infants and young children in which the diagnosis maybe missed due to non-specific signs and symptoms.
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Affiliation(s)
- Diego van Esso
- Primary Care Health Service SAP Muntanya, Catalan Institute of Health, Barcelona, Spain
| | - Monica Vilà
- Primary Care Carmel, Catalan Institute of Health, Barcelona, Spain
| | - Cristina Andrés
- Respiratory Virus Unit, Microbiology Department, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Sheila Iglesias
- Primary Care CAPI Casernes, Catalan Institute of Health, Barcelona, Spain
| | - Josep Ferrer
- Primary Care Roquetes-Canteres, Catalan Institute of Health, Barcelona, Spain
| | - Lucia Losada
- Primary Care LP Drassanes, Catalan Institute of Health, Barcelona, Spain
| | - Gemma Ricos
- Primary Care LP Drassanes, Catalan Institute of Health, Barcelona, Spain
| | - Lorena Sanchez
- Primary Care LP La Marina, Catalan Institute of Health, Barcelona, Spain
| | - Patricia Morera
- Primary Care LP Pare Claret, Catalan Institute of Health, Barcelona, Spain
| | - Mar Pérez
- Primary Care LP Pare Claret, Catalan Institute of Health, Barcelona, Spain
| | | | - Esther Hernando
- Primary Care LP Rio de Janeiro, Catalan Institute of Health, Barcelona, Spain
| | - Carlos Rodrigo
- Department of Paediatrics, Vall d'Hebron University Hospital, Barcelona, Spain.,School of Medicine Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Respiratory Virus Unit, Microbiology Department, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Andrés Antón
- Respiratory Virus Unit, Microbiology Department, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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19
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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: 13] [Impact Index Per Article: 2.6] [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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20
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Scholz S, Damm O, Schneider U, Ultsch B, Wichmann O, Greiner W. Epidemiology and cost of seasonal influenza in Germany - a claims data analysis. BMC Public Health 2019; 19:1090. [PMID: 31409319 PMCID: PMC6693205 DOI: 10.1186/s12889-019-7458-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/08/2019] [Indexed: 12/15/2022] Open
Abstract
Background Seasonal influenza contributes substantially to the burden of communicable diseases in Europe, especially among paediatric populations and the elderly. The aim of the present study was to estimate the incidence of seasonal influenza in Germany, the probabilities of related complications and the economic burden of influenza per case and on a population level for different age groups. Methods Claims data from 2012 to 2014 from > 8 million insured of a large German sick-ness fund were analysed. A matched case control study was used on a sub-sample of 100,000 influenza cases to calculate complication rates for ear infections/acute otitis media (AOM) and community-acquired pneumonia (CAP) as well as resource use and costs for seven age groups. Results Incidence of seasonal influenza varies between the years and is highest among infants and children 2 to 5 years of age. AOM is more likely in the younger age groups with up to 14% more patients in the influenza group than in the control group. CAP is more frequently observed in the younger age groups and in influenza patients 60 years and older. The manifestation of one influenza complication (AOM or CAP) significantly in-creases the occurrence of a second complication (AOM or CAP). The economic burden per case is highest in infants (€251.91) and persons over 60 years of age (€131.59). Conclusion The burden of influenza is highest among infants and young children, which is also reflected in the economic burden. Influenza related costs per case are nearly double for infants compared to persons over 60 years of age. Electronic supplementary material The online version of this article (10.1186/s12889-019-7458-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefan Scholz
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany. .,Centre for Health Economic Research Hanover (CHERH), Leibniz University Hanover, Hanover, Germany. .,Immunization Unit, Robert Koch Institute (RKI), Berlin, Germany.
| | - Oliver Damm
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | | | - Bernhard Ultsch
- Immunization Unit, Robert Koch Institute (RKI), Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute (RKI), Berlin, Germany
| | - Wolfgang Greiner
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
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21
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Rapid Influenza Testing in Infants and Children Younger than 6 Years in Primary Care: Impact on Antibiotic Treatment and Use of Health Services. Pediatr Infect Dis J 2019; 38:e187-e189. [PMID: 31310597 DOI: 10.1097/inf.0000000000002287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Influenza is often misdiagnosed in children because of the low sensitivity of clinical diagnosis because of nonspecific signs and symptoms. This can be overcome by using digital immunoassays or rapid molecular diagnostic tests with adequate sensitivity and specificity. When using these tests at the patient care site, antibiotic consumption and number of healthcare consultations were reduced.
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22
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Shi T, Nie Z, Huang L, Fan H, Lu G, Yang D, Zhang D. Mortality risk factors in children with severe influenza virus infection admitted to the pediatric intensive care unit. Medicine (Baltimore) 2019; 98:e16861. [PMID: 31464913 PMCID: PMC6736178 DOI: 10.1097/md.0000000000016861] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/09/2019] [Accepted: 07/24/2019] [Indexed: 11/25/2022] Open
Abstract
Some children hospitalized for severe influenza virus infection require intensive care or die because of disease progression, which may be combined with other complications. The objective of this study was to identify the mortality risk factors in the patients with severe influenza virus infection admitted to the pediatric intensive care unit (PICU).Seventy-seven pediatric patients with severe influenza virus infection who were admitted in the PICU at Guangzhou Women and Children's Medical Center between 2013 and 2017 were evaluated. Data were transcribed and analyzed.The patients' median age was 3.0 years (interquartile range, 1.0-4.0 years), with 59.7% of the patients aged <3 years. The mortality was 16.9%, and patients aged >3 years accounted for 69.2% of the cases. Influenza A virus infection was found in 83.1% of the patients. Coinfection was detected in 58.7% of the patients. Haemophilus influenzae (11.7%) and adenovirus (9.1%) were the predominant bacterial and viral pathogens isolated, respectively. Older age, oxygen saturation level of <90% at admission, acute respiratory distress syndrome, pneumorrhagia, influenza-associated encephalopathy (IEA), septic shock, low ratio of partial pressure of oxygen in arterial blood (PaO2, <60 mm Hg) to the fraction concentration of oxygen in inspired air (FiO2; P/F), higher oxygenation index, increased alanine aminotransferase level (>100 IU/L), increased aspartate aminotransferase level (>100 IU/L), increased lactate dehydrogenase level (>500 IU/L), high fraction concentration of oxygen in inspired air (FiO2 > 60%), and positive end-expiratory pressure (>8 cmH2O) were associated with poor outcome. The deceased patients were more likely to have oxygen saturation levels of <90% at admission and IEA than those who survived. Higher P/F ratio was a protective factor against death in patients.The children with severe influenza virus infection who were admitted in the PICU were mainly aged <3 years. The presence of an oxygen saturation level of <90% at admission and IEA were the prognostic variables independently associated with mortality. Higher P/F ratio was a protective factor against death in patients.
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Affiliation(s)
- Tingting Shi
- Department of Respiratory
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | - Zhiqiang Nie
- Department of Epidemiology, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Li Huang
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University
| | | | - Gen Lu
- Department of Respiratory
| | | | - Dongwei Zhang
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University
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Mameli C, Cocchi I, Fumagalli M, Zuccotti G. Influenza Vaccination: Effectiveness, Indications, and Limits in the Pediatric Population. Front Pediatr 2019; 7:317. [PMID: 31417886 PMCID: PMC6682587 DOI: 10.3389/fped.2019.00317] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/12/2019] [Indexed: 12/24/2022] Open
Abstract
Influenza vaccine is considered the most effective way to prevent influenza. Nonetheless, every year vaccine coverage is lower than recommended in the pediatric population. Many factors are supposed to contribute to this phenomenon such as the uncertainty about the indication for vaccination, and the suboptimal vaccine-effectiveness in pediatric age, especially in the youngest children. In this review we discuss the effectiveness, indications, and limits of influenza vaccination in the pediatric population based on the most recent evidences.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
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24
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Principi N, Camilloni B, Alunno A, Polinori I, Argentiero A, Esposito S. Drugs for Influenza Treatment: Is There Significant News? Front Med (Lausanne) 2019; 6:109. [PMID: 31192211 PMCID: PMC6546914 DOI: 10.3389/fmed.2019.00109] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022] Open
Abstract
Vaccines remain the best measure to reduce total influenza burden. However, presently available influenza vaccines have some limitations that cause a reduced efficacy compared to immunization practices with other respiratory pathogens. This paper shows the clinical roles of antiviral drugs against influenza that have been licensed in at least one country and the potential roles of compounds that are in development. Several attempts have been made to develop new agents against influenza viruses to overcome the supposed or demonstrated limitations of neuraminidase inhibitors (NAIs). Antibodies against the highly conserved stem region of the haemagglutinin molecule of influenza A viruses and drugs that target different stages of the influenza virus life cycle than NAIs in human cells have been developed and tested. Among these preparations, baloxavir marboxil (BAM), and favipiravir (FP) (i.e., polymerase inhibitors) are the only drugs that have reached the market (the first in Japan and the USA, and the second only in Japan). Other antiviral compounds and monoclonal antibodies are in advanced stage of development, but none of these new drugs and monoclonal antibodies in development have adequate characteristics to substitute for NAIs at present. However, although NAIs remain the drug of choice for influenza treatment, their overuse has to be avoided. Accurate selection of patients for whom treatment is truly needed is required.
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Affiliation(s)
| | - Barbara Camilloni
- Department of Medicine, Università degli Studi di Perugia, Perugia, Italy
| | - Anna Alunno
- Department of Medicine, Università degli Studi di Perugia, Perugia, Italy
| | - Ilaria Polinori
- Department of Surgical and Biomedical Sciences, Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
| | - Alberto Argentiero
- Department of Surgical and Biomedical Sciences, Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
| | - Susanna Esposito
- Department of Surgical and Biomedical Sciences, Pediatric Clinic, Università degli Studi di Perugia, Perugia, Italy
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Mammas IN, Theodoridou M, Thiagarajan P, Melidou A, Papaioannou G, Korovessi P, Koutsaftiki C, Papatheodoropoulou A, Calachanis M, Dalianis T, Spandidos DA. A paediatric influenza update 100 years after the Skyros island Spanish flu outbreak. Exp Ther Med 2019; 17:4327-4336. [PMID: 31186675 PMCID: PMC6507498 DOI: 10.3892/etm.2019.7515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
This year marks the 100th anniversary of the 1918 Spanish flu outbreak on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30 days. According to Constantinos Faltaits's annals published in 1919, the influenza attack on the island of Skyros commenced acutely ‘like a thunderbolt’ on the 27th of October, 1918 and was exceptionally severe and fatal. At that time, the viral cause of the influenza had not been detected, while the total number of victims of the Spanish flu outbreak has been estimated to have surpassed 50 million, worldwide. Almost one century after this Aegean Sea island's tragedy, the ‘4th Workshop on Paediatric Virology’, organised on the 22nd of September, 2018 in Athens, Greece, was dedicated to the 100 years of the ‘Spanish’ flu pandemic. This review article highlights the plenary and key lectures presented at the workshop on the recent advances on the epidemiology, clinical management and prevention of influenza in childhood.
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Affiliation(s)
- Ioannis N Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Maria Theodoridou
- First Department of Paediatrics, 'Aghia Sophia' Children's Hospital, University of Athens School of Medicine, 115 27 Athens, Greece
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women's & Children Health, Noble's Hospital, IM4 4RJ Douglas, Isle of Man, British Isles
| | - Angeliki Melidou
- Second Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Georgia Papaioannou
- Department of Paediatric Radiology, 'Mitera' Children's Hospital, 151 23 Athens, Greece
| | - Paraskevi Korovessi
- Department of Paediatrics, 'Penteli' Children's Hospital, 152 36 Penteli, Greece
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), 'Penteli' Children's Hospital, 152 36 Penteli, Greece
| | - Alexia Papatheodoropoulou
- Paediatric Intensive Care Unit (PICU), 'P. and A. Kyriakou' Children's Hospital, 115 27 Athens, Greece
| | - Marcos Calachanis
- Department of Paediatric Cardiology, 'Penteli' Children's Hospital, 152 36 Penteli, Greece
| | - Tina Dalianis
- Karolinska Institutet, Karolinska University Hospital, SE-117 77 Stockholm, Sweden
| | - Demetrios A Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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26
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Pepin S, Samson SI, Alvarez FP, Dupuy M, Gresset-Bourgeois V, De Bruijn I. Impact of a quadrivalent inactivated influenza vaccine on influenza-associated complications and health care use in children aged 6 to 35 months: Analysis of data from a phase III trial in the Northern and Southern Hemispheres. Vaccine 2019; 37:1885-1888. [PMID: 30745147 DOI: 10.1016/j.vaccine.2019.01.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/14/2019] [Accepted: 01/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND A multi-season phase III trial conducted in the Northern and Southern Hemispheres demonstrated the efficacy of a quadrivalent split-virion inactivated influenza vaccine (IIV4) in children 6-35 months of age. METHODS Data collected during the phase III trial were analysed to examine the vaccine efficacy (VE) of IIV4 in preventing laboratory-confirmed influenza in age subgroups and to determine the relative risk for IIV4 vs. placebo for severe outcomes, healthcare use, and parental absenteeism from work associated with laboratory-confirmed influenza. RESULTS VE (95% confidence interval [CI]) to prevent laboratory-confirmed influenza due to any A or B strain was 54.76% (40.24-66.03%) for participants aged 6-23 months and 46.91% (23.57-63.53%) for participants aged 24-35 months. VE (95% CI) to prevent laboratory-confirmed influenza due to vaccine-similar strains was 74.51% (53.55-86.91%) for participants aged 6-23 months and 59.78% (19.11-81.25%) for participants aged 24-35 months. Compared to placebo, IIV4 reduced the risk (95% CI) by 31.28% (8.96-89.34%) for acute otitis media, 21.76% (6.46-58.51%) for acute lower respiratory infection, 40.80% (29.62-55.59%) for healthcare medical visits, 29.71% (11.66-67.23%) for parent absenteeism from work, and 39.20% (26.89-56.24%) for antibiotic use. CONCLUSION In children aged 6-35 months, vaccination with IIV4 reduces severe outcomes of influenza as well as the associated burden for their parents and the healthcare system. In addition, vaccination with IIV4 is effective at preventing against influenza in children aged 6-23 and 24-35 months. TRIAL REGISTRATION EudraCT no. 2013-001231-51.
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Affiliation(s)
- Stephanie Pepin
- Sanofi Pasteur, 1541 Avenue Marcel Merieux, 69820 Marcy-l'Étoile, France.
| | | | | | - Martin Dupuy
- Sanofi Pasteur, 1541 Avenue Marcel Merieux, 69820 Marcy-l'Étoile, France.
| | | | - Iris De Bruijn
- Sanofi Pasteur, 1541 Avenue Marcel Merieux, 69820 Marcy-l'Étoile, France.
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27
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Robertson CA, Mercer M, Selmani A, Klein NP, Jeanfreau R, Greenberg DP. Safety and Immunogenicity of a Full-dose, Split-virion, Inactivated, Quadrivalent Influenza Vaccine in Healthy Children 6-35 Months of Age: A Randomized Controlled Clinical Trial. Pediatr Infect Dis J 2019; 38:323-328. [PMID: 30395011 PMCID: PMC6437098 DOI: 10.1097/inf.0000000000002227] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND For children <3 years of age, a half dose of inactivated influenza vaccine (7.5 μg hemagglutinin per strain) has been used for more than 30 years, but several studies indicate that a full dose (15 μg hemagglutinin per strain) can be used in this population without increasing the rate of fever or other reactions. Here, we compare the safety and immunogenicity of full and half doses of quadrivalent, split-virion, inactivated influenza vaccine (IIV4) in children 6-35 months of age. METHODS In this phase IV, randomized, observer-blinded, multi-center study, healthy children 6-35 months of age were randomized 1:1 to be vaccinated with a half or full dose of IIV4 (NCT02915302). The primary objective was to demonstrate that the rate of any fever (≥38.0°C) up to 7 days after a full dose of IIV4 was noninferior to the rate of fever after a half dose. RESULTS The study included 1950 children. Noninferiority in the rate of fever was demonstrated for the full dose versus the half dose of IIV4 (difference in rate = 0.84%; 95% confidence interval, -2.13% to 3.80%). Solicited reactions and unsolicited adverse events were similar between the dose groups. No vaccine-related serious adverse events were reported. Noninferiority of both hemagglutination inhibition geometric mean titers and seroconversion rates was demonstrated for all 4 vaccine strains for the full dose versus the half dose. CONCLUSIONS In children 6-35 months of age, a full dose of IIV4 was immunogenic and had a safety profile comparable to that of a half dose, with no new safety concerns observed.
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Affiliation(s)
- Corwin A. Robertson
- From the Scientific and Medical Affairs, Sanofi Pasteur, Swiftwater, Pennsylvania
| | - Monica Mercer
- From the Scientific and Medical Affairs, Sanofi Pasteur, Swiftwater, Pennsylvania
| | - Alexandre Selmani
- From the Scientific and Medical Affairs, Sanofi Pasteur, Swiftwater, Pennsylvania
| | | | | | - David P. Greenberg
- From the Scientific and Medical Affairs, Sanofi Pasteur, Swiftwater, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh Pennsylvania
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Pepin S, Dupuy M, Borja-Tabora CFC, Montellano M, Bravo L, Santos J, de Castro JA, Rivera-Medina DM, Cutland C, Ariza M, Diez-Domingo J, Gonzalez CD, Martinón-Torres F, Papadopoulou-Alataki E, Theodoriadou M, Kazek-Duret MP, Gurunathan S, De Bruijn I. Efficacy, immunogenicity, and safety of a quadrivalent inactivated influenza vaccine in children aged 6–35 months: A multi-season randomised placebo-controlled trial in the Northern and Southern Hemispheres. Vaccine 2019; 37:1876-1884. [DOI: 10.1016/j.vaccine.2018.11.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
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29
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Wang X, Tian Y. Microbiological and chest X-ray studies on influenza B virus-associated pneumonia. Indian J Med Microbiol 2019; 36:401-407. [PMID: 30429395 DOI: 10.4103/ijmm.ijmm_18_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction The signs and symptoms of influenza B are commonly ignored. Therefore, very few clinical reports are available. This study is an attempt to evaluate the clinical features and characteristics of influenza B virus-associated pneumonia patients. Objective The aim of this study is to investigate the microbiological and characteristics of influenza B virus-associated pneumonia patients. Methodology Patients with <16 years old with a clinical diagnosis of influenza B virus infection and who had chest radiography within 2 days were enrolled. A total of 49 patients were categorised as the pneumonia group by clinical symptoms and chest X-ray (CXR) findings, whereas 107 patients were categorised as the non-pneumonia group based on the laboratory data and normal CXR findings. Results The study observed that the age of the patients in the pneumonia group was significantly younger than the non-pneumonia group. The white blood cell (WBC) count of the pneumonia group was also higher. However, the haemoglobin (Hgb) level was lower in the pneumonia group. The C-reactive protein (CRP) level of the pneumonia group was also significantly high. The CXR findings revealed that 28.57% of patients had alveolar consolidation, 32.65% had interstitial infiltration and 40.82% had ground glass opacity. Conclusions High clinical suspicion is required to detect pneumonia in influenza B virus patients. Based on the CXR findings, the study also suggests that patients with pleural effusion and positive bacterial culture need more attention for the severity of clinical outcome. Moreover, critical care should be given to paediatric patients having higher WBC count, higher CRP level and lower Hgb. These parameters would be helpful to differentiate primary pneumonia from non-pneumonic influenza.
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Affiliation(s)
- Xiaoyun Wang
- Department of Neonatology, Jining No. 1 People's Hospital, Jining, Shandong, China
| | - Yan Tian
- Department of Neonatology, Jining No. 1 People's Hospital, Jining, Shandong, China
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Bleser WK, Miranda PY, Salmon DA. Child Influenza Vaccination and Adult Work Loss: Reduced Sick Leave Use Only in Adults With Paid Sick Leave. Am J Prev Med 2019; 56:251-261. [PMID: 30573337 DOI: 10.1016/j.amepre.2018.09.013] [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: 02/11/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Children are a population of interest for influenza. They are at increased risk for severe influenza, comprise a substantial portion of influenza morbidity, and significantly contribute to its transmission in the household and subsequent parental work loss. The association between influenza vaccination and work loss prevention, however, has rarely been studied, and the sparse existing literature has very limited generalizability to U.S. adults, thus requiring better characterization. METHODS Using pooled National Health Interview Survey data (2013-2015, analyses conducted in 2018) nationally representative of working U.S. adults with household children (n=23,014), zero-inflated negative binomial regression examined the association of child influenza vaccination (exposure) with sick days (outcome) stratified by paid sick leave (no: n=10,741, yes: n=12,273). RESULTS Child influenza vaccination was associated with significantly lower sick day usage, but only among adults with paid sick leave (prevalence rate ratio=0.79, 95% CI=0.67, 0.93), equating to average annual sick days of 4.07 vs 3.29 in adults with unvaccinated versus vaccinated household children (difference=0.78 fewer days annually). CONCLUSIONS Influenza vaccination of children is associated with reduced sick leave in household adults, helping to keep the workforce healthy and reduce influenza's costly annual economic burden. This only occurred among adults with paid sick leave, however, which is distributed inequitably by income, education, gender, occupation, and race/ethnicity. Health in All Policies considers downstream health effects of social and economic policy; the failure of federal policy to ensure paid sick leave likely contributes to propagating influenza and health inequities.
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Affiliation(s)
- William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, District of Columbia.
| | - Patricia Y Miranda
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania
| | - Daniel A Salmon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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31
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Hauge SH, Bakken IJ, de Blasio BF, Håberg SE. Burden of medically attended influenza in Norway 2008-2017. Influenza Other Respir Viruses 2019; 13:240-247. [PMID: 30637942 PMCID: PMC6468058 DOI: 10.1111/irv.12627] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 12/21/2022] Open
Abstract
Background The burden of influenza in Norway remains uncertain, and data on seasonal variations and differences by age groups are needed. Objective To describe number of patients diagnosed with influenza in Norway each season and the number treated in primary or specialist health care by age. Further, to compare the burden of seasonal influenza with the 2009‐2010 pandemic outbreak. Methods We used Norwegian national health registries and identified all patients diagnosed with influenza from 2008 to 2017. We calculated seasonal rates, compared hospitalized patients with patients in primary care and compared seasonal influenza with the 2009‐2010 pandemic outbreak. Results Each season, on average 1.7% of the population were diagnosed with influenza in primary care, the average rate of hospitalization was 48 per 100 000 population while the average number of hospitalized patients each season was nearly 2500. The number of hospitalized influenza patients ranged from 579 in 2008‐2009 to 4973 in 2016‐2017. Rates in primary care were highest among young adults while hospitalization rates were highest in patients 80 years and older and in children below 5 years. The majority of in‐hospital deaths were in patients 70 years and older. Fewer patients were hospitalized during the 2009‐2010 pandemic than in seasonal outbreaks, but during the pandemic, more people in the younger age groups were hospitalized and fatal cases were younger. Conclusion Influenza causes a substantial burden in primary care and hospitals. In non‐pandemic seasons, people above 80 years have the highest risk of influenza hospitalization and death.
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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
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Birgitte F 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 E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Diallo D, Hochart A, Lagree M, Dervaux B, Martinot A, Dubos F. Impact of the Sofia ® Influenza A+B FIA rapid diagnostic test in a pediatric emergency department. Arch Pediatr 2018; 26:6-11. [PMID: 30558857 DOI: 10.1016/j.arcped.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 08/09/2018] [Accepted: 10/14/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of a rapid diagnostic test for influenza (the Sofia® Influenza A+B FIA rapid diagnostic test [RDT]) in a pediatric emergency department (PED). METHODS A retrospective, observational, cross-sectional study was conducted in the PED of the Lille University Hospital between 2013 and 2015. All patients under 18 years of age for whom influenza RDT was administered were included. Clinical data, management, and related hospitalizations were compared between positive and negative RDT groups. The length of stay in the PED (main outcome) and the number of additional tests (biological and radiographic tests) between the two groups were compared. RESULTS A total of 238 tests were reported: 119 positive, 110 negative, nine invalid. The mean length of stay in the PED was significantly lower in the positive RDT group: 4.0h vs. 7.4h (P<10-6). Patients with positive RDT had significantly fewer biological tests (20% vs. 56%; P<10-7) and radiographs (23% vs. 52%; P<10-5). The prevalence of hospitalizations in a short-stay unit was significantly lower in patients with positive RDT (0.8% vs. 9.1%; P=0.009). CONCLUSIONS This study showed a significant medical impact of the use of Sofia® Influenza RDT A+B FIA in a PED regarding the length of stay and the number of additional explorations.
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Affiliation(s)
- D Diallo
- Pediatric emergency unit & infectious diseases, hôpital R.-Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - A Hochart
- Pediatric emergency unit & infectious diseases, hôpital R.-Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Lagree
- Pediatric emergency unit & infectious diseases, hôpital R.-Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - B Dervaux
- EA 2694-Santé publique: épidémiologie et qualité des soins, université de Lille, 59000 Lille, France; Health Economy Department, CHU de Lille, 59000 Lille, France
| | - A Martinot
- Pediatric emergency unit & infectious diseases, hôpital R.-Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; EA 2694-Santé publique: épidémiologie et qualité des soins, université de Lille, 59000 Lille, France
| | - F Dubos
- Pediatric emergency unit & infectious diseases, hôpital R.-Salengro, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France; EA 2694-Santé publique: épidémiologie et qualité des soins, université de Lille, 59000 Lille, France.
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Impact of bedside diagnosis of influenza in the paediatric emergency ward. Clin Microbiol Infect 2018; 25:898-903. [PMID: 30502486 DOI: 10.1016/j.cmi.2018.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/12/2018] [Accepted: 11/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This prospective study performed in the paediatric emergency department of the University Hospital of Saint-Etienne aimed to measure the impact of the 24/7 bedside use of the Veritor™ System (Becton Dickinson) on the reduction of supplementary investigations, hospital stay and antimicrobial use. METHODS Influenza virus A and B antigens were detected with a rapid influenza digital immunoassay (DIA) on nasopharyngeal aspirates (NPAs) sampled from the children consulting at the paediatric emergency department between January and March 2016 for influenza-like illness. The same NPA was tested by immunofluorescence and/or molecular routine assays. Before performing the DIA, the clinician filled in a questionnaire listing the tests that he/she would have prescribed in the absence of the rapid testing. The prescription of complementary investigations, antimicrobial treatments and hospital stay were also compared to those of the 3 previous years. RESULTS A total of 514 children with flu-like symptoms were included. The use of the DIA at bedside decreased the prescription of blood puncture by 47.9% (21.2% to 6.6%), of chest X-rays by 69.0% (33.3% to 10.3%), of lumbar puncture by 77.8% (7.0% to 1.6%), of urine culture by 79.2% (23.3% to 4.9%), of antibiotic treatments by 70.1% (16.9% to 5.1%), and of hospital stay by 25.0% (27.2% to 20.4%), resulting in a reduction of medical costs estimated to more than €69 000 in a season. CONCLUSIONS In addition to delivering a rapid aetiological diagnosis, this strategy saves medical costs and favours an antimicrobial stewardship strategy. However, further prospective studies are needed to confirm our findings.
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Moasser E, Moasser A, Zaraket H. Incidence of antiviral drug resistance markers among human influenza A viruses in the Eastern Mediterranean Region, 2005-2016. INFECTION GENETICS AND EVOLUTION 2018; 67:60-66. [PMID: 30389548 DOI: 10.1016/j.meegid.2018.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Two classes of antiviral drugs are available for influenza antiviral therapy: the adamantanes and the neuraminidase inhibitors (NAIs). Due to the emergence of adamantane-resistant variants, the use of these drugs has been largely limited in the world. The NAIs became the drugs of choice for treatment of influenza A infections. However, amino acid substitutions in the NA protein might lead to reduced sensitivity to NAIs. METHODS The frequency and distribution of matrix protein 2 (M2) and neuraminidase (NA) variants which confer resistance to antiviral drugs was investigated in the Eastern Mediterranean Region (EMR) between 2005 and 2016. A total of 314 M2 and 1209 NA protein sequences from influenza A/H1N1, A/H1N1pdm09, A/H3N2, and A/H5N1 available in the public database were analyzed. RESULTS Eighty-six percent of the influenza A viruses detected in the EMR were resistant to adamantanes, among which, H3 strains exhibited the highest (95.32%) level of adamantane resistance. Approximately 98.51% (265/269) of influenza A/H1N1 and H3N2 resistant viruses had the S31N substitution in their M2 sequences. The V27A mutation was the only resistance marker found in A/H5N1 viruses and was detected at a frequency of 7.40% among the investigated viruses. Other resistant mutations L26F, A30T, G34E, and L38F were not detected in any of the variants. We found that 2.81% (n = 34) of the detected NA sequences from influenza A viruses possessed at least one NAI-resistant mutation and the vast majority of resistant viruses 79.41% (27/34) bear the H274Y mutation. The frequency of NAI-resistant viruses was 3.29% (24/729) for the H1N1pdm09, 10.64% (5/47) for the seasonal H1N1, and 4.06% (5/123) for H5N1 viruses. None of the H3N2 viruses analyzed during the study period were resistant to NAIs. CONCLUSION Our study reveals the emergence and spread of antiviral drug resistant influenza A viruses in the EMR and emphasizes the importance of continuous surveillance to maintain the effective use of the current antivirals.
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Affiliation(s)
- Elham Moasser
- Department of Bacteriology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Moasser
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology & Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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Looi QH, Foo JB, Lim MT, Le CF, Show PL. How far have we reached in development of effective influenza vaccine? Int Rev Immunol 2018; 37:266-276. [PMID: 30252547 DOI: 10.1080/08830185.2018.1500570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite of ongoing research programs and numerous clinical trials, seasonal influenza epidemics remain a major concern globally. Vaccination remains the most effective method to prevent influenza infection. However, current flu vaccines have several limitations, including limited vaccine capacity, long production times, inconsistence efficacy in certain populations, and lack of a "universal" solution. Different next-generation approaches such as cell line-based culture, reverse genetics, and virus expression technology are currently under development to address the aforementioned challenges in conventional vaccine manufacture pipeline. Such approaches hope for safe and scalable production, induce broad-spectrum immunity, create premade libraries of vaccine strains, and target nonvariable regions of antigenic proteins for "universal" vaccination. Here, we discuss the process and challenges of the current influenza vaccine platform as well as new approaches that are being investigated. These developments indicate that an exciting future lies ahead in the influenza vaccine field.
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Affiliation(s)
- Qi Hao Looi
- a Ming Medical Services Sdn. Bhd , Petaling Jaya , Selangor Darul Ehsan , Malaysia
| | - Jhi Biau Foo
- b School of Pharmacy, Faculty of Health & Medical Sciences , Taylor's University , Subang Jaya , Selangor Darul Ehsan , Malaysia
| | - May Teng Lim
- c Department of Chemical and Environmental Engineering, Faculty of Engineering , University of Nottingham Malaysia Campus , Jalan Braga , Semenyih, Selangor Darul Ehsan , Malaysia
| | - Cheng Foh Le
- d School of Biosciences, Faculty of Science , University of Nottingham Malaysia Campus , Jalan Broga , Semenyih , Selangor Darul Ehsan , Malaysia
| | - Pau Loke Show
- c Department of Chemical and Environmental Engineering, Faculty of Engineering , University of Nottingham Malaysia Campus , Jalan Braga , Semenyih, Selangor Darul Ehsan , Malaysia.,e Molecular Pharming and Bioproduction Research Group, Food and Pharmaceutical Engineering Research Group, Department of Chemical and Environmental Engineering, Faculty of Engineering , University of Nottingham Malaysia Campus , Jalan Broga, Semenyih , Selangor Darul Ehsan , Malaysia
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Willis GA, Preen DB, Richmond PC, Jacoby P, Effler PV, Smith DW, Robins C, Borland ML, Levy A, Keil AD, Blyth CC. The impact of influenza infection on young children, their family and the health care system. Influenza Other Respir Viruses 2018; 13:18-27. [PMID: 30137663 PMCID: PMC6304317 DOI: 10.1111/irv.12604] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background Influenza is a major cause of respiratory illness in young children. Assessing the impact of infection on children and the community is required to guide immunisation policies. Objectives To describe the impact of laboratory‐proven influenza in young children and to compare its impact with that of other respiratory viruses on the child, their family and the health care system. Methods Preschool children presenting for care or admission to a tertiary paediatric hospital during the 2008‐2014 influenza seasons were tested for respiratory virus by polymerase chain reaction and culture. Parental surveys were used to determine the impact of infection on illness duration, medication use, absenteeism and health service utilisation. Multivariate regression analyses were used to assess the impact of influenza and to evaluate the association between influenza status and outcomes. Results Among 1191 children assessed, 238 had influenza. Among children with influenza, 87.8% were administered antipyretics and 40.9% antibiotics. 28.6% had secondary complications. 65.4% of children missed school/day care, and 53.4% of parents missed work. When influenza and other viruses were compared, significant differences were noted including duration of illness (influenza: 9.54 days, other viruses: 8.50 days; P = 0.005) and duration of absenteeism for both the child (23.1 vs 17.3 hours; P = 0.015) and their parents (28.5 vs 22.7 hours; P = 0.012). Conclusions Influenza infection in young children has a significant impact on medication use, absenteeism and the use of health care service. Significant differences are identified when compared with other ILI. These data demonstrate that influenza prevention strategies including immunisation are likely to have wide and significant impacts.
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Affiliation(s)
- Gabriela A Willis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, West Perth, Western Australia, Australia.,Department of Health, Population Health Services, Hobart, Tasmania, Australia
| | - David B Preen
- School of Population Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, West Perth, Western Australia, Australia.,School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of General Pediatrics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Peter Jacoby
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Paul V Effler
- Department of Health, Communicable Disease Control Directorate, Shenton Park, Western Australia, Australia
| | - David W Smith
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Christine Robins
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, West Perth, Western Australia, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Primary Aboriginal and Rural Healthcare, University of Western Australia, Perth, Western Australia, Australia
| | - Avram Levy
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Anthony D Keil
- Department of Microbiology, PathWest Laboratory Medicine, Princess Margaret Hospital, Nedlands, Western Australia, Australia
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, West Perth, Western Australia, Australia.,School of Pediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Princess Margaret Hospital, Nedlands, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
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Zhou F, Trieu MC, Davies R, Cox RJ. Improving influenza vaccines: challenges to effective implementation. Curr Opin Immunol 2018; 53:88-95. [DOI: 10.1016/j.coi.2018.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/08/2018] [Accepted: 04/13/2018] [Indexed: 12/15/2022]
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Trends in surveillance data of influenza virus in Tehran before decreasing dispatch of Iranian Hajj pilgrims to Mecca. Med J Islam Repub Iran 2018; 32:41. [PMID: 30159292 PMCID: PMC6108279 DOI: 10.14196/mjiri.32.41] [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] [Received: 07/03/2017] [Indexed: 01/04/2023] Open
Abstract
Background: Respiratory infections, especially viral infections, are the most prevalent infection affecting Hajj pilgrims. Commonly major human influenza viruses (A/H1N1, A/H3N2, and B) are responsible for these morbidities. The present study was conducted to develop a statistical report on human influenza in Hajj pilgrims.
Methods: Nasal and throat samples were collected from 232 returning Iranian pilgrims in hospitals of IUMS. All samples were kept in the refrigerator at 4 °C and stored at −70 °C until RNA extraction. RNA extraction was performed by QIAamp viral RNAmini kits (QIAGEN, Hilden, Germany) and influenza viruses were detected by TaqMan RT-PCR.
Results: Participants included 115 (49.5%) male and 117 (50.5%) female patients, with the age range of 10 to 93 years (mean: 53 years). The pandemic and seasonal influenza A (H1N1) virus were detected in 2 (0.8%) and 20 (8.6%) pilgrims, respectively, and also influenza B was identified in 1 person (0.4%).
Conclusions: Since the probability of an influenza pandemic has been anticipated for the coming years, it seems necessary to plan a continuous monitoring of large gatherings like Hajj and conduct statistical studies in the region. Moreover, material surveillance in humans needs to be boosted. Therefore, results of influenza research can be important for developing WHO reports.
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Orsi A, Colomba GME, Pojero F, Calamusa G, Alicino C, Trucchi C, Canepa P, Ansaldi F, Vitale F, Tramuto F. Trends of influenza B during the 2010-2016 seasons in 2 regions of north and south Italy: The impact of the vaccine mismatch on influenza immunisation strategy. Hum Vaccin Immunother 2018; 14:523-531. [PMID: 28708953 PMCID: PMC5861802 DOI: 10.1080/21645515.2017.1342907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/22/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022] Open
Abstract
Influenza A and B viruses are responsible for respiratory infections, representing globally seasonal threats to human health. The 2 viral types often co-circulate and influenza B plays an important role in the spread of infection. A 6-year retrospective surveillance study was conducted between 2010 and 2016 in 2 large administrative regions of Italy, located in the north (Liguria) and in the south (Sicily) of the country, to describe the burden and epidemiology of both B/Victoria and B/Yamagata lineages in different healthcare settings. Influenza B viruses were detected in 5 of 6 seasonal outbreaks, exceeding influenza A during the season 2012-2013. Most of influenza B infections were found in children aged ≤ 14 y and significant differences were observed in the age-groups infected by the different lineages. B/Victoria strains prevailed in younger population than B/Yamagata, but also were more frequently found in the community setting. Conversely, B/Yamagata viruses were prevalent among hospitalized cases suggesting their potential role in the development of more severe disease. The relative proportions of viral lineages varied from year to year, resulting in different lineage-level mismatch for the B component of trivalent influenza vaccine. Our findings confirmed the need for continuous virological surveillance of seasonal epidemics and bring attention to the adoption of universal influenza immunization program in the childhood. The use of tetravalent vaccine formulations may be useful to improve the prevention and control of the influenza burden in general population.
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Affiliation(s)
- Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital “San Martino” - IST National Institute for Cancer Research, Genoa, Italy
| | - Giuseppina Maria Elena Colomba
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Fanny Pojero
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | - Giuseppe Calamusa
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
| | | | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Paola Canepa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS University Hospital “San Martino” - IST National Institute for Cancer Research, Genoa, Italy
| | - Francesco Vitale
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Fabio Tramuto
- Department of Health Promotion Sciences and Mother-Child Care “G. D'Alessandro” – Hygiene section, University of Palermo, Palermo, Italy
- Clinical Epidemiology Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
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Liao Q, Lam WWT, Cowling BJ, Fielding R. Psychosocial Influences on Parental Decision-Making Regarding Vaccination Against Seasonal Influenza for Young Children in Hong Kong: a Longitudinal Study, 2012-2013. Int J Behav Med 2017; 23:621-34. [PMID: 26987657 DOI: 10.1007/s12529-016-9551-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Vaccination uptake remained low, although annual subsidies are provided to encourage 6-72-month-old Hong Kong children to be vaccinated against seasonal influenza. This study was aimed to investigate the psychosocial influences on parental decision-making regarding young children's seasonal influenza vaccination. METHODS One-thousand two-hundred twenty-six parents of eligible children were recruited using random digit dialing in August-October 2012 to assess baseline perceptions and re-contacted in March 2013 to record children's vaccination uptake. Structural equation modeling (SEM) was performed to examine factors associated with parental decision about children's vaccination based on the complete data of 1222 respondents. RESULTS Of the 1226 respondents who completed the follow-up survey, 34.3 % reported that their child was vaccinated during the follow-up period. Child's past influenza vaccination history (β = 0.48), belief in vaccination safety (β = 0.35), and social norms (β = 0.25) were strongly associated with parental intention to vaccinate their child which directly predicted child vaccination uptake (β = 0.57). Belief in vaccination safety (β = 0.42) and social norms (β = 0.36) were strongly associated with vaccination intention of parents whose children never received influenza vaccine. CONCLUSION Interventions that address concerns on vaccination safety and utilize social norms may be effective to initiate Chinese parents to vaccinate their children.
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Affiliation(s)
- Qiuyan Liao
- School of Public Health, Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region, The University of Hong Kong, Hong Kong, China.
| | - Wendy Wing Tak Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region, The University of Hong Kong, Hong Kong, China
| | - Richard Fielding
- School of Public Health, Li Ka Shing Faculty of Medicine, Hong Kong Special Administrative Region, The University of Hong Kong, Hong Kong, China
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Abstract
PURPOSE OF REVIEW We review the current information and evidence available on the global burden of disease in the pediatric population, clinical presentation and complications, testing, treatment, and immunization. RECENT FINDINGS In addition to multiple other risk factors for influenza complications, children with neurologic and neuromuscular disorders are significantly higher risk for serious complications. In practice, there is no lower age limit for children with influenza who can be treated with oseltamivir. The quadrivalent live attenuated influenza vaccine was not recommended for use during the 2016-2017 season due to poor effectiveness. SUMMARY Influenza infection causes a significant burden of disease each year in the pediatric population worldwide. Both healthy and chronically ill children can fall prey to complications either due to the virus itself or secondary bacterial infection. Children within high-risk groups should be tested and treated with neuraminidase inhibitors. Immunization against influenza is well tolerated and effective.
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Van Maanen BM, de Boer PT, Dolk FCK, Friedrich AW, Wilschut JC, Pitman R, Postma MJ. Dynamic modelling approaches for the analysis of the cost-effectiveness of seasonal influenza control. Expert Rev Vaccines 2016; 16:1-4. [DOI: 10.1080/14760584.2016.1221347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- B. M. Van Maanen
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - P. T. de Boer
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - F. C. K. Dolk
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - A. W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J. C. Wilschut
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R. Pitman
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- ICON Health Economics and Epidemiology, Oxfordshire, UK
| | - M. J. Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Institute of Science in Healthy Aging & healthcaRE (SHARE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Buchan SA, Hottes TS, Rosella LC, Crowcroft NS, Tran D, Kwong JC. Contribution of influenza viruses to medically attended acute respiratory illnesses in children in high-income countries: a meta-analysis. Influenza Other Respir Viruses 2016; 10:444-454. [PMID: 27311404 PMCID: PMC5059948 DOI: 10.1111/irv.12400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 01/11/2023] Open
Abstract
AIM The burden of disease in children attributable to influenza viruses is difficult to quantify given the similarity of symptoms caused by infection due to influenza and other viruses. This uncertainty impacts clinical decision-making and estimates of burden. We aimed to systematically review the literature to determine the proportion of healthy children presenting for health care with an acute respiratory illness (ARI) who have laboratory-confirmed seasonal influenza (PROSPERO ID#CRD42014013896). METHOD We searched Ovid MEDLINE, EMBASE, Scopus, and references of included articles. We included studies that used polymerase chain reaction methods to test for influenza in healthy children aged ≤5 years who presented for health care in high-income countries with an influenza-like or ARI. A standardized form was used to collect data on positivity and other relevant study elements. RESULTS Seventeen studies covering 12 different influenza seasons were included. The proportion of influenza positivity ranged from 11% to 56%. Subgroup analyses were performed by influenza season, continent, healthcare setting, age group, and vaccination status. Higher influenza positivity was reported among children aged 3-5 years compared with children aged ≤2 years, and for unvaccinated children. CONCLUSION The minority of healthy patients aged ≤5 years with medically attended influenza-like or acute respiratory symptoms have laboratory-confirmed influenza virus infection, although this varied by influenza season. Prevention efforts should be targeted accordingly. STATEMENT Most influenza-like illnesses are not laboratory-confirmed and have similar clinical presentations. Consequently, the true contribution of influenza to acute respiratory infections in children remains uncertain. Our systematic review estimates that this proportion ranges from 11% to 56%. This finding can help both clinicians and public health professionals target prevention.
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Affiliation(s)
- Sarah A Buchan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Travis S Hottes
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Dat Tran
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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Rahmqvist M, Gjessing K, Faresjö T. Influenza-related healthcare visits, hospital admissions, and direct medical costs for all children aged 2 to 17 years in a defined Swedish region, monitored for 7 years. Medicine (Baltimore) 2016; 95:e4599. [PMID: 27537594 PMCID: PMC5370820 DOI: 10.1097/md.0000000000004599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/22/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The seasonal variation of influenza and influenza-like illness (ILI) is well known. However, studies assessing the factual direct costs of ILI for an entire population are rare. METHODS In this register study, we analyzed the seasonal variation of ILI-related healthcare visits and hospital admissions for children aged 2 to 17 years, and the resultant parental absence from work, for the period 2005 to 2012. The study population comprised an open cohort of about 78,000 children per year from a defined region. ILI was defined as ICD-10 codes: J00-J06; J09-J15, J20; H65-H67. RESULTS Overall, the odds of visiting a primary care center for an ILI was 1.64-times higher during the peak influenza season, compared to the preinfluenza season. The corresponding OR among children aged 2 to 4 years was 1.96. On average, an estimated 20% of all healthcare visits for children aged 2 to 17 years, and 10% of the total healthcare costs, were attributable to seasonal ILI. In primary care, the costs per week and 10,000 person years for ILI varied - by season - from &OV0556;3500 to &OV0556;7400. The total ILI cost per year, including all physical healthcare forms, was &OV0556;400,400 per 10,000 children aged 2 to 17 years. The costs for prescribed and purchased drugs related to ILI symptoms constituted 52% of all medicine costs, and added 5.8% to the direct healthcare costs.The use of temporary parental employment benefits for caring of ill child followed the seasonal pattern of ILI (r = 0.91, P < 0.001). Parental absence from work was estimated to generate indirect costs, through loss of productivity of 5.2 to 6.2 times the direct costs. CONCLUSIONS Direct healthcare costs increased significantly during the influenza season for children aged 2 to 17 years, both in primary and hospital outpatient care, but not in hospital inpatient care. Primary care manages the majority of visits for influenza and ILI. Children 2 to 4 years have a larger portion of their total healthcare encounters related to ILI compared with older children. There is a clear correlation between ILI visits across the years and parental absence from work.
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Affiliation(s)
- Mikael Rahmqvist
- Department of Medical and Health Sciences, Division of Healthcare Analysis
| | - Kristian Gjessing
- Department of Medical and Health Sciences, Division of Community Medicine/General Practice, Linköping University, Linköping, Sweden
| | - Tomas Faresjö
- Department of Medical and Health Sciences, Division of Community Medicine/General Practice, Linköping University, Linköping, Sweden
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Heikkinen T, Silvennoinen H, Heinonen S, Vuorinen T. Clinical and socioeconomic impact of moderate-to-severe versus mild influenza in children. Eur J Clin Microbiol Infect Dis 2016; 35:1107-13. [PMID: 27086364 DOI: 10.1007/s10096-016-2641-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/28/2016] [Indexed: 01/05/2023]
Abstract
Some studies have assessed the efficacy of influenza vaccination in children separately for moderate-to-severe and any influenza, but the definition used for identifying children with moderate-to-severe illness has not been validated. We analyzed clinical and socioeconomic data from two prospective cohort studies of respiratory infections among children aged ≤13 years (four influenza seasons, 3,416 child-seasons of follow-up). We categorized children with laboratory-confirmed influenza into two mutually exclusive groups of moderate-to-severe and mild influenza using the previously proposed criteria. We obtained the data for the analyses from structured medical records filled out by the study physicians and from daily symptom cards filled out by the parents. Of 434 cases of influenza, 217 (50 %) were classified as moderate-to-severe and 217 (50 %) as mild. The mean duration of fever was 4.0 days in children with moderate-to-severe influenza and 3.1 days in those with milder illness (P < 0.0001). Antibiotics were prescribed to 111 (51 %) children with moderate-to-severe and to ten (5 %) children with mild influenza (P < 0.0001). The rates of parental work absenteeism were 184 days per 100 children with moderate-to-severe influenza and 135 days per 100 children with mild influenza (P = 0.02). The corresponding rates of children's own absenteeism from day care or school were 297 and 233 days respectively per 100 children (P = 0.006). Categorization of children into groups with moderate-to-severe and mild influenza is meaningful, and it identifies children in whom the clinical and socioeconomic impact of influenza is highest. Illness severity should be considered when assessing influenza vaccine effectiveness in children.
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Affiliation(s)
- T Heikkinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
- Department of Pediatrics, University of Turku, Kiinamyllynkatu 4-8, FI-20520, Turku, Finland.
| | - H Silvennoinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - S Heinonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Department of Pediatrics, Helsinki University Hospital, Helsinki, Finland
| | - T Vuorinen
- Department of Clinical Virology, Division of Microbiology and Genetics, Turku University Hospital, Turku, Finland
- Department of Virology, University of Turku, Turku, Finland
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Zhang T, Zhang J, Hua J, Wang D, Chen L, Ding Y, Zeng S, Wu J, Jiang Y, Geng Q, Zhou S, Song Y, Iuliano AD, Greene CM, McFarland J, Zhao G. Influenza-associated outpatient visits among children less than 5 years of age in eastern China, 2011-2014. BMC Infect Dis 2016; 16:267. [PMID: 27287453 PMCID: PMC4901396 DOI: 10.1186/s12879-016-1614-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 06/03/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The disease burden of influenza in China has not been well described, especially among young children. The aim of this study was to estimate the incidence of outpatient visits associated with influenza in young children in Suzhou, a city of more than 11 million residents in Jiangsu Province in eastern China. METHODS Influenza-like illness (ILI) was defined as the presence of fever (axillary temperature ≥38 °C) and cough or sore throat. We collected throat swabs for children less than 5 years of age with ILI who visited Suzhou University Affiliated Children's Hospital (SCH) outpatient clinic or emergency room between April 2011 and March 2014. Suzhou CDC, a national influenza surveillance network laboratory, tested for influenza viruses by real-time reverse transcription-polymerase chain reaction assay (rRT-PCR). Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza by rRT-PCR. To calculate the incidence of influenza-associated outpatient visits, we conducted community-based healthcare utilization surveys to determine the proportion of hospital catchment area residents who sought care at SCH. RESULTS The estimated incidence of influenza-associated ILI outpatient visits among children aged <5 years in the catchment area of Suzhou was, per 100 population, 17.4 (95 % CI 11.0-25.3) during April 2011-March 2012, 14.6 (95 % CI 5.2-26.2) during April 2012-March 2013 and 21.4 (95 % CI: 10.9-33.5) during April 2013-March 2014. The age-specific outpatient visit rates of influenza-associated ILI were 4.9, 21.1 and 21.2 per 100 children aged 0- <6 months, 6- <24 months and 24- <60 months, respectively. CONCLUSION Influenza virus infection causes a substantial burden of outpatient visits among young children in Suzhou, China. Targeted influenza prevention and control strategies for young children in Suzhou are needed to reduce influenza-associated outpatient visits in this age group.
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Affiliation(s)
- Tao Zhang
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Jun Zhang
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Jun Hua
- Suzhou University Affiliated Children's Hospital, Suzhou, China
| | - Dan Wang
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Liling Chen
- Suzhou Center for Disease Prevention and Control, Suzhou, China
| | - Yunfang Ding
- Suzhou University Affiliated Children's Hospital, Suzhou, China
| | - Shanshan Zeng
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Jing Wu
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Yanwei Jiang
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Qian Geng
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China
| | - Suizan Zhou
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ying Song
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Genming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, P.O. Box 289, No.138 Yi Xue Yuan Road, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Shanghai, China.
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Tramuto F, Orsi A, Maida CM, Costantino C, Trucchi C, Alicino C, Vitale F, Ansaldi F. The Molecular Epidemiology and Evolutionary Dynamics of Influenza B Virus in Two Italian Regions during 2010-2015: The Experience of Sicily and Liguria. Int J Mol Sci 2016; 17:549. [PMID: 27089319 PMCID: PMC4849005 DOI: 10.3390/ijms17040549] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/31/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
Molecular epidemiology of influenza B virus remained poorly studied in Italy, despite representing a major contributor to seasonal epidemics. This study aimed to reconstruct the phylogenetic relationships and genetic diversity of the hemagglutinin gene sequences of 197 influenza B strains circulating in both Southern (Sicily) and Northern (Liguria) Italy between 2010 and 2015. Upper respiratory tract specimens of patients displaying symptoms of influenza-like illness were screened by real-time RT-PCR assay for the presence of influenza B virus. PCR-positive influenza B samples were further analyzed by sequencing. Neighbor-joining phylogenetic trees were constructed and the amino-acid alignments were analyzed. Phylogenetic analysis showed clusters in B/Victoria clade 1A/1B (n = 29, 14.7%), and B/Yamagata clades 2 (n = 112, 56.8%) and 3 (n = 56, 28.4%). Both influenza B lineages were found to co-circulate during the study period, although a lineage swap from B/Victoria to B/Yamagata occurred in Italy between January 2011 and January 2013. The most represented amino-acid substitutions were N116K in the 120-loop (83.9% of B/Yamagata clade 3 strains) and I146V in the 150-loop (89.6% of B/Victoria clade 1 strains). D197N in 190-helix was found in almost all viruses collected. Our findings provide further evidence to support the adoption of quadrivalent influenza vaccines in our country.
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Affiliation(s)
- Fabio Tramuto
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
- Clinical Epidemiology Unit, University Hospital "Paolo Giaccone", Palermo 90127, Italy.
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
- Hygiene Unit, IRCCS University Hospital "San Martino"-IST National Institute for Cancer Research, Genoa 16132, Italy.
| | - Carmelo Massimo Maida
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
| | - Claudio Costantino
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
| | - Cecilia Trucchi
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
| | - Francesco Vitale
- Department of Health Promotion Sciences and Mother-Child Care "G. D'Alessandro"-Hygiene Section, University of Palermo, Palermo 90127, Italy.
- Clinical Epidemiology Unit, University Hospital "Paolo Giaccone", Palermo 90127, Italy.
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa 16132, Italy.
- Hygiene Unit, IRCCS University Hospital "San Martino"-IST National Institute for Cancer Research, Genoa 16132, Italy.
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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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49
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Reperant LA, Moesker FM, Osterhaus ADME. Influenza: from zoonosis to pandemic. ERJ Open Res 2016; 2:00013-2016. [PMID: 27730163 PMCID: PMC5005146 DOI: 10.1183/23120541.00013-2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/10/2022] Open
Abstract
Probable epidemic influenza outbreaks have been described as early as the 5th century BC, as part of the Cough of Perinthus associated with the winter solstice, in Hippocrates' Corpus Hippocraticum “Of the Epidemics” [1]. The word “influenza” was first introduced in the 16th century, defining the illness of the cold season that in the early 1930s was shown to be caused by “filterable agents”, since then called influenza viruses. Three types or genera of influenza viruses have been recognised (influenza A, B and C viruses), while a fourth genus has been recently proposed [2]. Today, we distinguish three manifestations of influenza in humans, which may impose from mild to severe morbidity and mortality burdens: zoonotic, pandemic and seasonal influenza, all caused by an infection with an influenza virus. Although our arsenal of intervention strategies for influenza has advanced in the past decades and a growing public conception has arisen of influenza as a usually seasonal inconvenience, threats posed by influenza A viruses, with their different manifestations and associated complications, are continuously knocking on our door. Global surveillance and advances in vaccine technology are essential to answer the threat of influenza pandemicshttp://ow.ly/Yt3e4
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Affiliation(s)
| | - Fleur M Moesker
- Dept of Viroscience, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Albert D M E Osterhaus
- Artemis One Health Research Foundation, Utrecht, The Netherlands; Research Centre for Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, Germany
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50
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McGuire A, Drummond M, Keeping S. Childhood and adolescent influenza vaccination in Europe: A review of current policies and recommendations for the future. Expert Rev Vaccines 2016; 15:659-70. [DOI: 10.1586/14760584.2016.1138861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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