1
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Rademacher J, Therre M, Hinze CA, Buder F, Böhm M, Welte T. Association of respiratory infections and the impact of vaccinations on cardiovascular diseases. Eur J Prev Cardiol 2024; 31:877-888. [PMID: 38205961 DOI: 10.1093/eurjpc/zwae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
Influenza, pneumococcal, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus infections are important causes of high morbidity and mortality in the elderly. Beyond the burden of infectious diseases, they are also associated with several non-infectious complications like cardiovascular events. A growing body of evidence in prospective studies and meta-analyses has shown the impact of influenza and pneumococcal vaccines on types of cardiovascular outcomes in the general population. Influenza vaccination showed a potential benefit for primary and secondary prevention of cardiovascular diseases across all ages. A reduced risk of cardiovascular events for individuals aged 65 years and older was associated with pneumococcal vaccination. Despite scientific evidence on the effectiveness, safety, and benefits of the vaccines and recommendations to vaccinate elderly patients and those with risk factors, vaccination rates remain sub-optimal in this population. Doubts about vaccine necessity or efficacy and concerns about possible adverse events in patients and physicians refer to delayed acceptance. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years. The aim of this review paper is to summarize the effect of vaccination in the field of cardiovascular disease to achieve a higher vaccination rate in this patient population.
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Affiliation(s)
- Jessica Rademacher
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
| | - Markus Therre
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Christopher Alexander Hinze
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
| | - Felix Buder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg 66421, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and Infectious Disease, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
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2
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Korolenko VV, Mokhort HA. Influence of respiratory infections pandemics on the mortality of the population of Ukraine. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2024; 77:841-846. [PMID: 38865645 DOI: 10.36740/wlek202404133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE Aim: To analyze the dynamics and structure of the excess mortality of the population of Ukraine for 76 years (1945-2021). PATIENTS AND METHODS Materials and Methods: An observational population study was conducted. Epidemiological methods were used, in particular, the method of graphical construction of time series, intensive, extensive indicators and indicators of excess mortality were calculated. CONCLUSION Conclusions: The coronavirus disease pandemic in Ukraine became the largest documented respiratory infection pandemic after 76 years, but did not outweigh the dramatic increase in mortality in the 1990s-2000s, in including death in 1995.
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3
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Kumar S, Kumar GS, Maitra SS, Malý P, Bharadwaj S, Sharma P, Dwivedi VD. Viral informatics: bioinformatics-based solution for managing viral infections. Brief Bioinform 2022; 23:6659740. [PMID: 35947964 DOI: 10.1093/bib/bbac326] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/26/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Several new viral infections have emerged in the human population and establishing as global pandemics. With advancements in translation research, the scientific community has developed potential therapeutics to eradicate or control certain viral infections, such as smallpox and polio, responsible for billions of disabilities and deaths in the past. Unfortunately, some viral infections, such as dengue virus (DENV) and human immunodeficiency virus-1 (HIV-1), are still prevailing due to a lack of specific therapeutics, while new pathogenic viral strains or variants are emerging because of high genetic recombination or cross-species transmission. Consequently, to combat the emerging viral infections, bioinformatics-based potential strategies have been developed for viral characterization and developing new effective therapeutics for their eradication or management. This review attempts to provide a single platform for the available wide range of bioinformatics-based approaches, including bioinformatics methods for the identification and management of emerging or evolved viral strains, genome analysis concerning the pathogenicity and epidemiological analysis, computational methods for designing the viral therapeutics, and consolidated information in the form of databases against the known pathogenic viruses. This enriched review of the generally applicable viral informatics approaches aims to provide an overview of available resources capable of carrying out the desired task and may be utilized to expand additional strategies to improve the quality of translation viral informatics research.
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Affiliation(s)
- Sanjay Kumar
- School of Biotechnology, Jawaharlal Nehru University, New Delhi, India.,Center for Bioinformatics, Computational and Systems Biology, Pathfinder Research and Training Foundation, Greater Noida, India
| | - Geethu S Kumar
- Department of Life Science, School of Basic Science and Research, Sharda University, Greater Noida, Uttar Pradesh, India.,Center for Bioinformatics, Computational and Systems Biology, Pathfinder Research and Training Foundation, Greater Noida, India
| | | | - Petr Malý
- Laboratory of Ligand Engineering, Institute of Biotechnology of the Czech Academy of Sciences v.v.i., BIOCEV Research Center, Vestec, Czech Republic
| | - Shiv Bharadwaj
- Laboratory of Ligand Engineering, Institute of Biotechnology of the Czech Academy of Sciences v.v.i., BIOCEV Research Center, Vestec, Czech Republic
| | - Pradeep Sharma
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Dhar Dwivedi
- Center for Bioinformatics, Computational and Systems Biology, Pathfinder Research and Training Foundation, Greater Noida, India.,Institute of Advanced Materials, IAAM, 59053 Ulrika, Sweden
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4
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Fiorino S, Tateo F, Biase DD, Gallo CG, Orlandi PE, Corazza I, Budriesi R, Micucci M, Visani M, Loggi E, Hong W, Pica R, Lari F, Zippi M. SARS-CoV-2: lessons from both the history of medicine and from the biological behavior of other well-known viruses. Future Microbiol 2021; 16:1105-1133. [PMID: 34468163 PMCID: PMC8412036 DOI: 10.2217/fmb-2021-0064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 is the etiological agent of the current pandemic worldwide and its associated disease COVID-19. In this review, we have analyzed SARS-CoV-2 characteristics and those ones of other well-known RNA viruses viz. HIV, HCV and Influenza viruses, collecting their historical data, clinical manifestations and pathogenetic mechanisms. The aim of the work is obtaining useful insights and lessons for a better understanding of SARS-CoV-2. These pathogens present a distinct mode of transmission, as SARS-CoV-2 and Influenza viruses are airborne, whereas HIV and HCV are bloodborne. However, these viruses exhibit some potential similar clinical manifestations and pathogenetic mechanisms and their understanding may contribute to establishing preventive measures and new therapies against SARS-CoV-2.
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Affiliation(s)
- Sirio Fiorino
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, 40054, Italy
| | - Fabio Tateo
- Institute of Geosciences & Earth Resources, CNR, c/o Department of Geosciences, Padova University, 35127, Italy
| | - Dario De Biase
- Department of Pharmacy & Biotechnology, University of Bologna, Bologna, 40126, Italy
| | - Claudio G Gallo
- Fisiolaserterapico Emiliano, Castel San Pietro Terme, Bologna, 40024, Italy
| | | | - Ivan Corazza
- Department of Experimental, Diagnostic & Specialty Medicine, University of Bologna, Bologna, 40126, Italy
| | - Roberta Budriesi
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna, 40126, Italy
| | - Matteo Micucci
- Department of Pharmacy & Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna, 40126, Italy
| | - Michela Visani
- Department of Pharmacy & Biotechnology, University of Bologna, Bologna, 40126, Italy
| | - Elisabetta Loggi
- Hepatology Unit, Department of Medical & Surgical Sciences, University of Bologna, Bologna, 40126, Italy
| | - Wandong Hong
- Department of Gastroenterology & Hepatology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang, 325035, PR China
| | - Roberta Pica
- Unit of Gastroenterology & Digestive Endoscopy, Sandro Pertini Hospital, Rome, 00157, Italy
| | - Federico Lari
- Internal Medicine Unit, Budrio Hospital, Budrio (Bologna), Azienda USL, Bologna, 40054, Italy
| | - Maddalena Zippi
- Unit of Gastroenterology & Digestive Endoscopy, Sandro Pertini Hospital, Rome, 00157, Italy
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5
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Vanella P, Basellini U, Lange B. Assessing excess mortality in times of pandemics based on principal component analysis of weekly mortality data-the case of COVID-19. GENUS 2021; 77:16. [PMID: 34393261 PMCID: PMC8350559 DOI: 10.1186/s41118-021-00123-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 outbreak has called for renewed attention to the need for sound statistical analyses to monitor mortality patterns and trends over time. Excess mortality has been suggested as the most appropriate indicator to measure the overall burden of the pandemic in terms of mortality. As such, excess mortality has received considerable interest since the outbreak of COVID-19 began. Previous approaches to estimate excess mortality are somewhat limited, as they do not include sufficiently long-term trends, correlations among different demographic and geographic groups, or autocorrelations in the mortality time series. This might lead to biased estimates of excess mortality, as random mortality fluctuations may be misinterpreted as excess mortality. We propose a novel approach that overcomes the named limitations and draws a more realistic picture of excess mortality. Our approach is based on an established forecasting model that is used in demography, namely, the Lee-Carter model. We illustrate our approach by using the weekly age- and sex-specific mortality data for 19 countries and the current COVID-19 pandemic as a case study. Our findings show evidence of considerable excess mortality during 2020 in Europe, which affects different countries, age, and sex groups heterogeneously. Our proposed model can be applied to future pandemics as well as to monitor excess mortality from specific causes of death.
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Affiliation(s)
- Patrizio Vanella
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstr. 7, DE-38124 Brunswick, Germany
- Chair of Empirical Methods in Social Science and Demography, University of Rostock, Ulmenstr. 69, DE-18057 Rostock, Germany
| | - Ugofilippo Basellini
- Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research (MPIDR), Konrad-Zuse-Str. 1, DE-18057 Rostock, Germany
- Institut National d’Etudes Démographiques (INED), 9 cours des Humanités, FR-93322 Aubervilliers, Cedex, France
| | - Berit Lange
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstr. 7, DE-38124 Brunswick, Germany
- German Center for Infection Research (DZIF), Inhoffenstr. 7, DE-38124 Brunswick, Germany
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6
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Karlinsky A, Kobak D. Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset. eLife 2021; 10:e69336. [PMID: 34190045 PMCID: PMC8331176 DOI: 10.7554/elife.69336] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022] Open
Abstract
Comparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy. Excess mortality, defined as the increase in all-cause mortality relative to the expected mortality, is widely considered as a more objective indicator of the COVID-19 death toll. However, there has been no global, frequently updated repository of the all-cause mortality data across countries. To fill this gap, we have collected weekly, monthly, or quarterly all-cause mortality data from 103 countries and territories, openly available as the regularly updated World Mortality Dataset. We used this dataset to compute the excess mortality in each country during the COVID-19 pandemic. We found that in several worst-affected countries (Peru, Ecuador, Bolivia, Mexico) the excess mortality was above 50% of the expected annual mortality (Peru, Ecuador, Bolivia, Mexico) or above 400 excess deaths per 100,000 population (Peru, Bulgaria, North Macedonia, Serbia). At the same time, in several other countries (e.g. Australia and New Zealand) mortality during the pandemic was below the usual level, presumably due to social distancing measures decreasing the non-COVID infectious mortality. Furthermore, we found that while many countries have been reporting the COVID-19 deaths very accurately, some countries have been substantially underreporting their COVID-19 deaths (e.g. Nicaragua, Russia, Uzbekistan), by up to two orders of magnitude (Tajikistan). Our results highlight the importance of open and rapid all-cause mortality reporting for pandemic monitoring.
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Affiliation(s)
| | - Dmitry Kobak
- Institute for Ophthalmic Research, University of TübingenTübingenGermany
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7
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Karlinsky A, Kobak D. The World Mortality Dataset: Tracking excess mortality across countries during the COVID-19 pandemic. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.01.27.21250604. [PMID: 33532789 PMCID: PMC7852240 DOI: 10.1101/2021.01.27.21250604] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Comparing the impact of the COVID-19 pandemic between countries or across time is difficult because the reported numbers of cases and deaths can be strongly affected by testing capacity and reporting policy. Excess mortality, defined as the increase in all-cause mortality relative to the expected mortality, is widely considered as a more objective indicator of the COVID-19 death toll. However, there has been no global, frequently-updated repository of the all-cause mortality data across countries. To fill this gap, we have collected weekly, monthly, or quarterly all-cause mortality data from 94 countries and territories, openly available as the regularly-updated World Mortality Dataset. We used this dataset to compute the excess mortality in each country during the COVID-19 pandemic. We found that in several worst-affected countries (Peru, Ecuador, Bolivia, Mexico) the excess mortality was above 50% of the expected annual mortality. At the same time, in several other countries (Australia, New Zealand) mortality during the pandemic was below the usual level, presumably due to social distancing measures decreasing the non-COVID infectious mortality. Furthermore, we found that while many countries have been reporting the COVID-19 deaths very accurately, some countries have been substantially underreporting their COVID-19 deaths (e.g. Nicaragua, Russia, Uzbekistan), sometimes by two orders of magnitude (Tajikistan). Our results highlight the importance of open and rapid all-cause mortality reporting for pandemic monitoring.
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Affiliation(s)
| | - Dmitry Kobak
- Institute for Ophthalmic Research, University of Tübingen, Germany
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8
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Gómez-Gómez A, Sánchez-Ramos EL, Noyola DE. Diabetes is a major cause of influenza-associated mortality in Mexico. Rev Epidemiol Sante Publique 2021; 69:205-213. [PMID: 34023186 DOI: 10.1016/j.respe.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Influenza is a major cause of mortality worldwide. Most influenza-associated deaths are associated with cardiovascular or respiratory disorders. However, a large proportion of influenza-associated deaths do not have respiratory or cardiovascular disorders declared as the underlying cause of death. Diabetic individuals are at increased risk for influenza-mortality. In this study, we assessed the contribution of diabetes to influenza-associated mortality in Mexico. METHODS Diabetes influenza-associated mortality was estimated for the Mexican population using National Mortality Databases from the Mexican Ministry of Health from 1998 through 2015. Diabetes influenza-associated mortality was calculated applying Serfling cyclical regression models to weekly mortality rates for persons 20-59 years, 60 and more years, and all ages, and by sex. RESULTS There was a high correlation between weekly pneumonia and influenza mortality and diabetes-related mortality. Yearly influenza-associated diabetes mortality rates varied between 2.0 and 5.9/100,000. Up until the 2005-2006 season, diabetes-associated mortality rates were higher in females, while after that season rates were higher in males. Yearly influenza-associated diabetes mortality rates for adults 20-59 years of age ranged between 1.7 and 3.4/100,000, while estimates for adults 60 years and older ranged between 16.3 and 46.1/100,000. Approximately one third of estimated diabetes influenza-associated deaths occurred in adults 20-59 years of age. On average, diabetes deaths accounted for 19.6% of estimated influenza-associated all-cause mortality. CONCLUSION Diabetes is a major cause of estimated influenza-associated mortality in Mexico. Health-care authorities and professionals in countries with high diabetes prevalence should be aware of the potential impact of influenza in individuals with this condition.
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Affiliation(s)
- A Gómez-Gómez
- Internal Medicine Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - D E Noyola
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, Avenida Venustiano Carranza 2405, 78210 San Luis Potosí, Mexico.
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9
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Abstract
The emergence and spread of infectious diseases with pandemic potential occurred regularly throughout history. Major pandemics and epidemics such as plague, cholera, flu, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) have already afflicted humanity. The world is now facing the new coronavirus disease 2019 (COVID-19) pandemic. Many infectious diseases leading to pandemics are caused by zoonotic pathogens that were transmitted to humans due to increased contacts with animals through breeding, hunting and global trade activities. The understanding of the mechanisms of transmission of pathogens to humans allowed the establishment of methods to prevent and control infections. During centuries, implementation of public health measures such as isolation, quarantine and border control helped to contain the spread of infectious diseases and maintain the structure of the society. In the absence of pharmaceutical interventions, these containment methods have still been used nowadays to control COVID-19 pandemic. Global surveillance programs of water-borne pathogens, vector-borne diseases and zoonotic spillovers at the animal-human interface are of prime importance to rapidly detect the emergence of infectious threats. Novel technologies for rapid diagnostic testing, contact tracing, drug repurposing, biomarkers of disease severity as well as new platforms for the development and production of vaccines are needed for an effective response in case of pandemics.
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Affiliation(s)
- Jocelyne Piret
- CHU de Québec - Laval University, Quebec City, QC, Canada
| | - Guy Boivin
- CHU de Québec - Laval University, Quebec City, QC, Canada
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10
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Trends in pneumococcal vaccination in patients presenting with acute coronary syndrome in the United States. Prog Cardiovasc Dis 2021; 67:111-113. [PMID: 33434536 DOI: 10.1016/j.pcad.2021.01.001] [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: 11/20/2022]
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11
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Pisano G, Royer-Carfagni G. A statistical theory of the strength of epidemics: an application to the Italian COVID-19 case. Proc Math Phys Eng Sci 2021; 476:20200394. [PMID: 33402873 PMCID: PMC7776968 DOI: 10.1098/rspa.2020.0394] [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: 05/18/2020] [Accepted: 11/19/2020] [Indexed: 11/12/2022] Open
Abstract
The proposed theory defines a relative index of epidemic lethality that compares any two configurations in different observation periods, preferably one in the acute and the other in a mild epidemic phase. Raw mortality data represent the input, with no need to recognize the cause of death. Data are categorized according to the victims' age, which must be renormalized because older people have a greater probability of developing a level of physical decay (human damage), favouring critical pathologies and co-morbidities. The probabilistic dependence of human damage on renormalized age is related to a death criterion considering a virus spread by contagion and our capacity to cure the disease. Remarkably, this is reminiscent of the Weibull theory of the strength of brittle structures containing a population of crack-like defects, in the correlation between the statistical distribution of cracks and the risk of fracture at a prescribed stress level. Age-of-death scaling laws are predicted in accordance with data collected in Italian regions and provinces during the first wave of COVID-19, taken as representative examples to validate the theory. For the prevention of spread and the management of the epidemic, the various parameters of the theory shall be informed on other existing epidemiological models.
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Affiliation(s)
- Gabriele Pisano
- Construction Technologies Institute - Italian National Research Council (ITC-CNR), Viale Lombardia 49, 20098 San Giuliano Milanese, Milano, Italy
| | - Gianni Royer-Carfagni
- Construction Technologies Institute - Italian National Research Council (ITC-CNR), Viale Lombardia 49, 20098 San Giuliano Milanese, Milano, Italy.,Department of Engineering and Architecture, University of Parma, Parco Area delle Scienze 181/A, 43100 Parma, Italy
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12
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Potus F, Mai V, Lebret M, Malenfant S, Breton-Gagnon E, Lajoie AC, Boucherat O, Bonnet S, Provencher S. Novel insights on the pulmonary vascular consequences of COVID-19. Am J Physiol Lung Cell Mol Physiol 2020; 319:L277-L288. [PMID: 32551862 PMCID: PMC7414237 DOI: 10.1152/ajplung.00195.2020] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
In the last few months, the number of cases of a new coronavirus-related disease (COVID-19) rose exponentially, reaching the status of a pandemic. Interestingly, early imaging studies documented that pulmonary vascular thickening was specifically associated with COVID-19 pneumonia, implying a potential tropism of the virus for the pulmonary vasculature. Moreover, SARS-CoV-2 infection is associated with inflammation, hypoxia, oxidative stress, mitochondrial dysfunction, DNA damage, and lung coagulopathy promoting endothelial dysfunction and microthrombosis. These features are strikingly similar to what is seen in pulmonary vascular diseases. Although the consequences of COVID-19 on the pulmonary circulation remain to be explored, several viruses have been previously thought to be involved in the development of pulmonary vascular diseases. Patients with preexisting pulmonary vascular diseases also appear at increased risk of morbidity and mortality. The present article reviews the molecular factors shared by coronavirus infection and pulmonary vasculature defects, and the clinical relevance of pulmonary vascular alterations in the context of COVID-19.
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Affiliation(s)
- François Potus
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Vicky Mai
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Marius Lebret
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Simon Malenfant
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Emilie Breton-Gagnon
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Annie C Lajoie
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Olivier Boucherat
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Sébastien Bonnet
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Centre de Recherche de l'Institut Universitaire de Cardiologie et Pneumologie de Quebec City, Quebec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec Research Centre, Laval University, Quebec City, Quebec, Canada
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
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13
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Clay K, Lewis J, Severnini E. What explains cross-city variation in mortality during the 1918 influenza pandemic? Evidence from 438 U.S. cities. ECONOMICS AND HUMAN BIOLOGY 2019; 35:42-50. [PMID: 31071595 DOI: 10.1016/j.ehb.2019.03.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
Disparities in cross-city pandemic severity during the 1918 Influenza Pandemic remain poorly understood. This paper uses newly assembled historical data on annual mortality across 438 U.S. cities to explore the determinants of pandemic mortality. We assess the role of three broad factors: i) pre-pandemic population health and poverty, ii) air pollution, and iii) the timing of onset and proximity to military bases. Using regression analysis, we find that cities in the top tercile of the distribution of pre-pandemic infant mortality had 21 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. Similarly, cities in the top tercile of the distribution of proportion of illiterate residents had 21.3 excess deaths per 10,000 residents during the pandemic relative to cities in the bottom tercile. Cities in the top tercile of the distribution of coal-fired electricity generating capacity, an important source of urban air pollution, had 9.1 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. There was no statistically significant relationship between excess mortality and city proximity to World War I bases or the timing of onset. In a counterfactual analysis, the three statistically significant factors accounted for 50 percent of cross-city variation in excess mortality in 1918.
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Affiliation(s)
- Karen Clay
- Heinz College, Carnegie Mellon University, 4800 Forbes Avenue, Pittsburgh, PA, 15213, United States
| | - Joshua Lewis
- Department of Economics, University of Montreal, C.P. 6128 succ. Centre-ville, Montreal, QC, H3C 3J7, United States
| | - Edson Severnini
- Heinz College, Carnegie Mellon University, 4800 Forbes Avenue, Pittsburgh, PA, 15213, United States.
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14
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Walaza S, Cohen C, Tempia S, Moyes J, Nguweneza A, Madhi SA, McMorrow M, Cohen AL. Influenza and tuberculosis co-infection: A systematic review. Influenza Other Respir Viruses 2019; 14:77-91. [PMID: 31568678 PMCID: PMC6928059 DOI: 10.1111/irv.12670] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction There are limited data on risk of severe disease or outcomes in patients with influenza and pulmonary tuberculosis (PTB) co‐infection compared to those with single infection. Methods We conducted a systematic review of published literature on the interaction of influenza viruses and PTB. Studies were eligible for inclusion if they presented data on prevalence, disease association, presentation or severity of laboratory‐confirmed influenza among clinically diagnosed or laboratory‐confirmed PTB cases. We searched eight databases from inception until December 2018. Summary characteristics of each study were extracted, and a narrative summary was presented. Cohort or case‐control studies were assessed for potential bias using the Newcastle‐Ottawa scale. Results We assessed 5154 abstracts, reviewed 146 manuscripts and included 19 studies fulfilling selection criteria (13 human and six animal). Of seven studies reporting on the possible effect of the underlying PTB disease in patients with influenza, three of four analytical studies reported no association with disease severity of influenza infection in those with PTB, whilst one study reported PTB as a risk factor for influenza‐associated hospitalization. An association between influenza infection and PTB disease was found in three of five analytical studies; whereas the two other studies reported a high frequency of PTB disease progression and complications among patients with seasonal influenza co‐infection. Conclusion Human analytical studies of an association between co‐infection and severe influenza‐ or PTB‐associated disease or increased prevalence of influenza co‐infection in individuals' hospitalized for PTB were not conclusive. Data are limited from large, high‐quality, analytical epidemiological studies with laboratory‐confirmed endpoints.
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Affiliation(s)
- Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jocelyn Moyes
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Athermon Nguweneza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa.,Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | - Meredith McMorrow
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,U.S. Public Health Service, Rockville, MD, USA
| | - Adam L Cohen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.,Global Immunization Monitoring and Surveillance, Expanded Programme on Immunization Department of Immunization, Vaccines and Biologicals World Health Organization, Geneva, Switzerland
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15
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Li L, Wong JY, Wu P, Bond HS, Lau EHY, Sullivan SG, Cowling BJ. Heterogeneity in Estimates of the Impact of Influenza on Population Mortality: A Systematic Review. Am J Epidemiol 2018; 187:378-388. [PMID: 28679157 PMCID: PMC5860627 DOI: 10.1093/aje/kwx270] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022] Open
Abstract
Influenza viruses are associated with a substantial global burden of morbidity and mortality every year. Estimates of influenza-associated mortality often vary between studies due to differences in study settings, methods, and measurement of outcomes. We reviewed 103 published articles assessing population-based influenza-associated mortality through searches of PubMed and Embase, and we identified considerable variation in the statistical methods used across studies. Studies using regression models with an influenza activity proxy applied 4 approaches to estimate influenza-associated mortality. The estimates increased with age and ranged widely, from -0.3-1.3 and 0.6-8.3 respiratory deaths per 100,000 population for children and adults, respectively, to 4-119 respiratory deaths per 100,000 population for older adults. Meta-regression analysis identified that study design features were associated with the observed variation in estimates. The estimates increased with broader cause-of-death classification and were higher for older adults than for children. The multiplier methods tended to produce lower estimates, while Serfling-type models were associated with higher estimates than other methods. No "average" estimate of excess mortality could reliably be made due to the substantial variability of the estimates, partially attributable to methodological differences in the studies. Standardization of methodology in estimation of influenza-associated mortality would permit improved comparisons in the future.
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Affiliation(s)
- Li Li
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
- WHO Collaborating Center for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Jessica Y Wong
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Helen S Bond
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sheena G Sullivan
- WHO Collaborating Center for Reference and Research on Influenza, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Benjamin J Cowling
- WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
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16
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Kwong JC, Schwartz KL, Campitelli MA, Chung H, Crowcroft NS, Karnauchow T, Katz K, Ko DT, McGeer AJ, McNally D, Richardson DC, Rosella LC, Simor A, Smieja M, Zahariadis G, Gubbay JB. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med 2018; 378:345-353. [PMID: 29365305 DOI: 10.1056/nejmoa1702090] [Citation(s) in RCA: 710] [Impact Index Per Article: 118.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute myocardial infarction can be triggered by acute respiratory infections. Previous studies have suggested an association between influenza and acute myocardial infarction, but those studies used nonspecific measures of influenza infection or study designs that were susceptible to bias. We evaluated the association between laboratory-confirmed influenza infection and acute myocardial infarction. METHODS We used the self-controlled case-series design to evaluate the association between laboratory-confirmed influenza infection and hospitalization for acute myocardial infarction. We used various high-specificity laboratory methods to confirm influenza infection in respiratory specimens, and we ascertained hospitalization for acute myocardial infarction from administrative data. We defined the "risk interval" as the first 7 days after respiratory specimen collection and the "control interval" as 1 year before and 1 year after the risk interval. RESULTS We identified 364 hospitalizations for acute myocardial infarction that occurred within 1 year before and 1 year after a positive test result for influenza. Of these, 20 (20.0 admissions per week) occurred during the risk interval and 344 (3.3 admissions per week) occurred during the control interval. The incidence ratio of an admission for acute myocardial infarction during the risk interval as compared with the control interval was 6.05 (95% confidence interval [CI], 3.86 to 9.50). No increased incidence was observed after day 7. Incidence ratios for acute myocardial infarction within 7 days after detection of influenza B, influenza A, respiratory syncytial virus, and other viruses were 10.11 (95% CI, 4.37 to 23.38), 5.17 (95% CI, 3.02 to 8.84), 3.51 (95% CI, 1.11 to 11.12), and 2.77 (95% CI, 1.23 to 6.24), respectively. CONCLUSIONS We found a significant association between respiratory infections, especially influenza, and acute myocardial infarction. (Funded by the Canadian Institutes of Health Research and others.).
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Affiliation(s)
- Jeffrey C Kwong
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Kevin L Schwartz
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Michael A Campitelli
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Hannah Chung
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Natasha S Crowcroft
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Timothy Karnauchow
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Kevin Katz
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Dennis T Ko
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Allison J McGeer
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Dayre McNally
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - David C Richardson
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Laura C Rosella
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Andrew Simor
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Marek Smieja
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - George Zahariadis
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
| | - Jonathan B Gubbay
- From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children's Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John's (G.Z.) - all in Canada
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17
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Chowell G, Simonsen L, Fuentes R, Flores J, Miller MA, Viboud C. Severe mortality impact of the 1957 influenza pandemic in Chile. Influenza Other Respir Viruses 2017; 11:230-239. [PMID: 27883281 PMCID: PMC5410718 DOI: 10.1111/irv.12439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 01/25/2023] Open
Abstract
Introduction Epidemiological studies of the 1957 influenza pandemic are scarce, particularly from lower‐income settings. Methods We analyzed the spatial–temporal mortality patterns of the 1957 influenza pandemic in Chile, including detailed age‐specific mortality data from a large city, and investigated risk factors for severe mortality impact across regions. Results Chile exhibited two waves of excess mortality in winter 1957 and 1959 with a cumulative excess mortality rate of 12 per 10 000, and a ~10‐fold mortality difference across provinces. High excess mortality rates were associated with high baseline mortality (R2=41.8%; P=.02), but not with latitude (P>.7). Excess mortality rates increased sharply with age. Transmissibility declined from R=1.4‐2.1 to R=1.2‐1.4 between the two pandemic waves. Conclusions The estimated A/H2N2 mortality burden in Chile is the highest on record for this pandemic—about three to five times as severe as that experienced in wealthier nations. The global impact of this pandemic may be substantially underestimated from previous studies based on high‐income countries.
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Affiliation(s)
- Gerardo Chowell
- Georgia State University, Atlanta, Georgia, USA.,Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Lone Simonsen
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.,George Washington University, Washington DC, USA.,University of Copenhagen, Copenhagen, Denmark
| | | | - Jose Flores
- The University of South Dakota, Vermillion, SD, USA.,Universidad de Chile, Santiago, Chile
| | - Mark A Miller
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Cécile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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18
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Xavier DR, Magalhães MDAFM, Gracie R, Reis ICD, Matos VPD, Barcellos C. Spatial-temporal diffusion of dengue in the municipality of Rio de Janeiro, Brazil, 2000-2013. CAD SAUDE PUBLICA 2017; 33:e00186615. [PMID: 28380130 DOI: 10.1590/0102-311x00186615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/02/2016] [Indexed: 11/22/2022] Open
Abstract
The city of Rio de Janeiro, Brazil, shows high potential receptiveness to the introduction, dissemination, and persistence of dengue transmission. The pattern of territorial occupation in the municipality produced a heterogeneous and diverse mosaic, with differential vector distribution between and within neighborhoods, producing distinct epidemics on this scale of observation. The study seeks to identify these epidemics and the pattern of spatial and temporal diffusion of dengue transmission. A model was used for the identification of epidemics, considering the epidemic peak years and months, spatial distribution, and permanence of epidemics from January 2000 to December 2013. A total of 495 epidemic peaks were counted, and the time scale showed the highest occurrence in the months of March, April, and February, respectively. Some neighborhoods appear to present persistent dengue incidence, and the pattern of diffusion allows identifying key trajectories and timely months for intervention.
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Affiliation(s)
- Diego Ricardo Xavier
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Renata Gracie
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Izabel Cristina Dos Reis
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.,Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Vanderlei Pascoal de Matos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Christovam Barcellos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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19
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Gostic KM, Ambrose M, Worobey M, Lloyd-Smith JO. Potent protection against H5N1 and H7N9 influenza via childhood hemagglutinin imprinting. Science 2016; 354:722-726. [PMID: 27846599 PMCID: PMC5134739 DOI: 10.1126/science.aag1322] [Citation(s) in RCA: 316] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/03/2016] [Indexed: 01/02/2023]
Abstract
Two zoonotic influenza A viruses (IAV) of global concern, H5N1 and H7N9, exhibit unexplained differences in age distribution of human cases. Using data from all known human cases of these viruses, we show that an individual's first IAV infection confers lifelong protection against severe disease from novel hemagglutinin (HA) subtypes in the same phylogenetic group. Statistical modeling shows that protective HA imprinting is the crucial explanatory factor, and it provides 75% protection against severe infection and 80% protection against death for both H5N1 and H7N9. Our results enable us to predict age distributions of severe disease for future pandemics and demonstrate that a novel strain's pandemic potential increases yearly when a group-mismatched HA subtype dominates seasonal influenza circulation. These findings open new frontiers for rational pandemic risk assessment.
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MESH Headings
- Age Factors
- Animals
- Child
- Genomic Imprinting
- Global Health
- Hemagglutinin Glycoproteins, Influenza Virus/genetics
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Humans
- Influenza A Virus, H5N1 Subtype/genetics
- Influenza A Virus, H5N1 Subtype/immunology
- Influenza A Virus, H7N9 Subtype/genetics
- Influenza A Virus, H7N9 Subtype/immunology
- Influenza, Human/epidemiology
- Influenza, Human/immunology
- Influenza, Human/virology
- Models, Statistical
- Pandemics/statistics & numerical data
- Risk Assessment
- Zoonoses/epidemiology
- Zoonoses/virology
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Affiliation(s)
- Katelyn M Gostic
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Monique Ambrose
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Michael Worobey
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ 85721, USA.
| | - James O Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
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20
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Cobos AJ, Nelson CG, Jehn M, Viboud C, Chowell G. Mortality and transmissibility patterns of the 1957 influenza pandemic in Maricopa County, Arizona. BMC Infect Dis 2016; 16:405. [PMID: 27516082 PMCID: PMC4982429 DOI: 10.1186/s12879-016-1716-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While prior studies have quantified the mortality burden of the 1957 H2N2 influenza pandemic at broad geographic regions in the United States, little is known about the pandemic impact at a local level. Here we focus on analyzing the transmissibility and mortality burden of this pandemic in Arizona, a setting where the dry climate was promoted as reducing respiratory illness transmission yet tuberculosis prevalence was high. METHODS Using archival death certificates from 1954 to 1961, we quantified the age-specific seasonal patterns, excess-mortality rates, and transmissibility patterns of the 1957 H2N2 pandemic in Maricopa County, Arizona. By applying cyclical Serfling linear regression models to weekly mortality rates, the excess-mortality rates due to respiratory and all-causes were estimated for each age group during the pandemic period. The reproduction number was quantified from weekly data using a simple growth rate method and assumed generation intervals of 3 and 4 days. Local newspaper articles published during 1957-1958 were also examined. RESULTS Excess-mortality rates varied between waves, age groups, and causes of death, but overall remained low. From October 1959-June 1960, the most severe wave of the pandemic, the absolute excess-mortality rate based on respiratory deaths per 10,000 population was 16.59 in the elderly (≥65 years). All other age groups exhibit very low excess-mortality and the typical U-shaped age-pattern was absent. However, the standardized mortality ratio was greatest (4.06) among children and young adolescents (5-14 years) from October 1957-March 1958, based on mortality rates of respiratory deaths. Transmissibility was greatest during the same 1957-1958 period, when the mean reproduction number was estimated at 1.08-1.11, assuming 3- or 4-day generation intervals with exponential or fixed distributions. CONCLUSIONS Maricopa County exhibited very low mortality impact associated with the 1957 influenza pandemic. Understanding the relatively low excess-mortality rates and transmissibility in Maricopa County during this historic pandemic may help public health officials prepare for and mitigate future outbreaks of influenza.
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Affiliation(s)
- April J. Cobos
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ USA
- School of Life Sciences, Arizona State University, Tempe, AZ USA
- Barrett, the Honors College, Arizona State University, Tempe, AZ USA
| | - Clinton G. Nelson
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ USA
- School of Life Sciences, Arizona State University, Tempe, AZ USA
| | - Megan Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ USA
| | - Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD USA
| | - Gerardo Chowell
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ USA
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD USA
- School of Public Health, Georgia State University, Atlanta, GA USA
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21
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Viboud C, Simonsen L, Fuentes R, Flores J, Miller MA, Chowell G. Global Mortality Impact of the 1957-1959 Influenza Pandemic. J Infect Dis 2016; 213:738-45. [PMID: 26908781 PMCID: PMC4747626 DOI: 10.1093/infdis/jiv534] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/03/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Quantitative estimates of the global burden of the 1957 influenza pandemic are lacking. Here we fill this gap by modeling historical mortality statistics. METHODS We used annual rates of age- and cause-specific deaths to estimate pandemic-related mortality in excess of background levels in 39 countries in Europe, the Asia-Pacific region, and the Americas. We modeled the relationship between excess mortality and development indicators to extrapolate the global burden of the pandemic. RESULTS The pandemic-associated excess respiratory mortality rate was 1.9/10,000 population (95% confidence interval [CI], 1.2-2.6 cases/10,000 population) on average during 1957-1959. Excess mortality rates varied 70-fold across countries; Europe and Latin America experienced the lowest and highest rates, respectively. Excess mortality was delayed by 1-2 years in 18 countries (46%). Increases in the mortality rate relative to baseline were greatest in school-aged children and young adults, with no evidence that elderly population was spared from excess mortality. Development indicators were moderate predictors of excess mortality, explaining 35%-77% of the variance. Overall, we attribute 1.1 million excess deaths (95% CI, .7 million-1.5 million excess deaths) globally to the 1957-1959 pandemic. CONCLUSIONS The global mortality rate of the 1957-1959 influenza pandemic was moderate relative to that of the 1918 pandemic but was approximately 10-fold greater than that of the 2009 pandemic. The impact of the pandemic on mortality was delayed in several countries, pointing to a window of opportunity for vaccination in a future pandemic.
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Affiliation(s)
- Cécile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Lone Simonsen
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- Department of Global Health, George Washington University, Washington D.C.
- Department of Public Health, University of Copenhagen, Denmark
| | | | - Jose Flores
- Department of Mathematical Sciences, University of South Dakota, Vermillion
- Biodiversity Laboratories, National Center for the Environment, Universidad de Chile, Santiago, Chile
| | - Mark A. Miller
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Gerardo Chowell
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
- School of Public Health, Georgia State University, Atlanta
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22
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Santaularia J, Hou W, Perveen G, Welsh E, Faseru B. Prevalence of influenza vaccination and its association with health conditions and risk factors among Kansas adults in 2013: a cross-sectional study. BMC Public Health 2016; 16:185. [PMID: 26911615 PMCID: PMC4766727 DOI: 10.1186/s12889-016-2884-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to the Centers for Disease Control and Prevention, approximately 5-20% of people are affected by influenza annually, and influenza causes more than 200,000 hospitalizations each year. The purpose of this study is to estimate the prevalence of influenza vaccination among high risk adults in Kansas. METHODS The 2013 Kansas BRFSS data (n = 20,712) were analyzed to assess the prevalence of receiving influenza vaccination among Kansas adults, overall and for selected demographic characteristics within the past 12 months. Crude and adjusted prevalence rate ratios were computed using univariate logistic regression models with influenza vaccination as the dependent variable and health conditions or high risk groups as the main independent variables; these models were then adjusted for potential confounding. RESULTS Overall, influenza vaccination rate was lower than the Healthy People 2020 target (42.2% vs. 80%). The prevalence of receiving influenza vaccination was higher among adults 65 years and older compared to adults 64 years and younger after adjusting for gender, annual household income, education, marital status, insurance status, and race/ethnicity. Similarly, the prevalence of receiving influenza vaccination was higher among adults who have current asthma, or have ever been diagnosed with diabetes, high blood pressure, cancer (excluding skin), and COPD compared to those who did not have these health conditions, as well as pregnant women compared to women who were not pregnant. CONCLUSIONS Although high risk groups have higher rates of influenza vaccination compared to low risk groups, more concerted efforts are needed to improve seasonal influenza vaccination in Kansas.
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Affiliation(s)
- Jeanie Santaularia
- Kansas Department of Health and Environment, Bureau of Health Promotion, 1000 SW Jackson Suite 200, Topeka, 66619, Kansas, USA.
| | - Wei Hou
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, Kansas City, KS, 66160, USA.
| | - Ghazala Perveen
- Kansas Department of Health and Environment, Bureau of Health Promotion, 1000 SW Jackson Suite 200, Topeka, 66619, Kansas, USA.
| | - Ericka Welsh
- Kansas Department of Health and Environment, Bureau of Health Promotion, 1000 SW Jackson Suite 200, Topeka, 66619, Kansas, USA.
| | - Babalola Faseru
- Kansas Department of Health and Environment, Bureau of Health Promotion, 1000 SW Jackson Suite 200, Topeka, 66619, Kansas, USA.
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 1008, Kansas City, KS, 66160, USA.
- Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, Kansas, 66160, USA.
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23
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Ludwig A, Lucero-Obusan C, Schirmer P, Winston C, Holodniy M. Acute cardiac injury events ≤30 days after laboratory-confirmed influenza virus infection among U.S. veterans, 2010-2012. BMC Cardiovasc Disord 2015; 15:109. [PMID: 26423142 PMCID: PMC4589211 DOI: 10.1186/s12872-015-0095-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 09/14/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Cardiac injury is a known potential complication of influenza infection. Because U.S. veterans cared for at the U.S. Department of Veterans Affairs are older and have more cardiovascular disease (CVD) risk factors than the general U.S. population, veterans are at risk for cardiac complications of influenza infection. We investigated biomarkers of cardiac injury characteristics and associated cardiac events among veterans who received cardiac biomarker testing ≤30 days after laboratory-confirmed influenza virus infection. METHODS Laboratory-confirmed influenza cases among veterans cared for at U.S. Department of Veterans Affairs' facilities for October 2010-December 2012 were identified using electronic medical records (EMRs). Influenza confirmation was based on respiratory specimen viral culture or antigen or nucleic acid detection. Acute cardiac injury (ACI) was defined as an elevated cardiac biomarker (troponin I or creatinine kinase isoenzyme MB) >99 % of the upper reference limit occurring ≤30 days after influenza specimen collection. EMRs were reviewed for demographics, CVD history and risk factors, and ACI-associated cardiac events. RESULTS Among 38,197 patients with influenza testing results, 4,469 (12 %) had a positive result; 600 of those patients had cardiac biomarker testing performed ≤30 days after influenza testing, and 143 (24 %) had one or more elevated cardiac biomarkers. Among these 143, median age was 73 years (range 44-98 years), and 98 (69 %) were non-Hispanic white. All patients had one or more CVD risk factors, and 98 (69 %) had a history of CVD. Eighty-six percent of ACI-associated events occurred within 3 days of influenza specimen collection date. Seventy patients (49 %) had documented or probable acute myocardial infarction, 8 (6 %) acute congestive heart failure, 6 (4 %) myocarditis, and 4 (3 %) atrial fibrillation. Eleven (8 %) had non-cardiac explanations for elevated cardiac biomarkers, and 44 (31 %) had no documented explanation. Sixty-eight (48 %) patients had received influenza vaccination during the related influenza season. CONCLUSION Among veterans with laboratory-confirmed influenza infection and cardiac biomarker testing ≤30 days after influenza testing, approximately 25 % had evidence of ACI, the majority within 3 days. Approximately half were myocardial infarctions. Our findings emphasize the importance of considering ACI associated with influenza infection among patients at high risk, including this older population with prevalent CVD risk factors.
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Affiliation(s)
- Alison Ludwig
- Centers for Disease Control and Prevention, assigned to Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA. .,Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Cynthia Lucero-Obusan
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Patricia Schirmer
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Carla Winston
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA.
| | - Mark Holodniy
- Veterans Affairs Office of Public Health Surveillance and Research, 3801 Miranda Avenue (132), Palo Alto, CA, 94304, USA. .,Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, 94303, USA.
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24
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Alcusky MJ, Pawasauskas J. Adherence to Guidelines for Hepatitis B, Pneumococcal, and Influenza Vaccination in Patients With Diabetes. Clin Diabetes 2015; 33. [PMID: 26203204 PMCID: PMC4503939 DOI: 10.2337/diaclin.33.3.116] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
IN BRIEF This single-center, cross-sectional study was designed to assess adherence to national guidelines for the immunization of patients with diabetes and to evaluate predictors of vaccination with the hepatitis B, influenza, and 23-valent pneumococcal polysaccharide vaccines. In patients considered to be at increased risk for infection and infectious disease complications because of their history of diabetes, extensive nonadherence to immunization recommendations for all three vaccines was found. Nonadherence to the 2011 Advisory Committee on Immunization Practices' recommendation for hepatitis B vaccination was ubiquitous. Allocation of health care resources to increase vaccine coverage should remain a priority, with a focus on spreading awareness of the hepatitis B vaccine recommendation for people with diabetes.
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Affiliation(s)
- Matthew J. Alcusky
- Thomas Jefferson University School of Population Health, Philadelphia, PA
| | - Jayne Pawasauskas
- University of Rhode Island College of Pharmacy, Kingston, RI, and Kent Hospital, Warwick, RI
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25
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Lin HC, Chiu HF, Ho SC, Yang CY. Association of influenza vaccination and reduced risk of stroke hospitalization among the elderly: a population-based case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3639-49. [PMID: 24699027 PMCID: PMC4025018 DOI: 10.3390/ijerph110403639] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the effect of influenza vaccination (and annual revaccination) on the risk of stroke admissions. We conducted a population-based case-control study in Taiwan. Cases consisted of patients >65 years of age who had a first-time diagnosis of stroke during the influenza seasons from 2006 to 2009. Controls were selected by matching age, sex, and index date to cases. Multiple logistic regression analysis was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Ever vaccinated individuals in the current vaccination season were associated with a reduced risk of ischemic stroke admissions (OR = 0.76, 95% CI = 0.60-0.97). Compared with individuals never vaccinated against influenza during the past 5 years, the adjusted ORs were 0.92 (95% CI = 0.68-1.23) for the group with 1 or 2 vaccinations, 0.73 (95% CI = 0.54-1.00) for the group with 3 or 4 vaccinations, and 0.56 (95% CI = 0.38-0.83) for the group with 5 vaccinations. There was a significant trend of decreasing risk of ischemic stroke admissions with an increasing number of vaccinations. This study provides evidence that vaccination against influenza may reduce the risk of hospitalization for ischemic stroke and that annual revaccination provides greater protection.
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Affiliation(s)
- Hui-Chen Lin
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Hui-Fen Chiu
- Institute of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Shu-Chen Ho
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
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26
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Park Y, Chin BS, Han SH, Yun Y, Kim YJ, Choi JY, Kim CO, Song YG, Kim JM. Pandemic Influenza (H1N1) and Mycobacterium tuberculosis Co-infection. Tuberc Respir Dis (Seoul) 2014; 76:84-7. [PMID: 24624218 PMCID: PMC3948857 DOI: 10.4046/trd.2014.76.2.84] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 09/27/2013] [Accepted: 10/14/2013] [Indexed: 11/24/2022] Open
Abstract
We hereby observe four co-infection cases of pandemic influenza H1N1 and Mycobacterium tuberculosis with various clinical presentations. It may be prudent to consider M. tuberculosis co-infections when patients with pandemic influenza reveal unusual clinical features that do not improve despite appropriate treatments against the influenza, especially in Korea, in the endemic areas of M. tuberculosis.
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Affiliation(s)
- Yehyun Park
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Bum Sik Chin
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yujung Yun
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ju Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Oh Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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27
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Abstract
Cardiovascular disease is a leading cause of morbidity and mortality. Individuals with underlying cardiovascular disease are at high risk for adverse outcomes from influenza infections. Although additional studies are needed, current evidence suggests the influenza vaccine may reduce the risk of cardiovascular death and coronary events. In addition to their overall efforts to encourage influenza vaccination for all eligible persons, pharmacists should pay special attention to these high-risk individuals.
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Affiliation(s)
| | - James W Kleoppel
- Clinical Assistant Professor, Department of Pharmacy Practice, University of Kansas Medical Center. Corresponding author: Patricia A. Howard, PharmD, Department of Pharmacy Practice, University of Kansas Medical Center, Mailstop 4047, 3901 Rainbow Boulevard, Kansas City, KS 66160; phone: 913-588-5391; fax: 913-588-2355 ; e-mail:
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28
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Lichy C, Grau AJ. Investigating the association between influenza vaccination and reduced stroke risk. Expert Rev Vaccines 2014; 5:535-40. [PMID: 16989633 DOI: 10.1586/14760584.5.4.535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute infections, mainly of the respiratory tract, have consistently been demonstrated to considerably increase the risk of stroke. At present, prospective interventional trials are lacking and there is no proof of the effectiveness of any therapeutic anti-infective strategy in stroke prevention. However, some new evidence from observational studies lends support to the idea that influenza vaccination may contribute importantly to fighting stroke. Although final proof of efficacy is still missing, patients with previous cerebral ischemia and subjects of any age at high risk of stroke should be encouraged to receive annual influenza vaccination.
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Affiliation(s)
- Christoph Lichy
- University of Heidelberg Im Neuenheimer Feld, Department of Neurology, 400, 69120 Heidelberg, Germany.
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Azarpazhooh MR, Shahripour RB, Kapral MK, Mokhber N, Shoeibi A, Farzadfard MT, Rafati MR, Thrift AG, Morovatdar N, Sajedi SA, Azarpazhooh A. Incidence of first ever stroke during Hajj ceremony. BMC Neurol 2013; 13:193. [PMID: 24308305 PMCID: PMC4234064 DOI: 10.1186/1471-2377-13-193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 11/27/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Hajj Ceremony, the largest annual gathering in the world, is the most important life event for any Muslim. This study was designed to evaluate the incidence of stroke among Iranian pilgrims during the Hajj ceremony. METHODS We ascertained all cases of stroke occurring in a population of 92,974 Iranian pilgrims between November 27, 2007 and January 12, 2008. Incidence and risk factors of the first ever stroke in Hajj pilgrims were compared, within the same time frame, to those of the Mashhad residents, the second largest city in Iran. Data for the latter group were extracted from the Mashhad Stroke Incidence Study (MSIS) database. RESULTS During the study period, 17 first-ever strokes occurred in the Hajj pilgrims and 40 first-ever stroke strokes occurred in the MSIS group. Overall, the adjusted incidence rate of first ever stroke in the Hajj cohort was lower than that of the MSIS population (9 vs. 16 per 100,000). For age- and gender-specific subgroups, the Hajj stroke crude rates were in general similar to or lower than the general population of Mashhad, Iran, with the exception of women aged 35 to 44 years and aged >75 years who were at greater risk of having first-ever stroke than the non-pilgrims of the same age. CONCLUSION The first ever stroke rate among Iranian Hajj pilgrims was lower than that of the general population in Mashhad, Iran, except for females 35-44 or more than 75 years old. The number of events occurring during the Hajj suggests that Islamic countries should consider designing preventive and screening programs for pilgrims.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Amir Azarpazhooh
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Ontario, Canada.
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Abstract
Catastrophic mortality events are characterized by a sudden and concentrated increase in mortality and as such present a major risk to life insurers. Such events include pandemics, war, natural disasters, terrorist attacks, and industrial, transport, and other accidents. Of these, pandemics arising from influenza are considered the most significant threat to the life insurance industry due to their capacity to cause a major increase in claims. We review the features and mortality implications of an influenza pandemic for life insurers, and describe a range of other risks that are likely to emerge as well.
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Mann AG, Mangtani P, Russell CA, Whittaker JC. The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study. BMJ Open 2013; 3:bmjopen-2013-002743. [PMID: 23906952 PMCID: PMC3733298 DOI: 10.1136/bmjopen-2013-002743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the impact on mortality due to pneumonia or influenza of the change from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales. DESIGN Excess mortality estimated using time series of deaths registered to pneumonia or influenza, accounting for seasonality, trend and artefacts. Non-excess mortality plotted as proxy for long-term trend in mortality. SETTING England and Wales. PARTICIPANTS Persons aged 65-74 and 75+ years whose deaths were registered to underlying pneumonia or influenza between 1975/1976 and 2004/2005. OUTCOME MEASURES Multiplicative effect on average excess pneumonia and influenza deaths each winter in the 4-6 winters since age group-based targeting of vaccination was introduced (in persons aged 75+ years from 1998/1999; in persons aged 65+ years from 2000/2001), estimated using multivariable regression adjusted for temperature, antigenic drift and vaccine mismatch, and stratified by dominant circulating influenza subtype. Trend in baseline weekly pneumonia and influenza death rates. RESULTS There is a suggestion of lower average excess mortality in the six winters after age group-based targeting began compared to before, but the CI for the 65-74 years age group includes no difference. Trend in baseline pneumonia and influenza mortality shows an apparent downward turning point around 2000 for the 65-74 years age group and from the mid-1990s in the 75+ years age group. CONCLUSIONS There is weakly supportive evidence that the marked increases in vaccine coverage accompanying the switch from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales were associated with lower levels of pneumonia and influenza mortality in older people in the first 6 years after age group-based targeting began. The possible impact of these policy changes is observed as weak evidence for lower average excess mortality as well as a turning point in baseline mortality coincident with the changes.
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Affiliation(s)
- Andrea G Mann
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Punam Mangtani
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Colin A Russell
- Department of Zoology, University of Cambridge, Cambridge, UK
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - John C Whittaker
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Statistical Platforms and Technologies, GlaxoSmithKline, Medicines Research Centre, Stevenage, UK
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The influence of influenza virus infections on the development of tuberculosis. Tuberculosis (Edinb) 2013; 93:338-42. [DOI: 10.1016/j.tube.2013.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 12/20/2012] [Accepted: 02/04/2013] [Indexed: 01/09/2023]
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Xu R, Krause JC, McBride R, Paulson JC, Crowe JE, Wilson IA. A recurring motif for antibody recognition of the receptor-binding site of influenza hemagglutinin. Nat Struct Mol Biol 2013; 20:363-70. [PMID: 23396351 PMCID: PMC3594569 DOI: 10.1038/nsmb.2500] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 12/26/2012] [Indexed: 11/21/2022]
Abstract
Influenza virus hemagglutinin (HA) mediates receptor binding and viral entry during influenza infection. The development of receptor analogs as viral-entry blockers has not been successful, which suggests that sialic acid may not be an ideal scaffold to obtain broad, potent HA inhibitors. Here, we report crystal structures of Fab fragments from three human antibodies that neutralize the 1957 pandemic H2N2 influenza virus in complex with H2 HA. All three antibodies use an aromatic residue to plug a conserved cavity in the HA receptor-binding site. Each antibody interacts with the absolutely conserved HA1 Trp153 at the cavity base through π-π stacking with the signature Phe54 of two VH1-69-encoded antibodies or a tyrosine from HCDR3 in the other antibody. This highly conserved interaction can be used as a starting point to design inhibitors targeting this conserved hydrophobic pocket in influenza viruses.
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Affiliation(s)
- Rui Xu
- Department of Molecular Biology, The Scripps Research Institute, La Jolla, California, USA
| | - Jens C. Krause
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan McBride
- Department of Chemical Physiology, The Scripps Research Institute, La Jolla, California, USA
| | - James C. Paulson
- Department of Molecular Biology, The Scripps Research Institute, La Jolla, California, USA
- Department of Chemical Physiology, The Scripps Research Institute, La Jolla, California, USA
| | - James E. Crowe
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ian A. Wilson
- Department of Molecular Biology, The Scripps Research Institute, La Jolla, California, USA
- Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, California, USA
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Abstract
BACKGROUND Influenza vaccination is recommended for asthmatic patients in many countries as observational studies have shown that influenza infection can be associated with asthma exacerbations. However, influenza vaccination has the potential to cause wheezing and adversely affect pulmonary function. While an overview concluded that there was no clear benefit of influenza vaccination in patients with asthma, this conclusion was not based on a systematic search of the literature. OBJECTIVES The objective of this review was to assess the efficacy and safety of influenza vaccination in children and adults with asthma. SEARCH METHODS We searched the Cochrane Airways Group trials register and reviewed reference lists of articles. The latest search was carried out in November 2012. SELECTION CRITERIA We included randomised trials of influenza vaccination in children (over two years of age) and adults with asthma. We excluded studies involving people with chronic obstructive pulmonary disease. DATA COLLECTION AND ANALYSIS Inclusion criteria and assessment of trial quality were applied by two review authors independently. Data extraction was done by two review authors independently. Study authors were contacted for missing information. MAIN RESULTS Nine trials were included in the first published version of this review, and nine further trials have been included in four updates. The included studies cover a wide diversity of people, settings and types of influenza vaccination, and we pooled data from the studies that employed similar vaccines. PROTECTIVE EFFECTS OF INACTIVATED INFLUENZA VACCINE DURING THE INFLUENZA SEASON: A single parallel-group trial, involving 696 children, was able to assess the protective effects of influenza vaccination. There was no significant reduction in the number, duration or severity of influenza-related asthma exacerbations. There was no difference in the forced expiratory volume in one second (FEV) although children who had been vaccinated had better symptom scores during influenza-positive weeks. Two parallel-group trials in adults did not contribute data to these outcomes due to very low levels of confirmed influenza infection. ADVERSE EFFECTS OF INACTIVATED INFLUENZA VACCINE IN THE FIRST TWO WEEKS FOLLOWING VACCINATION: Two cross-over trials involving 1526 adults and 712 children (over three years old) with asthma compared inactivated trivalent split-virus influenza vaccine with a placebo injection. These trials excluded any clinically important increase in asthma exacerbations in the two weeks following influenza vaccination (risk difference 0.014; 95% confidence interval -0.010 to 0.037). However, there was significant heterogeneity between the findings of two trials involving 1104 adults in terms of asthma exacerbations in the first three days after vaccination with split-virus or surface-antigen inactivated vaccines. There was no significant difference in measures of healthcare utilisation, days off school/symptom-free days, mean lung function or medication usage.EFFECTS OF LIVE ATTENUATED (INTRANASAL) INFLUENZA VACCINATION: There were no significant differences found in exacerbations or measures of lung function following live attenuated cold recombinant vaccine versus placebo in two small studies on 17 adults and 48 children. There were no significant differences in asthma exacerbations found for the comparison live attenuated vaccine (intranasal) versus trivalent inactivated vaccine (intramuscular) in one study on 2229 children (over six years of age). AUTHORS' CONCLUSIONS Uncertainty remains about the degree of protection that vaccination affords against asthma exacerbations that are related to influenza infection. Evidence from more recently published randomised trials of inactivated split-virus influenza vaccination indicates that there is no significant increase in asthma exacerbations immediately after vaccination in adults or children over three years of age. We were unable to address concerns regarding possible increased wheezing and hospital admissions in infants given live intranasal vaccination.
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Affiliation(s)
- Christopher J Cates
- Population Health Sciences and Education, St George’s, University of London, London,
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Alonso WJ, McCormick BJJ. EPIPOI: a user-friendly analytical tool for the extraction and visualization of temporal parameters from epidemiological time series. BMC Public Health 2012; 12:982. [PMID: 23153033 PMCID: PMC3527308 DOI: 10.1186/1471-2458-12-982] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 10/09/2012] [Indexed: 11/19/2022] Open
Abstract
Background There is an increasing need for processing and understanding relevant information generated by the systematic collection of public health data over time. However, the analysis of those time series usually requires advanced modeling techniques, which are not necessarily mastered by staff, technicians and researchers working on public health and epidemiology. Here a user-friendly tool, EPIPOI, is presented that facilitates the exploration and extraction of parameters describing trends, seasonality and anomalies that characterize epidemiological processes. It also enables the inspection of those parameters across geographic regions. Although the visual exploration and extraction of relevant parameters from time series data is crucial in epidemiological research, until now it had been largely restricted to specialists. Methods EPIPOI is freely available software developed in Matlab (The Mathworks Inc) that runs both on PC and Mac computers. Its friendly interface guides users intuitively through useful comparative analyses including the comparison of spatial patterns in temporal parameters. Results EPIPOI is able to handle complex analyses in an accessible way. A prototype has already been used to assist researchers in a variety of contexts from didactic use in public health workshops to the main analytical tool in published research. Conclusions EPIPOI can assist public health officials and students to explore time series data using a broad range of sophisticated analytical and visualization tools. It also provides an analytical environment where even advanced users can benefit by enabling a higher degree of control over model assumptions, such as those associated with detecting disease outbreaks and pandemics.
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Affiliation(s)
- Wladimir J Alonso
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.
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Loomba RS, Aggarwal S, Shah PH, Arora RR. Influenza vaccination and cardiovascular morbidity and mortality: analysis of 292,383 patients. J Cardiovasc Pharmacol Ther 2011; 17:277-83. [PMID: 22172681 DOI: 10.1177/1074248411429965] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have documented an association between influenza vaccination and risk reduction in myocardial infarction, all-cause mortality, and major adverse cardiac events. This meta-analysis pooled data from 5 trials with a total of 292 383 patients. Influenza vaccination was found to be associated with significant reductions in myocardial infarction, all-cause mortality, and major adverse cardiac events. The risk reduction afforded by vaccination and the lack of major adverse events related to the influenza vaccination makes it particularly important to vaccinate those with a known cardiovascular disease or those at high risk of developing cardiovascular disease.
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Affiliation(s)
- Rohit S Loomba
- Children's Hospital of Wisconsin/Medical College of Wisconsin Affiliated Hospitals, Wauwatosa, WI 53226, USA.
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Statement on Seasonal Influenza Vaccine for 2011-2012: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) †. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2011; 37:1-55. [PMID: 31682646 PMCID: PMC6802429 DOI: 10.14745/ccdr.v37i00a05] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Accumulating evidence suggests that maternal infection is a risk factor for schizophrenia. Prospective epidemiological studies indicate that maternal influenza, toxoplasmosis, and genital/reproductive infection are associated with this disorder in offspring. Preclinical models of maternal immune activation have supported the neurobiological plausibility of these microbes in schizophrenia. Previous studies suggest that treatment or prophylactic efforts targeting these and other infections could have significant effects on reducing the incidence of schizophrenia, given that they are common in the population and the effect sizes derived from epidemiological studies of these and other microbial pathogens and schizophrenia, to date, are not small. Fortunately, the occurrence of many of these infections can be reduced with relatively practical and inexpensive interventions that are scalable to large populations given adequate resources. Hence, in the present article, we focus on the potential for prevention of schizophrenia by control of infection, using these 3 categories of infection as examples. Lessons learned from previous successful public health efforts targeting these infections, including the relative advantages and disadvantages of these measures, are reviewed.
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MESH Headings
- Causality
- Cohort Studies
- Cytokines/blood
- Female
- Humans
- Infant, Newborn
- Influenza, Human/complications
- Influenza, Human/epidemiology
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/immunology
- Pregnancy Complications, Infectious/prevention & control
- Prenatal Care
- Risk Factors
- Schizophrenia/epidemiology
- Schizophrenia/etiology
- Schizophrenia/immunology
- Schizophrenia/prevention & control
- Sexually Transmitted Diseases/complications
- Sexually Transmitted Diseases/epidemiology
- Sexually Transmitted Diseases/immunology
- Sexually Transmitted Diseases/prevention & control
- Toxoplasmosis, Congenital/epidemiology
- Toxoplasmosis, Congenital/immunology
- Toxoplasmosis, Congenital/prevention & control
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Affiliation(s)
- Alan S Brown
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, NewYork, NY 10032, USA.
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Shaman J, Goldstein E, Lipsitch M. Absolute humidity and pandemic versus epidemic influenza. Am J Epidemiol 2011; 173:127-35. [PMID: 21081646 DOI: 10.1093/aje/kwq347] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Experimental and epidemiologic evidence indicates that variations of absolute humidity account for the onset and seasonal cycle of epidemic influenza in temperate regions. A role for absolute humidity in the transmission of pandemic influenza, such as 2009 A/H1N1, has yet to be demonstrated and, indeed, outbreaks of pandemic influenza during more humid spring, summer, and autumn months might appear to constitute evidence against an effect of humidity. However, here the authors show that variations of the basic and effective reproductive numbers for influenza, caused by seasonal changes in absolute humidity, are consistent with the general timing of pandemic influenza outbreaks observed for 2009 A/H1N1 in temperate regions, as well as wintertime transmission of epidemic influenza. Indeed, absolute humidity conditions correctly identify the region of the United States vulnerable to a third, wintertime wave of pandemic influenza. These findings suggest that the timing of pandemic influenza outbreaks is controlled by a combination of absolute humidity conditions, levels of susceptibility, and changes in population-mixing and contact rates.
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Transmission of a 2009 pandemic influenza virus shows a sensitivity to temperature and humidity similar to that of an H3N2 seasonal strain. J Virol 2010; 85:1400-2. [PMID: 21084485 DOI: 10.1128/jvi.02186-10] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In temperate regions of the world, influenza epidemics follow a highly regular seasonal pattern, in which activity peaks in midwinter. Consistently with this epidemiology, we have shown previously that the aerosol transmission of a seasonal H3N2 influenza virus is most efficient under cold, dry conditions. With the 2009 H1N1 pandemic, an exception to the standard seasonality of influenza developed: during 2009 in the Northern Hemisphere, an unusually high level of influenza virus activity over the spring and summer months was followed by a widespread epidemic which peaked in late October, approximately 2.5 months earlier than usual. Herein we show that aerosol transmission of a 2009 pandemic strain shows a dependence on relative humidity and temperature very similar to that of a seasonal H3N2 influenza virus. Our data indicate that the observed differences in the timings of outbreaks with regard to the seasons are most likely not due to intrinsic differences in transmission between the pandemic H1N1 and seasonal H3N2 influenza viruses.
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Abstract
The occurrence of stroke in populations is incompletely explained by traditional vascular risk factors. Data from several case-control studies and one large study using case series methodology indicate that recent infection is a temporarily acting, independent trigger factor for ischemic stroke. Both bacterial and viral infections, particularly respiratory tract infections, contribute to this association. A causal role for infection in stroke is supported by a graded temporal relationship between these conditions, and by multiple pathophysiological pathways linking infection and inflammation, thrombosis, and stroke. Furthermore, observational studies suggest that influenza vaccination confers a preventive effect against stroke. Case-control and prospective studies indicate that chronic infections, such as periodontitis, chronic bronchitis and infection with Helicobacter pylori, Chlamydia pneumoniae or Cytomegalovirus, might increase stroke risk, although considerable variation exists in the results of these studies, and methodological issues regarding serological results remain unresolved. Increasing evidence indicates that the aggregate burden of chronic and/or past infections rather than any one single infectious disease is associated with the risk of stroke. Furthermore, genetic predispositions relating to infection susceptibility and the strength of the inflammatory response seem to co-determine this risk. Here, we summarize and analyze the evidence for common acute and chronic infectious diseases as stroke risk factors.
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Statement on Seasonal Trivalent Inactivated Influenza Vaccine (TIV) for 2010-2011: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) †. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2010; 36:1-49. [PMID: 31682656 PMCID: PMC6802438 DOI: 10.14745/ccdr.v36i00a06] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Pathways to further boost treatment rates and clinical outcomes in hospitalized stroke patients. Crit Pathw Cardiol 2010; 9:8-13. [PMID: 20215904 DOI: 10.1097/hpc.0b013e3181cd5c84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inpatient quality improvement initiatives have been associated with impressive improvements in evidence-based discharge treatment rates in hospitalized stroke patients. However, these programs have generally focused only on optimizing recurrent stroke prevention strategies among ischemic stroke patients. Many patients hospitalized with recent symptomatic cerebral ischemia are also at risk for future ischemic episodes emanating from other vascular beds, and the inpatient setting could represent an opportunity to screen and appropriately manage such patients who harbor cross-vascular risk. The stroke hospitalization may also be ideal for identifying stroke patients susceptible to a highly preventable yet common trigger of vascular events and poor clinical outcomes like influenza infection. Finally, several hospital-based prevention measures are underutilized in patients hospitalized with intracerebral hemorrhage (ICH) compared with those with ischemic stroke or transient ischemic attack, and so protocols geared at enhancing prevention of ICH recurrence, are certainly warranted. This article presents pathways (algorithms, pocket cards, preprinted orders) developed from expert consensus prevention guidelines and implemented within a broader stroke inpatient quality improvement program, which target patients highly vulnerable to future coronary events, poor clinical outcomes following influenza infection, and recurrent ICH.
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Dutkowski R, Smith JR, Davies BE. Safety and pharmacokinetics of oseltamivir at standard and high dosages. Int J Antimicrob Agents 2010; 35:461-7. [PMID: 20189775 DOI: 10.1016/j.ijantimicag.2009.12.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 12/23/2009] [Accepted: 12/26/2009] [Indexed: 11/29/2022]
Abstract
Although clinical evidence is currently lacking, opinion in the literature on avian influenza A/H5N1 suggests that increased doses of the oral neuraminidase inhibitor oseltamivir may offer clinical benefits against highly pathogenic influenza where high levels of viral replication and disseminated infection cause severe disease. We assessed the pharmacokinetics and safety/tolerability of oseltamivir at dosages up to 450 mg twice daily. Healthy adult volunteers were randomised to receive placebo or oseltamivir 75, 225 or 450 mg every 12h for 5 days. Volunteers were followed up to Day 7 for pharmacokinetic parameters, vital signs, adverse events and cardiac safety. In total, 391 volunteers were randomised and evaluated. Pharmacokinetics were linear and dose-proportional, with no evidence of accumulation of oseltamivir or its active metabolite at any dosage. Headache was the most common adverse event (16.8-23.7% across groups), but its incidence was unrelated to dosage. Dosage-related events with oseltamivir included nausea (up to 31.3% of volunteers) and vomiting (up to 16.2%), which generally occurred on Day 1 and lasted <1 day, and possibly dizziness (up to 11.3%). Oseltamivir had no relevant effects on vital signs, laboratory parameters or cardiac function. In conclusion, oseltamivir was well tolerated, with dose-proportional pharmacokinetics and no accumulation. Possible clinical benefit in severe influenza infections could be investigated at dosages higher than those currently recommended.
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Posterior reversible encephalopathy syndrome and cerebral vasculopathy associated with influenza A infection: report of a case and review of the literature. J Comput Assist Tomogr 2010; 33:917-22. [PMID: 19940660 DOI: 10.1097/rct.0b013e3181993a43] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Influenza A infection can precipitate encephalopathy, encephalitis, or Reye syndrome with the development of cerebral edema in children and is associated with an increased incidence of stroke in adults. The mechanism of these events is poorly understood. Posterior reversible encephalopathy syndrome (PRES) is seen in association with infection/sepsis, and cerebral vasculopathy has been demonstrated in PRES. We describe a case of PRES that develops in association with influenza A. SUMMARY OF CASE A normotensive 65-year-old woman presented with altered mentation and nausea in the setting of a viral prodromal illness ultimately confirmed as influenza A. Posterior reversible encephalopathy syndrome developed on the second day after admission. Catheter cerebral angiogram documented vasculopathy in PRES-involved regions with areas of focal vessel dilatation and string-of-bead appearance. CONCLUSIONS The association between influenza A and PRES with documentation of cerebral vasculopathy suggests a common systemic vascular mechanism behind PRES and influenza-related encephalopathic edema and stroke.
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Thompson WW, Moore MR, Weintraub E, Cheng PY, Jin X, Bridges CB, Bresee JS, Shay DK. Estimating influenza-associated deaths in the United States. Am J Public Health 2009; 99 Suppl 2:S225-30. [PMID: 19797736 DOI: 10.2105/ajph.2008.151944] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Most estimates of US deaths associated with influenza circulation have been similar despite the use of different approaches. However, a recently published estimate suggested that previous estimates substantially overestimated deaths associated with influenza, and concluded that substantial numbers of deaths during a future pandemic could be prevented because of improvements in medical care. We reviewed the data sources and methods used to estimate influenza-associated deaths. We suggest that discrepancies between the recent estimate and previous estimates of the number of influenza-associated deaths are attributable primarily to the use of different outcomes and methods. We also believe that secondary bacterial infections will likely result in substantial morbidity and mortality during a future influenza pandemic, despite medical progress.
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Affiliation(s)
- William W Thompson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, MS A32, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
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Heffelfinger JD, Patel P, Brooks JT, Calvet H, Daley CL, Dean HD, Edlin BR, Gensheimer KF, Jereb J, Kent CK, Lennox JL, Louie JK, Lynfield R, Peters PJ, Pinckney L, Spradling P, Voetsch AC, Fiore A. Pandemic influenza: implications for programs controlling for HIV infection, tuberculosis, and chronic viral hepatitis. Am J Public Health 2009; 99 Suppl 2:S333-9. [PMID: 19797745 PMCID: PMC4504393 DOI: 10.2105/ajph.2008.158170] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2009] [Indexed: 01/21/2023]
Abstract
Among vulnerable populations during an influenza pandemic are persons with or at risk for HIV infection, tuberculosis, or chronic viral hepatitis. HIV-infected persons have higher rates of hospitalization, prolonged illness, and increased mortality from influenza compared with the general population. Persons with tuberculosis and chronic viral hepatitis may also be at increased risk of morbidity and mortality from influenza because of altered immunity and chronic illness. These populations also face social and structural barriers that will be exacerbated by a pandemic. Existing infrastructure should be expanded and pandemic planning should include preparations to reduce the risks for these populations.
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Affiliation(s)
- James D Heffelfinger
- Centers for Disease Control and Prevention, Mail Stop: E-46, Atlanta, GA 30333, USA.
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Warren-Gash C, Smeeth L, Hayward AC. Influenza as a trigger for acute myocardial infarction or death from cardiovascular disease: a systematic review. THE LANCET. INFECTIOUS DISEASES 2009; 9:601-10. [PMID: 19778762 DOI: 10.1016/s1473-3099(09)70233-6] [Citation(s) in RCA: 335] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiac complications of influenza infection, such as myocarditis, are well recognised, but the role of influenza as a trigger of acute myocardial infarction is less clear. We did a systematic review of the evidence that influenza (including influenza-like illness and acute respiratory infection) triggers acute myocardial infarction or cardiovascular death. We examined the effectiveness of influenza vaccines at protecting against cardiac events and did a meta-analysis of data from randomised controlled trials. 42 publications describing 39 studies were identified. Many observational studies in different settings with a range of methods reported consistent associations between influenza and acute myocardial infarction. There was weaker evidence of an association with cardiovascular death. Two small randomised trials assessed the protection provided by influenza vaccine against cardiac events in people with existing cardiovascular disease. Whereas one trial found that influenza vaccination gave significant protection against cardiovascular death, the other trial was inconclusive. A pooled estimate from a random-effects model suggests a protective, though non-significant, effect (relative risk 0.51, 95% CI 0.15-1.76). We believe influenza vaccination should be encouraged wherever indicated, especially in people with existing cardiovascular disease, among whom there is often suboptimum vaccine uptake. Further evidence is needed on the effectiveness of influenza vaccines to reduce the risk of cardiac events in people without established vascular disease.
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Skowronski DM, De Serres G. Is routine influenza immunization warranted in early pregnancy? Vaccine 2009; 27:4754-70. [PMID: 19515466 DOI: 10.1016/j.vaccine.2009.03.079] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/20/2009] [Accepted: 03/24/2009] [Indexed: 01/18/2023]
Abstract
Routine influenza immunization is recommended for select groups because of their higher risk of serious influenza outcomes. Based on that benefit-risk framework, we assessed whether routine administration of trivalent inactivated influenza vaccine (TIV) is warranted in pregnancy, beginning in 1st trimester. Higher maternal mortality due to influenza was extensively described during the 1918 and 1957 pandemics, but epidemiologic evidence thereafter is limited to case reports and a single ecologic analysis during a single season. Significantly elevated rates of hospitalization have been reported with seasonal influenza beginning in 1st trimester among women with select comorbidities and during the 2nd half of normal pregnancy. TIV protection against serious outcomes in pregnant women has not yet been shown. Although harm has also not been shown, sample size to date is insufficient to assert TIV safety in 1st trimester. Benefit-risk analysis suggests influenza immunization may be warranted at any stage of pregnancy during certain pandemics and annually among women with select comorbidities. TIV may also be warranted to protect women against influenza-related hospitalization during the 2nd half of normal pregnancy. Evidence is otherwise insufficient to recommend routine TIV as the standard of practice for all healthy women beginning in early pregnancy.
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Abstract
The impact of influenza has been recognized for centuries. Its seasonality in temperate climates has allowed estimates of mortality and severe morbidity, such as hospitalization, to be made statistically, without identifying cases virologically. Most influenza related mortality occurs in older individuals and those with underlying conditions. In addition to those groups, influenza hospitalizations occur in younger children and pregnant women. Morbidity is more difficult to identify and laboratory confirmation is required for precise estimates to be made. Younger individuals experience the highest frequency of illnesses caused by all subtypes. This has resulted in suggested strategies for community control by vaccinating children.
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Affiliation(s)
- Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109, USA.
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