Validez y utilidad del RAE-CMBD en el estudio de los pacientes hospitalizados con gripe / Validity and usefulness of the RAE-CMBD studying patients hospitalised with influenza

Background: Understanding the hospital impact of influenza requires enriching epidemiological surveillance registries with other sources of information. The aim of this study was to determine the validity of the Hospital Care Activity Record – Minimum Basic Data Set (RAE-CMBD) in the analysis of the outcomes of patients hospitalised with this infection. Methods: Observational and retrospective study of adults admitted with influenza in a tertiary hospital during the 2017/2018 and 2018/2019 seasons. We calculated the concordance of the RAE-CMBD with the influenza epidemiological surveillance registry (gold standard), as well as the main parameters of internal and external validity. Logistic regression models were used for risk adjustment of in-hospital mortality and length of stay. Results: A total of 907 (97.74%) unique matches were achieved, with high inter-observer agreement (ƙ=0.828). The RAE-CMBD showed a 79.87% sensitivity, 99.72% specificity, 86.71% positive predictive value and 99.54% negative predictive value. The risk-adjusted mortality ratio of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio was higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001). Conclusion: The RAE-CMBD is a valid source of information for the study of the impact of influenza on hospital care. The lower risk-adjusted mortality of patients admitted with influenza compared to other inpatients seems to point to the effectiveness of the main clinical and organisational measures adopted. (AU)

Objetivos: Conocer el impacto hospitalario de la gripe requiere enriquecer los registros de vigilancia epidemiológicos con otras fuentes de información. El objetivo de este estudio fue determinar la validez del Registro de Actividad de Atención Especializada – Conjunto Mínimo Básico de Datos (RAE-CMBD) en el análisis de los resultados asistenciales de los pacientes hospitalizados con esta infección. Métodos: Estudio observacional retrospectivo de los adultos ingresados con gripe en un hospital terciario durante las temporadas 2017/2018 y 2018/2019. Se calculó la concor-dancia del RAE-CMBD con el registro de vigilancia epidemiológica de gripe (estándar de referencia), así como los principales parámetros de validez interna y externa. Se utilizaron modelos de regresión logística para el ajuste por riesgo de la mortalidad intrahospitalaria y duración de la estancia. Resultados: Se lograron 907 (97,74%) emparejamientos únicos, con una concordancia interobservadores elevada (ƙ=0,828). El RAE-CMBD mostró una sensibilidad del 79,87%, especificidad del 99,72%, valor predictivo positivo del 86,71% y negativo del 99,54%. La razón de mortalidad ajustada por riesgo de los pacientes con gripe fue menor que la de los pacientes sin gripe: 0,667 (0,53–0,82) vs. 1,008 (0,98–1,04) y la razón de duración de la estancia ajustada por riesgo, mayor: 1,15 (1,12–1,18) vs. 1,00 (0,996–1,001). Conclusiones: El RAE-CMBD es una fuente de información válida para el estudio del impacto de la gripe en la atención hospitalaria. La menor mortalidad ajustada por riesgo de los pacientes ingresados con gripe respecto de los demás ingresados, parece apuntar a la efectividad de las principales medidas clínicas y organizativas adoptadas. (AU)

An airway-to-brain sensory pathway mediates influenza-induced sickness.

Pathogen infection causes a stereotyped state of sickness that involves neuronally orchestrated behavioural and physiological changes1,2. On infection, immune cells release a 'storm' of cytokines and other mediators, many of which are detected by neurons3,4; yet, the responding neural circuits and neuro-immune interaction mechanisms that evoke sickness behaviour during naturalistic infections remain unclear. Over-the-counter medications such as aspirin and ibuprofen are widely used to alleviate sickness and act by blocking prostaglandin E2 (PGE2) synthesis5. A leading model is that PGE2 crosses the blood-brain barrier and directly engages hypothalamic neurons2. Here, using genetic tools that broadly cover a peripheral sensory neuron atlas, we instead identified a small population of PGE2-detecting glossopharyngeal sensory neurons (petrosal GABRA1 neurons) that are essential for influenza-induced sickness behaviour in mice. Ablating petrosal GABRA1 neurons or targeted knockout of PGE2 receptor 3 (EP3) in these neurons eliminates influenza-induced decreases in food intake, water intake and mobility during early-stage infection and improves survival. Genetically guided anatomical mapping revealed that petrosal GABRA1 neurons project to mucosal regions of the nasopharynx with increased expression of cyclooxygenase-2 after infection, and also display a specific axonal targeting pattern in the brainstem. Together, these findings reveal a primary airway-to-brain sensory pathway that detects locally produced prostaglandins and mediates systemic sickness responses to respiratory virus infection.

Evaluation of the influenza-like illness sentinel surveillance system: A national perspective in Tanzania from January to December 2019.

BACKGROUND: The World Health Organization (WHO) recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data on the performance of established influenza surveillance systems are limited in Africa, including Tanzania. We aimed to assess the usefulness of the Influenza surveillance system in Tanzania and to ascertain if the system meets its objectives, including; estimating the burden of disease caused by the Influenza virus in Tanzania and identifying any circulating viral strains with pandemic potential. METHODOLOGY: From March to April 2021, we collected retrospective data through a review of the Tanzania National Influenza Surveillance System electronic forms for 2019. Furthermore, we interviewed the surveillance personnel about the system's description and operating procedures. Case definition (ILI-Influenza Like Illness and SARI-Severe Acute Respiratory Illness), results, and demographic characteristics of each patient were obtained from the Laboratory Information System (Disa*Lab) at Tanzania National Influenza Center. The United States Centers for disease control and prevention updated guidelines for evaluating public health surveillance systems were used to evaluate the system's attributes. Additionally, the system's performance indicators (including turnaround time) were obtained by evaluating Surveillance system attributes, each being scored on a scale of 1 to 5 (very poor to excellent performance). RESULTS: A total of 1731 nasopharyngeal and oropharyngeal samples were collected from each suspected influenza case in 2019 from fourteen (14/14) sentinel sites of the influenza surveillance system in Tanzania. Laboratory-confirmed cases were 21.5% (373/1731) with a predictive value positive of 21.7%. The majority of patients (76.1%) tested positive for Influenza A. Thirty-seven percent of patients' results met the required turnaround time, and 40% of case-based forms were incompletely filled. Although the accuracy of the data was good (100%), the consistency of the data was below (77%) the established target of ≥ 95%. CONCLUSION: The overall system performance was satisfactory in conforming with its objectives and generating accurate data, with an average performance of 100%. The system's complexity contributed to the reduced consistency of data from sentinel sites to the National Public Health Laboratory of Tanzania. Improvement in the use of the available data could be made to inform and promote preventive measures, especially among the most vulnerable population. Increasing sentinel sites would increase population coverage and the level of system representativeness.

Efficacy of the Adjuvanted Influenza Vaccine Compared With the High-Dose for Older People.

Reported cases of influenza are increasing among those 65 years of age and older. Older people may be less likely to get sick from influenza, but they are at an increased risk for influenza complications, hospitalizations, and deaths. Influenza infections and complications have become even more of a concern for this population recently because of the impact of COVID-19. Evidence exists of waning immunity in older people because of immunosenescence. Enhanced vaccines were manufactured to help boost the immune response more than what is seen with standard influenza vaccines in older people. There are currently two enhanced vaccines specifically approved for persons 65 years of age and older: the adjuvanted quadrivalent influenza vaccine (aQIV) and the high-dose quadrivalent influenza vaccine (HD-QIV). Based on current data, enhanced vaccines may be of more benefit for those 65 years of age and older. This is reflected in the most recent recommendations from the Advisory Committee on Immunization Practices (ACIP) for people 65 years of age and older, which advise to not delay vaccination and receive either a high-dose or adjuvanted influenza vaccine. There is currently no preference given over any enhanced vaccine in this age group. Influenza vaccinations have been found to reduce the risk of hospitalization from influenza complications, such as cardiovascular complications like strokes and myocardial infarction, in those 65 years of age and older, specifically those with co-existing cardiovascular disease. Immunizations are the primary prevention strategy, and we should ensure proper vaccine administration to provide maximal efficacy and reduce the chances of influenza complications.

Patient Perspective: Vaccines for Older People.

Pharmacists, as one of the most accessible health care professionals in the community, can educate, promote, and administer vaccinations. Immunizations are an important way to protect communities from potentially severe diseases, including COVID-19, influenza, pneumonia, shingles, hepatitis, and monkeypox. Though adults 65 years of age and older tend to have higher vaccination rates than other age groups, there are health care disparities that exist in relation to socioeconomic status, race, ethnicity, gender, and sexuality. Vaccine hesitancy and misconceptions cause concerns in older people that can challenge both vaccine administration and rates. Other concerns for older people are the cost, safety, and side effects of vaccines. In addition, updated vaccine guidelines were released by the Centers for Disease Control and Prevention (CDC) in early 2023 that affect recommendations for influenza, COVID-19, and pneumonia vaccines. Older people are at higher risk for severe illness, making immunizations especially important in this patient population. Pharmacists can play a pivotal role in health promotion by staying up to date on immunization guidelines and addressing barriers to vaccination.

Reducing COVID-19 Vaccine Hesitancy From a Decisional Conflict Model: A Cross-Sectional Study.

Coronavirus disease 2019 (COVID-19) vaccine hesitancy is a major concern in this pandemic context. This study postulates that vaccine hesitancy among individuals might be associated with a high state of decisional conflict which indicates a state of delayed decision-making. This study aimed to identify the factors related to COVID-19 vaccine hesitancy and examine the relationship between COVID-19 vaccine hesitancy and decisional conflict by focusing on 3 sub-factors: value, informed, and support. This cross-sectional study administered an online, self-administered survey to people aged over 20 years old who were living in Japan using an online self-administered survey. To clarify the association between hesitancy and decisional conflict for the first or second vaccination, this study compared the hesitant and non-hesitant groups. Multivariate analysis was conducted to determine which sub-factor contributing to decisional conflict was associated with vaccine hesitancy. A total of 527 responses were included in the analyses. For the first vaccination (n = 527), women and individuals in their 30s were more hesitant. For the second vaccination (n = 485), women, and individuals in their 40s, non-medical individuals, and individuals without any past history were more hesitant. No significant differences were found for employment status, household composition, convulsions history, allergies, or influenza vaccine hesitancy. For vaccine hesitancy and decisional conflict, a moderate positive correlation was found and means were significantly higher for the hesitant group. Unclear values and limited supported were positively associated with vaccine hesitancy. Eliminating decision-making conflicts can effectively reduce vaccine hesitancy. Furthermore, the findings suggest that it is insufficient to merely provide information. Thus, clarifying the value and providing tangible support from the administration is desirable.

Tailoring interventions to suit self-reported format preference does not decrease vaccine hesitancy.

Individually tailored vaccine hesitancy interventions are considered auspicious for decreasing vaccine hesitancy. In two studies, we measured self-reported format preference for statistical vs. anecdotal information in vaccine hesitant individuals, and experimentally manipulated the format in which COVID-19 and influenza vaccine hesitancy interventions were presented (statistical vs. anecdotal). Regardless of whether people received interventions that were in line with their format preference, the interventions did not influence their vaccine attitudes or vaccination intentions. Instead, a stronger preference for anecdotal information was associated with perceiving the material in both the statistical and the anecdotal interventions as more frustrating, less relevant, and less helpful. However, even if the participants reacted negatively to both intervention formats, the reactions to the statistical interventions were consistently less negative. These results suggest that tailoring COVID-19 and influenza vaccine hesitancy interventions to suit people's format preference, might not be a viable tool for decreasing vaccine hesitancy. The results further imply that using statistics-only interventions with people who hold anti-vaccination attitudes may be a less risky choice than using only anecdotal testimonies.

Rapid Detection of Influenza Outbreaks in Long Term Care Facilities Reduces Emergency Room Visits and Hospitalization.

Context: Influenza is a significant respiratory pathogen for residents of long-term care facilities (LTCFs). Rapid influenza detection tests (RIDT) may enable early outbreak detection allowing a timely response. Objective: We assessed whether RIDT for LTCF residents with acute respiratory infection is associated with increased antiviral use and decreased healthcare utilization. Study Design and Analysis: Non-blinded, pragmatic, randomized controlled trial (clinicaltrials.gov: NCT0296487). Setting: Wisconsin LTCFs. Population Studied: Residents of 20 LTCFs matched by bed capacity and geographic location. Intervention: (1) modified case identification criteria and (2) nursing-staff initiated collection of nasal swab specimen for on-site RIDT. Outcome Measures: Primary outcome measures, expressed as events per 1000 resident-weeks, included antiviral treatment courses, aniviral prophylaxis courses, total emergency department (ED) visits, ED visits for respiratory illness, total hospitalization, hospitalization for respiratory illness, hospital length of stay, total deaths, and deaths due to respiratory illness over three influenza seasons. Results: Oseltamivir use for prophylaxis was higher at intervention LTCFs (2.6 vs 1.9 courses per 1000 person-weeks; rate ratio: 1.38; 95%CI: 1.24-1.54; p<0.001); rates of oseltamivir use for treatment were not different. Rates of total ED visits (7.6 vs 9.8/1000 person-weeks; RR=0.78; 95%CI: 0.64-0.92; p=0.004), total hospitalizations (8.6 vs 11.0/1000 person-weeks; RR=0.79; 95%CI: 0.67-0.93; p=0.004), and hospital length of stay (35.6 days vs 55.5 days/1000 person-weeks; RR=0.64; 95%CI: 0.0.59-0.69; p<0.001) were lower at intervention as compared to control LTCFs. No significant differences were noted for respiratory-related ED visits or hospitalizations or in rates for all-cause or respiratory-associated mortality. Conclusions: The use of low threshold criteria to trigger nursing staff-initiated testing for influenza with RIDT resulted in increased prophylactic use of oseltamivir. There were significant reductions in the rates of all-cause ED visits (22% decline), hospitalizations (21% decline), and hospital length of stay (36% decline) across three combined influenza seasons. No significant differences were noted in respiratory-associated and all-cause deaths between intervention and control sites. This feasible, and low-cost intervention may provide significant benefit and should be further tested in other settings.

Guidelines on epidemics in Mexico. Historical perspective.

A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 9 (10 March 2023)

[WEEKLY SUMMARY]. North America: Influenza virus activity decreased throughout the sub-region, with the predominance of influenza A(H3N2)pdm09. Influenza A(H1N1)pdm09 and B/Victoria co-circulated. SARS-CoV-2 circulates at moderate levels, and RSV activity was low. In Canada, influenza activity was low, with influenza B virus predominance. In Mexico, influenza activity decreased, while SARS-CoV-2 and RSV activity remained elevated. In the United States, influenza and RSV activity were low, while SARS-CoV-2 activity remained moderate. Caribbean: Influenza activity remains increased, although showing a decreasing trend, with A(H1N1)pdm09 predominance and A(H3N2) and B/Victoria co-circulation. Belize and Haiti reported increased influenza activity, with influenza A(H1N1)pdm09 predominance. Likewise, Guadeloupe, Martinique, and Saint-Martin reported increased influenza activity in the French Territories. SARS-CoV-2 activity was low in the subregion, except in Jamaica and Suriname, where it was raised. Jamaica reported increased RSV activity; elsewhere in the subregion, RSV activity was low. Central America: Influenza activity was moderate, with influenza B/Victoria virus predominance. Influenza A(H3N2) and A(H1N1)pdm09 co-circulated. Guatemala, Honduras, and Panama reported increased influenza activity. SARS-CoV-2 percent positivity decreased in the subregion, except in Costa Rica. RSV activity was low overall. Andean: Influenza activity was low, predominating influenza A(H1N1)pdm09 viruses; influenza B/Victoria and A(H3N2) viruses co‑circulated. Bolivia, Ecuador, and Venezuela reported increased influenza activity. In Bolivia, SARI cases / 100 hospitalizations were at moderate levels, and 22% tested positive for influenza. SARS‑CoV-2 and RSV activity were low overall. Brazil and Southern Cone: Influenza activity was at interseason levels; influenza B/Victoria viruses were detected more frequently with A(H1N1)pdm09 co-circulation. Paraguay reported increased influenza B (lineage not performed) activity at low-intensity levels. SARS-CoV-2 activity was low overall, but Brazil and Chile reported increased activity. RSV activity was low in the subregion, except in Brazil, where high levels were registered. Avian Influenza: A summary of the avian influenza situation in the region, case management and recommendations are available at Epidemiological alerts and updates | PAHO/WHO | Pan American Health Organization (paho.org)

[RESUMEN SEMANAL]. América del Norte: la actividad del virus de la influenza disminuyó en toda la subregión, con predominio de influenza A(H3N2)pdm09. Circularon concurrentemente los virus influenza A(H1N1)pdm09 y B/Victoria. El SARS-CoV-2 circuló en niveles moderados y la actividad del VRS estuvo baja. En Canadá, la actividad de la influenza estuvo baja, con predominio del virus influenza B. En México, la actividad de la influenza disminuyó, mientras que la del SARS-CoV‑2 y del VRS permaneció elevada. En los Estados Unidos, la actividad de la influenza y del VRS estuvo baja, mientras que la del SARS-CoV-2 se mantuvo moderada. Caribe: la actividad de la influenza permaneció aumentada, aunque muestra una tendencia decreciente, con predominio de A(H1N1)pdm09 y circulación concurrente de A(H3N2) y B/Victoria. Belice y Haití reportaron un aumento de la actividad de la influenza, con predominio de influenza A(H1N1)pdm09. Asimismo, Guadalupe, Martinica y San Martín notificaron un aumento de la actividad de la influenza en los territorios franceses. La actividad del SARS-CoV-2 estuvo baja en la subregión, excepto en Jamaica y Surinam, donde se elevó. Jamaica notificó un aumento de la actividad del VRS; en el resto de la subregión, la actividad del VRS estuvo baja. América Central: la actividad de la influenza estuvo moderada, con predominio de influenza B/Victoria. Circularon concurrentemente los virus influenza A(H3N2) y A(H1N1)pdm09. Guatemala, Honduras y Panamá reportaron un aumento de la actividad de la influenza. El porcentaje de positividad de SARS-CoV-2 disminuyó en la subregión, excepto en Costa Rica. La actividad del VRS estuvo baja en general. Países Andinos: la actividad de influenza estuvo baja, con predominio de los virus influenza A(H1N1)pdm09; circularon concurrentemente los virus influenza B/Victoria y A(H3N2). Bolivia, Ecuador y Venezuela reportaron un aumento de la actividad de la influenza. En Bolivia el número de casos de IRAG por cada 100 hospitalizaciones estuvo en niveles moderados, y el 22% resultaron positivos para influenza. La actividad de SARS-CoV-2 y del VRS estuvo baja en general. Brasil y Cono Sur: la actividad de la influenza estuvo en niveles entre temporadas; los virus influenza B/Victoria se detectaron con mayor frecuencia con la circulación concurrente de A(H1N1)pdm09. Paraguay notificó un aumento de la actividad de la influenza B (linaje indeterminado) a niveles de baja intensidad. La actividad del SARS-CoV-2 estuvo baja en general, pero Brasil y Chile reportaron una mayor actividad. La actividad del VRS estuvo baja en la subregión, excepto en Brasil, donde se registraron niveles altos. Influenza Aviar: el resumen sobre la situación epidemiológica de influenza aviar en la región, manejo de los casos y recomendaciones se encuentran disponibles en Alertas y actualizaciones epidemiológicas | OPS/OMS | Organización Panamericana de la Salud (paho.org)

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 8 (3 March 2023)

[WEEKLY SUMMARY]. North America: Influenza activity was low in the subregion. Influenza A(H3N2)pdm09 predominated, with the co-circulation of A(H1N1)pdm09 and B/Victoria. SARS-CoV-2 circulates at moderate levels and RSV activity is low. In Canada, influenza activity continues low, with influenza A virus predominance. In Mexico, influenza activity was low, while SARS-CoV-2 and RSV activity remained elevated. In the United States, influenza and RSV activity was low overall and SARS-CoV-2 activity remained at moderate levels, with the percentage of deaths due to pneumonia, influenza, and COVID-19 above the average of previous seasons and increasing. Caribbean: Influenza activity remains elevated in the subregion, although presenting a decreasing trend, with A(H1N1)pdm09 predominance and A(H3N2) and B/Victoria co-circulation. Belize and Haiti reported increased influenza activity, and all seasonal subtypes co-circulated. SARS-CoV-2 activity was low in the subregion, except in Dominica and Suriname, where it was raised. RSV activity remained low in the subregion, except in Jamaica where increased RSV activity was reported. Central America: Influenza activity was moderate, with influenza B/Victoria virus predominance. Influenza A(H3N2) and A(H1N1)pdm09 co-circulated. Guatemala reported increased influenza activity with moderate levels of influenza B/Victoria circulation; SARI activity was low. Honduras reported increased influenza activity at moderate-intensity levels. SARS-CoV-2 percent positivity remains at moderate levels in the subregion, with high circulating levels in Costa Rica. RSV activity was low overall. Andean: Influenza activity was low, predominating influenza A(H1N1)pdm09 viruses; influenza B/Victoria and A(H3N2) viruses co-circulated. In Bolivia and Ecuador, influenza activity was increased. SARS-CoV-2 activity was low overall. In the subregion, RSV activity was low. Brazil and Southern Cone: Influenza activity was at interseason levels; influenza A viruses were detected more frequently with co-circulation of B/Victoria and A(H1N1)pdm09. Paraguay reported increased influenza B (indeterminate lineage) activity at low-intensity levels with SARI and ILI low levels. SARS-CoV-2 activity was low, except in Brazil and Chile with moderate circulating levels. RSV activity remained low in the subregion except in in Brazil, where high levels were observed. Global: Globally, influenza activity decreased compared to the peak in late 2022. Influenza A viruses predominated with a slightly larger proportion of A(H1N1)pdm09. The proportion of influenza B virus detections increased during this reporting period. In Europe, influenza detections remained stable. Influenza positivity from sentinel sites increased in the most recent week, remaining above the epidemic threshold at the regional level. Out of 39 countries, 18 reported high or moderate intensity, and over half continued to report widespread activity. Influenza A and B viruses were detected similarly in both sentinel and non-sentinel surveillance. The proportion of influenza B viruses increased in recent weeks. Other indicators of influenza activity remained stable or decreased in most countries, while a few countries reported increases. In Central Asia, influenza activity decreased, while in Northern Africa, activity driven by all seasonal influenza subtypes was low and continued to decline in Morocco and Tunisia. In Western Asia, influenza activity continued to be reported in some countries with detections of all seasonal influenza subtypes. In East Asia, influenza activity of predominantly A(H1N1)pdm09 steeply increased in China but decreased in the other reporting countries. In tropical Africa, influenza activity was highest in eastern Africa but remained low overall, with detections of all seasonal influenza subtypes reported. In Southern Asia, influenza activity remained low, with all seasonal influenza subtypes detected. In South-East Asia, detections of predominantly influenza B viruses remained elevated, mainly due to continued detections in Malaysia. In the temperate zones of the southern hemisphere, influenza activity remained at inter-seasonal levels. SARS-CoV-2 positivity from sentinel surveillance remained around 20% globally. The activity was about 25% in the WHO Region of the Americas, decreased to around 10% in the Western Pacific Region, and remained under 10% in the other regions. SARS-CoV-2 positivity from non-sentinel surveillance was reported at about 25% globally.

[RESUMEN SEMANAL]. América del Norte: en la subregión la actividad de la influenza estuvo baja. Predominó influenza A(H3N2)pdm09, con la circulación concurrente de A(H1N1)pdm09 y B/Victoria. El SARS-CoV-2 circuló a niveles moderados y la actividad del VRS estuvo baja. En Canadá, la actividad de la influenza continúa baja, con predominio del virus influenza A. En México, la actividad de la influenza estuvo baja, mientras que la actividad del SARS-CoV-2 y del VRS permaneció elevada. En los Estados Unidos, la actividad de la influenza y del VRSV estuvo baja en general y la actividad del SARS-CoV-2 permaneció en niveles moderados, con un porcentaje de muertes por neumonía, influenza y COVID-19 por encima del promedio de temporadas previas y con tendencia al aumento. Caribe: la actividad de la influenza estuvo moderada, con predominio del virus influenza B/Victoria. Circularon concurrentemente los virus influenza A(H3N2) y A(H1N1)pdm09. Guatemala reportó un aumento de la actividad de influenza con niveles moderados de circulación de influenza B/Victoria; la actividad de la IRAG estuvo baja. Honduras notificó un aumento de la actividad por influenza en niveles de intensidad moderada. El porcentaje de positividad del SARS-CoV-2 se mantiene en niveles moderados en la subregión, con altos niveles de circulación en Costa Rica. La actividad del VRS estuvo baja en general. América Central: la actividad de la influenza estuvo moderada, con predominio del virus influenza B/Victoria. Circularon concurrentemente los virus influenza A(H3N2) y A(H1N1)pdm09. Guatemala reportó mayor actividad de influenza con circulación moderada de influenza B/Victoria; la actividad de la IRAG estuvo baja. Honduras notificó un aumento de la actividad de la influenza ubicándose en niveles de moderada intensidad. El porcentaje de positividad de SARS-CoV-2 permanece en niveles moderados en la subregión ,con niveles elevados en Costa Rica. La actividad del VRS disminuyó en general. Países Andinos: la actividad de la influenza estuvo baja, predominando los virus influenza A(H1N1)pdm09; circularon concurrentemente los virus influenza B/Victoria y A(H3N2). En Bolivia y Ecuador se incrementó la actividad de la influenza. La actividad del SARS CoV-2 estuvo baja en general. En la subregión, la actividad del VRS estuvo baja. Brasil y Cono Sur: la actividad de la influenza estuvo en niveles observados entre temporadas; los virus de la influenza A se detectaron con mayor frecuencia con la circulación concurrente de B/Victoria y A(H1N1)pdm09. Paraguay notificó un aumento de la actividad de la influenza B (linaje indeterminado) en niveles de baja intensidad con niveles bajos de IRAG y ETI. La actividad del SARS-CoV-2 estuvo baja, excepto en Brasil y Chile con niveles de circulación moderados. La actividad del VRS permaneció baja en la subregión excepto en Brasil, donde se observaron niveles altos. Global: la actividad de la influenza disminuyó en comparación con el pico a fines de 2022. Predominaron los virus influenza A con una proporción ligeramente mayor de A(H1N1)pdm09. La proporción de detecciones del virus de la influenza B aumentó durante este período de informe. En Europa, las detecciones de influenza se mantuvieron estables. La positividad de la influenza en los sitios centinela aumentó en la semana más reciente, manteniéndose por encima del umbral epidémico a nivel regional. De 39 países, 18 reportaron una intensidad alta o moderada, y más de la mitad continuaron reportando una actividad generalizada. Los virus de la influenza A y B se detectaron en proporciones similares tanto en la vigilancia centinela como en la no centinela. La proporción de virus influenza B aumentó en las últimas semanas. Otros indicadores de la actividad de la influenza se mantuvieron estables o disminuyeron en la mayoría de los países, mientras que algunos países reportaron aumentos. En Asia central, la actividad de la influenza disminuyó, mientras que en el norte de África, la actividad impulsada por todos los subtipos de influenza estacional estuvo baja y siguió disminuyendo en Marruecos y Túnez. En Asia 0ccidental, continuó el reporte de actividad de la influenza en algunos países con detecciones de todos los subtipos de influenza estacional. En el este de Asia, la actividad de la influenza predominantemente A(H1N1)pdm09 aumentó considerablemente en China, pero disminuyó en los demás países que reportaron. En África tropical, la actividad de la influenza estuvo más alta en África oriental, pero se mantuvo baja en general, con detecciones de todos los subtipos de influenza estacional reportados. En el sur de Asia, la actividad de la influenza se mantuvo baja y se detectaron todos los subtipos de influenza estacional. En el sudeste asiático, las detecciones predominantemente de virus influenza B se mantuvieron elevadas, principalmente debido a las continuas detecciones en Malasia. En las zonas templadas del hemisferio sur, la actividad de influenza se mantuvo en niveles interestacionales. A nivel mundial la positividad de SARS-CoV-2 de la vigilancia centinela se mantuvo alrededor del 20%. La actividad estuvo alrededor del 25 % en las Américas, disminuyó a alrededor del 10 % en la Región del Pacífico Occidental y se mantuvo por debajo del 10 % en las demás regiones. La positividad de SARS-CoV-2 de la vigilancia no centinela estuvo aproximadamente en 25% a nivel mundial.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 7 (24 February 2023)

[WEEKLY SUMMARY]. North America: Influenza activity was low in the subregion. Influenza A virus predominated, with co-circulating A(H3N2) and A(H1N1)pdm09. All influenza B viruses with determined lineage were B/Victoria. The SARS-CoV-2 and RSV activity decreased in the subregion. In Canada, influenza activity decreased overall, with A(H1N1)pdm09 predominance. In Mexico, influenza activity was low, while SARS-CoV-2 and RSV activity remained elevated. In the United States, influenza activity was low nationally. Caribbean: Influenza activity was elevated with a decreasing trend. Influenza A and B viruses were equally detected. Influenza A(H1N1)pdm09, A(H3N2) and influenza B/Victoria co-circulated. In French Guyana, influenza activity was elevated but decreasing. SARS-CoV-2 activity was low in the subregion, with RSV activity at baseline levels except in Jamaica, where RSV activity was increased. Central America: Influenza activity was moderate, with the circulation of influenza B/Victoria virus. No influenza A virus detections were reported. Guatemala reported increased influenza activity with influenza B/Victoria circulation; severity indicators were at baseline levels. El Salvador and Honduras reported increased influenza activity at moderate-intensity levels; severity indicators were at baseline levels. SARS-CoV-2 percent positivity decreased in the subregion, except in Costa Rica and Panama. RSV activity remained elevated in Guatemala but is decreasing. Andean: Influenza activity was low, predominating influenza B/Victoria viruses; influenza A(H3N2) and A(H1N1)pdm09 viruses co-circulated. In Bolivia, influenza activity was elevated with B/Victoria circulation and SARI cases at moderate-intensity levels, with 50% of sampled cases positive for influenza. Ecuador reported increased influenza activity at a low-intensity level; severity indicators were at low-intensity levels. SARS-CoV-2 activity was elevated in Ecuador and Peru. In the subregion, RSV activity was low overall. Brazil and Southern Cone: Influenza activity was low, with influenza B viruses more frequently detected and co-circulated B/Victoria and A(H1N1)pdm09. In Paraguay, influenza activity was elevated at a low-intensity level, with influenza B (lineage undetermined) circulating; severity indicators were low. SARS-CoV-2 activity was low, except in Brazil and Chile, while RSV activity remains elevated in Brazil. Avian Influenza: A summary of the avian influenza situation in the region, case management and recommendations are available at Epidemiological alerts and updates | PAHO/WHO | Pan American Health Organization (paho.org)

[RESUMEN SEMANAL]. América del Norte: en la subregión la actividad de la influenza estuvo baja. Predominó el virus influenza A con A(H3N2) y A(H1N1)pdm09 circulando concurrentemente. Todos los virus influenza B con linaje determinado fueron B/Victoria. La actividad de SARS-CoV-2 y del VRS disminuyó en la subregión. En Canadá, la actividad de la influenza disminuyó en general, con predominio de A(H1N1)pdm09. En México, la actividad de la influenza estuvo baja, mientras que la actividad del SARS-CoV-2 y del VRS permaneció elevada. En los Estados Unidos, la actividad de la influenza estuvo baja a nivel nacional. Caribe: la actividad de la influenza estuvo elevada con una tendencia decreciente. Se detectaron en iguales proporciones los virus influenza A y B. Circularon concurrentemente influenza A(H1N1)pdm09, A(H3N2) e influenza B/Victoria. En la Guayana Francesa, la actividad de la influenza estuvo elevada, pero con tendencia a disminuir. La actividad del SARS-CoV-2 estuvo baja en la subregión y la actividad del VRS estuvo en los niveles basales, excepto en Jamaica en donde estuvo elevada. América Central: la actividad gripal fue moderada, con circulación del virus influenza B/Victoria. No se informaron detecciones del virus de la influenza A. Guatemala reportó mayor actividad de influenza con circulación de influenza B/Victoria; los indicadores de gravedad estaban en los niveles de referencia. El Salvador y Honduras informaron un aumento de la actividad de la influenza en niveles de intensidad moderada; los indicadores de gravedad se ubicaron en los niveles basales. El porcentaje de positividad de SARS-CoV-2 disminuyó en la subregión excepto en Costa Rica y Panamá. La actividad del VRS se mantuvo elevada en Guatemala pero con tendencia a la disminución. Países Andinos: la actividad de la influenza estuvo baja, predominando los virus influenza B/Victoria; circularon concurrentemente los virus influenza A(H3N2) y A(H1N1)pdm09. En Bolivia, la actividad de la influenza estuvo elevada con circulación de B/Victoria y los casos de IRAG en niveles de intensidad moderada, con un 50% de los casos con muestra positivos para influenza. Ecuador notificó un aumento de la actividad de la influenza ubicándose en un nivel de baja intensidad; los indicadores de severidad estuvieron en niveles de baja intensidad. La actividad del SARS-CoV-2 estuvo elevada en Ecuador y Perú. En la subregión, la actividad del VRS estuvo baja en general. Brasil y Cono Sur: la actividad de la influenza estuvo baja, y los virus de la influenza B se detectaron con mayor frecuencia y circularon conjuntamente B/Victoria y A(H1N1)pdm09. En Paraguay, la actividad de la influenza estuvo elevada, ubicándose en nivelas de baja intensidad, con la circulación de influenza B (linaje indeterminado); los indicadores de gravedad estuvieron bajos. La actividad del SARS-CoV-2 estuvo baja, excepto en Brasil y Chile, mientras que la actividad del VRS sigue estando elevada en Brasil. Influenza Aviar: el resumen sobre la situación epidemiológica de influenza aviar en la región, manejo de los casos y recomendaciones se encuentran disponibles en Alertas y actualizaciones epidemiológicas | OPS/OMS | Organización Panamericana de la Salud (paho.org)

5 non-COVID vaccine recommendations from ACIP.

Although COVID-19 vaccination remains at the forefront, ACIP has offered guidance on MMR, pneumococcal, influenza, and travel vaccines. Here's a round-up.

Potential health and economic impact of paediatric vaccination using next-generation influenza vaccines in Kenya: a modelling study.

BACKGROUND: Influenza is a major year-round cause of respiratory illness in Kenya, particularly in children under 5. Current influenza vaccines result in short-term, strain-specific immunity and were found in a previous study not to be cost-effective in Kenya. However, next-generation vaccines are in development that may have a greater impact and cost-effectiveness profile. METHODS: We expanded a model previously used to evaluate the cost-effectiveness of seasonal influenza vaccines in Kenya to include next-generation vaccines by allowing for enhanced vaccine characteristics and multi-annual immunity. We specifically examined vaccinating children under 5 years of age with improved vaccines, evaluating vaccines with combinations of increased vaccine effectiveness, cross-protection between strains (breadth) and duration of immunity. We evaluated cost-effectiveness using incremental cost-effectiveness ratios (ICERs) and incremental net monetary benefits (INMBs) for a range of values for the willingness-to-pay (WTP) per DALY averted. Finally, we estimated threshold per-dose vaccine prices at which vaccination becomes cost-effective. RESULTS: Next-generation vaccines can be cost-effective, dependent on the vaccine characteristics and assumed WTP thresholds. Universal vaccines (assumed to provide long-term and broad immunity) are most cost-effective in Kenya across three of four WTP thresholds evaluated, with the lowest median value of ICER per DALY averted ($263, 95% Credible Interval (CrI): $ - 1698, $1061) and the highest median INMBs. At a WTP of $623, universal vaccines are cost-effective at or below a median price of $5.16 per dose (95% CrI: $0.94, $18.57). We also show that the assumed mechanism underlying infection-derived immunity strongly impacts vaccine outcomes. CONCLUSIONS: This evaluation provides evidence for country-level decision makers about future next-generation vaccine introduction, as well as global research funders about the potential market for these vaccines. Next-generation vaccines may offer a cost-effective intervention to reduce influenza burden in low-income countries with year-round seasonality like Kenya.

Acute respiratory infection emergency access in a tertiary care children hospital in Italy, prior and after the SARS-CoV-2 emergence.

Background: The COVID-19 pandemic has changed the epidemiology of acute respiratory infections (ARIs) in children. The aims of the present study were to describe the epidemiological trend of ARI emergency visits and virology results prior and after the SARS-CoV-2 emergence and to estimate the association of ARI emergency department (ED) visits with respiratory viruses. Methods: This study was conducted at the Bambino Gesù Children's Hospital, a tertiary care children's hospital in the Lazio Region, Italy. The demographic and clinical information of children who accessed the ED and were diagnosed with ARI from January 1, 2018 to June 30, 2022 was retrospectively extracted from the electronic health records. The observed temporal trends in viruses diagnosed from respiratory samples were compared with the number of ARI ED visits over the same period through a multivariable linear regression model. Results: During the study period, there were 72,959 ED admissions for ARIs and 33,355 respiratory samples resulted positive for viruses. Prior to the pandemic, respiratory syncytial virus (RSV) and influenza had a clear seasonal pattern, which was interrupted in 2020. In 2021-2022, RSV reached the highest peak observed during the study period, whereas influenza activity was minimal. The peaks of ARI ED visits corresponded to peaks of influenza, RSV, and rhinovirus in the 2018-2019 and 2019-2020 seasons, to SARS-CoV-2 and rhinovirus in 2020, and to RSV and parainfluenza in 2021-2022. Conclusions: ARI resulting in ED visits should be included in the ARI disease burden measurement for a more accurate measure of the impact of preventive measures.

Kinetics of interferon-λ and receptor expression in response to in vitro respiratory viral infection.

The major protective immune response against viruses is the production of type I and III interferons (IFNs). IFNs induce the expression of hundreds of IFN-stimulated genes (ISGs) that block viral replication and further viral spread. In this report, we analyzed the expression of IFNs and some ISGs (MxA, PKR, OAS-1, IFIT-1, RIG-1, MDA5, SOCS-1) in alveolar epithelial cells (A549) in response to infection with influenza A viruses (A/California/07/09 (H1N1pdm); A/Texas/50/12 (H3N2)); influenza B virus (B/Phuket/3073/13); adenovirus type 5 and 6; or respiratory syncytial virus (strain A2). Influenza B virus had the ability to most rapidly induce IFNs and ISGs as well as to stimulate excessive IFN-α, IFN-ß and IFN-λ secretion. It seems curious that IAV H1N1pdm did not induce IFN-λ secretion, but enhanced type I IFN and interleukin (IL)-6 production. We emphasized the importance of the negative regulation of virus-triggered signaling and cellular IFN response. We showed a decrease in IFNLR1 mRNA in the case of IBV infection. The attenuation of SOCS-1 expression in IAV H1N1pdm can be considered as the inability of the system to restore the immune status. Presumably, the lack of negative feedback loop regulation of proinflammatory immune response may be a factor contributing to the particular pathogenicity of several strains of influenza. Keywords: lambda interferons; MxA; influenza; respiratory syncytial virus; A549 cells.

Influenza A virus coinfection dynamics are shaped by distinct virus-virus interactions within and between cells.

When multiple viral populations propagate within the same host environment, they often shape each other's dynamics. These interactions can be positive or negative and can occur at multiple scales, from coinfection of a cell to co-circulation at a global population level. For influenza A viruses (IAVs), the delivery of multiple viral genomes to a cell substantially increases burst size. However, despite its relevance for IAV evolution through reassortment, the implications of this positive density dependence for coinfection between distinct IAVs has not been explored. Furthermore, the extent to which these interactions within the cell shape viral dynamics at the level of the host remains unclear. Here we show that, within cells, diverse coinfecting IAVs strongly augment the replication of a focal strain, irrespective of their homology to the focal strain. Coinfecting viruses with a low intrinsic reliance on multiple infection offer the greatest benefit. Nevertheless, virus-virus interactions at the level of the whole host are antagonistic. This antagonism is recapitulated in cell culture when the coinfecting virus is introduced several hours prior to the focal strain or under conditions conducive to multiple rounds of viral replication. Together, these data suggest that beneficial virus-virus interactions within cells are counterbalanced by competition for susceptible cells during viral propagation through a tissue. The integration of virus-virus interactions across scales is critical in defining the outcomes of viral coinfection.

The Effect of the COVID-19 Pandemic on Pediatric Respiratory Hospitalizations.

BACKGROUND: During coronavirus disease 2019 (COVID-19) pandemic, less isolation of common winter viruses was reported in the southern hemisphere. OBJECTIVES: To evaluate annual trends in respiratory disease-related admissions in a large Israeli hospital during and before the pandemic. METHODS: A retrospective analysis of medical records from November 2020 to January 2021 (winter season) was conducted and compared to the same period in two previous years. Data included number of admissions, epidemiological and clinical presentation, and isolation of respiratory pathogens. RESULTS: There were 1488 respiratory hospitalizations (58% males): 632 in 2018-2019, 701 in 2019-2020, and 155 in 2020-2021. Daily admissions decreased significantly from a median value of 6 (interquartile range [IQR] 4-9) and 7 per day (IQR 6-10) for 2018-2019 and 2019-2020, respectively, to only 1 per day (IQR 1-3) in 2020-2021 (P-value < 0.001). The incidence of all respiratory viruses decreased significantly during the COVID-19 pandemic, with no hospitalizations due to influenza and only one with respiratory syncytial virus. There was also a significant decline in respiratory viral and bacterial co-infections during the pandemic (P-value < 0.001). CONCLUSIONS: There was a significant decline in pediatric respiratory admission rates during the COVID-19 pandemic. Possible etiologies include epidemiological factors such as mask wearing and social distancing, in addition to biological factors such as viral interference. A herd protection effect of adults and older children wearing masks may also have had an impact.

A fatal case of COVID-19-associated meningoencephalitis in a patient coinfected with influenza A.

We report a case of COVID-19-associated meningoencephalitis with a fatal outcome in a male patient with concomitant influenza A, who had been hospitalized at the beginning of 2022, in the Northeastern region of Brazil. He died due to cardiopulmonary arrest after developing status epilepticus on the third day of hospitalization. The SARS-CoV-2 RNA was detected in cerebrospinal fluid and Influenza A was detected in the nasopharyngeal swab. Meningoencephalitis due to COVID-19 is a rare manifestation and physicians must be aware of this complication, mainly during the pandemic. In viral co-circulation situations, the possibility of respiratory coinfections should be remembered.