1264. Healthcare-Acquired Influenza in Critical Ill Patients

Abstract Background Healthcare-associated infections (HAIs) increases morbidity and mortality. During 2014, at Hospital Clínico Red de Salud UC CHRISTUS (RS-UCCH), was estimated that 15% of viral respiratory infections were acquired during hospitalization, and influenza was the main etiologic agent. The aim of this study was to obtain clinical characterization of HAIs due to influenza virus in patients hospitalized in critical care units (CCU) and special care units (chronic patients who need hospitalized nurse care). Methods Descriptive study of CCU and special care patients with hospital acquired influenza during 2014–2017. HAI due to influenza was defined as: symptoms onset and/or positive influenza PCR ≥48 hours after hospital admission, without previous respiratory symptoms or with negative PCR. Results 22 patients with median age of 74 years old were identified, only three pediatric cases. The average time of acquired influenza was at 13th day of hospitalization. In 77% Influenza A was the only agent detected and 27% had respiratory co-infection. Thirteen (59%) were previously hospitalized in CCU, but only 2 (15%) due to respiratory problems. Nineteen patients (86%) presented comorbidity such as arterial hypertension (59%), chronic kidney disease (18%), and immunosuppression (18%). Half of them had a decompensation, mainly respiratory, associated to influenza infection. The observed lethality was 18%. Among all the influenza HAI, 59% occurred in unvaccinated patients, although 46% of them met criteria for vaccination recommendation. Conclusion HAI due to influenza occurred in chronic, older, and unvaccinated patients. Education about HAIs and continuing high vaccination coverage must be a priority. Disclosures All authors: No reported disclosures.

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The Past, Present, and Future of Healthcare-Associated Infection Prevention in Pediatrics: Viral Respiratory Infections

Infection Control and Hospital Epidemiology ◽

10.1086/655990 ◽

2010 ◽

Vol 31 (S1) ◽

pp. S22-S26 ◽

Cited By ~ 6

Author(s):

Danielle M. Zerr ◽

Aaron M. Milstone ◽

W. Charles Huskins ◽

Kristina A. Bryant

Keyword(s):

Influenza A ◽

Infection Prevention ◽

Virus Isolation ◽

Respiratory Infections ◽

Healthcare Associated Infection ◽

The Past ◽

Viral Respiratory Infections ◽

Healthcare Associated ◽

Pediatric Infection ◽

Viral Respiratory

Viral respiratory infections pose a significant challenge to pediatric infection prevention programs. We explore issues regarding the prevention of viral respiratory infections by discussing transmission of influenza A virus, isolation of infected patients, and hospital programs for influenza vaccination.

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Viral respiratory infections during the 2009 influenza A(H1N1) outbreak in the West Midlands Region, UK

Epidemiology and Infection ◽

10.1017/s0950268811002251 ◽

2011 ◽

Vol 140 (9) ◽

pp. 1551-1556 ◽

Cited By ~ 5

Author(s):

H. E. TANNER ◽

M. D. CURRAN ◽

E. H. BOXALL ◽

H. OSMAN

Keyword(s):

Influenza A ◽

Respiratory Infections ◽

Respiratory Viruses ◽

Virus Infections ◽

Influenza Outbreak ◽

Influenza A H1n1 ◽

Significant Difference ◽

West Midlands ◽

The Uk ◽

Viral Respiratory Infections

SUMMARYIn spring 2009 a new strain of influenza A(H1N1) emerged and caused a worldwide pandemic. This study utilized a large collection of respiratory specimens from suspected cases of influenza A(H1N1) in the UK West Midlands during the pandemic in order to investigate which other respiratory viruses were circulating and whether they played any role in the increased hospitalization rates seen during that period. Study specimens were selected from community and hospitalized patients positive and negative for influenza A(H1N1) and tested by PCR for other respiratory viruses. A number of infections diagnosed as influenza during the summer influenza outbreak were found to be due to other virus infections (most commonly rhinovirus). No statistically significant difference was found between the rates of respiratory virus co-infection with H1N1 in patients from community or hospital locations suggesting underlying factors were likely to be more significant than viral co-infections in determining severity of influenza A(H1N1) disease.

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1332. Clinical Indicators for When Bronchoalveolar Lavage (BAL) Is Needed Beyond Nasopharyngeal Swab (NP) Testing for Viral Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1524 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S754-S754

Author(s):

Patrizia Ulrich ◽

Derrick Chen

Keyword(s):

Influenza A ◽

Respiratory Infections ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Nasopharyngeal Swab ◽

Test Results ◽

Clinical Indicators ◽

Gi Symptoms ◽

Viral Respiratory Infections ◽

Viral Respiratory

Abstract Background This study evaluated the yield of testing NP vs BAL specimens using a multiplex PCR respiratory viral panel (RVP). Methods A retrospective chart review was conducted on all patients from 10/2017-3/2021 who had both an NP swab and BAL tested by RVP within a 4-week period. Results There were 477 cases where patients had both an NP and BAL specimen tested by RVP. Results were NP-/BAL- for 361 (76%) cases, NP+/BAL+ for 58 (12%), NP-/BAL+ for 40 (8%), and NP+/BAL- for 18 (4%). For NP+/BAL+, NP-/BAL+, and NP+/BAL-, respectively, rhinovirus was detected in 23 (40%), 3 (8%), and 16 (89%) cases (p< 0.001); influenza A or B in 9 (16%), 7 (18%), and 0 (0%) (ns); adenovirus in 3 (5%), 10 (25%), and 2 (11%) (p< 0.05); metapneumovirus in 9 (16%), 8 (20%), 2 (11%) (ns); RSV in 8 (14%), 6 (15%), and 1 (6%) (ns); and, parainfluenza in 7 (12%), 6 (15%), and 1 (6%) (ns), respectively. Average ages were 48, 48, and 48 years; numbers of males were 34 (58%), 28 (70%), and 11 (61%); immunocompromised were 56 (97%), 37 (92%), and 17 (94%); and, 16 (28%), 10 (25%), and 6 (33%) had an active malignancy, respectively (all ns). Average symptom durations prior to presentation were 7.0, 13.1, and 9.6 days (ns); pulmonary exams were abnormal in 35 (60%), 24 (60%), and 5 (28%) cases (p< 0.05); shortness of breath (SOB) was present in 40 (69%), 25 (62%), and 8 (44%) (ns); lower respiratory tract infection (LRTI) symptoms were absent in 1 (2%), 12 (30%), and 8 (45%) cases (p< 0.01); when spirometry values were available, they were reduced in 28/31 (90%), 15/19 (79%), and 3/8 (37%) cases (p< 0.05); and, mean SpO2 levels were 91.5%, 93.9%, and 93.7% (ns), respectively. Mean temperatures were 99.0F, 99.0F, and 99.1F (ns); chills, sweats, and malaise were present in 27 (47%), 13 (33%), and 3 (17%) cases (p< 0.05); GI symptoms were present in 20 (34%), 5 (13%), and 10 (56%) cases (p< 0.05); and, acute kidney injury was present in 38 (66%), 13 (33%), and 6 (33%) cases (p< 0.05), respectively. Conclusion Most (88%) RVP test results were concordant between NP and BAL. There were significant differences between cases of NP+/BAL+, NP-/BAL+, and NP+/BAL-. Rhinovirus and GI symptoms were more common for NP+/BAL- vs NP-/BAL+. Conversely, pulmonary exams were more often abnormal and spirometry values reduced for NP-/BAL+ vs NP+/BAL-. Disclosures All Authors: No reported disclosures

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The Crossroads between Host Copper Metabolism and Influenza Infection

International Journal of Molecular Sciences ◽

10.3390/ijms22115498 ◽

2021 ◽

Vol 22 (11) ◽

pp. 5498

Author(s):

Ludmila V. Puchkova ◽

Irina V. Kiseleva ◽

Elena V. Polishchuk ◽

Massimo Broggini ◽

Ekaterina Yu. Ilyechova

Keyword(s):

Respiratory Infections ◽

Influenza Infection ◽

Copper Metabolism ◽

Viral Proteins ◽

Metabolic System ◽

Copper Status ◽

Viral Particles ◽

Viral Respiratory Infections ◽

Genetic Constructs ◽

Host Metabolism

Three main approaches are used to combat severe viral respiratory infections. The first is preemptive vaccination that blocks infection. Weakened or dead viral particles, as well as genetic constructs carrying viral proteins or information about them, are used as an antigen. However, the viral genome is very evolutionary labile and changes continuously. Second, chemical agents are used during infection and inhibit the function of a number of viral proteins. However, these drugs lose their effectiveness because the virus can rapidly acquire resistance to them. The third is the search for points in the host metabolism the effect on which would suppress the replication of the virus but would not have a significant effect on the metabolism of the host. Here, we consider the possibility of using the copper metabolic system as a target to reduce the severity of influenza infection. This is facilitated by the fact that, in mammals, copper status can be rapidly reduced by silver nanoparticles and restored after their cancellation.

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Comparison of symptoms of influenza A with abacavir-associated hypersensitivity reaction

International Journal of STD & AIDS ◽

10.1258/095646203322025795 ◽

2003 ◽

Vol 14 (7) ◽

pp. 478-481 ◽

Cited By ~ 17

Author(s):

Philip Keiser ◽

Naiel Nassar ◽

Daniel Skiest ◽

Charla Andrews ◽

Beena Yazdani ◽

...

Keyword(s):

Multivariate Analysis ◽

Hypersensitivity Reaction ◽

Odds Ratio ◽

Influenza A ◽

Respiratory Symptoms ◽

Respiratory Infections ◽

Gastrointestinal Symptoms ◽

Gi Symptoms ◽

Viral Respiratory Infections ◽

Viral Respiratory

Differentiation between abacavir hypersensitivity and viral respiratory infections is problematic. Fifteen cases of abacavir hypersensitivity were matched to 30 controls with culture proven influenza A with no abacavir exposure. Rash was associated with hypersensitivity (odds ratio [OR] = 13.1, P = 0.02) as was the presence of nausea (OR = 30, P < 0.001), vomiting (OR = 17.1, P = 0.001) or diarrhoea (OR = 22, P < 0.001). The number of gastrointestinal symptoms was also predictive of hypersensitivity reaction ( P < 0.001). Respiratory symptoms (cough, sore throat, or dyspnoea) were not associated with abacavir hypersensitivity (OR = 0.08, P = 0.001). Multivariate analysis confirmed the following associations for abacavir hypersensitivity: the number of gastrointestinal symptoms (OR = 8.6, P = 0.0032), cough (OR = 0.039, P = 0.02) and rash (OR = 16.9, P = 0.07). Abacavir hypersensitivity is strongly associated with gastrointestinal (GI) symptoms. Cough without GI symptoms is associated with influenza.

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Influenza

10.33442/vt202143 ◽

2021 ◽

Author(s):

Leong Hoe Nam

Keyword(s):

Influenza Virus ◽

Pandemic Influenza ◽

Influenza A ◽

Respiratory Infections ◽

Rna Virus ◽

Treatment Options ◽

Antigenic Drift ◽

New Techniques ◽

Influenza A H1n1 ◽

Viral Respiratory Infections

The influenza virus is a segmented RNA virus with different mechanisms for mutations, and hence for minor (antigenic drift) and major (antigenic shift) changes. Influenza virus A was responsible for pandemics on average every 30 years in the past, with the most recent being the 2009 swine-origin influenza A H1N1 (SO-H1N1). The clinical picture is unspecific: seasonal or pandemic influenza cannot be differentiated from other viral respiratory infections on clinical grounds. PCR has become the standard for microbiological confirmation of the diagnosis. Treatment options remain limited with neuraminidase inhibitors (oseltamivir; zanamivir). Resistance may occur under treatment or under prophylaxis; however, it is still rare overall. Vaccination is still the preferred method for prevention. However, the long lead time for production (at least 6 months) poses a challenge. Innovative new techniques like cell culture or recombinant productions are urgently needed. Pandemic influenza vaccines for SO-H1N1 were shown to be effective and safe in children, pregnant women, adults, and also in elderly. Pre-pandemic vaccines (H5N1) are also available.

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Effect of the 2009 Influenza A/H1N1 Pandemic on Viral Respiratory Infections in the First Year of Life

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0b013e31825f29db ◽

2012 ◽

Vol 31 (11) ◽

pp. 1107-1112 ◽

Cited By ~ 8

Author(s):

Linda C. Ede ◽

Michael J. Loeffelholz ◽

Pedro Alvarez-Fernandez ◽

Dan L. Pong ◽

Janak A. Patel ◽

...

Keyword(s):

Influenza A ◽

Respiratory Infections ◽

First Year ◽

H1n1 Pandemic ◽

Influenza A H1n1 ◽

Viral Respiratory Infections ◽

First Year Of Life ◽

Viral Respiratory

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Challenges and Strategies of Laboratory Diagnosis for Newly Emerging Influenza Viruses in Taiwan: A Decade after SARS

BioMed Research International ◽

10.1155/2015/805306 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Jih-Hui Lin ◽

Ho-Sheng Wu

Keyword(s):

Public Health ◽

Influenza A ◽

Respiratory Infections ◽

Laboratory Diagnosis ◽

Influenza Viruses ◽

Health Concern ◽

Potential Threat ◽

First Case ◽

National Public Health ◽

Viral Respiratory Infections

Since the first case of severe acute respiratory syndrome (SARS) in Taiwan was identified in March 2003, viral respiratory infections, in particular the influenza virus, have become a national public health concern. Taiwan would face a serious threat of public health problems if another SARS epidemic overlapped with a flu outbreak. After SARS, the Taiwan Centers for Disease Control accelerated and strengthened domestic research on influenza and expanded the exchange of information with international counterparts. The capacity of influenza A to cross species barriers presents a potential threat to human health. Given the mutations of avian flu viruses such as H7N9, H6N1, and H10N8, all countries, including Taiwan, must equip themselves to face a possible epidemic or pandemic. Such preparedness requires global collaboration.

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Burden of Healthcare-Associated Viral Respiratory Infections in Children’s Hospitals

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piw072 ◽

2016 ◽

Vol 7 (1) ◽

pp. 18-24 ◽

Cited By ~ 5

Author(s):

Caroline Quach ◽

Rita Shah ◽

Lorry G Rubin

Keyword(s):

New York ◽

Intensive Care ◽

Respiratory Infections ◽

Medical Center ◽

Incidence Rates ◽

Children's Hospitals ◽

Children’S Hospitals ◽

Viral Respiratory Infections ◽

Healthcare Associated ◽

Viral Respiratory

Abstract Objective Although healthcare-associated (HA) viral respiratory infections (VRIs) are common in pediatrics, no benchmark for comparison exists. We aimed to determine, compare, and assess determinants of unit-specific HA-VRI incidence rates in 2 children’s hospitals. Methods This study was a retrospective comparison of prospective cohorts. The Montreal Children’s Hospital and the Cohen Children’s Medical Center of New York perform prospective surveillance for HA-VRI using standardized definitions that require the presence of symptoms compatible with VRI and virus detection. Cases detected between April 1, 2010, and March 31, 2013, were identified using surveillance databases. Annual incidence rates were calculated, and a generalized estimating equation model was used to assess determinants of HA-VRI rates. Results The overall HA-VRI rate during the 3-year study period was significantly higher at Montreal Children’s Hospital than that at Cohen Children’s Medical Center of New York (1.91 vs 0.80 per 1000 patient-days, respectively;P < .0001). Overall, the HA-VRI incidence rate was lowest in the neonatal intensive care unit. Rates in the pediatric intensive care, oncology, and medical/surgical units were similar. The most common etiology of HA-VRI at both institutions was rhinovirus (49% of cases), followed by parainfluenza virus and respiratory syncytial virus. Hospitals with less than 50% single rooms had HA-VRI rates 1.33 (95% confidence interval, 1.29–1.37) times higher than hospitals with more than 50% single rooms for a given unit type. Conclusions HA-VRI rates were substantial but different among 2 children’s hospitals. Future studies should examine the effect of HA-VRI and evaluate best practices for preventing such infections.

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Association Between Children’s Hospital Visitor Restrictions and Healthcare-Associated Viral Respiratory Infections: A Quasi-Experimental Study

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piz023 ◽

2019 ◽

Vol 9 (2) ◽

pp. 240-243 ◽

Cited By ~ 4

Author(s):

Hawa Forkpa ◽

Angela H Rupp ◽

Stanford T Shulman ◽

Sameer J Patel ◽

Elizabeth L Gray ◽

...

Keyword(s):

Respiratory Virus ◽

Respiratory Infections ◽

Virus Transmission ◽

Index Number ◽

Transmission Index ◽

Viral Respiratory Infection ◽

Quasi Experimental ◽

Viral Respiratory Infections ◽

Healthcare Associated ◽

Viral Respiratory

AbstractWe investigated the effect of annual winter visitor restrictions on hospital respiratory virus transmission. The healthcare-associated (HA) viral respiratory infection (VRI) transmission index (number of HA VRIs per 100 inpatient community-associated VRIs) was 59% lower during the months in which visitor restrictions were implemented. These data prompt consideration for instituting year-round visitor restrictions.

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