1
|
Feng SY, Jiang N, Yang JY, Yang LY, Du JC, Chen XQ, Liu D, Li RT, Zhong JD. Antiviral and anti-inflammatory activities of chemical constituents from twigs of Mosla chinensis Maxim. NATURAL PRODUCTS AND BIOPROSPECTING 2024; 14:26. [PMID: 38691189 PMCID: PMC11063020 DOI: 10.1007/s13659-024-00448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Seven undescribed compounds, including three flavones (1-3), one phenylpropanoid (19), three monoaromatic hydrocarbons (27-29), were isolated from the twigs of Mosla chinensis Maxim together with twenty-eight known compounds. The structures were characterized by HRESIMS, 1D and 2D NMR, and ECD spectroscopic techniques. Compound 20 displayed the most significant activity against A/WSN/33/2009 (H1N1) virus (IC50 = 20.47 μM) compared to the positive control oseltamivir (IC50 = 6.85 µM). Further research on the anti-influenza mechanism showed that compound 20 could bind to H1N1 virus surface antigen HA1 and inhibit the early attachment stage of the virus. Furthermore, compounds 9, 22, 23, and 25 displayed moderate inhibitory effects on the NO expression in LPS inducing Raw 264.7 cells with IC50 values of 22.78, 20.47, 27.66, and 30.14 µM, respectively.
Collapse
Affiliation(s)
- Shi-Yan Feng
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Na Jiang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Jia-Ying Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Lin-Yao Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Jiang-Chao Du
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Xuan-Qin Chen
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Dan Liu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Rong-Tao Li
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China
| | - Jin-Dong Zhong
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, People's Republic of China.
| |
Collapse
|
2
|
Cong B, Dighero I, Zhang T, Chung A, Nair H, Li Y. Understanding the age spectrum of respiratory syncytial virus associated hospitalisation and mortality burden based on statistical modelling methods: a systematic analysis. BMC Med 2023; 21:224. [PMID: 37365569 DOI: 10.1186/s12916-023-02932-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Statistical modelling studies based on excess morbidity and mortality are important for understanding RSV disease burden for age groups that are less frequently tested for RSV. We aimed to understand the full age spectrum of RSV morbidity and mortality burden based on statistical modelling studies, as well as the value of modelling studies in RSV disease burden estimation. METHODS The databases Medline, Embase and Global Health were searched to identify studies published between January 1, 1995, and December 31, 2021, reporting RSV-associated excess hospitalisation or mortality rates of any case definitions using a modelling approach. All reported rates were summarised using median, IQR (Interquartile range) and range by age group, outcome and country income group; where applicable, a random-effects meta-analysis was conducted to combine the reported rates. We further estimated the proportion of RSV hospitalisations that could be captured in clinical databases. RESULTS A total of 32 studies were included, with 26 studies from high-income countries. RSV-associated hospitalisation and mortality rates both showed a U-shape age pattern. Lowest and highest RSV acute respiratory infection (ARI) hospitalisation rates were found in 5-17 years (median: 1.6/100,000 population, IQR: 1.3-18.5) and < 1 year (2235.7/100,000 population, 1779.1-3552.5), respectively. Lowest and highest RSV mortality rates were found in 18-49 years (0.1/100,000 population, 0.06-0.2) and ≥ 75 years (80.0/100,000 population, 70.0-90.0) for high-income countries, respectively, and in 18-49 years (0.3/100,000 population, 0.1-2.4) and < 1 year (143.4/100,000 population, 143.4-143.4) for upper-middle income countries. More than 70% of RSV hospitalisations in children < 5 years could be captured in clinical databases whereas less than 10% of RSV hospitalisations could be captured in adults, especially for adults ≥ 50 years. Using pneumonia and influenza (P&I) mortality could potentially capture half of all RSV mortality in older adults but only 10-30% of RSV mortality in children. CONCLUSIONS Our study provides insights into the age spectrum of RSV hospitalisation and mortality. RSV disease burden using laboratory records alone could be substantially severely underreported for age groups ≥ 5 years. Our findings confirm infants and older adults should be prioritised for RSV immunisation programmes. TRIAL REGISTRATION PROSPERO CRD42020173430.
Collapse
Affiliation(s)
- Bingbing Cong
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Izzie Dighero
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tiantian Zhang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Alexandria Chung
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Harish Nair
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - You Li
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
3
|
Fisher WA, Gilca V, Murti M, Orth A, Garfield H, Roumeliotis P, Rampakakis E, Brown V, Yaremko J, Van Buynder P, Boikos C, Mansi JA. Parental Attitudes and Perceptions of Support after Brief Clinician Intervention Predict Intentions to Accept the Adjuvanted Seasonal Influenza Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-I. Vaccines (Basel) 2022; 10:1957. [PMID: 36423052 PMCID: PMC9698621 DOI: 10.3390/vaccines10111957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 08/29/2023] Open
Abstract
Adjuvanted trivalent influenza vaccine (aTIV) provides enhanced protection against seasonal influenza in children compared with nonadjuvanted trivalent influenza vaccine (TIV). This prospective cohort study assessed parental attitudes, beliefs, and intentions to vaccinate their infants aged 6-23 months with aTIV. Parents were surveyed before and after routine healthy baby visits, and post clinician interaction results were analyzed using multivariable logistic regression. Physicians at 15 community practice clinics and nurses at 3 public health clinics participated; 207 parents were surveyed. After clinician consultation, most parents considered immunization with aTIV to be safe (72.9%), effective (69.6%), and important (69.0%); most perceived support for vaccination from significant others (62.8%) and clinicians (81.6%); and 66.6% intended to vaccinate their infant with aTIV. Parental attitudes toward vaccinating their infant with aTIV were strongly correlated with perceptions of vaccine safety, efficacy, and importance, and these represented the strongest influence on intentions to vaccinate (odds ratio (OR) 79.25; 95% confidence interval (CI) 6.05-1037.50). Parental intentions were further influenced by perceived strength of clinician recommendation (OR 4.55, 95% CI 1.38-15.06) and social support for vaccination (OR 3.46, 95% CI 0.50-24.13). These findings may inform clinician approaches to parental education to ensure optimal seasonal pediatric influenza vaccination.
Collapse
Affiliation(s)
- William A. Fisher
- Department of Psychology, Department of Obstetrics and Gynaecology, Western University, London, ON N6A 3K7, Canada
| | - Vladimir Gilca
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Institut Nationale de Sante Publique du Québec and Université Laval, Québec City, QC G1V 5B3, Canada
| | - Michelle Murti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Alison Orth
- Fraser Health Authority, Vancouver, BC V3T 0H1, Canada
| | - Hartley Garfield
- The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | | | | | - Vivien Brown
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - John Yaremko
- The Montreal Children’s Hospital, Montreal, QC H4A 3J1, Canada
- Department of Pediatrics, McGill University, Montreal, QC H3A 0G4, Canada
| | - Paul Van Buynder
- School of Medicine, Griffith University, University of Western Australia, Perth, WA 6009, Australia
| | | | | |
Collapse
|
4
|
Clinicians Are Not Able to Infer Parental Intentions to Vaccinate Infants with a Seasonal Influenza Vaccine, and Perhaps They Should Not Try: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-IV. Vaccines (Basel) 2022; 10:vaccines10111955. [PMID: 36423050 PMCID: PMC9697433 DOI: 10.3390/vaccines10111955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/19/2022] Open
Abstract
This prospective cohort survey evaluated the concordance of clinicians’ perceptions of parental intentions and parents’ actual intentions to vaccinate their infants against influenza. During a routine healthy baby visit, clinicians provided parents with information about influenza, children’s vulnerability to influenza, and nonadjuvanted and adjuvanted trivalent influenza vaccines (TIV and aTIV, respectively). Before and after the clinician−parent interaction, parents were surveyed about their attitudes, their perceptions of support from significant others, and the intention to vaccinate their infant with aTIV. Clinicians were asked about their perception of parents’ intentions to choose aTIV for their children. These assessments included 24 clinicians at 15 community practices and nine public health clinics, and 207 parents. The correlation coefficients of the clinicians’ assessment of parents’ intention to vaccinate were 0.483 (p < 0.001) if the vaccine was presented as free of cost, 0.266 (p < 0.001) if the cost was $25, and 0.146 (p = 0.036) if the cost was $50, accounting for 23%, 7%, and 2% of the variance in parental intentions, respectively. The clinicians were poor at predicting parental intentions to immunize, particularly when cost was involved. Information on vaccine options and influenza infection should be provided for every eligible patient to allow parents to determine if the vaccine is appropriate for their child.
Collapse
|
5
|
Rafferty E, Paulden M, Buchan SA, Robinson JL, Bettinger JA, Kumar M, Svenson LW, MacDonald SE. Evaluating the Individual Healthcare Costs and Burden of Disease Associated with RSV Across Age Groups. PHARMACOECONOMICS 2022; 40:633-645. [PMID: 35553028 PMCID: PMC9130187 DOI: 10.1007/s40273-022-01142-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of acute respiratory infection (ARI), with high morbidity and mortality worldwide. RSV costing and burden estimates can highlight the potential benefits of future vaccination programs and are essential for economic evaluations. OBJECTIVE We aimed to determine RSV healthcare costs across age groups and the overall disease burden of medically attended RSV in Canada. METHODS We conducted a retrospective case-control study to estimate the attributable healthcare costs per RSV case in Alberta. We used two case definitions to capture diversity in case severity: laboratory-confirmed RSV and ARI attributable to RSV. Matching occurred on five criteria: (1) age, (2) urban/rural status, (3) sex, (4) prematurity and (5) Charlson Comorbidity Index score. We calculated the age-specific burden of medically attended RSV in Canada from 2010 to 2019 by multiplying the weekly age-specific incidence of medically attended ARI with the RSV positivity rate. RESULTS Costs per laboratory-confirmed RSV case were (in Canadian dollars [CAD], year 2020 values) $CAD12,713 and 40,028 in the first 30 and 365 days following diagnosis, respectively, whereas a case of ARI potentially attributable to RSV cost $CAD316 and 915, in 30 and 365 days, respectively. Older (aged ≥ 65 years) and younger (aged < 90 days) age groups had the highest case costs. The average medically attended RSV incidence rate across nine seasons was 1743 cases per 100,000 people per year. CONCLUSIONS RSV is a common and expensive infection at the extremes of life, and the development of immunization programs targeting older and younger ages may be important for the reduction of RSV burden and cost.
Collapse
Affiliation(s)
- Ellen Rafferty
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
- Institute of Health Economics, #1200, 10405 Jasper Avenue, Edmonton, AB, T5J 3N4, Canada.
| | - Mike Paulden
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sarah A Buchan
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Analytics and Performance Reporting, Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
6
|
Nourbakhsh S, Shoukat A, Zhang K, Poliquin G, Halperin D, Sheffield H, Halperin SA, Langley JM, Moghadas SM. Effectiveness and cost-effectiveness of RSV infant and maternal immunization programs: A case study of Nunavik, Canada. EClinicalMedicine 2021; 41:101141. [PMID: 34622186 PMCID: PMC8479643 DOI: 10.1016/j.eclinm.2021.101141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite passive immunization with palivizumab to select high-risk children under two years of age, the health and economic burden of respiratory syncytial virus (RSV) remains substantial. We evaluated the effectiveness and cost-effectiveness of immunization programs with new generations of RSV prophylactics, including long-acting monoclonal antibodies (LAMA) and maternal vaccines, in terms of reducing hospitalizations in Nunavik, a Canadian Arctic region. METHODS We developed an agent-based model of RSV transmission and parameterized it with the demographics and burden of RSV in Nunavik, Québec. We compared various immunization strategies, taking into account the costs associated with program delivery and calculating the incremental cost-effectiveness ratio (ICER) using quality-adjusted life-years (QALYs) gained as a measure of effectiveness. Scenario analyses included immunization with palivizumab and LAMA for infants under one year of age, and maternal vaccination in mild, moderate, and severe RSV seasons. Data were analysed from November 1, 2019 to May 1, 2021. FINDINGS We found that a Nunavik pilot program with palivizumab which included healthy full-term infants aged 0-2 months in addition to those considered high-risk for complicated RSV disease is not cost-effective, compared to offering palivizumab only to preterm/chronically ill infants under 1 year of age. Using LAMA as prophylaxis produces ICER values of CAD $39,414/QALY (95% Credible Interval [CrI]: $39,314-$40,017) in a mild season (moderately cost-effective) and CAD $5,255/QALY (95% CrI: $5,222-$5,307) in a moderate season (highly cost-effective). LAMA was a dominant (cost-saving with negative incremental costs and positive incremental effects) strategy in a severe RSV season. Maternal vaccination combined with immunization of preterm/chronically ill infants 3-11 months was also a dominant (cost-saving) strategy in all seasons. INTERPRETATION The switch from palivizumab in RSV immunization programs to new prophylactics would lead to significant savings, with LAMA being an effective strategy without compromising benefits in terms of reducing hospitalizations.
Collapse
Affiliation(s)
- Shokoofeh Nourbakhsh
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada
| | - Affan Shoukat
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada
| | - Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Guillaume Poliquin
- Department of Medical Microbiology and Infectious Diseases, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba R3E 0J9, Canada
- Office of the Scientific Director, National Microbiology Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba R3E 3R2, Canada
| | - Donna Halperin
- School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia B2G 2W5, Canada
| | - Holden Sheffield
- Department of Paediatrics, Qikiqtani General Hospital, Iqaluit, Nunavut X0A 0H0, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia B3K 6R8, Canada
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario M3J 1P3, Canada
| |
Collapse
|
7
|
Ogal M, Johnston SL, Klein P, Schoop R. Echinacea reduces antibiotic usage in children through respiratory tract infection prevention: a randomized, blinded, controlled clinical trial. Eur J Med Res 2021; 26:33. [PMID: 33832544 PMCID: PMC8028575 DOI: 10.1186/s40001-021-00499-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background In children, up to 30% of viral respiratory tract infections (RTIs) develop into bacterial complications associated with pneumonia, sinusitis or otitis media to trigger a tremendous need for antibiotics. This study investigated the efficacy of Echinacea for the prevention of viral RTIs, for the prevention of secondary bacterial complications and for reducing rates of antibiotic prescriptions in children. Methods Echinaforce® Junior tablets [400 mg freshly harvested Echinacea purpurea alcoholic extract] or vitamin C [50 mg] as control were given three times daily for prevention to children 4–12 years. Two × 2 months of prevention were separated by a 1-week treatment break. Parents assessed respiratory symptoms in children via e-diaries and collected nasopharyngeal secretions for screening of respiratory pathogens (Allplex® RT-PCR). Results Overall, 429 cold days occurred in NITT = 103 children with Echinacea in comparison to 602 days in NITT = 98 children with vitamin C (p < 0.001, Chi-square test). Echinacea prevented 32.5% of RTI episodes resulting in an odds ratio of OR = 0.52 [95% CI 0.30–0.91, p = 0.021]. Six children (5.8%) with Echinacea and 15 children (15.3%) with vitamin C required 6 and 24 courses of antibiotic treatment, respectively (reduction of 76.3%, p < 0.001). A total of 45 and 216 days of antibiotic therapy were reported in the two groups, respectively (reduction of 80.2% (p < 0.001). Eleven and 30 events of RTI complications (e.g., otitis media, sinusitis or pneumonia) occurred with Echinacea and vitamin C, respectively (p = 0.0030). Echinacea significantly prevented influenza (3 vs. 20 detections, p = 0.012) and enveloped virus infections (29 vs. 47 detections, p = 0.0038). Finally, 76 adverse events occurred with Echinacea and 105 events with vitamin C (p = 0.016), only three events were reported possibly related with Echinacea. Conclusions Our results support the use of Echinacea for the prevention of RTIs and reduction of associated antibiotic usage in children. Trial registration clinicaltrials.gov, NCT02971384, 23th Nov 2016. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-021-00499-6.
Collapse
Affiliation(s)
| | | | - Peter Klein
- d.s.h. Statistical Services GmbH, Rohrbach, Germany
| | - Roland Schoop
- A Vogel AG, Grünaustrasse 4, 9325, Roggwil, TG, Switzerland.
| |
Collapse
|
8
|
McCarthy Z, Athar S, Alavinejad M, Chow C, Moyles I, Nah K, Kong JD, Agrawal N, Jaber A, Keane L, Liu S, Nahirniak M, Jean DS, Romanescu R, Stockdale J, Seet BT, Coudeville L, Thommes E, Taurel AF, Lee J, Shin T, Arino J, Heffernan J, Chit A, Wu J. Quantifying the annual incidence and underestimation of seasonal influenza: A modelling approach. Theor Biol Med Model 2020; 17:11. [PMID: 32646444 PMCID: PMC7347407 DOI: 10.1186/s12976-020-00129-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seasonal influenza poses a significant public health and economic burden, associated with the outcome of infection and resulting complications. The true burden of the disease is difficult to capture due to the wide range of presentation, from asymptomatic cases to non-respiratory complications such as cardiovascular events, and its seasonal variability. An understanding of the magnitude of the true annual incidence of influenza is important to support prevention and control policy development and to evaluate the impact of preventative measures such as vaccination. METHODS We use a dynamic disease transmission model, laboratory-confirmed influenza surveillance data, and randomized-controlled trial (RCT) data to quantify the underestimation factor, expansion factor, and symptomatic influenza illnesses in the US and Canada during the 2011-2012 and 2012-2013 influenza seasons. RESULTS Based on 2 case definitions, we estimate between 0.42-3.2% and 0.33-1.2% of symptomatic influenza illnesses were laboratory-confirmed in Canada during the 2011-2012 and 2012-2013 seasons, respectively. In the US, we estimate between 0.08-0.61% and 0.07-0.33% of symptomatic influenza illnesses were laboratory-confirmed in the 2011-2012 and 2012-2013 seasons, respectively. We estimated the symptomatic influenza illnesses in Canada to be 0.32-2.4 million in 2011-2012 and 1.8-8.2 million in 2012-2013. In the US, we estimate the number of symptomatic influenza illnesses to be 4.4-34 million in 2011-2012 and 23-102 million in 2012-2013. CONCLUSIONS We illustrate that monitoring a representative group within a population may aid in effectively modelling the transmission of infectious diseases such as influenza. In particular, the utilization of RCTs in models may enhance the accuracy of epidemiological parameter estimation.
Collapse
Affiliation(s)
- Zachary McCarthy
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Safia Athar
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Mahnaz Alavinejad
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Christopher Chow
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Iain Moyles
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada
| | - Kyeongah Nah
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Jude D Kong
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | | | - Ahmed Jaber
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Laura Keane
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada
| | - Sam Liu
- McMaster University, Hamilton, L8S 4L8, ON, Canada
| | - Myles Nahirniak
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Danielle St Jean
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Razvan Romanescu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, M5G 1X5, ON, Canada
| | - Jessica Stockdale
- Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada
| | - Bruce T Seet
- Sanofi Pasteur, Toronto, M2R 3T4, Canada.,Department of Molecular Genetics, Toronto, M5S 1A8, ON, Canada
| | | | - Edward Thommes
- Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Department of Mathematics, Simon Fraser University, Burnaby, V5A 1S6, BC, Canada.,Sanofi Pasteur, Toronto, M2R 3T4, Canada
| | | | - Jason Lee
- Sanofi Pasteur, Toronto, M2R 3T4, Canada
| | | | - Julien Arino
- University of Manitoba, Department of Mathematics, Winnipeg, R3T 2N2, MB, Canada
| | - Jane Heffernan
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada.,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada.,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada.,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada
| | - Ayman Chit
- Leslie Dan School of Pharmacy, University of Toronto, Toronto, M5S 3M2, ON, Canada.,Sanofi Pasteur, Swiftwater, 18370, PA, USA
| | - Jianhong Wu
- Department of Mathematics and Statistics, York University, Toronto, M3J 1P3, Canada. .,Laboratory for Industrial and Applied Mathematics, York University, Toronto, M3J 1P3, ON, Canada. .,Centre for Disease Modelling, York University, Toronto, M3J 1P3, ON, Canada. .,Fields-CQAM Mathematics for Public Health Laboratory, York University, Toronto, M3J 1P3, ON, Canada.
| |
Collapse
|
9
|
Palivizumab compliance in congenital heart disease patients: factors related to compliance and altered lower respiratory tract infection viruses after palivizumab prophylaxis. Cardiol Young 2020; 30:818-821. [PMID: 32425145 DOI: 10.1017/s1047951120001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lower respiratory tract infections caused by respiratory syncytial virus can be severe during infancy, which requires admission to the hospital. These infections may be more severe especially in patients with congenital heart disease. Passive immunisation with palivizumab, a monoclonal antibody, is recommended in high-risk infants. We tried to determine the compliance rates, factors affecting compliance, and also other microorganisms responsible for lower respiratory tract infections after palivizumab prophylaxis in these patients. METHODS We evaluated patients' compliance to prophylaxis with palivizumab in two consecutive respiratory syncytial virus seasons from pharmacy records. We also investigated factors affecting compliance and the frequency of hospitalisations for lower respiratory tract infections. We investigated the causative microorganisms detected in hospitalised patients. RESULTS In this study, 86.7% of the desired number of injections was achieved in 176 patients in two seasons. Out of these, 117 patients (66.4%) received all the doses they were prescribed. Although not statistically significant, compliance to prophylaxis was higher in male patients, cyanotic patients, those who started under 1 year old, and who lived in the city centre. Human metapneumovirus, parainfluenza type 3, and bocavirus were detected in the hospitalised patients. CONCLUSION Patients with congenital heart disease can survive the period of infancy with less problem by making palivizumab prophylaxis more effective, and awareness about non- respiratory syncytial virus factors may be a guide for the development of new treatments.
Collapse
|
10
|
Feldman LY, Zhu J, To T. Estimating age-specific influenza-associated asthma morbidity in Ontario, Canada. Respir Med 2019; 155:104-112. [PMID: 31326737 DOI: 10.1016/j.rmed.2019.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a need to quantify the potential benefits of influenza-focused interventions in reducing asthma morbidity at a population level. This study aims to estimate age-specific annual excess asthma morbidity attributable to influenza in Ontario, Canada. METHODS Weekly counts of hospitalizations, emergency department (ED) visits and outpatient physician office visits for asthma were obtained from health administrative data in Ontario from 2010 to 2015, for ages 0-14, 15-59 and 60+. Asthma morbidity was modelled as a function of influenza A and B activity using linear regression, controlling for seasonal and long-term trend, mean temperature and respiratory syncytial virus. Excess asthma morbidity attributable to influenza was calculated as the difference between full model predictions and model predictions with influenza A and B variables set to 0. RESULTS Annually, influenza was associated with the following rates of excess asthma morbidity, per 100,000 people with prevalent asthma: 12.5 hospitalizations for ages 15-59 (95% confidence interval (CI): 1.1-23.5); 35.7 hospitalizations for ages 60+ (95% CI: 3.3-67.1); 114.1 ED visits for ages 15-59 (95% CI: 46.9-181.6); 154.6 ED visits for ages 60+ (95% CI: 86.7-223.3); and 1025.7 outpatient physician office visits for ages 60+ (95% CI: 79.0-1877.3). CONCLUSIONS Influenza was associated with excess asthma hospitalizations and ED visits for ages 15-59 and 60+ and outpatient physician office visits for ages 60+. Individuals with asthma aged 15-59 and 60+ might be important targets for influenza-focused interventions, to reduce asthma morbidity at the population level.
Collapse
Affiliation(s)
- Laura Y Feldman
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jingqin Zhu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
11
|
Butt ML, Elliott L, Paes BA. Respiratory syncytial virus hospitalization and incurred morbidities the season after prophylaxis. Paediatr Child Health 2018; 23:441-446. [PMID: 30374219 PMCID: PMC6199632 DOI: 10.1093/pch/pxy046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to determine the incidence and incurred morbidities of Respiratory syncytial virus (RSV)-related hospitalization (RSVH), the season following completion of prophylaxis. METHODS A retrospective study was conducted of all infants enrolled in a prophylaxis clinic in one institution during the 2009 to 2014 RSV seasons. RSV infection was identified by Diseases codes and confirmed by RSV-positivity. Data were classified into five groups based on indications for prophylaxis. The incidence of RSVH was calculated. For each subgroup, differences in characteristics between children with and without RSVH were analyzed by independent t test or chi-square test. RESULTS During five RSV seasons, 827 infants were enrolled. RSVH incidence the season following prophylaxis was 2.1% (n=17/827). Children with chronic lung disease (CLD) had the highest RSVH incidence (7.7%; n=4/52) followed by preterms 33 to 35 weeks gestation (2.5%; n=4/162), those with complex medical disorders (2.2%; n=3/135), those with congenital heart disease (1.5%; n=1/66) and preterms less than or equal to 32 weeks gestation (1.2%; n=5/412). There was no statistically significant association between indications for prophylaxis and RSVH (Fisher exact test, P=0.060). The odds of RSVH were 4.9 times greater (odds ratio [OR]=4.9; 95% CI: 1.53, 15.55; P=0.007) in CLD compared to those without CLD. The median length of RSVH stay was 4 days; 58.8% (n=10/17) required oxygen (median 1 day); 29.4% (n=5/17) required intensive care. CONCLUSIONS Infants with CLD are at highest risk for RSVH in the season postprophylaxis and may merit palivizumab for more than two seasons dependent on disease severity. However, larger prospective studies are necessary to confirm the findings before embarking on a strategy of providing prophylaxis for a third RSV season.
Collapse
Affiliation(s)
- Michelle L Butt
- School of Nursing, McMaster University, Hamilton, Ontario
- Department of Paediatrics, McMaster University, Hamilton, Ontario
| | - LouAnn Elliott
- Paediatrics, McMaster Children’s Hospital, Hamilton, Ontario
| | - Bosco A Paes
- Department of Paediatrics, McMaster University, Hamilton, Ontario
| |
Collapse
|
12
|
Lim A, Butt ML, Dix J, Elliott L, Paes B. Respiratory syncytial virus (RSV) infection in children with medical complexity. Eur J Clin Microbiol Infect Dis 2018; 38:171-176. [PMID: 30374685 DOI: 10.1007/s10096-018-3409-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
Children with medical complexity (CMC) are vulnerable to respiratory illness hospitalization (RIH) and respiratory syncytial virus (RSV)-related hospitalization (RSVH) due to multisystem disorders and compromised airways. It is unknown whether RSV prophylaxis is effective, or if RSVH is associated with significant morbidities in CMC. The study objectives were to (1) determine the incidence of RSV-related infection in prophylaxed CMC during the first 3 years of life and (2) assess the burden of illness following RSVH. A single tertiary center, retrospective study, was conducted of CMC who received palivizumab during the 2012-2016 RSV seasons. Fifty-four subjects were enrolled; most received one (38.9%, n = 21) or two (57.4%, n = 31) seasons of prophylaxis (mean = 4.2 [SD = 1.24], palivizumab doses per season). The cohort comprised children with multiple medical conditions (n = 22, 40.8%), tracheostomy (n = 18, 33.3%), and invasive (n = 10, 18.5%) or non-invasive (n = 4, 7.4%) ventilation. Of the CMC, 24 were hospitalized 47 times for a viral-related respiratory illness. RSV incidence in the first 3 years of life was 7.4%. Viral-related RIH and RSVH rates were 44.4% (n = 24/54) and 1.9% (n = 1/54), respectively. Of the four RSV-positive children, one was ventilated for 9 days, two acquired nosocomial RSV that was managed on the ward, and one was discharged home under close complex care supervision. All four RSV-positive cases required additional oxygen during their illness. CMC experience a high viral-related RIH rate and palivizumab likely minimizes RSV-related events and associated morbidities. The efficacy of palivizumab in CMC, especially in those ≤ 3 years, should be prospectively evaluated.
Collapse
Affiliation(s)
- A Lim
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - M L Butt
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,School of Nursing, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - J Dix
- McMaster Children's Hospital, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - L Elliott
- McMaster Children's Hospital, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - B Paes
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| |
Collapse
|
13
|
Kwon DH, Ji JH, Yim SH, Kim BS, Choi HJ. Suppression of influenza B virus replication by sakuranetin and mode of its action. Phytother Res 2018; 32:2475-2479. [PMID: 30187587 DOI: 10.1002/ptr.6186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 12/17/2022]
Abstract
This study aimed to investigate in vitro the anti-influenza B/Lee/40 virus effect of sakuranetin and mode of its action. The sakuranetin exhibited potent antiviral activity against influenza B/Lee/40 virus, reducing the formation of a visible cytopathic effect, with a 50% inhibitory concentration (IC50 ) of 7.21 μg/ml and no cytotoxicity at a concentration of 100 μg/ml, and the derived therapeutic index (TI) was >13.87. Oseltamivir showed weak anti-influenza B/Lee/40 virus activity with IC50 of 80.74 μg/ml, 50% cytotoxicity concentration of >100 μg/ml, and TI of >1.24. Sakuranetin also showed effective inhibitory effects when added at the viral attachment, entry, and postentry steps. Moreover, sakuranetin effectively inactivated influenza B/Lee/40 virus infection in dose- and temperature-dependent manners. Sakuranetin indicated an inhibitory effect in viral RNA synthesis in the presence of 100 μg/ml of sakuranetin. Overall, this research revealed that sakuranetin could inhibit influenza B/Lee/40 virus replication and that sakuranetin may be involved in the virus attachment, entry, and postentry. Therefore, sakuranetin is a good candidate for a chemopreventive agent for influenza virus-related diseases.
Collapse
Affiliation(s)
- Dur-Han Kwon
- Natural Medicine Research Center, Korea Research Institute of Bioscience and Biotechnology, Ochang, South Korea
| | - Jeong-Hun Ji
- Department of Beauty Science, Gwangju University, Gwangju, South Korea
| | - Soon-Ho Yim
- Department of Pharmaceutical Engineering, College of Oriental Medicine, Dongshin University, Naju, South Korea
| | - Byoung-Soo Kim
- Department of Physiology, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Hwa-Jung Choi
- Department of Beauty Science, Kwangju Women's University, Gwangju, South Korea
| |
Collapse
|
14
|
Persaud N, Laupacis A, Azarpazhooh A, Birken C, Hoch JS, Isaranuwatchai W, Maguire JL, Mamdani MM, Thorpe K, Allen C, Mason D, Kowal C, Bazeghi F, Parkin P. Xylitol for the prevention of acute otitis media episodes in children aged 2-4 years: protocol for a pragmatic randomised controlled trial. BMJ Open 2018; 8:e020941. [PMID: 30082349 PMCID: PMC6078241 DOI: 10.1136/bmjopen-2017-020941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/20/2018] [Accepted: 06/21/2018] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Xylitol (or 'birch sugar') is a naturally occurring sugar with antibacterial properties that has been used as a natural non-sugar sweetener in chewing gums, confectionery, toothpaste and medicines. In this preventative randomised trial, xylitol will be tested for the prevention of acute otitis media (AOM), a common and costly condition in young children. The primary outcome will be the incidence of AOM. Secondary outcomes will include upper respiratory tract infections (URTIs) and dental caries. METHODS AND ANALYSIS This study will be a pragmatic, blinded (participant and parents, practitioners and analyst), two-armed superiority, placebo-controlled randomised trial with 1:1 allocation, stratified by clinical site. The trial will be conducted in the 11 primary care group practices participating in the TARGet Kids! research network in Canada. Eligible participants between the ages of 2-4 years will be randomly assigned to the intervention arm of regular xylitol syrup use or the control arm of regular sorbitol use for 6 months. We expect to recruit 236 participants, per treatment arm, to detect a 20% relative risk reduction in AOM episodes. AOM will be identified through chart review. The secondary outcomes of URTIs and dental caries will be identified through monthly phone calls with specified questions. ETHICS AND DISSEMINATION Ethics approval from the Research Ethics Boards at the Hospital for Sick Children and St. Michael's Hospital has been obtained for this study and also for the TARGet Kids! research network. Results will be submitted for publication to a peer-reviewed journal and will be discussed with decision makers. TRIAL REGISTRATION NUMBER NCT03055091; Pre-results.
Collapse
Affiliation(s)
- Nav Persaud
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andreas Laupacis
- Department of Family and Community Medicine, St Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Canada
- Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Birken
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, the, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Jeffrey S Hoch
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Public Health Sciences, School of Medicine, University of California, Davis, California, USA
- Center for Health Policy and Research, University of California, Davis, California, USA
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jonathan L Maguire
- Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Paediatric Outcomes Research Team, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Muhammad M Mamdani
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Centre for Healthcare Analytics Research and Training, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Allen
- The Applied Health Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Dalah Mason
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Christine Kowal
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Farnaz Bazeghi
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Patricia Parkin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
- Pediatric Outcomes Research Team, Division of Pediatric Medicine, Department of Pediatrics, the, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | |
Collapse
|
15
|
Wu P, Escobar GJ, Gebretsadik T, Carroll KN, Li SX, Walsh EM, Mitchel EF, Sloan C, Dupont WD, Yu C, Horner JR, Hartert TV. Effectiveness of Respiratory Syncytial Virus Immunoprophylaxis in Reducing Bronchiolitis Hospitalizations Among High-Risk Infants. Am J Epidemiol 2018; 187:1490-1500. [PMID: 29351636 PMCID: PMC6030843 DOI: 10.1093/aje/kwy008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 01/03/2023] Open
Abstract
We sought to determine the real-world effectiveness of respiratory syncytial virus (RSV) immunoprophylaxis in a population-based cohort to inform policy. The study population included infants born during 1996-2008 and enrolled in the Kaiser Permanente Northern California integrated health-care delivery system. During the RSV season (November-March), the date of RSV immunoprophylaxis administration and the following 30 days were defined as RSV immunoprophylaxis protected period(s), and all other days were defined as unprotected period(s). Numbers of bronchiolitis hospitalizations were determined using International Classification of Diseases, Ninth Revision, codes during RSV season. We used a proportional hazards model to estimate risk of bronchiolitis hospitalization when comparing infants' protected period(s) with unprotected period(s). Infants who had ever received RSV immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.68, 95% confidence interval: 0.46, 1.00) when protected periods were compared with unprotected periods. Infants with chronic lung disease (CLD) had a 52% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.48, 95% confidence interval: 0.25, 0.94) when protected periods were compared with unprotected periods. Under the new 2014 American Academy of Pediatrics (AAP) guidelines, 48% of infants eligible for RSV immunoprophylaxis on the basis of AAP guidelines in place at birth would no longer be eligible, but nearly all infants with CLD would remain eligible. RSV immunoprophylaxis is effective in decreasing hospitalization. This association is greatest for infants with CLD, a group still recommended for receipt of RSV immunoprophylaxis under the new AAP guidelines.
Collapse
Affiliation(s)
- Pingsheng Wu
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gabriel J Escobar
- Department of Inpatient Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California
- Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kecia N Carroll
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sherian X Li
- Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Eileen M Walsh
- Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Edward F Mitchel
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chantel Sloan
- Department of Health Science, College of Life Sciences, Brigham Young University, Provo, Utah
| | - William D Dupont
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chang Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey R Horner
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tina V Hartert
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
16
|
Sanou AM, Wandaogo SCM, Poda A, Tamini L, Kyere AE, Sagna T, Ouedraogo MS, Pauly M, Hübschen JM, Muller CP, Tarnagda Z, Snoeck CJ. Epidemiology and molecular characterization of influenza viruses in Burkina Faso, sub-Saharan Africa. Influenza Other Respir Viruses 2018; 12:490-496. [PMID: 29350841 PMCID: PMC6005621 DOI: 10.1111/irv.12539] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 01/08/2023] Open
Abstract
Background The importance of influenza viruses in respiratory infections in sub‐Saharan Africa has been historically overlooked, including in Burkina Faso. Objectives This study therefore aimed at evaluating the prevalence and seasonal occurrence of influenza viruses in children under 5 years old, at risk of influenza‐related complications, presenting with influenza‐like illness (ILI) or severe acute respiratory infection (SARI). The study also aimed at identifying the periods with increased influenza transmission for vaccination recommendations in Burkina Faso. Methods From January 2014 to December 2015, ILI and SARI (2015 only) patients were recruited in six healthcare centers in Burkina Faso. Influenza A and B molecular detection and subtyping were performed. Clade clustering of a subset of A(H1N1)pdm09 and A(H3N2) strains was deduced by performing phylogenetic analyses on hemagglutinin gene sequences. Weekly surveillance data from FluNet (2011‐2013; 2016) and this study (2014‐2015) were used to identify periods of increased influenza activity. Results Influenza A and B viruses were detected in 15.1% (112 of 743) of ILI and 6.6% (12 of 181) of SARI patients. Overall, influenza A viruses were largely predominant (81 of 124, 65.3%), with 69.1% of A(H3N2) and 30.9% of A(H1N1)pdm09 strains. Four waves of increased transmission were identified in 2014‐2015, each dominated by different influenza subtypes and clades. Between 2011 and 2016, periods of increased influenza activity varied in their frequency, duration, and timing. Conclusion Influenza A and B viruses were detected in a substantial number of ILI and SARI cases in Burkina Faso. Vaccination in September‐October would likely protect the highest number of patients.
Collapse
Affiliation(s)
- Armel M Sanou
- National Influenza Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Sampoko Carine M Wandaogo
- National Influenza Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Hôpital du jour, Service des maladies infectieuses, CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso.,Université Polytechnique de Bobo-Dioulasso (UPB), Bobo-Dioulasso, Burkina Faso
| | - Laure Tamini
- Service de Pédiatrie, CHU Pédiatrique Charles De Gaulles, Ouagadougou, Burkina Faso.,Unité de Formation et de Recherche en Sciences de la Santé (UFR/SDS), Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Anselme E Kyere
- National Influenza Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Tani Sagna
- National Influenza Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Macaire S Ouedraogo
- Hôpital du jour, Service des maladies infectieuses, CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso.,Université Polytechnique de Bobo-Dioulasso (UPB), Bobo-Dioulasso, Burkina Faso
| | - Maude Pauly
- Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Judith M Hübschen
- Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Claude P Muller
- Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Zekiba Tarnagda
- National Influenza Reference Laboratory, Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Chantal J Snoeck
- Infectious Diseases Research Unit, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| |
Collapse
|
17
|
Ng C, Ye L, Noorduyn SG, Hux M, Thommes E, Goeree R, Ambrose A, Andrew MK, Hatchette T, Boivin G, Bowie W, ElSherif M, Green K, Johnstone J, Katz K, Leblanc J, Loeb M, MacKinnon‐Cameron D, McCarthy A, McElhaney J, McGeer A, Poirier A, Powis J, Richardson D, Sharma R, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA. Resource utilization and cost of influenza requiring hospitalization in Canadian adults: A study from the serious outcomes surveillance network of the Canadian Immunization Research Network. Influenza Other Respir Viruses 2018; 12:232-240. [PMID: 29125689 PMCID: PMC5820421 DOI: 10.1111/irv.12521] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Consideration of cost determinants is crucial to inform delivery of public vaccination programs. OBJECTIVES To estimate the average total cost of laboratory-confirmed influenza requiring hospitalization in Canadians prior to, during, and 30 days following discharge. To analyze effects of patient/disease characteristics, treatment, and regional differences in costs. METHODS Study utilized previously recorded clinical characteristics, resource use, and outcomes of laboratory-confirmed influenza patients admitted to hospitals in the Serious Outcomes Surveillance (SOS), Canadian Immunization Research Network (CIRN), from 2010/11 to 2012/13. Unit costs including hospital overheads were linked to inpatient/outpatient resource utilization before and after admissions. RESULTS Dataset included 2943 adult admissions to 17 SOS Network hospitals and 24 Toronto Invasive Bacterial Disease Network hospitals. Mean age was 69.5 years. Average hospital stay was 10.8 days (95% CI: 10.3, 11.3), general ward stays were 9.4 days (95% CI: 9.0, 9.8), and ICU stays were 9.8 days (95% CI: 8.6, 11.1) for the 14% of patients admitted to the ICU. Average cost per case was $14 612 CAD (95% CI: $13 852, $15 372) including $133 (95% CI: $116, $150) for medical care prior to admission, $14 031 (95% CI: $13 295, $14 768) during initial hospital stay, $447 (95% CI: $271, $624) post-discharge, including readmission within 30 days. CONCLUSION The cost of laboratory-confirmed influenza was higher than previous estimates, driven mostly by length of stay and analyzing only laboratory-confirmed influenza cases. The true per-patient cost of influenza-related hospitalization has been underestimated, and prevention programs should be evaluated in this context.
Collapse
Affiliation(s)
| | - Lingyun Ye
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | | | | | | | | | - Ardith Ambrose
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Melissa K. Andrew
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Todd Hatchette
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Guy Boivin
- Centre Hospitalier Universitaire de QuébecQuébecQCCanada
| | | | - May ElSherif
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | | | | | - Kevin Katz
- North York General HospitalTorontoONCanada
| | - Jason Leblanc
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | | | - Donna MacKinnon‐Cameron
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | - Anne McCarthy
- The Ottawa HospitalOttawa Hospital Civic CampusOttawaONCanada
| | | | | | - Andre Poirier
- Centre de santé et de service sociaux de Trois‐RivièresTrois RivièresQCCanada
| | | | - David Richardson
- Department of Infectious Diseases and Medical MicrobiologyWilliam Osler Health SystemBramptonONCanada
| | | | - Makeda Semret
- McGill University Health CentreMcGill UniversityMontrealQCCanada
| | | | | | | | | | | | | | - Shelly A. McNeil
- Canadian Center for VaccinologyIWK Health Centre and Nova Scotia Health AuthorityDalhousie UniversityHalifaxNSCanada
| | | | | |
Collapse
|
18
|
Schanzer DL, Saboui M, Lee L, Nwosu A, Bancej C. Burden of influenza, respiratory syncytial virus, and other respiratory viruses and the completeness of respiratory viral identification among respiratory inpatients, Canada, 2003-2014. Influenza Other Respir Viruses 2017; 12:113-121. [PMID: 29243369 PMCID: PMC5818333 DOI: 10.1111/irv.12497] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 12/01/2022] Open
Abstract
Background A regression‐based study design has commonly been used to estimate the influenza burden; however, these estimates are not timely and many countries lack sufficient virological data. Alternative approaches that would permit a timelier assessment of the burden, including a sentinel surveillance approach recommended by the World Health Organization (WHO), have been proposed. We aimed to estimate the hospitalization burden attributable to influenza, respiratory syncytial virus (RSV), and other respiratory viruses (ORV) and to assess both the completeness of viral identification among respiratory inpatients in Canada and the implications of adopting other approaches. Methods Respiratory inpatient records were extracted from the Canadian Discharge Abstract Database from 2003 to 2014. A regression model was used to estimate excess respiratory hospitalizations attributable to influenza, RSV, and ORV by age group and diagnostic category and compare these estimates with the number with a respiratory viral identification. Results An estimated 33 (95% CI: 29, 38), 27 (95% CI: 22, 33), and 27 (95% CI: 18, 36) hospitalizations per 100 000 population per year were attributed to influenza, RSV, and ORV, respectively. An influenza virus was identified in an estimated 78% (95% CI: 75, 81) and 17% (95% CI: 15, 21) of respiratory hospitalizations attributed to influenza for children and adults, respectively, and 75% of influenza‐attributed hospitalizations had an ARI diagnosis. Conclusions Hospitalization rates with respiratory viral identification still underestimate the burden. Approaches based on acute respiratory case definitions will likely underestimate the burden as well, although each proposed method should be compared with regression‐based estimates of influenza‐attributed burden as a way of assessing their validity.
Collapse
Affiliation(s)
- Dena L Schanzer
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Myriam Saboui
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Liza Lee
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Andrea Nwosu
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Christina Bancej
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| |
Collapse
|
19
|
Schnee SV, Pfeil J, Ihling CM, Tabatabai J, Schnitzler P. Performance of the Alere i RSV assay for point-of-care detection of respiratory syncytial virus in children. BMC Infect Dis 2017; 17:767. [PMID: 29237419 PMCID: PMC5729395 DOI: 10.1186/s12879-017-2855-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/26/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most important cause of severe acute respiratory tract infection in young children. Alere i RSV is a novel molecular rapid test which identifies respiratory syncytial virus in less than 13 min. METHODS We evaluated the clinical performance of the Alere i RSV assay in a pediatric point-of-care setting during winter season 2016 / 2017. Test results from 518 nasopharyngeal swab samples were compared to a real-time reverse transcription PCR reference standard. RESULTS The overall sensitivity and specificity of the Alere i RSV test assay was 93% (CI95 89% - 96%) and 96% (CI95 93% - 98%), respectively. Alere i RSV performed well in children of all age groups. An optimal sensitivity of 98% (CI95 94% - 100%) and specificity of 96% (CI95 90% - 99%) was obtained in children < 6 months. In children ≥ 2 years, sensitivity and specificity remained at 87% (CI95 73% - 96%) and 98% (CI95 92% - 100%), respectively. False negative Alere i RSV test results mostly occurred in samples with low viral load (mean CT value 31.1; CI95 29.6 - 32.6). The Alere i RSV assay is easy to use and can be operated after minimal initial training. Test results are available within 13 min, with most RSV positive samples being identified after approximately 5 min. CONCLUSION The Alere i RSV assay has the potential to facilitate the detection of RSV in pediatric point-of-care settings.
Collapse
Affiliation(s)
- Sarah Valerie Schnee
- Center for Childhood and Adolescent Medicine (General Pediatrics), University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,German Center for Infection Research (DZIF), Heidelberg partner site, Heidelberg, Germany.,Center for Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Pfeil
- Center for Childhood and Adolescent Medicine (General Pediatrics), University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Clara Marlene Ihling
- German Center for Infection Research (DZIF), Heidelberg partner site, Heidelberg, Germany.,Center for Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Tabatabai
- Center for Childhood and Adolescent Medicine (General Pediatrics), University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.,German Center for Infection Research (DZIF), Heidelberg partner site, Heidelberg, Germany.,Center for Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Center for Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
20
|
Burden of Respiratory Syncytial Virus Hospitalizations in Canada. Can Respir J 2017; 2017:4521302. [PMID: 29311757 PMCID: PMC5697123 DOI: 10.1155/2017/4521302] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/18/2017] [Accepted: 10/10/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To examine the socioeconomic burden of respiratory syncytial virus (RSV) disease for Canadian infants hospitalized for the condition. Data and Methods The descriptive study used data collected in Alberta, Canada, during 2 consecutive RSV seasons. Infants (<1 year of age) were included if they had not received palivizumab and were hospitalized with a confirmed diagnosis of RSV. Hospitalization resource use and parental time burden, out-of-pocket costs, lost work productivity, and stress and anxiety were assessed. Results 13.4% of all infants (n = 67) had intensive care unit (ICU) admission, and average ICU stay for these infants was 6.5 days. Families had average out-of-pocket expenses of 736.69 Canadian dollars (CAD $), and the average time both parents spent in hospital was nearly 7 days (164.0 hours). For working parents (n = 43), average absenteeism was 49% and overall work impairment was 77.8%. Parents also exhibited significant parental stress (3.6 on the Parental Stressor Scale: 43.9 state anxiety and 36.9 trait anxiety scores). Conclusions Results indicate a high burden associated with the hospitalization of an infant due to RSV disease in terms of resource use, time, productivity, costs, and stress, even among a population of infants not considered to be at risk for the condition.
Collapse
|
21
|
Respiratory Syncytial Virus: Infection, Detection, and New Options for Prevention and Treatment. Clin Microbiol Rev 2017; 30:277-319. [PMID: 27903593 DOI: 10.1128/cmr.00010-16] [Citation(s) in RCA: 342] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Respiratory syncytial virus (RSV) infection is a significant cause of hospitalization of children in North America and one of the leading causes of death of infants less than 1 year of age worldwide, second only to malaria. Despite its global impact on human health, there are relatively few therapeutic options available to prevent or treat RSV infection. Paradoxically, there is a very large volume of information that is constantly being refined on RSV replication, the mechanisms of RSV-induced pathology, and community transmission. Compounding the burden of acute RSV infections is the exacerbation of preexisting chronic airway diseases and the chronic sequelae of RSV infection. A mechanistic link is even starting to emerge between asthma and those who suffer severe RSV infection early in childhood. In this article, we discuss developments in the understanding of RSV replication, pathogenesis, diagnostics, and therapeutics. We attempt to reconcile the large body of information on RSV and why after many clinical trials there is still no efficacious RSV vaccine and few therapeutics.
Collapse
|
22
|
Prevalence of respiratory viruses among adults, by season, age, respiratory tract region and type of medical unit in Paris, France, from 2011 to 2016. PLoS One 2017; 12:e0180888. [PMID: 28708843 PMCID: PMC5510824 DOI: 10.1371/journal.pone.0180888] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/22/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multiplex PCR tests have improved our understanding of respiratory viruses' epidemiology by allowing their wide range detection. We describe here the burden of these viruses in hospital settings over a five-year period. METHODS All respiratory samples from adult patients (>20 years old) tested by multiplex-PCR at the request of physicians, from May 1 2011 to April 30 2016, were included retrospectively. Viral findings are reported by season, patient age group, respiratory tract region (upper or lower) and type of clinical unit (intensive care unit, pneumology unit, lung transplantation unit and other medical units). RESULTS In total, 7196 samples (4958 patients) were included; 29.2% tested positive, with viral co-infections detected in 1.6% of samples. Overall, two viral groups accounted for 60.2% of all viruses identified: picornaviruses (rhinovirus or enterovirus, 34.3%) and influenza (26.6%). Influenza viruses constituted the group most frequently identified in winter (34.4%), in the upper respiratory tract (32%) and in patients over the age of 70 years (36.4%). Picornavirus was the second most frequently identified viral group in these populations and in all other groups, including lower respiratory tract infections (41.3%) or patients in intensive care units (37.6%). CONCLUSION This study, the largest to date in Europe, provides a broad picture of the distribution of viruses over seasons, age groups, types of clinical unit and respiratory tract regions in the hospital setting. It highlights the burden associated with the neglected picornavirus group. These data have important implications for the future development of vaccines and antiviral drugs.
Collapse
|
23
|
Thommes EW, Kruse M, Kohli M, Sharma R, Noorduyn SG. Review of seasonal influenza in Canada: Burden of disease and the cost-effectiveness of quadrivalent inactivated influenza vaccines. Hum Vaccin Immunother 2017; 13:867-876. [PMID: 27858509 PMCID: PMC5404371 DOI: 10.1080/21645515.2016.1251537] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/26/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022] Open
Abstract
In the 2015/16 influenza season, the Canadian National Advisory Committee on Immunization (NACI) recommended vaccination with quadrivalent inactivated influenza vaccine (QIV) for infants aged 6-23 months and trivalent inactivated influenza vaccines (TIVs) or QIVs in adults. The objective of this review (GSK study identifier: HO-13-14054) is to examine the epidemiology and disease burden of influenza in Canada and the economic benefits of vaccination. To inform this review, we performed a systematic literature search of relevant Canadian literature and National surveillance data. Influenza B viruses from phylogenetically-distinct lineages (B/Yamagata and B/Victoria) co-circulate in Canada, and are an important cause of influenza complications. Modeling studies, including those postdating the search suggest that switching from TIV to QIV in Canada reduces the burden of influenza and would likely be cost-effective. However, more robust real-world outcomes data is required to inform health policy decision makers on appropriate influenza vaccination strategies for Canada.
Collapse
Affiliation(s)
- Edward W. Thommes
- GSK, Health Economics and Outcomes Research, Mississauga, Ontario, Canada
- Department of Mathematics and Statistics, University of Guelph, Guelph, Ontario, Canada
| | - Morgan Kruse
- Optum, Health Economics and Outcomes Research, San Jose, CA, USA
| | - Michele Kohli
- Optum, Health Economics and Outcomes Research, Burlington, Ontario, Canada
| | | | | |
Collapse
|
24
|
LeBras MH, Barry AR. Influenza Vaccination for Secondary Prevention of Cardiovascular Events: A Systematic Review. Can J Hosp Pharm 2017; 70:27-34. [PMID: 28348430 DOI: 10.4212/cjhp.v70i1.1626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Influenza is a common respiratory infection that may cause complications, including cardiovascular events. Influenza illness has been shown to double the risk of myocardial infarction, with the highest risk among patients with established cardiovascular disease. Vaccination against influenza has been associated with reductions in myocardial infarction, cerebrovascular disease, and death. OBJECTIVE To evaluate the evidence for influenza vaccination as a strategy to reduce cardiovascular events specifically in patients with established cardiovascular disease. DATA SOURCES AND STUDY SELECTION MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched with the terms "influenza vaccine" and "cardiovascular disease". Included in this review were randomized controlled trials (RCTs), nonrandomized studies, and meta-analyses that compared influenza vaccination against control in patients with established cardiovascular disease and that reported clinically meaningful cardiovascular outcomes (defined as cardiovascular death, myocardial infarction, and stroke). DATA EXTRACTION AND SYNTHESIS The search yielded 10 studies (3 nonrandomized studies, 5 RCTs, and 2 meta-analyses). The nonrandomized studies and the RCTs had inconsistent results with respect to cardiovascular death and adverse cardiovascular events. The 2 meta-analyses, which included the same 4 RCTs involving patients with established cardiovascular disease, showed that the influenza vaccine reduced cardiovascular death by about 50% relative to control. Vaccination also reduced major cardiovascular events by about 43%; the reduction was greater (54%) in the subgroup of patients with recent (≤ 1 year) acute coronary syndrome. However, these data are potentially confounded by small sample sizes, low event rates, and variable outcome reporting. There was also high clinical heterogeneity among the studies, which may not reflect contemporary practice. CONCLUSIONS Given the limitations of these data, it is unclear whether the cardiovascular benefit with influenza vaccination in patients with cardiovascular disease is a true effect. Nevertheless, because of the potential benefit and the low risk of adverse events, the annual influenza vaccine should be recommended for all patients with established cardiovascular disease.
Collapse
Affiliation(s)
- Marlys H LeBras
- , BSP, PharmD, ACPR, was, at the time of writing, with the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia. She is now with the RxFiles Academic Detailing Program, Saskatoon Health Region, Saskatoon, Saskatchewan
| | - Arden R Barry
- , BSc, BSc(Pharm), PharmD, ACPR, is with the Chilliwack General Hospital, Lower Mainland Pharmacy Services, Chilliwack, British Columbia, and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
25
|
Kim AY, Jung SY, Choi JY, Kim GB, Kim YH, Shim WS, Kang IS, Jung JW. Retrospective Multicenter Study of Respiratory Syncytial Virus Prophylaxis in Korean Children with Congenital Heart Diseases. Korean Circ J 2016; 46:719-726. [PMID: 27721865 PMCID: PMC5054186 DOI: 10.4070/kcj.2016.46.5.719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/24/2015] [Accepted: 11/02/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We conducted a review of current data on respiratory syncytial virus (RSV) prophylaxis with palivizumab, in Korean children with congenital heart diseases (CHD). In 2009, the Korean guideline for RSV prophylaxis had established up to five shots monthly per RSV season, only for children <1 year of age with hemodynamic significance CHD (HS-CHD). SUBJECTS AND METHODS During the RSV seasons in 2009-2015, we performed a retrospective review of data for 466 infants with CHD, examined at six centers in Korea. RESULTS Infants received an average of 3.7±1.9 (range, 1-10) injections during the RSV season. Fifty-seven HS-CHD patients (12.2%) were hospitalized with breakthrough RSV bronchiolitis, with a recurrence in three patients, one year after the initial check-up. Among patients with simple CHD, only five (1.1%) patients received one additional dose postoperatively, as per the limitations set by the Korean guideline. Among the 30 deaths (6.4%), five (1.1%) were attributed to RSV infection; three to simple CHD, one to Tetralogy of Fallot, and one to hypertrophic cardiomyopathy (HCM). Of the three HCM patients that exceeded guidelines for RSV prophylaxis, two (66.6%) were hospitalized, and one died of RSV infection (33.3%). CONCLUSION In accordance to the Korean guideline, minimal injections of palivizumab were administered to patients having HS-CHD <one year of age during the RSV season; the risk of RSV infection remains significant among children with simple CHD, cardiomyopathy, and children above the age of one year with HS-CHD.
Collapse
Affiliation(s)
- Ah Young Kim
- Yonsei University Severance Cardiovascular, Seoul, Korea
| | - Se Yong Jung
- Yonsei University Severance Cardiovascular, Seoul, Korea
| | - Jae Young Choi
- Yonsei University Severance Cardiovascular, Seoul, Korea
| | - Gi Beom Kim
- Seoul National University Children's Hospital, Seoul, Korea
| | | | | | - I-Seok Kang
- Sungkyunkwan University Samsung Medical Center, Seoul, Korea
| | - Jo Won Jung
- Yonsei University Severance Cardiovascular, Seoul, Korea
| |
Collapse
|
26
|
McGolrick D, Belanger P, Richardson H, Moore K, Maier A, Majury A. Evaluation of self-swabbing coupled with a telephone health helpline as an adjunct tool for surveillance of influenza viruses in Ontario. BMC Public Health 2016; 16:1017. [PMID: 27677310 PMCID: PMC5039901 DOI: 10.1186/s12889-016-3674-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/16/2016] [Indexed: 11/13/2022] Open
Abstract
Background Calls to a telephone health helpline (THHL) have been previously evaluated for the ability to monitor specific syndromes, such as fever and influenza-like-illness or gastrointestinal illness. This method of surveillance has been shown to be highly correlated with traditional surveillance methods, and to have potential for early detection of community-based illness. Self-sampling, or having a person take his/her own nasal swab, has also proven successful as a useful method for obtaining a specimen, which may be used for respiratory virus detection. Methods This study describes a self-swabbing surveillance system mediated by a nurse-led THHL in Ontario whereby syndromic surveillance concepts are used to recruit and monitor participants with influenza-like illness. Once recruited, participants collect a nasal specimen obtained by self-swabbing and submit for testing and laboratory confirmation. Enumeration of weekly case counts was used to evaluate the timeliness of the self-swabbing surveillance system through comparison to other respiratory virus and influenza surveillance systems in Ontario. The operational efficiency of the system was also evaluated. Results The mean and median number of days between the day that a participant called the THHL, to the day a package was received at the laboratory for testing were approximately 10.4 and 8.6 days, respectively. The time between self-swab collection and package reception was 4.9 days on average, with a median of 4 days. The self-swabbing surveillance system adequately captured the 2014 influenza B season in a timely manner when compared to other Ontario-based sources of influenza surveillance data from the same year; however, the emergence of influenza B was not detected any earlier than with these other surveillance systems. Influenza A surveillance was also evaluated. Using the THHL self-swabbing system, a peak in the number of cases for influenza A was observed approximately one week after or during the same week as that reported by the other surveillance systems. Conclusion This one-year pilot study suggests that the THHL self-swabbing surveillance system has significant potential as an adjunct tool for the surveillance of influenza viruses in Ontario. Recommendations for improving system efficacy are discussed. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3674-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- D McGolrick
- Queen's University, Kingston, Ontario, Canada
| | - P Belanger
- Queen's University, Kingston, Ontario, Canada.,Kingston, Frontenac, and Lennox & Addington Public Health, Kingston, Ontario, Canada
| | | | - K Moore
- Queen's University, Kingston, Ontario, Canada.,Kingston, Frontenac, and Lennox & Addington Public Health, Kingston, Ontario, Canada
| | - A Maier
- Kingston, Frontenac, and Lennox & Addington Public Health, Kingston, Ontario, Canada
| | - A Majury
- Queen's University, Kingston, Ontario, Canada. .,Public Health Ontario, Kingston, Ontario, Canada.
| |
Collapse
|
27
|
Fell DB, Wilson K, Ducharme R, Hawken S, Sprague AE, Kwong JC, Smith G, Wen SW, Walker MC. Infant Respiratory Outcomes Associated with Prenatal Exposure to Maternal 2009 A/H1N1 Influenza Vaccination. PLoS One 2016; 11:e0160342. [PMID: 27486858 PMCID: PMC4972313 DOI: 10.1371/journal.pone.0160342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/18/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Infants are at high risk for influenza illness, but are ineligible for vaccination before 6 months. Transfer of maternal antibodies to the fetus has been demonstrated for 2009 A/H1N1 pandemic vaccines; however, clinical effectiveness is unknown. Our objective was to evaluate the association between 2009 A/H1N1 pandemic vaccination during pregnancy and rates of infant influenza and pneumonia. METHODS We linked a population-based birth cohort to administrative databases to measure rates of influenza and pneumonia diagnosed during ambulatory physician visits, hospitalizations and emergency department visits during one year of follow-up. We estimated incidence rate ratios and 95% confidence intervals (95% CI) using Poisson regression, comparing infants born to A/H1N1-vaccinated women (vaccine-exposed infants) with unexposed infants, adjusted for confounding using high-dimensional propensity scores. RESULTS Among 117,335 infants in the study, 36,033 (31%) were born to A/H1N1-vaccinated women. Crude rates of influenza during the pandemic (per 100,000 infant-days) for vaccine-exposed and unexposed infants were similar (2.19, 95% CI: 1.27-3.76 and 3.60, 95% CI: 2.51-5.14, respectively), as were crude rates of influenza and pneumonia combined. We did not observe any significant differences in rates of study outcomes between study groups during the second wave of the 2009 A/H1N1 pandemic, nor during any post-pandemic time period. CONCLUSION We observed no difference in rates of study outcomes among infants born to A/H1N1-vaccinated mothers relative to unexposed infants born during the second A/H1N1 pandemic wave; however, due to late availability of the pandemic vaccine, the available follow-up time during the pandemic time period was very limited.
Collapse
MESH Headings
- Adult
- Cohort Studies
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/etiology
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza Vaccines/adverse effects
- Influenza Vaccines/therapeutic use
- Influenza, Human/congenital
- Influenza, Human/epidemiology
- Influenza, Human/prevention & control
- Male
- Middle Aged
- Pneumonia/congenital
- Pneumonia/epidemiology
- Pneumonia/etiology
- Pregnancy
- Prenatal Exposure Delayed Effects/epidemiology
- Prenatal Exposure Delayed Effects/etiology
- Prenatal Exposure Delayed Effects/immunology
- Respiratory Distress Syndrome, Newborn/epidemiology
- Respiratory Distress Syndrome, Newborn/etiology
- Retrospective Studies
- Treatment Outcome
- Vaccination/adverse effects
- Vaccination/statistics & numerical data
- Young Adult
Collapse
Affiliation(s)
- Deshayne B. Fell
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Ducharme
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven Hawken
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ann E. Sprague
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
| | - Jeffrey C. Kwong
- Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Graeme Smith
- Department of Obstetrics & Gynaecology, Queen’s University, Kingston, Ontario, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark C. Walker
- Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
28
|
Estimating Respiratory Syncytial Virus-associated Hospitalization in the First Year of Life Among Infants Born at 32-35 Weeks of Gestation. Pediatr Infect Dis J 2016; 35:851-5. [PMID: 27124687 DOI: 10.1097/inf.0000000000001186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prophylaxis against respiratory syncytial virus-associated hospitalization (RSV-H) with anti-RSV monoclonal antibody is not considered cost-effective for routine use in most jurisdictions. The aim of this study was to develop a scoring tool to estimate local risk of RSV-H in the first year of life among moderately premature infants to assist in prophylaxis decision making. METHODS A retrospective cohort was constructed from population-based databases in Nova Scotia, Canada, to follow 32- to 35-week gestation infants from the prenatal period to <12 months of age, from 1998 to 2008. Potential risk factors were entered into the logistic regression model, where the dependent variable was RSV-H. Receiver operator characteristic analysis demonstrated cutoff scores producing the highest predictive accuracy, and the likelihood ratio test was used to select the final set of variables for the predictive tool. RESULTS In 2811 eligible infants, the overall RSV-H rate was 3.1% (88/2811). Of 17 variables considered, 3 were used to create the scoring tool: birth during December to February, household smoke exposure and household crowding. The positive likelihood ratios of predictive tool scores for high, moderate and low of RSV-H were 3.57, 3.38 and 1.95, whereas posttest probabilities (risk of RSV-H) were 11.4%, 10.8% and 1.6%, respectively. CONCLUSIONS While able to predict infants at low risk of RSV-H, the tool did not discriminate high from moderate risk infants. The tool could be used in anticipatory care to help educate families about reducing risk of serious RSV illness in their newborn.
Collapse
|
29
|
Phadke VK, Omer SB. Maternal vaccination for the prevention of influenza: current status and hopes for the future. Expert Rev Vaccines 2016; 15:1255-80. [PMID: 27070268 DOI: 10.1080/14760584.2016.1175304] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Influenza is an important cause of morbidity and mortality among pregnant women and young infants, and influenza infection during pregnancy has also been associated with adverse obstetric and birth outcomes. There is substantial evidence - from randomized trials and observational studies - that maternal influenza immunization can protect pregnant women and their infants from influenza disease. In addition, there is compelling observational evidence that prevention of influenza in pregnant women can also protect against certain adverse pregnancy outcomes, including stillbirth and preterm birth. In this article we will review and evaluate the literature on both the burden of influenza disease in pregnant women and infants, as well as the multiple potential benefits of maternal influenza immunization for mother, fetus, and infant. We will also review key clinical aspects of maternal influenza immunization, as well as identify remaining knowledge gaps, and discuss avenues for future investigation.
Collapse
Affiliation(s)
- Varun K Phadke
- a Division of Infectious Diseases, School of Medicine , Emory University , Atlanta , GA , USA
| | - Saad B Omer
- b Department of Pediatrics, School of Medicine , Emory University , Atlanta , GA , USA.,c Departments of Global Health and Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,d Emory Vaccine Center , Emory University , Atlanta , GA , USA
| |
Collapse
|
30
|
Immunogenicity of Influenza Vaccine for Patients with Inflammatory Bowel Disease on Maintenance Infliximab Therapy: A Randomized Trial. Inflamm Bowel Dis 2016; 22:638-47. [PMID: 26595551 DOI: 10.1097/mib.0000000000000615] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND In patients with inflammatory bowel disease (IBD) on infliximab, data are limited on immune response to influenza vaccine and the impact of vaccine timing. The study aims were to evaluate immune responses to the influenza vaccine in IBD patients on infliximab and the impact of vaccine timing on immune responses. METHODS In this randomized study, 137 subjects with IBD on maintenance infliximab therapy were allocated to receive the 2012/2013 inactivated influenza vaccine at the time of infliximab infusion (n = 69) or midway between infusions (n = 68). Serum was collected before and after vaccination for hemagglutination inhibition titers. Serologic protection was defined by postvaccine titer of ≥1:40. RESULTS Comparing subjects vaccinated at the time of infliximab with those vaccinated midway, serologic protection was achieved in 67% versus 66% to H1N1 (P = 0.8), in 43% versus 49% to H3N2 (P = 0.5), and in 69% versus 79% to influenza B (P = 0.2). Although solicited adverse events were common (60%), no subject experienced a serious adverse event requiring additional medical attention. Only 6% of subjects had a clinically significant increase in disease activity score, not impacted by vaccine timing. CONCLUSIONS Serologic protection to influenza vaccine is achieved in only approximately 45% to 80% of IBD patients on maintenance infliximab therapy varying by antigen. Yet, importantly, vaccine timing relative to infliximab infusion does not affect the achievement of serologic protection, and the influenza vaccine is well tolerated. Therefore, influenza vaccination at any point during infliximab scheduling is recommended for patients with IBD and opportunities to broaden the availability and convenience of influenza vaccine to optimize coverage should be explored.
Collapse
|
31
|
Russell CJ, Hurwitz JL. Sendai virus as a backbone for vaccines against RSV and other human paramyxoviruses. Expert Rev Vaccines 2015; 15:189-200. [PMID: 26648515 DOI: 10.1586/14760584.2016.1114418] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Human paramyxoviruses are the etiological agents for life-threatening respiratory virus infections of infants and young children. These viruses, including respiratory syncytial virus (RSV), the human parainfluenza viruses (hPIV1-4) and human metapneumovirus (hMPV), are responsible for millions of serious lower respiratory tract infections each year worldwide. There are currently no standard treatments and no licensed vaccines for any of these pathogens. Here we review research with which Sendai virus, a mouse parainfluenza virus type 1, is being advanced as a Jennerian vaccine for hPIV1 and as a backbone for RSV, hMPV and other hPIV vaccines for children.
Collapse
Affiliation(s)
- Charles J Russell
- a Department of Infectious Diseases , St. Jude Children's Research Hospital , Memphis , TN , USA.,b Department of Microbiology, Immunology and Biochemistry , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Julia L Hurwitz
- a Department of Infectious Diseases , St. Jude Children's Research Hospital , Memphis , TN , USA.,b Department of Microbiology, Immunology and Biochemistry , University of Tennessee Health Science Center , Memphis , TN , USA
| |
Collapse
|
32
|
McMorrow ML, Emukule GO, Njuguna HN, Bigogo G, Montgomery JM, Nyawanda B, Audi A, Breiman RF, Katz MA, Cosmas L, Waiboci LW, Duque J, Widdowson MA, Mott JA. The Unrecognized Burden of Influenza in Young Kenyan Children, 2008-2012. PLoS One 2015; 10:e0138272. [PMID: 26379030 PMCID: PMC4574572 DOI: 10.1371/journal.pone.0138272] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022] Open
Abstract
Influenza-associated disease burden among children in tropical sub-Saharan Africa is not well established, particularly outside of the 2009 pandemic period. We estimated the burden of influenza in children aged 0–4 years through population-based surveillance for influenza-like illness (ILI) and acute lower respiratory tract illness (ALRI). Household members meeting ILI or ALRI case definitions were referred to health facilities for evaluation and collection of nasopharyngeal and oropharyngeal swabs for influenza testing by real-time reverse transcription polymerase chain reaction. Estimates were adjusted for health-seeking behavior and those with ILI and ALRI who were not tested. During 2008–2012, there were 9,652 person-years of surveillance among children aged 0–4 years. The average adjusted rate of influenza-associated hospitalization was 4.3 (95% CI 3.0–6.0) per 1,000 person-years in children aged 0–4 years. Hospitalization rates were highest in the 0–5 month and 6–23 month age groups, at 7.6 (95% CI 3.2–18.2) and 8.4 (95% CI 5.4–13.0) per 1,000 person-years, respectively. The average adjusted rate of influenza-associated medically attended (inpatient or outpatient) ALRI in children aged 0–4 years was 17.4 (95% CI 14.2–19.7) per 1,000 person-years. Few children who had severe laboratory-confirmed influenza were clinically diagnosed with influenza by the treating clinician in the inpatient (0/33, 0%) or outpatient (1/109, 0.9%) settings. Influenza-associated hospitalization rates from 2008–2012 were 5–10 times higher than contemporaneous U.S. estimates. Many children with danger signs were not hospitalized; thus, influenza-associated severe disease rates in Kenyan children are likely higher than hospital-based estimates suggest.
Collapse
Affiliation(s)
- Meredith L. McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
- * E-mail:
| | - Gideon O. Emukule
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Henry N. Njuguna
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya
| | - Joel M. Montgomery
- United States Public Health Service, Rockville, Maryland, United States of America
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Bryan Nyawanda
- Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya
| | - Allan Audi
- Kenya Medical Research Institute (KEMRI), Nairobi and Kisumu, Kenya
| | - Robert F. Breiman
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Mark A. Katz
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Leonard Cosmas
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Lilian W. Waiboci
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- Battelle, Atlanta, Georgia, United States of America
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Joshua A. Mott
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- United States Public Health Service, Rockville, Maryland, United States of America
- Centers for Disease Control and Prevention-Kenya Country Office, Nairobi, Kenya
| |
Collapse
|
33
|
Walsh EE, Hall CB. Respiratory Syncytial Virus (RSV). MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7173590 DOI: 10.1016/b978-1-4557-4801-3.00160-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
34
|
Kwong JC, Pereira JA, Quach S, Pellizzari R, Dusome E, Russell ML, Hamid JS, Feinberg Y, Winter AL, Gubbay JB, Sirtonski B, Moher D, Sider D, Finkelstein M, Loeb M. Randomized evaluation of live attenuated vs. inactivated influenza vaccines in schools (RELATIVES) pilot study: A cluster randomized trial. Vaccine 2015; 33:535-41. [DOI: 10.1016/j.vaccine.2014.11.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/11/2014] [Accepted: 11/20/2014] [Indexed: 11/28/2022]
|
35
|
Coviello S, Wimmenauer V, Polack FP, Irusta PM. Bacterial lysates improve the protective antibody response against respiratory viruses through Toll-like receptor 4. Hum Vaccin Immunother 2014; 10:2896-902. [PMID: 25483455 DOI: 10.4161/hv.29784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Respiratory viruses cause significant morbidity and mortality in infants and young children worldwide. Current strategies to modulate the immune system and prevent or treat respiratory viral infections in this age group have shown limited success. Here, we demonstrate that a lysate derived from Gram-positive and Gram-negative organisms positively modulates protective antibody responses against both respiratory syncytial virus (RSV) and influenza virus in murine models of infection. Interestingly, despite the complex mixture of Toll-like receptor (TLR) agonists present in the bacterial lysate, the modulatory effects were mostly dependent on TLR4 signaling. Our results indicate that the use of simple formulations of TLR-agonists can significantly improve the immune response against critical pediatric respiratory pathogens.
Collapse
|
36
|
Abstract
Objective This report summarizes influenza activity in Canada during the 2012-13 influenza season (August 26, 2012-August 24, 2013) from data obtained through the FluWatch surveillance program. Methods FluWatch collected information from six primary indicators of influenza activity that describe the epidemiologic and virologic behaviour of influenza in Canada: sentinel laboratory-based influenza detections; strain characterization and antiviral resistance for circulating influenza viruses; primary care consultation rates of influenza-like illness; regional influenza activity levels; influenza-associated severe outcomes; and pharmacy surveillance. Results The influenza season peaked nationally between late December 2012 and early January 2013 with influenza A(H3N2) identified as the predominant circulating influenza strain until early March, when influenza B became the predominant circulating strain. The cumulative reported hospitalization rates for all age groups were 25.0 per 100,000. Influenza A most greatly affected adults ≥65 years of age and influenza B most greatly affected children ≤19 years of age. Conclusion The influenza season was moderately severe. When compared to the previous two seasons, which were considered relatively mild, there was a significant increase in laboratory detections for influenza, as well as hospitalizations associated with influenza in 2012-13.
Collapse
|
37
|
Are we too passive in our attempts to prevent respiratory syncytial virus infection in Northern Canada? Can Respir J 2014; 21:163-4. [PMID: 24914608 DOI: 10.1155/2014/258504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
38
|
McCulloh RJ, Andrea S, Reinert S, Chapin K. Potential Utility of Multiplex Amplification Respiratory Viral Panel Testing in the Management of Acute Respiratory Infection in Children: A Retrospective Analysis. J Pediatric Infect Dis Soc 2014; 3:146-53. [PMID: 26625367 DOI: 10.1093/jpids/pit073] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/15/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Multiplex real-time polymerase chain reaction respiratory viral panel (RVP) testing offers enhanced test performance characteristics compared with older testing methods. However, the impact of RVP testing on physician antimicrobial prescription practices remains unclear. Our objective was to assess the potential relationship of RVP testing to physician treatment practices for children hospitalized with acute respiratory illness (ARI). METHODS We performed a retrospective chart review of children hospitalized for ARI during peak prevalence of respiratory viral infections in 2009-2011. Demographics, diagnostic testing, antimicrobial use, and clinical outcomes were abstracted from the electronic medical record. Antimicrobial use was compared with RVP testing data. RESULTS A total of 1727 patients met inclusion criteria. Of these patients, 254 (14.7%) children who were hospitalized for ARI received oseltamivir and 856 (49.6%) children received antibiotics. More children who received oseltamivir were positive for influenza by RVP (76.9% vs 18.0%; P < .0001). Children who underwent RVP testing received antibiotics more often than those who were not tested (53.7% vs 46.0%; P = .001), but children with a positive RVP test result received antibiotics less often (51.6% vs 67.0%; P = .003). A total of 5.8% of children who were positive for a viral pathogen by RVP had antibiotics discontinued. Antibiotics were started in fewer children when RVP results were positive (10.9% vs 100.0%; P < .0001). CONCLUSIONS Respiratory viral panel testing was associated with more appropriate oseltamivir use in children hospitalized with ARI. Physicians started antibiotics more often in children with a negative RVP test result and occasionally discontinued antibiotics in children diagnosed with a viral pathogen. These results suggest that RVP testing may enhance physician decision-making when prescribing antimicrobials in children hospitalized with ARI.
Collapse
Affiliation(s)
- Russell J McCulloh
- Division of Pediatric Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri
| | | | | | - Kimberle Chapin
- Department of Pathology, Rhode Island Hospital/Brown University, Providence
| |
Collapse
|
39
|
Respiratory syncytial virus prophylaxis in children with cardiac disease: a retrospective single-centre study. Cardiol Young 2014; 24:337-43. [PMID: 23628233 DOI: 10.1017/s1047951113000401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To examine the characteristics of congenital heart disease patients hospitalised with respiratory syncytial virus infection after prophylaxis and determine the associated comorbidities and the incidence of breakthrough respiratory syncytial virus infections. STUDY DESIGN This is a retrospective, single-centre study that was conducted over a period of 7 years. Respiratory syncytial virus infection was identified by classification codes and confirmed by virological tests. Data on baseline demographics, cardiac anomalies, other underlying disease, criteria for hospitalisation, type of respiratory illness and management, complications, and palivizumab prophylaxis were analysed by standard descriptive methods and comparative statistics. RESULTS A total of 30 patients were enrolled. The majority were ≤ 2 years (n = 24). The mean admission age was 15.1 months (standard deviation = 18.3). In all, 90% were acyanotic, 40% had haemodynamically significant disease, and 60% had ≥ 1 underlying medical illness. Patients were admitted with: respiratory distress (86.7%), hypoxaemia (66.7%), fever (60%), inability to maintain oral intake (36.7%), and apnoea (16.7%). More than 50% required mechanical ventilation and intensive care with a median stay of 11 days (range: 1-43); the length of hospital stay for all children was 10 days (range: 1-65). Complications included: concurrent bacterial sepsis (20%), electrolyte abnormalities (16.7%), and worsening pulmonary hypertension (13.3%). Of 10 infants ≤ 2 years with haemodynamically significant heart disease, four had received prophylaxis. There was one death, which was attributed to respiratory syncytial virus infection. CONCLUSIONS Overall, 185 infants ≤ 2 years with haemodynamically significant cardiac disease received prophylaxis. In all, six qualifying infants missed immunisation and were hospitalised. Breakthrough respiratory syncytial virus infections occurred in 2.2%, demonstrating good efficacy of palivizumab in this population compared with the original, multi-centre, randomised trial.
Collapse
|
40
|
Lind C, Russell ML, MacDonald J, Collins R, Frank CJ, Davis AE. School-based influenza vaccination: parents' perspectives. PLoS One 2014; 9:e93490. [PMID: 24686406 PMCID: PMC3970961 DOI: 10.1371/journal.pone.0093490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/06/2014] [Indexed: 12/04/2022] Open
Abstract
Background School-age children are important drivers of annual influenza epidemics yet influenza vaccination coverage of this population is low despite universal publicly funded influenza vaccination in Alberta, Canada. Immunizing children at school may potentially increase vaccine uptake. As parents are a key stakeholder group for such a program, it is important to consider their concerns. Purpose We explored parents’ perspectives on the acceptability of adding an annual influenza immunization to the immunization program that is currently delivered in Alberta schools, and obtained suggestions for structuring such a program. Participants Forty-eight parents of children aged 5-18 years participated in 9 focus groups. Participants lived in urban areas of the Alberta Health Services Calgary Zone. Findings Three major themes emerged: Advantages of school-based influenza vaccination (SBIV), Disadvantages of SBIV, and Implications for program design & delivery. Advantages were perceived to occur for different populations: children (e.g. emotional support), families (e.g. convenience), the community (e.g. benefits for school and multicultural communities), the health sector (e.g. reductions in costs due to burden of illness) and to society at large (e.g. indirect conduit of information about health services, building structure for pandemic preparedness, building healthy lifestyles). Disadvantages, however, might also occur for children (e.g. older children less likely to be immunized), families (e.g. communication challenges, perceived loss of parental control over information, choices and decisions) and the education sector (loss of instructional time). Nine second-level themes emerged within the major theme of Implications for program design & delivery: program goals/objectives, consent process, stakeholder consultation, age-appropriate program, education, communication, logistics, immunizing agent, and clinic process. Conclusions Parents perceived advantages and disadvantages to delivering annual seasonal influenza immunizations to children at school. Their input gives a framework of issues to address in order to construct robust, acceptable programs for delivering influenza or other vaccines in schools.
Collapse
Affiliation(s)
- Candace Lind
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Margaret L. Russell
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Judy MacDonald
- Alberta Health Services and Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ramona Collins
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Amy E. Davis
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
41
|
Abstract
Influenza A and B viruses are highly contagious respiratory pathogens with a considerable medical and socioeconomical burden and known pandemic potential. Current influenza vaccines require annual updating and provide only partial protection in some risk groups. Due to the global spread of viruses with resistance to the M2 proton channel inhibitor amantadine or the neuraminidase inhibitor oseltamivir, novel antiviral agents with an original mode of action are urgently needed. We here focus on emerging options to interfere with the influenza virus entry process, which consists of the following steps: attachment of the viral hemagglutinin to the sialylated host cell receptors, endocytosis, M2-mediated uncoating, low pH-induced membrane fusion, and, finally, import of the viral ribonucleoprotein into the nucleus. We review the current functional and structural insights in the viral and cellular components of this entry process, and the diverse antiviral strategies that are being explored. This encompasses small molecule inhibitors as well as macromolecules such as therapeutic antibodies. There is optimism that at least some of these innovative concepts to block influenza virus entry will proceed from the proof of concept to a more advanced stage. Special attention is therefore given to the challenging issues of influenza virus (sub)type-dependent activity or potential drug resistance.
Collapse
Affiliation(s)
| | - Lieve Naesens
- Rega Institute for Medical ResearchKU LeuvenLeuvenBelgium
| |
Collapse
|
42
|
Paes B, Mitchell I, Yi H, Li A, Lanctôt KL. Hospitalization for respiratory syncytial virus illness in Down syndrome following prophylaxis with palivizumab. Pediatr Infect Dis J 2014; 33:e29-33. [PMID: 23989104 DOI: 10.1097/inf.0000000000000019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Down syndrome (DS) is a risk factor for respiratory syncytial virus (RSV) hospitalization, but little is known about prophylaxis in these children. METHODS CARESS is a prospective registry of children who received ≥1 dose of palivizumab during the 2006-2012 RSV seasons across 32 sites in Canada. The objective was to compare respiratory illness hospitalization and RSV hospitalization (RSVH) hazard ratios in DS children aged <2 years who received palivizumab versus children who received prophylaxis for standard indications (SI) and for other medical illnesses (MI). RESULTS 13,310 children were enrolled; DS (600; 4.5%), SI (11,081; 83.3%) and MI (1629, 12.2%), with DS children increasing over the duration from 0.1% (2006) to 4.5% (2012). Participants were significantly different in mean birth weight, gestational and enrollment age and risk factors. Children in each group received an average of 4.3 ± 1.4 (DS), 4.1 ± 1.6 (SI) and 4.5 ± 1.4 (MI) palivizumab injections per RSV season, with DS, differing significantly from SI [F(2, 13,307) = 43.6, P = 0.01] but not MI [F(2, 13 307) = 43.6, P = 0.07]. Compliance rates were similar across the groups. While a significantly greater proportion of SI children had RIHs compared with DS, [hazard ratio: 0.64 (0.48-0.84); P = 0.001] hazard ratios were similar for DS and MI. RSVH incidence rates were: 1.53%, 1.45% and 2.27% for DS, SI and MI, respectively. Neither group nor compliance affected time to RSVH. CONCLUSIONS The proportion of DS children who received palivizumab in CARESS has increased almost 45-fold. RSVH rates were low in DS following prophylaxis and hazards were similar to those found in SI and MI.
Collapse
Affiliation(s)
- Bosco Paes
- From the *Department of Pediatrics, McMaster University, Hamilton, Ontario; †Department of Pediatrics, University of Calgary, Calgary, Alberta; and ‡Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
43
|
A model of the costs of community and nosocomial pediatric respiratory syncytial virus infections in Canadian hospitals. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 24:22-6. [PMID: 24421788 DOI: 10.1155/2013/916769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Approximately one in 10 hospitalized patients will acquire a nosocomial infection (NI) after admission to hospital, of which 71% are due to respiratory viruses, including the respiratory syncytial virus (RSV). NIs are concerning and lead to prolonged hospitalizations. The economics of NIs are typically described in generalized terms and specific cost data are lacking. OBJECTIVE To develop an evidence-based model for predicting the risk and cost of nosocomial RSV infection in pediatric settings. METHODS A model was developed, from a Canadian perspective, to capture all costs related to an RSV infection hospitalization, including the risk and cost of an NI, diagnostic testing and infection control. All data inputs were derived from published literature. Deterministic sensitivity analyses were performed to evaluate the uncertainty associated with the estimates and to explore the impact of changes to key variables. A probabilistic sensitivity analysis was performed to estimate a confidence interval for the overall cost estimate. RESULTS The estimated cost of nosocomial RSV infection adds approximately 30.5% to the hospitalization costs for the treatment of community-acquired severe RSV infection. The net benefits of the prevention activities were estimated to be equivalent to 9% of the total RSV-related costs. Changes in the estimated hospital infection transmission rates did not have a significant impact on the base-case estimate. CONCLUSIONS The risk and cost of nosocomial RSV infection contributes to the overall burden of RSV. The present model, which was developed to estimate this burden, can be adapted to other countries with different disease epidemiology, costs and hospital infection transmission rates.
Collapse
|
44
|
Ruf BR, Knuf M. The burden of seasonal and pandemic influenza in infants and children. Eur J Pediatr 2014; 173:265-76. [PMID: 23661234 PMCID: PMC3930829 DOI: 10.1007/s00431-013-2023-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 12/15/2022]
Abstract
UNLABELLED The burden of influenza is unevenly distributed, with more severe outcomes in children aged <5 years than older children and adults. In spite of this, immunisation policies for young children are far from universal. This article provides an overview of the published evidence on the burden of influenza in children worldwide, with a particular interest in the impact of pandemic influenza in 2009-2010 (caused by the H1N1pdm09 virus). In an average season, up to 9.8 % of 0- to 14-year olds present with influenza, but incidence rates can be markedly higher in younger children. Children aged <5 years have greater rates of hospitalisation and complications than their older counterparts, particularly if the children have co-existing illnesses; historically, this age group have had higher mortality rates from the disease than other children, although during the 2009-2010 pandemic the median age of those who died of influenza was higher than in previous seasons. Admissions to hospital and emergency departments appear to have been more frequent in children with H1N1pdm09 infections than during previous seasonal epidemics, with pneumonia continuing to be a common complication in this setting. Outcomes in children hospitalised with severe disease also seem to have been worse for those infected with H1N1pdm09 viruses compared with seasonal viruses. Studies in children confirm that vaccination reduces the incidence of seasonal influenza and the associated burden, underlining the importance of targeting this group in national immunisation policies. CONCLUSIONS Children aged <5 years are especially vulnerable to influenza, particularly that caused by seasonal viruses, and vaccination in this group can be an effective strategy for reducing disease burden.
Collapse
Affiliation(s)
- Bernhard R. Ruf
- Division of Infectious Diseases and Tropical Medicine, Klinikum Sankt Georg Leipzig, Leipzig, Germany
| | - Markus Knuf
- Klinik für Kinder und Jugendliche, Dr. Horst Schmidt Klinik, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany ,University Medicine, Pediatric Infectious Diseases, Mainz, Germany
| |
Collapse
|
45
|
Strategies for reducing the risk of respiratory syncytial virus infection in infants and young children: a Canadian nurses' perspective. Neonatal Netw 2013; 31:357-68. [PMID: 23134643 DOI: 10.1891/0730-0832.31.6.357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Respiratory syncytial virus (RSV) infections are prevalent globally and can cause substantial morbidity in infants and young children. The virus is easily transmitted by direct hand-to-hand contact and can lead to serious respiratory disease and hospitalization, particularly in premature infants and children with certain medical conditions. Educating families with young children, especially those in remote rural regions, regarding the potential adverse health outcomes of RSV infection and measures to reduce the risk of transmitting or acquiring RSV has been a key focus of the health care system in Canada. Geographic, cultural, and socioeconomic factors present formidable challenges to the execution of this endeavor. Therefore, it is critical to develop and systematically implement effective educational programs for both families and health care providers. In Canada, nurses play a critical role in education and counseling. In this review, we share our perspectives and suggest empirical practices that may be applicable worldwide.
Collapse
|
46
|
Statement on Seasonal Influenza Vaccine for 2013-2014: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI). CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2013; 39:1-37. [PMID: 31701948 PMCID: PMC6802458 DOI: 10.14745/ccdr.v39i00a04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
47
|
Seasonal respiratory syncytial virus prophylaxis based on predetermined dates versus regional surveillance data. Pediatr Infect Dis J 2013; 32:e360-4. [PMID: 23546534 DOI: 10.1097/inf.0b013e31829479d3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Ontario, Canada, the respiratory syncytial virus (RSV) prophylaxis period onset is defined by a fixed-date set provincially each year and offset by local hospital RSV admission activity. Inaccurate timing can result in inadequate or more costly prophylaxis. METHODS RSV positivity (2002/03 to 2010/11) was obtained from a local database. RSV activity was described: season start/end dates, duration and optimum number of palivizumab doses required compared with doses administered for the final 4 RSV seasons (2007 to 2011). Three prophylaxis period-setting methods were evaluated for seasons 2007/08 to 2010/11: 1) the provincial method currently in use, 2) a local fixed-date method based on laboratory data accrued from the previous 5 seasons and 3) an exploratory prospective method based on surveillance of laboratory data. These were compared with the observed RSV seasons. RESULTS The local RSV pattern closely reflects provincial seasonality. The local median season duration was 125 days (range 90-181). Median season onset and offset dates were December 19 and April 16, respectively. The prophylactic period definitions corresponded similarly, but the provincially set and local fixed-date methods provided longer immunity periods than required for the actual RSV season and involved the administration of more than 5 palivizumab doses compared with the prospective method. CONCLUSIONS The provincial prophylactic period aligned with the local fixed-date and prospective methods. However, the adoption of any of the first 2 strategies merits close observation to minimize excess healthcare expenditure. The prospective surveillance of laboratory isolates should be further explored as a preferred option to better define prophylactic periods.
Collapse
|
48
|
Schanzer DL, McGeer A, Morris K. Statistical estimates of respiratory admissions attributable to seasonal and pandemic influenza for Canada. Influenza Other Respir Viruses 2013; 7:799-808. [PMID: 23122189 PMCID: PMC3796862 DOI: 10.1111/irv.12011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The number of admissions to hospital for which influenza is laboratory confirmed is considered to be a substantial underestimate of the true number of admissions due to an influenza infection. During the 2009 pandemic, testing for influenza in hospitalized patients was a priority, but the ascertainment rate remains uncertain. METHODS The discharge abstracts of persons admitted with any respiratory condition were extracted from the Canadian Discharge Abstract Database, for April 2003-March 2010. Stratified, weekly admissions were modeled as a function of viral activity, seasonality, and trend using Poisson regression models. RESULTS An estimated 1 out of every 6.4 admissions attributable to seasonal influenza (2003-April 2009) were coded to J10 (influenza virus identified). During the 2009 pandemic (May-March 2010), the influenza virus was identified in 1 of 1.6 admissions (95% CI, 1.5-1.7) attributed to the pandemic strain. Compared with previous H1N1 seasons (2007/08, 2008/09), the influenza-attributed hospitalization rate for persons <65 years was approximately six times higher during the 2009 H1N1 pandemic, whereas for persons 75 years or older, the pandemic rate was approximately fivefold lower. CONCLUSIONS Case ascertainment was much improved during the pandemic period, with under ascertainment of admissions due to H1N1/2009 limited primarily to patients with a diagnosis of pneumonia.
Collapse
Affiliation(s)
- Dena L Schanzer
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada.
| | | | | |
Collapse
|
49
|
Abstract
Patients with IBD are at increased risk of infection, in part owing to the disease itself, but mostly because of treatment with immunosuppressive drugs. Although many of these infections are vaccine-preventable, vaccination coverage in patients with IBD is extremely low. The vaccine strategies examined in this Review are based on data that enable us to provide practical advice for clinicians. Clinical evidence indicates that vaccines do not increase the risk of relapse in patients with IBD. Live vaccines are contraindicated in immunocompromised individuals, but inactivated vaccines can be safely administered. Most patients receiving immunosuppressive therapy develop an immune response after vaccination, but response rates might differ from those of nonimmunosuppressed individuals. Therefore, vaccination status should be checked and updated upon diagnosis of IBD.
Collapse
|
50
|
Schanzer DL, Schwartz B. Impact of seasonal and pandemic influenza on emergency department visits, 2003-2010, Ontario, Canada. Acad Emerg Med 2013; 20:388-97. [PMID: 23701347 PMCID: PMC3748786 DOI: 10.1111/acem.12111] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 09/30/2012] [Accepted: 10/06/2012] [Indexed: 01/07/2023]
Abstract
Objectives Weekly influenza-like illness (ILI) consultation rates are an integral part of influenza surveillance. However, in most health care settings, only a small proportion of true influenza cases are clinically diagnosed as influenza or ILI. The primary objective of this study was to estimate the number and rate of visits to the emergency department (ED) that are attributable to seasonal and pandemic influenza and to describe the effect of influenza on the ED by age, diagnostic categories, and visit disposition. A secondary objective was to assess the weekly “real-time” time series of ILI ED visits as an indicator of the full burden due to influenza. Methods The authors performed an ecologic analysis of ED records extracted from the National Ambulatory Care Reporting System (NARCS) database for the province of Ontario, Canada, from September 2003 to March 2010 and stratified by diagnostic characteristics (International Classification of Diseases, 10th Revision [ICD-10]), age, and visit disposition. A regression model was used to estimate the seasonal baseline. The weekly number of influenza-attributable ED visits was calculated as the difference between the weekly number of visits predicted by the statistical model and the estimated baseline. Results The estimated rate of ED visits attributable to influenza was elevated during the H1N1/2009 pandemic period at 1,000 per 100,000 (95% confidence interval [CI] = 920 to 1,100) population compared to an average annual rate of 500 per 100,000 (95% CI = 450 to 550) for seasonal influenza. ILI or influenza was clinically diagnosed in one of 2.6 (38%) and one of 14 (7%) of these visits, respectively. While the ILI or clinical influenza diagnosis was the diagnosis most specific to influenza, only 87% and 58% of the clinically diagnosed ILI or influenza visits for pandemic and seasonal influenza, respectively, were likely directly due to an influenza infection. Rates for ILI ED visits were highest for younger age groups, while the likelihood of admission to hospital was highest in older persons. During periods of seasonal influenza activity, there was a significant increase in the number of persons who registered with nonrespiratory complaints, but left without being seen. This effect was more pronounced during the 2009 pandemic. The ratio of influenza-attributed respiratory visits to influenza-attributed ILI visits varied from 2.4:1 for the fall H1N1/2009 wave to 9:1 for the 2003/04 influenza A(H3N2) season and 28:1 for the 2007/08 H1N1 season. Conclusions Influenza appears to have had a much larger effect on ED visits than was captured by clinical diagnoses of influenza or ILI. Throughout the study period, ILI ED visits were strongly associated with excess respiratory complaints. However, the relationship between ILI ED visits and the estimated effect of influenza on ED visits was not consistent enough from year to year to predict the effect of influenza on the ED or downstream in-hospital resource requirements.
Collapse
Affiliation(s)
- Dena L. Schanzer
- Centre for Communicable Diseases and Infection Control Infectious Disease Prevention and Control Branch Public Health Agency of Canada Ottawa Ontario
| | - Brian Schwartz
- Public Health Ontario and the Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| |
Collapse
|