410. Influence of Pre-season Antibody Titers to Influenza on Influenza Risk in a Cohort of Healthcare Personnel

Abstract Background Influenza (flu) and other respiratory viruses circulate regularly throughout healthcare systems, often placing healthcare personnel (HCP) at high risk for illness. Hemagglutination inhibition (HAI) titers are associated with protection from flu illness, though few studies have characterized HAI in HCP. The Respiratory Protection Effectiveness Clinical Trial (ResPECT), provided HAI titers and data to assess infection risk based on four flu seasons. Participants from multiple outpatient settings wore respiratory protection within six feet of symptomatic patients. Methods Serological samples obtained at the beginning and end of each season and anterior nasopharyngeal swabs were taken randomly and when participants reported respiratory symptoms were assessed. Our primary outcome was PCR-confirmed influenza. Results During 5,180 participant-seasons of observation, 128 PCR-confirmed influenza A infections (20 H1N1, 108 H3N2) and 34 PCR-confirmed influenza B infections. 4,041 (78%) reported receiving an annual influenza vaccine. Each log base 2 increase in titer subtype-specific titer reduced the hazard of influenza infection with A/H3N2 by 18%(Relative Risk (RR) 0.82 95% CI 0.72,0.94), by 28% for influenza B (RR 0.72 95% CI 0.56,0.92 and by 25% for influenza A H1N1 (RR 0.75 95% CI 0.57–1.0). After adjusting for HAI titers, age was not significantly associated with risk for any of the subtypes. Conclusion In this prospective cohort of monitored HCPs, these findings support the current literature demonstrating that HAI titers are associated with protection from influenza infection. The relationship between HAI titers, influenza, and vaccination is complex, however. Vaccination was not shown to be associated with infection outcome in our model, though their effect may be difficult to separate from their effect on HAI titers. Disclosures Trish M. Perl, MD, MSc, 7–11: Advisory Board; medimmune: Research Grant.

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Comparison of Serum Hemagglutinin and Neuraminidase Inhibition Antibodies After 2010–2011 Trivalent Inactivated Influenza Vaccination in Healthcare Personnel

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu115 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 17

Author(s):

Maryrose R. Laguio-Vila ◽

Mark G. Thompson ◽

Sue Reynolds ◽

Sarah M. Spencer ◽

Manjusha Gaglani ◽

...

Keyword(s):

Influenza Vaccine ◽

Influenza A ◽

Influenza Infection ◽

Fold Increase ◽

Healthcare Personnel ◽

Virus Infections ◽

Influenza A Viruses ◽

Duration Of Illness ◽

Antibody Titers ◽

Influenza Vaccinations

Abstract Background. Most inactivated influenza vaccines contain purified and standardized hemagglutinin (HA) and residual neuraminidase (NA) antigens. Vaccine-associated HA antibody responses (hemagglutination inhibition [HAI]) are well described, but less is known about the immune response to the NA. Methods. Serum of 1349 healthcare personnel (HCP) electing or declining the 2010–2011 trivalent-inactivated influenza vaccine ([IIV3], containing A/California/7/2009 p(H1N1), A/Perth/16/2009 [H3N2], B/Brisbane/60/2008 strains) were tested for NA-inhibiting (NAI) antibody by a modified lectin-based assay using pseudotyped N1 and N2 influenza A viruses with an irrelevant (H5) HA. Neuraminidase-inhibiting and HAI antibody titers were evaluated approximately 30 days after vaccination and end-of-season for those with polymerase chain reaction (PCR)-confirmed influenza infection. Results. In 916 HCP (68%) receiving IIV3, a 2-fold increase in N1 and N2 NAI antibody occurred in 63.7% and 47.3%, respectively. Smaller responses occurred in HCP age >50 years and those without prior 2009–2010 IIV3 nor monovalent A(H1N1)pdm09 influenza vaccinations. Forty-four PCR-confirmed influenza infections were observed, primarily affecting those with lower pre-exposure HAI and NAI antibodies. Higher pre-NAI titers correlated with shorter duration of illness for A(H1N1)pdm09 virus infections. Conclusions. Trivalent-inactivated influenza vaccine is modestly immunogenic for N1 and N2 antigens in HCP. Vaccines eliciting robust NA immune responses may improve efficacy and reduce influenza-associated morbidity.

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Invasive Aspergillosis Associated With Severe Influenza Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw171 ◽

2016 ◽

Vol 3 (3) ◽

Cited By ~ 56

Author(s):

Nancy F. Crum-Cianflone

Keyword(s):

Invasive Aspergillosis ◽

Influenza A ◽

English Language ◽

Fungal Infections ◽

Influenza Infection ◽

Invasive Disease ◽

Influenza B ◽

European Organization ◽

Severe Influenza ◽

Influenza A H1n1

Abstract Background. Invasive aspergillosis may occur in the setting of severe influenza infections due to viral-induced respiratory epithelium disruption and impaired immune effects, but data are limited. Methods. A retrospective study was conducted among severe influenza cases requiring medical intensive care unit (ICU) admission at an academic center during the 2015–2016 season. Data collected included respiratory cultures, medical conditions and immunosuppressants, laboratory and radiographic data, and outcomes. A systematic literature review of published cases in the English language of aspergillosis complicating influenza was conducted. Results. Six (75%) of 8 ICU influenza cases had Aspergillus isolated; 5 were classified as invasive disease. No ICU patient testing negative for influenza infection developed aspergillosis during the study period. Among cases with invasive aspergillosis, influenza infection was type A (H1N1) (n = 2) and influenza B (n = 3). Published and current cases yielded n = 57 (European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria: 37% proven, 25% probable, and 39% possible cases). An increasing number of cases were reported since 2010. Sixty-five percent of cases lacked classic underlying conditions at admission for aspergillosis, 86% had lymphopenia, and 46% died. Conclusions. Aspergillosis may occur in the setting of severe influenza infections even among immunocompetent hosts. Risks may include influenza A (H1N1) or B infections and viral-induced lymphopenia, although further studies are needed. Prompt diagnosis and antifungal therapy are recommended given high mortality rates.

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Comparison of Immune Response to the Influenza Vaccine in Obese and Nonobese Healthcare Workers

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2014.59 ◽

2015 ◽

Vol 36 (3) ◽

pp. 249-253 ◽

Cited By ~ 4

Author(s):

Michael A. Sweet ◽

Jonathan A. McCullers ◽

Paul R. Lasala ◽

Frank E. Briggs ◽

Anne Smithmyer ◽

...

Keyword(s):

Influenza Vaccine ◽

Healthcare Workers ◽

Influenza A ◽

Medical Center ◽

Geometric Mean ◽

Fold Increase ◽

Influenza B ◽

Influenza A H1n1 ◽

Significant Difference ◽

Antibody Titers

OBJECTIVETo determine whether there is a difference in antibody titers and functionality after receipt of the influenza vaccine for obese versus nonobese healthcare workers (HCW).DESIGNProspective observational study.SETTINGTertiary medical center.PARTICIPANTSHealthcare workers.METHODSBaseline influenza antibody titers for obese and nonobese HCW were recorded during the hospital’s 2011 annual influenza vaccination day and follow-up antibody titers were measured 4 weeks later. Antibodies were measured using the hemagglutination inhibition assay and functionality was measured using the micro-neutralization method.RESULTSOf 200 initial HCWs, 190 completed the study (97 obese and 93 nonobese). Seroprotection after immunization was not significantly different for nonobese compared with obese HCW for each strain (influenza A [H1N1], 99% and 99%; influenza A [H3N2], 100% and 99%; and influenza B, 67% and 71%, respectively)All geometric mean titers measured by micro-neutralization showed statistically significant increases in activity. In comparison, there was no difference in the 4-fold increase in H1N1 or B titers. There was a significant difference in the 4-fold increase of H3N2 titers between the nonobese and obese HCWs (82/93 [88%] vs 64/97 [66%], P=.003)In an ad hoc analysis we found that obese HCWs had a statistically greater number of 4-fold decreases in titers with H1N1 and H3N2.CONCLUSIONSThere was no significant difference in protection from influenza between obese and nonobese HCWs after immunization.Infect Control Hosp Epidemiol 2014;00(0): 1–5

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Estimation of influenza activity in Vojvodina (Serbia) for five consecutive influenza seasons

Vojnosanitetski pregled ◽

10.2298/vsp160906379r ◽

2018 ◽

Vol 75 (6) ◽

pp. 589-597

Author(s):

Mioljub Ristic ◽

Mirjana Strbac ◽

Snezana Medic ◽

Vladimir Petrovic

Keyword(s):

Influenza A ◽

Influenza Season ◽

Influenza Infection ◽

Laboratory Data ◽

Respiratory Illness ◽

Case Definition ◽

Influenza Surveillance ◽

Influenza B ◽

Case Definitions ◽

Influenza A H1n1

Background/Aim. After pandemic 2009/10 influenza season, influenza A (H1N1)pdm09, A(H3N2) and B viruses have continued to circulate in the population. The aim of this study was to describe the epidemiological and virological characteristics of influenza and evaluate values of proposed case definitions of influenza like illness (ILI), severe acute respiratory illness (SARI) and acute respiratory distress syndrome (ARDS) for detecting laboratory-confirmed influenza cases in Vojvodina. Methods. We conducted a descriptive epidemiological study using surveillance reports and laboratory data from October 2010 to May 2015 (five surveillance seasons). Results. Out of 1,466 samples collected, 720 (49.1%) were laboratory confirmed as influenza. Influenza A infection was more frequently detected than influenza B infection. Using the case definition of ILI was a good predictor for influenza confirmation (p < 0.05) during 5 influenza seasons. The predominant age-range of patients with confirmed influenza A (42.2%) and B (43.0%) infections was 30 to 64, but the patients aged from 15 to 29 years were more likely to have influenza A (p = 0.0168). In the period from December to January, influenza A (17.8%) was more frequently registered than influenza B (7.6%). The highest number of deaths (19/38) and hospitalized patients (128/402) was registered during the last influenza season (2014/15). The immunosuppressed patients with confirmed influenza infection were more likely to have influenza B than influenza A (p = 0.0110). Conclusion. Our results indicate that influenza surveillance should be continued and expanded in order to fully assess the burden of the disease in given population.

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Epidemiology of seasonal influenza infection in pregnant women and its impact on birth outcomes

Epidemiology and Infection ◽

10.1017/s0950268817001972 ◽

2017 ◽

Vol 145 (14) ◽

pp. 2930-2939 ◽

Cited By ~ 9

Author(s):

A. K. REGAN ◽

H. C. MOORE ◽

S. G. SULLIVAN ◽

N. DE KLERK ◽

P. V. EFFLER

Keyword(s):

Pregnant Women ◽

Influenza A ◽

Seasonal Influenza ◽

Infant Health ◽

Influenza Infection ◽

Population Based ◽

Influenza B ◽

Influenza A H1n1 ◽

Epidemiological Characteristics ◽

The Impact

SUMMARYSeasonal influenza can cause significant morbidity in pregnant women. Much of the existing epidemiological evidence on influenza during pregnancy has focused on the 2009 A/H1N1 pandemic. To measure the epidemiological characteristics of seasonal influenza infection among pregnant women and the impact on infant health, a cohort of 86 779 pregnancies during the influenza season (2012–2014) was established using probabilistic linkage of notifiable infectious disease, hospital admission, and birth information. A total of 192 laboratory-confirmed influenza infections were identified (2·2 per 1000 pregnancies), 14·6% of which were admitted to hospital. There was no difference in the proportion of infections admitted to hospital by trimester or subtype of infection. Influenza B infections were more likely to occur in second trimester compared with influenza A/H3N2 and influenza A/H1N1 infections (41·3%, 23·6%, and 33·3%, respectively), and on average, infants born to women with influenza B during pregnancy had 4·0% (95% CI 0·3–7·6%) lower birth weight relative to optimal compared with infants born to uninfected women (P = 0·03). Results from this linked population-based study suggest that there are differences in maternal infection by virus type and subtype and support the provision of seasonal influenza vaccine to pregnant women.

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Differential Expression of Serum Exosome microRNAs and Cytokines in Influenza A and B Patients Collected in the 2016 and 2017 Influenza Seasons

Pathogens ◽

10.3390/pathogens10020149 ◽

2021 ◽

Vol 10 (2) ◽

pp. 149

Author(s):

Sreekumar Othumpangat ◽

William G. Lindsley ◽

Donald H. Beezhold ◽

Michael L. Kashon ◽

Carmen N. Burrell ◽

...

Keyword(s):

Healthy Volunteers ◽

Influenza A ◽

Influenza Infection ◽

Cell Types ◽

Airway Epithelial Cells ◽

Differentially Expressed ◽

Influenza B ◽

Airway Epithelial ◽

Monocyte Chemoattractant Protein 1 ◽

Novel Approach

MicroRNAs (miRNAs) have remarkable stability and are key regulators of mRNA transcripts for several essential proteins required for the survival of cells and replication of the virus. Exosomes are thought to play an essential role in intercellular communications by transporting proteins and miRNAs, making them ideal in the search for biomarkers. Evidence suggests that miRNAs are involved in the regulation of influenza virus replication in many cell types. During the 2016 and 2017 influenza season, we collected blood samples from 54 patients infected with influenza and from 30 healthy volunteers to identify the potential role of circulating serum miRNAs and cytokines in influenza infection. Data comparing the exosomal miRNAs in patients with influenza B to healthy volunteers showed 76 miRNAs that were differentially expressed (p < 0.05). In contrast, 26 miRNAs were differentially expressed between patients with influenza A (p < 0.05) and the controls. Of these miRNAs, 11 were commonly expressed in both the influenza A and B patients. Interferon (IFN)-inducing protein 10 (IP-10), which is involved in IFN synthesis during influenza infection, showed the highest level of expression in both influenza A and B patients. Influenza A patients showed increased expression of IFNα, GM-CSF, interleukin (IL)-13, IL-17A, IL-1β, IL-6 and TNFα, while influenza B induced increased levels of EGF, G-CSF, IL-1α, MIP-1α, and TNF-β. In addition, hsa-miR-326, hsa-miR-15b-5p, hsa-miR-885, hsa-miR-122-5p, hsa-miR-133a-3p, and hsa-miR-150-5p showed high correlations to IL-6, IL-15, IL-17A, IL-1β, and monocyte chemoattractant protein-1 (MCP-1) with both strains of influenza. Next-generation sequencing studies of H1N1-infected human lung small airway epithelial cells also showed similar pattern of expression of miR-375-5p, miR-143-3p, 199a-3p, and miR-199a-5p compared to influenza A patients. In summary, this study provides insights into the miRNA profiling in both influenza A and B virus in circulation and a novel approach to identify the early infections through a combination of cytokines and miRNA expression.

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Influenza: An Emerging and Re-emerging Public Health Threat in Nepal

Annals of Clinical Chemistry and Laboratory Medicine ◽

10.3126/acclm.v3i2.20737 ◽

2018 ◽

Vol 3 (2) ◽

pp. 1-2

Author(s):

Bishnu Prasad Upadhyay

Keyword(s):

Influenza Virus ◽

Influenza A ◽

Winter Season ◽

Emerging Infectious Diseases ◽

Influenza Viruses ◽

Influenza B ◽

Influenza A Viruses ◽

Influenza A H1n1 ◽

New Variant ◽

Seasonal Epidemics

Influenza virus type A and B are responsible for seasonal epidemics as well as pandemics in human. Influenza A viruses are further divided into two major groups namely, low pathogenic seasonal influenza (A/H1N1, A/H1N1 pdm09, A/H3N2) and highly pathogenic influenza virus (H5N1, H5N6, H7N9) on the basis of two surface antigens: hemagglutinin (HA) and neuraminidase (NA). Mutations, including substitutions, deletions, and insertions, are one of the most important mechanisms for producing new variant of influenza viruses. During the last 30 years; more than 50 viral threat has been evolved in South-East Asian countriesof them influenza is one of the major emerging and re-emerging infectious diseases of global concern. Similar to tropical and sub-tropical countries of Southeast Asia; circulation of A/H1N1 pdm09, A/H3N2 and influenza B has been circulating throughout the year with the peak during July-November in Nepal. However; the rate of infection transmission reach peak during the post-rain and winter season of Nepal.

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Effectiveness of seasonal influenza vaccine for adults and children in preventing laboratory-confirmed influenza in primary care in the United Kingdom: 2015/16 end-of-season results

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.38.30348 ◽

2016 ◽

Vol 21 (38) ◽

Cited By ~ 56

Author(s):

Richard Pebody ◽

Fiona Warburton ◽

Joanna Ellis ◽

Nick Andrews ◽

Alison Potts ◽

...

Keyword(s):

Primary Care ◽

United Kingdom ◽

Influenza Vaccine ◽

Influenza A ◽

Immunisation Programme ◽

Influenza B ◽

Live Attenuated Influenza Vaccine ◽

The United Kingdom ◽

Influenza A H1n1 ◽

The Uk

The United Kingdom (UK) is in the third season of introducing universal paediatric influenza vaccination with a quadrivalent live attenuated influenza vaccine (LAIV). The 2015/16 season in the UK was initially dominated by influenza A(H1N1)pdm09 and then influenza of B/Victoria lineage, not contained in that season’s adult trivalent inactivated influenza vaccine (IIV). Overall adjusted end-of-season vaccine effectiveness (VE) was 52.4% (95% confidence interval (CI): 41.0–61.6) against influenza-confirmed primary care consultation, 54.5% (95% CI: 41.6–64.5) against influenza A(H1N1)pdm09 and 54.2% (95% CI: 33.1–68.6) against influenza B. In 2–17 year-olds, adjusted VE for LAIV was 57.6% (95% CI: 25.1 to 76.0) against any influenza, 81.4% (95% CI: 39.6–94.3) against influenza B and 41.5% (95% CI: −8.5 to 68.5) against influenza A(H1N1)pdm09. These estimates demonstrate moderate to good levels of protection, particularly against influenza B in children, but relatively less against influenza A(H1N1)pdm09. Despite lineage mismatch in the trivalent IIV, adults younger than 65 years were still protected against influenza B. These results provide reassurance for the UK to continue its influenza immunisation programme planned for 2016/17.

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Virological analysis of fatal influenza cases in the United Kingdom during the early wave of influenza in winter 2010/11

Eurosurveillance ◽

10.2807/ese.16.01.19760-en ◽

2011 ◽

Vol 16 (1) ◽

Author(s):

J Ellis ◽

M Galiano ◽

R Pebody ◽

A Lackenby ◽

CI Thompson ◽

...

Keyword(s):

United Kingdom ◽

Vaccine Strain ◽

Influenza A ◽

Influenza Season ◽

Severe Illness ◽

Influenza B ◽

The United Kingdom ◽

Influenza A H1n1 ◽

Influenza Activity ◽

Children And Young Adults

The 2010/11 winter influenza season is underway in the United Kingdom, with co-circulation of influenza A(H1N1)2009 (antigenically similar to the current 2010/11 vaccine strain), influenza B (mainly B/Victoria/2/87 lineage, similar to the 2010/11 vaccine strain) and a few sporadic influenza A(H3N2) viruses. Clinical influenza activity has been increasing. Severe illness, resulting in hospitalisation and deaths, has occurred in children and young adults and has predominantly been associated with influenza A(H1N1)2009, but also influenza B viruses.

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Evaluation of Influenza Patients Admitted in 2019–2020 Flu Season

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0041-1741003 ◽

2022 ◽

Author(s):

Bahar Öztelcan Gündüz ◽

Erman Ataş ◽

Bülent Ünay ◽

Halit Halil

Keyword(s):

Physical Examination ◽

Chronic Diseases ◽

Influenza A ◽

Influenza Infection ◽

Febrile Seizures ◽

Influenza Viruses ◽

Influenza B ◽

Close Monitoring ◽

Group 2 ◽

Group 1

Abstract Objective Influenza viruses are among the most common respiratory pathogens for all age groups, and may cause seasonal outbreaks. The aim of our study was to describe the clinical characteristics of influenza cases in the 2019–2020 flu season and to study the risk factors for hospital admission and complications. Methods This was a retrospective study in 251 children (group 1: nonhospitalized; group 2: hospitalized) with influenza in the 2019–2020 flu season. Data on demographic features, influenza type, complaints, complications, and hospitalization length were collected and recorded. Results Influenza A was detected in 199 (79.3%) patients, and influenza B was detected in 52 (20.7%); 43.4% of patients were girls and 56.6% were boys. The mean age of the patients was 3.91 ± 3.3 years (16 days to 18 years). A total of 52 (20.7%) patients were hospitalized. The age of the patients in group 2 was lower than that in group 1 (3.1 vs. 4.2 years, p = 0.03). Group 2 patients were more likely to have creatine kinase (CK) elevation, febrile seizures, and physical examination abnormalities. Group 2 patients were also more likely to have influenza A. Patients with febrile seizures, chronic diseases, abnormal physical examination findings, developed complications, and additional drug use apart from oseltamivir in the treatment were also more likely to require hospitalization. Conclusion Infants and children with chronic diseases, history of febrile seizures, complications, and the use of drugs other than antiviral drugs should be carefully evaluated in case they need hospitalization. Increasing vaccination rates, initiation of antiviral treatment for selected patients, and close monitoring of patients in risk groups can decrease morbidity and mortality. Myalgias are a common complaint in patients with acute influenza infection. Previous studies suggest CK measurement be part of the work-up for the hospitalized patient with acute influenza infection.

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