#Mortality, #morbidity, and hospitalisations due to #influenza #LRTI, 2017: an analysis for the Global Burden of Disease Study 2017 (Lancet Resp Med., abstract)

[Source: The Lancet Respiratory Medicine, full page: (LINK). Abstract, edited.]

Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017

GBD 2017 Influenza Collaborators †

Open Access / Published: December 12, 2018 / DOI: https://doi.org/10.1016/S2213-2600(18)30496-X




Although the burden of influenza is often discussed in the context of historical pandemics and the threat of future pandemics, every year a substantial burden of lower respiratory tract infections (LRTIs) and other respiratory conditions (like chronic obstructive pulmonary disease) are attributable to seasonal influenza. The Global Burden of Disease Study (GBD) 2017 is a systematic scientific effort to quantify the health loss associated with a comprehensive set of diseases and disabilities. In this Article, we focus on LRTIs that can be attributed to influenza.


We modelled the LRTI incidence, hospitalisations, and mortality attributable to influenza for every country and selected subnational locations by age and year from 1990 to 2017 as part of GBD 2017. We used a counterfactual approach that first estimated the LRTI incidence, hospitalisations, and mortality and then attributed a fraction of those outcomes to influenza.


Influenza LRTI was responsible for an estimated 145 000 (95% uncertainty interval [UI] 99 000–200 000) deaths among all ages in 2017. The influenza LRTI mortality rate was highest among adults older than 70 years (16·4 deaths per 100 000 [95% UI 11·6–21·9]), and the highest rate among all ages was in eastern Europe (5·2 per 100 000 population [95% UI 3·5–7·2]). We estimated that influenza LRTIs accounted for 9 459 000 (95% UI 3 709 000–22 935 000) hospitalisations due to LRTIs and 81 536 000 hospital days (24 330 000–259 851 000). We estimated that 11·5% (95% UI 10·0–12·9) of LRTI episodes were attributable to influenza, corresponding to 54 481 000 (38 465 000–73 864 000) episodes and 8 172 000 severe episodes (5 000 000–13 296 000).


This comprehensive assessment of the burden of influenza LRTIs shows the substantial annual effect of influenza on global health. Although preparedness planning will be important for potential pandemics, health loss due to seasonal influenza LRTIs should not be overlooked, and vaccine use should be considered. Efforts to improve influenza prevention measures are needed.


Bill & Melinda Gates Foundation.

Keywords: Seasonal Influenza; Pneumonia; Worldwide.



The role of #pneumonia and secondary #bacterial infection in #fatal and serious outcomes of #pandemic #influenza A #H1N1pdm09 (BMC Infect Dis., abstract)

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

BMC Infect Dis. 2018 Dec 7;18(1):637. doi: 10.1186/s12879-018-3548-0.

The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09.

MacIntyre CR1, Chughtai AA2, Barnes M3, Ridda I3, Seale H3, Toms R3, Heywood A3.

Author information: 1 Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia. 2 School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW, 2052, Australia. journal.health.au@gmail.com. 3 School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW, 2052, Australia.




The aim of this study was to estimate the prevalence of pneumonia and secondary bacterial infections during the pandemic of influenza A(H1N1)pdm09.


A systematic review was conducted to identify relevant literature in which clinical outcomes of pandemic influenza A(H1N1)pdm09 infection were described. Published studies (between 01/01/2009 and 05/07/2012) describing cases of fatal or hospitalised A(H1N1)pdm09 and including data on bacterial testing or co-infection.


Seventy five studies met the inclusion criteria. Fatal cases with autopsy specimen testing were reported in 11 studies, in which any co-infection was identified in 23% of cases (Streptococcus pneumoniae 29%). Eleven studies reported bacterial co-infection among hospitalised cases of A(H1N1)2009pdm with confirmed pneumonia, with a mean of 19% positive for bacteria (Streptococcus pneumoniae 54%). Of 16 studies of intensive care unit (ICU) patients, bacterial co-infection identified in a mean of 19% of cases (Streptococcus pneumoniae 26%). The mean prevalence of bacterial co-infection was 12% in studies of hospitalised patients not requiring ICU (Streptococcus pneumoniae 33%) and 16% in studies of paediatric patients hospitalised in general or pediatric intensive care unit (PICU) wards (Streptococcus pneumoniae 16%).


We found that few studies of the 2009 influenza pandemic reported on bacterial complications and testing. Of studies which did report on this, secondary bacterial infection was identified in almost one in four patients, with Streptococcus pneumoniae the most common bacteria identified. Bacterial complications were associated with serious outcomes such as death and admission to intensive care. Prevention and treatment of bacterial secondary infection should be an integral part of pandemic planning, and improved uptake of routine pneumococcal vaccination in adults with an indication may reduce the impact of a pandemic.

KEYWORDS: Bacterial infection; Influenza A(H1N1)pdm09; Pneumonia; Respiratory infections hospitalization

PMID: 30526505 DOI: 10.1186/s12879-018-3548-0

Keywords: Pandemic Influenza; H1N1pdm09; Pneumonia; Streptococcus pneumoniae.


#Pneumonia is a #neglected problem: it is now time to act (Lancet Resp Med., summary)

[Source: The Lancet Respiratory Medicine, full page: (LINK). Summary, edited.]

Pneumonia is a neglected problem: it is now time to act

Stefano Aliberti, Charles S Dela Cruz, Giovanni Sotgiu, Marcos I Restrepo

Published: November 12, 2018 / DOI: https://doi.org/10.1016/S2213-2600(18)30470-3


Nov 12, 2018, marks World Pneumonia Day, the purpose of which is to increase awareness that pneumonia is a major global clinical and public health issue. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 showed that lower respiratory infections infected 291·8 million people worldwide, and led to more than 2·7 million deaths.1, 2 2018 also marks a century since the 1918–19 influenza pandemic caused 50–100 million deaths. 3 Mortality for seasonal influenza still remains unacceptable: 80 000 people died from influenza in the USA alone in 2017. 4 Influenza affects everyone regardless of age, race, sex, and income, and remains a major cause of pneumonia despite the development of effective vaccines. 5


Keywords: Pneumonia; Influenza A.


#Clinical implication of #radiographic scores in acute #MERS #coronavirus #pneumonia: Report from a single tertiary-referral center of South #Korea (Eur J Radiol., abstract)

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

Eur J Radiol. 2018 Oct;107:196-202. doi: 10.1016/j.ejrad.2018.09.008. Epub 2018 Sep 11.

Clinical implication of radiographic scores in acute Middle East respiratory syndrome coronavirus pneumonia: Report from a single tertiary-referral center of South Korea.

Cha MJ1, Chung MJ2, Kim K3, Lee KS1, Kim TJ1, Kim TS1.

Author information: 1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea. 2 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea. Electronic address: mj1.chung@samsung.com. 3 Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea; Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea.



The aim of this study is to determine the earliest cutoff of radiographic score as a potential prognostic indicator of fatal outcomes in patients with acute Middle East respiratory syndrome coronavirus (MERS-CoV) pneumonia. The institutional review board approved this retrospective study. Serial chest radiographies (CXRs) were obtained from viral exposure until death or discharge in 35 patients with laboratory confirmed MERS-CoV infection. Radiographic scores were calculated by multiplying a four-point scale of involved lung area and three-point scale of abnormal opacification, in each of the six lung zones. Receiver operating characteristics (ROC) analyses were performed to identify optimal day and radiographic score for the prediction of respiratory distress, and univariate and multivariate logistic regression analyses were performed to assess significant predictive factors for intubation or tracheostomy. Among 35 patients (22 men, 13 women; median age: 48 years), 25 demonstrated abnormal opacity on CXR (MERS pneumonia), whereas no abnormality was detected in 10 patients (MERS upper respiratory tract infection). Seven patients required ventilator support (intubation group) and three of them eventually expired. The average incubation period was 5.4 days (standard deviation, ±2.8; range, 2-11). Patients in the intubation group had a higher incidence of diffuse lung involvement, higher radiographic scores, and fibrosing sequela on follow up study compared with those in the non-intubation group. However, patients’ age and comorbidity did not differ significantly between the two groups. The ROC analysis revealed an area under curve of 0.726 for the radiographic score on day 10 with an optimal cutoff score of 10 for prediction of intubation, with a sensitivity of 71% and specificity of 67%. Our study suggest that MERS patients with radiographic score > 10 on day 10 from viral exposure require aggressive therapy with careful surveillance and follow-up evaluation.

KEYWORDS: Chest radiograph; Chest radiographic score; Middle East respiratory syndrome coronavirus (MERS-CoV); Prognostic indicator

PMID: 30292266 DOI: 10.1016/j.ejrad.2018.09.008

Keywords: Radiology; MERS-CoV; Pneumonia; S. Korea.


Estimates of the #global, regional, and national #morbidity, #mortality, and #aetiologies of #LRTIs in 195 countries, 1990–2016… (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Lower Respiratory Infections Collaborators †

Published: September 19, 2018 / DOIhttps://doi.org/10.1016/S1473-3099(18)30310-4




Lower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages.


We used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000–16 using the risk factors associated with LRI in GBD 2016.


In 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475–720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749–1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584–2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445–1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7–69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden.


Our findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world’s most susceptible populations.


Bill & Melinda Gates Foundation.

Keywords: Pneumonia; S. pneumoniae; Worldwide; Global Health.


#Cytokine Profiles and #Severity of #Influenza #Infection in #Transplant Recipients (J Infect Dis., abstract)

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

Cytokine Profiles and Severity of Influenza Infection in Transplant Recipients

Arnaud G L’Huillier, MD Victor H Ferreira, PhD Cedric Hirzel, MD Elisa Cordero, MD, PhDAjit P Limaye, MD Gail Reid, MD Janet Englund, MD Emily Blumberg, MDDeepali Kumar, MD Atul Humar, MD

The Journal of Infectious Diseases, jiy535, https://doi.org/10.1093/infdis/jiy535

Published: 05 September 2018



Influenza is responsible for significant morbidity after transplantation. We evaluated Th1/Th2 cytokines and IL-10 levels during influenza infection in the post-transplant setting. Sera from 277 transplant recipients were analyzed at influenza diagnosis and 28 days later for IFN-γ, IL-4, IL-13 and IL-10. IL-13 levels were associated with protection against pneumonia and ICU admission, whereas the IFN-γ/IL-13 ratio and IL-10 levels were associated with an increased risk of pneumonia and ICU admission. This association was independent of viral load. A skewing of immune responses towards Th2 in transplant patients appears to confer protection from severe influenza infection, independently of viral load.

influenza, transplantation, outcome, cytokines, hematopoietic stem cell transplantation, solid organ transplantation, immunity, intensive care unit, pneumonia

Topic: cytokine – influenza – intensive care unit – interleukin-10 – interleukin-13 – pneumonia – viral load result – transplantation – transplant recipients

Issue Section: Brief Report

© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Influenza A; Cytokines; Pneumonia.


#Surveillance for #RSV and #parainfluenza virus among patients hospitalized with #pneumonia in Sarawak, #Malaysia (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Surveillance for respiratory syncytial virus and parainfluenza virus among patients hospitalized with pneumonia in Sarawak, Malaysia

Jane K. Fieldhouse , Teck-Hock Toh, Wei-Honn Lim, Jakie Ting, Siaw-Jing Ha, King-Ching Hii, Cheng-Ing Kong, Toh-Mee Wong, See-Chang Wong, Tyler E. Warkentien, Gregory C. Gray

Published: August 15, 2018 / DOI: https://doi.org/10.1371/journal.pone.0202147




Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are frequent causes of pneumonia and death among children at Sibu and Kapit Hospitals in Sarawak, Malaysia.


To determine the prevalence and risk factors for RSV subtypes A and B and PIV types 1–4 among patients hospitalized with pneumonia.


In a cross-sectional, pilot study nasopharyngeal swabs were studied with real-time reverse transcription polymerase chain reaction assays. Concurrently, we helped Sibu and Kapit Hospitals adapt their first molecular diagnostics for RSV and PIV.


Of 129 specimens collected (June to July 2017), 39 tested positive for RSV-A (30.2%), two were positive for RSV B (1.6%), one was positive for PIV-3 (0.8%) and one was positive for PIV-4 (0.8%). No samples were positive for PIV-1 or PIV-2. Of the 39 RSV-A positive specimens, 46.2% were collected from children under one year of age and only 5.1% were from patients over the age of 18. A multivariable analysis found the odds of children <1 year of age testing positive for RSV-A were 32.7 (95% CI: 3.9, 276.2) times larger than >18 years of age, and the odds of patients hospitalized at Kapit Hospital testing positive for RSV-A were 3.2 (95% CI: 1.3, 7.8) times larger than patients hospitalized at Sibu Hospital.


This study found an unusually high prevalence of RSV-A among pneumonia patients admitted to the two hospitals. Subsequently, Sibu Hospital adapted the molecular assays with the goal of providing more directed care for such pneumonia patients.


Citation: Fieldhouse JK, Toh T-H, Lim W-H, Ting J, Ha S-J, Hii K-C, et al. (2018) Surveillance for respiratory syncytial virus and parainfluenza virus among patients hospitalized with pneumonia in Sarawak, Malaysia. PLoS ONE 13(8): e0202147. https://doi.org/10.1371/journal.pone.0202147

Editor: Oliver Schildgen, Kliniken der Stadt Köln gGmbH, GERMANY

Received: April 19, 2018; Accepted: July 27, 2018; Published: August 15, 2018

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are contained within the paper and supporting information files.

Funding: This work was funded in part by the US Naval Medical Research Center-Asia (http://www.med.navy.mil/sites/nmrca/SitePages/Home.aspx) and Vysnova Partners subcontract SC-2016-SABER-003-002 (http://www.vysnova.com/), received by CGC and THT. Research conducted by JKF was supported in part by funding from the Duke Global Health Institute (https://globalhealth.duke.edu/) and by discretionary funds from Dr. Gregory Gray with Duke University’s Global Health Institute. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: Vysnova Partners, a contractor of the US government, provided funds for this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Author T.W. is a US military service member. This work was prepared as part of their official duties. The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a US Government work as a work prepared by a military Service Member or employee of the US Government as part of that person’s official duties.

Keywords: Pneumonia; RSV; Parainfluenza Virus; Malaysia.