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1.
Infect Control Hosp Epidemiol ; 41(5): 499-504, 2020 05.
Article in English | MEDLINE | ID: covidwho-1452452

ABSTRACT

OBJECTIVE: Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults. DESIGN: Prospective cohort study. SETTING: The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults. METHODS: Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index. RESULTS: Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58-82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6-52.6) for younger adults versus 44.6% (95% CI, 43.6-45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7-65.6) of younger adults versus 57.1% (95% CI, 55.9-58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions. CONCLUSIONS: A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.


Subject(s)
Influenza, Human/diagnosis , Influenza, Human/epidemiology , Aged , Aged, 80 and over , Bias , Canada/epidemiology , Female , Frail Elderly , Hospitalization , Humans , Immunization , Laboratories, Hospital , Male , Prospective Studies , Research , Sensitivity and Specificity , Sentinel Surveillance
2.
J Investig Med ; 69(6): 1230-1237, 2021 08.
Article in English | MEDLINE | ID: covidwho-1342804

ABSTRACT

The impact of HIV on influenza-like illness (ILI) has been incompletely described in the era of combination antiretroviral therapy, particularly in the post-H1N1 pandemic period. This analysis informs on ILI in an otherwise healthy, predominantly outpatient cohort of adults with HIV in the USA. From September 2010 to March 2015, this multisite observational cohort study enrolled otherwise healthy adults presenting to a participating US military medical center with ILI, a subset of whom were HIV positive. Demographics, clinical data, and self-reported symptom severity were ascertained, and enrollees completed a daily symptom diary for up to 10 days. 510 men were included in the analysis; 50 (9.8%) were HIV positive. Subjects with HIV were older and less likely to be on active duty. Rhinovirus and influenza A were the most commonly identified pathogens. Moderate-severe diarrhea (p<0.001) and fatigue (p=0.01) were more frequently reported by HIV-positive men. HIV positivity was associated with higher gastrointestinal scores, but not other measures of ILI symptom severity, after controlling for age, race, military status, and influenza season. Few were hospitalized. HIV-positive subjects had more influenza B (p=0.04) and were more likely to receive antivirals (32% vs 6%, p<0.01). Antiviral use was not significantly associated with symptom scores when accounting for potential confounders. In this predominantly outpatient cohort of adult men, HIV had minimal impact on ILI symptom severity. Despite similar illness severity, a higher percentage of subjects with HIV reported undergoing antiviral treatment for ILI, likely reflecting differences in prescribing practices.Trial registration number: NCT01021098.


Subject(s)
HIV Infections , Influenza, Human , Adult , Antiviral Agents , Cohort Studies , HIV Infections/complications , Humans , Influenza, Human/epidemiology , Influenza, Human/pathology , Male , Outpatients , Picornaviridae Infections/epidemiology , Picornaviridae Infections/pathology
3.
Ir J Med Sci ; 191(1): 31-37, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1086658

ABSTRACT

KEY POINTS: In our clinical cross-sectional study, we identified 107 of 347 patients who were tested positive for antibodies of novel Coronavirus 2019 (SARS-CoV-2). Main symptoms were exhaustion and cough, exposition to other COVID-19-patients appeared frequently. BACKGROUND: There is urgent need for information on predictive parameters on immunity and infectivity in Coronavirus disease-2019 (COVID-19) pandemic. Our aim was to investigate distribution of novel Coronavirus 2019 (SARS-CoV-2) infections in a German General Practice and to learn about possible predictive parameters regarding infection and pathways of transmission. METHODS: In our cross-sectional study, we tested 347 patients of our General Practice using 2019-nCoV-2-IgG/IgM antibody test [2019-nCoV2 IgG/IgM Rapid Test Cassette (Ref.: INCP-402/INCP-402B; ACRO, BIOTECH, INC.)]. We asked for 13 specific symptoms and 4 questions to investigate patients' surroundings. RESULTS: A total of 107 of 347 patients were tested positive for antibodies (Immunoglobulin M-positive and/or Immunoglobulin G-positive). In antibody-positive group, body aches and rhinorrhea were seen more often and there were significantly less asymptomatic patients. Stay in area of risk was significantly more frequent in antibody-positive group as well as contact to infected persons. Distribution of other symptoms was not significantly different between both groups. Most adults or children with SARS-CoV-2 infection presented with mild flu-like symptoms. CONCLUSION: A total of 30% of patients had antibodies. It was not possible to identify one solid predictive symptom. Serological testing may be helpful for the diagnosis of suspected patients with negative RT-PCR results and for the identification of asymptomatic infections.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Antibodies, Viral , Child , Cross-Sectional Studies , Family Practice , Humans , Pandemics , Sensitivity and Specificity
4.
J Clin Virol ; 134: 104709, 2021 01.
Article in English | MEDLINE | ID: covidwho-957191

ABSTRACT

BACKGROUND: The Influenza-like Illness Surveillance Network (ILINet) can indicate the presence of novel, widespread community pathogens. Comparing week-to-week reported influenza-like illness percentages may identify the time of year a novel pathogen is introduced. However, changes in health-seeking behavior during the COVID-19 pandemic call in to question the reliability of 2019-2020 ILINet data as a comparison to prior years, potentially rendering this system less reliable as a novel pathogen surveillance tool. Corroboration of trends seen in the 2019-2020 ILINet data lends confidence to the validity of those trends. This study compares predicted versus reported influenza and influenza-like illnesses in vaccinated adults as a surrogate measure of novel pathogen surveillance. METHODS: An online survey was used to ask US adults their influenza vaccination status, whether they were diagnosed with influenza after vaccination, and whether they experienced an influenza-like illness other than flu. RESULTS: Prevalence of self-reported flu diagnosis in adults age 18-64 who received the flu vaccine between September 1, 2019 and April 15, 2020 (n = 3,225) was 5.8 %, while self-reported flu or flu-like illness (without a flu diagnosis) was 17.9 %. CONCLUSION: Flu and flu-like illness in this sample of flu-vaccinated U.S. adults is significantly higher than predicted, consistent with substantially higher ILI's in 2019-20 compared to ILI's from 2018-19, suggesting that the ILI values reported during the COVID-19 pandemic may be appropriate for comparison to prior years.


Subject(s)
COVID-19/epidemiology , Influenza, Human/epidemiology , Pandemics , Vaccination/statistics & numerical data , Adolescent , Adult , Female , Health Surveys/statistics & numerical data , Humans , Immunologic Surveillance , Influenza A Virus, H1N1 Subtype/pathogenicity , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Male , Middle Aged , SARS-CoV-2/pathogenicity , Self Report , United States/epidemiology
5.
Influenza Other Respir Viruses ; 15(1): 72-80, 2021 01.
Article in English | MEDLINE | ID: covidwho-740245

ABSTRACT

BACKGROUND: Influenza has been well studied in developed countries with temperate climates, in contrast to low- and middle-income (LMIC) countries, thus hampering the effort to attain representative global data. Furthermore, data on non-influenza respiratory infections are also limited. Insight in viral respiratory infections in Suriname, a tropical LMIC in South America, would contribute to improved local preventive measures and a better global understanding of respiratory viruses. METHODS: From May 2016 through April 2018, all patients (n = 1096) enrolled in the national severe acute respiratory infection and influenza-like illness surveillance were screened for the presence of 10 respiratory viruses with singleplex RT-PCR. RESULTS: The overall viral-positive detection rate was 45.3%, specified as RSV (19.4%), influenza (15.5%), hMPV (4.9%), AdV (4.6%), and parainfluenza (3.8%). Co-infections were detected in 6.2% of the positive cases. Lower overall positivity was observed in the SARI vs ILI surveillance and influenza prevalence was higher in outpatients (45.0% vs 6.7%), while RSV exhibited the reverse (4.8% vs 23.8%). Respiratory infections in general were more common in children than in adults (54.4% vs 29.5%), although children were significantly less affected by influenza (11.5% vs 22.7%). None of the respiratory viruses displayed a clear seasonal pattern, and viral interference was observed between RSV and influenza. CONCLUSIONS: The comprehensive information presented for Suriname, including first data on non-influenza respiratory viruses, displayed distinct differences between the viruses, in seasonality, within age groups and between SARI/ILI, accentuating the need, especially for tropical LMIC countries to continue ongoing surveillance and accumulate local data.


Subject(s)
Influenza, Human , Respiratory Syncytial Virus Infections , Respiratory Tract Infections , Virus Diseases , Viruses , Adult , Child , Humans , Infant , Influenza, Human/epidemiology , Respiratory Tract Infections/epidemiology , Suriname/epidemiology
6.
Curr Med Res Pract ; 10(2): 54-64, 2020.
Article in English | MEDLINE | ID: covidwho-100110

ABSTRACT

Coronavirus infections have emerged as epidemic and pandemic threats in last two decades. After the H1N1 influenza pandemic in 2009, recently diagnosed novel betacoronavirus or severe acute respiratory syndrome coronavirus (SARS-CoV)-2 has spread across 203 countries and territories in all 5 major continents. World Health Organization (WHO) declared this as a public health emergency of international concern on January 30, 2020. Subsequently on February 11, 2020 a new name was given to this disease i.e. COVID-19 by an expert group from WHO. As of April 12, 2020, 10:00 CET, GMT+2:00, 1,696,588 confirmed cases and 105,952 confirmed deaths have been reported to the WHO. (Coronavirus disease 2019, situation report 83). It possibly originated from a small animal market in Wuhan, China. A cluster of patients were admitted with unusual pneumonia not responding to treatment in various hospitals. Epidemiological, genomic analysis and correlation with other coronaviruses led to the isolation of new coronavirus, closely resembling the bat coronaviruses, from such patients in Wuhan. They were identified as the SARS-CoV-2. This virus infection presents as influenza like illness in the affected people. Fever, cough, respiratory distress with fatigue, diarrhea, nausea and vomiting are common symptoms seen in adults. This may progress on to severe respiratory distress, hypoxia, need for oxygen supplementation and ventilator support as seen in patients in the SARS-CoV-1 epidemic (2003) in Guangdong, China. The transmissibility of SARS-CoV-1 was less as compared to SARS-CoV-2 infection, and it was well controlled with good public health efforts. The present COVID-19 epidemic is still in the acceleration phase of 3 and 4 in various countries. Without any effective antiviral agents available at present, the need of the hour is early case detection, isolation of cases, use of good preventive care measures by the household contacts and in the hospital set up. The results of ongoing clinical trials on hydroxychloroquine, azithromycin alone or in combination and a new antiviral agent remdesivir may help to treat some of the infections. A need for effective vaccine is being seen an as good preventive strategy in this pandemic. However the results of clinical trials and incorporation of vaccines in public health programs is a long way to go.

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