Needs Assessment for a Targeted Health Promotion Campaign.

ABSTRACTSince the first human A/H7N9 infection in Hong Kong, there has been an ongoing threat of human-to-human transmission, potentially causing a pandemic. Because there is no vaccine for A/H7N9, the individual preventive measures become all the more important for reducing transmission. However, due to the ongoing threat of numerous avian influenza viruses, the public may suffer from pandemic-media-fatigue. This study was done to assess the need for a targeted A/H7N9 health promotion campaign. Steven and Gillam's framework using epidemiological, comparative, and corporate approaches was used to assess the need for a targeted A/H7N9 health promotion campaign.Local surveillance data showed that Hong Kong faces a double burden of increasing seasonal influenza activity and threat of an avian influenza pandemic. Experts warned of potential severity and difficulties in A/H7N9 control. In contrast, surveys showed that the Hong Kong public were suffering from pandemic-media-fatigue, lacked anxiety, had misconceptions, and were not vigilant in preventive practices. This was more evident in certain demographics. Content analysis showed that health promotion materials were not targeted or tailored in countries with human A/H7N9 cases. Targeted health promotion campaigns and framing the issue to increase public and media awareness are crucial in preventing the current pandemic-media-fatigue. (Disaster Med Public Health Preparedness. 2019;13:596-604).

Assessment of 12 influenza-like illness case definitions using Department of Defense Global, Laboratory-based Influenza Surveillance Program data, 2011-2014.

Despite the growth in influenza surveillance programs, standardization of a globally accepted influenza-like illness (ILI) case definition remains difficult. With 2011-2014 Department of Defense Global, Laboratory-based Influenza Surveillance Program (DISP) data, 12 case definitions were evaluated using a combination of ILI case definitions from the Centers for Disease Control and Prevention, World Health Organization, and the DISP. The sensitivity, specificity, positive and negative predictive values, and odds ratios for each case definition were calculated. Additionally, area under the curve (AUC) was calculated for a receiver operating characteristic (ROC) curve to compare the case definitions. Between 2 October 2011 and 27 September 2014, 52.3% (5,575 of 10,662) of respiratory specimens submitted met the inclusion criteria. The case definition for the DISP had a sensitivity of 54.6% and specificity of 63.7%. Case definitions should be selected according to the objectives of the surveillance system and resources available. Sensitive case definitions capture a larger proportion of cases but at the cost of testing more specimens. Definitions with higher specificity result in fewer false positives but may miss more cases.

Influenza A (H1N1pdm09)-Related Critical Illness and Mortality in Mexico and Canada, 2014.

OBJECTIVES: The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN: Observational study and a survey of available healthcare setting resources. SETTING: Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS: Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS: Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.

Using a discrete choice experiment to elicit time trade-off and willingness-to-pay amounts for influenza health-related quality of life at different ages.

BACKGROUND: Recent research suggests that values for health-related quality of life may vary with the age of the patient. Traditional health state valuation questions and discrete choice experiments are two approaches that could be used to value health. OBJECTIVE: To measure whether public values for health vary with the age of the affected individual. METHODS: A discrete choice experiment was administered via the Internet in December 2007 to measure preferences for different attributes of influenza-related health-related quality of life: age of hypothetical affected individual (range 1-85 years), length of episode (days of illness), severity of illness (workdays lost) and time trade-off or willingness-to-pay amounts. Each respondent answered identical choice questions for a hypothetical family member and for himself/herself. Data on sociodemographic characteristics and influenza illness experience were also collected. Respondents were US adults randomly sampled from an Internet survey panel (n = 1,012). The relative value of attributes was estimated using generalized estimating equations and controlling for sociodemographic characteristics and illness experience. Marginal time traded and marginal willingness to pay using discrete choice and traditional time trade-off or willingness-to-pay questions were compared. RESULTS: Respondents preferred shorter influenza episodes but did not significantly prefer fewer workdays lost if episode length was held constant. Respondents were more likely to choose to avert uncomplicated illness in children and less likely to choose to avert uncomplicated illness in working-age adults. Marginal time trade-off and willingness-to-pay amounts elicited using discrete choice questions were larger than those elicited using direct valuation questions. CONCLUSIONS: Approaches that assume values for health-related quality of life do not vary with the age of a patient may bias economic analyses that use these values. If patient age could affect valuations, then age should be included in the valuation exercise. Additional research should evaluate the effect of patient age on values for other conditions.

Obesity and the risk and outcome of infection.

The interactions between obesity and infectious diseases have recently received increasing recognition as emerging data have indicated an association between obesity and poor outcome in pandemic H1N1 influenza infection. Obesity is an established risk factor for surgical-site infections, nosocomial infections, periodontitis and skin infections. Several studies indicate that acute pancreatitis is more severe in the obese. Data are controversial and limited as regards the association between obesity and the risk and outcome of community-acquired infections such as pneumonia, bacteremia and sepsis and obesity and the course of HIV infection. As the cause-effect relationship between obesity and infection remains obscure in many infectious diseases, further studies are warranted. The consequences of obesity may have substantial effects on the global burden of infectious diseases.

Clinical and socioeconomic impact of pediatric seasonal and pandemic influenza.

Influenza is frequent among otherwise healthy day-care and school-aged children. Recent studies have demonstrated its significant effect on various outcome factors, including significantly more school and parental work absenteeism, and secondary illnesses among family members. Other studies have shown that the potential benefit of vaccinating children against influenza extends to other members of their families, thus supporting earlier economic modeling analyses of immunization programs. Although there are some differences in the clinical and socio-economic impact of seasonal and pandemic influenza, the benefits of vaccination are similar in both cases. The vaccination of otherwise healthy children may significantly reduce direct and indirect influenza-related costs, which supports the recommendation to make wider use of influenza vaccine in healthy children of any age in order to reduce the burden of infection on the community.

The burden of 2009 pandemic influenza A(H1N1) in the Netherlands.

BACKGROUND: The disease burden of the 2009 influenza pandemic has been debated but reliable estimates are lacking. To guide future policy and control, these estimates are necessary. This study uses burden of disease measurements to assess the contribution of the pandemic influenza A(H1N1) virus to the overall burden of disease in the Netherlands. METHODS: The burden of disease caused by 2009 pandemic influenza was estimated by calculating Disability Adjusted Life Years (DALY), a composite measure that combines incidence, sequelae and mortality associated with a disease, taking duration and severity into account. Available influenza surveillance data sources (primary care sentinel surveillance, notification data on hospitalizations and deaths and death registries) were used. Besides a baseline scenario, five alternative scenarios were used to assess effects of changing values of input parameters. RESULTS: The baseline scenario showed a loss of 5800 DALY for the Netherlands (35 DALY per 100 000 population). This corresponds to 0.13% of the estimated annual disease burden in the Netherlands and is comparable to the estimated disease burden of seasonal influenza, despite a different age distribution in incidence and mortality of the pandemic compared to seasonal influenza. CONCLUSIONS: This disease burden estimate confirmed that, although there was a higher mortality observed among young people, the 2009 pandemic was overall a mild influenza epidemic. The disease burden of this pandemic was comparable to the burden of seasonal influenza in the Netherlands.

GET WELL: an automated surveillance system for gaining new epidemiological knowledge.

BACKGROUND: The assumption behind the presented work is that the information people search for on the internet reflects the disease status in society. By having access to this source of information, epidemiologists can get a valuable complement to the traditional surveillance and potentially get new and timely epidemiological insights. For this purpose, the Swedish Institute for Infectious Disease Control collaborates with a medical web site in Sweden. METHODS: We built an application consisting of two conceptual parts. One part allows for trends, based on user specified requests, to be extracted from anonymous web query data from a Swedish medical web site. The second conceptual part permits tailored analyses of particular diseases, where more complex statistical methods are applied to the data. To evaluate the epidemiological relevance of the output, we compared Google search data and search data from the medical web site. RESULTS: In the paper, we give concrete examples of the output from the web query-based system. We also present results from the comparison between data from the search engine Google and search data from the national medical web site. CONCLUSIONS: The application is in regular use at the Swedish Institute for Infectious Disease Control. A system based on web queries is flexible in that it can be adapted to any disease; we get information on other individuals than those who seek medical care; and the data do not suffer from reporting delays. Although Google data are based on a substantially larger search volume, search patterns obtained from the medical web site may still convey more information from an epidemiological perspective. Furthermore we can see advantages with having full access to the raw data.

Predicting need for hospitalization of patients with pandemic (H1N1) 2009, Chicago, Illinois, USA.

In the absence of established guidelines for hospitalization of patients with pandemic (H1N1) 2009, we studied emergency department patients to identify clinical parameters that predict need for hospitalization. Independent predictors of hospitalization include multiple high-risk medical conditions, dyspnea, and hypoxia. These findings are easily applicable, with a 79% positive predictive value for hospitalization.

The burden of influenza in children under 5 years admitted to the Children's Hospital at Westmead in the winter of 2006.

OBJECTIVE: Active surveillance to determine influenza disease burden in children admitted to hospital with influenza-like illness (ILI). METHODS: A prospective hospital-based cohort study conducted June-October 2006 in children <5 years hospitalised at The Children's Hospital at Westmead with ILI (fever and respiratory symptoms). Influenza and other viral infections were diagnosed either by antigen detection using immunofluorescence or nucleic acid amplification testing of nasopharyngeal aspirates. Data were collected using researcher-administered questionnaires. Main outcome measures include proportion of hospitalisations with influenza, vaccination and treatment, risk factors for influenza and associated medical and social burdens. RESULTS: Data on 275 children with ILI aged <5 years were analysed. Thirty-one (11%) children with ILI had influenza (22 had influenza A and 9 had influenza B). Thirty-five percent were under 6 months of age and 61% under 1 year. Twenty-nine percent of children with influenza A were born prematurely. The mean duration of hospital stay for influenza was 2.8 days (95% confidence interval 2.1-3.4) and 26% had a lumbar puncture. Although 68% received intravenous antibiotics, only 3% (one case) was given an antiviral. Eighty-four percent had visited their local doctor before admission and all came through the emergency department. On average, in one-third (32%) of families of children with influenza a parent developed, ILI during admission or soon after hospital discharge resulted in an average of 3.2 days of work absenteeism. Only 3.5% (7/199) of children older than 6 months with ILI received any influenza vaccination. CONCLUSIONS: Both the burden of influenza in childhood morbidity and its social impact are substantial. There is considerable room for improvement in both the prevention and early recognition (trigger treatment with antivirals) of influenza. Our data will inform decisions regarding the value of a universal influenza vaccine programme.

Public health and medical responses to the 1957-58 influenza pandemic.

As the U.S. prepares to respond this fall and winter to pandemic (H1N1) 2009, a review of the 1957-58 pandemic of Asian influenza (H2N2) could be useful for planning purposes because of the many similarities between the 2 pandemics. Using historical surveillance reports, published literature, and media coverage, this article provides an overview of the epidemiology of and response to the 1957-58 influenza pandemic in the U.S., during which an estimated 25% of the population became infected with the new pandemic virus strain. While it cannot be predicted with absolute certainty how the H1N1 pandemic might play out in the U.S. this fall, lessons from the 1957-58 influenza pandemic provide useful and practical insights for current planning and response efforts.

Estimates of the impact of a future influenza pandemic in China.

BACKGROUND: The next influenza pandemic will create a surge in demand for health resources in China, with its current population of >1·3 billion persons and under-developed medical care and public health system. However, few pandemic impact data are available for China. OBJECTIVES: We estimated the effects of a future influenza pandemic in China by examining pandemic scenarios of varying severity and described the time distribution of cases during a first wave. METHODS: We used a Monte-Carlo simulation model and death rates, hospitalizations and outpatient visits for 1918- and 1968- like pandemic scenarios and data from the literature or experts' opinion to estimate four health outcomes: deaths, hospitalizations, outpatient medical visits and clinical illness for which medical care was not sought. For each of the two scenarios we estimated outcomes by week using a normal distribution. RESULTS: We estimated that a 1968 scenario in China would result in 460,000-700,000 deaths, 1·94-2·27 million hospitalizations, 111-117 million outpatient visits and 192-197 million illnesses for which medical care was not sought. Fifty-two percent of hospitalizations occurred during the two-peak weeks of the first wave. We estimated that patients at high-risk of influenza complications (10-17% of the population) would account for 61-75% of all deaths. For a 1918 scenario, we estimated that 4·95-6·95 million deaths, 20·8-22·7 million hospitalizations and 101-108 million outpatient visits could occur. CONCLUSION: Even a 1968 pandemic scenario will pose substantial challenges for the medical and public health system in China, and planning to manage these challenges is essential.

A household survey to assess the burden of influenza in rural Thailand.

Little is known about the disease burden of influenza in middle-income tropical countries like Thailand. The recent outbreak of avian influenza (H5N1) and studies on influenza from neighboring countries highlight the need for data on incidence, access to care, and health care cost. In May/ June 2003, we conducted a province-wide household survey using two-stage cluster sampling to determine the burden of influenza-like illness in Sa Kaeo Province. We used the total number of reported influenza that occurred in May 2003 and a prospective study of outpatient influenza in clinic patients to develop an estimate of the annualized incidence of influenza. Of 718 subjects, 16 (2.2%) suffered an episode of influenza-like illness in the preceding month; 14 sought care, of whom 7 went to a hospital facility. Fifty percent reported missing on average 3 days of work or school. The total individual cost per illness episode was 663 baht (15.78 US dollars). The proportion of outpatients with influenza-like illness caused by an influenza virus in May was 16% and the annualized influenza incidence was estimated to be 5,941/100,000 in Sa Kaeo Province. This survey adds to information indicating that in rural Thailand, the burden of influenza is substantial and costs associated with an illness episode are up to 20% of an average monthly income.

Clinical and socio-economic impact of influenza and respiratory syncytial virus infection on healthy children and their households.

This prospective study compared the clinical and socio-economic impact of laboratory-confirmed influenza and respiratory syncytial virus (RSV) infection on healthy children and their families. Among 1,520 otherwise healthy children aged< 15 years attending the Emergency Department for acute conditions other than trauma, influenza viruses and RSV were found in 234 (15.4%) and 116 (7.6%; p<0.0001) patients, respectively. The fact that influenza has a similar global clinical impact on the community to that of RSV infection, but represents a greater socio-economic burden, may contribute to broadening the acceptance of influenza vaccination.

Features of patients with influenza virus infection examined in the emergency department of a university hospital in north-western Japan.

We aimed to determine if there were any changes in the clinical features of patients infected with influenza during an influenza epidemic in north-western Japan. We retrospectively obtained data on influenza-infected patients from an electronic database set up in the emergency department. Patients were examined in the Department of Emergency Medicine, Kanazawa Medical University in 2001, 2002 or 2003. The information collected included age, sex, time of visiting the emergency department, visiting method, grade of emergency, where they were when their symptoms started to develop, influenza-related complication(s) and outcome. The retrospective data collected for the 3 years analysed (2001-2003) were similar despite the influenza epidemic in the winter of 2002/2003. These results allow us to estimate the influenza-related total medical costs and total work burden for staff in the emergency department of a university hospital during any future influenza epidemics.

Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP).

This report updates the 2002 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (CDC. Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51 [No. RR-3]:1-31). The 2003 recommendations include new or updated information regarding 1) the timing of influenza vaccination by age and risk group; 2) influenza vaccine for children aged 6-23 months; 3) the 2003-2004 trivalent inactivated vaccine virus strains: A/Moscow/10/99 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Hong Kong/330/2001-like antigens (for the A/Moscow/10/99 [H3N2]-like antigen, manufacturers will use the antigenically equivalent A/Panama/2007/99 [H3N2] virus, and for the B/Hong Kong/330/2001-like antigen, manufacturers will use either B/Hong Kong/330/2001 or the antigenically equivalent B/Hong Kong/1434/2002); 4) availability of certain influenza vaccine doses with reduced thimerosal content, including single 0.25 mL-dose syringes; and 5) manufacturers of influenza vaccine for the U.S. market. Although the optimal time to vaccinate against influenza is October and November, vaccination in December and later continues to be strongly recommended A link to this report and other information regarding influenza can be accessed at http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm.