Skowronski D, De Serres G, Orenstein W.

Abstract Background To improve national influenza vaccination recommendations, additional data on influenza A and B virus circulation are needed. Here, we describe the circulation of influenza A and B in the Czech Republic during 16 seasons. Methods This was a retrospective analysis of data collected from the 2000–2001 to 2015–2016 influenza seasons by the Czech Republic national influenza surveillance network. Influenza was confirmed and viral isolates subtyped by virological assays followed by antigen detection or by reverse transcriptase-polymerase chain reaction. Results Of 16,940 samples collected, 5144 (30.4%) were influenza-positive. Influenza A represented 78.6% of positive cases overall and accounted for more than 55.0% of all influenza cases in every season, except for 2005–2006 (6.0%). Both A/H1N1 and A/H3N2 were detected in most seasons, except for 2001–2002 and 2003–2004 (only A/H3N2), and 2007–2008 and 2009–2010 (only A/H1N1). Influenza B represented 21.4% of positive cases overall (range, 0.0–94.0% per season). Both influenza B lineages were detected in three seasons, a single B lineage in 11, and no B strain in two. For the 11 seasons where influenza B accounted for ≥20% of positive cases, the dominant lineage was Yamagata in six and Victoria in four. In the remaining season, the two lineages co-circulated. For two seasons (2005–2006 and 2007–2008), the B lineage in the trivalent influenza vaccine did not match the dominant circulating B lineage. Conclusions In the Czech Republic, during the 2000–2001 to 2015–2016 influenza seasons, influenza virus circulation varied considerably. Although influenza A accounted for the most cases in almost all seasons, influenza B made a substantial, sometimes dominant, contribution to influenza disease.…

Abstract Background Influenza and pneumococcal vaccine uptake in the older population aged 65 years or over of Hong Kong dramatically increased since the 2003 SARS outbreak. This study is aimed to evaluate the impact of increased coverage of influenza and pneumococcal vaccines by comparing the change of disease burden in the older population of Hong Kong, with the burden in the older population of Brisbane with relatively high vaccine coverage in the past fifteen years. Methods Time series segmented regression models were applied to weekly numbers of cause-specific mortality or hospitalization of Hong Kong and Brisbane. Annual excess rates of mortality or hospitalization associated with influenza in the older population were estimated for the pre-SARS (reference period), post-SARS and post-pandemic period, respectively. The rate ratios (RRs) between these periods were also calculated to assess the relative change of disease burden. Results Compared to the pre-SARS period, excess rates of mortality associated with influenza during the post-SARS period in Hong Kong decreased for cardiorespiratory diseases (RR = 0.90, 95% CI 0.80, 1.01), stroke (RR = 0.74, 95% CI 0.50, 1.09), and ischemic heart diseases (RR = 0.45, 95% CI 0.34, 0.58). The corresponding RRs in Brisbane were 0.79 (95% CI 0.54, 1.15), 0.33 (0.13, 0.80), and 1.09 (0.62, 1.90), respectively. Only the mortality of ischemic heart diseases showed a greater reduction in Hong Kong than in Brisbane. During the post-pandemic period, excess rates of all-cause mortality increased in Hong Kong, but to a lesser extent than in Brisbane (RR = 1.41 vs 2.39). Conclusion A relative decrease (or less of an increase) of influenza disease burden was observed in the older population of Hong Kong after increased coverage of influenza and pneumococcal vaccines in this population, as compared to those of Brisbane where vaccination rates remained stable. The lack of significant findings in some disease categories highlights the challenges of evaluating the benefits of vaccination at the population level.…

Danielle Vuichard-Gysin, Dominik Mertz, Eleanor Pullenayegum, Pardeep Singh, Marek Smieja, Mark Loeb

by Danielle Vuichard-Gysin, Dominik Mertz, Eleanor Pullenayegum, Pardeep Singh, Marek Smieja, Mark Loeb Predictive models have been developed for influenza but have seldom been validated. Typically they have focused on patients meeting a definition of infection that includes fever. Less is known about how models perform when more symptoms are considered. We, therefore, aimed to create and internally validate predictive scores of acute respiratory infection (ARI) symptoms to diagnose influenza virus infection as confirmed by polymerase chain reaction (PCR) from respiratory specimens. Data from a completed trial to study the indirect effect of influenza immunization in Hutterite communities were randomly split into two independent groups for model derivation and validation. We applied different multivariable modelling techniques and constructed Receiver Operating Characteristics (ROC) curves to determine predictive indexes at different cut-points. From 2008–2011, 3288 first seasonal ARI episodes and 321 (9.8%) influenza positive events occurred in 2202 individuals. In children up to 17 years, the significant predictors of influenza virus infection were fever, chills, and cough along with being of age 6 years and older. In adults, presence of chills and cough but not fever were highly specific for influenza virus infection (sensitivity 30%, specificity 96%). Performance of the models in the validation set was not significantly different. The predictors were consistently found to be significant irrespective of the multivariable technique. Symptomatic predictors of influenza virus infection vary between children and adults. The scores could assist clinicians in their test and treat decisions but the results need to be externally validated prior to application in clinical practice.

Lytras T, Mouratidou E, Andreopoulou A, et al.

AbstractBackgroundThe 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.MethodsThe study included all adults with laboratory-confirmed influenza hospitalized in intensive care units (ICU) in Greece over eight 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.Results1330 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% CrI 0.49–0.94; subdistribution Hazard Ratio 0.58, 95% CrI 0.37–0.88). This effect was purely due to an increased cause-specific hazard for discharge, while 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 0.5–3.5). No effect on mortality was observed for A/H1N1 and influenza B patients. ConclusionsSeverely 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.

Gamiño-Arroyo A, Guerrero M, McCarthy S, et al.

AbstractBackgroundEffective therapeutics for respiratory viruses are needed. Early data suggest Nitazoxanide (NTZ) may be beneficial for treating acute respiratory viral illness.MethodsFrom March 2014 through March 2017, a double-blind, placebo-controlled trial was conducted in 260 participants ≥ 1 year old hospitalized with influenza-like illness at six hospitals in Mexico. Participants were randomized 1:1 to NTZ (≥12 years old, 600 mg twice daily; 4-11 and 1-3 years old, 200 or 100 mg twice daily, respectively) or placebo for 5 days in addition to standard of care. The primary end point was time from first dose to hospital discharge. Influenza RT-PCR and Respifinder 22 multiplex test were used for virus detection. ClinicalTrials.gov, number NCT02057757.ResultsOf 260 participants enrolled, 257 were randomized and took at least one dose of study treatment (ITT population): 130 in the NTZ group and 127 in the placebo group. The Kaplan-Meier estimate of the median duration of hospitalization (interquartiles 25 th, 75 th) in the NTZ group was 6.5 (4.0, 9.0) days versus 7.0 (4.0, 9.0) days in the placebo group (P=0.56). Duration of hospitalization between the two treatments was similar in children (P=0.29) and adults (P=0.62), influenza A and B (P=0.32) and other respiratory viruses. 7(5.4%) and 6(4.7%) participants in the NTZ and placebo groups reported severe adverse events, respectively.ConclusionsTreatment with nitazoxanide did not reduce the duration of hospital stay in severe influenza-like illness. Further analyses based on age and evaluations by virus did not reveal any subgroups that appeared to benefit from nitazoxanide.

An error appeared in the initial publication of this article [Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza. Clin Infect Dis https://doi.org/10.1093/cid/ciy866]. This article was originally published with the two following errors:…

S. J. Olsen et al.

Jens Nielsen, Lasse S. Vestergaard, Lukas Richter, Daniela Schmid, Natalia Bustos, Tommi Asikainen, Ramona Trebbien, Gleb Denissov, Kaire Innos, Mikko J. Virtanen, Anne Fouillet, Theodore Lytras, Kassiani Gkolfinopoulou, Matthias an der Heiden, Linus Grabenhenrich, Helmut Uphoff, Anna Paldy, Janos Bobvos, Lisa Domegan, Joan O’Donnell, Matteo Scortichini, Annamaria de Martino, Joël Mossong, Kathleen England, Jackie Melillo, Liselotte van Asten, Marit MA de Lange, Ragnhild Tønnessen, Richard A. White, Susana

Weekly monitoring of European all-cause excess mortality, the EuroMOMO network, observed high excess mortality during the influenza B/Yamagata dominated 2017/18 winter season, especially among elderly. We describe all-cause excess and influenza-attributable mortality during the season 2017/18 in Europe.

Segaloff H, Leventer-Roberts M, Riesel D, et al.

AbstractBackgroundInfluenza vaccine effectiveness (VE) varies by season, circulating influenza strain, age, and geographic location. There have been few studies of influenza VE among hospitalized children, particularly in Europe and the Middle East. MethodsWe estimated VE against influenza hospitalization among children six months to eight years at Clalit Health Services hospitals in Israel in the 2015-16, 2016-17, and 2017-18 influenza seasons using the test-negative design. Estimates were computed for full and partial vaccination.ResultsWe included 326 influenza-positive cases and 2821 influenza-negative controls (140 cases and 971 controls from 2015-16, 36 cases and 1069 controls from 2016-17, and 150 cases and 781 controls from 2017-18). Over all seasons, VE was 53.9% for full vaccination (95% CI:(38.6,68.3)), and 25.6% for partial vaccination (95% CI:(-3, 47)). In 2015-16, most viruses were influenza A(H1N1) and vaccine lineage-mismatched influenza B/Victoria; VE for fully vaccinated children was statistically significant for influenza A (80.7%, 95% CI:(40.3,96.1)) but not B (23.0%, 95% CI:(-38.5, 59.4)). During 2016-17, influenza A(H3N2) predominated, and VE was (70.8%, 95% CI:(17.4, 92.4)). In 2017-18, influenza A(H3N2), H1N1 and lineage-mismatched influenza B/Yamagata co-circulated; VE was statistically significant for influenza B (63.0% 95% CI: (24.2,83.7)), but not A (46.3%, 95% CI:(-7.2, 75.3)).ConclusionsInfluenza vaccine was effective in preventing hospitalizations among fully vaccinated Israeli children over three influenza seasons, but not among partially vaccinated children. There was cross-lineage protection in a season where the vaccine contained B/Victoria and the circulating strain was B/Yamagata, but not in a season with the opposite vaccine-circulating strain distribution.

Abstract Background With an increased incidence of viral zoonoses, there is an impetus to strengthen collaborations between public health, agricultural and environmental departments. This interdisciplinary cooperation, also known as the ‘One Health’ approach, has received significant support from various stakeholders. However, current efforts and policies still fall short of those needed for an effective One Health approach towards disease control and prevention. The avian-origin H7N9 influenza A virus outbreak in China serves as an ideal case study to emphasise this point. Discussion Here, we present the features and epidemiology of human infections with H7N9 influenza virus. At the early stages of the H7N9 epidemic, there was limited virus surveillance and limited prevention measures implemented in live poultry markets. As a result, zoonotic infections with H7N9 influenza viruses continued to enlarge in both numbers and geographic distribution. It was only after the number of human infections with H7N9 influenza virus spiked in the 5th wave of the epidemic that inter-departmental alliances were formed. This resulted in the rapid control of the number of human infections. We therefore further discuss the barriers that prevented the implementation of an effective One Health approach in China and what this means for other emerging, zoonotic viral diseases. Summary Effective implementation of evidence-based disease management approaches in China will result in substantial health and economic gains. The continual threat of avian influenza, as well as other emerging zoonotic viral infections, emphasizes the need to remove the barriers that prevent the effective implementation of One Health policies in disease management.…

Nadia Soudani, Miguela A. Caniza, Aia Assaf‐Casals, Rouba Shaker, Mireille Lteif, Yin Su, Li Tang, Imad Akel, Samar Muwakkit, Ahmad Chmaisse, Maysam Homsi, Ghassan Dbaibo, Hassan Zaraket

Abstract Background Pediatric cancer patients have a higher risk of morbidity and mortality due to respiratory viral infections than do other patient populations. Objectives To investigate the causative viruses of respiratory infections and their burden among pediatric cancer patients in Lebanon. Study Design Nasopharyngeal swabs along with clinical and demographic data were collected from pediatric cancer patients presenting febrile episodes with upper respiratory tract symptoms. Total nucleic acid was extracted from specimens followed by real‐time PCR analysis targeting 14 respiratory viruses to estimate the frequency of infections. Results We obtained 89 nasopharyngeal swabs from pediatric cancer patients (mean age, 5.8 ± 4.2 years). Real‐time PCR confirmed viral infection in 77 swabs (86.5%). Among these, 151 respiratory viruses were detected. Several viruses cocirculated within the same period; respiratory syncytial virus (RSV) being the most common (45.45%), followed by parainfluenza virus (PIV, 26%), influenza type B (Flu B, 26%), human metapneumovirus (24.6%), and human coronavirus (HCoV, 24.6%). Coinfections were detected in 55% of the subjects, and most of them involved RSV with one or more other viruses. A strong correlation was found between PIV, Flu (influenza of any type), RSV, and HCoV with the incidence of coinfections. RSV was associated with lower respiratory tract infections, nasal congestion, bronchitis, and bacteremia. HCoV was associated with bronchiolitis; rhinovirus was associated with hospital admission. Conclusion Pediatric cancer patients have a high burden of respiratory viral infections and a high incidence of coinfections. Molecular diagnostics can improve management of febrile episodes and reduce antibiotic use. This article is protected by copyright. All rights reserved.

DeStefano F, Bodenstab H, Offit P.

AbstractConcerns about vaccine safety can lead to decreased acceptance of vaccines and resurgence of vaccine-preventable diseases. We summarize the key evidence on some of the main current vaccine safety controversies in the United States, including: 1) MMR vaccine and autism; 2) thimerosal, a mercury-based vaccine preservative, and the risk of neurodevelopmental disorders; 3) vaccine-induced Guillain-Barré Syndrome (GBS); 4) vaccine-induced autoimmune diseases; 5) safety of HPV vaccine; 6) aluminum adjuvant-induced autoimmune diseases and other disorders; and 7) too many vaccines given early in life predisposing children to health and developmental problems. A possible small increased risk of GBS following influenza vaccination has been identified, but the magnitude of the increase is less than the risk of GBS following influenza infection. Otherwise, the biological and epidemiologic evidence does not support any of the reviewed vaccine safety concerns.