Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.598
Filtrar
1.
JAMA Netw Open ; 4(2): e2037053, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33566109

RESUMO

Importance: Alpha 1-adrenergic receptor blocking agents (α1-blockers) have been reported to have protective benefits against hyperinflammation and cytokine storm syndrome, conditions that are associated with mortality in patients with coronavirus disease 2019 and other severe respiratory tract infections. However, studies of the association of α1-blockers with outcomes among human participants with respiratory tract infections are scarce. Objective: To examine the association between the receipt of α1-blockers and outcomes among adult patients hospitalized with influenza or pneumonia. Design, Setting, and Participants: This population-based cohort study used data from Danish national registries to identify individuals 40 years and older who were hospitalized with influenza or pneumonia between January 1, 2005, and November 30, 2018, with follow-up through December 31, 2018. In the main analyses, patients currently receiving α1-blockers were compared with those not receiving α1-blockers (defined as patients with no prescription for an α1-blocker filled within 365 days before the index date) and those currently receiving 5α-reductase inhibitors. Propensity scores were used to address confounding factors and to compute weighted risks, absolute risk differences, and risk ratios. Data were analyzed from April 21 to December 21, 2020. Exposures: Current receipt of α1-blockers compared with nonreceipt of α1-blockers and with current receipt of 5α-reductase inhibitors. Main Outcomes and Measures: Death within 30 days of hospital admission and risk of intensive care unit (ICU) admission. Results: A total of 528 467 adult patients (median age, 75.0 years; interquartile range, 64.4-83.6 years; 273 005 men [51.7%]) were hospitalized with influenza or pneumonia in Denmark between 2005 and 2018. Of those, 21 772 patients (4.1%) were currently receiving α1-blockers compared with a population of 22 117 patients not receiving α1-blockers who were weighted to the propensity score distribution of those receiving α1-blockers. In the propensity score-weighted analyses, patients receiving α1-blockers had lower 30-day mortality (15.9%) compared with patients not receiving α1-blockers (18.5%), with a corresponding risk difference of -2.7% (95% CI, -3.2% to -2.2%) and a risk ratio (RR) of 0.85 (95% CI, 0.83-0.88). The risk of ICU admission was 7.3% among patients receiving α1-blockers and 7.7% among those not receiving α1-blockers (risk difference, -0.4% [95% CI, -0.8% to 0%]; RR, 0.95 [95% CI, 0.90-1.00]). A comparison between 18 280 male patients currently receiving α1-blockers and 18 228 propensity score-weighted male patients currently receiving 5α-reductase inhibitors indicated that those receiving α1-blockers had lower 30-day mortality (risk difference, -2.0% [95% CI, -3.4% to -0.6%]; RR, 0.89 [95% CI, 0.82-0.96]) and a similar risk of ICU admission (risk difference, -0.3% [95% CI, -1.4% to 0.7%]; RR, 0.96 [95% CI, 0.83-1.10]). Conclusions and Relevance: This cohort study's findings suggest that the receipt of α1-blockers is associated with protective benefits among adult patients hospitalized with influenza or pneumonia.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Mortalidade Hospitalar , Hospitalização , Inflamação/tratamento farmacológico , Influenza Humana/tratamento farmacológico , Unidades de Terapia Intensiva , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , /patologia , Estudos de Coortes , Dinamarca , Feminino , Humanos , Inflamação/etiologia , Influenza Humana/mortalidade , Influenza Humana/patologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia/mortalidade , Pneumonia/patologia , Pontuação de Propensão , Índice de Gravidade de Doença
2.
Emerg Infect Dis ; 27(2): 411-420, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33395381

RESUMO

Since the 2009 influenza pandemic, the Netherlands has used a weekly death monitoring system to estimate deaths in excess of expectations. We present estimates of excess deaths during the ongoing coronavirus disease (COVID-19) epidemic and 10 previous influenza epidemics. Excess deaths per influenza epidemic averaged 4,000. The estimated 9,554 excess deaths (41% in excess) during the COVID-19 epidemic weeks 12-19 of 2020 appeared comparable to the 9,373 excess deaths (18%) during the severe influenza epidemic of 2017-18. However, these deaths occurred in a shorter time, had a higher peak, and were mitigated by nonpharmaceutical control measures. Excess deaths were 1.8-fold higher than reported laboratory-confirmed COVID-19 deaths (5,449). Based on excess deaths and preliminary results from seroepidemiologic studies, we estimated the infection-fatality rate to be 1%. Monitoring of excess deaths is crucial for timely estimates of disease burden for influenza and COVID-19. Our data complement laboratory-confirmed COVID-19 death reports and enable comparisons between epidemics.


Assuntos
/mortalidade , Epidemias/estatística & dados numéricos , Influenza Humana/mortalidade , Humanos , Mortalidade/tendências , Países Baixos/epidemiologia , Orthomyxoviridae , Estações do Ano
5.
Environ Health Perspect ; 128(12): 127004, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33325772

RESUMO

BACKGROUND: Environmental cadmium exposure is widespread. In humans, cadmium is poorly excreted, triggers pulmonary inflammation, reduces pulmonary function, and enhances lung injury by respiratory syncytial virus. OBJECTIVES: We examined the association of cadmium burden with mortality related to influenza or pneumonia. METHODS: This prospective analysis of the National Health and Nutrition Examination Survey (NHANES) included 7,173 and 8,678 participants ≥45 years of age enrolled in NHANES-III and NHANES 1999-2006, respectively. Associations were evaluated between cadmium and mortality from influenza or pneumonia during a median follow-up of 17.3 y (NHANES-III, based on creatinine-corrected urine cadmium) and 11.4 y (NHANES 1999-2006, based on blood cadmium). Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HRs) comparing the mortality of individuals at the 80th vs. the 20th percentile of cadmium concentrations. RESULTS: In NHANES-III, after adjustment for sex, race/ethnicity, education, body mass index, serum cholesterol, hypertension, and NHANES phase (or cycle), the HR comparing influenza or pneumonia mortality among participants with creatinine-corrected urinary cadmium in the 80th vs. 20th percentile was 1.15 (95% CI: 1.05, 1.26; p=0.002) in the population as a whole and 1.27 (95% CI: 1.12, 1.43; p=0.002) among never smokers. In NHANES 1999-2006, adjusted HRs for the 80th vs. 20th percentile of blood cadmium were 1.14 (95% CI: 0.96, 1.36; p=0.15) for the overall population and 1.71 (95% CI: 0.95, 3.09; p=0.07) in never smokers. DISCUSSION: Among middle-aged and older adults in the United States, higher cadmium burdens are associated with higher mortality from influenza or pneumonia. This raises the possibility that cadmium may worsen outcomes from COVID-19 infections. https://doi.org/10.1289/EHP7598.


Assuntos
/mortalidade , Cádmio/sangue , Poluentes Ambientais/sangue , Influenza Humana/mortalidade , Pneumonia/mortalidade , Idoso , Idoso de 80 Anos ou mais , /complicações , Exposição Ambiental , Feminino , Humanos , Influenza Humana/sangue , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Pneumonia/sangue , Pneumonia/complicações , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estados Unidos/epidemiologia
6.
Epidemiol Infect ; 148: e264, 2020 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-33115546

RESUMO

Deaths are frequently under-estimated during emergencies, times when accurate mortality estimates are crucial for emergency response. This study estimates excess all-cause, pneumonia and influenza mortality during the coronavirus disease 2019 (COVID-19) pandemic using the 11 September 2020 release of weekly mortality data from the United States (U.S.) Mortality Surveillance System (MSS) from 27 September 2015 to 9 May 2020, using semiparametric and conventional time-series models in 13 states with high reported COVID-19 deaths and apparently complete mortality data: California, Colorado, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania and Washington. We estimated greater excess mortality than official COVID-19 mortality in the U.S. (excess mortality 95% confidence interval (CI) 100 013-127 501 vs. 78 834 COVID-19 deaths) and 9 states: California (excess mortality 95% CI 3338-6344) vs. 2849 COVID-19 deaths); Connecticut (excess mortality 95% CI 3095-3952) vs. 2932 COVID-19 deaths); Illinois (95% CI 4646-6111) vs. 3525 COVID-19 deaths); Louisiana (excess mortality 95% CI 2341-3183 vs. 2267 COVID-19 deaths); Massachusetts (95% CI 5562-7201 vs. 5050 COVID-19 deaths); New Jersey (95% CI 13 170-16 058 vs. 10 465 COVID-19 deaths); New York (95% CI 32 538-39 960 vs. 26 584 COVID-19 deaths); and Pennsylvania (95% CI 5125-6560 vs. 3793 COVID-19 deaths). Conventional model results were consistent with semiparametric results but less precise. Significant excess pneumonia deaths were also found for all locations and we estimated hundreds of excess influenza deaths in New York. We find that official COVID-19 mortality substantially understates actual mortality, excess deaths cannot be explained entirely by official COVID-19 death counts. Mortality reporting lags appeared to worsen during the pandemic, when timeliness in surveillance systems was most crucial for improving pandemic response.


Assuntos
Infecções por Coronavirus/epidemiologia , Mortalidade , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Influenza Humana/mortalidade , Pandemias , Pneumonia/mortalidade , Estados Unidos/epidemiologia
8.
Aust J Gen Pract ; 49(10): 683-686, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33015684

RESUMO

BACKGROUND AND OBJECTIVES: SARS-CoV-2 is known to cause milder disease in children when compared with adults, but the extent of this is unclear. The aim of this article is to estimate the case fatality rate (CFR) for SARS-CoV-2 infection and SARS-CoV-2 pneumonia in young children aged <5 years, and compare this with estimated CFRs for respiratory syncytial virus (RSV) and influenza. METHOD: This article reviews published case series of SARS-CoV-2 infection in the paediatric population and epidemiological data on COVID-19 published on official government websites internationally and in Australia. RESULTS: The CFR of SARS-CoV-2 pneumonia in children aged <5 years is estimated to be 0.15-1.35%, which is lower than the estimated CFR of RSV pneumonia of 0.3-2.1%, but higher than the estimated CFR of influenza pneumonia of 0.14-0.45%. DISCUSSION: SARS-CoV-2 infection is likely to be less lethal than RSV in children aged <5 years, but more lethal than influenza.


Assuntos
Infecções por Coronavirus/mortalidade , Influenza Humana/mortalidade , Pneumonia Viral/mortalidade , Infecções por Vírus Respiratório Sincicial/mortalidade , Adolescente , Pré-Escolar , Saúde Global/estatística & dados numéricos , Humanos , Recém-Nascido , Mortalidade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia
10.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32900875

RESUMO

This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2020-2021 season.The American Academy of Pediatrics (AAP) recommends routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) pandemic. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference for one product or formulation over another.Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication is recommended for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza. Antiviral treatment may be considered for any previously healthy, symptomatic outpatient not at high risk for influenza complications in whom an influenza diagnosis is confirmed or suspected, if treatment can be initiated within 48 hours of illness onset, and for children whose siblings or household contacts either are younger than 6 months or have a high-risk condition that predisposes them to complications of influenza.


Assuntos
Vacinas contra Influenza , Influenza Humana/prevenção & controle , Antivirais/uso terapêutico , Criança , Pré-Escolar , Contraindicações de Medicamentos , Hospitalização/estatística & dados numéricos , Humanos , Esquemas de Imunização , Hospedeiro Imunocomprometido , Lactente , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/efeitos adversos , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Vacinação em Massa , Fatores de Risco , Estados Unidos/epidemiologia , Cobertura Vacinal , Vacinas Atenuadas/efeitos adversos , Vacinas de Produtos Inativados/efeitos adversos
11.
Epidemiol Infect ; 148: e209, 2020 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-32912363

RESUMO

Ecologic studies investigating COVID-19 mortality determinants, used to make predictions and design public health control measures, generally focused on population-based variable counterparts of individual-based risk factors. Influenza is not causally associated with COVID-19, but shares population-based determinants, such as similar incidence/mortality trends, transmission patterns, efficacy of non-pharmaceutical interventions, comorbidities and underdiagnosis. We investigated the ecologic association between influenza mortality rates and COVID-19 mortality rates in the European context. We considered the 3-year average influenza (2014-2016) and COVID-19 (31 May 2020) crude mortality rates in 34 countries using EUROSTAT and ECDC databases and performed correlation and regression analyses. The two variables - log transformed, showed significant Spearman's correlation ρ = 0.439 (P = 0.01), and regression coefficients, b = 0.743 (95% confidence interval, 0.272-1.214; R2 = 0.244; P = 0.003), b = 0.472 (95% confidence interval, 0.067-0.878; R2 = 0.549; P = 0.02), unadjusted and adjusted for confounders (population size and cardiovascular disease mortality), respectively. Common significant determinants of both COVID-19 and influenza mortality rates were life expectancy, influenza vaccination in the elderly (direct associations), number of hospital beds per population unit and crude cardiovascular disease mortality rate (inverse associations). This analysis suggests that influenza mortality rates were independently associated with COVID-19 mortality rates in Europe, with implications for public health preparedness, and implies preliminary undetected SARS-CoV-2 spread in Europe.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Influenza Humana/mortalidade , Pneumonia Viral/mortalidade , Ecologia , Europa (Continente)/epidemiologia , Humanos , Pandemias
12.
BMC Pulm Med ; 20(1): 239, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907585

RESUMO

BACKGROUND: Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown. METHODS: Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients. RESULTS: Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191-15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048-1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681-76.764, p <  0.001), leukocytes > 10 × 109/L (OR 1.988, 95% CI 1.028-6.454, p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR 34.813, 95% CI 1.676-73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002-0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients. CONCLUSIONS: Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.


Assuntos
Hospitalização , Vírus da Influenza A , Influenza Humana/complicações , Aspergilose Pulmonar Invasiva/complicações , Pneumonia Viral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imunocompetência , Influenza Humana/mortalidade , Aspergilose Pulmonar Invasiva/mortalidade , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Estudos Retrospectivos , Fatores de Risco
15.
PLoS Pathog ; 16(8): e1008761, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32790758

RESUMO

The virus-bacterial synergism implicated in secondary bacterial infections caused by Streptococcus pneumoniae following infection with epidemic or pandemic influenza A virus (IAV) is well documented. However, the molecular mechanisms behind such synergism remain largely ill-defined. In pneumocytes infected with influenza A virus, subsequent infection with S. pneumoniae leads to enhanced pneumococcal intracellular survival. The pneumococcal two-component system SirRH appears essential for such enhanced survival. Through comparative transcriptomic analysis between the ΔsirR and wt strains, a list of 179 differentially expressed genes was defined. Among those, the clpL protein chaperone gene and the psaB Mn+2 transporter gene, which are involved in the stress response, are important in enhancing S. pneumoniae survival in influenza-infected cells. The ΔsirR, ΔclpL and ΔpsaB deletion mutants display increased susceptibility to acidic and oxidative stress and no enhancement of intracellular survival in IAV-infected pneumocyte cells. These results suggest that the SirRH two-component system senses IAV-induced stress conditions and controls adaptive responses that allow survival of S. pneumoniae in IAV-infected pneumocytes.


Assuntos
Proteínas de Bactérias/metabolismo , Coinfecção/mortalidade , Vírus da Influenza A/patogenicidade , Influenza Humana/mortalidade , Pulmão/patologia , Infecções Pneumocócicas/mortalidade , Streptococcus pneumoniae/patogenicidade , Proteínas de Bactérias/genética , Sobrevivência Celular , Coinfecção/epidemiologia , Humanos , Influenza Humana/microbiologia , Influenza Humana/patologia , Influenza Humana/virologia , Pulmão/microbiologia , Pulmão/virologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/patologia , Infecções Pneumocócicas/virologia , Proteínas Quinases/genética , Proteínas Quinases/metabolismo , Streptococcus pneumoniae/metabolismo , Estresse Fisiológico , Virulência
16.
Int J Infect Dis ; 99: 393-396, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32768696

RESUMO

Based on data updated to 20 May 2020, the total recorded number of patients who died due to COVID-19-related reasons in Italy was 31,851. Demographic and clinical characteristics of patients who have died (including the number of comorbidities) are extremely relevant, especially to define those with a higher risk of mortality. Health authorities recommend influenza (flu) vaccinations in a number of categories at risk of serious medical complications, including: people aged ≥65 years, or patients with diabetes, cardiovascular diseases, chronic obstructive pulmonary disease (COPD), renal failure, cancer, immunodeficiencies, chronic hepatopathies, and chronic inflammatory bowel diseases. The seasonal flu peak certainly preceded that of the pandemic; however, it would seem clear that the two viruses have been simultaneously circulating in Italy for a while. Hence, after the peak of seasonal flu, influenza-like illness-related (ILI) deaths started to grow again. While some of the excess mortality reported in the ILI group may be attributable to COVID-19, a question arises: do we have to consider this observation as a result of a random sequence of events or a potential relationship between the two viruses play a role? A cooperation mechanism intended at establishing an absolute advantage over the host could also be assumed; this system often takes place to boost the reproductive probabilities. A characterization of those who died due to virus-related reasons can be performed by cross-linking data (stored in different warehouses) from the same geographical area and developing electronic health records. It would be of great relevance to identify people at very high risk of mortality as a result of an overlapping or combination of risk factors that were separately reported in patients who died from COVID-19 or influenza. A description of the subgroup of people at higher risk of mortality will be crucial for prioritizing and implementing future public health prevention and treatment programs.


Assuntos
Infecções por Coronavirus/complicações , Influenza Humana/complicações , Pneumonia Viral/complicações , Betacoronavirus , Infecções por Coronavirus/mortalidade , Humanos , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Itália , Pandemias , Pneumonia Viral/mortalidade , Medição de Risco
17.
Euro Surveill ; 25(26)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32643601

RESUMO

A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March-April 2020. Excess mortality particularly affected ≥ 65 year olds (91% of all excess deaths), but also 45-64 (8%) and 15-44 year olds (1%). No excess mortality was observed in 0-14 year olds.


Assuntos
Causas de Morte/tendências , Infecções por Coronavirus/mortalidade , Coronavirus/isolamento & purificação , Influenza Humana/mortalidade , Pneumonia Viral/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Europa (Continente)/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Influenza Humana/diagnóstico , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pandemias , Pneumonia Viral/diagnóstico , Vigilância da População , Dados Preliminares , Adulto Jovem
18.
Acta Med Hist Adriat ; 18(1): 47-62, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32638599

RESUMO

The Spanish flu pandemic spread in 1918-19 and infected about 500 million people, killing 50 to 100 million of them. People were suffering from severe poverty and malnutrition, especially in Europe, due to the First World War, and this contributed to the diffusion of the disease. In Italy, Spanish flu appeared in April 1918 with several cases of pulmonary congestion and bronchopneumonia; at the end of the epidemic, about 450.000 people died, causing one of the highest mortality rates in Europe. From the archive documents and the autoptic registers of the Hospital of Pisa, we can express some considerations on the impact of the pandemic on the population of the city and obtain some information about the deceased. In the original necroscopic registers, 43 autopsies were reported with the diagnosis of grippe (i.e. Spanish flu), of which the most occurred from September to December 1918. Most of the dead were young individuals, more than half were soldiers, and all of them showed confluent hemor agic lung bronchopneumonia, which was the typical feature of the pandemic flu. We believe that the study of the autopsy registers represents an incomparable instrument for the History of Medicine and a useful resource to understand the origin and the evolution of the diseases.


Assuntos
Autopsia/história , Broncopneumonia/história , Epidemias/história , Influenza Pandêmica, 1918-1919/história , Influenza Humana/história , Adolescente , Adulto , Distribuição por Idade , Idoso , Broncopneumonia/mortalidade , Broncopneumonia/virologia , Feminino , História do Século XX , Humanos , Influenza Pandêmica, 1918-1919/mortalidade , Influenza Humana/complicações , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Lancet Infect Dis ; 20(9): e238-e244, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32628905

RESUMO

The objective of this Personal View is to compare transmissibility, hospitalisation, and mortality rates for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with those of other epidemic coronaviruses, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and pandemic influenza viruses. The basic reproductive rate (R0) for SARS-CoV-2 is estimated to be 2·5 (range 1·8-3·6) compared with 2·0-3·0 for SARS-CoV and the 1918 influenza pandemic, 0·9 for MERS-CoV, and 1·5 for the 2009 influenza pandemic. SARS-CoV-2 causes mild or asymptomatic disease in most cases; however, severe to critical illness occurs in a small proportion of infected individuals, with the highest rate seen in people older than 70 years. The measured case fatality rate varies between countries, probably because of differences in testing strategies. Population-based mortality estimates vary widely across Europe, ranging from zero to high. Numbers from the first affected region in Italy, Lombardy, show an all age mortality rate of 154 per 100 000 population. Differences are most likely due to varying demographic structures, among other factors. However, this new virus has a focal dissemination; therefore, some areas have a higher disease burden and are affected more than others for reasons that are still not understood. Nevertheless, early introduction of strict physical distancing and hygiene measures have proven effective in sharply reducing R0 and associated mortality and could in part explain the geographical differences.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Influenza Humana/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Fatores Etários , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Epidemias , Hospitalização/estatística & dados numéricos , Humanos , Higiene , Influenza Humana/mortalidade , Influenza Humana/transmissão , Influenza Humana/virologia , Pneumonia Viral/mortalidade , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Síndrome Respiratória Aguda Grave/mortalidade , Síndrome Respiratória Aguda Grave/transmissão , Síndrome Respiratória Aguda Grave/virologia
20.
BMC Infect Dis ; 20(1): 465, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32615985

RESUMO

BACKGROUND: Since 2011, the Global Influenza Hospital Surveillance Network (GIHSN) has used active surveillance to prospectively collect epidemiological and virological data on patients hospitalized with influenza virus infection. Here, we describe influenza virus strain circulation in the GIHSN participant countries during 2017-2018 season and examine factors associated with complicated hospitalization among patients admitted with laboratory-confirmed influenza illness. METHODS: The study enrolled patients who were hospitalized in a GIHSN hospital in the previous 48 h with acute respiratory symptoms and who had symptoms consistent with influenza within the 7 days before admission. Enrolled patients were tested by reverse transcription-polymerase chain reaction to confirm influenza virus infection. "Complicated hospitalization" was defined as a need for mechanical ventilation, admission to an intensive care unit, or in-hospital death. In each of four age strata (< 15, 15-< 50, 50-< 65, and ≥ 65 years), factors associated with complicated hospitalization in influenza-positive patients were identified by mixed effects logistic regression and those associated with length of hospital stay using a linear mixed-effects regression model. RESULTS: The study included 12,803 hospitalized patients at 14 coordinating sites in 13 countries, of which 4306 (34%) tested positive for influenza. Influenza viruses B/Yamagata, A/H3N2, and A/H1N1pdm09 strains dominated and cocirculated, although the dominant strains varied between sites. Complicated hospitalization occurred in 10.6% of influenza-positive patients. Factors associated with complicated hospitalization in influenza-positive patients included chronic obstructive pulmonary disease (15-< 50 years and ≥ 65 years), diabetes (15-< 50 years), male sex (50-< 65 years), hospitalization during the last 12 months (50-< 65 years), and current smoking (≥65 years). Chronic obstructive pulmonary disease (50-< 65 years), other chronic conditions (15-< 50 years), influenza A (50-< 65 years), and hospitalization during the last 12 months (< 15 years) were associated with a longer hospital stay. The proportion of patients with complicated influenza did not differ between influenza A and B. CONCLUSIONS: Complicated hospitalizations occurred in over 10% of patients hospitalized with influenza virus infection. Factors commonly associated with complicated or longer hospitalization differed by age group but commonly included chronic obstructive pulmonary disease, diabetes, and hospitalization during the last 12 months.


Assuntos
Hospitalização , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H3N2/genética , Influenza Humana/epidemiologia , Influenzavirus B/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Influenza Humana/mortalidade , Influenza Humana/virologia , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA