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He C, Norton D, Temte JL, Barlow S, Goss M, Temte E, Bell C, Chen G, Uzicanin A. Effect of planned school breaks on student absenteeism due to influenza-like illness in school aged children-Oregon School District, Wisconsin September 2014-June 2019. Influenza Other Respir Viruses 2024; 18:e13244. [PMID: 38235373 PMCID: PMC10792089 DOI: 10.1111/irv.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024] Open
Abstract
Background School-aged children and school reopening dates have important roles in community influenza transmission. Although many studies evaluated the impact of reactive closures during seasonal and pandemic influenza outbreaks on medically attended influenza in surrounding communities, few assess the impact of planned breaks (i.e., school holidays) that coincide with influenza seasons, while accounting for differences in seasonal peak timing. Here, we analyze the effects of winter and spring breaks on influenza risk in school-aged children, measured by student absenteeism due to influenza-like illness (a-ILI). Methods We compared a-ILI counts in the 2-week periods before and after each winter and spring break over five consecutive years in a single school district. We introduced a "pseudo-break" of 9 days' duration between winter and spring break each year when school was still in session to serve as a control. The same analysis was applied to each pseudo-break to support any findings of true impact. Results We found strong associations between winter and spring breaks and a reduction in influenza risk, with a nearly 50% reduction in a-ILI counts post-break compared with the period before break, and the greatest impact when break coincided with increased local influenza activity while accounting for possible temporal and community risk confounders. Conclusions These findings suggest that brief breaks of in-person schooling, such as planned breaks lasting 9-16 calendar days, can effectively reduce influenza in schools and community spread. Additional analyses investigating the impact of well-timed shorter breaks on a-ILI may determine an optimal duration for brief school closures to effectively suppress community transmission of influenza.
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Affiliation(s)
- Cecilia He
- University of WisconsinMadisonWisconsinUSA
| | | | | | | | | | | | | | | | - Amra Uzicanin
- Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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Yang J, Zhang T, Yang L, Han X, Zhang X, Wang Q, Feng L, Yang W. Association between ozone and influenza transmissibility in China. BMC Infect Dis 2023; 23:763. [PMID: 37932657 PMCID: PMC10626750 DOI: 10.1186/s12879-023-08769-w] [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: 08/03/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Common air pollutants such as ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter play significant roles as influential factors in influenza-like illness (ILI). However, evidence regarding the impact of O3 on influenza transmissibility in multi-subtropical regions is limited, and our understanding of the effects of O3 on influenza transmissibility in temperate regions remain unknown. METHODS We studied the transmissibility of influenza in eight provinces across both temperate and subtropical regions in China based on 2013 to 2018 provincial-level surveillance data on influenza-like illness (ILI) incidence and viral activity. We estimated influenza transmissibility by using the instantaneous reproduction number ([Formula: see text]) and examined the relationships between transmissibility and daily O3 concentrations, air temperature, humidity, and school holidays. We developed a multivariable regression model for [Formula: see text] to quantify the contribution of O3 to variations in transmissibility. RESULTS Our findings revealed a significant association between O3 and influenza transmissibility. In Beijing, Tianjin, Shanghai and Jiangsu, the association exhibited a U-shaped trend. In Liaoning, Gansu, Hunan, and Guangdong, the association was L-shaped. When aggregating data across all eight provinces, a U-shaped association was emerged. O3 was able to accounted for up to 13% of the variance in [Formula: see text]. O3 plus other environmental drivers including mean daily temperature, relative humidity, absolute humidity, and school holidays explained up to 20% of the variance in [Formula: see text]. CONCLUSIONS O3 was a significant driver of influenza transmissibility, and the association between O3 and influenza transmissibility tended to display a U-shaped pattern.
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Affiliation(s)
- Jiao Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Ting Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Liuyang Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
- Department of Management Science and Information System, Faculty of Management and Economics, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Xuan Han
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Xingxing Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Qing Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China.
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China.
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China.
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China.
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Temte JL, Bell C, Goss MD, Reisdorf E, Tamerius J, Reddy S, Griesser R, Barlow S, Temte E, Wedig M, Shult PA. Adequacy of using a single nasal swab for rapid influenza diagnostic testing, PCR, and whole genome sequencing. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001422. [PMID: 37224148 DOI: 10.1371/journal.pgph.0001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/24/2023] [Indexed: 05/26/2023]
Abstract
Rapid influenza diagnostic tests (RIDT) demonstrate varying sensitivities, often necessitating reverse transcriptase polymerase chain reaction (RT-PCR) to confirm results. The two methods generally require separate specimens. Using the same anterior nasal swab for both RIDT and molecular confirmation would reduce cost and waste and increase patient comfort. The aim of this study was to determine if RIDT residual nasal swab (rNS) specimens are adequate for RT-PCR and whole genome sequencing (WGS). We performed RT-PCR and WGS on paired rNS and nasopharyngeal or oropharyngeal (NP/OP) swab specimens that were collected from primary care patients across all ages. We randomly selected 199 and 40 paired specimens for RT-PCR and WGS, respectively, from the 962 paired surveillance specimens collected during the 2014-2015 influenza season. Sensitivity and specificity for rNS specimens were 81.3% and 96.7%, respectively, as compared to NP/OP specimens. The mean cycle threshold (Ct) value for the NP/OP specimen was significantly lower when the paired specimens were both positive than when the NP/OP swab was positive and the nasal swab was negative (25.5 vs 29.5; p<0.001). Genomic information was extracted from all 40 rNS specimens and 37 of the 40 NP/OP specimens. Complete WGS reads were available for 67.5% (14 influenza A; 13 influenza B) of the rNS specimens and 59.5% (14 influenza A; 8 influenza B) of the NP/OP specimens. It is feasible to use a single anterior nasal swab for RIDT followed by RT-PCR and/or WGS. This approach may be appropriate in situations where training and supplies are limited. Additional studies are needed to determine if residual nasal swabs from other rapid diagnostic tests produce similar results.
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Affiliation(s)
- Jonathan L Temte
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Cristalyne Bell
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Maureen D Goss
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, United States of America
| | - John Tamerius
- Quidel Corporation, San Diego, California, United States of America
| | - Sushruth Reddy
- Quidel Corporation, San Diego, California, United States of America
| | - Richard Griesser
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, United States of America
| | - Shari Barlow
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Emily Temte
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Mary Wedig
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, United States of America
| | - Peter A Shult
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, United States of America
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Zhang ZS, Xi L, Yang LL, Lian XY, Du J, Cui Y, Li HJ, Zhang WX, Wang C, Liu B, Yang YN, Cui F, Lu QB. Impact of air pollutants on influenza-like illness outpatient visits under urbanization process in the sub-center of Beijing, China. Int J Hyg Environ Health 2023; 247:114076. [PMID: 36427387 DOI: 10.1016/j.ijheh.2022.114076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022]
Abstract
Air pollutants can cause serious harm to human health and a variety of respiratory diseases. This study aimed to explore the associations between air pollutants and outpatient visits for influenza-like illness (ILI) under urbanization process in the sub-center of Beijing. The data of ILI in sub-center of Beijing from April 1, 2014 to December 31, 2020 were obtained from Beijing Influenza Surveillance Network. A generalized additive Poisson model was applied to examine the associations between the concentrations of air pollutants and daily outpatient visits for ILI when controlling meteorological factors and holidays. A total of 322,559 patients with ILI were included. The results showed that in the early urbanization period, the effects of PM2.5, PM10, SO2, O3, and CO on lag0 day, and PM2.5, PM10, O3, and CO on lag1 day were not significant. In the later urbanization period, AQI and the concentrations of PM2.5, PM10, SO2, NO2 and CO on lag1 day were all significantly associated with an increased risk of outpatient visits for ILI, which increased by 0.34% (95%CI 0.23%, 0.45%), 0.42% (95%CI 0.29%, 0.56%), 0.44% (95%CI 0.33%, 0.55%), 0.36% (95%CI 0.24%, 0.49%), 0.91% (95%CI 0.62%, 1.21%) and 0.38% (95%CI 0.26%, 0.49%). The concentration of O3 on lag1 day was significantly associated with a decreased risk of outpatient visits for ILI, which decreased by 0.21% (95%CI 0.04%, 0.39%). We found that the urbanization process had significantly aggravated the impact of air pollutants on ILI outpatient visits. These findings expand the current knowledge of ILI outpatient visits correlated with air pollutants under urbanization process.
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Affiliation(s)
- Zhong-Song Zhang
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China
| | - Lu Xi
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Prevention and Control, Beijing, 101100, PR China
| | - Li-Li Yang
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Prevention and Control, Beijing, 101100, PR China
| | - Xin-Yao Lian
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China
| | - Juan Du
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, 100191, PR China
| | - Yan Cui
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Prevention and Control, Beijing, 101100, PR China
| | - Hong-Jun Li
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Prevention and Control, Beijing, 101100, PR China
| | - Wan-Xue Zhang
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, 100191, PR China
| | - Chao Wang
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, 100191, PR China
| | - Bei Liu
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, 100191, PR China
| | - Yan-Na Yang
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Prevention and Control, Beijing, 101100, PR China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China; Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, 100191, PR China.
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China; Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, 100191, PR China.
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Cohen PR, Rybak A, Werner A, Béchet S, Desandes R, Hassid F, André JM, Gelbert N, Thiebault G, Kochert F, Cahn-Sellem F, Vié Le Sage F, Angoulvant PF, Ouldali N, Frandji B, Levy C. Trends in pediatric ambulatory community acquired infections before and during COVID-19 pandemic: A prospective multicentric surveillance study in France. Lancet Reg Health Eur 2022; 22:100497. [PMID: 36034052 PMCID: PMC9398201 DOI: 10.1016/j.lanepe.2022.100497] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Covid-19 pandemic control has imposed several non-pharmaceutical interventions (NPIs). Strict application of these measures has had a dramatic reduction on the epidemiology of several infectious diseases. As the pandemic is ongoing for more than 2 years, some of these measures have been removed, mitigated, or less well applied. The aim of this study is to investigate the trends of pediatric ambulatory infectious diseases before and up to two years after the onset of the pandemic. Methods We conducted a prospective surveillance study in France with 107 pediatricians specifically trained in pediatric infectious diseases. From January 2018 to April 2022, the electronic medical records of children with an infectious disease were automatically extracted. The annual number of infectious diseases in 2020 and 2021 was compared to 2018-2019 and their frequency was compared by logistic regression. Findings From 2018 to 2021, 185,368 infectious diseases were recorded. Compared to 2018 (n=47,116) and 2019 (n=51,667), the annual number of cases decreased in 2020 (n=35,432) by about a third. Frequency of scarlet fever, tonsillopharyngitis, enteroviral infections, bronchiolitis, and gastroenteritis decreased with OR varying from 0·6 (CI95% [0·5;0·7]) to 0·9 (CI95% [0·8;0·9]), p<0·001. In 2021, among the 52,153 infectious diagnoses, an off-season rebound was observed with increased frequency of enteroviral infections, bronchiolitis, gastroenteritis and otitis with OR varying from 1·1 (CI95% [1·0;1·1]) to 1·5 (CI95% [1·4;1·5]), p<0·001. Interpretation While during NPIs strict application, the overall frequency of community-acquired infections was reduced, after relaxation of these measures, a rebound of some of them (enteroviral infections, bronchiolitis, gastroenteritis, otitis) occurred beyond the pre-pandemic level. These findings highlight the need for continuous surveillance of infectious diseases, especially insofar as future epidemics are largely unpredictable. Funding ACTIV, AFPA, GSK, MSD, Pfizer and Sanofi.
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Assessment of potential factors associated with the sensitivity and specificity of Sofia Influenza A+B Fluorescent Immunoassay in an ambulatory care setting. PLoS One 2022; 17:e0268279. [PMID: 35536787 PMCID: PMC9089855 DOI: 10.1371/journal.pone.0268279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background Seasonal influenza leads to an increase in outpatient clinic visits. Timely, accurate, and affordable testing could facilitate improved treatment outcomes. Rapid influenza diagnostic tests (RIDTs) provide results in as little as 15 minutes and are relatively inexpensive, but have reduced sensitivity when compared to RT-PCR. The contributions of multiple factors related to test performance are not well defined for ambulatory care settings. We assessed clinical and laboratory factors that may affect the sensitivity and specificity of Sofia Influenza A+B Fluorescence Immunoassay. Study design We performed a post-hoc assessment of surveillance data amassed over seven years from five primary care clinics. We analyzed 4,475 paired RIDT and RT-PCR results from specimens collected from patients presenting with respiratory symptoms and examined eleven potential factors with additional sub-categories that could affect RIDT sensitivity. Results In an unadjusted analysis, greater sensitivity was associated with the presence of an influenza-like illness (ILI), no other virus detected, no seasonal influenza vaccination, younger age, lower cycle threshold value, fewer days since illness onset, nasal discharge, stuffy nose, and fever. After adjustment, presence of an ILI, younger age, fewer days from onset, no co-detection, and presence of a nasal discharge maintained significance. Conclusion Clinical and laboratory factors may affect RIDT sensitivity. Identifying potential factors during point-of-care testing could aid clinicians in appropriately interpreting negative influenza RIDT results.
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Temte JL, Barlow S, Goss M, Temte E, Schemmel A, Bell C, Reisdorf E, Shult P, Wedig M, Haupt T, Conway JH, Gangnon R, Uzicanin A. Cause-specific student absenteeism monitoring in K-12 schools for detection of increased influenza activity in the surrounding community—Dane County, Wisconsin, 2014–2020. PLoS One 2022; 17:e0267111. [PMID: 35439269 PMCID: PMC9017898 DOI: 10.1371/journal.pone.0267111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background Schools are primary venues of influenza amplification with secondary spread to communities. We assessed K-12 student absenteeism monitoring as a means for early detection of influenza activity in the community. Materials and methods Between September 2014 and March 2020, we conducted a prospective observational study of all-cause (a-TOT), illness-associated (a-I), and influenza-like illness–associated (a-ILI) absenteeism within the Oregon School District (OSD), Dane County, Wisconsin. Absenteeism was reported through the electronic student information system. Students were visited at home where pharyngeal specimens were collected for influenza RT-PCR testing. Surveillance of medically-attended laboratory-confirmed influenza (MAI) occurred in five primary care clinics in and adjoining the OSD. Poisson general additive log linear regression models of daily counts of absenteeism and MAI were compared using correlation analysis. Findings Influenza was detected in 723 of 2,378 visited students, and in 1,327 of 4,903 MAI patients. Over six influenza seasons, a-ILI was significantly correlated with MAI in the community (r = 0.57; 95% CI: 0.53–0.63) with a one-day lead time and a-I was significantly correlated with MAI in the community (r = 0.49; 0.44–0.54) with a 10-day lead time, while a-TOT performed poorly (r = 0.27; 0.21–0.33), following MAI by six days. Discussion Surveillance using cause-specific absenteeism was feasible and performed well over a study period marked by diverse presentations of seasonal influenza. Monitoring a-I and a-ILI can provide early warning of seasonal influenza in time for community mitigation efforts.
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Affiliation(s)
- Jonathan L. Temte
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Shari Barlow
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Maureen Goss
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Emily Temte
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Amber Schemmel
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Cristalyne Bell
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
- * E-mail:
| | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, United States of America
| | - Peter Shult
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, United States of America
| | - Mary Wedig
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, United States of America
| | - Thomas Haupt
- Wisconsin Division of Public Health, Wisconsin Department of Health Services, Madison, Wisconsin, United States of America
| | - James H. Conway
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Ronald Gangnon
- Department of Biostatistics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Amra Uzicanin
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Jiang Y, Tong YQ, Fang B, Zhang WK, Yu XJ. Applying the Moving Epidemic Method to Establish the Influenza Epidemic Thresholds and Intensity Levels for Age-Specific Groups in Hubei Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031677. [PMID: 35162701 PMCID: PMC8834852 DOI: 10.3390/ijerph19031677] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND School-aged children were reported to act as the main transmitter during influenza epidemic seasons. It is vital to set up an early detection method to help with the vaccination program in such a high-risk population. However, most relative studies only focused on the general population. Our study aims to describe the influenza epidemiology characteristics in Hubei Province and to introduce the moving epidemic method to establish the epidemic thresholds for age-specific groups. METHODS We divided the whole population into pre-school, school-aged and adult groups. The virology data from 2010/2011 to 2017/2018 were applied to the moving epidemic method to establish the epidemic thresholds for the general population and age-specific groups for the detection of influenza in 2018/2019. The performances of the model were compared by the cross-validation process. RESULTS The epidemic threshold for school-aged children in the 2018/2019 season was 15.42%. The epidemic thresholds for influenza A virus subtypes H1N1 and H3N2 and influenza B were determined as 5.68%, 6.12% and 10.48%, respectively. The median start weeks of the school-aged children were similar to the general population. The cross-validation process showed that the sensitivity of the model established with school-aged children was higher than those established with the other age groups in total influenza, H1N1 and influenza B, while it was only lower than the general population group in H3N2. CONCLUSIONS This study proved the feasibility of applying the moving epidemic method in Hubei Province. Additional influenza surveillance and vaccination strategies should be well-organized for school-aged children to reduce the disease burden of influenza in China.
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Affiliation(s)
- Yuan Jiang
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan 430071, China; (Y.J.); (W.-k.Z.)
| | - Ye-qing Tong
- Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China; (Y.-q.T.); (B.F.)
| | - Bin Fang
- Hubei Provincial Center for Disease Control and Prevention, Wuhan 430079, China; (Y.-q.T.); (B.F.)
| | - Wen-kang Zhang
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan 430071, China; (Y.J.); (W.-k.Z.)
| | - Xue-jie Yu
- State Key Laboratory of Virology, School of Public Health, Wuhan University, Wuhan 430071, China; (Y.J.); (W.-k.Z.)
- Correspondence:
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9
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Temte JL, Barlow S, Goss M, Temte E, Bell C, He C, Hamer C, Schemmel A, Maerz B, Comp L, Arnold M, Breunig K, Clifford S, Reisdorf E, Shult P, Wedig M, Haupt T, Conway J, Gangnon R, Fowlkes A, Uzicanin A. The Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS): Rationale, objectives, and design. Influenza Other Respir Viruses 2021; 16:340-350. [PMID: 34623760 PMCID: PMC8818813 DOI: 10.1111/irv.12920] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Influenza viruses pose significant disease burdens through seasonal outbreaks and unpredictable pandemics. Existing surveillance programs rely heavily on reporting of medically attended influenza (MAI). Continuously monitoring cause-specific school absenteeism may identify local acceleration of seasonal influenza activity. The Oregon Child Absenteeism Due to Respiratory Disease Study (ORCHARDS; Oregon, WI) implements daily school-based monitoring of influenza-like illness-specific student absenteeism (a-ILI) in kindergarten through Grade 12 schools and assesses this approach for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities. METHODS Starting in September 2014, ORCHARDS combines automated reporting of daily absenteeism within six schools and home visits to school children with acute respiratory infection (ARI). Demographic, epidemiological, and symptom data are collected along with respiratory specimens. Specimens are tested for influenza and other respiratory viruses. Household members can opt into a supplementary household transmission study. Community comparisons are possible using a pre-existing and highly effective influenza surveillance program, based on MAI at five family medicine clinics in the same geographical area. RESULTS Over the first 5 years, a-ILI occurred on 6634 (0.20%) of 3,260,461 student school days. Viral pathogens were detected in 64.5% of 1728 children with ARI who received a home visit. Influenza was the most commonly detected virus, noted in 23.3% of ill students. CONCLUSION ORCHARDS uses a community-based design to detect influenza trends over multiple seasons and to evaluate the utility of absenteeism for early detection of accelerated influenza and other respiratory pathogen transmission in schools and surrounding communities.
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Affiliation(s)
- Jonathan L Temte
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Shari Barlow
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maureen Goss
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Emily Temte
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cristalyne Bell
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cecilia He
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Caroline Hamer
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amber Schemmel
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bradley Maerz
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lily Comp
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mitchell Arnold
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kimberly Breunig
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sarah Clifford
- Wisconsin Division of Public Health, Wisconsin Department of Health Services, Madison, Wisconsin, USA
| | - Erik Reisdorf
- Communicable Disease Division, Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Peter Shult
- Communicable Disease Division, Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Mary Wedig
- Communicable Disease Division, Wisconsin State Laboratory of Hygiene, Madison, Wisconsin, USA
| | - Thomas Haupt
- Wisconsin Division of Public Health, Wisconsin Department of Health Services, Madison, Wisconsin, USA
| | - James Conway
- Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ashley Fowlkes
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amra Uzicanin
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Li J, Wang C, Ruan L, Jin S, Ye C, Yu H, Zhu W, Wang X. Development of influenza-associated disease burden pyramid in Shanghai, China, 2010-2017: a Bayesian modelling study. BMJ Open 2021; 11:e047526. [PMID: 34497077 PMCID: PMC8438833 DOI: 10.1136/bmjopen-2020-047526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Negative estimates can be produced when statistical modelling techniques are applied to estimate morbidity and mortality attributable to influenza. Based on the prior knowledge that influenza viruses are hazardous pathogens and have adverse health outcomes of respiratory and circulatory disease (R&C), we developed an improved model incorporating Bayes' theorem to estimate the disease burden of influenza in Shanghai, China, from 2010 to 2017. DESIGN A modelling study using aggregated data from administrative systems on weekly R&C mortality and hospitalisation, influenza surveillance and meteorological data. We constrained the regression coefficients for influenza activity to be positive by truncating the prior distributions at zero. SETTING Shanghai, China. PARTICIPANTS People registered with R&C deaths (450 298) and hospitalisations (2621 787, from 1 July 2013), and with influenza-like illness (ILI) outpatient visits (342 149) between 4 January 2010 and 31 December 2017. PRIMARY OUTCOME MEASURES Influenza-associated disease burden (mortality, hospitalisation and outpatient visit rates) and clinical severity (outpatient-mortality, outpatient-hospitalisation and hospitalisation-mortality risks). RESULTS Influenza was associated with an annual average of 15.49 (95% credibility interval (CrI) 9.06-22.06) excess R&C deaths, 100.65 (95% CrI 48.79-156.78) excess R&C hospitalisations and 914.95 (95% CrI 798.51-1023.66) excess ILI outpatient visits per 100 000 population in Shanghai. 97.23% and 80.24% excess R&C deaths and hospitalisations occurred in people aged ≥65 years. More than half of excess morbidity and mortality were associated with influenza A(H3N2) virus, and its severities were 1.65-fold to 3.54-fold and 1.47-fold to 2.16-fold higher than that for influenza A(H1N1) and B viruses, respectively. CONCLUSIONS The proposed Bayesian approach with reasonable prior information improved estimates of influenza-associated disease burden. Influenza A(H3N2) virus was generally associated with higher morbidity and mortality, and was relatively more severe compared with influenza A(H1N1) and B viruses. Targeted influenza prevention and control strategies for the elderly in Shanghai may substantially reduce the disease burden.
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Affiliation(s)
- Jing Li
- School of Public Health, Fudan University, Shanghai, Shanghai, China
- Renal Division, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- Clinical Research Academy, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Chunfang Wang
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Luanqi Ruan
- Research Base of Key Laboratory of Surveillance and Early Warning on Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Shan Jin
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chuchu Ye
- Research Base of Key Laboratory of Surveillance and Early Warning on Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Huiting Yu
- Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Weiping Zhu
- Research Base of Key Laboratory of Surveillance and Early Warning on Infectious Disease, Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Xiling Wang
- School of Public Health, Fudan University, Shanghai, Shanghai, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai, China
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Chan TC, Tang JH, Hsieh CY, Chen KJ, Yu TH, Tsai YT. Approaching precision public health by automated syndromic surveillance in communities. PLoS One 2021; 16:e0254479. [PMID: 34358241 PMCID: PMC8345830 DOI: 10.1371/journal.pone.0254479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Sentinel physician surveillance in communities has played an important role in detecting early signs of epidemics. The traditional approach is to let the primary care physician voluntarily and actively report diseases to the health department on a weekly basis. However, this is labor-intensive work, and the spatio-temporal resolution of the surveillance data is not precise at all. In this study, we built up a clinic-based enhanced sentinel surveillance system named “Sentinel plus” which was designed for sentinel clinics and community hospitals to monitor 23 kinds of syndromic groups in Taipei City, Taiwan. The definitions of those syndromic groups were based on ICD-10 diagnoses from physicians. Methods Daily ICD-10 counts of two syndromic groups including ILI and EV-like syndromes in Taipei City were extracted from Sentinel plus. A negative binomial regression model was used to couple with lag structure functions to examine the short-term association between ICD counts and meteorological variables. After fitting the negative binomial regression model, residuals were further rescaled to Pearson residuals. We then monitored these daily standardized Pearson residuals for any aberrations from July 2018 to October 2019. Results The results showed that daily average temperature was significantly negatively associated with numbers of ILI syndromes. The ozone and PM2.5 concentrations were significantly positively associated with ILI syndromes. In addition, daily minimum temperature, and the ozone and PM2.5 concentrations were significantly negatively associated with the EV-like syndromes. The aberrational signals detected from clinics for ILI and EV-like syndromes were earlier than the epidemic period based on outpatient surveillance defined by the Taiwan CDC. Conclusions This system not only provides warning signals to the local health department for managing the risks but also reminds medical practitioners to be vigilant toward susceptible patients. The near real-time surveillance can help decision makers evaluate their policy on a timely basis.
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Affiliation(s)
- Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
- Institute of Public Health, School of Medicine, Yang-Ming Chiao Tung University, Taipei, Taiwan
- * E-mail:
| | - Jia-Hong Tang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yu Hsieh
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Kevin J. Chen
- Department of Health, Taipei City Government, Taipei, Taiwan
| | - Tsan-Hua Yu
- Department of Health, Taipei City Government, Taipei, Taiwan
| | - Yu-Ting Tsai
- Department of Health, Taipei City Government, Taipei, Taiwan
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12
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Zhang Y, Qiao L, Yao J, Yu N, Mu X, Huang S, Hu B, Li W, Qiu F, Zeng F, Chen C, Zhou Y, Zhang B, Cai T, Wang W, Wu X, Zhou Y, Wang G, Situ B, Lan S, Li N, Li X, Li Z, Li X, Wang C, Yang C, Feng P, Wang H, Zhu S, Xiong Y, Luo M, Shen W, Hu X, Zheng L. Epidemiological and clinical characteristics of respiratory viruses in 4403 pediatric patients from multiple hospitals in Guangdong, China. BMC Pediatr 2021; 21:284. [PMID: 34140022 PMCID: PMC8212487 DOI: 10.1186/s12887-021-02759-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Background Acute respiratory infections (ARI) cause considerable morbidity and mortality worldwide, especially in children. Unfortunately, there are limited multi-center data on common viral respiratory infections in south China. Methods A total of 4403 nasal swabs were collected from children in 10 cities in Guangdong, China in 2019. Seven respiratory viruses, influenza A virus (IFA), influenza B virus (IFB), respiratory syncytial virus (RSV), adenoviruses (ADV) and parainfluenza virus types 1–3 (PIV1, PIV2 and PIV3), were detected by direct immunofluorescence antibody assay. The personal information and clinical characteristics were recorded and analyzed. Results The results showed that at least one virus was detected in 1099 (24.96 %) samples. The detection rates of RSV, IFA, ADV, PIV3, PIV1 and PIV2 were 7.13 % (314/4403), 5.31 % (234/4403), 4.02 % (177/4403), 3.04 % (134/4403), 1.70 % (75/4403) and 1.16 % (51/4403), respectively. The detection rate of RSV was highest in 0–6-month-old children at 18.18 % (106/583), while the detection rate of IFA was highest in 12–18-year-old children at 20.48 % (17/83). The total detection rates in winter and spring were 35.67 % (219/614) and 34.56 % (403/1166), higher than those in summer, 17.41 % (284/1631), and autumn, 19.46 % (193/992). Conclusions RSV and IFA were the main respiratory viruses in children. With increasing age the detection rate of RSV decreased in children, but the trends for the detection rates of IFA and IFB were the opposite. This study provided the viral etiology and epidemiology of pediatric patients with ARI in Guangdong, China. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02759-0.
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Affiliation(s)
- Yajie Zhang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lin Qiao
- Guangdong 999 Brain Hospital, Guangzhou, China
| | - Jinxiu Yao
- Yangjiang People's Hospital, Yangjiang, China
| | - Nan Yu
- Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoping Mu
- Guangdong Women and Children Hospital, Guangzhou, China
| | | | - Bo Hu
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weixuan Li
- The First People's Hospital of Foshan, Foshan, China
| | - Feng Qiu
- Nanhai Hospital, Southern Medical University, Foshan, China
| | - Fangyin Zeng
- The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Cong Chen
- Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Yuqiu Zhou
- Zhuhai Maternal and Child Health Hospital, Zhuhai, China
| | | | - Tian Cai
- Nanhai District People's Hospital of Foshan, Foshan, China
| | - Weijia Wang
- Zhongshan People's Hospital, Zhongshan, China
| | - Xianjin Wu
- Central People's Hospital of Huizhou, Huizhou, China
| | - Yiwen Zhou
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Guochang Wang
- School of Economics, Jinan University, Guangdong, Guangzhou, China
| | - Bo Situ
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuling Lan
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Na Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiu Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zihua Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xin Li
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Congrong Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chao Yang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pingfeng Feng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hongxia Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sijing Zhu
- Nanfang College of Sun Yat-Sen University, Guangdong, Guangzhou, China
| | - Yufeng Xiong
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Luo
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenjuan Shen
- The Seventh Affiliated Hospital, Sun Yat-Sen University, Guangdong, Guangdong, China
| | - Xiumei Hu
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lei Zheng
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Impact of seasonal influenza on polyclinic attendances for upper respiratory tract infections in Singapore. Western Pac Surveill Response J 2021; 11:27-36. [PMID: 33537162 PMCID: PMC7829085 DOI: 10.5365/wpsar.2019.10.4.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The burden of influenza on primary health-care services is not well established in tropical countries, where there are no clearly defined influenza seasons. We aimed to estimate the association between influenza infection activity and polyclinic attendance rates for upper respiratory tract infections (URTIs) in the Singapore population. Methods We used generalized additive time series models to estimate the association between the proportion of respiratory tests positive for influenza infection in Singapore reported to the World Health Organization every week, and the population rate of polyclinic attendances in Singapore for physician-diagnosed URTI, which includes influenza-like illness (ILI), for six years from 2012 through 2017. Where data were available, we controlled for other infections that can cause fever or respiratory symptoms. Results Influenza, dengue fever and chickenpox (varicella) were positively associated with acute URTI polyclinic attendances. The estimated URTI polyclinic attendance rates attributable to influenza, dengue fever and chickenpox were 618.9 (95% confidence interval [CI]: 501.6–736.3), 153.3 (95% CI: 16.5–290.2) and 1751.5 (95% CI: 1246.3–2256.8) per 100 000 population per year, respectively. Conclusion Influenza poses a considerable burden on primary health-care services in Singapore. However, a substantial number of polyclinic attendances due to febrile infections such as dengue fever and chickenpox appear to be recorded as URTI in the polyclinic database. These associations require further investigation.
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Berkowitz D, Simpson J, Cohen JS, Kadakia A, Badolato G, Breslin KA. Implementing Paper Documentation During an Influenza Surge in a Pediatric Emergency Department. Pediatr Emerg Care 2021; 37:126-130. [PMID: 33512892 PMCID: PMC7850558 DOI: 10.1097/pec.0000000000002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We hypothesized that a paper documentation and discharge bundle can expedite patient care during an influenza-related surge. METHODS Retrospective cohort study of low-acuity patients younger than 21 years surging into a pediatric emergency department between January and March 2018 with influenza-like illness. Patient visits documented using a paper bundle were compared with those documented in the electronic medical record on the same date of visit. The primary outcome of interest was time from physician evaluation to discharge for patient visits documented using the paper bundle compared with those documented in the electronic medical record. Secondary outcome was difference in return visits within 72 hours. We identified patient and visit level factors associated with emergency department length of stay. RESULTS A total of 1591 patient visits were included, 1187 documented in the electronic health record and 404 documented using the paper bundle. Patient visits documented using the paper bundle had a 21% shortened median time from physician evaluation to discharge (41 minutes; interquartile range, 27-62.8 minutes) as compared with patient visits documented in the electronic health record (52 minutes; interquartile range, 35-61 minutes; P < 0.001). There was no difference in return visits (odds ratio, 0.7; 95% confidence interval, 0.2, 2.2). CONCLUSIONS Implementation of paper charting during an influenza-related surge was associated with shorter physician to discharge times when compared with patient visits documented in the electronic health record. A paper bundle may improve patient throughput and decrease emergency department overcrowding during influenza or coronavirus disease-related surge.
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Affiliation(s)
- Deena Berkowitz
- From the Department of Pediatrics and Emergency Medicine, Children's National Health System
- The George Washington School of Medicine and Health Sciences, Washington, DC
| | - Joelle Simpson
- From the Department of Pediatrics and Emergency Medicine, Children's National Health System
- The George Washington School of Medicine and Health Sciences, Washington, DC
| | - Joanna S. Cohen
- From the Department of Pediatrics and Emergency Medicine, Children's National Health System
- The George Washington School of Medicine and Health Sciences, Washington, DC
| | - Ashaini Kadakia
- The George Washington School of Medicine and Health Sciences, Washington, DC
| | - Gia Badolato
- From the Department of Pediatrics and Emergency Medicine, Children's National Health System
| | - Kristen A. Breslin
- From the Department of Pediatrics and Emergency Medicine, Children's National Health System
- The George Washington School of Medicine and Health Sciences, Washington, DC
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Estimation of influenza-attributable burden in primary care from season 2014/2015 to 2018/2019, France. Eur J Clin Microbiol Infect Dis 2021; 40:1263-1269. [PMID: 33474677 DOI: 10.1007/s10096-021-04161-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Influenza viruses cause seasonal epidemics whose intensity varies according to the circulating virus type and subtype. We aim to estimate influenza-like illness (ILI) incidence attributable to influenza viruses in France from October 2014 to May 2019. Physicians participating in the French Sentinelles network reported the number of patients with ILI seen in consultation and performed nasopharyngeal swabs in a sample of these patients. The swabs were tested by RT-PCR for the presence of influenza viruses. These clinical and virological data were combined to estimate ILI incidence attributable to influenza viruses by subtypes and age groups. Influenza incidence rates over seasons ranged from 1.9 (95% CI, 1.9; 2.0) to 3.4% (95% CI, 3.2; 3.6) of the population. Each season, more than half of ILI cases were attributable to influenza. Children under 15 years were the most affected, with influenza incidence rates ranging from 3.0 (95% CI, 2.8;3.3) to 5.7% (95% CI, 5.3;6.1). Co-circulation of several (sub)types of influenza viruses was observed each year, except in 2016/2017 where A(H3N2) viruses accounted for 98.0% of the influenza cases. Weekly ILI incidences attributable to each influenza virus (sub)type were mostly synchronized with ILI incidence, except in 2014/2015 and 2017/2018, where incidence attributable to type B viruses peaked few weeks later. The burden of medically attended influenza among patients with ILI is significant in France, varying considerably across years and age groups. These results show the importance of influenza surveillance in primary care combining clinical and virological data.
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Monamele CG, Messanga Essengue LL, Ripa Njankouo M, Munshili Njifon HL, Tchatchueng J, Tejiokem MC, Njouom R. Evaluation of a mobile health approach to improve the Early Warning System of influenza surveillance in Cameroon. Influenza Other Respir Viruses 2020; 14:491-498. [PMID: 32410384 PMCID: PMC7431645 DOI: 10.1111/irv.12747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/12/2020] [Indexed: 11/28/2022] Open
Abstract
Background Rapid reporting of surveillance data is essential to better inform national prevention and control strategies. Objectives We compare the newly implemented smartphone‐based system to the former paper‐based and short message service (SMS) for collecting influenza epidemiological data in Cameroon. Methods Of the 13 sites which collect data from persons with influenza‐like illness (ILI), six sites send data through the EWS, while seven sites make use of the paper‐based system and SMS. We used four criteria for the comparison of the data collection tools: completeness, timeliness, conformity and cost. Results Regarding the different collection tools, data sent by the EWS were significantly more complete (97.6% vs 81.6% vs 44.8%), prompt (74.4% vs n/a vs 60.7%) and of better quality (93.7% vs 76.1% vs 84.0%) than data sent by the paper‐based system and SMS, respectively. The average cost of sending a datum by a sentinel site per week was higher for the forms (5.0 USD) than for the EWS (0.9 USD) and SMS (0.1 USD). The number of outpatient visits and subsequently all surveillance data decreased across the years 2017‐2019 together with the influenza positivity rate from 30.7% to 28.3%. Contrarily, the proportion of influenza‐associated ILI to outpatient load was highest in the year 2019 (0.37 per 100 persons vs 0.28 and 0.26 in the other 2 years). Conclusion All sentinel sites and even other disease surveillance systems are expected to use this tool in the near term future due to its satisfactory performance and cost.
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Affiliation(s)
| | | | | | | | - Jules Tchatchueng
- Laboratory of Epidemiology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Richard Njouom
- Laboratory of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
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17
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Using Twitter to Track Unplanned School Closures: Georgia Public Schools, 2015-17. Disaster Med Public Health Prep 2020; 15:568-572. [PMID: 32406359 DOI: 10.1017/dmp.2020.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To aid emergency response, Centers for Disease Control and Prevention (CDC) researchers monitor unplanned school closures (USCs) by conducting online systematic searches (OSS) to identify relevant publicly available reports. We examined the added utility of analyzing Twitter data to improve USC monitoring. METHODS Georgia public school data were obtained from the National Center for Education Statistics. We identified school and district Twitter accounts with 1 or more tweets ever posted ("active"), and their USC-related tweets in the 2015-16 and 2016-17 school years. CDC researchers provided OSS-identified USC reports. Descriptive statistics, univariate, and multivariable logistic regression were computed. RESULTS A majority (1,864/2,299) of Georgia public schools had, or were in a district with, active Twitter accounts in 2017. Among these schools, 638 were identified with USCs in 2015-16 (Twitter only, 222; OSS only, 2015; both, 201) and 981 in 2016-17 (Twitter only, 178; OSS only, 107; both, 696). The marginal benefit of adding Twitter as a data source was an increase in the number of schools identified with USCs by 53% (222/416) in 2015-16 and 22% (178/803) in 2016-17. CONCLUSIONS Policy-makers may wish to consider the potential value of incorporating Twitter into existing USC monitoring systems.
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Feng L, Feng S, Chen T, Yang J, Lau YC, Peng Z, Li L, Wang X, Wong JYT, Qin Y, Bond HS, Zhang J, Fang VJ, Zheng J, Yang J, Wu P, Jiang H, He Y, Cowling BJ, Yu H, Shu Y, Lau EHY. Burden of influenza-associated outpatient influenza-like illness consultations in China, 2006-2015: A population-based study. Influenza Other Respir Viruses 2020; 14:162-172. [PMID: 31872547 PMCID: PMC7040965 DOI: 10.1111/irv.12711] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/04/2019] [Accepted: 12/08/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Human influenza virus infections cause a considerable burden of morbidity and mortality worldwide each year. Understanding regional influenza-associated outpatient burden is crucial for formulating control strategies against influenza viruses. METHODS We extracted the national sentinel surveillance data on outpatient visits due to influenza-like-illness (ILI) and virological confirmation of sentinel specimens from 30 provinces of China from 2006 to 2015. Generalized additive regression models were fitted to estimate influenza-associated excess ILI outpatient burden for each individual province, accounting for seasonal baselines and meteorological factors. RESULTS Influenza was associated with an average of 2.5 excess ILI consultations per 1000 person-years (py) in 30 provinces of China each year from 2006 to 2015. Influenza A(H1N1)pdm09 led to a higher number of influenza-associated ILI consultations in 2009 across all provinces compared with other years. The excess ILI burden was 4.5 per 1000 py among children aged below 15 years old, substantially higher than that in adults. CONCLUSIONS Human influenza viruses caused considerable impact on population morbidity, with a consequent healthcare and economic burden. This study provided the evidence for planning of vaccination programs in China and a framework to estimate burden of influenza-associated outpatient consultations.
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Affiliation(s)
- Luzhao Feng
- Key Laboratory of Surveillance and Early‐warning on Infectious DiseaseDivision of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
| | - Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Tao Chen
- National Institute for Viral Disease Control and PreventionCollaboration Innovation Center for Diagnosis and Treatment of Infectious DiseasesChinese Center for Disease Control and PreventionBeijingChina
| | - Juan Yang
- Key Laboratory of Surveillance and Early‐warning on Infectious DiseaseDivision of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Public Health SafetyMinistry of EducationSchool of Public HealthFudan UniversityShanghaiChina
| | - Yiu Chung Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Zhibin Peng
- Key Laboratory of Surveillance and Early‐warning on Infectious DiseaseDivision of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
| | - Li Li
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Xiling Wang
- Key Laboratory of Public Health SafetyMinistry of EducationSchool of Public HealthFudan UniversityShanghaiChina
| | - Jessica Y. T. Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Ying Qin
- Key Laboratory of Surveillance and Early‐warning on Infectious DiseaseDivision of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
| | - Helen S. Bond
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Juanjuan Zhang
- Key Laboratory of Public Health SafetyMinistry of EducationSchool of Public HealthFudan UniversityShanghaiChina
| | - Vicky J. Fang
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Jiandong Zheng
- Key Laboratory of Surveillance and Early‐warning on Infectious DiseaseDivision of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
| | - Jing Yang
- National Institute for Viral Disease Control and PreventionCollaboration Innovation Center for Diagnosis and Treatment of Infectious DiseasesChinese Center for Disease Control and PreventionBeijingChina
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Hui Jiang
- Key Laboratory of Surveillance and Early‐warning on Infectious DiseaseDivision of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
| | - Yangni He
- Key Laboratory of Public Health SafetyMinistry of EducationSchool of Public HealthFudan UniversityShanghaiChina
| | - Benjamin J. Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early‐warning on Infectious DiseaseDivision of Infectious DiseaseChinese Center for Disease Control and PreventionBeijingChina
- Key Laboratory of Public Health SafetyMinistry of EducationSchool of Public HealthFudan UniversityShanghaiChina
| | - Yuelong Shu
- National Institute for Viral Disease Control and PreventionCollaboration Innovation Center for Diagnosis and Treatment of Infectious DiseasesChinese Center for Disease Control and PreventionBeijingChina
- School of Public Health (Shenzhen)Sun Yat‐sen UniversityShenzhenChina
| | - Eric H. Y. Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and ControlSchool of Public HealthLi Ka Shing Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina
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19
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Al Hossain F, Lover AA, Corey GA, Reich NG, Rahman T. FluSense: A Contactless Syndromic Surveillance Platform for Influenza-Like Illness in Hospital Waiting Areas. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2020; 4:1. [PMID: 35846237 PMCID: PMC9286491 DOI: 10.1145/3381014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We developed a contactless syndromic surveillance platform FluSense that aims to expand the current paradigm of influenza-like illness (ILI) surveillance by capturing crowd-level bio-clinical signals directly related to physical symptoms of ILI from hospital waiting areas in an unobtrusive and privacy-sensitive manner. FluSense consists of a novel edge-computing sensor system, models and data processing pipelines to track crowd behaviors and influenza-related indicators, such as coughs, and to predict daily ILI and laboratory-confirmed influenza caseloads. FluSense uses a microphone array and a thermal camera along with a neural computing engine to passively and continuously characterize speech and cough sounds along with changes in crowd density on the edge in a real-time manner. We conducted an IRB-approved 7 month-long study from December 10, 2018 to July 12, 2019 where we deployed FluSense in four public waiting areas within the hospital of a large university. During this period, the FluSense platform collected and analyzed more than 350,000 waiting room thermal images and 21 million non-speech audio samples from the hospital waiting areas. FluSense can accurately predict daily patient counts with a Pearson correlation coefficient of 0.95. We also compared signals from FluSense with the gold standard laboratory-confirmed influenza case data obtained in the same facility and found that our sensor-based features are strongly correlated with laboratory-confirmed influenza trends.
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Affiliation(s)
| | - Andrew A Lover
- University of Massachusetts Amherst, Amherst, MA, 01002, USA
| | - George A Corey
- University of Massachusetts Amherst, Amherst, MA, 01002, USA
| | | | - Tauhidur Rahman
- University of Massachusetts Amherst, Amherst, MA, 01002, USA
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20
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Checovich MM, Barlow S, Shult P, Reisdorf E, Temte JL. Evaluation of Viruses Associated With Acute Respiratory Infections in Long-Term Care Facilities Using a Novel Method: Wisconsin, 2016‒2019. J Am Med Dir Assoc 2019; 21:29-33. [PMID: 31636034 PMCID: PMC7106273 DOI: 10.1016/j.jamda.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 01/06/2023]
Abstract
Residents of long-term care facilities (LCTFs) have high morbidity and mortality associated with acute respiratory infections (ARIs). Limited information exists on the virology of ARI in LTCFs, where virological testing is reactive. We report on findings of a surveillance feasibility substudy from a larger prospective trial of introducing rapid influenza diagnostic testing (RIDT) at 10 Wisconsin LTCFs. Any resident with symptoms consistent with ARI had a nasal swab specimen collected for RIDT by staff. Following RIDT, the residual swab was placed into viral transport medium and tested for influenza using Reverse transcription polymerase chain reaction, and for 20 pathogens using a multiplex polymerase chain reaction respiratory pathogen panel. Numbers of viruses in each of 7 categories (influenza A, influenza B, coronaviruses, human metapneumovirus, parainfluenza, respiratory syncytial virus, and rhinovirus/enterovirus) across the 3 years were compared using χ2. Totals of 160, 215, and 122 specimens were collected during 2016‒2017, 2017‒2018, and 2018‒2019, respectively. Respiratory pathogen panel identified viruses in 54.8% of tested specimens. Influenza A (19.2%), influenza B (12.6%), respiratory syncytial virus (15.9%), and human metapneumovirus (20.9%) accounted for 69% of all detections, whereas coronaviruses (17.2%), rhinovirus/enterovirus (10.5%) and parainfluenza (3.8%) were less common. The distribution of viruses varied significantly across the 3 years (χ2 = 71.663; df = 12; P < .001). Surveillance in LTCFs using nasal swabs collected for RIDT is highly feasible and yields high virus identification rates. Significant differences in virus composition occurred across the 3 study years. Simple approaches to surveillance may provide a more comprehensive assessment of respiratory viruses in LTCF settings.
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Affiliation(s)
- Mary M Checovich
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Shari Barlow
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Peter Shult
- Wisconsin State Laboratory of Hygiene, Madison, WI
| | | | - Jonathan L Temte
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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21
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Bersanelli M, Giannarelli D, Castrignanò P, Fornarini G, Panni S, Mazzoni F, Tiseo M, Rossetti S, Gambale E, Rossi E, Papa A, Cortellini A, Lolli C, Ratta R, Michiara M, Milella M, De Luca E, Sorarù M, Mucciarini C, Atzori F, Banna GL, La Torre L, Vitale MG, Massari F, Rebuzzi SE, Facchini G, Schinzari G, Tomao S, Bui S, Vaccaro V, Procopio G, De Giorgi U, Santoni M, Ficorella C, Sabbatini R, Maestri A, Natoli C, De Tursi M, Di Maio M, Rapacchi E, Pireddu A, Sava T, Lipari H, Comito F, Verzoni E, Leonardi F, Buti S. INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors: a transversal challenge. The INVIDIa study. Immunotherapy 2019; 10:1229-1239. [PMID: 30326787 DOI: 10.2217/imt-2018-0080] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
AIM Considering the unmet need for the counseling of cancer patients treated with immune checkpoint inhibitors (CKI) about influenza vaccination, an explorative study was planned to assess flu vaccine efficacy in this population. METHODS INVIDIa was a retrospective, multicenter study, enrolling consecutive advanced cancer outpatients receiving CKI during the influenza season 2016-2017. RESULTS Of 300 patients, 79 received flu vaccine. The incidence of influenza syndrome was 24.1% among vaccinated, versus 11.8% of controls; odds ratio: 2.4; 95% CI: 1.23-4.59; p = 0.009. The clinical ineffectiveness of vaccine was more pronounced among elderly: 37.8% among vaccinated patients, versus 6.1% of unvaccinated, odds ratio: 9.28; 95% CI: 2.77-31.14; p < 0.0001. CONCLUSION Although influenza vaccine may be clinically ineffective in advanced cancer patients receiving CKI, it seems not to negatively impact the efficacy of anticancer therapy.
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Affiliation(s)
| | - Diana Giannarelli
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Giuseppe Fornarini
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Stefano Panni
- Medical Oncology Unit, ASST - Istituti Ospitalieri Cremona Hospital, Cremona, Italy
| | | | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sabrina Rossetti
- SSD Oncologia Clinica Sperimentale Uro-Andrologica, Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | - Elisabetta Gambale
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Ernesto Rossi
- Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Anselmo Papa
- Department of Medical & Surgical Sciences & Biotechnology, University "La Sapienza", Latina, Italy
| | - Alessio Cortellini
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Cristian Lolli
- Medical Oncology, Scientific Institute of Romagna for the Study & Treatment of Tumors (IRST) IRCCS, Meldola, Italy
| | - Raffaele Ratta
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Maria Michiara
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Michele Milella
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Emmanuele De Luca
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | | | | | - Francesco Atzori
- Department of Medical Sciences "M. Aresu", Medical Oncology, University Hospital & University of Cagliari, Cagliari, Italy
| | | | - Leonardo La Torre
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | | | | | - Sara Elena Rebuzzi
- Medical Oncology Unit 1, IRCCS Policlinico San Martino Hospital, Genova, Italy
| | - Gaetano Facchini
- SSD Oncologia Clinica Sperimentale Uro-Andrologica, Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Napoli, Italy
| | | | - Silverio Tomao
- Department of Medical & Surgical Sciences & Biotechnology, University "La Sapienza", Latina, Italy
| | - Simona Bui
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Vanja Vaccaro
- Oncology Unit 1, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Procopio
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | - Ugo De Giorgi
- Medical Oncology, Scientific Institute of Romagna for the Study & Treatment of Tumors (IRST) IRCCS, Meldola, Italy
| | | | - Corrado Ficorella
- Department of Biotechnological & Applied Clinical Sciences, St Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | | | - Antonio Maestri
- Medical Oncology Department, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Clara Natoli
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Michele De Tursi
- Department of Medical, Oral & Biotechnological Sciences & CeSI-MeT, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Massimo Di Maio
- Medical Oncology, Ordine Mauriziano Hospital, University of Turin, Torino, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Annagrazia Pireddu
- Department of Medical Sciences "M. Aresu", Medical Oncology, University Hospital & University of Cagliari, Cagliari, Italy
| | - Teodoro Sava
- Medical Oncology, Camposampiero Hospital, Padova, Italy
| | - Helga Lipari
- Medical Oncology, Cannizzaro Hospital, Catania, Italy
| | - Francesca Comito
- Division of Oncology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Verzoni
- Genito-Urinary Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori of Milan, Milano, Italy
| | | | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
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MF59-adjuvanted seasonal trivalent inactivated influenza vaccine: Safety and immunogenicity in young children at risk of influenza complications. Int J Infect Dis 2019; 85S:S18-S25. [PMID: 31051279 DOI: 10.1016/j.ijid.2019.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the safety and immunogenicity of the MF59-adjuvanted seasonal trivalent inactivated influenza vaccine (aIIV3; Fluad) in children aged 6 months through 5 years who are at risk of influenza complications. METHODS A retrospective analysis was performed to examine unsolicited adverse events (AEs) in an integrated dataset from six randomized clinical studies that compared aIIV3 with non-adjuvanted inactivated influenza vaccines (IIV3). The integrated safety set comprised 10 784 children, of whom 373 (3%) were at risk of influenza complications. RESULTS The at-risk safety population comprised 373 children aged 6 months through 5 years: 179 received aIIV3 and 194 received non-adjuvanted IIV3 (128 subjects received a licensed IIV3). The most important risk factors were respiratory system illnesses (62-70%) and infectious and parasitic diseases (33-39%). During the treatment period, unsolicited AEs occurred in 54% of at-risk children and 55% of healthy children who received aIIV3; of those receiving licensed IIV3, 59% of at-risk and 62% of healthy subjects reported an unsolicited AE. The most common AEs were infections, including upper respiratory tract infection. Serious AEs (SAEs) were reported in <10% of at-risk subjects, and no vaccine-related SAEs were observed. In the immunogenicity subset (involving 103 participants from one study), geometric mean titers (GMTs) were approximately 2- to 3-fold higher with aIIV3 than with IIV3 for all three homologous strains (A/H1N1, A/H3N2, and B). Seroconversion rates were high for both aIIV3 (79-96%) and IIV3 (83-89%). CONCLUSIONS In young children at risk of influenza complications, aIIV3 was well-tolerated and had a safety profile that was generally similar to that of non-adjuvanted IIV3. Similar to the not-at-risk population, the immune response in at-risk subjects receiving aIIV3 was increased over those receiving IIV3, suggesting aIIV3 is a valuable option in young children at risk of influenza complications.
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23
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Edmond MB. Mandatory Flu Vaccine for Healthcare Workers: Not Worthwhile. Open Forum Infect Dis 2019; 6:ofy214. [PMID: 31011587 PMCID: PMC6468124 DOI: 10.1093/ofid/ofy214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/22/2018] [Indexed: 11/26/2022] Open
Abstract
In 2010, the Society for Healthcare Epidemiology published a recommendation that annual influenza vaccination of healthcare workers be made a condition of employment despite no high-level evidence to support this recommendation. A better strategy for reducing the transmission of respiratory viruses in the healthcare setting would be to encourage vaccination and reduce presenteeism, which is very common among healthcare workers with influenza-like illness. In a hospital with a baseline vaccination compliance of 70%, reducing presenteeism by 2% has the equivalent impact of mandating vaccination in terms of the number of healthcare workers with influenza-like illness at work. Expectations for compliance with interventions to improve the quality of care should be correlated tightly to the underlying evidence to support the intervention, reserving mandates for interventions with very high quality supporting evidence.
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24
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Temte JL, Meiman JG, Gangnon RE. School sessions are correlated with seasonal outbreaks of medically attended respiratory infections: electronic health record time series analysis, Wisconsin 2004-2011. Epidemiol Infect 2019; 147:e127. [PMID: 30868998 PMCID: PMC6518471 DOI: 10.1017/s0950268818003424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 11/17/2022] Open
Abstract
Increased social contact within school settings is thought to be an important factor in seasonal outbreaks of acute respiratory infection (ARI). To better understand the degree of impact, we analysed electronic health records and compared risks of respiratory infections within communities while schools were in session and out-of-session. A time series analysis of weekly respiratory infection diagnoses from 28 family medicine clinics in Wisconsin showed that people under the age of 65 experienced an increased risk of ARI when schools were in session. For children aged 5-17 years, the risk ratio for the first week of a school session was 1.12 (95% confidence interval (CI) 0.93-1.34), the second week of a session was 1.39 (95% CI 1.15-1.68) and more than 2 weeks into a session was 1.43 (95% CI 1.20-1.71). Less significant increased risk ratios were also observed in young children (0-4 years) and adults (18-64 years). These results were obtained after modelling for baseline seasonal variations in disease prevalence and controlling for short-term changes in ambient temperature and relative humidity. Understanding the mechanisms of seasonality make it easier to predict outbreaks and launch timely public health interventions.
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Affiliation(s)
- J. L. Temte
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin, USA
| | - J. G. Meiman
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, Wisconsin, USA
| | - R. E. Gangnon
- Department of Population Health Sciences and Biostatistics & Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
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Caini S, Spreeuwenberg P, Donker G, Korevaar J, Paget J. Climatic factors and long-term trends of influenza-like illness rates in The Netherlands, 1970-2016. ENVIRONMENTAL RESEARCH 2018; 167:307-313. [PMID: 30081307 DOI: 10.1016/j.envres.2018.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/11/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Climatic factors affect the survival and transmissibility of respiratory viruses causing influenza-like illness (ILI), and we hypothesized that changes in absolute humidity and temperature may affect long-term trends of ILI incidence rate in temperate countries. We tested this hypothesis using ILI and meteorological time series in the Netherlands for the period 1970-2016. METHODS We described the long-term trends of ILI incidence, absolute humidity and temperature; modelled the association between climatic factors and ILI activity using negative binomial regression models; and assessed the strength of the association between the seasonal average absolute humidity (or temperature) and ILI incidence rate using the Spearman's rank correlation coefficient. RESULTS The ILI incidence rate declined from 1970 and reached a minimum in the season 2002-03, but started to increase again from the season 2003-04 onwards. In the negative binominal regression models, the weekly ILI count was inversely associated (p < 0.001) with 0- and 1-week lagged absolute humidity and temperature. After three decades of rising absolute humidity and temperature (1970-2000), the early 2000s represented a trend-reversal point for the climatic time series. The seasonal average ILI incidence rate and absolute humidity (or temperature) were strongly (inversely) correlated. CONCLUSIONS Our findings suggest that climate change may have played a role in the long-term trends of ILI incidence rates in the Netherlands, as we were able to show that lower humidity and temperature in a given week were associated with higher ILI incidence in the next week, there was a clear time point reversal in climatic parameters and ILI rates in the 2000s, and the average annual ILI incidence was inversely related to average annual temperatures and humidity.
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Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Gé Donker
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Joke Korevaar
- 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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Estimation of the burden of flu-association influenza-like illness visits on total clinic visits through the sentinel influenza monitoring system in Senegal during the 2013-2015 influenza seasons. Epidemiol Infect 2018; 146:2049-2055. [PMID: 30196797 DOI: 10.1017/s0950268818002418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Knowing the burden of influenza is helpful for policy decisions. Here we estimated the contribution of influenza-like illness (ILI) visits associated with laboratory-confirmed influenza among all clinic visits in a Senegal sentinel network. ILI data from ten sentinel sites were collected from January 2013 to December 2015. ILI was defined as an axillary measured fever of more than 37.5 °C with a cough or a sore throat. Collected nasopharyngeal swabs were tested for influenza viruses by rRT-PCR. Influenza-associated ILI was defined as ILI with laboratory-confirmed influenza. For the influenza disease burden estimation, we used all-case outpatient visits during the study period who sought care at selected sites. Of 4030 ILI outpatients tested, 1022 were influenza positive. The estimated proportional contribution of influenza-associated ILI was, per 100 outpatients, 1.2 (95% CI 1.1-1.3), 0.32 (95% CI 0.28-0.35), 1.11 (95% CI 1.05-1.16) during 2013, 2014, 2015, respectively. The age-specific outpatient visits proportions of influenza-associated ILI were higher among children under 5 years (0.68%, 95% CI: 0.62-0.70). The predominant virus during years 2013 and 2015 was influenza B while A/H3N2 subtype was predominant during 2014. Influenza viruses cause a substantial burden of outpatient visits particularly among children under 5 of age in Senegal and highlight the need of vaccination in risk groups.
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27
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Jester B, Schwerzmann J, Mustaquim D, Aden T, Brammer L, Humes R, Shult P, Shahangian S, Gubareva L, Xu X, Miller J, Jernigan D. Mapping of the US Domestic Influenza Virologic Surveillance Landscape. Emerg Infect Dis 2018; 24. [PMID: 29715078 PMCID: PMC6038762 DOI: 10.3201/eid2407.180028] [Citation(s) in RCA: 18] [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: 11/19/2022] Open
Abstract
Influenza virologic surveillance is critical each season for tracking influenza circulation, following trends in antiviral drug resistance, detecting novel influenza infections in humans, and selecting viruses for use in annual seasonal vaccine production. We developed a framework and process map for characterizing the landscape of US influenza virologic surveillance into 5 tiers of influenza testing: outpatient settings (tier 1), inpatient settings and commercial laboratories (tier 2), state public health laboratories (tier 3), National Influenza Reference Center laboratories (tier 4), and Centers for Disease Control and Prevention laboratories (tier 5). During the 2015–16 season, the numbers of influenza tests directly contributing to virologic surveillance were 804,000 in tiers 1 and 2; 78,000 in tier 3; 2,800 in tier 4; and 3,400 in tier 5. With the release of the 2017 US Pandemic Influenza Plan, the proposed framework will support public health officials in modeling, surveillance, and pandemic planning and response.
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28
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Infection prevention and control in outpatient settings in China-structure, resources, and basic practices. Am J Infect Control 2018; 46:802-807. [PMID: 29395504 DOI: 10.1016/j.ajic.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND More than 7 billion visits are made by patients to ambulatory services every year in mainland China. Healthcare-associated infections are becoming a new source of illness for outpatients. Little is known about infection prevention, control structure, resources available, and basic practices in outpatient settings. METHODS In 2014, we conducted a multisite survey. Five provinces were invited to participate based on geographic dispersion. Self-assessment questionnaires regarding the structure, infrastructure, apparatus and materials, and basic activities of infection prevention and control were issued to 25 hospitals and 5 community health centers in each province. A weight was assigned to each question according to its importance. RESULTS Overall, 146 of 150 facilities (97.3%) participated in this study. The average survey score was 77.6 (95% confidence interval 75.7-79.5) and varied significantly between the different gross domestic product areas (P < .01), but scores were not significantly different between the 5 facility types (P = .07). The main lapse of infrastructure was in providing hand hygiene equipment (43.4%) and masks (38.7%) for patients in the waiting areas and main entrances. CONCLUSION In a sample of ambulatory facilities in 5 provinces in China, infection prevention and control was practiced consistently, although there were lapses in some areas.
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Russell KE, Fowlkes A, Stockwell MS, Vargas CY, Saiman L, Larson EL, LaRussa P, Di Lonardo S, Popowich M, St. George K, Steffens A, Reed C. Comparison of outpatient medically attended and community-level influenza-like illness-New York City, 2013-2015. Influenza Other Respir Viruses 2018; 12:336-343. [PMID: 29350791 PMCID: PMC5907822 DOI: 10.1111/irv.12540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI. OBJECTIVES To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza-Like Illness in the Community (MoSAIC) Study. METHODS The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community-based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. RESULTS Five-hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. CONCLUSIONS Outpatient and community-based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly.
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Affiliation(s)
- Kate E. Russell
- Epidemic Intelligence ServiceCenters for Disease Control and PreventionAtlantaGAUSA
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Ashley Fowlkes
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Melissa S. Stockwell
- Columbia University Medical CenterNew YorkNYUSA
- NewYork‐Presbyterian HospitalNew YorkNYUSA
| | | | - Lisa Saiman
- Columbia University Medical CenterNew YorkNYUSA
- NewYork‐Presbyterian HospitalNew YorkNYUSA
| | | | | | - Steve Di Lonardo
- New York City Department of Health and Mental HygieneNew YorkNYUSA
| | | | | | - Andrea Steffens
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
| | - Carrie Reed
- Influenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGAUSA
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Saha S, Gupta V, Dawood FS, Broor S, Lafond KE, Chadha MS, Rai SK, Krishnan A. Estimation of community-level influenza-associated illness in a low resource rural setting in India. PLoS One 2018; 13:e0196495. [PMID: 29698505 PMCID: PMC5919664 DOI: 10.1371/journal.pone.0196495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. Methods During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. Findings The HUS of 69,369 residents during the year generated risk-time of 3945 person-years (p-y) and identified 150 (5%, 95%CI: 4–6) ILI episodes (38 ILI episodes/1,000 p-y; 95% CI 32–44). Among 1,372 ILI cases enrolled from clinics, 126 (9%; 95% CI 8–11) had laboratory-confirmed influenza (A (H3N2) = 72; B = 54). After adjusting for age, month, and clinic type, overall influenza-associated ILI rate was 4.8/1,000 p-y; rates were highest among children <5 years (13; 95% CI: 4–29) and persons≥60 years (11; 95%CI: 2–30). Conclusion We present a novel way to use HUS and CBS data to generate estimates of community burden of influenza. Although the confidence intervals overlapped considerably, higher point estimates for burden among young children and older adults shows the utility for exploring the value of influenza vaccination among target groups.
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Affiliation(s)
- Siddhartha Saha
- Influenza Program, US Center for Disease Control and Prevention-India office, New Delhi, India
- * E-mail:
| | - Vivek Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Fatimah S. Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shobha Broor
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kathryn E. Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Sanjay K. Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Frazee BW, Rodríguez-Hoces de la Guardia A, Alter H, Chen CG, Fuentes EL, Holzer AK, Lolas M, Mitra D, Vohra J, Dekker CL. Accuracy and Discomfort of Different Types of Intranasal Specimen Collection Methods for Molecular Influenza Testing in Emergency Department Patients. Ann Emerg Med 2018; 71:509-517.e1. [DOI: 10.1016/j.annemergmed.2017.09.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
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Stewart RJ, Flannery B, Chung JR, Gaglani M, Reis M, Zimmerman RK, Nowalk MP, Jackson L, Jackson ML, Monto AS, Martin ET, Belongia EA, McLean HQ, Fry AM, Havers FP. Influenza Antiviral Prescribing for Outpatients With an Acute Respiratory Illness and at High Risk for Influenza-Associated Complications During 5 Influenza Seasons-United States, 2011-2016. Clin Infect Dis 2018; 66:1035-1041. [PMID: 29069334 PMCID: PMC6018951 DOI: 10.1093/cid/cix922] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background Influenza causes millions of illnesses annually; certain groups are at higher risk for complications. Early antiviral treatment can reduce the risk of complications and is recommended for outpatients at increased risk. We describe antiviral prescribing among high-risk outpatients for 5 influenza seasons and explore factors that may influence prescribing. Methods We analyzed antiviral prescription and clinical data for high-risk outpatients aged ≥6 months with an acute respiratory illness (ARI) and enrolled in the US Influenza Vaccine Effectiveness Network during the 2011-2012 through 2015-2016 influenza seasons. We obtained clinical information from interviews and electronic medical records and tested all enrollees for influenza with real-time reverse-transcription polymerase chain reaction (rRT-PCR). We calculated the number of patients with ARI that must be treated to treat 1 patient with influenza. Results Among high-risk outpatients with ARI who presented to care within 2 days of symptom onset (early), 15% (718/4861) were prescribed an antiviral medication, including 472 of 1292 (37%) of those with rRT-PCR-confirmed influenza. Forty percent of high-risk outpatients with influenza presented to care early. Earlier presentation was associated with antiviral treatment (odds ratio [OR], 4.1; 95% confidence interval [CI], 3.5-4.8), as was fever (OR, 3.2; 95% CI, 2.7-3.8), although 25% of high-risk outpatients with influenza were afebrile. Empiric treatment of 4 high-risk outpatients with ARI was needed to treat 1 patient with influenza. Conclusions Influenza antiviral medications were infrequently prescribed for high-risk outpatients with ARI who would benefit most. Efforts to increase appropriate antiviral prescribing are needed to reduce influenza-associated complications.
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Affiliation(s)
- Rebekah J Stewart
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessie R Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University Health Science Center College of Medicine, Temple
| | - Michael Reis
- Baylor Scott & White Health, Texas A&M University Health Science Center College of Medicine, Temple
| | | | | | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute), Seattle
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute), Seattle
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor
| | | | | | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fiona P Havers
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Zhou H, Thompson WW, Belongia EA, Fowlkes A, Baxter R, Jacobsen SJ, Jackson ML, Glanz JM, Naleway AL, Ford DC, Weintraub E, Shay DK. Estimated rates of influenza-associated outpatient visits during 2001-2010 in 6 US integrated healthcare delivery organizations. Influenza Other Respir Viruses 2018; 12:122-131. [PMID: 28960732 PMCID: PMC5818343 DOI: 10.1111/irv.12495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 12/01/2022] Open
Abstract
Background Population‐based estimates of influenza‐associated outpatient visits including both pandemic and interpandemic seasons are uncommon. Comparisons of such estimates with laboratory‐confirmed rates of outpatient influenza are rare. Objective To estimate influenza‐associated outpatient visits in 6 US integrated healthcare delivery organizations enrolling ~7.7 million persons. Methods Using negative binomial regression methods, we modeled rates of influenza‐associated visits with ICD‐9‐CM‐coded pneumonia or acute respiratory outpatient visits during 2001‐10. These estimated counts were added to visits coded specifically for influenza to derive estimated rates. We compared these rates with those observed in 2 contemporaneous studies recording RT‐PCR‐confirmed influenza outpatient visits. Results Outpatient rates estimated with pneumonia visits were 39 (95% confidence interval [CI], 30‐70) and 203 (95% CI, 180‐240) per 10 000 person‐years, respectively, for interpandemic and pandemic seasons. Corresponding rates estimated with respiratory visits were 185 (95% CI, 161‐255) and 542 (95% CI, 441‐823) per 10 000 person‐years. During the pandemic, children aged 2‐17 years had the largest increase in rates (when estimated with pneumonia visits, from 64 [95% CI, 50‐121] to 381 [95% CI, 366‐481]). Rates estimated with pneumonia visits were consistent with rates of RT‐PCR‐confirmed influenza visits during 4 of 5 seasons in 1 comparison study. In another, rates estimated with pneumonia visits during the pandemic for children and adults were consistent in timing, peak, and magnitude. Conclusions Estimated rates of influenza‐associated outpatient visits were higher in children than adults during pre‐pandemic and pandemic seasons. Rates estimated with pneumonia visits plus influenza‐coded visits were similar to rates from studies using RT‐PCR‐confirmed influenza.
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Affiliation(s)
- Hong Zhou
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | | | | | - Ashley Fowlkes
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Roger Baxter
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Derek C Ford
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - Eric Weintraub
- Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - David K Shay
- Centers for Disease Control & Prevention, Atlanta, GA, USA
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Gefenaite G, Pistol A, Popescu R, Popovici O, Ciurea D, Dolk C, Jit M, Gross D. Estimating burden of influenza-associated influenza-like illness and severe acute respiratory infection at public healthcare facilities in Romania during the 2011/12-2015/16 influenza seasons. Influenza Other Respir Viruses 2017; 12:183-192. [PMID: 29144598 PMCID: PMC5818344 DOI: 10.1111/irv.12525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Influenza is responsible for substantial morbidity and mortality, but there is limited information on reliable disease burden estimates, especially from middle-income countries in the WHO European Region. OBJECTIVES To estimate the incidence of medically attended influenza-associated influenza-like illness (ILI) and hospitalizations due to severe acute respiratory infection (SARI) presenting to public healthcare facilities in Romania. PATIENTS/METHODS Sentinel influenza surveillance data for ILI and SARI from 2011/12-2015/16, including virological data, were used to estimate influenza-associated ILI and SARI incidence/100 000 and their 95% confidence intervals (95% CI). RESULTS The overall annual incidence of ILI and influenza-associated ILI per 100 000 persons in Romania varied between 68 (95% CI: 61-76) and 318 (95% CI: 298-338) and between 23 (95% CI: 19-29) and 189 (95% CI: 149-240), respectively. The highest ILI and influenza incidence was among children aged 0-4 years. We estimated that SARI incidence per 100 000 persons was 6 (95% CI: 5-7) to 9 (95% CI: 8-10), of which 2 (95% CI: 1-2) to 3 (95% CI: 2-4) were due to influenza. Up to 0.3% of the Romanian population were annually reported with ILI, and 0.01% was hospitalized with SARI, of which as much as one-third could be explained by influenza. CONCLUSIONS This evaluation was the first study estimating influenza burden in Romania. We found that during each influenza season, a substantial number of persons in Romania suffer from influenza-related ILI or are hospitalized due to influenza-associated SARI.
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Affiliation(s)
- Giedre Gefenaite
- Infectious Hazards Management, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Adriana Pistol
- National Center for Communicable Diseases Surveillance and Control, National Institute of Public Health, Bucharest, Romania
| | - Rodica Popescu
- National Center for Communicable Diseases Surveillance and Control, National Institute of Public Health, Bucharest, Romania
| | - Odette Popovici
- National Center for Communicable Diseases Surveillance and Control, National Institute of Public Health, Bucharest, Romania
| | - Daniel Ciurea
- Center for Health Policies and Services, Bucharest, Romania
| | - Christiaan Dolk
- Infectious Hazards Management, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark.,PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Diane Gross
- Infectious Hazards Management, Division of Health Emergencies and Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
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Feng S, Fowlkes AL, Steffens A, Finelli L, Cowling BJ. Assessment of Virus Interference in a Test-negative Study of Influenza Vaccine Effectiveness. Epidemiology 2017; 28:514-524. [PMID: 28362642 PMCID: PMC5535302 DOI: 10.1097/ede.0000000000000670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The observational test-negative study design is used to estimate vaccine effectiveness against influenza virus infection. An important assumption of the test-negative design is that vaccination does not affect the risk of infection with another virus. If such virus interference occurred, detection of other respiratory viruses would be more common among influenza vaccine recipients and vaccine effectiveness estimates could differ. We evaluated the potential for virus interference using data from the Influenza Incidence Surveillance Project. METHODS From 2010 to 2013, outpatients presenting to clinics in 13 US jurisdictions with acute respiratory infections were tested for influenza and other respiratory viruses. We investigated whether virus interference might affect vaccine effectiveness estimates by first evaluating the sensitivity of estimates using alternative control groups that include or exclude patients with other respiratory virus detections by age group and early/middle/late stage of influenza seasons. Second, we evaluated the association between influenza vaccination receipt and other respiratory virus detection among influenza test-negative patients. RESULTS Influenza was detected in 3,743/10,650 patients (35%), and overall vaccine effectiveness was 47% (95% CI: 42%, 52%). Estimates using each control group were consistent overall or when stratified by age groups, and there were no differences among early, middle, or late phase during influenza season. We found no associations between detection of other respiratory viruses and receipt of influenza vaccination. CONCLUSIONS In this 3-year test-negative design study in an outpatient setting in the United States, we found no evidence of virus interference or impact on influenza vaccine effectiveness estimation.
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Affiliation(s)
- Shuo Feng
- From the aWHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; and bInfluenza Division, Centers for Disease Control and Prevention, Atlanta, GA
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Epidemiological Features and Forecast Model Analysis for the Morbidity of Influenza in Ningbo, China, 2006-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060559. [PMID: 28587073 PMCID: PMC5486245 DOI: 10.3390/ijerph14060559] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/17/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023]
Abstract
This study aimed to identify circulating influenza virus strains and vulnerable population groups and investigate the distribution and seasonality of influenza viruses in Ningbo, China. Then, an autoregressive integrated moving average (ARIMA) model for prediction was established. Influenza surveillance data for 2006–2014 were obtained for cases of influenza-like illness (ILI) (n = 129,528) from the municipal Centers for Disease Control and virus surveillance systems of Ningbo, China. The ARIMA model was proposed to predict the expected morbidity cases from January 2015 to December 2015. Of the 13,294 specimens, influenza virus was detected in 1148 (8.64%) samples, including 951 (82.84%) influenza type A and 197 (17.16%) influenza type B viruses; the influenza virus isolation rate was strongly correlated with the rate of ILI during the overall study period (r = 0.20, p < 0.05). The ARIMA (1, 1, 1) (1, 1, 0)12 model could be used to predict the ILI incidence in Ningbo. The seasonal pattern of influenza activity in Ningbo tended to peak during the rainy season and winter. Given those results, the model we established could effectively predict the trend of influenza-related morbidity, providing a methodological basis for future influenza monitoring and control strategies in the study area.
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Matias G, Haguinet F, Lustig RL, Edelman L, Chowell G, Taylor RJ. Model estimates of the burden of outpatient visits attributable to influenza in the United States. BMC Infect Dis 2016; 16:641. [PMID: 27821091 PMCID: PMC5100308 DOI: 10.1186/s12879-016-1939-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 10/18/2016] [Indexed: 12/31/2022] Open
Abstract
Background Although many studies have modelled the national burdens of hospitalizations and deaths due to influenza, few studies have considered the outpatient burden. To fill this gap for the United States (US), we applied traditional statistical modelling approaches to time series derived from large medical claims databases held in the private sector. Methods We accessed ICD-9-coded office visit data extracted from Truven Health Analytics’ MarketScan Commercial database covering about one third of the US population <65 years during 2001–2009, and Medicare Supplemental data covering about one fifth of US seniors 65+ during 2006–2009. We extracted weekly time series of visits due to respiratory diagnoses, otitis media (OM), and urinary tract infections (UTI), a “negative control”. We used multiple linear regression modelling to estimate age-specific influenza-related excess in office visits. Results In the <65 year age group, in the 8 pre-pandemic seasons studied and for the broadest defined respiratory outcome, the model attributed an average of ~14.5 M (Standard deviation [SD] across seasons 3.9 million) office visits to influenza (rate of 5,581/100,000 population). Of these, ~80 % of visits occurred in the 5–17 and 18–49 age group. In school children aged 5–17 year olds and adult 18–64 year age groups the majority of visits were due to influenza B, while A/H3N2 explained most visits in children <5 year olds. The model further attributed ~2.2 M OM visits (SD across seasons 790,000) annually to influenza, of which 86 % of these occurred in children <18 years; this indicates that 6.4 % of all infants <2 years and 4.9 % of all toddlers aged 2–4 years in the US have an influenza-attributable outpatient visit with an OM diagnosis. In seniors 65 years and older, our model attributed ~0.7 M (SD across seasons 351,000) respiratory visits to influenza (rate of 1,887/100,000 population). The model identified no significant excess UTI (negative control) visits in most seasons. Conclusions This is to our knowledge a first study of the outpatient burden of influenza in the US in a large database. The model estimated that 10 % of all children <18 years and 4 % of the entire population <65 years seek outpatient care for respiratory illness attributable to influenza annually. Trial registration ClinicalTrial.gov, NCT02019732.
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Affiliation(s)
- Gonçalo Matias
- GSK Vaccines, Avenue Fleming 20, Parc de la Noire Epine, Wavre, Belgium.
| | - François Haguinet
- GSK Vaccines, Avenue Fleming 20, Parc de la Noire Epine, Wavre, Belgium
| | - Roger L Lustig
- Sage Analytica, 4915 St. Elmo Ave., Suite 205, Bethesda, MD, 20814, USA
| | - Laurel Edelman
- Symphony Health Solutions, Suite 100, 550 Blair Mill Road, Horsham, PA, 19044, USA.,Present address: Independent Outcomes and Healthcare Researcher, 1591 White Chimney Road, West Chester, PA, 19380, USA
| | - Gerardo Chowell
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Robert J Taylor
- Sage Analytica, 4915 St. Elmo Ave., Suite 205, Bethesda, MD, 20814, USA
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Choi DK, Fuleihan RL, Walterhouse DO. Serologic response and clinical efficacy of influenza vaccination in children and young adults on chemotherapy for cancer. Pediatr Blood Cancer 2016; 63:2011-8. [PMID: 27327360 DOI: 10.1002/pbc.26110] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Influenza is a health risk to children receiving chemotherapy for cancer. An absolute lymphocyte count (ALC) >1,000 cells/mm(3) has been associated with the ability to produce an immune response to influenza vaccine during chemotherapy. However, clinical efficacy of influenza vaccination during chemotherapy remains unclear. PROCEDURE We conducted a prospective cohort study in children receiving chemotherapy for cancer during two consecutive influenza seasons. Assessments of immune cells and serologic response were measured immediately before and after receiving influenza vaccine. Patients were monitored for influenza or influenza-like illness (ILI). RESULTS Two hundred fifty-nine patients were studied over 2 years. The seroresponse rate was 62% (98/157). The median ALC at vaccination was higher in seroresponders than nonresponders, 854 cells/mm(3) versus 602 cells/mm(3) , respectively (P < 0.036). Univariate analysis showed that patients with an ALC <1,000 cells/mm(3) at the time of vaccination were twice as likely to be sero-nonresponders (P < 0.02, OR = 2.4, 95% CI: 1.1-5.0). Twelve percent (31/259) of patients developed influenza, of whom all had fever at presentation, 26% (8/31) required hospitalization, and 81% (25/31) had chemotherapy delays. No deaths were associated with influenza infection. The proportion of patients with influenza was not different between seroresponders and nonresponders. CONCLUSIONS Influenza infection following immunization remains a source of morbidity in children undergoing chemotherapy. Lymphopenia at vaccination predicted sero-nonresponse. Seroresponse was not associated with a decreased frequency of influenza infection or ILI when compared to sero-nonresponders, suggesting clinical effectiveness of vaccination is likely multifactorial. Further investigation into the efficacy of the influenza vaccine is needed to refine immunization recommendations.
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Affiliation(s)
- Daniel K Choi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois.
| | - Ramsay L Fuleihan
- Division of Allergy/Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David O Walterhouse
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Surveillance for Healthcare-Associated Influenza-Like Illness in Pediatric Clinics: Validity of Diagnosis Codes for Case Identification. Infect Control Hosp Epidemiol 2016; 37:1247-50. [PMID: 27418404 DOI: 10.1017/ice.2016.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Compared to chart review, a definition based on the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for healthcare-associated influenza-like illness (HA-ILI) among young children in a large pediatric network demonstrated high positive and negative predictive values. This finding suggests that electronic health record-based definitions for surveillance can accurately identify medically attended outpatient HA-ILI cases for research and surveillance. Infect Control Hosp Epidemiol 2016;1-4.
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Drews SJ. The Role of Clinical Virology Laboratory and the Clinical Virology Laboratorian in Ensuring Effective Surveillance for Influenza and Other Respiratory Viruses: Points to Consider and Pitfalls to Avoid. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016; 8:165-176. [PMID: 32226325 PMCID: PMC7100664 DOI: 10.1007/s40506-016-0081-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Influenza and respiratory viruses have a global impact on public health. Clinical virology laboratories and laboratorians play an important role in not only the diagnosis but also the surveillance of these pathogens. Surveillance for influenza and other respiratory pathogens is important, as it informs public health decision making in terms of influenza vaccine and antiviral effectiveness, informs clinicians and public health practitioners about the pathogenicity of specific viral strains, guides clinical practice, and supports laboratory panning activities. Key background issues include the following: the fact that the laboratory is only one of several data providers to a surveillance system, the biologic nature of influenza and respiratory viruses and the laboratory needs to keep up to date on the diagnosis of these agents, the need for laboratorians to be involved in case definition development, the impact of push and pull data flow models on laboratory resources, and the fact that laboratories may be asked to provide more than just test results to surveillance programs. This review also identifies some key issues or questions that arise during the pre-analytic, analytic, and post-analytic phases that could impact on the ability of the laboratory to link to surveillance programs. Finally, issues surrounding virus characterization programs and how they link to surveillance programs are identified and discussed.
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Affiliation(s)
- Steven J. Drews
- Provincial Laboratory for Public Health (ProvLab), 2B1.03 WMC, University of Alberta Hospital, Edmonton, Alberta T6G 2J2 Canada
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta Canada
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Population-based Surveillance for Medically Attended Human Parainfluenza Viruses From the Influenza Incidence Surveillance Project, 2010-2014. Pediatr Infect Dis J 2016; 35:717-22. [PMID: 26974891 PMCID: PMC4927308 DOI: 10.1097/inf.0000000000001140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parainfluenza viruses (PIV) have been shown to contribute substantially to pediatric hospitalizations in the United States. However, to date, there has been no systematic surveillance to estimate the burden among pediatric outpatients. METHODS From August 2010 through July 2014, outpatient health care providers with enumerated patient populations in 13 states and jurisdictions participating in the Influenza Incidence Surveillance Project conducted surveillance of patients with influenza-like illness (ILI). Respiratory specimens were collected from the first 10 ILI patients each week with demographic and clinical data. Specimens were tested for multiple respiratory viruses, including PIV1-4, using reverse transcriptase-polymerase chain reaction assays. Cumulative incidence was calculated using provider patient population size as the denominator. RESULTS PIVs 1-3 were detected in 8.0% of 7716 ILI-related outpatient specimens: 30% were PIV1, 26% PIV2 and 44% PIV3. PIV circulation varied noticeably by year and type, with PIV3 predominating in 2010-2011 (incidence 110 per 100,000 children), PIV1 in 2011-2012 (89 per 100,000), dual predominance of PIV2 and PIV3 (88 and 131 per 100,000) in 2012-2013 and PIV3 (100 per 100,000) in 2013-2014. The highest incidence of PIV detections was among patients aged <5 years (259-1307 per 100,000). The median age at detection for PIV3 (3.4 years) was significantly lower than the median ages for PIV1 (4.5 years) and PIV2 (7.0 years; P < 0.05). CONCLUSIONS PIVs 1-3 comprise a substantial amount of medically attended pediatric ILI, particularly among children aged <5 years. Distinct seasonal circulation patterns as well as significant differences in rates by age were observed between PIV types.
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Russell ES, Zheteyeva Y, Gao H, Shi J, Rainey JJ, Thoroughman D, Uzicanin A. Reactive School Closure During Increased Influenza-Like Illness (ILI) Activity in Western Kentucky, 2013: A Field Evaluation of Effect on ILI Incidence and Economic and Social Consequences for Families. Open Forum Infect Dis 2016; 3:ofw113. [PMID: 27800520 PMCID: PMC5084722 DOI: 10.1093/ofid/ofw113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/20/2016] [Indexed: 11/22/2022] Open
Abstract
A reactive school closure following high influenza-like illness-related student absenteeism in a Kentucky school district did not influence reported influenza-like illness transmission in student households. Background. School closures are an important mitigation strategy during influenza pandemic: if implemented early in a local outbreak, they can slow the disease spread in the surrounding community. During seasonal influenza epidemics, school closures may occur reactively, after the disease is already widespread in the community. Such reactive closures are often too late to reduce influenza transmission. However, they can provide data to determine under which circumstances they might be effective in reducing influenza-like illness (ILI) transmission. Methods. We conducted a household survey in a school district in Kentucky. District A closed after high student absenteeism due to influenza-like illness (ILI), whereas adjacent Districts B and C remained open. We collected data on self-reported ILI among household members in these 3 districts 2 weeks before the District A closure, during closure, and 2 weeks after reopening, and we evaluated economic and social consequences of school closure on student households in District A. The difference-in-differences method was applied to compare changes in ILI rates from before to after closure between districts. Results. Estimated average daily ILI rate decreased less in District A than in District B or C for the entire sample and when stratified by age groups (0–5 years old, 6–18 years old, and above 18 years old). Twenty-five percent of District A households reported ≥1 closure-related economic or social difficulty. Conclusions. Closing schools after a widespread ILI activity in District A did not reduce ILI transmission but caused difficulties for some households.
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Affiliation(s)
- Elizabeth S Russell
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort; Epidemic Intelligence Service Officer
| | | | | | | | | | - Douglas Thoroughman
- Division of Epidemiology and Health Planning, Kentucky Department for Public Health, Frankfort; Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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McGuire A, Drummond M, Keeping S. Childhood and adolescent influenza vaccination in Europe: A review of current policies and recommendations for the future. Expert Rev Vaccines 2016; 15:659-70. [DOI: 10.1586/14760584.2016.1138861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cowling BJ, Feng S, Finelli L, Steffens A, Fowlkes A. Assessment of influenza vaccine effectiveness in a sentinel surveillance network 2010-13, United States. Vaccine 2015; 34:61-6. [PMID: 26611200 DOI: 10.1016/j.vaccine.2015.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Influenza vaccines are now widely used to reduce the burden of annual epidemics of influenza virus infections. Influenza vaccine effectiveness (VE) is monitored annually to determine VE against each season's circulating influenza strains in different groups such as children, adults and the elderly. Few prospective surveillance programs are available to evaluate influenza VE against medically attended illness for patients of all ages in the United States. METHODS We conducted surveillance of patients with acute respiratory illnesses in 101 clinics across the US during three consecutive influenza seasons. We analyzed laboratory testing results for influenza virus, self-reported vaccine history, and patient characteristics, defining cases as patients who tested positive for influenza virus and controls as patients who tested negative for influenza virus. Comparison of influenza vaccination coverage among cases versus controls, adjusted for potential confounders, was used to estimate VE as one minus the adjusted odds ratio multiplied by 100%. RESULTS We included 10,650 patients during three influenza seasons from August 2010 through December 2013, and estimated influenza VE in children 6m-5y of age (58%; 95% CI: 49%-66%), children 6-17y (45%; 95% CI: 34%-53%), adults 18-49y (36%; 95% CI: 24%, 46%), and adults ≥50y (34%, 95% CI: 13%, 51%). VE was higher against influenza A(H1N1) compared to A(H3N2) and B. CONCLUSIONS Our estimates of moderate influenza VE confirm the important role of vaccination in protecting against medically attended influenza virus infection.
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Affiliation(s)
- Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Shuo Feng
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Lyn Finelli
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrea Steffens
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ashley Fowlkes
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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Emukule GO, Paget J, van der Velden K, Mott JA. Influenza-Associated Disease Burden in Kenya: A Systematic Review of Literature. PLoS One 2015; 10:e0138708. [PMID: 26398196 PMCID: PMC4580615 DOI: 10.1371/journal.pone.0138708] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 09/02/2015] [Indexed: 02/03/2023] Open
Abstract
Background In Kenya data on the burden of influenza disease are needed to inform influenza control policies. Methods We conducted a systematic review of published data describing the influenza disease burden in Kenya using surveillance data collected until December 2013. We included studies with laboratory confirmation of influenza, well-defined catchment populations, case definitions used to sample patients for testing and a description of the laboratory methods used for influenza testing. Studies with or without any adjustments on the incidence rates were included. Results Ten studies reporting the incidence of medically-attended and non-medically attended influenza were reviewed. For all age groups, the influenza positive proportion ranged from 5–10% among hospitalized patients, and 5–27% among all medically-attended patients (a combination of in- and outpatients). The adjusted incidence rate of hospitalizations with influenza among children <5 years ranged from 2.7–4.7 per 1,000 [5.7 per 1,000 in children <6 months old], and were 7–10 times higher compared to persons aged ≥5 years. The adjusted incidence of all medically-attended influenza among children aged <5 years ranged from 13.0–58.0 per 1,000 compared to 4.3–26.0 per 1,000 among persons aged ≥5 years. Conclusions Our review shows an expanding set of literature on disease burden associated with influenza in Kenya, with a substantial burden in children under five years of age. Hospitalizations with influenza in these children were 2–3 times higher than reported in the United States. These findings highlight the possible value of an influenza vaccination program in Kenya, with children <5 years and pregnant women being potentially important targets.
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Affiliation(s)
- Gideon O. Emukule
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
- * E-mail:
| | - John Paget
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Koos van der Velden
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Joshua A. Mott
- Centers for Disease Control and Prevention, Kenya Country Office, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- US Public Health Service, Rockville, Maryland, United States of America
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Incidence of medically attended influenza during pandemic and post-pandemic seasons through the Influenza Incidence Surveillance Project, 2009-13. THE LANCET RESPIRATORY MEDICINE 2015; 3:709-718. [PMID: 26300111 DOI: 10.1016/s2213-2600(15)00278-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Since the introduction of pandemic influenza A (H1N1) to the USA in 2009, the Influenza Incidence Surveillance Project has monitored the burden of influenza in the outpatient setting through population-based surveillance. METHODS From Oct 1, 2009, to July 31, 2013, outpatient clinics representing 13 health jurisdictions in the USA reported counts of influenza-like illness (fever including cough or sore throat) and all patient visits by age. During four years, staff at 104 unique clinics (range 35-64 per year) with a combined median population of 368,559 (IQR 352,595-428,286) attended 35,663 patients with influenza-like illness and collected 13,925 respiratory specimens. Clinical data and a respiratory specimen for influenza testing by RT-PCR were collected from the first ten patients presenting with influenza-like illness each week. We calculated the incidence of visits for influenza-like illness using the size of the patient population, and the incidence attributable to influenza was extrapolated from the proportion of patients with positive tests each week. FINDINGS The site-median peak percentage of specimens positive for influenza ranged from 58.3% to 77.8%. Children aged 2 to 17 years had the highest incidence of influenza-associated visits (range 4.2-28.0 per 1000 people by year), and adults older than 65 years had the lowest (range 0.5-3.5 per 1000 population). Influenza A H3N2, pandemic H1N1, and influenza B equally co-circulated in the first post-pandemic season, whereas H3N2 predominated for the next two seasons. Of patients for whom data was available, influenza vaccination was reported in 3289 (28.7%) of 11,459 patients with influenza-like illness, and antivirals were prescribed to 1644 (13.8%) of 11,953 patients. INTERPRETATION Influenza incidence varied with age groups and by season after the pandemic of 2009 influenza A H1N1. High levels of influenza virus circulation, especially in young children, emphasise the need for additional efforts to increase the uptake of influenza vaccines and antivirals. FUNDING US Centers for Disease Control and Prevention.
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Incidence of medically attended influenza infection and cases averted by vaccination, 2011/2012 and 2012/2013 influenza seasons. Vaccine 2015; 33:5181-7. [PMID: 26271827 DOI: 10.1016/j.vaccine.2015.07.098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND We estimated the burden of outpatient influenza and cases prevented by vaccination during the 2011/2012 and 2012/2013 influenza seasons using data from the United States Influenza Vaccine Effectiveness (US Flu VE) Network. METHODS We defined source populations of persons who could seek care for acute respiratory illness (ARI) at each of the five US Flu VE Network sites. We identified all members of the source population who were tested for influenza during US Flu VE influenza surveillance. Each influenza-positive subject received a sampling weight based on the proportion of source population members who were tested for influenza, stratified by site, age, and other factors. We used the sampling weights to estimate the cumulative incidence of medically attended influenza in the source populations. We estimated cases averted by vaccination using estimates of cumulative incidence, vaccine coverage, and vaccine effectiveness. RESULTS Cumulative incidence of medically attended influenza ranged from 0.8% to 2.8% across sites during 2011/2012 and from 2.6% to 6.5% during the 2012/2013 season. Stratified by age, incidence ranged from 1.2% among adults 50 years of age and older in 2011/2012 to 10.9% among children 6 months to 8 years of age in 2012/2013. Cases averted by vaccination ranged from 4 to 41 per 1000 vaccinees, depending on the study site and year. CONCLUSIONS The incidence of medically attended influenza varies greatly by year and even by geographic region within the same year. The number of cases averted by vaccination varies greatly based on overall incidence and on vaccine coverage.
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van Vugt SF, Broekhuizen BD, Zuithoff NP, van Essen GA, Ebell MH, Coenen S, Ieven M, Lammens C, Goossens H, Butler CC, Hood K, Little P, Verheij TJ. Validity of a clinical model to predict influenza in patients presenting with symptoms of lower respiratory tract infection in primary care. Fam Pract 2015; 32:408-14. [PMID: 26045544 DOI: 10.1093/fampra/cmv039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Valid clinical predictors of influenza in patients presenting with lower respiratory tract infection (LRTI) symptoms would provide adequate patient information and reassurance. AIM Assessing the validity of an existing diagnostic model (Flu Score) to detect influenza in LRTI patients. DESIGN AND SETTING A European diagnostic study recruited 1801 adult primary care patients with LRTI-like symptoms existing ≤7 days between October and April 2007-2010. METHOD History and physical examination findings were recorded and nasopharyngeal swabs taken. Polymerase chain reaction (PCR) for influenza A/B was performed as reference test. Diagnostic accuracy of the Flu Score (1× onset <48 hours + 2× myalgia + 1× chills or sweats + 2× fever and cough) was expressed as area under the curve (AUC), calibration slopes and likelihood ratios (LRs). RESULTS A total of 273 patients (15%) had influenza on PCR. The AUC of the Flu Score during winter months was 0.66 [95% CI (95% confidence internal) 0.63-0.70]. During peak influenza season, both influenza prevalence (24%) and AUC were higher [0.71 (95% CI 0.66-0.76], but calibration remained poor. The Flu Score assigned 64% of the patients as 'low-risk' (10% had influenza, LR - 0.6). About 12% were classified as 'high risk' of whom 32% had influenza (LR + 2.7). During peak influenza season, 60% and 14% of patients were classified as low and high risk, respectively, with influenza prevalences being 14% (LR - 0.5) and 50% (LR + 3.2). CONCLUSION The Flu-Score attributes a small subgroup of patients with a high influenza risk (prevalence 32%). However, clinical usefulness is limited because this group is small and the association between predicted and observed risks is poor. Considerable diagnostic imprecision remains when it comes to differentiating those with influenza on clinical grounds from the many other causes of LRTI in primary care. New point of care tests are required that accurately, rapidly and cost effectively detect influenza in patients with respiratory tract symptoms in primary care.
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Affiliation(s)
- Saskia F van Vugt
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands,
| | - Berna Dl Broekhuizen
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Nicolaas Pa Zuithoff
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Gerrit A van Essen
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Mark H Ebell
- Department of Epidemiology and Biostatistics, University of Georgia, College of Public Health, Athens, GA, USA
| | - Samuel Coenen
- Centre for General Practice, University of Antwerp and Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Antwerp, Belgium
| | - Christine Lammens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Antwerp, Belgium
| | - Chris C Butler
- Institute of Primary Care and Public Health, Cardiff University, School of Medicine, and
| | - Kerenza Hood
- Institute of Translation, Innovation, Methodology and Engagement, Cardiff, UK, and
| | - Paul Little
- University of Southampton, FMedSci FRCGP Primary Care and Population Sciences Unit, Faculty of Medicine, Southampton, UK
| | - Theo Jm Verheij
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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Lee DC, Long JA, Wall SP, Carr BG, Satchell SN, Braithwaite RS, Elbel B. Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance. Am J Public Health 2015; 105:e67-74. [PMID: 26180983 DOI: 10.2105/ajph.2015.302679] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to improve public health surveillance by using a geographic analysis of emergency department (ED) visits to determine local chronic disease prevalence. METHODS Using an all-payer administrative database, we determined the proportion of unique ED patients with diabetes, hypertension, or asthma. We compared these rates to those determined by the New York City Community Health Survey. For diabetes prevalence, we also analyzed the fidelity of longitudinal estimates using logistic regression and determined disease burden within census tracts using geocoded addresses. RESULTS We identified 4.4 million unique New York City adults visiting an ED between 2009 and 2012. When we compared our emergency sample to survey data, rates of neighborhood diabetes, hypertension, and asthma prevalence were similar (correlation coefficient = 0.86, 0.88, and 0.77, respectively). In addition, our method demonstrated less year-to-year scatter and identified significant variation of disease burden within neighborhoods among census tracts. CONCLUSIONS Our method for determining chronic disease prevalence correlates with a validated health survey and may have higher reliability over time and greater granularity at a local level. Our findings can improve public health surveillance by identifying local variation of disease prevalence.
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Affiliation(s)
- David C Lee
- David C. Lee and Stephen P. Wall are with the Ronald O. Perelman Department of Emergency Medicine and R. Scott Braithwaite and Brian Elbel are with the Department of Population Health, New York University School of Medicine, New York, NY. Judith A. Long is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. Brendan G. Carr is with the Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Samantha N. Satchell is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Judith A Long
- David C. Lee and Stephen P. Wall are with the Ronald O. Perelman Department of Emergency Medicine and R. Scott Braithwaite and Brian Elbel are with the Department of Population Health, New York University School of Medicine, New York, NY. Judith A. Long is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. Brendan G. Carr is with the Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Samantha N. Satchell is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Stephen P Wall
- David C. Lee and Stephen P. Wall are with the Ronald O. Perelman Department of Emergency Medicine and R. Scott Braithwaite and Brian Elbel are with the Department of Population Health, New York University School of Medicine, New York, NY. Judith A. Long is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. Brendan G. Carr is with the Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Samantha N. Satchell is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Brendan G Carr
- David C. Lee and Stephen P. Wall are with the Ronald O. Perelman Department of Emergency Medicine and R. Scott Braithwaite and Brian Elbel are with the Department of Population Health, New York University School of Medicine, New York, NY. Judith A. Long is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. Brendan G. Carr is with the Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Samantha N. Satchell is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Samantha N Satchell
- David C. Lee and Stephen P. Wall are with the Ronald O. Perelman Department of Emergency Medicine and R. Scott Braithwaite and Brian Elbel are with the Department of Population Health, New York University School of Medicine, New York, NY. Judith A. Long is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. Brendan G. Carr is with the Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Samantha N. Satchell is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - R Scott Braithwaite
- David C. Lee and Stephen P. Wall are with the Ronald O. Perelman Department of Emergency Medicine and R. Scott Braithwaite and Brian Elbel are with the Department of Population Health, New York University School of Medicine, New York, NY. Judith A. Long is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. Brendan G. Carr is with the Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Samantha N. Satchell is with the Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Brian Elbel
- David C. Lee and Stephen P. Wall are with the Ronald O. Perelman Department of Emergency Medicine and R. Scott Braithwaite and Brian Elbel are with the Department of Population Health, New York University School of Medicine, New York, NY. Judith A. Long is with the Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. Brendan G. Carr is with the Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Samantha N. Satchell is with the Milken Institute School of Public Health, George Washington University, Washington, DC
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Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Pillai SK, Meltzer MI, Koonin LM. Potential demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clin Infect Dis 2015; 60 Suppl 1:S42-51. [PMID: 25878300 PMCID: PMC7314226 DOI: 10.1093/cid/civ141] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background. To inform planning for an influenza pandemic, we estimated US demand for N95 filtering facepiece respirators (respirators) by healthcare and emergency services personnel and need for surgical masks by pandemic patients seeking care. Methods. We used a spreadsheet-based model to estimate demand for 3 scenarios of respirator use: base case (usage approximately follows epidemic curve), intermediate demand (usage rises to epidemic peak and then remains constant), and maximum demand (all healthcare workers use respirators from pandemic onset). We assumed that in the base case scenario, up to 16 respirators would be required per day per intensive care unit patient and 8 per day per general ward patient. Outpatient healthcare workers and emergency services personnel would require 4 respirators per day. Patients would require 1.2 surgical masks per day. Results and Conclusions. Assuming that 20% to 30% of the population would become ill, 1.7 to 3.5 billion respirators would be needed in the base case scenario, 2.6 to 4.3 billion in the intermediate demand scenario, and up to 7.3 billion in the maximum demand scenario (for all scenarios, between 0.1 and 0.4 billion surgical masks would be required for patients). For pandemics with a lower attack rate and fewer cases (eg, 2009-like pandemic), the number of respirators needed would be higher because the pandemic would have longer duration. Providing these numbers of respirators and surgical masks represents a logistic challenge for US public health agencies. Public health officials must urgently consider alternative use strategies for respirators and surgical masks during a pandemic that may vary from current practices.
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Affiliation(s)
- Cristina Carias
- National Center for Immunization and Respiratory Diseases (NCIRD) IHRC, Inc
| | - Gabriel Rainisch
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases
| | - Manjunath Shankar
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases
| | - Bishwa B Adhikari
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases
| | - David L Swerdlow
- National Center for Immunization and Respiratory Diseases (NCIRD) Modeling Unit and Office of the Director, NCIRD
| | | | - Satish K Pillai
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases
| | - Lisa M Koonin
- Influenza Coordination Unit, Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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