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Uthappa DM, McClain MT, Nicholson BP, Park LP, Zhbannikov I, Suchindran S, Jimenez M, Constantine FJ, Nichols M, Jones DC, Hudson LL, Jaggers LB, Veldman T, Burke TW, Tsalik EL, Ginsburg GS, Woods CW. Implementation of a Prospective Index-Cluster Sampling Strategy for the Detection of Presymptomatic Viral Respiratory Infection in Undergraduate Students. Open Forum Infect Dis 2024; 11:ofae081. [PMID: 38440301 PMCID: PMC10911223 DOI: 10.1093/ofid/ofae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 03/06/2024] Open
Abstract
Background Index-cluster studies may help characterize the spread of communicable infections in the presymptomatic state. We describe a prospective index-cluster sampling strategy (ICSS) to detect presymptomatic respiratory viral illness and its implementation in a college population. Methods We enrolled an annual cohort of first-year undergraduates who completed daily electronic symptom diaries to identify index cases (ICs) with respiratory illness. Investigators then selected 5-10 potentially exposed, asymptomatic close contacts (CCs) who were geographically co-located to follow for infections. Symptoms and nasopharyngeal samples were collected for 5 days. Logistic regression model-based predictions for proportions of self-reported illness were compared graphically for the whole cohort sampling group and the CC group. Results We enrolled 1379 participants between 2009 and 2015, including 288 ICs and 882 CCs. The median number of CCs per IC was 6 (interquartile range, 3-8). Among the 882 CCs, 111 (13%) developed acute respiratory illnesses. Viral etiology testing in 246 ICs (85%) and 719 CCs (82%) identified a pathogen in 57% of ICs and 15% of CCs. Among those with detectable virus, rhinovirus was the most common (IC: 18%; CC: 6%) followed by coxsackievirus/echovirus (IC: 11%; CC: 4%). Among 106 CCs with a detected virus, only 18% had the same virus as their associated IC. Graphically, CCs did not have a higher frequency of self-reported illness relative to the whole cohort sampling group. Conclusions Establishing clusters by geographic proximity did not enrich for cases of viral transmission, suggesting that ICSS may be a less effective strategy to detect spread of respiratory infection.
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Affiliation(s)
- Diya M Uthappa
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Micah T McClain
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | | | - Lawrence P Park
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Ilya Zhbannikov
- Bioinformatics and Clinical Analytics Team, Clinical Research Unit, Duke University Department of Medicine, Durham, North Carolina, USA
| | - Sunil Suchindran
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Monica Jimenez
- Institute for Medical Research, Durham, North Carolina, USA
| | - Florica J Constantine
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Marshall Nichols
- Duke Institute for Health Innovation, Durham, North Carolina, USA
| | - Daphne C Jones
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Lori L Hudson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - L Brett Jaggers
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Timothy Veldman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Thomas W Burke
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Ephraim L Tsalik
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
| | - Geoffrey S Ginsburg
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher W Woods
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Center for Infectious Disease Diagnostics and Innovation, Duke University Medical Center, Durham, North Carolina, USA
- Durham Veterans Affairs Health Care System, Durham, North Carolina, USA
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Bhat YR. Influenza B infections in children: A review. World J Clin Pediatr 2020; 9:44-52. [PMID: 33442534 PMCID: PMC7769779 DOI: 10.5409/wjcp.v9.i3.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Influenza B (IFB) virus belongs to the Orthomyxoviridae family and has two antigenically and genetically distinct lineages; B/Victoria/2/87-like (Victoria lineage) and B/Yamagata/16/88-like (Yamagata lineage). The illness caused by IFB differs from that caused by influenza A. Outbreaks of IFB occur worldwide and young children exposed to IFB are likely to have a higher disease severity compared with adults. IFB mostly causes mild to moderate respiratory illness in healthy children. However, the involvement of other systems, a severe disease especially in children with chronic medical conditions and immunosuppression, and rarely mortality, has been reported. Treatment with oseltamivir or zanamivir decreases the severity of illness and hospitalization. Due to the enormous health and economic impact of IFB, these strains are included in vaccines. IFB illness is less studied in children although its impact is substantial. In this review, the epidemiology, clinical manifestations, treatment, prognosis, and prevention of IFB illness in children are discussed.
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Affiliation(s)
- Yellanthoor Ramesh Bhat
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
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Clinical and demographic characteristics of influenza b outbreak in Erzincan province of Turkey. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.437319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Acar M, Sütçü M, Aktürk H, Törün SH, Uysalol M, Meşe S, Salman N, Somer A. Clinical differences of influenza subspecies among hospitalized children. Turk Arch Pediatr 2017; 52:15-22. [PMID: 28439196 DOI: 10.5152/turkpediatriars.2017.4695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/11/2017] [Indexed: 12/28/2022]
Abstract
AIM Clinical findings, mortality, and morbidity rates differ among influenza subspecies. Awareness of these differences will lead physicians to choose the proper diagnostic and therapeutic strategies and to foresee possible complications. The aim of this study was to evaluate the clinical differences of influenza subspecies among hospitalized children. MATERIAL AND METHODS Hospitalized children with proven influenza infection by polymerase chain reaction on nasopharyngeal swab specimens in our clinic, between December 2013 and March 2016, were enrolled. These children were divided into 3 groups as Influenza A/H1N1 (n=42), Influenza A/H3N2 (n=23), and Influenza B (n=35). RESULTS The median age of the children was 51.5 months (range, 3-204 months). The most common presenting symptoms were fever (n=83), cough (n=58), and difficulty in breathing (n=25). The most common non-respiratory findings were lymphadenopathy (n=18) and gastrointestinal system involvement (n=17). Sixty-two percent of the patients (n=62) had chronic diseases. H1N1 and H3N2 were significantly more common among patients with chronic neurologic disorders and renal failure, respectively. Leukopenia (n=32) and thrombocytopenia (n=22) were the most common pathologic laboratory findings. Neutropenia, elevated CRP levels, and antibiotic use were significantly more common among patients with H1N1 infection. Seven patients were transferred to the intensive care unit with diagnoses of acute respiratory distress syndrome (n=4), encephalitis (n=2), and bronchiolitis (n=1). Two patients with chronic diseases and H1N1 infection died secondary to acute respiratory distress syndrome. CONCLUSIONS Influenza A/H1N1 infection represented more severe clinical disease.
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Affiliation(s)
- Manolya Acar
- Department of Pediatrics, Pediatric Infectious Diseases and Clinical Immunology Division, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Murat Sütçü
- Department of Pediatrics, Pediatric Infectious Diseases and Clinical Immunology Division, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Hacer Aktürk
- Department of Pediatrics, Pediatric Infectious Diseases and Clinical Immunology Division, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Selda Hançerli Törün
- Department of Pediatrics, Pediatric Infectious Diseases and Clinical Immunology Division, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Metin Uysalol
- Department of Pediatrics, Division of Pediatric Emergency, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Sevim Meşe
- Department of Microbiology and Clinical Microbiology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Nuran Salman
- Department of Pediatrics, Pediatric Infectious Diseases and Clinical Immunology Division, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Ayper Somer
- Department of Pediatrics, Pediatric Infectious Diseases and Clinical Immunology Division, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Tran D, Vaudry W, Moore D, Bettinger JA, Halperin SA, Scheifele DW, Jadvji T, Lee L, Mersereau T. Hospitalization for Influenza A Versus B. Pediatrics 2016; 138:peds.2015-4643. [PMID: 27535144 DOI: 10.1542/peds.2015-4643] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The extent to which influenza A and B infection differs remains uncertain. METHODS Using active surveillance data from the Canadian Immunization Monitoring Program Active at 12 pediatric hospitals, we compared clinical characteristics and outcomes of children ≤16 years admitted with laboratory-confirmed influenza B or seasonal influenza A. We also examined factors associated with ICU admission in children hospitalized with influenza B. RESULTS Over 8 nonpandemic influenza seasons (2004-2013), we identified 1510 influenza B and 2645 influenza A cases; median ages were 3.9 and 2.0 years, respectively (P < .0001). Compared with influenza A patients, influenza B patients were more likely to have a vaccine-indicated condition (odds ratio [OR] = 1.30; 95% confidence interval [CI] = 1.14-1.47). Symptoms more often associated with influenza B were headache, abdominal pain, and myalgia (P < .0001 for all symptoms after adjustment for age and health status). The proportion of deaths attributable to influenza was significantly greater for influenza B (1.1%) than influenza A (0.4%); adjusted for age and health status, OR was 2.65 (95% CI = 1.18-5.94). A similar adjusted OR was obtained for all-cause mortality (OR = 2.95; 95% CI = 1.34-6.49). Among healthy children with influenza B, age ≥10 years (relative to <6 months) was associated with the greatest odds of ICU admission (OR = 5.79; 95% CI = 1.91-17.57). CONCLUSIONS Mortality associated with pediatric influenza B infection was greater than that of influenza A. Among healthy children hosptialized with influenza B, those 10 years and older had a significant risk of ICU admission.
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Affiliation(s)
- Dat Tran
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada;
| | - Wendy Vaudry
- Division of Infectious Diseases, Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Edmonton Alberta, Canada
| | - Dorothy Moore
- Division of Infectious Diseases, Department of Paediatrics, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David W Scheifele
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Taj Jadvji
- Section of Infectious Diseases, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada; and
| | - Liza Lee
- Centre for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
| | - Teresa Mersereau
- Centre for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Canada
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Mancinelli L, Onori M, Concato C, Sorge R, Chiavelli S, Coltella L, Raucci U, Reale A, Menichella D, Russo C. Clinical features of children hospitalized with influenza A and B infections during the 2012-2013 influenza season in Italy. BMC Infect Dis 2016; 16:6. [PMID: 26743673 PMCID: PMC4705698 DOI: 10.1186/s12879-015-1333-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 12/30/2015] [Indexed: 12/12/2022] Open
Abstract
Background Influenza is a major public health issue worldwide. It is characterized by episodes of infection that involve hundreds of millions of people each year. Since that in the seasons 2010–2011 and 2011–2012 the circulation of FLUB was decreasing we evaluated the clinical presentation, demographic characteristics, admitting department, and length of stay in children who contracted influenza admitted to Bambino Gesù Children’s Hospital, during the 2012–2013 influenza season, with the aim to establish if the recover of FLUB was associated to a clinical worsening, in comparison with those due to FLUA. Methods A total of 133 respiratory specimens, collected from patients with symptoms of respiratory tract infections, positive for the Influenza A and B viruses (FLUA and B) were subtyped. Comparisons between the FLUA and FLUB groups were performed with the one-way ANOVA for continuous parametric variables, the Mann-Whitney test for non-parametric variables, or the Chi-Square test or Fisher’s exact test (if cells <5) for categorical variables. Results 87.09 % of the FLUA isolates were the H1N1 subtype and 12.90 % were H3N2. Among the FLUB isolates, 91.54 % were the B/Yamagata/16/88 lineage and 8.45 % were the B/Victoria/02/87 lineage. The largest number of FLUA/H1N1 cases was observed in children less than 1 years old, while the B/Yamagata/16/88 lineage was most prevalent in children 3–6 years old. Fever was a common symptom for both FLUA and B affected patients. However, respiratory symptoms were more prevalent in patients affected by FLUA. The median length of stay in the hospital was 5 days for FLUA and 3 days for FLUB. Conclusions The clinical features correlated to different Influenza viruses, and relevant subtypes, were evaluated concluding that the increasing of FLUB in the season 2012–2013 was without any dramatic change in clinical manifestation. Our findings suggest, finally, that a stronger commitment to managing patients affected by FLUA is required, as the disease is more severe than FLUB.
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Affiliation(s)
- Livia Mancinelli
- Virology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Manuela Onori
- Virology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Carlo Concato
- Virology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Roberto Sorge
- Laboratory of Biometry, University of Tor Vergata, Rome, Italy.
| | - Stefano Chiavelli
- Virology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Luana Coltella
- Virology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Antonio Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Donato Menichella
- Medical Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Cristina Russo
- Virology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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Sakudo A, Baba K, Ikuta K. Analysis of Vis-NIR spectra changes to measure the inflammatory response in the nasal mucosal region of influenza A and B virus-infected patients. J Clin Virol 2012; 55:334-8. [PMID: 22981622 DOI: 10.1016/j.jcv.2012.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 08/13/2012] [Accepted: 08/16/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Human influenza A and B viruses cause severe seasonal respiratory tract infections, especially in infants and young children. Influenza A and B viruses have been reported to produce different symptoms and/or severity in infected patients, although these remain inconclusive. OBJECTIVES AND STUDY DESIGN In this study, non-invasive visible and near-infrared (Vis-NIR) spectroscopy was used for comparative analysis of the inflammatory response to influenza A and B virus infections, by measuring changes in water peak (970 nm) spectra collected from patient nasal mucosal regions. RESULTS The results suggested that infection with influenza B virus induced more severe inflammatory responses in the nasal mucosal region than influenza A virus. CONCLUSIONS These are the first data showing different inflammatory responses to influenza A and B viruses at the sites of virus infection.
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Affiliation(s)
- Akikazu Sakudo
- Department of Virology, Center for Infectious Disease Control, Research Institute for Microbial Diseases, Osaka University, Yamadaoka, Suita, Osaka 565-0871, Japan.
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Abstract
Effective management of influenza depends on early recognition of influenza in the community and on rapid diagnosis. Early recognition is achieved by integrated clinical and laboratory based surveillance programmes in representative populations. The recent introduction of 'near patient tests' for influenza provide increased opportunities for surveillance but diagnosis remains largely clinically based. The combination of cough and fever in conditons of known local influenza virus circulation provide a useful indicator of diagnosis to guide management.
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Affiliation(s)
- D Fleming
- RCGP Birmingham Research Unit, Harborne, UK.
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Daley AJ, Nallusamy R, Isaacs D. Comparison of influenza A and influenza B virus infection in hospitalized children. J Paediatr Child Health 2000; 36:332-5. [PMID: 10940165 DOI: 10.1046/j.1440-1754.2000.00533.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Influenza A and B viruses were cocirculating in Australia in the winter of 1997. OBJECTIVE To compare the clinical and demographic features of children with influenza A or influenza B virus infection admitted to a paediatric tertiary referral centre. METHODOLOGY Retrospective chart review of 91 hospitalized children with culture-proven influenza A or B virus infection during 1997. RESULTS Thirty-six (56%) of 64 children with influenza A were under 12 months of age compared with seven (26%) of 27 children with influenza B virus infection (P = 0.02). Influenza B virus infection was more common in children with underlying medical problems (P = 0. 01). Neurological manifestations were present in eight (12.5%) of 64 children with influenza A and none with influenza B virus infection (P = 0.09). There were no significant differences in signs and symptoms of children with influenza A and B virus infection, in severity of illness or in duration of hospital stay. CONCLUSIONS A greater proportion of children admitted with influenza A virus infection were under 12 months of age. Influenza B virus infection is associated more commonly with underlying medical disorders. It is not possible to differentiate between influenza A or B virus infection from presenting clinical signs and symptoms.
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Affiliation(s)
- A J Daley
- Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia.
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