Cases Of Influenza Research Articles

Surveillance of Influenza and Other Airborne Transmission Viruses during the 2021/2022 Season in Hospitalized Subjects in Tuscany, Italy.

Winter in the northern hemisphere is characterized by the circulation of influenza viruses, which cause seasonal epidemics, generally from October to April. Each influenza season has its own pattern, which differs from one year to the next in terms of the first influenza case notification, the period of highest incidence, and the predominant influenza virus subtypes. After the total absence of influenza viruses in the 2020/2021 season, cases of influenza were again recorded in the 2021/2022 season, although they remained below the seasonal average. Moreover, the co-circulation of the influenza virus and the SARS-CoV-2 pandemic virus was also reported. In the context of the DRIVE study, oropharyngeal swabs were collected from 129 Tuscan adults hospitalized for severe acute respiratory infection (SARI) and analyzed by means of real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 and 21 different airborne pathogens, including influenza viruses. In total, 55 subjects tested positive for COVID-19, 9 tested positive for influenza, and 3 tested positive for both SARS-CoV-2 and the A/H3N2 influenza virus. The co-circulation of different viruses in the population requires strengthened surveillance that is no longer restricted to the winter months. Indeed, constant, year-long monitoring of the trends of these viruses is needed, especially in at-risk groups and elderly people.

Efficacy of Hemagglutinin Gene of Highly Pathogenic Avian Influenza as a Vaccine Candidate in Poultry: A Review

The most prevalent fatal disease in poultry that can result in high morbidity and mortality is highly pathogenic avian influenza (HPAI), subtype H5N1. A vaccination program is the most frequent way to prevent HPAI cases in poultry, especially against the H5 subtype of HPAI. There are currently a number of avian influenza vaccines available, including recombinant and inactivated whole virus vaccines. The foundation of a recombinant vaccine is possible by the expression of an avian influenza gene of interest following insertion into a carrier vector (no pathogenic virus). A recombinant HPAI vaccine is required to further challenge avian influenza cases in poultry. As a recombinant vaccine inserted into a carrier vector, the hemagglutinin (HA) gene has proven effective. The recombinant Herpes Virus Turkey (rHVT) vector vaccine for avian influenza has been discovered and is commercially available. The rHVT vaccine was developed using a hemagglutinin insert from the HPAI virus clade 2.2. Overall, studies in this review aimed to determine the efficacy of any developed recombinant avian influenza vaccine that uses the HA gene from different clades challenged with any avian influenza virus (AIV) isolate. It was found that the efficacy of hemagglutinin as a recombinant vaccine could be promising for future HPAI vaccine development. In addition, it is possible to design a recombinant vaccine using local isolates to protect poultry farms, particularly in endemic regions.

Influenza Vaccine Effectiveness Among Children: 2011-2020.

Infants and children are at increased risk of severe influenza virus infection and its complications. Influenza vaccine effectiveness (VE) varies by age, influenza season, and influenza virus type/subtype. This study's objective was to examine the effectiveness of inactivated influenza vaccine against outpatient influenza illness in the pediatric population over 9 influenza seasons after the 2009 A(H1N1) pandemic. During the 2011-2012 through the 2019-2020 influenza seasons at outpatient clinics at 5 sites of the US Influenza Vaccine Effectiveness Network, children aged 6 months to 17 years with an acute respiratory illness were tested for influenza using real-time, reverse-transcriptase polymerase chain reaction. Vaccine effectiveness was estimated using a test-negative design. Among 24 148 enrolled children, 28% overall tested positive for influenza, 3017 tested positive for influenza A(H3N2), 1459 for influenza A(H1N1)pdm09, and 2178 for influenza B. Among all enrollees, 39% overall were vaccinated, with 29% of influenza cases and 43% of influenza-negative controls vaccinated. Across all influenza seasons, the pooled VE for any influenza was 46% (95% confidence interval, 43-50). Overall and by type/subtype, VE against influenza illness was highest among children in the 6- to 59-month age group compared with older pediatric age groups. VE was lowest for influenza A(H3N2) virus infection. Analysis of multiple seasons suggested substantial benefit against outpatient illness. Investigation of host-specific or virus-related mechanisms that may result in differences by age and virus type/subtype may help further efforts to promote increased vaccination coverage and other influenza-related preventative measures.

Lessons (Not) Learned: Chicago Death Inequities during the 1918 Influenza and COVID-19 Pandemics

During historical and contemporary crises in the U.S., Blacks and other marginalized groups experience an increased risk for adverse health, social, and economic outcomes. These outcomes are driven by structural factors, such as poverty, racial residential segregation, and racial discrimination. These factors affect communities' exposure to risk and ability to recover from disasters, such as pandemics. This study examines whether areas where descendants of enslaved Africans and other Blacks lived in Chicago were vulnerable to excess death during the 1918 influenza pandemic and whether these disparities persisted in the same areas during the COVID-19 pandemic. To examine disparities, demographic data and influenza and pneumonia deaths were digitized from historic weekly paper maps from the week ending on 5 October 1918 to the week ending on 16 November 1918. Census tracts were labeled predominantly Black or white if the population threshold for the group in a census tract was 40% or higher for only one group. Historic neighborhood boundaries were used to aggregate census tract data. The 1918 spatial distribution of influenza and pneumonia mortality rates and cases in Chicago was then compared to the spatial distribution of COVID-19 mortality rates and cases using publicly available datasets. The results show that during the 1918 pandemic, mortality rates in white, immigrant and Black neighborhoods near industrial areas were highest. Pneumonia mortality rates in both Black and immigrant white neighborhoods near industrial areas were approximately double the rates of neighborhoods with predominantly US-born whites. Pneumonia mortality in Black and immigrant white neighborhoods, far away from industrial areas, was also higher (40% more) than in US-born white neighborhoods. Around 100 years later, COVID-19 mortality was high in areas with high concentrations of Blacks based on zip code analysis, even though the proportion of the Black population with COVID was similar or lower than other racial and immigrant groups. These findings highlight the continued cost of racial disparities in American society in the form of avoidable high rates of Black death during pandemics.

Evaluation of the influenza-like illness sentinel surveillance system: A national perspective in Tanzania from January to December 2019.

The World Health Organization (WHO) recommends periodic evaluations of influenza surveillance systems to identify areas for improvement and provide evidence of data reliability for policymaking. However, data on the performance of established influenza surveillance systems are limited in Africa, including Tanzania. We aimed to assess the usefulness of the Influenza surveillance system in Tanzania and to ascertain if the system meets its objectives, including; estimating the burden of disease caused by the Influenza virus in Tanzania and identifying any circulating viral strains with pandemic potential. From March to April 2021, we collected retrospective data through a review of the Tanzania National Influenza Surveillance System electronic forms for 2019. Furthermore, we interviewed the surveillance personnel about the system's description and operating procedures. Case definition (ILI-Influenza Like Illness and SARI-Severe Acute Respiratory Illness), results, and demographic characteristics of each patient were obtained from the Laboratory Information System (Disa*Lab) at Tanzania National Influenza Center. The United States Centers for disease control and prevention updated guidelines for evaluating public health surveillance systems were used to evaluate the system's attributes. Additionally, the system's performance indicators (including turnaround time) were obtained by evaluating Surveillance system attributes, each being scored on a scale of 1 to 5 (very poor to excellent performance). A total of 1731 nasopharyngeal and oropharyngeal samples were collected from each suspected influenza case in 2019 from fourteen (14/14) sentinel sites of the influenza surveillance system in Tanzania. Laboratory-confirmed cases were 21.5% (373/1731) with a predictive value positive of 21.7%. The majority of patients (76.1%) tested positive for Influenza A. Thirty-seven percent of patients' results met the required turnaround time, and 40% of case-based forms were incompletely filled. Although the accuracy of the data was good (100%), the consistency of the data was below (77%) the established target of ≥ 95%. The overall system performance was satisfactory in conforming with its objectives and generating accurate data, with an average performance of 100%. The system's complexity contributed to the reduced consistency of data from sentinel sites to the National Public Health Laboratory of Tanzania. Improvement in the use of the available data could be made to inform and promote preventive measures, especially among the most vulnerable population. Increasing sentinel sites would increase population coverage and the level of system representativeness.

What motivates adults to accept influenza vaccine? An assessment of incentives, ease of access, messaging, and sources of information using a discrete choice experiment

Seasonal influenza vaccination rates remain low, and contribute to preventable influenza cases, hospitalizations, and deaths in the US. While numerous interventions have been implemented to increase vaccine uptake, there is a need to determine which interventions contribute most to vaccine willingness, particularly among age groups with vaccination rates that have plateaued at suboptimal levels. This study aimed to quantify the relative effect of multiple interventions on vaccine willingness to receive influenza vaccine in three age groups using a series of hypothetical situations with different behavioral interventions.We assessed the relative impact of four categories of interventions: source of vaccine messages, type of vaccination messages, vaccination incentives, and ease of vaccine access using a discrete choice experiment. Within each category, we investigated the role of four different attributes to measure their relative contribution to willingness to be vaccinated by removing one option from each of the intervention categories. Among the 1,763 Minnesota residents who volunteered for our study, participants expressed vaccine willingness in over 80% of the scenarios presented. Easy access to drop-in vaccination sites had the greatest impact on vaccine willingness in all age groups. Among the younger age group, small financial incentives also contributed to high vaccine willingness.Our results suggest that public health programs and vaccination campaigns may improve their chances of successfully increasing vaccine willingness if they offer interventions preferred by adults, including facilitating convenient access to vaccination and offering small monetary incentives, particularly for young adults.

The Spanish Flu of 1918: A Historical Reflection and Lessons from Masonic Lodges.

A catastrophic Spanish flu pandemic spread throughout the world during 1918-1919. In the spring of 1918, an army training center at the Fort Riley Kansas reported the first cases of Spanish flu in the United States. The first reported cases of the Spanish Flu of the virus in Kansas were quite moderate. The Spanish flu took an ominous turn in the fall of 1918 when injured soldiers who contracted the Spanish flu returned to the United States, spreading the illness across urban and rural communities. During this period of the Spanish flu, the freemason lodges served as accessory hospitals to help manage the growing Spanish flu cases across the United States. In this paper, we explore the experiences, challenges, and lessons from Freemason lodges during the Spanish flu to provide context and historical insights into the overlaps between the Spanish Flu and the current COVID-19 pandemic.

Effects of radiation on respiratory disease mortality: analysis of the national registry for radiation workers in United Kingdom

Purpose While some evidence of an effect of radiation exposure on respiratory disease at low dose levels has now emerged, there is heterogeneity in the risks between different studies and countries. In this paper, we aim to show the effect of radiation on three different sub-types of respiratory disease mortality through the analysis of the NRRW cohort in UK. Materials and methods The NRRW cohort consisted of 174,541 radiation workers. Doses to the surface of the body were monitored using individual film badges. Most of the doses are associated with X-rays and gamma rays and to a less extent of beta and neutron particles. The overall mean 10-year lagged lifetime external dose was 23.2 mSv. Some workers were potentially exposed to alpha particles. However, doses from internal emitters were not available for the NRRW cohort. 25% of male workers and 17% of female workers were identified as being monitored for internal exposure. The Poisson regression methods for grouped survival data with a stratified baseline hazard function were used to describe the dependence of the risk on cumulative external radiation dose. The disease was analyzed by the following subgroups: Pneumonia (1066 cases including 17 cases of influenza), COPD and allied disease (1517 cases) and other remaining respiratory diseases (479 cases). Results There was very little radiation effect on pneumonia mortality, but evidence of a reduction in mortality risk for COPD and allied disease (ERR/Sv= −0.56, 95%CI: −0.94, −0.06; p = .02) and an increase in risk for other respiratory disease mortality (ERR/Sv = 2.30, 95%CI: 0.67, 4.62; p = .01) with increasing cumulative external dose were observed. The effects of radiation were more prominent amongst workers monitored for internal exposure. The reduction in mortality risk of COPD and allied disease per cumulative external dose was statistically significant for the radiation workers monitored for internal exposure (ERR/Sv= −0.59, 95%CI: −0.99, −0.05; p = .017) but not significant among the workers who were not monitored (ERR/Sv= −0.43, 95%CI: −1.20, 0.74; p = .42). A statistically significant increased risk was observed for other respiratory diseases among monitored radiation workers (ERR/Sv = 2.46, 95%CI: 0.69, 5.08; p = .019), but not among unmonitored workers (ERR/Sv = 1.70, 95%CI: −0.82, 5.65; p = .25). Conclusion The effects of radiation exposure can be different depending on the type of respiratory disease. No effect was seen in pneumonia; a reduction in mortality risk of COPD, and increased mortality risk of other respiratory diseases were observed with cumulative external radiation dose. More studies are needed to verify these findings.

High Prevalence of Influenza A (H1N1 and H3N2) Infection in South Iran

Background: Influenza A is divided into a number of subtypes, the most common of which are circulating H3N2 and H1N1. Influenza A and B viruses, which normally circulate in humans (human influenza viruses), are responsible for seasonal influenza pandemics each year. This study evaluated the prevalence of influenza in Hormozgan province and determined the type and subtypes of influenza circulating in the community. Materials and Methods: The present study was conducted in a single center on 1237 patients with acute respiratory syndrome and flu-like symptoms in Hormozgan province, Iran from August 2022 to December 2022. Eventually, patients’ data such as the age, gender, and hospitalization rate of patients with influenza underwent investigation. Results: Out of a total of 1237 samples of patients, 349 (28.2%) cases were diagnosed with positive influenza and 888 (71.80%) cases were negative. Of 349 cases of positive influenza, 3 and 346 cases were diagnosed with influenza B and A, respectively. The results represented that out of a total of 349 positive cases of influenza, 216 (61.90%) and 133 (38.10%) people were hospitalized and visited as outpatients, respectively. Conclusion: From August 2022 to December 2022, Hormozgan province in the south of Iran witnessed an influenza peak with an increase in the prevalence of H1N1 and H3N2 subtypes. The dominant subtype of this peak was H3N2 influenza, but the prevalence of the H1N1 subtype also demonstrated a significant increase. Finally, the cases of hospitalization of patients with positive influenza represented an increase.

Human death due to H5N1 amid the COVID-19 pandemic and Mpox outbreak: A call for action.

Human death due to H5N1 amid the COVID-19 pandemic and Mpox outbreak: A call for action.

The main recommendations to fight human infections caused by avian influenza A (H5) and the way forward in Ecuador

Dear Editor, Influenza viruses are one of the viruses of public health importance because of their propensity of causing epidemics and pandemics. Waterfowls have been shown to be the main natural reservoirs of influenza viruses and humans, as the hosts are often infected with avian influenza viruses such as avian influenza A (H5)1. Last year, November 30, 2022, the health authorities of Ecuador declared a health emergency of 3 months outbreak of avian influenza A (H5) virus in their country, and an epidemiological alert in December 2022 was indicated after the detection of an outbreak of avian flu in poultry farms in the Andean province of Cotopaxi, Ecuador. This outbreak has extended to January 2023, thus prompting them to inform the World Health Organization about the scourge of avian influenza A H5 infection. They reported a case of human infection with avian influenza A (H5) in a 9-year-old girl from a rural area in Ecuador on January 9, 2023. So far, this is the first case of human infection caused by the avian influenza A (H5) virus reported in Ecuador but also in Latin America. This case of human infection has been linked to exposure to poultry animals2. Human cases of infection with avian influenza viruses are usually the result of exposure to life or dead infected poultry as well as contaminated environments3. Currently, bird flu is an incurable disease without treatment. At this stage, there is in fact no sufficiently effective vaccine with marketing authorization2. Hence, posing more public health challenges to the Ecuadorian communities and the world at large. The public health measures such as; health education about the signs and symptoms of avian influenza virus A (H5), good hand hygiene practices, good food handling, etc., should be well implemented at both the rural and urban centres in Ecuador. Emergency preparedness, surveillances and disease control strategies should be closely observed to avoid further infections of avian influenza A H5 and a pandemic that may arise. Also, at each entry and exit points in the country, surveillance, and control strategies should be imposed among travelers as well as restrictions on commercial travel. Also, rapid detection of infection should be done immediately there is a suspected case of avian influenza A H5 in the country. Travelers should avoid contact with animals in markets and should also avoid frequenting places or places that appear to be contaminated with animal faeces. Travelers should strictly adhere and comply to barrier measures, such as; washing their hands often with soap and water or with hydroalcoholic solutions, covering their mouth and nose, avoiding touching their eyes frequently. They should also practice good food safety and personal hygiene measures. These measures would serve to preventing a future pandemic or even an epidemic of avian influenza A (H5). Finally, the Government of Ecuador through its Ministry of Public Health in collaboration and in partnership with the World Health Organization (WHO) and the Centre for Disease Control (CDC) as well as the Food and Agriculture Organization (FAO) should put more efforts in strengthening the health facilities and equipments in Ecuador. Such facilities would include; mobile clinics, diagnosis for rapid detection of infection for a close surveillance of avian influenza in the country. Ethical approval None. Sources of funding None. Author contribution A.A.: conceptualization of ideas and manuscript preparation. A.A., M.O.O., C.B., H.C., J.O., K.L., H.E., F.K.: writing. M.O.O.: supervision; review and comments; and data curation. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Aymar Akilimali. Provenance and peer review Not commissioned, externally peer reviewed.

Prevalence of Influenza Virus in Patients with Severe Acute Respiratory Infections (SARI)

BACKGROUND
 Influenza is viral fever with the main symptoms of the respiratory tract like cough, fever, breathlessness, nasal discharge, sore throat & myalgia. Pandemic 2009 H1N1 influenza A was the virus that presented a significant public health threat on a global scale. This prospective study was undertaken to analyse the prevalence of the influenza virus in patients with a severe acute respiratory infection (SARI) and also to determine the demographic characteristics and seasonal variations.
 METHODS
 This was a hospital-based prospective study done in the Department of Microbiology, Silchar Medical College & Hospital, Silchar for 1 year from June 2021 to May 2022. Respiratory specimens were tested for Influenza virus by one step real-time reverse transcription polymerase chain reaction (RT-PCR).
 RESULTS
 In real-time PCR, the influenza virus was detected in 6 out of 85 SARI patients (7%). Of 6 total positives, 4(67%) were influenza A and 2(33%) were influenza B. Among 4 influenza A positive cases, 3(75%) were influenza A (H1N1) pdm09 and 1(25%) was seasonal influenza A (H3N2). The highest percentage of positivity (50%) was detected in the age group of 15-29 years. The most common symptoms among the positive influenza cases were fever (100%), cough (88%), and breathlessness (56%). Other associated symptoms were sore throat (63%), nasal discharge (75%), and myalgia (75%).
 CONCLUSIONS
 This study clearly shows that influenza is an important cause of severe acute respiratory infection. It also suggests the need for continuous effective surveillance of influenza viruses to detect cases and control outbreaks. Early intervention and proper management of influenza virus cases are required to curb the disease burden.

The Use of Casemix System to Estimate Providers` Inpatients’ Cost of Influenza Related Sari Diseases in Malaysia

Introduction: Influenza is an upper respiratory infection is caused by the influenza virus. It occurs throughout the whole year in Malaysia with occasional outbreaks. Influenza-like illnesses (ILI) are generally treated as outpatient care while the more severe ‘SARI’ is managed in patient care. The Casemix system, used in healthcare professionals' practices, may help in estimating the cost of influenza management.Methods: This cross-sectional study extracts the cost of influenza management from different public hospitals in years 2016, 2017 and 2018. Data used selected ICD-10 codes, and the cost was abstracted from Malaysian Diagnostic Related Groups (MyDRG) software. The secondary data are from 2 sources, an urban teaching hospital Hospital Cancellor Tuanku Muhriz (HCTM) and Ministry of Health (MoH) inpatient hospitals database. The sample size of the study was 586, while a structured datasheet collating patients’ sociodemographic data and cost of admission, per case, was obtained from the MyDRG software. Microsoft Excel and SPSS software were used in the analysis.Results: Most influenza cases (61.8%) are between the ages of 0 and 10, Malays, and have similar gender proportions. Overall, the influenza treatment cost for inpatient care, totalled to RM 294,017,112. In 2018, the GDP for health consumed 3.76% of Malaysia's GDP income of RM 1.4 trillion, with an estimated RM 60,339 million used for health. Thus, the three-year public cost consumed 0.5% of 2018 GDP.Conclusion: Influenza screening at the primary healthcare setting, health education and treatment compliance should be scale-up to minimize the cost of influenza management of the public providers.

Determining meteorologically-favorable zones for seasonal influenza activity in Hong Kong.

Investigations of simple and accurate meteorology classification systems for influenza epidemics, particularly in subtropical regions, are limited. To assist in preparing for potential upsurges in the demand on healthcare facilities during influenza seasons, our study aims to develop a set of meteorologically-favorable zones for epidemics of influenza A and B, defined as the intervals of meteorological variables with prediction performance optimized. We collected weekly detection rates of laboratory-confirmed influenza cases from four local major hospitals in Hong Kongbetween 2004 and 2019. Meteorological and air quality records for hospitals were collected from their closest monitoring stations. We employed classificationandregression trees to identify zones that optimize the prediction performance of meteorological data in influenza epidemics, defined as a weekly rate > 50th percentile over a year. According to the results, a combination of temperature > 25.1℃ and relative humidity > 79% was favorable to epidemics in hot seasons, whereas either temperature < 16.4℃ or a combination of < 20.4℃ and relative humidity > 76% was favorable to epidemics in cold seasons. The area under the receiver operating characteristic curve (AUC) in model training achieved 0.80 (95% confidence interval [CI], 0.76-0.83) and was kept at 0.71 (95%CI, 0.65-0.77) in validation. The meteorologically-favorable zones for predicting influenza A or A and B epidemics together were similar, but the AUC for predicting influenza B epidemics was comparatively lower. In conclusion, we established meteorologically-favorable zones for influenza A and B epidemics with a satisfactory prediction performance, even though the influenza seasonality in this subtropical setting was weak and type-specific.

Single centre experience: Managing seasonal influenza without a point-of-care test.

The use of point-of-care testing (POCT) for influenza is not routine in many hospitals in the United Kngdom and testing is currently by laboratory-based polymerase chain reaction (PCR) tests. This review aims to evaluate patients who were tested positive for influenza in the last winter season and project if future POCT usage at initial point of patient assessment could assist in better utilisation of healthcare resources. Retrospective review in a district general hospital without POCT facility for influenza. Medical records of patients who tested positive for influenza during a 4-month period from 1 October 2019 to 31 January 2020 in the paediatric department were reviewed and analysed. Thirty patients had laboratory-confirmed cases of influenza of which 63% (n = 19) were admitted to the ward. 56% of patients were not isolated at first instance on admission and 50% (n = 9) of admitted patients did not require inpatient management which totalled up to 224h length of stay in ward. Routine POCT for influenza can potentially improve management of patients presenting with respiratory symptoms and allocation of healthcare resources. We recommend its use to be introduced in diagnostic pathways for acute respiratory illness in the paediatric population in the next winter season in all hospitals.

Monitoring COVID-19 and Influenza: The Added Value of a Severe Acute Respiratory Infection Surveillance System in Portugal.

Severe acute respiratory infections (SARI) surveillance is recommended to assess the severity of respiratory infections disease. In 2021, the National Institute of Health Doutor Ricardo Jorge, in collaboration with two general hospitals, implemented a SARI sentinel surveillance system based on electronic health registries. We describe its application in the 2021/2022 season and compare the evolution of SARI cases with the COVID-19 and influenza activity in two regions of Portugal. The main outcome of interest was the weekly incidence of patients hospitalized due to SARI, reported within the surveillance system. SARI cases were defined as patients containing ICD-10 codes for influenza-like illness, cardiovascular diagnosis, respiratory diagnosis, and respiratory infection in their primary admission diagnosis. Independent variables included weekly COVID-19 and influenza incidence in the North and Lisbon and Tagus Valley regions. Pearson and cross-correlations between SARI cases, COVID-19 incidence and influenza incidence were estimated. A high correlation between SARI cases or hospitalizations due to respiratory infection and COVID-19 incidence was obtained (ρ = 0.78 and ρ = 0.82, respectively). SARI cases detected the COVID-19 epidemic peak a week earlier. A weak correlation was observed between SARI and influenza cases (ρ = -0.20). However, if restricted to hospitalizations due to cardiovascular diagnosis, a moderate correlation was observed (ρ = 0.37). Moreover, hospitalizations due to cardiovascular diagnosis detected the increase of influenza epidemic activity a week earlier. In the 2021/2022 season, the Portuguese SARI sentinel surveillance system pilot was able to early detect the COVID-19 epidemic peak and the increase of influenza activity. Although cardiovascular manifestations associated with influenza infection are known, more seasons of surveillance are needed, to confirm the potential use of cardiovascular hospitalizations as an indicator of influenza activity.

Tripledemic: A Short Commentary

Tripledemic is an informal word used to describe the collision of RSV (respiratory syncytial virus), seasonal influenza and COVID-19 cases. Tripledemic is a recent consortium of viruses that have permuted and caused public health havoc since the holiday season of 2022. The incidence of this triad is being reported in an almost synergistic manner and researchers are pushed to figure out the common grounds for this sudden outbreak.

Risk perceptions of avian influenza among poultry farmers on smallholder farms along border areas of Thailand.

Thailand has not reported any cases of avian influenza since 2008. However, avian influenza viruses circulating in poultry in neighboring countries may have potential for transmission to humans. The aim of this study was to assess risk perceptions of poultry farmers and traders in three border provinces of Thailand adjacent to Laos. Poultry farmers and traders were interviewed in-person during October-December 2021 by health and livestock officials using a standardized questionnaire to collect demographics, job histories, knowledge, and practices related to avian influenza. Knowledge and practices were scored using 22 questions with a 5-point scale. Exploratory data analysis scores above and below the 25th percentile was used as the cut-off point for perception scores. The cut-off point was used to describe perceptions of respondent characteristics in order to compare differences between groups with more or < 10 years of experience. Age adjusted perceptions of disease risk were analyzed by multivariable logistic regression. Of the 346 respondents, the median risk perception score was 77.3% (22 questions with a 5-point scale, so the total score was 110). Having more than 10 years of experience in poultry farming was significantly associated with an increased perception of the risk of avian influenza (adjusted odds ratio 3.9, 95% confidence interval 1.1-15.1). Thirty-two percent of participants perceived avian influenza as a risk only during the winter season, and more than one-third of the participants (34.4%) had not received recent information about new viral strains of avian influenza. Participants did not perceive some key information on the risks associated with avian influenza. Regular training on the risks of avian influenza could be provided by national, provincial and/or local officials and they, in turn, could share what they learn with their communities. Participants who had greater experience in poultry farming were associated with greater risk perception. Experienced poultry farmers and traders working on poultry farms can be a part of the community mentorship program to share their experiences and knowledge on avian influenza with new poultry producers to improve their perception of disease risk.

Excess hospitalizations and mortality associated with seasonal influenza in Spain, 2008–2018

BackgroundInfluenza may trigger complications, particularly in at-risk groups, potentially leading to hospitalization or death. However, due to lack of routine testing, influenza cases are infrequently coded with influenza-specific diagnosis. Statistical models using influenza activity as an explanatory variable can be used to estimate annual hospitalizations and deaths associated with influenza. Our study aimed to estimate the clinical and economic burden of severe influenza in Spain, considering such models.MethodsThe study comprised ten epidemic seasons (2008/2009–2017/2018) and used two approaches: (i) a direct method of estimating the seasonal influenza hospitalization, based on the number of National Health Service hospitalizations with influenza-specific International Classification of Diseases (ICD) codes (ICD-9: 487–488; ICD-10: J09-J11), as primary or secondary diagnosis; (ii) an indirect method of estimating excess hospitalizations and deaths using broader groups of ICD codes in time-series models, computed for six age groups and four groups of diagnoses: pneumonia or influenza (ICD-9: 480–488, 517.1; ICD-10: J09–J18), respiratory (ICD-9: 460–519; ICD-10: J00–J99), respiratory or cardiovascular (C&R, ICD-9: 390–459, 460–519; ICD-10: I00–I99, J00–J99), and all-cause. Means, excluding the H1N1pdm09 pandemic (2009/2010), are reported in this study.ResultsThe mean number of hospitalizations with a diagnosis of influenza per season was 13,063, corresponding to 28.1 cases per 100,000 people. The mean direct annual cost of these hospitalizations was €45.7 million, of which 65.7% was generated by patients with comorbidities. Mean annual influenza-associated C&R hospitalizations were estimated at 34,894 (min: 16,546; max: 52,861), corresponding to 75.0 cases per 100,000 (95% confidence interval [CI]: 63.3–86.3) for all ages and 335.3 (95% CI: 293.2–377.5) in patients aged ≥ 65 years. We estimate 3.8 influenza-associated excess C&R hospitalizations for each hospitalization coded with an influenza-specific diagnosis in patients aged ≥ 65 years. The mean direct annual cost of the estimated excess C&R hospitalizations was €142.9 million for all ages and €115.9 million for patients aged ≥ 65 years. Mean annual influenza-associated all-cause mortality per 100,000 people was estimated at 27.7 for all ages.ConclusionsResults suggest a relevant under-detected burden of influenza mostly in the elderly population, but not neglectable in younger people.

COVID-19 Mass Vaccination and Flu Season: Concern for Decreased Public Health Measures and Worsening the Influenza Situation.

Reports show that other ordinary childhood infections like measles or influenza are likely to reemerge. The re-emergence of infectious diseases may happen due to the direct impact of the pandemic on the community because of decreased access to health and medical services, interrupted transport systems, weaknesses in the supply chain, flight restrictions, closings of the border, and international trade problems. The most prevalent cause (60.9%) for low vaccine uptake and coverage during the current pandemic was fear of exposure to the COVID-19 virus outside the home. The expectation and hope that the pattern of reduction in transmission and number of influenza cases will continue over the next flu season depend on continued adherence to nonpharmaceutical interventions and their long-term application. But there is always the fear and threat of increasing the spread of influenza by reducing the movement restrictions and low adherence to protective health measures due to vaccination. So far, not much information has been published about the interaction between different infectious diseases in the background of the coronavirus pandemic and related interventions. The purpose of this article is to examine the general effects of the COVID-19 vaccination on the spread of influenza in the coming seasons.