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Cavallazzi R, Ramirez JA. Influenza and Viral Pneumonia. Infect Dis Clin North Am 2024; 38:183-212. [PMID: 38280763 DOI: 10.1016/j.idc.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are in general nonspecific. The advent of polymerase chain reaction testing has enormously facilitated the identification of respiratory viruses, which has important implications for infection control measures and treatment. Currently, treatment options for patients with viral infection are limited but there is ongoing research on the development and clinical testing of new treatment regimens and strategies.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Disorders, University of Louisville, Louisville, KY, USA.
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
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2
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Vander Woude CA, King EJ, Hirschtick JL, Titus AR, Power LE, Elliott MR, Fleischer NL. Differential care-seeking behaviors during the beginning of the COVID-19 pandemic in Michigan: a population-based cross-sectional study. BMC Public Health 2023; 23:2101. [PMID: 37880623 PMCID: PMC10601223 DOI: 10.1186/s12889-023-16999-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND At the beginning of the COVID-19 pandemic in the United States in the spring of 2020, many Americans avoided the healthcare system, while those with COVID-19 symptoms were faced with decisions about seeking healthcare services for this novel virus. METHODS Using a probability sample (n = 1088) from the Michigan adult population of PCR-confirmed COVID-19 cases who were diagnosed prior to July 31, 2020, we used logistic regression to examine sociodemographic and symptom severity predictors of care-seeking behaviors. The analyses examined three different outcomes: (1) whether respondents sought care and, among those who sought care, whether they sought care from (2) a primary care provider or (3) an emergency room. Final models were adjusted for sex, age, race and ethnicity, income, education, marital status, living arrangement, health insurance, and self-reported symptom severity. RESULTS We found that participants ages 65 and older had 4.00 times higher odds of seeking care than 18-34-year-olds (95% CI: 2.21, 7.24), while adults reporting very severe symptoms had roughly 15 times higher odds of seeking care than those with mild symptoms (95% CI: 7.73, 27.01). Adults who were non-Hispanic Black or were uninsured had lower odds of seeking care from a primary care physician versus seeking care from other locations in comparison to adults who were non-Hispanic White or were privately insured, respectively (non-Hispanic Black: aOR = 0.27, 95% CI: 0.16, 0.44; Uninsured: aOR = 0.19, 95% CI: 0.09, 0.42). Conversely, adults who were older or reported more severe symptoms had higher odds of seeking care from an emergency room versus other locations in comparison to adults who were younger or reported less severe symptoms (Age 65+: aOR = 2.96, 95% CI: 1.40, 6.28; Very Severe Symptoms: aOR = 6.63, 95% CI: 3.33, 13.20). CONCLUSIONS Our results suggest differential utilization of healthcare services early in the COVID-19 pandemic. Further analyses are needed to examine the reasons for these differences.
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Affiliation(s)
| | - Elizabeth J King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jana L Hirschtick
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Andrea R Titus
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Laura E Power
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Michael R Elliott
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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3
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Rogers JH, Hawes SE, Wolf CR, Hughes JP, Englund JA, Starita LM, Chu HY. Care-seeking correlates of acute respiratory illness among sheltered adults experiencing homelessness in Seattle, WA, 2019: a community-based cross-sectional study. Front Public Health 2023; 11:1090148. [PMID: 37408748 PMCID: PMC10319010 DOI: 10.3389/fpubh.2023.1090148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Multifarious barriers to accessing healthcare services among people experiencing homelessness (PEH) lead to delays in seeking care for acute infections, including those caused by respiratory viruses. PEH are at high risk of acute respiratory illness (ARI)-related complications, especially in shelter settings that may facilitate virus spread, yet data characterizing healthcare utilization for ARI episodes among sheltered PEH remained limited. Methods We conducted a cross-sectional study of viral respiratory infection among adult residents at two homeless shelters in Seattle, Washington between January and May 2019. We assessed factors associated with seeking medical care for ARI via self-report. We collected illness questionnaires and nasal swabs were tested for respiratory viruses by reverse transcription quantitative real-time PCR (RT-qPCR). Results We observed 825 encounters from 649 unique participants; 241 (29.2%) encounters reported seeking healthcare for their ARI episode. Seasonal influenza vaccine receipt (adjusted prevalence ratio [aPR] 1.39, 95% CI 1.02-1.88), having health insurance (aPR 2.77, 95% CI 1.27-6.02), chronic lung conditions (aPR 1.55, 95% CI 1.12-2.15), and experiencing influenza-like-illness symptoms (aPR 1.63, 95% CI 1.20 - 2.20) were associated with increased likelihood of seeking care. Smoking (aPR 0.65, 95% CI 0.45-0.92) was associated with decreased likelihood of seeking care. Discussion Findings suggest that care seeking for viral respiratory illness among PEH may be supported by prior engagement with primary healthcare services. Strategies to increase healthcare utilization may lead to earlier detection of respiratory viruses.
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Affiliation(s)
- Julia H. Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
| | - James P. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children’s Research Institute, University of Washington, Seattle, WA, United States
| | - Lea M. Starita
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
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4
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Prabhu N, Alonazi MA, Algarni HA, Issrani R, Alanazi SH, Alruwaili MK, Alanazi GR, Iqbal A, Khattak O. Knowledge, Attitude and Practice towards the COVID-19 Pandemic: A Cross-Sectional Survey Study among the General Public in the Kingdom of Saudi Arabia. Vaccines (Basel) 2022; 10:vaccines10111945. [PMID: 36423040 PMCID: PMC9695995 DOI: 10.3390/vaccines10111945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background: The novel coronavirus disease 2019 (COVID-19) is an infectious disease that has been spreading worldwide in an unprecedented manner. The knowledge, attitude and practices of the general population play a vital role in prevention of COVID-19. Objectives: The present study aimed to assess the COVID-19-related knowledge, attitudes and practices of the general public of Sakaka, Saudi Arabia, to identify which populations show low levels of knowledge, attitudes and practices towards COVID-19, making them highly likely to remain vulnerable during the pandemic. Methodology: For this study, a nineteen-item closed-ended questionnaire was hand delivered to the general public, including patients and other hospital attendees attending the Outpatient Department of the College of Dentistry, Jouf University, Saudi Arabia. The research questions focused on the demographic information, knowledge, attitude and practices related to COVID-19. Data analysis is presented through tables and descriptive methods. Results: A total of 722 participants took part in the survey questionnaire. The majority of the respondents belonged to the age group of 28–37 years (n = 320; 44.3%), with female participants (n = 419; 58.0%) outnumbering the male participants (n = 303; 42.0%). Most of the respondents had good knowledge, attitudes and practices towards COVID-19. Patients aged 28–37 years (p = 0.000) with a master’s degree (p = 0.011) and government employees (p = 0.000) had significantly better knowledge than their counterparts. Significantly optimistic attitudes were noticed in participants aged 28–37 years (p = 0.000) with a master’s degree (p = 0.000), the married (p = 0.047) and government employees (p = 0.000). Government employees (p = 0.014) had significantly better practices. Conclusions: Overall, the participants of this study had good COVID-19-related knowledge, attitudes and practices. These findings would be useful in motivating the general population to follow the precautionary measures that will aid in prevention of COVID-19. Furthermore, the findings may help policymakers identify the target populations, especially the less educated and older adults, for COVID-19 prevention and health education.
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Affiliation(s)
- Namdeo Prabhu
- Department of Oral & Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
- Correspondence: (N.P.); (R.I.)
| | - Meshal Aber Alonazi
- Department of Conservative Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
| | - Hmoud Ali Algarni
- Department of Conservative Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
| | - Rakhi Issrani
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
- Correspondence: (N.P.); (R.I.)
| | - Sarah Hatab Alanazi
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
| | - Mohammed Katib Alruwaili
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
- Department of Periodontology and Endodontology, Faculty of Dental Medicine, Hokkaido University, N13W7, Kita-ku, Sapporo 060-8586, Hokkaido, Japan
| | - Gharam Radhi Alanazi
- Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
| | - Azhar Iqbal
- Department of Conservative Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
- Department of Operative Dentistry & Endodontics, Frontier Medical and Dental College, Abbottabad 22010, Pakistan
| | - Osama Khattak
- Department of Conservative Dentistry, College of Dentistry, Jouf University, Sakaka 72388, Saudi Arabia
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Feasibility of an Antiracism Curriculum in an Academic Pulmonary, Critical Care, and Sleep Medicine Division. ATS Sch 2022; 3:433-448. [PMID: 36312797 PMCID: PMC9590586 DOI: 10.34197/ats-scholar.2022-0015oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Objective Methods Results Conclusion
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Zipfel CM, Colizza V, Bansal S. Health inequities in influenza transmission and surveillance. PLoS Comput Biol 2021; 17:e1008642. [PMID: 33705381 PMCID: PMC7951825 DOI: 10.1371/journal.pcbi.1008642] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/18/2020] [Indexed: 12/21/2022] Open
Abstract
The lower an individual's socioeconomic position, the higher their risk of poor health in low-, middle-, and high-income settings alike. As health inequities grow, it is imperative that we develop an empirically-driven mechanistic understanding of the determinants of health disparities, and capture disease burden in at-risk populations to prevent exacerbation of disparities. Past work has been limited in data or scope and has thus fallen short of generalizable insights. Here, we integrate empirical data from observational studies and large-scale healthcare data with models to characterize the dynamics and spatial heterogeneity of health disparities in an infectious disease case study: influenza. We find that variation in social and healthcare-based determinants exacerbates influenza epidemics, and that low socioeconomic status (SES) individuals disproportionately bear the burden of infection. We also identify geographical hotspots of influenza burden in low SES populations, much of which is overlooked in traditional influenza surveillance, and find that these differences are most predicted by variation in susceptibility and access to sickness absenteeism. Our results highlight that the effect of overlapping factors is synergistic and that reducing this intersectionality can significantly reduce inequities. Additionally, health disparities are expressed geographically, and targeting public health efforts spatially may be an efficient use of resources to abate inequities. The association between health and socioeconomic prosperity has a long history in the epidemiological literature; addressing health inequities in respiratory-transmitted infectious disease burden is an important step towards social justice in public health, and ignoring them promises to pose a serious threat.
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Affiliation(s)
- Casey M. Zipfel
- Department of Biology, Georgetown University, Washington DC, United States of America
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, F75012 Paris, France
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington DC, United States of America
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Lee M, Kang BA, You M. Knowledge, attitudes, and practices (KAP) toward COVID-19: a cross-sectional study in South Korea. BMC Public Health 2021; 21:295. [PMID: 33546644 PMCID: PMC7863060 DOI: 10.1186/s12889-021-10285-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The public must routinely practice precautionary behaviors to control the spread of COVID-19, as no vaccines and antiviral treatments are currently available. This paper examines the public's knowledge, attitudes, and practices (KAP) related to COVID-19 and their relationships and identified the pandemic's vulnerable populations to provide recommendations for behavioral interventions and policies. METHODS Data collection took place over 3 days (June 26-29) via an online survey 5 months after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first COVID case in South Korea; 970 subjects were included in the statistical data analysis. RESULTS Knowledge directly affected both attitudes (e.g., perceived risk and efficacy belief) and practices (e.g., personal hygiene practices and social distancing). Among the influencing factors of COVID-19 preventive behaviors, efficacy belief was the most influential and significant practice factor. It mediated the relationship between knowledge and all three preventive behaviors (wearing facial masks, practicing hand hygiene, and avoiding crowded places). The level of knowledge varied by sociodemographic characteristics. Females (β = 0.06, p < 0.05) and individuals with higher levels of education (β = 0.06, p < 0.05) demonstrated higher levels of knowledge. CONCLUSION To increase precautionary behaviors among the public, health officials and policymakers must promote knowledge and efficacy belief. Future interventions and policies should also be developed in a 'person-centered' approach, targeting vulnerable subgroups, embracing them, and closing the gap of KAP toward COVID-19.
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Affiliation(s)
- Minjung Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.,Office of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Bee-Ah Kang
- Department of Communication, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Myoungsoon You
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea. .,Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
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8
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Uddin S, Imam T, Khushi M, Khan A, Ali M. How did socio-demographic status and personal attributes influence compliance to COVID-19 preventive behaviours during the early outbreak in Japan? Lessons for pandemic management. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021; 175:110692. [PMID: 33526954 PMCID: PMC7839830 DOI: 10.1016/j.paid.2021.110692] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/23/2020] [Accepted: 01/22/2021] [Indexed: 12/27/2022]
Abstract
This study focuses on how socio-demographic status and personal attributes influence self-protective behaviours during a pandemic, with protection behaviours being assessed through three perspectives – social distancing, personal protection behaviour and social responsibility awareness. The research considers a publicly available and recently collected dataset on Japanese citizens during the COVID-19 early outbreak and utilises a data analysis framework combining Classification and Regression Tree (CART), a data mining approach, and regression analysis to gain deep insights. The analysis reveals Socio-demographic attributes – sex, marital family status and having children – as having played an influential role in Japanese citizens' abiding by the COVID-19 protection behaviours. Especially women with children are noted as more conscious than their male counterparts. Work status also appears to have some impact concerning social distancing. Trust in government also appears as a significant factor. The analysis further identifies smoking behaviour as a factor characterising subjective prevention actions with non-smokers or less-frequent smokers being more compliant to the protection behaviours. Overall, the findings imply the need of public policy campaigning to account for variations in protection behaviour due to socio-demographic and personal attributes during pandemics and national emergencies.
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Affiliation(s)
- Shahadat Uddin
- School of Project Management, Faculty of Engineering, The University of Sydney, Room 5050, ABS Building, Darlington, NSW 2008, Australia
| | - Tasadduq Imam
- School of Business and Law, CQUniversity (Melbourne), VIC 3000, L4, 120 Spencer Street, Melbourne, VIC 3000, Australia
| | - Matloob Khushi
- School of Computer Science, J12, Computer Science Building, The University of Sydney, Australia
| | - Arif Khan
- Faculty of Engineering, J12, Computer Science Building, The University of Sydney, Australia
| | - Mohammad Ali
- WHO Collaborating Centre on eHealth, School of Public Health and Community Medicine, Faculty of Medicine, The University of New South wales, Sydney, NSW 2052, Australia.,WHO Collaborating Centre on eHealth, UNSW Digital Health, School of Public Health and Community Medicine, Faculty of Medicine, UNSW, Sydney, Australia
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Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health 2020; 74:964-968. [PMID: 32535550 PMCID: PMC7298201 DOI: 10.1136/jech-2020-214401] [Citation(s) in RCA: 632] [Impact Index Per Article: 158.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022]
Abstract
This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemicpandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.
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Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
| | - Ryan Riordan
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - John Ford
- School of Clinical Medicine, Cambridge University, Cambridge, UK
| | - Fiona Matthews
- Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK
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10
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Abstract
Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are nonspecific. The advent of polymerase chain reaction testing has enormously facilitated the identification of respiratory viruses, which has important implications for infection control measures and treatment. Currently, treatment options for patients with viral infection are limited, but there is ongoing research on the development and clinical testing of new treatment regimens and strategies.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Disorders, University of Louisville, 550 South Jackson Street, ACB, A3R27, Louisville, KY 40202, USA.
| | - Julio A Ramirez
- Division of Infectious Diseases, University of Louisville, Med Center One, 501 E. Broadway Suite 100, Louisville, KY 40202, USA
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Schwarze J, Openshaw P, Jha A, Giacco SR, Firinu D, Tsilochristou O, Roberts G, Selby A, Akdis C, Agache I, Custovic A, Heffler E, Pinna G, Khaitov M, Nikonova A, Papadopoulos N, Akhlaq A, Nurmatov U, Renz H, Sheikh A, Skevaki C. Influenza burden, prevention, and treatment in asthma-A scoping review by the EAACI Influenza in asthma task force. Allergy 2018; 73:1151-1181. [PMID: 29105786 DOI: 10.1111/all.13333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma. The strongest evidence of an association was seen in studies of children. Countries in the European Union currently recommend influenza vaccination of adults with asthma; however, coverage varied between regions. Coverage was lower among children with asthma. Limited data suggest that good seroprotection and seroconversion can be achieved in both children and adults with asthma and that vaccination confers a degree of protection against influenza illness and asthma-related morbidity to children with asthma. There were insufficient data to determine efficacy in adults. Overall, influenza vaccines appeared to be safe for people with asthma. We identify knowledge gaps and make recommendations on future research needs in relation to influenza in patients with asthma.
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Affiliation(s)
- J. Schwarze
- Centre for Inflammation Research The Queens Medical Research Institute University of Edinburgh Edinburgh UK
| | - P. Openshaw
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - A. Jha
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - S. R. Giacco
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | - D. Firinu
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | | | - G. Roberts
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - A. Selby
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | - I. Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - A. Custovic
- Department of Paediatrics Imperial College London London UK
| | - E. Heffler
- Personalized Medicine Asthma and Allergy Clinic Department of Biomedical Sciences Humanitas University Milan Italy
| | - G. Pinna
- Department of Medical Microbiology National Kapodistrian University of Athens Athens Greece
| | - M. Khaitov
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - A. Nikonova
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - N. Papadopoulos
- Division of Infection, Inflammation & Respiratory Medicine The University of Manchester Manchester UK
- Allergy Department 2nd Paediatric Clinic National Kapodistrian University of Athens Athens Greece
| | - A. Akhlaq
- Department of Health and Hospital Management Institute of Business Management Korangi Creek Karachi 75190 Pakistan
| | - U. Nurmatov
- Division of Population Medicine School of Medicine Cardiff University the National Centre for Population Health and Wellbeing Research Wales UK
| | - H. Renz
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
| | - A. Sheikh
- Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - C. Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
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Lee EC, Arab A, Goldlust SM, Viboud C, Grenfell BT, Bansal S. Deploying digital health data to optimize influenza surveillance at national and local scales. PLoS Comput Biol 2018. [PMID: 29513661 PMCID: PMC5858836 DOI: 10.1371/journal.pcbi.1006020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The surveillance of influenza activity is critical to early detection of epidemics and pandemics and the design of disease control strategies. Case reporting through a voluntary network of sentinel physicians is a commonly used method of passive surveillance for monitoring rates of influenza-like illness (ILI) worldwide. Despite its ubiquity, little attention has been given to the processes underlying the observation, collection, and spatial aggregation of sentinel surveillance data, and its subsequent effects on epidemiological understanding. We harnessed the high specificity of diagnosis codes in medical claims from a database that represented 2.5 billion visits from upwards of 120,000 United States healthcare providers each year. Among influenza seasons from 2002-2009 and the 2009 pandemic, we simulated limitations of sentinel surveillance systems such as low coverage and coarse spatial resolution, and performed Bayesian inference to probe the robustness of ecological inference and spatial prediction of disease burden. Our models suggest that a number of socio-environmental factors, in addition to local population interactions, state-specific health policies, as well as sampling effort may be responsible for the spatial patterns in U.S. sentinel ILI surveillance. In addition, we find that biases related to spatial aggregation were accentuated among areas with more heterogeneous disease risk, and sentinel systems designed with fixed reporting locations across seasons provided robust inference and prediction. With the growing availability of health-associated big data worldwide, our results suggest mechanisms for optimizing digital data streams to complement traditional surveillance in developed settings and enhance surveillance opportunities in developing countries. Influenza contributes substantially to global morbidity and mortality each year, and epidemiological surveillance for influenza is typically conducted by sentinel physicians and health care providers recruited to report cases of influenza-like illness. While population coverage and representativeness, and geographic distribution are considered during sentinel provider recruitment, systems cannot always achieve these standards due to the administrative burdens of data collection. We present spatial estimates of influenza disease burden across United States counties by leveraging the volume and fine spatial resolution of medical claims data, and existing socio-environmental hypotheses about the determinants of influenza disease disease burden. Using medical claims as a testbed, this study adds to literature on the optimization of surveillance system design by considering conditions of limited reporting and spatial aggregation. We highlight the importance of considering sampling biases and reporting locations when interpreting surveillance data, and suggest that local mobility and regional policies may be critical to understanding the spatial distribution of reported influenza-like illness.
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Affiliation(s)
- Elizabeth C. Lee
- Department of Biology, Georgetown University, Washington, DC, United States of America
- * E-mail: (ECL); (SB)
| | - Ali Arab
- Department of Mathematics & Statistics, Georgetown University, Washington, DC, United States of America
| | - Sandra M. Goldlust
- Department of Biology, Georgetown University, Washington, DC, United States of America
| | - Cécile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bryan T. Grenfell
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Department of Ecology & Evolutionary Biology and Woodrow Wilson School, Princeton University, Princeton, New Jersey, United States of America
| | - Shweta Bansal
- Department of Biology, Georgetown University, Washington, DC, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail: (ECL); (SB)
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Healthcare-seeking behaviour in case of influenza-like illness in the French general population and factors associated with a GP consultation: an observational prospective study. BJGP Open 2017; 1:bjgpopen17X101253. [PMID: 30564694 PMCID: PMC6181105 DOI: 10.3399/bjgpopen17x101253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 05/04/2017] [Indexed: 10/31/2022] Open
Abstract
Background GP consultation rates for influenza-like illness (ILI) are poorly known in France and there is a paucity of literature on this topic. In the few articles that have been published, the results are heterogeneous. Aim The aim of the present study was to estimate the proportion of ILI inducing a GP consultation, and to assess its determinants. Design & setting Participants of a French web-based cohort study who reported ≥1 ILI episode between 2012 and 2015 were included. Sociodemographic characteristics, access to health care, and health status variables were collected. Method Healthcare-seeking behaviour was analysed and factors associated with a GP consultation identified using a conditional logistic regression. Results Of the 6023 ILI episodes reported, 1961 (32.6%) led to a GP consultation, with no difference between those at risk of influenza complications and those not (P = 0.42). A GP consultation was more frequent for individuals living in a rural area (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02 to 1.43); those with a lower educational level (OR = 1.43, 95% CI = 1.18 to 1.74); those using the internet to find information about influenza (OR = 1.63, 95% CI = 1.30 to 2.03); patients presenting with worrying symptoms (fever, cough, dyspnoea, sputum, or asthenia); patients having a negative perception of their own health status (OR = 1.51, 95% CI = 1.07 to 2.13; and those having declared a personal doctor (OR = 2.86, 95% CI = 1.72 to 4.76). A GP consultation was less frequent for individuals using alternative medicine (OR = 0.68, 95% CI = 0.58 to 0.78). Conclusion This study allows the identification of specific factors associated with GP consultation for an ILI episode. These findings may help to coordinate health information campaigns and to raise awareness, especially among individuals at risk of influenza complications.
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Peppa M, John Edmunds W, Funk S. Disease severity determines health-seeking behaviour amongst individuals with influenza-like illness in an internet-based cohort. BMC Infect Dis 2017; 17:238. [PMID: 28359335 PMCID: PMC5374571 DOI: 10.1186/s12879-017-2337-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background Seasonal influenza epidemics place considerable strain on health services. Robust systems of surveillance are therefore required to ensure preparedness. Sentinel surveillance does not accurately capture the community burden of epidemics as it misses cases that do not present to health services. In this study, Flusurvey (an internet-based community surveillance tool) was used to examine how severity of disease influences health-seeking behaviour in the UK. Methods Logistic regression with random effects was used to investigate the association between health-seeking and symptom severity, duration of illness and reduction in self-reported health-score over four flu seasons between 2011 and 2015. Results The majority of individuals did not seek care. In general, there was very strong evidence for an association between all severity indicators and visiting a health service (p < 0.0001). Being female (OR 1.62, 95% CI 1.23–2.14, p = 0.0003) and a self-diagnosis of the flu (OR 3.39, 95% CI 2.38–4.83, p < 0.0001) were also associated with increased likelihood of visiting a health service. During the 2012–13 and 2014–15 flu seasons, there was a significantly larger proportion of individuals with more severe sets of symptoms and a longer duration of illness. Despite this, the proportion of individuals with particular sets of symptoms visiting a health service showed only very slight variation across years. Conclusions Traditional surveillance systems capture only the more severe episodes of illness. However, in spite of variation in flu activity, the proportion of individuals visiting a health service remains relatively stable within specific sets of symptoms across years. These data could be used in combination with data on consultation rates to provide better estimates of community burden. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2337-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Peppa
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - W John Edmunds
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sebastian Funk
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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15
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Russell ES, Zheteyeva Y, Gao H, Shi J, Rainey JJ, Thoroughman D, Uzicanin A. Reactive School Closure During Increased Influenza-Like Illness (ILI) Activity in Western Kentucky, 2013: A Field Evaluation of Effect on ILI Incidence and Economic and Social Consequences for Families. Open Forum Infect Dis 2016; 3:ofw113. [PMID: 27800520 PMCID: PMC5084722 DOI: 10.1093/ofid/ofw113] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022] Open
Abstract
A reactive school closure following high influenza-like illness-related student absenteeism in a Kentucky school district did not influence reported influenza-like illness transmission in student households. Background. School closures are an important mitigation strategy during influenza pandemic: if implemented early in a local outbreak, they can slow the disease spread in the surrounding community. During seasonal influenza epidemics, school closures may occur reactively, after the disease is already widespread in the community. Such reactive closures are often too late to reduce influenza transmission. However, they can provide data to determine under which circumstances they might be effective in reducing influenza-like illness (ILI) transmission. Methods. We conducted a household survey in a school district in Kentucky. District A closed after high student absenteeism due to influenza-like illness (ILI), whereas adjacent Districts B and C remained open. We collected data on self-reported ILI among household members in these 3 districts 2 weeks before the District A closure, during closure, and 2 weeks after reopening, and we evaluated economic and social consequences of school closure on student households in District A. The difference-in-differences method was applied to compare changes in ILI rates from before to after closure between districts. Results. Estimated average daily ILI rate decreased less in District A than in District B or C for the entire sample and when stratified by age groups (0–5 years old, 6–18 years old, and above 18 years old). Twenty-five percent of District A households reported ≥1 closure-related economic or social difficulty. Conclusions. Closing schools after a widespread ILI activity in District A did not reduce ILI transmission but caused difficulties for some households.
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Affiliation(s)
- Elizabeth S Russell
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort; Epidemic Intelligence Service Officer
| | | | | | | | | | - Douglas Thoroughman
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Jones RM, Xia Y. Occupational exposures to influenza among healthcare workers in the United States. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2016; 13:213-222. [PMID: 26556672 DOI: 10.1080/15459624.2015.1096363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this study is to estimate the annual number of occupational exposures to influenza among healthcare workers that result from providing direct and supportive care to influenza patients in acute care, home care and long-term care settings. Literature review was used to identify healthcare utilization for influenza, and worker activity patterns. This information was used, with Monte Carlo simulation, to tabulate the mean annual number of occupational exposures. Given a medium-sized epidemic with a 6% annual symptomatic influenza incidence proportion, the mean number of occupational exposures was estimated to be 81.8 million annually. Among the approximately 14 million healthcare workers, this corresponds to 5.8 exposures per worker annually, on average. Exposures, however, are likely concentrated among subsets of healthcare workers. Occupational exposures were most numerous in ambulatory care settings (38%), followed by long-term care facilities (30%) and home care settings (21%). The annual number of occupational exposures to influenza is high, but not every occupational exposure will result in infection. Some infection control activities, like patient isolation, can reduce the number of occupational exposures.
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Affiliation(s)
- Rachael M Jones
- a Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago , Chicago , Illinois
| | - Yulin Xia
- a Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago , Chicago , Illinois
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17
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Evans CT, Rogers TJ, Goldstein B, Weaver FM, LaVela SL. Influenza antiviral treatment in spinal cord injury patients, 2007-2010. J Spinal Cord Med 2015; 38:48-56. [PMID: 24961594 PMCID: PMC4293533 DOI: 10.1179/2045772314y.0000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE This study assessed antiviral medication use for treatment of influenza-like illness (ILI) in Veterans with spinal cord injury or disorder (SCI/D) and examined whether antiviral prescribing improved over time. DESIGN Retrospective cohort study of Department of Veterans Affairs (VA) facilities. PARTICIPANTS Veterans with SCI/D and matched non-SCI/D controls (matched by facility and date of visit/admission) who were diagnosed by a clinician with ILI during the period 1 October 2007 to 31 May 2010. MAIN OUTCOME MEASURES Antiviral receipt and appropriateness were examined. Appropriate antiviral prescribing was defined as patients who received an antiviral medication within 2 days of collection of a sample for diagnostic testing or within 2 days of symptom onset. RESULTS We identified 101 influenza visits/admissions for veterans with SCI/D and 123 for controls. Antiviral prescribing for Veterans with SCI/D increased from 37.1% in 2007/2008 to 67.6% in 2009/2010 (P = 0.01) and appropriate antiviral prescribing increased from 20.0 to 41.2% (P = 0.05). Predictors of antiviral prescribing included being treated in the 2009/2010 influenza season (vs. 2007/2008) and having a cough. Fever, aches/myalgia, or a positive influenza test was associated with appropriate antiviral treatment. SCI/D was an independent predictor of receiving antiviral treatment (adjusted odds ratio = 1.16, 95% confidence interval 1.04-1.29), but having SCI/D was not associated with receiving appropriate treatment. CONCLUSIONS Influenza antiviral prescribing increased over time and in a larger proportion in veterans with SCI/D (vs. controls). This suggests that providers treating patients with SCI/D recognize treatment guidelines and their importance in a high-risk population. Continued efforts are needed to improve appropriate influenza antiviral prescribing.
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Affiliation(s)
- Charlesnika T. Evans
- Correspondence to: Charlesnika T. Evans, Edward J. Hines, Jr. VA Hospital (151H), 5th and Roosevelt Road, PO Box 5000, Room D302, Hines, IL 60141, USA.
| | - Thea J. Rogers
- Department of Veterans Affairs (VA), Center of Innovation for Complex Chronic Healthcare (CINCCH) and Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA
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Adler AJ, Eames KTD, Funk S, Edmunds WJ. Incidence and risk factors for influenza-like-illness in the UK: online surveillance using Flusurvey. BMC Infect Dis 2014; 14:232. [PMID: 24885043 PMCID: PMC4025540 DOI: 10.1186/1471-2334-14-232] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 04/04/2014] [Indexed: 11/20/2022] Open
Abstract
Background Influenza and Influenza-like-illness (ILI) represents a substantial public health problem, but it is difficult to measure the overall burden as many cases do not access health care. Community cohorts have the advantage of not requiring individuals to present at hospitals and surgeries and therefore can potentially monitor a wider variety of cases. This study reports on the incidence and risk factors for ILI in the UK as measured using Flusurvey, an internet-based open community cohort. Methods Upon initial online registration participants were asked background characteristics, and every week were asked to complete a symptoms survey. We compared the representativeness of our sample to the overall population. We used two case definitions of ILI, which differed in whether fever/chills was essential. We calculated ILI incidence week by week throughout the season, and investigated risk factors associated with ever reporting ILI over the course of the season. Risk factor analysis was conducted using binomial regression. Results 5943 participants joined the survey, and 4532 completed the symptoms survey at least twice. Participants who filled in symptoms surveys at least twice filled in a median of nine symptoms surveys over the course of the study. 46.1% of participants reported at least one episode of ILI, and 6.0% of all reports were positive for ILI. Females had slightly higher incidence, and individuals over 65 had the lowest incidence. Incidence peaked just before Christmas and declined dramatically during school holidays. Multivariate regression showed that, for both definitions of ILI considered, being female, unvaccinated, having underlying health issues, having contact with children, being aged between 35 and 64, and being a smoker were associated with the highest risk of reporting an ILI. The use of public transport was not associated with an increased risk of ILI. Conclusions Our results show that internet based surveillance can be used to measure ILI and understand risk factors. Vaccination is shown to be linked to a reduced risk of reporting ILI. Taking public transport does not increase the risk of reporting ILI. Flusurvey and other participatory surveillance techniques can be used to provide reliable information to policy makers in nearly real-time.
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Affiliation(s)
- Alma J Adler
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
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Lindegren ML, Schaffner W. Treatment with neuraminidase inhibitors for high-risk patients with influenza: why is adherence to antiviral treatment recommendations so low? J Infect Dis 2014; 210:510-3. [PMID: 24731958 DOI: 10.1093/infdis/jiu227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Biggerstaff M, Jhung MA, Reed C, Fry AM, Balluz L, Finelli L. Influenza-like illness, the time to seek healthcare, and influenza antiviral receipt during the 2010-2011 influenza season-United States. J Infect Dis 2014; 210:535-44. [PMID: 24731959 DOI: 10.1093/infdis/jiu224] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Few data exist describing healthcare-seeking behaviors among persons with influenza-like illness (ILI) or adherence to influenza antiviral treatment recommendations. METHODS We analyzed adult responses to the Behavioral Risk Factor Surveillance System in 31 states and the District of Columbia (DC) and pediatric responses in 25 states and DC for January-April 2011 by demographics and underlying health conditions. RESULTS Among 75 088 adult and 15 649 child respondents, 8.9% and 33.9%, respectively, reported ILI. ILI was more frequent among adults with asthma (16%), chronic obstruction pulmonary disease (COPD; 26%), diabetes (12%), heart disease (19%), kidney disease (16%), or obesity (11%). Forty-five percent of adults and 57% of children sought healthcare for ILI. Thirty-five percent of adults sought care ≤ 2 days after ILI onset. Seeking care ≤ 2 days was more frequent among adults with COPD (48%) or heart disease (55%). Among adults with a self-reported physician diagnosis of influenza, 34% received treatment with antiviral medications. The only underlying health condition with a higher rate of treatment was diabetes (46%). CONCLUSIONS Adults with underlying health conditions were more likely to report ILI, but the majority did not seek care promptly, missing opportunities for early influenza antiviral treatment.
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Affiliation(s)
- Matthew Biggerstaff
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Disease
| | - Michael A Jhung
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Disease
| | - Carrie Reed
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Disease
| | - Alicia M Fry
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Disease
| | - Lina Balluz
- Division of Behavioral Surveillance, Public Health Surveillance and Informatics Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyn Finelli
- Epidemiology and Prevention Branch, Influenza Division, National Center for Immunization and Respiratory Disease
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