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Leis AM, McSpadden E, Segaloff HE, Lauring AS, Cheng C, Petrie JG, Lamerato LE, Patel M, Flannery B, Ferdinands J, Karvonen-Gutierrez CA, Monto A, Martin ET. K-medoids clustering of hospital admission characteristics to classify severity of influenza virus infection. Influenza Other Respir Viruses 2023; 17:e13120. [PMID: 36909298 PMCID: PMC9992770 DOI: 10.1111/irv.13120] [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: 12/08/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
Background Patients are admitted to the hospital for respiratory illness at different stages of their disease course. It is important to appropriately analyse this heterogeneity in surveillance data to accurately measure disease severity among those hospitalized. The purpose of this study was to determine if unique baseline clusters of influenza patients exist and to examine the association between cluster membership and in-hospital outcomes. Methods Patients hospitalized with influenza at two hospitals in Southeast Michigan during the 2017/2018 (n = 242) and 2018/2019 (n = 115) influenza seasons were included. Physiologic and laboratory variables were collected for the first 24 h of the hospital stay. K-medoids clustering was used to determine groups of individuals based on these values. Multivariable linear regression or Firth's logistic regression were used to examine the association between cluster membership and clinical outcomes. Results Three clusters were selected for 2017/2018, mainly differentiated by blood glucose level. After adjustment, those in C171 had 5.6 times the odds of mechanical ventilator use than those in C172 (95% CI: 1.49, 21.1) and a significantly longer mean hospital length of stay than those in both C172 (mean 1.5 days longer, 95% CI: 0.2, 2.7) and C173 (mean 1.4 days longer, 95% CI: 0.3, 2.5). Similar results were seen between the two clusters selected for 2018/2019. Conclusion In this study of hospitalized influenza patients, we show that distinct clusters with higher disease acuity can be identified and could be targeted for evaluations of vaccine and influenza antiviral effectiveness against disease attenuation. The association of higher disease acuity with glucose level merits evaluation.
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Affiliation(s)
- Aleda M Leis
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor Michigan USA
| | - Erin McSpadden
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor Michigan USA
| | - Hannah E Segaloff
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor Michigan USA.,Epidemic Intelligence Service CDC Atlanta Georgia USA.,Wisconsin Department of Health Services Madison Wisconsin USA
| | - Adam S Lauring
- Departments of Internal Medicine and Microbiology and Immunology University of Michigan Ann Arbor Michigan USA
| | - Caroline Cheng
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor Michigan USA
| | - Joshua G Petrie
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor Michigan USA.,Marshfield Clinic Research Institute Marshfield Wisconsin USA
| | - Lois E Lamerato
- Department of Public Health Sciences Henry Ford Health System Detroit Michigan USA
| | - Manish Patel
- Influenza Division Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Brendan Flannery
- Influenza Division Centers for Disease Control and Prevention Atlanta Georgia USA
| | - Jill Ferdinands
- Influenza Division Centers for Disease Control and Prevention Atlanta Georgia USA
| | | | - Arnold Monto
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor Michigan USA
| | - Emily T Martin
- Department of Epidemiology University of Michigan School of Public Health Ann Arbor Michigan USA
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2
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Re-Admission of COVID-19 Patients Hospitalized with Omicron Variant-A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11175202. [PMID: 36079138 PMCID: PMC9457250 DOI: 10.3390/jcm11175202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
In accordance with previous publications, re-admission rates following hospitalization of patients with COVID-19 is 10%. The aim of the current study was to describe the rates and risk factors of hospital re-admissions two months following discharge from hospitalization during the fifth wave due to the dominant Omicron variant. A retrospective cohort study was performed in Rabin Medical Center, Israel, from November 2021 to February 2022. The primary outcome was re-admissions with any diagnosis; the secondary outcome was mortality within two months of discharge. Overall, 660 patients were hospitalized with a diagnosis of COVID-19. Of the 528 patients discharged from a primary hospitalization, 150 (28%) were re-admitted. A total of 164 patients (25%) died throughout the follow-up period. A multi-variable analysis determined that elevated creatinine was associated with a higher risk of re-admissions. Rates of re-admissions after discharge during the Omicron wave were considerably higher compared to previous waves. A discharge plan for surveillance and treatment following hospitalization is of great importance in the management of pandemics.
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Comorbid conditions as risk factors for West Nile neuroinvasive disease in Ontario, Canada: a population-based cohort study. Epidemiol Infect 2022; 150:e103. [PMID: 35543409 PMCID: PMC9171902 DOI: 10.1017/s0950268822000887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
West Nile neuroinvasive disease (WNND) is a severe neurological illness that can result from West Nile virus (WNV) infection, with long-term disability and death being common outcomes. Although WNV arrived in North America over two decades ago, risk factors for WNND are still being explored. The objective of this study was to identify WNND comorbid risk factors in the Ontario population using a retrospective, population-based cohort design. Incident WNV infections from laboratory records between 1 January 2002 – 31 December 2012 were individually-linked to health administrative databases to ascertain WNND outcomes and comorbid risk factors. WNND incidence was compared among individuals with and without comorbidities using risk ratios (RR) calculated with log binomial regression. Three hundred and forty-five individuals developed WNND (18.3%) out of 1884 WNV infections. West Nile encephalitis was driving most associations with comorbidities. Immunocompromised (aRR 2.61 [95% CI 1.23–4.53]) and male sex (aRR 1.32 [95% CI 1.00–1.76]) were risk factors for encephalitis, in addition to age, for which each 1-year increase was associated with a 2% (aRR 1.02 [95% CI 1.02–1.03]) relative increase in risk. Our results suggest that individuals living with comorbidities are at higher risk for WNND, in particular encephalitis, following WNV infection.
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Davido B, Lemarie B, Gault E, Pepin M, Jaffal K, Beaune S, Dahmane L, Dumoulin J, Greffe S, Annane D, De Truchis P. Superinfection is associated with short-term outcome and mortality in viral respiratory tract infections during the fall-winter seasons 2016-2018 in the Greater Paris area: the SUPERFLUOUS study. Int J Infect Dis 2022; 119:217-224. [DOI: 10.1016/j.ijid.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022] Open
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Linhares FMP, Abreu WJCD, Melo PDOC, Mendes RCMG, Silva TAD, Gusmão TLAD, Guedes TG. Effectiveness of educational interventions in knowledge, attitude, and practice for preventing respiratory infections: a systematic review and meta-analysis. Rev Bras Enferm 2022; 75:e20210522. [PMID: 35352787 DOI: 10.1590/0034-7167-2021-0522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/25/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to demonstrate the effectiveness of educational interventions in knowledge, attitude and practice for preventing respiratory infections in adults and older adults. METHODS this is a systematic review carried out in 11 databases. Primary studies, without language and time restrictions, of the randomized, non-randomized and before-and-after clinical trial type, were selected. The risk of bias was assessed by two independent researchers, and the methodological quality was generated by the Grading of Recommendations, Assessment, Development and Evaluation. RESULTS the intervention effectiveness was evidenced in seven studies. The results of the random effects meta-analysis show that there is a statistically significant difference between knowledge about preventing respiratory diseases, with an OR of 2.82 (95%CI 1.70 to 4.69) for the occurrence of events represented by improved knowledge. CONCLUSIONS most studies show the effectiveness of educational interventions, which was determined through the Knowledge, Attitude and Practice survey.
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Aziza E, Slemko J, Zapernick L, Smith SW, Lee N, Sligl WI. Outcomes among critically ill adults with influenza infection. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:269-277. [PMID: 36338460 PMCID: PMC9629264 DOI: 10.3138/jammi-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 06/16/2023]
Abstract
Background Influenza infection is a major cause of mortality in critical care units. Methods ata on critically ill adult patients with influenza infection from 2014 to 2019 were retrospectively collected, including mortality and critical care resource utilization. Independent predictors of mortality were identified using Cox regression. Results ne hundred thirty patients with confirmed influenza infection had a mean age of 56 (SD 16) years; 72 (55%) were male. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) score was 22 (SD 9). One hundred eight (83%) patients had influenza A (46% H1N1pdm09, 33% H3N2); 21 (16%) had influenza B. Fifty-five (42%) patients had bacterial co-infection. Only 5 (4%) had fungal co-infection. One hundred eight (83%) patients required mechanical ventilation; 94 (72%), vasopressor support; 26 (20%), continuous renal replacement therapy (CRRT); and 11 (9%), extracorporeal membrane oxygenation. One hundred twenty one (93%) patients received antiviral therapy (median 5 d). Thirty-day mortality was 23%. Patients who received antiviral treatment were more likely to survive with an adjusted hazard ratio (aHR) of 0.15 (95% CI 0.04 to 0.51, p = 0.003). Other independent predictors of mortality were the need for CRRT (aHR 2.48, 95% CI 1.14 to 5.43, p = 0.023), higher APACHE II score (aHR 1.08, 95% CI 1.02 to 1.14, p = 0.011), and influenza A (aHR 7.10, 95% CI 1.37 to 36.8, p = 0.020) compared with influenza B infection. Conclusions mong critically ill influenza patients, antiviral therapy was independently associated with survival. CRRT, higher severity of illness, and influenza A infection were associated with mortality.
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Affiliation(s)
- Eitan Aziza
- Division of Internal Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jocelyn Slemko
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Zapernick
- Infection Control and Prevention, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Stephanie W Smith
- Infection Control and Prevention, University of Alberta Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nelson Lee
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy I Sligl
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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DeJonge PM, Monto AS, Malosh RE, Petrie JG, Segaloff HE, McSpadden E, Cheng C, Bazzi L, Callear A, Johnson E, Truscon R, Martin ET. Distinct influenza surveillance networks and their agreement in recording regional influenza circulation: Experience from Southeast Michigan. Influenza Other Respir Viruses 2021; 16:521-531. [PMID: 34821476 PMCID: PMC8983886 DOI: 10.1111/irv.12944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/07/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION In Southeast Michigan, active surveillance studies monitor influenza activity in hospitals, ambulatory clinics, and community households. Across five respiratory seasons, we assessed the contribution of data from each of the three networks towards improving our overall understanding of regional influenza circulation. METHODS All three networks used case definitions for acute respiratory illness (ARI) and molecularly tested for influenza from research-collected respiratory specimens. Age- and network-stratified epidemic curves were created for influenza A and B. We compared stratified epidemic curves visually and by centering at seasonal midpoints. RESULTS Across all seasons (from 2014/2015 through 2018/2019), epidemic curves from each of the three networks were comparable in terms of both timing and magnitude. Small discrepancies in epidemics recorded by each network support previous conclusions about broader characteristics of particular influenza seasons. CONCLUSION Influenza surveillance systems based in hospital, ambulatory clinic, and community household settings appear to provide largely similar information regarding regional epidemic activity. Together, multiple levels of influenza surveillance provide a detailed view of regional influenza epidemics, but a single surveillance system-regardless of population subgroup monitored-appears to be sufficient in providing vital information regarding community influenza epidemics.
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Affiliation(s)
- Peter M DeJonge
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Arnold S Monto
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Ryan E Malosh
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Joshua G Petrie
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Hannah E Segaloff
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Erin McSpadden
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Caroline Cheng
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Latifa Bazzi
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Amy Callear
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Emileigh Johnson
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Rachel Truscon
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Emily T Martin
- Michigan Influenza Center, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Chow EJ, Tenforde MW, Rolfes MA, Lee B, Chodisetty S, Ramirez JA, Fry AM, Patel MM. Differentiating severe and non-severe lower respiratory tract illness in patients hospitalized with influenza: Development of the Influenza Disease Evaluation and Assessment of Severity (IDEAS) scale. PLoS One 2021; 16:e0258482. [PMID: 34673782 PMCID: PMC8530291 DOI: 10.1371/journal.pone.0258482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Experimental studies have shown that vaccination can reduce viral replication to attenuate progression of influenza-associated lower respiratory tract illness (LRTI). However, clinical studies are conflicting, possibly due to use of non-specific outcomes reflecting a mix of large and small airway LRTI lacking specificity for acute lung or organ injury. METHODS We developed a global ordinal scale to differentiate large and small airway LRTI in hospitalized adults with influenza using physiologic features and interventions (PFIs): vital signs, laboratory and radiographic findings, and clinical interventions. We reviewed the literature to identify common PFIs across 9 existing scales of pneumonia and sepsis severity. To characterize patients using this scale, we applied the scale to an antiviral clinical trial dataset where these PFIs were measured through routine clinical care in adults hospitalized with influenza-associated LRTI during the 2010-2013 seasons. RESULTS We evaluated 12 clinical parameters among 1020 adults; 210 (21%) had laboratory-confirmed influenza, with a median severity score of 4.5 (interquartile range, 2-8). Among influenza cases, median age was 63 years, 20% were hospitalized in the prior 90 days, 50% had chronic obstructive pulmonary disease, and 22% had congestive heart failure. Primary influencers of higher score included pulmonary infiltrates on imaging (48.1%), heart rate ≥110 beats/minute (41.4%), oxygen saturation <93% (47.6%) and respiratory rate >24 breaths/minute (21.0%). Key PFIs distinguishing patients with severity < or ≥8 (upper quartile) included infiltrates (27.1% vs 90.0%), temperature ≥ 39.1°C or <36.0°C (7.1% vs 27.1%), respiratory rate >24 breaths/minute (7.9% vs 47.1%), heart rate ≥110 beats/minute (29.3% vs 65.7%), oxygen saturation <90% (14.3% vs 31.4%), white blood cell count >15,000 (5.0% vs 27.2%), and need for invasive or non-invasive mechanical ventilation (2.1% vs 15.7%). CONCLUSION We developed a scale in adults hospitalized with influenza-associated LRTI demonstrating a broad distribution of physiologic severity which may be useful for future studies evaluating the disease attenuating effects of influenza vaccination or other therapeutics.
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Affiliation(s)
- Eric J. Chow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa A. Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benjamin Lee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shreya Chodisetty
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julio A. Ramirez
- Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Alicia M. Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Manish M. Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Risk-factors for re-admission and outcome of patients hospitalized with confirmed COVID-19. Sci Rep 2021; 11:17416. [PMID: 34465827 PMCID: PMC8408195 DOI: 10.1038/s41598-021-96716-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
Burden of COVID-19 on Hospitals across the globe is enormous and has clinical and economic implications. In this retrospective study including consecutive adult patients with confirmed SARS-CoV-2 who were admitted between 3/2020 and 30/9/20, we aimed to identify post-discharge outcomes and risk factors for re-admission among COVID-19 hospitalized patients. Mortality and re-admissions were documented for a median post discharge follow up of 59 days (interquartile range 28,161). Univariate and multivariate analyses of risk factors for re-admission were performed. Overall, 618 hospitalized COVID-19 patients were included. Of the 544 patient who were discharged, 10 patients (1.83%) died following discharge and 50 patients (9.2%) were re-admitted. Median time to re-admission was 7 days (interquartile range 3, 24). Oxygen saturation or treatment prior to discharge were not associated with re-admissions. Risk factors for re-admission in multivariate analysis included solid organ transplantation (hazard ratio [HR] 3.37, 95% confidence interval [CI] 2.73–7.5, p = 0.0028) and higher Charlson comorbidity index (HR 1.34, 95% CI 1.23–1.46, p < 0.0001). Mean age of post discharge mortality cases was 85.0 (SD 9.98), 80% of them had cognitive decline or needed help in ADL at baseline. In conclusion, re-admission rates of hospitalized COVID-19 are fairly moderate. Predictors of re-admission are non-modifiable, including baseline comorbidities, rather than COVID-19 severity or treatment.
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Tenforde MW, Chung J, Smith ER, Talbot HK, Trabue CH, Zimmerman RK, Silveira FP, Gaglani M, Murthy K, Monto AS, Martin ET, McLean HQ, Belongia EA, Jackson LA, Jackson ML, Ferdinands JM, Flannery B, Patel MM. Influenza Vaccine Effectiveness in Inpatient and Outpatient Settings in the United States, 2015-2018. Clin Infect Dis 2021; 73:386-392. [PMID: 32270198 DOI: 10.1093/cid/ciaa407] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Demonstration of influenza vaccine effectiveness (VE) against hospitalized illness in addition to milder outpatient illness may strengthen vaccination messaging. Our objective was to compare patient characteristics and VE between United States (US) inpatient and outpatient VE networks. METHODS We tested adults with acute respiratory illness (ARI) for influenza within 1 outpatient-based and 1 hospital-based VE network from 2015 through 2018. We compared age, sex, and high-risk conditions. The test-negative design was used to compare vaccination odds in influenza-positive cases vs influenza-negative controls. We estimated VE using logistic regression adjusting for site, age, sex, race/ethnicity, peak influenza activity, time to testing from, season (overall VE), and underlying conditions. VE differences (ΔVE) were assessed with 95% confidence intervals (CIs) determined through bootstrapping with significance defined as excluding the null. RESULTS The networks enrolled 14 573 (4144 influenza-positive) outpatients and 6769 (1452 influenza-positive) inpatients. Inpatients were older (median, 62 years vs 49 years) and had more high-risk conditions (median, 4 vs 1). Overall VE across seasons was 31% (95% CI, 26%-37%) among outpatients and 36% (95% CI, 27%-44%) among inpatients. Strain-specific VE (95% CI) among outpatients vs inpatients was 37% (25%-47%) vs 53% (37%-64%) against H1N1pdm09; 19% (9%-27%) vs 23% (8%-35%) against H3N2; and 46% (38%-53%) vs 46% (31%-58%) against B viruses. ΔVE was not significant for any comparison across all sites. CONCLUSIONS Inpatients and outpatients with ARI represent distinct populations. Despite comparatively poor health among inpatients, influenza vaccination was effective in preventing influenza-associated hospitalizations.
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Affiliation(s)
- Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jessie Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily R Smith
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher H Trabue
- University of Tennessee Health Science Center, Saint Thomas Health, Nashville, Tennessee, USA
| | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Kempapura Murthy
- Baylor Scott and White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | | | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jill M Ferdinands
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Ferdinands JM, Thompson MG, Blanton L, Spencer S, Grant L, Fry AM. Does influenza vaccination attenuate the severity of breakthrough infections? A narrative review and recommendations for further research. Vaccine 2021; 39:3678-3695. [PMID: 34090700 DOI: 10.1016/j.vaccine.2021.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 01/05/2023]
Abstract
The effect of influenza vaccination on influenza severity remains uncertain. We reviewed the literature for evidence to inform the question of whether influenza illness is less severe among individuals who received influenza vaccination compared with individuals with influenza illness who were unvaccinated prior to their illnesses. We conducted a narrative review to identify published findings comparing severity of influenza outcomes by vaccination status among community-dwelling adults and children ≥ 6 months of age with laboratory-confirmed influenza illness. When at least four effect estimates of the same type (e.g., odds ratio) were available for a specific outcome and age category (children versus adults), data were pooled with meta-analysis to generate a summary effect estimate. We identified 38 published articles reporting ≥ 1 association between influenza vaccination status and one of 21 indicators of severity of influenza illness among individuals with laboratory-confirmed influenza. Study methodologies and effect estimates were highly heterogenous, with only five severity indicators meeting criteria for calculating a combined effect. Among eight studies, influenza vaccination was associated with 26% reduction in odds of ICU admission among adults with influenza-associated hospitalization (OR = 0.74, 95% CI 0.58, 0.93). Among five studies of adults with influenza-associated hospitalization, vaccinated patients had 31% reduced risk of death compared with unvaccinated patients (OR = 0.69, 95% CI 0.52, 0.92). Among four studies of children with influenza virus infection, vaccination was associated with an estimated 45% reduction in the odds of manifesting fever (OR = 0.55, 95% CI 0.42, 0.71). Vaccination was not significantly associated with receiving a clinical diagnosis of pneumonia among adults hospitalized with influenza (OR = 0.92, 95% CI 0.82, 1.04) or with risk of hospitalization following outpatient influenza illness among adults (OR = 0.60, 95% CI 0.28, 1.28). Overall, our findings support the hypothesis that influenza vaccination may attenuate the course of disease among individuals with breakthrough influenza virus infection.
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Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauren Grant
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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12
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Verschoor CP, Andrew MK, Loeb M, Pawelec G, Haynes L, Kuchel GA, McElhaney JE. Antibody and Cell-Mediated Immune Responses Are Correlates of Protection against Influenza Infection in Vaccinated Older Adults. Vaccines (Basel) 2021; 9:vaccines9010025. [PMID: 33430191 PMCID: PMC7825602 DOI: 10.3390/vaccines9010025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 12/29/2022] Open
Abstract
Despite efforts to design better vaccines for older adults, the risk for serious complications of influenza remains disproportionately high. Identifying correlates of vaccine effectiveness and understanding the heterogeneity of health outcomes in older adults are key to the vaccine development pipeline. We sought correlates of protection against laboratory-confirmed influenza illness (LCII) in a 4-year randomized trial of standard versus high-dose influenza vaccination of adults 65 years and older. To this end, we quantified serum hemagglutination-inhibition (HAI) titers and interferon-gamma (IFNγ) and interleukin-10 (IL-10) secretion by virus-challenged peripheral blood mononuclear cells. Of the 608 participants included, 26 developed either A/H3N2-(n = 17) or B-LCII (n = 9) at 10-20 weeks post-vaccination. Antibody titres for A/H3N2 at 4-weeks post-vaccination were significantly associated with protection against LCII, where every 1-standard deviation increase reduced the odds of A/H3N2-LCII by 53%. Although B-titres did not correlate with protection against B-LCII, the fold-increase in IFNγ:IL-10 ratios from pre- to 4-weeks post-vaccination was significantly associated with protection against B-LCII, where every 1-standard deviation increase reduced the odds by 71%. Our results suggest that both antibody and cell-mediated immune measures are valuable and potentially complementary correlates of protection against LCII in vaccinated older adults, although this may depend on the viral type causing infection.
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Affiliation(s)
- Chris P. Verschoor
- Health Sciences North Research Institute, Sudbury, ON P3E 5J1, Canada; (G.P.); (J.E.M.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
- Correspondence:
| | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS B3H 2E1, Canada;
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Graham Pawelec
- Health Sciences North Research Institute, Sudbury, ON P3E 5J1, Canada; (G.P.); (J.E.M.)
- Department of Immunology, University of Tübingen, 72074 Tübingen, Germany
| | - Laura Haynes
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; (L.H.); (G.A.K.)
| | - George A. Kuchel
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT 06030, USA; (L.H.); (G.A.K.)
| | - Janet E. McElhaney
- Health Sciences North Research Institute, Sudbury, ON P3E 5J1, Canada; (G.P.); (J.E.M.)
- Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
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13
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Ludwig M, Jacob J, Basedow F, Andersohn F, Walker J. Clinical outcomes and characteristics of patients hospitalized for Influenza or COVID-19 in Germany. Int J Infect Dis 2020; 103:316-322. [PMID: 33279652 PMCID: PMC7774009 DOI: 10.1016/j.ijid.2020.11.204] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives Since the beginning of the severe acute respiratory syndrome coronavirus 2 pandemic, there is a discussion about the severity of coronavirus disease-2019 (COVID-19) in comparison to infections with seasonal Influenza. The objective of this study was to compare clinical and demographic characteristics of German patients hospitalized for infection with either SARS-CoV-2 or Influenza. Methods This study used anonymized German healthcare claims data. Patients with a confirmed COVID-19 or Influenza diagnosis, for whom a complete hospital course was available (i.e., the patient was discharged or died in hospital) were included. The data set included detailed information on patient characteristics and hospital treatment. Patients were grouped according to whether they were transferred to the intensive care unit (ICU), received mechanical ventilation (MV), or had a severe course of the disease (SD). Charlson Comorbidity Index in the eight quarters prior to hospitalization and secondary diagnoses during hospitalization were analyzed. Results A total of 2343 hospitalized patients with COVID-19 and 6762 hospitalized patients with Influenza were included. Fifty-four percent of the patients were male patients, with men being twice as frequent in the COVID-19 severe groups. For both diseases, patients >49 years accounted for almost three-quarters of hospital cases and hypertension, diabetes mellitus, chronic kidney disease, and chronic obstructive pulmonary disease were the most common comorbidities. The proportion of cases with ICU, MV, and SD was substantially higher for patients with COVID-19 (ICU+: 21 vs. 13 %; MV+: 15 vs. 9%; and SD+: 28 vs. 16%). Overall inhospital mortality was more than two-fold higher in COVID-19 vs. Influenza (14 vs. 6%).). The length of ventilation and hospitalization, and the proportion of patients diagnosed with acute respiratory distress syndrome, systemic inflammatory response syndrome, or acute kidney injury were considerably higher in patients with COVID-19. Conclusions COVID-19 resulted in higher inhospital mortality and worse clinical outcomes than Influenza. This was not attributable to demographic characteristics, preexisting comorbidities, or patient triage, because the German healthcare system had not reached its limits in the pandemic. Discussions suggesting that COVID-19 and seasonal Influenza have similar severity cannot be based on clinical evidence.
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Affiliation(s)
- Marion Ludwig
- InGef - Institute for applied healthcare research Berlin GmbH, Germany.
| | - Josephine Jacob
- InGef - Institute for applied healthcare research Berlin GmbH, Germany
| | - Frederike Basedow
- InGef - Institute for applied healthcare research Berlin GmbH, Germany
| | - Frank Andersohn
- Frank Andersohn Consulting and Research Services, Berlin, Germany
| | - Jochen Walker
- InGef - Institute for applied healthcare research Berlin GmbH, Germany
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14
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Venkatesan S, Myles PR, Bolton KJ, Muthuri SG, Al Khuwaitir T, Anovadiya AP, Azziz-Baumgartner E, Bajjou T, Bassetti M, Beovic B, Bertisch B, Bonmarin I, Booy R, Borja-Aburto VH, Burgmann H, Cao B, Carratala J, Chinbayar T, Cilloniz C, Denholm JT, Dominguez SR, Duarte PAD, Dubnov-Raz G, Fanella S, Gao Z, Gérardin P, Giannella M, Gubbels S, Herberg J, Higuera Iglesias AL, Hoeger PH, Hu XY, Islam QT, Jiménez MF, Keijzers G, Khalili H, Kusznierz G, Kuzman I, Langenegger E, Lankarani KB, Leo YS, Libster RP, Linko R, Madanat F, Maltezos E, Mamun A, Manabe T, Metan G, Mickiene A, Mikić D, Mohn KGI, Oliva ME, Ozkan M, Parekh D, Paul M, Rath BA, Refaey S, Rodríguez AH, Sertogullarindan B, Skręt-Magierło J, Somer A, Talarek E, Tang JW, To K, Tran D, Uyeki TM, Vaudry W, Vidmar T, Zarogoulidis P, Nguyen-Van-Tam JS. Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection. J Infect Dis 2020; 221:356-366. [PMID: 31314899 PMCID: PMC7313925 DOI: 10.1093/infdis/jiz152] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/16/2019] [Indexed: 02/05/2023] Open
Abstract
Background The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. Methods We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded. Results We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78–.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS. Conclusions When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.
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Affiliation(s)
- Sudhir Venkatesan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham
- Correspondence: S. Venkatesan, MPH, PhD, Rm B104, Clinical Sciences Bldg, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, UK ()
| | - Puja R Myles
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham
| | - Kirsty J Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham
| | - Stella G Muthuri
- MRC Unit for Lifelong Health and Ageing, University College London
| | - Tarig Al Khuwaitir
- Department of Medicine, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ashish P Anovadiya
- Department of Pharmacology, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, India
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tahar Bajjou
- University Mohammed V-Souissi, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Biosafety Level 3 and Research Laboratory, Rabat, Morocco
| | | | - Bojana Beovic
- Department of Infectious Diseases, University Medical Center, Ljubljana
| | | | | | - Robert Booy
- National Centre for Immunisation Research and Surveillance, Children’s Hospital at Westmead, University of Sydney
| | | | | | - Bin Cao
- Beijing Chao-Yang Hospital, Capital Medical University
| | - Jordi Carratala
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases
| | - Tserendorj Chinbayar
- National Influenza Center, National Center of Communicable Diseases, Ministry of Health, Ulaanbaatar, Mongolia
| | - Catia Cilloniz
- Hospital Clinic, August Pi I Sunyer Biomedical Research Institute, University of Barcelona, CIBERES, Barcelona
| | - Justin T Denholm
- Victorian Infectious Diseases Service and Department of Microbiology and Immunology, at the Peter Doherty Institute for Infection and Immunity, Parkville
| | - Samuel R Dominguez
- Department of Pediatric Infectious Diseases, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora
| | | | - Gal Dubnov-Raz
- Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Ramat Gan
| | - Sergio Fanella
- Section of Pediatric Infectious Diseases, University of Manitoba, Winnipeg
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital
| | - Patrick Gérardin
- Pôle Femme Mère Enfant
- Center for Clinical Investigation 1410, Institut National de la Santé et de la Recherche Médical (INSERM), Centre Hospitalier Universitaire de la Réunion, Saint Pierre
- Unité Mixte 134 Processus Infectieux en Milieu Insulaire Tropical, Centre National de la Recherche Scientifique 9192, INSERM U1187, Institut Recherche et Développement 249, Université de la Réunion, Cyclotron Réunion-océan Indien, Sainte Clotilde, Reunion
| | - Maddalena Giannella
- Department of Clinical and Surgical Sciences, Sant’Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid
| | - Sophie Gubbels
- Department of Infectious Disease Epidemiology, Sector for National Health Documentation and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jethro Herberg
- Section of Paediatrics, Division of Infectious Disease, Imperial College, London
| | - Anjarath Lorena Higuera Iglesias
- Department of Research in Clinical Epidemiology, Instituto Nacional de Enfermedades Respiratorias Dr. Ismael Cosío Villegas, Mexico City, Mexico
| | | | - Xiao Yun Hu
- Peking Union Medical College Hospital, Beijing
| | | | - Mirela F Jiménez
- Departamento de Ginecologia e Obstetrícia–UFCSPA, Preceptora da Residência Médica do Hospital Fêmina, Fêmina, Brazil
| | | | - Hossein Khalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Gabriela Kusznierz
- National Institute of Respiratory Diseases “Emilio Coni” ANLIS “C. Malbran,” Santa Fe
| | - Ilija Kuzman
- University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Croatia
| | - Eduard Langenegger
- Department of Obstetrics and Gynaecology, Stellenbosch University–Tygerberg, Cape Town, South Africa
| | - Kamran B Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yee-Sin Leo
- Department of Infectious Diseases, Tan Tock Seng Hospital
| | - Romina P Libster
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
- Fundacion INFANT
- National Scientific and Technical Research Council, Buenos Aires
| | | | - Faris Madanat
- Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan
| | - Efstratios Maltezos
- Unit of Infectious Diseases, University General Hospital of Alexandroupolis, Democritus University Thrace, Dragana
| | | | - Toshie Manabe
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Gokhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara
| | - Auksė Mickiene
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dragan Mikić
- Military Medical Academy, Clinic for Infectious and Tropical Diseases, University of Defense, Belgrade, Serbia
| | - Kristin G I Mohn
- Influenza Center, Department of Clinical Science, University of Bergen
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Maria E Oliva
- Department of Infection Control, Hospital San Martín de Paraná, Entre Ríos, Argentina
| | - Mehpare Ozkan
- Pediatric Neurology Department, Bahçeşehir University
| | - Dhruv Parekh
- Respiratory and Critical Care Medicine, Institute of Inflammation and Ageing, University of Birmingham, Birmingham
| | - Mical Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Barbara A Rath
- Department of Pediatrics, Charité–University Medical Center Berlin, Berlin, Germany
| | - Samir Refaey
- Epidemiology and Surveillance Department, Ministry of Health and Population, Cairo, Egypt
| | | | | | | | - Ayper Somer
- Department of Pediatric Infectious Diseases, Istanbul Medical Faculty, Istanbul University, Istanbul
| | - Ewa Talarek
- Department of Children’s Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Julian W Tang
- Department of Respiratory Sciences, University of Leicester
- University Hospitals Leicester, Leicester, United Kingdom
- Molecular Diagnostic Centre, Department of Laboratory Medicine, National University Hospital, Singapore
| | - Kelvin To
- Carol Yu Centre for Infection and Division of Infectious Diseases, Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dat Tran
- Acute and Communicable Disease Prevention, Public Health Division, Oregon Health Authority, Portland
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy Vaudry
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Stollery Children’s Hospital, Edmonton, Canada
| | - Tjasa Vidmar
- General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - Paul Zarogoulidis
- Pulmonary Department, “G. Papanikalaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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15
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Lees C, Godin J, McElhaney JE, McNeil SA, Loeb M, Hatchette TF, LeBlanc J, Bowie W, Boivin G, McGeer A, Poirier A, Powis J, Semret M, Webster D, Andrew MK. Frailty Hinders Recovery From Influenza and Acute Respiratory Illness in Older Adults. J Infect Dis 2020. [PMID: 32147711 DOI: 10.1093/infdis/jiaa092[publishedonlinefirst:2020/03/10]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND We examined frailty as a predictor of recovery in older adults hospitalized with influenza and acute respiratory illness. METHODS A total of 5011 patients aged ≥65 years were admitted to Canadian Serious Outcomes Surveillance Network hospitals during the 2011/2012, 2012/2013, and 2013/2014 influenza seasons. Frailty was measured using a previously validated frailty index (FI). Poor recovery was defined as death by 30 days postdischarge or an increase of more than 0.06 (≥2 persistent new health deficits) on the FI. Multivariable logistic regression controlled for age, sex, season, influenza diagnosis, and influenza vaccination status. RESULTS Mean age was 79.4 (standard deviation = 8.4) years; 53.1% were women. At baseline, 15.0% (n = 750) were nonfrail, 39.3% (n = 1971) were prefrail, 39.8% (n = 1995) were frail, and 5.9% (n = 295) were most frail. Poor recovery was experienced by 21.4%, 52.0% of whom had died. Frailty was associated with lower odds of recovery in all 3 seasons: 2011/2012 (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.59-0.84), 2012/2013 (OR = 0.72; 95% CI, 0.66-0.79), and 2013/2014 (OR = 0.75; 95% CI, 0.69-0.82); results varied by season, influenza status, vaccination status, and age. CONCLUSIONS Increasing frailty is associated with lower odds of recovery, and persistent worsening frailty is an important adverse outcome of acute illness.
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Affiliation(s)
- Caitlin Lees
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelly A McNeil
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd F Hatchette
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | | | - André Poirier
- Centre Intégré Universitaire de Santé et Services Sociaux, Quebec City, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Duncan Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
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16
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Lees C, Godin J, McElhaney JE, McNeil SA, Loeb M, Hatchette TF, LeBlanc J, Bowie W, Boivin G, McGeer A, Poirier A, Powis J, Semret M, Webster D, Andrew MK. Frailty Hinders Recovery From Influenza and Acute Respiratory Illness in Older Adults. J Infect Dis 2020; 222:428-437. [PMID: 32147711 PMCID: PMC7336554 DOI: 10.1093/infdis/jiaa092] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined frailty as a predictor of recovery in older adults hospitalized with influenza and acute respiratory illness. METHODS A total of 5011 patients aged ≥65 years were admitted to Canadian Serious Outcomes Surveillance Network hospitals during the 2011/2012, 2012/2013, and 2013/2014 influenza seasons. Frailty was measured using a previously validated frailty index (FI). Poor recovery was defined as death by 30 days postdischarge or an increase of more than 0.06 (≥2 persistent new health deficits) on the FI. Multivariable logistic regression controlled for age, sex, season, influenza diagnosis, and influenza vaccination status. RESULTS Mean age was 79.4 (standard deviation = 8.4) years; 53.1% were women. At baseline, 15.0% (n = 750) were nonfrail, 39.3% (n = 1971) were prefrail, 39.8% (n = 1995) were frail, and 5.9% (n = 295) were most frail. Poor recovery was experienced by 21.4%, 52.0% of whom had died. Frailty was associated with lower odds of recovery in all 3 seasons: 2011/2012 (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.59-0.84), 2012/2013 (OR = 0.72; 95% CI, 0.66-0.79), and 2013/2014 (OR = 0.75; 95% CI, 0.69-0.82); results varied by season, influenza status, vaccination status, and age. CONCLUSIONS Increasing frailty is associated with lower odds of recovery, and persistent worsening frailty is an important adverse outcome of acute illness.
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Affiliation(s)
- Caitlin Lees
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelly A McNeil
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd F Hatchette
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | | | - André Poirier
- Centre Intégré Universitaire de Santé et Services Sociaux, Quebec City, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Duncan Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
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17
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Segaloff HE, Cheng B, Miller AV, Petrie JG, Malosh RE, Cheng C, Lauring AS, Lamerato LE, Ferdinands JM, Monto AS, Martin ET. Influenza Vaccine Effectiveness in the Inpatient Setting: Evaluation of Potential Bias in the Test-Negative Design by Use of Alternate Control Groups. Am J Epidemiol 2020; 189:250-260. [PMID: 31673696 DOI: 10.1093/aje/kwz248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 11/13/2022] Open
Abstract
The test-negative design is validated in outpatient, but not inpatient, studies of influenza vaccine effectiveness. The prevalence of chronic pulmonary disease among inpatients can lead to nonrepresentative controls. Test-negative design estimates are biased if vaccine administration is associated with incidence of noninfluenza viruses. We evaluated whether control group selection and effects of vaccination on noninfluenza viruses biased vaccine effectiveness in our study. Subjects were enrolled at the University of Michigan and Henry Ford hospitals during the 2014-2015 and 2015-2016 influenza seasons. Patients presenting with acute respiratory infection were enrolled and tested for respiratory viruses. Vaccine effectiveness was estimated using 3 control groups: negative for influenza, positive for other respiratory virus, and pan-negative individuals; it was also estimated for other common respiratory viruses. In 2014-2015, vaccine effectiveness was 41.1% (95% CI: 1.7, 64.7) using influenza-negative controls, 24.5% (95% CI: -42.6, 60.1) using controls positive for other virus, and 45.8% (95% CI: 5.7, 68.9) using pan-negative controls. In 2015-2016, vaccine effectiveness was 68.7% (95% CI: 44.6, 82.5) using influenza-negative controls, 63.1% (95% CI: 25.0, 82.2) using controls positive for other virus, and 71.1% (95% CI: 46.2, 84.8) using pan-negative controls. Vaccination did not alter odds of other respiratory viruses. Results support use of the test-negative design among inpatients.
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Affiliation(s)
- Hannah E Segaloff
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bonnie Cheng
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Andrew V Miller
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Joshua G Petrie
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Ryan E Malosh
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Caroline Cheng
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Adam S Lauring
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lois E Lamerato
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arnold S Monto
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emily T Martin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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18
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Harding K, Zhu F, Alotaibi M, Duggan T, Tremlett H, Kingwell E. Multiple cause of death analysis in multiple sclerosis: A population-based study. Neurology 2020; 94:e820-e829. [PMID: 31932517 DOI: 10.1212/wnl.0000000000008907] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/08/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To gain a better understanding of the complex patterns of causes that contribute to death due to multiple sclerosis (MS) by assessing the relationship between MS and other causes of death listed on death certificates. METHODS Multiple cause of death data for all adult deaths (aged ≥18 years) in British Columbia, Canada, between 1986 and 2013 were accessed. All causes, as listed on the death certificate, whether underlying or contributing, were considered "any mention" causes. The associations between mention of MS on the death certificate and mention of other causes of death were examined by logistic regression, adjusted for age, sex, and calendar year (Bonferroni-corrected α level = 0.002). Findings were also sex-stratified. RESULTS Among 771,288 deaths, MS was mentioned on 2,153 certificates. If MS was mentioned (versus not mentioned), there was a greater chance that specific conditions contributed to the death: respiratory infection (adjusted odds ratio [aOR], 3.03 [95% confidence interval (CI), 2.73-3.36]), aspiration pneumonia (aOR, 7.15 [95% CI, 6.23-8.22]), urinary tract infection (UTI) (aOR, 10.2 [95% CI, 8.7-12.0]), other infection including sepsis (aOR, 1.34 [95% CI, 1.15-1.56]), and skin disease (aOR, 5.06 [95% CI, 3.96-6.46]). Sex differences existed for urinary tract infection (men: aOR, 14.9 [95% CI, 11.5-19.3]; women: aOR, 8.00 [95% CI, 6.53-9.81]) and chronic respiratory disease (men = aOR, 1.36 [95% CI, 1.14-1.63]; women = aOR, 0.97 [95% CI, 0.84-1.13]). CONCLUSIONS Deaths attributed to MS were commonly caused by infection (especially respiratory and urinary tract-related); conditions associated with advanced disability and immobility, such as aspiration pneumonia; and chronic respiratory disease in men. All are potentially modifiable; interventions that reduce the frequency or severity of these complications could improve survival in MS.
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Affiliation(s)
- Katharine Harding
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Feng Zhu
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Thomas Duggan
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Helen Tremlett
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia
| | - Elaine Kingwell
- From the Faculty of Medicine (Neurology) and Djavad Mowafaghian Centre for Brain Health (K.H., F.Z., T.D., H.T., E.K.), University of British Columbia, Vancouver, Canada; Department of Neurology (K.H.), Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK; and Department of Ophthalmology (M.A.), King Saud University, Riyadh, Saudi Arabia.
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Affanni P, Colucci ME, Bracchi MT, Capobianco E, Zoni R, Caruso L, Castrucci MR, Puzelli S, Cantarelli A, Veronesi L. Virological Surveillance of Influenza in the eight epidemic seasons after the 2009 pandemic in Emilia-Romagna (Northern Italy). ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:35-44. [PMID: 31517888 PMCID: PMC7233653 DOI: 10.23750/abm.v90i9-s.8722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Influenza virological surveillance is essential for monitoring the evolution of influenza viruses (IVs) as well as for annual updating of the vaccine composition. The aim of this study is to analyse IVs circulation in Emilia-Romagna during the eight epidemic seasons after the 2009 pandemic and to evaluate their match with seasonal vaccine strains. METHODS A total of 7882 respiratory specimens from patients with influenza-like illness (ILI), were collected by regional sentinel practitioners and hospital physicians. Viral investigations were conducted by rRT-PCR assay. Genetic characterization was performed for a spatial-temporal representative number of influenza laboratory-confirmed specimens. RESULTS Influenza-positive samples per season ranged between 28.9% (2013-2014) and 66.8% (2012-2013). Co-circulation of IVs type A and type B was observed in all seasons, although with a different intensity. In all seasons, the highest number of positive samples was recorded in younger patients aged 5-14 years with relative frequencies ranging from 40% in the 2013-2014 season and 78% in the 2012-2013 season. Since the 2009 pandemic, A/H1N1pdm09 IVs circulating were closely related to the vaccine strain A/California/7/2009. Antigenic mismatch between vaccine strain and A/H3N2 IVs was observed in the 2011-2012 and 2014-2015 seasons. During 2015-2016, 2016-2017 and 2017-2018 seasons a complete or nearly complete mismatch between the predominant influenza B lineage of IVs type B circulating and vaccine B lineage occurred. CONCLUSIONS This analysis confirms the importance of the virological surveillance and highlights the need of a continuous monitoring of IVs circulation, to improve the most appropriate vaccination strategies. (www.actabiomedica.it).
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Affiliation(s)
- Paola Affanni
- Department of Medicine and Surgery, University of Parma, Italy.
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