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Potential Arrival Pathway for Highly Pathogenic Avian Influenza H5N1 to Oceania 高致病性H5N1禽流感可能到达大洋洲的途径。
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-16 DOI: 10.1111/irv.70055
Pablo Plaza, Andrea Santangeli, Tommaso Cancellario, Sergio Lambertucci
<p>In late 2020, the Highly Pathogenic Avian Influenza A(H5N1) (hereafter, H5N1) fired the most severe panzootic ever recorded, causing alarming mortalities in wildlife and domestic animals, with an increasing risk to humans [<span>1-4</span>]. Almost the entire world has been affected by H5N1; the virus has expanded to new regions such as the Americas and Antarctica for the first time in its evolutionary history [<span>3</span>]. However, no cases of H5N1 have been detected in Oceania to date [<span>5, 6</span>] (only one human case infected outside this continent has been reported [<span>7</span>]). Regions not affected by this virus are of epidemiological importance, as they provide insights about potential limiting factors for its spread (e.g., geographic barriers, environmental features, wild species traits and movement). Moreover, in those areas, there is still time to prepare efficient preventive and mitigation actions to reduce the impact of this pathogen, if we can identify potential pathways of virus arrival. Here, leveraging range maps of suitable host bird species, we suggest a potential pathway of H5N1 arrival to the Oceania region that could be important to consider under the current epidemiological behavior of this virus.</p><p>To assess possible pathways of H5N1 arrival to Oceania (specifically, Australia, New Zealand, and Tasmania for this article), we performed a map of risk based on wild bird species already reported as infected by the virus anywhere in the world. These species could be considered suitable hosts of the virus. We integrated a list of H5N1-infected wild bird species reported in the World Animal Health Information System (WAHIS) database up to April 2024 [<span>3</span>] and Scientific Committee on Antarctic Research up to November 2024 (SCAR) [<span>8</span>], with species distributions primarily based on habitat maps (AOH) [<span>9</span>] and, when these were lacking, bird ranges provided by BirdLife International [<span>10</span>]. We removed records in which infected individuals were not identified at the species level and cases where individuals were kept in captivity. We obtained 345 unique wild bird species found infected by H5N1. To map the risk of H5N1 infection (i.e., areas where species reported as infected are distributed), we used the Additive Benefit Function (ABF) in Zonation v.5 [<span>11</span>].</p><p>Our risk map shows that Oceania presents a low risk compared with other regions, because it still does not host many species already reported as infected in the rest of the world (Figure 1A). However, more than 50 species that live in Oceania have already been infected in other regions (Table S1). Many of those species overlap their distributions in most of the coast of Australia and New Zealand, making this region of high risk (Figure 1B). Some key susceptible species reported infected in other regions (e.g., Antarctica and sub-Antarctic islands) such as Brown skuas (<i>Stercorarius antarcticus</i
2020年底,高致病性甲型禽流感(H5N1)(以下简称H5N1)引发了有史以来最严重的大流行病,导致野生动物和家畜的死亡率惊人,对人类的风险也在不断增加[1-4]。几乎整个世界都受到H5N1病毒的影响;该病毒在其进化史上首次扩展到美洲和南极洲等新地区。然而,迄今为止在大洋洲未发现H5N1病例[5,6](在该大陆以外仅报告了一例人间感染病例[2010])。未受该病毒影响的地区在流行病学上具有重要意义,因为它们提供了有关其传播的潜在限制因素(例如地理障碍、环境特征、野生物种特征和运动)的见解。此外,在这些地区,如果我们能够确定病毒到达的潜在途径,仍有时间准备有效的预防和缓解行动,以减少这种病原体的影响。在这里,利用合适宿主鸟类的范围图,我们提出了H5N1到达大洋洲地区的潜在途径,根据该病毒目前的流行病学行为,这可能是重要的考虑因素。为了评估H5N1到达大洋洲的可能途径(在本文中,特别是澳大利亚、新西兰和塔斯马尼亚),我们根据世界上任何地方已报告感染该病毒的野生鸟类绘制了风险图。这些物种可被认为是该病毒的适宜宿主。我们整合了世界动物卫生信息系统(WAHIS)数据库中截至2024年4月[3]和南极研究科学委员会(SCAR)数据库中截至2024年11月[8]的h5n1感染野生鸟类物种清单,物种分布主要基于栖息地地图(AOH)[9],如果缺乏栖息地地图,则采用国际鸟盟(BirdLife International)[10]提供的鸟类范围。我们删除了未在物种水平上识别受感染个体和个体被圈养的记录。我们获得了345种感染H5N1的独特野生鸟类。为了绘制H5N1感染风险分布图(即报告感染的物种分布区域),我们在分区v.5 bbb中使用了加性效益函数(ABF)。我们的风险图显示,与其他地区相比,大洋洲的风险较低,因为它仍然没有许多在世界其他地区已报告感染的物种(图1A)。然而,生活在大洋洲的50多个物种已经在其他区域受到感染(表1)。其中许多物种的分布在澳大利亚和新西兰的大部分海岸重叠,使该地区成为高风险地区(图1B)。据报告,在其他地区(如南极洲和亚南极岛屿)感染的一些关键易感物种,如褐贼鸥(Stercorarius antarcticus)、南极贼鸥(Stercorarius maccormicki)、流浪信天翁(Diomedea exulans)和巨海燕(Macronectes giganteus)均出现在大洋洲南部(图1A)。这些物种,尤其是未成熟的鸟类,有很大的移动模式(数千公里),覆盖世界各地的高纬度地区(图1A)。例如,未成熟的信天翁在第一年就被贴上标签,可以进行环球航行,飞行距离可达185,000公里[12,13](图1A);这个物种的个体在它们50年的一生中可以旅行850万公里。由于上述物种易感并可能将病毒传播到遥远的地区,因此在中短期内病毒通过南大洋飞行路线到达大洋洲的风险正在迅速增加。先前的研究对澳大利亚各地数千种不同野生鸟类进行了取样,以评估H5N1可能到达的情况,并提出东澳大利亚飞行路线是病毒到达的潜在途径;迄今为止,没有证据表明那里的鸟类感染了H5N1病毒[5,6]。虽然东澳大拉西亚的飞行路线及其鸟类可能被认为是病毒到达[5]的高风险,但我们的地图还表明,应该考虑其他南部飞行路线和使用它们的物种,以预测病毒可能到达和渗入该大陆(表S1)。褐鹰、南极贼鸥、漂泊信天翁和巨海燕的分布和运动模式包括巴塔哥尼亚、南美洲南端、亚南极岛屿、南极洲和大洋洲南部地区(图1A)。在南极洲和亚南极岛屿,从2023年至2024年11月报告了这些和其他野生鸟类中的H5N1病例和疑似感染;该地区报告了至少70例(确诊和疑似)[3,8](图1A)。 令人担忧的是,在2024年9月至11月期间,在南极半岛东部的新地区发现了感染和疑似病例,甚至到达了非洲南部附近的地区(马里恩岛,−46.876620,37.744890:3例疑似病例,以及占有岛,−46.427645,51.748694,2例疑似病例)(图1A)。该病毒可能在不到1年的时间内传播了约5000公里,从2023年10月的鸟岛(−54.006869,−38.036471)传播到2024年9月的马里恩岛疑似病例,主要与贼鸥有关,但也与其他海鸟[8]有关(图1A)。虽然从马里恩岛到澳大利亚的距离约为6500公里,但上述物种具有广泛的移动模式(图1A);因此,这些距离可能只是暂时的障碍。南美洲就是这种情况,在那里病毒从太平洋传播到大西洋约8000公里,在不到一年的时间内,沿其传播轨迹摧毁了鳍足类动物(如黄鳍足动物)种群。事实上,南极海岸到澳大利亚和新西兰的最近距离分别大约只有3000公里和2600公里;因此,如果受感染的鸟类从南极大陆向东传播,大洋洲也可能通过这一途径处于高风险之中。目前流行的H5N1谱系的流行病学行为不断发生变化;它有可能经由南大洋飞行路线到达大洋洲,如图1A、B所示。因此,大洋洲作为最后一个没有这种高度危险病原体的大陆,面临着候鸟通过太平洋(东亚-澳大拉西亚航路)和南大洋航路(图1B)到达的潜在风险。我们的地图显示,易感宿主物种在整个非洲大陆都存在,尤其是在南部(图1B)。考虑到他们与来自其他地区的个体有联系[13,15],他们可能在他们重叠的一些地方受到感染,并成为H5N1到达该地区的途径。这里提供的信息可能有助于大洋洲各国当局将重点放在实施监测计划上,同时考虑到这里提出的风险物种和地理区域。至关重要的是,要提前做好充分准备,掌握有关潜在感染途径的所有信息,以便更好地应对这种高毒性和传染性病原体。这种病毒一旦到达,就会导致大量野生鸟类和哺乳动物、包括家禽和奶牛场在内的生产系统大量死亡,甚至可能导致人类感染[16,17]。跨界协调努力是应对H5N1传播的根本;我们的主要努力应是尽可能限制H5N1到达新的地理区域,同时使这些区域做好准备,以便在病毒到达后立即减少传播。为此,了解病毒潜在传播媒介的潜在地点、物种及其生态行为,将有利于遏制和减轻这一正在全球造成毁灭性经济和环境影响的新出现病原体。Pablo Plaza:概念化、数据管理、调查、项目管理、资源、验证、可视化、角色/写作-原稿、写作-审查和编辑。Andrea Santangeli:概念化,数据管理,调查,项目管理,资源,验证,可视化,角色/写作-原始草案,写作-审查和编辑。Tommaso Cancellario:数据管理、资源、验证、可视化、写作审查和编辑。Sergio Lambertucci:概念化、数据管理、资金获取、调查、项目管理、资源、监督、验证、可视化、角色/写作-原创草案、写作-审查和编辑。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。
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引用次数: 0
Stability of Respiratory Syncytial Virus in Nasal Aspirate From Patients Infected With RSV RSV患者鼻吸物中呼吸道合胞病毒的稳定性。
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-16 DOI: 10.1111/irv.70058
Atsuko Yamamoto, Yoko Hayasaki-Kajiwara, Takamichi Baba, Saori Okaga, Mayumi Kakui, Takao Shishido

Background

Evaluation of infectious virus titer is a challenge for respiratory syncytial virus (RSV) clinical trials because of the labile nature of RSV and rapid loss of infectivity without proper specimen handling. However, there has been no rigorous investigation into RSV stability in clinical specimens.

Methods

RSV stability was investigated by evaluating virus titers and defined as titer variation from baseline within three standard deviations of our titration assay. RSV stability in viral transport medium (VTM) at 4°C and the effect of freezing method on stability were evaluated using RSV-A2 stock. RSV stability in nasal aspirates collected in VTM at 4°C was estimated by regression analysis of virus titers measured at several time points. Stability of these specimens stored at −80°C for 10–15 months after freezing by the method, which maintained RSV-A2 stability, was also assessed.

Results

Three standard deviations were calculated from our titration assay as 0.97 log10 50% tissue culture infectious dose (TCID50/mL), and RSV stability was defined as variation of virus titer from baseline within 1.0 log10TCID50/mL. RSV-A2 in VTM at 4°C was stable for at least 120 h. Freezing at −80°C negatively affected virus stability, whereas freezing in liquid nitrogen or a dry ice-ethanol bath did not. RSV in nasal aspirates was stable for 2 days at 4°C and for 10–15 months at −80°C after snap freezing.

Conclusions

RSV in nasal aspirates in VTM was estimated to be stable for 2 days at 4°C and for approximately 1 year at −80°C.

背景:由于呼吸道合胞病毒(RSV)的不稳定性和不适当的标本处理,传染性病毒滴度的评估是临床试验的一个挑战。然而,尚未对临床标本中RSV的稳定性进行严格的调查。方法:通过评估病毒滴度来研究RSV的稳定性,并将其定义为滴度在我们的滴定法的三个标准偏差内与基线的滴度变化。采用RSV- a2原液,研究了RSV在4℃条件下在病毒转运介质(VTM)中的稳定性,以及冷冻方法对稳定性的影响。通过对多个时间点测量的病毒滴度进行回归分析,估计在4°C时采集的VTM鼻吸液中RSV的稳定性。在冷冻后-80°C保存10-15个月的样品的稳定性也被评估,以保持RSV-A2的稳定性。结果:我们的滴定试验计算出3个标准差为0.97 log10 50%组织培养感染剂量(TCID50/mL),定义RSV稳定性为病毒滴度在1.0 log10TCID50/mL范围内与基线的变化。RSV-A2在4°C的VTM中至少稳定120 h。在-80°C冷冻会对病毒的稳定性产生负面影响,而在液氮或干冰-乙醇浴中冷冻则不会。鼻吸液中的RSV在4°C条件下稳定2天,在-80°C条件下快速冷冻后稳定10-15个月。结论:据估计,VTM患者鼻吸液中的RSV在4°C下稳定2天,在-80°C下稳定约1年。
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引用次数: 0
Impact of Variants, Epidemiological Trends, and Comorbidities on Hospitalization Rates of Unvaccinated Children in Brazil: A Retrospective Study (2020–2022) 变异、流行病学趋势和合并症对巴西未接种疫苗儿童住院率的影响:一项回顾性研究(2020-2022 年)》。
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-16 DOI: 10.1111/irv.70011
Danielle Dias Conte, Raí André Silva Watanabe, Ana Paula Cunha Chaves, Felipe Alberto-Lei, Ana Helena Sita Perosa, Gabriela Barbosa, Nancy Bellei

This retrospective study aimed to investigate the impact of the emergence of new variants and the epidemiological scenario on hospitalization rates of unvaccinated children (0–12 years) in Brazil. The study included 1614 children admitted to a hospital between March 2020 and December 2022 but 101 (6.3%) of them testing positive for COVID-19 via RT-PCR. The frequency of COVID-19 cases increased from 7.5% in 2020 to 9.3% in 2022 with the emergence of the Omicron variant. Children over 5 years old with comorbidities accounted for most cases (69% [70/101]). Sickle cell anemia was the most frequent comorbidity (20%), and influenza-like illness (36% [36/101]) and decompensation of underlying disease (33% [33/101]) were the main reasons for hospitalization. Coinfection was detected in 11% of cases, with respiratory syncytial virus (RSV) being the most common viral pathogen (71%). Hospital readmission occurred in 26% of cases, with a higher frequency in children over 5 years old. The death rate was 1.9%, with comorbidities such as cystic fibrosis and congenital heart disease as risk factors. These findings emphasize the need to prioritize vaccination with monovalent Omicron XBB for high-risk groups, including children over 5 years old with comorbidities, to mitigate the impact of new variants and reduce severe disease outcomes.

本回顾性研究旨在调查新变种的出现和流行病学情况对巴西未接种疫苗儿童(0-12岁)住院率的影响。该研究包括2020年3月至2022年12月期间入院的1614名儿童,但其中101名(6.3%)通过RT-PCR检测呈阳性。随着欧米克隆变异的出现,2019冠状病毒病的发病率从2020年的7.5%上升到2022年的9.3%。伴有合并症的5岁以上儿童占多数(69%[70/101])。镰状细胞性贫血是最常见的合并症(20%),流感样疾病(36%[36/101])和基础疾病失代偿(33%[33/101])是住院的主要原因。在11%的病例中检测到合并感染,呼吸道合胞病毒(RSV)是最常见的病毒病原体(71%)。26%的病例再入院,5岁以上儿童的再入院频率更高。死亡率为1.9%,伴有囊性纤维化和先天性心脏病等合并症为危险因素。这些发现强调需要优先为高危人群接种单价欧米克隆XBB疫苗,包括5岁以上有合并症的儿童,以减轻新变异的影响并减少严重的疾病结局。
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引用次数: 0
Examining the Influenza A Virus Sialic Acid Binding Preference Predictions of a Sequence-Based Convolutional Neural Network 基于序列的卷积神经网络检测甲型流感病毒唾液酸结合偏好预测。
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-11 DOI: 10.1111/irv.70044
Laura K. Borkenhagen, Jonathan A. Runstadler

Background

Though receptor binding specificity is well established as a contributor to host tropism and spillover potential of influenza A viruses, determining receptor binding preference of a specific virus still requires expensive and time-consuming laboratory analyses. In this study, we pilot a machine learning approach for prediction of binding preference.

Methods

We trained a convolutional neural network to predict the α2,6-linked sialic acid preference of influenza A viruses given the hemagglutinin amino acid sequence. The model was evaluated with an independent test dataset to assess the standard performance metrics, the impact of missing data in the test sequences, and the prediction performance on novel subtypes. Further, features found to be important to the generation of predictions were tested via targeted mutagenesis of H9 and H16 proteins expressed on pseudoviruses.

Results

The final model developed in this study produced predictions on a test dataset correctly 94% of the time and an area under the receiver operating characteristic curve of 0.93. The model tolerated about 10% missing test data without compromising accurate prediction performance. Predictions on novel subtypes revealed that the model can extrapolate feature relationships between subtypes when generating binding predictions. Finally, evaluation of the features important for model predictions helped identify positions that alter the sialic acid conformation preference of hemagglutinin proteins in practice.

Conclusions

Ultimately, our results provide support to this in silico approach to hemagglutinin receptor binding preference prediction. This work emphasizes the need for ongoing research efforts to produce tools that may aid future pandemic risk assessment.

背景:虽然受体结合特异性是甲型流感病毒宿主趋向性和溢出潜力的一个重要因素,但确定特定病毒的受体结合偏好仍然需要昂贵且耗时的实验室分析。在这项研究中,我们尝试了一种机器学习方法来预测绑定偏好。方法:根据血凝素氨基酸序列,训练卷积神经网络预测甲型流感病毒对α2,6-链唾液酸的偏好。使用独立的测试数据集对模型进行评估,以评估标准性能指标、测试序列中缺失数据的影响以及对新亚型的预测性能。此外,通过靶向诱变假病毒上表达的H9和H16蛋白,对发现的对预测产生重要的特征进行了测试。结果:本研究开发的最终模型在测试数据集上产生预测的正确率为94%,接受者工作特征曲线下的面积为0.93。该模型在不影响准确预测性能的情况下容忍大约10%的测试数据缺失。对新亚型的预测表明,该模型可以在生成绑定预测时推断亚型之间的特征关系。最后,对模型预测的重要特征的评估有助于确定在实践中改变血凝素蛋白唾液酸构象偏好的位置。结论:最终,我们的结果为这种预测血凝素受体结合偏好的计算机方法提供了支持。这项工作强调需要进行持续的研究工作,以产生可能有助于未来大流行风险评估的工具。
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引用次数: 0
Home-Based Testing as an Approach to Estimate Influenza Vaccine Effectiveness in South Africa, 2021–2022—A Pilot Study 以家庭为基础的测试作为估计南非流感疫苗有效性的方法,2021-2022-一项试点研究
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-08 DOI: 10.1111/irv.70034
Jocelyn Moyes, Mvuyo Makhazi, Sibongile Walaza, Phiwokuhle Ntombela, Fahima Moosa, Anne von Gottberg, Nicole Wolter, Mignon du Plessis, Gillian Hunt, Cherie Cawood, Erica Dueger, Cheryl Cohen

Background

Surveillance programmes for influenza and other respiratory pathogens are important to generate vaccine effectiveness (VE) estimates and to inform vaccine composition. We aimed to explore the feasibility and acceptability of home-based testing.

Methods

In three out of nine provinces in South Africa, we established a self-referral system for individuals aged ≥ 18 years with respiratory symptoms of ≤ 10 days duration. Following consent, swab collection material was delivered to participants who also completed a questionnaire including self-reported vaccination status. Swabs were tested by PCR for influenza, respiratory syncytial virus (RSV) and SARS-CoV-2. A test-negative methodology was used to estimate influenza VE.

Results

Of 1456 samples collected between 19 November 2021 and 3 September 2022, 73 (5%) tested positive for influenza, 38 (3%) tested positive for RSV and 394 (27%) for SARS-CoV-2. We subtyped 55% (40/73) of the influenza positive specimens; 16/40 (40%) were influenza A(H1N1)pdm09; 10/40 (25%)A(H3N2)) and all 14/40(35%) influenza B were B/Victoria. Only 20% (279/1451) of participants reported influenza-like illness case definition symptoms of fever and cough. Influenza vaccine coverage was 11% (157/1454). The overall influenza VE was 26% (95% confidence interval: −73%, 69%). Of the completed acceptability questionnaires, 123/127 (97%) participants would make use of the service again; 90% (1306) were recruited via the COVID-19 testing centre (call in, social media, webpage), and 7% (99/1306) through CoughWatchSA.

Conclusions

Home-based swabbing was feasible and acceptable. We were able to calculate an influenza VE, although a larger sample size and verification of vaccine status may improve the VE estimates in the future.

背景:流感和其他呼吸道病原体的监测计划对于估算疫苗有效性(VE)和确定疫苗组成非常重要。我们的目的是探索家庭检测的可行性和可接受性:在南非九个省中的三个省,我们为年龄≥18 岁、呼吸道症状持续时间≤10 天的人建立了自我转诊系统。在征得同意后,我们将拭子采集材料送到参与者手中,参与者还需填写一份问卷,其中包括自我报告的疫苗接种情况。拭子通过 PCR 对流感、呼吸道合胞病毒 (RSV) 和 SARS-CoV-2 进行检测。采用检测阴性的方法来估计流感 VE:在 2021 年 11 月 19 日至 2022 年 9 月 3 日期间采集的 1456 份样本中,73 份(5%)流感检测呈阳性,38 份(3%)RSV 检测呈阳性,394 份(27%)SARS-CoV-2 检测呈阳性。我们对 55%(40/73) 呈阳性的流感样本进行了分型,其中 16/40(40%) 为甲型 H1N1 pdm09 流感,10/40(25%)为甲型 H3N2 流感,14/40(35%)为乙型/维多利亚乙型流感。只有 20% 的参与者(279/1451)报告了流感样病例定义的发烧和咳嗽症状。流感疫苗接种率为 11%(157/1454)。总体流感病毒携带率为 26%(95% 置信区间:-73%,69%)。在完成的接受度调查问卷中,123/127(97%)的参与者表示会再次使用该服务;90%(1306)的参与者是通过 COVID-19 检测中心(电话、社交媒体、网页)招募的,7%(99/1306)的参与者是通过 CoughWatchSA 招募的:结论:在家中进行拭子测试是可行的,也是可以接受的。我们能够计算出流感VE,尽管更大的样本量和对疫苗接种情况的核实可能会提高未来的VE估计值。
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引用次数: 0
Rapid and Safe Neutralization Assay for Circulating H5N1 Influenza Virus in Dairy Cows 奶牛中流行H5N1流感病毒的快速安全中和试验
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-02 DOI: 10.1111/irv.70048
Kei Miyakawa, Makoto Ota, Kaori Sano, Fumitaka Momose, Takashi Okura, Noriko Kishida, Tomoko Arita, Yasushi Suzuki, Masayuki Shirakura, Hideki Asanuma, Shinji Watanabe, Akihide Ryo, Hideki Hasegawa

Rapid and safe neutralization assays are required for highly pathogenic avian influenza viruses, including a clade 2.3.4.4b H5N1 subtype recently found in cows. Here, we report a neutralization assay using luminescent virus-like particles. This assay has lower biosafety requirements and provides a larger dynamic range than conventional methods. We applied this technique to evaluate the cross-reactivity of neutralizing antibodies induced by clade 2.3.4.4b candidate vaccine viruses (CVVs) with the cow-derived H5N1 virus. Our findings indicate that these CVVs share antigenic characteristics with the cow-derived H5N1 virus, suggesting the potential efficacy of vaccines developed using these CVVs.

需要对高致病性禽流感病毒进行快速和安全的中和试验,包括最近在奶牛中发现的一种进化枝2.3.4.4b H5N1亚型。在这里,我们报告了一种使用发光病毒样颗粒的中和试验。该分析具有较低的生物安全要求,并提供比传统方法更大的动态范围。我们应用该技术评价了2.3.4.4b支候选疫苗病毒(CVVs)诱导的中和抗体与牛源H5N1病毒的交叉反应性。我们的研究结果表明,这些cvv与牛源性H5N1病毒具有相同的抗原特征,这表明使用这些cvv开发的疫苗具有潜在功效。
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引用次数: 0
Influenza Vaccine Effectiveness Against Symptomatic Influenza in Primary Care: A Test Negative Case Control Study Over Two Influenza Seasons 2022/2023 and 2023/2024 in Ireland 流感疫苗对初级保健中症状性流感的有效性:爱尔兰2022/2023和2023/2024两个流感季节的检测阴性病例对照研究
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-02 DOI: 10.1111/irv.70023
Louise Marron, Adele McKenna, Joan O'Donnell, Michael Joyce, Charlene Bennett, Jeff Connell, Lisa Domegan

Introduction

Live attenuated influenza vaccine (LAIV) is recommended in Ireland for all children aged 2–17 years. Quadrivalent influenza vaccine (QIV) is recommended for all others eligible for vaccination, including those ≥ 18 years with underlying medical conditions and all aged ≥ 65 years. We aimed to estimate influenza vaccine effectiveness (IVE) against acute respiratory infection (ARI) presentations to primary care due to influenza over two influenza seasons in Ireland, to inform vaccination recommendations and communication campaigns.

Methods

We undertook a test-negative case control study within the Irish sentinel general practice surveillance network as part of the Vaccine Effectiveness Burden and Impact Studies (VEBIS) network. We compared influenza vaccination status among influenza PCR positive cases with influenza PCR negative controls, both with ARI presentations, of all ages. We estimated IVE using logistic regression adjusting for age, onset time, medical conditions and sex.

Results

In 2022/2023, there were 288 cases and 765 controls. In 2023/2024, there were 567 cases and 1832 controls. In 2022/2023, overall IVE was 42% (95% CI 9 to 64) and 50% (95% CI −30 to 83) in 2- to 17-year-olds. Overall IVE in 2023/2024 was 35% (95% CI 15 to 51) and 68% (95% CI 30 to 87) in 2- to 17-year-olds.

Conclusion

Influenza vaccination reduced the risk of influenza among ARI patients presenting to general practice, demonstrating the benefits of vaccination, particularly among children. Promotion of the seasonal influenza vaccine to recommended groups, should remain a public health priority. Targeted vaccination campaigns for children promoting LAIV should emphasise the effectiveness of LAIV in children.

在爱尔兰,推荐所有2-17岁的儿童接种减毒流感活疫苗。建议所有其他符合接种条件的人接种四价流感疫苗(QIV),包括那些年龄≥18岁且有潜在疾病的人和年龄≥65岁的人。我们的目的是评估流感疫苗(IVE)在爱尔兰两个流感季节内预防因流感引起的急性呼吸道感染(ARI)向初级保健的有效性,为疫苗接种建议和宣传活动提供信息。作为疫苗有效性负担和影响研究(VEBIS)网络的一部分,我们在爱尔兰哨点全科医生监测网络中进行了一项检测阴性病例对照研究。我们比较了所有年龄的流感PCR阳性病例和流感PCR阴性对照的流感疫苗接种情况,两者都有ARI表现。我们使用逻辑回归对年龄、发病时间、医疗条件和性别进行校正,估计IVE。结果2022/2023年共288例,对照组765例。在2023/2024年,有567例病例和1832例对照。在2022/2023年,2- 17岁儿童的总体IVE为42% (95% CI 9 - 64)和50% (95% CI - 30 - 83)。2023/2024年,2- 17岁儿童的总体IVE为35% (95% CI 15 - 51)和68% (95% CI 30 - 87)。结论流感疫苗接种降低了ARI患者的流感风险,证明了疫苗接种的益处,特别是在儿童中。向推荐人群推广季节性流感疫苗仍应是公共卫生的优先事项。有针对性的儿童疫苗接种运动促进LAIV应强调LAIV在儿童中的有效性。
{"title":"Influenza Vaccine Effectiveness Against Symptomatic Influenza in Primary Care: A Test Negative Case Control Study Over Two Influenza Seasons 2022/2023 and 2023/2024 in Ireland","authors":"Louise Marron,&nbsp;Adele McKenna,&nbsp;Joan O'Donnell,&nbsp;Michael Joyce,&nbsp;Charlene Bennett,&nbsp;Jeff Connell,&nbsp;Lisa Domegan","doi":"10.1111/irv.70023","DOIUrl":"https://doi.org/10.1111/irv.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Live attenuated influenza vaccine (LAIV) is recommended in Ireland for all children aged 2–17 years. Quadrivalent influenza vaccine (QIV) is recommended for all others eligible for vaccination, including those ≥ 18 years with underlying medical conditions and all aged ≥ 65 years. We aimed to estimate influenza vaccine effectiveness (IVE) against acute respiratory infection (ARI) presentations to primary care due to influenza over two influenza seasons in Ireland, to inform vaccination recommendations and communication campaigns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We undertook a test-negative case control study within the Irish sentinel general practice surveillance network as part of the Vaccine Effectiveness Burden and Impact Studies (VEBIS) network. We compared influenza vaccination status among influenza PCR positive cases with influenza PCR negative controls, both with ARI presentations, of all ages. We estimated IVE using logistic regression adjusting for age, onset time, medical conditions and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2022/2023, there were 288 cases and 765 controls. In 2023/2024, there were 567 cases and 1832 controls. In 2022/2023, overall IVE was 42% (95% CI 9 to 64) and 50% (95% CI −30 to 83) in 2- to 17-year-olds. Overall IVE in 2023/2024 was 35% (95% CI 15 to 51) and 68% (95% CI 30 to 87) in 2- to 17-year-olds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Influenza vaccination reduced the risk of influenza among ARI patients presenting to general practice, demonstrating the benefits of vaccination, particularly among children. Promotion of the seasonal influenza vaccine to recommended groups, should remain a public health priority. Targeted vaccination campaigns for children promoting LAIV should emphasise the effectiveness of LAIV in children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13544,"journal":{"name":"Influenza and Other Respiratory Viruses","volume":"18 12","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/irv.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Biases in Routine Influenza Surveillance Indicators Used to Monitor Infection Incidence and Recommendations for Improvement 用于监测感染发生率的常规流感监测指标的偏差及改进建议
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-12-01 DOI: 10.1111/irv.70050
Oliver Eales, James M. McCaw, Freya M. Shearer

Background

Monitoring how the incidence of influenza infections changes over time is important for quantifying the transmission dynamics and clinical severity of influenza. Infection incidence is difficult to measure directly, and hence, other quantities which are more amenable to surveillance are used to monitor trends in infection levels, with the implicit assumption that they correlate with infection incidence.

Methods

Here, we demonstrate, through mathematical reasoning using fundamental mathematical principles, the relationship between the incidence of influenza infections and three commonly reported surveillance indicators: (1) the rate per unit time of influenza-like illness reported through sentinel healthcare sites, (2) the rate per unit time of laboratory-confirmed influenza infections and (3) the proportion of laboratory tests positive for influenza (‘test-positive proportion’).

Results

Our analysis suggests that none of these ubiquitously reported surveillance indicators are a reliable tool for monitoring influenza incidence. In particular, we highlight how these surveillance indicators can be heavily biassed by the following: the dynamics of circulating pathogens (other than influenza) with similar symptom profiles, changes in testing rates and differences in infection rates, symptom rates and healthcare-seeking behaviour between age-groups and through time. We make six practical recommendations to improve the monitoring of influenza infection incidence. The implementation of our recommendations would enable the construction of more interpretable surveillance indicator(s) for influenza from which underlying patterns of infection incidence could be readily monitored.

Conclusions

The implementation of all (or a subset) of our recommendations would greatly improve understanding of the transmission dynamics, infection burden and clinical severity of influenza, improving our ability to respond effectively to seasonal epidemics and future pandemics.

背景:监测流感感染发生率随时间的变化对于量化流感的传播动态和临床严重程度非常重要。感染发生率很难直接测量,因此,更适合监测的其他数量被用于监测感染水平的趋势,隐含的假设是它们与感染发生率相关。方法运用基本的数学原理,通过数学推理,论证了流感感染发生率与三个常用监测指标之间的关系:(1)卫生保健哨点报告的每单位时间流感样疾病发生率;(2)每单位时间实验室确诊流感感染率;(3)流感实验室检测呈阳性的比例(“检测阳性比例”)。结果我们的分析表明,这些普遍报道的监测指标都不是监测流感发病率的可靠工具。特别是,我们强调这些监测指标如何受到以下因素的严重影响:具有相似症状特征的流行病原体(流感除外)的动态、检测率的变化和感染率的差异、不同年龄组和不同时期的症状率和求医行为。我们提出了六项切实可行的建议,以改善流感感染发病率的监测。实施我们的建议将有助于建立更具可解释性的流感监测指标,由此可以很容易地监测感染发生率的基本模式。实施我们的全部(或部分)建议将大大提高对流感传播动态、感染负担和临床严重程度的了解,提高我们有效应对季节性流行病和未来大流行的能力。
{"title":"Biases in Routine Influenza Surveillance Indicators Used to Monitor Infection Incidence and Recommendations for Improvement","authors":"Oliver Eales,&nbsp;James M. McCaw,&nbsp;Freya M. Shearer","doi":"10.1111/irv.70050","DOIUrl":"https://doi.org/10.1111/irv.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Monitoring how the incidence of influenza infections changes over time is important for quantifying the transmission dynamics and clinical severity of influenza. Infection incidence is difficult to measure directly, and hence, other quantities which are more amenable to surveillance are used to monitor trends in infection levels, with the implicit assumption that they correlate with infection incidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Here, we demonstrate, through mathematical reasoning using fundamental mathematical principles, the relationship between the incidence of influenza infections and three commonly reported surveillance indicators: (1) the rate per unit time of influenza-like illness reported through sentinel healthcare sites, (2) the rate per unit time of laboratory-confirmed influenza infections and (3) the proportion of laboratory tests positive for influenza (‘test-positive proportion’).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our analysis suggests that none of these ubiquitously reported surveillance indicators are a reliable tool for monitoring influenza incidence. In particular, we highlight how these surveillance indicators can be heavily biassed by the following: the dynamics of circulating pathogens (other than influenza) with similar symptom profiles, changes in testing rates and differences in infection rates, symptom rates and healthcare-seeking behaviour between age-groups and through time. We make six practical recommendations to improve the monitoring of influenza infection incidence. The implementation of our recommendations would enable the construction of more interpretable surveillance indicator(s) for influenza from which underlying patterns of infection incidence could be readily monitored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The implementation of all (or a subset) of our recommendations would greatly improve understanding of the transmission dynamics, infection burden and clinical severity of influenza, improving our ability to respond effectively to seasonal epidemics and future pandemics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13544,"journal":{"name":"Influenza and Other Respiratory Viruses","volume":"18 12","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/irv.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
RSV Disease Burden in Older Adults: An Italian Multiregion Pilot Study of Acute Respiratory Infections in Primary Care Setting, Winter Season 2022–2023 老年人 RSV 疾病负担:意大利多地区基层医疗机构急性呼吸道感染试点研究(2022-2023 年冬季
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-11-26 DOI: 10.1111/irv.70049
Sara Bracaloni, Enrica Esposito, Michela Scarpaci, Tommaso Cosci, Beatrice Casini, Federica Chiovelli, Guglielmo Arzilli, Mauro Pistello, Donatella Panatto, Matilde Ogliastro, Daniela Loconsole, Maria Chironna, Caterina Rizzo, RSVComNet Italy

Background

Respiratory syncytial virus (RSV) is a major cause of hospital admission in adults over 65, leading to severe complications and death. However, the disease burden in primary care for older adults in Europe is poorly understood. This pilot study aims to test a study protocol for evaluating the clinical burden of RSV in older adults in primary care settings in Italy.

Methods

In the 2022–23 winter season, we designed a study on RSV burden in individuals over 65 with acute respiratory infections (ARIs) in Liguria, Apulia, and Tuscany, Italy. Recruited patients underwent nasopharyngeal swabs for RSV confirmation and provided epidemiological and clinical data. RSV-positive patients completed follow-up questionnaires after 14 and 30 days regarding their clinical conditions, healthcare utilization, and socio-economic impact.

Results

We enrolled 152 patients with ARIs; 33 (21.7%) tested positive for RSV. The median disease duration was 14 days, with 3% hospitalized. Among RSV-positive patients, 87% received drug treatment, 52% of whom received antibiotics. After diagnosis, 74% required further GP consultations within 2 weeks. Additionally, 48% incurred extra costs. On day 30, 21% reported health complications or deterioration.

Conclusions

Our pilot study highlights the need for an ARIs surveillance system for older adults in primary care. This is crucial for defining vaccination strategies to reduce the disease burden on these patients and the healthcare system. Moreover, these data are essential for assessing costs and parameters for cost-effectiveness models, facilitating informed decisions in public health planning and resource allocation.

背景 呼吸道合胞病毒(RSV)是 65 岁以上成年人入院治疗的主要原因,可导致严重并发症和死亡。然而,人们对欧洲老年人初级保健的疾病负担知之甚少。这项试点研究旨在测试一项研究方案,以评估意大利基层医疗机构中老年人 RSV 的临床负担。 方法 在 2022-23 年冬季,我们设计了一项关于意大利利古里亚、阿普利亚和托斯卡纳 65 岁以上急性呼吸道感染 (ARI) 患者 RSV 负担的研究。被招募的患者接受了鼻咽拭子检查以确认 RSV,并提供了流行病学和临床数据。RSV 阳性患者在 14 天和 30 天后填写了有关其临床状况、医疗保健使用情况和社会经济影响的随访问卷。 结果 我们共招募了 152 名急性呼吸道感染患者,其中 33 人(21.7%)的 RSV 检测结果呈阳性。中位病程为 14 天,3% 的患者住院治疗。在 RSV 阳性患者中,87% 接受了药物治疗,其中 52% 接受了抗生素治疗。确诊后,74%的患者需要在两周内进一步咨询全科医生。此外,48%的患者还产生了额外费用。第 30 天,21% 的患者报告出现健康并发症或病情恶化。 结论 我们的试点研究强调了在初级保健中为老年人建立急性呼吸道感染监控系统的必要性。这对于确定疫苗接种策略以减轻这些患者和医疗系统的疾病负担至关重要。此外,这些数据对于评估成本和成本效益模型参数至关重要,有助于在公共卫生规划和资源分配方面做出明智的决策。
{"title":"RSV Disease Burden in Older Adults: An Italian Multiregion Pilot Study of Acute Respiratory Infections in Primary Care Setting, Winter Season 2022–2023","authors":"Sara Bracaloni,&nbsp;Enrica Esposito,&nbsp;Michela Scarpaci,&nbsp;Tommaso Cosci,&nbsp;Beatrice Casini,&nbsp;Federica Chiovelli,&nbsp;Guglielmo Arzilli,&nbsp;Mauro Pistello,&nbsp;Donatella Panatto,&nbsp;Matilde Ogliastro,&nbsp;Daniela Loconsole,&nbsp;Maria Chironna,&nbsp;Caterina Rizzo,&nbsp;RSVComNet Italy","doi":"10.1111/irv.70049","DOIUrl":"https://doi.org/10.1111/irv.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Respiratory syncytial virus (RSV) is a major cause of hospital admission in adults over 65, leading to severe complications and death. However, the disease burden in primary care for older adults in Europe is poorly understood. This pilot study aims to test a study protocol for evaluating the clinical burden of RSV in older adults in primary care settings in Italy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the 2022–23 winter season, we designed a study on RSV burden in individuals over 65 with acute respiratory infections (ARIs) in Liguria, Apulia, and Tuscany, Italy. Recruited patients underwent nasopharyngeal swabs for RSV confirmation and provided epidemiological and clinical data. RSV-positive patients completed follow-up questionnaires after 14 and 30 days regarding their clinical conditions, healthcare utilization, and socio-economic impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 152 patients with ARIs; 33 (21.7%) tested positive for RSV. The median disease duration was 14 days, with 3% hospitalized. Among RSV-positive patients, 87% received drug treatment, 52% of whom received antibiotics. After diagnosis, 74% required further GP consultations within 2 weeks. Additionally, 48% incurred extra costs. On day 30, 21% reported health complications or deterioration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our pilot study highlights the need for an ARIs surveillance system for older adults in primary care. This is crucial for defining vaccination strategies to reduce the disease burden on these patients and the healthcare system. Moreover, these data are essential for assessing costs and parameters for cost-effectiveness models, facilitating informed decisions in public health planning and resource allocation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13544,"journal":{"name":"Influenza and Other Respiratory Viruses","volume":"18 12","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/irv.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Inpatient Burden of Respiratory Syncytial Virus Infection and Influenza in Children Younger Than 5 Years in Japan, 2011–2022: A Database Study 2011-2022 年日本 5 岁以下儿童呼吸道合胞病毒感染和流感的住院负担:一项数据库研究。
IF 4.3 4区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-11-21 DOI: 10.1111/irv.70045
Takeshi Arashiro, Rolf Kramer, Jing Jin, Munehide Kano, Fangyuan Wang, Isao Miyairi

Background

Respiratory syncytial virus (RSV) and influenza virus are major viral etiologies of pediatric lower respiratory tract infection, but comparative data on inpatient burden are lacking.

Methods

Using a large-scale health claims database in Japan, we identified patients under 5 years of age with a confirmed RSV or influenza diagnosis as an outpatient or inpatient between 2011 and 2022. Hospitalization rate, inpatient characteristics, various in-hospital outcomes/complications, and healthcare resource utilization were described.

Results

A total of 176,911 RSV-confirmed outpatients, 153,383 influenza-confirmed outpatients, 90,413 RSV-confirmed hospitalizations, and 11,186 influenza-confirmed hospitalizations were identified. Among outpatients, 24.7% of RSV infection and 2.8% of influenza cases required hospitalization within 1 week. There was no co-morbidities/prematurity for 95.0% of RSV hospitalizations and 96.5% of influenza hospitalizations. Proportions of in-hospital outcomes/complications were (RSV infection vs. influenza): oxygen use 47.6% vs. 14.8%, mechanical ventilation 2.1% vs. 0.7%, pneumonia 33.6% vs. 12.8%, otitis media 7.7% vs. 2.3%, febrile seizure 1.5% vs. 34.4%, encephalitis/encephalopathy 0.1% vs. 0.5%, myocarditis < 0.1% vs. 0.6%, antibiotics prescription 48.0% vs. 24.4%. The mean inpatient stay was 6.1 vs. 4.3 days at direct medical costs of 435,744 vs. 315,809 JPY/patient. These trends held true in age-stratified data. In-hospital death occurred in 31 RSV infection and 6 influenza cases.

Conclusions

Although both infections resulted in substantial burden, RSV infection led to more frequent hospitalizations, worse in-hospital outcomes, longer inpatient stays, higher medical costs, and more frequent antibiotics prescription compared to influenza. Most RSV hospitalizations occurred among healthy term children, emphasizing the need for prevention measures in all children.

背景:呼吸道合胞病毒(RSV呼吸道合胞病毒(RSV)和流感病毒是小儿下呼吸道感染的主要病毒病因,但缺乏有关住院患者负担的比较数据:我们利用日本的大规模健康索赔数据库,确定了 2011 年至 2022 年期间门诊或住院的确诊为 RSV 或流感的 5 岁以下患者。我们对住院率、住院病人特征、各种住院结果/并发症以及医疗资源利用情况进行了描述:结果:共发现 176911 名 RSV 确诊门诊患者、153383 名流感确诊门诊患者、90413 名 RSV 确诊住院患者和 11186 名流感确诊住院患者。在门诊病人中,24.7%的 RSV 感染病例和 2.8% 的流感病例需要在一周内住院治疗。在 95.0% 的 RSV 住院病例和 96.5% 的流感住院病例中,没有并发症/早产儿。住院结果/并发症的比例为(RSV 感染与流感):使用氧气 47.6% 对 14.8%、机械通气 2.1% 对 0.7%、肺炎 33.6% 对 12.8%、中耳炎 7.7% 对 2.3%、发热性惊厥 1.5% 对 34.4%、脑炎/脑病 0.1% 对 0.5%、心肌炎 结论:虽然两种感染都会造成巨大的负担,但与流感相比,RSV 感染导致更频繁的住院治疗、更差的院内预后、更长的住院时间、更高的医疗费用和更频繁的抗生素处方。大多数 RSV 住院病例都发生在健康的足月儿童身上,因此需要对所有儿童采取预防措施。
{"title":"Inpatient Burden of Respiratory Syncytial Virus Infection and Influenza in Children Younger Than 5 Years in Japan, 2011–2022: A Database Study","authors":"Takeshi Arashiro,&nbsp;Rolf Kramer,&nbsp;Jing Jin,&nbsp;Munehide Kano,&nbsp;Fangyuan Wang,&nbsp;Isao Miyairi","doi":"10.1111/irv.70045","DOIUrl":"10.1111/irv.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Respiratory syncytial virus (RSV) and influenza virus are major viral etiologies of pediatric lower respiratory tract infection, but comparative data on inpatient burden are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a large-scale health claims database in Japan, we identified patients under 5 years of age with a confirmed RSV or influenza diagnosis as an outpatient or inpatient between 2011 and 2022. Hospitalization rate, inpatient characteristics, various in-hospital outcomes/complications, and healthcare resource utilization were described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 176,911 RSV-confirmed outpatients, 153,383 influenza-confirmed outpatients, 90,413 RSV-confirmed hospitalizations, and 11,186 influenza-confirmed hospitalizations were identified. Among outpatients, 24.7% of RSV infection and 2.8% of influenza cases required hospitalization within 1 week. There was no co-morbidities/prematurity for 95.0% of RSV hospitalizations and 96.5% of influenza hospitalizations. Proportions of in-hospital outcomes/complications were (RSV infection vs. influenza): oxygen use 47.6% vs. 14.8%, mechanical ventilation 2.1% vs. 0.7%, pneumonia 33.6% vs. 12.8%, otitis media 7.7% vs. 2.3%, febrile seizure 1.5% vs. 34.4%, encephalitis/encephalopathy 0.1% vs. 0.5%, myocarditis &lt; 0.1% vs. 0.6%, antibiotics prescription 48.0% vs. 24.4%. The mean inpatient stay was 6.1 vs. 4.3 days at direct medical costs of 435,744 vs. 315,809 JPY/patient. These trends held true in age-stratified data. In-hospital death occurred in 31 RSV infection and 6 influenza cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although both infections resulted in substantial burden, RSV infection led to more frequent hospitalizations, worse in-hospital outcomes, longer inpatient stays, higher medical costs, and more frequent antibiotics prescription compared to influenza. Most RSV hospitalizations occurred among healthy term children, emphasizing the need for prevention measures in all children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13544,"journal":{"name":"Influenza and Other Respiratory Viruses","volume":"18 11","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Influenza and Other Respiratory Viruses
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