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Abstract

Background

The associations between viral etiology of acute respiratory infections (ARI) with meteorological factors and air pollutants among children is not fully understood. This study aimed to explore the viral etiology among children hospitalized for ARI and the association of meteorological factors and air pollutants with children hospitalization due to viral ARI.

Methods

Electronic health record data about children (aged between 1 month and 14 years) admitted for ARI at Kiang Wu Hospital in Macao between 2014 and 2017 was analyzed retrospectively. xMAP multiplex assays were used to detect viruses in the nasopharyngeal swab and distributed-lag nonlinear model (DLNM) was used to evaluate associations.

Results

Among the 4880 cases of children hospitalization due to ARI, 3767 (77.2%) were tested positive for at least one virus and 676 (18%) exhibited multiple infections. Enterovirus (EV)/rhinovirus (HRV), adenovirus (ADV), respiratory syncytial virus (RSV) and influenza virus (IFV) were the most common viral pathogens associated with ARI and human bocavirus (hBOV) exhibited the highest multiple infection rates. Meteorological factors and air pollutants (PM10, PM2.5 and NO2) were associated with the risk of viral ARI hospitalization. The relative risk of viral infection increased with daily mean temperature but plateaued when temperature exceeded 23 °C, and increased when the relative humidity was < 70% and peaked at 50%. The effect of solar radiation was insignificant. Air pollutants (including PM10, PM2.5, NO2 and O3) showed strong and immediate effect on the incidence of viral infection.

Conclusions

The effects of mean temperature, relative humidity and air pollutants should be taken into account when considering management of ARI among children.

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AbstractWe described bacterial/fungal co-infections and antibiotic resistant infections among inpatients diagnosed with COVID-19 and compared findings with inpatients diagnosed with influenza-like-illness. Less than 10% of COVID-19 inpatients had bacterial/fungal co-infection. Longer lengths of stay, critical care stay, and mechanical ventilation contribute to increased incidence of hospital-onset infections among COVID-19 inpatients.

We aimed to compared the clinical features of acute respiratory distress syndrome (ARDS) induced by COVID-19 and H7N9 virus infections.

by Núria Soldevila, Diana Toledo, Ana Martínez, Pere Godoy, Núria Torner, Cristina Rius, Mireia Jané, Angela Domínguez, the PIDIRAC Sentinel Surveillance Program of Catalonia

Background Disease surveillance using adequate case definitions is very important. The objective of the study was to compare the performance of influenza case definitions and influenza symptoms in the first two epidemic weeks with respect to other epidemic weeks. Methods We analysed cases of acute respiratory infection detected by the network of sentinel primary care physicians of Catalonia for 10 seasons. We calculated the diagnostic odds ratio (DOR) and 95% confidence intervals (CI) for the first two epidemic weeks and for other epidemic weeks. Results A total of 4,338 samples were collected in the epidemic weeks, of which 2,446 (56.4%) were positive for influenza. The most predictive case definition for laboratory-confirmed influenza was the WHO case definition for influenza-like illness (ILI) in the first two epidemic weeks (DOR 2.10; 95% CI 1.57–2.81) and in other epidemic weeks (DOR 2.31; 95% CI 1.96–2.72). The most predictive symptom was fever. After knowing that epidemic threshold had been reached, the DOR of the ILI WHO case definition in children aged…

Abstract

Background

We aimed to identify risk factors for sporadic campylobacteriosis in Australia, and to compare these for Campylobacter jejuni and Campylobacter coli infections.

Methods

In a multi-jurisdictional case–control study, we recruited culture-confirmed cases of campylobacteriosis reported to state and territory health departments from February 2018 through October 2019. We recruited controls from notified influenza cases in the previous 12 months that were frequency matched to cases by age group, sex, and location. Campylobacter isolates were confirmed to species level by public health laboratories using molecular methods. We conducted backward stepwise multivariable logistic regression to identify significant risk factors.

Results

We recruited 571 cases of campylobacteriosis (422 C. jejuni and 84 C. coli) and 586 controls. Important risk factors for campylobacteriosis included eating undercooked chicken (adjusted odds ratio [aOR] 70, 95% CI 13–1296) or cooked chicken (aOR 1.7, 95% CI 1.1–2.8), owning a pet dog aged < 6 months (aOR 6.4, 95% CI 3.4–12), and the regular use of proton-pump inhibitors in the 4 weeks prior to illness (aOR 2.8, 95% CI 1.9–4.3). Risk factors remained similar when analysed specifically for C. jejuni infection. Unique risks for C. coli infection included eating chicken pâté (aOR 6.1, 95% CI 1.5–25) and delicatessen meats (aOR 1.8, 95% CI 1.0–3.3). Eating any chicken carried a high population attributable fraction for campylobacteriosis of 42% (95% CI 13–68), while the attributable fraction for proton-pump inhibitors was 13% (95% CI 8.3–18) and owning a pet dog aged < 6 months was 9.6% (95% CI 6.5–13). The population attributable fractions for these variables were similar when analysed by campylobacter species. Eating delicatessen meats was attributed to 31% (95% CI 0.0–54) of cases for C. coli and eating chicken pâté was attributed to 6.0% (95% CI 0.0–11).

Conclusions

The main risk factor for campylobacteriosis in Australia is consumption of chicken meat. However, contact with young pet dogs may also be an important source of infection. Proton-pump inhibitors are likely to increase vulnerability to infection.

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Journal of Medical Virology, Accepted Article.

Objective

To compare the patient profile and outcomes in Qatar during the first and second waves of the COVID-19 pandemic.

Setting

A retrospective observational study was conducted comparing the demographic, clinical and laboratory characteristics of patients with COVID-19 infection admitted to a secondary care hospital, during the first and second waves of the pandemic.

Participants

1039 patients from the first wave and 991 from the second wave who had pneumonia on chest X-ray and had a confirmed SARS-CoV-2 infection by a real-time PCR test of a nasopharyngeal swab were included. Patients with a normal chest X-ray and those who had a negative PCR test despite a positive COVID-19 antigen test were excluded.

Outcome

Length of stay, need for mechanical ventilation, final disposition and mortality were the key outcomes studied

Results

Influenza like symptoms (18.5% in the first wave vs 36.1% in the second wave, p 0.001), cough (79.2% vs 87%, p<0.001) and dyspnoea (27.5% vs 38% p<0.001) were more common in the second wave. Second wave patients had significantly higher respiratory rate, lower peripheral oxygen saturation, needed more supplemental oxygen and had higher incidence of pulmonary embolism. More patients received hydroxychloroquine and antibiotics during the first wave and more received steroids, antivirals and interleukin-1 antagonist during the second wave. The second wave had a shorter length of stay (14.58±7.75 vs 12.61±6.16, p<0.001) and more patients were discharged home (22% vs 10%, p<0.001).

Conclusions

Patients who presented during the second wave of COVID-19 pandemic appeared to be more ill clinically and based on their laboratory parameters. They required shorter hospitalisation and were more likely to be discharged home. This could represent greater expertise in handling such patients that was acquired during the first wave as well as use of more appropriate and combination therapies during the second wave.

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Many of the current questions on the public health and research aspects of the future of COVID-19 vaccines and vaccine strategies have been topics of research and debate in the influenza vaccine literature for decades. Here, we describe how the lessons learned from the study of repeated influenza vaccinations might apply to the evaluation of COVID-19 vaccines, and the prospect of future seasonal or periodic booster vaccinations.

Abstract

Background

The risk of transmission of viral respiratory tract infections (RTIs) is high in mass gatherings including Hajj. This cohort study estimated the incidence of symptomatic RTIs and hand hygiene compliance with its impact among Hajj pilgrims during the COVID-19 pandemic.

Methods

During the week of Hajj rituals in 2021, domestic pilgrims were recruited by phone and asked to complete a baseline questionnaire. Pilgrims were followed up after seven days using a questionnaire about the development of symptoms, and practices of hand hygiene. Syndromic definitions were used to clinically diagnose ‘possible’ influenza-like illnesses (ILI) and COVID-19 infection.

Results

A total of 510 pilgrims aged between 18 and 69 (median of 50) years completed the questionnaire, 280 (54.9%) of whom were female, and all of them (except for one) were vaccinated against COVID-19 with at least one dose. The mean (± SD) of pilgrims’ hand hygiene knowledge score (on a scale of 0 to 6) was 4.15 (± 1.22), and a higher level of knowledge was correlated with a higher frequency of handwashing using soap and water. Among those 445 pilgrims who completed the follow-up form, 21 (4.7%) developed one or more respiratory symptoms, of which sore throat and cough were the commonest (respectively 76.2% and 42.8%); ‘possible ILI’ and ‘possible COVID-19’ were present in 1.1% and 0.9% of pilgrims. Obesity was found to be a significant factor associated with the risk of developing RTIs (odds ratio = 4.45, 95% confidence interval 1.15–17.13).

Conclusions

Hajj pilgrims are still at risk of respiratory infections. Further larger and controlled investigations are needed to assess the efficacy of hand hygiene during Hajj.

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Low antibody concentrations 6 months post-booster might indicate increased risk of pneumococcal infection. The preferred booster was PCV13 if priming did not have PCV13, otherwise either PCV13 or PHiD-CV10 boosters provided similar immunogenicity. Mixed schedules offer flexibility to regional priorities. Non-PCV13 serotypes and non-typeable H influenzae continue to cause substantial disease and disability in Australian First Nation's children.

AbstractBackgroundConcurrent detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and another respiratory virus in individuals can document contemporaneous circulation. We used an ongoing, community-based study of school-aged children and their households to evaluate SARS-CoV-2 co-detections with other respiratory viruses in a non-medically attended population over a two-year period.MethodsHousehold enrollment was predicated on an acute respiratory illness in a child residing in that household who was also a kindergarten through 12th grade student in the participating school district. Demographic, symptom and household composition data, and self-collected nasal specimens were obtained on the recruitment day, and 7 and 14 days later, from the index child and all other household members. All specimens were tested for SARS-CoV-2/influenza A/B by RT-PCR. Day 0 specimens from the index children were simultaneously tested for 17 viruses using a commercial respiratory pathogen panel (RPP). To assess viral co-detections involving SARS-CoV-2, all household specimens were tested via RPP if the index child’s Day 0 specimen tested positive to any of the 17 viral targets in RPP and any household member tested positive for SARS-CoV-2.ResultsOf 2,109 participants (497 index children in 497 households with 1,612 additional household members), two (0.1%) were positive for both SARS-CoV-2 and influenza A; an additional 11 (0.5%) were positive for SARS-CoV-2 and another RPP-covered respiratory virus. Co-detections predominantly affected school-aged children (12 out of 13 total) and were noted in 11 of 497 households.ConclusionsSARS-CoV-2 co-detections with other respiratory viruses were uncommon and predominated in school-aged children.

Journal of Medical Virology, Accepted Article.

by Aldiane Gomes de Macedo Bacurau, Ana Paula Sayuri Sato, Priscila Maria Stolses Bergamo Francisco…

Objective

To identify aetiologies of childhood community-acquired pneumonia (CAP) based on a comprehensive diagnostic approach.

Design

‘Partnerships for Enhanced Engagement in Research-Pneumonia in Paediatrics (PEER-PePPeS)’ study was an observational prospective cohort study conducted from July 2017 to September 2019.

Setting

Government referral teaching hospitals and satellite sites in three cities in Indonesia: Semarang, Yogyakarta and Tangerang.

Participants

Hospitalised children aged 2–59 months who met the criteria for pneumonia were eligible. Children were excluded if they had been hospitalised for >24 hours; had malignancy or history of malignancy; a history of long-term (>2 months) steroid therapy, or conditions that might interfere with compliance with study procedures.

Main outcome(s) measure(s)

Causative bacterial, viral or mixed pathogen(s) for pneumonia were determined using microbiological, molecular and serological tests from routinely collected specimens (blood, sputum and nasopharyngeal swabs). We applied a previously published algorithm (PEER-PePPeS rules) to determine the causative pathogen(s).

Results

188 subjects were enrolled. Based on our algorithm, 48 (25.5%) had a bacterial infection, 31 (16.5%) had a viral infection, 76 (40.4%) had mixed bacterial and viral infections, and 33 (17.6%) were unable to be classified. The five most common causative pathogens identified were Haemophilus influenzae non-type B (N=73, 38.8%), respiratory syncytial virus (RSV) (N=51, 27.1%), Klebsiella pneumoniae (N=43, 22.9%), Streptococcus pneumoniae (N=29, 15.4%) and Influenza virus (N=25, 13.3%). RSV and influenza virus diagnoses were highly associated with Indonesia’s rainy season (November–March). The PCR assays on induced sputum (IS) specimens captured most of the pathogens identified in this study.

Conclusions

Our study found that H. influenzae non-type B and RSV were the most frequently identified pathogens causing hospitalised CAP among Indonesian children aged 2–59 months old. Our study also highlights the importance of PCR for diagnosis and by extension, appropriate use of antimicrobials.

Trail registration number

NCT03366454

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by Liliana Castillo-Rodríguez, Diana Malo-Sánchez, Diana Díaz-Jiménez, Ingrid García-Velásquez, Paola Pulido, Carlos Castañeda-Orjuela

Objective To estimate the economic burden of Severe Acute Respiratory Infection (SARI) in lab-confirmed influenza patients from a low-income country setting such as Colombia. Methods A bottom-up costing analysis, from both third payer and social perspectives, was conducted. Direct costs of care were based on the review of 227 clinical records of lab-confirmed influenza inpatients in six facilities from three main Colombian cities. Resources were categorized as: length of stay (LOS), diagnostic and laboratory tests, medications, consultation, procedures, and supplies. A survey was designed to estimate out-of-pocket expenses (OOPE) and indirect costs covered by patients and their families. Cost per patient was estimated with the frequency of use and prices of activities, calculating median and 95% confidence intervals (95% CI) with bootstrapping. Total costs are expressed as the sum of direct medical costs, OOPE and indirect costs in 2018 US dollars. Results The media direct medical cost per SARI lab-confirmed influenza patient was US$ 700 (95% CI US$ 552–809). Diagnostic and laboratory tests correspond to the highest cost per patient (37%). Median OOPE and indirect costs per patient was US$ 147 (95% CI US$ 94–202), with the highest costs for caregiver expenses (27%). Total costs were US$ 848 (95% CI US$ 646–1,011), OOPE and indirect costs corresponded to 17.4% of the total. The median of direct medical costs per patient was three times higher in elderly patients. Conclusion SARI influenza costs impose a high economic burden on patients and their families. The results highlight the importance of strengthening preventive strategies nationwide in the age groups with higher occurrence and incurred health costs.…

Little is known about global variation in early epidemic growth rates and effective reproduction numbers (Re) of seasonal influenza. We aimed to estimate global variation in Re of influenza type A and B during a single period.

Introduction

The clinical course of patients with a SARS-CoV-2 (COVID-19) infection varies widely, from symptom-free to severe courses that can lead to death. Laboratory values of SARS-CoV-2 patients such as lymphocyte counts or C-reactive protein (CRP) do not allow a prediction of the actual course of the disease. To identify a possible predictive marker for the differentiation and prognosis of illness with influenza-like symptoms with and without SARS-CoV-2 infections in general practice, we will analyse the concentrations of cell-free DNA (cfDNA) levels, laboratory and clinical parameters, temperature, oxygen saturation, breathing rate and concomitant symptoms in patients with flu-like symptoms with and without a SARS-CoV-2 infection.

Methods and analysis

This is a single-centre, two-arm, parallel longitudinal cohort study with a total of 44 patients. 22 patients with flu-like symptoms without a SARS-CoV-2 infection and 22 patients with flu-like symptoms with a SARS-CoV-2 infection will be recruited. The primary objective is to compare cfDNA levels in ambulatory patients in general practice with flu-like symptoms with SARS-CoV-2 infection with those with influenza like symptoms without a SARS-CoV-2 infection during the disease (day 7 and day 14). The secondary objective is to determine whether there is a correlation between cfDNA concentrations on the one hand, and laboratory and clinical parameters on the other hand. cfDNA, differential blood count, high-sensitive CRP and erythrocyte sedimentation rate will be measured in blood samples, concomitant symptoms will be surveyed via a self-assessment questionnaire, and oxygen saturation, breathing rate and examination of the lungs will be reported by treating physicians.

Ethics and dissemination

Ethical approval was issued on 1 March 2021 by the Ethics Committee Essen under the number 21-9916-BO. Findings will be published in peer-reviewed open-access journals and presented at national and international conferences.

Trial registration number

DRKS00024722.

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New England Journal of Medicine, Ahead of Print. …

by Marcela de Andrade Pereira Silva, Helena Fiats Ribeiro, Rosana Rosseto de Oliveira, Fernando Castilho Pelloso, Constanza Pujals, Raíssa Bocchi Pedroso, Maria Dalva de Barros Carvalho, Sandra Marisa Pelloso

Objective To analyze the characteristics associated with vaccination against Covid-19 in pregnant and postpartum women with Severe Acute Respiratory Syndrome in Brazil and to investigate a possible association between vaccination and the clinical course and outcome of the disease. Methods Retrospective cohort study of hospitalized pregnant and postpartum women diagnosed with Severe Acute Respiratory Syndrome (SARS) by SARS-CoV-2, presenting onset of signs and symptoms between May and October 2021. Secondary data were used, available in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe). Data were analyzed using the SPSS statistical program, medians were applied to present continuous variables and frequencies, and proportions were calculated for categorical variables, using logistic and multivariate regression analysis. Results The final study population included 3,585 pregnant and postpartum women, of whom 596 (16.6) were vaccinated: 443 (74.3%) received one dose and 153 (25.7%) received two doses. They were factors associated with non-vaccination against Covid-19 age ≤ 19 anos (OR: 2.57; IC95% 1.40;4.71), non-white women (OR: 1.34; IC95% 1.07;1.67) and those who required ventilatory support (OR: 1.51; IC95% 1.19;1.90) and invasive ventilation (OR: 2.05; IC95% 1.37;3.08). On the other hand, vaccination was associated with advanced maternal age (OR: 0.60; IC95% 0.48;0.76), presence of comorbidities (OR: 0.57; IC95% 0.45;0.72) and loss of taste (OR: 0.63; IC95% 0.48;0.82). Conclusions Demographic, ethnic-racial and clinical characteristics were associated with the vaccination status of pregnant and postpartum women with SARS by SARS-CoV-2 in Brazil. Vaccination against Covid-19 in the obstetric population has already shown positive results in the evolution of severe cases, which reiterates its importance. It is essential that health services advance vaccination against Covid-19 in the obstetric population, especially adolescentes and non-white women.…

by Erika Bohn-Goldbaum, Katherine B. Owen, Vivian Y. J. Lee, Robert Booy, Kate M. Edwards

Whether the vaccine adjuvant potential of acute exercise is uniform among different populations, e.g., inactive persons, is unknown. This meta-analysis examines influenza vaccine antibody responses and the effect of physical activity, acute exercise, and their interaction. Inclusion criteria comprised randomized controlled trials with acute exercise intervention and influenza vaccination antibody measurements at baseline and 4–6 weeks, and participant baseline physical activity measurement; there were no exclusion criteria. Searching via six databases (Medline, Embase, CINAHL, Scopus, Web of Science, and Physiotherapy Evidence) and two clinical registries (WHO and NIH), nine studies were identified and assessed with the Cochrane revised risk-of-bias tool. Data analysis comprised one-stage random-effects generalized linear mixed-effects models with random intercept. Seven of nine identified studies, all of high risk of bias, provided data for 550 included participants. Clinical measures of antibody response tended to be higher in the acute-exercised participants compared to rested controls and physically active compared to inactive. Physical activity significantly increased H1 strain seroconversion (adjusted odds ratio (aOR) 1.69, 95%CI: 1.02–2.82) among all participants and titer response (aOR 1.20, 95%CI: 1.03–1.39) among the acute exercise group. Increasing age frequently reduced immunogenic responses whereas body mass index and sex had little-to-no effect. Adjuvant effects were more pronounced with interventions exercising the same arm in which the vaccination was administered. H1 response was increased by both physical activity and the acute exercise-physical activity interaction. Given the observed modifications by age and the subset analysis suggesting the benefit is more pronounced in older populations, future attention is due for acute exercise-PA interactions to impact vaccination response in the at-risk population of older adults. Further, we identify localized exercise as the likely most-effective protocol and encourage its use to augment the available evidence.

Abstract

Background

Acute myocardial injury is associated with poor prognosis in respiratory tract infections. We aimed to highlight the differences in prevalence of myocardial injury and its impact on prognosis in patients with COVID-19 compared to those with seasonal influenza.

Methods

This was a single-center prospective cohort study with a historical control group. 300 age-/sex-matched SARS-CoV-2 and seasonal influenza positive patients were enrolled. Myocardial injury was assessed by electrocardiogram (ECG), transthoracic echocardiography and biomarkers including high-sensitivity troponin-I. All patients were followed-up for 30 days after enrollment for all-cause mortalitiy, admission to the intensive care unit (ICU) and mechanical ventilation.

Results

Right ventricular distress was more common in COVID-19 whereas pathological ECG findings and impaired left ventricular function were more prevalent among influenza patients. COVID-19 patients suffered from a higher percentage of hypertension and dyslipidaemia. Contrary to COVID-19, pericardial effusion at admission was associated with poor outcome in the influenza group. Severe course of disease and respiratory failure resulted in significantly higher rates of ICU treatment and mechanical ventilation in COVID-19 patients. Although distribution of myocardial injury was similar, significantly fewer cardiac catheterizations were performed in COVID-19 patients. However, number of cardiac catheterizations was low in both groups. Finally, 30-day mortality was significantly higher in COVID-19 compared to influenza patients.

Conclusions

In adults requiring hospitalization due to COVID-19 or seasonal influenza, cardiovascular risk factors and signs of myocardial distress differ significantly. Furthermore, cardiovascular comorbidities may impair prognosis in COVID-19 patients to a higher degree than in their influenza counterparts.

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Abstract

Background

Acute myocardial injury is associated with poor prognosis in respiratory tract infections. We aimed to highlight the differences in prevalence of myocardial injury and its impact on prognosis in patients with COVID-19 compared to those with seasonal influenza.

Methods

This was a single-center prospective cohort study with a historical control group. 300 age-/sex-matched SARS-CoV-2 and seasonal influenza positive patients were enrolled. Myocardial injury was assessed by electrocardiogram (ECG), transthoracic echocardiography and biomarkers including high-sensitivity troponin-I. All patients were followed-up for 30 days after enrollment for all-cause mortalitiy, admission to the intensive care unit (ICU) and mechanical ventilation.

Results

Right ventricular distress was more common in COVID-19 whereas pathological ECG findings and impaired left ventricular function were more prevalent among influenza patients. COVID-19 patients suffered from a higher percentage of hypertension and dyslipidaemia. Contrary to COVID-19, pericardial effusion at admission was associated with poor outcome in the influenza group. Severe course of disease and respiratory failure resulted in significantly higher rates of ICU treatment and mechanical ventilation in COVID-19 patients. Although distribution of myocardial injury was similar, significantly fewer cardiac catheterizations were performed in COVID-19 patients. However, number of cardiac catheterizations was low in both groups. Finally, 30-day mortality was significantly higher in COVID-19 compared to influenza patients.

Conclusions

In adults requiring hospitalization due to COVID-19 or seasonal influenza, cardiovascular risk factors and signs of myocardial distress differ significantly. Furthermore, cardiovascular comorbidities may impair prognosis in COVID-19 patients to a higher degree than in their influenza counterparts.

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by Mitsuo Uchida, Takenori Yamauchi

Introduction Although influenza surveillance systems have been used to monitor influenza epidemics, these systems generally evaluate diagnostic information obtained from medical institutions and they do not include patients who have not been examined. In contrast, community based epidemiological studies target people with influenza-like illness (ILI) that self-reported influenza-like symptoms whether they have medical examinations or not. Because the criteria for influenza surveillance systems and ILI differ, there is a gap between them. The purpose of this study was to clarify this gap using school-based survey data. Methods Questionnaires about both ILI and the influenza diagnosis history during the 2018/19 season were administered to the guardians of 11,684 elementary schoolchildren in a single city in Japan. Based on their responses, a Bayesian model was constructed to estimate the probability of infection, ILI onset, and diagnosis at medical institutions. Results Responses were obtained from guardians of 10,309 children (88.2%). Of these, 3,380 children (32.8%) had experienced ILI, with 2,380 (23.1%) diagnosed as influenza at a medical institution. Bayesian estimation showed that the probability of influenza cases being diagnosed among ILI symptomatic children was 70% (95% credible interval, 69–71%). Of the infected children, 5% were without ILI symptoms, with 11% of these patients diagnosed with influenza. Conclusions This epidemiological study clarified the proportion gap between ILI and influenza diagnosis among schoolchildren. These results may help to establish epidemic control measures and secure sufficient medical resources.…

AbstractBackgroundSARS-CoV-2 and influenza viruses continue to co-circulate, representing two major public health threats from respiratory infections with similar clinical presentations. SARS-CoV-2 and influenza vaccines can also now be co-administered. However, data on antibody responses to SARS-CoV-2 and influenza co-infection, and vaccine co-administration remains limited.MethodsWe developed a 41-plex antibody immunity assay that can simultaneously characterize antibody landscapes to SARS-CoV-2/influenza/common human coronaviruses. We analyzed sera from 840 individuals (11-93 years), including sera from reverse transcription polymerase chain reaction (RT-PCR) confirmed SARS-CoV-2 positive (n = 218) and negative (n = 120) cases, paired sera from SARS-CoV-2 vaccination (n = 29) and infection (n = 11), and paired sera from influenza vaccination (n = 56) and RT-PCR confirmed influenza infection (n = 158) cases. Lastly, we analyzed sera collected from 377 individual that exhibited acute respiratory illness (ARI) in 2020.ResultsThis 41-plex assay has high sensitivity and specificity in detecting SARS-CoV-2 infections. It differentiated SARS-CoV-2 vaccination (antibody responses only to spike protein) from infection (antibody responses to both spike and nucleoprotein). No cross-reactive antibodies were detected to SARS-CoV-2 from influenza vaccination and infection, and vice versa, suggesting no interaction between SARS-CoV-2 and influenza antibody responses. However, cross-reactive antibodies were detected between spike proteins of SARS-CoV-2 and common human coronaviruses that were removed by serum adsorption. Among 377 individual who exhibited ARI in 2020, 129 were influenza positive, none had serological evidence of SARS-CoV-2/influenza co-infections.ConclusionsMultiplex detection of antibody landscapes can provide in-depth analysis of the antibody protective immunity to SARS-CoV-2 in the context of other respiratory viruses including influenza.

Northern Syria faces a large burden of influenza-like illness (ILI) and severe acute respiratory illness (SARI). This study aims to investigate trends of Early Warning and Response Network (EWARN) reported ILI and SARI in northern Syria between 2016-2021 and the potential impact of SARS-CoV-2.

Abstract

Background

Bacterial opportunistic infections are common in people living with HIV/AIDS (PLHA). Besides HIV-TB co-infection, lower respiratory tract infections (LRTIs) due to multidrug-resistant (MDR) bacteria cause significant morbidity and mortality among PLHA. This study identified bacterial co-infection of the lower respiratory tract and detected plasmid-mediated blaTEM and blaCTX-M genes among Extended-Spectrum β-Lactamase (ESBL) producing isolates from sputum samples in PLHA.

Methods

A total of 263 PLHA with LRTIs were enrolled in this study, out of which, 50 were smokers, 70 had previous pulmonary tuberculosis, and 21 had CD4 count < 200 cells/µl. Sputum samples collected from PLHA were processed with standard microbiological methods to identify the possible bacterial pathogens. The identified bacterial isolates were assessed for antibiotic susceptibility pattern using modified Kirby Bauer disk diffusion method following Clinical Laboratory Standard Institute (CLSI) guidelines. In addition, plasmid DNA was extracted from MDR and ESBL producers for screening of ESBL genes; blaCTX-M and blaTEM by conventional PCR method using specific primers.

Results

Of 263 sputum samples, 67 (25.48%) showed bacterial growth. Among different bacterial pathogens, Klebsiella pneumoniae, (17; 25.37%) was the most predominant, followed by Haemophillus influenzae, (14; 20.90%) and Escherichia coli, (12; 17.91%). A higher infection rate (4/8; 50%) was observed among people aged 61–70 years, whereas no infection was observed below 20 years. About 30.0% (15/50) of smokers, 32.86% (23/70) cases with previous pulmonary tuberculosis, and 52.38% (11/21) with CD4 count < 200 cells/µl had bacterial LRTIs. Among 53 bacterial isolates excluding H. influenzae, 28 isolates were MDR and 23 were ESBL producers. All ESBL producers were sensitive to colistin and polymyxin B. Among ESBL producers, 47.83% (11/23) possessed blaCTX-M, 8.6% (2/23) were positive for blaTEM gene, and 43.48% (10/23) possessed both ESBL genes.

Conclusion

The increasing rate of MDR bacterial infections, mainly ESBL producers of LRTIs causes difficulty in disease management, leading to high morbidity and mortality of PLHA. Hence, it is crucial to know the antibiogram pattern of the isolates to recommend effective antimicrobial therapy to treat LRTIs in PLHA.

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Objectives

To investigate what factors affect parents’ influenza vaccination preference for their children and whether there exists preference heterogeneity among respondents in China.

Design

Cross-sectional study. A discrete choice experiment was conducted. Five attributes were identified based on literature review and qualitative interviews, including protection rate, duration of vaccine-induced protection, risk of serious side effects, location of manufacturer and out-of-pocket cost.

Setting

Multistage sampling design was used. According to geographical location and the level of economic development, 10 provinces in China were selected, and the survey was conducted at community healthcare centres or stations.

Participants

Parents with at least one child aged between 6 months and 5 years old were recruited and the survey was conducted via a face-to-face interview in 2019. In total, 600 parents completed the survey, and 449 who passed the internal consistency test were included in the main analysis.

Main outcomes and measures

A mixed logit model was used to estimate factors affecting parents’ preference to vaccinate their children. In addition, sociodemographic characteristics were included to explore the preference heterogeneity.

Results

In general, respondents preferred to vaccinate their children. All attributes were statistically significant and among them, the risk of severe side effects was the most important attribute, followed by the protection rate and duration of vaccine-induced protection. Contrary to our initial expectation, respondents have a stronger preference for the domestic than the imported vaccine. Some preference heterogeneity among parents was also found and in particular, parents who were older, or highly educated placed a higher weight on a higher protection rate.

Conclusion

Vaccination safety and vaccine effectiveness are the two most important characteristics that influenced parents’ decision to vaccinate against influenza for their children in China. Results from this study will facilitate future policy implementations to improve vaccination uptake rates.

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by Hachung Yoon, Ilseob Lee, Hyeonjeong Kang, Kyung-Sook Kim, Eunesub Lee

Outbreaks of H5-type highly pathogenic avian influenza (HPAI) in poultry have been reported in various parts of the world. To respond to these continuous threats, numerous surveillance programs have been applied to poultry raising facilities as well as wild birds. In Korea, a surveillance program was developed aimed at providing a preemptive response to possible outbreaks at poultry farms. The purpose of this study is to comprehensively present the risks of HPAI evaluated by this program in relation to actual outbreak farms during the epidemic of 2020/2021. A deep learning-based risk assessment program was trained based on the pattern of livestock vehicles visiting poultry farms and HPAI outbreaks to calculate the risk of HPAI for farms linked by the movement of livestock vehicles (such farms are termed “epidemiologically linked farms”). A total of 7,984 risk assessments were conducted, and the results were categorized into four groups. The proportion of the highest risk level was greater in duck farms (13.6%) than in chicken farms (8.8%). Among the duck farms, the proportion of the highest risk level was much greater in farms where breeder ducks were raised (accounting for 26.4% of the risk) than in farms where ducks were raised to obtain meat (12.8% of the risk). A higher risk level was also found in cases where the species of the outbreak farm and epidemiologically linked farms were the same (proportion of the highest risk level = 13.2%) compared to that when the species between the two farms were different (7.9%). The overall proportion of farms with HPAI outbreaks among epidemiologically linked farms (attack rate, AR) was 1.7% as HPAI was confirmed on 67 of the 3,883 epidemiologically linked farms. The AR was highest for breeder ducks (15.3%) among duck farms and laying hens (4.8%) among chicken farms. The AR of the pairs where livestock vehicles entered the inner farm area was 1.3 times (95% confidence interval: 1.4–2.9) higher than that of all pairs. With the risk information provided, customized preventive measures can be implemented for each epidemiologically linked farm. The use of this risk assessment program would be a good example of information-based surveillance and support decision-making for controlling animal diseases.

by Gina R. Castro-Sanguinetti, Paulo Vitor Marques Simas, Ana Paola Apaza-Chiara, Jose Alonso Callupe-Leyva, Juan Alexander Rondon-Espinoza, Cesar M. Gavidia, Juan Anderson More-Bayona, Rosa Isabel Gonzalez Veliz, Vikram N. Vakharia, Maria Eliana Icochea

Avian influenza virus (AIV) represents a major concern with productive implications in poultry systems but it is also a zoonotic agent that possesses an intrinsic pandemic risk. AIV is an enveloped, negative-sense and single-stranded RNA virus with a segmented genome. The eight genomic segments, comprising the whole genome, encode for eleven proteins. Within these proteins, Hemagglutinin (HA) and Neuraminidase (NA) are the most relevant for studies of evolution and pathogenesis considering their role in viral replication, and have also been used for classification purposes. Migratory birds are the main hosts and play a pivotal role in viral evolution and dissemination due to their migratory routes that comprise large regions worldwide. Altogether, viral and reservoir factors contribute to the emergence of avian influenza viruses with novel features and pathogenic potentials. The study aimed to conduct surveillance of AIVs in wild birds from Peru. A multi-site screening of feces of migratory birds was performed to isolate viruses and to characterize the whole genome sequences, especially the genes coding for HA and NA proteins. Four-hundred-twenty-one (421) fecal samples, collected between March 2019 and March 2020 in Lima, were obtained from 21 species of wild birds. From these, we isolated five AIV from whimbrel, kelp gull, Franklin’s gulls and Mallard, which were of low pathogenicity, including four subtypes as H6N8, H13N6, H6N2 and H2N6. Genetic analysis of HA and NA genes revealed novel features in these viruses and phylogenetic analysis exhibited a close relationship with those identified in North America (US and Canada). Furthermore, H2N6 isolate presented a NA sequence with higher genetic relationship to Chilean isolates. These results highlight that the geographical factor is of major relevance in the evolution of AIV, suggesting that AIV circulating in Peru might represent a new site for the emergence of reassortant AIVs.

Abstract

Background

Bacterial opportunistic infections are common in people living with HIV/AIDS (PLHA). Besides HIV-TB co-infection, lower respiratory tract infections (LRTIs) due to multidrug-resistant (MDR) bacteria cause significant morbidity and mortality among PLHA. This study identified bacterial co-infection of the lower respiratory tract and detected plasmid-mediated blaTEM and blaCTX-M genes among Extended-Spectrum β-Lactamase (ESBL) producing isolates from sputum samples in PLHA.

Methods

A total of 263 PLHA with LRTIs were enrolled in this study, out of which, 50 were smokers, 70 had previous pulmonary tuberculosis, and 21 had CD4 count < 200 cells/µl. Sputum samples collected from PLHA were processed with standard microbiological methods to identify the possible bacterial pathogens. The identified bacterial isolates were assessed for antibiotic susceptibility pattern using modified Kirby Bauer disk diffusion method following Clinical Laboratory Standard Institute (CLSI) guidelines. In addition, plasmid DNA was extracted from MDR and ESBL producers for screening of ESBL genes; blaCTX-M and blaTEM by conventional PCR method using specific primers.

Results

Of 263 sputum samples, 67 (25.48%) showed bacterial growth. Among different bacterial pathogens, Klebsiella pneumoniae, (17; 25.37%) was the most predominant, followed by Haemophillus influenzae, (14; 20.90%) and Escherichia coli, (12; 17.91%). A higher infection rate (4/8; 50%) was observed among people aged 61–70 years, whereas no infection was observed below 20 years. About 30.0% (15/50) of smokers, 32.86% (23/70) cases with previous pulmonary tuberculosis, and 52.38% (11/21) with CD4 count < 200 cells/µl had bacterial LRTIs. Among 53 bacterial isolates excluding H. influenzae, 28 isolates were MDR and 23 were ESBL producers. All ESBL producers were sensitive to colistin and polymyxin B. Among ESBL producers, 47.83% (11/23) possessed blaCTX-M, 8.6% (2/23) were positive for blaTEM gene, and 43.48% (10/23) possessed both ESBL genes.

Conclusion

The increasing rate of MDR bacterial infections, mainly ESBL producers of LRTIs causes difficulty in disease management, leading to high morbidity and mortality of PLHA. Hence, it is crucial to know the antibiogram pattern of the isolates to recommend effective antimicrobial therapy to treat LRTIs in PLHA.

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Abstract

Background

Blood cultures remain the gold standard investigation for the diagnosis of bloodstream infections. In many locations, quality-assured processing of positive blood cultures is not possible. One solution is to incubate blood cultures locally, and then transport bottles that flag positive to a central reference laboratory for organism identification and antimicrobial susceptibility testing. However, the impact of delay between the bottle flagging positive and subsequent sub-culture on the viability of the isolate has received little attention.

Methods

This study evaluated the impact of delays to sub-culture (22 h to seven days) in three different temperature conditions (2–8 °C, 22–27 °C and 35 ± 2 °C) for bottles that had flagged positive in automated detection systems using a mixture of spiked and routine clinical specimens. Ninety spiked samples for five common bacterial causes of sepsis (Escherichia coli, Haemophilus influenzae, Staphylococcus aureus, Streptococcus agalactiae and Streptococcus pneumoniae) and 125 consecutive positive clinical blood cultures were evaluated at four laboratories located in Cambodia, Lao PDR and Thailand. In addition, the utility of transport swabs for preserving organism viability was investigated.

Results

All organisms were recoverable from all sub-cultures in all temperature conditions with the exception of S. pneumoniae, which was less likely to be recoverable after longer delays (> 46–50 h), when stored in hotter temperatures (35 °C), and from BacT/ALERT when compared with BACTEC blood culture bottles. Storage of positive blood culture bottles in cooler temperatures (22–27 °C or below) and the use of Amies bacterial transport swabs helped preserve viability of S. pneumoniae.

Conclusions

These results have practical implications for the optimal workflow for blood culture bottles that have flagged positive in automated detection systems located remotely from a central processing laboratory, particularly in tropical resource-constrained contexts.

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Abstract

Purpose

At the beginning of the COVID-19 pandemic, SARS-CoV-2 was often compared to seasonal influenza. We aimed to compare the outcome of hospitalized patients with cancer infected by SARS-CoV-2 or seasonal influenza including intensive care unit admission, mechanical ventilation and in-hospital mortality.

Methods

We analyzed claims data of patients with a lab-confirmed SARS-CoV-2 or seasonal influenza infection admitted to one of 85 hospitals of a German-wide hospital network between January 2016 and August 2021.

Results

29,284 patients with COVID-19 and 7442 patients with seasonal influenza were included.

Of these, 360 patients with seasonal influenza and 1625 patients with COVID-19 had any kind of cancer. Cancer patients with COVID-19 were more likely to be admitted to the intensive care unit than cancer patients with seasonal influenza (29.4% vs 24.7%; OR 1.31, 95% CI 1.00–1.73 p < .05). No statistical significance was observed in the mechanical ventilation rate for cancer patients with COVID-19 compared to those with seasonal influenza (17.2% vs 13.6% OR 1.34, 95% CI 0.96–1.86 p = .09). 34.9% of cancer patients with COVID-19 and 17.9% with seasonal influenza died (OR 2.45, 95% CI 1.81–3.32 p < .01). Risk factors among cancer patients with COVID-19 or seasonal influenza for in-hospital mortality included the male gender, age, a higher Elixhauser comorbidity index and metastatic cancer.

Conclusion

Among cancer patients, SARS-CoV-2 was associated with a higher risk for in-hospital mortality than seasonal influenza. These findings underline the need of protective measurements to prevent an infection with either COVID-19 or seasonal influenza, especially in this high-risk population.

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Abstract

Background

Blood cultures remain the gold standard investigation for the diagnosis of bloodstream infections. In many locations, quality-assured processing of positive blood cultures is not possible. One solution is to incubate blood cultures locally, and then transport bottles that flag positive to a central reference laboratory for organism identification and antimicrobial susceptibility testing. However, the impact of delay between the bottle flagging positive and subsequent sub-culture on the viability of the isolate has received little attention.

Methods

This study evaluated the impact of delays to sub-culture (22 h to seven days) in three different temperature conditions (2–8 °C, 22–27 °C and 35 ± 2 °C) for bottles that had flagged positive in automated detection systems using a mixture of spiked and routine clinical specimens. Ninety spiked samples for five common bacterial causes of sepsis (Escherichia coli, Haemophilus influenzae, Staphylococcus aureus, Streptococcus agalactiae and Streptococcus pneumoniae) and 125 consecutive positive clinical blood cultures were evaluated at four laboratories located in Cambodia, Lao PDR and Thailand. In addition, the utility of transport swabs for preserving organism viability was investigated.

Results

All organisms were recoverable from all sub-cultures in all temperature conditions with the exception of S. pneumoniae, which was less likely to be recoverable after longer delays (> 46–50 h), when stored in hotter temperatures (35 °C), and from BacT/ALERT when compared with BACTEC blood culture bottles. Storage of positive blood culture bottles in cooler temperatures (22–27 °C or below) and the use of Amies bacterial transport swabs helped preserve viability of S. pneumoniae.

Conclusions

These results have practical implications for the optimal workflow for blood culture bottles that have flagged positive in automated detection systems located remotely from a central processing laboratory, particularly in tropical resource-constrained contexts.

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Introduction

Infectious diseases are a major cause of mortality and morbidity among the highly vulnerable occupants of residential aged care facilities (RACFs). The burden of vaccine preventable diseases (VPDs) among RACFs residents is mostly unknown and there is a lack of quality data from population-based prospective VPD surveillance in RACFs. The increasing burden of emerging and existing VPDs (eg, COVID-19, influenza, pneumococcal, pertussis and varicella-zoster) necessitates the establishment of an active enhanced surveillance system to provide real-time evidence to devise strategies to reduce the burden of VPDs in RACFs.

Method and analysis

This study proposes a prospective active enhanced surveillance that will be implemented in RACFs across the Central Queensland (CQ) region. The study aims to measure the burden, identify aetiologies, risk factors, predictors of severe outcomes (eg, hospitalisations, mortality) and impact of the existing National Immunization Program (NIP) funded vaccines in preventing VPDs in this vulnerable population. CQ Public Health Unit (CQPHU) will implement the active surveillance by collecting demographic, clinical, pathological, diagnostic, therapeutic and clinical outcome data from the RACFs based on predefined selection criteria and case report forms as per routine public health practices. Descriptive statistics, univariate and multivariate regression analysis will be conducted to identify the predictors of morbidity and clinical outcomes following infection.

Ethics and dissemination

The study has been approved by the CQHHS Human Research Ethics Committee (HREC) (reference number HREC/2021/QCQ/74305). This study involves data that is routinely collected as part of the surveillance of notifiable conditions under the Public Health Act 2005. The CQHHS HREC approved a request to waive consent requirements of study participants as researchers will be provided non-identifiable data. The findings from the study will be actively disseminated through publication in peer-reviewed journals, conference presentations, social and print media, federal, state, and local authorities to reflect on the results that may facilitate revision of policy and highlight the stakeholders, funding bodies both locally and internationally.

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Abstract

Purpose

At the beginning of the COVID-19 pandemic, SARS-CoV-2 was often compared to seasonal influenza. We aimed to compare the outcome of hospitalized patients with cancer infected by SARS-CoV-2 or seasonal influenza including intensive care unit admission, mechanical ventilation and in-hospital mortality.

Methods

We analyzed claims data of patients with a lab-confirmed SARS-CoV-2 or seasonal influenza infection admitted to one of 85 hospitals of a German-wide hospital network between January 2016 and August 2021.

Results

29,284 patients with COVID-19 and 7442 patients with seasonal influenza were included.

Of these, 360 patients with seasonal influenza and 1625 patients with COVID-19 had any kind of cancer. Cancer patients with COVID-19 were more likely to be admitted to the intensive care unit than cancer patients with seasonal influenza (29.4% vs 24.7%; OR 1.31, 95% CI 1.00–1.73 p < .05). No statistical significance was observed in the mechanical ventilation rate for cancer patients with COVID-19 compared to those with seasonal influenza (17.2% vs 13.6% OR 1.34, 95% CI 0.96–1.86 p = .09). 34.9% of cancer patients with COVID-19 and 17.9% with seasonal influenza died (OR 2.45, 95% CI 1.81–3.32 p < .01). Risk factors among cancer patients with COVID-19 or seasonal influenza for in-hospital mortality included the male gender, age, a higher Elixhauser comorbidity index and metastatic cancer.

Conclusion

Among cancer patients, SARS-CoV-2 was associated with a higher risk for in-hospital mortality than seasonal influenza. These findings underline the need of protective measurements to prevent an infection with either COVID-19 or seasonal influenza, especially in this high-risk population.

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Journal of Medical Virology, Accepted Article.

by Brooke G. Rogers, Jun Tao, Alexi Almonte, Emily Toma, Katherine Nagel, Robert Fain, Siena C. Napoleon, Michaela A. Maynard, Matthew Murphy, Indra Neil Sarkar, Philip A. Chan

Background Vaccines are effective in preventing Coronavirus Disease 2019 (COVID-19). Vaccine hesitancy defined as delay of acceptance or refusal of the vaccine is a major barrier to effective implementation. Methods Participants were recruited statewide through an English and Spanish social media marketing campaign conducted by a local news station during a one-month period as vaccines were becoming available in Rhode Island (from December 21, 2020 to January 22, 2021). Participants completed an online survey about COVID-19 vaccines and vaccine hesitancy with constructs and items adopted from the Health Belief Model. Results A total of 2,007 individuals completed the survey. Eight percent (n = 161) reported vaccine hesitancy. The sample had a median age of 58 years (interquartile range [IQR]: 45, 67), were majority female (78%), White (96%), Non-Hispanic (94%), employed (58%), and reported an annual individual income of $50,000 (59%). COVID-19 vaccine hesitancy was associated with attitudes and behaviors related to COVID-19. A one unit increase in concern about COVID-19 was associated with a 69% (Adjusted Odds Ratio: 0.31, 95% CI: 0.26–0.37) decrease in vaccine hesitancy. A one-level increase in the likelihood of getting influenza vaccine was associated with a 55% (AOR: 0.45 95% CI: 0.41–0.50) decrease in vaccine hesitancy. Conclusions COVID-19 vaccine hesitancy was relatively low in a state-wide survey in Rhode Island. Future research is needed to better understand and tailor messaging related to vaccine hesitancy.…

AbstractBackgroundWe conducted double-blind, placebo-controlled trials assessing the efficacy and tolerability of favipiravir in acute influenza.MethodsOtherwise healthy adults with influenza-like symptoms and fever of ≤48 hours were randomized to favipiravir (1800 mg twice daily [BID] on day 1, 800 mg BID on days 2–5) or placebo tablets (1:1 in US316; 3:1 in US317). The primary efficacy endpoint was the time to illness alleviation when 6 influenza symptoms were self-rated as absent or mild and fever was absent in the intention-to-treat, influenza-infected participants.ResultsIn US316 (301 favipiravir, 322 placebo), favipiravir was associated with a 14.4-hour reduction (median, 84.2 vs 98.6 hours; P = .004) in time to illness alleviation vs placebo. In US317 (526 favipiravir, 169 placebo), favipiravir did not significantly reduce time to alleviation (median, 77.8 vs 83.9 hours). In both trials favipiravir was associated with reduced viral titers, RNA load area under the curve over days 1–5, and median times to cessation of virus detection (P < .001). Aside from asymptomatic hyperuricemia, no important differences in adverse events were found.ConclusionsThis favipiravir dosing regimen demonstrated significant antiviral efficacy but inconsistent illness alleviation in uncomplicated influenza. Studies of higher doses and antiviral combinations for treating serious influenza and other RNA viral infections are warranted.Clinical Trials Registration. NCT02026349; NCT02008344.

AbstractBackgroundChildren account for a large portion of global influenza burden and transmission, and a better understanding of influenza in children is needed to improve prevention and control strategies.MethodsTo examine the incidence and transmission of influenza we conducted a prospective community-based study of children aged 0-14 years in Managua, Nicaragua between 2011 and 2019. Participants were provided with medical care through study physicians and symptomatic influenza was confirmed by RT-PCR. Wavelet analyses were used to examine seasonality. Generalized growth models (GGMs) were used to estimate effective reproduction numbers.ResultsFrom 2011-2019, 3,016 children participated, with an average of ∼1,800 participants per year and median follow-up time of 5 years per child, and 48.3% of the cohort in 2019 had been enrolled their entire lives. The overall incidence rates per 100 person-years were 14.5 symptomatic influenza cases (95%CI: 13.9-15.1) and 1.0 influenza-associated ALRI case (95%CI: 0.8-1.1). Symptomatic influenza incidence peaked at age 9-11 months. Infants born during peak influenza circulation had lower incidence in the first year of their lives. The mean effective reproduction number was 1.2 (range 1.02-1.49), and we observed significant annual patterns for influenza and influenza A, and a 2.5-year period for influenza B.ConclusionsThis study provides important information for understanding influenza epidemiology and informing influenza vaccine policy. These results will aid in informing strategies to reduce the burden of influenza.

by Justice Moses K. Aheto, Oliver Pannell, Winfred Dotse-Gborgbortsi, Mary K. Trimner, Andrew J. Tatem, Dale A. Rhoda, Felicity T. Cutts, C. Edson Utazi

Background Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed. Methods Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months. Results Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome. Conclusion Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.…

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Journal of Medical Virology, Accepted Article.

Objectives

To estimate the prevalence of zero dose children (who have not received any dose of pentavalent (diphtheria, tetanus, pertussis, Haemophilus influenzae type B and hepatitis B) vaccine by their first birthday) among those who interacted with the immunisation system in Sindh, Pakistan along with their sociodemographic characteristics and risk factors.

Design and participants

We conducted a descriptive analysis of child-level longitudinal immunisation records of 1 467 975 0–23 months children from the Sindh’s Zindagi Mehfooz (Safe Life) Electronic Immunisation Registry (ZM-EIR), for the birth cohorts of 2017 and 2018.

Setting

Sindh province, Pakistan which has a population of 47.9 million people and an annual birth cohort of 1.7 million.

Primary and secondary outcome measures

The primary outcome measure was zero dose status among enrolled children. Logistic regression was performed to identify the risk factors associated with the zero dose status.

Results

Out of 1 467 975 children enrolled in the ZM-EIR in Sindh, 10.6% (154 881/1 467 975) were zero dose. There were sharp inequities across the 27 districts. Zero dose children had a lower proportion of hospital births (28.5% vs 34.0%; difference 5.5 percentage points (pp) (95% CI 5.26 to 5.74); p<0.001) and higher prevalence from slums (49.5% vs 42.3%; difference 7.2 pp (95% CI 6.93 to 7.46); p<0.001), compared with non-zero dose children. Children residing in urban compared with rural areas were at a higher risk (relative risk (RR): 1.20; p<0.001; 95% CI 1.18 to 1.22), while children with educated compared with uneducated mothers were at a lower risk of being zero dose (RR: 0.47–0.96; p<0.001; 95% CI 0.45 to 0.98).

Conclusions

Despite interacting with the immunisation system, 1 out of 10 children enrolled in the ZM-EIR in Sindh were zero dose. It is crucial to monitor the prevalence of zero dose children and investigate their characteristics and risk factors to effectively reach and follow-up with them.

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Journal of Medical Virology, Accepted Article.

Abstract

Background

Interactions between humans and animals are the key elements of zoonotic spillover leading to zoonotic disease emergence. Research to understand the high-risk behaviors associated with disease transmission at the human-animal interface is limited, and few consider regional and local contexts.

Objective

This study employed an integrated behavioral–biological surveillance approach for the early detection of novel and known zoonotic viruses in potentially high-risk populations, in an effort to identify risk factors for spillover and to determine potential foci for risk-mitigation measures.

Method

Participants were enrolled at two community-based sites (n = 472) in eastern and western Thailand and two hospital (clinical) sites (n = 206) in northeastern and central Thailand. A behavioral questionnaire was administered to understand participants’ demographics, living conditions, health history, and animal-contact behaviors and attitudes. Biological specimens were tested for coronaviruses, filoviruses, flaviviruses, influenza viruses, and paramyxoviruses using pan (consensus) RNA Virus assays.

Results

Overall 61/678 (9%) of participants tested positive for the viral families screened which included influenza viruses (75%), paramyxoviruses (15%), human coronaviruses (3%), flaviviruses (3%), and enteroviruses (3%). The most salient predictors of reporting unusual symptoms (i.e., any illness or sickness that is not known or recognized in the community or diagnosed by medical providers) in the past year were having other household members who had unusual symptoms and being scratched or bitten by animals in the same year. Many participants reported raising and handling poultry (10.3% and 24.2%), swine (2%, 14.6%), and cattle (4.9%, 7.8%) and several participants also reported eating raw or undercooked meat of these animals (2.2%, 5.5%, 10.3% respectively). Twenty four participants (3.5%) reported handling bats or having bats in the house roof. Gender, age, and livelihood activities were shown to be significantly associated with participants’ interactions with animals. Participants’ knowledge of risks influenced their health-seeking behavior.

Conclusion

The results suggest that there is a high level of interaction between humans, livestock, and wild animals in communities at sites we investigated in Thailand. This study highlights important differences among demographic and occupational risk factors as they relate to animal contact and zoonotic disease risk, which can be used by policymakers and local public health programs to build more effective surveillance strategies and behavior-focused interventions.

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Abstract

Background

Interactions between humans and animals are the key elements of zoonotic spillover leading to zoonotic disease emergence. Research to understand the high-risk behaviors associated with disease transmission at the human-animal interface is limited, and few consider regional and local contexts.

Objective

This study employed an integrated behavioral–biological surveillance approach for the early detection of novel and known zoonotic viruses in potentially high-risk populations, in an effort to identify risk factors for spillover and to determine potential foci for risk-mitigation measures.

Method

Participants were enrolled at two community-based sites (n = 472) in eastern and western Thailand and two hospital (clinical) sites (n = 206) in northeastern and central Thailand. A behavioral questionnaire was administered to understand participants’ demographics, living conditions, health history, and animal-contact behaviors and attitudes. Biological specimens were tested for coronaviruses, filoviruses, flaviviruses, influenza viruses, and paramyxoviruses using pan (consensus) RNA Virus assays.

Results

Overall 61/678 (9%) of participants tested positive for the viral families screened which included influenza viruses (75%), paramyxoviruses (15%), human coronaviruses (3%), flaviviruses (3%), and enteroviruses (3%). The most salient predictors of reporting unusual symptoms (i.e., any illness or sickness that is not known or recognized in the community or diagnosed by medical providers) in the past year were having other household members who had unusual symptoms and being scratched or bitten by animals in the same year. Many participants reported raising and handling poultry (10.3% and 24.2%), swine (2%, 14.6%), and cattle (4.9%, 7.8%) and several participants also reported eating raw or undercooked meat of these animals (2.2%, 5.5%, 10.3% respectively). Twenty four participants (3.5%) reported handling bats or having bats in the house roof. Gender, age, and livelihood activities were shown to be significantly associated with participants’ interactions with animals. Participants’ knowledge of risks influenced their health-seeking behavior.

Conclusion

The results suggest that there is a high level of interaction between humans, livestock, and wild animals in communities at sites we investigated in Thailand. This study highlights important differences among demographic and occupational risk factors as they relate to animal contact and zoonotic disease risk, which can be used by policymakers and local public health programs to build more effective surveillance strategies and behavior-focused interventions.

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Abstract

Background

Acute respiratory infections (ARIs) and severe acute respiratory illness (SARI) are public health burdens globally. The percentage of non-SARS CoV-2 respiratory viruses among patients having ARI and SARI who visit Car Nicobar's hospital settings is undocumented. Changes in the epidemiology of other respiratory viruses during COVID19 pandemic is being reported worldwide.

Methods

Inpatient and outpatient settings at BJR hospital, Car Nicobar Island, India, were used to conduct prospective monitoring for ARI and SARI among Nicobarese tribal members. The patients with ARI and SARI were enlisted in BJR hospital from June 2019 to May 2021. At the ICMR-NIV in Pune, duplex RT-PCR assays were used to test the presence of respiratory viruses. The prevalence of non- SARS CoV-2 respiratory viruses was measured by comparing here between pandemic and pre-pandemic periods.

Results

During the COVID19 pandemic, Influenza A (H3N2) and rhinovirus were predominantly reported non-SARS CoV-2 respiratory viruses while Human metapneumovirusand influenza A (H1N1)pdm09were most commonly reported in the prepandemic period. This result indicates the altered circulation of non-SARS CoV-2 during pandemic.

Conclusions

A considerable proportion of respiratory infection was correlated with respiratory viruses. Prevalence of non-SARS CoV-2 respiratory viruses was high at the time of infection when compared with pre-pandemic period, at Car Nicobar Island. This study enlightened the change in circulation of other respiratory viruses among the indigenous Nicobarese tribes. Clinicians and allied medical staff should be more prudent of these respiratory infections.

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: Due to the spread of the Omicron variant, many countries have experienced COVID-19 case numbers unseen since the start of the pandemic. We aimed to compare the epidemiological characteristics of Omicron with prior variants and different strains of influenza, to provide context for public health responses.

Abstract

Background

Acute respiratory infections (ARIs) and severe acute respiratory illness (SARI) are public health burdens globally. The percentage of non-SARS CoV-2 respiratory viruses among patients having ARI and SARI who visit Car Nicobar's hospital settings is undocumented. Changes in the epidemiology of other respiratory viruses during COVID19 pandemic is being reported worldwide.

Methods

Inpatient and outpatient settings at BJR hospital, Car Nicobar Island, India, were used to conduct prospective monitoring for ARI and SARI among Nicobarese tribal members. The patients with ARI and SARI were enlisted in BJR hospital from June 2019 to May 2021. At the ICMR-NIV in Pune, duplex RT-PCR assays were used to test the presence of respiratory viruses. The prevalence of non- SARS CoV-2 respiratory viruses was measured by comparing here between pandemic and pre-pandemic periods.

Results

During the COVID19 pandemic, Influenza A (H3N2) and rhinovirus were predominantly reported non-SARS CoV-2 respiratory viruses while Human metapneumovirusand influenza A (H1N1)pdm09were most commonly reported in the prepandemic period. This result indicates the altered circulation of non-SARS CoV-2 during pandemic.

Conclusions

A considerable proportion of respiratory infection was correlated with respiratory viruses. Prevalence of non-SARS CoV-2 respiratory viruses was high at the time of infection when compared with pre-pandemic period, at Car Nicobar Island. This study enlightened the change in circulation of other respiratory viruses among the indigenous Nicobarese tribes. Clinicians and allied medical staff should be more prudent of these respiratory infections.

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