1
|
Özgen-Top Ö, Aysert-Yıldız P, Özger HS, Güzel-Tunçcan Ö. Evaluation of Hospitalized Patients with Community-Acquired Influenza-Like Illness During Two Influenza Seasons. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:323-331. [PMID: 38633854 PMCID: PMC10986686 DOI: 10.36519/idcm.2023.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/02/2023] [Indexed: 04/19/2024]
Abstract
Objective Influenza is among the most important respiratory infections affecting all age groups and can lead to hospitalizations. We aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness (ILI) and evaluate the demographic, clinical findings, and outcomes of patients with influenza. Methods This prospective, active surveillance study was conducted in a university hospital between 2015 and 2017. Patients hospitalized for at least 24 hours in the selected units with community-acquired ILI were screened according to certain influenza-predicting ICD-10 codes. Nasopharyngeal and pharyngeal swab samples were taken from patients who were eligible for the study. Patients tested for influenza with real-time polymerase chain reaction. Univariate and multivariate analyses were performed for data. Results Among 440 patients screened according to influenza-related ICD-10 codes, 112 were included. Influenza positivity was detected in 37 of the 112 patients. Clinical findings were similar between influenza positive and negative groups and also between influenza subtypes, excluding sore throat, which was more common in the H1N1 group. Alanine transaminase (ALT), aspartate transaminase (AST), and creatine kinase (CK) elevations were found to be significantly higher in the influenza-positive group. When influenza-positive patients with and without pneumonia were compared, the rate of vaccination in the same season was higher in patients without pneumonia than in patients with pneumonia (38.8% and 10.5%, respectively; p=0.04). Conclusion Integrating molecular tests detecting both influenza and other respiratory viruses into influenza surveillance programs can increase the efficacy and quality of these programs. The elevation of AST, ALT, and CK in influenza cases can be considered in distinguishing influenza from other ILI cases. Vaccination in the same season can reduce the risk of pneumonia in influenza-positive patients.
Collapse
Affiliation(s)
- Özge Özgen-Top
- Department of Infectious Diseases and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye
| | - Pınar Aysert-Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye
| | - Hasan Selçuk Özger
- Department of Infectious Diseases and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye
| | - Özlem Güzel-Tunçcan
- Department of Infectious Diseases and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye
| |
Collapse
|
2
|
Dicembrini I, Silverii GA, Clerico A, Fornengo R, Gabutti G, Sordi V, Tafuri S, Peruzzi O, Mannucci E. Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2023; 33:1099-1110. [PMID: 37032254 DOI: 10.1016/j.numecd.2023.03.016] [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: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
AIMS In order to better define the need for influenza vaccination in people with diabetes (DM), we collected all available evidence on the effect of DM as a risk factor for complications of both seasonal and pandemic influenza, and on the specific effectiveness of vaccines in patients with DM. DATA SYNTHESIS Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and Embase databases were performed, one for each metanalysis, collecting all observational studies and randomized clinical trials performed on humans up to May 31st, 2022. We retrieved 34 observational studies comparing risk for influenza complications in people with or without diabetes, and 13 observational studies assessing vaccine effectiveness on preventing such complications. Mortality for influenza and hospitalization for influenza and pneumonia resulted significantly higher in individuals with versus without DM, both when unadjusted and adjusted data are analyzed. In diabetic individuals vaccinated for influenza overall hospitalization, hospitalization for influenza or pneumonia and overall mortality are significantly lower in comparison with not vaccinated DM subjects, both when unadjusted and adjusted data were analyzed. CONCLUSION This systematic review and meta-analysis shows that: 1) influenza is associated with more severe complications in diabetic versus not diabetic individuals and 2) influenza vaccination is effective in preventing clinically relevant outcomes in adults with DM with a NNT (number needed to treat) of 60, 319, and 250 for all-cause hospitalization, specific hospitalization, and all-cause mortality, respectively. The identification of diabetic patients as the target of vaccination campaigns for influenza appears to be justified by available clinical evidence.
Collapse
Affiliation(s)
- Ilaria Dicembrini
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy.
| | | | | | | | - Giovanni Gabutti
- Coordinator Working Group Vaccines and Immunization Policies, Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Italy
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro, University of Bari, Italy
| | - Ottavia Peruzzi
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
| | - Edoardo Mannucci
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
| |
Collapse
|
3
|
Wæhre T, Tunheim G, Bodin JE, Laake I, Kvale D, Kran AMB, Brekke H, Løken R, Oftung F, Mjaaland S, Dyrhol-Riise AM. Clinical characteristics and outcomes in hospitalized adult influenza patients: an observational study from Norway 2014-2018. Infect Dis (Lond) 2022; 54:367-377. [PMID: 34983302 DOI: 10.1080/23744235.2021.2022196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Seasonal influenza causes substantial numbers of hospitalizations annually. We have characterized the clinical picture and treatment practice in hospitalized adult influenza patients and assessed whether clinical risk scores on admission or influenza type were associated with severe outcomes. METHODS Clinical characteristics and risk scores on admission (CRB65, CRB, SIRS and quick Sequential Organ Failure Assessment [qSOFA]), treatment and severe outcomes (defined as: stay in intensive care unit (ICU), receiving oxygen supplementation or staying ≥5 days in hospital), were recorded in patients hospitalized with influenza at Oslo University Hospital, Norway, between 2014 and 2018. RESULTS Among the 156 included patients, 52.6% had influenza A(H3N2), 32.6% influenza B and 12.8% influenza A(H1N1). Median age was 70 years and 59.6% of patients were ≥65 years. Nine (5.8%) of the patients were treated in ICU, 43.0% received oxygen and 47.4% stayed ≥5 days in hospital. Overall, 34.6% of the patients had a high CRB score on admission which was associated with stay in ICU and oxygen supplementation. Multivariate analyses identified age, and pneumonia (46.8%), but not influenza type, to be associated with severe outcomes. Antiviral treatment was given to 37.2% of the patients, while 77.6% received antibiotics. Only 25.5% of patients with influenza B received antiviral therapy. CONCLUSIONS The influenza patients were mostly elderly, and few patients were treated in ICU. A high CRB score was associated with severe outcomes with possible implications for patient monitoring. Less than 40% of the patients received antiviral therapy, whereas the majority were treated with antibiotics, indicating potential for optimising treatment strategies.
Collapse
Affiliation(s)
- Torgun Wæhre
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway
| | - Gro Tunheim
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Johanna Eva Bodin
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ida Laake
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Dag Kvale
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Hanne Brekke
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Løken
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Fredrik Oftung
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Anne Margarita Dyrhol-Riise
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Al Khatib HA, Coyle PV, Al Maslamani MA, Al Thani AA, Pathan SA, Yassine HM. Molecular and biological characterization of influenza A viruses isolated from human fecal samples. INFECTION GENETICS AND EVOLUTION 2021; 93:104972. [PMID: 34153546 DOI: 10.1016/j.meegid.2021.104972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 01/14/2023]
Abstract
Human influenza viruses are occasionally detected in the stools of influenza patients. OBJECTIVES Here, we investigated the molecular and biological characteristics of intestinal influenza viruses and their potential role in virus transmission. METHODS Fecal samples were first screened for the presence of influenza viral RNA using RT-qPCR. Positive fecal samples were subjected to cell culture. Isolated viruses were then sequenced using MiSeq platform. Replication kinetics and receptor binding affinity were also evaluated. RESULTS Influenza RNA was detected in stool samples of 41% (36/87) of influenza A positive patients. Among the 36 stool samples subjected to viral isolation, 5 showed virus growth. Sequence analysis of isolated viruses revealed two distinct mutation patterns in fecal viruses. Set I viruses was able to replicate to higher titers in cell culture despite the limited number of mutations (6 mutations) compared to set II viruses (>10 mutations). Functional analysis of both sets revealed the ability to replicate efficiently in differentiated human bronchial cells. Receptor binding testing has also demonstrated their ability to bind α 2,3 and α 2,6 sialic acid receptors. CONCLUSION The ability of fecal influenza viruses to replicate in intestinal cells and human 3D bronchial cells might suggest their possible contribution in virus transmission.
Collapse
Affiliation(s)
| | - Peter V Coyle
- Virology Laboratory, Hamad Medical Corporation, Doha 3050, Qatar.
| | | | - Asmaa A Al Thani
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; Department of Biomedical Sciences, College of Health Sciences-QU Health, Qatar University, Doha 2713, Qatar.
| | - Sameer A Pathan
- Emergency Medicine, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; Department of Biomedical Sciences, College of Health Sciences-QU Health, Qatar University, Doha 2713, Qatar.
| |
Collapse
|
5
|
Althaqafi A, Farahat F, Alsaedi A, Alshamrani M, Alsaeed MS, AlhajHussein B, El-Kafrawy SA, Azhar EI. Molecular Detection of Influenza A and B Viruses in Four Consecutive Influenza Seasons 2015-16 to 2018-19 in a Tertiary Center in Western Saudi Arabia. J Epidemiol Glob Health 2021; 11:208-215. [PMID: 33969948 PMCID: PMC8242120 DOI: 10.2991/jegh.k.210427.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/02/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Influenza infection poses a significant public health threat. The core for disease prevention and control relies on strengthened surveillance activities, particularly in Saudi Arabia, the country that hosts the largest annual mass gathering event worldwide. This study aimed to assess the molecular and seasonal pattern of influenza virus subtypes in western Saudi Arabia to inform policy decisions on influenza vaccine. Methods: This cross-sectional study was conducted at King Abdulaziz Medical City, western Saudi Arabia. Medical records and surveillance database of laboratory-confirmed influenza cases were reviewed from October 2015 to 2019. A panel of real-time polymerase chain reactions was performed to detect influenza A and B. Extracted RNA from a subset of positive samples was used to determine influenza A subtypes and influenza B lineages. Results: This study included a total of 1928 patients with laboratory-confirmed influenza infections. Influenza peaks were observed in October each season, with variant predominant strains. Influenza virus subtypes co-circulate with no reports of co-infection. Influenza A(H3N2) was reported in 42% of the cases, then influenza B (30.7%) and influenza A(H1N1)pdm09 (27.3%). Healthcare workers represented 9.4% of the cases. One-third of the cases (30.4%) were admitted to the hospital with a median admission duration of 4 days. The influenza B viruses were subtyped in 218 cases. Victoria lineage was predominant (64.1%) in 2015 and 2016; however, Yamagata was predominant in the next two consecutive seasons (94.4% and 85.4%, respectively). Conclusion: The burden due to influenza B may be underestimated with an observed vaccine mismatch. A quadrivalent influenza vaccine is recommended to reduce the health impact associated with influenza B infections. Molecular surveillance of the influenza viruses should be enhanced continuously for a better understanding of the influenza activity and assessment of vaccine effectiveness.
Collapse
Affiliation(s)
- Abdulhakeem Althaqafi
- Department of Medicine, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Fayssal Farahat
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Infection Prevention and Control, Ministry of National Guard - Health Affairs, Saudi Arabia
| | - Asim Alsaedi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Infection Prevention and Control, Ministry of National Guard - Health Affairs, Saudi Arabia
| | - Majid Alshamrani
- Department of Infection Prevention and Control, Ministry of National Guard - Health Affairs, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Moneerah S Alsaeed
- Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Baraa AlhajHussein
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.,Department of Laboratory Medicine, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | - Sherif A El-Kafrawy
- Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Sciences, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
6
|
Sharma Y, Horwood C, Hakendorf P, Thompson C. Clinical characteristics and outcomes of influenza A and B virus infection in adult Australian hospitalised patients. BMC Infect Dis 2020; 20:913. [PMID: 33261559 PMCID: PMC7705848 DOI: 10.1186/s12879-020-05670-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Influenza B is often perceived as a less severe strain of influenza. The epidemiology and clinical outcomes of influenza B have been less thoroughly investigated in hospitalised patients. The aims of this study were to describe clinical differences and outcomes between influenza A and B patients admitted over a period of 4 years. METHODS We retrospectively collected data of all laboratory confirmed influenza patients ≥18 years at two tertiary hospitals in South Australia. Patients were confirmed as influenza positive if they had a positive polymerase-chain-reaction (PCR) test of a respiratory specimen. Complications during hospitalisation along with inpatient mortality were compared between influenza A and B. In addition, 30 day mortality and readmissions were compared. Logistic regression model compared outcomes after adjustment for age, Charlson index, sex and creatinine levels. RESULTS Between January 2016-March 2020, 1846 patients, mean age 66.5 years, were hospitalised for influenza. Of whom, 1630 (88.3%) had influenza A and 216 (11.7%) influenza B. Influenza B patients were significantly younger than influenza A. Influenza A patients were more likely be smokers with a history of chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) than influenza B. Complications, including pneumonia and acute coronary syndrome (ACS) were similar between two groups, however, septic shock was more common in patients with influenza B. Adjusted analyses showed similar median length of hospital stay (LOS), in hospital mortality, 30-day mortality and readmissions between the two groups. CONCLUSIONS Influenza B is less prevalent and occurs mostly in younger hospitalised patients than influenza A. Both strains contribute equally to hospitalisation burden and complications. TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry (ANZCR) no ACTRN12618000451202 date of registration 28/03/2018.
Collapse
Affiliation(s)
- Yogesh Sharma
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
- Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Chris Horwood
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Paul Hakendorf
- Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Campbell Thompson
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
7
|
Jiang C, Yao X, Zhao Y, Wu J, Huang P, Pan C, Liu S, Pan C. Comparative review of respiratory diseases caused by coronaviruses and influenza A viruses during epidemic season. Microbes Infect 2020; 22:236-244. [PMID: 32405236 PMCID: PMC7217786 DOI: 10.1016/j.micinf.2020.05.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to sweep the world, causing infection of millions and death of hundreds of thousands. The respiratory disease that it caused, COVID-19 (stands for coronavirus disease in 2019), has similar clinical symptoms with other two CoV diseases, severe acute respiratory syndrome and Middle East respiratory syndrome (SARS and MERS), of which causative viruses are SARS-CoV and MERS-CoV, respectively. These three CoVs resulting diseases also share many clinical symptoms with other respiratory diseases caused by influenza A viruses (IAVs). Since both CoVs and IAVs are general pathogens responsible for seasonal cold, in the next few months, during the changing of seasons, clinicians and public heath may have to distinguish COVID-19 pneumonia from other kinds of viral pneumonia. This is a discussion and comparison of the virus structures, transmission characteristics, clinical symptoms, diagnosis, pathological changes, treatment and prevention of the two kinds of viruses, CoVs and IAVs. It hopes to provide information for practitioners in the medical field during the epidemic season.
Collapse
Affiliation(s)
- Chao Jiang
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China; School of Life Sciences, Bengbu Medical College, Bengbu, Anhui, 233030, China
| | - Xingang Yao
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yulin Zhao
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China
| | - Jianmin Wu
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China
| | - Pan Huang
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China
| | - Chunhua Pan
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, 510000, China.
| | - Shuwen Liu
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Chungen Pan
- Laboratory of Molecular Virology & Immunology, Technology Innovation Center, Haid Research Institute, Guangdong Haid Group Co., Ltd, Guangzhou, 511400, China.
| |
Collapse
|
8
|
Chen L, Han XD, Li YL, Zhang CX, Xing XQ. Severity and outcomes of influenza-related pneumonia in type A and B strains in China, 2013-2019. Infect Dis Poverty 2020; 9:42. [PMID: 32321576 PMCID: PMC7175558 DOI: 10.1186/s40249-020-00655-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/31/2020] [Indexed: 02/08/2023] Open
Abstract
Background Inconsistencies exist regarding the severity of illness caused by different influenza strains. The aim of this study was to compare the clinical outcomes of hospitalized adults and adolescents with influenza-related pneumonia (Flu-p) from type A and type B strains in China. Methods We retrospectively reviewed data from Flu-p patients in five hospitals in China from January 2013 to May 2019. Multivariate logistic and Cox regression models were used to assess the effects of influenza virus subtypes on clinical outcomes, and to explore the risk factors of 30-day mortality for Flu-p patients. Results In total, 963 laboratory-confirmed influenza A-related pneumonia (FluA-p) and 386 influenza B-related pneumonia (FluB-p) patients were included. Upon adjustment for confounders, multivariate logistic regression models showed that FluA-p was associated with an increased risk of invasive ventilation (adjusted odds ratio [aOR]: 3.824, 95% confidence interval [CI]: 2.279–6.414; P < 0.001), admittance to intensive care unit (aOR: 1.630, 95% CI: 1.074–2.473, P = 0.022) and 30-day mortality (aOR: 2.427, 95% CI: 1.568–3.756, P < 0.001) compared to FluB-p. Multivariate Cox regression models confirmed that influenza A virus infection (hazard ratio: 2.637, 95% CI: 1.134–6.131, P = 0.024) was an independent predictor for 30-day mortality in Flu-p patients. Conclusions The severity of illness and clinical outcomes of FluA-p patients are more severe than FluB-p. This highlights the importance of identifying the virus strain during the management of severe influenza.
Collapse
Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China.
| | - Xiu-Di Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, Shandong Province, China
| | - Yan-Li Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chun-Xiao Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, China
| | - Xi-Qian Xing
- Department of Pulmonary and Critical Care Medicine, the 2nd People's Hospital of Yunnan Province, Kunming City, Yunnan Province, China
| |
Collapse
|
9
|
Papadimitriou-Olivgeris M, Gkikopoulos N, Wüst M, Ballif A, Simonin V, Maulini M, Nusbaumer C, Bertaiola Monnerat L, Tschopp J, Kampouri EE, Wilson P, Duplain H. Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment. Eur J Intern Med 2020; 74:86-91. [PMID: 31899057 DOI: 10.1016/j.ejim.2019.12.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Influenza infections have been associated with high morbidity. The aims were to determine predictors of mortality among patients with influenza infections and to ascertain the role of quick Sequential Organ Failure Assessment (qSOFA) in predicting poor outcomes. METHODS All adult patients with influenza infection at the Hospital of Jura, Switzerland during four influenza seasons (2014/15 to 2017/18) were included. Cepheid Xpert Xpress Flu/RSV was used during the first three influenza seasons and Cobas Influenza A/B and RSV during the 2017/18 season. RESULTS Among 1684 influenza virus tests performed, 441 patients with influenza infections were included (238 for influenza A virus and 203 for B). The majority of infections were community onset (369; 83.7%). Thirty-day mortality was 6.0% (25 patients). Multivariate analysis revealed that infection due to A virus (P 0.035; OR 7.1; 95% CI 1.1-43.8), malnutrition (P < 0.001; OR 25.0; 95% CI 4.5-138.8), hospital-acquired infection (P 0.003; OR 12.2; 95% CI 2.3-65.1), respiratory insufficiency (PaO2/FiO2 < 300) (P < 0.001; OR 125.8; 95% CI 9.6-1648.7) and pulmonary infiltrate on X-ray (P 0.020; OR 6.0; 95% CI 1.3-27.0) were identified as predictors of mortality. qSOFA showed a very good accuracy (0.89) equivalent to other more specific and burdensome scores such as CURB-65 and Pneumonia Severity Index (PSI). CONCLUSION qSOFA performed similarly to specific severity scores (PSI, CURB-65) in predicting mortality. Infection by influenza A virus, respiratory insufficiency and malnutrition were associated with worse prognosis.
Collapse
Affiliation(s)
- Matthaios Papadimitriou-Olivgeris
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland; Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland.
| | | | - Melissa Wüst
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Aurelie Ballif
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Valentin Simonin
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Marie Maulini
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | | | | | - Jonathan Tschopp
- Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Patrick Wilson
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Hervé Duplain
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland; Faculty of biology and medicine, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
10
|
Soto M, Gaffney KJ, Rodgers KE. Improving the Innate Immune Response in Diabetes by Modifying the Renin Angiotensin System. Front Immunol 2019; 10:2885. [PMID: 31921148 PMCID: PMC6914815 DOI: 10.3389/fimmu.2019.02885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
Patients with Type 2 Diabetes Mellitus (T2DM) suffer from a higher incidence and severity of pulmonary infections. This is likely due to immune impairment and structural abnormalities caused by T2DM-induced oxidative stress (OS) and chronic inflammation. Modulation of the Renin Angiotensin System (RAS) through blockade of the actions of angiotensin II (AII), or inducing the protective pathway, has the potential to reduce these pathological pathways. The effects of Angiotensin 1–7 [A(1-7)] and NorLeu3-A(1-7) [NorLeu], ligands of the protective RAS, on the innate immune response were evaluated in the db/db mouse model of T2DM. Only NorLeu treatment reduced the structural pathologies in the lung caused by T2DM. A decreased in bactericidal activity and phagocytosis in diabetic animals was also observed; both A(1-7) and NorLeu treatment restored these functions. Myeloid progenitor CFUs were reduced and neutrophil/progenitor OS was increased in saline-treated db/db mice, and was reversed by A(1-7) and NorLeu treatment. These results demonstrate the adverse effects of diabetes on factors that contribute to pulmonary infections and the therapeutic potential of protective RAS peptides. Overall, RAS-modification may be a viable therapeutic target to treat diabetic complications that are not addressed by glucose lowering drugs.
Collapse
Affiliation(s)
- Maira Soto
- Pharmacology Department, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Kevin J Gaffney
- Pharmacology Department, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Kathleen E Rodgers
- Pharmacology Department, College of Medicine, Center for Innovation in Brain Science, University of Arizona, Tucson, AZ, United States
| |
Collapse
|
11
|
Cantan B, Luyt CE, Martin-Loeches I. Influenza Infections and Emergent Viral Infections in Intensive Care Unit. Semin Respir Crit Care Med 2019; 40:488-497. [PMID: 31585475 PMCID: PMC7117087 DOI: 10.1055/s-0039-1693497] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Critically ill patients are admitted to an intensive care unit (ICU) for multiple reasons. In this study, we aim to analyze the current evidence and findings associated with influenza and other emergent viral infections, namely, herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Among medical conditions, community-acquired respiratory infections are the most frequent reason for ventilatory support in ICUs. Community-acquired pneumonia in a severe form including the need of invasive mechanical ventilation and/or vasopressors is associated with high mortality rates. However, after the pandemic that occurred in 2009 by H1N1 influenza, the number of cases being admitted to ICUs with viral infections is on the rise. Patients in whom an etiology would not have been identified in the past are currently being tested with more sensitive viral molecular diagnostic tools, and patients being admitted to ICUs have more preexisting medical conditions that can predispose to viral infections. Viral infections can trigger the dysregulation of the immune system by inducing a massive cytokine response. This cytokine storm can cause endothelial damage and dysfunction, deregulation of coagulation, and, consequently, alteration of microvascular permeability, tissue edema, and shock. In severe influenza, this vascular hyperpermeability can lead to acute lung injury, multiorgan failure, and encephalopathy. In immunocompetent patients, the most common viral infections are respiratory, and influenza should be considered in patients with severe respiratory failure being admitted to ICU. Seasonality and coinfection are two important features when considering influenza as a pathogen in critically ill patients. Herpesviridae (HSV, CMV, and EBV) may reactivate in ICU patients, and their reactivation is associated with morbidity/mortality. However, whether a specific treatment may impact on outcome remains to be determined.
Collapse
Affiliation(s)
- Ben Cantan
- Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland
| | - Charles-Edouard Luyt
- Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University (Paris 6), Paris, France.,INSERM, UMRS 1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization, St James's Hospital, Dublin, Ireland.,Department of Pulmonology, Hospital Clínic de Barcelona, Universitat de Barcelona and IDIBAPS, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER), University of Barcelona, Barcelona, Spain
| |
Collapse
|
12
|
Minodier L, Masse S, Capai L, Blanchon T, Ceccaldi PE, van der Werf S, Hanslik T, Charrel R, Falchi A. Risk factors for seasonal influenza virus detection in stools of patients consulting in general practice for acute respiratory infections in France, 2014-2016. Influenza Other Respir Viruses 2019; 13:398-406. [PMID: 29144593 PMCID: PMC6586184 DOI: 10.1111/irv.12523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/29/2022] Open
Abstract
Background Previous studies reported detection of influenza RNA in stools of patients with seasonal influenza infection. While this detection may have a clinical significance, other factors may influence the stool positivity for influenza viruses. Objectives The objective of this study was to investigate demographical, clinical, and microbiological factors which could favor the presence of influenza viral RNA in the stools of patients with laboratory‐confirmed influenza infection. Methods Acute respiratory infection (ARI) patients were enrolled by general practitioners (GP) during two winter seasons (2014‐2016). Nasopharyngeal swabs, stool specimens, and clinical data were collected. Samples were tested for 12 respiratory pathogen groups (nasopharyngeal and stool specimens) and for 12 enteric pathogens (stool specimens). Results Among the 331 patients with ARI enrolled by GP, 114 (34.4%) presented influenza infection. Influenza RNA was detected in stool samples of 21% (24/114) of the 114 stool specimens analyzed. Hospitalization (adjusted odds ratio (aOR) = 7.8 (95% confidence interval (CI)) [1.7‐33.7], P = .02), age between 45 and 64 years (aOR = 4.8 [1.7‐14.5], P = .01), consumption of raw shellfish and/or mollusks (aOR = 16.7 [3.6‐90.9], P = .00), and use of antibiotics (aOR = 6.4 [2.1‐19.8], P = .006) or antiviral treatment (aOR = 7.4 [1.9‐29], P = .01) were significantly associated with an increased odds of the detection of influenza RNA in stools. Among the 24 stool samples subjected to viral isolation, no one showed virus growth. Conclusions These findings will be useful to studies investigating the dissemination route of influenza viruses to gastrointestinal tract.
Collapse
Affiliation(s)
- Laëtitia Minodier
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - Shirley Masse
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - Lisandru Capai
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| | - Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Pierre-Emmanuel Ceccaldi
- Pasteur Institute, Virology Department, Epidemiology and Physiopathology of Oncogenic Viruses Unit, Paris, France.,UMR CNRS 3569, Paris, France.,Sorbonne Paris Cité, Institut Pasteur, Cellule Pasteur, Université Paris Diderot, Paris, France
| | - Sylvie van der Werf
- UMR CNRS 3569, Paris, France.,Pasteur Institute, Virology Department, Molecular Genetics of RNA Viruses Unit, Paris, France.,Unité de Génétique Moléculaire des Virus à ARN, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Thomas Hanslik
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Université Versailles Saint Quentin en Yvelines, UFR de Médecine, Versailles, France.,Hôpital universitaire Ambroise Paré APHP, Service de médecine interne, Boulogne-Billancourt, France
| | - Remi Charrel
- UMR "Emergence des Pathologies Virales" (EPV: Aix-Marseille Univ - IRD 190 - Inserm 1207 - EHESP) & Fondation IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
| | - Alessandra Falchi
- EA7310, Laboratoire de Virologie, Université de Corse-Inserm, Corte, France
| |
Collapse
|
13
|
Cohen R, Babushkin F, Geller K, Finn T. Characteristics of hospitalized adult patients with laboratory documented Influenza A, B and Respiratory Syncytial Virus - A single center retrospective observational study. PLoS One 2019; 14:e0214517. [PMID: 30921408 PMCID: PMC6438521 DOI: 10.1371/journal.pone.0214517] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/15/2019] [Indexed: 01/20/2023] Open
Abstract
Introduction The epidemiology, clinical features and outcomes of hospitalized adult patients with Influenza A (FluA), Influenza B (FluB) and Respiratory Syncytial Virus (RSV) have not been thoroughly compared. The aim of this study was to describe the differences between these viruses during 3 winter seasons. Methods A retrospective observational study was conducted consisting of all the polymerase chain reaction (PCR)-based diagnoses of FluA, FluB and RSV among adults during 2015–2018, in one regional hospital. Epidemiology, clinical symptoms and outcome-related data were comparatively analyzed. Results Between November 2015 and April 2018, 759 patients were diagnosed with FluA, FluB or RSV. Study cohort included 539 adult patients (306 FluA, 148 FluB and 85 RSV). FluB was predominant during the winter of 2017–18. RSV caused 15.7% of hospitalizations with diagnosed viral infection and in comparison to influenza, had distinct epidemiological, clinical features and outcomes, including older age (74.2 vs 66.2, p = 0.001) and higher rates of co-morbidities; complications including bacterial pneumonia (31 vs 18%, p = 0.02), mechanical ventilation (20 vs 7%, p = 0.001), and viral-related death (13 vs 6.6%, p = 0.04). FluA and FluB had similar epidemiology, clinical symptoms and outcomes, but vaccinated patients were less prone to be hospitalized with FluB as compared with FluA (3 vs 14%, p = 0.001). Paroxysmal atrial fibrillation and falls were common (8.7 and 8.5% respectively). Conclusions FluA and FluB had similar epidemiological, clinical features and contributed equally to hospitalization burden and complications. RSV had a major impact on hospitalizations, occurring among the more elderly and sick populations and causing significantly worse outcomes, when compared to influenza patients. Vaccination appeared as a protective factor against hospitalizations with FluB as compared with FluA.
Collapse
Affiliation(s)
- Regev Cohen
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Neytanya, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
- * E-mail: ,
| | - Frida Babushkin
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Neytanya, Israel
| | - Keren Geller
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Neytanya, Israel
| | - Talya Finn
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Neytanya, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
14
|
Molecular influenza surveillance at a tertiary university hospital during four consecutive seasons (2012-2016) in Catalonia, Spain. Vaccine 2019; 37:2470-2476. [PMID: 30926297 PMCID: PMC7173002 DOI: 10.1016/j.vaccine.2019.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 01/14/2023]
Abstract
There were shifts in the predominance of influenza types or subtypes. Drifted A(H3N2) strains circulated during the 2014–2015 season and a higher hospitalisation rate was reported. Circulation of B/Vic-like viruses not included in the trivalent vaccine during the 2015–2016 season. Virulence and resistance mutations were detected due to an enhanced surveillance. Virological surveillance should be strengthened in hospital settings.
Background Influenza viruses (FLUV) are continuously evolving, which explain the occurrence of seasonal influenza epidemics and the need to review the vaccine strain composition annually. The aim is to describe the genetic diversity and clinical outcomes of FLUV detected at a tertiary university hospital in Barcelona (Spain) during the 2012–2016 seasons. Methods The detection of FLUV from patients attended at the Emergency Department or admitted to the hospital was performed by either immunofluorescence or PCR-based assays. A specific real-time one-step multiplex RT-PCR was performed for influenza A (FLUAV) subtyping. The complete coding haemagglutinin domain 1 (HA1) and neuraminidase (NA) (2015–2016) protein sequences from a representative sampling were molecular characterised. Results A total 1774 (66.1%) FLUAV and 910 (33.9%) influenza B (FLUBV) cases were laboratory-confirmed. The hospitalisation rate was different between seasons, being the highest (81.4%) during the 2014–2015 season. FLUV were genetically close to vaccine strains except to the 2014–2015, in which most characterised A(H3N2) viruses belonged to a genetic group different from the vaccine strain. During the 2015–2016 season, B/Victoria-like viruses were the most predominant, but this component was not included in the trivalent vaccine used. Mutations D222G or D222N in HA1-domain were found in 3 A(H1N1)pdm09 strains from ICU-admitted cases. Three A(H1N1)pdm09 strains carried the NA H275Y (2) and S247N (1) mutations, respectively related to resistance or decreased susceptibility to oseltamivir. Conclusions The circulation of drifted A(H3N2) strains during the 2014–2015 season was related to the high hospitalisation rate due to the mismatch with the vaccine strains. The predominance of a FLUBV lineage not included in the trivalent influenza vaccine during the 2015–2016 season highlights the need to use a tetravalent influenza vaccine. Virological surveillance of viral variants carrying protein changes that alter tropism and susceptibility to antivirals features should be strengthened in hospital settings.
Collapse
|
15
|
Daoud A, Laktineh A, Macrander C, Mushtaq A, Soubani AO. Pulmonary complications of influenza infection: a targeted narrative review. Postgrad Med 2019; 131:299-308. [PMID: 30845866 DOI: 10.1080/00325481.2019.1592400] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Severe influenza infection represents a leading cause of global morbidity and mortality. Several clinical syndromes that involve a number of organs may be associated with Influenza infection. However, lower respiratory complications remain the most common and serious sequel of influenza infection. These include influenza pneumonia, superinfection with bacteria and fungi, exacerbation of underlying lung disease and ARDS. This review analyzes the available literature on the epidemiology and clinical considerations of these conditions. It also provides an overview of the effects of type of influenza, antiviral therapy, vaccination and other therapies on the outcome of these complications.
Collapse
Affiliation(s)
- Asil Daoud
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Amir Laktineh
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Corey Macrander
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Ammara Mushtaq
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| | - Ayman O Soubani
- a Division of Pulmonary, Critical Care and Sleep Medicine , Wayne State University, School of Medicine , Detroit , MI , USA
| |
Collapse
|
16
|
Yoshihara K, Le MN, Toizumi M, Nguyen HA, Vo HM, Odagiri T, Fujisaki S, Ariyoshi K, Moriuchi H, Hashizume M, Dang DA, Yoshida LM. Influenza B associated paediatric acute respiratory infection hospitalization in central vietnam. Influenza Other Respir Viruses 2019; 13:248-261. [PMID: 30575288 PMCID: PMC6468073 DOI: 10.1111/irv.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/06/2018] [Accepted: 12/08/2018] [Indexed: 11/28/2022] Open
Abstract
Background Influenza B is one of the major etiologies for acute respiratory infections (ARI) among children worldwide; however, its clinical‐epidemiological information is limited. We aimed to investigate the hospitalization incidence and clinical‐epidemiological characteristics of influenza B‐associated paediatric ARIs in central Vietnam. Methods We collected clinical‐epidemiological information and nasopharyngeal swabs from ARI children hospitalized at Khanh Hoa General Hospital, Nha Trang, Vietnam from February 2007 through June 2013. Nasopharyngeal samples were screened for 13 respiratory viruses using Multiplex‐PCRs. Influenza B‐confirmed cases were genotyped by Haemagglutinin gene sequencing. We analyzed the clinical‐epidemiological characteristics of influenza B Lineages (Victoria/Yamagata) and WHO Groups. Results In the pre‐A/H1N1pdm09 period, influenza B‐associated ARI hospitalization incidence among children under five was low, ranging between 14.7 and 80.7 per 100 000 population. The incidence increased to between 51.4 and 330 in the post‐A/H1N1pdm09. Influenza B ARI cases were slightly older with milder symptoms. Both Victoria and Yamagata lineages were detected before the A/H1N1pdm09 outbreak; however, Victoria lineage became predominant in 2010‐2013 (84% Victoria vs 16% Yamagata). Victoria and Yamagata lineages did not differ in demographic and clinical characteristics. In Victoria lineage, Group1 ARI cases were clinically more severe compared to Group5, presenting a greater proportion of wheeze, tachypnea, and lower respiratory tract infection. Conclusions The current results highlight the increased incidence of influenza B‐related ARI hospitalization among children in central Vietnam in the post‐A/H1N1pdm09 era. Furthermore, the difference in clinical severity between Victoria lineage Group1 and 5 implies the importance of influenza B genetic variation on clinical presentation.
Collapse
Affiliation(s)
- Keisuke Yoshihara
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Minh Nhat Le
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Michiko Toizumi
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Hien Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Takato Odagiri
- Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Seiichiro Fujisaki
- Influenza Virus Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Hiroyuki Moriuchi
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.,Department of Paediatrics, Nagasaki University Hospital, Nagasaki, Japan
| | - Masahiro Hashizume
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Lay-Myint Yoshida
- Department of Paediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
17
|
Dagdanpurev S, Abe S, Sun G, Nishimura H, Choimaa L, Hakozaki Y, Matsui T. A novel machine-learning-based infection screening system via 2013-2017 seasonal influenza patients' vital signs as training datasets. J Infect 2019; 78:409-421. [PMID: 30797793 DOI: 10.1016/j.jinf.2019.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Sumiyakhand Dagdanpurev
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo 191-0065, Japan; Machine Intelligence Laboratory, National University of Mongolia, Ulaanbaatar 14201, Mongolia.
| | - Shigeto Abe
- Takasaka Clinic, Iwaki, Fukushima 973-8407, Japan
| | - Guanghao Sun
- Graduate school of Informatics and Engineering, University of Electro-Communications, Tokyo 182-8585, Japan
| | - Hidekazu Nishimura
- Virus Research Center, Clinical Research Division, Sendai Medical Center, National Hospital Organization, Sendai 983-8520, Japan
| | - Lodoiravsal Choimaa
- Machine Intelligence Laboratory, National University of Mongolia, Ulaanbaatar 14201, Mongolia
| | | | - Takemi Matsui
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo 191-0065, Japan
| |
Collapse
|
18
|
Wang Y, Fan G, Horby P, Hayden F, Li Q, Wu Q, Zou X, Li H, Zhan Q, Wang C, Cao B. Comparative Outcomes of Adults Hospitalized With Seasonal Influenza A or B Virus Infection: Application of the 7-Category Ordinal Scale. Open Forum Infect Dis 2019; 6:ofz053. [PMID: 30895200 PMCID: PMC6419989 DOI: 10.1093/ofid/ofz053] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/13/2019] [Indexed: 11/12/2022] Open
Abstract
Background The objective of this study was to investigate the difference in disease severity between influenza A and B among hospitalized adults using a novel ordinal scale and existing clinical outcome end points. Methods A prospective, observational study was conducted over the 2016-2018 influenza seasons in a central hospital. The primary outcome was the rate of clinical improvement, defined as a decline of 2 categories from admission on a 7-category ordinal scale that ranges from 1 (discharged with normal activity) to 7 (death), or hospital discharge up to day 28. Results In total, 574 eligible patients were enrolled, including 369 (64.3%) influenza A cases and 205 (35.7%) influenza B cases. The proportion of patients with a worse ordinal scale at admission was higher in influenza A than influenza B (P = .0005). Clinical improvement up to 28 days occurred in 82.4% of patients with influenza A and 90.7% of patients with influenza B (P = .0067). The Cox model indicated that influenza B patients had a higher clinical improvement probability than influenza A cases (adjusted hazard ratio [HR], 1.266; 95% confidence interval [CI], 1.019-1.573; P = .0335). A similar pattern was observed in weaning oxygen supplement (adjusted HR, 1.285; 95% CI, 1.030-1.603; P = .0261). In-hospital mortality for influenza A was marginally higher than influenza B (11.4% vs 6.8%; P = .0782). Conclusions Our findings indicated that hospitalized patients with influenza A were more ill and had delayed clinical improvement compared with those with influenza B virus infection.
Collapse
Affiliation(s)
- Yeming Wang
- China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guohui Fan
- Institute of Clinical Medical Sciences, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Fredrick Hayden
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Qian Li
- Fuxing Hospital, Capital Medical University, Beijing, China
| | - Qiaoling Wu
- China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China
| | - Xiaohui Zou
- China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China
| | - Hui Li
- China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China
| | - Qingyuan Zhan
- China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China
| | - Chen Wang
- China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Bin Cao
- China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | | |
Collapse
|
19
|
Caini S, Kroneman M, Wiegers T, El Guerche-Séblain C, Paget J. Clinical characteristics and severity of influenza infections by virus type, subtype, and lineage: A systematic literature review. Influenza Other Respir Viruses 2018; 12:780-792. [PMID: 29858537 PMCID: PMC6185883 DOI: 10.1111/irv.12575] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/18/2022] Open
Abstract
Aim Studies carried out in the early 2000s found that the number of influenza‐associated hospitalizations and deaths was highest in seasons dominated by A(H3N2), suggesting that the clinical presentation and severity of influenza may differ across virus types, subtypes, and lineages. We aimed to review the studies that examined this hypothesis. Method We conducted a literature review of studies published until January 2017 that compared the clinical presentation, disease severity, and case‐fatality ratio of influenza patients infected with different virus types (A, B), subtypes (pre‐pandemic A(H1N1), A(H1N1)p, A(H3N2)), and lineages (Victoria, Yamagata). Results The literature search resulted in over 1700 entries: After applying in‐ and exclusion criteria, 47 studies were included in the literature review. Studies showed a wide diversity in setting and populations. Only a minority of studies provided results adjusted by patient's age and other potential confounders. There were very few differences in the clinical presentation of patients infected with different influenza viruses. We found weak evidence that the A(H1N1)p subtype in the post‐pandemic period was more often associated with secondary bacterial pneumonia, ICU admission, and death, than the other influenza virus (sub)types. Conclusion Contrary to what is commonly assumed, the causal virus subtype does not seem to be a major determinant of clinical presentation and severity of influenza illness. However, drawing conclusions was made difficult by the low comparability and methodological shortcomings of included studies, and more well‐designed studies are warranted.
Collapse
Affiliation(s)
- Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Madelon Kroneman
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Therese Wiegers
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| |
Collapse
|
20
|
Panatto D, Signori A, Lai PL, Gasparini R, Amicizia D. Heterogeneous estimates of influenza virus types A and B in the elderly: Results of a meta-regression analysis. Influenza Other Respir Viruses 2018; 12:533-543. [PMID: 29498477 PMCID: PMC6005586 DOI: 10.1111/irv.12550] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 02/06/2023] Open
Abstract
Influenza has many age‐dependent characteristics. A previous systematic review of randomized controlled trials showed that the detection rate of influenza B was higher in children than in non‐elderly adults. However, no comprehensive reviews have targeted the elderly, who carry the main burden of disease. We aimed to quantify the relative detection rates of virus types A and B among the elderly, to identify factors affecting these proportions, and to compare type distribution among seniors and younger age‐classes. A comprehensive literature search was conducted to identify multiseason studies reporting A and B virus type distributions in the elderly. A random‐effects meta‐analysis was planned to quantify the prevalence of type B among elderly subjects with laboratory‐confirmed influenza. Meta‐regression was then applied to explain the sources of heterogeneity. Across 27 estimates identified, the type B detection rate among seniors varied from 5% to 37%. Meta‐analysis was not feasible owing to high heterogeneity (I2 = 98.5%). Meta‐regression analysis showed that study characteristics, such as number of seasons included, hemisphere, and setting, could have contributed to the heterogeneity observed. The final adjusted model showed that studies that included both outpatients and inpatients reported a significantly (P = .024) lower proportion than those involving outpatients only. The detection rate of type B among the elderly was generally lower than in children/adolescents, but not non‐elderly adults. Influenza virus type B has a relatively low detection rate in older adults, especially in settings covering both inpatients and outpatients. Public health implications are discussed.
Collapse
Affiliation(s)
- Donatella Panatto
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Piero L Lai
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Roberto Gasparini
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
| | - Daniela Amicizia
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Interuniversity Research Center on Influenza and other Transmissible Infections (CIRI-IT), Genoa, Italy
| |
Collapse
|
21
|
Jennings L, Huang QS, Barr I, Lee PI, Kim WJ, Buchy P, Sanicas M, Mungall BA, Chen J. Literature review of the epidemiology of influenza B disease in 15 countries in the Asia-Pacific region. Influenza Other Respir Viruses 2018; 12:383-411. [PMID: 29127742 PMCID: PMC5907823 DOI: 10.1111/irv.12522] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 01/06/2023] Open
Abstract
Influenza control strategies focus on the use of trivalent influenza vaccines containing two influenza A virus subtypes and one of the two circulating influenza type B lineages (Yamagata or Victoria). Mismatches between the vaccine B lineage and the circulating lineage have been regularly documented in many countries, including those in the Asia‐Pacific region. We conducted a literature review with the aim of understanding the relative circulation of influenza B viruses in Asia‐Pacific countries. PubMed and Western Pacific Region Index Medicus were searched for relevant articles on influenza type B published since 1990 in English language for 15 Asia‐Pacific countries. Gray literature was also accessed. From 4834 articles identified, 121 full‐text articles were analyzed. Influenza was reported as an important cause of morbidity in the Asia‐Pacific region, affecting all age groups. In all 15 countries, influenza B was identified and associated with between 0% and 92% of laboratory‐confirmed influenza cases in any one season/year. Influenza type B appeared to cause more illness in children aged between 1 and 10 years than in other age groups. Epidemiological data for the two circulating influenza type B lineages remain limited in several countries in the Asia‐Pacific, although the co‐circulation of both lineages was seen in countries where strain surveillance data were available. Mismatches between circulating B lineages and vaccine strains were observed in all countries with available data. The data suggest that a shift from trivalent to quadrivalent seasonal influenza vaccines could provide additional benefits by providing broader protection.
Collapse
Affiliation(s)
- Lance Jennings
- Canterbury District Health Board, Christchurch, New Zealand
| | - Qiu Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Porirua, New Zealand
| | - Ian Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, VIC, Australia
| | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Woo Joo Kim
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | | | | | | | | |
Collapse
|
22
|
Chagvardieff A, Persico N, Marmillot C, Badiaga S, Charrel R, Roch A. Prospective comparative study of characteristics associated with influenza A and B in adults. Med Mal Infect 2017; 48:180-187. [PMID: 29258804 DOI: 10.1016/j.medmal.2017.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/21/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe and compare the epidemiological characteristics associated with influenza type A and B as well as the characteristics associated with influenza pneumonia. The secondary objective was to evaluate the performance of influenza rapid diagnostic tests (RDT) in the emergency department. PATIENTS AND METHODS Prospective study, including 251 adult patients admitted to the emergency department during the 2013-2014 influenza outbreaks for flu-like illness confirmed by RT-PCR. RESULTS A total of 106 patients were infected with influenza type B (42%) and 145 with influenza type A (58%). Mean age was 56 and the sex-ratio was 0.9. In a multivariate analysis, the only factor independently related with the type of influenza strain was the patient's age. Overall, 17% of influenza-infected patients were vaccinated and 38% presented with pneumonia, with no significant difference between strains. In a univariate analysis, the risk factors associated with the occurrence of pneumonia were age, vaccination, and chronic obstructive pulmonary disease. Only 22% of samples positive by RT-PCR for influenza B and 40% for influenza A were positive by RDT. CONCLUSION Influenza type A and type B had similar clinical and biological signs, including severity. Influenza type B should not be neglected. Any emergency department may use the RDT for its ease-of-use and rapidity. However, its low sensitivity should be taken into consideration when interpreting results.
Collapse
Affiliation(s)
- A Chagvardieff
- Service d'accueil des urgences adultes, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
| | - N Persico
- Service d'accueil des urgences adultes, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - C Marmillot
- Service d'accueil des urgences adultes, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France
| | - S Badiaga
- Service d'accueil des urgences adultes, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; URMITE, CNRS-IRD, UMR 6236/198, Aix-Marseille université, pôle des maladies infectieuses, IHU, Méditerranée infection, 19-21 bd Jean Moulin, 13005 Marseille, France
| | - R Charrel
- Aix-Marseille, université, UMR190 « Émergence des pathologies virales » (AMU-IRD-EHESP), 27 bd Jean Moulin, 13005 Marseille, France
| | - A Roch
- Service d'accueil des urgences adultes, CHU Nord, chemin des Bourrely, 13915 Marseille cedex 20, France; URMITE, CNRS-IRD, UMR 6236/198, Aix-Marseille université, pôle des maladies infectieuses, IHU, Méditerranée infection, 19-21 bd Jean Moulin, 13005 Marseille, France; Aix-Marseille, université, UMR190 « Émergence des pathologies virales » (AMU-IRD-EHESP), 27 bd Jean Moulin, 13005 Marseille, France; Inserm 1095, URMITE, UM63, CNRS 7278, IRD 198, Aix-Marseille université, 27 bd Jean Moulin, 13005 Marseille, France
| |
Collapse
|
23
|
Coleman BL, Fadel SA, Fitzpatrick T, Thomas SM. Risk factors for serious outcomes associated with influenza illness in high- versus low- and middle-income countries: Systematic literature review and meta-analysis. Influenza Other Respir Viruses 2017; 12:22-29. [PMID: 29197154 PMCID: PMC5818335 DOI: 10.1111/irv.12504] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 11/29/2022] Open
Abstract
Aim To determine factors associated with a serious outcome (hospital admission or severe outcome: critical care or death) and associated with illness caused by laboratory‐confirmed influenza, with a specific interest in low‐ and middle‐income countries (LMIC). Method Databases were searched on 11 March 2016 for reports of influenza and factors associated with mortality or morbidity in humans, with no language restrictions. Pooled risks were estimated using random‐effects models. Results Despite the heterogeneity of results across studies, known risk factors for serious disease were associated with both hospital admission and severe outcomes (critical care and/or death). In LMIC, but not in high income countries (HIC), pregnant women, people with HIV/AIDS and children < 5 years old (compared with older children) were at increased risk of a severe outcome. Also, although all patients with neurological conditions were at higher risk of severe outcomes than those without, children were at higher risk than adults and children who lived in a LMIC were at significantly higher risk than those living in HIC. Adults were more likely than children to suffer a severe outcome if they had diabetes or a hematologic condition, were obese or had liver disease. Asthma is a risk factor for hospital admission but not for severe outcomes. Conclusion Known risk factors for serious disease remain important predictors of hospital admission and severe outcomes with few differences between HIC and LMIC countries. These differences likely reflect differences in health‐seeking behaviours and health services, but high heterogeneity between studies limits conclusions about the effect size.
Collapse
Affiliation(s)
- Brenda L Coleman
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| | - Shaza A Fadel
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| | - Tiffany Fitzpatrick
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| | - Sera-Melisa Thomas
- Sinai Health System, Infectious Disease Epidemiology Research Unit, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
24
|
Chu S, Park SJ, Koo SM, Kim YK, Kim KU, Uh ST, Kim TH, Park S. Incidence and Risk Factors of Pneumonia in Hospitalized Patients with Seasonal Influenza A or B. Tuberc Respir Dis (Seoul) 2017; 80:392-400. [PMID: 28905532 PMCID: PMC5617856 DOI: 10.4046/trd.2016.0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/21/2017] [Accepted: 05/15/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most patients with influenza recover spontaneously or following treatment with an anti-viral agent, but some patients experience pneumonia requiring hospitalization. We conducted a retrospective review to determine the incidence and risk factors of pneumonia in hospitalized patients with influenza A or B. METHODS A total of 213 patients aged 18 years or older and hospitalized with influenza between January 2012 and January 2015 were included in this study. A reverse-transcriptase polymerase chain reaction assay was used to detect the influenza A or B virus in the patients' sputum samples. We collected demographic and laboratory data, combined coexisting diseases, and radiologic findings. RESULTS The incidence of pneumonia was higher in patients in the influenza A group compared to those in the influenza B group (68.6% vs. 56.9%), but this difference was not statistically significant. The presence of underlying respiratory disease was significantly associated with pneumonia in the influenza A group (adjusted odds ratio [OR], 3.975; 95% confidence interval [CI], 1.312-12.043; p=0.015). In the influenza B group, the white blood cell count (adjusted OR, 1.413; 95% CI, 1.053-1.896; p=0.021), platelet count (adjusted OR, 0.988; 95% CI, 0.978-0.999; p=0.027), and existence of an underlying medical disease (adjusted OR, 15.858; 95% CI, 1.757-143.088; p=0.014) were all significantly associated with pneumonia in multivariate analyses. CONCLUSION The incidence of pneumonia was 65.7% in hospitalized patients with influenza A or B. The risk factors of pneumonia differed in hospitalized patients with influenza A or B.
Collapse
Affiliation(s)
- Seongjun Chu
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Sang Joon Park
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - So My Koo
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Yang Ki Kim
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Ki Up Kim
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Soo Taek Uh
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea.
| | - Tae Hyung Kim
- Division of Infectious Disease, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, Seoul, Korea
| |
Collapse
|
25
|
Higgins P, Runnegar N, Bird RJ, Markey KA. Rates of neutropenia in adults with influenza A or B: a retrospective analysis of hospitalised patients in South East Queensland during 2015. Intern Med J 2017; 46:1328-1332. [PMID: 27813353 DOI: 10.1111/imj.13239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 10/20/2022]
Abstract
Neutropenia in adult patients is often attributed to intercurrent viral infections; however, there are limited data describing the frequency or natural history of this phenomenon. We examined all patients presenting to three large hospitals in the Metro South region of South East Queensland with laboratory-confirmed influenza A or B throughout the 2015 influenza season (January-October). Four hundred and thirty-six patients were studied and 15.3% of this cohort were neutropenic (absolute neutrophil count <2.0 × 109 /L) with no identifiable cause other than the influenza. Importantly, the majority of cases were mild, with absolute neutrophil count remaining >1.0 × 109 /L. The incidence of neutropenia was significantly higher in association with influenza B than influenza A (18.3% vs 10.3%). We conclude that mild, transient neutropenia is common among patients with influenza infection and advise that it should not cause alarm or invite specific investigation unless severe or prolonged.
Collapse
Affiliation(s)
- P Higgins
- Haematology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - N Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - R J Bird
- Haematology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - K A Markey
- Haematology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia. .,Department of Immunology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. .,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| |
Collapse
|
26
|
Ray R, Dos Santos G, Buck PO, Claeys C, Matias G, Innis BL, Bekkat-Berkani R. A review of the value of quadrivalent influenza vaccines and their potential contribution to influenza control. Hum Vaccin Immunother 2017; 13:1640-1652. [PMID: 28532276 PMCID: PMC5512791 DOI: 10.1080/21645515.2017.1313375] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The contribution of influenza B to the seasonal influenza burden varies from year-to-year. Although 2 antigenically distinct influenza B virus lineages have co-circulated since 2001, trivalent influenza vaccines (TIVs) contain antigens from only one influenza B virus. B-mismatch or co-circulation of both B lineages results in increased morbidity and mortality attributable to the B lineage absent from the vaccine. Quadrivalent vaccines (QIVs) contain both influenza B lineages. We reviewed currently licensed QIVs and their value by focusing on the preventable disease burden. Modeling studies support that QIVs are expected to prevent more influenza cases, hospitalisations and deaths than TIVs, although estimates of the case numbers prevented vary according to local specificities. The value of QIVs is demonstrated by their capacity to broaden the immune response and reduce the likelihood of a B-mismatched season. Some health authorities have preferentially recommended QIVs over TIVs in their influenza prevention programmes.
Collapse
Affiliation(s)
| | - Gaël Dos Santos
- b Business & Decision Life Sciences , Brussels , Belgium (on behalf of GSK)
| | | | | | | | | | | |
Collapse
|
27
|
Kim JI, Lee I, Park S, Bae JY, Yoo K, Cheong HJ, Noh JY, Hong KW, Lemey P, Vrancken B, Kim J, Nam M, Yun SH, Cho WI, Song JY, Kim WJ, Park MS, Song JW, Kee SH, Song KJ, Park MS. Phylogenetic relationships of the HA and NA genes between vaccine and seasonal influenza A(H3N2) strains in Korea. PLoS One 2017; 12:e0172059. [PMID: 28257427 PMCID: PMC5336230 DOI: 10.1371/journal.pone.0172059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/30/2017] [Indexed: 11/18/2022] Open
Abstract
Seasonal influenza is caused by two influenza A subtype (H1N1 and H3N2) and two influenza B lineage (Victoria and Yamagata) viruses. Of these antigenically distinct viruses, the H3N2 virus was consistently detected in substantial proportions in Korea during the 2010/11-2013/14 seasons when compared to the other viruses and appeared responsible for the influenza-like illness rate peak during the first half of the 2011/12 season. To further scrutinize possible causes for this, we investigated the evolutionary and serological relationships between the vaccine and Korean H3N2 strains during the 2011/12 season for the main antigenic determinants of influenza viruses, the hemagglutinin (HA) and neuraminidase (NA) genes. In the 2011/12 season, when the number of H3N2 cases peaked, the majority of the Korean strains did not belong to the HA clade of A/Perth/16/2009 vaccine, and no Korean strains were of this lineage in the NA segment. In a serological assay, post-vaccinated human sera exhibited much reduced hemagglutination inhibition antibody titers against the non-vaccine clade Korean H3N2 strains. Moreover, Korean strains harbored several amino acid differences in the HA antigenic sites and in the NA with respect to vaccine lineages during this season. Of these, the HA antigenic site C residues 45 and 261 and the NA residue 81 appeared to be the signatures of positive selection. In subsequent seasons, when H3N2 cases were lower, the HA and NA genes of vaccine and Korean strains were more phylogenetically related to each other. Combined, our results provide indirect support for using phylogenetic clustering patterns of the HA and possibly also the NA genes in the selection of vaccine viruses and the assessment of vaccine effectiveness.
Collapse
Affiliation(s)
- Jin Il Kim
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ilseob Lee
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sehee Park
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Joon-Yong Bae
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kirim Yoo
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyung Wook Hong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Philippe Lemey
- Department of Microbiology and Immunology, Rega Institute, KU Leuven–University of Leuven, Leuven, Belgium
| | - Bram Vrancken
- Department of Microbiology and Immunology, Rega Institute, KU Leuven–University of Leuven, Leuven, Belgium
| | - Juwon Kim
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Misun Nam
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Soo-Hyeon Yun
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Woo In Cho
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Mee Sook Park
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jin-Won Song
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sun-Ho Kee
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Ki-Joon Song
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Man-Seong Park
- Department of Microbiology, the Institute of Viral Diseases, College of Medicine, Korea University, Seoul, Republic of Korea
| |
Collapse
|
28
|
Kim WJ, Lee JS, Lee CK, Cheong HJ, Kim M, Monegal JS, Carneiro R, Kyaw MH, Haguinet F, Ray R, Matias G. Clinical Features of Influenza and Acute Respiratory Illness in Older Adults at Least 50 Years of Age in an Outpatient Setting in the Republic of Korea: a Prospective, Observational, Cohort Study. J Korean Med Sci 2017; 32:407-414. [PMID: 28145642 PMCID: PMC5290098 DOI: 10.3346/jkms.2017.32.3.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/20/2016] [Indexed: 11/20/2022] Open
Abstract
Two prospective, multi-centre, observational studies (GlaxoSmithKline [GSK] identifier No. 110938 and 112519) were performed over 2 influenza seasons (2007-2008 and 2008-2009) in the Republic of Korea (ROK) with the aim to evaluate the burden of laboratory-confirmed influenza (LCI) in patients ≥ 50 years of age seeking medical attention for acute respiratory illness (ARI). The median participant age was 58 years in the 2007-2008 season and 60 years in the 2008-2009 season. LCI was observed in 101/346 (29.2%) of ARI patients in the 2007-2008 season and in 166/443 (37.5%) of ARI patients in the 2008-2009 season. Compared to patients with non-influenza ARI, those with LCI had higher rates of decreased daily activities (60.4% vs. 32.9% in 2007-2008 and 46.4% vs. 25.8% in 2008-2009), work absenteeism (51.1% vs. 25.6% and 14.4% vs. 7.7%), and longer duration of illness. These results indicated that influenza is an important cause of ARI in adults aged 50 and older causing more severe illness than non-influenza related ARI.
Collapse
Affiliation(s)
- Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
| | - Jin Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University Inha Hospital, Incheon, Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Mijeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
29
|
Moa AM, Muscatello DJ, Turner RM, MacIntyre CR. Epidemiology of influenza B in Australia: 2001-2014 influenza seasons. Influenza Other Respir Viruses 2016; 11:102-109. [PMID: 27650482 PMCID: PMC5304570 DOI: 10.1111/irv.12432] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2016] [Indexed: 01/24/2023] Open
Abstract
Background Influenza B is characterised by two antigenic lineages: B/Victoria and B/Yamagata. These lineages circulate together with influenza A during influenza seasons, with varying incidence from year to year and by geographic region. Objective To determine the epidemiology of influenza B relative to influenza A in Australia. Methods Laboratory‐confirmed influenza notifications between 2001 and 2014 in Australia were obtained from the Australian National Notifiable Diseases Surveillance System. Results A total of 278 485 laboratory‐confirmed influenza cases were notified during the study period, comprising influenza A (82.2%), B (17.1%) and ‘other and untyped’ (0.7%). The proportion of notifications that were influenza B was highest in five‐ to nine‐year‐olds (27.5%) and lowest in persons aged 85 years and over (11.5%). Of all B notifications with lineage determined, 77.1% were B/Victoria and 22.9% were B/Yamagata infections. Mismatches between the dominant B lineage in a season and the trivalent vaccine B lineage occurred in over one‐third of seasons during the study years. In general, influenza B notifications peaked later than influenza A notifications. Conclusion The proportion of circulating influenza B in Australia during 2001‐2014 was slightly lower than the global average and was dominated by B/Victoria. Compared with influenza A, influenza B infection was more common among older children and young adults and less common in the very elderly. Influenza B lineage mismatch with the trivalent vaccine occurred about one‐third of the time.
Collapse
Affiliation(s)
- Aye M Moa
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - David J Muscatello
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Robin M Turner
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chandini R MacIntyre
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia.,College of Public Service & Community Solutions, Arizona State University, Phoenix, Arizona, USA
| |
Collapse
|
30
|
Minodier L, Charrel RN, Ceccaldi PE, van der Werf S, Blanchon T, Hanslik T, Falchi A. Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J 2015; 12:215. [PMID: 26651485 PMCID: PMC4676820 DOI: 10.1186/s12985-015-0448-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/04/2015] [Indexed: 12/14/2022] Open
Abstract
This review provides for the first time an assessment of the current understanding about the occurrence and the clinical significance of gastrointestinal (GI) symptoms in influenza patients, and their correlation with the presence of human influenza viruses in stools of patients with confirmed influenza virus infection. Studies exploring how human influenza viruses spread to the patient’s GI tract after a primary respiratory infection have been summarized. We conducted a systematic search of published peer-reviewed literature up to June 2015 with regard to the above-mentioned aspects, focusing on human influenza viruses (A(H1N1), A(H1N1)pdm09, A(H3N2), and B). Forty-four studies were included in this systematic review and meta-analysis. The pooled prevalence of any digestive symptoms ranged from 30.9 % (95 % CI, 9.8 to 57.5; I2 = 97.5 %) for A(H1N1)pdm09 to 2.8 % (95 % CI, 0.6 to 6.5; I2 = 75.4 %) for A(H1N1). The pooled prevalence of influenza viruses in stool was 20.6 % (95 % CI, 8.9 to 35.5; I2 = 96.8 %), but their correlation with GI symptoms has rarely been explored. The presence of viral RNA in stools because of haematogenous dissemination to organs via infected lymphocytes is likely, but the potential to cause direct intestinal infection and faecal–oral transmission warrants further investigation. This review highlights the gaps in our knowledge, and the high degree of uncertainty about the prevalence and significance of GI symptoms in patients with influenza and their correlation with viral RNA positivity in stool because of the high level of heterogeneity among studies.
Collapse
Affiliation(s)
- Laetitia Minodier
- EA 7310, laboratory of virology, University of Corsica-Inserm, 20250, Corte, France.
| | - Remi N Charrel
- Aix Marseille Université, IRD French Institute of Research for Development, INSERM U1207, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", & IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France.
| | - Pierre-Emmanuel Ceccaldi
- Unité EPVO, Institut Pasteur, Paris-UMR CNRS 3569-Université Paris Diderot, Paris Sorbonne Cité, Cellule Pasteur, Paris, France.
| | - Sylvie van der Werf
- Unit of Molecular Genetics of RNA viruses, Institut Pasteur-UMR CNRS 3569-Université Paris Diderot-Sorbonne Paris Cité, Paris, France. .,Coordinating Center of the National Reference Center for influenza viruses, National Influenza Center (Northern-France), Institut Pasteur, Paris, France.
| | - Thierry Blanchon
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Paris, France. .,INSERM, UMR_S 1136, Paris, France.
| | - Thomas Hanslik
- INSERM, UMR_S 1136, Paris, France. .,Université Versailles Saint Quentin en Yvelines, UFR de Médecine Paris-Ile-de-France-Ouest, 9 boulevard d'Alembert, 78280, Guyancourt, France. .,Service de médecine interne, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne Billancourt, France.
| | - Alessandra Falchi
- EA 7310, laboratory of virology, University of Corsica-Inserm, 20250, Corte, France.
| |
Collapse
|
31
|
Cohen JM, Silva ML, Caini S, Ciblak M, Mosnier A, Daviaud I, Matias G, Badur S, Valette M, Enouf V, Paget J, Fleming DM. Striking Similarities in the Presentation and Duration of Illness of Influenza A and B in the Community: A Study Based on Sentinel Surveillance Networks in France and Turkey, 2010-2012. PLoS One 2015; 10:e0139431. [PMID: 26426119 PMCID: PMC4591015 DOI: 10.1371/journal.pone.0139431] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/13/2015] [Indexed: 11/24/2022] Open
Abstract
Influenza B represents a high proportion of influenza cases in some seasons (even over 50%). The Influenza B study in General Practice (IBGP) is a multicenter study providing information about the clinical, demographic and socio-economic characteristics of patients affected by lab-confirmed influenza A or B. Influenza B patients and age-matched influenza A patients were recruited within the sentinel surveillance networks of France and Turkey in 2010–11 and 2011–12 seasons. Data were collected for each patient at the swab test day, after 9±2 days and, if not recovered, after 28±5 days. It was related to patient's characteristics, symptoms at presentation, vaccination status, prescriptions of antibiotics and antivirals, duration of illness, follow-up consultations in general practice or emergency room. We performed descriptive analyses and developed a multiple regression model to investigate the effect of patients and disease characteristics on the duration of illness. Overall, 774 influenza cases were included in the study: 419 influenza B cases (209 in France and 210 in Turkey) and 355 influenza A cases (205 in France and 150 in Turkey). There were no differences between influenza A and B patients in terms of clinical presentation and number of consultations with a practitioner; however, the use of antivirals was higher among influenza B patients in both countries. The average (median) reported duration of illness in the age groups 0–14 years, 15–64 years and 65+ years was 7.4 (6), 8.7 (8) and 10.5 (9) days in France, and 6.3 (6), 8.2 (7) and 9.2 (6) days in Turkey; it increased with age but did not differ by virus type; increased duration of illness was associated with antibiotics prescription. In conclusion, our findings show that influenza B infection appears not to be milder disease than influenza A infection.
Collapse
Affiliation(s)
- Jean Marie Cohen
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
- Réseau des GROG, Paris, France
- * E-mail:
| | - Maria Laura Silva
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
| | - Saverio Caini
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
| | | | - Anne Mosnier
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
- Réseau des GROG, Paris, France
| | - Isabelle Daviaud
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
| | | | | | - Martine Valette
- Virology Department, National Influenza Center, Claude Bernard University Lyon 1, Lyon, France
| | - Vincent Enouf
- Virology Department, Unit of Molecular Genetics of RNA viruses, National Influenza Center, Pasteur Institute, CNRS UMR3569, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | - John Paget
- Netherlands Institute for Health Services research (NIVEL), Utrecht, The Netherlands
| | - Douglas M. Fleming
- Royal College of General Practitioners, Surveillance and Research Unit, Birmingham, United Kingdom
| | | |
Collapse
|
32
|
Mosnier A, Caini S, Daviaud I, Nauleau E, Bui TT, Debost E, Bedouret B, Agius G, van der Werf S, Lina B, Cohen JM. Clinical Characteristics Are Similar across Type A and B Influenza Virus Infections. PLoS One 2015; 10:e0136186. [PMID: 26325069 PMCID: PMC4556513 DOI: 10.1371/journal.pone.0136186] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/30/2015] [Indexed: 12/15/2022] Open
Abstract
Background Studies that aimed at comparing the clinical presentation of influenza patients across virus types and subtypes/lineages found divergent results, but this was never investigated using data collected over several years in a countrywide, primary care practitioners-based influenza surveillance system. Methods The IBVD (Influenza B in Vircases Database) study collected information on signs and symptoms at disease onset from laboratory-confirmed influenza patients of any age who consulted a sentinel practitioner in France. We compared the clinical presentation of influenza patients across age groups (0–4, 5–14, 15–64 and 65+ years), virus types (A, B) and subtypes/lineages (A(H3N2), pandemic A(H1N1), B Victoria, B Yamagata). Results Overall, 14,423 influenza cases (23.9% of which were influenza B) were included between 2003–2004 and 2012–2013. Influenza A and B accounted for over 50% of total influenza cases during eight and two seasons, respectively. There were minor differences in the distribution of signs and symptoms across influenza virus types and subtypes/lineages. Compared to patients aged 0–4 years, those aged 5–14 years were more likely to have been infected with type B viruses (OR 2.15, 95% CI 1.87–2.47) while those aged 15–64 years were less likely (OR 0.83, 95% CI 0.73–0.96). Males and influenza patients diagnosed during the epidemic period were less likely to be infected with type B viruses. Conclusions Despite differences in age distribution, the clinical illness produced by the different influenza virus types and subtypes is indistinguishable among patients that consult a general practitioner for acute respiratory infections.
Collapse
Affiliation(s)
- Anne Mosnier
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
- * E-mail: (AM); (EN)
| | - Saverio Caini
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
| | - Isabelle Daviaud
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
| | - Elodie Nauleau
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
- * E-mail: (AM); (EN)
| | - Tan Tai Bui
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
| | - Emmanuel Debost
- General Practitioner or Paediatrician, contributor of the GROG network, Paris, France
| | - Bernard Bedouret
- General Practitioner or Paediatrician, contributor of the GROG network, Paris, France
| | - Gérard Agius
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Sylvie van der Werf
- Centre National de Référence des virus influenza, Génétique moléculaire des virus respiratoires, Institut Pasteur, CNRS UMR 3569, Université Paris Diderot Sorbonne Paris-Cité, Paris, France
| | - Bruno Lina
- Centre National de Référence des virus influenza, CBPE, Hospices Civils de Lyon et Virpath, Université Claude Bernard Lyon, Lyon, France
| | - Jean Marie Cohen
- Open Rome (Organize and Promote Epidemiological Network), Paris, France
| | | |
Collapse
|
33
|
Abstract
Antiviral therapy has an important role in the treatment and chemoprophylaxis of influenza. At present, two classes of antiviral agents, adamantanes and neuraminidase inhibitors, are available for the treatment and chemoprophylaxis of influenza in Korea. Because of the widespread resistance against adamantanes, neuraminidase inhibitors are mainly used. Because each country has a unique epidemiology of influenza, the proper use of antiviral agents should be determined based on local data. Decisions on the clinical practice in the treatment of influenza in South Korea are guided by the local surveillance data, practice guidelines, health insurance system and the resistance patterns of the circulating influenza viruses. This review highlights the role of antiviral agents in the treatment and outcome of influenza in Korea by providing comprehensive information of their clinical usage in Korea.
Collapse
Affiliation(s)
- Young June Choe
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | | | | | | |
Collapse
|
34
|
Age-specific differences in influenza virus type and subtype distribution in the 2012/2013 season in 12 European countries. Epidemiol Infect 2015; 143:2950-8. [PMID: 25648399 PMCID: PMC4595855 DOI: 10.1017/s0950268814003422] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The epidemiology of seasonal influenza is influenced by age. During the influenza season, the European Influenza Surveillance Network (EISN) reports weekly virological and syndromic surveillance data [mostly influenza-like illness (ILI)] based on national networks of sentinel primary-care providers. Aggregated numbers by age group are available for ILI, but not linked to the virological data. At the end of the influenza season 2012/2013, all EISN laboratories were invited to submit a subset of their virological data for this season, including information on age. The analysis by age group suggests that the overall distribution of circulating (sub)types may mask substantial differences between age groups. Thus, in cases aged 5–14 years, 75% tested positive for influenza B virus whereas all other age groups had an even distribution of influenza A and B viruses. This means that the intepretation of syndromic surveillance data without age group-specific virological data may be misleading. Surveillance at the European level would benefit from the reporting of age-specific influenza data.
Collapse
|
35
|
Park S, Lee M, Chung HS. Evaluation of the Performance of a New Chromatographic Assay BD Veritor System for Rapid Detection of Influenza A & B. ANNALS OF CLINICAL MICROBIOLOGY 2015. [DOI: 10.5145/acm.2015.18.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sholhui Park
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Miae Lee
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hae-Sun Chung
- Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
36
|
Hong KW, Cheong HJ, Song JY, Noh JY, Yang TU, Kim WJ. Clinical manifestations of influenza A and B in children and adults at a tertiary hospital in Korea during the 2011-2012 season. Jpn J Infect Dis 2014; 68:20-6. [PMID: 25420662 DOI: 10.7883/yoken.jjid.2013.466] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to evaluate and compare the epidemiological patterns and clinical courses of influenza A and B among children and adults. For this purpose, we retrospectively reviewed the medical records of 809 children and 271 adolescents/adults with laboratory-confirmed influenza between October 2011 and May 2012 at a tertiary-care hospital. Children with influenza B presented with high fever (body temperature >39℃), sputum production, diarrhea, nausea/vomiting, and myalgia more frequently than those with influenza A. Children with influenza B also showed longer intervals from symptom onset to the initiation of antivirals and higher rates of antibiotic prescription and hospitalization than those with influenza A. Adults aged 20-59 years accounted for approximately 16% and 20% of patients with influenza A and B, respectively. Although clinical manifestations and outcomes were similar between adult patients with influenza A and those with influenza B, influenza B may cause substantial disease burden among not only children but also socially active adults aged 20-59 years.
Collapse
Affiliation(s)
- Kyung-Wook Hong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine
| | | | | | | | | | | |
Collapse
|
37
|
Sočan M, Prosenc K, Učakar V, Berginc N. A comparison of the demographic and clinical characteristics of laboratory-confirmed influenza B Yamagata and Victoria lineage infection. J Clin Virol 2014; 61:156-60. [PMID: 25034374 DOI: 10.1016/j.jcv.2014.06.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/09/2014] [Accepted: 06/19/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The evolution of influenza viruses is characterized by the co-circulation of two antigenically and genetically distinct lineages B/Victoria/2/87-like viruses (Victoria) and B/Yamagata/16/88-like viruses (Yamagata). To date, there is not much data associating lineages variation with demographic and clinical data. OBJECTIVES We compared the demographic and clinical characteristics of patients with laboratory-confirmed influenza B Victoria or Yamagata lineage infection. STUDY DESIGN We retrospectively analyzed data from 6811 patients aged from <1 through 99 years with influenza like-illness who consulted the sentinel site or sentinel hospital in the seasons 2010/2011, 2011/2012 and 2012/2013. There were 662 patients positive for influenza B virus by multiplex real-time RT-PCR. Six hundred thirty-seven (96.8%) were successfully subtyped for Victoria or Yamagata lineage infection. The available demographic and clinical data was compared. RESULTS Patients with the Victoria lineage were significantly younger compared to patients infected with the Yamagata lineage. The Victoria lineage was the predominant strain in the 15-34 age groups in patients consulting at primary care level and in hospitalized patients. In the youngest age group (0-4 years) approximately half of the confirmed influenza B cases belonged to the Victoria (55%) and the rest to the Yamagata lineage (45%). Aside from age, there was no statistically significant difference found in gender distribution, vaccination history, clinical presentation or risk factors for severe influenza infection in hospitalized patients after adjustment for the age. CONCLUSIONS The frequency of influenza B Victoria and Yamagata infection is age dependent with no significant differences detected in clinical presentation comparing both lineages.
Collapse
Affiliation(s)
- Maja Sočan
- Centre for Communicable Diseases, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.
| | - Katarina Prosenc
- Laboratory for Public Health Virology, National Laboratory for Health, Environment and Food, Bohoričeva 15, 1000 Ljubljana, Slovenia.
| | - Veronika Učakar
- Centre for Communicable Diseases, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.
| | - Nataša Berginc
- Laboratory for Public Health Virology, National Laboratory for Health, Environment and Food, Bohoričeva 15, 1000 Ljubljana, Slovenia.
| |
Collapse
|
38
|
Adlhoch C, Broberg E, Beauté J, Snacken R, Bancroft E, Zucs P, Penttinen P. Influenza season 2013/14 has started in Europe with influenza A(H1)pdm09 virus being the most prevalent subtype. ACTA ACUST UNITED AC 2014; 19. [PMID: 24507465 DOI: 10.2807/1560-7917.es2014.19.4.20686] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The 2013/14 influenza season has started in Europe. Four countries have reported medium intensity influenza activity, with children under 15 years being the most affected age group. A growing number of countries see increasing rates of influenza-like illness or acute respiratory infection and increasing proportions of specimens positive for influenza A(H1)pdm09 virus. In previous seasons, this subtype was associated with higher reported numbers of severe and fatal cases. Clinicians should offer influenza vaccination to unvaccinated persons belonging to risk groups.
Collapse
Affiliation(s)
- C Adlhoch
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|