Effects of parental childhood cultural health environment on children's influenza and COVID-19 vaccination status

Most studies examining factors associated with pediatric influenza (flu) and coronavirus disease (COVID-19) vaccination uptake focus on parental demographics. We examined whether the childhood cultural health environment (CHE) of parents (measured by self-reported regular attendance at doctor and dentist visits during childhood) was associated with flu and COVID-19 vaccination of their children. Using 2023 survey data from 397 US parents and causal inference methods, we estimated the average causal effect of parental CHE on flu vaccination rates (0.16 [95 % confidence interval: 0.06,0.27]) and COVID-19 (0.14 [95 % confidence interval: 0.04,0.24]), indicating that if all parents had attended regular doctor/dentist visits as children, flu and COVID-19 vaccination rates in children would be 16 % and 14 % higher, respectively, than if none had. Our findings suggest that early life exposure to medical and dental care has significant and lasting effects on the health of individuals and families.

Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO

During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitis B, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated. Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines. The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines, and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6 months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36.

Identify future epidemic threshold and intensity for influenza-like illness in Iraq by using the moving epidemic method

Objectives

Influenza-like illness (ILI) entered the Iraq surveillance system in 2021. The alert threshold was determined using the cumulative sum 2 method, which did not provide other characteristics. This study uses the moving epidemic method (MEM) to describe duration and estimate alert thresholds for ILI in Iraq for 2023-2024.

Methods

MEM default package was used to estimate influenza 2023-2024 epidemic thresholds. Analysis was repeated using optimum parameter of epidemic timing for fixed criteria method, which is 3.3. Arithmetic means and 95% confidence interval upper limit were used to estimate threshold. Geometric mean and 40%, 90%, and 97.3% confidence interval upper limits were used to estimate intensity levels. Aggregated Centers for Disease Control and Prevention surveillance data were used to detect epidemic thresholds, length, sensitivity, and predictive values.

Results

ILI activity starts at week 30 and lasts 7 weeks. Optimized epidemic threshold is 4513 cases, lower than default (4540 cases). Optimized medium-intensity level was higher than default, and high and very high-intensity levels were lower.

Conclusions

MEM is essential to determine an influenza epidemic's threshold and intensity levels. Despite requiring 3-5 years of data, using it on data for 2.5 years has resulted in an epidemic threshold slightly higher than the threshold calculated using the cumulative sum 2 method.

[Relationship between the lung ultrasound and the clinical severity of the patient with seasonal flu]

INTRODUCTION

The seasonal flu is a very important reason for consultation every winter. Symptoms can quickly progress to severe pneumonia. Currently, few tools exist to assess the clinical severity of patients. The aim of this study is to demonstrate the role of lung ultrasound as a marker of severity in patients with influenza.

METHODS

79 patients who arrived at the emergency department with flu-like symptoms were included. A pulmonary ultrasound looking for an interstitial syndrome or consolidation was performed. The qSOFA, the SOFA, the saturation, the PaO2/FiO2 ratio, the oxygen needs, the destination of the patient made it possible to establish the seriousness of the pathology of the patient. Ultrasound was then compared to these different tools.

RESULTS

The more the ultrasound became pathological, the more we observed a proportion of qSOFA (p = 0.001) and pathological SOFA (p = 0.009). Most patients with acute respiratory distress syndrome have pathological ultrasound (p < 0.001). The average admission saturation is 89.2 % in the "pathological ultrasound" group compared to 95.8 % in the "normal ultrasound" group (p < 0.001). Patients who required invasive therapies had pathological ultrasound (p < 0.001). Of the 28 patients with pathological ultrasound, 24 required hospitalization (p < 0.001).

CONCLUSION

Lung ultrasound is a major asset for assessing the severity of the patient with seasonal flu. In addition, ultrasound allows better monitoring of the patient by being able to influence the destination of the latter towards a return home or monitoring in intensive care.

Community-acquired and hospital-acquired bacterial co-infections in patients hospitalized with Covid-19 or influenza: a retrospective cohort study

BACKGROUND

Bacterial co-infections are believed to be less frequent in patients with Covid-19 than influenza, but frequencies varied between studies.

METHODS

This single-center retrospective, propensity score-matched analysis included adult patients with Covid-19 or influenza admitted to normal-care wards between 02/2014 and 12/2021. Covid-19 cases were propensity score matched to influenza cases at a 2:1 ratio. Community-acquired and hospital-acquired bacterial co-infections were defined as positive blood or respiratory cultures ≤ 48 h or > 48 h after hospital admission, respectively. The primary outcome was comparison of community-acquired and hospital-acquired bacterial infections between patients with Covid-19 and influenza in the propensity score-matched cohort. Secondary outcomes included frequency of early and late microbiological testing.

RESULTS

A total of 1337 patients were included in the overall analysis, of which 360 patients with Covid-19 were matched to 180 patients with influenza. Early (≤ 48 h) microbiological sampling was performed in 138 (38.3%) patients with Covid-19 and 75 (41.7%) patients with influenza. Community-acquired bacterial co-infections were found in 14 (3.9%) of 360 patients with Covid-19 and 7 (3.9%) of 180 patients with influenza (OR 1.0, 95% CI 0.3-2.7). Late (> 48 h) microbiological sampling was performed in 129 (35.8%) patients with Covid-19 and 74 (41.1%) patients with influenza. Hospital-acquired bacterial co-infections were found in 40 (11.1%) of 360 patients with Covid-19 and 20 (11.1%) of 180 patients with influenza (OR 1.0, 95% CI 0.5-1.8).

CONCLUSION

The rate of community-acquired and hospital-acquired bacterial co-infections was similar in hospitalized Covid-19 and influenza patients. These findings contrast previous literature reporting that bacterial co-infections are less common in Covid-19 than influenza.

Influenza vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Society of Diabetology, the Portuguese Society of Cardiology, the Portuguese Society of Geriatrics and Gerontology, the Study Group of Geriatrics of the Portuguese Society of Internal Medicine, and the Portuguese Society of Infectious Diseases and Clinical Microbiology

Influenza affects millions of people worldwide each year and can lead to severe complications, hospitalizations, and even death, especially among vulnerable populations such as older adults and those with chronic medical conditions. Annual vaccination is considered the most effective measure for preventing influenza and its complications. Despite the widespread availability of influenza vaccines, however, vaccination coverage rates remain suboptimal in several countries. Based on the latest scientific evidence and expert opinions on influenza vaccination in older people and patients with chronic disease, the Portuguese Society of Pulmonology (SPP), the Portuguese Society of Diabetology (SPD), the Portuguese Society of Cardiology (SPC), the Portuguese Society of Geriatrics and Gerontology (SPGG), the Study Group of Geriatrics of the Portuguese Society of Internal Medicine (NEGERMI-SPMI), and the Portuguese Society of Infectious Diseases and Clinical Microbiology (SPDIMC) discussed best practices for promoting vaccination uptake and coverage and drew up several recommendations to mitigate the impact of influenza. These recommendations focus on the efficacy and safety of available vaccines; the impact of influenza vaccination on older adults; patients with chronic medical conditions, namely cardiac and respiratory conditions, diabetes, and immunosuppressive diseases; and health care professionals, optimal vaccination timing, and strategies to increase vaccination uptake and coverage. The resulting position paper highlights the critical role that vaccinations play in promoting public health, raising awareness, and encouraging more people to get vaccinated.

[Adaptation and validation of the MoVac-flu scale on motivation towards the flu vaccine]

OBJECTIVE

To translate, adapt and validate the psychometric properties of MoVac-flu scale in order to be used in Spanish.

METHOD

The present research was an analytical observational study of cross-cultural adaptation and validation into Spanish of the MoVac-flu scale. It has been carried out between the months of March and July 2022. The sample size was 142 people who were obtained by consecutive sampling. The processes used for the adaptation have been translation, validation by a committee of experts, back-translation and pilot test. For validation, the psychometric properties of reliability, internal consistency, appearance validity, content validity, utility and ceiling-floor effect have been verified.

RESULTS

The internal consistency of the MoVac-flu scale in its version translated into Spanish was high, showing a McDonald's ω of 0.914.

CONCLUSIONS

The MoVac-flu scale in Spanish allows to measure the degree of motivation towards vaccination against influenza in the adult population.

Epidemiology of influenza over a ten-year period in Belgium: overview of the historical and current evidence

BACKGROUND

Generally influenza, a contagious respiratory disease, leads to mild illness, but can present as a severe illness with significant complications for some. It entails significant health challenges and an economic burden. Annual vaccination is considered the most effective preventive measure against influenza, especially in high-risk groups.

METHOD

Epidemiological, demographic and vaccination data of influenza from 2009-to-2019 is collected from Sciensano, the Belgian Institute for Health. Sciensano monitors influenza virus through two surveillances: the Influenza-Like Illness (ILI) surveillance in primary care and the Severe Acute Respiratory Infections (SARI) surveillance in hospital settings.

RESULTS

49.6% [± 8.5] of all ILI-samples tested positive in this period. Influenza A was the dominant circulating type, accounting for 73.7% [± 27.5] of positive samples, while influenza B accounted for 24.3% [± 26.7]. For SARI-surveillance, the average rate of samples tested positive was 36.3% [± 9.3]. Influenza A was responsible for respectively 77.7% [± 23.8] of positive samples and influenza B for 22.2% [± 23.7]. Since 2010, epidemics typically lasted about 9.3 weeks [± 2.7]. From 2012 to 2019 the average vaccine effectiveness was 34.9% [± 15.3].

CONCLUSION

Influenza is quickly considered a trivial disease, but can have substantial repercussions. It remains difficult to identify the level of treat of influenza due to antigenic evolution. Measures to prevent, control and treat are needed. Vaccines that provide broader and more durable protection that can be produced more rapidly could be a potential solution.

Association between ozone and influenza transmissibility in China

BACKGROUND

Common air pollutants such as ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matter play significant roles as influential factors in influenza-like illness (ILI). However, evidence regarding the impact of O3 on influenza transmissibility in multi-subtropical regions is limited, and our understanding of the effects of O3 on influenza transmissibility in temperate regions remain unknown.

METHODS

We studied the transmissibility of influenza in eight provinces across both temperate and subtropical regions in China based on 2013 to 2018 provincial-level surveillance data on influenza-like illness (ILI) incidence and viral activity. We estimated influenza transmissibility by using the instantaneous reproduction number ([Formula: see text]) and examined the relationships between transmissibility and daily O3 concentrations, air temperature, humidity, and school holidays. We developed a multivariable regression model for [Formula: see text] to quantify the contribution of O3 to variations in transmissibility.

RESULTS

Our findings revealed a significant association between O3 and influenza transmissibility. In Beijing, Tianjin, Shanghai and Jiangsu, the association exhibited a U-shaped trend. In Liaoning, Gansu, Hunan, and Guangdong, the association was L-shaped. When aggregating data across all eight provinces, a U-shaped association was emerged. O3 was able to accounted for up to 13% of the variance in [Formula: see text]. O3 plus other environmental drivers including mean daily temperature, relative humidity, absolute humidity, and school holidays explained up to 20% of the variance in [Formula: see text].

CONCLUSIONS

O3 was a significant driver of influenza transmissibility, and the association between O3 and influenza transmissibility tended to display a U-shaped pattern.

Flu vaccination coverage in Italy in the COVID-19 era: A fuzzy functional k-means (FFKM) approach

BACKGROUND

In Europe, flu vaccination coverage has decreased, and there are complex barriers to overcome to vaccinate against flu. Many studies have been conducted to estimate vaccination coverage. The COVID-19 pandemic threatens to disrupt immunization programs in many countries, including Italy, where vaccination against the flu is recommended but not mandatory. This paper aims to understand changes in flu vaccine uptake in Italian regions.

METHODS

Using functional data analysis and fuzzy functional k-means clustering, we investigated changes in flu vaccine coverage in Italian regions before (2010-2019) and after (2020-2022) the COVID-19 vaccination period.

RESULTS

The period of COVID-19 pandemic brought an increase in vaccine coverage globally. Elbow's method determined that the optimal number of clusters in vaccination uptake is 2. Apulia, Basilicata, Emilia Romagna, Liguria, Molise, Tuscany, and Umbria in 2019 belong less to the group with low flu vaccination uptake (G1) but increase their tendency to belong to this group over time: they decrease their propensity to be vaccinated for flu. For others, it seems that COVID-19 served as a push to increase flu vaccination coverage rates. Sicily appears to be the region that has responded best to the pandemic, changing its membership value from 2019 to 2022.

CONCLUSION

The present study highlights that the COVID-19 era has resulted in a higher flu vaccination coverage rate. Moreover, the regional level's improvement or worsening in flu vaccination coverage rate is not affected by the historical gap and socio-cultural and economic differences prevailing among Italian regions.

Primary care during COVID-19 pandemic - a survey to establish clinical needs and lessons learned in infectious respiratory diseases in Spain

BACKGROUND

The COVID-19 pandemic has exposed gaps and areas of need in health care systems. General practitioners (GPs) play a crucial role in the response to COVID-19 and other respiratory infectious diseases (e.g., influenza). Knowing the current flow of these patients and the real needs of GPs is necessary to implement new therapeutic and diagnostic strategies. We sought to learn about the flow of COVID-19 and flu patients in Spanish primary health centers and understand the training needs in both the diagnosis and treatment of these diseases.

METHODS

A total of 451 regionally representative GPs completed an online survey between January and February 2022.

RESULTS

Most of the GPs had available infection containment measures (79%) and access to point-of-care (POC) rapid diagnostic testing (81%) in their centers. The availability of on-the-day diagnostic tests for COVID-19 was higher than that for influenza (80% vs. 20%). Most GPs referred 1 of 10 COVID-19 or flu patients with moderate to severe disease to the emergency department (80% and 90%, respectively). Training/knowledge was considered good regarding diagnostic tests and vaccines (85%) but null or low regarding antivirals (60%) and monoclonal antibodies (80%).

CONCLUSIONS

This survey identified the conditions of Spanish GPs in terms of the diagnosis and treatment of COVID-19 and flu patients. Respondents' comments suggested that quite radical system-level adjustments are needed to allow GPs to capitalize on the potential benefits of POC tests for diagnosis, reduction of referrals, and monitoring of these diseases.

Immunogenicity and safety of inactivated quadrivalent influenza vaccine compared with the trivalent vaccine for influenza infection: an overview of systematic reviews

BACKGROUND

Influenza infection is a highly preventable transmissible viral disease associated with mild upper respiratory symptoms and more severe conditions such as lethal pneumonia. Studies have shown that a broader spectrum influenza vaccine could reduce influenza's burden of disease in low- and middle-income countries. A considerable number of systematic reviews reported that quadrivalent influenza vaccines are considered more effective compared to trivalent vaccines, hence, there is a need for an overview in order to synthesize the current evidence pertaining to the comparison between quadrivalent and trivalent inactivated influenza vaccines.

OBJECTIVE

The aim was to summarize the evidence from systematic reviews that investigated the immunogenicity and safety of the Influenza's inactivated quadrivalent vaccine (QIV) compared to the trivalent vaccine (TIV), in the general population.

METHODS

We searched articles up to December 2022 at: Web of Science, EMBASE, MEDLINE, Cochrane Library, and SCOPUS. The search strategy was conducted following the PICO model. We included systematic reviews comparing the primary outcomes of immunogenicity (seroprotection rate and seroconversion rate) and adverse events using risk ratios. The AMSTAR 2 and ROBIS were used for quality assessments, and GRADE was used for evidence certainty assessments.

FINDINGS

We included five systematic reviews, totalling 47,740 participants. The Quadrivalent Inactivated Influenza Vaccine (QIV) exhibited enhanced immunogenicity in the context of B-lineage mismatch when compared to the Trivalent Inactivated Influenza Vaccine (TIV). While the safety profile of QIV was found to be comparable to that of TIV, the QIV showed a higher incidence of solicited local pain among children and adolescents, as well as an increased frequency of local adverse events within the adult population.

CONCLUSION

Our findings suggest that the QIV provides a superior immunogenicity response compared to the TIV in all age groups evaluated, especially when a lineage mismatch occurred. The safety of QIV was considered similar to the TIV, with no serious or systemic solicited or unsolicited adverse events; tough pain at the injection site was greater for QIV. We recommend caution owing to the high risk of bias in the selection process and no protocol registration.

Three-year COVID-19 and flu vaccinations among medical residents in a tertiary hospital in Italy: The threat of acceptance decline in seasonal campaigns

The COVID-19 vaccination campaign in Italy started in December 2020, and, due to the Omicron variant's emergence, a second booster dose was recommended for high-risk individuals and healthcare workers from July 2022. The aim of the study was to evaluate the vaccination coverages for the COVID-19 second booster dose and to identify predictors of its acceptance within the population of medical residents (MRs) of the Fondazione Policlinico Universitario "A. Gemelli" IRCCS (FPG) University Hospital. The study was conducted at FPG from October 4th to December 21st, 2022, and COVID-19 second booster dose and influenza vaccines were administered. The study analyzed collected data and conducted multivariate logistic regressions to explore potential predictors of vaccination adherence. The analyses performed were compared with the sample enrolled in FPG residency programs at the start of the COVID-19 vaccination campaign. 1968 MRs were involved in the 2022-2023 vaccination campaign (mean age 28.97, SD 3.44), and the second booster dose of COVID-19 vaccination coverage was low (18.80%). Almost all participants opted for co-administration of COVID-19 and influenza vaccinations, leading to a similar rate of influenza vaccination coverage (16.26%). Being a frontline resident, meaning a direct involvement in managing COVID-19 patients and vaccination campaigns, was the main predictor of vaccination adherence (OR 1.72, 95% CI 1.25-2.17). The dropping in influenza vaccination coverage in 2022-2023 and the low adherence to COVID-19 second booster dose among young physicians is concerning, calling for tailored vaccination campaigns and interventions.

Associations of dietary patterns with common infections and antibiotic use among Finnish preschoolers

Background

Preschoolers suffer frequently from infections. Although nutrition plays a key role in immune function, very little is known about the impact of overall diet on preschoolers' infections.

Objective

To assess the associations between dietary patterns, common infections and antibiotic use among Finnish preschoolers.

Design

The study included 721 3-6-year-old preschoolers participating in the cross-sectional DAGIS survey. Parents retrospectively reported the number of common colds, gastroenteritis episodes and antibiotic courses their children had acquired during the past year. Food consumption outside preschool hours was recorded using a food frequency questionnaire. Dietary patterns were derived from the consumption frequencies using principal component analysis. Associations between the thirds of the dietary pattern scores and the outcomes were analysed using logistic and negative binomial regression models.

Results

Prevalence of common colds was lower in moderate and high adherence to the sweets-and-treats pattern than in low adherence (prevalence ratio [PR]: 0.89, 95% confidence interval [CI]: 0.80-1.00, and PR: 0.88, 95% CI: 0.79-0.99, respectively) and higher in high adherence to the health-conscious pattern than in low adherence (PR: 1.13, 95% CI: 1.01-1.27) after adjusting for age, sex, number of children living in the same household, frequency of preschool attendance, family's highest education and probiotic use. The risk of ≥1 gastroenteritis episode and the prevalence of antibiotic courses were lower in moderate adherence to the sweets-and-treats pattern than in low adherence (odds ratio [OR]: 0.63, 95% CI: 0.44-0.92 and PR: 0.77, 95% CI: 0.59-1.00, respectively).

Conclusions

The results were unexpected. Parents who were most health-conscious of their children's diet might also have been more aware of their children's illness.

Seasonality, mass vaccination and critical policy evaluation on global exit strategy of COVID-19 crisis

There is a strong coordinated effort by vaccination groups all over the world to put an end to the current crisis of COVID-19. Now sufficient data are available to analyse and compare some results to explore the aftereffects of vaccination. Some influence variables on transmissions of the disease were discussed e.g., mass vaccination, lockdown and seasonality. Most studies covered here are up to the beginning of July 2022, while some analyses focused on the earlier period of mass vaccination. Well established, simple statistical techniques to evaluate results were presented those used open data sources of authoritative bodies. Some comparisons between vaccinated vs. unvaccinated were also discussed based on data from UK Government Health Security Agency (UHSA). In terms of mass vaccination, adverse reactions after vaccination received attention, as health and safety issues of the general public are of prime importance. Apart from direct side effects, the secondary effect of mass vaccination needs attention too. After the initiation of the vaccination programme, almost all countries experienced a sudden surge in transmission and most countries had to impose strict lockdown measures. Many countries, with a low prevalence of disease, suddenly showed a steep jump and some countries even followed a synchronized pattern between the rate of transmissions and the variation of vaccine doses. Time series analyses and bar diagram presentations were able to capture those features. In that context, fast mutation of the virus and new variants after mass vaccination and possible mechanisms/consequences were also attended. To understand the effect of seasonality, similarities between COVID-19 and the seasonal Flu are discussed for Europe and US to gain useful insight. Using time series analyses and spatial plots of regional temperature composites we showed, like Flu, seasonality played a dominant role in transmissions of COVID-19 in the Europe. Regulations of vaccine dose and policy implication were explored too. From 22^nd December 2021, global vaccine doses were reduced substantially, which followed a dramatic reduction in cases and thereafter deaths with around one month's lag between each. As strong dependency on seasonality is noticed in certain countries and observing that regulation of vaccine doses has roles in modulating the transmission with certain lags, globally as well as regionally, our results have policy implications for the management of COVID. Debating, questioning and criticism are always the foundation of great science and the major pillars of its progress. Following that objective, it is an effort to explore pragmatically, supported by scientific analyses, areas relating to the effectiveness of the COVID-19 vaccine and the exit strategy via the pathway of vaccination.

Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis

BACKGROUND

The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization.

METHODS

We conducted a multifactorial vignette survey experiment (2⁸-design, i.e., N_Vignettes = 256) in Germany (N_Respondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19.

RESULTS

Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less.

CONCLUSION

Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.

Characterization of Flu MOSAIC nanoparticle vaccine candidate using high performance size-exclusion chromatography to support vaccine process development

This report describes an application of analytical high performance size exclusion chromatography with UV and Fluorescent detection (HPSEC-UV/FLR) method that enabled a bridging from research vaccine candidate discovery (His-tagged model) to clinical product development (Non-His-tagged molecules). HPSEC measurement can accurately determine the total trimer-to-pentamer molar ratio by either titration evaluation during the nanoparticle being assembled or dissociation during a well-formed nanoparticle being dis-assembled. Through experimental design with small sample consumptions, HPSEC can provide a quick determination on the nanoparticle assembling efficiency which can therefore guide the buffer optimization for an assembly, from His-tagged model nanoparticle, to non-His-tagged clinical development product. HPSEC has also discovered a difference in assembling efficiencies for various strains of HA_x-dn5B with Pentamer-dn5A components, and different efficiencies for monovalent assembly vs. multivalent assembly. The present study demonstrates HPSEC as a pivotal tool to support the Flu Mosaic nanoparticle vaccine development from research to clinical production.

Real-world uptake of COVID-19 vaccination among individuals expressing vaccine hesitancy: A registry-linkage study

INTRODUCTION

Uptake of COVID-19 vaccination remains suboptimal in the United States and other settings. Though early reports indicated that a strong majority of people were interested in receiving the COVID-19 vaccine, the association between vaccine intention and uptake is not yet fully understood. Ourobjective was todescribe predictors of vaccine uptake, and estimate the sensitivity, specificity, and predictive values of self-reported COVID-19 vaccine status compared to a comprehensive statewide COVID-19 vaccine registry.

METHODS

A cohort of California residents that received a molecular test for SARS-CoV-2 infection during 24 February-5 December 2021 were enrolled in a telephone-administered survey. Survey participants were matched with records in a statewide immunization registry. Cox proportional hazards model were used to compare time to vaccination among those unvaccinated at survey enrollment by self-reported COVID-19 vaccination intention.

RESULTS

Among 864 participants who were unvaccinated at the time of interview, 272 (31%) had documentation of receipt of COVID-19 vaccination at a later date; including 194/423 (45.9%) who had initially reported being willing to receive vaccination, 41/185 (22.2%) who reported being unsure about vaccination, and 37/278 (13.3%) who reported unwillingness to receive vaccination.Adjusted hazard ratios (aHRs) for registry-confirmed COVID-19 vaccination were 0.49 (95% confidence interval: 0.32-0.76) and 0.21 (0.12-0.36) for participants expressing uncertainty and unwillingness to receive vaccination, respectively, as compared with participants who reported being willing to receive vaccination. Time to vaccination was shorter among participants from higher-income households (aHR = 3.30 [2.02-5.39]) and who reported co-morbidities or immunocompromising conditions (aHR = 1.54 [1.01-2.36]).Sensitivity of self-reported COVID-19 vaccination status was 82% (80-85%) overall, and 98% (97-99%) among those referencing vaccination records; specificity was 87% (86-89%).

CONCLUSION

Willingness to receive COVID-19 vaccination was an imperfect predictor of real-world vaccine uptake. Improved messaging about COVID-19 vaccination regardless of previous SARS-CoV-2 infection status may help improve uptake.

Race and Sex Differences in Vital Signs Associated with COVID-19 and Flu Diagnoses in Mississippi

Early detection of viral infections, such as COVID-19 and flu, have potential to reduce risk of morbidity, mortality, and disease transmission through earlier intervention strategies. For example, detecting changes in vital signs have the potential to more rapidly diagnose respiratory virus diseases. The objective of this study was to utilize the University of Mississippi Medical Center's extensive clinical database (EPIC) to investigate associations between temperature, pulse rate, blood pressure (BP), and respiration rate in COVID-19 and flu diagnosed patients. Data from 1,363 COVID-19 (March 3, 2020, to February 27, 2021) and 507 flu (October 1, 2017, to September 30, 2018) diagnosed patients with reported demographic dimensions (age, first race, and sex) and office visit dimensions (BMI, diastolic BP, pulse rate, respiration rate, systolic BP, and temperature) was obtained, including day of diagnosis and additional encounter visits 60 days before and after first unique diagnosis. Patients with COVID-19 or flu were disproportionately obese, with 93% of COVID-19 and 79% of flu patients with BMI ≥ 30. Most striking, Black women 50-64 years of age disproportionately carried the burden of disease. At the time of diagnosis, temperature was significantly increased for all patients, yet pulse rate was only significantly increased for flu diagnosis, and BP was not significantly different in either. Our findings show the need for more complete demographic and office visit dimension data from patients during epidemic and pandemic events and support further studies needed to understand association between vital signs and predicting respiratory disease.

Effect of Flu Vaccination on Severity and Outcome of Heart Failure Decompensations

OBJECTIVE

To investigate the relationship of seasonal flu vaccination with the severity of decompensation and long-term outcomes of patients with heart failure (HF).

METHODS

We analyzed 6147 consecutively enrolled patients with decompensated HF who presented to 33 Spanish emergency departments (EDs) during January and February of 2018 and 2019, grouped according to seasonal flu vaccination status. The severity of HF decompensation was assessed by the Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) + MEESSI scale, need of hospitalization and in-hospital all-cause mortality. The long-term outcomes analyzed were 90-day postdischarge adverse events and 90-day all-cause death. Associations between vaccination, HF decompensation severity and long-term outcomes were explored by unadjusted and adjusted logistic and Cox regressions by using 14 covariables that could act as potential confounders.

RESULTS

Overall median (IQR) age was 84 (IQR = 77-89) years, and 56% were women. Vaccinated patients (n = 1139; 19%) were older, had more comorbidities and had worse baseline status, as assessed by New York Heart Association class and Barthel index, than did unvaccinated patients (n = 5008; 81%). Infection triggering decompensation was more common in vaccinated patients (50% vs 41%; P < 0.001). In vaccinated and unvaccinated patients, high or very-high risk decompensation was seen in 21.9% and 21.1%; hospitalization occurred in 72.5% and 73.7%; in-hospital mortality was 7.4% and 7.0%; 90-day postdischarge adverse events were 57.4% and 53.2%; and the 90-day mortality rate was 15.8% and 16.6%, respectively, with no significant differences between cohorts. After adjusting, vaccinated decompensated patients with HF had decreased odds for hospitalization (OR = 0.823, 95%CI = 0.709-0.955).

CONCLUSION

In patients with HF, seasonal flu vaccination is associated with less severe decompensations.

Trends and Non-Clinical Predictors of Respiratory Syncytial Virus (RSV) and Influenza Diagnosis in an Urban Pediatric Population

Objective

To evaluate the demographic, maternal, and community-level predictors of pediatric respiratory syncytial virus (RSV) and influenza diagnosis among an urban population of children residing in Rochester, NY.

Study design

A test-negative case-control design was used to investigate various non-clinical determinants of RSV and influenza diagnosis among 1,808 children aged 0-14 years who presented to the University of Rochester Medical Center (URMC) or an affiliated health clinic in Rochester, NY between 2012-2019. These children were all tested for RSV and influenza via polymerase-chain-reaction (PCR) method, including RSV and influenza diagnosis of all severity types. Test results were linked to medical records, birth certificates, questionnaires administered through the Statewide Perinatal Data System, and the US census by census tracts to obtain information on child, maternal, demographic, and socio-economic characteristics.

Results

Overall the strongest predictor of RSV and influenza diagnosis was child's age, with every year increase in child's age, risk for RSV decreased (OR: 0.75; 95% CI: 0.71, 0.79) and risk for influenza increased (OR: 1.20; 95%: 1.16, 1.24). In addition to age, non-private insurance type was positively associated with influenza diagnosis. When considering the proportion of positive cases for RSV and influenza over all PCR tests by respiratory season, a spike in influenza cases was observed in 2018-2019.

Conclusions

Age was a strong predictor of RSV and influenza diagnosis among this urban sample of children.

Postinfluenza Cardiac Tamponade: A Review of Published Case Reports

Increased vaccination rates and better understanding of influenza virus infection and clinical presentation have improved the disease's overall prognosis. However, influenza can cause life-threatening complications such as cardiac tamponade, which has only been documented in case reports. We searched PubMed/Medline and SCOPUS and EMBASE through December 2021 and identified 25 case reports on echocardiographically confirmed cardiac tamponade in our review of influenza-associated cardiac tamponade. Demographics, clinical presentation, investigations, management, and outcomes were analyzed using descriptive statistics. Among 25 cases reports [19 adults (47.6 ±15.12) and 6 pediatric (10.1 ± 4.5)], 15 (60%) were females and 10 (40%) were male patients. From flu infection to the occurrence of cardiac tamponade, the average duration was 7±8.5 days. Fever (64%), weakness (40%), dyspnea (24%), cough (32%), and chest pain (32%) were the most prevalent symptoms. Hypertension, diabetes, and renal failure were most commonly encountered comorbidities. Sinus tachycardia (11 cases, 44%) and ST-segment elevation (7 cases, 28%) were the most common ECG findings. Fourteen cases (56%) reported complications, the most common being hypotension (24%), cardiac arrest (16%), and acute kidney injury (8%). Mechanical circulatory/respiratory support was required for 14 cases (56%), the most common being intubation (9 cases, 64%). Outcomes included recovery in 88% and death in 3 cases. With improving vaccination rates, pericardial tamponade remains an infrequently encountered complication following influenza virus infection. The complicated cases appear within the first week of diagnosis, of which nearly half suffer from concurrent complications including cardiac arrest or acute kidney injury. Majority of patients recovered with timely diagnoses and therapeutic interventions.

Evaluation of knowledge and barriers of influenza vaccine uptake among university students in Saudi Arabia; a cross-sectional analysis

Background

Influenza vaccine hesitancy is a significant threat to global maneuvers for reducing the burden of seasonal and pandemic influenza. This study estimated the vaccine uptake, barriers, and willingness for influenza vaccines among university students in Saudi Arabia.

Methods

A cross-sectional survey was conducted among health science (HS) and non-health science (NHS) university students. A 31-item questionnaire was used to ascertain the vaccination rate, barriers, and willingness for the flu vaccine.

Results

This study included 790 students (mean age: 21.40 ± 1.94 years), 246 (31.1%) from HS and 544 (68.9%) from NHS disciplines. About 70% did not take flu shots before the arrival of the winter. The mean knowledge score was 7.81 ± 1.96, where 20.4%, 67.6%, and 12% of respondents had good, moderate, and poor knowledge regarding flu vaccines. The relative importance index (RII) analysis showed a lack of recommendation from physicians (51.5%, RI ranked: 1) was a top-ranked barrier to vaccine uptake, followed by negative perceptions and accessibility issues. Only 36.6% of the participants were willing to get vaccinated every year, 70% were willing to receive a vaccine on their doctor's recommendations, and 46% agreed to vaccinate if vaccines were freely available in the university. The knowledge, barriers, and willingness widely varied across students from two disciplines.

Conclusions

Our analysis underscored low flu vaccine uptake among university students. In addition, the study participants' knowledge was unsatisfactory, and they were less inclined to receive the flu vaccine in the future. Lack of recommendation from the physicians, negative perceptions towards the flu vaccine, and difficult accessibility were found as significant barriers to the vaccine uptake. A multidimensional approach at educational institutes to cover the knowledge gap and address the barriers curtailing the vaccination rate among students is recommended.

Impact and characteristics of hospital-acquired influenza over 10 seasons in a third-level university hospital

OBJECTIVES

To analyze the characteristics of patients with nosocomial flu, to compare them with patients with community-acquired influenza to study possible differences and to identify possible risk factors associated with this type of flu.

PATIENTS AND METHODS

Observational, cross-sectional and retrospective study of hospitalized patients with a microbiological confirmation of influenza in a third-level university hospital over 10 seasons, from 2009 to 2019. Nosocomial influenza was defined as that infection whose symptoms began 72h after hospital admission, and its incidence, characteristics and consequences were further analyzed.

RESULTS

A total of 1260 hospitalized patients with a microbiological diagnosis of influenza were included, which 110 (8.7%) were nosocomial. Patients with hospital-acquired influenza were younger (71.74±16.03 years, P=0.044), had a longer hospital stay (24.25±20.25 days, P<0.001), had more frequently a history of chronic pulmonary pathologies (P=0.010), immunodeficiency (P<0.001), and were associated with greater development of bacterial superinfection (P<0.001), respiratory distress (P=0.003), and admission to the intensive care unit (ICU) (P<0.001). In the multivariate logistic regression analysis, the following characteristics were identified as independent risk factors: immunodeficiency (ORa=2.33; 95% CI: 1.47-3.60); ICU admission (ORa=4.29; 95% CI: 2.23-10.91); bacterial superinfection (ORa=1.64; 95% CI: 1.06-2.53) and respiratory distress (ORa=3.88; 95% CI: 1.23-12.23).

CONCLUSIONS

Nosocomial influenza is more common in patients with a history of immunodeficiency. In addition, patients with hospital-acquired influenza had an increased risk of bacterial superinfection, admission to the ICU, and development of respiratory distress.

SARS-CoV-2 and influenza coinfection throughout the COVID-19 pandemic: an assessment of coinfection rates, cohort characteristics, and clinical outcomes

Case reports of patients infected with COVID-19 and influenza virus ("flurona") have raised questions around the prevalence and severity of coinfection. Using data from HHS Protect Public Data Hub, NCBI Virus, and CDC FluView, we analyzed trends in SARS-CoV-2 and influenza hospitalized coinfection cases and strain prevalences. We also characterized coinfection cases across the Mayo Clinic Enterprise from January 2020 to April 2022. We compared expected and observed coinfection case counts across different waves of the pandemic and assessed symptoms and outcomes of coinfection and COVID-19 monoinfection cases after propensity score matching on clinically relevant baseline characteristics. From both the Mayo Clinic and nationwide datasets, the observed coinfection rate for SARS-CoV-2 and influenza has been higher during the Omicron era (2021 December 14 to 2022 April 2) compared to previous waves, but no higher than expected assuming infection rates are independent. At the Mayo Clinic, only 120 coinfection cases were observed among 197,364 SARS-CoV-2 cases. Coinfected patients were relatively young (mean age: 26.7 years) and had fewer serious comorbidities compared to monoinfected patients. While there were no significant differences in 30-day hospitalization, ICU admission, or mortality rates between coinfected and matched COVID-19 monoinfection cases, coinfection cases reported higher rates of symptoms including congestion, cough, fever/chills, headache, myalgia/arthralgia, pharyngitis, and rhinitis. While most coinfection cases observed at the Mayo Clinic occurred among relatively healthy individuals, further observation is needed to assess outcomes among subpopulations with risk factors for severe COVID-19 such as older age, obesity, and immunocompromised status.

Multiplexed electrospray enables high throughput production of cGAMP microparticles to serve as an adjuvant for a broadly acting influenza vaccine

Subunit vaccines employing designer antigens such as Computationally Optimized Broadly Reactive Antigen (COBRA) hemagglutinin (HA) hold the potential to direct the immune response toward more effective and broadly-neutralizing targets on the Influenza virus. However, subunit vaccines generally require coadministration with an adjuvant to elicit a robust immune response. One such adjuvant is the stimulator of interferon genes (STING) agonist cyclic dinucleotide 3'3'-cyclic guanosine monophosphate-adenosine monophosphate (cGAMP). We have shown that encapsulation of cGAMP in acetalated dextran (Ace-DEX) microparticles through electrospray results in significantly greater biological activity. Electrospray is a continuous manufacturing process which achieves excellent encapsulation efficiency. However, the throughput of electrospray with a single spray head is limited. Here we report the development of a multiplexed electrospray apparatus with an order of magnitude greater throughput than a single-head apparatus. Physicochemical characterization and evaluation of adjuvant activity in vitro and in vivo indicated that microparticles produced with the higher throughput process are equally suited for use as a potent vaccine adjuvant to induce a balanced immune response to COBRA HA antigens.

Clinical data to be used as a foundation to combat Covid-19 vaccine hesitancy

The coronavirus has become the paramount subject in peoples' lives, affecting and disrupting virtually every aspect of society, as the pandemic casts a shadow over the world. The facts, myths, and conspiracy theories centered on the Covid-19 pandemic have dominated social media accounts, local and national newspapers, as well as television programs. Strategies need to be evolved to counter Covid-19 vaccine hesitancy and mitigate health disparities in at-risk populations. Overcoming misinformation and distrust will require an interdisciplinary approach to deal with Covid-19. The purpose of this review is to offer a factual basis to all healthcare providers to assist in framing strategies to mitigate vaccine hesitancy and achieve herd immunity to combat the deadly Covid-19 pandemic. First an overview of the discovery of the viruses and their molecular structures will be presented. Secondly, a historical perspective is offered, comparing the differences between the 1918 flu pandemic and the current covid-19 pandemic. Lastly, an overview for proposed techniques and methods to counter and or mitigate covid-19 vaccine misinformation that may be used by an interdisciplinary team will be offered narratively and graphically.

Evidence for interannual persistence of infectious influenza A viruses in Alaska wetlands

Influenza A viruses (IAVs) deposited by wild birds into the environment may lead to sporadic mortality events and economically costly outbreaks among domestic birds. There is a paucity of information, however, regarding the persistence of infectious IAVs within the environment following deposition. In this investigation, we assessed the persistence of 12 IAVs that were present in cloacal and/or oropharyngeal swabs of naturally infected ducks. Infectivity of these IAVs was monitored over approximately one year with each virus tested in five water types: (1) distilled water held in the lab at 4 °C and (2-5) filtered surface water from each of four Alaska sites and maintained in the field at ambient temperature. By evaluating infectivity of IAVs in ovo following sample retrieval at four successive time points, we observed declines in IAV infectivity through time. Many viruses persisted for extended periods, as evidenced by ≥25% of IAVs remaining infectious in replicate samples for each treatment type through three sampling time points (144-155 days post-sample collection) and two viruses remaining viable in a single replicate sample each when tested upon collection at a fourth time point (361-377 days post-sample collection). The estimated probability of persistence of infectious IAVs in all five water types was estimated to be between 0.25 and 0.75 during days 50-200 post-sample collection as inferred through Kaplan-Meier survival analysis. Our results provide evidence that IAVs may remain infectious for extended periods, up to or even exceeding one year, when maintained in surface waters under ambient temperatures. Therefore, wetlands may represent an important medium in which infectious IAVs may reside outside of a biotic reservoir.

Factors Impacting Vaccine Uptake during Pregnancy: A Retrospective Analysis

BACKGROUND AND OBJECTIVE

Vaccine uptake rates during pregnancy remain below target goals due to a convergence of factors. In particular, women of lower socioeconomic means and racial minorities typically have reduced rates of vaccine acceptance. This study aims to identify additional factors contributing to vaccine acceptance within a sample population of women receiving prenatal care in Houston, Texas, United States of America.

METHODS

We performed a retrospective cross-sectional analysis of 11,500 pregnant women covered by Medicaid or ChipPerinate who received prenatal care during 2013-2021, assessing influenza (flu) and combined Tetanus, Diphtheria, Acellular Pertussis (TDAP) vaccine acceptance in the patient population. We examined temporal trends in flu and TDAP vaccination rates using Joinpoint regression analyses and evaluated the factors associated with single or concomitant vaccine acceptance during the study period and during the COVID-19 pandemic using adjusted log-binomial regression models.

RESULTS

In our population, 54% of patients received flu vaccination, and 76.1% received TDAP. TDAP rates increased from 2013-2015 but have shown an overall decline since then, as with the flu vaccine. Earlier entry to prenatal care (Prevalence Ratio [PR] 6.32; Confidence Interval [CI] 3.28-12.24) and pregnancy comorbidity such as gestational diabetes (PR 1.32; CI 0.82-2.19) were positively associated with uptake. In contrast, the NH-Black race was negatively associated with vaccine acceptance (PR 0.51 CI; 0.25-0.99). Otherwise, age and history of pre-pregnancy comorbidities were not significant predictors.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Within demographic groups identified as at-risk for vaccine refusal, modifying factors further impact vaccine hesitancy. Identifying these elements will guide targeted patient efforts to promote vaccine uptake, both for routine prenatal recommendations and for COVID vaccination.

Infodemiology of flu: Google trends-based analysis of Italians' digital behavior and a focus on SARS-CoV-2, Italy

Introduction

The aim of the current study was to assess if the frequency of internet searches for influenza are aligned with Italian National Institute of Health (ISS) cases and deaths. Also, we evaluate the distribution over time and the correlation between search volume of flu and flu symptoms with reported new cases of SARS-CoV-2.

Materials and methods

The reported cases and deaths of flu and the reported cases of SARS-CoV-2 were selected from the reports of ISS, the data have been aggregated by week. The search volume provided by Google Trends (GT) has a relative nature and is calculated as a percentage of query related to a specific term in connection with a determined place and time-frame.

Results

The strongest correlation between GT search and influenza cases was found at a lag of +1 week particularly for the period 2015-2019. A strong correlation was also found at a lag of +1 week between influenza death and GT search. About the correlation between GT search and SARS-CoV-2 new cases the strongest correlation was found at a lag of +3 weeks for the term flu.

Conclusion

In the last years research in health care has used GT data to explore public interest in various fields of medicine. Caution should be used when interpreting the findings of digital surveillance.

Influenza vaccination knowledge, attitudes, and practices among Tunisian elderly with chronic diseases

BACKGROUND

Generally, seasonal influenza does not cause severe infection in healthy adults, but for the elderly, an infection can pose a serious health concern. Although several measures can help prevent influenza, vaccination is considered the most effective. This study aimed to assess influenza vaccine uptake among elderly with chronic diseases in Tunisia during the 2018-2019 influenza season, and to identify knowledge, attitudes and barriers associated with influenza vaccine uptake.

METHODS

During influenza season of 2018-2019, we conducted a national cross-sectional study among elderly with chronic disease who were attending primary and secondary health care facilities in Tunisia. We collected data regarding practices, general knowledge and attitudes related to influenza and influenza vaccine, using a standardized questionnaire. A multivariate analysis by logistic regression was performed to assess the factors influencing willingness to receive influenza vaccine.

RESULTS

Among the 1191 surveyed elderly, 19.4% (95%CI 14.1-21.9) were vaccinated during the 2018-2019 influenza season and 64.7% (61.9-67.3) expressed willingness to be vaccinated in the next season regardless of vaccination status in the 2018-2019 season. Previous vaccination in the 2018-2019 influenza season was the most significantly associated factor with willingness to receive influenza vaccine (adjusted OR = 16.5 [3.7-72.4]). Significant associations were also observed between knowledge of influenza severity for the elderly as well as for those with chronic diseases and willingness to be vaccinated (p < 0.01). Likewise, participants who were convinced by flu vaccine effectiveness and those who were not concerned about vaccine side effects were more likely to be vaccinated (p < 0.001). The main reason that may lead to vaccine acceptance was a doctor's recommendation (41.1%), while the two main reasons that may lead to vaccine refusal were concerns about side effects (71.5%) and a belief that vaccine was ineffective in averting influenza illness (33.9%). Doctors were the most trusted source for information about influenza vaccine (91.5%).

CONCLUSION

Our study revealed low influenza vaccination coverage among Tunisian elderly with chronic diseases believed to be at higher risk for severe acute respiratory infections and death if infected with influenza. Treating physicians' role in promoting influenza vaccination in this high-risk group seems to be crucial.

Effectiveness of oseltamivir treatment on clinical failure in hospitalized patients with lower respiratory tract infection

BACKGROUND

Influenza is associated with excess morbidity and mortality of individuals each year. Few therapies exist for treatment of influenza infection, and each require initiation as early as possible in the course of infection, making efficacy difficult to estimate in the hospitalized patient with lower respiratory tract infection. Using causal machine learning methods, we re-analyze data from a randomized trial of oseltamivir versus standard of care aimed at reducing clinical failure in hospitalized patients with lower respiratory tract infection during the influenza season.

METHODS

This was a secondary analysis of the Rapid Empiric Treatment with Oseltamivir Study (RETOS). Conditional average treatment effects (CATE) and 95% confidence intervals were computed from causal forest including 85 clinical and demographic variables. RETOS was a multicenter, randomized, unblinded, trial of adult patients hospitalized with lower respiratory tract infections in Kentucky from 2009 through 2012. Adult hospitalized patients with lower respiratory tract infection were randomized to standard of care or standard of care plus oseltamivir as early as possible after hospital admission but within 24 h of enrollment. After randomization, oseltamivir was initiated in the treatment arm per package insert. The primary outcome was clinical failure, a composite measure including failure to reach clinical improvement within 7 days, transfer to intensive care 24 h after admission, or rehospitalization or death within 30 days.

RESULTS

A total of 691 hospitalized patients with lower respiratory tract infections were included in the study. The only subgroup of patients with a statistically significant CATE was those with laboratory-confirmed influenza infection with a 26% lower risk of clinical failure when treated with oseltamivir (95% CI 3.2-48.0%).

CONCLUSIONS

This study suggests that addition of oseltamivir to standard of care may decrease clinical failure in hospitalized patients with influenza-associated lower respiratory tract infection versus standard of care alone. These results are supportive of current recommendations to initiate antiviral treatment in hospitalized patients with confirmed or suspected influenza as soon as possible after admission. Trial registration Original trial: Clinical Trials.Gov; Rapid Empiric Treatment With Oseltamivir Study (RETOS) (RETOS); ClinicalTrials.gov Identifier: NCT01248715 https://clinicaltrials.gov/ct2/show/NCT01248715.

Management of hospitalized influenza A patients during the season 2018/19 : Comparison of three medical departments and the effect on outcome and antibiotic usage

BACKGROUND

Diagnosis and treatment of influenza patients are often provided across several medical specialties. We compared patient outcomes at an infectious diseases (ID), a rheumatology (Rheu) and a pulmonology (Pul) department.

MATERIAL AND METHODS

In this prospective observational multicenter study we included all influenza positive adults who were hospitalized and treated at flu isolation wards in three hospitals in Vienna during the season 2018/2019.

RESULTS

A total of 490 patients (49% female) with a median age of 73 years (interquartile range [IQR] 61-82) were included. No differences regarding age, sex and most underlying diseases were present at admission. Frequencies of the most common complications differed: acute kidney failure (ID 12.7%, Rheu 21.2%, Pulm 37.1%, p < 0.001), acute heart failure (ID 4.3%, Rheu 17.1%, Pulm 14.4%, p < 0.001) and respiratory insufficiency (ID 45.1%, Rheu 41.5%, Pulm 56.3%, p = 0.030). Oseltamivir prescription was lowest at the pulmonology flu ward (ID 79.6%, Rheu 90.5%, Pulm 61.7%, p < 0.001). In total 176 patients (35.9%) developed pneumonia. Antibiotic selection varied between the departments: amoxicillin/clavulanic acid (ID 28.9%, Rheu 63.8%, Pulm 5.9%, p < 0.001), cefuroxime (ID 28.9%, Rheu 1.3%, Pulm 0%, p < 0.001), 3rd generation cephalosporins (ID 4.4%, Rheu 5%, Pulm 72.5%, p < 0.001), doxycycline (ID 17.8%, Rheu 0%, Pulm 0%, p < 0.001). The median length of stay was significantly different between wards: ID 6 days (IQR 5-8), Rheu 6 days (IQR 5-7) and Pulm 7 days (IQR 5-9.5, p = 0.034). In-hospital mortality was 4.3% and did not differ between specialties.

CONCLUSION

We detected differences in oseltamivir usage, length of in-hospital stay and antibiotic choices for pneumonia. Influenza-associated mortality was unaffected by specialty.

Complementary medicine use and flu vaccination - A nationally representative survey of US adults

BACKGROUND

Prior research presented inconsistent results with less, equal or higher vaccination rates among patients using complementary medicine. Given that complementary medicine includes a wide range of therapies, variable vaccination patterns may occur within consultations with different professions. This analysis aims to to evaluate differences between categories of complementary medicine regarding vaccination behavior among US adults.

METHODS AND RESULTS

This analysis used data from the 2017 National Health Interview Survey (NHIS; n = 26,742; response rate 80.7%). Prevalences of flu vaccination, consultations with complementary medicine practitioners in the past 12 months and their potential interactions were examined. 42.7% of participants had received flu vaccination in the past 12 months, 32.4% had seen one or more complementary medicine practitioner. Users of any type of complementary medicine were as likely as non-users to have received a flu vaccination (44.8% users versus 41.7% non-users; p = 0,862; adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.95-1.07). Regarding specific complementary medicine types, individuals consulting with naturopaths (p < 0.001; AOR = 0.67, 95 %CI = 0.54-0.82), homeopaths (p < 0.001; AOR = 0.55; 95 %CI = 0.44-0.69) and chiropractors (p = 0.016; AOR = 0.9, 95 %CI = 0.83-0.98) were less likely, while other complementary medicine approaches showed no significant association with flu vaccination behavior. Independent predictors for a flu shot were prior diabetes, cancer, current asthma, kidney disease, overweight and current pregnancy. As well, higher educational level, age, ethnicity, health insurance coverage and having seen a general physician or medical specialist in the past 12 months were also associated with a higher vaccination rate.

CONCLUSIONS

Complementary medicine users were equally likely to receive an influenza vaccination compared with non-users. Different complementary therapies showed varied associations with vaccination behavior. Further analyses may be needed to distinguish influencing factors among patients' vaccination behavior.

The effect of influenza vaccine on severity of COVID-19 infection: An original study from Iran

Background: The COVID-19 infection is a novel virus that mainly targets the respiratory system via specific receptors without any coronavirus-targeted therapies. Many efforts have been made to prepare specific vaccines for COVID-19 or use of prefabricated vaccines of other similar viruses, especially severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and influenza (flu). We aimed to evaluate the effects of previous flu vaccine injection on severity of incoming COVID-19 infection. Methods: We conducted a large cross-sectional study of 529 hospitalized Iranian COVID patients to evaluate the severity of disease courses in patients with or without previous flu vaccination history using some main factors like length of hospitalization, need for the intensive care unit (ICU) admission and length of stay in the ICU for comparison between COVID-19 infected patients with or without flu vaccination history. For the quantitative data, we used independent-samples t and Mann-Whitney tests. The qualitative data were calculated using the Fisher exact and chi-square tests in IBM SPSS Statistics version 22 (SPSS Inc) and P value <0.05 was considered statistically significant. Results: There were no significant differences in the demographic data of patients, disease, and severity-related parameters between the 2 groups. It means that there were not any significant differences between patients with and without history of flu vaccination regarding mean days of hospitalization, percentage of needing to be admitted to the ICU, days being admitted to the ICU (8.44±6.36 vs 7.94±8.57; 17% vs 11.5%; and 1.17±3.09 vs 0.92±3.04, retrospectively) (p=0.883, 0.235, and 0.809, respectively). In the laboratory tests, in comparison between patients with and without history of previous flu vaccination, only lymphocytes count in the vaccine positive group was higher than the vaccine negative group (20.82±11.23 vs 18.04±9.71) (p=0.067) and creatine phosphokinase (CPK) levels were higher in the vaccine negative group (146.57±109.72 vs 214.15±332.06) (p=0.006). Conclusion: We did not find any association between flu vaccination and decrease in disease severity in our patients. It seems that patients with previous history of flu vaccination may experience less laboratory abnormalities in some parameters that could be interpreted in favor of lower overall inflammation; however, this study cannot answer this definitely because of its design. As we collected retrospective data from only alive discharged patients and had no healthy control group, we could not discuss the probable effect of the vaccine on the mortality rate or its probable protective role against the infection. We need more well-designed controlled studies with different populations in different geographic areas to address the controversies.

[The new generation of messenger RNA (mRNA) vaccines against influenza]

En la actualidad existen múltiples tipos de vacunas frente a la gripe. La irrupción de la tecnología de ácidos nucleicos utilizada en las vacunas frente al SARS-CoV-2 hace pensar en su aplicación futura frente a esta infección. Frente a la gripe se han desarrollado 2 tipos de vacunas basadas en el ARN mensajero (ARNm): las convencionales o no replicativas y las autoamplificables o replicativas (auARNm), ambas incluidas en nanopartículas lipídicas. Los estudios en animales realizados con las primeras han mostrado su intensa capacidad para inducir anticuerpos e inmunidad celular Th-1 frente a la hemaglutinina gripal con escasos efectos secundarios. Los ensayos en humanos han mostrado una seroconversión del 87% y una seroprotección del 100%. Las vacunas auARNm han obtenido resultados en animales semejantes, pero a una concentración 64 veces inferior a la convencional. Las vacunas basadas en las plataformas de ARNm cumplen los requisitos establecidos por la OMS para vacunas de gripe de la generación siguiente.

M2e conjugated gold nanoparticle influenza vaccine displays thermal stability at elevated temperatures and confers protection to ferrets

Currently approved influenza vaccines are not only limited in breadth of protection but also have a limited shelf-life of 12-18 months when stored under appropriate conditions (2-8 °C). Inadvertent alteration in storage temperatures during manufacturing, transportation, distribution until delivery to patient, can damage the vaccine thus reducing its efficacy. A thermally stable vaccine can decrease the economic burden by reducing reliance on refrigeration system and can also enhance outreach of the vaccination program by allowing transportation to remote areas of the world where refrigerated conditions are scarce. We have previously developed a broadly protective influenza A vaccine by coupling the highly conserved extracellular region of the matrix 2 protein (M2e) of influenza A virus to gold nanoparticles (AuNPs) and upon subsequent addition of toll-like receptor 9 agonist - CpG, as an adjuvant, have shown its breadth of protection in a mouse model. In this study, we show that the vaccine is thermally stable when stored at 4 °C for 3 months, 37 °C for 3 months and 50 °C for 2 weeks in its lyophilized form, and later it was possible to readily reconstitute it in water without aggregation. Intranasal vaccination of mice using reconstituted vaccine induced M2e-specific IgG and IgG subtypes in serum similar to the freshly formulated vaccine, and fully protected mice against lethal influenza A challenge. Immunization of ferrets intranasally or intramuscularly with the vaccine induced M2e-specific IgG and there was reduced virus level in nasal wash of ferrets immunized through intranasal route.

The impact of influenza vaccination on cardiovascular disease

Influenza infection has been identified as a triggering or exacerbating factor for cardiovascular events. To analyse the effect of influenza vaccination on cardiovascular disease, a systematic search of studies published between 2009-2019 was conducted. All the studies that evaluated the effect of vaccination against influenza on cardiovascular events and their outcome were considered. Finally, 30 of the 1147 identified studies were included. These studies show a protective effect of the influenza vaccine on the development of cardiovascular events (myocardial infarction, cerebrovascular accidents, atrial fibrillation, and heart failure) and on the worsening of these conditions. Furthermore, the data showed that vaccinated patients have a lower risk of death from cardiovascular pathologies. Influenza vaccination is therefore an effective measure in the prevention of cardiovascular diseases both in patients with established cardiovascular disease and in the population without previous coronary pathology.

[SARS-CoV-2, influenza and norovirus infection : A direct epidemiologic comparison]

Hintergrund

Hospitalisierungsraten, Notaufnahmeprävalenzen und Fallsterblichkeiten (CFP) stationärer SARS-CoV-2-Patienten und wie sich diese von anderen pandemischen oder saisonalen Viruserkrankungen, wie Influenza A/B oder Norovirusinfektionen unterscheiden, wurden bisher nicht untersucht. Diese Arbeit gibt einen Überblick aus einer Kommune darüber und vergleicht diesen auch mit den negativ getesteten stationären Verdachtsfällen.

Methoden

Im Rahmen retrospektiver Kohortenanalysen von 67.000 Krankenhausfällen eines Klinikums mit umfassender Notfallversorgung und Meldedaten des regionalen Gesundheitsamts wurden für die Virusinfektionen SARS-CoV‑2, Influenza A/B und Norovirus Genotyp 1/2 Hospitalisierungsraten, Notaufnahmeprävalenzen und CFP berechnet.

Ergebnisse

In Fürth (Stadt‑/Landkreis) wurden 0,34 % der Bevölkerung, 824 Personen, bis 07.05.2020 positiv auf SARS-CoV‑2 getestet, wovon 162 (19,7 %) stationär behandelt wurden. 91 der Infizierten verstarben (CFP 11,0 %), davon 48 stationär. In der aktuellen Grippe‑/Norovirussaison wurden 992 Einwohner als influenzapositiv und 135 als noroviruspositiv gemeldet, davon 202 (20,3 %) bzw. 125 (91,9 %) stationär behandelt. Die Notaufnahmeprävalenzen waren 4,1 %, 2,0 % und 0,6 %. Die CFP der SARS-CoV-2-, influenza- und noroviruspositiven Krankenhauspopulationen betrugen 29,1 %, 3,0 % und 1,6 %, die der testnegativen Verdachtsfälle 5,9 %, 4,8 % und 6,9 % bei einer Krankenhausmortalität von 2,1 % für 2020.

Schlussfolgerungen

Bei gleichen Hospitalisierungsraten von SARS-CoV-2- und Influenzapatienten unterschieden sich die CFP massiv, während die CFP der testnegativen Verdachtsfälle aller 3 Infektionserkrankungen sich nicht signifikant unterschieden.

Impact of non-pharmaceutical interventions targeted at COVID-19 pandemic on influenza burden - a systematic review

OBJECTIVES

To better understand the impact of comprehensive COVID-19 targeted non-pharmaceutical interventions (NPIs) on influenza burden worldwide.

METHODS

We conducted a systematic literature search in selected databases (PubMed, WHO COVID-19), preprint servers (medRxiv, bioRxiv) and websites of European Public Health institutes. Documents that compared influenza estimates in the 2019/2020 season with previous seasons were included. Information synthesis was qualitative due to a high heterogeneity in the number and periods of comparative seasons, outcome measures and statistical methods.

RESULTS

We included 23 records reporting from 15 countries/regions as well as 8 reports from European Public Health agencies. Estimates in the 2019/2020 season based on influenza virus tests (4 out of 7 countries/regions), defined influenza cases (8 out of 9), influenza positivity rate (7 out of 8), and severe complications (1 out of 2) were lower than in former seasons. Results from syndromic indicators, such as influenza-like-illness (ILI), were less clear or even raised (4 out of 7) after the influenza season indicating a misclassification with COVID-19 cases.

CONCLUSIONS

Evidence synthesis suggests that NPIs targeted at SARS-CoV-2-transmission reduce influenza burden as well. Low threshold NPIs need to be more strongly emphasized in influenza prevention strategies.

Lessons to be learnt from 100 year old 1918 influenza pandemic viz a viz 2019 corona pandemic with an eye on NTEP

The article is about the 1918 H1N1 flu pandemic also called the “Spanish flu“ which killed 50 million plus people worldwide, and the coronavirus pandemic (Covid-19) which has spread in the world at an alarming pace. As of now there are 11,327,790 cases and 532,340 deaths globally. Aim of this article is to draw conclusions and share knowledge from both the pandemics and apply these lessons in other health programmes.

The Way We Live Now

This is a personal account of one man's experience of the months during which COVID-19 spread in Australia. Though personal, it aims to also be representative, so that readers will find in it reflections of their own experiences. Various social incidents are described, some in which social distancing is involved. The altering states of the author's mind as time passes are carefully described in sequence, and the impact of continued anxiety and isolation on his mental well-being is presented as a form of madness, in one dramatic incident.

[Strategies in the prevention and control of the Covid-19 pandemic caused by SARS-CoV-2. Environmental factors.]

The role that environmental factors can play in preventing and controlling the Covid-19 epidemic was explored and compared to that of influenza. Papers cited by the U.S. National Academy of Sciences were discussed, which indicate that temperature and humidity in the environment can influence the intensity of the spread of the disease. The fact that influenza viruses and coronaviruses appeared seasonally, prevailing in the winter and declining in the summer, was illustrated. It was discussed that ultraviolet light in the environment can contribute to the control of the spread of the virus. A study was cited to suggest that particulate matter contributes to increased infection mortality, and that it increases in summer in some regions, countering the health effects of humidity and temperature. Data generated by online electronic tools was compared with surveillance reports generated by the U.S. Centers for Disease Control and Prevention. The epidemic began stronger in northern hemisphere countries during the northern winter. (Evidence that the epidemic intensified during the southern winter is not disputed.) The incidence declined in the northern hemisphere during the summer, except for the U.S., where cases doubled. Evidence suggests that the high degree of SARS-CoV-2 infection counteracts the role that environmental factors may play in Covid-19 control.

Minimizing disease spread on a quarantined cruise ship: A model of COVID-19 with asymptomatic infections

On February 5 the Japanese government ordered the passengers and crew on the Diamond Princess to start a two week quarantine after a former passenger tested positive for COVID-19. During the quarantine the virus spread rapidly throughout the ship. By February 20, there were 651 cases. We model this quarantine with a SEIR model including asymptomatic infections with differentiated shipboard roles for crew and passengers. The study includes the derivation of the basic reproduction number and simulation studies showing the effect of quarantine with COVID-19 or influenza on the total infection numbers. We show that quarantine on a ship with COVID-19 will lead to significant disease spread if asymptomatic infections are not identified. However, if the majority of the crew and passengers are immune or vaccinated to COVID-19, then quarantine would slow the spread. We also show that a disease similar to influenza, even with a ship with a fully susceptible crew and passengers, could be contained through quarantine measures.

Gender differences and influenza-associated mortality in hospitalized influenza A patients during the 2018/19 season

BACKGROUND

In this study we analyzed gender differences in the clinical presentation of patients with molecular confirmed influenza A. Additionally, we tried to identify predictors of influenza-associated mortality.

MATERIALS/METHODS

In this prospective observational multi-center-study we included all influenza-positive patients ≥ 18 years who were hospitalized and treated on flu-isolation-wards in three hospitals in Vienna during the 2018/19 influenza season. Diagnoses were made via Cobas^® Liat^® POCT.

RESULTS

490 Patients (48.8% female) tested positive for influenza A. Female patients were older (median age 76 years vs. 70 years, p < 0.001). Male patients had a higher rate of chronic liver disease in history (8.8% vs. 2.9%, p = 0.006), myositis (11.7% vs. 3.1%, p < 0.001) and ICU admissions (9.6% vs. 4.6%, p = 0.03). The in-hospital mortality rate was 4.3% and increased to 9.5% during the 90-day follow-up period. Female patients > 75 years had a significantly higher in-hospital mortality rate than ≤ 75-year-old females (9.2% vs. 1.7%, p = 0.019). This effect was not observed in male patients (5.4% vs. 1.9%, p = ns). Age > 75 years (OR 5.49, 95% CI 1.10-27.43), acute heart failure (OR 3.56, 95% CI 1.03-12.05) and ICU admission (OR 6.1, 95% CI 0.98-37.91) were predictors for in-hospital mortality for female patients, while any malignancy (OR 9.4, 95% CI 1.90-46.54) and ICU admission (OR 7.05, 95% CI 1.44-34.55) were predictors in male patients.

CONCLUSIONS

Gender is associated with differences in clinical presentation and complications of influenza A virus infection. Women with acute heart failure or aged > 75 years have an increased risk of influenza associated in-hospital mortality, while ICU admission and any malignancy are predictors for male patients. Mortality rates in patients > 75 years are 5-10 times higher compared to their non-hospitalized influenza-negative Austrian counterparts.

[Public health measures during the flu pandemic in the period 1918-1920 in Spain.]

BACKGROUND

The 1918 influenza epidemic was an event of great social and health resonance, which caused high morbidity and mortality in the population. The rapidity in the development of symptoms, the extension to very large groups of the population and the lack of knowledge of the causative agent, were the factors that, added together, made the flu a major public health problem. The objective of this study was to review, through the Spanish written press, of the public health measures adopted as a consequence of the influenza epidemic of 1918.

METHODS

A selection of the Spanish press was carried out through the Digital Newspaper Library of the National Library (HDBN) of Spain, from January 1, 1918 to December 31, 1920; and the concept "flu" was searched, selecting those units of analysis that made reference to the public health measures adopted during the flu epidemic of 1918.

RESULTS

The newspapers analyzed reported the public health measures adopted by the health authorities of the different countries in order to reduce the spread of the epidemic, such as the closure of schools and the postponement of the opening of the academic year, disinfection of premises, quarantines, isolation, suspension, popular celebrations, disinfection and hygiene, border control, suspension of communications by train, as well as the creation and use of different vaccines and serums to immunize the population.

CONCLUSIONS

The poor management of the epidemic could be one of the causes of the great impact of influenza in the first half of October 1918, as the decisions of the administration to promote public health measures were adopted with some delay.

Low rates of influenza vaccination uptake among healthcare workers: Distinguishing barriers between occupational groups

BACKGROUND

To gain further insights into health care workers (HCWs) attitudes toward influenza vaccination to guide future interventions to increase vaccination rates.

METHODS

A standardized anonymous questionnaire was sent to all employees of the University Hospital Basel, Switzerland following the influenza season 2013/2014. We collected information regarding HCW's demographics, experiences with flu vaccinations, and reasons for nonvaccination.

RESULTS

Vaccination rates ranged from 14.7% to 31% from 2007 to 2019. A total of 1,454 HCW participated in the survey, of which 62% reported being vaccinated. HCW not vaccinated were more commonly female and differed by occupational group and department. The main reasons for nonvaccination were fear of short-term adverse reactions, followed by assessing the evidence regarding vaccination-benefits as insufficient and fears of violation of the right to self-determination. Fear of long-term sequela and violation of the right of self-determination differed between the 4 professional groups, both being most commonly indicated by nurses and at least indicated by physicians.

CONCLUSIONS

This study provides some insight into differences regarding barriers to vaccination between different occupational groups, which might not have been adequately addressed so far. Policy makers should consider such differences when designing campaigns to raise acceptance of influenza vaccine among HCWs.

The efficacy and safety of influenza vaccination in older people: An umbrella review of evidence from meta-analyses of both observational and randomized controlled studies

Vaccination is the main public health intervention to prevent influenza. We aimed to evaluate the efficacy and safety of influenza vaccination including systematic reviews and meta-analyses of observational studies and randomized controlled trials (RCTs). Peer-reviewed systematic reviews with meta-analyses of prospective studies that investigated the association of influenza vaccination with any health-related outcome, as well as RCTs that investigated the efficacy and safety of influenza vaccination, were included. Among 1240 references, 6 meta-analyses were included. In cohort studies of community-dwelling older people influenza vaccination was associated with a lower risk of hospitalization for heart disease and for influenza/pneumonia (strength of evidence: convincing). Evidence in lowering the risk of mortality in community-dwelling older people, of all deaths/severe respiratory diseases in high risk community-dwelling older people and of hospitalization for influenza/pneumonia in case-control studies, was highly suggestive. In RCTs, influenza vaccination, compared to placebo/no intervention, was associated to higher risk of local tenderness/sore arm and to a reduced risk of influenza like-illness. Both these associations showed moderate evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation). In conclusion, influenza vaccination in older people seems safe and effective. Further, the evidence on safety and efficacy of vaccines in this population might benefit by an extension of the follow-up period both in RCTs and in longitudinal studies, beyond the usual 6-month period, in order to be able to evaluate the impact of vaccination on long term outcomes.

Effect of vaccination on the prevention of influenza-related severe illness in adults attended in a third level hospital during the 2017-2018 epidemic season

OBJECTIVES

The objective of this research was to evaluate the effect of influenza vaccination on the prevention of influenza-related severe cases in adults treated in a third-level hospital during the 2017-2018 epidemic season.

METHODOLOGY

A descriptive analysis was performed on the entire population of subjects with a laboratory-confirmed influenza test during the 2017-2018 season. A severe case was defined as a patient treated in one of the Intensive Care Units (ICUs) and/or death. The effect of the vaccine on the adult population was determined by multivariate logistic regression analysis.

RESULTS

Between epidemiological weeks 44/2017 and 19/2018, the hospital's laboratory detected 706 positive samples for influenza virus. Of the 551 confirmed patients aged 18 years or older, forty-three were admitted to one of the ICUs, and 26 died during admission. The explanatory multivariate model has shown that flu vaccination prior to or during the epidemic season was a protective factor for the development of severity [OR:0.27 (0.11-0.65, p=0.004)], adjusted by age [OR: 1.03 (1.01-1.06), p=.04], sex, type of virus (H1N1-pdm09, H3N2 or B virus), Chronic Complex Patient index or Advanced Chronic Disease index.

CONCLUSSIONS

Influenza vaccination is a protective factor against the development of severity associated with influenza infection in a season when vaccination did not contain the virus with higher epidemic circulation among the population. Flu vaccination should be recommended annually following the guidelines established by the health authorities.

Ginseng integrative supplementation for seasonal acute upper respiratory infections: A systematic review and meta-analysis

BACKGROUND

The aim of the review was to assess whether ginseng can be a useful supplementation for seasonal acute upper respiratory infections (SAURIs).

METHODS

All clinical studies investigating ginseng efficacy for the treatment or prevention of SAURIs were included in the review. Medline, EMBASE, Web of Science, Scopus, Cochrane Library, Google Scholar were systematically screened for relevant articles up to May 26th, 2020. The risk of bias was assessed with the Cochrane tool (RoB 2).

RESULTS

Nine articles (describing ten trials about P. ginseng or P. quinquefolius) were included in the review. Evidence globally indicated some useful activity of intervention when administered in adjunct to influenza vaccination. The results of our quantitative synthesis suggested a significant effect on SAURIs incidence (RR = 0.69 [95 % C.I. 0.52 to 0.90], p < 0.05), as well as a significant reduction of their duration if only studies with healthy individuals were included in the analysis (MD=-3.11 [95 % C.I.-5.81 to -0.40], p < 0.05). However, the risk of bias was high-to-unclear for most included trials, and publication bias couldn't be excluded.

DISCUSSION

Limitations of existing evidence don't allow to draw conclusions on the topic. Nevertheless, it is not excluded that ginseng supplementation in adjunct to influenza vaccination and standard care might be useful for SAURIs prevention and management in healthy adult subjects, but further high-quality trials are needed to support this hypothesis.

OTHER

This research was not funded. The protocol was registered in PROSPERO under the following code: CRD42020156235.