A randomized controlled trial to evaluate the effect of influenza vaccination and probiotic supplementation on immune response and incidence of influenza-like illness in an elderly population in Indonesia

Aim To investigate the effect of influenza vaccination with or without probiotic supplementation on the immune response and incidence of influenza-like illness (ILI) in the elderly. Methods A randomized double-blind, placebo-controlled trial with a modified factorial design was conducted in 554 healthy elderly subjects aged 67 ± 5.6 (ranging from 60–90) years old in the Primary Health Care Center (Puskesmas area) of the Pulo Gadung District East Jakarta. Subjects received either a trivalent influenza vaccine or placebo at the start of the study, and a probiotic supplement (Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011) or a placebo for 6 months. Subjects were randomly assigned into four intervention groups: influenza vaccine and probiotics (n = 141), influenza vaccine and placebo (n = 136), placebo and probiotics (n = 140), and both placebo (n = 137). The primary outcome was ILI incidence within 6 months. The secondary outcomes were seroprotection and seroconversion rates at 1, 4, and 6 months after administering the interventions. Results This study showed that the trivalent influenza vaccine increased seroprotection (RR 3.6 [95%CI 2.92–4.47]; p<0.010) and seroconversion (RR 29.8 [95%CI 11.1–79.5]; p<0.010) rates 1 month after vaccination in elderly people while the probiotic supplement did not alter influenza antibody titers (p = 1.000 and p = 0.210). The relative ILI incidence risk was similar between vaccinated and non-vaccinated groups, as well as in the probiotic group compared to the non-probiotic group. Conclusion The tested trivalent influenza vaccine significantly induced seroprotection and seroconversion in the vaccinated subjects, while probiotics administration did not influence these parameters. Vaccinated individuals displayed a similarly low ILI incidence as those in the Control Group. However, the observed trend towards a reduction of ILI incidence with probiotics supplementation warrants further assessments in a larger, at-risk population. Clinical trial registry number NCT03695432.

Seroprevalence of SARS-CoV-2 in a Large Cohort of Italian Police Officers

Certain professional categories are at a high occupational exposure to COVID-19. The aim of this survey was to quantify the seroprevalence of SARS-CoV-2 among police officers in Italy and identify its correlates. In this cross-sectional study, a nationally representative sample of State police employees was tested for IgG and IgM before the start of the National vaccination campaign. A total of 10,535 subjects (approximately 10% of the total workforce) participated in the study. The overall seroprevalence was 4.8% (95% CI: 4.4–5.3%). However, seropositivity was unevenly distributed across the country with a clear (p < 0.001) North–South gradient. In particular, the seroprevalence was 5.6 times higher in northern regions than in southern regions (9.0% vs 1.6%). Most (71.2%) seropositive subjects reported having no recent symptoms potentially attributable to SARS-CoV-2 infection. Previous dysosmia, dysgeusia, and influenza-like illness symptoms were positive predictors of being seropositive. However, the prognostic value of dysosmia depended (p < 0.05) on both sex and prior influenza-like illness. The baseline seroprevalence of SARS-CoV-2 in police employees is considerable. A significant risk of occupational exposure, frequent asymptomatic cases and the progressive waning of neutralizing antibodies suggest that the police workers should be considered among the job categories prioritized for the booster COVID-19 vaccine dose.

The National Burden of Influenza-Like Illness and Severe Respiratory Illness Overall and Associated with Nine Respiratory Viruses in South Africa, 2013-2015

Background Estimates of the disease burden associated with different respiratory viruses are severely limited in low- and middle-income countries, especially in Africa. Methods We estimated age-specific numbers and rates of medically and non-medically attended influenza-like illness (ILI) and severe respiratory illness (SRI) that were associated with influenza, respiratory syncytial virus (RSV), rhinovirus, human metapneumovirus, adenovirus, enterovirus and parainfluenza virus types 1-3 after adjusting for the attributable fraction (AF) of virus detection to illness in South Africa during 2013-2015. Rates were reported per 100,000 population. Results The mean annual rates were 51,383 and 4,196 for ILI and SRI, respectively. Of these, 26% (for ILI) and 46% (for SRI) were medically attended. Among outpatients with ILI, rhinovirus had the highest AF-adjusted rate (7,221), followed by influenza (6,443) and adenovirus (1,364); whereas, among inpatients with SRI, rhinovirus had the highest AF-adjusted rate (400), followed by RSV (247) and influenza (130). Rhinovirus (9,424) and RSV (2,026) had the highest AF-adjusted rates among children aged <5 years with ILI or SRI, respectively; whereas rhinovirus (757) and influenza (306) had the highest AF-adjusted rates among individuals aged ≥65 years with ILI or SRI, respectively Conclusions There was a substantial burden of ILI and SRI in South Africa during 2013-2015. Rhinovirus and influenza had a prominent disease burden among patients with ILI. Rhinovirus had the highest burden of illness among patients of any age with SRI, followed by RSV. RSV and influenza were the most prominent causes of SRI in children and the elderly, respectively.

Efficacy of Influenza Like Illness (ILI) Screening OPD for COVID-19 at a High-Volume Centre: Unlocking Routine OPD

Background: The Impact of COVID-19 pandemic over non-essential health services has been massive. We initiated Influenza Like Illness (ILI) screening for resumption of out-patient services at a tertiary care centre and this study attempted to gauge its efficacy in effectively pruning out COVID-19. Methods: We included all the patients who had visited for an OPD appointment during the study period. Patient details and ILI symptoms were noted. Patients were then followed up telephonically after 2 weeks. The telephonic follow up was to ensure RT-PCR status and complaints of any newly developed ILI post OPD visit (within the last 14 days). Results: Out of the 957 patients who were enrolled, 929 patients were successfully followed up telephonically after 14 days. Only 13 who were screened out as ‘possible ILI’, were either RT-PCR negative or did not follow up with a confirmatory test. The telephonic follow up to ensure RT-PCR status and complaints of any newly developed ILI post OPD visit (within the last 14 days) was noted in the rest of the patients. Only 1 participant out of 957 screened, tested positive for COVID-19. Conclusion:The period in which the study was held the national positivity rate was low (around 3%). Therefore, in a resource limited country such as India it is astute to restart the OPD services in the pre-existing setup using basic precautions and a verbal questionnaire during the slope of the pandemic.