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Kaddour O, Ben Mabrouk A, Arfa S, Lassoued N, Berriche O, Chelli J. Knowledge and attitudes of healthcare workers about influenza vaccination. Infect Dis Health 2024:S2468-0451(24)00027-0. [PMID: 38679564 DOI: 10.1016/j.idh.2024.04.005] [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: 08/05/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Influenza infection is a highly contagious viral disease. It may cause several nosocomial outbreaks. This study aimed to evaluate the knowledge and attitudes of healthcare workers (HCWs) about influenza vaccination and to identify factors associated with the uptake of influenza vaccination. METHODS We conducted a cross-sectional study over 5 months between November 2021 and March 2022. Data was collected using an anonymous self-administered questionnaire. We included all HCWs at Taher Sfar University Hospital who were willing to participate in the study. RESULTS A total of 395 HCWs were included. They were mainly women (78.7%) with an average age of 27 years. The medical personnel was the largest group (67.8%). Most respondents considered the vaccination to be optional and knew that it should be renewed every year, but 97.5% of them judged the efficacy of the vaccine to be low. The influenza vaccination uptake was only 20.2%. The main reasons for accepting vaccination were to protect patients and families. However, misconceptions about the severity and the risk of influenza and the belief that barrier measures were sufficient to prevent infection were the main causes of avoiding vaccination. The factors associated with adherence to vaccination were being a medical professional, old age, longer professional experience, and considering vaccination to be mandatory for HCWs. CONCLUSION Our study showed a low adherence to influenza vaccination with misconceptions about vaccine efficacy and safety. More efforts are needed to improve the knowledge of HCW about the vaccine and boost the adherence rates.
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Affiliation(s)
- Oussama Kaddour
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Asma Ben Mabrouk
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia.
| | - Sondess Arfa
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Najoua Lassoued
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Olfa Berriche
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | - Jihene Chelli
- Internal Medicine and Endocrinology Department, Taher Sfar Hospital, Mahdia, Tunisia
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Akmatova R, Ebama MS, Temirbekov S, Alymkulova V, Otorbaeva D. A comparative analysis of knowledge, attitude, and practice (KAP) towards influenza and influenza vaccination among healthcare workers in Kyrgyzstan prior to and during the COVID-19 pandemic. Vaccine 2024:S0264-410X(24)00420-1. [PMID: 38594119 DOI: 10.1016/j.vaccine.2024.04.008] [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: 02/22/2024] [Revised: 03/12/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Influenza, a globally significant respiratory illness with pandemic potential, affects around 1 billion individuals annually, leading to increased risk for severe illness and mortality. Despite recommendations from the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and MoH prioritization, influenza vaccination coverage rate among HCWs in Kyrgyzstan remains low, ranging between 16 % and 46 % over the past five years. Understanding the Knowledge, Attitudes, and Practices (KAP) dynamics of HCWs regarding influenza vaccinations, both before and during the COVID-19 pandemic is crucial for refining national strategies and institutional approaches to enhance vaccination coverage rates in this important risk group. METHOD This study employed cross sectional investigations aimed at assessing KAPs among HCWs regarding influenza disease and vaccination. Conducted prior to and during the initial phase of the COVID-19 pandemic, the project involved 2400 participants from diverse medical disciplines. EPI Info was utilized to run biostatistical analyses, with descriptive and logistic regression models, to elucidate the dynamics of KAP over time. RESULTS The findings indicate that HCWs with over 5 years of experience were more likely to get vaccinated or recommend it to patients (p = 0.000). Low confidence in vaccine effectiveness influenced on recommendations of influenza vaccination in pre-pandemic time, where insufficient (95 %CI 0.08-0.6; p = 0.003) or uncertain assurance in vaccine effectiveness (95 %CI 0.007-0.18; p = 0.000) was a barrier for vaccine promotion during the pandemic. The study underscores to consider mandatory influenza vaccination for HCWs which may impact on likelihood of flu vaccination (p = 0.001). Priority groups for influenza vaccination shifted during the COVID-19 period, emphasizing older adults, individuals with existing conditions, and HCWs, compared to the pre-pandemic focus on HCWs, children, and patients with pre-existing conditions. CONCLUSION Our investigation provides valuable insights into HCWs KAP concerning influenza vaccination in Kyrgyzstan, highlighting the need for targeted interventions addressing factors influencing vaccine acceptance. The study suggests policy implications, advocating for the revision of national strategies to strengthen capacity building for medical staff.
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Affiliation(s)
- Rakhat Akmatova
- Center for Vaccine Equity, Task Force for Global Health, 330 W. Ponce de Leon Avenue, Decatur, GA 30030, United States.
| | - Malembe S Ebama
- Center for Vaccine Equity, Task Force for Global Health, 330 W. Ponce de Leon Avenue, Decatur, GA 30030, United States.
| | - Sanjar Temirbekov
- Department of Disease Prevention and State Sanitary and Epidemiology Surveillance under the Ministry of Health, 535 Frunze Street, 720033 Bishkek, Kyrgyzstan
| | - Venera Alymkulova
- Department of Disease Prevention and State Sanitary and Epidemiology Surveillance under the Ministry of Health, 535 Frunze Street, 720033 Bishkek, Kyrgyzstan
| | - Dinara Otorbaeva
- Department of Disease Prevention and State Sanitary and Epidemiology Surveillance under the Ministry of Health, 535 Frunze Street, 720033 Bishkek, Kyrgyzstan.
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Boukthir A, Bouguerra H, Ben Salah A, Erber AC, Chaabene S, Moussa H, Guillemette F, Alaya NB, Bettaieb J. Influenza vaccine uptake in Tunisia from two high-risk groups' perception and attitudes: a qualitative study. Front Public Health 2023; 11:1212431. [PMID: 37655288 PMCID: PMC10466396 DOI: 10.3389/fpubh.2023.1212431] [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: 04/26/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Pregnant women (PW) and older adult with chronic diseases (ECD) are priority groups for the influenza vaccination. This study was designed to have a better insight into the influenza perceptions and barriers of the vaccine uptake from these groups' perspectives. Methods This qualitative study consisted of 20 focus group discussions (FGDs) enrolled from five governorates across the country (north, center, and south) between March 18 and July 10, 2019, in urban and rural areas. FGDs were conducted in Arabic (Tunisian dialect) and following the topic guide. Data were transcribed in the local language then translated into English and analyzed using Nvivo12 Software. This permitted the analysis thematic approach, using codes determined by the focus groups. Results A total of 170 individuals participated in the FGDs (84 ECD and 86 PW). Both groups recognized the weakness of the immune system as key determinant for severity. While PW raised the lack of information about the vaccine, the ECD emphasized accessibility problems. Five main barriers to influenza vaccination were identified: cultural barriers and use of traditional medicine, misleading or lack of information about influenza and the vaccine, advice against its uptake, problems of availability and accessibility of the vaccine as well as mistrust towards the vaccine including adverse effects, vaccine composition and effectiveness. Conclusion The study provided refined information from the perspectives of users to orient the policies regarding the promotion of influenza vaccine by decision makers among these two high risk groups.
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Affiliation(s)
- Aicha Boukthir
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Département de communication sociale, Laboratoire Interdisciplinaire de Recherche en Enseignement Supérieur (LIRES), Université du Québec à Trois-Rivières, Québec, QC, Canada
| | - Hind Bouguerra
- Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Astrid C. Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sana Chaabene
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Hayet Moussa
- Département de Sociologie et d’Anthropologie, Institut Supérieur des Sciences Humaines de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - François Guillemette
- Département des Sciences de l’Education, Laboratoire Interdisciplinaire de Recherche en Enseignement Supérieur (LIRES), Université du Québec à Trois-Rivières, Québec, QC, Canada
| | - Nissaf Ben Alaya
- Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
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Anwar MMU, Sumon SA, Mohona TM, Rahman A, Md Abdullah SAH, Islam MS, Harun MGD. Uptake of Influenza Vaccine and Factors Associated with Influenza Vaccination among Healthcare Workers in Tertiary Care Hospitals in Bangladesh: A Multicenter Cross-Sectional Study. Vaccines (Basel) 2023; 11:vaccines11020360. [PMID: 36851238 PMCID: PMC9966774 DOI: 10.3390/vaccines11020360] [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: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Influenza, highly contagious in hospital settings, imposes a substantial disease burden globally, and influenza vaccination is critical for healthcare workers (HCWs) to prevent this illness. This study assessed influenza vaccine uptake, including its associated factors among HCWs of tertiary care hospitals in Bangladesh. Between September and December 2020, this multicenter study included 2046 HCWs from 11 hospitals. Face-to-face interviews were conducted using a semi-structured questionnaire to collect data from physicians, nurses, and cleaning and administrative staff for the survey. Only 13.8% (283/2046) of HCWs received the influenza vaccine, of which the majority (76.7%, 217/283) received it for free from the hospital. Nurses had the highest (20.0%, 187/934) influenza vaccine coverage, followed by physicians at 13.5% (71/526), whereas cleaning staff had the lowest at 6.0% (19/318). Among unvaccinated HCWs, the desire to get vaccinated was high (86.2%), with half of the respondents even being willing to pay for it. The HCWs who were aware of the influenza vaccine were over five times more likely to get the vaccine (OR 5.63; 95% CI: 1.04, 1.88) compared to those who were not. HCWs in Bangladesh were vaccinated against influenza at a very low rate. Free and mandatory influenza vaccination programs should be initiated to optimize vaccine coverage among HCWs.
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Affiliation(s)
| | - Shariful Amin Sumon
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | - Tahrima Mohsin Mohona
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control (CDC), Directorate General of Health Services, Government of Bangladesh, Dhaka 1212, Bangladesh
| | | | - Md. Saiful Islam
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia
| | - Md. Golam Dostogir Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
- Correspondence:
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Baldi ME, Laghrissi A, Marso Z, Chellat FZ, Berraho M, Tachfouti N, Fakir SE, Mellas S, Fahd AM, kohen J, Boulaguige F, Naamane J, Lahmadi K, Rhazi KE. Prevalence and associated factors of COVID-19 among Moroccan physicians: A cross-sectional study. PLoS One 2022; 17:e0277157. [PMID: 36322588 PMCID: PMC9629645 DOI: 10.1371/journal.pone.0277157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) has emerged and spread rapidly worldwide and established a global public health crisis in early 2020. The first Moroccan case was reported on March 2, 2020. Since then, healthcare workers (HCWs) played a major role in saving human lives threatened by COVID-19. This study aimed to assess the prevalence of COVID-19 infection among Moroccan physicians and to report associated risk factors prior vaccination campaign. METHODS A cross-sectional study was carried out in the Fez-Meknes region of Morocco, 545 physicians' data was collected using a self-reported online questionnaire. The data collection was done between December 1, 2020, and February 1, 2021. RESULTS The prevalence of COVID-19 among physicians was 27.3%. The mean age of the confirmed COVID-19 group was 38.4±12.9 years old. There was no association between COVID-19 infection and preventive measures compliance by physicians and healthcare authorities in the workplace. However, multivariate analysis strengthened the following factors such as increased risk of COVID-19 infection within men ☯aOR:1.896; 95% IC 1.272-2.828; p = 0.002]; the presence of at least one comorbidity ☯aOR:2.268; 95%IC 1.414-3.637; p = 0.001]; and working at a university or military hospitals ☯aOR:2.578; 95%IC 1.667-3.989; p = 0.001]. CONCLUSION This study allows comparing COVID-19 prevalence among healthcare workers before and after vaccination programs. This should support better preparation strategy for any future pandemics with appropriate and increased awareness for men, carrying comorbidity, and working environment with high COVID-19 disease management.
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Affiliation(s)
- Marwa El Baldi
- Faculty of Medicine and Pharmacy, Laboratory of Epidemiology, Clinical Research, and Community Health, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Amina Laghrissi
- Faculty of Medicine and Pharmacy, Laboratory of Epidemiology, Clinical Research, and Community Health, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Zakia Marso
- Regional Direction of Health, Fez Meknes Region, Morocco
| | | | - Mohamed Berraho
- Faculty of Medicine and Pharmacy, Laboratory of Epidemiology, Clinical Research, and Community Health, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Nabil Tachfouti
- Faculty of Medicine and Pharmacy, Laboratory of Epidemiology, Clinical Research, and Community Health, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Samira El Fakir
- Faculty of Medicine and Pharmacy, Laboratory of Epidemiology, Clinical Research, and Community Health, Sidi Mohamed Ben Abdallah University, Fez, Morocco
| | - Soufiane Mellas
- Regional Council for the Order of Physicians, Fez-Meknes Region, Morocco
| | - Amar Mohamed Fahd
- Regional Council for the Order of Physicians, Fez-Meknes Region, Morocco
| | - Jamal kohen
- Regional Council for the Order of Physicians, Fez-Meknes Region, Morocco
| | - Fouad Boulaguige
- Regional Council for the Order of Physicians, Fez-Meknes Region, Morocco
| | - Jamal Naamane
- Regional Council for the Order of Physicians, Fez-Meknes Region, Morocco
| | - Khalid Lahmadi
- Hematology Department, Moulay Ismail Military Hospital, Meknes, Morocco
| | - Karima El Rhazi
- Faculty of Medicine and Pharmacy, Laboratory of Epidemiology, Clinical Research, and Community Health, Sidi Mohamed Ben Abdallah University, Fez, Morocco
- Regional Council for the Order of Physicians, Fez-Meknes Region, Morocco
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Hassan MZ, Shirin T, Rahman M, Alamgir ASM, Jahan N, Al Jubayer Biswas MA, Khan SH, Basher MAK, Islam MA, Hussain K, Islam MN, Rabbany MA, Haque MA, Chakraborty SR, Parvin SR, Rahman M, Chowdhury F. Seasonal influenza vaccine uptake among healthcare workers in tertiary care hospitals, Bangladesh: Study protocol for influenza vaccine supply and awareness intervention. BMC Public Health 2022; 22:1819. [PMID: 36153529 PMCID: PMC9509585 DOI: 10.1186/s12889-022-14182-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Healthcare workers (HCWs), such as doctors, nurses, and support staffs involved in direct or indirect patient care, are at increased risk of influenza virus infections due to occupational exposures. Vaccination is the most effective way to prevent influenza. Despite the World Health Organization (WHO) recommendations, Bangladesh lacks a seasonal influenza vaccination policy for HCWs, and thus vaccination rates remain low. The current project aims to investigate the effect of interventions on influenza vaccine awareness and availability of vaccine supply, explore HCWs’ knowledge and perceptions about influenza vaccination, understand the barriers and motivators for influenza vaccine uptake, and understand policymakers' views on the practicality of influenza vaccination among HCWs.
Method
We will conduct the study at four tertiary care teaching hospitals in Bangladesh, using a cluster randomized controlled trial approach, with the hospital as the unit of randomization and intervention. The study population will include all types of HCWs.The four different types of intervention will be randomly allocated and implemented in four study hospitals separately. The four interventions will be: i) ensuring the availability of influenza vaccine supply; ii) developing influenza vaccine awareness; iii) both ensuring influenza vaccine supply and developing influenza vaccine awareness and iv) control arm with no intervention. Both quantitative and qualitative approaches will be applied to assess the intervention effect. We will estimate the Difference in Differences (DID) with 95% CI of the proportion of vaccine uptake between each intervention and control (non-intervention) arm, adjusting for the clustering effect. The qualitative data will be summarised using a framework matrix method.
Discussion
The results of this study will inform the development and implementation of a context-specific strategy to enhance influenza vaccination rates among Bangladeshi HCWs.
Trial registration
Clinicaltrials.gov NCT05521763. Version 2.0 was registered in September 2022, and the first participant enrolled in March 2022. Retrospectively registered.
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Alobwede SM, Kidzeru EB, Katoto PDMC, Lumngwena EN, Cooper S, Goliath R, Jackson A, Wiysonge CS, Shey MS. Influenza Vaccination Uptake and Hesitancy among Healthcare Workers in Early 2021 at the Start of the COVID-19 Vaccine Rollout in Cape Town, South Africa. Vaccines (Basel) 2022; 10:1176. [PMID: 35893825 PMCID: PMC9332543 DOI: 10.3390/vaccines10081176] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination attitudes among healthcare workers (HCWs) predict their level of vaccination uptake and intention to recommend vaccinations to their patients. To our knowledge, no study has been conducted in South Africa to assess hesitancy toward influenza vaccines among HCWs. We adapted a questionnaire developed and validated by Betsch and colleagues and used it to conduct online and face-to-face interviews among HCWs at the start of the COVID-19 vaccine rollout. Multivariate logistic regression was used to assess predictors of influenza vaccine hesitancy. Of 401 participants, 64.5% were women, 49.2% were nurses, and 12.5% were physicians. A total of 54.9% were willing to accept, 20.4% were undecided, and 24.7% intended to refuse influenza vaccination. Participants who were above 25 years of age and physicians were more likely to accept the vaccine. Key predictors of vaccine acceptance were confidence in the effectiveness, consideration of benefits and risks, and willingness to be vaccinated to protect others. Influenza vaccine hesitancy was highest in those who did not trust that influenza vaccines are safe. For future flu seasons, tailored education programs on the safety and effectiveness of flu vaccines targeting younger HCWs, could be vital to improving vaccine uptake.
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Affiliation(s)
- Samuel M. Alobwede
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
- Clinical Division, Department of Research and Innovation, Partners in Sexual Health, Cape Town 7500, South Africa
| | - Elvis B. Kidzeru
- Centre for Research on Health and Priority Pathologies (CRHPP), Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaounde P.O. Box 13033, Cameroon;
- Hair and Skin Research Laboratory, Division of Dermatology, Department of Medicine and Groote Schuur Hospital, University of Cape Town, Cape Town 7925, South Africa
- Division of Radiation Oncology, Department of Radiation Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Patrick D. M. C. Katoto
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- Centre for General Medicine and Global Health, Department of Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Evelyn N. Lumngwena
- School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa;
- Centre for the Study of Emerging and Re-Emerging Infections (CREMER), Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaounde P.O. Box 13033, Cameroon
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
| | - Amanda Jackson
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7500, South Africa; (P.D.M.C.K.); (S.C.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
- Department of Global Health, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Muki S. Shey
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (R.G.); (A.J.)
- Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
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Jamoussi A, Ayed S, Merhabene T, Doghri H, Ben Khelil J, Besbes M. Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features. PLoS One 2022; 17:e0270814. [PMID: 35793318 PMCID: PMC9258871 DOI: 10.1371/journal.pone.0270814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/19/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia. Methods It was a single-center study, including all hospitalized patients in intensive care, between November 1st, 2009 and October 31st, 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized. Results During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H1N1 pdm09 (84.2%) and H3N2 (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25–13] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC95% [1.474–37.317]; p = 0.015), PaO2/FiO2 ≤ 95 mmHg (OR = 9.078; IC95% [1.636–50.363]; p = 0.012) and lymphocytes count ≤ 1.325 109/L (OR = 10.199; IC95% [1.550–67.101]; p = 0.016). Conclusion Influenza A in ICU is not uncommon, even in A(H1N1) dominant seasons; its management is highly demanding. It is responsible for considerable morbi-mortality especially in elderly patients.
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Affiliation(s)
- Amira Jamoussi
- University of Tunis EI Manar, Faculty of Medicine, Medical Intensive Care Unit, Abderrahmen Mami Hospital, Ariana, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
- * E-mail:
| | - Samia Ayed
- University of Tunis EI Manar, Faculty of Medicine, Medical Intensive Care Unit, Abderrahmen Mami Hospital, Ariana, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
| | - Takoua Merhabene
- University of Tunis EI Manar, Faculty of Medicine, Medical Intensive Care Unit, Abderrahmen Mami Hospital, Ariana, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
| | - Hamdi Doghri
- University of Tunis EI Manar, Faculty of Medicine, Medical Intensive Care Unit, Abderrahmen Mami Hospital, Ariana, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
| | - Jalila Ben Khelil
- University of Tunis EI Manar, Faculty of Medicine, Medical Intensive Care Unit, Abderrahmen Mami Hospital, Ariana, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
| | - Mohamed Besbes
- University of Tunis EI Manar, Faculty of Medicine, Medical Intensive Care Unit, Abderrahmen Mami Hospital, Ariana, Tunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01, Abderrahmen Mami Hospital, Ministry of Higher Education and Scientific Research, Ariana, Tunisia
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