Lessons from 40 years' surveillance of influenza in England and Wales

SUMMARYThe influenza virus continues to pose a significant threat to public health throughout the world. Current avian influenza outbreaks in humans have heightened the need for improved surveillance and planning. Despite recent advances in the development of vaccines and antiviral drugs, seasonal epidemics of influenza continue to contribute significantly to general practitioner workloads, emergency hospital admissions, and deaths. In this paper we review data produced by the Royal College of General Practitioners Weekly Returns Service, a sentinel general practice surveillance network that has been in operation for over 40 years in England and Wales. We show a gradually decreasing trend in the incidence of respiratory illness associated with influenza virus infection (influenza-like illness; ILI) over the 40 years and speculate that there are limits to how far an existing virus can drift and yet produce substantial new epidemics. The burden of disease caused by influenza presented to general practitioners varies considerably by age in each winter. In the pandemic winter of 1969/70 persons of working age were most severely affected; in the serious influenza epidemic of 1989/90 children were particularly affected; in the millennium winter (in which the NHS was severely stretched) ILI was almost confined to adults, especially the elderly. Serious confounders from infections due to respiratory syncytial virus are discussed, especially in relation to assessing influenza vaccine effectiveness. Increasing pressure on hospitals during epidemic periods are shown and are attributed to changing patterns of health-care delivery.

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Vaccine effectiveness for influenza in the elderly in welfare nursing homes during an influenza A (H3N2) epidemic

Epidemiology and Infection ◽

10.1017/s0950268899004410 ◽

2000 ◽

Vol 125 (2) ◽

pp. 393-397 ◽

Cited By ~ 10

Author(s):

Y. DEGUCHI ◽

Y. TAKASUGI ◽

K. NISHIMURA

Keyword(s):

Nursing Homes ◽

Influenza Vaccine ◽

Influenza A ◽

Hospital Admissions ◽

Influenza Virus Infection ◽

Severe Infection ◽

The Elderly ◽

Trivalent Influenza Vaccine ◽

Homes For The Elderly ◽

Vaccine Effect

Influenza vaccine effect on the occurrence and severity of influenza virus infection in a population residing in nursing homes for the elderly was studied as a cohort study during an influenza A (H3N2) epidemic in Japan. Of 22462 individuals living in 301 welfare nursing homes, 10739 voluntarily received inactivated, sub-unit trivalent influenza vaccine in a programme supported by the Osaka Prefectural Government. There were statistically significantly fewer cases of influenza, hospital admissions due to severe infection, and deaths due to influenza in the vaccinated cohort compared to the unvaccinated controls. No serious adverse reactions to vaccination were recorded. Thus influenza vaccination is effective for preventing influenza disease in persons aged 65 years and over, and should be an integral part of the care of this population residing in nursing homes.

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Characterization of recombinant influenza A virus as a vector expressing respiratory syncytial virus fusion protein epitopes

Journal of General Virology ◽

10.1099/vir.0.064105-0 ◽

2014 ◽

Vol 95 (9) ◽

pp. 1886-1891 ◽

Cited By ~ 6

Author(s):

Peirui Zhang ◽

Hongjing Gu ◽

Chengrong Bian ◽

Na Liu ◽

Zhiwei Li ◽

...

Keyword(s):

Influenza Virus ◽

Respiratory Syncytial Virus ◽

Cell Line ◽

Nuclear Export ◽

Influenza A ◽

Haemagglutination Inhibition ◽

The Elderly ◽

Ns Gene ◽

Syncytial Virus

Respiratory syncytial virus (RSV) is the most common cause of respiratory infection in infants and the elderly, and no vaccine against this virus has yet been licensed. Here, we report a recombinant PR8 influenza virus with the RSV fusion (F) protein epitopes of the subgroup A gene inserted into the influenza virus non-structural (NS) gene (rFlu/RSV/F) that was generated as an RSV vaccine candidate. The rescued viruses were assessed by microscopy and Western blotting. The proper expression of NS1, the NS gene product, and the nuclear export protein (NEP) of rFlu/RSV/F was also investigated using an immunofluorescent assay. The rescued virus replicated well in the MDCK kidney cell line, A549 lung adenocarcinoma cell line and CNE-2Z nasopharyngeal carcinoma cell line. BALB/c mice immunized intranasally with rFlu/RSV/F had specific haemagglutination inhibition antibody responses against the PR8 influenza virus and RSV neutralization test proteins. Furthermore, intranasal immunization with rFlu/RSV/F elicited T helper type 1-dominant cytokine profiles against the RSV strain A2 virus. Taken together, our findings suggested that rFlu/RSV/F was immunogenic in vivo and warrants further development as a promising candidate vaccine.

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Concurrent influenza virus infection and tuberculosis in patients hospitalized with respiratory illness in Thailand

Influenza and Other Respiratory Viruses ◽

10.1111/j.1750-2659.2012.00413.x ◽

2012 ◽

Vol 7 (3) ◽

pp. 244-248 ◽

Cited By ~ 9

Author(s):

Serena Roth ◽

Sara Whitehead ◽

Somsak Thamthitiwat ◽

Malinee Chittaganpitch ◽

Susan A. Maloney ◽

...

Keyword(s):

Influenza Virus ◽

Virus Infection ◽

Influenza Virus Infection ◽

Respiratory Illness

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Occurrence of influenza B/Hong Kong-Like strains in Brazil, during 2002

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652003000100011 ◽

2003 ◽

Vol 45 (1) ◽

pp. 51-52 ◽

Cited By ~ 7

Author(s):

Terezinha Maria de Paiva ◽

Maria Akiko Ishida ◽

Maria Gisele Gonçalves ◽

Margareth Aparecida Benega ◽

Maria Candida Oliveira de Souza ◽

...

Keyword(s):

Influenza Virus ◽

Hong Kong ◽

Influenza A ◽

Vaccination Campaign ◽

Age Groups ◽

Respiratory Illness ◽

The Elderly ◽

Influenza B ◽

Surveillance Period ◽

Influenza A H1n1

Through the influenza virus surveillance from January to October 2002, influenza B/Hong Kong-like strains circulating in the Southeast and Centre East regions of Brazil have been demonstrated. This strain is a variant from B/Victoria/02/88 whose since 1991 and until recently have been isolated relatively infrequently and have been limited to South-Eastern Asia. A total of 510 respiratory secretions were collected from patients 0 to 60 years of age, with acute respiratory illness, living in the Southeast and Centre East regions of Brazil, of which 86 (17.13%) were positive for influenza virus. Among them 12 (13.95%) were characterized as B/Hong Kong/330/2001; 3 (3.49%) as B/Hong Kong/1351/2002 a variant from B/Hong Kong/330/2001; 1 (1.16%) as B/Sichuan/379/99; 1 (1.16%) as B/Shizuoka/5/2001, until now. The percentages of cases notified during the surveillance period were 34.88%, 15.12%, 15.12%, 4.65%, 15.12%, 13.95%, in the age groups of 0-4, 5-10, 11-15, 16-20, 21-30, 31-50, respectively. The highest proportion of isolates was observed among children younger than 4 years but serious morbidity and mortality has not been observed among people older than 65 years, although B influenza virus component for vaccination campaign 2002 was B/Sichuan/379/99 strain. This was probably due to the elderly protection acquired against B/Victoria/02/88. In addition, in influenza A/Panama/2007/99-like (H3N2) strains 22 (25.58%) were also detected, but influenza A(H1N1) has not been detected yet.

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INTERFERENCE BETWEEN OUTBREAKS OF RESPIRATORY SYNCYTIAL VIRUS AND INFLUENZA VIRUS INFECTION

The Lancet ◽

10.1016/s0140-6736(82)91466-0 ◽

1982 ◽

Vol 319 (8270) ◽

pp. 502 ◽

Cited By ~ 34

Author(s):

G PNESTAD

Keyword(s):

Influenza Virus ◽

Respiratory Syncytial Virus ◽

Virus Infection ◽

Influenza Virus Infection ◽

Syncytial Virus

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Further studies with short duration ribavirin aerosol for the treatment of influenza virus infection in mice and respiratory syncytial virus infection in cotton rats

Antiviral Research ◽

10.1016/0166-3542(92)90088-m ◽

1992 ◽

Vol 17 (1) ◽

pp. 33-42 ◽

Cited By ~ 23

Author(s):

Brian E. Gilbert ◽

Philip R. Wyde ◽

Mark W. Ambrose ◽

Samuel Z. Wilson ◽

Vernon Knight

Keyword(s):

Influenza Virus ◽

Respiratory Syncytial Virus ◽

Virus Infection ◽

Short Duration ◽

Respiratory Syncytial Virus Infection ◽

Influenza Virus Infection ◽

Cotton Rats ◽

Syncytial Virus

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Macrolide Therapy in Respiratory Viral Infections

Mediators of Inflammation ◽

10.1155/2012/649570 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 32

Author(s):

Jin-Young Min ◽

Yong Ju Jang

Keyword(s):

Influenza Virus ◽

Viral Infection ◽

Viral Infections ◽

Wide Spectrum ◽

Influenza Virus Infection ◽

Respiratory Viral Infection ◽

Rsv Infection ◽

Respiratory Viral Infections ◽

Syncytial Virus ◽

Viral Titers

Background. Macrolides have received considerable attention for their anti-inflammatory and immunomodulatory actions beyond the antibacterial effect. These two properties may ensure some efficacy in a wide spectrum of respiratory viral infections. We aimed to summarize the properties of macrolides and their efficacy in a range of respiratory viral infection.Methods. A search of electronic journal articles through PubMed was performed using combinations of the following keywords including macrolides and respiratory viral infection.Results. Bothin vitroandin vivostudies have provided evidence of their efficacy in respiratory viral infections including rhinovirus (RV), respiratory syncytial virus (RSV), and influenza virus. Much data showed that macrolides reduced viral titers of RV ICAM-1, which is the receptor for RV, and RV infection-induced cytokines including IL-1β, IL-6, IL-8, and TNF-α. Macrolides also reduced the release of proinflammatory cytokines which were induced by RSV infection, viral titers, RNA of RSV replication, and the susceptibility to RSV infection partly through the reduced expression of activated RhoA which is an RSV receptor. Similar effects of macrolides on the influenza virus infection and augmentation of the IL-12 by macrolides which is essential in reducing virus yield were revealed.Conclusion. This paper provides an overview on the properties of macrolides and their efficacy in various respiratory diseases.

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Discrete Dynamical Modeling of Influenza Virus Infection Suggests Age-Dependent Differences in Immunity

Journal of Virology ◽

10.1128/jvi.00395-17 ◽

2017 ◽

Vol 91 (23) ◽

Cited By ~ 2

Author(s):

Ericka Keef ◽

Li Ang Zhang ◽

David Swigon ◽

Alisa Urbano ◽

G. Bard Ermentrout ◽

...

Keyword(s):

Immune Response ◽

Influenza Virus ◽

Virus Infection ◽

Immune Responses ◽

Influenza Virus Infection ◽

The Elderly ◽

Morbidity And Mortality ◽

Age Group ◽

Rule Based ◽

Delayed Onset

ABSTRACT Immunosenescence, an age-related decline in immune function, is a major contributor to morbidity and mortality in the elderly. Older hosts exhibit a delayed onset of immunity and prolonged inflammation after an infection, leading to excess damage and a greater likelihood of death. Our study applies a rule-based model to infer which components of the immune response are most changed in an aged host. Two groups of BALB/c mice (aged 12 to 16 weeks and 72 to 76 weeks) were infected with 2 inocula: a survivable dose of 50 PFU and a lethal dose of 500 PFU. Data were measured at 10 points over 19 days in the sublethal case and at 6 points over 7 days in the lethal case, after which all mice had died. Data varied primarily in the onset of immunity, particularly the inflammatory response, which led to a 2-day delay in the clearance of the virus from older hosts in the sublethal cohort. We developed a Boolean model to describe the interactions between the virus and 21 immune components, including cells, chemokines, and cytokines, of innate and adaptive immunity. The model identifies distinct sets of rules for each age group by using Boolean operators to describe the complex series of interactions that activate and deactivate immune components. Our model accurately simulates the immune responses of mice of both ages and with both inocula included in the data (95% accurate for younger mice and 94% accurate for older mice) and shows distinct rule choices for the innate immunity arm of the model between younger and aging mice in response to influenza A virus infection. IMPORTANCE Influenza virus infection causes high morbidity and mortality rates every year, especially in the elderly. The elderly tend to have a delayed onset of many immune responses as well as prolonged inflammatory responses, leading to an overall weakened response to infection. Many of the details of immune mechanisms that change with age are currently not well understood. We present a rule-based model of the intrahost immune response to influenza virus infection. The model is fit to experimental data for young and old mice infected with influenza virus. We generated distinct sets of rules for each age group to capture the temporal differences seen in the immune responses of these mice. These rules describe a network of interactions leading to either clearance of the virus or death of the host, depending on the initial dosage of the virus. Our models clearly demonstrate differences in these two age groups, particularly in the innate immune responses.

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The burden of influenza and other respiratory viruses in hospitalized infants and children in a university hospital, Jordan

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2021.763 ◽

2021 ◽

Vol 16 ◽

Author(s):

Enas Al-Zayadneh ◽

Dina Mohammad Abu Assab ◽

Esraa Adeeb Arabiat ◽

Montaha Al-Iede ◽

Hanin Ahmad Kayed ◽

...

Keyword(s):

Influenza Virus ◽

Influenza Infection ◽

Influenza Virus Infection ◽

Respiratory Viruses ◽

University Hospital ◽

Acute Lower Respiratory Infection ◽

Respiratory Pathogens ◽

Syncytial Virus ◽

Viral Surveillance ◽

Viral Respiratory

Background: Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide in young children and is predominately caused by viral respiratory pathogens. This study aims to identify the viral etiologies of acute ALRI in hospitalized children in Jordan University Hospital and compare the clinical characteristics of influenza virus infection with other respiratory viruses. Methods: a retrospective viral surveillance study that included 152 children below 15 years of age admitted with ALRI from December 2018 through April 2019. We recorded results of real-time reverse transcriptase-polymerase chain reaction (RT- PCR ) for common respiratory viruses. Clinical and demographic information of the study population was collected from patients’ electronic medical records. Results: 152 were identified with a median age of 1 year (mean was 2.1 years). Ninety-five patients (62.5%) were males. One or more viral respiratory pathogens were detected in 145 (95.3%) children. Respiratory syncytial virus was the most commonly detected virus in 68 patients (44.8%). Influenza virus was detected in 25 (16.4%). Children with influenza infection had more fever and less leukocyte count compared to children infected with other viruses. The severity of the ALRI correlated significantly with several factors, including age less than 6 months and the presence of neuromuscular disease (p<0.05). Conclusion: Viral detection was common among children admitted with viral ALRI. Viruses, including influenza, are recognized as major contributors to the morbidity associated with ALRI. More attention is needed on strategies for the prevention and detection of viral ALRI in developing countries.

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