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Low ZY, Wong KH, Wen Yip AJ, Choo WS. The convergent evolution of influenza A virus: Implications, therapeutic strategies and what we need to know. CURRENT RESEARCH IN MICROBIAL SCIENCES 2023; 5:100202. [PMID: 37700857 PMCID: PMC10493511 DOI: 10.1016/j.crmicr.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Influenza virus infection, more commonly known as the 'cold flu', is an etiological agent that gives rise to recurrent annual flu and many pandemics. Dated back to the 1918- Spanish Flu, the influenza infection has caused the loss of many human lives and significantly impacted the economy and daily lives. Influenza virus can be classified into four different genera: influenza A-D, with the former two, influenza A and B, relevant to humans. The capacity of antigenic drift and shift in Influenza A has given rise to many novel variants, rendering vaccines and antiviral therapies useless. In light of the emergence of a novel betacoronavirus, the SARS-CoV-2, unravelling the underpinning mechanisms that support the recurrent influenza epidemics and pandemics is essential. Given the symptom similarities between influenza and covid infection, it is crucial to reiterate what we know about the influenza infection. This review aims to describe the origin and evolution of influenza infection. Apart from that, the risk factors entail the implication of co-infections, especially regarding the COVID-19 pandemic is further discussed. In addition, antiviral strategies, including the potential of drug repositioning, are discussed in this context. The diagnostic approach is also critically discussed in an effort to understand better and prepare for upcoming variants and potential influenza pandemics in the future. Lastly, this review encapsulates the challenges in curbing the influenza spread and provides insights for future directions in influenza management.
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Affiliation(s)
- Zheng Yao Low
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ka Heng Wong
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Ashley Jia Wen Yip
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Wee Sim Choo
- School of Science, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
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Purandare CN, Preiss S, Kolhapure S, Sathyanarayanan S. Expert opinion on the way forward for improving maternal influenza vaccination in India. Expert Rev Vaccines 2021; 20:773-778. [PMID: 34018897 DOI: 10.1080/14760584.2021.1932474] [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] [Indexed: 12/21/2022]
Abstract
INTRODUCTION : Rates of maternal vaccination against influenza are extremely low in India. An expert panel of obstetric-gynecologists and pediatricians met to develop consensus-based recommendations for improving awareness of the benefits of influenza vaccination during pregnancy in India. AREAS COVERED : The group discussed experiences of influenza infection in pregnancy and infancy before focusing on maternal vaccination practices in India, including the degree of communication between obstetric-gynecologists and pediatricians and opinions on optimal timing for vaccination. The impact of inconsistent vaccine prescription practices by healthcare providers was discussed, as well as current clinical recommendations on maternal influenza vaccination. EXPERT OPINION : Although clinical evidence demonstrates the benefit of maternal influenza vaccination in any trimester, influenza vaccination is not widely accepted in India as an integral part of antenatal care. There is a lack of familiarity among obstetricians of clinical guidelines on maternal influenza vaccination. This can be addressed with an education campaign targeting obstetricians and other providers of maternal healthcare. With variable influenza seasons between regions in India, common vaccine stock shortages, and data suggesting influenza vaccination is feasible anytime in pregnancy, all opportunities to offer vaccination to this high-risk group for severe influenza disease should be considered.
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Affiliation(s)
| | - Scott Preiss
- Global Medical Affairs Lead, GSK, Rockville, USA
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Abraham K, Abraham A, Regi A, Lionel J, Thomas E, Vijayaselvi R, Jeyaseelan L, Abraham AM, Santhanam S, Kuruvilla KA, Steinhoff MC. Maternal and Perinatal Outcomes of Influenza in Pregnancy after Treatment with Oseltamivir. J Glob Infect Dis 2021; 13:20-26. [PMID: 33911448 PMCID: PMC8054794 DOI: 10.4103/jgid.jgid_157_20] [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: 05/31/2020] [Revised: 07/15/2020] [Accepted: 08/18/2020] [Indexed: 11/05/2022] Open
Abstract
Context: Influenza infection in pregnancy causes 4%–8% case fatality and five times more perinatal mortality. Influenza is a major contributor to mortality in developing countries; however, the morbidity has largely been underestimated. Public health interventions for prevention are also lacking. Aims: This study aimed to determine the seasonality of influenza in pregnant Indian women and to estimate the maternal and perinatal morbidity after treatment with oseltamivir. Settings and Design: This was a prospective observational cohort study, conducted in a tertiary hospital. Subjects and Methods: Pregnant women with ILI (influenza-like illness) were recruited into Cohort 1 (polymerase chain reaction [PCR] positive) and Cohort 2 (PCR negative). Gestational age-matched asymptomatic controls formed Cohort 3. Women in Cohort 1 received oseltamivir for 5 days. The incidence of small-for-gestational age (SGA) and preterm birth were the primary outcomes. Maternal and neonatal morbidity formed the secondary outcomes. Statistical Analysis: Unmatched (Cohort 1 and 2) and matched analysis (Cohort 1 and 3) were done. Student's t-test and Chi-square test were used to compare between variables. Results: Year-round incidence of influenza was recorded. Severe illness was more in Cohort 1 compared to Cohort 2 (36.2% vs. 6.3%; P < 0.001). SGA was comparable in all the cohorts (13%). Preterm birth (7.8% vs. 3.3%; P < 0.08; relative risk-2.75) was considerably high in Cohort 1. Secondary maternal and neonatal outcomes were similar between the groups. Conclusion: Influenza in pregnancy showed year-round incidence and increased maternal and neonatal morbidity despite treatment with oseltamivir. We suggest the need for newer interventions to curtail the illness in pregnancy.
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Affiliation(s)
- Kavitha Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anuja Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Annie Regi
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Jessie Lionel
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Elsy Thomas
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Reeta Vijayaselvi
- Department of Obstetrics and Gynaecology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Asha Mary Abraham
- Department of Virology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Kurian Anil Kuruvilla
- Department of Neonatology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Mark C Steinhoff
- Global Health Center, Cincinnati Children's Hospital, Cincinnati, OH, USA
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Morales KF, Menning L, Lambach P. The faces of influenza vaccine recommendation: A Literature review of the determinants and barriers to health providers' recommendation of influenza vaccine in pregnancy. Vaccine 2020; 38:4805-4815. [PMID: 32499068 PMCID: PMC7306152 DOI: 10.1016/j.vaccine.2020.04.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/09/2020] [Accepted: 04/12/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION WHO recommends influenza vaccination for pregnant women and health providers (HPs), yet global uptake for both is persistently low. Research suggests that HPs greatly influence uptake of influenza vaccine in pregnant women. Our review studies HPs' recommendation of influenza vaccine to pregnant women, determinants and barriers to recommendation, and the role that HPs may play in global influenza vaccine coverage. METHODS We undertook a comprehensive global review of literature relating to HPs' recommendation of seasonal influenza vaccines to pregnant women and the determinants and barriers to recommendation and how this may vary by country and context. We evaluated data from each study including frequency of HP recommendation, vaccine coverage, determinants and barriers to recommendation, and the odds of recommending. We tracked the frequency of determinants and barriers to recommendation in heat maps and organized data by world regions and income classifications. RESULTS From 32 studies in 15 countries, we identified 68 determinants or barriers to HPs' recommendation. Recommendation rates were highest (77%) in the Americas and lowest in South East Asia (18%). A HP's own influenza vaccine status was a main determinant of recommendation in multiple country contexts and from different provider types. Financial barriers to recommendation were present in higher-income countries and policy-related barriers were highlighted in lower-income countries. HP perceptions of safety, efficacy, and the utility of vaccine were the most frequently cited barriers, relevant in almost every context. CONCLUSIONS HP recommendation is important to influenza vaccine implementation in pregnant women. A HP's own status is an important recommendation determinant in multiple contexts. Vaccine program implementation plans should consider the impact of HPs' knowledge, awareness and vaccine confidence on their own uptake and recommendation practices, as well as on the uptake among pregnant women. Addressing safety and efficacy concerns is relevant in all contexts for HPs and pregnant women.
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Koul PA. Clinical practice guidelines for influenza and pneumococcal vaccination: The Indian perspective. Lung India 2020; 37:S1-S3. [PMID: 32830788 PMCID: PMC7703814 DOI: 10.4103/lungindia.lungindia_628_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Risk Factors Associated with Outcomes of Seasonal Influenza in Pregnant Women Referring to Healthcare Centers in Iran in 2015 - 2016. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.96403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Koul P, Potdar V, Mir H, Chadha M. The 2015 Outbreak of Severe Influenza in Kashmir, North India: Emergence of a New Clade of A/H1n1 Influenza Virus. PLOS CURRENTS 2018; 10. [PMID: 30245911 PMCID: PMC6122875 DOI: 10.1371/currents.outbreaks.519e170f2740fabd4ccd1642ff533364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction: Following the initial outbreak of A/H1N1pdm09, periodic resurgences of the virus, with variable morbidity and mortality, have been reported from various parts of India including the temperate Kashmir region of northern India. An outbreak of A/H1N1 was reported in early 2015 across India with a high morbidity and mortality. We studied patients during the outbreak in Kashmir. Methods: Patients (n=1780, age 1 month to 90 years, median 35 years) presenting with acute respiratory illness to a tertiary care hospital in Srinagar, Kashmir from October 2014 to April 2015 were recruited. After clinical data recording, combined throat and nasal swabs were collected in viral transport medium and tested by real-time RT-PCR for influenza viruses. All influenza A positive samples were further subtyped using primers and probes for A/H1N1pdm09 and A/H3 whereas influenza B samples were further subtyped into B/Yamagata and B/Victoria lineages. Virus isolation, hemagglutination inhibition testing, sequencing and phylogenetic analysis was carried out using standard procedures. Testing for H275Y mutation was done to determine sensitivity to oseltamivir. All patients received symptomatic therapy and influenza positive patients were administered oseltamivir. Results: Of the 1780 patients, 540 (30%) required hospitalization and 533 tested positive for influenza [influenza A=517(A/H1N1pdm09=437, A/H3N2=78 with co-infection of both in 2 cases); influenza B=16 (B/Yamgata=15)]. About 14% (n=254) had been vaccinated against influenza, having received the NH 2014-15 vaccine, 27 (11.3%) of these testing positive for influenza. Sixteen patients, including 4 pregnant females, died due to multi-organ failure. HA sequencing depicted that 2015 isolates belonged to Clade 6B.1. No H275Y mutation was reported from A/H1N1 positives. Conclusion: Resurgent outbreak of A/H1N1pdm09, with emergence of clade 6B.1, in 2014-15 resulted in high rate of hospitalizations, morbidity and mortality. Periodic resurgences and appearance of mutants emphasize continued surveillance so as to identify newer mutations with potential for outbreaks and severe outcomes.
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Affiliation(s)
- Parvaiz Koul
- Internal & Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, J&K, India
| | | | - Hyder Mir
- Internal & Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, J&K, India
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Koul PA, Mir H. The biggest barrier to influenza vaccination in pregnant females in India: Poor sensitization of the care providers. Vaccine 2018; 36:3569-3570. [DOI: 10.1016/j.vaccine.2018.04.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 02/02/2018] [Accepted: 04/16/2018] [Indexed: 10/16/2022]
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Kostinov MP, Cherdantsev AP, Akhmatova NK, Praulova DA, Kostinova AM, Akhmatova EA, Demina EO. Immunogenicity and safety of subunit influenza vaccines in pregnant women. ERJ Open Res 2018; 4:00060-2017. [PMID: 29637079 PMCID: PMC5890026 DOI: 10.1183/23120541.00060-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 02/08/2018] [Indexed: 11/23/2022] Open
Abstract
Pregnancy is a condition of modulated immune suppression, so this group of patients has increased risk of infectious diseases. Trivalent subunit vaccines, unadjusted Agrippal S1 (group I) and immunoadjuvant Grippol Plus (group II), containing 5 μg of actual influenza virus strains, were administered respectively to 37 and 42 women in the second and third trimester of physiological pregnancy. The administration of subunit influenza vaccines was accompanied by the development of local reactions in no more than 10% of patients, compared with 4.9% of the 41 pregnant women in the placebo group (group III). Systemic reactions were of a general somatic nature, did not differ between vaccinated and placebo groups, and were not associated with vaccination. Physiological births in groups I, II and III were 94.6%, 92.9% and 85.4%, respectively, and the birth rates of children without pathologies were 91.9%, 90.5% and 80.5%, respectively, and were comparable between groups. Vaccination stimulated the production of protective antibodies against influenza virus strains in 64.8-94.5% of patients after immunisation with an unadjusted vaccine and in 72.5-90.0% of patients after the administration of an immunoadjuvant vaccine. After 9 months, antibody levels were recorded in 51.3-72.9% in group I and 54.2-74.2% in group II. Immunisation against influenza in pregnant women provided a high level of seroprotection and seroconversion. Nevertheless, the level of seroprotection against the influenza strain A(H3N2, Victoria) was slightly lower in the group immunised with an unadjusted vaccine compared to those vaccinated with the immunoadjuvant vaccine.
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Affiliation(s)
- Mikhail P. Kostinov
- Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander P. Cherdantsev
- Federal State Budget-funded Educational Establishment of Higher Professional Education Ulyanovsk State University, Ulyanovsk, Russia
| | | | - Daria A. Praulova
- Federal State Budget-funded Establishment “Federal Research Clinical Center of Pediatric Hematology, Oncology and Immunology named after Dmitriy Rogachev” of the Russian Federation Ministry of Health, Moscow, Russia
| | - Aristitsa M. Kostinova
- National Research Center – Institute of Immunology Federal Medical-Biological Agency of Russia, Moscow, Russia
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Moghoofei M, Monavari SH, Mostafaei S, Hadifar S, Ghasemi A, Babaei F, Kavosi H, Tavakoli A, Javanmard D, Esghaei M, Khodabandehlou N. Prevalence of influenza A infection in the Middle-East: A systematic review and meta-analysis. CLINICAL RESPIRATORY JOURNAL 2018; 12:1787-1801. [DOI: 10.1111/crj.12758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Mohsen Moghoofei
- Department of Microbiology, School of Medicine; Kermanshah University of Medical Sciences; Kermanshah Iran
| | | | - Shayan Mostafaei
- Department of Biostatistics, Faculty of Medical Sciences; Tarbiat Modares University; Tehran Iran
- Rheumatology Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Shima Hadifar
- Department of Mycobacteriology & Pulmonary Research; Pasteur Institute of Iran; Tehran Iran
- Microbiology Research Center (MRC); Pasteur Institute of Iran; Tehran Iran
| | - Amir Ghasemi
- Department of Materials Science and Engineering; Sharif University of Technology; Tehran Iran
| | - Farhad Babaei
- Department of Microbiology, School of Medicine; Kermanshah University of Medical Sciences; Kermanshah Iran
| | - Hoda Kavosi
- Rheumatology Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Ahmad Tavakoli
- Department of Virology, Faculty of Medicine; Iran University of Medical Sciences; Tehran Iran
| | - Davod Javanmard
- Department of Virology, Faculty of Medicine; Iran University of Medical Sciences; Tehran Iran
| | - Maryam Esghaei
- Department of Virology, Faculty of Medicine; Iran University of Medical Sciences; Tehran Iran
| | - Nilofar Khodabandehlou
- Department of Internal Medicine, Faculty of Medicine; Iran University of Medical Sciences; Tehran Iran
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Nigam A, Varun N, Saxena P. Maternal immunization: An opportunity to protect the vulnerable from infectious disease. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cowling BJ, Caini S, Chotpitayasunondh T, Djauzi S, Gatchalian SR, Huang QS, Koul PA, Lee PI, Muttalif AR, Plotkin S. Influenza in the Asia-Pacific region: Findings and recommendations from the Global Influenza Initiative. Vaccine 2017; 35:856-864. [PMID: 28081970 DOI: 10.1016/j.vaccine.2016.12.064] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/15/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
The fourth roundtable meeting of the Global Influenza Initiative (GII) was held in Hong Kong, China, in July 2015. An objective of this meeting was to gain a broader understanding of the epidemiology, surveillance, vaccination policies and programs, and obstacles to vaccination of influenza in the Asia-Pacific region through presentations of data from Australia, Hong Kong, India, Indonesia, Malaysia, New Zealand, the Philippines, Taiwan, Thailand, and Vietnam. As well as a need for improved levels of surveillance in some areas, a range of factors were identified that act as barriers to vaccination in some countries, including differences in climate and geography, logistical challenges, funding, lack of vaccine awareness and education, safety concerns, perceived lack of vaccine effectiveness, and lack of inclusion in national guidelines. From the presentations at the meeting, the GII discussed a number of recommendations for easing the burden of influenza and overcoming the current challenges in the Asia-Pacific region. These recommendations encompass the need to improve surveillance and availability of epidemiological data; the development and publication of national guidelines, where not currently available and/or that are in line with those proposed by the World Health Organization; the requirement for optimal timing of vaccination programs according to local or country-specific epidemiology; and calls for advocacy and government support of vaccination programs in order to improve availability and uptake and coverage. In conclusion, in addition to the varied epidemiology of seasonal influenza across this diverse region, there are a number of logistical and resourcing issues that present a challenge to the development of optimally effective vaccination strategies and that need to be overcome to improve access to and uptake of seasonal influenza vaccines. The GII has developed a number of recommendations to address these challenges and improve the control of influenza.
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Affiliation(s)
- Benjamin J Cowling
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Saverio Caini
- NIVEL, Dutch Institute for Health Services Research, Utrecht, The Netherlands
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | | | - Salvacion R Gatchalian
- University of the Philippines Manila, College of Medicine, Philippine General Hospital, Manila City, Philippines
| | - Q Sue Huang
- Institute of Environmental Science and Research (ESR), Wallaceville, Upper Hutt, New Zealand
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ping-Ing Lee
- National Taiwan University Children's Hospital, Taipei, Taiwan
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