Epidemiology and costs of severe acute respiratory infection and influenza hospitalizations in adults with diabetes in India.

INTRODUCTION: The incidence of diabetes mellitus is increasing rapidly in India. In addition to well-known complications, diabetes increases the risk for hospitalization and death from severe acute respiratory infection (SARI) and influenza. Here we examined the impact of SARI and influenza in Indian adults with diabetes. METHODOLOGY: This was a single-center, active surveillance study conducted in Jammu and Kashmir State, India, during the 2015-2016 and 2016-2017 influenza seasons. Adults hospitalized for SARI and receiving at least one diabetes medication were included. Demographics, health care use, and direct costs were collected from medical records and interviews of patients or caregivers. Indirect costs were estimated based on lost earnings and WHO-CHOICE estimates for hospital costs. RESULTS: The study included 192 patients with type 2 diabetes. Median age was 66 years, median body mass index was 26.6 kg/m2, and most patients had comorbidities, especially hypertension and cardiovascular disease (83.9%). Only 32.2% regularly monitored blood glucose or hemoglobin A1C, and median values at admission indicated poor glycemic control for most. Influenza was detected in 8.9% of cases. The median hospital stay for SARI was 8 days, and 22 patients (11.4%) died. Median total costs associated with hospitalization were US$710 (interquartile range, $539-$1067) for SARI patients and US$716 ($556-$1078) for influenza patients, mostly (~75%) from indirect costs. CONCLUSIONS: Adults with diabetes in India hospitalized with SARI or influenza are generally older, in poor health, and suffer from poor glycemic control. The costs for their hospitalization and care are substantial.

Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial.

Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2-14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14's active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions.

Effect of intensive hand washing education on hand washing behaviors in thai households with an influenza-positive child in urban Thailand.

This study assessed the effect of intensive education on self-reported frequency of hand washing (FHW), measured quality of hand washing (QHW), and measured scores of knowledge, attitude, and practice (KAP) after 7 days and 90 days home-based intensive education of participants (aged >7 years) in households with a influenza-positive child. The authors provided intensive hand washing education using interactive participation including individual training, self-monitoring diary, provision of soap, and so on. There were significant improvements on FHW and QHW on day 7, control group (n(1) = 135) reported 3.9 hand washing episodes/day, whereas the intervention group (n(2) = 140) reported 5.7 episodes/day; control group (n(1) = 164) obtained a 3.2 measured quality score, whereas the intervention group (n(2) = 166) obtained a score of 6.4. Pre-education and 90 days post-education, FHW significantly improved by 2 episodes/day and QHW increased by 3 scores/episode. Knowledge of influenza and hand washing following coughing/sneezing showed significant improvement, but attitude modification toward severity of influenza requires a more intensified and longer intervention.