Colds and Influenza-Like Illnesses in University Students: Impact on Health, Academic and Work Performance, and Health Care Use

College health centers: An update on medical issues

College health centers are an important source of health care for large numbers of young adults throughout the country. With 16.9 million students enrolled in 2023 in post-secondary institutions in the United States, the potential impact that health centers at these institutions have is significant. Late adolescence and early adulthood is a particularly vulnerable stage of both cognitive and psychosocial development, and college health centers that provide comprehensive medical and mental-health care play an important role in providing comprehensive care for this age group. As we move into a post-pandemic era, colleges and universities across the country continue to navigate all the changes that have been brought about by the COVID-19 pandemic. It is perhaps now more important than ever to review and assess the clinical care college health centers provide, who they provide this care to, and identify opportunities for improvement and where there may be need for change.

Molecular Epidemiology and Clinical Characteristics of an Outbreak on Respiratory Virus Coinfection in Gansu, China

This study aims to analyze the epidemiological and pathogenic characteristics of an outbreak primarily caused by respiratory syncytial virus (RSV), human rhinovirus (HRV), and human metapneumovirus (HMPV) in a kindergarten and primary school. The outbreak was investigated by field epidemiological investigation, and the common respiratory pathogens were screened by RT-PCR detection technology. The attack rate of this outbreak was 63.95% (110/172). Main symptoms included cough (85.45%), sore throat (60.91%), and sneezing (60.00%). Multifactorial logistic regression analysis revealed that continuous handwashing and mouth and nose covering when sneezing were protective factors. All 15 collected throat swab specimens tested positive for viruses, with HMPV as the predominant pathogen (80.00%), followed by HRV (53.33%), and two cases of positive respiratory syncytial virus (13.33%). Among them, six samples showed coinfections of HMPV and HRV, and one had coinfections of HMPV and RSV, resulting in a coinfection rate of 46.67%. Genetic sequencing indicated that the HMPV genotype in this outbreak was A2c, and the HRV genotype was type A, resulting in a coinfection outbreak of HMPV, HRV, and RSV in schools and kindergartens, suggesting that multi-pathogen surveillance of respiratory tract infections should be strengthened.

Implementation of a Prospective Index-Cluster Sampling Strategy for the Detection of Presymptomatic Viral Respiratory Infection in Undergraduate Students

Background

Index-cluster studies may help characterize the spread of communicable infections in the presymptomatic state. We describe a prospective index-cluster sampling strategy (ICSS) to detect presymptomatic respiratory viral illness and its implementation in a college population.

Methods

We enrolled an annual cohort of first-year undergraduates who completed daily electronic symptom diaries to identify index cases (ICs) with respiratory illness. Investigators then selected 5-10 potentially exposed, asymptomatic close contacts (CCs) who were geographically co-located to follow for infections. Symptoms and nasopharyngeal samples were collected for 5 days. Logistic regression model-based predictions for proportions of self-reported illness were compared graphically for the whole cohort sampling group and the CC group.

Results

We enrolled 1379 participants between 2009 and 2015, including 288 ICs and 882 CCs. The median number of CCs per IC was 6 (interquartile range, 3-8). Among the 882 CCs, 111 (13%) developed acute respiratory illnesses. Viral etiology testing in 246 ICs (85%) and 719 CCs (82%) identified a pathogen in 57% of ICs and 15% of CCs. Among those with detectable virus, rhinovirus was the most common (IC: 18%; CC: 6%) followed by coxsackievirus/echovirus (IC: 11%; CC: 4%). Among 106 CCs with a detected virus, only 18% had the same virus as their associated IC. Graphically, CCs did not have a higher frequency of self-reported illness relative to the whole cohort sampling group.

Conclusions

Establishing clusters by geographic proximity did not enrich for cases of viral transmission, suggesting that ICSS may be a less effective strategy to detect spread of respiratory infection.

RVdb: a comprehensive resource and analysis platform for rhinovirus research

Rhinovirus (RV), a prominent causative agent of both upper and lower respiratory diseases, ranks among the most prevalent human respiratory viruses. RV infections are associated with various illnesses, including colds, asthma exacerbations, croup and pneumonia, imposing significant and extended societal burdens. Characterized by a high mutation rate and genomic diversity, RV displays a diverse serological landscape, encompassing a total of 174 serotypes identified to date. Understanding RV genetic diversity is crucial for epidemiological surveillance and investigation of respiratory diseases. This study introduces a comprehensive and high-quality RV data resource, designated RVdb (http://rvdb.mgc.ac.cn), covering 26 909 currently identified RV strains, along with RV-related sequences, 3D protein structures and publications. Furthermore, this resource features a suite of web-based utilities optimized for easy browsing and searching, as well as automatic sequence annotation, multiple sequence alignment (MSA), phylogenetic tree construction, RVdb BLAST and a serotyping pipeline. Equipped with a user-friendly interface and integrated online bioinformatics tools, RVdb provides a convenient and powerful platform on which to analyse the genetic characteristics of RVs. Additionally, RVdb also supports the efforts of virologists and epidemiologists to monitor and trace both existing and emerging RV-related infectious conditions in a public health context.

Exploring strategies to increase college students' motivation to receive their annual influenza vaccine

OBJECTIVE

To evaluate college students' awareness of an educational initiative to increase campus influenza vaccination rates and strategies to improve it.

PARTICIPANTS

Students attending a large public comprehensive university.

METHODS

An investigator-developed, online survey evaluated awareness of the initiative, the students' perception of incentives, and other motivations to receive seasonal influenza vaccine.

RESULTS

The vaccination rate was 43%, despite low awareness of the initiative (28%). Awareness was significantly higher among vaccinated students (p = 0.0013). Having knowledge that appointments to receive vaccine were not needed increased the motivation of vaccinated students more than unvaccinated students (p = 0.0001). Personal influencers increased motivation of vaccinated students only when they were aware of the initiative (p = 0.04). Tangible incentives did not motivate students.

CONCLUSIONS

Campus vaccination rates increased despite low initiative awareness. Improvements to the initiative should include strategies to increase emphasis on vaccination program conveniences like accessibility and perhaps engage personal influencers more.

Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study

University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.

Genetic diversity and characterization of rhinoviruses from Chinese clinical samples with a global perspective

IMPORTANCE

Based on clinical samples collected in China, we detected and reported 22 types for the first time in China, as well as three types for the first time in Asia, and reported their genetic characteristics and diversity. We identified a novel type of Rhinovirus (RV), A110, highlighting its unique genetic features. We annotated the genomic structure and serotype of all the existing RV sequences in the database, and four novel RV types were identified and their genetic diversity reported. Combined with the sequence annotation, we constructed a complete VP1 data set of RV and conducted the first large-scale evolutionary dynamics analysis of RV. Based on a high-quality data set, we conducted a comprehensive analysis of the guanine-cytosine (GC) content variations among serotypes of RVs. This study provides crucial theoretical support and valuable data for understanding RV's genetic diversity and developing antiviral strategies.

Content Analysis of YouTube Videos on the Effect of Vitamin C on Common Cold

BACKGROUND

With the growth of the Internet, social media platforms have emerged as major sources of medical information. We assessed the reliability, quality, and accuracy of the most-viewed YouTube videos containing information on the effect of vitamin C on the common cold.

METHODS

The YouTube videos were searched on August 1, 2022, using the keywords: ("ascorbic acid" OR "vitamin C" OR "Sodium Ascorbate" OR "L-ascorbic") AND "common cold". The 30 most-viewed videos were included in our study. The reliability and quality of the videos were analyzed using modified DISCERN and Global Quality Scales, respectively. When the videos included at least one correct or inaccurate scientific statement about the effect of vitamin C on the common cold, they were classified as accurate or misleading videos, respectively; those without any pertinent information were considered neither accurate nor misleading. If a video contained both accurate and inaccurate statements, it was classified as misleading.

RESULTS

Of the 30 most-viewed videos, 73% were unreliable, and 67% contained misleading information and were of a poor quality. Of these 30 videos, 14 videos were produced and posted by customers who were not specialized in medicine or nutrition. Moreover, these videos were of significantly lower reliability, quality, and accuracy than those produced by nutrition or fitness channels or by medical or nutrition professionals.

CONCLUSION

The reliability, quality, and accuracy of videos uploaded by non-professionals were low. Therefore, video creators should upload reliable, high-quality videos to ensure the dissemination of accurate medical information.

Catch the tweet to fight the flu: Using Twitter to promote flu shots on a college campus

Objective: Over the 2018-2019 flu season we conducted a randomized controlled trial examining the efficacy of a Twitter campaign on vaccination rates. Concurrently we investigated potential interactions between digital social network structure and vaccination status. Participants: Undergratuates at a large midwestern public university were randomly assigned to an intervention (n = 353) or control (n = 349) group. Methods: Vaccination data were collected via monthly surveys. Participant Twitter data were collected through the public-facing Twitter API. Intervention impact was assessed with logistic regression. Standard network science tools examined vaccination coverage over online social networks. Results: The campaign had no effect on vaccination outcome. Receiving a flu shot the prior year had a positive impact on participant vaccination. Evidence of an interaction between digital social network structure and vaccination status was detected. Conclusions: Social media campaigns may not be sufficient for increasing vaccination rates. There may be potential for social media campaigns that leverage network structure.

Ingredients of Vicks VapoRub inhibit rhinovirus-induced ATP release

Background

Over-the-counter therapies, such as Vicks VapoRub, are frequently used in the management of upper respiratory tract infection symptoms. Of these, acute cough is the most bothersome; however, the mechanisms involved have not been fully elucidated. The temperature-sensitive transient receptor potential (TRP) channels, including TRPA1, TRPV1, TRPM8 and TRPV4, are potential candidates. TRPV4 is also thought to be involved in cough through the TRPV4-ATP-P2X3 pathway. Here, we hypothesise that Vicks VapoRub ingredients (VVRIs) modulate the TRP cough channels.

Methods

Stably transfected HEK cells expressing TRP channels were challenged with VVRIs, individually or in combination, and the agonist and antagonist effects were measured using calcium signalling responses. In addition, rhinovirus serotype-16 (RV16)-infected A549 airway epithelial cells were pre-incubated with individual or combinations of VVRIs prior to hypotonic challenge and extracellular ATP release analysis.

Results

Calcium signalling reconfirmed some previously defined activation of TRP channels by specific VVRIs. The combined VVRIs containing menthol, camphor and eucalyptus oil activated TRPV1, TRPV4, TRPM8 and untransfected wild-type HEK293 cells. However, pre-incubation with VVRIs did not significantly inhibit any of the channels compared with the standard agonist responses. Pre-incubation of RV16-infected A549 cells with individual or combined VVRIs, except menthol, resulted in a 0.45-0.55-fold reduction in total ATP release following hypotonic stimulation, compared with infected cells not treated with VVRIs.

Conclusion

These findings suggest that some VVRIs may reduce symptoms associated with upper respiratory tract infection by modulating specific TRP receptors and by reducing RV16-induced ATP release.

A survey of university students on attitudes, behaviors, and intentions toward influenza vaccination

Objective To determine attitudes, behaviors, and intentions of university students regarding influenza vaccination.ParticipantsUndergraduate, graduate, and professional students enrolled at a private, midwestern university.Methods A 24-item electronic survey was designed and distributed after literature review and inputs from experts on immunizations. Bivariate tests were performed to observe differences between various subgroups of respondents (age, gender, race/ethnicity, housing, and academic program). Multivariate logistic regression was performed to find associations with their vaccination preferences.Results Of 3,267 complete responses (36.3% of total students), 75% reported obtaining influenza vaccination in 2016-2017. Vaccination rates were highest for Asian (81.0%) and lowest for Black students (59.6%). Health professional student vaccination rates of 89.3% were achieved with a vaccination mandate in place. Lowest immunization rates were identified for law (47.1%) and business (52.7%) students. Positive promotional factors were identified.Conclusions Access to free, on-campus vaccinations, mandates and promotional efforts are associated with high influenza vaccination rates.

Using a rapid ethnographic assessment to explore vaccine hesitancy on a public university campus in the Upper Midwest

Objective: This exploratory study examined campus attitudes toward vaccines to guide subsequent development of context-relevant interventions for increasing vaccine acceptance and uptake. Participants: We gathered ethnographic data on a convenience sample of campus community members (students, faculty, staff) at a public university over six weeks in spring 2022. Methods: Student researchers conducted a rapid ethnographic assessment across campus locations. Weekly team debriefs enabled ongoing, iterative refinement of instruments and supplemented observational fieldnotes. Data analysis was inductive and oriented toward practical recommendations for intervention development. Results: Four themes, and attendant recommendations, emerged: 1) social identities and social roles influence health-related beliefs, including vaccination; 2) vaccine knowledge influences vaccination behaviors; 3) language surrounding vaccines (sometimes) matters; 4) vaccines aren't considered part of general health and wellness and can't be forced. Conclusions: Findings highlight the need to address individual, social, and institutional contexts when designing campus-based behavioral interventions for vaccine uptake.

Effects of Vaccine Literacy, Health Beliefs, and Flu Vaccination on Perceived Physical Health Status among Under/Graduate Students

Physicians highlight that receiving the flu vaccine is critical, especially during the COVID-19 pandemic period. Younger groups' flu vaccination coverage is very low, and this tendency is potentially related to a lower level of vaccine literacy and perceptions toward vaccination. This study investigated the relationship between flu vaccine literacy, health beliefs, and flu vaccinations (benefit, barrier, severity, and susceptibility) and their impact on perceived health status controlling for socioeconomic factors. It used the Health Belief Model andHealth Literacy Skills Framework with under/graduate students (N = 382) in Ohio, U.S. Path analyses were performed to examine the causal process using SPSS and Amos 23.0. Indicators of CFI, RMSEA, SRMR, and the chi-square/df of the path models were good-acceptable. Vaccine literacy directly impacted on health beliefs and vaccination. Susceptibility belief directly influenced perceived health status. The mediation effects of health beliefs (benefit, barrier) between vaccine literacy and vaccination were confirmed. The study highlights the need for healthcare providers and governments to work together to improve flu vaccine literacy and reduce negative perceptions toward vaccination among younger populations. Educational programs and official communication channels can be used to address concerns and provide accurate information about vaccines to increase flu vaccination rates and protect public health.

Coughs, colds and "freshers' flu" survey in the University of Cambridge, 2007-2008

Universities provide many opportunities for the spread of infectious respiratory illnesses. Students are brought together into close proximity from all across the world and interact with one another in their accommodation, through lectures and small group teaching and in social settings. The COVID-19 global pandemic has highlighted the need for sufficient data to help determine which of these factors are important for infectious disease transmission in universities and hence control university morbidity as well as community spillover. We describe the data from a previously unpublished self-reported university survey of coughs, colds and influenza-like symptoms collected in Cambridge, UK, during winter 2007-2008. The online survey collected information on symptoms and socio-demographic, academic and lifestyle factors. There were 1076 responses, 97% from University of Cambridge students (5.7% of the total university student population), 3% from staff and <1% from other participants, reporting onset of symptoms between September 2007 and March 2008. Undergraduates are seen to report symptoms earlier in the term than postgraduates; differences in reported date of symptoms are also seen between subjects and accommodation types, although these descriptive results could be confounded by survey biases. Despite the historical and exploratory nature of the study, this is one of few recent detailed datasets of influenza-like infection in a university context and is especially valuable to share now to improve understanding of potential transmission dynamics in universities during the current COVID-19 pandemic.

Digital Media Exposure and Health Beliefs Influencing Influenza Vaccination Intentions: An Empirical Research in China

The purpose of this study was to investigate whether/how digital media exposure influences people's intention to influenza vaccination. Through an anonymous online survey, we collected data on Chinese people's exposure to influenza and influenza vaccine information on digital media platforms and their attitudes toward influenza vaccines (N = 600). The structural equation model analysis results strongly support to the research hypotheses and the proposed model. The findings reveal three major themes: (1) digital media exposure significantly influence the susceptibility and severity of influenza. (2) After exposure to digital media, it is helpful to understand the vaccine's benefits, reduce the barriers to vaccination, and finally improve the intention to vaccination. (3) Users receive cues to action from digital media, and their vaccination intention tends to be positive. These findings explore how digital media exposure influences influenza vaccination intention and may provide insights into vaccine promotion efforts in countries. Research has shown that digital media exposure contributes to getting vaccinated against influenza.

Factors associated with influenza vaccine noncompliance at a Rural Texas University

Objective: To investigate influenza vaccination rates and perceptions underlying vaccine noncompliance. Participants: Participants included undergraduate students (N = 365) at a rural, medium-sized university in Texas. Methods: Students were anonymously surveyed in the spring of 2018 on demographics, insurance status, perceived barriers of influenza vaccination, and vaccination status. Results: Nearly 90% of students had health insurance; however, only 30% of them received the influenza vaccination annually. The top two reasons for non-vaccination were the low perceived threat (20.20%) and having a busy schedule (11.10%). Having health insurance [OR: 2.84, CI: (1.16, 7.0)] and being in the younger age group (18-24) [OR: 1.98, CI: (1.11, 3.54)] were both positively associated with the annual vaccination status. Conclusion: Health education efforts should be focused on vaccination initiatives that increase awareness about the health benefits and ease of access, especially among the older age groups (> =25 years). Information on myths versus facts should also be disseminated.

Respiratory Infections Are More Common Than Healthcare Records Indicate: Results From an Anonymous Survey

INTRODUCTION

Influenza-like illnesses (ILIs) are common in military populations and can impair mission-readiness, particularly in the current severe acute respiratory syndrome coronavirus 2 pandemic; therefore, it is important to identify potential risk factors for infection and better understand the burden of infection.

MATERIALS AND METHODS

A survey was administered to military medical trainees living in a congregated setting on JBSA Fort Sam Houston, Texas, from January 2017 to February 2019. The survey included questions about ILI experience and potential ILI risk factors.

RESULTS

2,121 individuals completed the survey. Respondents had a median age of 21 years, 46% were female, 32.6% were Air Force, 33.6% were Army, and 33.8% were Navy/Marines. Among the 815 (38%) who reported an ILI during training, 40% sought health care. The primary reasons for seeking healthcare included illness severity, concern about transmission, and accessibility of healthcare. Over half (54%) of the trainees who reported an ILI said the ILI had an impact on their performance, including reduced study time, missed physical training, and missed class. Multivariate model results indicate that women and younger trainees (<30 years) were more likely to report having had an ILI (women: OR 1.58, (95% CI 1.30, 1.92); age <30 years: OR 1.58, (1.06, 2.36)). In a subset analysis, those who reported washing their hands 10+ times per day were less likely to report an ILI (OR 0.61 (0.42, 0.89)).

CONCLUSIONS

ILIs are likely to be more common during training than healthcare records indicate and may result in decreased training effectiveness. Increasing access to handwashing facilities and education about the importance of handwashing to prevent the spread of disease will likely reduce the ILI burden in this population.

Interprofessional Collaboration Improves Uptake of Flu Vaccines on a College Campus

In spite of an increased risk of transmission of influenza on college campuses, only 20% or fewer of college students in the United States receive the flu vaccine. This project evaluated an existing university program for flu vaccination, resulting in a collaboration pilot program in which a pharmacy conducted a mobile health clinic on campus. The percentage of students who obtained a flu vaccine from this initiative rose from about 4% to 9.46%, a 131% increase over the historical average.

Exploring the potential of foodborne transmission of respiratory viruses

The ongoing pandemic involving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised the question whether this virus, which is known to be spread primarily though respiratory droplets, could be spread through the fecal-oral route or via contaminated food. In this article, we present a critical review of the literature exploring the potential foodborne transmission of several respiratory viruses including human coronaviruses, avian influenza virus (AVI), parainfluenza viruses, human respiratory syncytial virus, adenoviruses, rhinoviruses, and Nipah virus. Multiple lines of evidence, including documented expression of receptor proteins on gastrointestinal epithelial cells, in vivo viral replication in gastrointestinal epithelial cell lines, extended fecal shedding of respiratory viruses, and the ability to remain infectious in food environments for extended periods of time raises the theoretical ability of some human respiratory viruses, particularly human coronaviruses and AVI, to spread via food. However, to date, neither epidemiological data nor case reports of clear foodborne transmission of either viruses exist. Thus, foodborne transmission of human respiratory viruses remains only a theoretical possibility.

Relative Effectiveness of the Cell-Cultured Quadrivalent Influenza Vaccine Compared to Standard, Egg-derived Quadrivalent Influenza Vaccines in Preventing Influenza-like Illness in 2017-2018

Background

Influenza antigens may undergo adaptive mutations during egg-based vaccine production. In the 2017–2018 influenza season, quadrivalent, inactivated cell-derived influenza vaccine (ccIIV4) vaccine was produced using A(H3N2) seed virus propagated exclusively in cell culture, thus lacking egg adaptive changes. This United States study estimated relative vaccine effectiveness (rVE) of ccIIV4 vs egg-derived quadrivalent vaccines (egg-derived IIV4) for that season.

Methods

Vaccination, outcome, and covariate data were ascertained retrospectively from a electronic medical record (EMR) dataset and analyzed. The study cohort included patients ≥ 4 years of age. rVE was estimated against influenza-like illness (ILI) using diagnostic International Classification of Diseases, Ninth or Tenth Revision codes. The adjusted odds ratios used to derive rVE estimates were estimated from multivariable logistic regression models adjusted for age, sex, race/ethnicity, geographic region, and health status.

Results

Overall, 92 187 individuals had a primary care EMR record of ccIIV4 and 1 261 675 had a record of egg-derived IIV4. In the ccIIV4 group, 1705 narrowly defined ILI events occurred, and 25 645 occurred in the standard egg-derived IIV4 group. Crude rVE was 9.2% (95% confidence interval [CI], 4.6%–13.6%). When adjusted for age, sex, health status, comorbidities, and geographic region, the estimated rVE changed to 36.2% (95% CI, 26.1%–44.9%).

Conclusions

ccIIV4, derived from A(H3N2) seed virus propagated exclusively in cell culture, was more effective than egg-derived IIV4 in preventing ILI during the 2017–2018 influenza season. This result suggests that cell-derived influenza vaccines may have greater effectiveness than standard egg-derived vaccines.

Occurrence of respiratory viruses on school desks

BACKGROUND

Schools represent high occupancy environments and well-documented high-risk locations for the transmission of respiratory viruses. The goal of this study was to report on the area density, occurrence, and type of respiratory viruses on desks in primary school classrooms.

METHODS

Quantitative reverse transcription polymerase chain reaction (qPCR) techniques were employed to measure nucleic acid area densities from a broad range of human adenoviruses and rhinoviruses, as well as coronavirus OC43, influenza A, and norovirus GI. Every two weeks, virus monitoring was conducted on the desks of four primary school classrooms in Colorado, USA, during the 2019 respiratory virus season.

RESULTS

DNA and RNA from respiratory viruses and norovirus were recovered from more than 20% of the desks sampled; occurrence patterns that indicate a greater than 60% probability of encountering any virus, if more than five desks were occupied in a day. Rhinoviruses and adenoviruses were the most commonly detected viruses as judged by the composite of occurrence and number of gene copies recovered. Desktop adenosine triphosphate monitoring did not predict the recovery of viral genomic materials on desks. School desks can be commonly contaminated with respiratory viruses.

CONCLUSIONS

Genomic surveys of the identity, distribution and abundance of human viruses on "high-touch" surfaces, can help inform risk assessments, design cleaning interventions, and may be useful for infection surveillance.

Molecular epidemiology of Enteroviruses and Rhinoviruses in patients with acute respiratory infections in Yaounde, Cameroon

Background

Acute respiratory infections (ARI) are associated with a huge morbidity and mortality worldwide. Rhinoviruses (RVs) and Enteroviruses (EVs) are recognized as leading causes of ARI.

Objectives

The present study describes the molecular epidemiology of RVs and EVs in Cameroon over a 3‐year surveillance period.

Methods

From September 2011 to October 2014, nasopharyngeal swabs were collected from patients with influenza‐like illness (ILI) and severe acute respiratory infections (SARI). Two sub‐genomic regions of the EVs and RVs were targeted for molecular characterization. These included the most conserved 5′‐untranslated region (5′UTR) and the viral protein 4/viral protein 2 transition region (VP4/VP2).

Results

A total of 974 samples were collected. Children ≤5 years accounted for 85.7% (835/974) of all participants. Among them, 160 (16.4%) were positive for RVs and/or EVs. RVs and/or EVs were significantly more identified in ILI compared to SARI patients (P = .015). Both viruses co‐circulated all year long with a marked increase of occurrence during rainy and cold season. All RV species were found to circulate in Cameroon, with 6, 10 and 6 virus types belonging to the RV‐A, RV‐B and RV‐C, respectively. EV species identified comprised EV‐A (1 Coxsackie virus A5), EV‐B (1 Coxsackie virus A9 and 2 Coxsackie virus B1) and EV‐C (1 EV‐C117).

Conclusions

This study indicates a strong year‐round occurrence of EV and RV associated respiratory infections in Cameroon. Molecular characterization identified a wide variety of RVs and EVs in patients with ARI in Cameroon.

Etiology of febrile respiratory infections in the general adult population in Singapore, 2007-2013

Pathogens that cause upper respiratory infections are numerous and specific preventive and therapeutic strategies are scarce. In order to ascertain the etiological agents resulting in upper respiratory tract infections (URTI) in adults in Singapore, nasal swab samples were collected from 2057 patients presenting with fever at primary healthcare clinics in Singapore from December 2007 to February 2013. Samples were tested using the Luminex NxTAG Respiratory Pathogen Panel that includes 22 respiratory pathogen targets. Patient-reported symptoms and vital signs were recorded and full blood and differential counts taken. Pathogens were detected in the following order of frequency: influenza viruses, rhino-/enteroviruses, coronaviruses, parainfluenza viruses, pneumoviruses, adenovirus, bocavirus and C. pneumoniae. Fifteen virus species were detected as part of coinfections, in which rhinoviruses were the most commonly observed pathogen. Our results suggest that influenza viruses are the main etiological agents, but multiple other respiratory viruses contribute to the total burden of URTI in adults in Singapore.

Variation in the timing of Covid-19 communication across universities in the UK

During the Covid-19 pandemic, universities in the UK used social media to raise awareness and provide guidance and advice about the disease to students and staff. We explain why some universities used social media to communicate with stakeholders sooner than others. To do so, we identified the date of the first Covid-19 related tweet posted by each university in the country and used survival models to estimate the effect of university-specific characteristics on the timing of these messages. In order to confirm our results, we supplemented our analysis with a study of the introduction of coronavirus-related university webpages. We find that universities with large numbers of students are more likely to use social media and the web to speak about the pandemic sooner than institutions with fewer students. Universities with large financial resources are also more likely to tweet sooner, but they do not introduce Covid-19 webpages faster than other universities. We also find evidence of a strong process of emulation, whereby universities are more likely to post a coronavirus-related tweet or webpage if other universities have already done so.

Prolonged lockdown and academic uncertainties in Bangladesh: A qualitative investigation during the COVID-19 pandemic

The erratic nature of the novel coronavirus disease (COVID-19) forced the Bangladeshi government to shut down all the educational institutions since March 18, 2020. This prolonged closure not only detached the students from their study but also increased anxiety among them regarding their future academic as well as professional careers. The present study aimed to explore the perception and understanding of the students and teachers regarding the impact of COVID-19 on the academic life and career pursuit of university students in Bangladesh. With a semi-structured interview schedule, data for this qualitative study were collected from 8 purposively selected participants, using telephone interviews, affiliated with a public university in Bangladesh. Students argued that the extended closure is responsible for the delayed graduation of the senior students, thereby, mounting mental stress and frustration among them. The informants unequivocally opposed the online education platform, as a solution for the ongoing gap, due to scarcity of the resources, and unequal accesses and opportunities for all. It has been suggested that the education gap can be reduced by shortening the term, curtailing the preparatory leave, and taking extra classes over the weekends when the universities re-open together with enforced collective health hygiene.

Influenza Vaccination Among U.S. College or University Students: A Systematic Review

OBJECTIVE

Influenza is one of the major causes of morbidity. This study summarized major components that influence college/university students' use of the vaccination using Ecological System Theory; and evaluated racial differences in key predictors of influenza vaccination/intention.

DATA SOURCE

Sixteen engines (e.g., PsycINFO, Academic Search Premier, Science Citation Index) were used to search for cross-sectional studies (2009-2019).

STUDY INCLUSION/EXCLUSION CRITERIA

PI/CO criteria were applied (U.S. students, multidimensional ecological system, influenza vaccination/intention).

DATA EXTRACTION

25 cross-sectional studies were included from the initial 810 citations. Four reviewers performed the cross-checking.

DATA SYNTHESIS AND RESULTS

Higher SES (e.g., education, vaccine affordability, healthcare resource) were positively associated with vaccination/intention. Under micro levels, both internal factors (e.g., positive beliefs, perceptions, attitudes) and external factors (e.g., supports/recommendations from physicians, families or peers, information, engagement in campus activities) enhanced influenza vaccination/intention of students. Meso level factors (private university, dorm-residence, or student housing) also influenced influenza vaccination/intention. Despite limited information on the effects of race on influenza vaccination, the current study synthesized the racial variances in vaccination behaviors of students.

CONCLUSIONS

Enhancing positive beliefs, perceptions, or attitudes toward influenza vaccination with students is critical. Information about the safety and effectiveness of vaccination could be provided for students through official media, medical sources/physicians, campaigns, or internet websites. Family-to-student or peer-to-peer awareness campaigns could facilitate the vaccination of students.

Evaluation of COVID-19 Testing Strategies for Repopulating College and University Campuses: A Decision Tree Analysis

PURPOSE

The optimal approach to identify SARS-CoV-2 infection among college students returning to campus is unknown. Recommendations vary from no testing to two tests per student. This research determined the strategy that optimizes the number of true positives and negatives detected and reverse transcription polymerase chain reaction (RT-PCR) tests needed.

METHODS

A decision tree analysis evaluated five strategies: (1) classifying students with symptoms as having COVID-19, (2) RT-PCR testing for symptomatic students, (3) RT-PCR testing for all students, (4) RT-PCR testing for all students and retesting symptomatic students with a negative first test, and (5) RT-PCR testing for all students and retesting all students with a negative first test. The number of true positives, true negatives, RT-PCR tests, and RT-PCR tests per true positive (TTP) was calculated.

RESULTS

Strategy 5 detected the most true positives but also required the most tests. The percentage of correctly identified infections was 40.6%, 29.0%, 53.7%, 72.5%, and 86.9% for Strategies 1-5, respectively. All RT-PCR strategies detected more true negatives than the symptom-only strategy. Analysis of TTP demonstrated that the repeat RT-PCR strategies weakly dominated the single RT-PCR strategy and that the thresholds for more intensive RT-PCR testing decreased as the prevalence of infection increased.

CONCLUSION

Based on TTP, the single RT-PCR strategy is never preferred. If the cost of RT-PCR testing is of concern, a staged approach involving initial testing of all returning students followed by a repeat testing decision based on the measured prevalence of infection might be considered.

Health care provider use of motivational interviewing to address vaccine hesitancy in college students

BACKGROUND

Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.

LOCAL PROBLEM

Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.

METHODS

This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.

RESULTS

Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.

CONCLUSION

MI can be an effective part of a strategy to increase vaccination rates.

Awareness of H1N1 influenza among Pakistani pharmacy students

Aim — This study was aimed to investigate knowledge and attitudes of H1N1 influenza among pharmacy students. Material and Methods — A cross-sectional study was carried out among undergraduate and postgraduate students of the Punjab University College of Pharmacy, University of the Punjab, Lahore from February-May 2018. A self-administered questionnaire was used to evaluate knowledge and attitudes of H1N1 influenza. All data were analyzed using SPSS 22. Results — The median age of study participants (N=420) was 20 years, with majority of females (72.4%), undergraduate students (96.7%) belonging to middle economic class (89.8%). The median knowledge score was 18, with 38.1% having poor, 55.7% moderate and 6.2% excellent knowledge score (score <17, 17-25, and 26-34, respectively). The median attitude score was 47 (9); around 52% of the participants were found to have positive attitudes. Initially, there was a significant difference of knowledge score, not attitude, among age categories. However, in post hoc analysis, after Bonferroni adjustment (P<0.017), individuals > 26 years of age had better knowledge scores than 21-25 years (p=0.015) and ≤20 years (p=0.005) age categories. Gender had no significant influence on the knowledge as well as attitude score. Futhermore, postgraduate students had signifcanlty better knowledge scores, not attitude, than undergraduates (p=0.002). Conclusions — Our findings highlight the need to equip pharmacy students with comprehensive knowledge of H1N1 influenza so that in future they can help increase the public awareness at community pharmacies, hospitals or the communities they reside.

Immune Modulatory Effects of Vitamin D on Viral Infections

Viral infections have been a cause of mortality for several centuries and continue to endanger the lives of many, specifically of the younger population. Vitamin D has long been recognized as a crucial element to the skeletal system in the human body. Recent evidence has indicated that vitamin D also plays an essential role in the immune response against viral infections and suggested that vitamin D deficiency increases susceptibility to viral infections as well as the risk of recurrent infections. For instance, low serum vitamin D levels were linked to increased occurrence of high burdens viral diseases such as hepatitis, influenza, Covid-19, and AIDS. As immune cells in infected patients are responsive to the ameliorative effects of vitamin D, the beneficial effects of supplementing vitamin D-deficient individuals with an infectious disease may extend beyond the impact on bone and calcium homeostasis. Even though numerous studies have highlighted the effect of vitamin D on the immune cells, vitamin D's antiviral mechanism has not been fully established. This paper reviews the recent mechanisms by which vitamin D regulates the immune system, both innate and adaptive systems, and reflects on the link between serum vitamin D levels and viral infections.

Travel health risk perceptions of Chinese international students in Australia - Implications for COVID-19

BACKGROUND

International students frequently return to their country of origin to visit friends and relatives (VFR), and are at increased risk of travel-associated infections. Little is known of their travel health seeking behaviours. China is the biggest source of international students studying in Australia and the unprecedented epidemic of COVID-19 in China makes this an important area of research.

METHODS

Focus groups of Chinese international students were conducted to explore travel health-related knowledge, attitudes and practices. Eligible participants were studying in Sydney, and had travelled to China and Hong Kong to visit friends and relatives in the preceding 18 months. A variety of topics were explored, using a focus group guide. Thematic analysis was undertaken on the transcripts using nVivo software. The list of codes and themes were not pre-determined but developed through content analysis.

RESULTS

Two focus groups were held with a total of 28 participants. Risk perception about VFR travel was generally low among Chinese international students. Pre-travel healthcare was not sought. Students strongly relied on the Internet, social media, parents and friends in China for travel health advice.

CONCLUSION

This research provides insights into Chinese international students as VFR travellers. It confirms students could be a risk population for importations of infections such as COVID-19 because of low risk perception and lack of seeking travel health advice. This can inform health promotion strategies for students.

Attractive Flu Shot: A Behavioral Approach to Increasing Influenza Vaccination Uptake Rates

Background. We suggest and examine a behavioral approach to increasing seasonal influenza vaccine uptake. Our idea combines behavioral effects generated by a dominated option, together with more traditional tools, such as providing information and recommendations. Methods. Making use of the seasonal nature of the flu, our treatments present participants with 2 options to receive the shot: early in the season, which is recommended and hence "attractive," or later. Three additional layers are examined: 1) mentioning that the vaccine is more likely to run out of stock late in the season, 2) the early shot is free while the late one costs a fee, and 3) the early shot carries a monetary benefit. We compare vaccination intentions in these treatments to those of a control group who were invited to receive the shot regardless of timing. Results. Using a sample of the Israeli adult population (n = 3271), we found positive effects of all treatments on vaccination intentions, and these effects were significant for 3 of the 4 treatments. In addition, the vast majority of those who are willing to vaccinate intend to get the early shot. Conclusions. Introducing 2 options to get vaccinated against influenza (early or late) positively affects intentions to receive the flu shot. In addition, this approach nudges participants to take the shot in early winter, a timing that has been shown to be more cost-effective.

Effects of Patient-Centered Communication on Influenza Vaccination and Self-Reported General Health Status among Asian Americans: A Comparison Model for Young/Middle-Aged and Older Adults

Objectives: Asian American subgroups’ influenza vaccination is still below the US standards. This study examined the effects of patient-centered communication (PCC) on influenza vaccination and the general health (GH) of Chinese, Vietnamese, and Korean Americans. A group difference between younger and older adults was investigated. Methods: The 2014–2016 California Health Interview Surveys were merged (Chinese [ N = 1,680], Korean [ N = 514], and Vietnamese [ N = 644]; age 18+; younger = 1,629 and older = 1,209). Two path models (PCC [measured by physicians’ careful listening], vaccination, and GH; PCC [measured by physicians’ clear explanation], vaccination, and GH) were evaluated. Regression maximum likelihood was applied for missing values. Results: Both the first and second models showed good model fit scores (comparative fit index [CFI] = .95, root mean square error of approximation [RMSEA] = .04, and standardized root mean residual [SRMR] = .03; CFI = .93, RMSEA = .04, and SRMR = .03). There were direct effects of PCC on vaccination among younger adults. PCC directly influenced GH for both age-groups. Discussion: A PCC manual for physicians in local or community health centers could enhance both younger and older adults’ influenza vaccination.

T-bet+ Memory B Cells Link to Local Cross-Reactive IgG upon Human Rhinovirus Infection

Human rhinoviruses cause the common cold and exacerbate chronic respiratory diseases. Although infection elicits neutralizing antibodies, these do not persist or cross-protect across multiple rhinovirus strains. To analyze rhinovirus-specific B cell responses in humans, we developed techniques using intact RV-A16 and RV-A39 for high-throughput high-dimensional single-cell analysis, with parallel assessment of antibody isotypes in an experimental infection model. Our approach identified T-bet+ B cells binding both viruses that account for ∼5% of CXCR5- memory B cells. These B cells infiltrate nasal tissue and expand in the blood after infection. Their rapid secretion of heterotypic immunoglobulin G (IgG) in vitro, but not IgA, matches the nasal antibody profile post-infection. By contrast, CXCR5+ memory B cells binding a single virus are clonally distinct, absent in nasal tissue, and secrete homotypic IgG and IgA, mirroring the systemic response. Temporal and spatial functions of dichotomous memory B cells might explain the ability to resolve infection while rendering the host susceptible to re-infection.

Community health workers on a college campus: Effects on influenza vaccination

OBJECTIVE

To assess the impact of a campus community health worker program (HealthPALs) on student influenza vaccination.

PARTICIPANTS

Undergraduate students at a northeastern US university (enrollment 6650), influenza seasons 2011-2012 through 2015-2016.

METHODS

Study design: Difference-in-differences analysis of student vaccination at campus dormitory influenza clinics during intervention vs. baseline.

INTERVENTION

In the first intervention year, HealthPALs conducted in-person peer outreach at several campus dormitory flu clinics. Subsequent years, HealthPALs conducted an enhanced intervention, with the addition of a personalized, dormitory-specific social media campaign appealing to students' community identity.

RESULTS

The initial intervention increased vaccinations by 66% (IRR = 1.66, 95%CI 1.39-1.97) at intervention clinics relative to control. The enhanced intervention increased vaccinations by 85% (IRR = 1.85, 95%CI 1.75-1.96).

CONCLUSION

Community health workers can be a highly effective, low-cost strategy for increasing influenza vaccination among college students. This model could also be used to address other campus health challenges where student engagement is key.

How can the health belief model and self-determination theory predict both influenza vaccination and vaccination intention ? A longitudinal study among university students

Background and objective Seasonal influenza is frequent among students and often responsible for impaired academic performance and lower levels of general health. However, the vaccination rate in this population is very low. As the seasonal influenza vaccine is not compulsory in France, it is important to improve the vaccination uptake by identifying predictors of both intention and behaviour. This study investigated the effect of decisional balance, motivation and self-efficacy on vaccination acceptance using the Extended Health Belief Model (HBM) and Self-Determination Theory (SDT). Design and Main Outcome Measures University students were invited to fill in an online survey to answer questions about their influenza vaccination intention, and HBM and SDT constructs. A one-year longitudinal follow-up study investigated vaccination behaviour. Results Autonomous motivation and self-efficacy significantly influenced the intention to have the influenza vaccine, and vaccine behaviour at one-year follow-up. Intention predicted a significant proportion of variation (51%) in behaviour, and mediated the effect of these predictors on vaccination behaviour. Conclusion These results suggest that motivation concepts of the Self-Determination Theory can be adequately combined with the Health Belief Model to understand vaccination behaviour.

Rhinovirus viremia in adult patients with high viral load in bronchoalveolar lavages

BACKGROUND

In children, rhinovirus viremia has been associated with higher nasopharyngeal loads and increase in severity of clinical signs and symptoms.

OBJECTIVES

This study aims to detect rhinovirus viremia in adult patients and to establish potential correlations with the clinical course.

STUDY DESIGN

Adult patients with rhinovirus strongly positive bronchoalveolar lavages (BAL, quantitation cycle, Cq values <25) detected between 2008 and 2014 were studied retrospectively. Blood sampled between two weeks before and two weeks after BAL sampling was tested for rhinovirus RNA. Underlying conditions, symptoms, radiography, microbiological data, and disease outcome were analysed.

RESULTS

Twenty-seven of 43 patients with rhinovirus positive BAL at Cq values <25 had blood samples available within the prespecified time-frame (mean blood 3-4 samples per patient). Four of these 27 patients (15%) tested rhinovirus RNA positive in their blood (of whom one patient twice). Genotyping demonstrated rhinovirus A01, A24, B52 and B92 in these four immunocompromised patients. Viremic patients were not significantly different with regard to underlying conditions, respiratory symptoms, radiological findings, co-pathogens nor the number of blood samples tested for RV. However, patients with rhinovirus viremia had significant higher mortality rates compared to patients without viremia, as all four died as a consequence of respiratory problems (100%) versus 22% (5/23), p=0.007 (Fisher's exact).

CONCLUSIONS

Rhinovirus viremia can occur in adult patients with a high viral load in BAL fluid. Rhinovirus viremia may be considered a negative prognostic factor, although a causative role with regard to the adverse outcome has yet to be demonstrated.

Freshman Flu Vaccination Behavior and Intention During a Nonpandemic Season

Objective. To examine predictors of flu vaccination and vaccination intention among college freshmen during a nonpandemic influenza season using the health belief model (HBM). Participants. A total of 184 college freshmen at a single institution participated in a mixed-mode (paper or online) survey in October-November 2015. Method. Flu vaccination and intention to vaccinate were predicted using binomial logistic regression on HBM constructs (perceived susceptibility, severity, benefits, barriers, cues to action, and availability), prior flu vaccination history, family and peer reference behaviors, and demographics. Results. Overall, 31.5% of participants received the seasonal flu vaccine by mid-November, and 25% intended to receive it. In full models, history of past flu vaccination (adjusted odds ratio [aOR] = 7.90; 95% confidence interval [CI] = 2.55-24.49) was significant for vaccination while availability (aOR = 2.00; 95% CI = 1.32-3.01) and family intention (aOR = 250.59; 95% CI = 3.77 to >999) were positively associated with intent to vaccinate. Significant confounding by past behavior and family intentions existed for both outcomes. Conclusions. Past flu vaccination behavior and family member intentions to vaccinate were better predictors of annual flu vaccination behavior and intention than HBM constructs among college freshmen. College campuses may enhance flu vaccine coverage by highlighting benefits and availability to students and families.

Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017

When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).

Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017

When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).

Common Cold - an Umbrella Term for Acute Infections of Nose, Throat, Larynx and Bronchi

Acute respiratory tract infections, i. e. rhinitis, sinusitis, pharyngitis, laryngitis, bronchitis, belong to the most common medical conditions with a high economic burden. Nonetheless, there is little agreement concerning their differential diagnosis.This paper will discuss to what extent different anatomical sites of acute respiratory tract infections can be uniquely identified or whether the overlap and consecutive development in signs and symptoms renders these distinctions meaningless.Acute respiratory tract infections are variable but definition of diagnostic categories based on the anatomical sites of the dominant complaints shows that signs and symptoms both overlap to a great extent and/or emerge successively. Thus, in common cold distinguishing between acute symptom-based diagnoses arising from different anatomical sites of the aerodigestive system remains elusive. Therefore, preferred symptomatic treatments should foster a resolution of all possible symptoms as opposed to an isolated treatment of a single symptom (e. g. mucus hypersecretion) according to the presumed anatomical site (i. e. acute bronchitis).

Factors affecting the willingness of nursing students to receive annual seasonal influenza vaccination: A large-scale cross-sectional study

Nursing students are at high risk of exposure to vaccine-preventable diseases such as seasonal influenza. However, due to the limited number of studies conducted in this area, the prevalence and factors affecting annual seasonal influenza vaccination (ASIV) uptake remain unclear. This was a large-scale cross-sectional survey study conducted among 902 nursing students in different years of study. The questionnaire was developed based on the Health Belief Model (HBM), and logistic regression was used to determine the predictors of ASIV uptake. The results of our study reveal that only 15.2% of nursing students declared having the vaccine in the previous year, and that ASIV uptake was self-reported. ASIV uptake was associated with perceived susceptibility (odds ratio=2.76), perceived seriousness (odds ratio=2.06) and perceived barriers (odds ratio=0.50). The odds of receiving ASIV were 17.96times higher for those participants having had ASIV at least once than those who had not received ASIV in the previous five years. In addition, the odds of receiving ASIV were 4.01times higher for master's than undergraduate students. Our study concludes that the ASIV uptake among nursing students is low. In order to increase vaccination uptake in subsequent years, future studies should promote vaccination based on HBM, focusing on nursing students in undergraduate studies by emphasizing not only vaccination knowledge, but also their social responsibility to protect patients. Influenza vaccination can be viewed as an ethical professional responsibility and a patient safety issue, as well as being an infection control strategy.

Task Engagement and Attentional Resources

OBJECTIVE

Two studies tested multivariate models of relationships between subjective task engagement and vigilance. The second study included a stress factor (cold infection). Modeling tested relationships between latent factors for task engagement and vigilance, and the role of engagement in mediating effects of cold infection.

BACKGROUND

Raja Parasuraman's research on vigilance identified several key issues, including the roles of task factors, arousal processes, and individual differences, within the framework of resource theory. Task engagement is positively correlated with performance on various attentional tasks and may serve as a marker for resource availability.

METHOD

In the first study, 229 participants performed simultaneous and successive vigilance tasks. In the second study, 204 participants performed a vigilance task and a variable-foreperiod simple reaction-time task on two separate days. On the second day, 96 participants performed while infected with a naturally occurring common cold. Task engagement was assessed in both studies.

RESULTS

In both studies, vigilance decrement in hit rate was observed, and task performance led to loss of task engagement. Cold infection also depressed both vigilance and engagement. Fitting structural equation models indicated that simultaneous and successive tasks should be represented by separate latent factors (Study 1), and task engagement fully mediated the impact of cold infection on vigilance but not reaction time (Study 2).

CONCLUSIONS

Modeling individual differences in task engagement elucidates the role of resources in vigilance and underscores the relevance of Parasuraman's vision of the field.

APPLICATION

Assessment of task engagement may support diagnostic monitoring of operators performing tasks requiring vigilance.

Respiratory Diseases in University Students Associated with Exposure to Residential Dampness or Mold

University students are frequently exposed to residential dampness or mold (i.e., visible mold, mold odor, dampness, or water leaks), a well-known contributor to asthma, allergic rhinitis, and respiratory infections. This study aims to: (a) describe the prevalence of these respiratory diseases among university students; and (b) examine the independent contribution of residential dampness or mold to these diseases. An online survey was conducted in March 2014 among the 26,676 students registered at the Université de Sherbrooke (Quebec, Canada). Validated questions and scores were used to assess self-reported respiratory diseases (i.e., asthma-like symptoms, allergic rhinitis, and respiratory infections), residential dampness or mold, and covariates (e.g., student characteristics). Using logistic regressions, the crude and adjusted odd ratios between residential dampness or mold and self-reported respiratory diseases were examined. Results from the participating students (n = 2097; response rate: 8.1%) showed high prevalence of allergic rhinitis (32.6%; 95% CI: 30.6–34.7), asthma-like symptoms (24.0%; 95% CI: 22.1–25.8) and respiratory infections (19.4%; 95% CI: 17.7–21.2). After adjustment, exposure to residential dampness or mold was associated with allergic rhinitis (OR: 1.25; 95% CI: 1.01–1.55) and asthma-like symptoms (OR: 1.70; 95% CI: 1.37–2.11), but not with respiratory infections (OR: 1.07; 95% CI: 0.85–1.36). Among symptomatic students, this exposure was also associated with uncontrolled and burdensome respiratory symptoms (p < 0.01). University students report a high prevalence of allergic rhinitis, asthma-like symptoms and respiratory infections. A common indoor hazard, residential dampness or mold, may play a role in increasing atopic respiratory diseases and their suboptimal control in young adults. These results emphasize the importance for public health organizations to tackle poor housing conditions, especially amongst university students who should be considered “at-risk”.

Barriers Associated with Seasonal Influenza Vaccination among College Students

Influenza can spread rapidly on college campuses because of high-density living conditions and frequent social interactions. However, seasonal influenza vaccination rates on college campuses are low. The purpose of this study is to identify barriers associated with receipt of the seasonal influenza vaccination. Questionnaires were completed by a convenience sample of 383 undergraduate students in January 2014. Data were analyzed to identify barriers associated with receiving the seasonal influenza vaccine. Only 20.6% of students reported receiving the vaccine within the last 6 months. Among students who did not receive the vaccine, 47.8% believed they would get influenza from the vaccine, 41.6% believed the vaccination may have dangerous side effects, and 39.6% believed they were not at risk for contracting influenza. The majority of nonvaccinated students did not believe cost of the vaccine or access to the vaccine were barriers. Many college students are not receiving the seasonal influenza vaccine, representing an important area for improvement. Understanding potential barriers associated with receipt of this vaccine is important for identifying and creating effective public health education programs and campaigns. There is a need for enhanced vaccination education efforts among college students, particularly with respect to the safety and importance of this vaccine.

Serotype and genetic diversity of human rhinovirus strains that circulated in Kenya in 2008

Background

Human rhinoviruses (HRVs) are a well‐established cause of the common cold and recent studies indicated that they may be associated with severe acute respiratory illnesses (SARIs) like pneumonia, asthma, and bronchiolitis. Despite global studies on the genetic diversity of the virus, the serotype diversity of these viruses across diverse geographic regions in Kenya has not been characterized.

Objectives

This study sought to characterize the serotype diversity of HRV strains that circulated in Kenya in 2008.

Methods

A total of 517 archived nasopharyngeal samples collected in a previous respiratory virus surveillance program across Kenya in 2008 were selected. Participants enrolled were outpatients who presented with influenza‐like (ILI) symptoms. Real‐time RT‐PCR was employed for preliminary HRV detection. HRV‐positive samples were amplified using RT‐PCR and thereafter the nucleotide sequences of the amplicons were determined followed by phylogenetic analysis.

Results

Twenty‐five percent of the samples tested positive for HRV. Phylogenetic analysis revealed that the Kenyan HRVs clustered into three main species comprising HRV‐A (54%), HRV‐B (12%), and HRV‐C (35%). Overall, 20 different serotypes were identified. Intrastrain sequence homology among the Kenyan strains ranged from 58% to 100% at the nucleotide level and 55% to 100% at the amino acid level.

Conclusion

These results show that a wide range of HRV serotypes with different levels of nucleotide variation were present in Kenya. Furthermore, our data show that HRVs contributed substantially to influenza‐like illness in Kenya in 2008.

Economic and Social Impact of Pertussis Among Adolescents in San Diego County

PURPOSE

During recent pertussis epidemics, adolescents have experienced a large burden of disease. We assessed the impact of pertussis among San Diego adolescents and their households.

METHODS

Parents of pertussis patients aged 13-17 years were surveyed about health care utilization, missed work and school, and other factors. Costs of medical visits, medication use, and lost wages were estimated.

RESULTS

The parents of 53 (of 108 [49%]) eligible 2013 pertussis patients were interviewed; 51 (96%) of these patients previously received tetanus, diphtheria, and acellular pertussis vaccine. Medical visits included primary care (81%), urgent care (11%), and emergency department (9%); all patients received antibiotics. Forty-seven households (89%) received a post-exposure prophylaxis recommendation, and five (9%) reported ≥1 unpaid parental leave day. Thirty-eight patients (72%) missed ≥1 school day (mean = 5.4 days). Societal costs were estimated at $315.15 per household and $236,047.35 in San Diego during 2013-2014.

CONCLUSIONS

Even among vaccinated adolescents, pertussis can result in considerable societal costs.