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Gharpure R, Chard AN, Cabrera Escobar M, Zhou W, Valleau MM, Yau TS, Bresee JS, Azziz-Baumgartner E, Pallas SW, Lafond KE. Costs and cost-effectiveness of influenza illness and vaccination in low- and middle-income countries: A systematic review from 2012 to 2022. PLoS Med 2024; 21:e1004333. [PMID: 38181066 PMCID: PMC10802964 DOI: 10.1371/journal.pmed.1004333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/22/2024] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. METHODS AND FINDINGS We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. CONCLUSIONS The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs.
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Affiliation(s)
- Radhika Gharpure
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna N. Chard
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Weigong Zhou
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Molly M. Valleau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tat S. Yau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph S. Bresee
- Task Force for Global Health, Atlanta, Georgia, United States of America
| | | | - Sarah W. Pallas
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn E. Lafond
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Bolek H, Ozisik L, Caliskan Z, Tanriover MD. Clinical outcomes and economic burden of seasonal influenza and other respiratory virus infections in hospitalized adults. J Med Virol 2023; 95:e28153. [PMID: 36110064 DOI: 10.1002/jmv.28153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 01/11/2023]
Abstract
The cost of influenza and other respiratory virus infections should be determined to analyze the real burden of these diseases. We aimed to investigate the clinical outcomes and cost of illness due to respiratory virus infections in hospitalized adult patients. Hospitalized patients who had nasal swab sampling for a suspected viral infection between August 1, 2018 to March 31, 2019 were included. Outcome variables were oxygen requirement, mechanical ventilation need, intensive care unit admission, and cost. At least one viral pathogen was detected in 125 (47.7%) of 262 patients who were included in the study. Fifty-five (20.9%) of the patients were infected with influenza. Influenza-positive patients had higher rates for respiratory support, intensive care unit admission, and mortality compared to all other patients. The average cost of hospitalization per person was 2879.76 USD in the influenza-negative group, while the same cost was 3274.03 USD in the influenza-positive group. Although all of the vaccinated influenza-positive patients needed oxygen support, neither of them required invasive mechanical ventilation or intensive care unit admission. The average hospitalization cost per person was 779.70 USD in the vaccinated group compared to 3762.01 USD in the unvaccinated group. Disease-related direct cost of influenza in the community was estimated as 22 776 075.61 USD in the 18-65 years of age group and 15 756 120.02 USD in the 65 years of age and over group per year. Influenza, compared to other respiratory virus infections, can lead to untoward clinical outcomes and mortality as well as higher direct medical costs in adults.
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Affiliation(s)
- Hatice Bolek
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lale Ozisik
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Zafer Caliskan
- Department of Economics, Hacettepe University Faculty of Economics and Administrative Sciences, Ankara, Turkey
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Thu NN, Mai TT, Trang TTT, Tuan NA, Quyen TC, Hanh NL, Hoan NH, Lan BTH, Hau PT, Tue HH, Dung TV, Tsuji R, Watanabe Y, Yamamoto N, Kanauchi O. Impact of Infectious Disease after Lactococcus lactis Strain Plasma Intake in Vietnamese Schoolchildren: A Randomized, Placebo-Controlled, Double-Blind Study. Nutrients 2022; 14:nu14030552. [PMID: 35276914 PMCID: PMC8839753 DOI: 10.3390/nu14030552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Lactococcus lactis strain Plasma (LC-Plasma) is reported to have anti-viral effects via direct activation of plasmacytoid dendritic cells, which upregulate the production of type I and III interferons. A randomized, placebo-controlled, double-blind, parallel group study was designed for elementary schoolchildren, grades 1 to 3, in Vietnam. LC-Plasma or a control were administered to schoolchildren as a beverage (1.0 × 1011 count LC-Plasma/day/person). The primary endpoint was to determine the efficacy of LC-Plasma in reducing the cumulative days absent from school due to upper respiratory disease (URID) and gastrointestinal disease (GID), and the secondary endpoint was to evaluate the potency of LC-Plasma on URID/GID symptoms and general well-being scores. LC-Plasma intake significantly reduced the cumulative days absent from school due to URID/GID (Odds ratio (OR) = 0.57, p = 0.004) and URID alone (OR = 0.56, p = 0.005); LC-Plasma also significantly reduced the number of cumulative fever positive days during the first 4 weeks of intervention (OR = 0.58, p = 0.001) and cumulative days with diarrhea during the last 4 weeks of the intervention period (OR = 0.78, p = 0.01). The number of positive general wellbeing days was significantly improved in the LC-Plasma group compared with the control throughout the intervention period (OR = 0.93, 0.93, p = 0.03, 0.04 in the first and last 4 weeks of the intervention, respectively). These data suggest that LC-Plasma seems to improve the health condition of elementary schoolchildren and reduces school absenteeism due to infectious disease, especially URID.
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Affiliation(s)
- Nghiem Nguyet Thu
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Truong Tuyet Mai
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
- Correspondence: ; Tel.: +84-94-677-7176
| | - Tran Thị Thu Trang
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Nguyen Anh Tuan
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Tran Chau Quyen
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Nguyen Lien Hanh
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Nguyen Huu Hoan
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Bui Thi Huong Lan
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Phung Thi Hau
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Ha Huy Tue
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Truong Viet Dung
- Hanoi Medical University, 1 Ton That Tung, Dong Da, Hanoi 100000, Vietnam;
| | - Ryohei Tsuji
- Kirin Central Research Institute, Kirin Holdings Co., Ltd., 1-13-5 Fukuura Kanazawa-ku, Kanagawa, Yokohama-shi 236-0004, Japan;
| | - Yuta Watanabe
- Research and Development Strategy Department, Kirin Holdings Co., Ltd., 4-10-2 Nakano, Nakano-ku, Tokyo 164-0001, Japan; (Y.W.); (O.K.)
| | - Naoki Yamamoto
- Genome Medical Sciences Project, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa-shi, Chiba 272-8516, Japan;
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Osamu Kanauchi
- Research and Development Strategy Department, Kirin Holdings Co., Ltd., 4-10-2 Nakano, Nakano-ku, Tokyo 164-0001, Japan; (Y.W.); (O.K.)
- Interfood Shareholding Company, 127 Lo Duc, Hanoi 100000, Vietnam
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Murillo-Zamora E, Mendoza-Cano O, Delgado-Enciso I, Guzmán-Esquivel J. National retrospective cohort study to identify risk factors for in-hospital 30-day lethality in laboratory-confirmed cases of influenza. Rev Clin Esp 2021; 221:76-85. [PMID: 32674849 DOI: 10.1016/j.rce.2020.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify factors associated with the risk of death in adolescent and adult inpatients with laboratory-positive (reverse-transcription polymerase chain reaction) influenza in Mexico during consecutive influenza seasons (2018-2020). PATIENTS AND METHODS A retrospective cohort study used national surveillance system data, enrolling 3422 individuals. The association between various risk factors and 30-day in-hospital lethality were evaluated through risk ratios (RR) and 95% confidence intervals (CI). RESULTS The lethality rate was 18.1%. Flu vaccination history (RR = 0.56, 95% CI 0.42-0.78), early antiviral drug administration (≤ two days from symptom onset [reference ≥ 5 days], RR = 0.68, 95% CI 0.58-0.81), and a history of asthma (RR = 0.66, 95% CI 0.47-0.95) showed protective effects against influenza-attributable death. Mechanical ventilator support produced the highest increase in death risk (RR = 3.31, 95% CI 2.89-3.79). Male sex, older age, AH1N1 subtype, and other chronic diseases were also associated with fatal in-hospital influenza-related outcomes. CONCLUSIONS Our findings highlight the major relevance of promoting immunization in high-risk individuals, together with ensuring early and effective antiviral management in suspected influenza cases.
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Affiliation(s)
- E Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, México
| | - O Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Colima, México
| | | | - J Guzmán-Esquivel
- Facultad de Medicina, Universidad de Colima, Colima, México; Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, México.
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Murillo-Zamora E, Mendoza-Cano O, Delgado-Enciso I, Guzmán-Esquivel J. National retrospective cohort study to identify risk factors for in-hospital 30-day lethality in laboratory-confirmed cases of influenza. Rev Clin Esp 2020; 221:76-85. [PMID: 33998492 DOI: 10.1016/j.rceng.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify factors associated with the risk of death in adolescent and adult inpatients with laboratory-positive (reverse-transcription polymerase chain reaction) influenza in Mexico during consecutive influenza seasons (2018-2020). METHODS A retrospective cohort study used national surveillance system data, enrolling 3.422 individuals. The association between various risk factors and 30-day in-hospital lethality were evaluated through risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS The lethality rate was 18.1%. Flu vaccination history (RR=0.56, 95% CI 0.42-0.78), early antiviral drug administration (≤2 days from symptom onset [reference ≥5 days], RR=0.68, 95% CI 0.58-0.81), and a history of asthma (RR=0.66, 95% CI 0.47-0.95) showed protective effects against influenza-attributable death. Mechanical ventilator support produced the highest increase in death risk (RR=3.31, 95% CI 2.89-3.79). Male sex, older age, AH1N1 subtype, and other chronic diseases were also associated with fatal in-hospital influenza-related outcomes. CONCLUSIONS Our findings highlight the major relevance of promoting immunization in high-risk individuals, together with ensuring early and effective antiviral management in suspected influenza cases.
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Affiliation(s)
- E Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro, Colima, Colima, Mexico
| | - O Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, km. 9 carretera Colima-Coquimatlán, Colima, Mexico
| | - I Delgado-Enciso
- Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Colima, Mexico
| | - J Guzmán-Esquivel
- Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Colima, Mexico; Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, Mexico.
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Le XTT, Nguyen HT, Le HT, Do TTT, Nguyen TH, Vu LG, Nguyen CT, Hoang MT, Tran BX, Latkin CA, Ho CSH, Ho RCM. Rural-urban differences in preferences for influenza vaccination among women of childbearing age: implications for local vaccination service implementation in Vietnam. Trop Med Int Health 2020; 26:228-236. [PMID: 33164300 DOI: 10.1111/tmi.13515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Pregnant women and new mothers are among the most vulnerable to seasonal influenza; however, little is known about their preferences for flu vaccination. We examined the rural-urban differences in uptake, demand and willingness to pay (WTP) for influenza vaccination among women of childbearing age, to assess the feasibility of implementing locally produced vaccines in Vietnam. METHODS A cross-sectional study was performed in both urban and rural areas of Hanoi in 2018. Socio-demographic characteristics, history of vaccination, demand and WTP for influenza vaccines were obtained. A multivariate logistic regression model was employed to identify the associated factors. RESULTS Of 750 participants, 29.9% had had flu shots in the current or previous flu season and 64.3% indicated demand for this vaccine. The median of the maximum amount of WTP for influenza vaccination services was US$ 8.5 (IQR: 8.5-17.0). Women living in rural areas had a significantly lower uptake and higher demand, and were willing to pay less than women in urban locations (21.1% vs. 36.6%; 69% vs. 60.2%; and US $8.5 vs. US $11.7, respectively). For urban participants, factors associated with higher demand and WTP for flu shots included having ANC in health facilities and having been vaccinated against influenza in the past; for rural women, these factors were having suffered from influenza and hearing about it. CONCLUSIONS This study informs the feasibility of implementing locally produced influenza vaccines in Vietnam. Educational programs, along with counselling services and government subsidies, should be implemented to improve the coverage, demand and WTP for the vaccine.
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Affiliation(s)
- Xuan T T Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hien T Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong T Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Toan T T Do
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Thang H Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Linh G Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Cuong T Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Men T Hoang
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Institute for Health Innovation and Technology, National University of Singapore, Singapore
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Abstract
In several lately published studies, the association between single-nucleotide polymorphism (SNP, rs12252) of IFITM3 and the risk of influenza is inconsistent. To further understand the association between the SNP of IFITM3 and the risk of influenza, we searched related studies in five databases including PubMed published earlier than 9 November 2017. Ten sets of data from nine studies were included and data were analysed by Revman 5.0 and Stata 12.0 in our updated meta-analysis, which represented 1365 patients and 5425 no-influenza controls from four different ethnicities. Here strong association between rs12252 and influenza was found in all four genetic models. The significant differences in the allelic model (C vs. T: odds ratio (OR) = 1.35, 95% confidence interval (CI) (1.03–1.79), P = 0.03) and homozygote model (CC vs. TT: OR = 10.63, 95% CI (3.39–33.33), P < 0.00001) in the Caucasian subgroup were discovered, which is very novel and striking. Also novel discoveries were found in the allelic model (C vs. T: OR = 1.37, 95% CI (1.08–1.73), P = 0.009), dominant model (CC + CT vs. TT: OR = 1.48, 95% CI (1.08–2.02), P = 0.01) and homozygote model (CC vs. TT: OR = 2.84, 95% CI (1.36–5.92), P = 0.005) when we compared patients with mild influenza with healthy individuals. Our meta-analysis suggests that single-nucleotide T to C polymorphism of IFITM3 associated with increasingly risk of severe and mild influenza in both Asian and Caucasian populations.
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