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Nancy H. L. Leung, Daniel K. W. Chu, Eunice Y. C. Shiu, Kwok-Hung Chan, James J. McDevitt, Benien J. P. Hau, Hui-Ling Yen, Yuguo Li, Dennis K. M. Ip, J. S. Malik Peiris, Wing-Hong Seto, Gabriel M. Leung, Donald K. Milton, Benjamin J. Cowling
Nature Medicine, Published online: 03 April 2020; doi:10.1038/s41591-020-0843-2A study of 246 individuals with seasonal respiratory virus infections randomized to wear or not wear a surgical face mask showed that masks can significantly reduce detection of coronavirus and influenza virus in exhaled breath and may help interrupt virus transmission.
Monto A, DeJonge P, Callear A, et al.
AbstractBackgroundAs part of the Household Influenza Vaccine Evaluation (HIVE) study, acute respiratory infections (ARI) have been identified in children and adults over 8 years.MethodsAnnually, 890 to 1441 individuals were followed and contacted weekly to report ARIs. Specimens collected during illness were tested for human coronaviruses (HCoV) types OC43, 229E, HKU1, and NL63.ResultsIn total, 993 HCoV infections were identified over 8 years, with OC43 most commonly seen and 229E the least. HCoVs were detected in a limited time period, between December and April/May, and peaked in January/February. Highest infection frequency was in children
Siegers J, Novakovic B, Hulme K, et al.
AbstractBackgroundInfluenza A virus (IAV) causes a wide range of extra-respiratory complications. However, the role of host factors in these complications of influenza virus infection remains to be defined.MethodsHere, we sought to use transcriptional profiling, virology, histology and echocardiograms to investigate the role of a high fat diet in IAV associated cardiac damage.ResultsTranscriptional profiling showed that, compared to their low fat (LF) counterparts, mice fed a high fat (HF) diet had impairments in inflammatory signalling in the lung and heart after IAV infection. This was associated with increased viral titres in the heart, increased left ventricular mass and thickening of the left ventricular wall in IAV-infected HF mice compared to both IAV-infected LF mice and uninfected HF mice. Retrospective analysis of clinical trials revealed that cardiac complications were more common in patients with excess weight, an association which was significant in 2 out of 4 studies.ConclusionsTogether, these data provide the first evidence that a high fat diet may be a risk factor for the development of IAV-associated cardiovascular damageand emphasises the need for further clinical research in this area.
Maaweya E. Hamed,
Journal of Medical Virology, EarlyView.
Kathryn Lago, Kalyani Telu, David Tribble, Anuradha Ganesan, Anjali Kunz, Charla Geist, Jamie Fraser, Indrani Mitra, Tahaniyat Lalani, Heather Yun and for the Infectious Disease Clinical Research Program TravMil Study Group
Travelers are often at risk for both influenza-like illness (ILI) and malaria. Doxycycline is active against pathogens causing ILI and is used for malaria prophylaxis. We evaluated the risk factors for ILI, and whether the choice of malaria prophylaxis was associated with ILI. TravMil is a prospective observational study enrolling subjects presenting to military travel clinics. Influenza-like illness was defined as subjective fever with either a sore throat or cough. Characteristics of trip and use of malaria prophylaxis were analyzed to determine association with development of ILI. Poisson regression models with robust error variance were used to estimate relative risk (RR) of ILI. A total of 3,227 trips were enrolled: 62.1% male, median age of 39 years (interquartile range [IQR] 27,59), median travel duration 19 days (IQR 12, 49); 32% traveled to Africa, 40% to Asia, and 27% to the Caribbean and Latin America. Military travel (46%) and vacation (40%) were most common reasons for travel. Among them, 20% took doxycycline, 50% other prophylaxis, and 30% took none; 8.7% developed ILI. Decreased RR of ILI was associated with doxycycline (RR 0.65 [0.43–0.99], P = 0.046) and military travel (RR 0.30 [0.21–0.43], P < 0.01). Increased risk of ILI was associated with female gender (RR 1.57 [1.24–1.98], P < 0.01), travel to Asia (RR 1.37 [1.08–1.75], P = 0.01), and cruises (RR 2.21 [1.73–2.83], P < 0.01). Use of doxycycline malaria prophylaxis is associated with a decreased risk of ILI. Possible reasons include anti-inflammatory or antimicrobial effects, or other unmeasured factors. With few strategies for decreasing ILI in travelers, these findings bear further investigation.
R. Somayaji et al.
Tokars J, Patel M, Foppa I, et al.
AbstractIntroductionSeveral observational studies have shown decreases in measured influenza vaccine effectiveness (mVE) during influenza seasons. One study found decreases of 6%-11% per month during the 2011-12 to 2014-15 seasons. These findings could indicate waning immunity but could also occur if vaccine effectiveness is stable and vaccine provides partial protection in all vaccinees (“leaky”) rather than complete protection in a subset of vaccinees. Since it is not known whether influenza vaccine is leaky, we simulated the 2011-12 to 2014-15 influenza seasons to estimate the potential contribution of leaky vaccine effect to the observed decline in mVE.MethodsWe used available data to estimate daily numbers of vaccinations and infections with A/H1N1, A/H3N2 and B viruses. We assumed that vaccine effect was leaky, calculated mVE as 1 minus the Mantel-Haenszel relative risk of vaccine on incident cases and determined the mean mVE change per 30 days since vaccination. Because change in mVE was highly dependent on infection rates, we performed simulations using low (15%) and high (31%) total (including symptomatic and asymptomatic) seasonal infection rates.ResultsFor the low infection rate, decreases (absolute) in mVE per 30 days after vaccination were 2% for A/H1N1 and 1% for A/H3N2and B viruses. For high infection rate, decreases were 5% for A/H1N1, 4% for A/H3, and 3% for B viruses.ConclusionsThe leaky vaccine bias could account for some, but probably not all of the observed intra-seasonal decreases in mVE. These results underscore the need for strategies to deal with intra-seasonal vaccine effectiveness decline.
Vernon J Lee, Marc Ho, Chen Wen Kai, Ximena Aguilera, David Heymann, Annelies Wilder-Smith
In recent decades, many emerging infectious diseases have been occurring at an increasing scale and frequency—i.e. Ebola virus disease, severe acute respiratory syndrome (SARS), avian and pandemic influenza, Middle-East respiratory syndrome (MERS), and the recently emerged coronavirus disease 2019 (COVID-19). The outbreaks of these diseases resulted in wide ranging socioeconomic consequences, including loss of lives and disruption to trade and travel. Preparedness is a crucial investment because its cost is small compared with the unmitigated impact of a health emergency.
Dimple D Rajgor, Meng Har Lee, Sophia Archuleta, Natasha Bagdasarian, Swee Chye Quek
Since the outbreak of coronavirus disease 2019 (COVID-19) began in December, a question at the forefront of many people's minds has been its mortality rate. Is the mortality rate of COVID-19 higher than that of influenza, but lower than that of severe acute respiratory syndrome (SARS)?
Christopher M. Ziegler, Jason W. Botten
Viral defective interfering particles (DIPs) were intensely studied several decades ago but research waned leaving open many critical questions. New technologies and other advances led to a resurgence in DIP studies for negative-strand RNA viruses. While DIPs have long been recognized, their exact contribution to the outcome of acute or persistent viral infections has remained elusive. Recent studies have identified defective viral genomes (DVGs) in human infections, including respiratory syncytial virus and influenza, and growing evidence indicates that DVGs influence disease severity and may contribute to viral persistence.
Puja Mehta, Daniel F McAuley, Michael Brown, Emilie Sanchez, Rachel S Tattersall, Jessica J Manson, HLH Across Speciality Collaboration, UK
As of March 12, 2020, coronavirus disease 2019 (COVID-19) has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 3·7%,1 compared with a mortality rate of less than 1% from influenza. There is an urgent need for effective treatment. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. We recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality.
Skowronski D, Leir S, Sabaiduc S, et al.
AbstractBackgroundThe influenza A(H3N2) vaccine was updated from clade 3C.3a in 2015-16 to a clade 3C.2a strain for both 2016-17 and 2017-18. Circulating 3C.2a viruses showed considerable diversity in the hemagglutinin glycoprotein and the egg-adapted vaccine strain also bore mutations, notably T160K loss-of-glycosylation.MethodsVaccine effectiveness (VE) in 2016-17 and 2017-18 was assessed by test-negative-design, explored by A(H3N2) phylogenetic sub-cluster and prior season's vaccination history.ResultsIn 2016-17, A(H3N2) VE was 36%(95%CI=18-50%): comparable with (43%;95%CI=24-58%) or without (33%;95%CI=-16-64%) prior vaccination in 2015-16. In 2017-18,VE was 14%(95%CI=-8-31%):lower with (9%;95%CI=-18-30%) versus without (45%;95%CI=-7-71%) prior vaccination in 2016-17.ConclusionsExploring VE by phylogenetic sub-cluster and prior vaccination history reveals informative heterogeneity, but requires enhanced sample-size. Pivotal mutations conferring loss-of-glycosylation, and repeat vaccination with unchanged antigen, may be associated with reduced VE.
Bernstein D, Atmar R, Hoft D.
Swerdlow DL, Finelli L.
This Viewpoint discusses the concepts of transmissibility and severity as the critical factors that determine the extent of an epidemic, drawing on the previous pandemic of influenza A(H1N1) and epidemics of SARS and MERS to consider what the scope, morbidity, and mortality of the 2019 novel coronavirus (2019-nCoV) epidemic might be.
Livingston E, Bucher K, Rekito A.
Journal of Medical Virology, Accepted Article.
A. Bal, J.S. Casalegno, C. Melenotte, F. Daviet, L. Ninove, S. Edouard, F. Morfin, M. Valette, X. De Lamballerie, B. Lina, L. Papazian, A. Nougairède, S. Hraiech
We aimed to describe bacterial co-infections and acute respiratory distress (ARDS) outcomes according to influenza type and subtype.
The current national influenza vaccination schedule in Mexico does not recommend vaccination in the school-aged population (5–11 years). Currently, there are limited data from middle-income countries analysing the cost-effectiveness of influenza vaccination in this population. We explored the clinical effects and economic benefits of expanding the current national influenza vaccination schedule in Mexico to include the school-aged population.
A static 1-year model incorporating herd effect was used to assess the cost-effectiveness of expanding the current national influenza vaccination schedule of Mexico to include the school-aged population. We performed a cross-sectional epidemiological study using influenza records (2009–2018), death records (2010–2015), and discharge and hospitalisation records (2010–2016), from the databases of Mexico’s Influenza Surveillance System (SISVEFLU), the National Mortality Epidemiological and Statistical System (SEED), and the Automated Hospital Discharge System (SAEH), respectively. Cost estimates for influenza cases were based on 7 scenarios using data analysed from SISVEFLU; assumptions for clinical management of cases were defined according to Mexico’s national clinical guidelines. The primary health outcome for this study was the number of influenza cases avoided. A sensitivity analysis was performed using conservative and optimistic parameters (vaccination coverage: 30% / 70%, Vaccine effectiveness: 19% / 68%).
It was estimated that expanding the influenza immunisation programme to cover school-aged population in Mexico over the 2018–2019 influenza season would result in 671,461 cases of influenza avoided (50% coverage and 50% effectiveness assumed). Associated with this were 262,800 fewer outpatient consultations; 154,100 fewer emergency room consultations; 97,600 fewer hospitalisations, and 15 fewer deaths. Analysis of cases avoided by age-group showed that 55.4% of them were in the school-aged population, and the decrease in outpatient consultations was largest in this population. There was an overall decrease in the economic burden for the Mexican health care system of 111.9 million US dollars; the immunization programme was determined to be cost-saving in the base, conservative and optimistic scenarios.
Vaccinating school-aged population in Mexico would be cost-effective; expansion of the current national vaccination schedule to this age group is supported.
Dobrzynski D, Jr, Ndi D, Zhu Y, et al.
AbstractBackgroundInfluenza infection causes substantial morbidity and mortality. However, little is known about hospital readmissions after an influenza hospitalization. The aim of our study was to characterize frequency of hospital readmissions among patients hospitalized with laboratory-confirmed influenza.MethodsWe conducted a retrospective study using Tennessee Emerging Infections Program Influenza Surveillance data from 2006 to 2016 and the concurrent TN Hospital Discharge Data System. We analyzed demographic characteristics and outcomes to better understand frequency and factors associated with hospital readmissions.ResultsOf the 2897 patients with a laboratory-confirmed influenza hospitalization, 409 (14%) and 1364 (47%) had at least one hospital readmission within 30 days and 1 year of the influenza hospitalization respectively. Multiple readmissions occurred in 739 patients (54%). The readmission group was older, female predominant, and had more comorbidities than patients not hospitalized. Pneumonia, acute COPD/asthma exacerbation, septicemia, acute respiratory failure, and acute renal failure were the most common causes for readmission at 30 days. Underlying cardiovascular disease, lung disease, kidney disease, diabetes, immunosuppression, and liver disease were associated with increased risk of readmission during the subsequent year.ConclusionsAfter an admission with laboratory-confirmed influenza, there is a high likelihood of readmission within 30 days and 1 year adding to the morbidity of influenza.
Fong M, Leung N, Xiao J, et al.
AbstractInfluenza virus can survive on some surfaces, facilitating indirect person-to-person transmission. We collected swab samples weekly from commonly-touched surfaces in 7 kindergartens and primary schools during the 2017/18 winter influenza season in Hong Kong. We detected influenza virus RNA in 12/1352 samples (
Gao, Chang; Wang, Yeming; Gu, Xiaoying; Shen, Xinghua; Zhou, Daming; Zhou, Shujun; Huang, Jian-an; Cao, Bin; Guo, Qiang; for the Community-Acquired Pneumonia–China Network
To evaluate the prevalence of cardiac injury and its association with mortality in hospitalized patients infected with avian influenza A (H7N9) virus.
Retrospective cohort study.
A total of 133 hospitals in 17 provinces, autonomous regions, and municipalities of mainland China that admitted influenza A (H7N9) virus–infected patients between January 22, 2015, and June 16, 2017.
A total of 321 patients with influenza A (H7N9) virus infection were included in the final analysis.
Measurements and Main Results:
Demographics and clinical characteristics were collected from medical records. Cardiac injury was defined according to cardiac biomarkers, electrocardiography, or echocardiography. Among the 321 patients, 203 (63.2%) showed evidence of cardiac injury. Compared with the uninjured group, the cardiac injury group had lower PaO2/FIO2 (median, 102.0 vs 148.4 mm Hg; p < 0.001), higher Acute Physiology and Chronic Health Evaluation II score (median, 17.0 vs 11.0; p < 0.001), longer stay in the ICU (10.0 vs 9.0 d; p = 0.029), and higher proportion of in-hospital death (64.0% vs 20.3%; p < 0.001). The proportion of virus clearance until discharge or death was lower in the cardiac injury group than in the uninjured group (58.6% vs 86.4%; p < 0.001). Multivariable-adjusted Cox proportional hazards regression analysis showed that cardiac injury was associated with higher mortality (hazards ratio, 2.06; 95% CI, 1.31–3.24) during hospitalization.
Cardiac injury is a frequent condition among hospitalized patients infected with influenza A (H7N9) virus, and it is associated with higher risk of mortality.
Drs. Gao, Wang, and Gu contributed equally to this work.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http:/journals.lww.com/ccmjournal).
Supported, in part, by grants from National Science and Technology Major Project (2017ZX10204401004 and 2017ZX10103004); Emergency Special Project of the Ministry of Science and Technology (10600100000015001206); National Key Research and Development Program of China (2018YFC1200102); CAMS Innovation Fund for Medical Sciences (CIFMS 2018-I2M-1-003); National Science Grant for Distinguished Young Scholars (81425001/H0104); Jiangsu Province’s Key Provincial Talents Program (ZDRCA2016046); and Key Health Talents in Gusu (GSWS2019009).
The authors have disclosed that they do not have any potential conflicts of interest.
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Copyright © by 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
John N Nkengasong, Wessam Mankoula
Because of the high volume of air traffic and trade between China and Africa,1 Africa is at a high risk for the introduction and spread of the novel coronavirus disease 2019 (COVID-19); although only Egypt has reported the first case, from a non-national.2 The greatest concern for public health experts is whether COVID-19 will become a pandemic, with sustained year-round transmission, similar to influenza, as is now being observed in several countries.3 What might happen to Africa—where most countries have weak health-care systems, including inadequate surveillance and laboratory capacity, scarcity of public health human resources, and limited financial means—if a pandemic occurs? With neither treatment nor vaccines, and without pre-existing immunity, the effect might be devastating because of the multiple health challenges the continent already faces: rapid population growth and increased movement of people; existing endemic diseases, such as human immunodeficiency virus, tuberculosis, and malaria; remerging and emerging infectious pathogens such as Ebola virus disease, Lassa haemorrhagic fever, and others; and increasing incidence of non-communicable diseases.
Journal of Medical Virology, Volume 0, Issue ja, -Not available-.
X. Wu et al.
M. Toda et al.
Philippon D, Wu P, Cowling B, et al.
AbstractBackgroundAvian influenza A viruses (AIVs) are among the most concerning emerging and re-emerging pathogens because of the potential risk in causing an influenza pandemic with catastrophic impact. The recent increase in domestic animals and poultry worldwide was followed by an increase of human AIV outbreaks reported.MethodsWe reviewed the epidemiology of human infections with AIV from the literature including reports from the World Health Organization, extracting information on virus subtype, time, location, age, sex, outcome and exposure.ResultsWe described the characteristics of more than 2,500 laboratory-confirmed human infections with AIVs. Human infections with H5N1 and H7N9 were more frequently reported than other subtypes. The risk of death was highest among reported cases infected with H5N1, H5N6, H7N9 and H10N8 infections. Older people and males tended to have a lower risk of infection with most AIV subtypes, except for H7N9. Visiting live poultry markets were mostly reported by H7N9, H5N6 and H10N8 cases, while exposure to sick or dead bird mostly reported by H5N1, H7N2, H7N3, H7N4, H7N7 and H10N7 cases.DiscussionUnderstanding the profile of human cases of different AIV subtypes would guide control strategy. Continued monitoring of human infections with AIVs is essential for pandemic preparedness.
Lees C, Godin J, McElhaney J, et al.
W. Wang et al.
Lumby C, Zhao L, Oporto M, et al.
AbstractA combination of favipiravir and zanamivir successfully cleared influenza B infection in a child who had undergone bone marrow transplant for X-linked severe combined immunodeficiency, with no recovery of T lymphocytes. Deep sequencing of viral samples illuminated the within-host dynamics of infection, demonstrating the effectiveness of favipiravir in this case.
De Chang, Huiwen Xu, Andre Rebaza, Lokesh Sharma, Charles S Dela Cruz
Health-care workers face an elevated risk of exposure to infectious diseases, including the novel coronavirus (COVID-19) in China. It is imperative to ensure the safety of health-care workers not only to safeguard continuous patient care but also to ensure they do not transmit the virus. COVID-19 can spread via cough or respiratory droplets, contact with bodily fluids, or from contaminated surfaces.1 According to recent guidelines from the China National Health Commission, pneumonia caused by COVID-19 was included as a Group B infectious disease, which is in the same category as other infectious viruses such as severe acute respiratory syndrome (SARS) and highly pathogenic avian influenza (HPAI).
Antonio Lalueza, Blanca Ayuso, Estibaliz Arrieta, Hernando Trujillo, Dolores Folgueira, Cecilia Cueto, Antonio Serrano, Jaime Laureiro, Coral Arévalo-Cañas, Cristina Castillo, Carmen Díaz-Pedroche, Carlos Lumbreras, the INFLUDOC group
There is an increasing evidence that ferritin is a key marker of macrophage activation but its potential role in influenza infection remains unexplored. The aim was to assess if hyperferritinemia (ferritin ≥500 ng/mL) could be a marker of poor prognosis in hospitalized patients with confirmed influenza A infection.
Phu N, Day N, Tuan P, et al.
AbstractBackgroundApproximately 6% of children hospitalised with severe falciparum malaria in Africa are also bacteremic. It is therefore recommended that all children with severe malaria should receive broad spectrum antibiotics in addition to parenteral artesunate. Empirical antibiotics are not recommended currently for adults with severe malaria.MethodsBlood cultures were performed on sequential prospectively studied adult patients with strictly defined severe falciparum malaria admitted to a single referral centre in Vietnam between 1991 and 2003.ResultsIn 845 Vietnamese adults with severe falciparum malaria admission blood cultures were positive in 9 (1.07%: 95%CI 0.37 to 1.76%); S. aureus 2, S. pyogenes 1, S. Typhi 3, Non-typhoid Salmonella 1, K. pneumoniae 1, H. influenzae type b 1. Bacteremic patients presented usually with a combination of jaundice, acute renal failure and high malaria parasitemia. Four bacteremic patients died compared with 108 (12.9%) of 836 non-bacteremic severe malaria patients; risk ratio 3.44 (95%CI 1.62 to 7.29). In patients with >20% parasitemia the prevalence of concomitant bacteremia was 5.2% (4/76: 95%CI 0.2 to 10.3%) compared with 0.65% (5/769: 0.08 to 1.2%) in patients with
Tuberculosis (TB) is a major global health burden, with an estimated quarter of the world’s population being infected. The World Health Organization (WHO) launched the “End TB Strategy” in 2014 emphasising knowing the epidemic. WHO ranks Vietnam 12th in the world of high burden countries.
TB spatial and temporal patterns have been observed globally with evidence of Vitamin D playing a role in seasonality. We explored the presence of temporal and spatial clustering of TB in Vietnam and their determinants to aid public health measures.
Data were collected by the National TB program of Vietnam from 2010 to 2015 and linked to the following datasets: socio-demographic characteristics; climatic variables; influenza-like-illness (ILI) incidence; geospatial data. The TB dataset was aggregated by province and quarter. Descriptive time series analyses using LOESS regression were completed per province to determine seasonality and trend. Harmonic regression was used to determine the amplitude of seasonality by province.
A mixed-effect linear model was used with province and year as random effects and all other variables as fixed effects.
There were 610,676 cases of TB notified between 2010 and 2015 in Vietnam. Heat maps of TB incidence per quarter per province showed substantial temporal and geospatial variation. Time series analysis demonstrated seasonality throughout the country, with peaks in spring/summer and troughs in autumn/winter. Incidence was consistently higher in the south, the three provinces with the highest incidence per 100,000 population were Tay Ninh, An Giang and Ho Chi Minh City. However, relative seasonal amplitude was more pronounced in the north.
Mixed-effect linear model confirmed that TB incidence was associated with time and latitude. Of the demographic, socio-economic and health related variables, population density, percentage of those under 15 years of age, and HIV infection prevalence per province were associated with TB incidence. Of the climate variables, absolute humidity, average temperature and sunlight were associated with TB incidence.
Preventative public health measures should be focused in the south of Viet Nam where incidence is highest. Vitamin D is unlikely to be a strong driver of seasonality but supplementation may play a role in a package of interventions.
Do L, Tsedenbal N, von Mollendorf C, et al.
measles virusmeasles mortalityrespiratory syncytial virusinfluenzaimmunosuppression
Izurieta H, Chillarige Y, Kelman J, et al.
AbstractBackgroundStudies among individuals ages ≥65 years have found a moderately higher relative vaccine effectiveness (RVE) for the high-dose (HD) influenza vaccine compared to standard-dose (SD) products for most seasons. Studies during the A(H3N2)-dominated 2017-18 season showed slightly higher RVE for the cell-cultured vaccine compared to SD egg-based vaccines. We investigated the RVE of influenza vaccines among Medicare beneficiaries ages ≥65 years during the 2018-19 season.MethodsRetrospective cohort study using inverse probability of treatment weighting and Poisson regression to evaluate RVE in preventing influenza hospital encounters.ResultsAmong 12,777,214 beneficiaries, the egg-based adjuvanted (RVE 7.7%, 95% CI: 3.9 to 11.4%) and high-dose (RVE 4.9%, 95% CI: 1.7 to 8.1%) vaccines were marginally more effective than the egg-based quadrivalent vaccines. The cell-cultured quadrivalent vaccines were not significantly more effective than the egg-based quadrivalent vaccines (RVE 2.5%, 95% CI: -2.4 to 7.3%).ConclusionsWe did not find major effectiveness differences between licensed vaccines used among the elderly during the 2018-19 season. Consistent with prior research, we found that the egg-based adjuvanted and high-dose vaccines were slightly more effective than the egg-based quadrivalent vaccines.
Philippe Buchy, Selim Badur
Radonovich LJ, Jr, Simberkoff MS, Perl TM.
In Reply Dr McDiarmid and colleagues comment on the design and conduct of our study, the Respiratory Protection Effectiveness Clinical Trial (ResPECT). They note, and we agree, that a number of laboratory and simulated workplace studies have shown respirators to have superior performance compared with medical masks; however, the results of clinical trials have not been definitive. The complexities of delivering health care introduce behavioral factors that may influence the effectiveness of infection prevention measures, including adherence to procedures that have been shown in laboratory settings to optimize efficacy. ResPECT was designed as a pragmatic clinical trial comparing the effectiveness of N95 respirators with medical masks as worn by health care personnel who are exposed to patients with respiratory infections in outpatient clinical practice settings. Our goal was to assess the incidence of viral respiratory infection and illness among these frontline health care personnel using laboratory-confirmed and clinical end points. Cluster randomization was used to balance exposures and behavioral characteristics in the intervention groups. Precise quantification of exposures in terms of viral loads of particles was beyond the scope of the study. Despite limitations, we believe our study contributes valuable information to the body of literature about prevention of respiratory infections in clinical settings and calls attention to challenges that remain when implementing broader respiratory protection efforts. Health systems need to weigh the full spectrum of scientific evidence, including laboratory studies and randomized clinical trials, when making decisions about the protection of health care personnel against influenza and other viral respiratory infections.
McDiarmid M, Harrison R, Nicas M.
To the Editor In a pragmatic effectiveness study among outpatient health care personnel, Dr Radonovich and colleagues reported that use of N95 respirators vs medical masks “as worn by participants” resulted in no significant difference in the incidence of laboratory-confirmed influenza between the groups. An accompanying editorial suggested that the study findings can be generalized and used by hospital epidemiologists to argue against the use of respirators for protection of health care workers in outpatient settings against all respiratory viruses. However, the study has limitations—principally, the exposure assessment and potential for differential exposure between the study groups.
Sader, H. S., Carvalhaes, C. G., Duncan, L. R., Shortridge, D.
Nine hundred Haemophilus influenzae clinical isolates from 83 U.S. and European medical centers were tested for susceptibility by reference broth microdilution methods against ceftolozane-tazobactam and comparators. Results were stratified by β-lactamase production and infection type. Overall, ceftolozane-tazobactam MIC50/90 values were 0.12/0.25 mg/L and 99.0% of isolates were inhibited at the susceptible breakpoint of ≤0.5 mg/L; the highest MIC value was only 2 mg/L. Our results support using ceftolozane-tazobactam to treat H. influenzae infections.
Respiratory tract infection (RTI) in young children is a leading cause of morbidity and hospitalization worldwide. There are few studies assessing the performance for bronchoalveolar lavage fluid (BALF) versus oropharyngeal swab (OPS) specimens in microbiological findings for children with RTI. The primary purpose of this study was to compare the detection rates of OPS and paired BALF in detecting key respiratory pathogens using suspension microarray.
We collected paired OPS and BALF specimens from 76 hospitalized children with respiratory illness. The samples were tested simultaneously for 8 respiratory viruses and 5 bacteria by suspension microarray.
Of 76 paired specimens, 62 patients (81.6%) had at least one pathogen. BALF and OPS identified respiratory pathogen infections in 57 (75%) and 49 (64.5%) patients, respectively (P > 0.05). The etiology analysis revealed that viruses were responsible for 53.7% of the patients, whereas bacteria accounted for 32.9% and Mycoplasma pneumoniae for 13.4%. The leading 5 pathogens identified were respiratory syncytial virus, Streptococcus pneumoniaee, Haemophilus influenzae, Mycoplasma pneumoniae and adenovirus, and they accounted for 74.2% of etiological fraction. For detection of any pathogen, the overall detection rate of BALF (81%) was marginally higher than that (69%) of OPS (p = 0.046). The differences in the frequency distribution and sensitivity for most pathogens detected by two sampling methods were not statistically significant.
In this study, BALF and OPS had similar microbiological yields. Our results indicated the clinical value of OPS testing in pediatric patients with respiratory illness.
The emergence of human infection with avian influenza A(H7N9) virus was reported in Wenshan City, southwestern China in 2017. The study describes the epidemiological and virological features of the outbreak and discusses the origin of the infection.
Poultry exposure and timelines of key events for each patient were collected. Samples derived from the patients, their close contacts, and environments were tested for influenza A(H7N9) virus by real-time reverse transcription polymerase chain reaction. Genetic sequencing and phylogenetic analysis were also conducted.
Five patients were reported in the outbreak. An epidemiological investigation showed that all patients had been exposed at live poultry markets. The A(H7N9) isolates from these patients had low pathogenicity in avian species. Both epidemiological investigations of chicken sources and phylogenetic analysis of viral gene sequences indicated that the source of infection was from Guangxi Province, which lies 100 km to the east of Wenshan City.
In the study, a sudden emergence of human cases of H7N9 was documented in urban area of Wenshan City. Chickens were an important carrier in the H7N9 virus spreading from Guangxi to Wenshan. Hygienic management of live poultry markets and virological screening of chickens transported across regions should be reinforced to limit the spread of H7N9 virus.
The influenza virus spreads rapidly around the world in seasonal epidemics, resulting in significant morbidity and mortality. Influenza-related incidence data are limited in many countries in Africa despite established sentinel surveillance. This study aimed to address the information gap by estimating the burden and seasonality of medically attended influenza like illness in Ethiopia.
Influenza sentinel surveillance data collected from 3 influenza like illness (ILI) and 5 Severe Acute Respiratory Illness (SARI) sites from 2012 to 2017 was used for analysis. Descriptive statistics were applied for simple analysis. The proportion of medically attended influenza positive cases and incidence rate of ILI was determined using total admitted patients and catchment area population. Seasonality was estimated based on weekly trend of ILI and predicted threshold was done by applying the “Moving Epidemic Method (MEM)”.
A total of 5715 medically attended influenza suspected patients who fulfills ILI and SARI case definition (77% ILI and 23% SARI) was enrolled. Laboratory confirmed influenza virus (influenza positive case) among ILI and SARI suspected case was 25% (1130/4426) and 3% (36/1289). Of which, 65% were influenza type A. The predominantly circulating influenza subtype were seasonal influenza A(H3N2) (n = 455, 60%) and Influenza A(H1N1)pdm09 (n = 293, 38.81%). The estimated mean annual influenza positive case proportion and ILI incidence rate was 160.04 and 52.48 per 100,000 population. The Incidence rate of ILI was higher in the age group of 15–44 years of age [‘Incidence rate (R) = 254.6 per 100,000 population’, 95% CI; 173.65, 335.55] and 5–14 years of age [R = 49.5, CI 95%; 31.47, 130.43]. The seasonality of influenza has two peak seasons; in a period from October–December and from April–June.
Significant morbidity of influenza like illness was observed with two peak seasons of the year and seasonal influenza A (H3N2) remains the predominantly circulating influenza subtype. Further study need to be considered to identify potential risks and improving the surveillance system to continue early detection and monitoring of circulating influenza virus in the country has paramount importance.
Pfaller, M. A., Huband, M. D., Shortridge, D., Flamm, R. K.
Omadacycline is a broad-spectrum aminomethylcycline approved in October 2018 by the United States Food and Drug Administration for treating acute bacterial skin and skin structure infections and community-acquired pneumonia as both an oral and intravenous once-daily formulation. In this report, omadacycline and comparators were tested against 49,000 non-duplicate bacterial isolates collected prospectively during 2016-2018 from medical centers in Europe (24,500 isolates; 40 medical centers [19 countries]) and the United States (24,500 isolates; 33 medical centers [23 states and all 9 United States Census Divisions]). Omadacycline was tested by broth microdilution following Clinical and Laboratory Standards Institute M07 (2018) methods.Omadacycline (MIC50/90, 0.12/0.25 mg/L) inhibited 98.6% of Staphylococcus aureus isolates at ≤0.5 mg/L including 96.3% of methicillin-resistant S. aureus and 99.8% of methicillin-susceptible S. aureus. Omadacycline potency was comparable for Streptococcus pneumoniae (MIC50/90, 0.06/0.12 mg/L), viridans group streptococci (MIC50/90, 0.06/0.12 mg/L) and β-hemolytic streptococci (MIC50/90, 0.12/0.25 mg/L) regardless of species and susceptibility to penicillin, macrolides or tetracycline. Omadacycline was active against Enterobacterales (MIC50/90, 1/8 mg/L; 87.5% inhibited at ≤4 mg/L) except Proteus mirabilis (MIC50/90, 16/>32 mg/L) and Indole-positive Proteus spp. (MIC50/90, 8/32 mg/L) and was most active against Escherichia coli (MIC50/90, 0.5/2 mg/L), Klebsiella oxytoca (MIC50/90, 1/2 mg/L) and Citrobacter spp. (MIC50/90, 1/4 mg/L). Omadacycline inhibited 92.4% of Enterobacter cloacae species complex and 88.5% of Klebsiella pneumoniae isolates at ≤4 mg/L. Omadacycline was active against Haemophilus influenzae (MIC50/90, 0.5/1 mg/L) regardless of β-lactamase status and against Moraxella catarrhalis (MIC50/90, ≤0.12/0.25 mg/L). The potent activity of omadacycline against Gram-positive and -negative bacteria indicates that omadacycline merits further study in serious infections in which multidrug resistance and mixed Gram-positive and -negative infections may be a concern.
Doyle J, Beacham L, Martin E, et al.
AbstractBackgroundSeasonal influenza causes substantial morbidity and mortality in older adults. High-dose inactivated influenza vaccine (HD-IIV), with increased antigen content compared to standard-dose influenza vaccines (SD-IIV), is licensed for use in people aged ≥65 years. We sought to evaluate the effectiveness of HD-IIV and SD-IIV for prevention of influenza-associated hospitalizations.MethodsHospitalized patients with acute respiratory illness were enrolled in an observational vaccine effectiveness study at eight hospitals in the United States Hospitalized Adult Influenza Vaccine Effectiveness Network during the 2015-2016 and 2016-2017 influenza seasons. Enrolled patients were tested for influenza, and receipt of influenza vaccine by type was recorded. Effectiveness of SD-IIV and HD-IIV was estimated using a test-negative design (comparing odds of influenza among vaccinated and unvaccinated patients). Relative effectiveness of SD-IIV and HD-IIV was estimated using logistic regression.ResultsAmong 1487 enrolled patients aged ≥65 years, 1107 (74%) were vaccinated; 622 (56%) received HD-IIV and 485 (44%) received SD-IIV. Overall, 277 (19%) tested positive for influenza, including 98 (16%) who received HD-IIV, 87 (18%) who received SD-IIV, and 92 (24%) who were unvaccinated. After adjusting for confounding variables, effectiveness of SD-IIV was 6% (95% confidence interval [CI] −42%, 38%) and that of HD-IIV was 32% (95%CI −3%, 54%), for a relative effectiveness of HD-IIV versus SD-IIV of 27% (95%CI −1%, 48%).ConclusionsDuring two U.S. influenza seasons, vaccine effectiveness was low to moderate for prevention of influenza hospitalization among adults aged ≥65 years. High-dose vaccine offered greater effectiveness. None of these findings were statistically significant.
To describe the burden, and characteristics, of influenza-like illness (ILI) associated with non-influenza respiratory viruses (NIRV).
We performed a prospective, multicenter, observational study of adults admitted with ILI during three influenza seasons (2012–2015). Patients were screened for picornavirus, respiratory syncytial virus (RSV), coronavirus, human metapneumovirus, adenovirus, bocavirus, parainfluenza virus, and influenza, by PCR on nasopharyngeal samples. We excluded patients coinfected with NIRV and influenza.
Among 1421 patients enrolled, influenza virus was detected in 535 (38%), and NIRV in 215 (15%), mostly picornavirus (n = 61), RSV (n = 53), coronavirus 229E (n = 48), and human metapneumovirus (n = 40). In-hospital mortality was 5% (NIRV), 4% (influenza), and 5% (no respiratory virus). As compared to influenza, NIRV were associated with age (median, 73 years vs. 68, P = 0.026), chronic respiratory diseases (53% vs. 45%, P = 0.034), cancer (14% vs. 9%, P = 0.029), and immunosuppressive drugs (21% vs. 14%, P = 0.028), and inversely associated with diabetes (18% vs. 25%, P = 0.038). On multivariable analysis, only chronic respiratory diseases (OR 1.5 [1.1–2.0], P = 0.008), and diabetes (OR 0.5 [0.4–0.8], P = 0.01) were associated with NIRV detection.
NIRV are common in adults admitted with ILI during influenza seasons. Outcomes are similar in patients with NIRV, influenza, or no respiratory virus.
This study is to elucidate the disinfection effect of ozone producing low-pressure Hg vapor lamps against human pathogens. Ozone producing low-pressure Hg vapor lamps emit mainly 254 nm ultraviolet light C (UVC) with about 10% power of Vacuum-ultraviolet (VUV) light at 185 nm. The combination of UVC and VUV can inactivate airborne pathogens by disrupting the genetic materials or generation of reactive oxygen species, respectively. In this study, inactivation of common bacteria including Escherichia coli ATCC25922 (E. coli), Extended Spectrum Beta-Lactamase-producing E. coli (ESBL), Methicillin-resistant Staphylococcus aureus (MRSA) and Mycobacterium tuberculosis (MTB), and that of influenza A viruses H1N1 and H3N2 under the radiation from ozone producing low-pressure Hg vapor lamps was examined. Log reduction values at different treatment durations were determined.
In vitro tests were carried out. Various bacterium and virus suspensions were added onto nitrocellulose filter papers and subjected to the illumination from ozone producing low-pressure Hg vapor lamps. The extents of pathogen inactivation at different illumination times were investigated by conducting a series of experiments with increasing duration of illumination. log10 reduction in CFU/ml and reduction at log10(TCID50) were respectively measured for bacteria and viruses. The disinfection effectiveness of this type of lamps against the pathogens under the environment with a moderate barrier to light was therefore evaluated.
Ozone producing low-pressure Hg vapor lamp successfully inactivated these human pathogens. Nevertheless, among these pathogens, disinfection of MTB required more intense treatment. In the best tested situation, 3-log10 inactivation of pathogens can be achieved with ≤10 min of VUV treatment except MTB which needed about 20 min. This demonstrated the high resistance against UV disinfection of MTB.
Following the criteria that valid germicidal results can be reflected with 3-log10 inactivation for bacteria, 4-log10 inactivation for viruses and 5-log10 inactivation for MTB, most of the bacteria required ≤10 min of VUV treatment, 20 min for the influenza viruses while MTB needed about 30 min VUV treatment. This indicated that VUV light is an effective approach against different environmental microorganisms.
Sato M, Takashita E, Katayose M, et al.
AbstractDuring the 2018–2019 influenza seasons, we detected reduced baloxavir marboxil (baloxavir) susceptible variants with I38S or I38T amino acid substitutions on the PA subunit of influenza virus RNA polymerase in 7 of 18 baloxavir treated children and found that virus titer rebounded in some of these children with variants. We also found fever durations to be similar between patients with or without the variants, but the patients with variants shed the virus 3 days longer and took longer to improve clinical symptoms than those without variants.The emergence of these variants should be monitored during future influenza seasons.
Carlo Foppiano Palacios, John J. Openshaw, Mark A. Travassos
New England Journal of Medicine, Ahead of Print.
International Liver Congress (ILC) 2020
15.04.2020 - 19.04.2020
European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2020
18.04.2020 - 21.04.2020
DSI årsmøde 2020 (aflyst)
Hindsgavl Slot, Middelfart
1.05.2020 - 2.05.2020
Kursus i rejsemedicin 2020
Statens Serum Institut
4.05.2020 - 6.05.2020
5.05.2020 - 7.05.2020
COVID-19 retningslinje (2020)
National handlingsplan for antibiotika til mennesker (2017)
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
A real-world evaluation of a Case-Based Reasoning algorithm to support antimicrobial prescribing decisions in acute care
4.04.2020Clinical Infectious Diseases Advance Access
Open versus endovascular repair of aortic aneurysms
COVID-19 will not leave behind refugees and migrants
Redefining vulnerability in the era of COVID-19
The COVID-19 pandemic in the USA: what might we expect?
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