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Chien SJ, Hsieh YJ, Shih YL, Tseng YJ. Clinical characteristics and outcomes of mixed virus or bacterial infection in children with laboratory-confirmed influenza infection. J Formos Med Assoc 2022; 121:2074-2084. [PMID: 35331620 DOI: 10.1016/j.jfma.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/PURPOSE This study investigated the demographic characteristics and influenza complications of paediatric patients and explored the association of different influenza virus types and viral and bacterial coinfections with disease severity. METHODS This retrospective cohort study used data collected in 2010-2016 from the Chang Gung Research Database (CGRD), the largest collection of multi-institutional electronic medical records in Taiwan. Data were retrieved for children aged 0-18 years with laboratory-confirmed influenza. We extracted and analysed the demographic characteristics and the data on clinical features, complications, microbiological information, and advanced therapies of each case. RESULTS We identified 6193 children with laboratory-confirmed influenza, of whom 1964 (31.7%) were hospitalised. The age of patients with influenza A infection was lower than that of patients with influenza B (4.48 vs. 6.68, p < 0.001). Patients with influenza B infection had a higher incidence of myositis or rhabdomyolysis (4.4%, p < 0.001) and a higher need for advanced therapies (OR, 1.96; 95% CI, 1.32-2.9, p < 0.001). In addition to bacterial (OR, 9.07; 95% CI, 5.29-15.54, p < 0.001) and viral coinfection (OR, 7.73; 95% CI, 5.4-11.07, p < 0.001), dual influenza A and B infection was also a risk factor for influenza complications (OR, 2.13; 95% CI, 1.47-3.09, p < 0.001). CONCLUSION Dual influenza A and B infection and bacterial coinfection can contribute to influenza complications. Early recognition of any influenza complication is critical for the timely initiation of organ-specific advanced therapies to improve influenza-associated outcomes.
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Affiliation(s)
- Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Department of Early Childhood Care and Education, Cheng Shiu University, Kaohsiung, Taiwan
| | - Yun-Jung Hsieh
- Department of Information and Finance Management, National Taipei University of Technology, Taipei, Taiwan; Department of Information Management, Chung Gung University, Taoyuan, Taiwan
| | - Yu-Lien Shih
- Department of Information Management, Chung Gung University, Taoyuan, Taiwan; Department of Nursing, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Ju Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
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García-Moncó JC, Cabrera Muras A, Erburu Iriarte M, Rodrigo Armenteros P, Collía Fernández A, Arranz-Martínez J, Kapetanovic S, Lorenzo-García A, Bilbao González A, Gomez-Beldarrain M. Neurologic Manifestations in a Prospective Unselected Series of Hospitalized Patients With COVID-19. Neurol Clin Pract 2020; 11:e64-e72. [PMID: 33842073 DOI: 10.1212/cpj.0000000000000913] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Background An increasing number of neurologic problems are being described in coronavirus disease 2019 (COVID-19) disease, but their frequency and type have not been defined. In this study, we sought to determine the extent of neurologic manifestations of COVID-19 in a prospective series of unselected patients admitted to the general medicine wards of our hospitals due to COVID-19 and who were examined by a team of neurologists. Methods Eight neurologists provided medical attention to patients hospitalized for COVID-19 to provide medical support to other hospital units tasked with the care of an increasingly larger influx of patients with COVID-19. A series of 100 consecutive, unselected patients were evaluated systematically, including a questionnaire that collected medical information derived from the initial examination and the medical history. Results Eighty-eight percent of the patients had 1 neurologic manifestation associated with COVID-19 during hospitalization. Most common were anosmia-dysgeusia and headache (44% each), myalgias (43%), and dizziness (36%). Less frequent were encephalopathy (8%), syncope (7%), seizures (2%), and ischemic stroke during the period of hospitalization (2%). Anosmia and headache associated with younger patients with less severe disease, and both were associated with each other and with serum inflammatory markers. Encephalopathy was associated with fever and syncope and with markers of inflammation. Conclusions Neurologic disturbances are common in patients with COVID-19, particularly if patients are evaluated by neurologists. There is a wide variety of neurologic conditions, some of them severe, in the spectrum of COVID-19 disease that will benefit from an evaluation by practicing neurologists.
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Affiliation(s)
- Juan Carlos García-Moncó
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Antonio Cabrera Muras
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Markel Erburu Iriarte
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Patricia Rodrigo Armenteros
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Alejandra Collía Fernández
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Javier Arranz-Martínez
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Solange Kapetanovic
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Ana Lorenzo-García
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Amaia Bilbao González
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
| | - Marian Gomez-Beldarrain
- Osakidetza Basque Health Service (JCG-M, ACM, MEI, PRA, ACF, SK, AL-G, ABG), Basurto University Hospital, Departments of Neurology and Research Unit; and Galdakao Hospital (JA-M, MG-B), Vizcaya, Spain
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Jennings L, Huang QS, Barr I, Lee PI, Kim WJ, Buchy P, Sanicas M, Mungall BA, Chen J. Literature review of the epidemiology of influenza B disease in 15 countries in the Asia-Pacific region. Influenza Other Respir Viruses 2018; 12:383-411. [PMID: 29127742 PMCID: PMC5907823 DOI: 10.1111/irv.12522] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 01/06/2023] Open
Abstract
Influenza control strategies focus on the use of trivalent influenza vaccines containing two influenza A virus subtypes and one of the two circulating influenza type B lineages (Yamagata or Victoria). Mismatches between the vaccine B lineage and the circulating lineage have been regularly documented in many countries, including those in the Asia‐Pacific region. We conducted a literature review with the aim of understanding the relative circulation of influenza B viruses in Asia‐Pacific countries. PubMed and Western Pacific Region Index Medicus were searched for relevant articles on influenza type B published since 1990 in English language for 15 Asia‐Pacific countries. Gray literature was also accessed. From 4834 articles identified, 121 full‐text articles were analyzed. Influenza was reported as an important cause of morbidity in the Asia‐Pacific region, affecting all age groups. In all 15 countries, influenza B was identified and associated with between 0% and 92% of laboratory‐confirmed influenza cases in any one season/year. Influenza type B appeared to cause more illness in children aged between 1 and 10 years than in other age groups. Epidemiological data for the two circulating influenza type B lineages remain limited in several countries in the Asia‐Pacific, although the co‐circulation of both lineages was seen in countries where strain surveillance data were available. Mismatches between circulating B lineages and vaccine strains were observed in all countries with available data. The data suggest that a shift from trivalent to quadrivalent seasonal influenza vaccines could provide additional benefits by providing broader protection.
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Affiliation(s)
- Lance Jennings
- Canterbury District Health Board, Christchurch, New Zealand
| | - Qiu Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Porirua, New Zealand
| | - Ian Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, VIC, Australia
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
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H5N1 influenza vaccine induces a less robust neutralizing antibody response than seasonal trivalent and H7N9 influenza vaccines. NPJ Vaccines 2017; 2:16. [PMID: 29263872 PMCID: PMC5627238 DOI: 10.1038/s41541-017-0017-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 02/01/2023] Open
Abstract
Conventional inactivated avian influenza vaccines have performed poorly in past vaccine trials, leading to the hypothesis that they are less immunogenic than seasonal influenza vaccines. We tested this hypothesis by comparing the immunogenicity of the H5N1 and H7N9 vaccines (avian influenza vaccines) to a seasonal trivalent inactivated influenza vaccine in naïve ferrets, administered with or without the adjuvants MF59 or AS03. Vaccine immunogenicity was assessed by measuring neutralizing antibody titers against hemagglutinin and neuraminidase and by hemagglutinin -specific IgG levels. Two doses of unadjuvanted vaccines induced low or no HA-specific IgG responses and hemagglutination-inhibiting titers. Adjuvanted vaccines induced comparable IgG-titers, but poorer neutralizing antibody titers for the H5 vaccine. All adjuvanted vaccines elicited detectable anti- neuraminidase -antibodies with the exception of the H5N1 vaccine, likely due to the low amounts of neuraminidase in the vaccine. Overall, the H5N1 vaccine had poorer capacity to induce neutralizing antibodies, but not HA-specific IgG, compared to H7N9 or trivalent inactivated influenza vaccine. Evidence shows that vaccines for avian flu provoke a poorer immune response than those for seasonal human flu. Avian influenza is an emergent disease that poses a credible threat to public health, yet vaccines to treat avian flu have not performed well in clinical trials. A team of scientists led by Richard Webby of St Jude Children’s Research Hospital, United States, investigated the reasons for this by comparing vaccine’s ability to stimulate the immune system in comparison to a vaccine to treat seasonal human flu. In contrast to previous hypotheses, Webby’s group found that only the avian H5N1 flu vaccine provoked a lesser release of neutralizing antibodies compared to the H7N9 (another avian flu) and seasonal flu vaccine, and hypothesized that differences in viral surface proteins may account for the difference. The authors hope this helps to direct future research into vaccine-induced immunity.
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Burnham AJ, Baranovich T, Govorkova EA. Neuraminidase inhibitors for influenza B virus infection: efficacy and resistance. Antiviral Res 2013; 100:520-34. [PMID: 24013000 DOI: 10.1016/j.antiviral.2013.08.023] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/17/2013] [Accepted: 08/25/2013] [Indexed: 01/28/2023]
Abstract
Many aspects of the biology and epidemiology of influenza B viruses are far less studied than for influenza A viruses, and one of these aspects is efficacy and resistance to the clinically available antiviral drugs, the neuraminidase (NA) inhibitors (NAIs). Acute respiratory infections are one of the leading causes of death in children and adults, and influenza is among the few respiratory infections that can be prevented and treated by vaccination and antiviral treatment. Recent data has suggested that influenza B virus infections are of specific concern to pediatric patients because of the increased risk of severe disease. Treatment of influenza B is a challenging task for the following reasons: This review presents current knowledge of the efficacy of NAIs for influenza B virus and antiviral resistance in clinical, surveillance, and experimental studies.
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Affiliation(s)
- Andrew J Burnham
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
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Paul Glezen W, Schmier JK, Kuehn CM, Ryan KJ, Oxford J. The burden of influenza B: a structured literature review. Am J Public Health 2013; 103:e43-51. [PMID: 23327249 PMCID: PMC3673513 DOI: 10.2105/ajph.2012.301137] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2012] [Indexed: 01/14/2023]
Abstract
We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010. Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B-specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant. The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disease and assist in vaccine development.
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Affiliation(s)
- W Paul Glezen
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
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Post-marketing assessment of neuropsychiatric adverse events in influenza patients treated with oseltamivir: an updated review. Adv Ther 2012; 29:826-48. [PMID: 23054689 DOI: 10.1007/s12325-012-0050-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Indexed: 10/27/2022]
Abstract
A 2008 review by our group concluded that the risk of neuropsychiatric adverse events (NPAEs) in influenza patients was not increased by oseltamivir exposure, and did not identify any mechanism by which oseltamivir or its metabolites could cause or worsen such events. The current article reviews new information on this topic. Between September 16, 2007 and May 15, 2010, 1,805 spontaneously-reported NPAEs were identified in 1,330 patients receiving oseltamivir: 767 (42.5%) from Japan, 296 (16.4%) from the USA, and 742 (41.1%) from other countries. NPAEs were more common in children: 1,072 (59.4%) events were in those aged ≤16 years. NPAEs often occurred within 48 h of treatment initiation (953 events; 52.8%). Nearly half of the events were serious in nature (838; 46.4%). The three largest categories of events were abnormal behavior (457 events, 25.3%), miscellaneous psychiatric events (370; 20.5%), and delusions/perceptual disturbances (316 events, 17.5%). A total of 1,545 events (85.6%) in eight different categories were considered to be delirium or delirium-like. Twenty-eight suicide-related events were reported. A US healthcare claims database analysis showed that the risk of NPAEs in 7,798 oseltamivir-treated patients was no higher than that in 10,411 patients not on antivirals, but a study on oseltamivir and abnormal behavior in Japan was less conclusive. NPAE frequency in oseltamivir-exposed Japanese and Taiwanese children with influenza was the same as in unexposed children. New analysis of the UK General Practice Research Database showed that the relative adjusted risk of NPAEs in influenza patients was 2.18-times higher than in the general population. Other epidemiology studies report frequent occurrence of encephalitis and similar disorders in influenza patients independently of oseltamivir exposure. The new data support the findings of the original assessment. Evidence suggests that influenza-related encephalopathies are caused by influenza-induced inflammatory responses, but more work is needed to confirm the underlying mechanisms.
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Paddock CD, Liu L, Denison AM, Bartlett JH, Holman RC, Deleon-Carnes M, Emery SL, Drew CP, Shieh WJ, Uyeki TM, Zaki SR. Myocardial injury and bacterial pneumonia contribute to the pathogenesis of fatal influenza B virus infection. J Infect Dis 2012; 205:895-905. [PMID: 22291193 DOI: 10.1093/infdis/jir861] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Influenza B virus infection causes rates of hospitalization and influenza-associated pneumonia similar to seasonal influenza A virus infection and accounts for a substantial percentage of all influenza-related hospitalizations and deaths among those aged <18 years; however, the pathogenesis of fatal influenza B virus infection is poorly described. METHODS Tissue samples obtained at autopsy from 45 case patients with fatal influenza B virus infection were evaluated by light microscopy and immunohistochemical assays for influenza B virus, various bacterial pathogens, and complement components C4d and C9, to identify the cellular tropism of influenza B virus, characterize concomitant bacterial pneumonia, and describe the spectrum of cardiopulmonary injury. RESULTS Viral antigens were localized to ciliated respiratory epithelium and cells of submucosal glands and ducts. Concomitant bacterial pneumonia, caused predominantly by Staphylococcus aureus, was identified in 38% of case patients and occurred with significantly greater frequency in those aged >18 years. Pathologic evidence of myocardial injury was identified in 69% of case patients for whom cardiac tissue samples were available for examination, predominantly in case patients aged <18 years. CONCLUSIONS Our findings suggest that bacterial pneumonia and cardiac injury contribute to fatal outcomes after infection with influenza B virus and that the frequency of these manifestations may be age related.
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Affiliation(s)
- Christopher D Paddock
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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