Unveiling the role of preceding seasonal influenza in the development of bacteremic pneumococcal pneumonia in older adults before the COVID-19 pandemic in Japan.

OBJECTIVE: We aimed to investigate the impact of preceding seasonal influenza on the clinical characteristics of adult patients with invasive pneumococcal disease (IPD) in Japan. METHODS: Data for 1722 adult patients with IPD were analyzed before (2017-2019) and during the COVID-19 pandemic (2020-2022). RESULTS: The seasonal influenza epidemic disappeared soon after the emergence of the pandemic. Compared with that before the pandemic (66.7%), we observed a lower bacteremic pneumonia proportion in patients with IPD during the pandemic (55.6%). The clinical presentations of IPD cases significantly differed between those with and without preceding influenza. The proportion of bacteremic pneumonia was higher in IPD patients with preceding influenza than in those without in both younger (44.9% vs 84.2%) and older adults (65.5% vs 87.0%) before the pandemic. The case fatality rate was significantly higher in IPD patients with preceding influenza (28.3%) than in those without (15.3%) in older adults before the pandemic (P = 0.020). Male and aging are high risk factors for death in older patients with IPD who had preceding influenza. CONCLUSION: Our study reveals that preceding seasonal influenza plays a role in the development of bacteremic pneumococcal pneumonia, increasing the risk of death in older adults.

Beyond the sine wave: unveiling climate-driven baseline mortality cycles.

The relationship between temperature and mortality is well-established, with higher mortality rates occurring in moderate climates during winter. Studies on COVID-19 and influenza-related excess deaths often assume a sine-like wave pattern for baseline mortality. This study aims to assess the accuracy of this approximation in capturing the observed mortality pattern and explore its linkage with climate. Weekly mortality data from European regions (2000-2019) were modeled using the seasonal-trend decomposition procedure based on Loess. Cycles were grouped into clusters, and underlying trends were extracted using principal component analysis. Generalized linear models assuming a sine-like pattern were used to test predictive value. Cluster analysis divided the regional cycles approximately into continental and temperate climate regions, further subdivided into oceanic and Mediterranean. While the continental region exhibited a sine-like mortality pattern, it displayed modest deviations that compounded further south. The period of elevated winter mortality became shorter but more intense, while decreased summer mortality became more pronounced yet delayed. This study improves weekly estimations of excess mortality models by providing enhanced baselines. The deviation from the sine-like approximation mirrors the idealized outbreak pattern from epidemiological models with sharper surges and more gradual declines. The results point to winter infections, impacted by acquired immunity and weather conditions, as the primary drivers of fluctuations in mortality. In warmer regions, there is an apparent shift toward a lower number of overall infections within a compressed time span.

Boletim epidemiológico de vírus respiratórios (RS): semana epidemiológica (SE) 34 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 34 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 30 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 30 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Severe forms of influenza infections admitted in intensive care units: Analysis of mortality factors.

Background: The severe forms of influenza infection requiring intensive care unit (ICU) admission remain a medical challenge due to its high mortality. New H1N1 strains were hypothesized to increase mortality. The studies below represent a large series focusing on ICU-admitted influenza patients over the last decade with an emphasis on factors related to death. Methods: A retrospective study of patients admitted in ICU for influenza infection over the 2010-2019 period in Réunion Island (a French overseas territory) was conducted. Demographic data, underlying conditions, and therapeutic management were recorded. A univariate analysis was performed to assess factors related to ICU mortality. Results: Three hundred and fifty adult patients were analyzed. Overall mortality was 25.1%. Factors related to higher mortality were found to be patient age >65, cancer history, need for intubation, early intubation within 48 h after admission, invasive mechanical ventilation (MV), acute respiratory distress syndrome (ARDS), vaso-support drugs, extracorporal oxygenation by membrane (ECMO), dialysis, bacterial coinfection, leucopenia, anemia, and thrombopenia. History of asthma and oseltamivir therapy were correlated with a lower mortality. H1N1 did not impact mortality. Conclusion: Patient's underlying conditions influence hospital admission and secondary ICU admission but were not found to impact ICU mortality except in patients age >65, history of cancer, and bacterial coinfections. Pulmonary involvement was often present, required MV, and often evolved toward ARDS. ICU mortality was strongly related to ARDS severity. We recommend rapid ICU admission of patients with influenza-related pneumonia, management of bacterial coinfection, and early administration of oseltamivir.

A Pathology-based Case Series of Influenza- and COVID-19-associated Pulmonary Aspergillosis: The Proof Is in the Tissue.

Rationale: Invasive pulmonary aspergillosis has emerged as a frequent coinfection in severe coronavirus disease (COVID-19), similarly to influenza, yet the clinical invasiveness is more debated. Objectives: We investigated the invasive nature of pulmonary aspergillosis in histology specimens of influenza and COVID-19 ICU fatalities in a tertiary care center. Methods: In this monocentric, descriptive, retrospective case series, we included adult ICU patients with PCR-proven influenza/COVID-19 respiratory failure who underwent postmortem examination and/or tracheobronchial biopsy during ICU admission from September 2009 until June 2021. Diagnosis of probable/proven viral-associated pulmonary aspergillosis (VAPA) was made based on the Intensive Care Medicine influenza-associated pulmonary aspergillosis and the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) COVID-19-associated pulmonary aspergillosis consensus criteria. All respiratory tissues were independently reviewed by two experienced pathologists. Measurements and Main Results: In the 44 patients of the autopsy-verified cohort, 6 proven influenza-associated and 6 proven COVID-19-associated pulmonary aspergillosis diagnoses were identified. Fungal disease was identified as a missed diagnosis upon autopsy in 8% of proven cases (n = 1/12), yet it was most frequently found as confirmation of a probable antemortem diagnosis (n = 11/21, 52%) despite receiving antifungal treatment. Bronchoalveolar lavage galactomannan testing showed the highest sensitivity for VAPA diagnosis. Among both viral entities, an impeded fungal growth was the predominant histologic pattern of pulmonary aspergillosis. Fungal tracheobronchitis was histologically indistinguishable in influenza (n = 3) and COVID-19 (n = 3) cases, yet macroscopically more extensive at bronchoscopy in influenza setting. Conclusions: A proven invasive pulmonary aspergillosis diagnosis was found regularly and with a similar histological pattern in influenza and in COVID-19 ICU case fatalities. Our findings highlight an important need for VAPA awareness, with an emphasis on mycological bronchoscopic work-up.

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 25 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 25 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 23 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 23 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 21 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 21 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 18 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 18 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Risk of Death in Patients Hospitalized for COVID-19 vs Seasonal Influenza in Fall-Winter 2022-2023.

This study uses data from the US Department of Veterans Affairs to assess whether SARS-CoV-2 remains associated with higher risk of death compared with seasonal influenza in fall-winter 2022-2023.

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 16 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 16 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 14 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 14 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 09 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 09 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico de Vírus Respiratórios (RS): semana epidemiológica (SE) 03 de 2023 / Epidemiological bulletin of respiratory viruses (RS): epidemiological week (SE) 03 of 2023

Com a declaração do fim das emergências de saúde pública de importância Nacional (abril/2022) e Internacional (maio/2023) e o ressurgimentos dos outros vírus respiratórios, o Boletim de COVID-19 foi expandido e passa avaliar de forma integrada os agentes virais de importância à saúde pública. Utilizado o modelo de Vigilância Sentinela para monitoramento da circulação de vírus respiratórios de interesse à saúde pública nas Síndromes Gripais(SG). O objetivo desta estratégia é detectar novos agentes virais e/ou novas linhagens para oportunamente desencadear medidas de controle necessárias e reduzir a carga da doença na sociedade. (AU)

Boletim Epidemiológico COVID-2019 (RS): semana epidemiológica (SE) 49 de 2022 / Epidemiological Bulletin COVID-2019 (RS): epidemiological week (SE) 49 de 2022

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)

Boletim Epidemiológico COVID-2019 (RS): semana epidemiológica (SE) 52 de 2022 / Epidemiological Bulletin COVID-2019 (RS): epidemiological week (SE) 52 de 2022

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)

Boletim Epidemiológico COVID-2019 (RS): semana epidemiológica (SE) 39 de 2022 / - Epidemiological Bulletin COVID-2019 (RS): epidemiological week (SE) 39 de 2022

Neste boletim são apresentados: situação mundial, ocorrência de hospitalizações confirmadas para sars-cov-2, perfil das pessoas, distribuição espacial, Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P), povos indígenas, descrição de surtos, trabalhadores da saúde, Vigilância sentinela de síndrome gripal e tabelas de descrição do surto. (AU)

Severe influenza A in a Tunisian ICU sentinel SARI centre: Epidemiological and clinical features.

INTRODUCTION: Influenza A virus infection is a contagious acute respiratory infection which mostly evolves in an epidemic form, less frequently as pandemic outbreaks. It can take a severe clinical form that needs to be managed in intensive care unit (ICU). The aim of this study was to describe the epidemiological and clinical aspects of influenza A, then to determine independent predictive factors of ICU mortality in Abderrahmen Mami hospital, Ariana, Tunisia. METHODS: It was a single-center study, including all hospitalized patients in intensive care, between November 1st, 2009 and October 31st, 2019, with influenza A virus infection. We recorded demographic, clinical and biological data, evolving features; then multivariate analysis of the predictive factors of ICU mortality was realized. RESULTS: During the study period (10 consecutive seasons), 120 patients having severe Influenza A were admitted (Proportion = 2.5%) from all hospitalized patients, with a median age of 48 years and a gender-ratio of 1.14. Among women, 14 were pregnant. Only 7 patients (5.8%) have had seasonal flu vaccine during the year before ICU admission. The median values of the Simplified Acute Physiology Score II, Acute Physiologic and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment were respectively 26, 10 and 3. Virus strains identified with polymerase chain reaction were H1N1 pdm09 (84.2%) and H3N2 (15.8%). Antiviral therapy was prescribed in 88 (73.3%) patients. A co-infection was recorded in 19 cases: bacterial (n = 17) and aspergillaire (n = 2). An acute respiratory distress syndrome (ARDS) was diagnosed in 82 patients. Non-invasive ventilation (NIV) was conducted for 72 (60%) patients with success in 34 cases. Endotracheal intubation was performed in 59 patients with median duration of invasive mechanical ventilation 8 [3.25-13] days. The most frequent complications were acute kidney injury (n = 50, 41.7%), shock (n = 48, 40%), hospital-acquired infections (n = 46, 38.8%) and thromboembolic events (n = 19, 15.8%). The overall ICU mortality rate was of 31.7% (deceased n = 38). Independent predictive factors of ICU mortality identified were: age above 56 years (OR = 7.417; IC95% [1.474-37.317]; p = 0.015), PaO2/FiO2 ≤ 95 mmHg (OR = 9.078; IC95% [1.636-50.363]; p = 0.012) and lymphocytes count ≤ 1.325 109/L (OR = 10.199; IC95% [1.550-67.101]; p = 0.016). CONCLUSION: Influenza A in ICU is not uncommon, even in A(H1N1) dominant seasons; its management is highly demanding. It is responsible for considerable morbi-mortality especially in elderly patients.