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

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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Influenza virus inhibits respiratory syncytial virus (RSV) infection via a two-wave expression of interferon-induced protein with tetratricopeptide (IFIT) proteins

10.1101/2020.08.17.253708 ◽

2020 ◽

Author(s):

Yaron Drori ◽

Jasmine Jacob-Hirsch ◽

Rakefet Pando ◽

Aharona Glatman-Freedman ◽

Nehemya Friedman ◽

...

Keyword(s):

Mass Spectrometry ◽

Influenza Virus ◽

Respiratory Syncytial Virus ◽

Influenza Infection ◽

Treatment Strategies ◽

Respiratory Viruses ◽

Influenza Viruses ◽

Rsv Infection ◽

Syncytial Virus ◽

Mouse Lungs

AbstractInfluenza viruses and respiratory syncytial virus (RSV) are respiratory viruses that primarily circulate worldwide during the autumn and winter seasons. Seasonal surveillance shows that RSV infection generally precedes influenza. However, in the last four winter seasons (2016-2020) an overlap of the morbidity peaks of both viruses was observed in Israel, and was paralleled by significantly lower RSV infection rates. To investigate whether the influenza virus inhibits RSV we performed coinfection of Human cervical carcinoma (HEp2) cells or mice with influenza and RSV and we observed that the influenza inhibited RSV growth, both in vitro and in vivo. Mass spectrometry analysis of mouse lungs infected with influenza identified a two-wave pattern of protein expression upregulation, which included members of the interferon-induced protein with tetratricopeptide (IFITs) family. Interestingly, in the second peak of upregulation, influenza viruses were no longer detectable in mouse lungs. We also observed that knockdown and overexpression of IFITs in HEp2 cells affected RSV multiplicity. In conclusion, influenza infection inhibits RSV infectivity via upregulation of IFIT proteins in a two-wave modality. Understanding of the interaction between influenza and RSV viruses and immune system involvement will contribute to the development and optimization of future treatment strategies against these viruses.Author SummaryRespiratory syncytial virus (RSV) and influenza viruses are both respiratory viruses associated with morbidity and mortality worldwide. RSV is usually detected in October, with a clear peak in December, whereas influenza virus arrives in November and peaks in January. In the last four seasons, influenza infection overlapped with that of RSV in Israel, which resulted in decreased morbidity of RSV suggesting that influenza virus inhibits RSV infection. To identify the mechanism responsible for the influenza inhibition of RSV we performed experiments in culture and in mice. We observed that influenza infection results in two wave modality of inhibition of RSV infection. Using mass spectrometry perfornmed on lungs from infected mice we show that influenza infection induces the expression of (IFIT) family of proteins which also showed a two-wave modality. Using knockdown and overexpression experiments we showed that indeed the IFTIs inhibits RSV infection. Our study provides new insights on the interaction between influenza and RSV viruses and immune system involvement and contribute to the development of future treatment strategies against these viruses.

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Investigation of influenza and respiratory viruses in hospitalised patients with influenza-like illness in an emergency room

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10893 ◽

2019 ◽

Vol 13 (11) ◽

pp. 1021-1028

Author(s):

Pinar Aysert-Yildiz ◽

Firdevs Aktas

Keyword(s):

Influenza Virus ◽

Hospital Admission ◽

Emergency Room ◽

Active Surveillance ◽

Influenza Virus Infection ◽

Respiratory Viruses ◽

University Hospital ◽

Influenza Like Illness ◽

Hospitalised Patients ◽

Icd 10

Introduction: Influenza-like illness (ILI) surveillance is usually performed using outpatient data, and information on the surveillance of patients hospitalised for ILI, which is critical for the complete assessment of the influenza burden, is lacking. Methodology: In this prospective active surveillance study, patients with community-acquired ILI hospitalised for at least 24 hours in the Emergency Room (ER) of Gazi University Hospital were identified according to the ICD-10 codes at hospital admission through active surveillance of the 2013–2014 and 2014–2015 influenza seasons. The presence of influenza and other respiratory viruses was analysed in the nasopharyngeal or pharyngeal specimens by real-time polymerase chain reaction. Results: 351 patients admitted to emergency room with certain ICD-10 codes were assessed, and 111 patients with ILI were included in the study. We detected 15 influenza and 23 other respiratory viruses in 33 of the 111 patients. More than one virus was detected in 5 patients. No virus was detected in a majority of the patients with ILI. The sensitivity of hospital admission/discharge ICD-10 codes used in the study to detect real influenza cases was low. Patients with influenza were admitted to the hospital more frequently with high fever symptoms compared with patients with influenza virus-negative and other respiratory virus-positive (p < 0.05). Conclusions: This study revealed that non-influenza respiratory viruses were a major contributor to ILI. Patients admitted with fever during the influenza seasons should be evaluated for influenza virus infection, and the use of diagnostic codes in surveillance studies can lead to incorrect results.

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Mortality Following Isolation of Various Respiratory Viruses in Nursing Home Residents

Infection Control and Hospital Epidemiology ◽

10.1086/501589 ◽

1999 ◽

Vol 20 (12) ◽

pp. 812-815 ◽

Cited By ~ 33

Author(s):

Paul J. Drinka ◽

Stefan Gravenstein ◽

Elizabeth Langer ◽

Peggy Krause ◽

Peter Shult

Keyword(s):

Nursing Home ◽

Influenza A ◽

Skilled Nursing Facility ◽

Nursing Home Residents ◽

Respiratory Illness ◽

Respiratory Viruses ◽

Influenza B ◽

Respiratory Pathogens ◽

Syncytial Virus ◽

Viral Respiratory

AbstractObjective:To compare mortality following isolation of influenza A to mortality following isolation of other respiratory viruses in a nursing home.Setting:The Wisconsin Veterans Home, a 688-bed skilled nursing facility for veterans and their spouses.Participants:All residents with respiratory viral isolates obtained between 1988 and 1999.Design:Thirty-day mortality was determined following each culture-proven illness.Results:Thirty-day mortality following isolation of viral respiratory pathogens was 4.7% (15/322) for influenza A 5.4% (7/129) for influenza B; 6.1% (3/49) for parainfluenza type 1; 0% (0/26) for parainfluenza types 2,3, and 4; 0% (0/26) for respiratory syncytial virus (RSV); and 1.6% (1/61) for rhinovirus.Conclusions:Mortality following isolation of certain other respiratory viruses may be comparable to that following influenza A (although influenza A mortality might be higher without vaccination and antiviral agents). The use of uniform secretion precautions for all viral respiratory illness deserves consideration in nursing homes.

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Thapsigargin Is a Broad-Spectrum Inhibitor of Major Human Respiratory Viruses: Coronavirus, Respiratory Syncytial Virus and Influenza A Virus

Viruses ◽

10.3390/v13020234 ◽

2021 ◽

Vol 13 (2) ◽

pp. 234

Author(s):

Sarah Al-Beltagi ◽

Cristian Alexandru Preda ◽

Leah V. Goulding ◽

Joe James ◽

Juan Pu ◽

...

Keyword(s):

Influenza Virus ◽

Respiratory Syncytial Virus ◽

Influenza A Virus ◽

Broad Spectrum ◽

Influenza A ◽

Respiratory Viruses ◽

Influenza Viruses ◽

Virus Challenge ◽

2009 H1n1 ◽

Syncytial Virus

The long-term control strategy of SARS-CoV-2 and other major respiratory viruses needs to include antivirals to treat acute infections, in addition to the judicious use of effective vaccines. Whilst COVID-19 vaccines are being rolled out for mass vaccination, the modest number of antivirals in use or development for any disease bears testament to the challenges of antiviral development. We recently showed that non-cytotoxic levels of thapsigargin (TG), an inhibitor of the sarcoplasmic/endoplasmic reticulum (ER) Ca2+ ATPase pump, induces a potent host innate immune antiviral response that blocks influenza A virus replication. Here we show that TG is also highly effective in blocking the replication of respiratory syncytial virus (RSV), common cold coronavirus OC43, SARS-CoV-2 and influenza A virus in immortalized or primary human cells. TG’s antiviral performance was significantly better than remdesivir and ribavirin in their respective inhibition of OC43 and RSV. Notably, TG was just as inhibitory to coronaviruses (OC43 and SARS-CoV-2) and influenza viruses (USSR H1N1 and pdm 2009 H1N1) in separate infections as in co-infections. Post-infection oral gavage of acid-stable TG protected mice against a lethal influenza virus challenge. Together with its ability to inhibit the different viruses before or during active infection, and with an antiviral duration of at least 48 h post-TG exposure, we propose that TG (or its derivatives) is a promising broad-spectrum inhibitor against SARS-CoV-2, OC43, RSV and influenza virus.

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Performance of case definitions and clinical predictors for influenza surveillance among patients followed in a rural cohort in Senegal

BMC Infectious Diseases ◽

10.1186/s12879-020-05724-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mamadou Aliou Barry ◽

Florent Arinal ◽

Cheikh Talla ◽

Boris Gildas Hedible ◽

Fatoumata Diene Sarr ◽

...

Keyword(s):

Influenza Virus ◽

Virus Infection ◽

Sore Throat ◽

Predictive Value ◽

Influenza Infection ◽

Clinical Signs ◽

Influenza Virus Infection ◽

Nasal Discharge ◽

Age Group ◽

Case Definitions

Abstract Background Influenza is a major cause of morbidity and mortality in Africa. However, a lack of epidemiological data remains for this pathology, and the performances of the influenza-like illness (ILI) case definitions used for sentinel surveillance have never been evaluated in Senegal. This study aimed to i) assess the performance of three different ILI case definitions, adopted by the WHO, USA-CDC (CDC) and European-CDC (ECDC) and ii) identify clinical factors associated with a positive diagnosis for Influenza in order to develop an algorithm fitted for the Senegalese context. Methods All 657 patients with a febrile pathological episode (FPE) between January 2013 and December 2016 were followed in a cohort study in two rural villages in Senegal, accounting for 1653 FPE observations with nasopharyngeal sampling and influenza virus screening by rRT-PCR. For each FPE, general characteristics and clinical signs presented by patients were collected. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for the three ILI case definitions were assessed using PCR result as the reference test. Associations between clinical signs and influenza infection were analyzed using logistic regression with generalized estimating equations. Sore throat, arthralgia or myalgia were missing for children under 5 years. Results WHO, CDC and ECDC case definitions had similar sensitivity (81.0%; 95%CI: 77.0–85.0) and NPV (91.0%; 95%CI: 89.0–93.1) while the WHO and CDC ILI case definitions had the highest specificity (52.0%; 95%CI: 49.1–54.5) and PPV (32.0%; 95%CI: 30.0–35.0). These performances varied by age groups. In children < 5 years, the significant predictors of influenza virus infection were cough and nasal discharge. In patients from 5 years, cough, nasal discharge, sore throat and asthenia grade 3 best predicted influenza infection. The addition of “nasal discharge” as a symptom to the WHO case definition decreased sensitivity but increased specificity, particularly in the pediatric population. Conclusion In summary, all three definitions studies (WHO, ECDC & CDC) have similar performance, even by age group. The revised WHO ILI definition could be chosen for surveillance purposes for its simplicity. Symptomatic predictors of influenza virus infection vary according the age group.

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Increased Detection of Viruses in Children with Respiratory Tract Infection Using PCR

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020564 ◽

2020 ◽

Vol 17 (2) ◽

pp. 564 ◽

Cited By ~ 7

Author(s):

Chien-Yu Lin ◽

David Hwang ◽

Nan-Chang Chiu ◽

Li-Chuan Weng ◽

Hsin-Fu Liu ◽

...

Keyword(s):

Influenza Virus ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Respiratory Viruses ◽

Accurate Diagnosis ◽

Human Bocavirus ◽

Detection Rates ◽

Syncytial Virus ◽

Antigen Tests

Respiratory viruses are a common cause of respiratory tract infection (RTI), particularly in neonates and children. Rapid and accurate diagnosis of viral infections could improve clinical outcomes and reduce the use of antibiotics and treatment sessions. Advances in diagnostic technology contribute to the accurate detection of viruses. We performed a multiplex real-time polymerase chain reaction (PCR) to investigate the viral etiology in pediatric patients and compared the detection rates with those determined using traditional antigen tests and virus cultures. Fifteen respiratory viruses were included in our investigation: respiratory syncytial virus A/B (RSV), influenza virus A (FluA) and influenza virus B (FluB), human metapneumovirus (MPV), enterovirus (EV), human parainfluenza virus (PIV) types 1–4, human rhinovirus (RV), human coronavirus OC43, NL63, and 229E, human adenovirus (ADV), and human bocavirus (Boca). In total, 474 specimens were collected and tested. Respiratory viruses were detected more frequently by PCR (357, 75.3%) than they were by traditional tests (229, 49.3%). The leading pathogens were RSV (113, 23.8%), RV (72, 15.2%), PIV3 (53, 11.2%), FluA (51, 10.8%), and ADV (48, 10.1%). For children younger than 5 years, RSV and RV were most prevalent; for children older than 5 years, FluA and ADV were the most frequently detected. Of the specimens, 25.8% (92/357) were coinfected with two or more viruses. RV, Boca, PIV2, FluB, and PIV4 had higher rates of coinfection; MPV and PIV1 had the lowest rates of coinfection (9.1% and 5.3%). To conclude, the detection power of PCR was better than that of traditional antigen tests and virus cultures when considering the detection of respiratory viruses. RSV and RV were the leading viral pathogens identified in the respiratory specimens. One-quarter of the positive specimens were coinfected with two or more viruses. In the future, further application of PCR may contribute to the rapid and accurate diagnosis of respiratory viruses and could improve patient outcomes.

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Circulation of Respiratory Viruses in Hospitalized Adults before and during the COVID-19 Pandemic in Brescia, Italy: A Retrospective Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189525 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9525

Author(s):

Maria Antonia De Francesco ◽

Caterina Pollara ◽

Franco Gargiulo ◽

Mauro Giacomelli ◽

Arnaldo Caruso

Keyword(s):

Respiratory Syncytial Virus ◽

Influenza A ◽

Statistical Significance ◽

Respiratory Viruses ◽

Influenza Viruses ◽

Contact Tracing ◽

Nucleic Acid Detection ◽

Respiratory Pathogens ◽

Syncytial Virus ◽

Human Coronaviruses

Different preventive public health measures were adopted globally to limit the spread of SARS-CoV-2, such as hand hygiene and the use of masks, travel restrictions, social distance actions such as the closure of schools and workplaces, case and contact tracing, quarantine and lockdown. These measures, in particular physical distancing and the use of masks, might have contributed to containing the spread of other respiratory viruses that occurs principally by contact and droplet routes. The aim of this study was to evaluate the prevalence of different respiratory viruses (influenza viruses A and B, respiratory syncytial virus, parainfluenza viruses 1, 2, 3 and 4, rhinovirus, adenovirus, metapneumovirus and human coronaviruses) after one year of the pandemic. Furthermore, another aim was to evaluate the possible impact of these non-pharmaceutical measures on the circulation of seasonal respiratory viruses. This single center study was conducted between January 2017–February 2020 (pre-pandemic period) and March 2020–May 2021 (pandemic period). All adults >18 years with respiratory symptoms and tested for respiratory pathogens were included in the study. Nucleic acid detection of all respiratory viruses was performed by multiplex real time PCR. Our results show that the test positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus and human coronaviruses decreased with statistical significance during the pandemic. Contrary to this, for adenovirus the decrease was not statistically significant. Conversely, a statistically significant increase was detected for rhinovirus. Coinfections between different respiratory viruses were observed during the pre-pandemic period, while the only coinfection detected during pandemic was between SARS-CoV-2 and rhinovirus. To understand how the preventive strategies against SARS-CoV-2 might alter the transmission dynamics and epidemic patterns of respiratory viruses is fundamental to guide future preventive recommendations.

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Routine blood parameters are helpful for early identification of influenza infection in children

10.21203/rs.3.rs-54705/v2 ◽

2020 ◽

Author(s):

Ronghe Zhu ◽

Cuie Chen ◽

Qiu Wang ◽

Xixi Zhang ◽

Chaosheng Lu ◽

...

Keyword(s):

Influenza Virus ◽

Virus Infection ◽

Influenza A Virus ◽

Early Identification ◽

Influenza A ◽

Influenza Infection ◽

Influenza Virus Infection ◽

Cutoff Value ◽

Routine Blood ◽

Influenza A Virus Infection

Abstract Purpose Routine blood parameters, such as the lymphocyte (LYM) count, platelet (PLT) count, lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), LYM*PLT and mean platelet volume-to-platelet ratio (MPV/PLT), are widely used to predict the prognosis of infectious diseases. We aimed to explore the value of these parameters in the early identification of influenza virus infection in children.Methods We conducted a single-center, retrospective, observational study of fever with influenza-like symptoms in pediatric outpatients from different age groups and evaluated the predictive value of various routine blood parameters measured within 48 hours of the onset of fever for influenza virus infection.Results The LYM count, PLT count, LMR and LYM*PLT were lower, and the NLR and MPV/PLT were higher in children with an influenza infection (PCR-confirmed and symptomatic). The LYM count, LMR and LYM*PLT in the influenza infection group were lower in the 1- to 6-year-old subgroup, and the LMR and LYM*PLT in the influenza infection group were lower in the >6-year-old subgroup. In the 1- to 6-year-old subgroup, the cutoff value of the LMR for predicting influenza A virus infection was 3.75, the sensitivity was 81.87%, the specificity was 84.31%, and the area under the curve (AUC) was 0.886; the cutoff value of the LMR for predicting influenza B virus infection was 3.71, the sensitivity was 73.58%, the specificity was 84.31%, and the AUC was 0.843. In the >6-year-old subgroup, the cutoff value of the LMR for predicting influenza A virus infection was 3.05, the sensitivity was 89.27%, the specificity was 89.61%, and the AUC was 0.949; the cutoff value of the LMR for predicting influenza B virus infection was 2.88, the sensitivity was 83.19%, the specificity was 92.21%, and the AUC was 0.924.Conclusions Routine blood tests are simple, inexpensive and easy to perform, and they are useful for the early identification of influenza virus infection in children. The LMR had the strongest predictive value for influenza virus infection in children older than 1 year, particularly influenza A virus infection.

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Brugada-Like Electrocardiographic Changes during Influenza Infection

Journal of International Medical Research ◽

10.1177/147323000303100313 ◽

2003 ◽

Vol 31 (3) ◽

pp. 244-246 ◽

Cited By ~ 8

Author(s):

K Kusaka ◽

J Yamakawa ◽

K Kawaura ◽

T Itoh ◽

T Takahashi ◽

...

Keyword(s):

Influenza Virus ◽

Virus Infection ◽

Viral Infection ◽

Brugada Syndrome ◽

Influenza Infection ◽

Influenza Virus Infection ◽

Ecg Changes ◽

Early Repolarization ◽

Electrocardiographic Changes

We describe a 32-year-old man with electrocardiographic (ECG) changes consistent with Brugada syndrome and influenza virus infection. The ECG pattern changed after 1 week to one of early repolarization in V1 and V2. This case suggests an association between Brugada syndrome and viral infection.

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RSV burden among hospitalized patients: 6-years surveillance of Liguria regional reference lab

European Journal of Public Health ◽

10.1093/eurpub/ckz186.522 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

F Grammatico ◽

F Butera ◽

I G Iavarone ◽

I Schenone ◽

C Arcuri ◽

...

Keyword(s):

Surveillance System ◽

Adult Population ◽

Respiratory Viruses ◽

Hospitalized Patients ◽

University Hospital ◽

Reference Laboratory ◽

Rsv Infection ◽

Syncytial Virus ◽

Virological Surveillance ◽

Regional Reference

Abstract Background Respiratory syncytial virus (RSV) represents one of the most common agent causing respiratory infections in infants and adults. It causes seasonal epidemics, with a peak prevalence in winter. RSV epidemiology and burden are still under-recognized, although it leads to complications and increased mortality in patients at risk, such as infants, pregnant women, the elderly and patients with chronic diseases. Materials/Methods Data analyzed in this study were collected during the virological surveillance system activities at the Policlinico San Martino university hospital in Genoa, Italy. The regional reference laboratory receive swabs from all Liguria region, and detects the main circulating respiratory viruses by using molecular methods. The proportion rate of RSV (subtypes A and B) positive samples was determined in the period January 2013 - December 2018, stratifying data by gender, age and hospital units. Results From January 2013 to December 2018, 14911 swabs were analyzed, 585 patients reported at least once RSV positive respiratory sample. The median age of RSV positive patients was 56 years (IQR 27-71), with a males: females ratio of 0.93: 1. The peak RSV infection period occurred mainly during first quarter, confirming the seasonal trend of the virus. Greatest proportion of RSV positive samples were received from hematology-oncology wards (45.2% of isolations) and medicine units (31.9%). From 2013 to 2018 an increase of swabs collection of 207% was observed. Neonatology and pediatrics resulted in the highest rate of positive swabs (above 30%), hemato-oncology departments collected 7932 swabs with 3,3 % resulted positive. Conclusions A virological surveillance system able to detect the principal respiratory viruses circulating in adult population is a key element to better understand the RSV epidemiology and evaluate therapeutical strategies, in view of the availability of effective vaccines able to prevent RSV infection in the next future. Key messages RSV represents a leading cause of respiratory disease in hospitalized patients, especially in hematology-oncology, medicine and intensive care unit wards. Virological surveillance is a key element to better understand RSV epidemiology in all ages, in view of the availability of new effective vaccines.

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