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Hamid S, Grajeda L, de Leon O, Lopez M, Maldonado H, Gomez A, Lopman B, Clasen T, McCracken J. Variability in the Timing of Respiratory Syncytial Virus Epidemics in Guatemala, 2008-2018. Influenza Other Respir Viruses 2024; 18:e13334. [PMID: 38980961 PMCID: PMC11232890 DOI: 10.1111/irv.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 05/12/2024] [Accepted: 05/19/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The description of local seasonality patterns in respiratory syncytial virus (RSV) incidence is important to guide the timing of administration of RSV immunization products. METHODS We characterized RSV seasonality in Guatemala using the moving epidemic method (MEM) with absolute counts of RSV-associated acute respiratory infections (ARI) from hospital surveillance in Santa Rosa and Quetzaltenango departments of Guatemala. RESULTS From Week 17 of 2008 through Week 16 of 2018, 8487 ARI cases tested positive for RSV by rRT-PCR. Season onsets varied up to 5 months; early seasons starting in late May to early August and finishing in September to November were most common, but late seasons starting in October to November and finishing in March to April were also observed. Both epidemic patterns had similar durations ranging from 4 to 6 months. Epidemic thresholds (the levels of virus activity that signal the onset and end of a seasonal epidemic) calculated prospectively using previous seasons' data captured between 70% and 99% of annual RSV detections. Onset weeks differed by 2-10 weeks, and offset weeks differed by 2-16 weeks between the two surveillance sites. CONCLUSIONS Variability in the timing of seasonal RSV epidemics in Guatemala demonstrates the difficulty in precisely predicting the timing of seasonal RSV epidemics based on onset weeks from past seasons and suggests that maximal reduction in RSV disease burden would be achieved through year-round vaccination and immunoprophylaxis administration to at-risk infants.
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Affiliation(s)
- Sarah Hamid
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Laura M. Grajeda
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
- Global Health Institute, College of Public HealthUniversity of GeorgiaAthensGeorgiaUSA
| | - Oscar de Leon
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
- Gangarosa Department of Environmental Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Maria Renee Lopez
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
| | - Herberth Maldonado
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
| | - Ana Beatriz Gomez
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
| | - Benjamin Lopman
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Thomas F. Clasen
- Department of Epidemiology, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
- Gangarosa Department of Environmental Health, Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - John P. McCracken
- Centro de Estudios en SaludUniversidad del Valle de GuatemalaGuatemala CityGuatemala
- Global Health Institute, College of Public HealthUniversity of GeorgiaAthensGeorgiaUSA
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Islam MA, Hassan MZ, Aleem MA, Akhtar Z, Chowdhury S, Ahmmed MK, Rahman M, Rahman MZ, Mah-E-Muneer S, Uzzaman MS, Shirin T, Flora MS, Rahman M, Davis WW, Azziz-Baumgartner E, Iuliano AD, Chowdhury F. Post-discharge mortality among patients hospitalised with severe acute respiratory infection, Bangladesh, 2012-2019: a prospective observational study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100363. [PMID: 39021479 PMCID: PMC467067 DOI: 10.1016/j.lansea.2024.100363] [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: 05/10/2023] [Revised: 11/09/2023] [Accepted: 01/31/2024] [Indexed: 07/20/2024]
Abstract
Background Enhancing outcomes post-hospitalisation requires an understanding of predictive factors for adverse events. This study aimed to estimate post-discharge mortality rates among patients with severe acute respiratory infection (SARI) in Bangladesh, identify associated factors, and document reported causes of death. Methods From January 2012 to December 2019, we conducted follow-up calls to patients or their families 30 days after discharge to assess the status of patients with SARI. Proportions of deaths within 30 days of discharge were estimated, and a comparative analysis of demographics, clinical characteristics, and influenza illness between decedents and survivors was performed using multivariable Cox regression models. Findings Among 23,360 patients with SARI (median age: 20 years, IQR: 1.5-48, 65% male), 351 (1.5%) died during hospitalisation. Of 23,009 patients alive at discharge, 20,044 (87%) were followed, with 633 (3.2%) deaths within 30 days of discharge. In children (<18 years), difficulty breathing (adjusted hazard ratio [aHR] 1.8; 95% CI 1.1-3.0), longer hospital stay (aHR 1.1; 95% CI 1.1-1.1), and heart diseases (aHR 8.5; 95% CI 3.2-23.1) were associated with higher post-discharge death risk. Among adults (≥18 years), difficulty breathing (aHR 2.3; 95% CI 1.7-3.0), chronic obstructive pulmonary disease (aHR 1.7; 95% CI 1.4-2.2), and intensive care unit admission (aHR 5.2; 95% CI 1.9-14.0) were linked to elevated post-discharge death risk. Influenza virus was detected in 13% (46/351) of in-hospital SARI deaths and 10% (65/633) of post-discharge SARI deaths. Interpretation Nearly one in twenty patients with SARI died during hospitalisation or within 1 month of discharge, with two-thirds of deaths occurring post-discharge. Seasonal influenza vaccination is recommended to mitigate influenza-associated mortality. To enhance post-discharge outcomes, hospitals should consider developing safe-discharge algorithms, reinforcing post-discharge care plans, and establishing outpatient monitoring for recently discharged patients. Funding Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA [U01GH002259].
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Affiliation(s)
- Md Ariful Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Zakiul Hassan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Abdul Aleem
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sukanta Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Kaousar Ahmmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Syeda Mah-E-Muneer
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Salim Uzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Mahmudur Rahman
- Global Health Development (GHD), The Eastern Mediterranean Public Health Network (EMPHNET), Dhaka, Bangladesh
| | - William W. Davis
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - A. Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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3
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Ramay BM, Castillo C, Grajeda L, Santos LF, Romero JC, Lopez MR, Gomez A, Caudell M, Smith RM, Styczynski A, Herzig CTA, Bollinger S, Ning MF, Horton J, Omulo S, Palmer GH, Cordon-Rosales C, Call DR. Colonization With Antibiotic-Resistant Bacteria in a Hospital and Associated Communities in Guatemala: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S82-S88. [PMID: 37406049 PMCID: PMC10321699 DOI: 10.1093/cid/ciad222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND We estimated the prevalence of colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) from a hospital and associated communities in western Guatemala. METHODS Randomly selected infants, children, and adults (<1, 1-17, and ≥18 years, respectively) were enrolled from the hospital (n = 641) during the coronavirus disease 2019 (COVID-19) pandemic, March to September 2021. Community participants were enrolled using a 3-stage cluster design between November 2019 and March 2020 (phase 1, n = 381) and between July 2020 and May 2021 (phase 2, with COVID-19 pandemic restrictions, n = 538). Stool samples were streaked onto selective chromogenic agar, and a Vitek 2 instrument was used to verify ESCrE or CRE classification. Prevalence estimates were weighted to account for sampling design. RESULTS The prevalence of colonization with ESCrE and CRE was higher among hospital patients compared to community participants (ESCrE: 67% vs 46%, P < .01; CRE: 37% vs 1%, P < .01). Hospital ESCrE colonization was higher for adults (72%) compared with children (65%) and infants (60%) (P < .05). Colonization was higher for adults (50%) than children (40%) in the community (P < .05). There was no difference in ESCrE colonization between phase 1 and 2 (45% and 47%, respectively, P > .05), although reported use of antibiotics among households declined (23% and 7%, respectively, P < .001). CONCLUSIONS While hospitals remain foci for ESCrE and CRE colonization, consistent with the need for infection control programs, community prevalence of ESCrE in this study was high, potentially adding to colonization pressure and transmission in healthcare settings. Better understanding of transmission dynamics and age-related factors is needed.
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Affiliation(s)
- Brooke M Ramay
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Carmen Castillo
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Laura Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Lucas F Santos
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Juan Carlos Romero
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Andrea Gomez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Mark Caudell
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Rachel M Smith
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Styczynski
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolyn T A Herzig
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Bollinger
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mariangeli Freitas Ning
- Central America Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala Department, Republic of Guatemala
| | - Jennifer Horton
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
- Washington State University Global Health–Kenya, Nairobi, Nairobi County, Kenya
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Celia Cordon-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala Department, Republic of Guatemala
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
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Jambo A, Gashaw T, Mohammed AS, Edessa D. Treatment outcomes and its associated factors among pneumonia patients admitted to public hospitals in Harar, eastern Ethiopia: a retrospective follow-up study. BMJ Open 2023; 13:e065071. [PMID: 36792331 PMCID: PMC9933768 DOI: 10.1136/bmjopen-2022-065071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Although there is a high risk of drug resistance, empiric treatment is a common approach for pneumonia management. In this respect, it is relevant to know treatment outcomes of patients with pneumonia. This study aimed to assess treatment outcomes and its associated factors among pneumonia patients treated at two public hospitals in Harar, eastern Ethiopia. DESIGN Retrospective follow-up study. SETTING Jugal General Hospital and Hiwot Fana Specialised University Hospital in Harar, eastern Ethiopia. PARTICIPANTS Patients admitted and treated for pneumonia in the two public hospitals in eastern Ethiopia between April 2020 and April 2021. PRIMARY OUTCOME The primary outcome was unfavourable treatment outcome (died or transferred to intensive care unit) for pneumonia patients. RESULTS A total of 693 patients with pneumonia were included in the study. 88 (12.7%) of these patients had an unfavourable treatment outcome, which included 14 (2%) transfers to the intensive care unit and 74 (10.7%) deaths. Patients with comorbidity (adjusted OR, AOR=2.96; 95% CI: 1.47 to 5.97) and with clinical features including abnormal body temperature (AOR=4.03; 95% CI: 2.14 to 7.58), tachycardia (AOR=2.57; 95% CI: 1.45 to 4.55), bradypnoea or tachypnoea (AOR=3.92; 95% CI:1.94 to 7.92), oxygen saturation below 90% (AOR=2.52; 95% CI:1.37 to 4.64) and leucocytosis (AOR=2.78, 95%, CI:1.38 to 5.58) had a significantly increased unfavourable treatment outcome. CONCLUSION We found that nearly one out of eight patients with pneumonia had unfavourable treatment outcomes. It was considerably high among patients with comorbidities and apparent abnormal clinical conditions. Therefore, taking into account regionally adaptable intervention and paying close attention to pneumonia patients admitted with comorbidity and other superimposed abnormal conditions might help improve the treatment outcomes of these populations.
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Affiliation(s)
- Abera Jambo
- Clinical Pharmacy Department, Haramaya University, Dire Dawa, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and Toxicology, Haramaya University, Dire Dawa, Ethiopia
| | | | - Dumessa Edessa
- Clinical Pharmacy Department, Haramaya University, Dire Dawa, Ethiopia
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Epidemiology of Community-Acquired Respiratory Tract Infections in Patients Admitted at the Emergency Departments. Trop Med Infect Dis 2022; 7:tropicalmed7090233. [PMID: 36136644 PMCID: PMC9501977 DOI: 10.3390/tropicalmed7090233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Community-acquired respiratory infections (CARTIs) are responsible for serious morbidities worldwide. Identifying the aetiology can decrease the use of unnecessary antimicrobial therapy. In this study, we intend to determine the pathogenic agents responsible for respiratory infections in patients presenting to the emergency department of several Lebanese hospitals. Methods: A total of 100 patients presenting to the emergency departments of four Lebanese hospitals and identified as having CARTIs between September 2017 and September 2018 were recruited. Specimens of upper and lower respiratory tract samples were collected. Pathogens were detected by a multiplex polymerase chain reaction respiratory panel. Results: Of 100 specimens, 84 contained at least one pathogen. Many patients were detected with ≥2 pathogens. The total number of pathogens from these 84 patients was 163. Of these pathogens, 36 (22%) were human rhinovirus, 28 (17%) were Streptococcus pneumoniae, 16 (10%) were metapneumovirus, 16 (10%) were influenza A virus, and other pathogens were detected with lower percentages. As expected, the highest occurrence of pathogens was observed between December and March. Respiratory syncytial virus accounted for 2% of the cases and only correlated to paediatric patients. Conclusion: CARTI epidemiology is important and understudied in Lebanon. This study offers the first Lebanese data about CARTI pathogens. Viruses were the most common aetiologies of CARTIs. Thus, a different approach must be used for the empirical management of CARTI. Rapid testing might be useful in identifying patients who need antibiotic therapy.
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von Mollendorf C, Berger D, Gwee A, Duke T, Graham SM, Russell FM, Mulholland EK. Aetiology of childhood pneumonia in low- and middle-income countries in the era of vaccination: a systematic review. J Glob Health 2022; 12:10009. [PMID: 35866332 PMCID: PMC9305023 DOI: 10.7189/jogh.12.10009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background This systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries. Methods We searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830]. Results We screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria - 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis. Conclusions Several viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.
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Affiliation(s)
- Claire von Mollendorf
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Daria Berger
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Trevor Duke
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen M Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia
| | - Fiona M Russell
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - E Kim Mulholland
- Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Jaramillo J, Ning MF, Cadena L, Park M, Lo T, Zielinski-Gutierrez E, Espinosa-Bode A, Reyes M, Del Rosario Polo M, Henao O. Evaluation of the collaborative integrated surveillance system (ViCo) in Guatemala: a qualitative study on lessons learned and future perspectives. BMC Public Health 2022; 22:350. [PMID: 35183153 PMCID: PMC8857857 DOI: 10.1186/s12889-022-12719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The collaborative integrated surveillance system known as Vigilancia Integrada Comunitaria (ViCo) was implemented in 2007 to better understand and characterize the burden of diarrheal, respiratory and febrile illnesses in Guatemala. METHODS To evaluate the usefulness of ViCo and inform a redesign of the system and new surveillance activities in the Central American region, personnel from the United States Centers for Disease Control and Prevention (CDC) conducted thirty-nine in-depth interviews from June-December 2018 with key stakeholders responsible for the design and implementation of ViCo in Guatemala. A semi-structured questionnaire adapted from the Updated CDC Guidelines for Evaluating Public Health Surveillance Systems was used for data collection. We used a grounded theory approach to explore stakeholder perceptions of ViCo and generate recommendations for improvement. Primary qualitative findings were organized based on thematic areas using ATLAS.ti version 8 software. RESULTS Emergent themes relevant to the usefulness of ViCo were organized across strengths, weaknesses, and recommendations pertaining to the: (1) Size and Complexity of ViCo, (2) Stakeholder Expectations About the Objectives of ViCo, (3) Data Management and Structure of the Information System, (4) Local Control of Data, (5) Integration of ViCo within the Ministry of Health, and, (6) Improvement of the Operational and Design Aspects of ViCo across System, Process, and Output levels. CONCLUSIONS Stakeholders perceived ViCo to be useful. They recommended measures to improve system performance and quality, including simplifying the surveillance system, routine data analysis and feedback, and channeling efforts towards integrating surveillance data into the national health information system. To create a well-performing surveillance system and achieve the intended objective of surveillance for public health action, ongoing evaluation and assessment of surveillance activities are necessary.
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Affiliation(s)
- Jahn Jaramillo
- Public Health Institute/U.S. Centers for Disease Control and Prevention Global Health Fellowship Program, Oakland, CA, USA.
- Division of Global Health Protection, Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala.
| | - Mariangeli Freitas Ning
- Division of Global Health Protection, Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
- Training Programs in Epidemiology and Public Health Interventions Network, Decatur, GA, USA
| | - Loren Cadena
- Division of Global Health Protection, Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Michael Park
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terrence Lo
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Zielinski-Gutierrez
- Division of Global Health Protection, Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Andres Espinosa-Bode
- Division of Global Health Protection, Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Marines Reyes
- Division of Global Health Protection, Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Maria Del Rosario Polo
- Division of Global Health Protection, Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Olga Henao
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Grajeda LM, McCracken JP, Berger-González M, López MR, Álvarez D, Méndez S, Pérez O, Cordón-Rosales C, Zinsstag J. Sensitivity and representativeness of one-health surveillance for diseases of zoonotic potential at health facilities relative to household visits in rural Guatemala. One Health 2021; 13:100336. [PMID: 34703874 PMCID: PMC8524745 DOI: 10.1016/j.onehlt.2021.100336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 10/31/2022] Open
Abstract
Most human and animal disease notification systems are unintegrated and passive, resulting in underreporting. Active surveillance can complement passive efforts, but because they are resource-intensive, their attributes must be evaluated. We assessed the sensitivity and representativeness of One-Health surveillance conducted at health facilities compared to health facilities plus monthly household visits in three rural communities of Guatemala. From September 2017 to November 2018, we screened humans for acute diarrheal, febrile and respiratory infectious syndromes and canines, swine, equines and bovines for syndromic events or deaths. We estimated the relative sensitivity as the incidence rate ratio of detecting an event in health facility surveillance compared to household surveillance from Poisson models. We used interaction terms between the surveillance method and sociodemographic factors or time trends to assess effect modification as a measure of relative representativeness. We used generalized additive models with smoothing splines to model incidence over time by surveillance method. We randomized 216 households to health facility surveillance and 198 to health facility surveillance plus monthly household visits. Health facility surveillance alone was less sensitive than when combined with household surveillance by 0.42 (95% CI: 0.34, 0.53), 0.56 (95% CI: 0.39, 0.79), 0.02 (95% CI: 0.00, 0.10), 0.28 (95% CI: 0.15, 0.50) and 0.22 (95% CI: 0.03, 0.92) times for human acute infections, human severe acute infections, and deaths in canines, swine and equines, respectively. Health facility surveillance alone underrepresented Spanish speakers (interaction p-value = 0.0003) and persons in higher economic assets (interaction p-values = 0.0008). The trend in incidence over time was different between the two study groups, with a larger decrease in the group with household surveillance (all interaction p-values <0.10). Surveillance at health facilities under ascertains syndromes in humans and animals which leads to underestimation of the burden of zoonotic disease. The magnitude of under ascertainment was differentially by sociodemographic factors, yielding an unrepresentative sample of health events. However, it is less time-intensive, thus might be sustained over time longer than household surveillance. The choice between methodologies should be evaluated against surveillance goals and available resources.
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Affiliation(s)
- Laura M. Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
- Global Health Institute, College of Public Health, University of Georgia, GA, USA
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
- Global Health Institute, College of Public Health, University of Georgia, GA, USA
| | - Mónica Berger-González
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - María Reneé López
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Danilo Álvarez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Salvador Méndez
- Ministry of Public Health and Social Welfare, Petén, Guatemala
| | - Oscar Pérez
- Ministry of Agriculture, Livestock and Food, Petén, Guatemala
| | - Celia Cordón-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, PO Box, CH-4002 Basel, Switzerland
- University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland
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Johnson EK, Sylte D, Chaves SS, Li Y, Mahe C, Nair H, Paget J, van Pomeren T, Shi T, Viboud C, James SL. Hospital utilization rates for influenza and RSV: a novel approach and critical assessment. Popul Health Metr 2021; 19:31. [PMID: 34126993 PMCID: PMC8204427 DOI: 10.1186/s12963-021-00252-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/31/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Influenza and respiratory syncytial virus (RSV) contribute significantly to the burden of acute lower respiratory infection (ALRI) inpatient care, but heterogeneous coding practices and availability of inpatient data make it difficult to estimate global hospital utilization for either disease based on coded diagnoses alone. METHODS This study estimates rates of influenza and RSV hospitalization by calculating the proportion of ALRI due to influenza and RSV and applying this proportion to inpatient admissions with ALRI coded as primary diagnosis. Proportions of ALRI attributed to influenza and RSV were extracted from a meta-analysis of 360 total sources describing inpatient hospital admissions which were input to a Bayesian mixed effects model over age with random effects over location. Results of this model were applied to inpatient admission datasets for 44 countries to produce rates of hospital utilization for influenza and RSV respectively, and rates were compared to raw coded admissions for each disease. RESULTS For most age groups, these methods estimated a higher national admission rate than the rate of directly coded influenza or RSV admissions in the same inpatient sources. In many inpatient sources, International Classification of Disease (ICD) coding detail was insufficient to estimate RSV burden directly. The influenza inpatient burden estimates in older adults appear to be substantially underestimated using this method on primary diagnoses alone. Application of the mixed effects model reduced heterogeneity between countries in influenza and RSV which was biased by coding practices and between-country variation. CONCLUSIONS This new method presents the opportunity of estimating hospital utilization rates for influenza and RSV using a wide range of clinical databases. Estimates generally seem promising for influenza and RSV associated hospitalization, but influenza estimates from primary diagnosis seem highly underestimated among older adults. Considerable heterogeneity remains between countries in ALRI coding (i.e., primary vs non-primary cause), and in the age profile of proportion positive for influenza and RSV across studies. While this analysis is interesting because of its wide data utilization and applicability in locations without laboratory-confirmed admission data, understanding the sources of variability and data quality will be essential in future applications of these methods.
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Affiliation(s)
- Emily K Johnson
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.
| | - Dillon Sylte
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Sandra S Chaves
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
- Vaccine Epidemiology and Modeling Department, Sanofi Pasteur, Lyon, France
| | - You Li
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Cedric Mahe
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
- Vaccine Epidemiology and Modeling Department, Sanofi Pasteur, Lyon, France
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - John Paget
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Tayma van Pomeren
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Ting Shi
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Cecile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, USA
| | - Spencer L James
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA
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10
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Núñez-Samudio V, Landires I. Epidemiology of viral respiratory infections in a pediatric reference hospital in Central Panama. BMC Infect Dis 2021; 21:43. [PMID: 33422002 PMCID: PMC7796567 DOI: 10.1186/s12879-020-05720-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 12/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background Acute respiratory infections (ARIs) are a worldwide public health problem. It is estimated that up to 80% of cases of ARIs are caused by viruses. In Central America, however, we identified few epidemiologic studies on the main ARI-related viruses in hospitalized children. Methods This study retrospectively analyzed the clinical charts of patients ages 29 days to 14 years admitted with diagnoses of ARIs in a pediatric reference hospital in central Panama during 2016. The variables analyzed were age, sex, signs, symptoms, and diagnosis at admission. Samples of patients to whom a viral panel was indicated were analyzed via quantitative polymerase chain reaction, qPCR. Results The most common virus was respiratory syncytial virus (RSV; 25.9%), followed by influenza A virus (10.6%), rhinovirus (10.6%), parainfluenza type 3 (PIV-3; 8.2%) and adenovirus (5.9%). However, virus detection varied with patient age and season. RSV and Influenza virus were respectively identified mainly during July–November and May–July. All cases of viral co-infection occurred in children < 5-years-old. Both influenza A (H1N1) pdm09 and rhinovirus were detected in all pediatric ages analyzed in this study, unlike RSV and PIV-3, which were only present in children < 5-years-old. Conclusions This study analyzed the epidemiological patterns of different respiratory viruses in pediatric patients with ARI from central Panama and found that the prevalence of the specific respiratory viruses identified varied with season and age. The most common viruses were RSV, influenza A, and rhinovirus. There were no reports of human metapneumovirus associated with ARI, which may be explained by the time and geographic location of the study. Knowledge of the local epidemiology of respiratory viruses in tropical countries is helpful in forecasting the peaks of hospitalizations due to ARIs and may help improve prevention efforts aiming at respiratory disease control in these settings.
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Affiliation(s)
- Virginia Núñez-Samudio
- Instituto de Ciencias Médicas, PO Box 0710-00043, Las Tablas, Los Santos, Panama.,Sección de Epidemiología, Departamento de Salud Pública, Región de Salud de Herrera, Ministry of Health, Chitré, Panama
| | - Iván Landires
- Instituto de Ciencias Médicas, PO Box 0710-00043, Las Tablas, Los Santos, Panama. .,Centro Regional Universitario de Azuero (CRUA), Universidad de Panamá, Chitré, Herrera, Panama. .,Hospital Joaquín Pablo Franco Sayas, Región de Salud de Los Santos, Ministry of Health, Las Tablas, Panama.
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11
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Madewell ZJ, López MR, Espinosa-Bode A, Brouwer KC, Sánchez CG, McCracken JP. Inverse association between dengue, chikungunya, and Zika virus infection and indicators of household air pollution in Santa Rosa, Guatemala: A case-control study, 2011-2018. PLoS One 2020; 15:e0234399. [PMID: 32559225 PMCID: PMC7304608 DOI: 10.1371/journal.pone.0234399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/24/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Dengue, chikungunya, and Zika viruses are increasingly important public health problems. Burning vegetation, leaves, and other plant products have been shown to be effective mosquito repellents for their vector, Aedes spp., but there has been scant research on whether firewood cooking smoke in households influences mosquito populations or mosquito-borne diseases. About 2.9 billion people worldwide use biomass fuel for household cooking and heating, resulting in an estimated 1.6 million deaths annually from household air pollution (HAP)-related diseases. Global health agencies now encourage households to transition from biomass to clean fuels, but it is unclear whether such interventions may actually increase risk for mosquito-borne diseases. This retrospective case-control study evaluated associations between arboviral infections and cooking with firewood in Santa Rosa, Guatemala. METHOD Vigilancia Integrada Comunitaria (VICo) was a prospective public health surveillance system for bacterial, parasitic, and viral causes of diarrheal, neurological, respiratory, and febrile illnesses in hospitals and clinics in the department of Santa Rosa, Guatemala. Enrolled VICo in-patients and out-patients during 2011-2018 were interviewed using standardized questionnaires on demographics and household characteristics. Blood and stool specimens were collected and tested to identify the etiologies presenting symptoms. Cases were defined as laboratory-positive for dengue, chikungunya, or Zika virus infections. Controls were laboratory-positive for bacterial and viral diarrheal illnesses (e.g., Salmonella, Shigella, Campylobacter, Escherichia coli, rotavirus, norovirus, sapovirus, or astrovirus). Cooking with firewood, kitchen location, stove type, and firewood cooking frequency were the independent exposure variables. Logistic regression models were used to analyze unadjusted and adjusted associations between arboviral infections and exposures of interest. RESULT There were 311 arboviral cases and 1,239 diarrheal controls. Arboviral infections were inversely associated with cooking with firewood in the main house (AOR: 0.22; 95% CI: 0.08-0.57), cooking with firewood on an open hearth (AOR: 0.50; 95% CI: 0.33-0.78), and cooking with firewood ≥5 times per week (AOR: 0.54; 95% CI: 0.36-0.81), adjusting for age, sex, ethnicity, socioeconomic status index, number of people per household, community population density, community elevation, recruitment location, season, and admission year. CONCLUSION Several primary determinants of HAP exposure were inversely associated with arboviral infections. Additional studies are needed to understand whether interventions to reduce HAP might actually increase risk for mosquito-borne infectious diseases, which would warrant improved education and mosquito control efforts in conjunction with fuel interventions.
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Affiliation(s)
- Zachary J. Madewell
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- PhD Program in Public Health (Epidemiology), University of California, San Diego, CA, United States of America
- San Diego State University, San Diego, CA, United States of America
| | - María Reneé López
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Andrés Espinosa-Bode
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Kimberly C. Brouwer
- Division of Global Health, Department of Family Medicine & Public Health, University of California, San Diego, CA, United States of America
| | - César G. Sánchez
- Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala
| | - John P. McCracken
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
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12
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Milucky JL, Compaore T, Obulbiga F, Cowman G, Whitney CG, Bicaba B. Estimating the catchment population and incidence of severe acute respiratory infections in a district hospital in Boussé, Burkina Faso. J Glob Health 2020; 10:010422. [PMID: 32426122 PMCID: PMC7211418 DOI: 10.7189/jogh.10.010422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The primary cause of death in Burkina Faso is lower respiratory tract infections, accounting for 1 in 7 deaths. The Ministry of Health is building surveillance for severe acute respiratory infections (SARI) in four districts. This study sought to determine the catchment area of the Boussé district hospital and to describe disease burden of individuals hospitalized for SARI. Methods Data were collected from hospital log books to identify individuals with a SARI diagnosis during 2015 and 2016. Residence of SARI patients was recorded to determine the catchment area of the hospital. Population data were used to estimate SARI incidence rates. Results Investigators reviewed logs for 3034 hospital admissions; 885 SARI cases were identified. Five communes were identified as the hospital catchment area, with 770 SARI patients residing in these communes. The SARI incidence rate (IR) for all ages was 136 (95% confidence interval (CI) = 115, 161) and 266 (95% CI = 236, 300) cases per 100 000 population for 2015 and 2016, respectively. Children <1 (RI = 1111 cases per 100 000, 95% CI = 1047, 1178, and RI = 2425 cases per 100 000, 95% CI = 2330, 2524) and adults ≥65 years old (RI = 377 cases per 100 000, 95% CI = 341, 417, and RI = 816 cases per 100 000, 95% CI = 762, 874) had the highest burden of disease for 2015 and 2016, respectively. Conclusion Our analysis found high rates of SARI, especially among children <1 year of age, and marked variation in incidence between the years studied. These baseline data and the method developed will be useful for the new SARI surveillance system.
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Affiliation(s)
- Jennifer L Milucky
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia, USA
| | - Toussaint Compaore
- Ministry of Health, Directorate for the Protection of Population Health, Ouagadougou, Burkina Faso
| | - Franck Obulbiga
- Ministry of Health, Directorate for the Protection of Population Health, Ouagadougou, Burkina Faso
| | - Gretchen Cowman
- Centers for Disease Control and Prevention, Center for Global Health, Ouagadougou, Burkina Faso
| | - Cynthia G Whitney
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia, USA
| | - Brice Bicaba
- Ministry of Health, Directorate for the Protection of Population Health, Ouagadougou, Burkina Faso
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13
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Abstract
Respiratory syncytial virus (RSV) is the most common pathogen associated with acute lower respiratory tract infections in young children. RSV is also a major viral pathogen causing severe lung disease in the adult population, particularly among the elderly. We conducted a review of adult RSV studies published from January 1970 to February 2017 to determine the burden of disease among adults worldwide. There were no restrictions on health care setting or definition of RSV infection. A total of 1530 published studies were identified, 95 of which were included in this review. The incidence rates of hospitalised RSV acute respiratory tract infection (ARI) in adults >65 years old ranged from 7.3 to 13.0/105 population in Africa and Asia and from 190 to 254/105 population in the USA. Higher incidence rates (195–1790/105 population) were observed in adults ≥50 years old for outpatient or emergency visits in the USA. Of all ARI patients, RSV accounted for 1–10% in adults and 2–14% in patients with chronic diseases or transplantation. Given the limitations in the existing data, significant efforts should be made to generate evidence on the burden of RSV infections in adults and to estimate the potential impact of future preventive interventions.
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14
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Alves MS, da Silva Cariolano M, Dos Santos Ferreira HL, Sousa de Abreu Silva E, Felipe KKP, Monteiro SG, de Sousa EM, Abreu AG, Campbell LA, Rosenfeld ME, Hirata MH, Hirata RDC, Bastos GM, de Paula Abreu Silva IC, Lima-Neto LG. High frequency of Chlamydia pneumoniae and risk factors in children with acute respiratory infection. Braz J Microbiol 2020; 51:629-636. [PMID: 31997263 DOI: 10.1007/s42770-020-00229-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/13/2020] [Indexed: 11/27/2022] Open
Abstract
This study was performed as a contribution for a better understanding of Chlamydia pneumoniae frequency in children with respiratory infections. A total of 416 children were recruited from two clinical centers in Sao Luis, Brazil. Of these patients, 165 children had upper respiratory tract infections (URTI), 150 had community-acquired pneumonia (CAP), and 101 were asymptomatic volunteer children. Clinical and epidemiological data from the participants were recorded. Nasopharyngeal swab samples were collected to extract DNA. C. pneumoniae DNA positivity and copy numbers were obtained by an absolute quantitative real-time PCR method. RESULTS: Positivity for C. pneumoniae DNA was higher in samples from URTI children (38.2%) and from CAP children (18.0%) than in those from the control group (7.9%; p < 0.001). Moreover, C. pneumoniae DNA was denser in children with URTI than in asymptomatic children. Considering the cutoff, the highest value of C. pneumoniae DNA found in asymptomatic children of the 3.98 log10 copies/mL, 8.5% (14/165) of the children with URTI, and 3.3% (5/150) with CAP presented high copy numbers of C. pneumoniae DNA. CONCLUSION: Taken together, these results revealed a high frequency of C. pneumoniae in both children with URTI and CAP.
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Affiliation(s)
- Matheus Silva Alves
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | - Marilha da Silva Cariolano
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | | | - Elen Sousa de Abreu Silva
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | | | - Silvio Gomes Monteiro
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | - Eduardo Martins de Sousa
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil.,Programa de Pós-Graduação da Rede BIONORTE, Sao Luis, Brazil
| | - Afonso Gomes Abreu
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Maranhão, Sao Luis, MA, Brazil
| | - Lee Ann Campbell
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Michael E Rosenfeld
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil.,Institute Dante Pazzanese of Cardiology, Sao Paulo, SP, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Lidio Gonçalves Lima-Neto
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil. .,Programa de Pós-Graduação da Rede BIONORTE, Sao Luis, Brazil.
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15
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Sitnikov IG, Fazylov VK, Silina EV. [Treatment of influenza and other acute respiratory viral infections in patients with diabetes mellitus]. TERAPEVT ARKH 2019; 91:39-47. [PMID: 32598630 DOI: 10.26442/00403660.2019.10.000333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE OF THE STUDY The study of the influenza and ARVI clinical performance, the development of patients with diabetes mellitus, evaluation of the effectiveness and safety application of antiviral therapy, carried out in the framework of routine clinical practice. MATERIALS AND METHODS 126 patients aged from 22 to 83 years (27.8% of men) with ARVI or influenza that occurred with medical care during the first 5 days of the disease (60.3% in the first 48 hours) are included. All patients suffer from diabetes, for the treatment of which oral hypoglycemic agents or insulins were constantly taken. The patients were divided into two groups: the first group received standard symptomatic treatment of ARVI; antiviral drug Kagocel. RESULTS AND CONCLUSION Diabetes and other acute respiratory viral infections. There is an increase in the incidence of bacterial complications - 2.2 times, an increase in the frequency of systemic antibiotics - 2.3 times. The purpose of the drug prescription led to a more rapid regression of all the symptoms of influenza and ARVI, but the most striking positive dynamics was observed in the symptoms of general weakness and headache. The prescription of Kagocel was accompanied by a 58% reduction in the number of bacterial complications and a 53% reduction in the use of antibiotics, which led to a reduction in the number of cases of the disease and an improvement in initial diseases, with an frequency increase in 1.8 times. The most significant effect achieved with early treatment and early initiation of antiviral therapy (in the first 48 hours of the disease).
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Affiliation(s)
| | | | - E V Silina
- Sechenov First Moscow State Medical University (Sechenov University)
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16
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Palekar RS, Rolfes MA, Arriola CS, Acosta BO, Guidos PA, Vargas XB, Bancej C, Ramirez JB, Baumeister E, Bruno A, Cabello MA, Chen J, Couto P, Junior FJDP, Fasce R, Ferreira de Almeida W, Solorzano VEF, Ramírez CF, Goñi N, Isaza de Moltó Y, Lara J, Malo DC, Medina Osis JL, Mejía H, Castillo LM, Mustaquim D, Nwosu A, Ojeda J, Samoya AP, Pulido PA, Ramos Hernandez HM, Lopez RR, Rodriguez A, Saboui M, Bolanos HS, Santoro A, Silvera JE, Sosa P, Sotomayor V, Suarez L, Von Horoch M, Azziz-Baumgartner E. Burden of influenza-associated respiratory hospitalizations in the Americas, 2010-2015. PLoS One 2019; 14:e0221479. [PMID: 31490961 PMCID: PMC6730873 DOI: 10.1371/journal.pone.0221479] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/07/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Despite having influenza vaccination policies and programs, countries in the Americas underutilize seasonal influenza vaccine, in part because of insufficient evidence about severe influenza burden. We aimed to estimate the annual burden of influenza-associated respiratory hospitalizations in the Americas. METHODS Thirty-five countries in the Americas with national influenza surveillance were invited to provide monthly laboratory data and hospital discharges for respiratory illness (International Classification of Diseases 10th edition J codes 0-99) during 2010-2015. In three age-strata (<5, 5-64, and ≥65 years), we estimated the influenza-associated hospitalizations rate by multiplying the monthly number of respiratory hospitalizations by the monthly proportion of influenza-positive samples and dividing by the census population. We used random effects meta-analyses to pool age-group specific rates and extrapolated to countries that did not contribute data, using pooled rates stratified by age group and country characteristics found to be associated with rates. RESULTS Sixteen of 35 countries (46%) contributed primary data to the analyses, representing 79% of the America's population. The average pooled rate of influenza-associated respiratory hospitalization was 90/100,000 population (95% confidence interval 61-132) among children aged <5 years, 21/100,000 population (13-32) among persons aged 5-64 years, and 141/100,000 population (95-211) among persons aged ≥65 years. We estimated the average annual number of influenza-associated respiratory hospitalizations in the Americas to be 772,000 (95% credible interval 716,000-829,000). CONCLUSIONS Influenza-associated respiratory hospitalizations impose a heavy burden on health systems in the Americas. Countries in the Americas should use this information to justify investments in seasonal influenza vaccination-especially among young children and the elderly.
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Affiliation(s)
- Rakhee S. Palekar
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
- * E-mail:
| | - Melissa A. Rolfes
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - C. Sofia Arriola
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Belsy O. Acosta
- Department of Virology, “Pedro Kouri” Institute of Tropical Medicine, Havana, Cuba
| | | | | | | | | | - Elsa Baumeister
- National Reference Laboratory for Viral Respiratory Infections and National Influenza Center, Buenos Aires, Argentina
| | - Alfredo Bruno
- National Institute of Public Health Research, Guayaquil, Ecuador
| | | | - Jufu Chen
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Battelle Memorial Institute, Atlanta, GA, United States of America
| | - Paula Couto
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | | | | | | | | | | | - Natalia Goñi
- Department of Public Health Laboratories, Montevideo, Uruguay
| | | | - Jenny Lara
- Costa Rican Institute of Research and Education in Nutrition and Health, Cartago, Costa Rica
| | | | - José L. Medina Osis
- National Center of Epidemiology, Prevention, and Control of Diseases, Lima, Peru
| | | | | | - Desiree Mustaquim
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | | | | | | | | | | | - Angel Rodriguez
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | | | | | - Adrián Santoro
- Directorate of Statistics and Health Information, Buenos Aires, Argentina
| | | | - Paulina Sosa
- Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | | | | | - Marta Von Horoch
- Ministry of Public Health and Social Welfare, Asuncion, Paraguay
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17
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Ao T, McCracken JP, Lopez MR, Bernart C, Chacon R, Moscoso F, Paredes A, Castillo L, Azziz-Baumgartner E, Arvelo W, Lindblade KA, Peruski LF, Bryan JP. Hospitalization and death among patients with influenza, Guatemala, 2008-2012. BMC Public Health 2019; 19:463. [PMID: 32326933 PMCID: PMC6696630 DOI: 10.1186/s12889-019-6781-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Influenza is a major cause of respiratory illness resulting in 3–5 million severe cases and 291,243-645,832 deaths annually. Substantial health and financial burden may be averted by annual influenza vaccine application, especially for high risk groups. Methods We used an active facility-based surveillance platform for acute respiratory diseases in three hospitals in Guatemala, Central America, to estimate the incidence of laboratory-confirmed hospitalized influenza cases and identify risk factors associated with severe disease (defined as admission to the intensive care unit (ICU) or death). We enrolled patients presenting with signs and symptoms of acute respiratory infection (ARI) and obtained naso- and oropharyngeal samples for real-time reverse transcriptase polymerase chain reaction (RT-PCR). We used multivariable logistic regression to identify risk factors for ICU admission or death, adjusted for age and sex. Results From May 2008 to July 2012, among 6326 hospitalized ARI cases, 446 (7%) were positive for influenza: of those, 362 (81%) had influenza A and 84 (18%) had influenza B. Fifty nine percent of patients were aged ≤ 5 years, and 10% were aged ≥ 65 years. The median length of hospitalization was 5 days (interquartile range: 5). Eighty of 446 (18%) were admitted to the ICU and 28 (6%) died. Among the 28 deaths, 7% were aged ≤ 6 months, 39% 7–60 months, 21% 5–50 years, and 32% ≥ 50 years. Children aged ≤ 6 months comprised 19% of cases and 22% of ICU admissions. Women of child-bearing age comprised 6% of cases (2 admitted to ICU; 1 death). In multivariable analyses, Santa Rosa site (adjusted odds ratio [aOR] = 10, 95% confidence interval [CI] = 2–50), indigenous ethnicity (aOR = 4, 95% CI = 2–13, and radiologically-confirmed pneumonia (aOR = 5, 95% CI = 3–11) were independently associated with severe disease. Adjusted for hospital utilization rate, annual incidence of hospitalized laboratory-confirmed influenza was 24/100,000 overall, 93/100,000 for children aged < 5 years and 50/100,000 for those ≥ 65 years. Conclusions Influenza is a major contributor of hospitalization and death due to respiratory diseases in Guatemala. Further application of proven influenza prevention and treatment strategies is warranted.
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Affiliation(s)
- Trong Ao
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS E-04, Atlanta, GA, 30329, USA.
| | - John P McCracken
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala.,Global Disease Detection Program, CDC Central America Regional Office, Guatemala City, Guatemala
| | - Maria Rene Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Chris Bernart
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Rafael Chacon
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Fabiola Moscoso
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Antonio Paredes
- Ministry of Public Health and Social Welfare, Guatemala City, Guatemala
| | - Leticia Castillo
- Ministry of Public Health and Social Welfare, Guatemala City, Guatemala
| | | | - Wences Arvelo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS E-04, Atlanta, GA, 30329, USA.,Global Disease Detection Program, CDC Central America Regional Office, Guatemala City, Guatemala
| | - Kim A Lindblade
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS E-04, Atlanta, GA, 30329, USA.,Global Disease Detection Program, CDC Central America Regional Office, Guatemala City, Guatemala
| | - Leonard F Peruski
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS E-04, Atlanta, GA, 30329, USA.,Global Disease Detection Program, CDC Central America Regional Office, Guatemala City, Guatemala
| | - Joe P Bryan
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS E-04, Atlanta, GA, 30329, USA.,Global Disease Detection Program, CDC Central America Regional Office, Guatemala City, Guatemala
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Montgomery JM, Woolverton A, Hedges S, Pitts D, Alexander J, Ijaz K, Angulo F, Dowell S, Katz R, Henao O. Ten years of global disease detection and counting: program accomplishments and lessons learned in building global health security. BMC Public Health 2019; 19:510. [PMID: 32326920 PMCID: PMC6696700 DOI: 10.1186/s12889-019-6769-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Joel M Montgomery
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mailstop H16-+5, Building 16, Atlanta, GA, 30329, USA. .,Present Address: National Center for Emerging and Zoonotic Infectious Diseases, Office of the Director, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Abbey Woolverton
- Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Sarah Hedges
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mailstop H16-+5, Building 16, Atlanta, GA, 30329, USA
| | - Dana Pitts
- Office of Public Health Science and Surveillance, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Alexander
- National Center for Health Statistics, Division of Vital Statistics, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kashef Ijaz
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mailstop H16-+5, Building 16, Atlanta, GA, 30329, USA
| | - Fred Angulo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mailstop H16-+5, Building 16, Atlanta, GA, 30329, USA.,Present Address: Pfizer Vaccines, Portland, OR, USA
| | - Scott Dowell
- Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Rebecca Katz
- Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Olga Henao
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road N.E., Mailstop H16-+5, Building 16, Atlanta, GA, 30329, USA
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19
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Tomczyk S, McCracken JP, Contreras CL, Lopez MR, Bernart C, Moir JC, Escobar K, Reyes L, Arvelo W, Lindblade K, Peruski L, Bryan JP, Verani JR. Factors associated with fatal cases of acute respiratory infection (ARI) among hospitalized patients in Guatemala. BMC Public Health 2019; 19:499. [PMID: 31053069 PMCID: PMC6498661 DOI: 10.1186/s12889-019-6824-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Acute respiratory infection (ARI) is an important cause of mortality in children and adults. However, studies assessing risk factors for ARI-related deaths in low- and middle-income settings are limited. We describe ARI-related death and associated factors among children aged < 2 years and adults aged ≥18 years hospitalized with ARI in Guatemala. Methods We used respiratory illness surveillance data in Guatemala from 2007 to 2013. ARI was defined as evidence of acute infection and ≥ 1 sign/symptom of respiratory disease in hospitalized patients. Clinical, sociodemographic, and follow-up data were gathered. Nasopharyngeal/oropharyngeal swabs were collected from patients with ARI and tested for 6 respiratory viruses; urine was collected only from adults with ARI and tested for pneumococcal antigen. Blood cultures and chest radiographs were performed at the physician’s discretion. Radiographs were interpreted per World Health Organization guidelines to classify endpoint pneumonia (i.e. suggestive of bacterial pneumonia). Multivariable logistic regression was used to compare characteristics of patients with fatal cases, including those who died in-hospital or were discharged in a moribund state, with those of patients with non-fatal cases. Results Among 4109 ARI cases identified in hospitalized children < 2 years old, 174 (4%) were fatal. Median age at admission was 4 and 6 months for children with fatal and non-fatal cases, respectively. Factors associated with fatality included low weight-for-age, low family income, heart disease, and endpoint pneumonia; breastfeeding and respiratory syncytial virus (RSV) detection were negatively associated with fatality. Among 1517 ARI cases identified in hospitalized adults ≥18 years, 181 (12%) episodes were fatal. Median age at admission was 57 years for adults with fatal and non-fatal cases. Low body mass index, male sex, kidney disease, and endpoint pneumonia were significantly more common among patients with fatal versus non-fatal cases. Conclusions Our findings highlight some of the factors that must be addressed in order to reduce ARI-related mortality, including promotion of good nutrition, breastfeeding, management and prevention of chronic comorbidities, and poverty reduction. Although no specific pathogen increased risk for death, endpoint pneumonia was significantly associated with fatality, suggesting that the pneumococcal conjugate vaccine could contribute to future reductions in ARI-related mortality.
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Affiliation(s)
- Sara Tomczyk
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
| | - Carmen Lucia Contreras
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Chris Bernart
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Juan Carlos Moir
- Quetzaltenango Health Area, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Kenneth Escobar
- Western Regional Hospital San Juan de Dios, Ministry of Public Health and Social Welfare, Quetzaltenango, Guatemala
| | - Lisette Reyes
- Santa Rosa Health Area, Ministry of Public Health and Social Welfare, Cuilapa, Guatemala
| | - Wences Arvelo
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kim Lindblade
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Leonard Peruski
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
| | - Joe P Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, USA
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20
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Phadke VK, McCracken JP, Kriss JL, Lopez MR, Lindblade KA, Bryan JP, Garcia ME, Funes CE, Omer SB. Clinical Characteristics of Hospitalized Infants With Laboratory-Confirmed Pertussis in Guatemala. J Pediatric Infect Dis Soc 2018; 7:310-316. [PMID: 29045690 PMCID: PMC5899054 DOI: 10.1093/jpids/pix081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pertussis is an important cause of hospitalization and death in infants too young to be vaccinated (aged <2 months). Limited data on infant pertussis have been reported from Central America. The aim of this study was to characterize acute respiratory illnesses (ARIs) attributable to Bordetella pertussis among infants enrolled in an ongoing surveillance study in Guatemala. METHODS As part of a population-based surveillance study in Guatemala, infants aged <2 months who presented with ARI and required hospitalization were enrolled, and nasopharyngeal and oropharyngeal swab specimens were obtained. For this study, these specimens were tested for B pertussis using real-time polymerase chain reaction (PCR). RESULTS Among 301 infants hospitalized with ARI, we found 11 with pertussis confirmed by PCR (pertussis-positive infants). Compared to pertussis-negative infants, pertussis-positive infants had a higher mean admission white blood cell count (20900 vs 12579 cells/μl, respectively; P = .024), absolute lymphocyte count (11517 vs 5591 cells/μl, respectively; P < .001), rate of admission to the intensive care unit (64% vs 35%, respectively; P = .054), and case fatality rate (18% vs 3%, respectively; P = .014). Ten of the 11 pertussis-positive infants had cough at presentation; the majority (80%) of them had a cough duration of <7 days, and only 1 had a cough duration of >14 days. Fever (temperature ≥ 38°C) was documented in nearly half (45%) of the pertussis-positive infants (range, 38.0-38.4°C). CONCLUSIONS In this study of infants <2 months of age hospitalized with ARI in Guatemala, pertussis-positive infants had a high rate of intensive care unit admission and a higher case fatality rate than pertussis-negative infants.
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Affiliation(s)
- Varun K Phadke
- Division of Infectious Diseases, School of Medicine,Correspondence: V. K. Phadke, MD, 49 Jesse Hill Jr. Dr, Atlanta, GA 30303 ()
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City
| | - Jennifer L Kriss
- Department of Epidemiology, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala
| | - Maria R Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City
| | - Kim A Lindblade
- Division of Global Health Protection, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala
| | - Joe P Bryan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Miguel E Garcia
- Department of Pediatrics, Hospital Nacional de Cuilapa, Santa Rosa, Guatemala
| | - Carlos E Funes
- Department of Pediatrics, Hospital Regional de Occidente, Quetzaltenango, Guatemala
| | - Saad B Omer
- Department of Epidemiology, Centers for Disease Control and Prevention, Central American Regional Office, Guatemala City, Guatemala,Hubert Department of Global Health, Rollins School of Public Health,Emory Vaccine Center, Emory University, Atlanta, Georgia
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21
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Ching NS, Kotsanas D, Easton ML, Francis MJ, Korman TM, Buttery JP. Respiratory virus detection and co-infection in children and adults in a large Australian hospital in 2009-2015. J Paediatr Child Health 2018; 54:1321-1328. [PMID: 29873433 PMCID: PMC7166960 DOI: 10.1111/jpc.14076] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/07/2018] [Accepted: 04/01/2018] [Indexed: 01/27/2023]
Abstract
AIM This hospital network-based retrospective observational study aimed to describe the prevalence and seasonality of paediatric and adult viral respiratory pathogens and their rates of co-infections, following the introduction of a rapid multiplex molecular diagnostic assay. METHODS All nasopharyngeal samples tested in patients presenting to Monash Health, Melbourne, Australia, from August 2009 to July 2015 by means of multiplex tandem polymerase chain reaction using the Respiratory Pathogen 12Plex kit (AusDiagnostics) were included in the analysis. RESULTS There were 28 729 patient samples analysed after duplicate samples were excluded. Positive results were twice as likely in paediatrics, 7573/11 491 (65.9%), compared to adults, 5410/17 238 (31.4%). Co-infection was more frequent in paediatrics, 1642/7573 (21.7% of positives), compared to adults 299/5410 (5.5%). Adenovirus had a high prevalence as a co-infection, 639/990 (64.5%), in paediatrics. Testing frequency increased by 179% in the paediatric group and by 949% for adults over the 6 years of observation. CONCLUSIONS This study demonstrated a significant difference in the positive detection rate of pathogens and co-infections between the population groups. Adenovirus had a surprisingly high prevalence as a co-infection, especially in paediatric patients. Over the study period, rapid uptake of the test was observed, especially in adults. This raises concerns about how we can ensure that testing remains rational and is able to be provided in a cost-effective manner in the future.
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Affiliation(s)
- Natasha S Ching
- Department of Infection and ImmunityMonash Children's Hospital, Monash HealthMelbourneVictoriaAustralia,Department of PaediatricsThe Ritchie Centre, Hudson Institute of Medical Research, Monash UniversityMelbourneVictoriaAustralia,General PaediatricsMonash Children's Hospital, Monash HealthMelbourneVictoriaAustralia
| | - Despina Kotsanas
- Monash Infectious DiseasesMonash HealthMelbourneVictoriaAustralia
| | - Mee L Easton
- SAEFVICMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Michelle J Francis
- Microbiology Laboratory, Monash PathologyMonash HealthMelbourneVictoriaAustralia
| | - Tony M Korman
- Monash Infectious DiseasesMonash HealthMelbourneVictoriaAustralia,Department of Medicine, School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Jim P Buttery
- Department of Infection and ImmunityMonash Children's Hospital, Monash HealthMelbourneVictoriaAustralia,Department of PaediatricsThe Ritchie Centre, Hudson Institute of Medical Research, Monash UniversityMelbourneVictoriaAustralia,SAEFVICMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Epidemiology and Preventative MedicineMonash UniversityMelbourneVictoriaAustralia
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22
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Rao CY, Goryoka GW, Henao OL, Clarke KR, Salyer SJ, Montgomery JM. Global Disease Detection-Achievements in Applied Public Health Research, Capacity Building, and Public Health Diplomacy, 2001-2016. Emerg Infect Dis 2018; 23. [PMID: 29155662 PMCID: PMC5711302 DOI: 10.3201/eid2313.170859] [Citation(s) in RCA: 8] [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] [Indexed: 11/19/2022] Open
Abstract
The Centers for Disease Control and Prevention has established 10 Global Disease Detection (GDD) Program regional centers around the world that serve as centers of excellence for public health research on emerging and reemerging infectious diseases. The core activities of the GDD Program focus on applied public health research, surveillance, laboratory, public health informatics, and technical capacity building. During 2015-2016, program staff conducted 205 discrete projects on a range of topics, including acute respiratory illnesses, health systems strengthening, infectious diseases at the human-animal interface, and emerging infectious diseases. Projects incorporated multiple core activities, with technical capacity building being most prevalent. Collaborating with host countries to implement such projects promotes public health diplomacy. The GDD Program continues to work with countries to strengthen core capacities so that emerging diseases can be detected and stopped faster and closer to the source, thereby enhancing global health security.
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23
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Chittaganpitch M, Waicharoen S, Yingyong T, Praphasiri P, Sangkitporn S, Olsen SJ, Lindblade KA. Viral etiologies of influenza-like illness and severe acute respiratory infections in Thailand. Influenza Other Respir Viruses 2018. [PMID: 29518269 PMCID: PMC6005612 DOI: 10.1111/irv.12554] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Information on the burden, characteristics and seasonality of non‐influenza respiratory viruses is limited in tropical countries. Objectives Describe the epidemiology of selected non‐influenza respiratory viruses in Thailand between June 2010 and May 2014 using a sentinel surveillance platform established for influenza. Methods Patients with influenza‐like illness (ILI; history of fever or documented temperature ≥38°C, cough, not requiring hospitalization) or severe acute respiratory infection (SARI; history of fever or documented temperature ≥38°C, cough, onset <10 days, requiring hospitalization) were enrolled from 10 sites. Throat swabs were tested for influenza viruses, respiratory syncytial virus (RSV), metapneumovirus (MPV), parainfluenza viruses (PIV) 1‐3, and adenoviruses by polymerase chain reaction (PCR) or real‐time reverse transcriptase‐PCR. Results We screened 15 369 persons with acute respiratory infections and enrolled 8106 cases of ILI (5069 cases <15 years old) and 1754 cases of SARI (1404 cases <15 years old). Among ILI cases <15 years old, influenza viruses (1173, 23%), RSV (447, 9%), and adenoviruses (430, 8%) were the most frequently identified respiratory viruses tested, while for SARI cases <15 years old, RSV (196, 14%) influenza (157, 11%) and adenoviruses (90, 6%) were the most common. The RSV season significantly overlapped the larger influenza season from July to November in Thailand. Conclusions The global expansion of influenza sentinel surveillance provides an opportunity to gather information on the characteristics of cases positive for non‐influenza respiratory viruses, particularly seasonality, although adjustments to case definitions may be required.
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Affiliation(s)
| | | | | | - Prabda Praphasiri
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Sonja J Olsen
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim A Lindblade
- Influenza Program, Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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24
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Xu W, Guo L, Dong X, Li X, Zhou P, Ni Q, Zhou X, Wagner AL, Li L. Detection of Viruses and Mycoplasma pneumoniae in Hospitalized Patients with Severe Acute Respiratory Infection in Northern China, 2015-2016. Jpn J Infect Dis 2018; 71:134-139. [PMID: 29491245 DOI: 10.7883/yoken.jjid.2017.412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe acute respiratory infection (SARI) presents a huge disease and economic burden worldwide. The present study described the frequency and types of different infectious etiologies among hospitalized patients with SARI in Tianjin, China, during 2015 and 2016. Basic information, in addition to a throat or serum sample, was collected from SARI patients. Nine viruses were detected using reverse transcription polymerase chain reaction, and Mycoplasma pneumoniae was detected using the Serodia Myco II gelatin particle agglutination test. A total of 585 specimens from 2,290 SARI cases were collected. The most common infection (19.66%, 115/585) was M. pneumoniae, followed by influenza virus A/B (6.15%, 36/585), and respiratory syncytial virus (4.96%, 29/585). Identification of viral or M. pneumoniae infections was the highest in the pediatric medicine ward (74.84%, 119/159), followed by the intensive care unit (37.04%, 80/216) and respiratory medicine ward (34.29%, 72/210). M. pneumoniae was highest (38.71%, 24/62) in the 5-14-year age group. Influenza was the main infection in January 2015 and March 2016. The correlation coefficient for the proportion of hospitalized cases of SARI and the positive detection rate within the same week was 0.25. M. pneumoniae and influenza were the leading pathogens among hospitalized SARI patients. A continued surveillance of hospitalized cases of SARI can detect emerging diseases, such as avian influenza A (H7N9) virus and other respiratory disease outbreaks.
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Affiliation(s)
- Wenti Xu
- Department of Infectious Disease Control, Tianjin Centers for Disease Control and Prevention
| | - Liru Guo
- Department of Pathogen Test, Tianjin Centers for Disease Control and Prevention
| | - Xiaochun Dong
- Department of Infectious Disease Control, Tianjin Centers for Disease Control and Prevention
| | - Xiaoxia Li
- Department of Disease Prevention, Tianjin Third Center Hospital
| | - Penghui Zhou
- Department of Infectious Disease Control, Tianjin Centers for Disease Control and Prevention
| | - Qiang Ni
- Department of Disease Prevention, Tianjin Third Center Hospital
| | - Xinying Zhou
- Department of Pediatrics, Tianjin Third Center Hospital
| | | | - Lin Li
- Department of Infectious Disease Control, Tianjin Centers for Disease Control and Prevention
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25
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Fancourt N, Deloria Knoll M, Barger-Kamate B, de Campo J, de Campo M, Diallo M, Ebruke BE, Feikin DR, Gleeson F, Gong W, Hammitt LL, Izadnegahdar R, Kruatrachue A, Madhi SA, Manduku V, Matin FB, Mahomed N, Moore DP, Mwenechanya M, Nahar K, Oluwalana C, Ominde MS, Prosperi C, Sande J, Suntarattiwong P, O'Brien KL. Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study. Clin Infect Dis 2018; 64:S253-S261. [PMID: 28575359 PMCID: PMC5447844 DOI: 10.1093/cid/cix082] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background. Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials. Methods. The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1–59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion. Results. A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (κ = 0.50) and between arbitrators was 84% (κ = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (κ = 0.25) and 48.5% (κ = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively). Conclusions. Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process.
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Affiliation(s)
- Nicholas Fancourt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Murdoch Childrens Research Institute, and.,Royal Children's Hospital, Melbourne, Australia
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Breanna Barger-Kamate
- Department of Pediatrics, Division of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Spokane Emergency Physicians, Washington
| | - John de Campo
- Department of Radiology, Melbourne University, Australia
| | | | | | | | - Daniel R Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Wenfeng Gong
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Rasa Izadnegahdar
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Manduku
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Fariha Bushra Matin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Nasreen Mahomed
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.,Department of Diagnostic Radiology, and
| | - David P Moore
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Musaku Mwenechanya
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia; and
| | - Kamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | | | | | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joyce Sande
- Aga Khan University Hospital, Nairobi, Kenya
| | | | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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26
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Gonzalez-Reiche AS, Ramírez AL, Müller ML, Orellana D, Sosa SM, Ola P, Paniagua J, Ortíz L, Hernandez J, Cordón-Rosales C, Perez DR. Origin, distribution, and potential risk factors associated with influenza A virus in swine in two production systems in Guatemala. Influenza Other Respir Viruses 2017; 11:182-192. [PMID: 27860313 PMCID: PMC5304577 DOI: 10.1111/irv.12437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 01/02/2023] Open
Abstract
Background Guatemala is the country with the largest swine production in Central America; however, evidence of influenza A virus (IAV) in pigs has not been clearly delineated. Objectives In this study, we analyzed the presence and spatial distribution of IAV in commercial and backyard swine populations. Methods Samples from two nationwide surveys conducted in 2010 and 2011 were tested using virological (rRT‐PCR and virus isolation) and serological (ELISA and hemagglutination inhibition) assays to detect IAV. Results Influenza A virus was detected in 15.7% of the sampled pigs (30.6% of herds) in 2010 and in 11.7% (24.2% of herds) in 2011. The percentage of seropositive pigs was 10.6% (16.1% of herds) and 1.4% (3.1% of herds) for each year, respectively. Three pandemic H1N1 and one seasonal human‐like H3N2 viruses were isolated. Antibodies against viruses from different genetic clusters were detected. No reassortant strains with swine viruses were detected. The H3N2 virus was closely related to human viruses that circulated in Central America in 2010, distinct to the most recent human seasonal vaccine lineages. Spatial clusters of rRT‐PCR positive herds were detected each year by scan statistics. Conclusions Our results demonstrate circulation of IAV throughout Guatemala and identify commercial farms, animal health status, and age as potential risk factors associated with IAV infection and exposure. Detection of human‐origin viruses in pigs suggests a role for humans in the molecular epidemiology of IAV in swine in Guatemala and evidences gaps in local animal and human surveillance.
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Affiliation(s)
- Ana S Gonzalez-Reiche
- Department of Population Health, Poultry Diagnostic and Research Center Athens, University of Georgia, Athens, GA, USA.,Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ana L Ramírez
- Universidad del Valle de Guatemala, Guatemala City, Guatemala.,Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium
| | - María L Müller
- Department of Population Health, Poultry Diagnostic and Research Center Athens, University of Georgia, Athens, GA, USA.,Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - David Orellana
- Ministerio de Agricultura Ganadería y Alimentación, Guatemala city, Guatemala
| | - Silvia M Sosa
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Pablo Ola
- Ministerio de Agricultura Ganadería y Alimentación, Guatemala city, Guatemala
| | - Jorge Paniagua
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Lucía Ortíz
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | - Daniel R Perez
- Department of Population Health, Poultry Diagnostic and Research Center Athens, University of Georgia, Athens, GA, USA
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27
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Rowlinson E, Dueger E, Mansour A, Azzazy N, Mansour H, Peters L, Rosenstock S, Hamid S, Said MM, Geneidy M, Abd Allah M, Kandeel A. Incidence and etiology of hospitalized acute respiratory infections in the Egyptian Delta. Influenza Other Respir Viruses 2016; 11:23-32. [PMID: 27458989 PMCID: PMC5155652 DOI: 10.1111/irv.12409] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Acute Respiratory Infections (ARI) are responsible for nearly two million childhood deaths worldwide. A limited number of studies have been published on the epidemiology of viral respiratory pathogens in Egypt. Methods A total of 6113 hospitalized patients >1 month of age with suspected ARI were enrolled between June 23, 2009 and December 31, 2013. Naso‐ and oropharyngeal specimens were collected and tested for influenza A and B, respiratory syncytial virus, human metapneumovirus, adenovirus, and parainfluenza viruses 1–3. Blood specimens from children 1–11 months were cultured and bacterial growth was identified by polymerase chain reaction. Results from a healthcare utilization survey on the proportion of persons seeking care for ARI was used to calculate adjusted ARI incidence rates in the surveillance population. Results The proportion of patients with a viral pathogen detected decreased with age from 67% in patients age 1–11 months to 19% in patients ≥65 years of age. Influenza was the dominant viral pathogen detected in patients ≥1 year of age (13.9%). The highest incidence rates for hospitalized ARI were observed in children 1–11 months (1757.9–5537.5/100 000 population) and RSV was the most commonly detected pathogen in this age group. Conclusion In this study population, influenza is the largest viral contributor to hospitalized ARIs and children 1–11 months of age experience a high rate of ARI hospitalizations. This study highlights a need for surveillance of additional viral pathogens and alternative detection methods for bacterial pathogens, which may reveal a substantial proportion of as yet unidentified etiologies in adults.
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Affiliation(s)
- Emily Rowlinson
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Erica Dueger
- US Centers for Disease Control & Prevention, Atlanta, GA, USA.,US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Adel Mansour
- US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Nahed Azzazy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Hoda Mansour
- US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Lisa Peters
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Summer Rosenstock
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Sarah Hamid
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Mayar M Said
- Global Disease Detection and Response Program, US Naval Medical Research Unit No. 3, Cairo, Egypt
| | - Mohamed Geneidy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Monier Abd Allah
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
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Dut R, Kocagöz S. Clinical Signs and Diagnostic Tests in Acute Respiratory Infections. Indian J Pediatr 2016; 83:380-5. [PMID: 26687497 PMCID: PMC7090667 DOI: 10.1007/s12098-015-1943-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate clinical manifestations of acute respiratory system infectious diseases and specific tests for causative agents in pediatric patients. METHODS The authors evaluated children aged 0-16 y with clinical symptoms of acute respiratory tract infections who were administered rapid strep A test and/or throat culture test and/or respiratory viral panel test, from February 2012 through January 2013 at pediatric department of Acıbadem Maslak Hospital, Turkey. RESULTS A total of 1654 patients were evaluated; 45.9 % were girls, 54.1 % were boys. Absence of cough and presence of headache were higher in the patients >6 y of age (p 0.0001, p 0.002 respectively). Positive respiratory viral panel test was higher in the patients <2 y of age (p 0.002). Both positive rapid strep A test and positive throat culture test were higher in the patients >6 y of age (p 0.0001). Positivity of rapid strep A or throat culture test were not observed in children <2 y of age. CONCLUSIONS A clinician should mostly consider viral infections in the etiology of acute respiratory infections in children under 2 y of age and there is no need to rush for the use antibiotherapy. Bacterial etiology should be frequently considered after 6 y of age and rapid use of antibiotherapy is essential to avoid the complications.
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Affiliation(s)
- Raziye Dut
- Department of Pediatrics, Acıbadem Maslak Hospital, 063340, İstanbul, Turkey.
| | - Sesin Kocagöz
- Division of Infectious Diseases, University of Acıbadem, İstanbul, Turkey
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Chen Y, He H, Pan P, He S, Dong X, Chen Y, Wang S, Yu D. Rapid and combined detection of Mycoplasma pneumoniae, Epstein-Barr virus and human cytomegalovirus using AllGlo quadruplex quantitative PCR. J Med Microbiol 2016; 65:590-595. [PMID: 27093597 DOI: 10.1099/jmm.0.000266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acute respiratory infections (ARIs) cause substantial morbidity and mortality worldwide. The causes of ARI are dynamic, and co-infections of Mycoplasma pneumoniae, Epstein-Barr virus and human cytomegalovirus are recently developed causes of ARI. Here, we established a quadruplex quantitative PCR (qPCR) method to rapidly identify and simultaneously detect a single infection or co-infection of these three pathogens and an internal control in a single tube using AllGlo probes. The analysis demonstrated a wide linear range of detection from 101 to 108 copies per test and a low coefficient of variation of less than 5 %. The amplification efficiencies were all close to 1, and the correlation coefficients (r2) were all greater than 0.99. We found no significant difference in a comparative reagent test (P >0.05). Moreover, the results of tests on clinical samples using AllGlo quadruplex qPCR and TaqMan uniplex qPCR were in near-perfect agreement (κ =0.97). Clinically, the availability of this method will enable better differential diagnosis, disease surveillance and controlled outcomes.
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Affiliation(s)
- Yi Chen
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Hui He
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Ping Pan
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Songzhe He
- Department of Clinical Laboratory, Affiliated Hospital of Guilin Medical University, Guilin, PR China
| | - Xueyan Dong
- Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Yueming Chen
- Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Shuying Wang
- Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Daojun Yu
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
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Lagare A, Maïnassara HB, Issaka B, Sidiki A, Tempia S. Viral and bacterial etiology of severe acute respiratory illness among children < 5 years of age without influenza in Niger. BMC Infect Dis 2015; 15:515. [PMID: 26567015 PMCID: PMC4644278 DOI: 10.1186/s12879-015-1251-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/28/2015] [Indexed: 01/18/2023] Open
Abstract
Background Globally, pneumonia is the leading cause of morbidity and mortality in children, with the highest burden experienced in sub-Saharan Africa and Asia. However, there is a dearth of information on the etiology of severe acute respiratory illness (SARI) in Africa, including Niger. Methods We implemented a retrospective study as part of national influenza sentinel surveillance in Niger. We randomly selected a sample of nasopharyngeal specimens collected from children <5 years of age hospitalized with SARI from January 2010 through December 2012 in Niger. The samples were selected from individuals that tested negative by real-time reverse transcription polymerase chain reaction (rRT-PCR) for influenza A and B virus. The samples were analyzed using the Fast Track Diagnostic Respiratory Pathogens 21plus Kit (BioMérieux, Luxemburg), which detects 23 respiratory pathogens including 18 viral and 5 bacterial agents. Results Among the 160 samples tested, 138 (86 %) tested positive for at least one viral or bacterial pathogen; in 22 (16 %) sample, only one pathogen was detected. We detected at least one respiratory virus in 126 (78 %) samples and at least one bacterium in 102 (64 %) samples. Respiratory syncytial virus (56/160; 35 %), rhinovirus (47/160; 29 %) and parainfluenza virus (39/160; 24 %) were the most common viral pathogens detected. Among bacterial pathogens, Streptococcus pneumoniae (90/160; 56 %) and Haemophilus influenzae type b (20/160; 12 %) predominated. Conclusions The high prevalence of certain viral and bacterial pathogens among children <5 years of age with SARI highlights the need for continued and expanded surveillance in Niger.
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Affiliation(s)
- Adamou Lagare
- Centre de Recherche Médicale et Sanitaire (CERMES), 634 Bld de la Nation, BP:10887, YN034-, Niamey, Niger.
| | - Halima Boubacar Maïnassara
- Centre de Recherche Médicale et Sanitaire (CERMES), 634 Bld de la Nation, BP:10887, YN034-, Niamey, Niger.
| | - Bassira Issaka
- Centre de Recherche Médicale et Sanitaire (CERMES), 634 Bld de la Nation, BP:10887, YN034-, Niamey, Niger.
| | - Ali Sidiki
- Centre de Recherche Médicale et Sanitaire (CERMES), 634 Bld de la Nation, BP:10887, YN034-, Niamey, Niger.
| | - Stefano Tempia
- Influenza Division, Centers for Disease Control and Prevention, Georgia, Atlanta, USA. .,Influenza Program, Centers for Disease Control and Prevention, Pretoria, South Africa.
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Contreras CL, Verani JR, Lopez MR, Paredes A, Bernart C, Moscoso F, Roldan A, Arvelo W, Lindblade KA, McCracken JP. Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012. PLoS One 2015; 10:e0140939. [PMID: 26488871 PMCID: PMC4619266 DOI: 10.1371/journal.pone.0140939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/30/2015] [Indexed: 11/21/2022] Open
Abstract
Background Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described. Methods Data from 2008–2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI). Results Among 1595 adults admitted with ARI, 1363 (82%) had either urine testing (n = 1286) or blood culture (n = 338) performed. Of these, 188 (14%) had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18–24 year-olds (2.75/100,000) and the highest among ≥65 year-olds (31.3/100,000). The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%. Conclusions An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala.
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Affiliation(s)
- Carmen Lucía Contreras
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- * E-mail:
| | - Jennifer R. Verani
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States of America
| | - María Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Antonio Paredes
- National Center for Epidemiology, Ministry of Public Health and Social Welfare (MSPAS), Guatemala City, Guatemala
| | - Chris Bernart
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Fabiola Moscoso
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Aleida Roldan
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Wences Arvelo
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention (CDC), Atlanta GA, United States of America
| | - Kim A. Lindblade
- Division of Global Disease Detection and Emergency Response, Centers for Disease Control and Prevention (CDC), Atlanta GA, United States of America
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
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Wortham JM, Gray J, Verani J, Contreras CL, Bernart C, Moscoso F, Moir JC, Reyes Marroquin EL, Castellan R, Arvelo W, Lindblade K, McCracken JP. Using Standardized Interpretation of Chest Radiographs to Identify Adults with Bacterial Pneumonia--Guatemala, 2007-2012. PLoS One 2015. [PMID: 26207918 PMCID: PMC4514878 DOI: 10.1371/journal.pone.0133257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Bacterial pneumonia is a leading cause of illness and death worldwide, but quantifying its burden is difficult due to insensitive diagnostics. Although World Health Organization (WHO) protocol standardizes pediatric chest radiograph (CXR) interpretation for epidemiologic studies of bacterial pneumonia, its validity in adults is unknown. Methods Patients (age ≥15 years) admitted with respiratory infections to two Guatemalan hospitals between November 2007 and March 2012 had urine and nasopharyngeal/oropharyngeal (NP/OP) swabs collected; blood cultures and CXR were also performed at physician clinical discretion. ‘Any bacterial infection’ was defined as a positive urine pneumococcal antigen test, isolation of a bacterial pneumonia pathogen from blood culture, or detection of an atypical bacterial pathogen by polymerase chain reaction (PCR) of nasopharyngeal/oropharyngeal (NP/OP) specimens. ‘Viral infection’ was defined as detection of viral pathogens by PCR of NP/OP specimens. CXRs were interpreted according to the WHO protocol as having ‘endpoint consolidation’, ‘other infiltrate’, or ‘normal’ findings. We examined associations between bacterial and viral infections and endpoint consolidation. Findings Urine antigen and/or blood culture results were available for 721 patients with CXR interpretations; of these, 385 (53%) had endpoint consolidation and 253 (35%) had other infiltrate. Any bacterial infection was detected in 119 (17%) patients, including 106 (89%) pneumococcal infections. Any bacterial infection (Diagnostic Odds Ratio [DOR] = 2.9; 95% confidence Interval (CI): 1.3–7.9) and pneumococcal infection (DOR = 3.4; 95% CI: 1.5–10.0) were associated with ‘endpoint consolidation’, but not ‘other infiltrate’ (DOR = 1.7; 95% CI: 0.7–4.9, and 1.7; 95% CI: 0.7–4.9 respectively). Viral infection was not significantly associated with ‘endpoint consolidation’, ‘other infiltrate,’ or ‘normal’ findings. Interpretation ‘Endpoint consolidation’ was associated with ‘any bacterial infection,’ specifically pneumococcal infection. Therefore, endpoint consolidation may be a useful surrogate for studies measuring the impact of interventions, such as conjugate vaccines, against bacterial pneumonia.
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Affiliation(s)
- Jonathan M. Wortham
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Jennifer Gray
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Jennifer Verani
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Chris Bernart
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Fabiola Moscoso
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Juan Carlos Moir
- Ministerio de Salud Pública y Asistencia Social, Guatemala City, Guatemala
| | | | | | - Wences Arvelo
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kim Lindblade
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Adenoviruses and acute respiratory infections in children living in an equatorial area of Brazil. Epidemiol Infect 2015; 144:355-62. [DOI: 10.1017/s0950268815000916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
SUMMARYHuman adenoviruses (HAdVs) are important respiratory pathogens, found in 2–27% of acute respiratory infection (ARI) cases. Few studies have analysed the diversity of species and types of HAdVs associated with ARI in Brazil. The purpose of this study was to determine the circulation patterns of the different HAdV species and respective types associated with ARI in children in the city of Fortaleza, northeastern Brazil. HAdVs were screened by an indirect immunofluorescence assay, and subsequently identified as species and types by PCR and sequencing of the hexon gene (HVR1–HVR6). Between 2001 and 2013, a total of 290 HAdV strains were detected, 190 of which were identified as belonging to the HAdV-B, -C and -E species. Seven types of HAdVs circulated in the studied population during the analysed period, with HAdV-3 being predominant.
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Salez N, Vabret A, Leruez-Ville M, Andreoletti L, Carrat F, Renois F, de Lamballerie X. Evaluation of Four Commercial Multiplex Molecular Tests for the Diagnosis of Acute Respiratory Infections. PLoS One 2015; 10:e0130378. [PMID: 26107509 PMCID: PMC4481272 DOI: 10.1371/journal.pone.0130378] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
Acute Respiratory Infections (ARIs) are responsible for considerable morbidity and mortality worldwide. Documentation of respiratory specimens can help for an appropriate clinical management with a significant effect on the disease progress in patient, the antimicrobial therapy used and the risk of secondary spread of infection. Here, we compared the performances of four commercial multiplex kits used in French University Hospital diagnostic microbiology laboratories for the detection of ARI pathogens (i.e., the xTAG Respiratory Viral Panel Fast, RespiFinder SMART 22, CLART PneumoVir and Fast Track Diagnostics Respiratory Pathogen 33 kits). We used a standardised nucleic acids extraction protocol and a comprehensive comparative approach that mixed reference to well established real-time PCR detection techniques and analysis of convergent positive results. We tested 166 respiratory clinical samples and identified a global high degree of correlation for at least three of the techniques (xTAG, RespiFinder and FTD33). For these techniques, the highest Youden's index (YI), positive predictive (PPV) and specificity (Sp) values were observed for Core tests (e.g., influenza A [YI:0.86-1.00; PPV:78.95-100.00; Sp:97.32-100.00] & B [YI:0.44-1.00; PPV:100.00; Sp:100.00], hRSV [YI:0.50-0.99; PPV:85.71-100.00; Sp:99.38-100.00], hMPV [YI:0.71-1.00; PPV:83.33-100.00; Sp:99.37-100.00], EV/hRV [YI:0.62-0.82; PPV:93.33-100.00; Sp:94.48-100.00], AdV [YI:1.00; PPV:100.00; Sp:100.00] and hBoV [YI:0.20-0.80; PPV:57.14-100.00; Sp:98.14-100.00]). The present study completed an overview of the multiplex techniques available for the diagnosis of acute respiratory infections.
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Affiliation(s)
- Nicolas Salez
- Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
- * E-mail:
| | - Astrid Vabret
- Laboratory of Human and Molecular Virology, IFR146 ICORE, University Hospital, Caen, France
| | - Marianne Leruez-Ville
- Virology Laboratory, Hôpital Necker Enfants malades, APHP, Université Paris Descartes, Sorbonne Paris Cité-EA 36–20, Paris, France
| | - Laurent Andreoletti
- Unité de Virologie Médicale et Moléculaire, Centre Hospitalier Universitaire, and IFR 53/EA-4303 (DAT/PPCIDH), Faculté de Médecine, Reims, France
| | - Fabrice Carrat
- UMR-S 707 INSERM, Pierre et Marie Curie University, Paris, France
- Public Assistance Hospital of Paris, Department of Internal Medicine, Hôpital Saint Antoine, Unité de Santé Publique, Paris, France
| | - Fanny Renois
- Unité de Virologie Médicale et Moléculaire, Centre Hospitalier Universitaire, and IFR 53/EA-4303 (DAT/PPCIDH), Faculté de Médecine, Reims, France
| | - Xavier de Lamballerie
- Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Marseille, France
- IHU Institute hospitalo-universitaire Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
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Immunogenicity and safety of inactivated quadrivalent and trivalent influenza vaccines in children 18-47 months of age. Pediatr Infect Dis J 2014; 33:1262-9. [PMID: 25386965 DOI: 10.1097/inf.0000000000000463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because inactivated trivalent influenza vaccines (TIVs) contain 1 influenza B strain, whereas 2 lineages may co-circulate, B lineage mismatch is frequent. We assessed an inactivated quadrivalent influenza vaccine (QIV) containing both B lineages versus TIV in young children. METHODS Children aged 18-47 months who had received 2 doses of TIV in a study during the previous season (primed cohort, n = 192) were randomized 1:1 to receive 1 dose of TIV or QIV, and a further 407 children (unprimed cohort) were randomized 1:1 to receive 2 doses of TIV or QIV 28 days apart. Immunogenicity was assessed by hemagglutination-inhibition (HI) prevaccination and 28 days after each vaccination. Immunogenic non-inferiority QIV versus TIV for shared strains, and superiority against the alternate-lineage B strain were based on HI geometric mean titers (pooled analyses of primed and half of unprimed cohort with Day 56 immunogenicity assessment). Solicited and unsolicited adverse events were assessed during each 7- and 28-day postvaccination period, respectively (NCT00985790). RESULTS Non-inferiority for shared strains and superiority for the alternate-lineage B strain unique to QIV was demonstrated for QIV versus TIV. QIV was immunogenic against all 4 vaccine strains and 87.0%, 88.6%, 69.8% and 97.9% of children had postvaccination titers of ≥ 1:40 against A/H1N1, A/H3N2, B/Victoria and B/Yamagata, respectively. Reactogenicity and safety of QIV was consistent with TIV. CONCLUSIONS QIV provided superior immunogenicity for the alternate-lineage B strain compared with TIV without interfering with immune responses to shared strains. Further studies are warranted to assess QIVs in children and to establish the clinical benefits of QIV versus TIV.
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Influenza and other respiratory viruses involved in severe acute respiratory disease in northern Italy during the pandemic and postpandemic period (2009-2011). BIOMED RESEARCH INTERNATIONAL 2014; 2014:241298. [PMID: 25013770 PMCID: PMC4075074 DOI: 10.1155/2014/241298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 11/18/2022]
Abstract
Since 2009 pandemic, international health authorities recommended monitoring severe and complicated cases of respiratory disease, that is, severe acute respiratory infection (SARI) and acute respiratory distress syndrome (ARDS). We evaluated the proportion of SARI/ARDS cases and deaths due to influenza A(H1N1)pdm09 infection and the impact of other respiratory viruses during pandemic and postpandemic period (2009-2011) in northern Italy; additionally we searched for unknown viruses in those cases for which diagnosis remained negative. 206 respiratory samples were collected from SARI/ARDS cases and analyzed by real-time RT-PCR/PCR to investigate influenza viruses and other common respiratory pathogens; also, a virus discovery technique (VIDISCA-454) was applied on those samples tested negative to all pathogens. Influenza A(H1N1)pdm09 virus was detected in 58.3% of specimens, with a case fatality rate of 11.3%. The impact of other respiratory viruses was 19.4%, and the most commonly detected viruses were human rhinovirus/enterovirus and influenza A(H3N2). VIDISCA-454 enabled the identification of one previously undiagnosed measles infection. Nearly 22% of SARI/ARDS cases did not obtain a definite diagnosis. In clinical practice, great efforts should be dedicated to improving the diagnosis of severe respiratory disease; the introduction of innovative molecular technologies, as VIDISCA-454, will certainly help in reducing such "diagnostic gap."
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