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Chard AN, Machingaidze C, Loayza S, Gharpure R, Nogareda F, González R, Domínguez R, Tinoco YO, Dawood FS, Carreon JD, Lafond KE, Jara J, Azziz-Baumgartner E, Cozza V, Couto P, Rolfes MA, Tempia S. Estimating averted illnesses from influenza vaccination for children and pregnant women - El Salvador, Panama, and Peru, 2011-2018. Vaccine 2024:S0264-410X(24)00419-5. [PMID: 38584055 DOI: 10.1016/j.vaccine.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Estimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011-2017 among two influenza vaccine target populations: children aged 6-23 months and pregnant women. METHODS We derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries' vaccine coverage was achieved using four different vaccine deployment strategies. RESULTS Among children aged 6-23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March-June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women). DISCUSSION Influenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.
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Affiliation(s)
- Anna N Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Chiedza Machingaidze
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Sergio Loayza
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Radhika Gharpure
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Francisco Nogareda
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Rosalba González
- Gorgas Memorial Institute of Health Studies, Ave. Justo Arosemena, Calle 35, Panama City, Panama
| | - Rhina Domínguez
- National Institute of Health of El Salvador, C. Gabriela Mistral 211, San Salvador, El Salvador
| | - Yeny O Tinoco
- U.S. Naval Medical Research Unit SOUTH, Av. Venezuela. Cuadra 36 s/n. Bellavista. Callao, Lima, Peru
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Joseph Daniel Carreon
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Jorge Jara
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Vanessa Cozza
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Paula Couto
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States; Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Stefano Tempia
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
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Okoli GN, Righolt CH, Zhang G, Alessi-Severini S, Van Caeseele P, fan Kuo I, Mahmud SM. Characteristics and determinants of seasonal influenza vaccination in Manitoba, Canada: A population-wide record-linkage study. Vaccine X 2024; 17:100435. [PMID: 38299203 PMCID: PMC10825609 DOI: 10.1016/j.jvacx.2024.100435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Background Seasonal influenza vaccine (SIV) uptake (receipt of vaccine) in Manitoba, Canada is consistently low notwithstanding vaccine availability and free-of-charge vaccination. Despite, there is a lack of published evidence on the determinants of uptake of the vaccine. We sought to assess the association between SIV uptake and certain population and primary care physician (PCP) characteristics in Manitoba. Methods We conducted a longitudinal study utilizing Manitoba administrative health databases. We summarized SIV uptake from 2000/01-2019/20 influenza seasons across subpopulations defined by socioeconomic, health-related and PCP characteristics. Utilizing multivariable generalized estimating equation logistic regression models, we assessed the association between SIV uptake and the socioeconomic, health-related and PCP characteristics, stratified by age group (<5-, 5-17-, 18-44-, 45-64-, ≥65-year-olds) and sex. Results are adjusted odds ratios with associated 95 % confidence intervals. Results SIV uptake percentage increased over time with 4.4 %, 13.1 %, 17.5 % and 21.7 % of < 5-year-olds, 2 %, 4.9 %, 9.7 % and 13.1 % of 5-17-year-olds, 5.4 %, 8.8 %, 10.7 % and 13.5 % of 18-44-year-olds, 16.8 %, 21.3 %, 23.6 % and 24.6 % of 45-64-year-olds receiving the SIV in 2000-2004, 2005-2009, 2010-2014 and 2015-2019, respectively. There was a decline among ≥ 65-year-olds from 58.5 % to 53.5 %. We observed a similar pattern across subpopulations. There were significantly increased odds of SIV uptake among females within the age groups ≥ 18 years, in higher income quintiles, mostly with increased contact with a PCP/hospitalization within age groups ≥ 18 years, among those who had older or female PCPs (the opposite observation among ≥ 65-year-olds) and whose PCP administered at least one SIV in prior influenza season. These observations were largely consistent irrespective of sex. Conclusion SIV uptake in Manitoba appears to increase with age, and many socioeconomic, health-related and PCP characteristics appear to be associated with it. These findings may inform targeted vaccination programs to optimize influenza vaccination in Manitoba and similar Canadian jurisdictions.
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Affiliation(s)
- George N. Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christiaan H. Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geng Zhang
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Departments of Medical Microbiology and Infectious Diseases, and Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Cadham Provincial Public Health Laboratories, Manitoba Health and Seniors Care, Winnipeg, Manitoba, Canada
| | - I fan Kuo
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Optimal Use and Evaluation, Ministry of Health, Government of British Columbia, Vancouver, British Columbia, Canada
| | - Salaheddin M. Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Chen D, Zhang T, Chen S, Ru X, Shao Q, Ye Q, Cheng D. The effect of nonpharmaceutical interventions on influenza virus transmission. Front Public Health 2024; 12:1336077. [PMID: 38389947 PMCID: PMC10881707 DOI: 10.3389/fpubh.2024.1336077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Background The use of nonpharmaceutical interventions (NPIs) during severe acute respiratory syndrome 2019 (COVID-19) outbreaks may influence the spread of influenza viruses. This study aimed to evaluate the impact of NPIs against SARS-CoV-2 on the epidemiological features of the influenza season in China. Methods We conducted a retrospective observational study analyzing influenza monitoring data obtained from the China National Influenza Center between 2011 and 2023. We compared the changes in influenza-positive patients in the pre-COVID-19 epidemic, during the COVID-19 epidemic, and post-COVID-19 epidemic phases to evaluate the effect of NPIs on influenza virus transmission. Results NPIs targeting COVID-19 significantly suppressed influenza activity in China from 2019 to 2022. In the seventh week after the implementation of the NPIs, the number of influenza-positive patients decreased by 97.46% in southern regions of China and 90.31% in northern regions of China. However, the lifting of these policies in December 2022 led to an unprecedented surge in influenza-positive cases in autumn and winter from 2022 to 2023. The percentage of positive influenza cases increased by 206.41% (p < 0.001), with high positivity rates reported in both the northern and southern regions of China. Conclusion Our findings suggest that NPIs against SARS-CoV-2 are effective at controlling influenza epidemics but may compromise individuals' immunity to the virus.
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Affiliation(s)
- Danlei Chen
- School of Medical Technology and Informatlon Engineering, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Laboratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Ting Zhang
- School of Medical Technology and Informatlon Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Simiao Chen
- Department of Laboratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Xuanwen Ru
- Department of Laboratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Qingyi Shao
- School of Medical Technology and Informatlon Engineering, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Laboratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Qing Ye
- Department of Laboratory Medicine, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Dongqing Cheng
- School of Medical Technology and Informatlon Engineering, Zhejiang Chinese Medical University, Hangzhou, China
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Kakoullis L, Steffen R, Osterhaus A, Goeijenbier M, Rao SR, Koiso S, Hyle EP, Ryan ET, LaRocque RC, Chen LH. Influenza: seasonality and travel-related considerations. J Travel Med 2023; 30:taad102. [PMID: 37535890 DOI: 10.1093/jtm/taad102] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
RATIONALE FOR REVIEW This review aims to summarize the transmission patterns of influenza, its seasonality in different parts of the globe, air travel- and cruise ship-related influenza infections and interventions to reduce transmission. KEY FINDINGS The seasonality of influenza varies globally, with peak periods occurring mainly between October and April in the northern hemisphere (NH) and between April and October in the southern hemisphere (SH) in temperate climate zones. However, influenza seasonality is significantly more variable in the tropics. Influenza is one of the most common travel-related, vaccine-preventable diseases and can be contracted during travel, such as during a cruise or through air travel. Additionally, travellers can come into contact with people from regions with ongoing influenza transmission. Current influenza immunization schedules in the NH and SH leave individuals susceptible during their respective spring and summer months if they travel to the other hemisphere during that time. CONCLUSIONS/RECOMMENDATIONS The differences in influenza seasonality between hemispheres have substantial implications for the effectiveness of influenza vaccination of travellers. Health care providers should be aware of influenza activity when patients report travel plans, and they should provide alerts and advise on prevention, diagnostic and treatment options. To mitigate the risk of travel-related influenza, interventions include antivirals for self-treatment (in combination with the use of rapid self-tests), extending the shelf life of influenza vaccines to enable immunization during the summer months for international travellers and allowing access to the influenza vaccine used in the opposite hemisphere as a travel-related vaccine. With the currently available vaccines, the most important preventive measure involves optimizing the seasonal influenza vaccination. It is also imperative that influenza is recognized as a travel-related illness among both travellers and health care professionals.
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Affiliation(s)
- Loukas Kakoullis
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, 8001, Switzerland
- Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX 77030, USA
| | - Albert Osterhaus
- Research Center Emerging Infections and Zoonoses, University of Veterinary Medicine, Hannover, 30559, Germany
| | - Marco Goeijenbier
- Department of Intensive Care, Spaarne Gasthuis, Haarlem, 2035, Netherlands
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, 3015, Netherlands
| | - Sowmya R Rao
- Department of Global Health, Boston University, Boston, MA 02118, USA
| | - Satoshi Koiso
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Emily P Hyle
- Harvard Medical School, Boston, MA 02115, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, 02114, USA
| | - Edward T Ryan
- Harvard Medical School, Boston, MA 02115, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, 02114, USA
| | - Regina C LaRocque
- Harvard Medical School, Boston, MA 02115, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, 02114, USA
| | - Lin H Chen
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, Cambridge, MA 02138, USA
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Designing multi-epitope mRNA construct as a universal influenza vaccine candidate for future epidemic/pandemic preparedness. Int J Biol Macromol 2023; 226:885-899. [PMID: 36521707 DOI: 10.1016/j.ijbiomac.2022.12.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/25/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Despite the availability of prevention and treatment strategies and advancing immunization approaches, the influenza virus remains a global threat that continues to plague humanity with unpredictable pandemics. Due to the unusual genetic variability and segmented genome, the reassortment between different strains of influenza is facilitated and the viruses continuously evolve and adapt to the host cell's immunity. This underlies the seasonal vaccine mismatches that decrease the vaccine efficacy and increase the risk of outbreaks. Thus, the development of a universal vaccine covering all the influenza A and B strains would reduce the pervasiveness of the influenza virus. In the current study, a potentially universal influenza multi-epitope vaccine was designed based on the experimentally tested conserved T cell and B cell epitopes of hemagglutinin (HA), neuraminidase (NA), nucleoprotein (NP), and matrix-2 proton channel (M2) of the virus. The immune simulation and molecular docking of the vaccine construct with TLR2, TLR3, and TLR4 elicited the favorable immunogenicity of the vaccine and the formation of stable complexes, respectively. Ultimately, based on the immunoinformatics analysis, the universal mRNA multi-epitope vaccine designed in this study might have a protection potential against the various subtypes of influenza A and B.
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Rcheulishvili N, Papukashvili D, Liu C, Ji Y, He Y, Wang PG. Promising strategy for developing mRNA-based universal influenza virus vaccine for human population, poultry, and pigs- focus on the bigger picture. Front Immunol 2022; 13:1025884. [PMID: 36325349 PMCID: PMC9618703 DOI: 10.3389/fimmu.2022.1025884] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/03/2022] [Indexed: 08/08/2023] Open
Abstract
Since the first outbreak in the 19th century influenza virus has remained emergent owing to the huge pandemic potential. Only the pandemic of 1918 caused more deaths than any war in world history. Although two types of influenza- A (IAV) and B (IBV) cause epidemics annually, influenza A deserves more attention as its nature is much wilier. IAVs have a large animal reservoir and cause the infection manifestation not only in the human population but in poultry and domestic pigs as well. This many-sided characteristic of IAV along with the segmented genome gives rise to the antigenic drift and shift that allows evolving the new strains and new subtypes, respectively. As a result, the immune system of the body is unable to recognize them. Importantly, several highly pathogenic avian IAVs have already caused sporadic human infections with a high fatality rate (~60%). The current review discusses the promising strategy of using a potentially universal IAV mRNA vaccine based on conserved elements for humans, poultry, and pigs. This will better aid in averting the outbreaks in different susceptible species, thus, reduce the adverse impact on agriculture, and economics, and ultimately, prevent deadly pandemics in the human population.
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Affiliation(s)
| | | | | | | | - Yunjiao He
- *Correspondence: Yunjiao He, ; Peng George Wang,
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Hassan MZ, Shirin T, Rahman M, Alamgir ASM, Jahan N, Al Jubayer Biswas MA, Khan SH, Basher MAK, Islam MA, Hussain K, Islam MN, Rabbany MA, Haque MA, Chakraborty SR, Parvin SR, Rahman M, Chowdhury F. Seasonal influenza vaccine uptake among healthcare workers in tertiary care hospitals, Bangladesh: Study protocol for influenza vaccine supply and awareness intervention. BMC Public Health 2022; 22:1819. [PMID: 36153529 PMCID: PMC9509585 DOI: 10.1186/s12889-022-14182-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Healthcare workers (HCWs), such as doctors, nurses, and support staffs involved in direct or indirect patient care, are at increased risk of influenza virus infections due to occupational exposures. Vaccination is the most effective way to prevent influenza. Despite the World Health Organization (WHO) recommendations, Bangladesh lacks a seasonal influenza vaccination policy for HCWs, and thus vaccination rates remain low. The current project aims to investigate the effect of interventions on influenza vaccine awareness and availability of vaccine supply, explore HCWs’ knowledge and perceptions about influenza vaccination, understand the barriers and motivators for influenza vaccine uptake, and understand policymakers' views on the practicality of influenza vaccination among HCWs.
Method
We will conduct the study at four tertiary care teaching hospitals in Bangladesh, using a cluster randomized controlled trial approach, with the hospital as the unit of randomization and intervention. The study population will include all types of HCWs.The four different types of intervention will be randomly allocated and implemented in four study hospitals separately. The four interventions will be: i) ensuring the availability of influenza vaccine supply; ii) developing influenza vaccine awareness; iii) both ensuring influenza vaccine supply and developing influenza vaccine awareness and iv) control arm with no intervention. Both quantitative and qualitative approaches will be applied to assess the intervention effect. We will estimate the Difference in Differences (DID) with 95% CI of the proportion of vaccine uptake between each intervention and control (non-intervention) arm, adjusting for the clustering effect. The qualitative data will be summarised using a framework matrix method.
Discussion
The results of this study will inform the development and implementation of a context-specific strategy to enhance influenza vaccination rates among Bangladeshi HCWs.
Trial registration
Clinicaltrials.gov NCT05521763. Version 2.0 was registered in September 2022, and the first participant enrolled in March 2022. Retrospectively registered.
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Chan CP, Wong NS, Lee SS. The double-edged impacts of COVID-19 epidemic on influenza vaccination uptake in nurses in Hong Kong. Infect Dis (Lond) 2022; 54:794-803. [PMID: 35786125 DOI: 10.1080/23744235.2022.2094461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Worldwide, the COVID-19 pandemic has disrupted influenza seasonality and impacted influenza vaccination behaviours. This study examines the patterns of influenza vaccination uptake in nurses during the pre-pandemic seasons and amidst the pandemic in 2020/21 in subtropical Hong Kong. METHODS In April 2021, a cross-sectional survey was conducted in practising and student nurses. Six patterns were differentiated by their influenza vaccination status in 2020/21 and preceding five seasons: (a) resistance throughout, (b) negative change, (c) decreased tendency, (d) increased tendency (e) positive change, and (f) adherence throughout. Participants' characteristics and reasons for vaccination/non-vaccination and their associations with each vaccination pattern were explored using multivariable multinomial regression. RESULTS Among 1323 nurses (88% female with a median age of 39 years), no substantial change in vaccination uptake was noted from 2019/20 (41%) to 2020/21 (42%). Some 4% were positive-changers who were older at age of ≥50 years (aOR 4.77) and more likely to anticipate a reduced risk of severe disease with COVID-19/influenza co-infection following vaccination (aOR 8.76). Negative-changers made up 3% and were more inclined to perceive an unlikelihood of widespread influenza outbreaks amidst the pandemic (aOR 3.67). Some 26 and 43% remained adherent and resistant to influenza vaccination throughout respectively notwithstanding the COVID-19 outbreak. CONCLUSIONS In contrast to the increased uptake elsewhere, the stable influenza vaccination coverage among nurses in Hong Kong could be explained by the ubiquity of strict physical distancing regulations, which have deterred vaccination in some nurses that offsets the new uptakes induced by the mild COVID-19 outbreaks.
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Affiliation(s)
- Chin Pok Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ngai Sze Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Zanobini P, Bonaccorsi G, Lorini C, Haag M, McGovern I, Paget J, Caini S. Global patterns of seasonal influenza activity, duration of activity and virus (sub)type circulation from 2010 to 2020. Influenza Other Respir Viruses 2022; 16:696-706. [PMID: 35212157 PMCID: PMC9178051 DOI: 10.1111/irv.12969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 01/18/2022] [Indexed: 01/02/2023] Open
Abstract
Background Seasonal influenza viruses undergo unpredictable changes, which may lead to antigenic mismatch between circulating and vaccine strains and to a reduced vaccine effectiveness. A continuously updated knowledge of influenza strain circulation and seasonality is essential to optimize the effectiveness of influenza vaccination campaigns. We described the global epidemiology of influenza between the 2009 A(H1N1)p and the 2020 COVID‐19 pandemic. Methods Influenza virological surveillance data were obtained from the WHO‐FluNet database. We determined the median proportion of influenza cases caused by the different influenza virus types, subtypes, and lineages; the typical timing of the epidemic peak; and the median duration of influenza epidemics (applying the annual average percentage method with a 75% threshold). Results We included over 4.6 million influenza cases from 149 countries. The median proportion of influenza cases caused by type A viruses was 75.5%, highest in the Southern hemisphere (81.6%) and lowest in the intertropical belt (73.0%), and ranged across seasons between 60.9% in 2017 and 88.7% in 2018. Epidemic peaks typically occurred during winter months in Northern and Southern hemisphere countries, while much more variability emerged in tropical countries. Influenza epidemics lasted a median of 25 weeks (range 8–42) in countries lying between 30°N and 26°S, and a median of 9 weeks (range 5–25) in countries outside this latitude range. Conclusions This work will establish an important baseline to better understand factors that influence seasonal influenza dynamics and how COVID‐19 may have affected seasonal activity and influenza virus types, subtypes, and lineages circulation patterns.
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Affiliation(s)
- Patrizio Zanobini
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Chiara Lorini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Mendel Haag
- Center for Outcomes Research and Epidemiology, Seqirus NL BV, Amsterdam, The Netherlands
| | - Ian McGovern
- Center for Outcomes Research and Epidemiology, Seqirus Inc, Cambridge, Massachusetts, USA
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Saverio Caini
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Dang TKNS, Rivero Cabrera R, Yeung KHT, van der Putten IM, Nelson EAS. Feasibility of age- and gestation-based routine universal influenza vaccines schedules for children aged 6 months - 2 years and pregnant women. Vaccine 2021; 39:6754-6761. [PMID: 34674893 DOI: 10.1016/j.vaccine.2021.09.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hong Kong's seasonal influenza schedule follows the World Health Organization's northern hemisphere vaccine composition recommendations but with year-round influenza activity there is the potential to implement routine age- and gestation-based schedules utilising both northern and southern hemisphere vaccines for children aged 6 months to 2 years and for pregnant women. This study assessed the potential feasibility of such schedules. METHODS A literature review was conducted and in-depth interviews with vaccine experts, policy makers and nurses were undertaken. RESULTS The following schedules were proposed and assessed for perceived feasibility: 1) a four-dose schedule in the first two years of life requiring an additional unscheduled clinic visit at 7 months; 2) a three-dose schedule excluding the 4-week booster after the first dose; 3) a two-dose schedule for pregnant women involving a dose at the booking visit and a dose with pertussis vaccine at 7 months gestation; and 4) a one-dose schedule at 7 months gestation. CONCLUSIONS Age- and gestation-based routine influenza vaccination schedules are theoretically feasible for both young children and pregnant women. The three-dose paediatric and one-dose obstetric schedules were assessed in interviews with vaccine experts, policy makers and nurses to be most acceptable. Further clinical studies are required to determine whether such schedules are non-inferior to current seasonal-based schedules in terms of vaccine effectiveness and vaccine uptake.
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Affiliation(s)
- T K N Sandra Dang
- CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.
| | - Romén Rivero Cabrera
- CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.
| | | | - Ingeborg M van der Putten
- CAPHRI, Care and Public Health Research Institute, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.
| | - E Anthony S Nelson
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong.
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Elhakim MM, Kandil SK, Abd Elaziz KM, Anwar WA. Epidemiology of Severe Acute Respiratory Infection (SARI) Cases at a sentinel site in Egypt, 2013-15. J Public Health (Oxf) 2021; 42:525-533. [PMID: 31090911 PMCID: PMC7107553 DOI: 10.1093/pubmed/fdz053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 04/13/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Sentinel surveillance for severe acute respiratory infection (SARI) in Egypt began in 2006 and occurs at eight sites. Avian influenza is endemic, and human cases of influenza A (H5N1) have been reported annually since 2006. This study aimed to describe the epidemiology of SARI at a major sentinel site in the country. METHODS Data included in the study were collected from a major SARI sentinel site in Egypt during three consecutive years (2013-15). RESULTS A total of 1254 SARI patients conforming to the WHO case definition were admitted to the sentinel site, representing 5.6% of admitted patients for all causes and 36.6% of acute respiratory infection patients. A total of 99.7% of the patients were tested, and 21.04% tested positive; 48.7% of cases involved influenza A viruses, while 25% involved influenza B. The predominant age group was under 5 years of age, accounting for 443 cases. The seasonality of the influenza data conformed to the Northern Hemisphere pattern. CONCLUSIONS The present study's results show that SARI leads to substantial morbidity in Egypt. There is a great need for high-quality data from the SARI surveillance system in Egypt, especially with endemic respiratory threats such as influenza A (H5N1) in Egypt.
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Affiliation(s)
- Mohamed M Elhakim
- Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Ain Shams University, 11566, Cairo, Egypt
| | - Sahar K Kandil
- Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Ain Shams University, 11566, Cairo, Egypt
| | - Khaled M Abd Elaziz
- Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Ain Shams University, 11566, Cairo, Egypt
| | - Wagida A Anwar
- Community, Environmental and Occupational Medicine Department, Faculty of Medicine, Ain Shams University, 11566, Cairo, Egypt
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Ortiz-Prado E, Simbaña-Rivera K, Gómez-Barreno L, Rubio-Neira M, Guaman LP, Kyriakidis NC, Muslin C, Jaramillo AMG, Barba-Ostria C, Cevallos-Robalino D, Sanches-SanMiguel H, Unigarro L, Zalakeviciute R, Gadian N, López-Cortés A. Clinical, molecular, and epidemiological characterization of the SARS-CoV-2 virus and the Coronavirus Disease 2019 (COVID-19), a comprehensive literature review. Diagn Microbiol Infect Dis 2020; 98:115094. [PMID: 32623267 PMCID: PMC7260568 DOI: 10.1016/j.diagmicrobio.2020.115094] [Citation(s) in RCA: 211] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
Coronaviruses are an extensive family of viruses that can cause disease in both animals and humans. The current classification of coronaviruses recognizes 39 species in 27 subgenera that belong to the family Coronaviridae. From those, at least 7 coronaviruses are known to cause respiratory infections in humans. Four of these viruses can cause common cold-like symptoms. Those that infect animals can evolve and become infectious to humans. Three recent examples of these viral jumps include SARS CoV, MERS-CoV and SARS CoV-2 virus. They are responsible for causing severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the most recently discovered coronavirus disease during 2019 (COVID-19). COVID-19, a respiratory disease caused by the SARS-CoV-2 virus, was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. The rapid spread of the disease has taken the scientific and medical community by surprise. Latest figures from 20 May 2020 show more than 5 million people had been infected with the virus, causing more than 330,000 deaths in over 210 countries worldwide. The large amount of information received daily relating to COVID-19 is so abundant and dynamic that medical staff, health authorities, academics and the media are not able to keep up with this new pandemic. In order to offer a clear insight of the extensive literature available, we have conducted a comprehensive literature review of the SARS CoV-2 Virus and the Coronavirus Diseases 2019 (COVID-19).
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Medicine, Universidad de Las Americas (UDLA), Quito, Ecuador.
| | - Katherine Simbaña-Rivera
- One Health Research Group, Faculty of Medicine, Universidad de Las Americas (UDLA), Quito, Ecuador.
| | - Lenin Gómez-Barreno
- One Health Research Group, Faculty of Medicine, Universidad de Las Americas (UDLA), Quito, Ecuador.
| | - Mario Rubio-Neira
- Hospital Baca Ortiz, Pediatric and Cardiology Department, Quito, Ecuador.
| | - Linda P Guaman
- Centro de Investigación Biomédica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador.
| | - Nikolaos C Kyriakidis
- Grupo de Investigación en Biotecnología Aplicada a Biomedicina (BIOMED), Universidad de la Americas, Quito, Ecuador.
| | - Claire Muslin
- One Health Research Group, Faculty of Medicine, Universidad de Las Americas (UDLA), Quito, Ecuador.
| | | | - Carlos Barba-Ostria
- One Health Research Group, Faculty of Medicine, Universidad de Las Americas (UDLA), Quito, Ecuador.
| | | | - Hugo Sanches-SanMiguel
- One Health Research Group, Faculty of Medicine, Universidad de Las Americas (UDLA), Quito, Ecuador.
| | - Luis Unigarro
- Intensive Care Unit, Hospital SOLCA Quito, Quito, Ecuador.
| | - Rasa Zalakeviciute
- Grupo de Biodiversidad Medio Ambiente y Salud (BIOMAS), Universidad de Las Américas, Quito, Ecuador; Intelligent and Interactive Systems Lab (SI2 Lab) Universidad de Las Américas (UDLA), Quito, Ecuador.
| | - Naomi Gadian
- University of Southampton, Department of Public Health, Southampton, United Kingdome.
| | - Andrés López-Cortés
- Centro de Investigación Genética y Genómica, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador; Red Latinoamericana de Implementación y Validación de Guías Clínicas Farmacogenómicas (RELIVAF-CYTED), Quito, Ecuador.
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13
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Dawa J, Emukule GO, Barasa E, Widdowson MA, Anzala O, van Leeuwen E, Baguelin M, Chaves SS, Eggo RM. Seasonal influenza vaccination in Kenya: an economic evaluation using dynamic transmission modelling. BMC Med 2020; 18:223. [PMID: 32814581 PMCID: PMC7438179 DOI: 10.1186/s12916-020-01687-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is substantial burden of seasonal influenza in Kenya, which led the government to consider introducing a national influenza vaccination programme. Given the cost implications of a nationwide programme, local economic evaluation data are needed to inform policy on the design and benefits of influenza vaccination. We set out to estimate the cost-effectiveness of seasonal influenza vaccination in Kenya. METHODS We fitted an age-stratified dynamic transmission model to active surveillance data from patients with influenza from 2010 to 2018. Using a societal perspective, we developed a decision tree cost-effectiveness model and estimated the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for three vaccine target groups: children 6-23 months (strategy I), 2-5 years (strategy II) and 6-14 years (strategy III) with either the Southern Hemisphere influenza vaccine (Strategy A) or Northern Hemisphere vaccine (Strategy B) or both (Strategy C: twice yearly vaccination campaigns, or Strategy D: year-round vaccination campaigns). We assessed cost-effectiveness by calculating incremental net monetary benefits (INMB) using a willingness-to-pay (WTP) threshold of 1-51% of the annual gross domestic product per capita ($17-$872). RESULTS The mean number of infections across all ages was 2-15 million per year. When vaccination was well timed to influenza activity, the annual mean ICER per DALY averted for vaccinating children 6-23 months ranged between $749 and $1385 for strategy IA, $442 and $1877 for strategy IB, $678 and $4106 for strategy IC and $1147 and $7933 for strategy ID. For children 2-5 years, it ranged between $945 and $1573 for strategy IIA, $563 and $1869 for strategy IIB, $662 and $4085 for strategy IIC, and $1169 and $7897 for strategy IID. For children 6-14 years, it ranged between $923 and $3116 for strategy IIIA, $1005 and $2223 for strategy IIIB, $883 and $4727 for strategy IIIC and $1467 and $6813 for strategy IIID. Overall, no vaccination strategy was cost-effective at the minimum ($17) and median ($445) WTP thresholds. Vaccinating children 6-23 months once a year had the highest mean INMB value at $872 (WTP threshold upper limit); however, this strategy had very low probability of the highest net benefit. CONCLUSION Vaccinating children 6-23 months once a year was the most favourable vaccination option; however, the strategy is unlikely to be cost-effective given the current WTP thresholds.
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Affiliation(s)
- Jeanette Dawa
- KAVI-Institute of Clinical Research, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
- Washington State University Global Health Programs Kenya Office, Nairobi, Kenya.
| | - Gideon O Emukule
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marc Alain Widdowson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Omu Anzala
- KAVI-Institute of Clinical Research, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Marc Baguelin
- London School of Hygiene & Tropical Medicine, London, UK
- Imperial College London, London, UK
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rguig A, Cherkaoui I, McCarron M, Oumzil H, Triki S, Elmbarki H, Bimouhen A, El Falaki F, Regragui Z, Ihazmad H, Nejjari C, Youbi M. Establishing seasonal and alert influenza thresholds in Morocco. BMC Public Health 2020; 20:1029. [PMID: 32600376 DOI: 10.1186/s12889-020-09145-y] [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] [Received: 04/07/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several statistical methods of variable complexity have been developed to establish thresholds for influenza activity that may be used to inform public health guidance. We compared the results of two methods and explored how they worked to characterize the 2018 influenza season performance-2018 season. METHODS Historical data from the 2005/2006 to 2016/2018 influenza season performance seasons were provided by a network of 412 primary health centers in charge of influenza like illness (ILI) sentinel surveillance. We used the WHO averages and the moving epidemic method (MEM) to evaluate the proportion of ILI visits among all outpatient consultations (ILI%) as a proxy for influenza activity. We also used the MEM method to evaluate three seasons of composite data (ILI% multiplied by percent of ILI with laboratory-confirmed influenza) as recommended by WHO. RESULTS The WHO method estimated the seasonal ILI% threshold at 0.9%. The annual epidemic period began on average at week 46 and lasted an average of 18 weeks. The MEM model estimated the epidemic threshold (corresponding to the WHO seasonal threshold) at 1.5% of ILI visits among all outpatient consultations. The annual epidemic period began on week 49 and lasted on average 14 weeks. Intensity thresholds were similar using both methods. When using the composite measure, the MEM method showed a clearer estimate of the beginning of the influenza epidemic, which was coincident with a sharp increase in confirmed ILI cases. CONCLUSIONS We found that the threshold methodology presented in the WHO manual is simple to implement and easy to adopt for use by the Moroccan influenza surveillance system. The MEM method is more statistically sophisticated and may allow a better detection of the start of seasonal epidemics. Incorporation of virologic data into the composite parameter as recommended by WHO has the potential to increase the accuracy of seasonal threshold estimation.
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Affiliation(s)
- Ahmed Rguig
- Direction of Epidemiology and Disease Control, MoH, Rabat, Morocco
| | - Imad Cherkaoui
- Direction of Epidemiology and Disease Control, MoH, Rabat, Morocco.
| | | | - Hicham Oumzil
- National Institute of Hygiène, NIC, MoH, Rabat, Morocco
| | | | - Houria Elmbarki
- Direction of Epidemiology and Disease Control, MoH, Rabat, Morocco
| | | | | | | | | | - Chakib Nejjari
- University Mohammed VI of Health Sciences, Casablanca, Morocco
| | - Mohammed Youbi
- Direction of Epidemiology and Disease Control, MoH, Rabat, Morocco
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15
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Pepin KM, Pedersen K, Wan XF, Cunningham FL, Webb CT, Wilber MQ. Individual-Level Antibody Dynamics Reveal Potential Drivers of Influenza A Seasonality in Wild Pig Populations. Integr Comp Biol 2020; 59:1231-1242. [PMID: 31251341 DOI: 10.1093/icb/icz118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Swine are important in the ecology of influenza A virus (IAV) globally. Understanding the ecological role of wild pigs in IAV ecology has been limited because surveillance in wild pigs is often for antibodies (serosurveillance) rather than IAVs, as in humans and domestic swine. As IAV antibodies can persist long after an infection, serosurveillance data are not necessarily indicative of current infection risk. However, antibody responses to IAV infections cause a predictable antibody response, thus time of infection can be inferred from antibody levels in serological samples, enabling identification of risk factors of infection at estimated times of infection. Recent work demonstrates that these quantitative antibody methods (QAMs) can accurately recover infection dates, even when individual-level variation in antibody curves is moderately high. Also, the methodology can be implemented in a survival analysis (SA) framework to reduce bias from opportunistic sampling. Here we integrated QAMs and SA and applied this novel QAM-SA framework to understand the dynamics of IAV infection risk in wild pigs seasonally and spatially, and identify risk factors. We used national-scale IAV serosurveillance data from 15 US states. We found that infection risk was highest during January-March (54% of 61 estimated peaks), with 24% of estimated peaks occurring from May to July, and some low-level of infection risk occurring year-round. Time-varying IAV infection risk in wild pigs was positively correlated with humidity and IAV infection trends in domestic swine and humans, and did not show wave-like spatial spread of infection among states, nor more similar levels of infection risk among states with more similar meteorological conditions. Effects of host sex on IAV infection risk in wild pigs were generally not significant. Because most of the variation in infection risk was explained by state-level factors or infection risk at long-distances, our results suggested that predicting IAV infection risk in wild pigs is complicated by local ecological factors and potentially long-distance translocation of infection. In addition to revealing factors of IAV infection risk in wild pigs, our framework is broadly applicable for quantifying risk factors of disease transmission using opportunistic serosurveillance sampling, a common methodology in wildlife disease surveillance. Future research on the factors that determine individual-level antibody kinetics will facilitate the design of serosurveillance systems that can extract more accurate estimates of time-varying disease risk from quantitative antibody data.
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Affiliation(s)
- Kim M Pepin
- National Wildlife Research Center, USDA-APHIS, Wildlife Services, Fort Collins, CO 80521-2154, USA
| | - Kerri Pedersen
- USDA-APHIS, Wildlife Services, 920 Main Campus Drive, Suite 200, Raleigh, NC 27606, USA
| | - Xiu-Feng Wan
- Missouri University Center for Research on Influenza Systems Biology (CRISB), University of Missouri, Columbia, MO 65211, USA.,Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, MO, USA.,Department of Electrical Engineering & Computer Science, College of Engineering, University of Missouri, Columbia, MO, USA.,Bond Life Sciences Center, University of Missouri, Columbia, MO, USA.,MU Informatics Institute, University of Missouri, Columbia, MO, USA.,Department of Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Fred L Cunningham
- National Wildlife Research Center, USDA-APHIS, Wildlife Services, Mississippi Field Station, MS 39762, USA
| | - Colleen T Webb
- Department of Biology, Colorado State University, Fort Collins, CO 80523, USA
| | - Mark Q Wilber
- National Wildlife Research Center, USDA-APHIS, Wildlife Services, Fort Collins, CO 80521-2154, USA.,Department of Biology, Colorado State University, Fort Collins, CO 80523, USA
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16
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Njouom R, Monamele CG, Munshili Njifon HL, Kenmoe S, Ripa Njankouo M. Circulation of influenza virus from 2009 to 2018 in Cameroon: 10 years of surveillance data. PLoS One 2019; 14:e0225793. [PMID: 31794579 PMCID: PMC6890244 DOI: 10.1371/journal.pone.0225793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022] Open
Abstract
Since the recent emergence of several subtypes of influenza viruses with pandemic potentials, there has been growing interest on the control of this infection worldwide. This study aimed to describe the 10 years of influenza activity in Cameroon between January 2009 and December 2018. Respiratory samples were collected from sentinel sites responsible for influenza surveillance in Cameroon and analyzed for the presence of influenza. Globally, 9 of the 10 administrative regions of the country were represented with at least 1 year of data. A total of 11816 respiratory samples were collected and influenza virus detection rate was 24.0%. The most represented age group was the 0-1 years representing more than 40% of the collected samples and possessing the lowest proportion of influenza cases (16.2%). Meanwhile higher proportions of influenza positive cases was found in the 2-4, 5-14 and 15-49 years age group at ≥29%. Among outpatients, the frequency of influenza virus was 24.8% while in hospitalized patients, 18.7% of samples were positive for influenza virus. We noted year-round circulation of influenza virus in Cameroon with 2 peaks in activity: a major peak in the months of September to December and a minor peak in the months of March to July. Antigenic characterization of influenza isolates showed 37.5% (6/16) vaccine match between the predominant Cameroon strains and the Northern hemisphere vaccine strains with majority of vaccine match observed in influenza B/Victoria subtype (4/6; 66.7%). Data collected from this surveillance system is essential to add to global information on the spread of influenza.
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Affiliation(s)
- Richard Njouom
- Virology department, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- * E-mail:
| | | | | | - Sebastien Kenmoe
- Virology department, Centre Pasteur of Cameroon, Yaoundé, Cameroon
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O'Brien KL, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, Higdon MM, Howie SR, Deloria Knoll M, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, Prosperi C, Scott JAG, Shi Q, Thea DM, Wu Z, Zeger SL, Adrian PV, Akarasewi P, Anderson TP, Antonio M, Awori JO, Baillie VL, Bunthi C, Chipeta J, Chisti MJ, Crawley J, DeLuca AN, Driscoll AJ, Ebruke BE, Endtz HP, Fancourt N, Fu W, Goswami D, Groome MJ, Haddix M, Hossain L, Jahan Y, Kagucia EW, Kamau A, Karron RA, Kazungu S, Kourouma N, Kuwanda L, Kwenda G, Li M, Machuka EM, Mackenzie G, Mahomed N, Maloney SA, McLellan JL, Mitchell JL, Moore DP, Morpeth SC, Mudau A, Mwananyanda L, Mwansa J, Silaba Ominde M, Onwuchekwa U, Park DE, Rhodes J, Sawatwong P, Seidenberg P, Shamsul A, Simões EA, Sissoko S, Wa Somwe S, Sow SO, Sylla M, Tamboura B, Tapia MD, Thamthitiwat S, Toure A, Watson NL, Zaman K, Zaman SM. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet 2019; 394:757-779. [PMID: 31257127 PMCID: PMC6727070 DOI: 10.1016/s0140-6736(19)30721-4] [Citation(s) in RCA: 484] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings. METHODS We did a multi-site, international case-control study in nine study sites in seven countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1-59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted to cases without HIV infection and with abnormal chest x-rays and to controls without HIV infection. We applied a Bayesian, partial latent class analysis to estimate probabilities of aetiological agents at the individual and population level, incorporating case and control data. FINDINGS Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6-97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3-65·6) of causes, whereas bacteria accounted for 27·3% (23·3-31·6) and Mycobacterium tuberculosis for 5·9% (3·9-8·3). Viruses were less common (54·5%, 95% CrI 47·4-61·5 vs 68·0%, 62·7-72·7) and bacteria more common (33·7%, 27·2-40·8 vs 22·8%, 18·3-27·6) in very severe pneumonia cases than in severe cases. RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4-34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus-enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site's aetiological fraction. INTERPRETATION In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes. FUNDING Bill & Melinda Gates Foundation.
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18
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Nisar N, Badar N, Aamir UB, Yaqoob A, Tripathy JP, Laxmeshwar C, Munir F, Zaidi SSZ. Seasonality of influenza and its association with meteorological parameters in two cities of Pakistan: A time series analysis. PLoS One 2019; 14:e0219376. [PMID: 31323025 PMCID: PMC6641468 DOI: 10.1371/journal.pone.0219376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Influenza is known to have a specific pattern of seasonality the reasons for which are yet to be fully ascertained. Temperate zones show influenza epidemic during the winter months. The tropical and subtropical regions show more diverse influenza outbreak patterns. This study explores the seasonality of influenza activity and predicts influenza peak based on historical surveillance time series data in Islamabad and Multan, Pakistan. Methods This is a descriptive study of routinely collected monthly influenza sentinel surveillance data and meteorological data from 2012–16 in two sentinel sites of Pakistan: Islamabad (North) and Multan (Central). Results Mean number of cases of influenza and levels of precipitation were higher in Islamabad compared to Multan. Mean temperature and humidity levels were similar in both the cities. The number of influenza cases rose with decrease in precipitation and temperature in Islamabad during 2012–16, although the same cannot be said about humidity. The relationship between meteorological parameters and influenza incidence was not pronounced in case of Multan. The forecasted values in both the cities showed a significant peak during the month of January. Conclusion The influenza surveillance system gave a better understanding of the disease trend and could accurately forecast influenza activity in Pakistan.
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Affiliation(s)
- Nadia Nisar
- National Influenza Center, Department of Virology, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
- * E-mail:
| | - Nazish Badar
- National Influenza Center, Department of Virology, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Uzma Bashir Aamir
- National Influenza Center, Department of Virology, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Aashifa Yaqoob
- National TB Control Program (NTP), Ministry of National Health Services Regulation & Coordination, Government of Pakistan, Islamabad, Pakistan
| | - Jaya Prasad Tripathy
- International Union against Tuberculosis and Lung Diseases, The Union South East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | | | - Fariha Munir
- National Influenza Center, Department of Virology, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
| | - Syed Sohail Zahoor Zaidi
- National Influenza Center, Department of Virology, Public Health Laboratories Division, National Institute of Health, Islamabad, Pakistan
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Singh M, Tanvir T, Nagoji D, Madan A, Gattem S, Singh H. Influenza vaccine: A viable option to protect pregnant women and infants from seasonal flu: A retrospective hospital-based study in India. Int J Clin Pract 2019; 73:e13361. [PMID: 31074182 DOI: 10.1111/ijcp.13361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/14/2019] [Accepted: 05/04/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Influenza is a highly contagious disease with global annual outbreaks of 3-5 million severe cases and 0.25-0.5 million deaths. The risk is greater in pregnant women that results in high morbidity and mortality. OBJECTIVE The objective of this study was to see the efficacy of influenza vaccine on pregnant women and their newborn upto 6 months. METHOD This was a retrospective study (January 2016-March 2018). Records of 346 pregnant women were included in this study (vaccinated: 288; unvaccinated: 58). Women and infants were categorised into Category A, B or C according to the guidelines issued by the Ministry of Health and Family Welfare, India on influenza. RESULTS The groups were comparable with respect to baseline characteristics. Greater number of women received influenza vaccine during the first trimester (n = 117). During the gestation period, majority of the women in the vaccinated group were symptom-free compared with the unvaccinated (92% vs 70.7%). Also, none of the vaccinated women were categorised into category C compared with one who was laboratory tested positive for influenza in the unvaccinated group. Similar results were seen postpartum and more number of infants remained symptom-free in the vaccinated group compared with unvaccinated (69.3% vs 25.9%). More number of infants were born pre-term in the unvaccinated group compared with vaccinated (15.5% vs 8.6%). CONCLUSIONS Immunisation with influenza vaccine in any trimester during pregnancy was found to protect the mother and infants upto 6 months of age against seasonal influenza without significant maternal adverse effects. In order to improve vaccination rates, there must be a national vaccination policy and incorporation of maternal immunisation in standard antenatal care.
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Affiliation(s)
- Meeta Singh
- Tanvir Hospital, Hyderabad, Telangana, India
| | | | - Dharani Nagoji
- SVS Medical College & Hospital, Mahbubnagar, Telangana, India
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20
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Gentile A, Paget J, Bellei N, Torres JP, Vazquez C, Laguna-Torres VA, Plotkin S. Influenza in Latin America: A report from the Global Influenza Initiative (GII). Vaccine 2019; 37:2670-2678. [PMID: 30975568 DOI: 10.1016/j.vaccine.2019.03.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 01/01/2023]
Abstract
The Global Influenza Initiative (GII) is a global expert group that aims to raise acceptance and uptake of influenza vaccines globally and provides recommendations and strategies to address challenges at local, national, regional, and global levels. This article provides a consolidated estimation of disease burden in Latin America, currently lacking in published literature, and delivers the GII recommendations specific to Latin America that provide guidance to combat existing vaccination challenges. While many countries worldwide, especially in the tropics and subtropics, do not have a seasonal influenza policy, 90% of Latin American countries have a seasonal influenza policy in place. Local governments in the Latin American countries and The Pan American Health Organization's Technical Advisory Group on Vaccine-preventable Diseases play a major role in improving the vaccination coverage and reducing the overall disease burden. Influenza seasonality poses the biggest challenge in deciding on optimal timing for vaccination in Latin America, as in temperate climates seasonal influenza activity peaks during the winter months (November-February and May-October) in the northern and southern hemispheres, respectively, while in the tropics and subtropical regions it usually occurs throughout the year, but especially during the rainy season. Besides this, vaccine mismatch with circulating strains, misconception concerning influenza vaccine effectiveness, and poor disease and vaccine awareness among the public are also key challenges that need to be overcome. Standardization of clinical case definitions is important across all Latin American countries. Surveillance (mostly passive) has improved substantially in the Latin American countries over the past decade, but more is still required to better understand the disease burden and help inform policies.
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Affiliation(s)
- Angela Gentile
- Ricardo Gutiérrez Children's Hospital, 1405 Buenos Aires, Argentina.
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, the Netherlands.
| | - Nancy Bellei
- Department of Medicine, Federal University of São Paulo, 04024-002 São Paulo, Brazil.
| | - Juan Pablo Torres
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, University of Chile, 1058 Santiago, Chile.
| | - Cynthia Vazquez
- Department of Virology, Central Laboratory for Public Health, 1429 Asunción, Paraguay
| | - V Alberto Laguna-Torres
- Tropical Medicine Institute Daniel A. Carrion, Virology Section, San Marcos University, 15081 Lima, Peru
| | - Stanley Plotkin
- University of Pennsylvania, Vaxconsult, Doylestown, PA 18907, USA.
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Debellut F, Hendrix N, Ortiz JR, Lambach P, Neuzil KM, Bhat N, Pecenka C. Forecasting demand for maternal influenza immunization in low- and lower-middle-income countries. PLoS One 2018; 13:e0199470. [PMID: 29933402 PMCID: PMC6014664 DOI: 10.1371/journal.pone.0199470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022] Open
Abstract
Immunization of pregnant women against seasonal influenza remains limited in low- and lower-middle-income countries despite being recommended by the World Health Organization (WHO). The WHO/PATH Maternal Influenza Immunization Project was created to identify and address obstacles to delivering influenza vaccines to pregnant women in low resource setting. To gain a better understanding of potential demand from this target group, we developed a model simulating pregnant women populations eligible for vaccination during antenatal care (ANC) services in all low- and lower-middle-income countries. We assessed potential vaccine demand in the context of both seasonal and year-round vaccination strategies and identified the ways that immunization programs may be affected by availability gaps in supply linked to current vaccine production cycles and shelf life duration. Results of our analysis, which includes 54 eligible countries in 2015 for New Vaccine Support from Gavi, the Vaccine Alliance, suggest the demand for influenza vaccines could be 7.7 to 16.0 million doses in 2020, and 27.0 to 61.7 million doses by 2029. If current trends in production capacity and actual production of seasonal influenza vaccines were to continue, global vaccine supply would be sufficient to meet this additional demand—although a majority of countries would face implementation issues linked to timing of supply.
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Affiliation(s)
- Frédéric Debellut
- Center for Vaccine Innovation and Access, PATH, Geneva, Switzerland
- * E-mail:
| | - Nathaniel Hendrix
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, United States of America
| | - Justin R. Ortiz
- Center for Vaccine Development, University of Maryland, Baltimore, Maryland, United States of America
| | - Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Kathleen M. Neuzil
- Center for Vaccine Development, University of Maryland, Baltimore, Maryland, United States of America
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, United States of America
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, United States of America
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Cortes-Alcala R, Dos Santos G, DeAntonio R, Devadiga R, Ruiz-Matus C, Jimenez-Corona ME, Diaz-Quinonez JA, Romano-Mazzotti L, Cervantes-Apolinar MY, Kuri-Morales P. The burden of influenza A and B in Mexico from the year 2010 to 2013: An observational, retrospective, database study, on records from the Directorate General of Epidemiology database. Hum Vaccin Immunother 2018; 14:1890-1898. [PMID: 29746798 PMCID: PMC6149840 DOI: 10.1080/21645515.2018.1456281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/09/2018] [Indexed: 11/01/2022] Open
Abstract
Despite vaccination programs, influenza still represents a significant disease burden in Mexico. We conducted an observational, retrospective analysis to better understand the epidemiological situation of the influenza virus in Mexico. Analysis of the seasonal patterns of influenza A and B were based on the Directorate General of Epidemiology dataset of influenza-like illness(ILI), and severe acute respiratory infection(SARI) that were recorded between January 2010 and December 2013. Our objectives were 1) to describe influenza A and B activity, by age group, and subtype and, 2) to analyze the number of laboratory-confirmed cases presenting with ILI by influenza type, the regional distribution of influenza, and its clinical features. Three periods of influenza activity were captured: August 2010-January 2011, December 2011-March 2012, and October 2012-March 2013. Cases were reported throughout Mexico, with 50.3% (n = 10,320) of cases found in 18-49 year olds. Over the entire capture period, a total of 76,085 ILI/SARI episodes had swab samples analyzed for influenza, 27% were positive. During the same period, influenza A cases were higher in the 18-49 years old, and influenza B cases in both 5-17 and 18-49 age groups. Peak activity occurred in January 2012 (n = 4,159) and December 2012 (n = 348) for influenza A and B respectively. This analysis confirms that influenza is an important respiratory pathogen for children and adults in Mexico despite vaccination recommendations. School-age children and adolescents were more prone to influenza B infection; while younger adults were susceptible to both influenza A and B viruses. Over the seasons, influenza A and B co-circulated.
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Affiliation(s)
| | | | - Rodrigo DeAntonio
- GSK, Urbanización Industrial Juan Díaz Entre Calles A y B, Apartado Postal 6-1697, Panama City, Panama
| | - Raghavendra Devadiga
- GSK, 5, Embassy Links, SRT Road, Opp to Accenture, Cunningham Road, Vasanth Nagar, Bengaluru, Karnataka, India
| | - Cuitlahuac Ruiz-Matus
- Director General of Epidemiology, Ministry of Health, Francisco de P. Miranda 177 Lomas de Plateros, Ciudad de México, México
| | - Maria E. Jimenez-Corona
- Deputy Director General of Epidemiology, Ministry of Health, Francisco de P. Miranda 177 Lomas de Plateros, Ciudad de México, México
| | - Jose A. Diaz-Quinonez
- Deputy Director General of the Institute for Epidemic Diagnose and Reference, Ministry of Health, Francisco de P. Miranda 177 Lomas de Plateros, Ciudad de México, México
- Faculty of Medicine, National Autonomous University of Mexico, Division of Graduate Studies, Avenida Universidad 3000, Copilco El Bajo, Coyoacan, CDMX, Ciudad de México, México
| | | | | | - Pablo Kuri-Morales
- Faculty of Medicine, National Autonomous University of Mexico, Division of Graduate Studies, Avenida Universidad 3000, Copilco El Bajo, Coyoacan, CDMX, Ciudad de México, México
- Assistant Secretary for Health Promotion and Disease Prevention, Lieja No. 7, Col. Juarez, Ciudad de México, México
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Monamele GC, Vernet MA, Nsaibirni RFJ, Bigna JJR, Kenmoe S, Njankouo MR, Njouom R. Associations between meteorological parameters and influenza activity in a subtropical country: Case of five sentinel sites in Yaoundé-Cameroon. PLoS One 2017; 12:e0186914. [PMID: 29088290 PMCID: PMC5663393 DOI: 10.1371/journal.pone.0186914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/10/2017] [Indexed: 12/04/2022] Open
Abstract
Influenza is associated with highly contagious respiratory infections. Previous research has found that influenza transmission is often associated with climate variables especially in temperate regions. This study was performed in order to fill the gap of knowledge regarding the relationship between incidence of influenza and three meteorological parameters (temperature, rainfall and humidity) in a tropical setting. This was a retrospective study performed in Yaoundé-Cameroon from January 2009 to November 2015. Weekly proportions of confirmed influenza cases from five sentinel sites were considered as dependent variables, whereas weekly values of mean temperature, average relative humidity and accumulated rainfall were considered as independent variables. A univariate linear regression model was used in determining associations between influenza activity and weather covariates. A time-series method was used to predict on future values of influenza activity. The data was divided into 2 parts; the first 71 months were used to calibrate the model, and the last 12 months to test for prediction. Overall, there were 1173 confirmed infections with influenza virus. Linear regression analysis showed that there was no statistically significant association observed between influenza activity and weather variables. Very weak relationships (-0.1 < r < 0.1) were observed. Three prediction models were obtained for the different viral types (overall positive, Influenza A and Influenza B). Model 1 (overall influenza) and model 2 (influenza A) fitted well during the estimation period; however, they did not succeed to make good forecasts for predictions. Accumulated rainfall was the only external covariate that enabled good fit of both models. Based on the stationary R2, 29.5% and 41.1% of the variation in the series can be explained by model 1 and 2, respectively. This study laid more emphasis on the fact that influenza in Cameroon is characterized by year-round activity. The meteorological variables selected in this study did not enable good forecast of future influenza activity and certainly acted as proxies to other factors not considered, such as, UV radiation, absolute humidity, air quality and wind.
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Affiliation(s)
- Gwladys C. Monamele
- National Influenza Centre, Centre Pasteur du Cameroun, Yaoundé, Cameroon
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | | | | | - Jean Joel R. Bigna
- National Influenza Centre, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | - Sebastien Kenmoe
- National Influenza Centre, Centre Pasteur du Cameroun, Yaoundé, Cameroon
| | | | - Richard Njouom
- National Influenza Centre, Centre Pasteur du Cameroun, Yaoundé, Cameroon
- * E-mail:
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Ayora-Talavera G, Flores GMZ, Gómez-Carballo J, González-Losa R, Conde-Ferraez L, Puerto-Solís M, López-Martínez I, Díaz-Quiñonez A, Barrera-Badillo G, Acuna-Soto R, Livinski AA, Alonso WJ. Influenza seasonality goes south in the Yucatan Peninsula: The case for a different influenza vaccine calendar in this Mexican region. Vaccine 2017; 35:4738-4744. [PMID: 28755836 DOI: 10.1016/j.vaccine.2017.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/22/2017] [Accepted: 07/05/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While vaccination may be relatively straightforward for regions with a well-defined winter season, the situation is quite different for tropical regions. Influenza activity in tropical regions might be out of phase with the dynamics predicted for their hemispheric group thereby impacting the effectiveness of the immunization campaign. OBJECTIVE To investigate how the climatic diversity of Mexico hinders its existing influenza immunization strategy and to suggest that the hemispheric vaccine recommendations be tailored to the regional level in order to optimize vaccine effectiveness. METHODS We studied the seasonality of influenza throughoutMexico by modeling virological and mortality data.De-trended time series of each Mexican state were analyzed by Fourier decomposition to describe the amplitude and timing of annual influenza epidemic cycles and to compare with each the timing of the WHO's Northern and Southern Hemispheric vaccination schedule. FINDINGS The timings of the primary (major) peaks of both virological and mortality data for most Mexican states are well aligned with the Northern Hemisphere winter (December-February) and vaccine schedule. However, influenza peaks in September in the three states of the Yucatan Peninsula. Influenza-related mortality also peaks in September in Quintana Roo and Yucatan whereas it peaks in May in Campeche. As the current timing of vaccination in Mexico is between October and November, more than half of the annual influenza cases have already occurred in the Yucatan Peninsula states by the time the Northern Hemispheric vaccine is delivered and administered. CONCLUSION The current Northern Hemispheric influenza calendar adopted for Mexico is not optimal for the Yucatan Peninsula states thereby likely reducing the effectiveness of the immunization of the population. We recommend that Mexico tailor its immunization strategy to better reflect its climatologic and epidemiological diversity and adopt the WHO Southern Hemisphere influenza vaccine and schedule for the Yucatan Peninsula.
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Affiliation(s)
- Guadalupe Ayora-Talavera
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Av. Itzaes #490x59, Centro, C. P. 97000 Merida, Yucatan, Mexico.
| | - Gerardo Montalvo-Zurbia Flores
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Av. Itzaes #490x59, Centro, C. P. 97000 Merida, Yucatan, Mexico.
| | - Jesus Gómez-Carballo
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Av. Itzaes #490x59, Centro, C. P. 97000 Merida, Yucatan, Mexico.
| | - Refugio González-Losa
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Av. Itzaes #490x59, Centro, C. P. 97000 Merida, Yucatan, Mexico.
| | - Laura Conde-Ferraez
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Av. Itzaes #490x59, Centro, C. P. 97000 Merida, Yucatan, Mexico.
| | - Marylin Puerto-Solís
- Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Autónoma de Yucatán, Av. Itzaes #490x59, Centro, C. P. 97000 Merida, Yucatan, Mexico.
| | - Irma López-Martínez
- Instituto de Diagnóstico y Referencia Epidemiológicos "Dr. Manuel Martínez Báez" (InDRE), Secretaría de Salud, Francisco de P. Miranda 177, Lomas de Plateros, 01480 Álvaro Obregón, Mexico City, Mexico.
| | - Alberto Díaz-Quiñonez
- Instituto de Diagnóstico y Referencia Epidemiológicos "Dr. Manuel Martínez Báez" (InDRE), Secretaría de Salud, Francisco de P. Miranda 177, Lomas de Plateros, 01480 Álvaro Obregón, Mexico City, Mexico.
| | - Gisela Barrera-Badillo
- Instituto de Diagnóstico y Referencia Epidemiológicos "Dr. Manuel Martínez Báez" (InDRE), Secretaría de Salud, Francisco de P. Miranda 177, Lomas de Plateros, 01480 Álvaro Obregón, Mexico City, Mexico.
| | - Rodolfo Acuna-Soto
- Departamento de Microbiologia y Parasitologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad Universitaria, Avenida Insurgentes Sur 3000, Del. Coyoacán, C.P. 04510 Ciudad de México, Mexico.
| | - Alicia A Livinski
- National Institute of Health Library, Division of Library Services, Office of Research Services, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Wladimir J Alonso
- Fogarty International Center, National Institutes of Health, 16 Center Drive, Bethesda, MD 20892, USA.
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Horton KC, Dueger EL, Kandeel A, Abdallat M, El-Kholy A, Al-Awaidy S, Kohlani AH, Amer H, El-Khal AL, Said M, House B, Pimentel G, Talaat M. Viral etiology, seasonality and severity of hospitalized patients with severe acute respiratory infections in the Eastern Mediterranean Region, 2007-2014. PLoS One 2017; 12:e0180954. [PMID: 28704440 PMCID: PMC5509236 DOI: 10.1371/journal.pone.0180954] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/23/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Little is known about the role of viral respiratory pathogens in the etiology, seasonality or severity of severe acute respiratory infections (SARI) in the Eastern Mediterranean Region. Methods Sentinel surveillance for SARI was conducted from December 2007 through February 2014 at 20 hospitals in Egypt, Jordan, Oman, Qatar and Yemen. Nasopharyngeal and oropharyngeal swabs were collected from hospitalized patients meeting SARI case definitions and were analyzed for infection with influenza, respiratory syncytial virus (RSV), adenovirus (AdV), human metapneumovirus (hMPV) and human parainfluenza virus types 1–3 (hPIV1-3). We analyzed surveillance data to calculate positivity rates for viral respiratory pathogens, describe the seasonality of those pathogens and determine which pathogens were responsible for more severe outcomes requiring ventilation and/or intensive care and/or resulting in death. Results At least one viral respiratory pathogen was detected in 8,753/28,508 (30.7%) samples tested for at least one pathogen and 3,497/9,315 (37.5%) of samples tested for all pathogens–influenza in 3,345/28,438 (11.8%), RSV in 3,942/24,503 (16.1%), AdV in 923/9,402 (9.8%), hMPV in 617/9,384 (6.6%), hPIV1 in 159/9,402 (1.7%), hPIV2 in 85/9,402 (0.9%) and hPIV3 in 365/9,402 (3.9%). Multiple pathogens were identified in 501/9,316 (5.4%) participants tested for all pathogens. Monthly variation, indicating seasonal differences in levels of infection, was observed for all pathogens. Participants with hMPV infections and participants less than five years of age were significantly less likely than participants not infected with hMPV and those older than five years of age, respectively, to experience a severe outcome, while participants with a pre-existing chronic disease were at increased risk of a severe outcome, compared to those with no reported pre-existing chronic disease. Conclusions Viral respiratory pathogens are common among SARI patients in the Eastern Mediterranean Region. Ongoing surveillance is important to monitor changes in the etiology, seasonality and severity of pathogens of interest.
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Affiliation(s)
- Katherine C. Horton
- Global Disease Detection Center, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit, No.3, Cairo, Egypt
- * E-mail:
| | - Erica L. Dueger
- Global Disease Detection Center, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit, No.3, Cairo, Egypt
- Global Disease Detection Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Mohamed Abdallat
- Communicable Disease Department, Ministry of Health, Amman, Jordan
| | - Amani El-Kholy
- Clinical Pathology Department, Cairo University Hospitals, Cairo, Egypt
| | - Salah Al-Awaidy
- Communicable Disease Department, Ministry of Health, Muscat, Oman
| | | | - Hanaa Amer
- Clinical Pathology Department, Ain Shams University, Cairo, Egypt
| | | | - Mayar Said
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit, No.3, Cairo, Egypt
| | - Brent House
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit, No.3, Cairo, Egypt
| | - Guillermo Pimentel
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit, No.3, Cairo, Egypt
| | - Maha Talaat
- Global Disease Detection Center, U.S. Centers for Disease Control and Prevention, Cairo, Egypt
- Global Disease Detection and Response Program, U.S. Naval Medical Research Unit, No.3, Cairo, Egypt
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26
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Steinhoff MC, Katz J, Englund JA, Khatry SK, Shrestha L, Kuypers J, Stewart L, Mullany LC, Chu HY, LeClerq SC, Kozuki N, McNeal M, Reedy AM, Tielsch JM. Year-round influenza immunisation during pregnancy in Nepal: a phase 4, randomised, placebo-controlled trial. THE LANCET. INFECTIOUS DISEASES 2017; 17:981-989. [PMID: 28522338 DOI: 10.1016/s1473-3099(17)30252-9] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 02/10/2017] [Accepted: 03/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Influenza immunisation during pregnancy is recommended but not widely implemented in some low-income regions. We assessed the safety and efficacy in mothers and infants of year-round maternal influenza immunisation in Nepal, where influenza viruses circulate throughout the year. METHODS In this phase 4, randomised, placebo-controlled trial, we enrolled two consecutive sequential annual cohorts of pregnant women from the Sarlahi district in southern Nepal. We randomised mothers 1:1 to receive seasonally recommended trivalent inactivated influenza vaccine or saline placebo in blocks of eight, stratified by gestational age at enrolment (17-25 weeks vs 26-34 weeks). Women were eligible if they were married, 15-40 years of age, 17-34 weeks' gestation at enrolment, and had not previously received any influenza vaccine that season. We collected serum samples before and after immunisation, and cord blood from a subset of women and infants. Staff masked to allocation made home visits every week from enrolment to 6 months after delivery. Midnasal swabs for respiratory virus PCR testing were collected during maternal acute febrile respiratory infections, and from infants with any respiratory symptom. We assessed vaccine immunogenicity, safety, and three primary outcomes: the incidence of maternal influenza-like illness in pregnancy and 0-180 days postpartum, the incidence of low birthweight (<2500 g), and the incidence of laboratory-confirmed infant influenza disease from 0 to 180 days. This trial is registered with ClinicalTrials.gov, number NCT01034254. FINDINGS From April 25, 2011, to Sept 9, 2013, we enrolled 3693 women in two cohorts of 2090 (1041 assigned to placebo and 1049 to vaccine) and 1603 (805 assigned to placebo and 798 to vaccine), with 3646 liveborn infants (cohort 1, 999 in placebo group and 1010 in vaccine group; cohort 2, 805 in placebo group and 798 in vaccine group). Immunisation reduced maternal febrile influenza-like illness with an overall efficacy of 19% (95% CI 1 to 34) in the combined cohorts; 9% efficacy (-16 to 29) in the first cohort, and 36% efficacy (9 to 55) in the second cohort. For laboratory-confirmed influenza infections in infants aged 0-6 months, immunisation had an overall efficacy for the combined cohorts of 30% (95% CI 5 to 48); in the first cohort, the efficacy was 16% (-19 to 41), and in the second cohort it was 60% (26 to 88). Maternal immunisation reduced the rates of low birthweight by 15% (95% CI 3-25) in both cohorts combined. The rate of small for gestational age infants was not modified by immunisation. The number of adverse events was similar regardless of immunisation status. Miscarriage occurred in three (0·2%) participants in the placebo group versus five (0·3%) in the vaccine group, stillbirth occurred in 31 (1·7%) versus 33 (1·8%), and congenital defects occurred in 18 (1·0%) versus 20 (1·1%). Five women died in the placebo group and three died in the vaccine group. The number of infant deaths at age 0-6 months was similar in each group (50 in the placebo group and 61 in the vaccine group). No serious adverse events were associated with receipt of immunisation. INTERPRETATION Year-round maternal influenza immunisation significantly reduced maternal influenza-like illness, influenza in infants, and low birthweight over the entire course of the study, indicating the strategy could be useful in subtropical regions. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Mark C Steinhoff
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Janet A Englund
- Seattle Children's Hospital and Research Foundation, University of Washington, Seattle, WA, USA
| | | | - Laxman Shrestha
- Tribhuvan University, Department of Pediatrics and Child Health, Institute of Medicine, Kathmandu, Nepal
| | - Jane Kuypers
- School of Medicine, University of Washington, Molecular Virology Laboratory, Seattle, WA, USA
| | - Laveta Stewart
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Helen Y Chu
- School of Medicine, University of Washington, Seattle, WA, USA; Harborview Medical Center, Seattle, WA, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Nepal Nutrition Intervention Project, Sarlahi, Kathmandu, Nepal
| | - Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Monica McNeal
- Division of Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adriana M Reedy
- Global Health Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James M Tielsch
- Department of Global Health Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Cowling BJ, Caini S, Chotpitayasunondh T, Djauzi S, Gatchalian SR, Huang QS, Koul PA, Lee PI, Muttalif AR, Plotkin S. Influenza in the Asia-Pacific region: Findings and recommendations from the Global Influenza Initiative. Vaccine 2017; 35:856-864. [PMID: 28081970 DOI: 10.1016/j.vaccine.2016.12.064] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/15/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022]
Abstract
The fourth roundtable meeting of the Global Influenza Initiative (GII) was held in Hong Kong, China, in July 2015. An objective of this meeting was to gain a broader understanding of the epidemiology, surveillance, vaccination policies and programs, and obstacles to vaccination of influenza in the Asia-Pacific region through presentations of data from Australia, Hong Kong, India, Indonesia, Malaysia, New Zealand, the Philippines, Taiwan, Thailand, and Vietnam. As well as a need for improved levels of surveillance in some areas, a range of factors were identified that act as barriers to vaccination in some countries, including differences in climate and geography, logistical challenges, funding, lack of vaccine awareness and education, safety concerns, perceived lack of vaccine effectiveness, and lack of inclusion in national guidelines. From the presentations at the meeting, the GII discussed a number of recommendations for easing the burden of influenza and overcoming the current challenges in the Asia-Pacific region. These recommendations encompass the need to improve surveillance and availability of epidemiological data; the development and publication of national guidelines, where not currently available and/or that are in line with those proposed by the World Health Organization; the requirement for optimal timing of vaccination programs according to local or country-specific epidemiology; and calls for advocacy and government support of vaccination programs in order to improve availability and uptake and coverage. In conclusion, in addition to the varied epidemiology of seasonal influenza across this diverse region, there are a number of logistical and resourcing issues that present a challenge to the development of optimally effective vaccination strategies and that need to be overcome to improve access to and uptake of seasonal influenza vaccines. The GII has developed a number of recommendations to address these challenges and improve the control of influenza.
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Affiliation(s)
- Benjamin J Cowling
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Saverio Caini
- NIVEL, Dutch Institute for Health Services Research, Utrecht, The Netherlands
| | - Tawee Chotpitayasunondh
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | | | - Salvacion R Gatchalian
- University of the Philippines Manila, College of Medicine, Philippine General Hospital, Manila City, Philippines
| | - Q Sue Huang
- Institute of Environmental Science and Research (ESR), Wallaceville, Upper Hutt, New Zealand
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ping-Ing Lee
- National Taiwan University Children's Hospital, Taipei, Taiwan
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Lucero MG, Inobaya MT, Nillos LT, Tan AG, Arguelles VLF, Dureza CJC, Mercado ES, Bautista AN, Tallo VL, Barrientos AV, Rodriguez T, Olveda RM. National Influenza Surveillance in the Philippines from 2006 to 2012: seasonality and circulating strains. BMC Infect Dis 2016; 16:762. [PMID: 27993136 PMCID: PMC5168815 DOI: 10.1186/s12879-016-2087-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/01/2016] [Indexed: 11/15/2022] Open
Abstract
Background The results of routine influenza surveillance in 13 regions in the Philippines from 2006 to 2012 are presented, describing the annual seasonal epidemics of confirmed influenza virus infection, seasonal and alert thresholds, epidemic curve, and circulating influenza strains. Methods Retrospective analysis of Philippine influenza surveillance data from 2006 to 2012 was conducted to determine seasonality with the use of weekly influenza positivity rates and calculating epidemic curves and seasonal and alert thresholds using the World Health Organization (WHO) global epidemiological surveillance standards for influenza. Results Increased weekly influenza positive rates were observed from June to November, coinciding with the rainy season and school opening. Two or more peaks of influenza activity were observed with different dominant influenza types associated with each peak. A-H1N1, A-H3N2, and two types of B viruses circulated during the influenza season in varying proportions every year. Increased influenza activity for 2012 occurred 8 weeks late in week 29, rather than the expected week of rise of cases in week 21 as depicted in the established average epidemic curve and seasonal threshold. The intensity was severe going above the alert threshold but of short duration. Southern Hemisphere vaccine strains matched circulating influenza virus for more surveillance years than Northern Hemisphere vaccine strains. Conclusions Influenza seasonality in the Philippines is from June to November. The ideal time to administer Southern Hemisphere influenza vaccine should be from April to May. With two lineages of influenza B circulating annually, quadrivalent vaccine might have more impact on influenza control than trivalent vaccine. Establishment of thresholds and average epidemic curve provide a tool for policy-makers to assess the intensity or severity of the current influenza epidemic even early in its course, to help plan more precisely resources necessary to control the outbreak. Influenza surveillance activities should be continued in the Philippines and funding for such activities should already be incorporated into the Philippine health budget. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2087-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marilla G Lucero
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines.
| | - Marianette T Inobaya
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Leilani T Nillos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Alvin G Tan
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Vina Lea F Arguelles
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Christine Joy C Dureza
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Edelwisa S Mercado
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Analisa N Bautista
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Veronica L Tallo
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Agnes V Barrientos
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
| | - Tomas Rodriguez
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Remigio M Olveda
- Department of Health, Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines
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Divala TH, Kalilani-Phiri L, Mawindo P, Nyirenda O, Kapito-Tembo A, Laufer MK. Incidence and Seasonality of Influenza-Like Illnesses Among Pregnant Women in Blantyre, Malawi. Am J Trop Med Hyg 2016; 95:915-917. [PMID: 27527633 DOI: 10.4269/ajtmh.16-0243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/06/2016] [Indexed: 11/07/2022] Open
Abstract
Pregnant women with influenza infection are at increased risk of developing complications compared with other adults. Information about burden of influenza in pregnant women in Africa is limited. To determine incidence and seasonality of influenza-like illness (ILI) in pregnant women in Blantyre, Malawi, we recruited a cohort of 450 pregnant women and conducted surveillance for ILI and malaria infection. We recorded gestational age and birthweight. We accrued 157 person-years of observation (PYO) and detected 37 episodes of ILI (24/100 PYO) and 83 episodes of malaria infection (including all new episodes of parasitemia) (53/100 PYO). ILI was the most common cause of fever, but was not associated with adverse pregnancy outcomes. ILI incidence peaked during the hot dry season. These results indicate that ILI is a significant burden among Malawian pregnant women and it is somewhat seasonal. Studies with molecular diagnostics are needed to establish influenza-specific burden and the potential role of vaccination.
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Affiliation(s)
- Titus H Divala
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Linda Kalilani-Phiri
- Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi
| | - Patricia Mawindo
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Osward Nyirenda
- Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi
| | - Atupele Kapito-Tembo
- Malaria Alert Centre, University of Malawi College of Medicine, Blantyre, Malawi
| | - Miriam K Laufer
- Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
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Hirve S, Newman LP, Paget J, Azziz-Baumgartner E, Fitzner J, Bhat N, Vandemaele K, Zhang W. Influenza Seasonality in the Tropics and Subtropics - When to Vaccinate? PLoS One 2016; 11:e0153003. [PMID: 27119988 PMCID: PMC4847850 DOI: 10.1371/journal.pone.0153003] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/22/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The timing of the biannual WHO influenza vaccine composition selection and production cycle has been historically directed to the influenza seasonality patterns in the temperate regions of the northern and southern hemispheres. Influenza activity, however, is poorly understood in the tropics with multiple peaks and identifiable year-round activity. The evidence-base needed to take informed decisions on vaccination timing and vaccine formulation is often lacking for the tropics and subtropics. This paper aims to assess influenza seasonality in the tropics and subtropics. It explores geographical grouping of countries into vaccination zones based on optimal timing of influenza vaccination. METHODS Influenza seasonality was assessed by different analytic approaches (weekly proportion of positive cases, time series analysis, etc.) using FluNet and national surveillance data. In case of discordance in the seasonality assessment, consensus was built through discussions with in-country experts. Countries with similar onset periods of their primary influenza season were grouped into geographical zones. RESULTS The number and period of peak activity was ascertained for 70 of the 138 countries in the tropics and subtropics. Thirty-seven countries had one and seventeen countries had two distinct peaks. Countries near the equator had secondary peaks or even identifiable year-round activity. The main influenza season in most of South America and Asia started between April and June. The start of the main season varied widely in Africa (October and December in northern Africa, April and June in Southern Africa and a mixed pattern in tropical Africa). Eight "influenza vaccination zones" (two each in America and Asia, and four in Africa and Middle East) were defined with recommendations for vaccination timing and vaccine formulation. The main limitation of our study is that FluNet and national surveillance data may lack the granularity to detect sub-national variability in seasonality patterns. CONCLUSION Distinct influenza seasonality patterns, though complex, could be ascertained for most countries in the tropics and subtropics using national surveillance data. It may be possible to group countries into zones based on similar recommendations for vaccine timing and formulation.
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Affiliation(s)
| | - Laura P. Newman
- University of Washington, Seattle, Washington, United States of America
| | - John Paget
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | | | - Julia Fitzner
- Global Influenza Program, World Health Organization, Geneva, Switzerland
| | - Niranjan Bhat
- Program for Appropriate Technology, Seattle, Washington, United States of America
| | | | - Wenqing Zhang
- Global Influenza Program, World Health Organization, Geneva, Switzerland
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Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination? PLoS One 2016; 11:e0152310. [PMID: 27031105 PMCID: PMC4816507 DOI: 10.1371/journal.pone.0152310] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/11/2016] [Indexed: 12/28/2022] Open
Abstract
Introduction Determining the optimal time to vaccinate is important for influenza vaccination programmes. Here, we assessed the temporal characteristics of influenza epidemics in the Northern and Southern hemispheres and in the tropics, and discuss their implications for vaccination programmes. Methods This was a retrospective analysis of surveillance data between 2000 and 2014 from the Global Influenza B Study database. The seasonal peak of influenza was defined as the week with the most reported cases (overall, A, and B) in the season. The duration of seasonal activity was assessed using the maximum proportion of influenza cases during three consecutive months and the minimum number of months with ≥80% of cases in the season. We also assessed whether co-circulation of A and B virus types affected the duration of influenza epidemics. Results 212 influenza seasons and 571,907 cases were included from 30 countries. In tropical countries, the seasonal influenza activity lasted longer and the peaks of influenza A and B coincided less frequently than in temperate countries. Temporal characteristics of influenza epidemics were heterogeneous in the tropics, with distinct seasonal epidemics observed only in some countries. Seasons with co-circulation of influenza A and B were longer than influenza A seasons, especially in the tropics. Discussion Our findings show that influenza seasonality is less well defined in the tropics than in temperate regions. This has important implications for vaccination programmes in these countries. High-quality influenza surveillance systems are needed in the tropics to enable decisions about when to vaccinate.
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Saha S, Chadha M, Shu Y. Divergent seasonal patterns of influenza types A and B across latitude gradient in Tropical Asia. Influenza Other Respir Viruses 2016; 10:176-84. [PMID: 26781162 PMCID: PMC4814861 DOI: 10.1111/irv.12372] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Influenza circulation in tropics and subtropics reveals a complex seasonal pattern with year‐round circulation in some areas and biannual peaks in others. Methods We analyzed influenza surveillance data from nine countries around southern and southeastern Asia spanning latitudinal gradient from equatorial to temperate zones to further characterize influenza type‐specific seasonality in the region. We calculated proportion of positives by month out of positives during that year and adjust for variation in samples tested and positivity in these countries. Results Influenza A epidemics were identified between November and March during winters in areas lying above 30°N latitude, during monsoon months of June–November in areas between 10° and 30°N latitude, and no specific seasonality for influenza A virus circulation in areas lying closer to the equator. Influenza B circulation coincided with influenza A circulation in areas lying above 30°N latitude; however, in areas south of 30°N Asia, influenza B circulated year round at 3–8% of annual influenza B positives during most months with less pronounced peaks during post‐monsoon period. Conclusion Even though influenza B circulates round the year in most areas of the tropical regions of southern and southeastern Asia, the most appropriate time for influenza vaccination using the most recent WHO recommended vaccine would be prior to the monsoon season conferring protection against influenza A and B peaks.
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Affiliation(s)
| | | | - Yuelong Shu
- Chinese National Influenza Center, Beijing, China
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Lambach P, Alvarez AMR, Hirve S, Ortiz JR, Hombach J, Verweij M, Hendriks J, Palkonyay L, Pfleiderer M. Considerations of strategies to provide influenza vaccine year round. Vaccine 2015; 33:6493-8. [PMID: 26319745 PMCID: PMC8218336 DOI: 10.1016/j.vaccine.2015.08.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/27/2015] [Accepted: 08/11/2015] [Indexed: 11/20/2022]
Abstract
There is potential for influenza vaccine programmes to make a substantial impact on severe disease in low-resource settings, however questions around vaccine composition and programmatic issues will require special attention. Some countries may benefit from immunization programmes that provide year-round supply of vaccine; however the best way to ensure adequate vaccine supply has yet to be determined. In this report, we discuss vaccine composition, availability, and programmatic issues that must be considered when developing year-round influenza immunization programmes. We then explore how these considerations have influenced immunization practices in the Latin American region as a case study. We identify three different approaches to achieve year-round supply: (1) alternating between Northern Hemisphere and Southern Hemisphere formulations, (2) extending the expiration date to permit extended use of a single hemisphere formulation, and (3) local vaccine manufacture with production timelines that align with local epidemiology. Each approach has its challenges and opportunities. The growing data suggesting high influenza disease burden in low resource countries underscores the compelling public health need to determine the best strategies for vaccine delivery.
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Affiliation(s)
- Philipp Lambach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland.
| | - Alba Maria Ropero Alvarez
- Immunization Unit, Pan American Health Organization, 525 Twenty Third St., NW, Washington, DC 20037, USA
| | | | - Justin R Ortiz
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Joachim Hombach
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Marcel Verweij
- Department of Social Sciences, Subdepartment Communication, Philosophy, and Technology, Wageningen University, Wageningen, The Netherlands
| | - Jan Hendriks
- Essential Medicines Department, World Health Organization, Geneva, Switzerland
| | - Laszlo Palkonyay
- Essential Medicines Department, World Health Organization, Geneva, Switzerland
| | - Michael Pfleiderer
- Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Institut, Langen, Germany
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Koul PA, Broor S, Saha S, Barnes J, Smith C, Shaw M, Chadha M, Lal RB. Differences in influenza seasonality by latitude, northern India. Emerg Infect Dis 2015; 20:1723-6. [PMID: 25279651 PMCID: PMC4193176 DOI: 10.3201/eid2010.140431] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The seasonality of influenza in the tropics complicates vaccination timing. We investigated influenza seasonality in northern India and found influenza positivity peaked in Srinagar (34.09°N) in January–March but peaked in New Delhi (28.66°N) in July–September. Srinagar should consider influenza vaccination in October–November, but New Delhi should vaccinate in May–June.
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Gerasimov SV, Belova HA, Pavuk HL, Seniuk IM, Strekalina YI. The Ukrainian version of the pediatric Canadian acute respiratory illness and flu scale: a linguistic validation study. PATIENT-RELATED OUTCOME MEASURES 2014; 5:111-7. [PMID: 25378963 PMCID: PMC4218903 DOI: 10.2147/prom.s70925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is no internationally recognized outcome measure for the assessment of acute respiratory tract infections (ARTIs) in children. The only identifiable scale initially developed for pediatric application has been the Canadian acute respiratory illness and flu scale (CARIFS). The aim of our trial was to adapt the English version of the CARIFS to the Ukrainian language. MATERIALS AND METHODS We performed forward and backward translation of the original version of the CARIFS according to the recommended standard. Then, the final CARIFS-based Ukrainian questionnaires were given to 149 caregivers whose 3-12 years old children suffered from ARTI. The questionnaires were completed twice by a caregiver 3-6 hours apart and once by a physician just after the second completion by a caregiver. The database was analyzed to assess the consistency (the Cronbach's α coefficient), sensitivity (the standardized response mean; the effect size), reliability (test-retest analysis), and validity (Pearson's correlation) of the CARIFS in the Ukrainian language. RESULTS The backward translation of the Ukrainian version of the CARIFS demonstrated its good correspondence to the English version. The Cronbach's α coefficient was 0.805, and item to total correlation coefficients varied from 0.185 to 0.665. The standardized response mean was 1.73, and the effect size was 2.50 suggesting good sensitivity of the scale. In the test-retest reliability analysis of 99 questionnaires, the median CARIFS score for the first and the second measurement was 19.0 (interquartile range [IQR]: 14.5-25.0) and 19.0 (IQR: 15.0-25.0), respectively, with a median change of 0.0 (IQR: -1.0 to 0.0, P=0.996). The Pearson's correlation coefficient between the CARIFS score completed by a responder and a physician was 0.832 (P=0.004). CONCLUSION The Ukrainian version of the CARIFS-based English questionnaire proved to be a consistent, sensitive, reliable, and valid instrument in the assessment of ARTI in preschool and elementary school children in the Ukrainian population.
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Affiliation(s)
- Sergei V Gerasimov
- Lviv National Medical University, Lviv City Children's Hospital, Lviv, Ukraine
| | | | - Halyna L Pavuk
- The Fifth Lviv Community Outpatient Clinic, Lviv, Ukraine
| | - Ihor M Seniuk
- The Fifth Lviv Community Outpatient Clinic, Lviv, Ukraine
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