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Savagner J, Trémeaux P, Baudou E, Mansuy JM, Cheuret E. Neurological involvement related to the influenza virus in children: A 5-year single-centre retrospective study. Eur J Paediatr Neurol 2024; 51:100-109. [PMID: 38908343 DOI: 10.1016/j.ejpn.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 05/19/2024] [Accepted: 05/26/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Inflammation related to influenza virus infection can lead to multiple neurological presentations. Encephalitis is one of them, mostly accompanied by seizures, with different profiles depending on the epidemics and previous medical conditions. MATERIALS AND METHODS All children presenting neurological symptoms and positive for influenza virus RNA detection in a respiratory sample between November 2018 and April 2023, hospitalized in the Department of Paediatric Neurology of Toulouse Children's Hospital, were retrospectively analysed. RESULTS Among the 1,277 children diagnosed with influenza in our centre, 131 (10.3 %) were hospitalized for neurological features. The year 2020-2021 was marked by zero incidence of positive influenza tests, associated with the COVID-19 pandemic. Among the 131 patients included, 71.6 % were under 5 years old. Most of them (80.9 %) were infected by influenza A virus. The first neurological symptoms were mainly seizures in 73.3 % of patients. Possible or confirmed encephalitis was observed in 29 % of cases, including one acute necrotizing encephalopathy. Few children (6.1 %) presented with acute myositis. Twenty-seven patients (20.6 %) had a personal history of significant previous neurological disorders. Most patients (88.5 %) displayed a rapid favourable outcome, marked by the disappearance of their neurological symptoms within the first 2 days. Anti-epileptic drugs were introduced in 1.5 % of cases, and adapted in 16.8 %, mainly in patients with febrile status epilepticus and an abnormal EEG. CONCLUSION Neurological features were frequently associated with influenza infection in children; most were transient. Effects on long-term neurodevelopmental outcomes need to be clarified as our follow-up was limited, especially in children with pre-existing neurological conditions.
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Affiliation(s)
- Julie Savagner
- Department of Paediatric Neurology, Toulouse Children's Hospital, 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Pauline Trémeaux
- Department of Virology, Toulouse University Hospital, Federative Institute of Biology (IFB), 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Eloïse Baudou
- Department of Paediatric Neurology, Toulouse Children's Hospital, 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Jean Michel Mansuy
- Department of Virology, Toulouse University Hospital, Federative Institute of Biology (IFB), 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
| | - Emmanuel Cheuret
- Department of Paediatric Neurology, Toulouse Children's Hospital, 330 Avenue de Grande Bretagne, 31300, Toulouse, France.
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Antoon JW, Sarker J, Abdelaziz A, Lien PW, Williams DJ, Lee TA, Grijalva CG. Trends in Outpatient Influenza Antiviral Use Among Children and Adolescents in the United States. Pediatrics 2023; 152:e2023061960. [PMID: 37953658 PMCID: PMC10681853 DOI: 10.1542/peds.2023-061960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Influenza antivirals improve outcomes in children with duration of symptoms <2 days and those at high risk for influenza complications. Real-world prescribing of influenza antivirals in the pediatric population is unknown. METHODS We performed a cross-sectional study of outpatient and emergency department prescription claims in individuals <18 years of age included in the IBM Marketscan Commercial Claims and Encounters Database between July 1, 2010 and June 30, 2019. Influenza antiviral use was defined as any dispensing of oseltamivir, baloxavir, or zanamivir. The primary outcome was the rate of antiviral dispensing per 1000 enrolled children. Secondary outcomes included antiviral dispensing per 1000 influenza diagnoses and inflation-adjusted costs of antiviral agents. Outcomes were calculated and stratified by age, acute versus prophylactic treatment, influenza season, and geographic region. RESULTS The analysis included 1 416 764 unique antiviral dispensings between 2010 and 2019. Oseltamivir was the most frequently prescribed antiviral (99.8%). Dispensing rates ranged from 4.4 to 48.6 per 1000 enrolled children. Treatment rates were highest among older children (12-17 years of age), during the 2017 to 2018 influenza season, and in the East South Central region. Guideline-concordant antiviral use among young children (<2 years of age) at a high risk of influenza complications was low (<40%). The inflation-adjusted cost for prescriptions was $208 458 979, and the median cost ranged from $111 to $151. CONCLUSIONS There is wide variability and underuse associated with influenza antiviral use in children. These findings reveal opportunities for improvement in the prevention and treatment of influenza in children.
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Affiliation(s)
| | - Jyotirmoy Sarker
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | - Abdullah Abdelaziz
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | - Pei-Wen Lien
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | | | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois
| | - Carlos G. Grijalva
- Health Policy and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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Wolf RM, Antoon JW. Influenza in Children and Adolescents: Epidemiology, Management, and Prevention. Pediatr Rev 2023; 44:605-617. [PMID: 37907421 PMCID: PMC10676733 DOI: 10.1542/pir.2023-005962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
EDUCATION GAP Influenza is among the most common infectious causes of pediatric emergency department visits and hospitalizations. Clinicians should use evidence-based guidelines to learn how to identify, manage, prevent, and treat influenza cases. Disease caused by influenza virus can be mitigated with appropriate treatment and prevention efforts. OBJECTIVES After completing this article, readers should be able to: 1. Describe the virology and epidemiology of influenza. 2. List the clinical features and complications of influenza infections. 3. List the benefits and limitations of testing modalities for the diagnosis of influenza. 4. Appropriately apply American Academy of Pediatrics, Infectious Diseases Society of America, and Centers for Disease Control and Prevention (CDC) treatment guidelines for influenza or suspected influenza. 5. Describe the importance of influenza vaccination.
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Affiliation(s)
- Ryan M Wolf
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - James W Antoon
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
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Li H, Yang W, Li H, Bai X, Zhang H, Fan W, Liu W, Sun L. PROTAC targeting cyclophilin A controls virus-induced cytokine storm. iScience 2023; 26:107535. [PMID: 37636080 PMCID: PMC10448112 DOI: 10.1016/j.isci.2023.107535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/22/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Cytokine storms caused by viruses are associated with elevated cytokine levels and uncontrolled inflammatory responses that can lead to acute respiratory distress syndrome. Current antiviral therapies are not sufficient to prevent or treat these complications. Cyclophilin A (CypA) is a key factor that regulates the production of multiple cytokines and could be a potential therapeutic target for cytokine storms. Here, three proteolysis targeting chimeras (PROTACs) targeting CypA were designed. These PROTACs bind to CypA, enhance its ubiquitination, and promote its degradation in both cell lines and mouse organs. During influenza B virus (IBV) infection, PROTAC-mediated CypA depletion reduces P65 phosphorylation and NF-κB-mediated proinflammatory cytokine production in A549 cells. Moreover, Comp-K targeting CypA suppresses excessive secretion of proinflammatory cytokines in bronchoalveolar lavage fluid, reduces lung injury, and enhances survival rates of IBV-infected mice. Collectively, we provide PROTACs targeting CypA, which are potential candidates for the control of cytokine storms.
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Affiliation(s)
- Heqiao Li
- Institute of Infectious Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong 518107, China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wenxian Yang
- Institute of Infectious Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong 518107, China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Huizi Li
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiaoyuan Bai
- Institute of Infectious Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong 518107, China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - He Zhang
- Institute of Infectious Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong 518107, China
| | - Wenhui Fan
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Wenjun Liu
- Institute of Infectious Diseases, Shenzhen Bay Laboratory, Shenzhen, Guangdong 518107, China
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Lei Sun
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing 100049, China
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Moller C, van Driel M, Davey A, Tapley A, Holliday EG, Fielding A, Davis J, Ball J, Ralston A, Turner A, Mulquiney K, Spike N, Fitzgerald K, Magin P. Influenza presentations and use of neuraminidase inhibitors by Australian general practice registrars: a cross-sectional analysis from the ReCEnT study. Fam Med Community Health 2023; 11:e002107. [PMID: 37328280 PMCID: PMC10277129 DOI: 10.1136/fmch-2022-002107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
OBJECTIVE This study aims to establish prevalence and associations of (1) influenza and influenza-like illness (IILI) presentations to Australian general practice (GP) registrars (trainees) and (2) the use of neuraminidase inhibitors (NAIs) by GP registrars for new presentations of IILI, for the 10 years leading up to the COVID-19 pandemic in Australia (2010-2019). DESIGN This was a cross-sectional analysis of the Registrar Clinical Encounters in Training ongoing inception cohort study of the in-consultation experience and clinical behaviours of GP registrars. Data are collected by individual registrars three times (from 60 consecutive consultations each time) at 6 monthly intervals. Data include diagnoses/problems managed and medicines prescribed, along with multiple other variables. Univariate and multivariable logistic regression was used to establish associations of registrars seeing patients with IILI and of prescribing NAIs for IILI. SETTING Teaching practices within the Australian general practitioner specialist vocational training programme. Practices were located in five of the six Australian states (plus one territory). PARTICIPANTS GP registrars in each of their three compulsory 6-month GP training terms. RESULTS From 2010 to 2019, 0.2% of diagnoses/problems seen by registrars were IILI. 15.4% of new IILI presentations were prescribed an NAI. IILI diagnoses were less likely in younger (0-14) and older (65+) age groups, and more likely in an area of higher socioeconomic advantage. There was considerable variation in NAI prescribing between regions. There was no significant association of prescribing NAIs with age or Aboriginal and/or Torres Strait Islander patients. CONCLUSIONS IILI presentations were more likely among working-age adults and not among those groups at higher risk. Similarly, high-risk patient groups who would benefit most were not more likely to receive NAIs. The epidemiology and management of IILI has been distorted by the COVID-19 pandemic, but the burden of influenza in vulnerable populations must not be overlooked. Appropriately targeted antiviral therapy with NAIs influences outcomes for vulnerable patients. General practitioners manage the majority of IILI in Australia, and understanding GP IILI presentation and NAI prescribing patterns is a key first step to enabling sound and rational prescribing decisions for better patient outcomes.
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Affiliation(s)
- Chris Moller
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Mieke van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Andrew Davey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
| | - Amanda Tapley
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
| | - Elizabeth G Holliday
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Alison Fielding
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
| | - Joshua Davis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Anna Ralston
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
| | - Alexandria Turner
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
| | - Katie Mulquiney
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
| | - Neil Spike
- The University of Melbourne Department of General Practice and Primary Health Care, Carlton, Victoria, Australia
- Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Kristen Fitzgerald
- General Practice Training Tasmania, Regional Training Organisation, Hobart, Tasmania, Australia
- University of Tasmania School of Medicine, Hobart, Tasmania, Australia
| | - Parker Magin
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
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Antoon JW, Hall M, Feinstein JA, Kyler KE, Shah SS, Girdwood ST, Goldman JL, Grijalva CG, Williams DJ. Guideline-Concordant Antiviral Treatment in Children at High Risk for Influenza Complications. Clin Infect Dis 2023; 76:e1040-e1046. [PMID: 35867691 PMCID: PMC10169402 DOI: 10.1093/cid/ciac606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND National guidelines recommend antiviral treatment for children with influenza at high risk for complications regardless of symptom duration. Little is known about concordance of clinical practice with this recommendation. METHODS We performed a cross-sectional study of outpatient children (aged 1-18 years) at high risk for complications who were diagnosed with influenza during the 2016-2019 influenza seasons. High-risk status was determined using an existing definition that includes age, comorbidities, and residence in a long-term care facility. The primary outcome was influenza antiviral dispensing within 2 days of influenza diagnosis. We determined patient- and provider-level factors associated with guideline-concordant treatment using multivariable logistic regression. RESULTS Of the 274 213 children with influenza at high risk for influenza complications, 159 350 (58.1%) received antiviral treatment. Antiviral treatment was associated with the presence of asthma (aOR, 1.13; 95% confidence interval [CI], 1.11-1.16), immunosuppression (aOR, 1.10; 95% CI, 1.05-1.16), complex chronic conditions (aOR, 1.04; 95% CI, 1.01-1.07), and index encounter in the urgent care setting (aOR, 1.3; 95% CI, 1.26-1.34). Factors associated with decreased odds of antiviral treatment include age 2-5 years compared with 6-17 years (aOR, 0.95; 95% CI, .93-.97), residing in a chronic care facility (aOR, .61; 95% CI, .46-.81), and index encounter in an emergency department (aOR, 0.66; 95% CI, .63-.71). CONCLUSIONS Among children with influenza at high risk for complications, 42% did not receive guideline-concordant antiviral treatment. Further study is needed to elucidate barriers to appropriate use of antivirals in this vulnerable population.
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Affiliation(s)
- James W Antoon
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.,Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - James A Feinstein
- Department of Pediatrics, Adult and Child Consortium for Health Outcomes Research & Delivery Science, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Kathryn E Kyler
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sonya Tang Girdwood
- Divisions of Hospital Medicine and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Division of Clinical Pharmacology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Carlos G Grijalva
- Division of Pharmacoepidemiology, Departments of Health Policy and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Derek J Williams
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.,Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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