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Maltezou HC, Papadima K, Gkolfinopoulou K, Ferentinos G, Mouratidou E, Andreopoulou A, Pavli A, Magaziotou I, Georgakopoulou T, Mellou K, Vorou R, Antoniadou A, Stathakarou A, Chrysochoou A, Gogos C, Karaiskou A, Kotanidou A, Koutsoukou A, Marangos M, Mentis A, Metallidis S, Papa A, Pefanis A, Tsakris A, Sipsas NV. Coronavirus disease 2019 pandemic in Greece, February 26 - May 3, 2020: The first wave. Travel Med Infect Dis 2021; 41:102051. [PMID: 33819570 PMCID: PMC8016712 DOI: 10.1016/j.tmaid.2021.102051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - Kalliopi Papadima
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Gkolfinopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - George Ferentinos
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Elisavet Mouratidou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Andreopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Ioanna Magaziotou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Theano Georgakopoulou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Kassiani Mellou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Rengina Vorou
- Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Stathakarou
- Infection Control Committee, Pammakaristos Hospital of Divine Providence, Athens, Greece
| | | | - Charalambos Gogos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Angeliki Karaiskou
- Infection Control Department, Thriassio General Hospital of Elefsina, Athens, Greece
| | - Anastasia Kotanidou
- Department of Intensive Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonia Koutsoukou
- Intensive Care Unit, Department of Respiratory Medicine, University of Athens, Greece
| | - Markos Marangos
- Department of Internal Medicine, University of Patras Medical School, Patras, Greece
| | - Andreas Mentis
- National Reference Laboratory for Influenza and Other Respiratory Viruses, Hellenic Pasteur Institute, Athens, Greece
| | - Symeon Metallidis
- First Internal Medicine Department, Infectious Diseases Division, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Papa
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Pefanis
- First Internal Medicine and Infectious Diseases Department, "Sotiria" General and Chest Diseases Hospital of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Greece
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Maltezou HC, Dedoukou X, Tseroni M, Tsonou P, Raftopoulos V, Papadima K, Mouratidou E, Poufta S, Panagiotakopoulos G, Hatzigeorgiou D, Sipsas N. SARS-CoV-2 Infection in Healthcare Personnel With High-risk Occupational Exposure: Evaluation of 7-Day Exclusion From Work Policy. Clin Infect Dis 2021; 71:3182-3187. [PMID: 32594160 PMCID: PMC7337654 DOI: 10.1093/cid/ciaa888] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As of late February 2020, Greece has been experiencing the coronavirus disease 2019 (COVID-19) epidemic. Healthcare personnel (HCP) were disproportionately affected, accounting for ~10% of notified cases. Exclusion from work for 7 days was recommended for HCP with high-risk occupational exposure. Our aim was to evaluate the 7-day exclusion from work policy for HCP with high-risk exposure. METHODS HCP with a history of occupational exposure to COVID-19 were notified to the Hellenic National Public Health Organization, regardless of their exposure risk category. Exposed HCP were followed for 14 days after last exposure. RESULTS We prospectively studied 3398 occupationally exposed HCP; nursing personnel accounted for most exposures (n = 1705; 50.2%). Of the 3398 exposed HCP, 1599 (47.1%) were classified as low-risk, 765 (22.5%) as moderate-risk, and 1031 (30.4%) as high-risk exposures. Sixty-six (1.9%) HCP developed COVID-19 at a mean of 3.65 (range: 0-17) days postexposure. Of the 66 HCP with COVID-19, 46, 7, and 13 had a history of high-, moderate- or low-risk exposure (4.5%, 0.9%, and 0.8% of all high-, moderate-, and low-risk exposures, respectively). Hospitalization and absenteeism were more prevalent among HCP with high-risk exposure. A logistic regression analysis showed that the following variables were significantly associated with an increased risk for the onset of COVID-19: male, administrative personnel, underlying disease, and high-risk exposure. CONCLUSIONS HCP with high-risk occupational exposure to COVID-19 had increased probability of serious morbidity, healthcare seeking, hospitalization, and absenteeism. Our findings justify the 7-day exclusion from work policy for HCP with high-risk exposure.
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Affiliation(s)
- Helena C Maltezou
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | - Maria Tseroni
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Paraskevi Tsonou
- Department of Cardiovascular Diseases, Directorate of Noncommunicable Diseases, National Public Health Organization, Athens, Greece
| | - Vasilios Raftopoulos
- Department of HIV Surveillance, National Public Health Organization, Athens, Greece
| | - Kalliopi Papadima
- Department of Respiratory Infections, Directorate for Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Elisavet Mouratidou
- Department of Respiratory Infections, Directorate for Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Sophia Poufta
- Department of Respiratory Infections, Directorate of Epidemiological Surveillance and Interventions for Infectious Diseases, National Public Health Organization, Athens, Greece
| | | | | | - Nikolaos Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Lytras T, Mouratidou E, Andreopoulou A, Bonovas S, Tsiodras S. Effect of Early Oseltamivir Treatment on Mortality in Critically Ill Patients With Different Types of Influenza: A Multiseason Cohort Study. Clin Infect Dis 2020; 69:1896-1902. [PMID: 30753349 DOI: 10.1093/cid/ciz101] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The available evidence on whether neuraminidase inhibitors reduce mortality in patients with influenza is inconclusive and focuses solely on influenza A/H1N1pdm09. We assessed whether early oseltamivir treatment (≤48 hours from symptom onset) decreases mortality compared to late treatment in a large cohort of critically ill patients with influenza of all types. METHODS The study included all adults with laboratory-confirmed influenza hospitalized in intensive care units (ICUs) in Greece over 8 seasons (2010-2011 to 2017-2018) and treated with oseltamivir. The association of early oseltamivir with mortality was assessed with log-binomial models and a competing risks analysis estimating cause-specific and subdistribution hazards for death and discharge. Effect estimates were stratified by influenza type and adjusted for multiple covariates. RESULTS A total of 1330 patients were studied, of whom 622 (46.8%) died in the ICU. Among patients with influenza A/H3N2, early treatment was associated with significantly lower mortality (relative risk, 0.69 [95% credible interval {CrI}, .49-.94]; subdistribution hazard ratio, 0.58 [95% CrI, .37-.88]). This effect was purely due to an increased cause-specific hazard for discharge, whereas the cause-specific hazard for death was not increased. Among survivors, the median length of ICU stay was shorter with early treatment by 1.8 days (95% CrI, .5-3.5 days). No effect on mortality was observed for A/H1N1 and influenza B patients. CONCLUSIONS Severely ill patients with suspected influenza should be promptly treated with oseltamivir, particularly when A/H3N2 is circulating. The efficacy of oseltamivir should not be assumed to be equal against all types of influenza.
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Affiliation(s)
- Theodore Lytras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - Elisavet Mouratidou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece.,European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University.,Humanitas Clinical and Research Center, Milan, Italy
| | - Sotirios Tsiodras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece.,Fourth Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Greece
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Lytras T, Pantavou K, Mouratidou E, Tsiodras S. Mortality attributable to seasonal influenza in Greece, 2013 to 2017: variation by type/subtype and age, and a possible harvesting effect. ACTA ACUST UNITED AC 2020; 24. [PMID: 30968823 PMCID: PMC6462785 DOI: 10.2807/1560-7917.es.2019.24.14.1800118] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
IntroductionEstimating the contribution of influenza to excess mortality in the population presents substantial methodological challenges.AimIn a modelling study we combined environmental, epidemiological and laboratory surveillance data to estimate influenza-attributable mortality in Greece, over four seasons (2013/14 to 2016/17), specifically addressing the lag dimension and the confounding effect of temperature.MethodsAssociations of influenza type/subtype-specific incidence proxies and of daily mean temperature with mortality were estimated with a distributed-lag nonlinear model with 30 days of maximum lag, separately by age group (all ages, 15-64 and ≥ 65 years old). Total and weekly deaths attributable to influenza and cold temperatures were calculated.ResultsOverall influenza-attributable mortality was 23.6 deaths per 100,000 population per year (95% confidence interval (CI): 17.8 to 29.2), and varied greatly between seasons, by influenza type/subtype and by age group, with the vast majority occurring in persons aged ≥ 65 years. Most deaths were attributable to A(H3N2), followed by influenza B. During periods of A(H1N1)pdm09 circulation, weekly attributable mortality to this subtype among people ≥ 65 years old increased rapidly at first, but then fell to zero and even negative, suggesting a mortality displacement (harvesting) effect. Mortality attributable to cold temperatures was much higher than that attributable to influenza.ConclusionsStudies of influenza-attributable mortality need to consider distributed-lag effects, stratify by age group and adjust both for circulating influenza virus types/subtypes and daily mean temperatures, in order to produce reliable estimates. Our approach addresses these issues, is readily applicable in the context of influenza surveillance, and can be useful for other countries.
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Affiliation(s)
- Theodore Lytras
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | | | | | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece.,Hellenic Centre for Disease Control and Prevention, Athens, Greece
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Mouratidou E, Lambrou A, Andreopoulou A, Gioula G, Exindari M, Kossyvakis A, Pogka V, Mentis A, Georgakopoulou T, Lytras T. Influenza vaccine effectiveness against hospitalization with laboratory-confirmed influenza in Greece: A pooled analysis across six seasons, 2013-2014 to 2018-2019. Vaccine 2020; 38:2715-2724. [PMID: 32033848 DOI: 10.1016/j.vaccine.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Monitoring seasonal influenza Vaccine Effectiveness (VE) is key to inform vaccination strategies and sustain uptake. Pooling data across multiple seasons increases precision and allows for subgroup analyses, providing more conclusive evidence. Our aim was to assess VE against hospitalization with laboratory-confirmed influenza in Greece over six seasons, from 2013 to 2014 to 2018-2019, using routinely collected surveillance data. METHODS Swab samples from hospitalized patients across the country were tested for influenza by RT-PCR. We used the test-negative design, with patients testing positive for influenza serving as cases and those testing negative serving as controls. VE was calculated as one minus the Odds Ratio (OR) for influenza vaccination, estimated by mixed-effects logistic regression and adjusted for age, sex, hospitalization type (being in intensive care or not), time from symptom onset to swabbing, and calendar time. Stratified estimates by age and hospitalization type were obtained, and also subgroup estimates by influenza type/subtype and season. Antigenic and genetic characterization of a subset of circulating influenza strains was performed. RESULTS A total of 3,882 test-positive cases and 5,895 test-negative controls were analyzed. Across all seasons, adjusted VE was 45.5% (95% CI: 31.6-56.6) against all influenza, 62.8% against A(H1N1)pdm09 (95% CI: 40.7-76.7), 28.2% against A(H3N2) (95% CI: 12.0-41.3) and 45.5% against influenza B (95% CI: 29.1-58.1). VE was slightly lower for patients aged 60 years and over, and similar between patients hospitalized inside or outside intensive care. Circulating A(H1N1)pdm09 and B strains were antigenically similar to the vaccine strains, whereas A(H3N2) were not. CONCLUSION Our results confirm the public health benefits from seasonal influenza vaccination, despite the suboptimal effectiveness against A(H3N2) strains. Continued monitoring of VE is essential, and routinely collected surveillance data can be valuable in this regard.
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Affiliation(s)
- Elisavet Mouratidou
- National Public Health Organization, Athens, Greece; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | | | | | - Georgia Gioula
- National Influenza Centre for Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Exindari
- National Influenza Centre for Northern Greece, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Kossyvakis
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Vasiliki Pogka
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
| | - Andreas Mentis
- National Influenza Centre for Southern Greece, Hellenic Pasteur Institute, Athens, Greece
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Lytras T, Andreopoulou A, Gkolfinopoulou K, Mouratidou E, Tsiodras S. Association between type-specific influenza circulation and incidence of severe laboratory-confirmed cases; which subtype is the most virulent? Clin Microbiol Infect 2019; 26:922-927. [PMID: 31760112 DOI: 10.1016/j.cmi.2019.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/09/2019] [Accepted: 11/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Excess population mortality during winter is most often associated with influenza A(H3N2), though susceptibility differs by age. We examined differences between influenza types/subtypes in their association with severe laboratory-confirmed cases, overall and by age group, to determine which type is the most virulent. METHODS We used nine seasons of comprehensive nationwide surveillance data from Greece (2010-2011 to 2018-2019) to examine the association, separately for influenza A(H1N1)pdm09, A(H3N2) and B, between the number of laboratory-confirmed severe cases (intensive care hospitalizations or deaths) per type/subtype and the overall type-specific circulation during the season (expressed as a cumulative incidence proxy). Quasi-Poisson models with identity link were used, and multiple imputation to handle missing influenza A subtype. RESULTS For the same level of viral circulation and across all ages, influenza A(H1N1)pdm09 was associated with twice as many intensive care hospitalizations as A(H3N2) (rate ratio (RR) 1.89, 95% CI 1.38-2.74) and three times more than influenza B (RR 3.27, 95%CI 2.54-4.20). Similar associations were observed for laboratory-confirmed deaths. A(H1N1)pdm09 affected adults over 40 years at similar rates, whereas A(H3N2) affected elderly people at a much higher rate than younger persons (≥65 vs. 40-64 years, RR for intensive care 5.42, 95% CI 3.45-8.65, and RR for death 6.19, 95%CI 4.05-9.38). Within the 40-64 years age group, A(H1N1)pdm09 was associated with an approximately five times higher rate of severe disease than both A(H3N2) and B. DISCUSSION Influenza A(H1N1)pdm09 is associated with many more severe laboratory-confirmed cases, likely due to a more typical clinical presentation and younger patient age, leading to more testing. A(H3N2) affects older people more, with cases less often recognized and confirmed.
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Affiliation(s)
- T Lytras
- National Public Health Organization, Athens, Greece.
| | | | | | - E Mouratidou
- National Public Health Organization, Athens, Greece
| | - S Tsiodras
- National Public Health Organization, Athens, Greece; 4th Department of Internal Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece
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Magaziotou I, Tsiodras S, Andreopoulou A, Mouratidou E, Vernardaki A, Gkolfinopoulou K, Panagiotopoulos T, Kossyvakis A, Exindari M, Mentis A, Papa A, Theodoridou M, Georgakopoulou T. 2631. Influenza-Associated Intensive Care Unit Hospitalizations and Deaths in Children, During 2010–2019 in Greece. Open Forum Infect Dis 2019. [PMCID: PMC6809667 DOI: 10.1093/ofid/ofz360.2309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The clinico-epidemiological characteristics of children with severe influenza-related intensive care unit (ICU) admissions in Greece during 2010–2019 are described. Methods All laboratory-confirmed influenza cases (real-time PCR), in children 0–16 years old, admitted to Pediatric ICUs throughout the country, are reported using a mandatory notification system to the National Public Health Organization of Greece. Case fatality rates (CFR) were analyzed according to age and presence of comorbidities. Results From October 2010 to April 2019, 131 influenza cases [7.2/100,000 children, 65 (49.6%) girls] with PICUs admissions were recorded. The majority of cases (n = 78; 60%) occurred in the age group 0–4 years-old [31 (24%) children were < 12 months-old]. Sixty-five (49.6%) children had underlying comorbidities (22 neurological disease, 12 congenital syndromes, 7 cancer, 5 chronic respiratory, 19 other). The most common diagnosis was febrile ARDS and 67 (51.14%) had severe pneumonia (40% viral, 7% bacterial). Seventy-five (57.2%) children required invasive ventilation. Influenza A accounted for 102 (77.86%) of cases; out of 86 (84.31%) subtyped, 68 (79%) were AH1N1pdm09, and 18 (21%) were AH3N2. Influenza B accounted for 29 (22.13%) of cases. All children received oseltamivir. Median length of stay was 10 days (range 1–90). A total of 32 deaths was recorded (CFR 24.4%, total rate: 1.76/100,000 children); 13 (40.1%) deaths occurred in children with no known co-morbidity. Mortality rates were higher in children aged > 4 years (18/53, 33.9% vs. 14/78, 17.9%, P = 0.04) while there was a trend for children with comorbidities (19/65, 29.2% vs. 13/66, 19.69%, P = 0.1). Only 4% of children were previously immunized against influenza. Conclusion AH1N1pdm09 accounted for the vast majority of severe cases and influenza associated deaths in children in Greece over the last 10 years. Severe disease occurred also in children with no comorbitidies. Longitudinal clinico-epidemiological data should be considered in shaping the national immunization program. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Sotirios Tsiodras
- Athens Medical School, National and Kapodistrian University of Athens, Athens, Attiki, Greece
| | | | | | | | | | | | | | - Maria Exindari
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece
| | | | - Anna Papa
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Thessaloniki, Greece
| | - Maria Theodoridou
- Athens Medical School, National and Kapodistrian University of Athens, Athens, Attiki, Greece
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Lytras T, Andreopoulou A, Mouratidou E, Gkolfinopoulou K, Tsiodras S. 1631. Association Between Type-Specific Influenza Circulation and Incidence of Severe Laboratory-confirmed Cases; Which Subtype Is the Most Virulent? Open Forum Infect Dis 2019. [PMCID: PMC6808987 DOI: 10.1093/ofid/ofz360.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Excess population mortality during winter is most often associated with influenza A(H3N2), particularly “pneumonia and influenza” deaths. We examined differences between influenza types in their association with severe laboratory-confirmed cases, to determine which is the most virulent. Methods We used nine seasons of comprehensive nationwide surveillance data from Greece (from 2010/11 to 2018/19) to examine the association, separately for influenza A(H1N1)pdm09, A(H3N2) and B, between the number of laboratory-confirmed severe cases (intensive care hospitalizations or deaths) and the overall type-specific circulation during the season (expressed as a cumulated incidence proxy—ILI rate times percent positive, summed over the season), using additive Poisson regression. Results During the study period, and for the same level of circulation during a season, influenza A(H1N1)pdm09 was associated with 3.7 times (95% CI 2.7–5.0) more laboratory-confirmed deaths compared with influenza B, and 2.2 times (95% CI 1.6–3.1) more compared with A(H3N2) (Figure 1). Similar differences were observed for intensive care hospitalizations. Laboratory-confirmed A(H1N1)pdm09 severe cases were more often younger (median age 56 years) compared with influenza B or A(H3N2) (median age 64 and 72 years respectively, both P < 0.001) (Figure 2). Conclusion Influenza A(H1N1)pdm09 is associated with many more severe laboratory-confirmed cases; this is likely due to a more typical clinical presentation and younger patient age, leading to more laboratory testing. In contrast A(H3N2) affects older people and presents more atypically, which is less likely to lead to laboratory testing and confirmation. Focusing on laboratory-confirmed cases, although useful in itself, may provide severely biased estimates of the burden of influenza mortality and morbidity. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Sotirios Tsiodras
- Athens Medical School, National and Kapodistrian University of Athens, Athens, Attiki, Greece
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Lytras T, Kopsachilis F, Mouratidou E, Papamichail D, Bonovas S. Interventions to increase seasonal influenza vaccine coverage in healthcare workers: A systematic review and meta-regression analysis. Hum Vaccin Immunother 2017; 12:671-81. [PMID: 26619125 DOI: 10.1080/21645515.2015.1106656] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Influenza vaccination is recommended for healthcare workers (HCWs), but coverage is often low. We reviewed studies evaluating interventions to increase seasonal influenza vaccination coverage in HCWs, including a meta-regression analysis to quantify the effect of each component. Fourty-six eligible studies were identified. Domains conferring a high risk of bias were identified in most studies. Mandatory vaccination was the most effective intervention component (Risk Ratio of being unvaccinated [RRunvacc] = 0.18, 95% CI: 0.08-0.45), followed by "soft" mandates such as declination statements (RRunvacc = 0.64, 95% CI: 0.45-0.92), increased awareness (RRunvacc = 0.83, 95% CI: 0.71-0.97) and increased access (RRunvacc = 0.88, 95% CI: 0.78-1.00). For incentives the difference was not significant, while for education no effect was observed. Heterogeneity was substantial (τ(2) = 0.083). These results indicate that effective alternatives to mandatory HCWs influenza vaccination do exist, and need to be further explored in future studies.
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Affiliation(s)
- Theodore Lytras
- a Department of Epidemiological Surveillance and Intervention , Hellenic Centre for Disease Control and Prevention , Athens , Greece.,b Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain.,c Department of Experimental and Health Sciences , Universitat Pompeu Fabra (UPF) , Barcelona , Spain
| | - Frixos Kopsachilis
- d Department of Occupational and Industrial Hygiene , National School of Public Health , Athens , Greece
| | - Elisavet Mouratidou
- a Department of Epidemiological Surveillance and Intervention , Hellenic Centre for Disease Control and Prevention , Athens , Greece
| | - Dimitris Papamichail
- e Department of Child Health , National School of Public Health , Athens , Greece
| | - Stefanos Bonovas
- f Humanitas Clinical and Research Center , Rozzano , Milan , Italy
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Lytras T, Baka A, Andreopoulou A, Mouratidou E, Kalkouni O, Georgakopoulou T, Tsiodras S. Severe Influenza; Greece 2016–2017: Vaccine Failures in Type A Influenza and Risk Factors for Poor Outcome. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baka A, Andreopoulou A, Mouratidou E, Spala G, Lytras T, Kalkouni O, Koukouli S, Velioti E, Georgakopoulou T, Hadjichristodoulou C, Tsiodras S. Severe Influenza Cases in Season 2015–2016, Greece: Surveillance and Risk Factors for Poor Outcome. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Agoritsa Baka
- Hellenic Centre for Disease Control and Prevention, Marousi, Greece
| | - Anastasia Andreopoulou
- Epidemiology and Intervention, Hellenic Centre for Disease Control and Prevention, Marousi, Greece
| | | | - Georgia Spala
- Epidemiology and Intervention, Hellenic Center for Disease Control and Prevention, Marousi, Greece
| | - Theodore Lytras
- Epidemiology Surveillance and Response, Hellenic Centre for Disease Control and Prevention, Marousi, Greece
| | - Ourania Kalkouni
- Epidemiology and Intervention, Hellenic Centre for Disease Control and Prevention, Marousi, Greece
| | - Stavroula Koukouli
- Epidemiology Surveillance and Response, Hellenic Centre for Disease Control and Prevention, Marousi, Greece
| | - Eirini Velioti
- Epidemiology Surveillance and Response, Hellenic Centre for Disease Control and Prevention, Marousi, Greece
| | - Theano Georgakopoulou
- Epidemiology Surveillance and Response, Hellenic Centre for Disease Control and Prevention, Marousi, Greece
| | | | - Sotirios Tsiodras
- 4th Department of Internal Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Office for Scientific Advice, Hellenic Center for Disease Control and Prevention, Marousi, Athens, Greece
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Andreopoulou A, Mouratidou E, Spala G, Kalkouni O, Lytras T, Baka A, Koukouli S, Velioti E, Georgakopoulou T, Hadjichristodoulou C, Tsiodras S. Risk Factors and Vaccine Failure Associated With Influenza Related Death in Severe Cases in Greece During the 2014-15 Season. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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