Excess #mortality is associated with #influenza A (#H1N1) in patients with #SARI (J Clin Virol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Clin Virol. 2019 May 8;116:62-68. doi: 10.1016/j.jcv.2019.05.003. [Epub ahead of print]

Excess mortality is associated with influenza A (H1N1) in patients with severe acute respiratory illness.

Lobo SM1, Watanabe ASA2, Salomão MLM3, Queiroz F3, Gandolfi JV4, de Oliveira NE4, Covello LHS4, Sacillotto GH4, de Godoy LG4, Simões ES4, Frini ICM4, Da Silva Teixeira RER4, Furlan NP4, Dutra KR4, Nogueira ML2.

Author information: 1 Intensive Care Division – Hospital De Base -FAMERP, São José Do Rio Preto, SP – Brasil. Electronic address: suzana.lobo@famerp.br. 2 Virology Laboratory – Famerp, São José Do Rio Preto SP – Brasil; Epidemiology Department – FAMERP, São José Do Rio Preto, SP – Brasil. 3 Department Of Epidemiology – FAMERP, São José Do Rio Preto SP – Brasil; Intensive Care Division – Hospital De Base – Famerp, São José Do Rio Preto, SP – Brasil. 4 Intensive Care Division – Hospital De Base -FAMERP, São José Do Rio Preto, SP – Brasil.

 

Abstract

BACKGROUND:

Acute respiratory infections caused by viruses are among the leading causes of morbidity and mortality. The inflammatory response that follows viral infection is important for the control of virus proliferation. However, if overwhelming, may be associated with complicated outcomes.

OBJECTIVES:

We assessed the clinical characteristics of patients with severe acute respiratory illness (SARI) evolving to acute respiratory distress syndrome (ARDS) and the factors related to death.

STUDY DESIGN:

Prospective study in 273 adult patients with SARI performed in a university-affiliated 800-bed hospital serving an area of epidemiologic vigilance of 102 municipalities and more than 2 million inhabitants. Influenza A (H1N1) 2009 (A/H1N1), influenza A H3N2, and influenza B were tested in all patients by RT-PCR.

RESULTS:

The overall hospital mortality rate was 17.6%. A total of 30.4% of patients tested positive for influenza A/H1N1. Patients with SARI that evolved to ARDS took significantly longer to take the first dose of oseltamivir (6.0 vs 1.0 days, p=0.002). Patients with H1N1 positive tests had almost 3 times higher probability of death, despite having significantly less comorbidities (p=0.027). The influenza A/H1N1 pdm09 vaccine reduced the odds of death by 78%. Nonsurvivors had a more intense inflammatory response than did survivors at 48 h (C-reactive protein: 31.0 ± 17.5 vs. 14.6 ± 8.9 mg/dl, p=0.001) as well as a more positive fluid balance.

CONCLUSIONS:

Hospital mortality associated with influenza H1N1-associated SARI and ARDS continued to be high years after the 2009 pandemic in a population with low vaccine coverage. Antiviral treatment started more than two days after onset of symptoms was more frequently associated with ARDS and death and, having had vaccine against influenza A (H1N1) was a factor independently related to survival.

Copyright © 2019 Elsevier B.V. All rights reserved.

KEYWORDS: Acute respiratory distress syndrome; C-reactive protein; Influenza A virus; Severe acute respiratory illness; Viral pneumonia

PMID: 31103803 DOI: 10.1016/j.jcv.2019.05.003

Keywords: Seasonal Influenza; H1N1pdm09; ARDS; SARI.

——

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#Effectiveness of the #Neuraminidase #Inhibitors: The Supporting #Evidence Increases (J Infect Dis., summary)

[Source: The Journal of Infectious Diseases, full page: (LINK). Summary, edited.]

Effectiveness of the Neuraminidase Inhibitors: The Supporting Evidence Increases

Arnold S Monto

The Journal of Infectious Diseases, jiz157, https://doi.org/10.1093/infdis/jiz157

Published: 20 May 2019

Issue Section: Editorial Commentary

___

The neuraminidase inhibitors (NAIs) zanamivir and oseltamivir were the first in that class of influenza antivirals to receive approval by the Food and Drug Administration, with both approved at the turn of the last century [1, 2] The regulatory approvals, for both prophylaxis and treatment of uncomplicated influenza, occurred after standard review of studies. The 2 drugs target nearby sites in the enzymatically active pocket of the virus but are very different in their route of administration and pharmacokinetics [1, 2]. Despite these differences, the results of the clinical trials of both were remarkably similar in terms of the characteristics of prophylactic efficacy and of treatment effects. Recruitment of cases to the treatment studies was based on clinical criteria but was limited to the influenza season; these cases were the intent-to-treat population [3–5]. The studies were done before use of polymerase chain reaction analysis had become accepted for influenza diagnosis, so the standard method of detecting the infecting virus was by cell culture.

(…)

___

Notes

Potential conflicts of interest.

A. S. M. reports personal fees from Roche outside the submitted work. The author has submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Keywords: Antivirals; Oseltamivir; Zanamivir; Peramivir; Influenza A; Pandemic Influenza.

——

In vitro #neuraminidase inhibitory concentration (#IC50) of four neuraminidase inhibitors in the #Japanese 2017-18 #season: Comparison with the 2010-11 to 2016-17 seasons (J Infect Chemother., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Infect Chemother. 2019 May 14. pii: S1341-321X(19)30099-6. doi: 10.1016/j.jiac.2019.04.007. [Epub ahead of print]

In vitro neuraminidase inhibitory concentration (IC50) of four neuraminidase inhibitors in the Japanese 2017-18 season: Comparison with the 2010-11 to 2016-17 seasons.

Ikematsu H1, Kawai N2, Chong Y3, Bando T2, Iwaki N2, Kashiwagi S2.

Author information: 1 Japan Physicians Association, Tokyo, Japan; Ricerca Clinica Co., Fukuoka, Japan. Electronic address: ikematsu@gray.plala.or.jp. 2 Japan Physicians Association, Tokyo, Japan. 3 Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.

 

Abstract

To assess the extent of susceptibility to the four most commonly used neuraminidase inhibitors (NAIs) of the viruses epidemic in the 2017-18 Japanese influenza season, we measured the 50% inhibitory concentration (IC50) for influenza virus isolates from patients and compared them with the results from the 2010-11 to 2016-17 seasons. Viral isolation was done with specimens obtained prior to treatment, and the type and subtype was determined by RT-PCR using type- and subtype-specific primers. The IC50 was determined by a neuraminidase inhibition assay using a fluorescent substrate. A total of 237 virus isolates, 50 A(H1N1)pdm09, 92 A(H3N2), and 95 B were measured. No A(H1N1)pdm09 with highly reduced sensitivity for oseltamivir was found in the 2017-18 season. No isolates with highly reduced sensitivity to the four NAIs have been found for A(H3N2) or B from the 2010-11 to 2017-18 seasons. The geometric mean IC50s of the four NAIs were quite consistent during the eight studied seasons. These results indicate that the sensitivity to the four commonly used NAIs has been maintained.

Copyright © 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: 50% inhibitory concentration; Influenza virus; Neuraminidase inhibitor; Resistance; Surveillance

PMID: 31101530 DOI: 10.1016/j.jiac.2019.04.007

Keywords: Antivirals; Drugs Resistance; Oseltamivir; Zanamivir; Peramivir; Laninamivir; Japan; Seasonal Influenza; H1N1pdm09; H3N2; Influenza B.

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Hemagglutination Inhibition #Antibody #Response Following #Influenza A #H1N1pdm09 Virus Natural #Infection: A Cross-Sectional Study from Thirthahalli, #Karnataka, #India (Viral Immunol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Viral Immunol. 2019 May 9. doi: 10.1089/vim.2019.0010. [Epub ahead of print]

Hemagglutination Inhibition Antibody Response Following Influenza A(H1N1)pdm09 Virus Natural Infection: A Cross-Sectional Study from Thirthahalli, Karnataka, India.

Alladi CSH1, Jagadesh A1, Prabhu SG1, Arunkumar G1.

Author information: 1 Manipal Centre for Virus Research, Manipal Academy of Higher Education (MAHE), Manipal, India.

 

Abstract

Influenza viruses are major respiratory pathogens that cause seasonal epidemics and occasional pandemics. Immune response to influenza viruses is majorly targeted against the hemagglutinin antigen. A laboratory-based retrospective cross-sectional study was conducted on 50 acute and 50 follow-up samples to assess the immune response to influenza A(H1N1)pdm09 virus after natural infection and detect the presence of pre-existing antibodies against influenza A(H3N2) and influenza B viruses. Two-fourfold rise in hemagglutination-inhibition (HAI) titer was observed in 100% of the follow-up samples for influenza A(H1N1)pdm09 virus. No change in HAI titers for influenza A(H3N2) and influenza B viruses was observed.

KEYWORDS: hemagglutination-inhibition assay; immune response; influenza virus; pre-existing antibodies

PMID: 31070522 DOI: 10.1089/vim.2019.0010

Keywords: Pandemic Influenza; H1N1pdm09; Serology; India.

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Excess #Mortality is Associated with #Influenza A (#H1N1) in #Patients with #SARI (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 8 May 2019 / In Press, Accepted Manuscript

EXCESS MORTALITY IS ASSOCIATED WITH INFLUENZA A (H1N1) IN PATIENTS WITH SEVERE ACUTE RESPIRATORY INFECTIONS

Suzana Margareth Lobo a, Aripuanã Sakurada Aranha Watanabe b,c, Maria Lúcia Machado Salomão d,e, Flavia Queiroz a, Joelma Vilafanha Gandolfi a, Neymar Elias de Oliveira a, Henrique Simões Covello a, Guilherme Hirassawa Sacillotto a, Livia Gonçalezde Godoy a, Estela Silva Simões a,  Inara Cristina Marciano Frini a, Rayane  Estefani Ribas Da Silva Teixeira a, Nathália Pimentel Furlan a, Karina Rocha Dutra a, Maurício Lacerda Nogueira b,c

{a} Intensive Care Division – Hospital De Base -FAMERP, São José Do Rio Preto, SP, Brazil; {b} Virology Laboratory – Famerp, São José Do Rio Preto, SP, Brazil; {c} Epidemiology Department – FAMERP, São José Do Rio Preto, SP, Brazil; {d} Department of Epidemiology – FAMERP, São José Do Rio Preto, SP, Brazil; {e} Intensive Care Division – Hospital De Base – Famerp, São José Do Rio Preto, SP, Brazil

Received 28 August 2018, Revised 13 April 2019, Accepted 7 May 2019, Available online 8 May 2019. DOI: https://doi.org/10.1016/j.jcv.2019.05.003

 

  • Highlights
    • Excess mortality was associated withinfluenza H1N1-associated SARI.
    • Delayed administration of oseltamivir was associated with worsening outcomes.
    • Vaccine decreased the likelihood of death by almost 80%.
    • Death was associated with more intense inflammatory.

 

Abstract

Background

Acute respiratory infections caused by viruses are among the leading causes of morbidity and mortality. The inflammatory response that follows viral infection is important for the control of virus proliferation. However, if overwhelming, may be associated with complicated outcomes.

Objectives

We assessed the clinical characteristics of patients with severe acute respiratory illness (SARI) evolving to acute respiratory distress syndrome (ARDS) and the factors related to death. Study design. Prospective study in 273 adult patients with SARI performed in a university-affiliated 800-bed hospital serving an area of epidemiologic vigilance of 102 municipalities and more than 2 million inhabitants. Influenza A (H1N1) 2009 (A/H1N1), influenza A H3N2, and influenza B were tested in all patients by RT-PCR.

Results

The overall hospital mortality rate was 17.6%. A total of 30.4% of patients tested positive for influenza A/H1N1. Patients with SARI that evolved to ARDS took significantly longer to take the first dose of oseltamivir (6.0 vs 1.0 days, p=0.002). Patients with H1N1 positive tests had almost 3 times higher probability of death, despite having significantly less comorbidities (p=0.027). The influenza A/H1N1 pdm09 vaccine reduced the odds of death by 78%. Nonsurvivors had a more intense inflammatory response than did survivors at 48 h (C-reactive protein: 31.0 ± 17.5 vs. 14.6 ± 8.9 mg/dl, p=0.001) as well as a more positive fluid balance.

Conclusions

Hospital mortality associated with influenza H1N1-associated SARI and ARDS continued to be high years after the 2009 pandemic in a population with low vaccine coverage. Antiviral treatment started more than two days after onset of symptoms was more frequently associated with ARDS and death and, having had vaccine against influenza A (H1N1) was a factor independently related to survival

Keywords: Influenza A virus – Severe acute respiratory infections – Viral pneumonia – Acute respiratory distress syndrome – C-reactive protein

© 2019 Published by Elsevier B.V.

Keywords: Seasonal Influenza; H1N1pdm09; SARI; ARDS.

——

Change in #risk for #narcolepsy over time and impact of definition of onset date following #vaccination with #AS03 adjuvanted pandemic A/H1N1 influenza vaccine (#Pandemrix) during the 2009 H1N1 influenza #pandemic (Pharmacoepidemiol Drug Saf., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Pharmacoepidemiol Drug Saf. 2019 May 6. doi: 10.1002/pds.4788. [Epub ahead of print]

Change in risk for narcolepsy over time and impact of definition of onset date following vaccination with AS03 adjuvanted pandemic A/H1N1 influenza vaccine (Pandemrix) during the 2009 H1N1 influenza pandemic.

Granath F1, Gedeborg R2, Smedje H3, Feltelius N4.

Author information: 1 Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden. 2 Department of Efficacy and Safety 1, Medical Products Agency, Uppsala, Sweden. 3 Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden. 4 Department of Scientific Expertise, Medical Products Agency, Uppsala, Sweden.

 

Abstract

PURPOSE:

To estimate risk for narcolepsy in defined time windows following exposure to adjuvanted A(H1N1) pandemic vaccine (Pandemrix) and impact of different definitions of index date for the narcolepsy diagnosis.

METHODS:

Vaccine exposure in approximately 30% of the Swedish population in 2009 was linked to information on narcolepsy diagnosis retrieved from the national patient registry. Cases were verified by a systematic chart review. Poisson regression was used to compare incidence in defined time windows following vaccination.

RESULTS:

Of 266 cases of narcolepsy identified, 25% (66/266) were prevalent cases with symptom onset documented before vaccine exposure. Incident cases had a median time interval between first symptom and the date recorded in the patient registry of 64 weeks (IQR 39-107) when vaccinated (N = 182) and 65 weeks (IQR 51-72) when unvaccinated (N = 16). With first symptom defining index date, the adjusted risk for narcolepsy in younger patients was increased 14 times during the first year after vaccination, three times elevated the second year, but with no detectable increased risk more than 2 years after vaccination exposure. Using the index date from the patient registry, the adjusted increase in risk was about seven times elevated for all three time intervals.

CONCLUSIONS:

The magnitude of the estimated increased risk for narcolepsy following exposure to the A(H1N1) pandemic vaccine is highly dependent on the method used to determine the index date for disease onset. The sometimes very long and potentially variable interval from first symptom to a health care registry diagnosis complicates estimations of risk.

© 2019 John Wiley & Sons, Ltd.

KEYWORDS: H1N1 subtype; adverse effects; influenza A virus; mass vaccination; narcolepsy; pandemics; pharmacoepidemiology; vaccination

PMID: 31062443 DOI: 10.1002/pds.4788

Keywords: Pandemic Influenza; H1N1pdm09; Vaccines; Narcolepsy; Sweden.

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Rapid #detection and #clinical #spectrum of the novel #influenza #H1N1 strain in a #diabetic #pediatric population (J Med Virol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Med Virol. 2019 May 3. doi: 10.1002/jmv.25497. [Epub ahead of print]

Rapid detection and clinical spectrum of the novel influenza H1N1 strain in a diabetic pediatric population.

Ammar RA1, Montasser K2, Ezz H1, Albishi LA3, Ghareeb A4.

Author information: 1 Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2 Clinical Pathology Department, Faculty of Medicine, Helwan University, Cairo, Egypt. 3 Pediatric Medicine Department, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia. 4 Microbiology Department, Faculty of Science, Cairo University, Cairo, Egypt.

 

Abstract

OBJECTIVES:

H1N1 infection in diabetic patients is of special concern and serious interest, since the virus can place individuals, especially children, at great possible risk of subsequently developing type 1 diabetes. This work aims to describe the demographic characteristics, clinical features and severity of illness of children with type 1 diabetes mellitus (DM), compare the incidence of pandemic H1N1 virus in children, with that of the general pediatric population with influenza-like symptoms, and identify the complications of H1N1 virus infection associated with glycemic control.

METHODS:

The present study included 45 children and adolescents with type 1 diabetes, who were subject to clinical and laboratory investigations. Another thirty healthy adolescents and children with a mean age of (10.43± 4.38) years were included as a control group. H1N1 reverse transcriptase quantitative PCR (RT-Q PCR) was tested for H1N1 virus detection.

RESULTS:

Diabetic patients positive for (H1N1) showed significantly higher random blood sugar levels than diabetic patients negative for (H1N1). Moreover, the H1N1- positive patients had significantly higher hemoglobin (Hb) g/dl, platelet counts, total leucocyte counts (TLCs) and CRP levels. Newly diagnosed patients who tested positive for (H1N1) and DKA had significantly higher random blood sugar levels and TLCs than patients who presented with hyperglycemia.

CONCLUSION:

RT-PCR is a rapid and specific method for influenza A (H1N1) virus diagnosis. Additionally, early administration of oseltamivir no later than 48 hours after infection is highly recommended in either diabetic or DKA patients suspected of having H1N1.

This article is protected by copyright. All rights reserved.

KEYWORDS: 2009 H1N1; DKA; Diabetes mellitus; Influenza A; Oseltamivir; RT-PCR

PMID: 31054173 DOI: 10.1002/jmv.25497

Keywords: Seasonal Influenza; H1N1pdm09; Diabetes; Egypt; Pediatrics.

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