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Aung AH, Lye DC, Cui L, Ooi CK, Chow ALP. The "timeless" use of influenza-like illness criteria for influenza detection in the tropics. Int J Infect Dis 2021; 106:160-168. [PMID: 33741485 DOI: 10.1016/j.ijid.2021.03.045] [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: 11/27/2020] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE We assessed the performance of influenza-like illness (ILI) case definitions by the Centers for Disease Control and Prevention (CDC), European Centers for Disease Control and Prevention and World Health Organization (WHO) in the tropics where seasonal patterns of respiratory viruses in acute upper respiratory tract infections (AURTIs) are ill-defined. METHODS Clinical data and samples for respiratory multiplex polymerase chain reaction test were collected from 717 consecutive patients attending an emergency department in Singapore for uncomplicated AURTI in 2016-2018. RESULTS Influenza (20.6%), rhinoviruses (14.4%), and coronaviruses (3.6%) were the most common viral pathogens identified. Biannual peaks with year-round activity were identified for influenza. Although higher rhinovirus activity was observed in inter-influenza seasonal periods, rhinoviruses and coronaviruses circulated year-round without distinct seasonal patterns. During high influenza activity months, the CDC and WHO ILI case definitions had moderate-to-high positive likelihood ratio (LR+) of 3.8-6.8 and 4.5-10.7, respectively, for ruling in influenza. They had moderately-high LR + of 3.3-3.8 and 3.9-4.6 for diagnosing influenza during other months. The ILI case definitions had high specificity (77.2%-85.4%) for rhinoviruses and coronaviruses. CONCLUSION The CDC and WHO ILI case definitions can be applied to clinically diagnose influenza in the tropics, regardless of the time of the year.
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Affiliation(s)
- Aung H Aung
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore
| | - David C Lye
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore
| | - Lin Cui
- National Public Health Laboratory, Ministry of Health, Singapore
| | - Chee K Ooi
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore
| | - Angela L P Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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2
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Chen ICM, Loh JP, Chuah CXP, Gao QHC, Sun Y, Ng SH, Koh WHV, Goh EH, Zhao X, Tambyah PA, Cook AR, Chng J, Pang J, Tan BH, Lee VJ. Evidence for Cross-Protection Against Subsequent Febrile Respiratory Illness Episodes From Prior Infections by Different Viruses Among Singapore Military Recruits 2009-2014. J Infect Dis 2020; 219:1913-1923. [PMID: 30722024 PMCID: PMC6534195 DOI: 10.1093/infdis/jiz046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/27/2019] [Indexed: 12/22/2022] Open
Abstract
Background Few studies have evaluated the relative cross-protection conferred by infection with different groups of viruses through studies of sequential infections in humans. We investigated the presence of short-lived relative cross-protection conferred by specific prior viral infections against subsequent febrile respiratory illness (FRI). Methods Men enlisted in basic military training between December 2009 and December 2014 were recruited, with the first FRI as the study entry point. ResPlex II assays and real-time polymerase chain reaction assays were used to detect viral pathogens in nasal wash samples, and survival analyses were performed to determine whether infection with particular viruses conferred short-lived relative cross-protection against FRI. Results Prior infection with adenovirus (hazard ratio [HR], 0.24; 95% confidence interval [CI], .14–.44) or influenza virus (HR, 0.52; 95% CI, .38–.73) conferred relative protection against subsequent FRI episode. Results were statistically significant even after adjustment for the interval between enlistment and FRI (P < .001). Adenovirus-positive participants with FRI episodes tended to be protected against subsequent infection with adenovirus, coronavirus, enterovirus/rhinovirus, and influenza virus (P = .062–.093), while men with influenza virus–positive FRI episodes tended be protected against subsequent infection with adenovirus (P = .044) and influenza virus (P = .081). Conclusion Prior adenovirus or influenza virus infection conferred cross-protection against subsequent FRI episodes relative to prior infection due to other circulating viruses.
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Affiliation(s)
- I-Cheng Mark Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore.,Infectious Disease Research and Training Office, National Centre for Infectious Diseases, Singapore
| | | | - Cheryl X P Chuah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore
| | | | - Yinxiaohe Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore.,Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore
| | | | | | - Ee Hui Goh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore
| | - Xiahong Zhao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore
| | - Paul Anantharajah Tambyah
- Yong Loo Lin School of Medicine, National University of Singapore and National University Hospital System, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore
| | - Jeremiah Chng
- Biodefence Centre, Headquarters Medical Corps, Singapore Armed Forces, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore.,Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore
| | - Boon-Huan Tan
- DSO National Laboratories, Singapore.,Infection and Immunity, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Vernon J Lee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Hospital System, Singapore.,Biodefence Centre, Headquarters Medical Corps, Singapore Armed Forces, Singapore
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3
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Lawrence H, Hunter A, Murray R, Lim WS, McKeever T. Cigarette smoking and the occurrence of influenza - Systematic review. J Infect 2019; 79:401-406. [PMID: 31465780 DOI: 10.1016/j.jinf.2019.08.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The association of current smoking with influenza infection is not widely recognised. The aim of this systematic review was to summarise published evidence and quantify the risk of influenza infection in tobacco smokers compared to non-smokers. METHODS We systematically searched MEDLINE, EMBASE, CINAHL, LILACS and Web of Science, from inception to 7 November 2017, to identify relevant randomised control trials, cohort and case-control studies. Study quality was assessed using the Newcastle-Ottawa Scale. We included studies defining influenza as a clinical syndrome and those using confirmatory microbiological tests. Pooled odds ratios (ORs) were estimated by using random effects model. RESULTS The mean quality score across the nine included studies (n = 40,685 participants) was 5.4 of 9 (SD 1.07). Current smokers were over 5 times more likely to develop laboratory-confirmed influenza than non-smokers (pooled OR 5.69 (95% CI 2.79-11.60), 3 studies). For studies reporting the occurrence of an influenza-like illness (ILI), current smokers were 34% more likely to develop ILI than non-smokers (pooled OR 1.34 (95% CI 1.13-1.59), 6 studies). CONCLUSION Current smokers have an increased risk of developing influenza compared to non-smokers. The association was strongest in studies examining cases with laboratory confirmed influenza.
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Affiliation(s)
- H Lawrence
- Nottingham University Hospitals NHS Trust, Clinical Sciences Building, Hucknall Road, Nottingham NG5 1 PB, UK; Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK.
| | - A Hunter
- Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - R Murray
- Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - W S Lim
- Nottingham University Hospitals NHS Trust, Clinical Sciences Building, Hucknall Road, Nottingham NG5 1 PB, UK; Nottingham Biomedical Research Centre NIHR, UK
| | - T McKeever
- Department of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies (UKCTAS), School of Medicine, Clinical Sciences Building, Nottingham City Hospital, University of Nottingham, Nottingham, UK; Nottingham Biomedical Research Centre NIHR, UK
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Tan BH, Guzman MRTD, Donato LKS, Kalimuddin S, Lee WHL, Tan AL, Wong GC. Impact of an alternating first-line antibiotics strategy in febrile neutropenia. PLoS One 2018; 13:e0208039. [PMID: 30485357 PMCID: PMC6261621 DOI: 10.1371/journal.pone.0208039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
Background Rising antibiotic resistance poses a challenge to the management of febrile neutropenia in patients with haematological malignancies receiving chemotherapy. Aim We studied an alternating first-line antibiotic strategy to determine its impact on all-cause mortality and bacteremia rates in patients with febrile neutropenia. Methods An alternating first-line antibiotic strategy was established in mid-2013. Data for 2012 (before strategy implementation) and 2014 (post-strategy implementation) were compared. Antibiotic Heterogeneity Index (AHI) for each of the two time-periods was also calculated. Findings There were 2012 admissions (26082 patient-days) in 2012 and 1843 admissions (24331 patient-days) in 2014. There was no significant difference in the baseline characteristics of patients in the two groups. The defined daily doses (DDD) of cefepime (CEF) fell while the DDD of piperacillin-tazobactam (PTZ) rose in 2014 compared with 2012. Vancomycin DDD fell in 2014. The AHI was 0.466 in 2012 and 0.582 in 2014. The difference in all-cause mortality was not statistically significant. There was no difference in rates of bacteremia with CEF-resistant, PTZ-resistant and carbapenem-resistant gram-negative organisms in the two groups. Rates of new cases of Methicillin-resistant Staphylococcus aureus (MRSA) were 2.38/1000 and 2.59/1000 patient-days in 2012 and 2014 respectively. Rates of new cases of Vancomycin-resistant Enterococcus (VRE) were 1.84/1000 and 1.81/1000 patient-days in 2012 and 2014 respectively. There was no Carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in 2012 and 1 in 2014. Conclusion An alternating first-line antibiotic strategy resulted in an increase in antibiotic heterogeneity, without increasing mortality. There was also no significant increase in bacteremia rates.
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Affiliation(s)
- Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
- * E-mail:
| | | | | | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | | | - Ai Ling Tan
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Gee Chuan Wong
- Department of Haematology, Singapore General Hospital, Singapore, Singapore
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Chen WW, Xu W, Xie YX, Zhang YH, Wu D, Wang FS, Zhao M. Surveillance for respiratory infectious diseases caused by 6 common viruses in a recruit training site in the Northern region of China. Mil Med Res 2017; 4:10. [PMID: 28373908 PMCID: PMC5376280 DOI: 10.1186/s40779-017-0120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/16/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Recruit training sites are places with a high incidence of respiratory infectious diseases. Effective surveillance for acute respiratory infectious diseases in a recruit training site is an important way to prevent disease outbreaks. METHODS Eight hundred recruits (722 males and 78 females) enlisted in autumn 2015 received a background survey within 24 h of settlement at the recruit training site, including their general personal information, vaccination history, mental status and clinical symptoms. Then, nasopharyngeal swabs of these recruits were collected to detect common respiratory pathogens [influenza virus type A, influenza virus type B, adenovirus (Adv), human respiratory syncytial virus, human bocavirus and human metapneumovirus] by PCR. In addition, fasting venous blood was collected in the morning for adenovirus IgG antibody detection. During the three months of training, the recruits were monitored for symptoms of respiratory infection, and nasopharyngeal swabs were collected from those with an axillary temperature ≥38 °C and other respiratory symptoms within 4 h of symptom onset. Samples were further examined by PCR. RESULTS Among the 795 effective nasopharyngeal swab samples collected during survey, two cases of group C type 1 adenovirus were identified by PCR. During the 3 months of training, fever and respiratory symptoms occurred in 39 recruits (incidence rate of 4.9%) and 5 cases of adenovirus were detected (positive rate of 12.8%). Genotyping showed 3 cases of type 4 adenovirus and 2 of type 3 adenovirus. No type 7, 14 or 55 adenovirus was detected. The Adv-IgG positive rate of recruits was 48.2%. Among the 5 Adv positive cases with fever and respiratory symptoms, 4 were Adv-IgG positive. CONCLUSION The pathogen carrier rate in recruits was low, and only group C adenovirus, which causes mild infection in humans, was detected. No respiratory outbreak was observed at the recruit training site, and sporadic cases were mainly caused by type 3 and type 4 adenoviruses.
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Affiliation(s)
- Wei-Wei Chen
- Treatment and Research Center for Infectious Diseases, 302 Hospital of PLA, Beijing, 100039 China
| | - Wen Xu
- Treatment and Research Center for Infectious Diseases, 302 Hospital of PLA, Beijing, 100039 China
| | - Yang-Xin Xie
- Treatment and Research Center for Infectious Diseases, 302 Hospital of PLA, Beijing, 100039 China
| | - Yun-Hui Zhang
- Center for Medical information, 302 Hospital of PLA, Beijing, 100039 China
| | - Dan Wu
- Treatment and Research Center for Infectious Diseases, 302 Hospital of PLA, Beijing, 100039 China
| | - Fu-Sheng Wang
- Treatment and Research Center for Infectious Diseases, 302 Hospital of PLA, Beijing, 100039 China
| | - Min Zhao
- Treatment and Research Center for Infectious Diseases, 302 Hospital of PLA, Beijing, 100039 China
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