Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis.

BACKGROUND: Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. METHODS AND FINDINGS: We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000-5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000-44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265-612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. CONCLUSIONS: In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.

Use of public data to describe COVID-19 contact tracing in Hubei Province and non-Hubei provinces in China between 20 January and 29 February 2020

@#Objective: Contact tracing has been used in China and several other countries in the WHO Western Pacific Region as part of the COVID-19 response. We describe COVID-19 cases and the number of contacts traced and quarantined per case as part of COVID-19 emergency public health response activities in China. Methods: We abstracted publicly available, online aggregated data published in daily COVID-19 situational reports by China’s National Health Commission and provincial health commissions between 20 January and 29 February 2020. The number of new contacts traced by report date was computed as the difference between total contacts traced in consecutive reports. A proxy for the number of contacts traced per case was computed as the number of new contacts traced divided by the number of new cases. Results: During the study period, China reported 80 968 new COVID-19 cases and 659 899 contacts. In Hubei Province, there were 67 608 cases and 264 878 contacts, representing 83% and 40% of the total, respectively. Non-Hubei provinces reported tracing 1.5 times more contacts than Hubei Province; the weekly number of contacts traced per case was also higher in non-Hubei provinces than in Hubei Province and increased from 17.2 in epidemiological week 4 to 115.7 in epidemiological week 9. Discussion: More contacts per case were reported from areas and periods with lower COVID-19 case counts. With other non-pharmaceutical interventions used in China, contact tracing and quarantining large numbers of potentially infected contacts probably contributed to reducing SARS-CoV-2 transmission.

Use of Public Data to Describe COVID-19 Contact Tracing in China during January 20-February 29, 2020

ObjectiveAlthough contact tracing is generally not used to control influenza pandemics, China and several countries in the Western Pacific Region employed contact tracing as part of COVID-19 response activities. To improve understanding on the use of contact tracing for COVID-19 emergency public health response activities, we describe reported COVID-19 contacts traced and quarantined in China and a proxy for number of reported contacts traced per reported case. MethodsWe abstracted publicly available online aggregate data reported from Chinas National Health Commission and provincial health commissions COVID-19 daily situational reports for January 20-February 29, 2020. The number of new contacts traced by report date was computed as the difference between total contacts traced on consecutive reports. A proxy for the number of contacts traced per case was computed as the number of new contacts traced divided by the number of new cases. ResultsDuring January 20-February 29, 2020, China reported 80,968 new COVID-19 cases (Hubei Province = 67,608 [83%]), and 659,899 contacts traced (Hubei Province = 265,617 [40%]). Non-Hubei provinces reported more contacts traced per case than Hubei Province; this difference increased over time. DiscussionAlong with other NPI used in China, contact tracing likely contributed to reducing SARS-CoV-2 transmission by quarantining a large number of potentially infected contacts. Despite reporting only 15% of total cases, non-Hubei provinces had 1.5 times more reported contacts traced compared to Hubei Province. Contract tracing may have been more complete in areas and periods with lower case counts.

Influenza-associated paediatric respiratory hospitalizations in China, 1996–2012: a systematic analysis

Background@#The World Health Organization recommends that children aged ≥6 months be vaccinated against influenza. Influenza vaccination policies depend on the evidence of the burden of influenza, yet few national data on influenza-associated severe outcomes among children exist in China.@*Methods@#We conducted a systematic review of articles published from 1996 to 2012 on laboratory-confirmed, influenza-associated paediatric respiratory hospitalizations in China. We extracted data and stratified the percentage of samples testing positive for influenza by age group (<2, <5 and <18 years old); case definition; test methods; and geographic location. The pooled percentage of samples testing positive for influenza was estimated with a random effects regression model.@*Results@#Influenza was associated with 8.8% of respiratory hospitalizations among children aged <18 years, ranging from 7.0% (95% confidence interval: 4.2–9.8%) in children aged <2 years to 8.9% (95% confidence interval: 6.8–11%) in children aged <5 years. The percentage of samples testing positive for influenza was consistently higher among studies with data from children aged <5 years and <18 years than those restricted only to children aged <2 years; the percentages were higher in Northern China than Southern China.@*Discussion@#Influenza is an important cause of paediatric respiratory hospitalizations in China. Influenza vaccination of school-aged children could prevent substantial influenza-associated illness, including hospitalizations, in China.

Strategies for combating avian influenza in the Asia–Pacific

@#Avian, swine and other zoonotic influenza viruses may cause disease with significant impact in both human and animal populations. The Asia Pacific Strategy for Emerging Diseases (APSED), long recognizing the increased global impact of zoonotic diseases on human populations, has been used as the foundation for improving national preparedness and regional coordination for response to zoonotic diseases in the World Health Organization (WHO) Western Pacific Region.1 APSED encourages multisectoral coordination at the human–animal–environment interface as the primary action required for zoonotic disease control.2 In this article we emphasize the effectiveness of these multisectoral collaborations in responding to zoonotic diseases at the regional and country level, using avian influenza as an example.

Quality of life and its application in postnatal health research / 北京大学学报(医学版)

Quality of life(QOL) is a broad-ranging concept,incorporating in a complex way the person's physical health,psychological state,social relationships,and has been widely used as health outcomes.But in postnatal research or health care in China,the application of QOL was restricted due to the deficiency of assessment tool.Quality of life scale includes two categories: general scale(designed for general population) and specific scale(designed for specific population).General scale didn't cover the specific issues introduced by childbirth.Specific scale for postnatal women was lacking until Symon designed an open Mother-Generated Index(MGI).But the MGI had a high requirement for the understanding ability of audiences,and the completion was easily influenced by environment,both restricted the utilization in China.A specific,valid and reliable postnatal QOL scale is needed to develop in China.The aim of this overview is to describe the traits of the postnatal women's health,the meaning of the application of QOL in this period,and the situation analysis of the application in China.

Puerperal practice pattern in a rural area of north China / 北京大学学报(医学版)

Objective:To describe women's behavioral patterns in the period of “doing the month”(confinement in childbirth)and to determine the degree of differences between “doing the month” practices and daily behaviors.Methods:A retrospective survey was conducted with a random sample of 1 813 women who were interviewed using a questionnaire undertaken in May of 2004.Results:The results showed that the majority of women adhered to the traditional customs.While “doing the month”,more than 90% of women did not eat cold,hard,or sour food;more than 90% of the women did not wash their hair or body at all,and more than 70% of women did not brush their teeth or wash their!feet.As compared to what women normally do,most women drastically changed their practices in eating,sanitation,dress,activity,doing chores,and so on,during their “doing the month”.Further analysis indicated that women's age had no effect on the change of practice patterns and that women's education had an inconsequential effect.Conclusion:The traditional “doing the month” practices are still very popular in the rural areas of China.Birth belief,illness concept and traditional village culture are the main factors for the pattern of “doing the month”.

Item selection for postnatal quality of life scale / 北京大学学报(医学版)

Objective:To select items to compose the final scale from 101-item pool for assessment of postnatal quality of life which was developed by the authors before. Methods: Ten experts in maternal and child health scored the importance of every item. A total of 200 women at 0-12 months after childbirth who took their babies for vaccination or clinic services were investigated by the item pool, and 10% of them were retested in one month. Based on these data, items in the item pool were screened by following principles respectively: score of item importance, factor loading, variation coefficient, Cronbach Alpha, correlation coefficient of item with domains (2 types) and test-retest correlation coefficient. Then we summarized the screening results of these methods, and retained the items which could be selected in at least five methods. Results: The numbers of items deleted in these seven screening methods respectively were: 39 items in experts scoring method; 43 items in factor analysis method; 49 items in variation analysis method; 50 items in Cronbach Alpha method; 26 items in correlation coefficient method 1; 9 items in correlation coefficient method 2; and 11 items in test-retest method. After summarizing these screening results, 60 items were selected. In order to simplify the scale,only kept 2 items in each aspect which had more frequency retained. Finally, 40 items remained in the postnatal quality of life scale. Conclusion: This is the first Chinese scale for evaluating postnatal quality of life of women. It needs to establish the validity and reliability in the future.