A possible #European #origin of the #Spanish #influenza and the first attempts to reduce #mortality to combat superinfecting #bacteria: an opinion from a virologist and a military historian (Hum Vaccin Immunother., abstract)

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

Hum Vaccin Immunother. 2019 May 23:1-4. doi: 10.1080/21645515.2019.1607711. [Epub ahead of print]

A possible European origin of the Spanish influenza and the first attempts to reduce mortality to combat superinfecting bacteria: an opinion from a virologist and a military historian.

Oxford JS1, Gill D1.

Author information: 1a Blizard Institute, Queen Mary University London , Whitechapel, London.

 

Abstract

When we reconsider the virology and history of the Spanish Influenza Pandemic, the science of 2018 provides us with tools which did not exist at the time. Two such tools come to mind. The first lies in the field of ‘gain of function’ experiments. A potential pandemic virus, such as influenza A (H5N1), can be deliberately mutated in the laboratory in order to change its virulence and spreadability. Key mutations can then be identified. A second tool lies in phylogenetics, combined with molecular clock analysis. It shows that the 1918 pandemic virus first emerged in the years 1915-1916. We have revisited the literature published in Europe and the United States, and the notes left by physicians who lived at the time. In this, we have followed the words of the late Alfred Crosby: who wrote that “contemporary documentary evidence from qualified physicians” is the key to understanding where and how the first outbreaks occurred. In our view, the scientists working in Europe fulfill Crosby’s requirement for contemporary evidence of origin. Elsewhere, Crosby also suggested that “the physicians of 1918 were participants in the greatest failure of medical science in the twentieth century”. Ours is a different approach. We point to individual pathologists in the United States and in France, who strove to construct the first universal vaccines against influenza. Their efforts were not misdirected, because the ultimate cause of death in nearly all cases flowed from superinfections with respiratory bacteria.

KEYWORDS: Etaples Administrative District; Hospital Beds in the Great War; Hygiene in the Great War; Influenza Epidemics in 1917; New Vaccines; Spanish Influenza Origin

PMID: 31121112 DOI: 10.1080/21645515.2019.1607711

Keywords: Pandemic Influenza; H1N1; Spanish flu; History.

——

Advertisements

One hundred years after the 1918 #pandemic: new concepts for #preparing for #influenza pandemics (Curr Opin Infect Dis., abstract)

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

Curr Opin Infect Dis. 2019 May 20. doi: 10.1097/QCO.0000000000000564. [Epub ahead of print]

One hundred years after the 1918 pandemic: new concepts for preparing for influenza pandemics.

Pavia A1.

Author information: 1 Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA.

 

Abstract

PURPOSE OF REVIEW:

In the 100 years since the influenza pandemic of 1918-1919, the most deadly event in human history, we have made substantial progress yet we remain vulnerable to influenza pandemics This article provides a brief overview of important advances in preparing for an influenza pandemic, viewed largely from the perspective of the healthcare system.

RECENT FINDINGS:

We have gained insights into influenza pathogenicity, the animal reservoir and have improved global surveillance for new strains and tools for assessing the pandemic risk posed by novel strains. Public health has refined plans for severity assessment, distribution of countermeasures and nonpharmaceutical approaches. Modest improvements in vaccine technology include cell culture-based vaccines, adjuvanted vaccine and recombinant technology. Conventional infection control tools will be critical in healthcare settings. New evidence suggests that influenza virus may be present in aerosols; the contribution of airborne transmission and role of N95 respirators remains unknown. Baloxavir and pimodivir are new antivirals that may improve treatment, especially for severely ill patients. Optimal use and the risk of resistance require further study.

SUMMARY:

Despite the progress in pandemic preparedness, gaps remain including important scientific questions, adequate resources and most importantly, the ability to rapidly deliver highly effective vaccines.

PMID: 31116135 DOI: 10.1097/QCO.0000000000000564

Keywords: Pandemic Influenza; Spanish flu; Pandemic Preparedness; Antivirals; Vaccines.

——-

#Risk modeling the #mortality impact of #antimicrobial #resistance in secondary #pneumococcal #pneumonia infections during the 2009 #influenza #pandemic (Int J Infect Dis., abstract)

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

Int J Infect Dis. 2019 May 13. pii: S1201-9712(19)30211-5. doi: 10.1016/j.ijid.2019.05.005. [Epub ahead of print]

Risk modeling the mortality impact of antimicrobial resistance in secondary pneumococcal pneumonia infections during the 2009 influenza pandemic.

Barnes CE1, MacIntyre CR2.

Author information: 1 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia. Electronic address: barnes103@hotmail.com. 2 School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia; The Kirby Institute, Sydney, Australia. Electronic address: r.macintyre@unsw.edu.au.

 

Abstract

OBJECTIVES:

The aim of this study was to estimate the impact of antimicrobial resistance (AMR) in secondary pneumococcal pneumonia infections on global mortality during the 2009 influenza pandemic, to estimate future pandemic mortality risk and to inform pandemic preparedness.

METHODS:

Risk analysis modeling was conducted using a multivariate risk formula. Literature reviews were conducted to generate global central estimates for each of the parameters of the risk formula in relation to the 2009 influenza pandemic, secondary pneumococcal pneumonia, rates of AMR and pneumococcal vaccine efficacy as a component of pandemic preparedness.

RESULTS:

Global Streptococcus pneumoniae AMR was estimated at 21.8% to 27.6%, and contributed to 1.8% to 2.3% of deaths during the 2009 influenza pandemic. When directly applied to mortality due to multidrug resistance, pneumococcal vaccination could potentially prevent 1,277 to 3,754 deaths and could have reduced mortality from multidrug resistant S. pneumoniae to 1% to 1.2%.

CONCLUSION:

AMR in secondary pneumococcal infections contributed towards a small percentage of the global mortality during the 2009 influenza pandemic. Increased S. pnuemoniae AMR could result in a three- to four-fold rise in mortality due to secondary pneumococcal infections in future influenza pandemics. Pneumococcal vaccination has an important role in preventing pneumococcal co-infections and combating AMR in all populations, and should be considered a key component of influenza pandemic preparedness or early action plans.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Streptococcus pneumoniae; antimicrobial resistance; pandemic influenza; secondary pneumococcal pneumonia

PMID: 31096052 DOI: 10.1016/j.ijid.2019.05.005

Keywords: Pandemic Influenza; Streptococcus pneumoniae; Vaccines; Antibiotics; Drugs Resistance.

——

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.

——

What explains cross-city #variation in #mortality during the 1918 #influenza #pandemic? Evidence from 438 #US cities (Econ Hum Biol., abstract)

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

Econ Hum Biol. 2019 Apr 29;35:42-50. doi: 10.1016/j.ehb.2019.03.010. [Epub ahead of print]

What explains cross-city variation in mortality during the 1918 influenza pandemic? Evidence from 438 U.S. cities.

Clay K1, Lewis J2, Severnini E3.

Author information: 1 Heinz College, Carnegie Mellon University, 4800 Forbes Avenue, Pittsburgh, PA, 15213, United States. 2 Department of Economics, University of Montreal, C.P. 6128 succ. Centre-ville, Montreal, QC, H3C 3J7, United States. 3 Heinz College, Carnegie Mellon University, 4800 Forbes Avenue, Pittsburgh, PA, 15213, United States. Electronic address: edsons@andrew.cmu.edu.

 

Abstract

Disparities in cross-city pandemic severity during the 1918 Influenza Pandemic remain poorly understood. This paper uses newly assembled historical data on annual mortality across 438 U.S. cities to explore the determinants of pandemic mortality. We assess the role of three broad factors: i) pre-pandemic population health and poverty, ii) air pollution, and iii) the timing of onset and proximity to military bases. Using regression analysis, we find that cities in the top tercile of the distribution of pre-pandemic infant mortality had 21 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. Similarly, cities in the top tercile of the distribution of proportion of illiterate residents had 21.3 excess deaths per 10,000 residents during the pandemic relative to cities in the bottom tercile. Cities in the top tercile of the distribution of coal-fired electricity generating capacity, an important source of urban air pollution, had 9.1 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. There was no statistically significant relationship between excess mortality and city proximity to World War I bases or the timing of onset. In a counterfactual analysis, the three statistically significant factors accounted for 50 percent of cross-city variation in excess mortality in 1918.

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

KEYWORDS: Air pollution; Influenza; Mortality; Pandemic

PMID: 31071595 DOI: 10.1016/j.ehb.2019.03.010

Keywords: Pandemic Influenza; Spanish Flu; USA; Society; Poverty; Environmental pollution.

——

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.

——-

Are we prepared for the next #influenza #pandemic? #Lessons from modelling different #preparedness policies against four pandemic #scenarios (J Theor Biol., abstract)

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

J Theor Biol. 2019 May 3. pii: S0022-5193(19)30187-0. doi: 10.1016/j.jtbi.2019.05.003. [Epub ahead of print]

Are we prepared for the next influenza pandemic? Lessons from modelling different preparedness policies against four pandemic scenarios.

Panovska-Griffiths J1, Grieco L2, van Leeuwen E3, Baguelin M4, Pebody R5, Utley M6.

Author information: 1 Clinical Operational Research Unit, University College London, London, United Kingdom; Department of Applied Health Research, University College London, London, United Kingdom; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: j.panovska-griffiths@ucl.ac.uk. 2 Clinical Operational Research Unit, University College London, London, United Kingdom. Electronic address: l.grieco@ucl.ac.uk. 3 Vaccines and Countermeasures Service, Public Health England, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: Edwin.VanLeeuwen@phe.gov.uk.4 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vaccines and Countermeasures Service, Public Health England, London, United Kingdom. Electronic address: marc.baguelin@phe.gov.uk. 5 Vaccines and Countermeasures Service, Public Health England, London, United Kingdom. Electronic address: richard.pebody@phe.gov.uk. 6 Clinical Operational Research Unit, University College London, London, United Kingdom. Electronic address: m.utley@ucl.ac.uk.

 

Abstract

In the event of a novel influenza strain that is markedly different to the current strains circulating in humans, the population have little/no immunity and infection spreads quickly causing a global pandemic. Over the past century, there have been four major influenza pandemics: the 1918 pandemic (“Spanish Flu”), the 1957-58 pandemic (the “Asian Flu”), the 1967-68 pandemic (the “Hong Kong Flu”) and the 2009 pandemic (the “Swine flu”). To inform planning against future pandemics, this paper investigates how different is the net-present value of employing pre-purchase and responsive- purchased vaccine programmes in presence and absence of anti-viral drugs to scenarios that resemble these historic influenza pandemics. Using the existing literature and in discussions with policy decision makers in the UK, we first characterised the four past influenza pandemics by their transmissibility and infection-severity. For these combinations of parameters, we then projected the net-present value of employing pre-purchase vaccine (PPV) and responsive-purchase vaccine (RPV) programmes in presence and absence of anti-viral drugs. To differentiate between PPV and RPV policies, we changed the vaccine effectiveness value and the time to when the vaccine is first available. Our results are “heat-map” graphs displaying the benefits of different strategies in pandemic scenarios that resemble historic influenza pandemics. Our results suggest that immunisation with either PPV or RPV in presence of a stockpile of effective antiviral drugs, does not have positive net-present value for all of the pandemic scenarios considered. In contrast, in the absence of effective antivirals, both PPV and RPV policies have positive net-present value across all the pandemic scenarios. Moreover, in all considered circumstances, vaccination was most beneficial if started sufficiently early and covered sufficiently large number of people. When comparing the two vaccine programmes, the RPV policy allowed a longer timeframe and lower coverage to attain the same benefit as the PPV policy. Our findings suggest that responsive-purchase vaccination policy has a bigger window of positive net-present value when employed against each of the historic influenza pandemic strains but needs to be rapidly available to maximise benefit. This is important for future planning as it suggests that future preparedness policies may wish to consider utilising timely (i.e. responsive-purchased) vaccines against emerging influenza pandemics.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Epidemiological modelling; Net-present value of pandemic immunisation; Pandemic influenza; Pre-purchase pandemic vaccine; Responsive-purchase pandemic vaccine

PMID: 31059716 DOI: 10.1016/j.jtbi.2019.05.003

Keywords: Pandemic Influenza; Pandemic Preparedness; Vaccines; Antivirals; UK.

——