Clinical practice guidelines 2019: Indian consensus-based recommendations on influenza vaccination in adults

Surveillance of influenza A and B viruses from community and hospital wastewater treatment plants

Influenza virus is a well-known pathogen that can cause epidemics and pandemics. Several surveillance methods are being followed to monitor the transmission patterns and spread of influenza in the community. Wastewater-based Epidemiology (WBE) can serve as an additional tool to detect the presence of influenza viruses. The current study primarily focuses on surveillance of Influenza A and Influenza B in wastewater treatment plant (WWTP) samples. A total of 100 wastewater samples were collected in July (n = 50) and August (n = 50) 2023 from four different WWTPs in Manipal and Udupi, district of Karnataka, India. The WWTP samples were processed and tested by Real-Time reverse transcriptase PCR (RT-PCR). The data generated was analysed in comparison with the clinical Influenza cases. Of the 100 samples, 18 (18%) tested positive for Influenza A virus and 2 (2%) tested positive for Influenza B virus, with a viral load ranging 1.4 x 102-2.2 x 103 gc/L for influenza A virus and 5.2 x 103-7.7 x 103gc/L for influenza B virus. On correlating the WWTP positivity with clinical case, it was found that influenza clinical cases and virus positivity in wastewater increased simultaneously, emphasizing WBE as a concurrent method for monitoring influenza virus activity.

Review of the unmet medical need for vaccination in adults with immunocompromising conditions: An Indian perspective

Immunocompromised (IC) populations are at increased risk of vaccine-preventable diseases (VPDs). In India, the concern of VPDs in IC populations is particularly acute due to the prevalence of crowded living situations, poor sanitation and variable access to healthcare services. We present a narrative review of IC-related disease and economic burden, risk of VPDs and vaccination guidelines, based on global and India-specific literature (2000-2022). IC conditions considered were cancer, diabetes mellitus, chronic kidney disease, respiratory disorders, disorders treated with immunosuppressive therapy, and human immune deficiency virus (HIV). The burden of IC populations in India is comparable to the global population, except for cancer and HIV, which have lower prevalence compared with the global average. Regional and socioeconomic inequalities exist in IC prevalence; VPDs add to the burden of IC conditions, especially in lower income strata. Adult vaccination programs could improve health and reduce the economic impact of VPDs in IC populations.

A Malaysian consensus recommendation for the prevention of influenza in older persons

BACKGROUND

Older persons are at high-risk of developing severe complications from influenza. This consensus statement was developed to provide guidance on appropriate influenza prevention strategies relevant to the Malaysian healthcare setting.

METHODS

Under the initiative of the Malaysian Influenza Working Group (MIWG), a panel comprising 11 multi-speciality physicians was convened to develop a consensus statement. Using a modified Delphi process, the panellists reviewed published evidence on various influenza management interventions and synthesised 10 recommendations for the prevention of influenza among the aged population via group discussions and a blinded rating exercise.

RESULTS

Overall, annual influenza vaccination is recommended for individuals aged ≥ 60 years, particularly those with specific medical conditions or residing in aged care facilities (ACFs). There is no preference for a particular vaccine type in this target population. Antiviral agents can be given for post-exposure chemoprophylaxis or when vaccine contraindication exists. Infection control measures should serve as adjuncts to prevent the spread of influenza, especially during Hajj.

CONCLUSION

This consensus statement presents 10 evidence-based recommendations that can be adopted by healthcare providers to prevent influenza among the aged population in Malaysia. It could also serve as a basis for health policy planning in other lower- and middle-income countries.

Knowledge, attitude and practices towards seasonal influenza vaccination among healthcare workers

Background

Vaccination as a primary prevention strategy is a well-established public health policy for preventing influenza. Despite strong recommendation, vaccination coverage among health workers is still not satisfying. The intention of the current study is to evaluate the knowledge, attitudes and practices towards influenza vaccination among healthcare workers.

Materials and Methods

In this cross-sectional, single-centre study, 789 healthcare workers (out of total 1380) participated. Institutional ethical committee clearance was obtained before the study. It was conducted in October 2021. A structured questionnaire in the form of Google sheet was sent to all healthcare professionals (HCPs) affiliated with the institution. Data collected was tabulated using MS Excel and analysed using appropriate statistical tools.

Results

Of the 1380 approached, a total of 789 (57.17%) HCPs responded to the questionnaire. The overall vaccination coverage in the study population was 71.6%. The overall vaccination acceptance rate drops to 36.78% when those taken vaccine as a recommended pre-employment requisite and got never vaccinated again were excluded. Also, 88.21% of the respondents believed that influenza is a potentially dangerous disease and 93.16% believed that flu vaccination is effective against preventing influenza. Although 736 participants (93.28%) were aware that seasonal influenza vaccine is recommended for healthcare workers, irrespective of age and comorbidities, only 411 (52.1%) intended to take vaccine in the coming year. Also, 97.34% of the participants considered vaccine as safe.

Conclusion

Influenza vaccination coverage among healthcare workers is still at an unsatisfactory level. This is despite majority of the HCPs accepting that the vaccine is safe and preventive against influenza. Efforts are still needed to improve the coverage.