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Pott H, LeBlanc JJ, ElSherif M, Hatchette TF, McNeil SA, Andrew MK. Predicting major clinical events among Canadian adults with laboratory-confirmed influenza infection using the influenza severity scale. Sci Rep 2024; 14:18378. [PMID: 39112632 PMCID: PMC11306731 DOI: 10.1038/s41598-024-67931-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
We developed and validated the Influenza Severity Scale (ISS), a standardized risk assessment for influenza, to estimate and predict the probability of major clinical events in patients with laboratory-confirmed infection. Data from the Canadian Immunization Research Network's Serious Outcomes Surveillance Network (2011/2012-2018/2019 influenza seasons) enabled the selecting of all laboratory-confirmed influenza patients. A machine learning-based approach then identified variables, generated weighted scores, and evaluated model performance. This study included 12,954 patients with laboratory-confirmed influenza infections. The optimal scale encompassed ten variables: demographic (age and sex), health history (smoking status, chronic pulmonary disease, diabetes mellitus, and influenza vaccination status), clinical presentation (cough, sputum production, and shortness of breath), and function (need for regular support for activities of daily living). As a continuous variable, the scale had an AU-ROC of 0.73 (95% CI, 0.71-0.74). Aggregated scores classified participants into three risk categories: low (ISS < 30; 79.9% sensitivity, 51% specificity), moderate (ISS ≥ 30 but < 50; 54.5% sensitivity, 55.9% specificity), and high (ISS ≥ 50; 51.4% sensitivity, 80.5% specificity). ISS demonstrated a solid ability to identify patients with hospitalized laboratory-confirmed influenza at increased risk for Major Clinical Events, potentially impacting clinical practice and research.
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Affiliation(s)
- Henrique Pott
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada.
- Department of Medicine, Universidade Federal de São Carlos, Rod. Washington Luis, km 235, São Carlos, SP, 13656-905, Brazil.
| | - Jason J LeBlanc
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
| | - May ElSherif
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - Todd F Hatchette
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
| | - Shelly A McNeil
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Canada
| | - Melissa K Andrew
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Canada
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Trovarelli G, Pala E, Angelini A, Ruggieri P. A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up. Bone Joint J 2022; 104-B:1352-1361. [DOI: 10.1302/0301-620x.104b12.bjj-2022-0401.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Aims We performed a systematic literature review to define features of patients, treatment, and biological behaviour of multicentric giant cell tumour (GCT) of bone. Methods The search terms used in combination were “multicentric”, “giant cell tumour”, and “bone”. Exclusion criteria were: reports lacking data, with only an abstract; papers not reporting data on multicentric GCT; and papers on multicentric GCT associated with other diseases. Additionally, we report three patients treated under our care. Results A total of 52 papers reporting on 104 patients were included in the analysis, with our addition of three patients. Multicentric GCT affected predominantly young people at a mean age of 22 years (10 to 62), manifesting commonly as metachronous tumours. The mean interval between the first and subsequent lesions was seven years (six months to 27 years). Synchronous lesions were observed in one-third of the patients. Surgery was curettage in 63% of cases (163 lesions); resections or amputation were less frequent. Systemic treatments were used in 10% (n = 14) of patients. Local recurrence and distant metastases were common. Conclusion Multicentric GCT is rare, biologically aggressive, and its course is unpredictable. Patients with GCT should be followed indefinitely, and referred promptly if new symptoms, particularly pain, emerge. Denosumab can have an important role in the treatment. Cite this article: Bone Joint J 2022;104-B(12):1352–1361.
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Affiliation(s)
- Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Elisa Pala
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy
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Holstein R, Dawood FS, O'Halloran A, Cummings C, Ujamaa D, Daily Kirley P, Yousey-Hindes K, Fawcett E, Monroe ML, Kim S, Lynfield R, McMullen C, Muse A, Bennett NM, Billing LM, Sutton M, Thomas A, Talbot HK, Schaffner W, Risk I, Reed C, Garg S. Characteristics and Outcomes of Hospitalized Pregnant Women With Influenza, 2010 to 2019 : A Repeated Cross-Sectional Study. Ann Intern Med 2022; 175:149-158. [PMID: 34958603 DOI: 10.7326/m21-3668] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pregnant women may be at increased risk for severe influenza-associated outcomes. OBJECTIVE To describe characteristics and outcomes of hospitalized pregnant women with influenza. DESIGN Repeated cross-sectional study. SETTING The population-based U.S. Influenza Hospitalization Surveillance Network during the 2010-2011 through 2018-2019 influenza seasons. PATIENTS Pregnant women (aged 15 to 44 years) hospitalized with laboratory-confirmed influenza identified through provider-initiated or facility-based testing practices. MEASUREMENTS Clinical characteristics, interventions, and in-hospital maternal and fetal outcomes were obtained through medical chart abstraction. Multivariable logistic regression was used to evaluate the association between influenza A subtype and severe maternal influenza-associated outcomes, including intensive care unit (ICU) admission, mechanical ventilation, extracorporeal membrane oxygenation, or in-hospital death. RESULTS Of 9652 women aged 15 to 44 years and hospitalized with influenza, 2690 (27.9%) were pregnant. Among the 2690 pregnant women, the median age was 28 years, 62% were in their third trimester, and 42% had at least 1 underlying condition. Overall, 32% were vaccinated against influenza and 88% received antiviral treatment. Five percent required ICU admission, 2% required mechanical ventilation, and 0.3% (n = 8) died. Pregnant women with influenza A H1N1 were more likely to have severe outcomes than those with influenza A H3N2 (adjusted risk ratio, 1.9 [95% CI, 1.3 to 2.8]). Most women (71%) were still pregnant at hospital discharge. Among 754 women who were no longer pregnant at discharge, 96% had a pregnancy resulting in live birth, and 3% experienced fetal loss. LIMITATION Maternal and fetal outcomes that occurred after hospital discharge were not captured. CONCLUSION Over 9 influenza seasons, one third of reproductive-aged women hospitalized with influenza were pregnant. Influenza A H1N1 was associated with more severe maternal outcomes. Pregnant women remain a high-priority target group for vaccination. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Rachel Holstein
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Fatimah S Dawood
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Charisse Cummings
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Dawud Ujamaa
- Centers for Disease Control and Prevention, Atlanta, Georgia, and General Dynamics Information Technology, Falls Church, Virginia (D.U.)
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California (P.D.K.)
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut (K.Y.)
| | - Emily Fawcett
- Emerging Infections Program, Georgia Department of Health, and Veterans Affairs Medical Center, Atlanta, Georgia, and Foundation for Atlanta Veterans Education and Research, Decatur, Georgia (E.F.)
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland (M.L.M.)
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan (S.K.)
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota (R.L.)
| | | | - Alison Muse
- New York State Department of Health, Albany, New York (A.M.)
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York (N.M.B.)
| | | | | | - Ann Thomas
- Oregon Health Authority, Portland, Oregon (M.S., A.T.)
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, Tennessee (H.K.T., W.S.)
| | - Ilene Risk
- Salt Lake County Health Department, Salt Lake City, Utah (I.R.)
| | - Carrie Reed
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
| | - Shikha Garg
- Centers for Disease Control and Prevention, Atlanta, Georgia (R.H., F.S.D., A.O., C.C., C.R., S.G.)
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Adams K, Tenforde MW, Chodisetty S, Lee B, Chow EJ, Self WH, Patel MM. A literature review of severity scores for adults with influenza or community-acquired pneumonia - implications for influenza vaccines and therapeutics. Hum Vaccin Immunother 2021; 17:5460-5474. [PMID: 34757894 PMCID: PMC8903905 DOI: 10.1080/21645515.2021.1990649] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/02/2021] [Indexed: 12/11/2022] Open
Abstract
Influenza vaccination and antiviral therapeutics may attenuate disease, decreasing severity of illness in vaccinated and treated persons. Standardized assessment tools, definitions of disease severity, and clinical endpoints would support characterizing the attenuating effects of influenza vaccines and antivirals. We review potential clinical parameters and endpoints that may be useful for ordinal scales evaluating attenuating effects of influenza vaccines and antivirals in hospital-based studies. In studies of influenza and community-acquired pneumonia, common physiologic parameters that predicted outcomes such as mortality, ICU admission, complications, and duration of stay included vital signs (hypotension, tachypnea, fever, hypoxia), laboratory results (blood urea nitrogen, platelets, serum sodium), and radiographic findings of infiltrates or effusions. Ordinal scales based on these parameters may be useful endpoints for evaluating attenuating effects of influenza vaccines and therapeutics. Factors such as clinical and policy relevance, reproducibility, and specificity of measurements should be considered when creating a standardized ordinal scale for assessment.
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Affiliation(s)
- Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shreya Chodisetty
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin Lee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric J. Chow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H. Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manish M. Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Potential benefits of precise corticosteroid therapy for critical COVID-19. Respir Physiol Neurobiol 2021; 297:103813. [PMID: 34801741 PMCID: PMC8600764 DOI: 10.1016/j.resp.2021.103813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 12/21/2022]
Abstract
This study was aimed to explore the precise dose of corticosteroid therapy in critical COVID-19. A total of forty-five critical COVID-19 patients were enrolled. The process of critical COVID-19 was divided into alveolitis and fibrosis stages. Most nonsurvivors died in fibrosis phase. Nonsurvivors had more dyspnea symptoms, fewer days of hospitalization, shorter duration of alveolitis and fibrosis. High-dose daily corticosteroid therapy (≥150 mg/d) was associated with shorter survival time and lower lymphocyte count in fibrosis phase. Moreover, a high cumulative dose (≥604 mg) was tied to longer duration of virus shedding, lower oxygenation index (OI), higher incidence of tracheal intubation, fewer lymphocytes and higher levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). In alveolitis phase, the low-to-moderate-dose daily corticosteroid therapy and a small cumulative dose reduced lymphocytes. In conclusion, low-to-moderate dose corticosteroids may be beneficial in the fibrosis phase. High-dose corticosteroid therapy in the fibrosis phase aggravates the severity of critical COVID-19.
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Chow EJ, Tenforde MW, Rolfes MA, Lee B, Chodisetty S, Ramirez JA, Fry AM, Patel MM. Differentiating severe and non-severe lower respiratory tract illness in patients hospitalized with influenza: Development of the Influenza Disease Evaluation and Assessment of Severity (IDEAS) scale. PLoS One 2021; 16:e0258482. [PMID: 34673782 PMCID: PMC8530291 DOI: 10.1371/journal.pone.0258482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Experimental studies have shown that vaccination can reduce viral replication to attenuate progression of influenza-associated lower respiratory tract illness (LRTI). However, clinical studies are conflicting, possibly due to use of non-specific outcomes reflecting a mix of large and small airway LRTI lacking specificity for acute lung or organ injury. METHODS We developed a global ordinal scale to differentiate large and small airway LRTI in hospitalized adults with influenza using physiologic features and interventions (PFIs): vital signs, laboratory and radiographic findings, and clinical interventions. We reviewed the literature to identify common PFIs across 9 existing scales of pneumonia and sepsis severity. To characterize patients using this scale, we applied the scale to an antiviral clinical trial dataset where these PFIs were measured through routine clinical care in adults hospitalized with influenza-associated LRTI during the 2010-2013 seasons. RESULTS We evaluated 12 clinical parameters among 1020 adults; 210 (21%) had laboratory-confirmed influenza, with a median severity score of 4.5 (interquartile range, 2-8). Among influenza cases, median age was 63 years, 20% were hospitalized in the prior 90 days, 50% had chronic obstructive pulmonary disease, and 22% had congestive heart failure. Primary influencers of higher score included pulmonary infiltrates on imaging (48.1%), heart rate ≥110 beats/minute (41.4%), oxygen saturation <93% (47.6%) and respiratory rate >24 breaths/minute (21.0%). Key PFIs distinguishing patients with severity < or ≥8 (upper quartile) included infiltrates (27.1% vs 90.0%), temperature ≥ 39.1°C or <36.0°C (7.1% vs 27.1%), respiratory rate >24 breaths/minute (7.9% vs 47.1%), heart rate ≥110 beats/minute (29.3% vs 65.7%), oxygen saturation <90% (14.3% vs 31.4%), white blood cell count >15,000 (5.0% vs 27.2%), and need for invasive or non-invasive mechanical ventilation (2.1% vs 15.7%). CONCLUSION We developed a scale in adults hospitalized with influenza-associated LRTI demonstrating a broad distribution of physiologic severity which may be useful for future studies evaluating the disease attenuating effects of influenza vaccination or other therapeutics.
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Affiliation(s)
- Eric J. Chow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa A. Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benjamin Lee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shreya Chodisetty
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julio A. Ramirez
- Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Alicia M. Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Manish M. Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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7
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A rare presentation of primary lymphoma of bone with aneurysmal bone cyst-like changes. Skeletal Radiol 2021; 50:1029-1037. [PMID: 33044565 DOI: 10.1007/s00256-020-03641-3] [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] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
Primary lymphoma of bone occurs rarely in children with variable imaging findings ranging from a lytic lesion to an aggressive permeative lesion. We detail a case report with review of literature of a 14-year-old boy with a rare presentation of primary lymphoma of bone with aneurysmal bone cyst-like changes. The lesion was surgically excised as management for aneurysmal bone cyst but histopathological examination of the excised tissue revealed a non-Hodgkin's type of lymphoma. This unique type of aneurysmal bone cyst-like presentation has not been well characterised until now in the imaging spectrum of primary lymphoma of bone. Clinicians need to be aware of this uncommon presentation for early intervention and appropriate management of this malignancy in children.
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Schofield C, Colombo RE, Richard SA, Chen WJ, Fairchok MP, Maves RC, Arnold JC, Danaher PJ, Deiss RG, Lalani T, Rajnik M, Millar EV, Coles CL, Burgess TH. Comparable Disease Severity by Influenza Virus Subtype in the Acute Respiratory Infection Consortium Natural History Study. Mil Med 2021; 185:e1008-e1015. [PMID: 32588899 DOI: 10.1093/milmed/usaa120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Since the influenza A/H1N1 pandemic of 2009 to 2010, numerous studies have described the clinical course and outcome of the different subtypes of influenza (A/H1N1, A/H3N2, and B). A recent systematic literature review concluded that there were no appreciable differences in either clinical presentation or disease severity among these subtypes, but study parameters limit the applicability of these results to military populations. We sought to evaluate differences in disease severity among influenza subtypes in a cohort of healthy, primarily outpatient adult U.S. Department of Defense beneficiaries. MATERIALS AND METHODS From 2009 to 2014, we enrolled otherwise healthy adults age 18 to 65 years with influenza-like illness in an observational cohort study based in 5 U.S. military medical centers. Serial nasopharyngeal swabs were collected for determination of etiology and viral shedding by polymerase chain reaction. The presence and severity of symptoms was assessed by interview and patient diary. RESULTS Over a 5-year period, a total of 157 adults with laboratory-confirmed influenza and influenza subtype were enrolled. Of these, 69 (44%) were positive for influenza A(H1N1), 69 (44%) for influenza A(H3N2), and 19 (12%) for influenza B. About 61% were male, 64% were active duty military personnel, and 72% had received influenza vaccine in the past 8 months. Almost 10% were hospitalized with influenza. Seasonal influenza virus distribution among enrollees mirrored that of nationwide trends each year of study. Individuals with A/H1N1 had upper respiratory composite scores that were lower than those with A/H3N2. Multivariate models indicated that individuals with A(H1N1) and B had increased lower respiratory symptom scores when compared to influenza A(H3N2) (A[H1N1]: 1.51 [95% CI 0.47, 2.55]; B: 1.46 [95% CI 0.09, 2.83]), whereas no other differences in symptom severity scores among influenza A(H1N1), influenza A(H3N2), and influenza B infection were observed. Overall, influenza season (maximum in 2012-2013 season) and female sex of the participant were found to be associated with increased influenza symptom severity. CONCLUSIONS Our study of influenza in a cohort of otherwise healthy, outpatient adult Department of Defense beneficiaries over 5 influenza seasons revealed few differences between influenza A(H1N1), influenza A(H3N2), and influenza B infection with respect to self-reported disease severity or clinical outcomes. This study highlights the importance of routine, active, and laboratory-based surveillance to monitor ongoing trends and severity of influenza in various populations to inform prevention measures.
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Affiliation(s)
- Christina Schofield
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431
| | - Rhonda E Colombo
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431.,Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Stephanie A Richard
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Wei-Ju Chen
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Mary P Fairchok
- Infectious Disease Service, Madigan Army Medical Center, 9040 Jackson Ave, Fort Lewis, Washington, Washington DC 98431.,Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Ryan C Maves
- Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - John C Arnold
- Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Patrick J Danaher
- Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX 78234
| | - Robert G Deiss
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088.,Division of Infectious Disease, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134
| | - Tahaniyat Lalani
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088.,Infectious Disease Division, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708
| | - Michael Rajnik
- Division of Infectious Disease, Walter Reed National Military Medical Center, 4494 Palm Rd N, Bethesda, MD 20889
| | - Eugene V Millar
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Christian L Coles
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 2088
| | - Timothy H Burgess
- Infectious Diseases Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 2088
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Delgado-Sanz C, Mazagatos-Ateca C, Oliva J, Gherasim A, Larrauri A. Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010-2017. Emerg Infect Dis 2021; 26:220-228. [PMID: 31961295 PMCID: PMC6986827 DOI: 10.3201/eid2602.181732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Influenza A(H1N1)pdm09 caused more hospitalizations, intensive care unit admissions, and deaths than influenza A(H3N2) or B. We conducted a retrospective cohort study to assess the effect of influenza virus type and subtype on disease severity among hospitalized influenza patients in Spain. We analyzed the cases of 8,985 laboratory-confirmed case-patients hospitalized for severe influenza by using data from a national surveillance system for the period 2010–2017. Hospitalized patients with influenza A(H1N1)pdm09 virus were significantly younger, more frequently had class III obesity, and had a higher risk for pneumonia or acute respiratory distress syndrome than patients infected with influenza A(H3N2) or B (p<0.05). Hospitalized patients with influenza A(H1N1)pdm09 also had a higher risk for intensive care unit admission, death, or both than patients with influenza A(H3N2) or B, independent of other factors. Determining the patterns of influenza-associated severity and how they might differ by virus type and subtype can help guide planning and implementation of adequate control and preventive measures during influenza epidemics.
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Xing X, Hu S, Chen M, Zhan F, Liu H, Chen Z, Zhang H, Zeng G, Xu Q, Zhang H, Liu M, Liu H, Gao L, Zhang L. Severe acute respiratory infection risk following glucocorticosteroid treatment in uncomplicated influenza-like illness resulting from pH1N1 influenza infection: a case control study. BMC Infect Dis 2019; 19:1080. [PMID: 31878888 PMCID: PMC6933691 DOI: 10.1186/s12879-019-4669-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 11/29/2019] [Indexed: 01/07/2023] Open
Abstract
Background Current studies regarding glucocorticosteroid treatment of influenza have only estimated risk of critical illness or death which can be easily confounded by timing of treatment administration. We used severe acute respiratory infection (sARI) as an endpoint and investigated risk associated with receiving glucocorticosteroids before sARI onset. Methods sARI cases were defined as influenza-like illness (ILI) with pH1N1 infection and respiratory distress. Controls were defined as pH1N1 cases other than sARI and randomly selected from the community. We compared glucocorticosteroids and other medications used before sARI onset using a matched case control study adjusted for age group as well as underlying disease. Time-dependent risk and dose responses at different time periods over the course of sARI cases were also examined. Results Of the sARI cases, 34% received glucocorticosteroids before sARI onset compared to 3.8% of controls during equivalent days (ORM-H = 17,95%CI = 2.1–135). Receiving glucocorticosteroids before sARI onset increased risk of developing subsequent critical illness or death (ORM-H = 5.7,95%CI = 1.6–20.2), and the ORM-H increased from 5.7 to 8.5 for continued glucocorticosteroid use after sARI onset. However, only receiving glucocorticosteroids after sARI onset did not increase risk of severe illness (ORM-H = 1.1,95%CI = 0.3–4.6). Each increase in glucocorticosteroids dose of 1 mg/kg/day before sARI onset resulted in an increase of 0.62 (R2 = 0.87) in the pMEWS score at the time of sARI onset. Conclusions Early glucocorticosteroid treatment increased risk of sARI and subsequent critical illness or death; however, only receiving glucocorticosteroids after sARI onset did not increase risk of severe illness.
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Affiliation(s)
- Xuesen Xing
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei Province, China. .,Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
| | - Shixiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Meihua Chen
- Wuhan No. 1 Hospital, Wuhan, Hubei Province, China
| | - Faxian Zhan
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei Province, China
| | - Huihui Liu
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Zhang Chen
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Hengjiao Zhang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Ge Zeng
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Qiaohua Xu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Hong Zhang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Man Liu
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei Province, China
| | - Honghui Liu
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei Province, China
| | - Lidong Gao
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China.
| | - Lijie Zhang
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
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11
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Martínez A, Soldevila N, Romero-Tamarit A, Torner N, Godoy P, Rius C, Jané M, Domínguez À. Risk factors associated with severe outcomes in adult hospitalized patients according to influenza type and subtype. PLoS One 2019; 14:e0210353. [PMID: 30633778 PMCID: PMC6329503 DOI: 10.1371/journal.pone.0210353] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/20/2018] [Indexed: 01/07/2023] Open
Abstract
Seasonal influenza is a cause of hospitalization, especially in people with underlying disease or extreme age, and its severity may differ depending on the types and subtypes of circulating viruses. We investigated the factors associated with ICU admission or death in hospitalized patients with severe laboratory-confirmed influenza according to the viral type and subtype. An observational epidemiological study was carried out in patients aged ≥18 years from 12 Catalan hospitals between 2010 and 2016. For each reported case we collected demographic, virological and clinical characteristics. A mixed-effects logistic regression model was used to estimate crude and adjusted ORs. 1726 hospitalized patients were included: 595 (34.5%) were admitted to the ICU and 224 (13.0%) died. Lower ICU admission was associated with age ≥75 years in all influenza types and subtypes and with age 65-74 years for type A. In contrast, the 65-74 and ≥75 years age groups were associated with an increased risk of death in all types and subtypes, especially for type B (aOR 27.42, 95% CI: 4.95-151.93 and 15.96; 95% CI: 3.01-84.68). The comorbidity most closely associated with severe outcomes was immune deficiency, which was associated with death for type B (aOR 9.02, 95% CI: 3.05-26.69) and subtype A(H1N1)pdm09 (aOR 3.16, 95% CI: 1.77-5.66). Older age was a differential factor for ICU admission and death: it was associated with lower ICU admission but a risk factor for death. The comorbidity with the closest association with death was immune deficiency, mainly in influenza type B patients.
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Affiliation(s)
- Ana Martínez
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | - Núria Torner
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Pere Godoy
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Mireia Jané
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Àngela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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12
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Caini S, Kroneman M, Wiegers T, El Guerche-Séblain C, Paget J. Clinical characteristics and severity of influenza infections by virus type, subtype, and lineage: A systematic literature review. Influenza Other Respir Viruses 2018; 12:780-792. [PMID: 29858537 PMCID: PMC6185883 DOI: 10.1111/irv.12575] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/18/2022] Open
Abstract
Aim Studies carried out in the early 2000s found that the number of influenza‐associated hospitalizations and deaths was highest in seasons dominated by A(H3N2), suggesting that the clinical presentation and severity of influenza may differ across virus types, subtypes, and lineages. We aimed to review the studies that examined this hypothesis. Method We conducted a literature review of studies published until January 2017 that compared the clinical presentation, disease severity, and case‐fatality ratio of influenza patients infected with different virus types (A, B), subtypes (pre‐pandemic A(H1N1), A(H1N1)p, A(H3N2)), and lineages (Victoria, Yamagata). Results The literature search resulted in over 1700 entries: After applying in‐ and exclusion criteria, 47 studies were included in the literature review. Studies showed a wide diversity in setting and populations. Only a minority of studies provided results adjusted by patient's age and other potential confounders. There were very few differences in the clinical presentation of patients infected with different influenza viruses. We found weak evidence that the A(H1N1)p subtype in the post‐pandemic period was more often associated with secondary bacterial pneumonia, ICU admission, and death, than the other influenza virus (sub)types. Conclusion Contrary to what is commonly assumed, the causal virus subtype does not seem to be a major determinant of clinical presentation and severity of influenza illness. However, drawing conclusions was made difficult by the low comparability and methodological shortcomings of included studies, and more well‐designed studies are warranted.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Madelon Kroneman
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Therese Wiegers
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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13
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Cao B, Huang Y, She DY, Cheng QJ, Fan H, Tian XL, Xu JF, Zhang J, Chen Y, Shen N, Wang H, Jiang M, Zhang XY, Shi Y, He B, He LX, Liu YN, Qu JM. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. CLINICAL RESPIRATORY JOURNAL 2017; 12:1320-1360. [PMID: 28756639 PMCID: PMC7162259 DOI: 10.1111/crj.12674] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/25/2017] [Indexed: 02/05/2023]
Abstract
Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.
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Affiliation(s)
- Bin Cao
- National Clinical Research Center of Respiratory Diseases, Center for Respiratory Diseases, China-Japan Friendship Hospital, Capital Medical University, Beijing 100029, China
| | - Yi Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai 200433, China
| | - Dan-Yang She
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Jian Cheng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Hong Fan
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan 610041, China
| | - Xin-Lun Tian
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jin-Fu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu Chen
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing 100044, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xiang-Yan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing 210002, China
| | - Bei He
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Li-Xian He
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - You-Ning Liu
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Jie-Ming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
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14
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Li H, Yang SG, Gu L, Zhang Y, Yan XX, Liang ZA, Zhang W, Jia HY, Chen W, Liu M, Yu KJ, Xue CX, Hu K, Zou Q, Li LJ, Cao B, Wang C. Effect of low-to-moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia. Influenza Other Respir Viruses 2017; 11:345-354. [PMID: 28464462 PMCID: PMC5485871 DOI: 10.1111/irv.12456] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 02/05/2023] Open
Abstract
Background The effect of corticosteroids on influenza A(H1N1)pdm09 viral pneumonia patients remains controversial, and the impact of dosage has never been studied. Methods Using data of hospitalized adolescent and adult patients with influenza A(H1N1)pdm09 viral pneumonia, prospectively collected from 407 hospitals in mainland China, the effects of low‐to‐moderate‐dose (25‐150 mg d−1) and high‐dose (>150 mg d−1) corticosteroids on 30‐day mortality, 60‐day mortality, and nosocomial infection were assessed with multivariate Cox regression and propensity score‐matched case–control analysis. Results In total, 2141 patients (median age: 34 years; morality rate: 15.9%) were included. Among them, 1160 (54.2%) had PaO2/FiO2<300 mm Hg on admission, and 1055 (49.3%) received corticosteroids therapy. Corticosteroids, without consideration of dose, did not influence either 30‐day or 60‐day mortality. Further analysis revealed that, as compared with the no‐corticosteroid group, low‐to‐moderate‐dose corticosteroids were related to reduced 30‐day mortality (adjusted hazard ratio [aHR] 0.64 [95% CI 0.43‐0.96, P=.033]). In the subgroup analysis among patients with PaO2/FiO2<300 mm Hg, low‐to‐moderate‐dose corticosteroid treatment significantly reduced both 30‐day mortality (aHR 0.49 [95% CI 0.32‐0.77]) and 60‐day mortality (aHR 0.51 [95% CI 0.33‐0.78]), while high‐dose corticosteroid therapy yielded no difference. For patients with PaO2/FiO2 ≥300 mm Hg, corticosteroids (irrespective of dose) showed no benefit and even increased 60‐day mortality (aHR 3.02 [95% CI 1.06‐8.58]). Results were similar in the propensity model analysis. Conclusions Low‐to‐moderate‐dose corticosteroids might reduce mortality of influenza A(H1N1)pdm09 viral pneumonia patients with PaO2/FiO2<300 mm Hg. Mild patients with PaO2/FiO2 ≥300 mm Hg could not benefit from corticosteroid therapy.
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Affiliation(s)
- Hui Li
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shi-Gui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Li Gu
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yao Zhang
- Global Health, Population & Nutrition, Global Research & Services, Family Health International 360, Durham, NC, USA
| | - Xi-Xin Yan
- Department of Respiratory Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zong-An Liang
- West China Hospital of Sichuan University, Chengdu, China
| | - Wei Zhang
- The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Hong-Yu Jia
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Chen
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Meng Liu
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Kai-Jiang Yu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chun-Xue Xue
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ke Hu
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Qi Zou
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Lan-Juan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Bin Cao
- Center for Respiratory Diseases China-Japan Friendship Hospital, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China.,National Clinical Research Centre for Respiratory Disease, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- Center for Respiratory Diseases China-Japan Friendship Hospital, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China.,National Clinical Research Centre for Respiratory Disease, Beijing, China.,Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
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15
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Rath B, Conrad T, Myles P, Alchikh M, Ma X, Hoppe C, Tief F, Chen X, Obermeier P, Kisler B, Schweiger B. Influenza and other respiratory viruses: standardizing disease severity in surveillance and clinical trials. Expert Rev Anti Infect Ther 2017; 15:545-568. [PMID: 28277820 PMCID: PMC7103706 DOI: 10.1080/14787210.2017.1295847] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Influenza-Like Illness is a leading cause of hospitalization in children. Disease burden due to influenza and other respiratory viral infections is reported on a population level, but clinical scores measuring individual changes in disease severity are urgently needed. Areas covered: We present a composite clinical score allowing individual patient data analyses of disease severity based on systematic literature review and WHO-criteria for uncomplicated and complicated disease. The 22-item ViVI Disease Severity Score showed a normal distribution in a pediatric cohort of 6073 children aged 0-18 years (mean age 3.13; S.D. 3.89; range: 0 to 18.79). Expert commentary: The ViVI Score was correlated with risk of antibiotic use as well as need for hospitalization and intensive care. The ViVI Score was used to track children with influenza, respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus infections and is fully compliant with regulatory data standards. The ViVI Disease Severity Score mobile application allows physicians to measure disease severity at the point-of care thereby taking clinical trials to the next level.
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Affiliation(s)
- Barbara Rath
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Tim Conrad
- d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Puja Myles
- c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Maren Alchikh
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xiaolin Ma
- b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
| | - Christian Hoppe
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Franziska Tief
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xi Chen
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Patrick Obermeier
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Bron Kisler
- f Clinical Data Standards Interchange Consortium (CDISC) , Austin , TX , USA
| | - Brunhilde Schweiger
- e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
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16
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Kwok KO, Riley S, Perera RAPM, Wei VWI, Wu P, Wei L, Chu DKW, Barr IG, Malik Peiris JS, Cowling BJ. Relative incidence and individual-level severity of seasonal influenza A H3N2 compared with 2009 pandemic H1N1. BMC Infect Dis 2017; 17:337. [PMID: 28494805 PMCID: PMC5425986 DOI: 10.1186/s12879-017-2432-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 04/28/2017] [Indexed: 12/25/2022] Open
Abstract
Background Two subtypes of influenza A currently circulate in humans: seasonal H3N2 (sH3N2, emerged in 1968) and pandemic H1N1 (pH1N1, emerged in 2009). While the epidemiological characteristics of the initial wave of pH1N1 have been studied in detail, less is known about its infection dynamics during subsequent waves or its severity relative to sH3N2. Even prior to 2009, few data was available to estimate the risk of severe outcomes following infection with one circulating influenza strain relative to another. Methods We analyzed antibodies in quadruples of sera from individuals in Hong Kong collected between July 2009 and December 2011, a period that included three distinct influenza virus epidemics. We estimated infection incidence using these assay data and then estimated rates of severe outcomes per infection using population-wide clinical data. Results Cumulative incidence of infection was high among children in the first epidemic of pH1N1. There was a change towards the older age group in the age distribution of infections for pH1N1 from the first to the second epidemic, with the age distribution of the second epidemic of pH1N1 more similar to that of sH3N2. We found no serological evidence that individuals were infected in both waves of pH1N1. The risks of excess mortality conditional on infection were higher for sH3N2 than for pH1N1, with age-standardized risk ratios of 2.6 [95% CI: 1.8, 3.7] for all causes and 1.5 [95% CI: 1.0, 2.1] for respiratory causes throughout the study period. Conclusions Overall increase in clinical incidence of pH1N1 and higher rates of severity in older adults in post pandemic waves were in line with an age-shift in infection towards the older age groups. The absence of repeated infection is good evidence that waning immunity did not cause the second wave. Despite circulating in humans since 1968, sH3N2 is substantially more severe per infection than the pH1N1 strain. Infection-based estimates of individual-level severity have a role in assessing emerging strains; updating seasonal vaccine components; and optimizing of vaccination programs. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2432-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kin On Kwok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China.,Tanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong, Special Administrative Region of China.,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Steven Riley
- MRC Centre for Outbreak Analysis and Modelling, Department for Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Ranawaka A P M Perera
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Vivian W I Wei
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Lan Wei
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Daniel K W Chu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Ian G Barr
- WHO Collaborating Centre for Reference and Research, Melbourne, VIC, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia
| | - J S Malik Peiris
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, Special Administrative Region of China
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17
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Kusznierz G, Carolina C, Manuel RJ, Sergio L, Lucila O, Julio B, Mirta V, Pedro M, Graciana M, Andrea U, Elsa Z. Impact of influenza in the post-pandemic phase: Clinical features in hospitalized patients with influenza A (H1N1) pdm09 and H3N2 viruses, during 2013 in Santa Fe, Argentina. J Med Virol 2017; 89:1186-1191. [PMID: 28004402 DOI: 10.1002/jmv.24758] [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] [Received: 08/11/2016] [Revised: 11/22/2016] [Accepted: 12/20/2016] [Indexed: 01/02/2023]
Abstract
It is important to characterize the clinical and epidemiological pattern of the influenza A (H1N1) pdm09 virus and compare it with influenza A (H3N2) virus, as surveyed in just a few studies, in order to contribute to the implementation and strengthening of influenza control and prevention strategies. The aims in this study were to describe influenza clinical and epidemiological characteristics in hospitalized patients, caused by influenza A (H1N1)pdm09 and influenza A (H3N2) viruses during 2013, in Santa Fe, Argentina. A retrospective study was conducted over 2013 among hospitalized patients with laboratory-confirmed influenza diagnosis. In contrast to patients with influenza A (H3N2) (20.5%), a higher proportion of hospitalizations associated with influenza H1N1pdm were reported among adults aged 35-65 years (42.8%). Of all patients, 73.6% had an underlying medical condition. Hospitalized patients with H1N1pdm were subject to 2.6 (95%CI, 1.0-6.8) times higher risk of severity, than those hospitalized with influenza A (H3N2). This results demonstrate the impact in the post-pandemic era of H1N1pdm virus, with increased risk of severe disease, in relation to H3N2 virus, both viruses co-circulating during 2013.
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Affiliation(s)
- Gabriela Kusznierz
- Instituto Nacional Enfermedades Respiratorias "Dr. Emilio Coni", Santa Fe, Argentina
| | - Cudós Carolina
- Instituto Nacional Enfermedades Respiratorias "Dr. Emilio Coni", Santa Fe, Argentina
| | - Rudi Juan Manuel
- Instituto Nacional Enfermedades Respiratorias "Dr. Emilio Coni", Santa Fe, Argentina
| | - Lejona Sergio
- Centro de Especialidades Médicas de Rosario, Santa Fe, Argentina
| | | | | | - Villani Mirta
- Dirección Provincial de Promoción y Protección de la Salud, Ministerio de Salud, Santa Fe, Argentina
| | - Morana Pedro
- Dirección Provincial de Promoción y Protección de la Salud, Ministerio de Salud, Santa Fe, Argentina
| | | | - Uboldi Andrea
- Dirección Provincial de Promoción y Protección de la Salud, Ministerio de Salud, Santa Fe, Argentina
| | - Zerbini Elsa
- Instituto Nacional Enfermedades Respiratorias "Dr. Emilio Coni", Santa Fe, Argentina
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18
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Rendón-Ramirez EJ, Ortiz-Stern A, Martinez-Mejia C, Salinas-Carmona MC, Rendon A, Mata-Tijerina VL, Rosas-Taraco AG. TGF-β Blood Levels Distinguish Between Influenza A (H1N1)pdm09 Virus Sepsis and Sepsis due to Other Forms of Community-Acquired Pneumonia. Viral Immunol 2015; 28:248-54. [PMID: 25923384 DOI: 10.1089/vim.2014.0123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
There is a strong interest in finding adequate biomarkers to aid in the diagnosis and prognosis of influenza A (H1N1)pdm09 virus infection. In this study, serum levels of inflammatory cytokines and laboratory markers were evaluated to assess their usefulness as biomarkers of influenza A (H1N1)pdm09 and their association with fatal cases. Serum samples of consecutive patients with a clinical presentation suggestive of influenza A (H1N1)pdm09 and progression to sepsis were evaluated. Serum inflammatory cytokines and routine laboratory tests were performed and correlated with positivity for influenza A (H1N1)pdm09 influenza by real time reverse transcription polymerase chain reaction and the results of three clinical severity scores (Sequential Organ Failure Assessment [SOFA], CURB-65, and Acute Physiology and Chronic Health Evaluation II [APACHE II]). High SOFA scores and some of its individual components, but not CURB-65 or APACHE II scores, correlate with fatal cases regardless of etiology. Total and unconjugated bilirubin, Ca(++), Cl(-), prothrombin times, and partial thromboplastin times discriminate influenza A (H1N1)pdm09 from other causes of community-acquired pneumonia. High levels of IL-8, IL-10, and IL-17 were increased in influenza A (H1N1)pdm09 patients when compared with controls (p<0.05). IL-6 levels were significantly elevated in influenza A (H1N1)pdm09 patients and non-(H1N1)pdm09 patients when compared with controls (p<0.05). TGF-β serum levels discern between healthy controls, influenza A (H1N1)pdm09 patients, and patients with other causes of community-acquired pneumonia. TGF-β levels were negatively correlated with SOFA on admission in influenza A (H1N1)pdm09 patients. TGF-β levels are a useful tool for differentiating influenza A (H1N1)pdm09 from other causes of pneumonia progressing to sepsis.
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Affiliation(s)
- Erick J Rendón-Ramirez
- 1Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.,2Department of Internal Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Ortiz-Stern
- 1Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.,2Department of Internal Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Corazon Martinez-Mejia
- 1Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.,2Department of Internal Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Mario C Salinas-Carmona
- 1Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.,2Department of Internal Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Adrian Rendon
- 3CIPTIR (Centro de Investigación, Prevención y Tratamiento de Infecciones Respiratorias), Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Viviana L Mata-Tijerina
- 4Centro de Investigaciones Biomédicas del Noreste del Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon, Mexico
| | - Adrian G Rosas-Taraco
- 1Department of Immunology, Faculty of Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.,2Department of Internal Medicine, Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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Lee N, Leo YS, Cao B, Chan PKS, Kyaw WM, Uyeki TM, Tam WWS, Cheung CSK, Yung IMH, Li H, Gu L, Liu Y, Liu Z, Qu J, Hui DSC. Neuraminidase inhibitors, superinfection and corticosteroids affect survival of influenza patients. Eur Respir J 2015; 45:1642-52. [PMID: 25573405 DOI: 10.1183/09031936.00169714] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/11/2014] [Indexed: 01/18/2023]
Abstract
We aimed to study factors influencing outcomes of adults hospitalised for seasonal and pandemic influenza. Individual-patient data from three Asian cohorts (Hong Kong, Singapore and Beijing; N=2649) were analysed. Adults hospitalised for laboratory-confirmed influenza (prospectively diagnosed) during 2008-2011 were studied. The primary outcome measure was 30-day survival. Multivariate Cox regression models (time-fixed and time-dependent) were used. Patients had high morbidity (respiratory/nonrespiratory complications in 68.4%, respiratory failure in 48.6%, pneumonia in 40.8% and bacterial superinfections in 10.8%) and mortality (5.9% at 30 days and 6.9% at 60 days). 75.2% received neuraminidase inhibitors (NAI) (73.8% received oseltamivir and 1.4% received peramivir/zanamivir; 44.5% of patients received NAI ≤2 days and 65.5% ≤5 days after onset of illness); 23.1% received systemic corticosteroids. There were fewer deaths among NAI-treated patients (5.3% versus 7.6%; p=0.032). NAI treatment was independently associated with survival (adjusted hazard ratio (HR) 0.28, 95% CI 0.19-0.43), adjusted for treatment-propensity score and patient characteristics. Superinfections increased (adjusted HR 2.18, 95% CI 1.52-3.11) and chronic statin use decreased (adjusted HR 0.44, 95% CI 0.23-0.84) death risks. Best survival was shown when treatment started within ≤2 days (adjusted HR 0.20, 95% CI 0.12-0.32), but there was benefit with treatment within 3-5 days (adjusted HR 0.35, 95% CI 0.21-0.58). Time-dependent analysis showed consistent results of NAI treatment (adjusted HR 0.39, 95% CI 0.27-0.57). Corticosteroids increased superinfection (9.7% versus 2.7%) and deaths when controlled for indications (adjusted HR 1.73, 95% CI 1.14-2.62). Early NAI treatment was associated with shorter length of stay in a subanalysis. NAI treatment may improve survival of hospitalised influenza patients; benefit is greatest from, but not limited to, treatment started within 2 days of illness. Superinfections and corticosteroids increase mortality. Antiviral and non-antiviral management strategies should be considered.
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Affiliation(s)
- Nelson Lee
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
| | - Yee-Sin Leo
- Communicable Diseases Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bin Cao
- Dept of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Paul K S Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China. Dept of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - W M Kyaw
- Communicable Diseases Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wilson W S Tam
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Catherine S K Cheung
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Irene M H Yung
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Hui Li
- Dept of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Li Gu
- Dept of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yingmei Liu
- Dept of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Zhenjia Liu
- Dept of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Jiuxin Qu
- Dept of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, Beijing, China
| | - David S C Hui
- Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China. Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
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