1
|
Fitero A, Bungau SG, Tit DM, Endres L, Khan SA, Bungau AF, Romanul I, Vesa CM, Radu AF, Tarce AG, Bogdan MA, Nechifor AC, Negrut N. Comorbidities, Associated Diseases, and Risk Assessment in COVID-19-A Systematic Review. Int J Clin Pract 2022; 2022:1571826. [PMID: 36406478 PMCID: PMC9640235 DOI: 10.1155/2022/1571826] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
It is considered that COVID-19's pandemic expansion is responsible for the particular increase in deaths, especially among the population with comorbidities. The health system is often overwhelmed by the large number of cases of patients addressing it, by the regional limitation of funds, and by the gravity of cases at subjects suffering from this pathology. Several associated conditions including diabetes, cardiovascular illnesses, obesity, persistent lung condition, neurodegenerative diseases, etc., increase the mortality risk and hospitalization of subjects suffering from COVID-19. The rapid identification of patients with increased risk of death from the SARS-CoV-2 virus, the stratification in accordance with the risk and the allocation of human, financial, and logistical resources in proportion must be a priority for health systems worldwide.
Collapse
Affiliation(s)
- Andreea Fitero
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Laura Endres
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Shamim Ahmad Khan
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | | | - Ioana Romanul
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | - Andrei-Flavius Radu
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| | | | - Mihaela Alexandra Bogdan
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410028, Romania
| | - Aurelia Cristina Nechifor
- Analytical Chemistry and Environmental Engineering Department, Polytechnic University of Bucharest, Bucharest 011061, Romania
| | - Nicoleta Negrut
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea 410073, Romania
| |
Collapse
|
2
|
Sharif N, Opu RR, Ahmed SN, Sarkar MK, Jaheen R, Daullah MU, Khan S, Mubin M, Rahman H, Islam F, Haque N, Islam S, Khan FB, Haque N, Ayman U, Shohael AM, Dey SK, Talukder AA. Prevalence and impact of comorbidities on disease prognosis among patients with COVID-19 in Bangladesh: A nationwide study amid the second wave. Diabetes Metab Syndr 2021; 15:102148. [PMID: 34186349 PMCID: PMC8236060 DOI: 10.1016/j.dsx.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Socio-demographics and comorbidities are involved in determining the severity and fatality in patients with COVID-19 suggested by studies in various countries, but study in Bangladesh is insufficient. AIMS We designed the study to evaluate the association of sociodemographic and comorbidities with the prognosis of adverse health outcomes in patients with COVID-19 in Bangladesh. METHODS A multivariate retrospective cohort study was conducted on data from 966 RT-PCR positive patients from eight divisions during December 13, 2020, to February 13, 2021. Variables included sociodemographic, comorbidities, symptoms, Charlson comorbidity index (CCI) and access to health facilities. Major outcome was fatality. Secondary outcomes included hospitalization, duration of hospital stay, requirement of mechanical ventilation and severity. RESULTS Male (65.8%, 636 of 966) was predominant and mean age was 39.8 ± 12.6 years. Fever (79%), dry cough (55%), and loss of test/smell (51%) were frequent and 74% patients had >3 symptoms. Fatality was recorded in 10.5% patients. Comorbidities were found in 44% patients. Hypertension (21.5%) diabetes (14.6%), and cardiovascular diseases (11.3%) were most prevalent. Age >60 years (OR: 4.83, 95% CI: 2.45-6.49), and CCI >3 (OR: 5.48, 95% CI: 3.95-7.24) were predictors of hospitalizations. CCI >4 (aOR: 3.41, 95% CI: 2.57-6.09) was predictor of severity. Age >60 years (aOR: 3.77, 95% CI: 1.07-6.34), >3 symptoms (aOR: 2.14, 95% CI: 0.97-4.91) and CCI >3 vs. CCI <3 (aOR: 5.23, 95% CI: 3.77-8.09) were independently associated with fatality. CONCLUSIONS Increased age, >3 symptoms, increasing comorbidities, higher CCI were associated with increased hospitalization, severity and fatality in patients with COVID-19.
Collapse
Affiliation(s)
- Nadim Sharif
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Rubayet Rayhan Opu
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Shamsun Nahar Ahmed
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Mithun Kumar Sarkar
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Raisah Jaheen
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Muktasid Ud Daullah
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Shahriar Khan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Mir Mubin
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Habibur Rahman
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Faiza Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Nusaira Haque
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Suchana Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Fariha Bushra Khan
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Nabila Haque
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Umme Ayman
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Abdullah Mohammad Shohael
- Department of Biotechnology and Genetic Engineering, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Shuvra Kanti Dey
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Ali Azam Talukder
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
| |
Collapse
|
3
|
Satia I, Adatia A, Cusack RP, Greene JM, O'Byrne PM, Killian KJ, Johnston N. Influence of age, sex and respiratory viruses on the rates of emergency department visits and hospitalisations with respiratory tract infections, asthma and COPD. ERJ Open Res 2021; 7:00053-2021. [PMID: 34046485 PMCID: PMC8141702 DOI: 10.1183/23120541.00053-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023] Open
Abstract
Background The importance of age, sex and respiratory virus prevalence in emergency department (ED) visits and hospitalisations for respiratory tract infections (RTIs), asthma and COPD in a whole population over time is not well established. Methods This study retrospectively analysed data for daily ED visits and hospitalisations from 2003 to 2013 in Ontario, Canada and the daily number of virus positive tests. Daily numbers of ED visits and hospitalisations with RTIs, asthma and COPD listed as a primary diagnosis were collected from the Canadian Institute for Health Information. Virus data were obtained from the Respiratory Virus Detection Surveillance System. Multiple linear regression was used to assess the association of individual viruses with the daily rates. Results There were 4 365 578 ED visits and 321 719 (7.4%) admissions for RTIs, 817 141 ED visits and 260 665 (31.9%) admissions for COPD and 649 666 ED visits and 68 626 (10.6%) admissions for asthma. Respiratory syncytial virus and influenza A were associated with male ED visits, whereas human rhinovirus was associated with female ED visits for RTIs in preschool children. 19.2% of males, but only 7.2% of females were admitted. The correlation between the prevalence of each virus and ED visits and hospitalisations for asthma was weak, irrespective of age group and sex. Influenza A was most strongly associated with COPD ED visits and hospitalisations in males and females. Conclusions There are significant age and sex differences in the contribution of respiratory viruses to the number of ED visits and hospitalisations for RTIs, asthma and COPD. There are important age- and sex-related differences in the contribution of respiratory viruses to the number of ED visits and hospitalisations for respiratory tract infections, asthma and COPDhttps://bit.ly/39hrhIW
Collapse
Affiliation(s)
- Imran Satia
- Dept of Medicine, McMaster University, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada.,Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,These authors contributed equally
| | - Adil Adatia
- Dept of Medicine, McMaster University, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada.,These authors contributed equally
| | - Ruth P Cusack
- Dept of Medicine, McMaster University, Hamilton, Canada
| | | | - Paul M O'Byrne
- Dept of Medicine, McMaster University, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | | | - Neil Johnston
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| |
Collapse
|
4
|
Schofield C, Colombo RE, Richard SA, Chen WJ, Fairchok MP, Maves RC, Arnold JC, Danaher PJ, Deiss RG, Lalani T, Rajnik M, Millar EV, Coles CL, Burgess TH. Comparable Disease Severity by Influenza Virus Subtype in the Acute Respiratory Infection Consortium Natural History Study. Mil Med 2021; 185:e1008-e1015. [PMID: 32588899 DOI: 10.1093/milmed/usaa120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Since the influenza A/H1N1 pandemic of 2009 to 2010, numerous studies have described the clinical course and outcome of the different subtypes of influenza (A/H1N1, A/H3N2, and B). A recent systematic literature review concluded that there were no appreciable differences in either clinical presentation or disease severity among these subtypes, but study parameters limit the applicability of these results to military populations. We sought to evaluate differences in disease severity among influenza subtypes in a cohort of healthy, primarily outpatient adult U.S. Department of Defense beneficiaries. MATERIALS AND METHODS From 2009 to 2014, we enrolled otherwise healthy adults age 18 to 65 years with influenza-like illness in an observational cohort study based in 5 U.S. military medical centers. Serial nasopharyngeal swabs were collected for determination of etiology and viral shedding by polymerase chain reaction. The presence and severity of symptoms was assessed by interview and patient diary. RESULTS Over a 5-year period, a total of 157 adults with laboratory-confirmed influenza and influenza subtype were enrolled. Of these, 69 (44%) were positive for influenza A(H1N1), 69 (44%) for influenza A(H3N2), and 19 (12%) for influenza B. About 61% were male, 64% were active duty military personnel, and 72% had received influenza vaccine in the past 8 months. Almost 10% were hospitalized with influenza. Seasonal influenza virus distribution among enrollees mirrored that of nationwide trends each year of study. Individuals with A/H1N1 had upper respiratory composite scores that were lower than those with A/H3N2. Multivariate models indicated that individuals with A(H1N1) and B had increased lower respiratory symptom scores when compared to influenza A(H3N2) (A[H1N1]: 1.51 [95% CI 0.47, 2.55]; B: 1.46 [95% CI 0.09, 2.83]), whereas no other differences in symptom severity scores among influenza A(H1N1), influenza A(H3N2), and influenza B infection were observed. Overall, influenza season (maximum in 2012-2013 season) and female sex of the participant were found to be associated with increased influenza symptom severity. CONCLUSIONS Our study of influenza in a cohort of otherwise healthy, outpatient adult Department of Defense beneficiaries over 5 influenza seasons revealed few differences between influenza A(H1N1), influenza A(H3N2), and influenza B infection with respect to self-reported disease severity or clinical outcomes. This study highlights the importance of routine, active, and laboratory-based surveillance to monitor ongoing trends and severity of influenza in various populations to inform prevention measures.
Collapse
Affiliation(s)
- Christina Schofield
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431
| | - Rhonda E Colombo
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431.,Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Stephanie A Richard
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Wei-Ju Chen
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Mary P Fairchok
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431.,Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Ryan C Maves
- Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - John C Arnold
- Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Patrick J Danaher
- Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78234
| | - Robert G Deiss
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088.,Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Tahaniyat Lalani
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088.,Infectious Disease Division, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708
| | - Michael Rajnik
- Division of Infectious Disease, Walter Reed National Military Medical Center, 4494 Palm Rd N, Bethesda, MD 20889
| | - Eugene V Millar
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Christian L Coles
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Timothy H Burgess
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088
| |
Collapse
|
5
|
Lehmann HC, Schoser B, Wunderlich G, Berlit P, Fink GR. [Neuromuscular complications of SARS-CoV-2 infection-Part 2: muscle disorders]. DER NERVENARZT 2021; 92:548-555. [PMID: 33779772 PMCID: PMC8005661 DOI: 10.1007/s00115-021-01093-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 01/08/2023]
Abstract
Neben Störungen und Erkrankungen peripherer Nerven sind in den letzten Monaten im Zusammenhang mit COVID-19 („coronavirus disease 2019“) auch Begleitsymptome und Störungen der Muskulatur bzw. der neuromuskulären Transmission beschrieben worden. Im zweiten Teil unserer Zusammenfassung geben wir eine Übersicht über häufig berichtete Symptome wie Myalgien und definierte Erkrankungen wie Rhabdomyolysen, Myositiden, Myasthenie und „intensive care unit acquired weakness“ (ICUAW), die im Rahmen eine SARS-CoV-2(„severe acute respiratory syndrome coronavirus 2“)-Infektion bzw. COVID-19 beschrieben wurden. Darüber hinaus werden Kriterien für eine Kausalität wie Effektstärke, Plausibilität, Zeitverlauf und experimentelle Evidenz für einen kausalen Zusammenhang der in beiden Teilen der Übersicht beschriebenen COVID-19 assoziierten neuromuskulären Erkrankungen diskutiert. Zum jetzigen Zeitpunkt sind – neben der auch in der Laienpresse bekannten Geruchssinnstörung – vor allem Myalgien als unspezifisches Symptom häufige Folge einer symptomatischen SARS-CoV‑2 Infektion. Andere neuromuskuläre Komplikationen erscheinen hinsichtlich ihrer Pathogenese prinzipiell plausibel, aber offenbar selten Folge einer SARS-CoV-2-Infektion zu sein. Prospektive bzw. Kohortenstudien sind notwendig, um eine Kausalität zu bestätigen und das Risiko abzuschätzen.
Collapse
Affiliation(s)
- Helmar C Lehmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Benedikt Schoser
- LMU Klinikum, Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Gilbert Wunderlich
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.,Zentrum für Seltene Erkrankungen, Universitätsklinikum Köln, Köln, Deutschland
| | - Peter Berlit
- Deutsche Gesellschaft für Neurologie (DGN), Berlin, Deutschland
| | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.,Institut für Neurowissenschaften (INM-3), Forschungszentrum Jülich, Jülich, Deutschland
| |
Collapse
|
6
|
Hussain M, Iltaf S, Salman S, Ghuman F, Abbas S, Fatima M. Frequency of Comorbidities in Admitting COVID-19 Pneumonia Patients in a Tertiary Care Setup: An Observational Study. Cureus 2021; 13:e13546. [PMID: 33815969 PMCID: PMC8007124 DOI: 10.7759/cureus.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The novel coronavirus disease 2019 (COVID-19) is a highly infectious and pandemic disease with a variable mode of action. Patients with underlying illnesses such as diabetes, hypertension, and other diseases are more prone to infection. An understanding of the different comorbidities that place patients at the highest risk of COVID-19 pneumonia and other fatal complications associated with COVID-19 is necessary for healthcare professionals. This study aimed to determine the frequency of different comorbid illnesses among COVID-19 patients admitted to a tertiary care hospital in Karachi, Pakistan. Methodology All patients diagnosed with COVID-19 who required admission for the care of their symptoms were included in this observational, cross-sectional study conducted from May 1 to July 30, 2020. The patients were treated at a specialized COVID-19 isolation ward built at the Dow University of Health Sciences at the Ojha campus. The patients were referred from the emergency department, medical and allied wards, and COVID-19 screening units. A detailed history and clinical examination were performed, and comorbidities were evaluated. Results A total of 212 patients were admitted during the study with a mean age of 52 ± 16 years. The study population consisted of 120 (56.6%) males and 92 (43.39%) females, and the most common comorbidities were uncontrolled diabetes with hypertension (n = 56; 26.4%), controlled diabetes (n = 22; 10.37%), obstructive airway disease (n = 16; 7.5%), and interstitial lung disease (n = 14; 6.6%). A total of 48 (22.64%) patients had no comorbidities. Conclusions Most COVID-19-positive patients with pneumonia were male, and common comorbidities included uncontrolled diabetes, hypertension, and obstructive and restrictive lung disease. The presence of comorbidities was associated with a marked increase in the risk of morbidity and mortality. Further studies are warranted to confirm these findings.
Collapse
Affiliation(s)
- Muneer Hussain
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Samar Iltaf
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Salma Salman
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Faiza Ghuman
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Saira Abbas
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Meraj Fatima
- Neurology, Dow University of Health Sciences, Karachi, PAK
| |
Collapse
|
7
|
Gok M, Cetinkaya H, Kandemir T, Karahan E, Tuncer İB, Bukrek C, Sahin G. Chronic kidney disease predicts poor outcomes of COVID-19 patients. Int Urol Nephrol 2021; 53:1891-1898. [PMID: 33394281 PMCID: PMC7780605 DOI: 10.1007/s11255-020-02758-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
Purpose The recent outbreak of COVID-19 rapidly spread worldwide. Comorbid diseases are determinants of the severity of COVID-19 infection and mortality. The aim of this study was to explore the potential association between chronic kidney disease (CKD) and the severity of COVID-19 infection. Methods The study included 609 consecutive adult patients (male: 54.52%, mean age: 59.23 ± 15.55 years) hospitalized with the diagnosis of COVID-19 in a tertiary level hospital. Data were collected from the electronic health records of the hospital. The patients were separated into two groups: Group I included COVID-19-positive patients with CKD stage 1–2, and Group II included COVID-19-positive with CKD stage 3–5. The relationships were examined between CKD stage, laboratory parameters and mortality. Results Significant differences were determined between the groups in respect of the inflammation parameters and the parameters used in prognosis. In Group II, statistically significantly higher rates were determined of comorbid diseases [hypertension (p < 0.001) and diabetes mellitus (p < 0.001), acute kidney injury (AKI), which was found to be associated with mortality (p < 0.001), and mortality (p < 0.001)]. In multivariate regression analysis, CKD stage 3–5, AKI, male gender, hypertension, DM and malignancy were found to be significant independent variables increasing mortality. Conclusion The prevelance of CKD stage 3–5 on admission is associated with a high risk of in-hospital mortality in patients with COVID-19. Close follow-up can be recommended for patients with a reduced glomerular filtration rate (GFR).
Collapse
Affiliation(s)
- Mahmut Gok
- Nephrology Department, Sultan Abdulhamid Han Training Hospital, Istanbul, Turkey.
| | - Hakki Cetinkaya
- Nephrology Department, Sultan Abdulhamid Han Training Hospital, Istanbul, Turkey
| | - Tugba Kandemir
- Internal Medicine Department, Sultan Abdulhamid Han Training Hospital, Istanbul, Turkey
| | - Erdem Karahan
- Internal Medicine Department, Sultan Abdulhamid Han Training Hospital, Istanbul, Turkey
| | - İzzet Burak Tuncer
- Internal Medicine Department, Sultan Abdulhamid Han Training Hospital, Istanbul, Turkey
| | - Cengiz Bukrek
- Internal Medicine Department, Sultan Abdulhamid Han Training Hospital, Istanbul, Turkey
| | - Gulizar Sahin
- Nephrology Department, Sultan Abdulhamid Han Training Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
Bashir S, Moneeba S, Alghamdi A, Alghamdi F, Niaz A, Anan H, Kaleem I. Comorbidities in Patients with COVID-19 and Their Impact on the Severity of the Disease. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2020. [DOI: 10.1055/s-0040-1718848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractInfection with COVID-19 is associated with significant morbidity, especially in patients with chronic medical conditions. At least one-fifth of cases require supportive care in intensive care units, which have limited availability in most developing countries. A literature search was conducted on PubMed, Medline, Scopus, Embase, and Google Scholar to find articles published by May 7, 2020 on the role of comorbidities in patients with COVID-19 and the impact of comorbidities on the disease. This review highlighted that patients with comorbidities are more likely to experience severe disease than those with no other conditions; that is, comorbidities correlated with greater disease severity in patients with COVID-19. Proper screening of COVID-19 patients should include careful inquiries into their medical history; this will help healthcare providers identify patients who are more likely to develop serious disease or experience adverse outcomes. Better protection should also be given to patients with COVID-19 and comorbidities upon confirmation of the diagnosis. This literature review showed that the comorbidities most often associated with more severe cases of COVID-19 are hypertension, cardiovascular disease, and diabetes. Individuals with these comorbidities should adopt restrictive measures to prevent exposure to COVID-19, given their higher risk of severe disease.
Collapse
Affiliation(s)
- Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Sadaf Moneeba
- Department of Bioinformatics and Biotechnology, International Islamic University Islamabad, Islamabad, Pakistan
| | - Alaa Alghamdi
- King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fouad Alghamdi
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Asim Niaz
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Hadeel Anan
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Imdad Kaleem
- Department of Bioinformatics and Biosciences, COMSATS University (CUI), Islamabad, Pakistan
| |
Collapse
|
9
|
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, Liu XQ, Chen RC, Tang CL, Wang T, Ou CQ, Li L, Chen PY, Sang L, Wang W, Li JF, Li CC, Ou LM, Cheng B, Xiong S, Ni ZY, Xiang J, Hu Y, Liu L, Shan H, Lei CL, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Cheng LL, Ye F, Li SY, Zheng JP, Zhang NF, Zhong NS, He JX. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020; 55:13993003.00547-2020. [PMID: 32217650 PMCID: PMC7098485 DOI: 10.1183/13993003.00547-2020] [Citation(s) in RCA: 2093] [Impact Index Per Article: 523.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. Objective To evaluate the risk of serious adverse outcomes in patients with COVID-19 by stratifying the comorbidity status. Methods We analysed data from 1590 laboratory confirmed hospitalised patients from 575 hospitals in 31 provinces/autonomous regions/provincial municipalities across mainland China between 11 December 2019 and 31 January 2020. We analysed the composite end-points, which consisted of admission to an intensive care unit, invasive ventilation or death. The risk of reaching the composite end-points was compared according to the presence and number of comorbidities. Results The mean age was 48.9 years and 686 (42.7%) patients were female. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached the composite end-points. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD (HR (95% CI) 2.681 (1.424–5.048)), diabetes (1.59 (1.03–2.45)), hypertension (1.58 (1.07–2.32)) and malignancy (3.50 (1.60–7.64)) were risk factors of reaching the composite end-points. The hazard ratio (95% CI) was 1.79 (1.16–2.77) among patients with at least one comorbidity and 2.59 (1.61–4.17) among patients with two or more comorbidities. Conclusion Among laboratory confirmed cases of COVID-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes. The presence and number of comorbidities predict clinical outcomes of COVID-19http://bit.ly/3b9ibw5
Collapse
Affiliation(s)
- Wei-Jie Guan
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Wen-Hua Liang
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Yi Zhao
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Heng-Rui Liang
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Zi-Sheng Chen
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,The sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China.,These authors are joint first authors
| | - Yi-Min Li
- Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Qing Liu
- Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ru-Chong Chen
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chun-Li Tang
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Tao Wang
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ping-Yan Chen
- State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ling Sang
- Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian-Fu Li
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cai-Chen Li
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Min Ou
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bo Cheng
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shan Xiong
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Jie Xiang
- Wuhan Jin-yintan Hospital, Wuhan, China
| | - Yu Hu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Liu
- Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Hong Shan
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chun-Liang Lei
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | | | - Li Wei
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
| | - Yong Liu
- Chengdu Public Health Clinical Medical Center, Chengdu, China
| | - Ya-Hua Hu
- Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China
| | - Peng Peng
- Wuhan Pulmonary Hospital, Wuhan, China
| | - Jian-Ming Wang
- Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Ji-Yang Liu
- The First Hospital of Changsha, Changsha, China
| | - Zhong Chen
- The Third People's Hospital of Hainan Province, Sanya, China
| | - Gang Li
- Huanggang Central Hospital, Huanggang, China
| | | | - Shao-Qin Qiu
- The Third People's Hospital of Yichang, Yichang, China
| | - Jie Luo
- Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China
| | | | - Shao-Yong Zhu
- The People's Hospital of Huangpi District, Wuhan, China
| | - Lin-Ling Cheng
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Shi-Yue Li
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jin-Ping Zheng
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Nuo-Fu Zhang
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jian-Xing He
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | |
Collapse
|
10
|
Yu X, Sun X, Cui P, Pan H, Lin S, Han R, Jiang C, Fang Q, Kong D, Zhu Y, Zheng Y, Gong X, Xiao W, Mao S, Jin B, Wu H, Fu C. Epidemiological and clinical characteristics of 333 confirmed cases with coronavirus disease 2019 in Shanghai, China. Transbound Emerg Dis 2020; 67:1697-1707. [PMID: 32351037 PMCID: PMC7267440 DOI: 10.1111/tbed.13604] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/30/2020] [Accepted: 04/25/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease first identified in Wuhan City, Hubei Province, China. As of 19 February 2020, there had been 333 confirmed cases reported in Shanghai, China. This study elaborates on the epidemiological and clinical characteristics of COVID-19 based on a descriptive study of the 333 patients infected with COVID-19 in Shanghai for the purpose of probing into this new disease and providing reference. Among the 333 confirmed cases in Shanghai, 172 (51.7%) were males and 161 (48.3%) were females, with a median age of 50 years. 299 (89.8%) cases presented mild symptoms. 139 (41.7%) and 111 (33.3%) cases were infected in Wuhan and Shanghai, respectively. 148 (44.4%) cases once had contact with confirmed cases before onset, while 103 (30.9%) cases had never contacted confirmed cases but they had a sojourn history in Wuhan. The onset date of the first case in Shanghai was 28 December, with the peak appearing on 27 January. The median incubation period of COVID-19 was estimated to be 7.2 days. 207 (62.2%) cases had fever symptoms at the onset, whereas 273 (82.0%) cases experienced fever before hospitalization. 56 (18.6%) adults experienced a decrease in white blood cell and 84 (42.9%) had increased C-reactive protein after onset. Elderly, male and heart disease history were risk factors for severe or critical pneumonia. These findings suggest that most cases experienced fever symptoms and had mild pneumonia. Strengthening the health management of elderly men, especially those with underlying diseases, may help reduce the incidence of severe and critical pneumonia. Time intervals from onset to visit, hospitalization and diagnosis confirmed were all shortened after Shanghai's first-level public health emergency response. Shanghai's experience proves that COVID-19 can be controlled well in megacities.
Collapse
Affiliation(s)
- Xiao Yu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiaodong Sun
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Peng Cui
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Hao Pan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Sheng Lin
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ruobing Han
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chenyan Jiang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qiwen Fang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Dechuan Kong
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yiyi Zhu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yaxu Zheng
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xiaohuan Gong
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Wenjia Xiao
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Shenghua Mao
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Bihong Jin
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huanyu Wu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chen Fu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| |
Collapse
|
11
|
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, Liu XQ, Chen RC, Tang CL, Wang T, Ou CQ, Li L, Chen PY, Sang L, Wang W, Li JF, Li CC, Ou LM, Cheng B, Xiong S, Ni ZY, Xiang J, Hu Y, Liu L, Shan H, Lei CL, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Cheng LL, Ye F, Li SY, Zheng JP, Zhang NF, Zhong NS, He JX. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020. [PMID: 32217650 DOI: 10.1183/13993003.00547‐2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) outbreak is evolving rapidly worldwide. OBJECTIVE To evaluate the risk of serious adverse outcomes in patients with COVID-19 by stratifying the comorbidity status. METHODS We analysed data from 1590 laboratory confirmed hospitalised patients from 575 hospitals in 31 provinces/autonomous regions/provincial municipalities across mainland China between 11 December 2019 and 31 January 2020. We analysed the composite end-points, which consisted of admission to an intensive care unit, invasive ventilation or death. The risk of reaching the composite end-points was compared according to the presence and number of comorbidities. RESULTS The mean age was 48.9 years and 686 (42.7%) patients were female. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached the composite end-points. 399 (25.1%) reported having at least one comorbidity. The most prevalent comorbidity was hypertension (16.9%), followed by diabetes (8.2%). 130 (8.2%) patients reported having two or more comorbidities. After adjusting for age and smoking status, COPD (HR (95% CI) 2.681 (1.424-5.048)), diabetes (1.59 (1.03-2.45)), hypertension (1.58 (1.07-2.32)) and malignancy (3.50 (1.60-7.64)) were risk factors of reaching the composite end-points. The hazard ratio (95% CI) was 1.79 (1.16-2.77) among patients with at least one comorbidity and 2.59 (1.61-4.17) among patients with two or more comorbidities. CONCLUSION Among laboratory confirmed cases of COVID-19, patients with any comorbidity yielded poorer clinical outcomes than those without. A greater number of comorbidities also correlated with poorer clinical outcomes.
Collapse
Affiliation(s)
- Wei-Jie Guan
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Wen-Hua Liang
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Yi Zhao
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Heng-Rui Liang
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,These authors are joint first authors
| | - Zi-Sheng Chen
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,The sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China.,These authors are joint first authors
| | - Yi-Min Li
- Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Qing Liu
- Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ru-Chong Chen
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chun-Li Tang
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Tao Wang
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Li Li
- State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ping-Yan Chen
- State Key Laboratory of Organ Failure Research, Dept of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Ling Sang
- Dept of Pulmonary and Critical Care Medicine, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian-Fu Li
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cai-Chen Li
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li-Min Ou
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bo Cheng
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shan Xiong
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Jie Xiang
- Wuhan Jin-yintan Hospital, Wuhan, China
| | - Yu Hu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Liu
- Shenzhen Third People's Hospital, Shenzhen, China.,The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Hong Shan
- The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chun-Liang Lei
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | | | - Li Wei
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China
| | - Yong Liu
- Chengdu Public Health Clinical Medical Center, Chengdu, China
| | - Ya-Hua Hu
- Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China
| | - Peng Peng
- Wuhan Pulmonary Hospital, Wuhan, China
| | - Jian-Ming Wang
- Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Ji-Yang Liu
- The First Hospital of Changsha, Changsha, China
| | - Zhong Chen
- The Third People's Hospital of Hainan Province, Sanya, China
| | - Gang Li
- Huanggang Central Hospital, Huanggang, China
| | | | - Shao-Qin Qiu
- The Third People's Hospital of Yichang, Yichang, China
| | - Jie Luo
- Affiliated Taihe Hospital of Hubei University of Medicine, Shiyan, China
| | | | - Shao-Yong Zhu
- The People's Hospital of Huangpi District, Wuhan, China
| | - Lin-Ling Cheng
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Shi-Yue Li
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jin-Ping Zheng
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Nuo-Fu Zhang
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Nan-Shan Zhong
- State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Jian-Xing He
- Dept of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | |
Collapse
|
12
|
Post-pandemic influenza A/H1N1pdm09 is associated with more severe outcomes than A/H3N2 and other respiratory viruses in adult hospitalisations. Epidemiol Infect 2019; 147:e310. [PMID: 31775940 PMCID: PMC7003621 DOI: 10.1017/s095026881900195x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2–5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6–5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47–0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.
Collapse
|
13
|
Clinical and Epidemiological Profile of Pandemic Influenza A H1N1, H3N2, and Type B in the Southeast of Caspian Sea, Iran. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.35616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
14
|
Ambrozaitis A, Radzišauskienė D, Žagminas K, Kuprevičienė N, Gravenstein S, Jančorienė L. Influenza A(H1N1)pdm09 and postpandemic influenza in Lithuania. Open Med (Wars) 2016; 11:341-353. [PMID: 28352819 PMCID: PMC5329851 DOI: 10.1515/med-2016-0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/01/2016] [Indexed: 12/25/2022] Open
Abstract
The objective of this study is to describe the clinical and epidemiological characteristics of patients hospitalized in Lithuania who are infected with influenza A(H1N1)pdm09 and to compare pandemic A(H1N1) pdm09 infection with postpandemic. In total, 146 subjects hospitalized with influenza A(H1N1) pdm09 were identified from 2009–2011. There were 53 during the initial pandemic wave in the summer of 2009, 69 during the peak pandemic period, and 24 during the “postpandemic” period that we included in this study. There were 22 subjects who died after laboratory confirmation of influenza A(H1N1)pdm09. No deaths were documented during the first wave. Subjects presenting during the peak of pandemic influenza had a greater incidence of fever (100% vs 77.4%; p<0.001), dry cough (95.7% vs 82.7%; p=0.01), and vomiting (26.1% vs 1.9%, p<0.001) as compared with patients infected during the first wave. The rate of bacterial pneumonia was 18.8% (13/69) during the peak pandemic period and 12.5% (3/24, p=0.754) during the postpandemic period. None of the postpandemic influenza subjects’ intensive care unit stays were due to pneumonia. The hospitalized early 2009 H1N1 pandemic cases and postpandemic cases were milder compared with those at the peak of pandemic activity.
Collapse
Affiliation(s)
- Arvydas Ambrozaitis
- Department of Infectious, Chest Diseases Dermatovenereology and Allergology, Vilnius University, Lithuania , Vilnius, LT-08117
| | - Daiva Radzišauskienė
- Department of Infectious, Chest Diseases Dermatovenereology and Allergology, Vilnius University, Lithuania , Vilnius, LT-08117
| | - Kęstutis Žagminas
- Public Health Institute, Vilnius University, Lithuania , Vilnius, LT-03101
| | | | - Stefan Gravenstein
- University Hospitals-Case Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America and Warren Alpert Medical School of Brown University
| | - Ligita Jančorienė
- Department of Infectious, Chest Diseases Dermatovenereology and Allergology, Vilnius University, Lithuania , Vilnius, LT-08117
| |
Collapse
|
15
|
Leung MK, You JHS. Cost-effectiveness of an influenza vaccination program offering intramuscular and intradermal vaccines versus intramuscular vaccine alone for elderly. Vaccine 2016; 34:2469-76. [PMID: 27079928 DOI: 10.1016/j.vaccine.2016.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/19/2016] [Accepted: 04/04/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Intradermal (ID) injection is an alternative route for influenza vaccine administration in elderly with potential improvement of vaccine coverage. This study aimed to investigate the cost-effectiveness of an influenza vaccination program offering ID vaccine to elderly who had declined intramuscular (IM) vaccine from the perspective of Hong Kong public healthcare provider. METHODS A decision analytic model was used to simulate outcomes of two programs: IM vaccine alone (IM program), and IM or ID vaccine (IM/ID program) in a hypothetic cohort of elderly aged 65 years. Outcome measures included influenza-related direct medical cost, infection rate, mortality rate, quality-adjusted life years (QALYs) loss, and incremental cost per QALY saved (ICER). Model inputs were derived from literature. Sensitivity analyses evaluated the impact of uncertainty of model variables. RESULTS In base-case analysis, the IM/ID program was more costly (USD52.82 versus USD47.59 per individual to whom vaccine was offered) with lower influenza infection rate (8.71% versus 9.65%), mortality rate (0.021% versus 0.024%) and QALYs loss (0.00336 versus 0.00372) than the IM program. ICER of IM/ID program was USD14,528 per QALY saved. One-way sensitivity analysis found ICER of IM/ID program to exceed willingness-to-pay threshold (USD39,933) when probability of influenza infection in unvaccinated elderly decreased from 10.6% to 5.4%. In 10,000 Monte Carlo simulations of elderly populations of Hong Kong, the IM/ID program was the preferred option in 94.7% of time. CONCLUSIONS An influenza vaccination program offering ID vaccine to elderly who had declined IM vaccine appears to be a highly cost-effective option.
Collapse
Affiliation(s)
- Man-Kit Leung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Joyce H S You
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| |
Collapse
|
16
|
Sheu SM, Tsai CF, Yang HY, Pai HW, Chen SCC. Comparison of age-specific hospitalization during pandemic and seasonal influenza periods from 2009 to 2012 in Taiwan: a nationwide population-based study. BMC Infect Dis 2016; 16:88. [PMID: 26911158 PMCID: PMC4765149 DOI: 10.1186/s12879-016-1438-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
Background Determining the age-specific hospitalization burden associated with seasonal influenza and the (H1N1) 2009 pandemic is important for the development of effective vaccine strategies and clinical management. The aim of this study was to investigate age-specific differences in hospitalization rates during the pandemic and seasonal periods. Methods Using the Taiwan National Health Insurance Research Database (NHIRD), we identified hospitalized patients with a principle discharge diagnosis of influenza-related infection (ICD-9-CM 487) between 2009 and 2012. Results Based on the time distribution of influenza-related hospitalizations and previously reported epidemic periods, the first and second waves of the (H1N1) 2009 pandemic (p1 is known as 2009.07-2010.01, and p2 is known as 2010.12-2011.03) and three seasonal periods (s1 is known as 2010.03-2010.11, s2 is known as 2011.10-2012.03, and s3 is known as 2012.04-2012.10) were found. During these five periods, children younger than 7 years of age consistently had the highest hospitalization rate of the studied age groups. In individuals younger than 50 years of age, the seasonal periods were associated with a significantly lower risk of hospitalization than that of p1 (Relative risk (RR) range = 0.18–0.85); however, they had a significantly higher hospitalization risk for adults over 50 years of age (RR = 1.51–3.22). Individuals over 50 years of age also had a higher intensive care unit admission rate and case fatality ratio than individuals under than 50 years of age during the seasonal periods and especially during the pandemic periods. Conclusions In both pandemic and seasonal periods, the highest hospitalization rate was observed for children younger than 7 years of age. Adults over 50 years of age had a higher hospitalization risk during the seasonal periods and a higher clinical severity during the pandemic periods. Those results emphasize that the importance of influenza-related prevention strategies in the younger and older age groups, either seasonal or pandemic periods.
Collapse
Affiliation(s)
- Shew-Meei Sheu
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hsin-Yi Yang
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Hui-Wen Pai
- Department of Geriatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan. .,Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
17
|
Chacon R, Mirza S, Rodriguez D, Paredes A, Guzman G, Moreno L, Then CJ, Jara J, Blanco N, Bonilla L, Clara WA, Minaya P, Palekar R, Azziz-Baumgartner E. Demographic and clinical characteristics of deaths associated with influenza A(H1N1) pdm09 in Central America and Dominican Republic 2009-2010. BMC Public Health 2015; 15:734. [PMID: 26227404 PMCID: PMC4521479 DOI: 10.1186/s12889-015-2064-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 07/16/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The demographic characteristics of pandemic influenza decedents among middle and low-income tropical countries are poorly understood. We explored the demographics of persons who died with influenza A (H1N1)pdm09 infection during 2009-2010, in seven countries in the American tropics. METHODS We used hospital-based surveillance to identify laboratory-confirmed influenza deaths in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and Dominican Republic. An influenza death was defined as a person who died within two weeks of a severe acute respiratory infection (SARI) defined as sudden onset of fever >38 °C, cough or sore-throat, and shortness of breath, or difficulty breathing requiring hospitalization, and who tested positive for influenza A (H1N1)pdm09 virus by real time polymerase chain reaction. We abstracted the demographic and clinical characteristics of the deceased from their medical records. RESULTS During May 2009-June 2010, we identified 183 influenza deaths. Their median age was 32 years (IQR 18-46 years). One-hundred and one (55 %) were female of which 20 (20 %) were pregnant and 7 (7 %) were in postpartum. One-hundred and twelve decedents (61 %) had pre-existing medical conditions, (15 % had obesity, 13 % diabetes, 11 % asthma, 8 % metabolic disorders, 5 % chronic obstructive pulmonary disease, and 10 % neurological disorders). 65 % received oseltamivir but only 5 % received it within 48 h of symptoms onset. CONCLUSIONS The pandemic killed young adults, pregnant women and those with pre-existing medical conditions. Most sought care too late to fully benefit from oseltamivir. We recommend countries review antiviral treatment policies for people at high risk of developing complications.
Collapse
Affiliation(s)
- Rafael Chacon
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala.
| | - Sara Mirza
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA.
| | | | | | | | | | - Cecilia J Then
- Ministry of Health, Dominican Republic, Dominican Republic.
| | - Jorge Jara
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala.
| | - Natalia Blanco
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala.
| | - Luis Bonilla
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Av. 11-95, zona 15, Vista Hermosa III, Guatemala, Guatemala.
| | - Wilfrido A Clara
- Centers for Disease Control and Prevention, Influenza Division, Atlanta, Georgia, USA.
| | - Percy Minaya
- Training of Epidemiology and Public Health Intervention Network, Guatemala, Guatemala.
| | - Rakhee Palekar
- Influenza Group. Pan-American Health Organization, Washington DC, USA.
| | | |
Collapse
|
18
|
Tillekeratne LG, Bodinayake CK, Nagahawatte A, Vidanagama D, Devasiri V, Arachchi WK, Kurukulasooriya R, De Silva AD, Østybe T, Reller ME, Woods CW. An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013. Am J Trop Med Hyg 2015; 92:1023-9. [PMID: 25732679 DOI: 10.4269/ajtmh.14-0708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 01/28/2015] [Indexed: 12/21/2022] Open
Abstract
Influenza accounts for a large burden of acute respiratory tract infections in high-income countries; data from lower-income settings are limited due to lack of confirmatory testing. Consecutive outpatients presenting to the largest tertiary care hospital in southern Sri Lanka were surveyed for influenza-like illness (ILI), defined as acute onset of fever ≥ 38.0°C and cough. Patients were administered a questionnaire and nasal/nasopharyngeal sampling for rapid influenza A/B testing. We enrolled 311 patients with ILI from March to November 2013: 170 (54.7%) children and 172 (55.3%) males. Approximately half (147, 47.3%) tested positive for influenza, but 253 (81.4%) were prescribed antibiotics. On bivariable analysis, symptoms associated with influenza included pain with breathing (P < 0.001), headache (P = 0.005), fatigue (P = 0.003), arthralgias (P = 0.003), and myalgias (P = 0.006) in children and pain with breathing (P = 0.01), vomiting (P = 0.03), and arthralgias (P = 0.03) in adults. Our final clinical predictive models had low sensitivity and fair specificity-50.0% (95% CI: 38.6-61.4%) and 83.2% (95% CI: 73.4-90.0%), respectively, in children and 52.2% (95% CI: 39.9-64.2%) and 81.4% (95% CI: 70.0-89.4%), respectively, in adults. Our study confirms the ability of rapid influenza testing to identify an influenza epidemic in a setting in which testing is not routinely available.
Collapse
Affiliation(s)
- L Gayani Tillekeratne
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Champica K Bodinayake
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Ajith Nagahawatte
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Dhammika Vidanagama
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Vasantha Devasiri
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Wasantha Kodikara Arachchi
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Ruvini Kurukulasooriya
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Aruna Dharshan De Silva
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Truls Østybe
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Megan E Reller
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| | - Christopher W Woods
- Duke Global Health Institute, Durham, North Carolina; Departments of Medicine, Microbiology, and Pediatrics, Faculty of Medicine, Ruhuna University, Galle, Sri Lanka; Teaching Hospital Karapitiya, Galle, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Duke University, Durham, North Carolina
| |
Collapse
|
19
|
Exploring national surveillance for health-related workplace absenteeism: lessons learned from the 2009 influenza A pandemic. Disaster Med Public Health Prep 2015; 7:160-6. [PMID: 24618167 DOI: 10.1017/dmp.2013.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND During the 2009 influenza A (H1N1) virus pandemic, the Centers for Disease Control and Prevention did a pilot study to test the feasibility of using national surveillance of workplace absenteeism to assess the pandemic's impact on the workplace to plan for preparedness and continuity of operations and to contribute to health awareness during the emergency response. METHODS Population-based and sentinel worksite approaches were used. Monthly measures of the 1-week prevalence of health-related absenteeism among full-time workers were estimated using nationally representative data from the Current Population Survey. Enhanced passive surveillance of absenteeism was conducted using weekly data from a convenience sample of sentinel worksites. RESULTS Nationally, the pandemic's impact on workplace absenteeism was small. Estimates of 1-week absenteeism prevalence did not exceed 3.7%. However, peak workplace absenteeism was correlated with the highest occurrence of both influenza-like illness and influenza-positive laboratory tests. CONCLUSIONS Systems for monitoring workplace absenteeism should be included in pandemic preparedness planning.
Collapse
|
20
|
Rabagliati R, Labarca J, Siri L, Perez CM, Ferres M. Rates of Hospital-Acquired Influenza Due to the Pandemic H1N1 Virus in 2009, Compared with Seasonal Influenza. Infect Control Hosp Epidemiol 2015; 32:198-200. [DOI: 10.1086/657913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
21
|
Postpandemic Influenza A/H1N1pdm09 is still Causing Severe Perinatal Complications. Mediterr J Hematol Infect Dis 2015; 7:e2015007. [PMID: 25574366 PMCID: PMC4283922 DOI: 10.4084/mjhid.2015.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/26/2014] [Indexed: 12/05/2022] Open
Abstract
Although influenza A/H1N1pdm09 is not causing a pandemic anymore, we recently observed two critically ill pregnant women infected by this virus. We present these cases to illustrate the possible severe complications of an – at that moment – seasonal influenza in pregnancy. We discuss the epidemiological differences between the pandemic and post pandemic phase and try to explain the high virulence of influenza A/H1N1pdm09 -infections in pregnancy by discussing insights in immunology during pregnancy. We conclude that although influenza A/H1N1pdm09 is in the post pandemic phase, infection by this influenza virus still needs to be considered in pregnant women with progressive respiratory dysfunction.
Collapse
|
22
|
Ailes EC, Newsome K, Williams JL, McIntyre AF, Jamieson DJ, Finelli L, Honein MA. CDC Pregnancy Flu Line: monitoring severe illness among pregnant women with influenza. Matern Child Health J 2014; 18:1578-82. [PMID: 24368408 PMCID: PMC4498262 DOI: 10.1007/s10995-013-1415-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Centers for Disease Control and Prevention implemented the Pregnancy Flu Line (PFL) during the influenza A(H1N1)pdm09 (pH1N1) pandemic and continued operation through the 2010-2011 influenza season to collect reports of intensive care unit (ICU) admissions and deaths among pregnant women with influenza. The system documented the severe impact of influenza on pregnant women during both seasons with 181 ICU/survivals and 37 deaths reported during the 2009 fall pandemic wave and 69 ICU/survivals and ten deaths reported in the subsequent influenza season (2010-2011). A health department survey suggests PFL participants perceived public health benefits and minimum time burdens.
Collapse
Affiliation(s)
- Elizabeth C. Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Kimberly Newsome
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Jennifer L. Williams
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Anne F. McIntyre
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Denise J. Jamieson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Lyn Finelli
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Margaret A. Honein
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| |
Collapse
|
23
|
Influenza epidemiology and vaccine effectiveness among patients with influenza-like illness, viral watch sentinel sites, South Africa, 2005-2009. PLoS One 2014; 9:e94681. [PMID: 24736452 PMCID: PMC3988097 DOI: 10.1371/journal.pone.0094681] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background There is limited data on the epidemiology of influenza and few published estimates of influenza vaccine effectiveness (VE) from Africa. In April 2009, a new influenza virus strain infecting humans was identified and rapidly spread globally. We compared the characteristics of patients ill with influenza A(H1N1)pdm09 virus to those ill with seasonal influenza and estimated influenza vaccine effectiveness during five influenza seasons (2005–2009) in South Africa. Methods Epidemiological data and throat and/or nasal swabs were collected from patients with influenza-like illness (ILI) at sentinel sites. Samples were tested for seasonal influenza viruses using culture, haemagglutination inhibition tests and/or polymerase chain reaction (PCR) and for influenza A(H1N1)pdm09 by real-time PCR. For the vaccine effectiveness (VE) analysis we considered patients testing positive for influenza A and/or B as cases and those testing negative for influenza as controls. Age-adjusted VE was calculated as 1-odds ratio for influenza in vaccinated and non-vaccinated individuals. Results From 2005 through 2009 we identified 3,717 influenza case-patients. The median age was significantly lower among patients infected with influenza A(H1N1)pdm09 virus than those with seasonal influenza, 17 and 27 years respectively (p<0.001). The vaccine coverage during the influenza season ranged from 3.4% in 2009 to 5.1% in 2006 and was higher in the ≥50 years (range 6.9% in 2008 to 13.2% in 2006) than in the <50 years age group (range 2.2% in 2007 to 3.7% in 2006). The age-adjusted VE estimates for seasonal influenza were 48.6% (4.9%, 73.2%); −14.2% (−9.7%, 34.8%); 12.0% (−70.4%, 55.4%); 67.4% (12.4%, 90.3%) and 29.6% (−21.5%, 60.1%) from 2005 to 2009 respectively. For the A(H1N1)pdm09 season, the efficacy of seasonal vaccine was −6.4% (−93.5%, 43.3%). Conclusion Influenza vaccine demonstrated a significant protective effect in two of the five years evaluated. Low vaccine coverage may have reduced power to estimate vaccine effectiveness.
Collapse
|
24
|
Wong VWY, Fong DYT, Tarrant M. Brief education to increase uptake of influenza vaccine among pregnant women: a study protocol for a randomized controlled trial. BMC Pregnancy Childbirth 2014; 14:19. [PMID: 24423245 PMCID: PMC3898030 DOI: 10.1186/1471-2393-14-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Pregnant women are the highest priority group for annual influenza vaccination. Studies have shown unacceptably low uptake of both seasonal and pandemic A/H1N1 influenza vaccination among pregnant women. This paper will describe the study protocol and methodology of a randomised controlled trial designed to assess the effectiveness of a brief educational intervention in improving the uptake of seasonal influenza vaccine among pregnant women in Hong Kong. Methods A randomised controlled trial will be conducted with pregnant women in at least the second trimester of pregnancy from four publicly funded hospital antenatal clinics in Hong Kong. Participants will be randomly assigned to either one of the two treatment groups: standard care (control) or standard care plus brief education (intervention). Pregnant women in the standard care group will receive the usual antenatal care with an educational pamphlet developed by the Hong Kong Centre for Health Protection and those in the intervention group will be provided with usual care plus a brief ten-minute education intervention. Content of the education session will cover four core components recommended in the research literature. The primary study outcome will be the proportion of participants who have received influenza vaccine during their pregnancy. A total of 184 pregnant women (92 per group) will be required to give an 80% power to detect a treatment effect of 15%. Discussion Most intervention studies aimed at improving influenza vaccination rates in pregnant women have targeted obstetric-care providers and the results of the two patient-oriented RCT interventions are conflicting. The high priority for vaccination given to pregnant women and the low influenza vaccination rate among pregnant women worldwide strongly indicates a need for interventions to improve uptake. Trial registration This trial is registered with the Clinical Trials Registry at www.clinicaltrials.gov(NCT01772901).
Collapse
Affiliation(s)
| | | | - Marie Tarrant
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China.
| |
Collapse
|
25
|
Angkasekwinai N, Kaewnapha B, Waywa D, Werarak P, Tongsai S, Chokephaibulkit K, Thamlikitkul V, Siritantikorn S. Serological response of patients with influenza A (H1N1) pdm09-associated pneumonia: an observational study. PLoS One 2013; 8:e81436. [PMID: 24312299 PMCID: PMC3842268 DOI: 10.1371/journal.pone.0081436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/13/2013] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the dynamics or magnitude of antibody response in patients with influenza A (H1N1) pdm09-associated pneumonia. We described and compared the antibody response to influenza A (H1N1) pdm09 in patients with and without pneumonia. Methods We collected serum samples and determined antibody titers by the hemagglutination inhibition (HI) and microneutralization (mNT) assays from patients with RT-PCR confirmed influenza A (H1N1) pdm09 virus at baseline, 1, 2 and 6 months after onset of illness. Results Fifty-nine patients were enrolled, 45 (76.3%) were between 15 and 60 years of age, 49 (83.1%) were hospitalized and 25 (42.4%) had complications with pneumonia. Ninety-four percent of patients had HI titers ≥ 1: 40 and 90% had mNT titers ≥ 1: 160 at 2 months after illness. Geometric mean titers (GMT) of HI and mNT increased significantly (p<0.001) between baseline and months 1 or 2, then declined significantly (p<0.001) at month 6 by the HI assay, but dropped to an insignificant level (p=0.24) by the mNT assay. The mNT-GMT was at least twice as high as corresponding HI antibodies over a 6 month period. The GMT of HI and mNT in those with pneumonia (1 mo) peaked earlier than that of those without pneumonia (2 mo). When adjusted by age and gender, those with pneumonia had a higher HI-GMT than those without pneumonia at 1 month (264 vs. 117, p=0.007), 2 months (212 vs. 159, p=0.013), and 6 months (160 vs. 82, p=0.018). Conclusions The patients recovered from influenza A (H1N1) pdm09-associated pneumonia, clearly developed an earlier and more robust antibody response until 6 months after onset of illness. The results in our study are useful to determine an appropriate donor and timing to obtain convalescent plasma for adjunctive treatment of seriously ill patients with pandemic H1N1 influenza.
Collapse
Affiliation(s)
- Nasikarn Angkasekwinai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Bualan Kaewnapha
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Duangdao Waywa
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerawong Werarak
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasima Tongsai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visanu Thamlikitkul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sontana Siritantikorn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
26
|
Purakayastha DR, Gupta V, Broor S, Sullender W, Fowler K, Widdowson MA, Lal RB, Krishnan A. Clinical differences between influenza A (H1N1) pdm09 & influenza B infections identified through active community surveillance in North India. Indian J Med Res 2013; 138:962-8. [PMID: 24521643 PMCID: PMC3978989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND & OBJECTIVES Most studies on the clinical presentation with influenza viruses have been conducted in outpatient or inpatient medical facilities with only a few studies in community settings. Clinical differences between influenza A (H1N1) pdm 09 and influenza B virus infections have importance for community-based public health surveillance. An active community surveillance at the time of emergence of pandemic influenza provided us with an opportunity to compare the clinical features among patients infected with influenza A (H1N1) pdm09 virus and those with influenza B virus co-circulating in an active community-based weekly surveillance in three villages in Faridabad, Haryana, north India. METHODS Active surveillance for febrile acute respiratory infection (FARI) was carried out in a rural community (n=16,182) in the context of an inactivated trivalent influenza vaccine trial (among children <11 yr). Individuals with FARI were assessed clinically by nurses and respiratory samples collected and tested for influenza viruses by real time RT-PCR from November 2009 to August 2010. Clinical symptoms of patients with influenza A (H1N1) pdm 09 and influenza B infection were compared. RESULTS Of the 4796 samples tested, 822 (17%) were positive for influenza virus. Of these, 443 (54%) were influenza A (H1N1) pdm09, 373 (45%) were influenza B and six were other subtypes/mixed infections. The mean age was lower for patients with influenza B (16.4 yr) than influenza A (H1N1) pdm09 infection (18.7 yr; P=0.04). Among children aged 5-18 yr, chills/rigours (OR 4.0; CI 2.2, 7.4), sore throat (OR 6.8; CI 2.3, 27.3) and headache (OR2.0; CI 1.3, 3.3) were more common in influenza A (H1N1) pdm09 infection than in influenza B cases. Chills/rigours (OR 2.4; CI 1.4, 4.0) and headache (OR 1.7; CI 1.0, 2.7) were associated with influenza A (H1N1) pdm09 infection in those >18 yr. No significant differences were seen in children <5 yr. CONCLUSION Our findings show that the differences in the clinical presentation of influenza A(H1N1)pdm09 and influenza B infections are not likely to be of clinical or public health significance.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Anand Krishnan
- Department of Microbiology, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
27
|
Mitchell R, Taylor G, McGeer A, Frenette C, Suh KN, Wong A, Katz K, Wilkinson K, Amihod B, Gravel D. Understanding the burden of influenza infection among adults in Canadian hospitals: a comparison of the 2009-2010 pandemic season with the prepandemic and postpandemic seasons. Am J Infect Control 2013; 41:1032-7. [PMID: 24176768 DOI: 10.1016/j.ajic.2013.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND The degree to which the 2009-2010 influenza pandemic season differed from previous and subsequent influenza seasons in Canadian hospitals has not yet been assessed. METHODS Surveillance for laboratory-confirmed influenza among adults in 51 Canadian Nosocomial Infection Surveillance Program hospitals was conducted between November 1, 2006, and May 31, 2011. Inpatient characteristics, treatment, and outcomes of influenza cases in the pandemic season (2009-2010) were compared with those in the prepandemic (2006-2007 to 2008-2009) and postpandemic (2010-2011) seasons. RESULTS The incidence of influenza infection was lower in the postpandemic season (1.59/1,000 admissions) compared with the prepandemic seasons (2.00/1,000 admissions; P < .001) and the pandemic season (1.80/1,000 admissions; P < .001). The proportion of cases classified as health care-associated was much smaller during the pandemic season (6.6%) than in either the prepandemic season (23.2%; P < .001) or the postpandemic season (23.6%; P < .001). Inpatients in the pandemic season were significantly younger compared with those in the prepandemic and postpandemic seasons (P < .001). Inpatients in the pandemic season were less likely to have been vaccinated (P < .001), but more likely to be treated with antiviral agents (P < .001), than inpatients in both the prepandemic and postpandemic seasons. Intensive care unit admission was greater during the pandemic season, but there were no significant differences in 30-day mortality among the seasons. CONCLUSIONS Among adult inpatients, the pH1N1 pandemic season differed from seasonal influenza in terms of age, vaccination status, antiviral use, and intensive care unit admission, but not in terms of 30-day mortality.
Collapse
Affiliation(s)
- Robyn Mitchell
- Public Health Agency of Canada, Centre for Communicable Diseases and Infection Control, Ottawa, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Bhandari R, Hartley TA, Lindsley WG, Fisher MA, Palmer JE. Assessing Healthcare Utilization for Influenza-like Illness at an Emergency Department and a Student Health Service during the 2009-2010 H1N1 Pandemic. Infect Dis (Lond) 2013; 6:15-23. [PMID: 24847173 PMCID: PMC3988625 DOI: 10.4137/idrt.s11315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Estimates of healthcare utilization during an influenza pandemic are needed in order to plan for the allocation of staff and resources. The aim of this study was to assess the number, age, and arrival time of patients with influenza-like-illness (ILI), and associations between their symptoms during the 2009-2010 H1N1 pandemic. We conducted a cross-sectional analysis of electronic health records from the student health service (SHS) and an emergency department (ED) in Morgantown, West Virginia, between January 2009 and December 2010. During the 2009-2010 H1N1 pandemic, patient arrivals at SHS and ED varied over the week. SHS patients arrived early in the week and primarily in the afternoon. ED patient arrivals were more evenly distributed, with busier evenings and weekends. Those with fever were more likely to experience cough, sore throat, vomiting/nausea, chills, congestion, headache, and body-ache. These results can assist health professionals in preparing for an influenza pandemic.
Collapse
Affiliation(s)
- Ruchi Bhandari
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Tara A. Hartley
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - William G. Lindsley
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Melanie A. Fisher
- Global Health Program, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Jan E. Palmer
- WELL WVU—The Students’ Center of Health, Student Health Service, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
29
|
Hsieh YH, Kelen GD, Dugas AF, Chen KF, Rothman RE. Emergency Physicians' Adherence to Center for Disease Control and Prevention Guidance During the 2009 Influenza A H1N1 Pandemic. West J Emerg Med 2013; 14:191-9. [PMID: 23599869 PMCID: PMC3628481 DOI: 10.5811/westjem.2012.11.12246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 09/14/2012] [Accepted: 11/21/2012] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Little is known regarding compliance with management guidelines for epidemic influenza in adult emergency department (ED) settings during the 2009 novel influenza A (H1N1) epidemic, especially in relation to the Centers for Disease Control and Prevention (CDC) guidance. METHODS We investigated all patients with a clinical diagnosis of influenza at an inner-city tertiary academic adult ED with an annual census of approximately 60,000 visits from May 2008 to December 2009. We aimed to determine patterns of presentation and management for adult patients with an ED diagnosis of influenza during the H1N1 pandemic, using seasonal influenza (pre-H1N1) as reference and to determine the ED provider's adherence to American College of Emergency Physicians and CDC guidance during the 2009 H1N1 influenza pandemic. Adherence to key elements of CDC 2009 H1N1 guidance was defined as (1) the proportion of admitted patients who were recommended to receive testing or treatment who actually received testing for influenza or treatment with antivirals; and (2) the proportion of high-risk patients who were supposed to be treated who actually were treated with antivirals. RESULTS Among 339 patients with clinically diagnosed influenza, 88% occurred during the H1N1 pandemic. Patients were similarly managed during both phases. Median length of visit (pre-H1N1: 385 min, H1N1: 355 min, P > 0.05) and admission rates (pre-H1N1: 8%, H1N1: 11%, P > 0.05) were similar between the 2 groups. 28% of patients in the pre-H1N1 group and 16% of patients in the H1N1 group were prescribed antibiotics during their ED visits (P > 0.05). There were 34 admitted patients during the pandemic;, 30 (88%) of them received influenza testing in the ED, and 22 (65%) were prescribed antivirals in the ED. Noticeably, 19 (56%) of the 34 admitted patients, including 6 with a positive influenza test, received antibiotic treatment during their ED stay. CONCLUSION During the recent H1N1 pandemic, most admitted patients received ED diagnostic testing corresponding to the current recommended guidance. Antibiotic treatment for ED patients admitted with suspected influenza is not uncommon. However, less than 70% of admitted patients and less than 50% of high-risk patients were treated with antivirals during their ED visit, indicating a specific call for closer adherence to guidelines in future influenza pandemics.
Collapse
Affiliation(s)
- Yu-Hsiang Hsieh
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | | | | | | | | |
Collapse
|
30
|
Nitsch-Osuch A, Wozniak-Kosek A, Korzeniewski K, Zycinska K, Wardyn K, Brydak LB. Clinical features and outcomes of influenza A and B infections in children. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 788:89-96. [PMID: 23835964 DOI: 10.1007/978-94-007-6627-3_14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The aim of the study was to describe the course of influenza among children aged 0-59 months. A total of 150 children with influenza-like symptoms (ILI): cough, fever >37.8 °C, and sore throat was included into the observation. All children were tested with both rapid influenza detection test (RIDT) BD Directigen™ EZ Flu A+B® and RT-PCR. Sixty four cases of influenza were diagnosed (incidence rate 40 %): 19 (30 %) cases of influenza caused by type B virus and 45 (70 %) cases caused by type A virus. Children with influenza required more often follow up visits (p < 0.05, OR 1.99, 95 % CI 1.03-3.85) and less often were administrated antibiotic therapy (p < 0.05, OR 0.25, 95 % CI 0.04-0.97). The logistic regression analysis revealed that only positive result of rapid influenza detection test, not any of clinical symptoms, could be found as an independent predictor of influenza (OR 4.37, 95 % CI 2.03-9.43). Patients with influenza type A more often reported muscle ache (p < 0.05) and complications (p < 0.05; OR 6.06, 95 % CI 1.20-60.38). Otitis media occurred more often among patients with than without influenza (p < 0.01; OR 15.50, 95 % CI 2.10-688.5). We conclude that although influenza infections among children younger than 59 months were generally mild and self-limited, pediatric burden of the disease was significant.
Collapse
Affiliation(s)
- Aneta Nitsch-Osuch
- Department of Family Medicine, Warsaw Medical University, 1A Banacha St., Bldg. F, 02-097, Warsaw, Poland,
| | | | | | | | | | | |
Collapse
|
31
|
Hansen C, Desai S, Bredfeldt C, Cheetham C, Gallagher M, Li DK, Raebel MA, Riedlinger K, Shay DK, Thompson M, Davis RL. A large, population-based study of 2009 pandemic Influenza A virus subtype H1N1 infection diagnosis during pregnancy and outcomes for mothers and neonates. J Infect Dis 2012; 206:1260-8. [PMID: 22859826 DOI: 10.1093/infdis/jis488] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pregnant women were at increased risk for serious outcomes of 2009 pandemic influenza A virus subtype H1N1 (influenza A[H1N1]pdm09) infection, but little is known about the overall impact of the pandemic on neonatal and maternal outcomes. METHODS We identified live births that occurred from 1 July 2008 through 31 May 2010 in 5 Kaiser Permanente regions. Pregnant women were considered to have influenza if they had a positive result of a laboratory test for influenza virus or if they received a diagnosis of influenza during a period in which seasonal influenza virus or A(H1N1)pdm09 was the predominant circulating virus. RESULTS There were 111 158 births from 109 015 pregnancies involving 107 889 mothers; 368 pregnant women (0.3%) received a diagnosis of influenza due to seasonal virus, and 959 (0.9%) received a diagnosis of influenza due to A(H1N1)pdm09; 107 688 did not receive an influenza diagnosis. Pregnant women with influenza due to A(H1N1)pdm09 were more likely than women with seasonal influenza infection to be hospitalized within 30 days of the diagnosis (27% vs 12%; odds ratio [OR], 2.84 [95% confidence interval {CI}, 2.01-4.02]). Pregnant women with A(H1N1)pdm09 who started antiviral treatment ≥2 days after the diagnosis were significantly more likely to be hospitalized than those who started antiviral treatment <2 days after diagnosis (OR, 3.43 [95% CI, 1.55-7.56]). Mothers with seasonal influenza virus infection had an increased risk for having a small-for-gestational-age infant (OR, 1.59 [95% CI, 1.15-2.20]). CONCLUSIONS In this large, geographically diverse population, A(H1N1)pdm09 infection increased the risk for hospitalization during pregnancy. Late initiation of antiviral treatment was also associated with an increased risk for hospitalization.
Collapse
Affiliation(s)
- Craig Hansen
- Center for Health Research, Kaiser Permanente Georgia, GA 30305, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Snacken R, Quinten C, Devaux I, Plata F, Broberg E, Zucs P, Amato-Gauci A. Surveillance of hospitalised severe cases of influenza A(H1N1)pdm09 and related fatalities in nine EU countries in 2010-2011. Influenza Other Respir Viruses 2012; 6:e93-6. [PMID: 22788875 DOI: 10.1111/j.1750-2659.2012.00406.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A few months into the 2009 influenza pandemic, nine European countries implemented case-based surveillance of hospitalised severe influenza infections. In the present study, we assess the association between patient characteristics, in particular underlying conditions, and the severity level of influenza A(H1N1)pdm09 infection during the 2010-2011 season. Patient age, the presence of underlying conditions, pneumonia, acute respiratory distress syndrome (ARDS) and the need for ventilation were significantly associated with the severity of influenza A(H1N1)pdm09 infection. Despite limitations essentially because of the heterogeneity of the data reported, this study provides insight into severe influenza cases.
Collapse
Affiliation(s)
- René Snacken
- Unit of Surveillance and Response Support, European Centre for Disease Prevention and Control, Stockholm, Sweden.
| | | | | | | | | | | | | |
Collapse
|
33
|
Farooqui A, Leon AJ, Lei Y, Wang P, Huang J, Tenorio R, Dong W, Rubino S, Lin J, Li G, Zhao Z, Kelvin DJ. Heterogeneous virulence of pandemic 2009 influenza H1N1 virus in mice. Virol J 2012; 9:104. [PMID: 22672588 PMCID: PMC3444956 DOI: 10.1186/1743-422x-9-104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 05/10/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Understanding the pathogenesis of influenza infection is a key factor leading to the prevention and control of future outbreaks. Pandemic 2009 Influenza H1N1 infection, although frequently mild, led to a severe and fatal form of disease in certain cases that make its virulence nature debatable. Much effort has been made toward explaining the determinants of disease severity; however, no absolute reason has been established. RESULTS This study presents the heterogeneous virulence of clinically similar strains of pandemic 2009 influenza virus in human alveolar adenocarcinoma cells and mice. The viruses were obtained from patients who were admitted in a local hospital in China with a similar course of infection and recovered. The A/Nanchang/8002/2009 and A/Nanchang/8011/2009 viruses showed efficient replication and high lethality in mice while infection with A/Nanchang/8008/2009 was not lethal with impaired viral replication, minimal pathology and modest proinflammatory activity in lungs. Sequence analysis displayed prominent differences between polymerase subunits (PB2 and PA) of viral genomes that might correlate with their different phenotypic behavior. CONCLUSIONS The study confirms that biological heterogeneity, linked with the extent of viral replication, exists among pandemic H1N1 strains that may serve as a benchmark for future investigations on influenza pathogenesis.
Collapse
Affiliation(s)
- Amber Farooqui
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Division of Experimental Therapeutics, Toronto General Research Institute, University Health Network, 101 College Street, Toronto, ON, M5G 1 L7, Canada
| | - Alberto J Leon
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
- Division of Experimental Therapeutics, Toronto General Research Institute, University Health Network, 101 College Street, Toronto, ON, M5G 1 L7, Canada
| | - Yanchang Lei
- Division of Viral Hepatitis and Liver Failure, Infectious Disease Hospital, Nanchang University, Nanchang 9th Hospital, 167 Hongdu Middle Road, Nanchang, Jiangxi, 330002, China
| | - Pusheng Wang
- Center for Disease Control and Prevention of Shantou, 58 Shanfen Road, Shantou, Guangdong, 515041, China
| | - Jianyun Huang
- Center for Disease Control and Prevention of Shantou, 58 Shanfen Road, Shantou, Guangdong, 515041, China
| | - Raquel Tenorio
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
| | - Wei Dong
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Center for Biotechnology Development and Biodiversity Research, University of Sassari, Sassari, Italy
| | - Jie Lin
- Center for Disease Control and Prevention of Shantou, 58 Shanfen Road, Shantou, Guangdong, 515041, China
| | - Guishuang Li
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
| | - Zhen Zhao
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
| | - David J Kelvin
- Division of Immunology, International Institute of Infection and Immunity, Shantou University Medical College, 22 Xinling Road, Shantou, Guangdong, 515041, China
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
- Division of Experimental Therapeutics, Toronto General Research Institute, University Health Network, 101 College Street, Toronto, ON, M5G 1 L7, Canada
| |
Collapse
|
34
|
Essential role of IL-6 in protection against H1N1 influenza virus by promoting neutrophil survival in the lung. Mucosal Immunol 2012; 5:258-66. [PMID: 22294047 PMCID: PMC3328598 DOI: 10.1038/mi.2012.2] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Influenza virus infection is considered a major worldwide public health problem. Seasonal infections with the most common influenza virus strains (e.g., H1N1) can usually be resolved, but they still cause a high rate of mortality. The factors that influence the outcome of the infection remain unclear. Here, we show that deficiency of interleukin (IL)-6 or IL-6 receptor is sufficient for normally sublethal doses of H1N1 influenza A virus to cause death in mice. IL-6 is necessary for resolution of influenza infection by protecting neutrophils from virus-induced death in the lung and by promoting neutrophil-mediated viral clearance. Loss of IL-6 results in persistence of the influenza virus in the lung leading to pronounced lung damage and, ultimately, death. Thus, we demonstrate that IL-6 is a vital innate immune cytokine in providing protection against influenza A infection. Genetic or environmental factors that impair IL-6 production or signaling could increase mortality to influenza virus infection.
Collapse
|
35
|
Orosi P, Szidor J, Tóthné Tóth T, Kónya J. [A(H1N1)v cases of the 2009/2010 and 2010/2011 influenza seasons in the Medical and Health Sciences Centre of Debrecen University]. Orv Hetil 2012; 153:649-54. [PMID: 22543220 DOI: 10.1556/oh.2012.29329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED The swine-origin new influenza variant A(H1N1) emerged in 2009 and changed the epidemiology of the 2009/2010 influenza season globally and at national level. AIMS The aim of the authors was to analyse the cases of two influenza seasons. METHODS The Medical and Health Sciences Centre of Debrecen University has 1690 beds with 85 000 patients admitted per year. The diagnosis of influenza was conducted using real-time polymerase chain reaction in the microbiological laboratories of the University and the National Epidemiological Centre, according to the recommendation of the World Health Organization. RESULTS The incidence of influenza was not higher than that observed in the previous season, but two high-risk patient groups were identified: pregnant women and patients with immunodeficiency (oncohematological and organ transplant patients). The influenza vaccine, which is free for high-risk groups and health care workers in Hungary, appeared to be effective for prevention, because in the 2010/2011 influenza season none of the 58 patients who were administered the vaccination developed influenza. CONCLUSION It is an important task to protect oncohematological and organ transplant patients.
Collapse
Affiliation(s)
- Piroska Orosi
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Kórházhigiéné és Infekciókontroll Tanszék Debrecen.
| | | | | | | |
Collapse
|
36
|
Simonsen KA, Hunskaar S, Wensaas KA, Rørtveit S, Cox R, Njølstad G, Rortveit G. Influenza-like illness in Norway: clinical course, attitudes towards vaccination and preventive measures during the 2009 pandemic. Fam Pract 2012; 29:139-46. [PMID: 21896504 PMCID: PMC7314038 DOI: 10.1093/fampra/cmr064] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To document clinical characteristics of influenza-like illness, reported use of health preventive measures and attitudes towards vaccination among patients with influenza-like illness in general practice during the influenza pandemic in 2009. METHODS Cross-sectional survey in general practice. Patients, who were identified as having influenza-like illness during the peak of the influenza pandemic activity in Norway, were eligible for inclusion in the study. A questionnaire was sent 2-4 weeks after the patients visit to the GP with influenza-like illness diagnosis during October to December 2009, from general practices in Norway. A sample of responders >18 years also had a blood test to check for serological response to the pandemic H1N1 virus. RESULTS Questionnaires were sent to 1324 patients, and 357 (27%) were returned. Fever (91% versus 49%, P < 0.01), cough (85% versus 73%, P = 0.016) and gastrointestinal symptoms (58% versus 38%, P < 0.01) were more frequent in the age group <18 years compared to older patients. Serological H1N1 responses were analysed in 72 patients; 34 (47%) were positive (haemagglutination inhibition assay titres ≥ 40). There were no statistically significant differences in symptoms between seropositive and seronegative patients. Women reported better adherence to personal protective measures, such as hand washing and cough etiquette than men. Women were also more concerned about possible adverse effects of the pandemic influenza vaccine than men. CONCLUSIONS Discrimination between influenza and other viral upper respiratory tract infections is difficult in daily clinical practice, even during an influenza pandemic. A gender difference was found in reported precautions to prevent influenza.
Collapse
|
37
|
You JHS, Chan ESK, Leung MYK, Ip M, Lee NLS. A cost-effectiveness analysis of "test" versus "treat" patients hospitalized with suspected influenza in Hong Kong. PLoS One 2012; 7:e33123. [PMID: 22479363 PMCID: PMC3315544 DOI: 10.1371/journal.pone.0033123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 02/04/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Seasonal and 2009 H1N1 influenza viruses may cause severe diseases and result in excess hospitalization and mortality in the older and younger adults, respectively. Early antiviral treatment may improve clinical outcomes. We examined potential outcomes and costs of test-guided versus empirical treatment in patients hospitalized for suspected influenza in Hong Kong. METHODS We designed a decision tree to simulate potential outcomes of four management strategies in adults hospitalized for severe respiratory infection suspected of influenza: "immunofluorescence-assay" (IFA) or "polymerase-chain-reaction" (PCR)-guided oseltamivir treatment, "empirical treatment plus PCR" and "empirical treatment alone". Model inputs were derived from literature. The average prevalence (11%) of influenza in 2010-2011 (58% being 2009 H1N1) among cases of respiratory infections was used in the base-case analysis. Primary outcome simulated was cost per quality-adjusted life-year (QALY) expected (ICER) from the Hong Kong healthcare providers' perspective. RESULTS In base-case analysis, "empirical treatment alone" was shown to be the most cost-effective strategy and dominated the other three options. Sensitivity analyses showed that "PCR-guided treatment" would dominate "empirical treatment alone" when the daily cost of oseltamivir exceeded USD18, or when influenza prevalence was <2.5% and the predominant circulating viruses were not 2009 H1N1. Using USD50,000 as the threshold of willingness-to-pay, "empirical treatment alone" and "PCR-guided treatment" were cost-effective 97% and 3% of time, respectively, in 10,000 Monte-Carlo simulations. CONCLUSIONS During influenza epidemics, empirical antiviral treatment appears to be a cost-effective strategy in managing patients hospitalized with severe respiratory infection suspected of influenza, from the perspective of healthcare providers in Hong Kong.
Collapse
Affiliation(s)
- Joyce H. S. You
- School of Pharmacy, Faculty of Medicine, Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eva S. K. Chan
- School of Pharmacy, Faculty of Medicine, Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Maggie Y. K. Leung
- School of Pharmacy, Faculty of Medicine, Centre for Pharmacoeconomics Research, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Margaret Ip
- Faculty of Medicine, Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Nelson L. S. Lee
- Division of Infectious Diseases, Faculty of Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- * E-mail:
| |
Collapse
|
38
|
Wu UI, Wang JT, Chen YC, Chang SC. Severity of pandemic H1N1 2009 influenza virus infection may not be directly correlated with initial viral load in upper respiratory tract. Influenza Other Respir Viruses 2011; 6:367-73. [PMID: 22074016 PMCID: PMC5779809 DOI: 10.1111/j.1750-2659.2011.00300.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Please cite this paper as: Wu et al. (2012) Severity of pandemic H1N1 2009 influenza virus infection may not be directly correlated with initial viral load in upper respiratory tract. Influenza and Other Respiratory Viruses 6(5), 367–373. Background Recent studies have demonstrated that rapid influenza diagnostic tests (RIDTs) have a relatively low sensitivity in detecting severe cases of pandemic H1N1 2009 influenza virus (pH1N1) infection. We hypothesized that viral load in upper respiratory specimens obtained on presentation may not be correlated with disease severity. Methods We conducted a prospective study to compare patterns of viral shedding using nasopharyngeal swab specimens, according to the number of days of post‐symptom onset and post‐antiviral therapy, between patients with and without complications. Results From July 15, 2009 through July 23, 2010, we collected and processed a total of 141 nasopharyngeal swab specimens from 64 inpatients and outpatients with laboratory‐confirmed pH1N1 infection. These included 46 patients without any complications (uncomplicated group) and 18 patients who required hospital admission (complicated group). The mean initial viral load was higher in the uncomplicated group than in the complicated group (3·4 ± 1·6 log10 copies/μl versus 1·9 ± 1·7, P = 0·02). However, prolonged viral shedding was only detected in the complicated group (44% by day 7 of antiviral therapy). By multivariate analysis, we found that age (OR, 1·1; 95% CI, 1·0–1·1) and initial nasopharyngeal viral load (OR, 0·5; 95% CI, 0·3–0·8) were significant factors associated with complications. Conclusion Given that patients with severe pH1N1 infection may have relatively lower initial viral load in the upper respiratory tract, cautious interpretation of negative RIDT results is particularly warranted in this patient population.
Collapse
Affiliation(s)
- Un-In Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | |
Collapse
|
39
|
Seto WH, Cowling BJ, Lam HS, Ching PTY, To ML, Pittet D. Clinical and nonclinical health care workers faced a similar risk of acquiring 2009 pandemic H1N1 infection. Clin Infect Dis 2011; 53:280-3. [PMID: 21765076 DOI: 10.1093/cid/cir375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Reporting of confirmed pandemic influenza A virus (pH1N1) 2009 infection was mandatory among health care workers in Hong Kong. Among 1158 confirmed infections, there was no significant difference in incidence among clinical versus nonclinical staff (relative risk, 0.98; 95% confidence interval, 0.78-1.20). Reported community exposure to pH1N1 was common and was similar in both groups.
Collapse
Affiliation(s)
- Wing-Hong Seto
- Hospital Authority, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | | | | | | | | |
Collapse
|
40
|
Pierangeli A, Scagnolari C, Selvaggi C, Monteleone K, Verzaro S, Nenna R, Cangiano G, Moretti C, Papoff P, Antonelli G, Midulla F. Virological and clinical characterization of respiratory infections in children attending an emergency department during the first autumn-winter circulation of pandemic A (H1N1) 2009 influenza virus. Clin Microbiol Infect 2011; 18:366-73. [PMID: 21923780 PMCID: PMC7128277 DOI: 10.1111/j.1469-0691.2011.03590.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To characterize respiratory virus infections during the first autumn-winter season of pandemic A (H1N1) 2009 influenza virus (A/H1N1/2009) circulation, a prospective study in children attending a paediatric emergency department at the Sapienza University hospital, Rome, was conducted from November 2009 to March 2010. By means of both nasal washings and pharyngeal swabs, enrolled children were checked for 14 respiratory viruses. The majority of acute respiratory infections resulted from viral pathogens (135/231, 58%). Overall, the most common was respiratory syncytial virus (RSV), in 64% of positive samples; A/H1N1/2009 was the only influenza virus found in 16% and rhinovirus (RV) in 15%. Virus-positive children did not differ significantly from virus-negative children in signs and symptoms at presentation; of the virus groups, RSV-infected children were younger and more frequently admitted to intensive-care units than those infected with A/H1N1/2009 and RV. Of the hospitalized children, stratified by age, both infants and children aged >1 year with RSV were most severely affected, whereas A/H1N1/2009 infections were the mildest overall, although with related pulmonary involvement in older children. Children with RV infections, detected in two flares partially overlapping with the A/H1N1/2009 and RSV peaks, presented with bronchiolitis, wheezing and pneumonia. Leukocytosis occurred more frequently in RV-infected and A/H1N1/2009-infected children, and numbers of blood eosinophils were significantly elevated in RV-infected infants. Given the fact that clinical and epidemiological criteria are not sufficient to identify viral respiratory infections, a timely virological diagnosis could allow different infections to be managed separately.
Collapse
Affiliation(s)
- A Pierangeli
- Virology laboratory, Department of Molecular Medicine Department of Paediatrics, Sapienza University, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Impact of pandemic A/H1N1/2009 influenza on children and their families: comparison with seasonal A/H1N1 and A/H3N2 influenza viruses. J Infect 2011; 63:300-7. [PMID: 21839113 DOI: 10.1016/j.jinf.2011.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To make a direct comparison between the total burden of pandemic influenza and that of other seasonal influenza A viral subtypes in otherwise healthy children. METHODS The total clinical and socioeconomic burden of pandemic A/H1N1/2009 influenza was compared with that of seasonal influenza A viral subtypes in 389 otherwise healthy children with A/H1N1/2009, 126 with seasonal A/H1N1 and 486 with seasonal A/H3N2 infection referred to the Emergency Room and hospitalised in the in-patient units of a large, university-based paediatric hospital. Influenza diagnosis was confirmed by real-time polymerase chain reaction. RESULTS Regardless of age or gender, the variables significantly associated with pandemic A/H1N1/2009 and seasonal A/H3N2 infection were a diagnosis of lower respiratory tract infection upon clinical presentation, the need for hospitalisation, hospitalisation for ≥7 days, school absences of ≥7 days, the need for aerosol therapy, the household development of a disease similar to that of the infected child, and the need for additional household medical visits and antibiotic prescriptions (p < 0.001). A longer period of hospitalisation and lost school days seemed to be associated with pandemic A/H1N1/2009 infection (p < 0.01). CONCLUSIONS Perceived symptom severity and the risk of serious outcomes are similar in children with influenza due to pandemic A/H1N1/2009 or seasonal A/H3N2 influenza, but both of these viruses seem to have a greater clinical and socioeconomic impact than seasonal A/H1N1 virus, regardless of the patients' age or gender.
Collapse
|
42
|
Renaud C, Campbell AP. Changing epidemiology of respiratory viral infections in hematopoietic cell transplant recipients and solid organ transplant recipients. Curr Opin Infect Dis 2011; 24:333-43. [PMID: 21666460 PMCID: PMC3210111 DOI: 10.1097/qco.0b013e3283480440] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW New respiratory viruses have been discovered in recent years and new molecular diagnostic assays have been developed that improve our understanding of respiratory virus infections. This article will review the changing epidemiology of these viruses after hematopoietic stem cell and solid organ transplantation. RECENT FINDINGS Respiratory viruses are frequently detected in transplant recipients. A number of viruses have been newly discovered or emerged in the last decade, including human metapneumovirus, human bocavirus, new human coronaviruses and rhinoviruses, human polyomaviruses, and a new 2009 pandemic strain of influenza A/H1N1. The potential for these viruses to cause lower respiratory tract infections after transplantation varies, and is greatest for human metapneumovirus and H1N1 influenza, but appears to be limited for the other new viruses. Acute and long-term complications in hematopoietic and solid organ transplant recipients are active areas of research. SUMMARY Respiratory viral infections are frequently associated with significant morbidity following transplantation and are therefore of great clinical and epidemiologic interest. As new viruses are discovered, and more sensitive diagnostic methods are developed, defining the full impact of emerging respiratory viruses in transplant recipients must be elucidated by well designed clinical studies.
Collapse
Affiliation(s)
- Christian Renaud
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and Department of Pediatrics, University of Washington, Seattle, Washington 98105, USA
| | | |
Collapse
|
43
|
Theocharis G, Vouloumanou EK, Barbas SG, Spiropoulos T, Rafailidis PI, Falagas ME. Comparison of characteristics of outpatients with 2009 H1N1 pandemic and seasonal influenza. Int J Clin Pract 2011; 65:871-8. [PMID: 21762312 DOI: 10.1111/j.1742-1241.2011.02684.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The latest influenza pandemic intensified the interest in this infection. OBJECTIVE We aimed to compare the characteristics of outpatients with seasonal and pandemic influenza. METHODS We retrospectively reviewed data regarding outpatients who sought medical advice from a network of physicians performing house-call visits at the area of Attica, Greece, and who underwent a direct influenza test during the period of seasonal influenza (1/1/2009-1/5/2009) and 2009 H1N1 pandemic influenza period (17/5/2009-15/4/2010). RESULTS A total of 195 and 1317 patients had a direct influenza test during the seasonal and pandemic influenza period, respectively; 50.7% and 32% of these patients had a positive test result for influenza, respectively. Viral culture or polymerase chain reaction (PCR) were not implemented. Patients found positive for influenza during the pandemic period, compared with those evaluated during the seasonal period, were younger (mean age ± SD: 33 ± 17.2 vs. 38.2 ± 19.2, p = 0.008), more likely to have no comorbidity (62.9% vs. 45.5%, p = 0.002), had milder clinical manifestations, and were treated with more antibiotics (38.3% vs. 9.9%, p < 0.001). However, patients found positive during the seasonal period were treated with more antivirals (oseltamivir: 69.1% vs. 85.7%, p = 0.006). No difference was observed regarding the need for immediate hospitalisation. These findings were consistent in the complementary analysis involving patients tested for influenza during the compared periods. CONCLUSION Despite the methodological limitations, our findings suggest that patients with pandemic influenza were younger, had milder clinical manifestations and were less likely to have any kind of comorbidity compared with patients with seasonal influenza.
Collapse
|
44
|
Lee N, Chan PKS, Lui GCY, Wong BCK, Sin WWY, Choi KW, Wong RYK, Lee ELY, Yeung ACM, Ngai KLK, Chan MCW, Lai RWM, Yu AWY, Hui DSC. Complications and outcomes of pandemic 2009 Influenza A (H1N1) virus infection in hospitalized adults: how do they differ from those in seasonal influenza? J Infect Dis 2011; 203:1739-47. [PMID: 21606532 DOI: 10.1093/infdis/jir187] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is unclear whether pandemic 2009 influenza A (pH1N1) infection caused more significant disease among hospitalized adults than seasonal influenza. METHODS A prospective, observational study was conducted in adults hospitalized with polymerase chain reaction-confirmed pH1N1 infection in 2 acute-care general hospitals from June 2009 to May 2010 (n = 382). Complications and outcomes were described and compared with those in a seasonal influenza cohort (2007-2008, same hospitals; n = 754). RESULTS Hospitalized patients with pH1N1 influenza were younger than those with seasonal influenza (mean age ± standard deviation, 47 ± 20 vs 70 ± 19 years) and fewer had comorbid conditions (48% vs 64%). The rate of positive immunofluorescence assay results was low (54% vs 84%), and antiviral use was frequent (96% vs 52%). Most patients in both cohorts developed complicated illnesses (67.8% vs 77.1%), but patients with pH1N1 influenza had higher rates of extrapulmonary complications (23% vs 16%; P = .004) and intensive care unit admission and/or death (patient age <35 years, 2.3% vs 0%; 35-65 years, 12.4% vs 3.2%; >65 years, 13.5% vs 8.5%; adjusted odds ratio [OR] 2.13; 95% confidence interval [CI], 1.25-3.62; P = .005). Patients who received antiviral treatment within 96 h after onset had better survival (log-rank test, P < .001). However, without timely treatment, the mortality risk was higher with pH1N1 infection (9.0% vs 5.8% for seasonal influenza; adjusted OR, 6.85; 95% CI, 1.64-28.65; P = .008]. Bacterial superinfection worsened outcomes. CONCLUSIONS Adults hospitalized for pH1N1 influenza had significant complications and mortality despite being younger than patients with seasonal influenza. Antiviral treatment within 96 h may improve survival.
Collapse
Affiliation(s)
- Nelson Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Peoples Republic of China
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Mosby LG, Rasmussen SA, Jamieson DJ. 2009 pandemic influenza A (H1N1) in pregnancy: a systematic review of the literature. Am J Obstet Gynecol 2011; 205:10-8. [PMID: 21345415 DOI: 10.1016/j.ajog.2010.12.033] [Citation(s) in RCA: 216] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 12/01/2010] [Accepted: 12/15/2010] [Indexed: 11/24/2022]
Abstract
To summarize the literature regarding 2009 H1N1 influenza A during pregnancy, we conducted a systematic literature review using a PubMed search and other strategies. Studies were included if they reported 2009 H1N1 influenza in pregnant women as original data. In all, 2153 abstracts were reviewed, and a total of 120 studies were included. Data were extracted regarding number of cases, additional risk factors for influenza-associated complications, treatment, and maternal and pregnancy outcomes. Authors were contacted to determine the extent of overlap when it was suspected. Pregnancy was associated with increased risk of hospital and intensive care unit admission and of death. Pregnant women who received delayed treatment with neuraminidase inhibitors or who had additional risk factors were more likely to develop severe disease. Preterm and emergency cesarean deliveries were frequently reported. These results reinforce the importance of early identification and treatment of suspected influenza in this high-risk population.
Collapse
|
46
|
Renaud C, Kuypers J, Englund JA. Emerging oseltamivir resistance in seasonal and pandemic influenza A/H1N1. J Clin Virol 2011; 52:70-8. [PMID: 21684202 DOI: 10.1016/j.jcv.2011.05.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 05/17/2011] [Accepted: 05/19/2011] [Indexed: 11/25/2022]
Abstract
The emergence of oseltamivir resistance in seasonal and pandemic influenza A/H1N1 has created challenges for diagnosis and clinical management. This review discusses how clinical virology laboratories have handled diagnosis of oseltamivir-resistant H1N1 and what we have learned from clinical studies and case series. Immunocompetent patients infected with oseltamivir-resistant H1N1 have similar outcomes as patients infected with oseltamivir-susceptible H1N1. However, immunocompromised patients infected with oseltamivir-resistant H1N1 experience potentially more risks of complication and transmissibility with few therapeutic options.
Collapse
Affiliation(s)
- Christian Renaud
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
| | | | | |
Collapse
|
47
|
Severity of pH1N1 influenza A. Crit Care Med 2011. [DOI: 10.1097/ccm.0b013e31820f70d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Differences in clinical outcomes after 2009 influenza A/H1N1 and seasonal influenza among hematopoietic cell transplant recipients. Blood 2011; 117:5050-6. [PMID: 21372154 DOI: 10.1182/blood-2010-11-319186] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
It is not known whether pandemic 2009 influenza A/H1N1 (2009 H1N1) leads to more serious disease than seasonal influenza in hematopoietic cell transplant (HCT) recipients. In a retrospective study in HCT recipients with virologically proven influenza virus infection, a total of 161 HCT recipients (18 2009 H1N1, 103 seasonal influenza A, and 40 seasonal influenza B) were analyzed. In multivariable analyses, more patients with 2009 H1N1 had lower respiratory tract disease (LRD), hypoxemia, and prolonged viral shedding compared with seasonal influenza A. Seasonal influenza A and B outcomes were similar. There was no difference in overall and influenza-associated mortality among influenza virus types. Both early and delayed administration of antiviral therapy was shown to be beneficial in terms of decreased rates of development of LRD, although earlier intervention appeared to be more effective. Profound lymphopenia and lack of early antiviral therapy were associated significantly with LRD, hypoxemia, and death. High-dose corticosteroid treatment (≥ 1 mg/kg) given at the time of influenza diagnosis was associated with a reduced risk for mechanical ventilation. Thus, our data suggest that infection with 2009 influenza A/H1N1 resulted in more severe respiratory disease in HCT recipients compared with seasonal influenza.
Collapse
|
49
|
Hung IF, To KK, Lee CK, Lee KL, Chan K, Yan WW, Liu R, Watt CL, Chan WM, Lai KY, Koo CK, Buckley T, Chow FL, Wong KK, Chan HS, Ching CK, Tang BS, Lau CC, Li IW, Liu SH, Chan KH, Lin CK, Yuen KY. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis 2011; 52:447-56. [PMID: 21248066 PMCID: PMC7531589 DOI: 10.1093/cid/ciq106] [Citation(s) in RCA: 473] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background. Experience from treating patients with Spanish influenza and influenza A(H5N1)
suggested that convalescent plasma therapy might be beneficial. However, its efficacy in
patients with severe pandemic influenza A(H1N1) 2009 virus (H1N1 2009) infection remained
unknown. Methods. During the period from 1 September 2009 through 30 June 2010, we conducted a
prospective cohort study by recruiting patients aged ≥18 years with severe H1N1 2009
infection requiring intensive care. Patients were offered treatment with convalescent
plasma with a neutralizing antibody titer of ≥1:160, harvested by apheresis from patients
recovering from H1N1 2009 infection. Clinical outcome was compared with that of patients
who declined plasma treatment as the untreated controls. Results. Ninety-three patients with severe H1N1 2009 infection requiring intensive care
were recruited. Twenty patients (21.5%) received plasma treatment. The treatment and
control groups were matched by age, sex, and disease severity scores. Mortality in the
treatment group was significantly lower than in the nontreatment group (20.0% vs 54.8%;
P = .01). Multivariate analysis showed that plasma treatment reduced
mortality (odds ratio [OR], .20; 95% confidence interval [CI], .06-.69;
P = .011), whereas complication of acute renal failure was independently
associated with death (OR, 3.79; 95% CI, 1.15-12.4; P = .028). Subgroup
analysis of 44 patients with serial respiratory tract viral load and cytokine level
demonstrated that plasma treatment was associated with significantly lower day 3, 5, and 7
viral load, compared with the control group (P < .05). The
corresponding temporal levels of interleukin 6, interleukin 10, and tumor necrosis factor
α (P < .05) were also lower in the treatment group. Conclusions. Treatment of severe H1N1 2009 infection with convalescent plasma reduced
respiratory tract viral load, serum cytokine response, and mortality.
Collapse
Affiliation(s)
- Ivan Fn Hung
- Infectious Disease Division, Queen Mary Hospital, State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
A comparison of the epidemiology and clinical presentation of seasonal influenza A and 2009 pandemic influenza A (H1N1) in Guatemala. PLoS One 2010; 5:e15826. [PMID: 21209850 PMCID: PMC3012722 DOI: 10.1371/journal.pone.0015826] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 11/29/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A new influenza A (H1N1) virus was first found in April 2009 and proceeded to cause a global pandemic. We compare the epidemiology and clinical presentation of seasonal influenza A (H1N1 and H3N2) and 2009 pandemic influenza A (H1N1) (pH1N1) using a prospective surveillance system for acute respiratory disease in Guatemala. METHODOLOGY/FINDINGS Patients admitted to two public hospitals in Guatemala in 2008-2009 who met a pneumonia case definition, and ambulatory patients with influenza-like illness (ILI) at 10 ambulatory clinics were invited to participate. Data were collected through patient interview, chart abstraction and standardized physical and radiological exams. Nasopharyngeal swabs were taken from all enrolled patients for laboratory diagnosis of influenza A virus infection with real-time reverse transcription polymerase chain reaction. We identified 1,744 eligible, hospitalized pneumonia patients, enrolled 1,666 (96%) and tested samples from 1,601 (96%); 138 (9%) had influenza A virus infection. Surveillance for ILI found 899 eligible patients, enrolled 801 (89%) and tested samples from 793 (99%); influenza A virus infection was identified in 246 (31%). The age distribution of hospitalized pneumonia patients was similar between seasonal H1N1 and pH1N1 (P = 0.21); the proportion of pneumonia patients <1 year old with seasonal H1N1 (39%) and pH1N1 (37%) were similar (P = 0.42). The clinical presentation of pH1N1 and seasonal influenza A was similar for both hospitalized pneumonia and ILI patients. Although signs of severity (admission to an intensive care unit, mechanical ventilation and death) were higher among cases of pH1N1 than seasonal H1N1, none of the differences was statistically significant. CONCLUSIONS/SIGNIFICANCE Small sample sizes may limit the power of this study to find significant differences between seasonal influenza A and pH1N1. In Guatemala, influenza, whether seasonal or pH1N1, appears to cause severe disease mainly in infants; targeted vaccination of children should be considered.
Collapse
|