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Ison MG, Marrazzo J. The Emerging Threat of H5N1 to Human Health. N Engl J Med 2024. [PMID: 39740035 DOI: 10.1056/nejme2416323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Affiliation(s)
- Michael G Ison
- From the Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases (M.G.I.), National Institute of Allergy and Infectious Diseases, National Institutes of Health (J.M.), Bethesda, MD
| | - Jeanne Marrazzo
- From the Respiratory Diseases Branch, Division of Microbiology and Infectious Diseases (M.G.I.), National Institute of Allergy and Infectious Diseases, National Institutes of Health (J.M.), Bethesda, MD
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2
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Georgakopoulou VE. Insights from respiratory virus co-infections. World J Virol 2024; 13:98600. [PMID: 39722753 PMCID: PMC11551690 DOI: 10.5501/wjv.v13.i4.98600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 10/18/2024] Open
Abstract
Respiratory viral co-infections present significant challenges in clinical settings due to their impact on disease severity and patient outcomes. Current diagnostic methods often miss these co-infections, complicating the epidemiology and management of these cases. Research, primarily conducted in vitro and in vivo, suggests that co-infections can lead to more severe illnesses, increased hospitalization rates, and greater healthcare utilization, especially in high-risk groups such as children, the elderly, and immunocompromised individuals. Common co-infection patterns, risk factors, and their impact on disease dynamics highlight the need for advanced diagnostic techniques and tailored therapeutic strategies. Understanding the virological interactions and immune response modulation during co-infections is crucial for developing effective public health interventions and improving patient outcomes. Future research should focus on the molecular mechanisms of co-infection and the development of specific therapies to mitigate the adverse effects of these complex infections.
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Affiliation(s)
- Vasiliki E Georgakopoulou
- Department of Pathophysiology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens 11527, Greece
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3
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Antoon JW, Amarin JZ, Hamdan O, Stopczynski T, Stewart LS, Michaels MG, Williams JV, Klein EJ, Englund JA, Weinberg GA, Szilagyi PG, Schuster JE, Selvarangan R, Harrison CJ, Boom JA, Sahni LC, Muñoz FM, Staat MA, Schlaudecker EP, Chappell JD, Clopper BR, Moline HL, Campbell AP, Spieker AJ, Olson SM, Halasa NB. Antiviral Use Among Children Hospitalized With Laboratory-Confirmed Influenza Illness: A Prospective, Multicenter Surveillance Study. Clin Infect Dis 2024:ciae573. [PMID: 39688383 DOI: 10.1093/cid/ciae573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children. METHODS We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31 March 2020 at 7 pediatric medical centers in the New Vaccine Surveillance Network. The cohort consisted of children hospitalized with influenza A or B confirmed by clinical or research testing. The primary outcome was frequency of antiviral receipt during hospitalization. We used logistic regression to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with antiviral receipt. RESULTS A total of 1213 children with laboratory-confirmed influenza were included. Overall, 652 children (53.8%) received an antiviral. Roughly 63.0% of children received clinical influenza testing. Among those with clinical testing, 67.4% received an antiviral. Factors associated with higher odds of antiviral receipt included hematologic (aOR = 1.76; 95% CI = 1.03-3.02) or oncologic/immunocompromising (aOR = 2.41; 95% CI = 1.13-5.11) disorders, prehospitalization antiviral receipt (aOR = 2.34; 95% CI = 1.49-3.67), clinical influenza testing (aOR = 3.07; 95% CI = 2.28-4.14), and intensive care unit admission (aOR = 1.53; 95% CI = 1.02-2.29). Symptom duration >2 days was associated with lower odds of antiviral treatment (aOR = 0.40; 95% CI = .30-.52). Antiviral receipt varied by site with a 5-fold difference across sites. CONCLUSIONS Almost half of children hospitalized with influenza did not receive antivirals. Additional efforts to understand barriers to guideline adherence are crucial for optimizing care in children hospitalized with influenza.
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Affiliation(s)
- James W Antoon
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin Z Amarin
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Epidemiology Doctoral Program, Vanderbilt University, Nashville, Tennessee, USA
| | - Olla Hamdan
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Laura S Stewart
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marian G Michaels
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John V Williams
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Eileen J Klein
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Janet A Englund
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Geoffrey A Weinberg
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Peter G Szilagyi
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- UCLA Mattel Children's Hospital and Department of Pediatrics, University of California at Los Angeles, Los Angeles, California, USA
| | - Jennifer E Schuster
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Rangaraj Selvarangan
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Christopher J Harrison
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Julie A Boom
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Leila C Sahni
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Flor M Muñoz
- Texas Children's Hospital and Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Mary Allen Staat
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth P Schlaudecker
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Benjamin R Clopper
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heidi L Moline
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela P Campbell
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Samantha M Olson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Ito H, Ito S, Hirose T, Kimura T, Mori T, Ito S. Severe influenza A viral pneumonia in a hemodialysis patient: successful treatment with steroid pulse therapy. CEN Case Rep 2024:10.1007/s13730-024-00951-6. [PMID: 39658702 DOI: 10.1007/s13730-024-00951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 11/11/2024] [Indexed: 12/12/2024] Open
Abstract
Seasonal influenza is prevalent globally, particularly during winter months. It is well documented that this disease causes severe, often fatal complications in hemodialysis patients. While numerous reports have focused on novel influenza viruses, there is a paucity of case reports detailing seasonal influenza viral infections in this patient population. This case presents a 71-year-old male undergoing hemodialysis who developed severe seasonal influenza A pneumonia despite receiving the influenza vaccine and early antiviral treatment. Initially presenting with fever, cough, and myalgia, the patient was diagnosed with influenza A virus infection and hospitalized due to heightened risk associated with dialysis and an elevated inflammatory response. Despite treatment with two different antiviral medications, his condition deteriorated, leading to ARDS (acute respiratory distress syndrome). The administration of steroid pulse therapy resulted in significant clinical improvement. This case underscores the severe nature of influenza virus-related illnesses in dialysis patients, even with vaccination and early antiviral intervention. It also suggests the potential benefit of early steroid pulse therapy in managing severe influenza pneumonia in high-risk individuals.
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Affiliation(s)
- Hiroki Ito
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan.
- Katta General Hospital, Shiroishi, Japan.
| | | | - Takuo Hirose
- Division of Integrative Renal Replacement Therapy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoyoshi Kimura
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, Miyagi, 983-8536, Japan
- Division of Integrative Renal Replacement Therapy, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Sadayoshi Ito
- Katta General Hospital, Shiroishi, Japan
- Division of Nephrology, Endocrinology and Vascular Medicine, Graduate School of Medicine, Tohoku University School of Medicine, Sendai, Japan
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5
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Hovind MJ, Berdal JE, Dalgard O, Lyngbakken MN. Impact of antibiotic therapy in patients with respiratory viral infections: a retrospective cohort study. Infect Dis (Lond) 2024; 56:1031-1039. [PMID: 39042560 DOI: 10.1080/23744235.2024.2375592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/17/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES The impact of antibiotics in patients with positive polymerase chain reaction (PCR) for respiratory viruses without evidence of a respiratory bacterial co-infection is largely unknown. The aim of this study was to assess the association of antibiotics on 30-day mortality and length of hospital stay in patients with an acute respiratory infection and PCR documented presence of respiratory viruses. METHODS We conducted a retrospective cohort study of adult patients admitted to hospital between 2012 and 2021 with positive PCR for influenza virus (H3N2, H1N1, influenza B), respiratory syncytial virus, human metapneumovirus or severe acute respiratory syndrome coronavirus 2. We used logistic regression, the Kaplan-Meier estimator and Poisson's regression to assess the impact of antibiotic therapy on outcomes. RESULTS Among 3979 patients, 67.7% received antibiotics. In adjusted analyses, antibiotics initiated in the emergency department (adjusted OR 1.23, 95% CI 0.77-1.96) and days of antibiotic therapy (adjusted OR per day of therapy 0.98, 95% CI 0.95-1.00) had no significant impact on mortality, whereas antibiotics initiated later during admission (adjusted OR 2.25, 95% CI 1.26-4.02) was associated with increased mortality. Patients prescribed antibiotics had longer duration of hospital admission. CONCLUSIONS We observed no protective association between in-hospital antibiotic therapy and outcomes, suggesting overuse of antibiotics in respiratory infections with proven respiratory viruses. A restrictive antibiotic strategy may be warranted.
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Affiliation(s)
- M J Hovind
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - J E Berdal
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - O Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - M N Lyngbakken
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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6
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Scherger SJ, Kalil AC. In persons exposed to influenza, zanamivir, oseltamivir, laninamivir, and baloxavir reduce symptomatic seasonal influenza. Ann Intern Med 2024; 177:JC134. [PMID: 39622061 DOI: 10.7326/annals-24-03197-jc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2024] Open
Abstract
SOURCE CITATION Zhao Y, Gao Y, Guyatt G, et al. Antivirals for post-exposure prophylaxis of influenza: a systematic review and network meta-analysis. Lancet. 2024;404:764-772. 39181596.
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Affiliation(s)
- Sias J Scherger
- University of Nebraska Medical Center, Omaha, Nebraska, USA (S.J.S., A.C.K.)
| | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, Nebraska, USA (S.J.S., A.C.K.)
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7
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Singleton JB, Wang D, Louis S, Smith DJ, Lambrou AS, Beekmann SE, Midgley CM, Polgreen P, Garg S, Ricaldi JN, Uyeki TM, Santibañez S, Patel P. Perceptions and Barriers to Outpatient Antiviral Therapy for COVID-19 and Influenza as Observed by Infectious Disease Specialists in North America: Results of an Emerging Infections Network (EIN) Survey, February 2024. Open Forum Infect Dis 2024; 11:ofae666. [PMID: 39610406 PMCID: PMC11604064 DOI: 10.1093/ofid/ofae666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 11/06/2024] [Indexed: 11/30/2024] Open
Abstract
Antiviral therapy is underutilized for outpatients at increased risk for severe COVID-19 or influenza. Results from this survey offer insights into treatment barriers from the infectious disease specialist perspective. Further education is needed about the benefits of early antiviral therapy.
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Affiliation(s)
| | - Dennis Wang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Souci Louis
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dallas J Smith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Susan E Beekmann
- University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa, USA
| | - Claire M Midgley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Philip Polgreen
- University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa, USA
| | - Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Timothy M Uyeki
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Santibañez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pragna Patel
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Scherger SJ, Kalil AC. In hospitalized patients with influenza, oseltamivir or peramivir may reduce hospital length of stay (low-certainty evidence). Ann Intern Med 2024; 177:JC135. [PMID: 39622060 DOI: 10.7326/annals-24-03198-jc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2024] Open
Abstract
SOURCE CITATION Gao Y, Guyatt G, Uyeki TM, et al. Antivirals for treatment of severe influenza: a systematic review and network meta-analysis of randomised controlled trials. Lancet. 2024;404:753-763. 39181595.
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Affiliation(s)
- Sias J Scherger
- University of Nebraska Medical Center, Omaha, Nebraska, USA (S.J.S., A.C.K.)
| | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, Nebraska, USA (S.J.S., A.C.K.)
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9
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Stockl KM, Tucker J, Beaubrun A, Certa JM, Becker L, Chase JG. Real-world use of multiplex point-of-care molecular testing or laboratory-based molecular testing for influenza-like illness in a 2021 to 2022 US outpatient sample. PLoS One 2024; 19:e0313660. [PMID: 39527576 PMCID: PMC11554232 DOI: 10.1371/journal.pone.0313660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open
Abstract
While molecular testing is recommended for symptomatic patients suspected of having coronavirus disease 2019 (COVID-19), limited data are available examining real-world use of tests for severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the impact of SARS-CoV-2 testing on patient outcomes. In this retrospective cohort study using de-identified administrative claims data in the Optum Labs Data Warehouse, we identified 2 groups of patients with ≥1 outpatient claims with a procedure code for SARS-CoV-2 testing between January 2021 and September 2022. Group 1 had ≥1 claims with CPT code 0240U or 0241U ("Xpert Xpress") (N = 51,602); Group 2 had ≥1 claims for laboratory-based molecular testing (N = 317,192). Outcomes assessed on the identification date and through the 90-day follow-up included claims evidence of use of SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) tests, diagnosis of active COVID-19, influenza, or RSV, and use of treatments (antivirals for COVID-19, influenza, and RSV and other treatments for COVID-19 and RSV). Patients in Group 1 had fewer tests for SARS-CoV-2, influenza, or RSV (mean ± standard deviation 1.6±1.4 versus 2.6±2.6, standardized difference -0.45), faster time to diagnosis of COVID-19 (median 0 versus 4 days, standardized difference -0.27) or influenza (median 0 versus 5 days, standardized difference -0.74), and faster time to treatment of COVID-19, influenza, or RSV (median 1 versus 5 days, standardized difference 0.16) than patients in Group 2. In this nationwide real-world study of outpatient testing, use of point-of-care molecular multiplex SARS-CoV-2 testing resulted in fewer claims for SARS-CoV-2, influenza, and RSV tests, faster time to diagnosis, and faster time to treatment than laboratory-based molecular testing.
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Affiliation(s)
| | - Jamie Tucker
- Optum, Eden Prairie, Minnesota, United States of America
| | - Anne Beaubrun
- Cepheid, Sunnyvale, California, United States of America
| | - Julia M. Certa
- Optum, Eden Prairie, Minnesota, United States of America
| | - Laura Becker
- Optum, Eden Prairie, Minnesota, United States of America
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Olson SM, Dawood FS, Grohskopf LA, Ellington S. Preventing Influenza Virus Infection and Severe Influenza Among Pregnant People and Infants. J Womens Health (Larchmt) 2024. [PMID: 39491270 DOI: 10.1089/jwh.2024.0893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2024] Open
Abstract
The landscape of research on the benefits of influenza vaccines and antivirals to protect pregnant persons and infants has increased in recent years, while influenza vaccination rates and antiviral usage have declined. Pregnant people and infants <6 months of age are at increased risk of hospitalization with influenza, making protection of this population essential. Maternal influenza vaccination at any time during pregnancy is the best way to reduce the risk of influenza and severe influenza in both pregnant people and their infants <6 months of age. Influenza antiviral medications for pregnant people and infants are also recommended as early as possible if influenza is confirmed or suspected. This report will update on the current research on the benefits of influenza vaccination during pregnancy and influenza antiviral medication for the pregnant person and infant, current Advisory Committee on Immunization Practices recommendations for influenza vaccination in pregnancy and vaccination coverage rates, current influenza antiviral medication guidance and usage rates in pregnancy and among infants, and future directions for influenza pregnancy research. With over half a century of maternal influenza vaccination in the United States, we have improved protection for pregnant persons and infants against influenza, but we still have room for improvement and optimization with new challenges to overcome following the COVID-19 pandemic. By continuing to fill research gaps and increase vaccination coverage and antiviral usage, there is potential for significant reductions in the domestic and global burden of influenza in pregnant persons and infants.
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Affiliation(s)
- Samantha M Olson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa A Grohskopf
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Naquin A, O’Halloran A, Ujamaa D, Sundaresan D, Masalovich S, Cummings CN, Noah K, Jain S, Kirley PD, Alden NB, Austin E, Meek J, Yousey-Hindes K, Openo K, Witt L, Monroe ML, Henderson J, Nunez VT, Lynfield R, McMahon M, Shaw YP, McCahon C, Spina N, Engesser K, Tesini BL, Gaitan MA, Shiltz E, Lung K, Sutton M, Hendrick MA, Schaffner W, Talbot HK, George A, Zahid H, Reed C, Garg S, Bozio CH. Laboratory-Confirmed Influenza-Associated Hospitalizations Among Children and Adults - Influenza Hospitalization Surveillance Network, United States, 2010-2023. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2024; 73:1-18. [PMID: 39471107 PMCID: PMC11537671 DOI: 10.15585/mmwr.ss7706a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2024]
Abstract
Problem/Condition Seasonal influenza accounts for 9.3 million-41 million illnesses, 100,000-710,000 hospitalizations, and 4,900-51,000 deaths annually in the United States. Since 2003, the Influenza Hospitalization Surveillance Network (FluSurv-NET) has been conducting population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in the United States, including weekly rate estimations and descriptions of clinical characteristics and outcomes for hospitalized patients. However, a comprehensive summary of trends in hospitalization rates and clinical data collected from the surveillance platform has not been available. Reporting Period 2010-11 through 2022-23 influenza seasons. Description of System FluSurv-NET conducts population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among children and adults. During the reporting period, the surveillance network included 13-16 participating sites each influenza season, with prespecified geographic catchment areas that covered 27 million-29 million persons and included an estimated 8.8%-9.5% of the U.S. population. A case was defined as a person residing in the catchment area within one of the participating states who had a positive influenza laboratory test result within 14 days before or at any time during their hospitalization. Each site abstracted case data from hospital medical records into a standardized case report form, with selected variables submitted to CDC on a weekly basis for rate estimations. Weekly and cumulative laboratory-confirmed influenza-associated hospitalization rates per 100,000 population were calculated for each season from 2010-11 through 2022-23 and stratified by patient age (0-4 years, 5-17 years, 18-49 years, 50-64 years, and ≥65 years), sex, race and ethnicity, influenza type, and influenza A subtype. During the 2020-21 season, only the overall influenza hospitalization rate was reported because case counts were insufficient to estimate stratified rates. Results During the 2010-11 to 2022-23 influenza seasons, laboratory-confirmed influenza-associated hospitalization rates varied significantly across seasons. Before the COVID-19 pandemic, hospitalization rates per 100,000 population ranged from 8.7 (2011-12) to 102.9 (2017-18) and had consistent seasonality. After SARS-CoV-2 emerged, the hospitalization rate for 2020-21 was 0.8, and the rate did not return to recent prepandemic levels until 2022-23. Inconsistent seasonality also was observed during 2020-21 through 2022-23, with influenza activity being very low during 2020-21, extending later than usual during 2021-22, and occurring early during 2022-23. Molecular assays, particularly multiplex standard molecular assays, were the most common influenza test type in recent seasons, increasing from 12% during 2017-18 for both pediatric and adult cases to 43% and 55% during 2022-23 for pediatric and adult cases, respectively. During each season, adults aged ≥65 years consistently had the highest influenza-associated hospitalization rate across all age groups, followed in most seasons by children aged 0-4 years. Black or African American and American Indian or Alaska Native persons had the highest age-adjusted influenza-associated hospitalization rates across these seasons. Among patients hospitalized with influenza, the prevalence of at least one underlying medical condition increased with increasing age, ranging from 36.9% among children aged 0-4 years to 95.4% among adults aged ≥65 years. Consistently across each season, the most common underlying medical conditions among children and adolescents were asthma, neurologic disorders, and obesity. The most common underlying medical conditions among adults were hypertension, obesity, chronic metabolic disease, chronic lung disease, and cardiovascular disease. The proportion of FluSurv-NET patients with acute respiratory signs and symptoms at hospital admission decreased from 90.6% during 2018-19 to 83.2% during 2022-23. Although influenza antiviral use increased during the 2010-11 through the 2017-18 influenza seasons, it decreased from 90.2% during 2018-19 to 79.1% during 2022-23, particularly among children and adolescents. Admission to the intensive care unit, need for invasive mechanical ventilation, and in-hospital death ranged from 14.1% to 22.3%, 4.9% to 11.1%, and 2.2% to 3.5% of patients hospitalized with influenza, respectively, during the reported surveillance period. Interpretations Influenza continues to cause severe morbidity and mortality, particularly in older adults, and disparities have persisted in racial and ethnic minority groups. Persons with underlying medical conditions represented a large proportion of patients hospitalized with influenza. Increased use of multiplex tests and other potential changes in facility-level influenza testing practices (e.g., influenza screening at all hospital admissions) could have implications for the detection of influenza infections among hospitalized patients. Antiviral use decreased in recent seasons, and explanations for the decrease should be further evaluated. Public Health Action Continued robust influenza surveillance is critical to monitor progress in efforts to encourage antiviral treatment and improve clinical outcomes for persons hospitalized with influenza. In addition, robust influenza surveillance can potentially reduce disparities by informing efforts to increase access to preventive measures for influenza and monitoring any subsequent changes in hospitalization rates.
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12
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Rodríguez A, Gómez J, Martín-Loeches I, Claverias L, Díaz E, Zaragoza R, Borges-Sa M, Gómez-Bertomeu F, Franquet Á, Trefler S, González Garzón C, Cortés L, Alés F, Sancho S, Solé-Violán J, Estella Á, Berrueta J, García-Martínez A, Suberviola B, Guardiola JJ, Bodí M. A Machine Learning Approach to Determine Risk Factors for Respiratory Bacterial/Fungal Coinfection in Critically Ill Patients with Influenza and SARS-CoV-2 Infection: A Spanish Perspective. Antibiotics (Basel) 2024; 13:968. [PMID: 39452234 PMCID: PMC11504409 DOI: 10.3390/antibiotics13100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/09/2024] [Accepted: 10/10/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Bacterial/fungal coinfections (COIs) are associated with antibiotic overuse, poor outcomes such as prolonged ICU stay, and increased mortality. Our aim was to develop machine learning-based predictive models to identify respiratory bacterial or fungal coinfections upon ICU admission. Methods: We conducted a secondary analysis of two prospective multicenter cohort studies with confirmed influenza A (H1N1)pdm09 and COVID-19. Multiple logistic regression (MLR) and random forest (RF) were used to identify factors associated with BFC in the overall population and in each subgroup (influenza and COVID-19). The performance of these models was assessed by the area under the ROC curve (AUC) and out-of-bag (OOB) methods for MLR and RF, respectively. Results: Of the 8902 patients, 41.6% had influenza and 58.4% had SARS-CoV-2 infection. The median age was 60 years, 66% were male, and the crude ICU mortality was 25%. BFC was observed in 14.2% of patients. Overall, the predictive models showed modest performances, with an AUC of 0.68 (MLR) and OOB 36.9% (RF). Specific models did not show improved performance. However, age, procalcitonin, CRP, APACHE II, SOFA, and shock were factors associated with BFC in most models. Conclusions: Machine learning models do not adequately predict the presence of co-infection in critically ill patients with pandemic virus infection. However, the presence of factors such as advanced age, elevated procalcitonin or CPR, and high severity of illness should alert clinicians to the need to rule out this complication on admission to the ICU.
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Affiliation(s)
- Alejandro Rodríguez
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (L.C.); (S.T.); (J.B.); (A.G.-M.); (M.B.)
- Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain; (J.G.); (F.G.-B.); (Á.F.)
- Pere Virgili Health Research Institute, 43005 Tarragona, Spain
- Centre for Biomedical Research Network Respiratory Diseases (CIBERES), 43005 Tarragona, Spain
| | - Josep Gómez
- Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain; (J.G.); (F.G.-B.); (Á.F.)
- Technical Secretary’s Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
| | - Ignacio Martín-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James’ Hospita, D08 NHY1 Dublin, Ireland;
| | - Laura Claverias
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (L.C.); (S.T.); (J.B.); (A.G.-M.); (M.B.)
- Pere Virgili Health Research Institute, 43005 Tarragona, Spain
| | - Emili Díaz
- Critical Care Department, Hospital Universitari Parc Tauli, 08208 Sabadell, Spain;
- Medicine Faculty, Universitat Autónoma de Barcelona, 08193 Sabadell, Spain
| | - Rafael Zaragoza
- Critical Care Department, Hospital Dr. Peset, 46017 Valencia, Spain;
| | - Marcio Borges-Sa
- Critical Care Department, Hospital Son Llatzer, 07198 Palma de Mallorca, Spain;
| | - Frederic Gómez-Bertomeu
- Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain; (J.G.); (F.G.-B.); (Á.F.)
- Pere Virgili Health Research Institute, 43005 Tarragona, Spain
- Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), 28220 Madrid, Spain
| | - Álvaro Franquet
- Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain; (J.G.); (F.G.-B.); (Á.F.)
- Technical Secretary’s Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain
| | - Sandra Trefler
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (L.C.); (S.T.); (J.B.); (A.G.-M.); (M.B.)
- Pere Virgili Health Research Institute, 43005 Tarragona, Spain
| | - Carlos González Garzón
- Postgrado Medicina Crítica y Cuidado Intensivo, Facultad de Medicina, Fundación Universitari Ciencias de la Salud, Distrito Especial, Cra. 54 No.67A-80, Bogotá 111221, Colombia; (C.G.G.); (L.C.)
| | - Lissett Cortés
- Postgrado Medicina Crítica y Cuidado Intensivo, Facultad de Medicina, Fundación Universitari Ciencias de la Salud, Distrito Especial, Cra. 54 No.67A-80, Bogotá 111221, Colombia; (C.G.G.); (L.C.)
| | - Florencia Alés
- Internal Medicine Department, Hospital Dr. Alejandro Gutiérrez, Venado Tuerto S2600, Argentina;
| | - Susana Sancho
- Critical Care Department, Hospital Universitrio y Politécnico La Fe, 46026 Valencia, Spain;
| | - Jordi Solé-Violán
- Critical Care Department, Hospital Dr. Negrin, 35010 Las Palmas de Gran Canaria, Spain;
| | - Ángel Estella
- Critical Care Department, University Hospital of Jerez, INIBiCA, 11407 Jerez, Spain;
- Faculty of Medicine, University of Cádiz, 11407 Jerez, Spain
| | - Julen Berrueta
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (L.C.); (S.T.); (J.B.); (A.G.-M.); (M.B.)
- Tarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, Spain
| | - Alejandro García-Martínez
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (L.C.); (S.T.); (J.B.); (A.G.-M.); (M.B.)
- Tarragona Health Data Research Working Group (THeDaR), 43005 Tarragona, Spain
| | - Borja Suberviola
- Critical Care Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Juan J. Guardiola
- Robley Rex VA Medical Center, University of Louisville, Louisville, KY 40202, USA;
| | - María Bodí
- Critical Care Department, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain; (L.C.); (S.T.); (J.B.); (A.G.-M.); (M.B.)
- Faculty of Medicine, Universitat Rovira & Virgili, 43005 Tarragona, Spain; (J.G.); (F.G.-B.); (Á.F.)
- Pere Virgili Health Research Institute, 43005 Tarragona, Spain
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13
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Wang Y, So HC, Tsang NNY, Kwok SK, Cowling BJ, Leung GM, Ip DKM. Clinical profile analysis of SARS-CoV-2 community infections during periods with omicron BA.2, BA.4/5, and XBB dominance in Hong Kong: a prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00574-7. [PMID: 39419049 DOI: 10.1016/s1473-3099(24)00574-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 10/19/2024]
Abstract
BACKGROUND Existing studies on SARS-CoV-2 infection have mainly focused on severe clinical outcomes; understanding of the clinical severity profile of general community infections is poor. We aimed to assess and compare the clinical profiles of infections with SARS-CoV-2 omicron (B.1.1.529) subvariants in a representative community cohort in Hong Kong during periods of BA.2, BA.4/5, and XBB dominance. METHODS In this prospective cohort study in Hong Kong, a representative community cohort of individuals aged at least 5 years were recruited by random-digit dialling and underwent weekly rapid antigen testing for SARS-CoV-2, irrespective of symptoms, during three periods from March 1, 2022, to Oct 31, 2023, in which the BA.2, BA.4/5, or XBB subvariants were dominant. We analysed the likelihood of symptoms, as well as the patterns, severity, and duration of symptoms and their associations with participant demographics and vaccination and infection histories. FINDINGS 1126 (11·0%) of 10 279 participants in the BA.2 period, 830 (6·6%) of 12 588 in the BA.4/5 period, and 633 (11·1%) of 5690 during the XBB period tested positive for SARS-CoV-2 infection on rapid antigen tests. Community infections were generally mild, with asymptomatic infections comprising 22·0-25·0% of infections. No hospitalisations or deaths occurred as a direct result of SARS-CoV-2 infection during the study period. Compared with children aged 5-17 years, a higher likelihood of being symptomatic on infection was found for adults aged 18-59 years during the period of BA.2 dominance and adults aged 60 years or older during XBB dominance. Most (>90·0%) participants with symptomatic infections reported respiratory and systemic symptoms. Up-to-date vaccination with a regimen containing the BNT162b2 vaccine, compared with those without an up-to-date vaccine, was associated with a reduced likelihood of symptoms on infection during the period of BA.2 dominance and of severe symptoms causing substantial disturbance to daily life (grade 3 symptoms) during periods of BA.2 and BA.4/5 dominance, whereas no association was observed during the period of XBB dominance. Previous SARS-CoV-2 infection was associated with a reduced likelihood of symptoms on infection during BA.4/5 and XBB dominance and of severe symptoms during XBB dominance. Reports of severe symptoms increased over the three periods, from 236 (27·7%) of 852 symptomatic participants during BA.2 dominance to 176 (37·1%) of 475 during XBB dominance. The duration of symptoms was longest in the BA.2 period (median 10·0 days [95% CI 9·0-10·0]) and similar in the other two periods (8·0 [8·0-9·0] during BA.4/5 dominance and 8·0 [8·0-9·0] during XBB dominance). A symptom duration of 60 days or longer was reported only during the period of BA.2 dominance, in six (0·7%) of 824 infections. INTERPRETATION SARS-CoV-2 infections were generally mild, but not increasingly so, along the evolution of omicron subvariants in this highly vaccinated population. About a third of participants with symptomatic infections reported that the symptoms severely affected daily life even if they were not admitted to hospital, resulting in morbidity, absence from work or school due to illness, productivity loss, and increased medicoeconomic burden. A gradual reduction in the association of vaccines and increase in the association of previous infection with the symptom profile, possibly reflecting the effects of immune escape and waning, were observed over the study period. FUNDING Henry Fok Foundation and Hong Kong Health Bureau.
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Affiliation(s)
- Yawei Wang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hau Chi So
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Nicole Ngai Yung Tsang
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Siu Kan Kwok
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China
| | - Dennis Kai Ming Ip
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Mostafa HH, Fall A, Norton JM, Sachithanandham J, Yunker M, Abdullah O, Hanlon A, Gluck L, Morris CP, Pekosz A, Klein EY. Respiratory virus disease and outcomes at a large academic medical center in the United States: a retrospective observational study of the early 2023/2024 respiratory viral season. Microbiol Spectr 2024; 12:e0111624. [PMID: 39162510 PMCID: PMC11448398 DOI: 10.1128/spectrum.01116-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
Respiratory disease, attributed to influenza, respiratory syncytial virus (RSV), and SARS-CoV-2, was reported nationally during the 2023/2024 respiratory viral season. The emergence of novel SARS-CoV-2 variants was considered a significant factor contributing to the rise in COVID-19 cases. Data from the Johns Hopkins Hospital System (JHHS) showed that enterovirus/rhinovirus had also been circulating at high rates. Analyzing clinical outcomes of the most prevalent respiratory viruses is crucial for understanding the role of circulating viral genotypes. A retrospective cohort of patients who tested positive for SARS-CoV-2, influenza, RSV, or enterovirus/rhinovirus between 1 June and 31 December 2023 was included in the study. Remnant clinical samples were utilized for targeted viral whole-genome sequencing and genotyping. Patients' metadata and outcomes following infection were studied, stratified by viral variants and genotypes. The increase of SARS-CoV-2 positivity in December was associated with the predominance of JN.1. Admissions for patients under 18 years old were primarily associated with enterovirus/rhinovirus and RSV, while older age groups were mainly linked to SARS-CoV-2 and influenza infections. SARS-CoV-2-related admissions increased with the predominance of the JN.1 variant in December. No significant difference in admissions for influenza subtypes, rhinovirus species, or SARS-CoV-2 variants was observed. RSV A was associated with slightly higher odds of admission compared with RSV B. Our data highlight the importance of systematically analyzing respiratory viral infections to inform public health strategies and clinical management, especially as SARS-CoV-2 becomes endemic. The findings highlight the value of expanded genomic surveillance in elucidating the clinical significance of viral evolution.IMPORTANCEThe analysis of the epidemiology and clinical outcomes of multiple co-circulating respiratory viruses in the early 2023/2024 respiratory virus season highlights the emergence of the SARS-CoV-2 JN.1 variant as well as underscores the importance of enterovirus/rhinovirus in respiratory infections. Understanding these dynamics is essential for refining public health strategies and clinical management, especially as SARS-CoV-2 transitions to an endemic status. This work emphasizes the need for ongoing surveillance, robust diagnostic algorithms, and detailed genomic analyses to anticipate and mitigate the burden of respiratory viral infections, ultimately contributing to more informed decision-making in healthcare settings and better patient outcomes.
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Affiliation(s)
- Heba H Mostafa
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amary Fall
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Julie M Norton
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jaiprasath Sachithanandham
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Madeline Yunker
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Omar Abdullah
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ann Hanlon
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Linda Gluck
- Department of Pathology, Division of Medical Microbiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - C Paul Morris
- Integrated Research Facility, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland, USA
| | - Andrew Pekosz
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Center for Disease Dynamics, Economics, and Policy, Washington, DC, USA
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15
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Margarita V, Pau MC, Carboni G, Mannu F, Turrini F, Rappelli P, Pantaleo A, Dessì D, Zinellu E, Piras B, Fois AG, Rubino S, Pirina P, Fiori PL. Comparison of microbiological and molecular diagnosis for identification of respiratory secondary infections in COVID-19 patients and their antimicrobial resistance patterns. Diagn Microbiol Infect Dis 2024; 110:116479. [PMID: 39116653 DOI: 10.1016/j.diagmicrobio.2024.116479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 07/30/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
We report the use of a new multiplex Real-Time PCR platform to simultaneously identify 24 pathogens and 3 antimicrobial-resistance genes directly from respiratory samples of COVID-19 patients. Results were compared to culture-based diagnosis. Secondary infections were detected in 60% of COVID-19 patients by molecular analysis and 73% by microbiological assays, with no significant differences in accuracy, indicating Gram-negative bacteria as the predominant species. Among fungal superinfections, Aspergillus spp. were detected by both methods in more than 7% of COVID-19 patients. Oxacillin-resistant S. aureus and carbapenem-resistant K. pneumoniae were highlighted by both methods. Secondary microbial infections in SARS-CoV-2 patients are associated with poor outcomes and an increased risk of death. Since PCR-based tests significantly reduce the turnaround time to 4 hours and 30 minutes (compared to 48 hours for microbial culture), we strongly support the routine use of molecular techniques, in conjunction with microbiological analysis, to identify co/secondary infections.
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Affiliation(s)
- Valentina Margarita
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Carmina Pau
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Gavino Carboni
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | | | | | - Paola Rappelli
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; Azienda Ospedaliero Università (AOU), Sassari, 07100 Sassari, Italy
| | - Antonella Pantaleo
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Daniele Dessì
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | | | - Barbara Piras
- Azienda Ospedaliero Università (AOU), Sassari, 07100 Sassari, Italy
| | - Alessandro G Fois
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; Azienda Ospedaliero Università (AOU), Sassari, 07100 Sassari, Italy
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; Azienda Ospedaliero Università (AOU), Sassari, 07100 Sassari, Italy
| | - Pietro Pirina
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; Azienda Ospedaliero Università (AOU), Sassari, 07100 Sassari, Italy
| | - Pier Luigi Fiori
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; Azienda Ospedaliero Università (AOU), Sassari, 07100 Sassari, Italy
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O’Leary ST, Campbell JD, Ardura MI, Bryant KA, Caserta MT, Espinosa C, Frenck RW, Healy CM, John CC, Kourtis AP, Milstone A, Myers A, Pannaraj P, Ratner AJ, Bryant KA, Hofstetter AM, Chaparro JD, Michel JJ, Kimberlin DW, Banerjee R, Barnett ED, Lynfield R, Sawyer MH, Barton-Forbes M, Cardemil CV, Farizo KM, Kafer LM, Moore D, Okeke C, Prestel C, Patel M, Starke JR, Thompson J, Torres JP, Wharton M, Woods CR, Gibbs G. Recommendations for Prevention and Control of Influenza in Children, 2024-2025: Policy Statement. Pediatrics 2024; 154:e2024068507. [PMID: 39183669 DOI: 10.1542/peds.2024-068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccines and antiviral medications in the prevention and treatment of influenza in children during the 2024-2025 influenza season. A detailed review of the evidence supporting these recommendations is published in the accompanying technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2024-068508). The American Academy of Pediatrics recommends annual influenza vaccination of all children without medical contraindications starting at 6 months of age. Children are at risk for hospitalization and death from influenza. Influenza vaccination is an important strategy for protecting children and the broader community as well as reducing the overall burden of respiratory illnesses when other viruses are cocirculating. Any licensed influenza vaccine appropriate for age and health status can be administered, ideally as soon as possible in the season, without preference for one product or formulation over another. All licensed influenza vaccines for use in the United States are trivalent for the 2024-2025 influenza season. Antiviral treatment of influenza is recommended for children with suspected (eg, influenza-like illness [fever with either cough or sore throat]) or confirmed influenza who are hospitalized or have severe or progressive disease or have underlying conditions that increase their risk of complications of influenza, regardless of duration of illness. Antiviral treatment should be initiated as soon as possible. Antiviral treatment may be considered in the outpatient setting for symptomatic children who are not at high risk for influenza complications with suspected or confirmed influenza disease, if treatment can be initiated within 48 hours of illness onset. Antiviral treatment may also be considered for children with suspected or confirmed influenza disease whose siblings or household contacts either are younger than 6 months or have a high-risk condition that predisposes them to complications of influenza. Antiviral chemoprophylaxis is recommended for the prevention of influenza virus infection as an adjunct to vaccination in certain individuals, especially exposed children who are asymptomatic and are at high risk for influenza complications but have not yet been immunized or those who are not expected to mount an effective immune response.
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O’Leary ST, Campbell JD, Ardura MI, Bryant KA, Caserta MT, Espinosa C, Frenck RW, Healy CM, John CC, Kourtis AP, Milstone A, Myers A, Pannaraj P, Ratner AJ, Bryant KA, Hofstetter AM, Chaparro JD, Michel JJ, Kimberlin DW, Banerjee R, Barnett ED, Lynfield R, Sawyer MH, Barton-Forbes M, Cardemil CV, Farizo KM, Kafer LM, Moore D, Okeke C, Prestel C, Patel M, Starke JR, Thompson J, Torres JP, Wharton M, Woods CR, Gibbs G. Recommendations for Prevention and Control of Influenza in Children, 2024-2025: Technical Report. Pediatrics 2024; 154:e2024068508. [PMID: 39183667 DOI: 10.1542/peds.2024-068508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2024 to 2025 season. The rationale for the American Academy of Pediatrics recommendation for annual influenza vaccination of all children without medical contraindications starting at 6 months of age is provided. Influenza vaccination is an important strategy for protecting children and the broader community against influenza. This technical report summarizes recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, and vaccination coverage and provides detailed guidance on vaccine storage, administration, and implementation. The report also provides a brief background on inactivated (nonlive) and live attenuated influenza vaccines, available vaccines for the 2024-2025 influenza season, vaccination during pregnancy and breastfeeding, diagnostic testing for influenza, and antiviral medications for treatment and chemoprophylaxis. Strategies to promote vaccine uptake are emphasized.
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18
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Dotters-Katz SK. Influenza in Pregnancy: Maternal, Obstetric, and Fetal Implications, Diagnosis, and Management. Clin Obstet Gynecol 2024; 67:557-564. [PMID: 39061125 DOI: 10.1097/grf.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Influenza(flu) in pregnancy is associated with higher rates of hospitalization, ICU admission, and death and with increased odds of congenital anomalies and stillbirth, but not preterm birth. Clinical manifestations of flu in pregnancy are the same as nonpregnant patients. Pregnant individuals with flu-like symptoms or flu exposure should be treated with antivirals. Diagnostic testing is not needed. Oseltamivir is the mainstay of treatment(and prophylaxis), and when given within 48 hours of symptom onset, it decreases morbidity and mortality. Influenza is associated with worse maternal, obstetric, and neonatal outcomes. These risks are mitigated by early oseltamivir treatment and maternal vaccination; hence the recommendation for universal vaccination in pregnancy.
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Affiliation(s)
- Sarah K Dotters-Katz
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
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19
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van der Westhuizen C, Newton-Foot M, Nel P. Performance comparison of three commercial multiplex molecular panels for respiratory viruses at a South African academic hospital. Afr J Lab Med 2024; 13:2415. [PMID: 39228900 PMCID: PMC11369576 DOI: 10.4102/ajlm.v13i1.2415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/29/2024] [Indexed: 09/05/2024] Open
Abstract
Background Respiratory infections are a major contributor to hospital admissions. Identification of respiratory pathogens by means of conventional culture and serology methods remains challenging. Multiplex molecular assays are an appealing alternative that endeavours to be rapid, more accurate and less arduous. Objective The study aimed to compare the clinical performance of three commercial multiplex molecular assays for respiratory viruses. Methods Forty-eight respiratory specimens obtained from patients at Tygerberg Hospital in the Western Cape province of South Africa were studied. These specimens were collected between May 2020 and August 2020. The results of the Seegene Anyplex™ II RV16, FilmArray® Respiratory 2.1 plus Panel (FARP), and QIAstat-Dx® Respiratory SARS-CoV-2 Panel (QRP) were analysed based on the overlapping targets. A composite reference standard was applied to provide a standard reference for comparison. Results The overall sensitivity of the Seegene Anyplex™ II RV16 was 96.6% (57/59), the FARP 98.2% (56/57) and the QRP 80.7% (46/57). The overall specificities were 99.8% (660/661), 99.0% (704/711) and 99.7% (709/711), respectively. The QRP failed to detect coronaviruses and parainfluenza viruses in 41.7% (5/12) and 28.6% (4/14) of positive specimens, respectively, while the FARP produced the lowest target specificity of 88.4% (38/43) for rhinovirus/enterovirus. Conclusion The overall specificity of all three platforms was comparable; however, the sensitivity of the QRP was inferior to that of the ARV and FARP. What this study adds This study adds to the body of performance characteristics described for respiratory multiplex panels, especially in the African context where molecular diagnostics for infectious diseases are gaining momentum.
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Affiliation(s)
- Clinton van der Westhuizen
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Medical Microbiology, Tygerberg Hospital, National Health Laboratory Service, Cape Town, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Medical Microbiology, Tygerberg Hospital, National Health Laboratory Service, Cape Town, South Africa
| | - Pieter Nel
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Medical Microbiology, Tygerberg Hospital, National Health Laboratory Service, Cape Town, South Africa
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Han A, Henderson DK. Postexposure prophylaxis for occupational exposure to selected pathogens for healthcare personnel. Curr Opin Infect Dis 2024; 37:296-303. [PMID: 38899948 PMCID: PMC11213494 DOI: 10.1097/qco.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW Timely postexposure prophylaxis is important after an occupational exposure. Here we review select organisms, exposure opportunities in the healthcare setting, and postexposure prophylaxis regimens. RECENT FINDINGS Needlestick injuries pose a risk of exposure to bloodborne pathogens, such as HIV, Hepatitis B, and Hepatitis C. Risk mitigation strategies should be reexamined in light of newer vaccines and therapeutics. Increased vaccine hesitancy and vaccine denialisms may foster the re-emergence of some infections that have become extremely uncommon because of effective vaccines. With increasing occurrences of zoonotic infections and the ease of global spread as evidenced by COVID-19 and mpox, healthcare exposures must also consider risks related to emerging and re-emerging infectious diseases. SUMMARY Early recognition and reporting of occupational exposures to pathogens with available postexposure prophylaxis is key to mitigating the risk of transmission. Providers should be able to evaluate the exposure and associated risks to provide prompt and appropriate postexposure prophylaxis.
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Affiliation(s)
- Alison Han
- Hospital Epidemiology Service, Clinical Center, National Institutes of Health Service
| | - David K. Henderson
- Hospital Epidemiology Service, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
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21
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Apaydın ÇB, Naesens L, Cihan-Üstündağ G. One-pot synthesis, characterization and antiviral properties of new benzenesulfonamide-based spirothiazolidinones. Mol Divers 2024; 28:2681-2688. [PMID: 38935302 PMCID: PMC11450120 DOI: 10.1007/s11030-024-10912-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
A novel series of benzenesulfonamide substituted spirothiazolidinone derivatives (3a-j) were synthesized, characterized and evaluated for their antiviral activity. The spirocyclic compounds were prepared by the condensation of 4-(aminosulfonyl)-2-methoxybenzohydrazide, appropriate cyclic ketones and 2-mercaptopropionic acid in a one-pot reaction. The structures of the new compounds were established by IR, 1H NMR, 13C NMR (APT), and elemental analysis. The new compounds were evaluated in vitro antiviral activity against influenza A/H1N1, A/H3N2 and B viruses, as well as herpes simplex virus type 1 (HSV-1), respiratory syncytial virus (RSV) and yellow fever virus (YFV). Two derivatives bearing propyl (3d) and tert-butyl (3e) substituents at position 8 of the spiro ring exhibited activity against influenza A/H1N1 virus with EC50 values in the range of 35-45 µM and no cytotoxicity at 100 μM, the highest concentration tested.
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Affiliation(s)
- Çağla Begüm Apaydın
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Istanbul University, Fatih, 34126, Istanbul, Turkey.
| | - Lieve Naesens
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, B-3000, Louvain, Belgium
| | - Gökçe Cihan-Üstündağ
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Istanbul University, Fatih, 34126, Istanbul, Turkey
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22
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Du J, Shui H, Chen R, Dong Y, Xiao C, Hu Y, Wong NK. Neuraminidase-1 (NEU1): Biological Roles and Therapeutic Relevance in Human Disease. Curr Issues Mol Biol 2024; 46:8031-8052. [PMID: 39194692 DOI: 10.3390/cimb46080475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/24/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
Neuraminidases catalyze the desialylation of cell-surface glycoconjugates and play crucial roles in the development and function of tissues and organs. In both physiological and pathophysiological contexts, neuraminidases mediate diverse biological activities via the catalytic hydrolysis of terminal neuraminic, or sialic acid residues in glycolipid and glycoprotein substrates. The selective modulation of neuraminidase activity constitutes a promising strategy for treating a broad spectrum of human pathologies, including sialidosis and galactosialidosis, neurodegenerative disorders, cancer, cardiovascular diseases, diabetes, and pulmonary disorders. Structurally distinct as a large family of mammalian proteins, neuraminidases (NEU1 through NEU4) possess dissimilar yet overlapping profiles of tissue expression, cellular/subcellular localization, and substrate specificity. NEU1 is well characterized for its lysosomal catabolic functions, with ubiquitous and abundant expression across such tissues as the kidney, pancreas, skeletal muscle, liver, lungs, placenta, and brain. NEU1 also exhibits a broad substrate range on the cell surface, where it plays hitherto underappreciated roles in modulating the structure and function of cellular receptors, providing a basis for it to be a potential drug target in various human diseases. This review seeks to summarize the recent progress in the research on NEU1-associated diseases and highlight the mechanistic implications of NEU1 in disease pathogenesis. An improved understanding of NEU1-associated diseases should help accelerate translational initiatives to develop novel or better therapeutics.
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Affiliation(s)
- Jingxia Du
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang 471023, China
| | - Hanqi Shui
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang 471023, China
| | - Rongjun Chen
- Clinical Pharmacology Section, Department of Pharmacology, Shantou University Medical College, Shantou 515041, China
| | - Yibo Dong
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang 471023, China
| | - Chengyao Xiao
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang 471023, China
| | - Yue Hu
- College of Basic Medicine and Forensic Medicine, Henan University of Science and Technology, Luoyang 471023, China
| | - Nai-Kei Wong
- Clinical Pharmacology Section, Department of Pharmacology, Shantou University Medical College, Shantou 515041, China
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23
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Kwok WC, Lung DC, Tam TCC, Yap DYH, Ma TF, Tsui CK, Zhang R, Lam DCL, Ip MSM, Ho JCM. Protective Effects from Prior Pneumococcal Vaccination in Patients with Chronic Airway Diseases during Hospitalization for Influenza-A Territory-Wide Study. Vaccines (Basel) 2024; 12:704. [PMID: 39066342 PMCID: PMC11281690 DOI: 10.3390/vaccines12070704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/15/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Influenza is an important respiratory viral pathogen in adults, with secondary bacterial pneumonia being a common complication. While pneumococcal vaccines can prevent pneumococcal pneumonia and invasive pneumococcal disease, whether they can also prevent the severe in-hospital outcomes among patients hospitalized for influenza has not been examined. A territory-wide retrospective study was conducted in Hong Kong, which included all adult patients having chronic airway diseases (asthma, bronchiectasis, and chronic obstructive pulmonary disease) hospitalized for influenza and who had received seasonal influenza vaccine. The occurrence of secondary bacterial pneumonia, mortality, and other severe in-hospital outcomes were compared among subjects with or without pneumococcal vaccination. There was a total of 3066 eligible patients who were hospitalized for influenza in public hospitals in Hong Kong from 1 January 2016 to 30 June 2023. Completed pneumococcal vaccination with PSV23/PCV13 conferred protection against secondary bacterial pneumonia, all-cause mortality, and respiratory cause of mortality with adjusted odds ratios of 0.74 (95% CI = 0.57-0.95, p = 0.019), 0.12 (95% CI = 0.03-0.53, p = 0.005), and 0.04 (95% CI = 0.00-0.527, p = 0.0038), respectively.
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Affiliation(s)
- Wang-Chun Kwok
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - David Christopher Lung
- Department of Pathology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong SAR, China;
| | - Terence Chi-Chun Tam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Desmond Yat-Hin Yap
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Ting-Fung Ma
- Department of Statistics, University of South Carolina, Columbia, SC 29208, USA;
| | - Chung-Ki Tsui
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Ru Zhang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - David Chi-Leung Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Mary Sau-Man Ip
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - James Chung-Man Ho
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
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24
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Wrotek A, Jackowska T. A noninferiority randomized open-label pilot study of 3- versus 7-day influenza postexposure prophylaxis with oseltamivir in hospitalized children. Sci Rep 2024; 14:14192. [PMID: 38902383 PMCID: PMC11189916 DOI: 10.1038/s41598-024-65244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/18/2024] [Indexed: 06/22/2024] Open
Abstract
Short influenza postexposure prophylaxis (PEP) showed high efficacy in adults, but studies in children are lacking. This randomized open-label pilot trial aimed to verify noninferiority of a 3- versus 7-day prophylaxis with oral oseltamivir in hospitalized children. Influenza contacts were randomized to the 3- or 7-day group and efficacy, relative risk of adverse events (AEs), and the cumulative costs of drugs and AEs management were compared. The intention-to-treat (ITT) analysis included 59 children (n = 28 and n = 31 in the 3- and 7-day group, respectively). The efficacy was 100% (95% CI 87.7-100%) versus 93.6% (95% CI 78.6-99.2%) in the 3- and 7-day group; the differences were statistically insignificant. A per-protocol (PP) analysis including 56 patients (n = 27 and n = 29, respectively) showed 100% (95% CI 87.2-100%) and 93.1% (95% CI 77.2-99.2%) efficacy, respectively, without statistical significance. Differences were within the predefined noninferiority margin with an efficacy difference Δ = 6.45 percentage points (p.p.) with 1-sided 95% CI (- 2.8, - 1.31, p = 0.86; ITT) and Δ = 6.9 p.p. (1-sided 95% CI - 2.83, - 1.27, p = 0.85; PP). Adverse events did not differ significantly, while the cumulative costs of the prophylaxis and AEs management were higher in the 7-day group (median 10.5 euro vs. 4.5 euro, p < 0.01). This pilot study showed the noninferiority of the 3-day versus 7-day PEP, which was associated with lower costs.Trial registration number: NCT04297462, 5th March 2020, restrospectively registered.
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Affiliation(s)
- August Wrotek
- Department of Pediatrics, The Centre of Postgraduate Medical Education, Warsaw, Poland.
- Department of Pediatrics, Bielanski Hospital, Warsaw, Poland.
| | - Teresa Jackowska
- Department of Pediatrics, The Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Pediatrics, Bielanski Hospital, Warsaw, Poland
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25
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Abdulrazzaq N, Chkhis A. Prevalence of antimicrobial use and healthcare-associated infections in the UAE: Results from the first nationwide point-prevalence survey. Infect Dis Now 2024; 54:104891. [PMID: 38537707 DOI: 10.1016/j.idnow.2024.104891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES The WHO's Global Antimicrobial Resistance Surveillance System (GLASS) 2017-2018 reported a significant increase in antimicrobial resistance among nosocomial pathogens. This was the first national point of prevalence survey in United Arab Emirates. METHODS A one-day multicenter cross-sectional survey using a unified web-based platform was conducted in forty-four hospitals across the country from 3 to 23 November 2019 to estimate the prevalence of antimicrobial use and healthcare-associated infections among both governmental and private sectors. RESULTS All in all, 3657 inpatients in the 44 participating hospitals were surveyed; 51.4 % were on at least one antibiotic at that time. Pneumonia was the most frequently reported hospital-acquired (47 %), followed by intra-abdominal sepsis (10.9 %), upper respiratory tract infections (10.6 %), and urinary tract infections (9.9 %). Ceftriaxone and piperacillin/Tazobactam were the most frequently used antibiotics (13.5 %, 9.6 %). Compliance with guidelines was reported in 70.3 % of prescriptions. Only 11.4 % of patients received a single dose of surgical prophylaxis. CONCLUSION Our results on antimicrobial use and hospital-acquired infection prevalence are comparable to other regional and international findings. Local guidelines are needed to reduce the excessive use of Watch and Reserve antibiotics, reduce prolonged antibiotic use after surgery, and decrease hospital-acquired infections.
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Affiliation(s)
- Najiba Abdulrazzaq
- Al Kuwait Hospital - Dubai, Emirates Health Services, United Arab Emirates
| | - Ayman Chkhis
- Al Kuwait Hospital - Dubai, Emirates Health Services, United Arab Emirates.
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26
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Hernandez Lopez AL, Fassett MJ. Infectious diseases in pregnancy: A continuing struggle. Case Rep Womens Health 2024; 42:e00610. [PMID: 39021443 PMCID: PMC11252523 DOI: 10.1016/j.crwh.2024.e00610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 07/20/2024] Open
Affiliation(s)
- Adrian L. Hernandez Lopez
- Department of Obstetrics and Gynecology, University of California, San Francisco Mission Bay Medical Center, 1855 4 Street, San Francisco, CA 94158, United States of America
| | - Michael J. Fassett
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, West Los Angeles Medical Center, 6041 Cadillac Ave 3rd Floor, Los Angeles, CA 90034, United States of America
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27
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Schober T, Morris SK, Bettinger JA, Burton C, Halperin SA, Jadavji T, Kazmi K, Modler J, Sadarangani M, Papenburg J. Antibiotic use in children hospitalised for influenza, 2010-2021: the Canadian Immunization Monitoring Program Active (IMPACT). Infection 2024; 52:865-875. [PMID: 37930625 DOI: 10.1007/s15010-023-02124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To determine characteristics associated with inappropriate antibiotic use amongst children hospitalised for influenza. METHODS We performed active surveillance for laboratory-confirmed influenza hospitalizations amongst children ≤ 16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from September 2010 to August 2021. Antibiotic use was presumed appropriate if any of the following indications were met: age < 1 month, immunocompromised, hemoglobinopathy, laboratory-confirmed bacterial infection, radiographically confirmed pneumonia, admission to an intensive care unit and mechanical ventilation. Regression analyses were used to identify baseline and clinical characteristics associated with antibiotic use amongst patients without an appropriate indication. RESULTS Amongst 8971 children, 6424 (71.6%) received any antibiotics during their hospitalisation. Amongst the 4429 children without an appropriate indication, 2366 (53.2%) received antibiotics. Antibiotic use amongst children without appropriate indication differed between study centres, ranging from 33.2% to 66.1% (interquartile range [IQR] 50.6-56.3%); it did not change significantly over time (p-value for trend = 0.28). In multivariable analyses, older age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96-0.99), presence of any high-risk condition (aOR 0.80, 95% CI 0.70-0.92), influenza virus type B (aOR 0.8, 95% CI 0.70-0.91) and croup (aOR 0.64, 95% CI 0.49-0.83) were associated with less, whilst fever ≥ 38.5 °C (aOR 1.82, 95% CI 1.42-2.35) and hospitalisation duration (aOR 1.12, 95% CI 1.09-1.15) were associated with more inappropriate antibiotic use. CONCLUSIONS Over two-third of children hospitalised for influenza received antibiotics, including over half of those without an appropriate indication for antibiotic treatment. Differences amongst study centres suggest the importance of contextual determinants of antibiotic use.
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Affiliation(s)
- Tilmann Schober
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, E05.1905, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada
- Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Shaun K Morris
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute,, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Burton
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Taj Jadavji
- Section of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Kescha Kazmi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jacqueline Modler
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute,, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, E05.1905, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada.
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, QC, Canada.
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28
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Morris SE, Zipfel CM, Peer K, Madewell ZJ, Brenner S, Garg S, Paul P, Slayton RB, Biggerstaff M. Modeling the Impacts of Antiviral Prophylaxis Strategies in Mitigating Seasonal Influenza Outbreaks in Nursing Homes. Clin Infect Dis 2024; 78:1336-1344. [PMID: 38072652 PMCID: PMC11260992 DOI: 10.1093/cid/ciad764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Antiviral chemoprophylaxis is recommended for use during influenza outbreaks in nursing homes to prevent transmission and severe disease among non-ill residents. Centers for Disease Control and Prevention (CDC) guidance recommends prophylaxis be initiated for all non-ill residents once an influenza outbreak is detected and be continued for at least 14 days and until 7 days after the last laboratory-confirmed influenza case is identified. However, not all facilities strictly adhere to this guidance and the impact of such partial adherence is not fully understood. METHODS We developed a stochastic compartmental framework to model influenza transmission within an average-sized US nursing home. We compared the number of symptomatic illnesses and hospitalizations under varying prophylaxis implementation strategies, in addition to different levels of prophylaxis uptake and adherence by residents and healthcare personnel (HCP). RESULTS Prophylaxis implemented according to current guidance reduced total symptomatic illnesses and hospitalizations among residents by a median of 12% and 36%, respectively, compared with no prophylaxis. We did not find evidence that alternative implementations of prophylaxis were more effective: compared to full adoption of current guidance, partial adoption resulted in increased symptomatic illnesses and/or hospitalizations, and longer or earlier adoption offered no additional improvements. In addition, increasing uptake and adherence among nursing home residents was effective in reducing resident illnesses and hospitalizations, but increasing HCP uptake had minimal indirect impacts for residents. CONCLUSIONS The greatest benefits of influenza prophylaxis during nursing home outbreaks will likely be achieved through increasing uptake and adherence among residents and following current CDC guidance.
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Affiliation(s)
- Sinead E Morris
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Casey M Zipfel
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komal Peer
- Division of Environmental Health Science and Practice, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephan Brenner
- Agency for Toxic Substances and Disease Registry, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Prabasaj Paul
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel B Slayton
- Divison of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Matthew Biggerstaff
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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29
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Berry GJ, Jhaveri TA, Larkin PMK, Mostafa H, Babady NE. ADLM Guidance Document on Laboratory Diagnosis of Respiratory Viruses. J Appl Lab Med 2024; 9:599-628. [PMID: 38695489 DOI: 10.1093/jalm/jfae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 06/06/2024]
Abstract
Respiratory viral infections are among the most frequent infections experienced worldwide. The COVID-19 pandemic has highlighted the need for testing and currently several tests are available for the detection of a wide range of viruses. These tests vary widely in terms of the number of viral pathogens included, viral markers targeted, regulatory status, and turnaround time to results, as well as their analytical and clinical performance. Given these many variables, selection and interpretation of testing requires thoughtful consideration. The current guidance document is the authors' expert opinion based on the preponderance of available evidence to address key questions related to best practices for laboratory diagnosis of respiratory viral infections including who to test, when to test, and what tests to use. An algorithm is proposed to help laboratories decide on the most appropriate tests to use for the diagnosis of respiratory viral infections.
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Affiliation(s)
- Gregory J Berry
- Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian-Columbia University Irving Medical Center, New York, NY, United States
| | - Tulip A Jhaveri
- Department of Internal Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, United States
| | - Paige M K Larkin
- University of Chicago Pritzker School of Medicine, NorthShore University Health System, Chicago, IL, United States
| | - Heba Mostafa
- Johns Hopkins School of Medicine, Department of Pathology, Baltimore, MD, United States
| | - N Esther Babady
- Clinical Microbiology and Infectious Disease Services, Department of Pathology and Laboratory Medicine and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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30
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Dockrell DH, Breen R, Collini P, Lipman MCI, Miller RF. British HIV Association guidelines on the management of opportunistic infection in people living with HIV: The clinical management of pulmonary opportunistic infections 2024. HIV Med 2024; 25 Suppl 2:3-37. [PMID: 38783560 DOI: 10.1111/hiv.13637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/25/2024]
Affiliation(s)
- D H Dockrell
- University of Edinburgh, UK
- Regional Infectious Diseases Unit, NHS Lothian Infection Service, Edinburgh, UK
| | - R Breen
- Forth Valley Royal Hospital, Larbert, Scotland, UK
| | | | - M C I Lipman
- Royal Free London NHS Foundation Trust, UK
- University College London, UK
| | - R F Miller
- Royal Free London NHS Foundation Trust, UK
- Institute for Global Health, University College London, UK
- Central and North West London NHS Foundation Trust, UK
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31
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Coughlan L, Neuzil KM. Outpacing antiviral resistance: new treatments for influenza virus infection. THE LANCET. INFECTIOUS DISEASES 2024; 24:447-449. [PMID: 38330976 DOI: 10.1016/s1473-3099(23)00820-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024]
Affiliation(s)
- Lynda Coughlan
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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32
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Schober T, Wong K, DeLisle G, Caya C, Brendish NJ, Clark TW, Dendukuri N, Doan Q, Fontela PS, Gore GC, Li P, McGeer AJ, Noël KC, Robinson JL, Suarthana E, Papenburg J. Clinical Outcomes of Rapid Respiratory Virus Testing in Emergency Departments: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:528-536. [PMID: 38436951 PMCID: PMC10913011 DOI: 10.1001/jamainternmed.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024]
Abstract
Importance Rapid tests for respiratory viruses, including multiplex panels, are increasingly available in emergency departments (EDs). Their association with patient outcomes remains unclear. Objective To determine if ED rapid respiratory virus testing in patients with suspected acute respiratory infection (ARI) was associated with decreased antibiotic use, ancillary tests, ED length of stay, and ED return visits and hospitalization and increased influenza antiviral treatment. Data Sources Ovid MEDLINE, Embase (Ovid), Scopus, and Web of Science from 1985 to November 14, 2022. Study Selection Randomized clinical trials of patients of any age with ARI in an ED. The primary intervention was rapid viral testing. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. Main Outcomes and Measures Antibiotic use and secondary outcomes were pooled separately as risk ratios (RRs) and risk difference estimates with 95% CIs. Results Of 7157 studies identified, 11 (0.2%; n = 6068 patients) were included in pooled analyses. Routine rapid viral testing was not associated with antibiotic use (RR, 0.99; 95% CI, 0.93-1.05; high certainty) but was associated with higher use of influenza antivirals (RR, 1.33; 95% CI, 1.02-1.75; moderate certainty) and lower use of chest radiography (RR, 0.88; 95% CI, 0.79-0.98; moderate certainty) and blood tests (RR, 0.81; 95% CI, 0.69-0.97; moderate certainty). There was no association with urine testing (RR, 0.95; 95% CI, 0.77-1.17; low certainty), ED length of stay (0 hours; 95% CI, -0.17 to 0.16; moderate certainty), return visits (RR, 0.93; 95%, CI 0.79-1.08; moderate certainty) or hospitalization (RR, 1.01; 95% CI, 0.95-1.08; high certainty). Adults represented 963 participants (16%). There was no association of viral testing with antibiotic use in any prespecified subgroup by age, test method, publication date, number of viral targets, risk of bias, or industry funding. Conclusions and Relevance The results of this systematic review and meta-analysis suggest that there are limited benefits of routine viral testing in EDs for patients with ARI. Further studies in adults, especially those with high-risk conditions, are warranted.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kimberly Wong
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Gaëlle DeLisle
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathan J Brendish
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, England
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, England
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, England
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, England
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Nandini Dendukuri
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia S Fontela
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Genevieve C Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Patricia Li
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Allison J McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Kim Chloe Noël
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
- Health Technology Assessment Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Su X, Zhou J, Liu L, Gao H, Lin Y, Wang Z, Zhang X, Pan B, Wang B, Zhang C, Guo W. Performance evaluation of influenza a rapid antigen test and PCR among nasopharyngeal and oropharyngeal samples. Pract Lab Med 2024; 40:e00416. [PMID: 38989481 PMCID: PMC11234145 DOI: 10.1016/j.plabm.2024.e00416] [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] [Received: 03/12/2024] [Revised: 05/08/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024] Open
Abstract
Objectives Rapid antigen test (RAT) and polymerase chain reaction (PCR) using nasopharyngeal (NP) or oropharyngeal (OP) swab specimens are the two main testing techniques used for laboratory diagnosis of influenza in clinical practice. However, performance variations have been observed not only between techniques, but also between different specimens. This study evaluated the differences in performance between specimens and testing techniques to identify the best combination in clinical practice. Methods Both NP and OP samples from suspected influenza patients collected in the 2023/4-2023/5 Flu-season in Xiamen, China, were tested for RAT and quantitative PCR. The testing performance of the different specimens and testing techniques were recorded and evaluated. Results Compared to PCR, RAT showed 58.9 % and 10.3 % sensitivity for NP and OP swabs, respectively. The Limit of Detection (LoD) was 28.71 the Median Tissue Culture Infectious Dose (TCID50)/mL. Compared with PCR using NP swabs, PCR with OP swabs showed 89.5 % sensitivity and 95.4 % specificity. Conclusions There were no significant differences in performance between the specimens when PCR was used to test for influenza. However, a decrease in sensitivity was observed when the RAT was used, regardless of the specimen type. Therefore, to avoid false-negative results, PCR may be a better choice when OP swabs are used as specimens. In contrast, NP swabs should be the recommended specimens for RAT.
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Affiliation(s)
- Xiaosong Su
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
| | - Jiaye Zhou
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ling Liu
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
| | - Hongzhi Gao
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
| | - Yan Lin
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
| | - Zhile Wang
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
| | - Xin Zhang
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
| | - Baishen Pan
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Beili Wang
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chunyan Zhang
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wei Guo
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, Xiamen Branch, 668 Jinhu Road, 361015, Xiamen, China
- Department of Clinical Laboratory, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
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Cilloniz C, Dy-Agra G, Pagcatipunan RS, Torres A. Viral Pneumonia: From Influenza to COVID-19. Semin Respir Crit Care Med 2024; 45:207-224. [PMID: 38228165 DOI: 10.1055/s-0043-1777796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.
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Affiliation(s)
- Catia Cilloniz
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Guinevere Dy-Agra
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Rodolfo S Pagcatipunan
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Antoni Torres
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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Pickens CI, Gao CA, Morales-Nebreda L, Wunderink RG. Microbiology of Severe Community-Acquired Pneumonia and the Role of Rapid Molecular Techniques. Semin Respir Crit Care Med 2024; 45:158-168. [PMID: 38196061 DOI: 10.1055/s-0043-1777770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
The microbiology of severe community acquired pneumonia (SCAP) has implications on management, clinical outcomes and public health policy. Therefore, knowledge of the etiologies of SCAP and methods to identify these microorganisms is key. Bacteria including Streptococcus pneumoniae, Staphylococcus aureus and Enterobacteriaceae continue to be important causes of SCAP. Viruses remain the most commonly identified etiology of SCAP. Atypical organisms are also important etiologies of SCAP and are critical to identify for public health. With the increased number of immunocompromised individuals, less common pathogens may also be found as the causative agent of SCAP. Traditional diagnostic tests, including semi-quantitative respiratory cultures, blood cultures and urinary antigens continue to hold an important role in the evaluation of patients with SCAP. Many of the limitations of the aforementioned tests are addressed by rapid, molecular diagnostic tests. Molecular diagnostics utilize culture-independent technology to identify species-specific genetic sequences. These tests are often semi-automated and provide results within hours, which provides an opportunity for expedient antibiotic stewardship. The existing literature suggests molecular diagnostic techniques may improve antibiotic stewardship in CAP, and future research should investigate optimal methods for implementation of these assays into clinical practice.
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Affiliation(s)
- Chiagozie I Pickens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Catherine A Gao
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Luisa Morales-Nebreda
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Cavallazzi R, Ramirez JA. Influenza and Viral Pneumonia. Infect Dis Clin North Am 2024; 38:183-212. [PMID: 38280763 DOI: 10.1016/j.idc.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Influenza and other respiratory viruses are commonly identified in patients with community-acquired pneumonia, hospital-acquired pneumonia, and in immunocompromised patients with pneumonia. Clinically, it is difficult to differentiate viral from bacterial pneumonia. Similarly, the radiological findings of viral infection are in general nonspecific. The advent of polymerase chain reaction testing has enormously facilitated the identification of respiratory viruses, which has important implications for infection control measures and treatment. Currently, treatment options for patients with viral infection are limited but there is ongoing research on the development and clinical testing of new treatment regimens and strategies.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care, and Sleep Disorders, University of Louisville, Louisville, KY, USA.
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
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37
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Thampi N, Guzman-Cottrill J, Bartlett AH, Berg W, Cantey JB, Kitt E, Ravin K, Zangwill KM, Elward A. SHEA NICU white paper series: Practical approaches for the prevention of viral respiratory infections. Infect Control Hosp Epidemiol 2024; 45:267-276. [PMID: 37877172 DOI: 10.1017/ice.2023.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
This white paper provides clinicians and hospital leaders with practical guidance on the prevention and control of viral respiratory infections in the neonatal intensive care unit (NICU). This document serves as a companion to Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee (HICPAC)'s "Prophylaxis and Screening for Prevention of Viral Respiratory Infections in Neonatal Intensive Care Unit Patients: A Systematic Review." It provides practical, expert opinion and/or evidence-based answers to frequently asked questions about viral respiratory detection and prevention in the NICU. It was developed by a writing panel of pediatric and pathogen-specific experts who collaborated with members of the HICPAC systematic review writing panel and the SHEA Pediatric Leadership Council to identify questions that should be addressed. The document has been endorsed by SHEA, the American Hospital Association (AHA), The Joint Commission, the Pediatric Infectious Diseases Society (PIDS), the Association for Professionals in Infection Control and Epidemiology (APIC), the Infectious Diseases Society of America (IDSA), and the National Association of Neonatal Nurses (NANN).
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Affiliation(s)
- Nisha Thampi
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Allison H Bartlett
- University of Chicago and Comer Children's Hospital, Chicago, Illinois, USA
| | - Wendy Berg
- Children's Minnesota, St. Paul, Minnesota, USA
| | - Joseph B Cantey
- The University of Texas Health Science Center, San Antonio, Texas, USA
| | - Eimear Kitt
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen Ravin
- Nemours Children's Health, Wilmington, Delaware, USA
| | | | - Alexis Elward
- Washington University School of Medicine, St. Louis, Missouri, USA
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38
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Fodor E, Nagy RN, Nógrádi A, Toovey S, Kamal MA, Vadász P, Bencsik P, Görbe A, Ferdinandy P. An Observational Study on the Pharmacokinetics of Oseltamivir in Lactating Influenza Patients. Clin Pharmacol Ther 2024; 115:318-323. [PMID: 37975276 DOI: 10.1002/cpt.3107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
Influenza infection may lead to serious complications in the postpartum period, therefore, oseltamivir treatment in these patients and their breastfed infants is of great importance. However, the pharmacokinetics of oseltamivir in postpartum lactating women with acute influenza infection, and the consequent infant exposure to oseltamivir are still unknown, and these data would help in assessing risk and the need for dose adjustment in breastfed infants. Six lactating women with influenza-like symptoms, at a standard dose of 75 mg oral oseltamivir twice daily for 5 days, were recruited in this phase IV clinical study during the 2011/2012 H1N1 pandemic seasons. Breast milk/colostrum and venous blood samples were taken at multiple timepoints, maternal urine samples were obtained from total output within the 12-hour observational period following the seventh dose of oseltamivir. Oseltamivir phosphate (OP) reached a maximum 69.5 ± 29.4 ng/mL concentration in breast milk, higher than that found in the plasma, and showed elimination within ~ 8 hours. Oseltamivir carboxylate (active metabolite of OP) showed a lower, nearly steady-state concentration in breast milk during the observational period (maximum plasma concentration (Cmax ) = 38.4 ± 12.9 ng/mL). Based on estimated daily milk consumption of exclusively breastfed infants, their calculated daily exposure is < 0.1% of the infant dose of oseltamivir for treatment of influenza as per marketing authorization. Here, we provide the first maternal breast milk pharmacokinetic data for oral multiple-dose oseltamivir in lactating patients with influenza and showed that its concentration in the breast milk is not sufficient to reach a therapeutic dose for breastfed infants.
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Affiliation(s)
| | - Regina N Nagy
- MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | | | | | | | - Péter Vadász
- Department of Obstetrics and Gynecology, Selye János Hospital, Komárom, Hungary
| | - Péter Bencsik
- Pharmahungary Group, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Anikó Görbe
- Pharmahungary Group, Szeged, Hungary
- MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
| | - Péter Ferdinandy
- Pharmahungary Group, Szeged, Hungary
- MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
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Chao S, Wang Y, Wu B, Li R, Dong J, Ji L, Li X, Li R, Yin X, Zhao X, Liang W. Characterization of viral infections in children with influenza-like-illness during December 2018-January 2019. Front Cell Infect Microbiol 2024; 13:1351814. [PMID: 38304460 PMCID: PMC10830827 DOI: 10.3389/fcimb.2023.1351814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/26/2023] [Indexed: 02/03/2024] Open
Abstract
Introduction Respiratory viral infection (RVI) is of very concern after the outbreak of COVID-19, especially in pediatric departments. Learning pathogen spectrum of RVI in children previous the epidemic of COVID-19 could provide another perspective for understanding RVI under current situation and help to prepare for the post COVID-19 infection control. Methods A nucleic acid sequence-based amplification (NASBA) assay, with 19 pairs of primers targeting various respiratory viruses, was used for multi-pathogen screening of viral infections in children presenting influenza-like illness (ILI) symptoms. Children with ILI at the outpatient department of Beijing Tsinghua Changgung Hospital during the influenza epidemic from 12/2018 to 01/2019 were included. Throat swabs were obtained for both the influenza rapid diagnostic test (IRDT) based on the colloidal gold immunochromatographic assay and the NASBA assay, targeting various respiratory viruses with an integrated chip technology. Results and discussion Of 519 patients, 430 (82.9%) were positive in the NASBA assay. The predominant viral pathogens were influenza A H1N1 pdm1/2009 (pH1N1) (48.4%) and influenza A (H3N2) (18.1%), followed by human metapneumovirus (hMPV) (8.8%) and respiratory syncytial virus (RSV) (6.1%). Of the 320 cases identified with influenza A by NASBA, only 128 (40.0%) were positive in the IRDT. The IRDT missed pH1N1 significantly more frequently than A (H3N2) (P<0.01). Influenza A pH1N1 and A (H3N2) were the major pathogens in <6 years and 6-15 years old individuals respectively (P<0.05). In summary, influenza viruses were the major pathogens in children with ILI during the 2018-2019 winter influenza epidemic, while hMPV and RSV were non-negligible. The coexistence of multiple pathogen leading to respiratory infections is the normalcy in winter ILI cases.
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Affiliation(s)
- Shuang Chao
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuejiao Wang
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Baolei Wu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Runqing Li
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jingxiao Dong
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lina Ji
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xuejun Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ran Li
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiaomei Yin
- Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiuying Zhao
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Antoon JW, Grijalva CG, Talbot K. Oseltamivir May or May Not Reduce Hospitalizations. JAMA Intern Med 2024; 184:116-117. [PMID: 37983034 PMCID: PMC10843694 DOI: 10.1001/jamainternmed.2023.4720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- James W Antoon
- Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Carlos G Grijalva
- Division of Pharmacoepidemiology, Departments of Health Policy and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Keipp Talbot
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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Uyeki TM, Hui DSC, Lee N. Oseltamivir May or May Not Reduce Hospitalizations. JAMA Intern Med 2024; 184:116. [PMID: 37983025 DOI: 10.1001/jamainternmed.2023.4711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Timothy M Uyeki
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David S C Hui
- Department of Medicine and Therapeutics, S.H. Ho Research Center for Infectious Diseases, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Nelson Lee
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Davies S, Boller E, Chase J, Beaubrun A, Miller C, Jensen I. A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses. J Med Econ 2024; 27:430-441. [PMID: 38328858 DOI: 10.1080/13696998.2024.2313391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
AIMS Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies. METHODS A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course. RESULTS The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies. LIMITATIONS Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic. CONCLUSION The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.
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Affiliation(s)
- Shawn Davies
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | - Emily Boller
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | | | | | - Cynthia Miller
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | - Ivar Jensen
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
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Tamai M, Taba S, Mise T, Yamashita M, Ishikawa H, Shintake T. Effect of Ethanol Vapor Inhalation Treatment on Lethal Respiratory Viral Infection With Influenza A. J Infect Dis 2023; 228:1720-1729. [PMID: 37101418 PMCID: PMC10733743 DOI: 10.1093/infdis/jiad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/12/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
Ethanol (EtOH) effectively inactivates enveloped viruses in vitro, including influenza and severe acute respiratory syndrome coronavirus 2. Inhaled EtOH vapor may inhibit viral infection in mammalian respiratory tracts, but this has not yet been demonstrated. Here we report that unexpectedly low EtOH concentrations in solution, approximately 20% (vol/vol), rapidly inactivate influenza A virus (IAV) at mammalian body temperature and are not toxic to lung epithelial cells on apical exposure. Furthermore, brief exposure to 20% (vol/vol) EtOH decreases progeny virus production in IAV-infected cells. Using an EtOH vapor exposure system that is expected to expose murine respiratory tracts to 20% (vol/vol) EtOH solution by gas-liquid equilibrium, we demonstrate that brief EtOH vapor inhalation twice a day protects mice from lethal IAV respiratory infection by reducing viruses in the lungs without harmful side effects. Our data suggest that EtOH vapor inhalation may provide a versatile therapy against various respiratory viral infectious diseases.
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Affiliation(s)
- Miho Tamai
- Immune Signal Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Seita Taba
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Takeshi Mise
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Masao Yamashita
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Hiroki Ishikawa
- Immune Signal Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
| | - Tsumoru Shintake
- Quantum Wave Microscopy Unit, Okinawa Institute of Science and Technology, Tancha 1919-1, Onna-son, Okinawa 904-0495, Japan
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44
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Soto R, Paul L, Porucznik CA, Xie H, Stinnett RC, Briggs B, Biggerstaff M, Stanford J, Schlaberg R. Effectiveness of Self-Collected, Ambient Temperature-Preserved Nasal Swabs Compared to Samples Collected by Trained Staff for Genotyping of Respiratory Viruses by Shotgun RNA Sequencing: Comparative Study. JMIR Form Res 2023; 7:e32848. [PMID: 37999952 DOI: 10.2196/32848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 02/16/2023] [Accepted: 08/09/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has underscored the need for field specimen collection and transport to diagnostic and public health laboratories. Self-collected nasal swabs transported without dependency on a cold chain have the potential to remove critical barriers to testing, expand testing capacity, and reduce opportunities for exposure of health professionals in the context of a pandemic. OBJECTIVE We compared nasal swab collection by study participants from themselves and their children at home to collection by trained research staff. METHODS Each adult participant collected 1 nasal swab, sampling both nares with the single swab, after which they collected 1 nasal swab from 1 child. After all the participant samples were collected for the household, the research staff member collected a separate single duplicate sample from each individual. Immediately after the sample collection, the adult participants completed a questionnaire about the acceptability of the sampling procedures. Swabs were placed in temperature-stable preservative and respiratory viruses were detected by shotgun RNA sequencing, enabling viral genome analysis. RESULTS In total, 21 households participated in the study, each with 1 adult and 1 child, yielding 42 individuals with paired samples. Study participants reported that self-collection was acceptable. Agreement between identified respiratory viruses in both swabs by RNA sequencing demonstrated that adequate collection technique was achieved by brief instructions. CONCLUSIONS Our results support the feasibility of a scalable and convenient means for the identification of respiratory viruses and implementation in pandemic preparedness for novel respiratory pathogens.
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Affiliation(s)
- Raymond Soto
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Litty Paul
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Christina A Porucznik
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Heng Xie
- IDbyDNA, Salt Lake City, UT, United States
| | | | | | - Matthew Biggerstaff
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
| | - Robert Schlaberg
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, United States
- IDbyDNA, Salt Lake City, UT, United States
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45
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Kojima N, Peterson L, Hawkins R, Allen M, Flannery B, Uyeki TM. Influenza Antiviral Shortages Reported by State and Territorial Public Health Officials, 2022-2023. JAMA 2023; 330:1793-1795. [PMID: 37862007 PMCID: PMC10646723 DOI: 10.1001/jama.2023.17244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 10/21/2023]
Abstract
This study provides survey results from state and territorial public health preparedness directors regarding antiviral shortages during the 2022-2023 respiratory viral season.
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Affiliation(s)
- Noah Kojima
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa Peterson
- The Association of State and Territorial Health Officials, Arlington, Virginia
| | - Regina Hawkins
- The Association of State and Territorial Health Officials, Arlington, Virginia
| | - Meredith Allen
- The Association of State and Territorial Health Officials, Arlington, Virginia
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46
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Balas WM, Śliwczyński A, Olszewski P, Gołębiak I, Sybilski AJ. Comparative Analysis of Symptomatology in Hospitalized Children with RSV, COVID-19, and Influenza Infections. Med Sci Monit 2023; 29:e941229. [PMID: 37950434 PMCID: PMC10647936 DOI: 10.12659/msm.941229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/28/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The clinical course of respiratory syncytial virus (RSV), SARS-CoV-2, and influenza infections comprises many non-specific symptoms, which makes diagnosis difficult. The aim of this study was to retrospectively analyze the symptomatology of these infections in children and to search for correlations between them. MATERIAL AND METHODS A total of 121 children with a positive RSV (n=61), influenza (n=31), or SARS-CoV-2 (n=29) antigen test were enrolled in this retrospective analysis. Children were aged up to 71 months (median, 8 months). The collected data were collated by performing statistical analysis using the chi-square test and comparing the results using OR (odds ratio) and 95%CI (confidence interval). RESULTS There was a higher risk of fever in children with influenza than in those with RSV. Patients infected with RSV had a higher risk of nasal blockage than those with SARS-CoV-2. Dyspnea was more common in RSV infection than in influenza. Severe, sleep-awakening cough was more frequent in children with RSV than in those with COVID-19. Influenza was more prevalent in children aged >24 months than in those aged 7-24 months. RSV-infected children had a higher risk of numerous auscultatory changes compared to those with SARS-CoV-2. In the case of RSV infection, symptoms requiring hospitalization occurred later than in SARS-CoV-2 infection. CONCLUSIONS Children aged >24 months were at higher risk of contracting influenza. Numerous auscultatory changes, nasal blockage, and dyspnea were more common in children with RSV. There was a higher risk of dyspnea in children with RSV. Fever was more frequent in children with influenza. However, none of the symptoms clearly indicated the etiology of the infection.
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Affiliation(s)
- Weronika M. Balas
- Department of Paediatrics and Neonatology with Allergology Center, The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Andrzej Śliwczyński
- Health Public Department, The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland
| | | | | | - Adam J. Sybilski
- Department of Paediatrics and Neonatology with Allergology Center, The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland
- Second Department of Paediatrics, Centre of Postgraduate Medical Education, Warsaw, Poland
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47
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Liu TH, Huang PY, Wu JY, Chuang MH, Hsu WH, Tsai YW, Tsai MH, Lai CC. Real-world data analysis of post-COVID-19 condition risk in older patients. Age Ageing 2023; 52:afad204. [PMID: 37962418 DOI: 10.1093/ageing/afad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Indexed: 11/15/2023] Open
Abstract
This study investigated the risk of post-COVID-19 conditions in older patients with COVID-19 compared to those with influenza, and how age impacts this relationship. Patients aged ≥65 years with COVID-19 or influenza were identified using the TriNetX network. The risk of post-COVID-19 conditions was compared between survivors of COVID-19 and influenza, followed by a comparison of post-COVID-19 conditions risk between patients aged 65-74 years and those aged over 75 years. Compared with influenza survivors, post-COVID-19 conditions were significantly more prevalent in patients with COVID-19 (hazard ratio [HR], 1.534; 95% confidence interval [CI]: 1.405-1.675). Specifically, COVID-19 survivors have a significantly higher risk of experiencing abnormal breathing (HR, 2.052; 95% CI: 1.757-2.397), fatigue (HR, 1.587; 95% CI: 1.322-1.905), anxiety/depression (HR, 1.587; 95% CI: 1.322-1.905), cognitive symptoms (HR, 1.667; 95% CI: 1.295-2.146) and cough (HR, 1.250; 95% CI: 1.006-1.553) compared with the influenza group. Contrastingly, no significant difference was observed in the risk of any post-COVID-19 condition between COVID-19 survivors aged 65-74 years and those aged over 75 years (HR, 0.994; 95% CI: 0.920-1.073). However, a lower incidence of cognitive symptoms was observed in patients aged 65-74 years compared to those aged ≥75 years (HR, 0.543; 95% CI: 0.445-0.661). In conclusion, compared with influenza, older patients have a higher risk of developing post-COVID-19 conditions after SARS-CoV-2 infection, and those aged over ≥75 years may have an increased risk of developing cognitive symptoms compared to those aged 65-74 years.
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Affiliation(s)
- Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, Tainan Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wan-Hsuan Hsu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ya-Wen Tsai
- Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Meng-Hsiu Tsai
- Department of Geriatrics and Gerontology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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48
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Harrison R, Mubareka S, Papenburg J, Schober T, Allen UD, Hatchette TF, Evans GA. AMMI Canada 2023 update on influenza: Management and emerging issues. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2023; 8:176-185. [PMID: 38058499 PMCID: PMC10697102 DOI: 10.3138/jammi-2023-07-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Affiliation(s)
- Robyn Harrison
- University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Upton D Allen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Todd F Hatchette
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gerald A Evans
- Division of Infectious Diseases, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada
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49
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Baker JB, Block SL, Cagas SE, Macutkiewicz LB, Collins C, Sadeghi M, Sarkar S, Williams S. Safety and Efficacy of Baloxavir Marboxil in Influenza-infected Children 5-11 Years of Age: A Post Hoc Analysis of a Phase 3 Study. Pediatr Infect Dis J 2023; 42:983-989. [PMID: 37595103 PMCID: PMC10569673 DOI: 10.1097/inf.0000000000004062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND miniSTONE-2 (NCT03629184) was a global, phase 3, randomized, controlled study that investigated the safety and efficacy of single-dose baloxavir marboxil in otherwise healthy children 1-<12 years of age and showed a positive risk-benefit profile. This post hoc analysis evaluated the safety and efficacy of baloxavir versus oseltamivir in children 5-11 years old with influenza. METHODS Children received single-dose baloxavir or twice-daily oseltamivir for 5 days. Safety was the primary objective. Efficacy and virological outcomes included time to alleviation of symptoms, duration of fever and time to cessation of viral shedding by titer. Data were summarized descriptively. RESULTS Ninety-four children 5-11 years old were included (61 baloxavir and 33 oseltamivir). Baseline characteristics were similar between the groups. The incidence of adverse events was balanced and low in both treatment groups, with the most common being vomiting (baloxavir 5% vs. oseltamivir 18%), diarrhea (5% vs. 0%) and otitis media (0% vs. 5%). No serious adverse events or deaths occurred. Median (95% CI) time to alleviation of symptoms with baloxavir was 138.4 hours (116.7-163.4) versus 126.1 hours (95.9-165.7) for oseltamivir; duration of fever was comparable between groups [41.2 hours (23.5-51.4) vs. 51.3 hours (30.7-56.8), respectively]. Median time to cessation of viral shedding was shorter in the baloxavir group versus oseltamivir (1 vs. ≈3 days). CONCLUSIONS Safety, efficacy and virological results in children 5-11 years were similar to those from the overall study population 1-<12 years of age. Single-dose baloxavir provides an additional treatment option for pediatric patients 5-11 years old with influenza.
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Affiliation(s)
| | | | | | | | | | | | - Sriparna Sarkar
- Roche Products Ltd, Welwyn Garden City, Hertfordshire, United Kingdom
| | - Sarah Williams
- Roche Products Ltd, Welwyn Garden City, Hertfordshire, United Kingdom
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50
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Wolf RM, Antoon JW. Influenza in Children and Adolescents: Epidemiology, Management, and Prevention. Pediatr Rev 2023; 44:605-617. [PMID: 37907421 PMCID: PMC10676733 DOI: 10.1542/pir.2023-005962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
EDUCATION GAP Influenza is among the most common infectious causes of pediatric emergency department visits and hospitalizations. Clinicians should use evidence-based guidelines to learn how to identify, manage, prevent, and treat influenza cases. Disease caused by influenza virus can be mitigated with appropriate treatment and prevention efforts. OBJECTIVES After completing this article, readers should be able to: 1. Describe the virology and epidemiology of influenza. 2. List the clinical features and complications of influenza infections. 3. List the benefits and limitations of testing modalities for the diagnosis of influenza. 4. Appropriately apply American Academy of Pediatrics, Infectious Diseases Society of America, and Centers for Disease Control and Prevention (CDC) treatment guidelines for influenza or suspected influenza. 5. Describe the importance of influenza vaccination.
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Affiliation(s)
- Ryan M Wolf
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - James W Antoon
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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