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Carter A, Klinner C, Young A, Strnadová I, Wong H, Vujovich-Dunn C, Newman CE, Davies C, Skinner SR, Danchin M, Hynes S, Guy R. "I Thought It Was Better to Be Safe Than Sorry": Factors Influencing Parental Decisions on HPV and Other Adolescent Vaccinations for Students with Intellectual Disability and/or Autism in New South Wales, Australia. Vaccines (Basel) 2024; 12:922. [PMID: 39204045 PMCID: PMC11359071 DOI: 10.3390/vaccines12080922] [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: 07/09/2024] [Revised: 07/26/2024] [Accepted: 08/10/2024] [Indexed: 09/03/2024] Open
Abstract
The uptake of human papilloma virus (HPV) and other adolescent vaccinations in special schools for young people with disability is significantly lower than in mainstream settings. This study explored the factors believed to influence parental decision making regarding vaccine uptake for students with intellectual disability and/or on the autism spectrum attending special schools in New South Wales, Australia, from the perspective of all stakeholders involved in the program. Focus groups and interviews were conducted with 40 participants, including parents, school staff, and immunisation providers. The thematic analysis identified two themes: (1) appreciating diverse parental attitudes towards vaccination and (2) educating parents and managing vaccination questions and concerns. While most parents were described as pro-vaccination, others were anti-vaccination or vaccination-hesitant, articulating a marked protectiveness regarding their child's health. Reasons for vaccine hesitancy included beliefs that vaccines cause autism, concerns that the vaccination may be traumatic for the child, vaccination fatigue following COVID-19, and assumptions that children with disability will not be sexually active. Special school staff regarded the vaccination information pack as inadequate for families, and nurses described limited educational impact resulting from minimal direct communication with parents. More effective communication strategies are needed to address vaccine hesitancy among parents with children with disability.
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Affiliation(s)
- Allison Carter
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW 2052, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Christiane Klinner
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
| | - Alexandra Young
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
| | - Iva Strnadová
- School of Education, UNSW Sydney, Sydney, NSW 2052, Australia;
- Disability Innovation Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Horas Wong
- Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW 2050, Australia;
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia;
| | | | - Christy E. Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia;
| | - Cristyn Davies
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia; (C.D.); (S.R.S.)
- Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW 2050, Australia
| | - S. Rachel Skinner
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia; (C.D.); (S.R.S.)
| | - Margie Danchin
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Sarah Hynes
- Health Protection NSW, Sydney, NSW 2065, Australia;
| | - Rebecca Guy
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW 2052, Australia; (C.K.); (A.Y.); (R.G.)
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Li S, Xiao W, Li H, Hu D, Li K, Chen Q, Liu G, Yang H, Song Y, Peng Q, Wang Q, Ning S, Xiong Y, Ma W, Shen J, Zheng K, Hong Y, Yang S, Li P. Identification of neurological complications in childhood influenza: a random forest model. BMC Pediatr 2024; 24:347. [PMID: 38769496 PMCID: PMC11103977 DOI: 10.1186/s12887-024-04773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Among the neurological complications of influenza in children, the most severe is acute necrotizing encephalopathy (ANE), with a high mortality rate and neurological sequelae. ANE is characterized by rapid progression to death within 1-2 days from onset. However, the knowledge about the early diagnosis of ANE is limited, which is often misdiagnosed as simple seizures/convulsions or mild acute influenza-associated encephalopathy (IAE). OBJECTIVE To develop and validate an early prediction model to discriminate the ANE from two common neurological complications, seizures/convulsions and mild IAE in children with influenza. METHODS This retrospective case-control study included patients with ANE (median age 3.8 (2.3,5.4) years), seizures/convulsions alone (median age 2.6 (1.7,4.3) years), or mild IAE (median age 2.8 (1.5,6.1) years) at a tertiary pediatric medical center in China between November 2012 to January 2020. The random forest algorithm was used to screen the characteristics and construct a prediction model. RESULTS Of the 433 patients, 278 (64.2%) had seizures/convulsions alone, 106 (24.5%) had mild IAE, and 49 (11.3%) had ANE. The discrimination performance of the model was satisfactory, with an accuracy above 0.80 from both model development (84.2%) and internal validation (88.2%). Seizures/convulsions were less likely to be wrongly classified (3.7%, 2/54), but mild IAE (22.7%, 5/22) was prone to be misdiagnosed as seizures/convulsions, and a small proportion (4.5%, 1/22) of them was prone to be misdiagnosed as ANE. Of the children with ANE, 22.2% (2/9) were misdiagnosed as mild IAE, and none were misdiagnosed as seizures/convulsions. CONCLUSION This model can distinguish the ANE from seizures/convulsions with high accuracy and from mild IAE close to 80% accuracy, providing valuable information for the early management of children with influenza.
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Grants
- Pre-NSFC-2019-002 Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
- Pre-NSFC-2019-002 Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China
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Affiliation(s)
- Suyun Li
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Weiqiang Xiao
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Huixian Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Dandan Hu
- Pediatric Neurology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Kuanrong Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qinglian Chen
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Guangming Liu
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Haomei Yang
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Yongling Song
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qiuyan Peng
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Qiang Wang
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Shuyao Ning
- Neuroelectrophysiology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Guangzhou, 510623, China
| | - Yumei Xiong
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Wencheng Ma
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Jun Shen
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Kelu Zheng
- Pediatric Neurology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Yan Hong
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Sida Yang
- Neuroelectrophysiology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, Guangzhou, 510623, China.
| | - Peiqing Li
- Pediatric Emergency Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
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Hook JL, Bhattacharya J. The pathogenesis of influenza in intact alveoli: virion endocytosis and its effects on the lung's air-blood barrier. Front Immunol 2024; 15:1328453. [PMID: 38343548 PMCID: PMC10853445 DOI: 10.3389/fimmu.2024.1328453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
Lung infection by influenza A virus (IAV) is a major cause of global mortality from lung injury, a disease defined by widespread dysfunction of the lung's air-blood barrier. Endocytosis of IAV virions by the alveolar epithelium - the cells that determine barrier function - is central to barrier loss mechanisms. Here, we address the current understanding of the mechanistic steps that lead to endocytosis in the alveolar epithelium, with an eye to how the unique structure of lung alveoli shapes endocytic mechanisms. We highlight where future studies of alveolar interactions with IAV virions may lead to new therapeutic approaches for IAV-induced lung injury.
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Affiliation(s)
- Jaime L. Hook
- Lung Imaging Laboratory, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Global Health and Emerging Pathogens Institute, Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jahar Bhattacharya
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States
- Department of Physiology and Cellular Biophysics, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States
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Zhang Z, Tan J, Li Y, Zhou X, Niu J, Chen J, Sheng H, Wu X, Yuan Y. Bibliometric analysis of publication trends and topics of influenza-related encephalopathy from 2000 to 2022. Immun Inflamm Dis 2023; 11:e1013. [PMID: 37773718 PMCID: PMC10510462 DOI: 10.1002/iid3.1013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Influenza-related encephalopathy is a rapidly progressive encephalopathy that usually presents during the early phase of influenza infection and primarily manifests as central nervous system dysfunction. This study aimed to analyze the current research status and hotspots of influenza-related encephalopathy since 2000 through bibliometrics analysis. METHODS The Web of Science Core Collection (WOSCC) was used to extract global papers on influenza-related encephalopathy from 2000 to 2022. Meanwhile, the VOSviewer and CiteSpace software were used for data processing and result visualization. RESULTS A total of 561 published articles were included in the study. Japan was the country that published the most articles, with 205 articles, followed by the United States and China. Okayama University and Tokyo Medical University published the most articles, followed by Nagoya University, Tokyo University, and Juntendo University. Based on the analysis of keywords, four clusters with different research directions were identified: "Prevalence of H1N1 virus and the occurrence of neurological complications in different age groups," "mechanism of brain and central nervous system response after influenza virus infection," "various acute encephalopathy" and "diagnostic indicators of influenza-related encephalopathy." CONCLUSIONS The research progress, hotspots, and frontiers on influenza-related encephalopathy after 2000 were described through the visualization of bibliometrics. The findings will lay the groundwork for future studies and provide a reference for influenza-related encephalopathy. Research on influenza-related encephalopathy is basically at a stable stage, and the number of research results is related to outbreaks of the influenza virus.
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Affiliation(s)
- Zhengyu Zhang
- Medical Records Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Juntao Tan
- Operation Management OfficeAffiliated Banan Hospital of Chongqing Medical UniversityChongqingChina
| | - Ying Li
- Department of Medical Administration, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiumei Zhou
- Department of Infectious DiseasesPeople's Hospital of Pujiang CountyZhejiangChina
- PuJiang branch of the First Affiliated HospitalZhejiang University School of MedicineJinhuaChina
| | - Jianhua Niu
- Intensive Care Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jun Chen
- Lung Transplant Department, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Hongfeng Sheng
- Department of OrthopedicsTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Xiaoxin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesThe First Affiliated Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Infectious DiseasesHangzhouZhejiangChina
| | - Yuan Yuan
- Medical Records DepartmentWomen and Children's Hospital of Chongqing Medical UniversityChongqingChina
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Roland D, Gardiner A, Razzaq D, Rose K, Bressan S, Honeyford K, Buonsenso D, Da Dalt L, De T, Farrugia R, Parri N, Oostenbrink R, Maconochie IK, Bognar Z, Moll HA, Titomanlio L, Nijman RGG. Influence of epidemics and pandemics on paediatric ED use: a systematic review. Arch Dis Child 2023; 108:115-122. [PMID: 36162959 DOI: 10.1136/archdischild-2022-324108] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice. SETTING Systematic review. DESIGN Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO). PATIENTS Children under 18 years. INTERVENTIONS National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used. MAIN OUTCOME MEASURES Changes in paediatric emergency care utilisation. RESULTS 131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively. CONCLUSIONS The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed. TRIAL REGISTRATION NUMBER CRD42021242808.
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Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Gardiner
- School of Medicine, University of Leicester, Leicester, UK
| | - Darakhshan Razzaq
- Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK
| | - Katy Rose
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Division of Emergency Medicine, University College London NHS Foundation Trust, London, UK
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Kate Honeyford
- Health Informatics Team, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Danilo Buonsenso
- Department of Women, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
- Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Università degli Studi di Padova, Padova, Italy
| | - Tisham De
- Imperial College Medical School, Imperial College London, London, UK
| | - Ruth Farrugia
- Department of Child and Adolescent Health, Mater Dei Hospital, Msida, Malta
| | - Niccolo Parri
- Emergency Department & Trauma Center, Ospedale Paediatrico Meyer Firenze, Florence, Italy
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Ian K Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
| | - Zsolt Bognar
- Department of Paediatric Emergency Medicine, Heim Pal National Paediatric Institute, Budapest, Hungary
| | - Henriette A Moll
- Department of General Paediatrics, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Luigi Titomanlio
- Pediatric Emergency Department, Hopital Universitaire Robert-Debre, Paris, France
| | - Ruud Gerard Gerard Nijman
- Department of Paediatric Emergency Medicine, St. Mary's Hospital - Imperial College NHS Healthcare Trust, London, UK
- Section of Paediatric Infectious Diseases, Imperial College London, London, UK
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Choi H, Jeon B, Han E. Seasonal influenza vaccine uptake among adults with disabilities in Korea. Disabil Health J 2023; 16:101372. [PMID: 36156272 DOI: 10.1016/j.dhjo.2022.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous research on vaccination among people with disabilities has focused on children or adolescents. OBJECTIVE To examine variations in seasonal influenza vaccination (SIV) uptake according to disability type and age group and explore the vulnerable groups and risk factors of non-vaccination to identify areas of policy support in Korea. METHODS This pooled cross-sectional study included adults who participated in the 2011, 2014, and 2017 National Survey of Persons with Disabilities. The dependent variable was SIV uptake. Age-stratified multivariate logistic regression was conducted to assess its relationship with disability characteristics. RESULTS Among 18,069 adults with disabilities, the overall SIV uptake rate increased with age (33.8%, 50.1%, and 85.3% in 20-49, 50-65, and ≥65 years, respectively). In the multivariate analyses (reporting the adjusted odds ratio and 95% confidence interval), severe disability was associated with lower and higher SIV uptake rates in older adults and younger age-groups (0.88, 0.76-1.01; 1.62, 1.42-1.86; and 1.54, 1.24-1.92 in those aged ≥65; 50-64; and 20-49 years), respectively. Health behaviors (regular doctor visits, general health examinations, and non-smoking) were significantly associated with higher odds of SIV uptake. After adjusting for covariates (age, medical conditions, functional ability, and behavioral factors), individuals with brain, epileptic, and psychiatric disabilities showed lower odds of SIV uptake compared to those with internal organ disabilities across all age groups. CONCLUSIONS Policy initiatives that can improve the health behaviors of people with disabilities (especially the elderly and people with intellectual, brain, epilepsy, and psychiatric disabilities) to promote SIV uptake are needed.
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Affiliation(s)
- HeeKyoung Choi
- Department of Infectious Diseases, National Health Insurance Service Ilsan Hospital, Goyang, South Korea; College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Seoul, South Korea
| | - Boyoung Jeon
- Department of Health and Medical Information, Myongji College, Seoul, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Seoul, South Korea.
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Osborne B, Moorjani-Houle M, Fakhraei R, Walker M, Wen SW, Guo Y. Impact of COVID-19 pandemic on emergency department visits and infant health: a scoping review protocol. BMJ Open 2022; 12:e061778. [PMID: 35906061 PMCID: PMC9344596 DOI: 10.1136/bmjopen-2022-061778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/01/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The novel SARS-CoV-2 pandemic has provided a set of unique challenges for paediatric patients requiring emergency care across the globe. Reduction in paediatric emergency department (ED) usage during the COVID-19 pandemic has been widely reported, but no studies to date have consolidated and described what ramifications these reductions may have on neonatal and infant health. This scoping review aims to characterise the impact of the COVID-19 pandemic on infant ED visits and neonatal and infant health. METHODS AND ANALYSIS A comprehensive literature search will be conducted from March 2020 to July 2022 using the following databases: Embase (Ovid), Web of Science (Clarivate Analytics), Medline (Ovid) and CINAHL (EBSCOhost). This scoping review will use a five-step framework to guide the selection, extraction and analysis of data from eligible studies, with an additional sixth step for clinical consultation. Studies in English reporting the effect of the COVID-19 pandemic on infant ED visits, as well as neonatal and infant health, will be included for screening. Key findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. ETHICS AND DISSEMINATION Research ethics board approval will not be required due to the nature of the study design. The results of this scoping review will be disseminated through publication in a peer-reviewed journal and presentation at academic conferences.
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Affiliation(s)
- Brenden Osborne
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mélika Moorjani-Houle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Romina Fakhraei
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yanfang Guo
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- BORN Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Abstract
The COVID-19 pandemic is a severe ongoing health crisisworldwide. Studying the socio-economic impacts of COVID-19 can help policymakers develop successful pandemic management plans. This paper focuses on the spatial epidemiology of COVID-19 among different social classes in the Kermanshah metropolis, Iran. This cross-sectional study uses the data of people infected with COVID-19 in the Kermanshah metropolis in 2020, acquired from the official COVID-19 Registry of Kermanshah. The results show that 2013 people were infected with COVID-19 (male = 1164 and female = 849). The mean age of the patients was 45 ± 18.69. The Moran’s I show that COVID-19 in different social classes was clustered across the neighbourhoods in the Kermanshah metropolis. The mean ages of men and women were 44.51 ± 18.62 and 45.69 ± 18.76, respectively. Importantly, COVID-19 was highly prevalent in the middle-class groups. Age group comparisons indicate that older people were the most infected in poorer neighbourhoods. In the middle-classtheage group of 0–14 years and in the rich neighbourhoods the age group of 15–64 years were the most exposed to the disease. The findings of this study suggest that older people and lower socioeconomic classes should be prioritised while developing and implementing preventative programs for COVID-19 and similar pandemics.
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9
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Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G, Arora P. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep 2021; 11:10231. [PMID: 33986390 PMCID: PMC8119690 DOI: 10.1038/s41598-021-89553-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Children and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatric COVID-19 patients. We conducted a retrospective cross-sectional analysis of pediatric patients diagnosed with COVID-19 from healthcare organizations in the United States. The study outcomes (hospitalization, mechanical ventilation, critical care) were assessed using logistic regression. The subgroups of sex and race were compared after propensity score matching. Among 12,306 children with lab-confirmed COVID-19, 16.5% presented with respiratory symptoms (cough, dyspnea), 13.9% had gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), 8.1% had dermatological symptoms (rash), 4.8% had neurological (headache), and 18.8% had other non-specific symptoms (fever, malaise, myalgia, arthralgia and disturbances of smell or taste). In the study cohort, the hospitalization frequency was 5.3%, with 17.6% needing critical care services and 4.1% requiring mechanical ventilation. Following propensity score matching, the risk of all outcomes was similar between males and females. Following propensity score matching, the risk of hospitalization was greater in non-Hispanic Black (RR 1.97 [95% CI 1.49–2.61]) and Hispanic children (RR 1.31 [95% CI 1.03–1.78]) compared with non-Hispanic Whites. In the pediatric population infected with COVID-19, a substantial proportion were hospitalized due to the illness and developed adverse clinical outcomes.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA
| | - Katherine S Booker
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA.,Division of Hospital Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | | | - Lorenzo Berra
- Anesthesia & Critical Care, Pulmonary Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA. .,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Sanchez-Vazquez R, Guío-Carrión A, Zapatero-Gaviria A, Martínez P, Blasco MA. Shorter telomere lengths in patients with severe COVID-19 disease. Aging (Albany NY) 2021; 13:1-15. [PMID: 33428591 PMCID: PMC7835063 DOI: 10.18632/aging.202463] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022]
Abstract
The incidence of severe manifestations of COVID-19 increases with age with older patients showing the highest mortality, suggesting that molecular pathways underlying aging contribute to the severity of COVID-19. One mechanism of aging is the progressive shortening of telomeres, which are protective structures at chromosome ends. Critically short telomeres impair the regenerative capacity of tissues and trigger loss of tissue homeostasis and disease. The SARS-CoV-2 virus infects many different cell types, forcing cell turn-over and regeneration to maintain tissue homeostasis. We hypothesize that presence of short telomeres in older patients limits the tissue response to SARS-CoV-2 infection. We measure telomere length in peripheral blood lymphocytes COVID-19 patients with ages between 29 and 85 years-old. We find that shorter telomeres are associated to increased severity of the disease. Individuals within the lower percentiles of telomere length and higher percentiles of short telomeres have higher risk of developing severe COVID-19 pathologies.
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Affiliation(s)
- Raul Sanchez-Vazquez
- Telomeres and Telomerase Group, Molecular Oncology Program, Spanish National Cancer Centre (CNIO), Melchor Fernández Almagro 3, Madrid, Spain
| | - Ana Guío-Carrión
- Telomeres and Telomerase Group, Molecular Oncology Program, Spanish National Cancer Centre (CNIO), Melchor Fernández Almagro 3, Madrid, Spain
| | | | - Paula Martínez
- Telomeres and Telomerase Group, Molecular Oncology Program, Spanish National Cancer Centre (CNIO), Melchor Fernández Almagro 3, Madrid, Spain
| | - Maria A Blasco
- Telomeres and Telomerase Group, Molecular Oncology Program, Spanish National Cancer Centre (CNIO), Melchor Fernández Almagro 3, Madrid, Spain
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11
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[Racism and mental health]. DER NERVENARZT 2020; 91:1017-1024. [PMID: 32930813 PMCID: PMC7490571 DOI: 10.1007/s00115-020-00990-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Der Beitrag gibt einen Überblick zu Rassismusdiskursen in Forschung und Praxis im Gesundheitsbereich und erörtert individuelle und institutionelle Auswirkungen von Rassismus und Diskriminierung auf die psychische Gesundheit. Daran anschließend wird erörtert, welche rassismuskritischen Transformationen in den Versorgungsstrukturen für psychisch erkrankte Personen notwendig sind, um eine gleichberechtigte Teilhabe von Menschen, die von Diskriminierung und Rassismus betroffen sind, zu ermöglichen.
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12
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Children facing natural, economic and public health crisis in Europe: The risks of a predictable unpredictability. Turk Arch Pediatr 2020; 55:4-9. [PMID: 32963476 PMCID: PMC7488185 DOI: 10.14744/turkpediatriars.2020.55553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This opening article for the volume dedicated to the diversity of paediatric healthcare systems in Europe, discusses the topic of children facing natural, economic, and public health crises in Europe. The natural and economic adversities and public health crises, which have repeatedly stormed the globe during the past twenty years, have often unveiled a low degree of self-sufficiency and a high degree of unpreparedness by European countries. It is always the case that the most vulnerable take the brunt, and these adverse events have shown their effects and a negative direct impact particularly on the population aged 0–18 years, with important implications for families and communities. The article discusses a rational approach to properly confront future public health emergencies and crises in general. The authors stress the concept that such approaches should be built on past negative experiences, in order to explore, identify, and make clear which are the priorities governing the disaster management activities at all levels in this population group. The authors conclude that safeguarding the health of children could be effectively accomplished by developing adequate, shared emergency management strategies. Improving pediatric preparedness approaches with the use of emergency measures and ongoing collaboration will facilitate a better and more efficient response, able to effectively care for the needs of children in actual crises.
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13
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Trienekens SCM, Shepherd W, Pebody RG, Mangtani P, Cleary P. Overrepresentation of South Asian ethnic groups among cases of influenza A(H1N1)pdm09 during the first phase of the 2009 pandemic in England. Influenza Other Respir Viruses 2020; 15:270-277. [PMID: 32875701 PMCID: PMC7902259 DOI: 10.1111/irv.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During the first wave of the influenza A(H1N1)pdm09 pandemic in England in 2009, morbidity and mortality were higher in patients of South Asian (Indian, Pakistani or Bangladeshi) ethnic minority groups. OBJECTIVES This study aims to provide insights in the representation of this group among reported cases, indicating susceptibility and exposure. METHODS All laboratory-confirmed cases including basic demographic and limited clinical information that were reported to the FluZone surveillance system between April and October 2009 were retrieved. Missing ethnicity data were imputed using the previously developed and validated South Asian Names and Group Recognition Algorithm (SANGRA). Differences between ethnic groups were calculated using chi-square, log-rank and t tests and rate ratios. Geographic clustering was compared using Ripley's K functions. RESULTS SANGRA identified 2447 (28%) of the total of 8748 reported cases as South Asian. South Asian cases were younger (P < .001), more often male (P = .002) and more often from deprived areas (P < .001) than cases of other ethnic groups. Time between onset of symptoms and laboratory sampling was longer in this group (P < .001), and they were less often advised antiviral treatment (P < .001), however, declined treatment less. The highest cumulative incidence was seen in the West Midlands region (32.7/10 000), London (7.0/10 000) and East of England region (5.7/10 000). CONCLUSIONS People of South Asian ethnic groups were disproportionally affected by the first wave of the influenza pandemic in England in 2009. The findings presented contribute to further understanding of demographic, socioeconomic and ethnic factors of the outbreak and inform future influenza preparedness to ensure appropriate prevention and care.
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Affiliation(s)
- Suzan C M Trienekens
- Field Epidemiology Training Programme, Public Health England, UK.,Field Service North West, National Infection Service, Public Health England, UK
| | - Wendi Shepherd
- North West Health Protection Team, Public Health England, UK.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Punam Mangtani
- Department of Infectious Disease Epidemiology, London School of Tropical Medicine and Hygiene, London, UK
| | - Paul Cleary
- Field Service North West, National Infection Service, Public Health England, UK
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14
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Kim L, Whitaker M, O’Halloran A, Kambhampati A, Chai SJ, Reingold A, Armistead I, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Weigel A, Ryan P, Monroe ML, Fox K, Kim S, Lynfield R, Bye E, Shrum Davis S, Smelser C, Barney G, Spina NL, Bennett NM, Felsen CB, Billing LM, Shiltz J, Sutton M, West N, Talbot HK, Schaffner W, Risk I, Price A, Brammer L, Fry AM, Hall AJ, Langley GE, Garg S. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 - COVID-NET, 14 States, March 1-July 25, 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1081-1088. [PMID: 32790664 PMCID: PMC7440125 DOI: 10.15585/mmwr.mm6932e3] [Citation(s) in RCA: 389] [Impact Index Per Article: 97.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Most reported cases of coronavirus disease 2019 (COVID-19) in children aged <18 years appear to be asymptomatic or mild (1). Less is known about severe COVID-19 illness requiring hospitalization in children. During March 1-July 25, 2020, 576 pediatric COVID-19 cases were reported to the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system that collects data on laboratory-confirmed COVID-19-associated hospitalizations in 14 states (2,3). Based on these data, the cumulative COVID-19-associated hospitalization rate among children aged <18 years during March 1-July 25, 2020, was 8.0 per 100,000 population, with the highest rate among children aged <2 years (24.8). During March 21-July 25, weekly hospitalization rates steadily increased among children (from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000). Overall, Hispanic or Latino (Hispanic) and non-Hispanic black (black) children had higher cumulative rates of COVID-19-associated hospitalizations (16.4 and 10.5 per 100,000, respectively) than did non-Hispanic white (white) children (2.1). Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization. Although the cumulative rate of pediatric COVID-19-associated hospitalization remains low (8.0 per 100,000 population) compared with that among adults (164.5),* weekly rates increased during the surveillance period, and one in three hospitalized children were admitted to the ICU, similar to the proportion among adults. Continued tracking of SARS-CoV-2 infections among children is important to characterize morbidity and mortality. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.
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15
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Abuelgasim E, Saw LJ, Shirke M, Zeinah M, Harky A. COVID-19: Unique public health issues facing Black, Asian and minority ethnic communities. Curr Probl Cardiol 2020; 45:100621. [PMID: 32448759 PMCID: PMC7207142 DOI: 10.1016/j.cpcardiol.2020.100621] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 12/12/2022]
Abstract
The 2019 coronavirus disease is a serious public health emergency, with serious adverse implications for populations, healthcare systems, and economies globally. Recently, concerns have been raised about possible association between ethnicity, incidence and outcomes of COVID-19 arisen from early government data. In this review, we will explore the possible association using both recent COVID-19 studies and studies of previous pandemics. We call for data on ethnicity to be routinely collected by governments, as part of an international collaboration, alongside other patient demographics and further research to robustly determine the magnitude of association. Moreover, governments must learn from previous pandemics and recommended strategies to mitigate risks on minority ethnicities due to socioeconomic disadvantages.
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Affiliation(s)
- Eyad Abuelgasim
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Li Jing Saw
- University of Liverpool School of Medicine, Liverpool, United Kingdom
| | - Manasi Shirke
- Queen's University Belfast School of Medicine, Belfast, United Kingdom
| | - Mohamed Zeinah
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Amer Harky
- University of Liverpool School of Medicine, Liverpool, United Kingdom; Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
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16
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Abstract
Endemic and pandemic viral respiratory infections have recently emerged as a critical topic of investigation given the recent severe acute respiratory syndrome coronavirus-2 outbreak. Data from such outbreaks indicate that severe systemic comorbidities including acute neurologic illness are associated with illness and lead to significant outcome differences. Herein, we will discuss the neurologic manifestations of severe viral respiratory infections including coronavirus, influenza, respiratory syncytial virus, metapneumovirus, and enterovirus. Data Sources PubMed and EMBASE were searched by two independent investigators up to March 2020. Study Selection Data selection included preclinical and clinical studies detailing neurologic manifestations of viral respiratory infections. Data Extraction and Synthesis Two independent investigators reviewed and extracted the data. Conclusions Neurologic manifestations including seizures, status epilepticus, encephalitis, critical illness neuromyopathy, acute disseminated encephalomyelitis, acute necrotizing encephalitis, Guillan-Barré syndrome, transverse myelitis, and acute flaccid myelitis have all been associated with severe viral respiratory infections. Having an understanding of the direct neurotropism of such viruses is imperative to understanding pathogenesis, clinical presentation, and potential treatment paradigms aimed at improving morbidity and mortality.
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17
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Verfürden ML, Fitzpatrick T, Holder L, Zylbersztejn A, Rosella L, Gilbert R, Guttmann A, Hardelid P. Deprivation and mortality related to pediatric respiratory tract infection: a cohort study in 3 high-income jurisdictions. CMAJ Open 2020; 8:E273-E281. [PMID: 32345706 PMCID: PMC7207030 DOI: 10.9778/cmajo.20190074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Deaths from respiratory tract infections (RTIs) in children are preventable through timely access to public health and medical interventions. We aimed to assess whether socioeconomic disparities in mortality related to pediatric RTI persisted after accounting for health status at birth. METHODS We compared the prevalence of and risk factors for RTI-related death in singletons aged 28 days to 4 years across Ontario (Canada), Scotland and England (jurisdictions with universal health care) using linked administrative data for 2003-2013. We estimated rates of RTI-related mortality for children living in deprived areas and those born to teenage girls; we estimated both crude rates and those adjusted for health status at birth. RESULTS A total of 1 299 240 (Ontario), 547 556 (Scotland) and 3 910 401 (England) children were included in the study. Across all jurisdictions, children born in the most deprived areas experienced the highest rates of RTI-related mortality. After adjustment for high-risk chronic conditions and prematurity, we observed differences in mortality according to area-level deprivation in Ontario and England but not in Scotland. In Ontario, teenage motherhood was also an independent risk factor for RTI-related mortality. INTERPRETATION Socioeconomic disparities played a substantial role in child mortality related to RTI in all 3 jurisdictions. Context-specific investigations around the mechanisms of this increased risk and development of programs to address socioeconomic disparities are needed.
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Affiliation(s)
- Maximiliane L Verfürden
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont.
| | - Tiffany Fitzpatrick
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Laura Holder
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Ania Zylbersztejn
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Laura Rosella
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Ruth Gilbert
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Astrid Guttmann
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
| | - Pia Hardelid
- Population, Policy and Practice Programme (Verfürden, Zylbersztejn, Gilbert, Hardelid), UCL Great Ormond Street Institute of Child Health, London, UK; Dalla Lana School of Public Health (Fitzpatrick, Rosella, Guttmann) and Department of Paediatrics (Guttmann), University of Toronto; Child Health Evaluative Sciences (Fitzpatrick, Guttmann) and Division of Paediatric Medicine (Guttmann), The Hospital for Sick Children; ICES (Holder, Rosella, Guttmann), Toronto, Ont
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18
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Li SY, Li PQ, Xiao WQ, Liu HS, Yang SD. Brainstem folding in an influenza child with Dandy-Walker variant. World J Clin Cases 2020; 8:382-389. [PMID: 32047789 PMCID: PMC7000932 DOI: 10.12998/wjcc.v8.i2.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/04/2019] [Accepted: 12/22/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Influenza in children is a major cause of morbidity and mortality worldwide. Nervous system diseases are a factor relating to increased mortality rate. However, reports of how these underlying diseases contribute to the death of children with influenza are rare.
CASE SUMMARY A 4-year-old-girl developed type A influenza-related encephalopathy (IAE) with seizures, acute disorder of consciousness, and intracranial hypertension (cerebrospinal fluid pressure: 250 mmH2O), and the Dandy-Walker variant was found by her first magnetic resonance imaging (MRI) when admission. Three days later, she suddenly presented anisocoria, acute pulmonary edema, and coma, and the later MRI found that she had compressed brainstem, oblongata “Z-like folding”, and swelling bilateral basal ganglia. After admission, the patient were tested for routine and special biomarkers and underwent neuroimaging and neuroelectrophysiology examinations as well as Oseltamivir and intravenous immunogloblin treatments. When predicting that unstable intracranial structures detected by MRI might have disastrous consequences in the progression of IAE, she was transferred into the pediatric intensive care unit and underwent continuous assessment of clinical condition while she did not have instability of basic vital signs; at the same time, her parents were fully informed about the risk and prognosis. Although she was ultimately dead from brain stem failure, the parents expressed understanding and did not trigger a doctor-patient conflict.
CONCLUSION In case of finding an unstable intracranial structure, intensive care should be given to IAE patient and their clinical condition should be monitored continuously.
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Affiliation(s)
- Su-Yun Li
- Department of Pediatric Emergency Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
| | - Pei-Qing Li
- Department of Pediatric Emergency Medicine, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
| | - Wei-Qiang Xiao
- Department of Radiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
| | - Hong-Sheng Liu
- Department of Radiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
| | - Si-Da Yang
- Department of Pediatric Neurology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong Province, China
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19
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O'Neill J, Newall F, Antolovich G, Lima S, Danchin MH. Adolescent immunisation in young people with disabilities in Australia. Med J Aust 2019; 211:199-200.e1. [PMID: 31342525 DOI: 10.5694/mja2.50293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jenny O'Neill
- University of Melbourne, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC
| | | | - Giuliana Antolovich
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| | - Sally Lima
- University of Melbourne, Melbourne, VIC.,Bendigo Health, Bendigo, VIC
| | - Margie H Danchin
- Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
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20
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O’Neill J, Newall F, Antolovich G, Lima S, Danchin M. Vaccination in people with disability: a review. Hum Vaccin Immunother 2019; 16:7-15. [PMID: 31287773 PMCID: PMC7012164 DOI: 10.1080/21645515.2019.1640556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022] Open
Abstract
People with disabilities are vulnerable to complications from vaccine-preventable diseases, and every effort should be made to ensure equitable access to immunization for this population. This paper aims to summarize the research on immunizations in people with disabilities, in order to ensure a comprehensive understanding of knowledge in this area and direct further research. The literature is weighted towards coverage data that is difficult to synthesize because of the different definitions of disability, and the variety of settings, vaccinations and age groups across the studies. In-depth qualitative data and data from a variety of health-care providers and people with disability is notably lacking. This is vital to redress in order to develop effective immunization interventions in this population.
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Affiliation(s)
- Jenny O’Neill
- Department of Neurodevelopment and Disability, The Royal Children’s Hospital, Melbourne, Australia
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Developmental Disability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Fiona Newall
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Haematology, The Royal Children’s Hospital, Melbourne, Australia
- Nursing Research, The Royal Children’s Hospital, Melbourne, Australia
- Clinical Haematology Research Group, Murdoch Children’s Research Institute, Australia
- The Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Giuliana Antolovich
- Department of Neurodevelopment and Disability, The Royal Children’s Hospital, Melbourne, Australia
- Developmental Disability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Sally Lima
- Nursing Research, The Royal Children’s Hospital, Melbourne, Australia
- The Department of Nursing, The University of Melbourne, Melbourne, Australia
- Clinical Learning and Development Unit, Bendigo Health, Victoria, Australia
| | - Margie Danchin
- The Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of General Medicine, The Royal Children’s Hospital, Melbourne, Australia
- Vaccine and Immunisation Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- The School of Population Health, The University of Melbourne, Melbourne, Australia
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21
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Kockuzu E, Bayrakcı B, Kesici S, Cıtak A, Karapınar B, Emeksiz S, Anıl AB, Kendirli T, Yukselmis U, Sevketoglu E, Paksu Ş, Kutlu O, Agın H, Yıldızdas D, Keskin H, Kalkan G, Hasanoglu A, Yazıcı MU, Sık G, Kılınc A, Durak F, Perk O, Talip M, Yener N, Uzuner S. Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs during the Winter Season in Turkey. Indian J Crit Care Med 2019; 23:263-269. [PMID: 31435144 PMCID: PMC6698354 DOI: 10.5005/jp-journals-10071-23177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. MATERIALS AND METHODS It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. RESULTS Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p <0.05). Clinical presentations influencing mortality were neurologic symptoms, tachycardia, hypoxia, hypotension, elevated lactate, and acidosis. The critical pH value related with mortality was ≤7.10, and critical PCO2 ≥60 mm Hg. CONCLUSION Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them. HOW TO CITE THIS ARTICLE Kockuzu E, Bayrakcı B, Kesici S, Cıtak A, Karapınar K, Emeksiz S, et al. Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs During the Winter Season in Turkey. Indian J Crit Care Med 2019;23(6):263-269.
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Affiliation(s)
- Esra Kockuzu
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakcı
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Clinic of Pediatric Intensive Care Unit, Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Agop Cıtak
- Department of Pediatric Intensive Care Unit, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Bulent Karapınar
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Serhat Emeksiz
- Clinic of Pediatric Intensive Care Unit, Ankara Pediatric Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayşe Berna Anıl
- Clinic of Pediatric Intensive Care Unit, Ankara Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ufuk Yukselmis
- Clinic of Pediatric Intensive Care Unit, Kartal Lutfi Kırdar Education Research Hospital, Istanbul, Turkey
| | - Esra Sevketoglu
- Clinic of Pediatric Intensive Care Unit, Bakırkoy Sadi Konuk Education Research Hospital, Istanbul, Turkey
| | - Şukru Paksu
- Department of Pediatric Intensive Care Unit, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Onur Kutlu
- Department of Pediatric Intensive Care Unit, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Hasan Agın
- Clinic of Pediatric Intensive Care Unit Dr. Behcet Uz Education Research Hospital, Izmir, Turkey
| | - Dincer Yıldızdas
- Department of Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Halil Keskin
- Department of Pediatric Intensive Care Unit, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Gokhan Kalkan
- Department of Pediatric Intensive Care Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Arzu Hasanoglu
- Department of Pediatric Intensive Care Unit, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Mutlu Uysal Yazıcı
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guntulu Sık
- Clinic of Pediatric Intensive Care Unit, Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Arda Kılınc
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Fatih Durak
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Oktay Perk
- Department of Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mey Talip
- Clinic of Pediatric Intensive Care Unit, Bakırkoy Sadi Konuk Education Research Hospital, Istanbul, Turkey
| | - Nazik Yener
- Department of Pediatric Intensive Care Unit, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Selcuk Uzuner
- Department of Pediatric Intensive Care Unit, Bezmialem University Faculty of Medicine, Istanbul, Turkey
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Priority Needs for Conducting Pandemic-relevant Clinical Research With Children in Europe: A Consensus Study With Pediatric Clinician-researchers. Pediatr Infect Dis J 2019; 38:e82-e86. [PMID: 30256315 DOI: 10.1097/inf.0000000000002204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infectious disease (ID) pandemics pose a considerable global threat and can disproportionately affect vulnerable populations including children. Pediatric clinical research in pandemics is essential to improve children's healthcare and minimize risks of harm by interventions that lack an adequate evidence base for this population. The unique features of ID pandemics require consideration of special processes to facilitate clinical research. We aimed to obtain consensus on pediatric clinician-researchers' perceptions of the priorities to feasibly conduct clinical pediatric pandemic research in Europe. METHODS Mixed method study in 2 stages, recruiting pediatric clinician-researchers with experience of conducting pediatric ID research in clinical settings in Europe. Stage 1 was an expert stakeholder workshop and interviews. Discussions focused on participant's experience of conducting pediatric ID research and processes to facilitate pandemic research. Information informed stage 2, an online consensus survey to identify pediatric inician-researchers priorities to enable ID pandemic research. RESULTS Twenty-three pediatric clinician-researchers attended the workshop and 39 completed the survey. Priorities were primarily focused on structural and operational requirements of research design and regulation: (1) clarity within the European Clinical Trials Directive for pediatric pandemic research; (2) simplified regulatory processes for research involving clinical samples and data; and (3) improved relationships between regulatory bodies and researchers. CONCLUSIONS Results suggest that changes need to be made to the current regulatory environment to facilitate and improve pediatric research in the pandemic context. These findings can provide expert evidence to research policy decision-makers and regulators and to develop a strategy to lobby for change.
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The uptake of adolescent vaccinations through the School Immunisation Program in specialist schools in Victoria, Australia. Vaccine 2018; 37:272-279. [PMID: 30522907 DOI: 10.1016/j.vaccine.2018.11.034] [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: 06/16/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND As part of the National Immunisation Program (NIP) students in Australia receive adolescent immunisations through the School Immunisation Program at 12 to 13 years. For children with disabilities attending specialist schools, no vaccine uptake data is collected at this time point. We aimed to determine uptake of diphtheria-tetanus-pertussis (dTpa) and Human Papillomavirus (HPV) immunisations amongst young people with disabilities in specialist schools in Victoria. METHODS A prospective cohort study was conducted in Victoria, Australia. Data was collected on immunisation days in the 2017 school year from specialist schools in Victoria. The school immunisation coordinator entered data online for eligible students for receipt of dTpa and HPV on each school immunisation day. Demographic data, motor and intellectual function of students and reasons for non-receipt of dTpa and HPV vaccine were recorded. Data were analysed using descriptive statistics. RESULTS Of 73 eligible specialist schools in Victoria, 28 (38%) participated. dTpa was received by 63% (237/374) of participating students and HPV dose 1 (HPV1) was received by 66% (76/114) females and 67% (174/260) male students respectively. Three doses of HPV were received by only 41% (100/241) of students. The main reasons for missed immunisation were absence from school, lack of consent and inability to immunise due to the student's behaviour and/or anxiety. CONCLUSION This is the first study in Australia to report that uptake of adolescent immunisations in specialist schools for young people with a disability is significantly lower than in mainstream settings. Comparative data during the same time period for students in mainstream schools demonstrated higher uptake, at 89% for dTpa and 75% for three doses of HPV. These data highlight the inequity of receipt of school-based immunisations for this group of adolescents, the barriers to which could be more thoroughly explored through qualitative inquiry from a socio-ecological perspective.
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Nationwide Study on the Course of Influenza A (H1N1) Infections in Hospitalized Children in the Netherlands During the Pandemic 2009-2010. Pediatr Infect Dis J 2018; 37:e283-e291. [PMID: 30169483 DOI: 10.1097/inf.0000000000002177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The influenza H1N1 pandemic of 2009-2010, provided a unique opportunity to assess the course of disease, as well as the analysis of risk factors for severe disease in hospitalized children (< 18 years). METHODS Retrospective national chart study on hospitalized children with H1N1 infection during the 2009-2010 pH1N1 outbreak. RESULTS Nine hundred forty patients (56% boys), median age 3.0 years, were enrolled; the majority were previously healthy. Treatment consisted of supplemental oxygen (24%), mechanical ventilation (5%) and antiviral therapy (63%). Fifteen patients died (1.6%), 5 of whom were previously healthy. Multivariable analyses confirmed pre-existent heart and lung disease as risk factors for intensive care unit admission. Risk factors for mortality included children with a neurologic or oncologic disease and psychomotor retardation. CONCLUSIONS This nationwide overview of hospitalized children confirms known risk groups for severe influenza infections. However, most of the acute and severe presentations of influenza occurred in previously healthy children.
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25
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Kazanasmaz H, Geter S, Solmaz A, Genç Ş, Gümüş H. Epidemik Dönemde Şanlıurfa İli Pandemik H1N1 İnfluenza Olgularının Klinik Değerlendirmesi. ACTA MEDICA ALANYA 2018. [DOI: 10.30565/medalanya.368195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Characteristics and mortality risk of children with life-threatening influenza infection admitted to paediatric intensive care in England 2003-2015. Respir Med 2018; 137:23-29. [PMID: 29605208 DOI: 10.1016/j.rmed.2018.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Information is lacking about the severity of complications in children with influenza admitted to paediatric intensive care units (PICU) in the UK. In this study, we report risk factors for mortality, invasive ventilation and use of vasoactive drugs for children admitted to PICU with influenza. METHODS We evaluated all admissions to PICUs in England for resident children with a recorded influenza diagnosis between September 2003 and March 2015. We used the Paediatric Intensive Care Audit Network (PICANet) database linked to hospital admission records to identify influenza cases, and high-risk comorbidities among admitted children. We used mixed effects logistic regression models to determine risk factors for mortality, use of invasive ventilation and vasoactive drugs. RESULTS We identified 1961 influenza-related PICU admissions in 1778 children. Children with high-risk conditions accounted for 1540 admissions (78.5%). The odds of mortality were significantly higher for girls than boys (adjusted odds ratio 1.91; 95% confidence interval 1.31, 2.79), children from Asian/Asian British (2.70; 1.74, 4.20) or other minority ethnic groups (3.95; 1.65, 9.42) compared to white British children, and significantly increased before and during the A(H1N1)pdm 2009 pandemic compared to the post-pandemic period. Children required invasive ventilation in 1588 admissions (81.0%), and received vasoactive drugs in 586 admissions (29.9%). CONCLUSIONS Nearly four fifths of influenza-related PICU admissions occurred in children with high-risk conditions, highlighting the burden of severe influenza in this vulnerable population Further research is required to explain sex and ethnic group differences in PICU mortality among children admitted with influenza.
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Paksu MS, Aslan K, Kendirli T, Akyildiz BN, Yener N, Yildizdas RD, Davutoglu M, Yaman A, Isikay S, Sensoy G, Tasdemir HA. Neuroinfluenza: evaluation of seasonal influenza associated severe neurological complications in children (a multicenter study). Childs Nerv Syst 2018; 34:335-347. [PMID: 28762041 DOI: 10.1007/s00381-017-3554-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Although influenza primarily affects the respiratory system, in some cases, it can cause severe neurological complications. Younger children are especially at risk. Pediatric literature is limited on the diagnosis, treatment, and prognosis of influenza-related neurological complications. The aim of the study was to evaluate children who suffered severe neurological manifestation as a result of seasonal influenza infection. METHODS The medical records of 14 patients from six hospitals in different regions of the country were evaluated. All of the children had a severe neurological manifestations related to laboratory-confirmed influenza infection. RESULTS Median age of the patients was 59 months (6 months-15.5 years) and nine (64.3%) were male. Only 4 (28.6%) of the 14 patients had a comorbid disease. Two patients were admitted to hospital with influenza-related late complications, and the remainder had acute complication. The most frequent complaints at admission were fever, altered mental status, vomiting, and seizure, respectively. Cerebrospinal fluid (CSF) analysis was performed in 11 cases, and pleocytosis was found in only two cases. Neuroradiological imaging was performed in 13 patients. The most frequent affected regions of nervous system were as follows: cerebellum, brainstem, thalamus, basal ganglions, periventricular white matter, and spinal cords. Nine (64.3%) patients suffered epileptic seizures. Two patients had focal seizure, and the rest had generalized seizures. Two patients developed status epilepticus. Most frequent diagnoses of patients were encephalopathy (n = 4), encephalitis (n = 3), and meningitis (n = 3), respectively. The rate of recovery without sequelae from was found to be 50%. At discharge, three (21.4%) patients had mild symptoms, another three (21.4%) had severe neurological sequelae. One (7.1%) patient died. The clinical findings were more severe and outcome was worse in patients <5 years old than patients >5 years old and in patients with comorbid disease than previously healthy group. CONCLUSION Seasonal influenza infection may cause severe neurological complications, especially in children. Healthy children are also at risk such as patients with comorbid conditions. All children who are admitted with neurological findings, especially during the influenza season, should be evaluated for influenza-related neurological complications even if their respiratory complaints are mild or nonexistent.
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Affiliation(s)
- Muhammet Sukru Paksu
- Pediatric Intensive Care Unit, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey. .,Ondokuz Mayis Universitesi Tip Fakultesi Cocuk Yogun Bakim Unitesi, 55139, Samsun, Turkey.
| | - Kerim Aslan
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Tanil Kendirli
- Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Basak Nur Akyildiz
- Pediatric Intensive Care Unit, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nazik Yener
- Pediatric Intensive Care Unit, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Riza Dincer Yildizdas
- Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Mehmet Davutoglu
- Pediatric Intensive Care Unit, Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Ayhan Yaman
- Pediatric Intensive Care Unit, Obstetrics and Gynecology and Children's Hospital, Gaziantep, Turkey
| | - Sedat Isikay
- Pediatric Neurology, Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - Gulnar Sensoy
- Department of Pediatric Infection Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Haydar Ali Tasdemir
- Department of Pediatric Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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MacDonald P. Extension of influenza immunization program to children in England - Future plans. Hum Vaccin Immunother 2018; 12:2707-2708. [PMID: 27548837 DOI: 10.1080/21645515.2016.1218099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Pauline MacDonald
- a National Childhood Flu Immunisation Taskforce , National Health Service , London , UK
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Mammas IN, Theodoridou M, Kramvis A, Thiagarajan P, Gardner S, Papaioannou G, Melidou A, Koutsaki M, Kostagianni G, Achtsidis V, Koutsaftiki C, Calachanis M, Zaravinos A, Greenough A, Spandidos DA. Paediatric Virology: A rapidly increasing educational challenge. Exp Ther Med 2017; 13:364-377. [PMID: 28352303 PMCID: PMC5348700 DOI: 10.3892/etm.2016.3997] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/16/2016] [Indexed: 12/12/2022] Open
Abstract
The '2nd Workshop on Paediatric Virology', which took place on Saturday the 8th of October 2016 in Athens, Greece, provided an overview on recent views and advances on Paediatric Virology. Emphasis was given to HIV-1 management in Greece, a country under continuous financial crisis, hepatitis B vaccination in Africa, treatment options for hepatitis C virus in childhood, Zika virus in pregnancy and infancy, the burden of influenza on childhood, hand-foot-mouth disease and myocarditis associated with Coxsackie viruses. Other general topics covered included a critical evaluation of Paediatric Accident and Emergency viral infections, multimodality imaging of viral infections in children, surgical approaches of otolaryngologists to complex viral infections, new advances in the diagnosis and treatment of viral conjunctivitis and novel molecular diagnostic methods for HPV in childhood. A brief historical overview of the anti-vaccination movement was also provided, as well as presentations on the educational challenge of Paediatric Virology as a new subspecialty of Paediatrics. This review highlights selected lectures and discussions of the workshop.
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Affiliation(s)
- Ioannis N. Mammas
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
| | - Maria Theodoridou
- 1st Department of Paediatrics, ‘Aghia Sophia’ Children's Hospital, University of Athens School of Medicine, Athens 11527, Greece
| | - Anna Kramvis
- Hepatitis Virus Diversity Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Prakash Thiagarajan
- Neonatal Unit, Division for Women's and Children's Health, Noble's Hospital, Douglas, Isle of Man IM4 4RJ, British Isles
| | - Sharryn Gardner
- Department of Children's Accident and Emergency, Southport and Ormskirk Hospital NHS Trust, Ormskirk L39 2AZ, UK
| | - Georgia Papaioannou
- Department of Paediatric Radiology, ‘Mitera’ Children's Hospital, Athens 15123, Greece
| | - Angeliki Melidou
- 2nd Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Maria Koutsaki
- Paediatric Neurology Division, 3rd Department of Paediatrics, School of Medicine, University of Athens, ‘Attikon’ University Hospital, Athens 12462, Greece
| | - Georgia Kostagianni
- Department of Otorhinolaryngology - Head and Neck Surgery, ‘Triassio’ General Hospital, Elefsina 19200, Greece
| | - Vassilis Achtsidis
- Department of Ophthalmology, Royal Cornwall Hospitals, Truro, Cornwall TR1 3LQ, UK
| | - Chryssie Koutsaftiki
- Paediatric Intensive Care Unit (PICU), ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Marcos Calachanis
- Department of Paediatric Cardiology, ‘Penteli’ Children's Hospital, Penteli 15236, Greece
| | - Apostolos Zaravinos
- Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 1516, Cyprus
| | - Anne Greenough
- Division of Asthma, Allergy and Lung Biology, King's College London, London SE5 9RS, UK
| | - Demetrios A. Spandidos
- Department of Clinical Virology, School of Medicine, University of Crete, Heraklion 71003, Greece
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Abstract
Immunocompromised children have a higher risk of developing infections and associated higher rates of mortality and morbidity. Although this group could benefit the most from vaccine administration, specific considerations regarding immunisations are required. This review is a summary of the vaccines that are relevant to the immunocompromised host, covering both live and non-live vaccines. The burden of disease, safety, immunogenicity/effectiveness and specific recommendations for each vaccine are described as well as specific guidelines from different organisations.
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Affiliation(s)
- Marta Valente Pinto
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, OX3 7LE, United Kingdom.
| | - Smiti Bihari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, OX3 7LE, United Kingdom.
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, OX3 7LE, United Kingdom.
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Hardelid P, Rait G, Gilbert R, Petersen I. Factors associated with influenza vaccine uptake during a universal vaccination programme of preschool children in England and Wales: a cohort study. J Epidemiol Community Health 2016; 70:1082-1087. [PMID: 27177579 DOI: 10.1136/jech-2015-207014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Influenza vaccination through primary care has been recommended for all preschool children in the UK since 2013 as part of a universal immunisation programme. Vaccination is required annually and effectiveness varies by season. Factors associated with influenza vaccine receipt and those for other childhood vaccines may therefore differ. METHODS We used The Health Improvement Network, a large primary care database, to create a cohort of children in England and Wales aged 2-4 years eligible for vaccination in the 2014/2015 season. Mixed-effects Poisson regression models were used to determine sociodemographic and clinical factors associated with influenza vaccine receipt, allowing for practice-level variation. RESULTS Overall, 38.7% (95% CI 38.3% to 39.1%) of 57 545 children were vaccinated against influenza. Children in the poorest deprivation quintile were 19% less likely to receive influenza vaccine than those in the wealthiest quintile (adjusted risk ratio (ARR) 0.81, 95% CI 0.77 to 0.86). Children who received a timely first dose of measles-mumps-rubella vaccine were twice as likely to receive influenza vaccine (ARR 2.00 95% CI 1.87 to 2.13). Being 4 years old, not in a clinical risk group, or living with 2 or more other children were also significantly associated with a lower probability of vaccination. DISCUSSION Children living in areas of higher deprivation and in larger families are less likely to receive influenza vaccine. Further research is required into whether interventions, such as offering vaccinations in other settings, could increase uptake in children, particularly in deprived areas.
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Affiliation(s)
- Pia Hardelid
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Ruth Gilbert
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Irene Petersen
- Research Department of Primary Care and Population Health, University College London, London, UK Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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Influenza A (H1N1). DIAGNOSTIC IMAGING OF EMERGING INFECTIOUS DISEASES 2016. [PMCID: PMC7122501 DOI: 10.1007/978-94-017-7363-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
In March 2009, an outbreak of human-infected swine influenza occurred in Mexico, with reports of deaths. Soon afterward, such cases were reported worldwide, namely, a pandemic outbreak. The prevailing disease is then defined as an acute respiratory infectious disease caused by swine-origin influenza A (H1N1) virus, a new variant of influenza virus. Its viral strains contain gene segments of three types of influenza viruses, namely swine influenza virus, avian influenza virus and human influenza virus. And the virus is mainly transmitted among humans via direct and indirect contact or respiratory tract.
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Knuf M, Leroux-Roels G, Rümke H, Rivera L, Pedotti P, Arora AK, Lattanzi M, Kieninger D, Cioppa GD. Immunogenicity and safety of cell-derived MF59®-adjuvanted A/H1N1 influenza vaccine for children. Hum Vaccin Immunother 2015; 11:358-76. [PMID: 25621884 DOI: 10.4161/21645515.2014.987014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Mass immunization of children has the potential to decrease infection rates and prevent the transmission of influenza. We evaluated the immunogenicity, safety, and tolerability of different formulations of cell-derived MF59-adjuvanted and nonadjuvanted A/H1N1 influenza vaccine in children and adolescents. This was a randomized, single-blind, multicenter study with a total of 666 healthy subjects aged 6 months-17 y in one of 3 vaccination groups, each receiving formulations containing different amounts of influenza A/H1N1 antigen with or without MF59. A booster trivalent seasonal MF59 vaccine was administered one year after primary vaccinations. Antibody titers were assessed by hemagglutination inhibition (HI) and microneutralization assays obtained on days 1, 22, 43, 366, and 387 (3 weeks post booster). Safety was monitored throughout the study. One vaccination with 3.75 μg of A/H1N1 antigen formulated with 50% MF59 (3.75_halfMF59) or 7.5 μg of A/H1N1 antigen formulated with 100% MF59 (7.5_fullMF59) induced an HI titer ≥1:40 in >70% of children in the 1-<3, 3-8, and 9-17 y cohorts; however, 2 vaccinations with nonadjuvanted 15 μg A/H1N1 antigen were needed to achieve this response in the 1-<3 and 3-8 y cohorts. Among children aged 6-11 months, 1 dose of 7.5_fullMF59 resulted in an HI titer ≥1:40 in >70% while 2 doses of 3.75_halfMF59 were required to achieve this result. All vaccines were well tolerated. Our findings support the immunogenicity and safety of the 3.75_halfMF59 (2 doses for children <12 months) and 7.5_fullMF59 vaccine formulations for use in children and adolescents aged 6 months to 17 y The use of the 3.75_halfMF59 could have the benefit of antigen and adjuvant sparing, increasing the available vaccine doses allowing vaccination of more people.
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Key Words
- AE, adverse event
- CHMP, European Committee for Medicinal Products for Human Use
- CI, confidence interval
- GMR, geometric mean ratio
- GMT, geometric mean titer
- H1N1
- HI, hemagglutination inhibition
- MF59
- MN, microneutralization
- PPS, per-protocol set
- SAE, serious adverse event
- WHO, World Health Organization
- adjuvant
- cell-culture
- pandemic
- pediatric
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Affiliation(s)
- Markus Knuf
- a Clinic for Children and Youth; Dr. Horst Schmidt Clinics ; Wiesbaden , Germany
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Nandhini G, Sujatha S. Epidemiology of influenza viruses from 2009 to 2013 - A sentinel surveillance report from Union territory of Puducherry, India. ASIAN PAC J TROP MED 2015; 8:718-23. [PMID: 26433657 DOI: 10.1016/j.apjtm.2015.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To report the findings of influenza surveillance programme from Union territory of Puducherry and to document the clinical and epidemiological data of influenza viruses over a five year period from 2009 to 2013. METHODS Respiratory samples were collected from patients with influenza-like illness from 2009 to 2013 as part of routine diagnostic and surveillance activity. Detection of pandemic influenza A (H1N1) 2009, influenza A (H3N2) and influenza B was done using Real-time PCR. RESULTS Of the total 2247 samples collected from patients with influenza-like illness during the study period 287 (12.7%) and 92 (4.0%) were positive for influenza A (H1N1) 2009 and influenza A (H3N2) respectively. A subset of 557 of these samples were also tested for influenza B and 24 (4.3%) were positive. Significantly higher positivity rate for both viruses was observed in adults when compared with children. The peak positivity of influenza A (H1N1) 2009 was observed in 2009 followed by 2012, while that of influenza A (H3N2) was more uniformly distributed with the exception of 2012. Overall mortality rate due to influenza A (H1N1) 2009 was 7.6% while it was 1% for influenza A (H3N2). Each year influenza-like illness and influenza virus activity coincided with period of high rainfall and low temperature except in the first half of 2012. CONCLUSIONS As the sole referral laboratory in this region, the data provides a comprehensive picture of influenza activity. This information will be useful in future planning of the vaccine schedule and influenza pandemic preparedness.
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Affiliation(s)
- Ganesh Nandhini
- Department of Microbiology, JIPMER, Puducherry, 605006, India
| | - Sistla Sujatha
- Department of Microbiology, JIPMER, Puducherry, 605006, India.
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Ethnicity, deprivation and mortality due to 2009 pandemic influenza A(H1N1) in England during the 2009/2010 pandemic and the first post-pandemic season. Epidemiol Infect 2015; 143:3375-83. [PMID: 25850904 DOI: 10.1017/s0950268815000576] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The relationship between risk of death following influenza A(H1N1)pdm09 infection and ethnicity and deprivation during the 2009/2010 pandemic period and the first post-pandemic season of 2010/2011 in England was examined. Poisson regression models were used to estimate the mortality risk, adjusted for age, gender, and place of residence. Those of non-White ethnicity experienced an increased mortality risk compared to White populations during the 2009/2010 pandemic [10·5/1000 vs. 6·0/1000 general population; adjusted risk ratio (RR) 1·84, 95% confidence interval (CI) 1·39-2·54] with the highest risk in those of Pakistani ethnicity. However, no significant difference between ethnicities was observed during the following 2010/2011 season. Persons living in areas with the highest level of deprivation had a significantly higher risk of death (RR 2·08, 95% CI 1·49-2·91) compared to the lowest level for both periods. These results highlight the importance of rapid identification of groups at higher risk of severe disease in the early stages of future pandemics to enable the implementation of optimal prevention and control measures for vulnerable populations.
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36
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Yin M, Tambyah PA. The 2009 influenza pandemic and the Ebola crisis: what are the lessons learnt? Future Virol 2015. [DOI: 10.2217/fvl.15.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Mo Yin
- National University Hospital, Singapore, Singapore
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Cárdenas G, Soto-Hernández JL, Díaz-Alba A, Ugalde Y, Mérida-Puga J, Rosetti M, Sciutto E. Neurological events related to influenza A (H1N1) pdm09. Influenza Other Respir Viruses 2014; 8:339-46. [PMID: 24895698 PMCID: PMC4181482 DOI: 10.1111/irv.12241] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To review neurological complications after the influenza A (H1N1) pdm09, highlighting the clinical differences between patients with post-vaccine or viral infection. DESIGN A search on Medline, Ovid, EMBASE, and PubMed databases using the keywords “neurological complications of Influenza AH1N1” or “post-vaccine Influenza AH1N1.” SETTING Only papers written in English, Spanish, German, French, Portuguese, and Italian published from March 2009 to December 2012 were included. SAMPLE We included 104 articles presenting a total of 1636 patient cases. In addition, two cases of influenza vaccine-related neurological events from our neurological care center, arising during the period of study, were also included. MAIN OUTCOME MEASURES Demographic data and clinical diagnosis of neurological complications and outcomes: death, neurological sequelae or recovery after influenza A (H1N1) pdm09 vaccine or infection. RESULTS The retrieved cases were divided into two groups: the postvaccination group, with 287 patients, and the viral infection group, with 1349 patients. Most patients in the first group were adults. The main neurological complications were Guillain-Barre syndrome (GBS) or polyneuropathy (125), and seizures (23). All patients survived. Pediatric patients were predominant in the viral infection group. In this group, 60 patients (4.7%) died and 52 (30.1%) developed permanent sequelae. A wide spectrum of neurological complications was observed. CONCLUSIONS Fatal cases and severe, permanent, neurological sequelae were observed in the infection group only. Clinical outcome was more favorable in the post-vaccination group. In this context, the relevance of an accurate neurological evaluation is demonstrated for all suspicious cases, as well as the need of an appropriate long-term clinical and imaging follow-up of infection and post-vaccination events related to influenza A (H1N1) pdm09, to clearly estimate the magnitude of neurological complications leading to permanent disability.
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Affiliation(s)
- Graciela Cárdenas
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - José Luis Soto-Hernández
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Alexandra Díaz-Alba
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Yair Ugalde
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Jorge Mérida-Puga
- Department of Neuroinfectology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco SuárezMexico City, Mexico
| | - Marcos Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de MéxicoMexico City, Mexico
| | - Edda Sciutto
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de MéxicoMexico City, Mexico
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Hardelid P, Dattani N, Cortina-Borja M, Gilbert R. Contribution of respiratory tract infections to child deaths: a data linkage study. BMC Public Health 2014; 14:1191. [PMID: 25409736 PMCID: PMC4247691 DOI: 10.1186/1471-2458-14-1191] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/07/2014] [Indexed: 11/30/2022] Open
Abstract
Background Respiratory tract infections (RTIs) are an important cause of death in children, and often contribute to the terminal decline in children with chronic conditions. RTIs are often underrecorded as the underlying cause of death; therefore the overall contribution of RTIs to child deaths and the potential preventability of RTI-related deaths have not been adequately quantified. Methods We analysed deaths in children resident in England who died of non-injury causes aged 28 days to 18 years between 2001 and 2010 using death certificates linked to a longitudinal hospital admission database. We defined deaths as RTI-related if RTIs or other respiratory conditions were recorded on death certificates or linked hospital records up to 30 days before death. We examined trends in mortality by age group, year and season (winter or summer) and determined the winter excess of RTI-related deaths using rate differencing techniques. We estimated the proportion of RTI-related deaths in children with chronic conditions. Results 22.4% (5039/22509) of child deaths were RTI-related. RTI-related deaths declined by 2.3% per year in infants aged 28 to 364 days between 2001 and 2010. No decline was observed for older children. On average there were 161 winter excess RTI-related deaths annually, accounting for 32% of all RTI-related deaths. 89.0% of children with RTI-related deaths had at least one chronic condition; neurological conditions were the most prevalent. Conclusions RTI-related deaths have not declined in the last decade except in infants. Targeted strategies to prevent the winter excess of RTIs and to treat RTIs in children, particularly children with chronic conditions, may reduce RTI-related deaths. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1191) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pia Hardelid
- Population, Policy and Practice Programme, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Abstract
In the past century, child mortality has fallen to very low rates in all developed countries. However, rates between and within countries vary widely, and factors can be identified that could be modified to reduce the risk of future deaths. An understanding of the nature and patterns of child death and of the factors contributing to child deaths is essential to drive preventive initiatives. We discuss the epidemiology of child deaths in England and Wales. We use available data, particularly that of death registration and other available datasets, and published literature to emphasise issues relevant to reduction of child deaths in developed countries. We examine the different patterns of mortality at different ages in five broad categories of death: perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths. For each category, we explore what is known about the main causes of death and some of the contributory factors. We then explain how this knowledge might be used to help to drive prevention initiatives.
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Affiliation(s)
- Peter Sidebotham
- Division of Mental Health and Well Being, University of Warwick, Coventry, UK.
| | - James Fraser
- Bristol Royal Hospital for Children, Bristol, UK
| | - Peter Fleming
- School of Social and Community Medicine, St Michaels Hospital, Bristol, UK
| | | | - Richard Hain
- Welsh Paediatric Palliative Medicine Network, Bangor University, Bangor, UK; University of Glamorgan Children's Hospital, Cardiff, UK
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Effect of ethnicity on care pathway and outcomes in patients hospitalized with influenza A(H1N1)pdm09 in the UK. Epidemiol Infect 2014; 143:1129-38. [PMID: 25084481 PMCID: PMC4412072 DOI: 10.1017/s0950268814001873] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Data were extracted from the case records of UK patients admitted with laboratory-confirmed influenza A(H1N1)pdm09. White and non-White patients were characterized by age, sex, socioeconomic status, pandemic wave and indicators of pre-morbid health status. Logistic regression examined differences by ethnicity in patient characteristics, care pathway and clinical outcomes; multivariable models controlled for potential confounders. Whites (n = 630) and non-Whites (n = 510) differed by age, socioeconomic status, pandemic wave of admission, pregnancy, recorded obesity, previous and current smoking, and presence of chronic obstructive pulmonary disease. After adjustment for a priori confounders non-Whites were less likely to have received pre-admission antibiotics [adjusted odds ratio (aOR) 0·43, 95% confidence interval (CI) 0·28-0·68, P < 0·001) but more likely to receive antiviral drugs as in-patients (aOR 1·53, 95% CI 1·08-2·18, P = 0·018). However, there were no significant differences by ethnicity in delayed admission, severity at presentation for admission, or likelihood of severe outcome.
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Tarnagda Z, Yougbaré I, Ilboudo AK, Kagoné T, Sanou AM, Cissé A, Médah I, Yelbéogo D, Nzussouo NT. Sentinel surveillance of influenza in Burkina Faso: identification of circulating strains during 2010-2012. Influenza Other Respir Viruses 2014; 8:524-9. [PMID: 25074591 PMCID: PMC4181815 DOI: 10.1111/irv.12259] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2014] [Indexed: 12/14/2022] Open
Abstract
Background Although influenza surveillance has recently been improved in some sub-Saharan African countries, no information is yet available from Burkina Faso. Objectives Our study was the first to determine the prevalence of influenza viruses circulating in Burkina Faso through a sentinel surveillance system. Methods We conducted sentinel surveillance with oropharyngeal (OP) swabs collected from outpatients (1 month to 83 years) from six sites in Bobo-Dioulasso and Ouagadougou, among patients meeting the WHO/CDC case definition for influenza-like illness (ILI; fever ≥38°C, and cough and/or sore throat in the absence of other diagnosis) from July 2010 to May 2012. Influenza viruses were detected by real-time RT-PCR using CDC primers, probes, and protocols. Results The first three ILI cases were enrolled each day; of 881 outpatients with ILI enrolled and sampled, 58 (6·6%) tested positive for influenza viruses (29 influenza A and 29 influenza B). Among the influenza A viruses, 55·2% (16/29) were influenza A (H1N1)pdm09 and 44·8% (13/29) were seasonal A (H3N2). No cases of seasonal A/H1N1 were detected. Patients within 0–5 years and 6–14 years were the most affected, comprising 41·4% and 22·4% laboratory-confirmed influenza cases, respectively. Influenza infections occurred during both the dry, dusty Harmattan months from November to March and the rainy season from June to October with peaks in January and August. Conclusions This surveillance was the first confirming the circulation of influenza A (H1N1)pdm09, A/H3N2, and influenza B viruses in humans in Burkina Faso.
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Affiliation(s)
- Zékiba Tarnagda
- Institut de Recherche en Sciences de la Santé, Centre National de Référence pour la Grippe, Bobo-Dioulasso, Burkina Faso; West African Master Field Epidemiology and Laboratory Training Program (WA FELTP), University of Ouagadougou, Ouagadougou, Burkina Faso
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Shi L, Loveless M, Spagnuolo P, Zhang M, Liu S, Liu J, Xu Y, Chen E, Han J. Antiviral treatment of influenza in children: a retrospective cohort study. Adv Ther 2014; 31:735-50. [PMID: 25015536 DOI: 10.1007/s12325-014-0136-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Influenza is a common and potentially serious disease in children. This retrospective cohort study examined the incidence of complications and associated risk factors in this population, and the effects of antiviral treatment. METHODS Data for children aged ≤17 years with a clinical diagnosis of influenza (ICD-9-CM codes 487.xx or 488.xx) during the 2006-2010 influenza seasons (including the 2009-2010 pandemic season) were obtained from US insurance claims databases. Unconditional logistic regression was used to evaluate the effect of antiviral treatment on the incidence of complications and healthcare resource utilization during the 30 days post the index influenza diagnosis. A sub-analysis in children aged <1 year was performed. RESULTS Antiviral treatment was used in 315,128 (39.53%) of 797,284 cases. The risk of complications was higher in children with pre-existing conditions, e.g., asthma (odds ratio [OR] = 1.86) or cystic fibrosis (OR = 1.67) than otherwise healthy children. Antiviral treatment reduced the 30-day risk of complications, hospitalization, emergency department visits, and ≥2 outpatient visits versus no treatment (ORs = 0.76, 0.69, 0.76, and 0.81, respectively); 30-day risks were further reduced by early treatment (within 2 days of diagnosis). The sub-analysis included 19,666 children aged <1 year; 7.38% received antiviral treatment during the pre-pandemic seasons and 33.00% during the pandemic season. Findings were similar to the main analyses; however, healthcare resource utilization was only significantly reduced by early treatment. CONCLUSIONS Antiviral treatment is associated with reduced risk of complications and healthcare resource utilization in children of all ages with influenza, especially when initiated early.
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Lees EA, Carrol ED, Gerrard C, Hardiman F, Howel G, Timmis A, Thorburn K, Guiver M, McNamara PS. Characterisation of acute respiratory infections at a United Kingdom paediatric teaching hospital: observational study assessing the impact of influenza A (2009 pdmH1N1) on predominant viral pathogens. BMC Infect Dis 2014; 14:343. [PMID: 24948099 PMCID: PMC4091667 DOI: 10.1186/1471-2334-14-343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 06/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background According to the World Health Organisation, influenza A (2009 pdmH1N1) has moved into the post-pandemic phase, but there were still high numbers of infections occurring in the United Kingdom in 2010-11. It is therefore important to examine the burden of acute respiratory infections at a large children’s hospital to determine pathogen prevalence, occurrence of co-infection, prevalence of co-morbidities and diagnostic yield of sampling methods. Methods This was a retrospective study of respiratory virus aetiology in acute admissions to a paediatric teaching hospital in the North West of England between 1st April 2010 and 31st March 2011. Respiratory samples were analysed either with a rapid RSV test if the patient had symptoms suggestive of bronchiolitis, followed by multiplex PCR testing for ten respiratory viruses, or with multiplex PCR testing alone if the patient had suspected other ARI. Patient demographics and data regarding severity of illness, presence of co-morbidities and respiratory virus sampling method were retrieved from case notes. Results 645 patients were admitted during the study period. 82/645 (12.7%) patients were positive for 2009 pdmH1N1, of whom 24 (29.2%) required PICU admission, with 7.3% mortality rate. Viral co-infection occurred in 48/645 (7.4%) patients and was not associated with more severe disease. Co-morbidities were present more frequently in older children, but there was no significant difference in prevalence of co-morbidity between 2009 pdmH1N1 patients and those with other ARI. NPA samples had the highest diagnostic yield with 192/210 (91.4%) samples yielding an organism. Conclusions Influenza A (2009 pdmH1N1) is an ongoing cause of occasionally severe disease affecting both healthy children and those with co-morbidities. Surveillance of viral pathogens provides valuable information on patterns of disease.
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Affiliation(s)
- Emily A Lees
- Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Building, 1-5 Brownlow Street, Liverpool L69 3GL, England.
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Tricco AC, Lillie E, Soobiah C, Perrier L, Straus SE. Impact of H1N1 on socially disadvantaged populations: summary of a systematic review. Influenza Other Respir Viruses 2014; 7 Suppl 2:54-58. [PMID: 24034485 DOI: 10.1111/irv.12082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Previous reviews found that the H1N1 pandemic was associated with a large proportion of hospitalizations, severe illness, workplace absenteeism, and high costs. However, the burden among socially disadvantaged groups of the population is unclear. This is a summary of a previously published systematic review commissioned by the World Health Organization on the burden of H1N1 pandemic (influenza A/Mexico/2009 (H1N1)) among socially disadvantaged populations. METHODS MEDLINE and EMBASE were searched to identify studies reporting hospitalization, severe illness, and mortality attributable to the 2009 H1N1 pandemic among socially disadvantaged populations, including ethnic minorities and low-income or lower-middle-income economy countries (LIC/LMIC). SAS and Review Manager were used to conduct random effects meta-analysis. RESULTS Forty-eight cohort studies and 14 companion reports including 44 777 patients were included after screening 787 citations and 164 full-text articles. Twelve of the included studies provided data on LIC/LMIC, including one study from Guatemala, two from Morocco, one from Pakistan, and eight from India, plus four companion reports. The rest provided data on ethnic minorities living in high-income economy countries (HIC). Significantly more hospitalizations were observed among ethnic minorities versus nonethnic minorities in two North American studies [1313 patients, odds ratio (OR) 2·26 (95% confidence interval: 1·53-3·32)]. Among hospitalized patients in HIC, statistically significant differences in intensive care unit admissions (n = 8 studies, 15 352 patients, OR 0·84 [0·69-1·02]) and deaths (n = 6 studies, 14 757 patients, OR 0·85 [95% CI: 0·73-1·01]) were not observed. CONCLUSION We found significantly more hospitalizations among ethnic minorities versus nonethnic minorities in North America, yet no differences in intensive care unit admissions or deaths among H1N1-infected hospitalized patients were observed in North America and Australia. Our results suggest a similar burden of H1N1 between ethnic minorities and nonethnic minorities living in HIC.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
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Joseph C, Togawa Y, Shindo N. Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses 2014; 7 Suppl 2:105-113. [PMID: 24034494 PMCID: PMC5909385 DOI: 10.1111/irv.12089] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Influenza‐associated bacterial and viral infections are responsible for high levels of morbidity and death during pandemic and seasonal influenza episodes. A review was undertaken to assess and evaluate the incidence, epidemiology, aetiology, clinical importance and impact of bacterial and viral co‐infection and secondary infection associated with influenza. A review was carried out of published articles covering bacterial and viral infections associated with pandemic and seasonal influenza between 1918 and 2009 (and published through December 2011) to include both pulmonary and extra‐pulmonary infections. While pneumococcal infection remains the predominant cause of bacterial pneumonia, the review highlights the importance of other co‐ and secondary bacterial and viral infections associated with influenza, and the emergence of newly identified dual infections associated with the 2009 H1N1 pandemic strain. Severe influenza‐associated pneumonia is often bacterial and will necessitate antibiotic treatment. In addition to the well‐known bacterial causes, less common bacteria such as Legionella pneumophila may also be associated with influenza when new influenza strains emerge. This review should provide clinicians with an overview of the range of bacterial and viral co‐ or secondary infections that could present with influenza illness.
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Affiliation(s)
- Carol Joseph
- Global Influenza Programme, World Health Organization, Geneva, Switzerland
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Richter D, Anca I, André FE, Bakir M, Chlibek R, Čižman M, Mangarov A, Mészner Z, Pokorn M, Prymula R, Salman N, Šimurka P, Tamm E, Tešović G, Urbančíková I, Usonis V, Wysocki J, Zavadska D. Immunization of high-risk paediatric populations: Central European Vaccination Awareness Group recommendations. Expert Rev Vaccines 2014; 13:801-15. [DOI: 10.1586/14760584.2014.897615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Rutter P, Mytton O, Ellis B, Donaldson L. Access to the NHS by telephone and Internet during an influenza pandemic: an observational study. BMJ Open 2014; 4:e004174. [PMID: 24491382 PMCID: PMC3918981 DOI: 10.1136/bmjopen-2013-004174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 12/23/2013] [Accepted: 01/10/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine use of a novel telephone and Internet service-the National Pandemic Flu Service (NPFS)-by the population of England during the 2009-2010 influenza pandemic. SETTING National telephone and Internet-based service. PARTICIPANTS Service available to population of England (n=51.8 million). PRIMARY AND SECONDARY OUTCOME MEASURES Primary: service use rate, by week. Numbers and age-specific and sex-specific rates of population who: accessed service; were authorised to collect antiviral medication; collected antiviral medication; were advised to seek further face-to-face assessment. Secondary: daily mean contacts by hour; proportion using service by telephone/Internet. RESULTS The NPFS was activated on 23 July 2009, operated for 204 days and assessed 2.7 million patients (5200 consultations/100 000 population). This was six times the number of people who consulted their general practitioner with influenza-like illness during the same period (823 consultations/100 000 population, rate ratio (RR)=6.30, 95% CI 6.28 to 6.32). Women used the service more than men (52.6 vs 43.4 assessments/1000 population, RR1 21, 95% CI 1.21 to 1.22). Among adults, use of the service declined with age (16-29 years: 74.4 vs 65 years+: 9.9 assessments/1000 population (RR 7.46 95% CI 7.41 to 7.52). Almost three-quarters of those assessed met the criteria to receive antiviral medication (1 807 866/2 488 510; 72.6%). Most of the people subsequently collected this medication, although more than one-third did not (n=646 709; 35.8%). Just over one-third of those assessed were advised to seek further face-to-face assessment with a practitioner (951 332/2 488 504; 38.2%). CONCLUSIONS This innovative healthcare service operated at large scale and achieved its aim of relieving considerable pressure from mainstream health services, while providing appropriate initial assessment and management for patients. This offers proof-of-concept for such a service that, with further refinement, England can use in future pandemics. Other countries may wish to adopt a similar system as part of their pandemic emergency planning.
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Affiliation(s)
| | - Oliver Mytton
- Department of Public Health, University of Oxford, Oxford, UK
| | - Benjamin Ellis
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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INGLIS NJ, BAGNALL H, JANMOHAMED K, SULEMAN S, AWOFISAYO A, DE SOUZA V, SMIT E, PEBODY R, MOHAMED H, IBBOTSON S, SMITH GE, HOUSE T, OLOWOKURE B. Measuring the effect of influenza A(H1N1)pdm09: the epidemiological experience in the West Midlands, England during the 'containment' phase. Epidemiol Infect 2014; 142:428-37. [PMID: 23731730 PMCID: PMC9151159 DOI: 10.1017/s0950268813001234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 04/27/2013] [Accepted: 05/01/2013] [Indexed: 11/07/2022] Open
Abstract
The West Midlands was the first English region to report sustained community transmission during the 'containment' phase of the influenza A(H1N1)pdm09 pandemic in England. To describe the epidemiological experience in the region, West Midlands and national datasets containing laboratory-confirmed A(H1N1)pdm09 virus cases in the region during the 'containment' phase were analysed. The region accounts for about 10·5% of England's population, but reported about 42% of all laboratory-confirmed cases. Altogether 3063 cases were reported, with an incidence rate of 56/100 000 population. School-associated cases accounted for 25% of cases. Those aged <20 years, South Asian ethnic groups, and residents of urban and socioeconomically deprived areas were disproportionately affected. Imported cases accounted for 1% of known exposures. Regional R 0 central estimates between 1·41 and 1·43 were obtained. The West Midlands experience suggests that interpretation of transmission rates may be affected by complex interactions within and between sub-populations in the region.
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Affiliation(s)
- N. J. INGLIS
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - H. BAGNALL
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - K. JANMOHAMED
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - S. SULEMAN
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - A. AWOFISAYO
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - V. DE SOUZA
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - E. SMIT
- Heart of England Foundation Trust, Birmingham, UK
| | - R. PEBODY
- Centre for Infections, Health Protection Agency, London, UK
| | - H. MOHAMED
- Health Protection Unit West Midlands East, Health Protection Agency, Birmingham, UK
| | - S. IBBOTSON
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - G. E. SMITH
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
| | - T. HOUSE
- Mathematics Institute, University of Warwick, Coventry, UK
| | - B. OLOWOKURE
- Regional Epidemiology Unit, Health Protection Agency West Midlands, Birmingham, UK
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Abstract
BACKGROUND During the 2009 influenza pandemic, uncertainty surrounding the seriousness of human infections with the H1N1pdm09 virus hindered appropriate public health response. One measure of seriousness is the case fatality risk, defined as the probability of mortality among people classified as cases. METHODS We conducted a systematic review to summarize published estimates of the case fatality risk of the pandemic influenza H1N1pdm09 virus. Only studies that reported population-based estimates were included. RESULTS We included 77 estimates of the case fatality risk from 50 published studies, about one-third of which were published within the first 9 months of the pandemic. We identified very substantial heterogeneity in published estimates, ranging from less than 1 to more than 10,000 deaths per 100,000 cases or infections. The choice of case definition in the denominator accounted for substantial heterogeneity, with the higher estimates based on laboratory-confirmed cases (point estimates = 0-13,500 per 100,000 cases) compared with symptomatic cases (point estimates = 0-1,200 per 100,000 cases) or infections (point estimates = 1-10 per 100,000 infections). Risk based on symptomatic cases increased substantially with age. CONCLUSIONS Our review highlights the difficulty in estimating the seriousness of infection with a novel influenza virus using the case fatality risk. In addition, substantial variability in age-specific estimates complicates the interpretation of the overall case fatality risk and comparisons among populations. A consensus is needed on how to define and measure the seriousness of infection before the next pandemic.
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Renk H, Regamey N, Hartl D. Influenza A(H1N1)pdm09 and cystic fibrosis lung disease: a systematic meta-analysis. PLoS One 2014; 9:e78583. [PMID: 24427261 PMCID: PMC3888399 DOI: 10.1371/journal.pone.0078583] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/27/2013] [Indexed: 01/01/2023] Open
Abstract
Background To systematically assess the literature published on the clinical impact of Influenza A(H1N1)pdm09 on cystic fibrosis (CF) patients. Methods An online search in PUBMED database was conducted. Original articles on CF patients with Influenza A(H1N1)pdm09 infection were included. We analyzed incidence, symptoms, clinical course and treatment. Results Four surveys with a total of 202 CF patients infected by Influenza A(H1N1)pdm09 were included. The meta-analysis showed that hospitalisation rates were higher in CF patients compared to the general population. While general disease symptoms were comparable, the clinical course was more severe and case fatality rate (CFR) was higher in CF patients compared to asthmatics and the general population. Conclusions Evidence so far suggests that CF patients infected with Influenza A(H1N1)pdm09 show increased morbidity and a higher CFR compared to patients with other chronic respiratory diseases and healthy controls. Particularly, CF patients with advanced stage disease seem to be more susceptible to severe lung disease. Accordingly, early antiviral and antibiotic treatment strategies are essential in CF patients. Preventive measures, including vaccination as well as hygiene measures during the influenza season, should be reinforced and improved in CF patients.
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Affiliation(s)
- Hanna Renk
- University Children's Hospital, Eberhard-Karls-University, Tuebingen, Germany
| | - Nicolas Regamey
- Department of Paediatrics, Inselspital and University of Bern, Bern, Switzerland
| | - Dominik Hartl
- University Children's Hospital, Eberhard-Karls-University, Tuebingen, Germany
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