Hospital-based Surveillance Network Research Articles

The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study.

A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations.

Operational lessons learned in conducting an international study on pharmacovigilance in pregnancy in resource-constrained settings: The WHO Global Vaccine safety Multi-Country collaboration project

The WHO Global Vaccine Safety Multi-Country Collaboration study on safety in pregnancy aims to estimate the minimum detectable risk for selected perinatal and neonatal outcomes and assess the applicability of standardized case definitions for study outcomes and maternal immunization in low- and middle-income countries (LMICs). This paper documents the operational lessons learned from the study.A prospective observational study was conducted across 21 hospitals in seven countries. All births occurring at sites were screened to identify select perinatal and neonatal outcomes from May 2019 to August 2020. Up to 100 cases per outcome were recruited to assess the applicability of standardized case definitions. A multi-pronged study quality assurance plan was implemented. The impact of the COVID-19 pandemic on site functioning and project implementation was also assessed.Multi-layered ethics and administrative approvals, limited clinical documentation, difficulty in identifying outcomes requiring in-hospital follow-up, and poor quality internet connectivity emerged as important barriers to study implementation. Use of electronic platforms, application of a rigorous quality assurance plan with frequent interaction between the central and site teams helped improve data quality. The COVID-19 pandemic disrupted data collection for up to 6 weeks in some sites.Our study succeeded in establishing an international hospital-based surveillance network for evaluating perinatal and neonatal outcomes using common study protocol and procedures in geographically diverse sites with differing levels of infrastructure, clinical and health-utilization practices. The enhanced surveillance capacity of participating sites shall help support future pharmacovigilance efforts for pregnancy interventions.

Epidemiology of Hypoxic Community-Acquired Pneumonia in Children Under 5 Years of Age: An Observational Study in Northern India.

BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of under-five mortality in India. An increased risk of mortality has been reported in cases of hypoxic pneumonia.MethodsThe primary objective of this study was to assess the proportion of children aged 2–59 months, hospitalized with hypoxic CAP, as well as socio-demographic, clinical, and radiological features associated with it. The secondary objective was to determine the risk of mortality among hospitalized cases of hypoxic CAP. This prospective, observational study was conducted in four districts of Northern India, between January 2015 and April 2021. A hospital-based surveillance network was established. Inclusion criteria were as follows: (a) child between 2 and 59 months, (b) hospitalization with symptoms of WHO-defined CAP, (c) resident of project district, (d) illness of <14 days, and (e) child had neither been hospitalized for this illness nor recruited previously. Children whose chest x-rays (CXRs) were either unavailable/un-interpretable and those that received any dose of pneumococcal conjugate vaccine-13 were excluded. Hypoxic pneumonia was defined as oxygen saturation <90% on pulse oximetry or requiring oxygen supplementation during hospital stay.ResultsDuring the study period, 71.9% (7,196/10,006) children of severe pneumonia were eligible for inclusion, of whom 35.9% (2,580/7,196) were having hypoxic pneumonia. Female gender and use of biomass fuel for cooking increased the odds of hypoxic CAP. Clinical factors like wheezing, pallor, tachypnea, low pulse volume, presence of comorbidity, general danger signs, severe malnutrition, and radiological finding of primary end-point pneumonia ± other infiltrates (PEP±OI) also increased the odds of hypoxic CAP in a conditional logistic regression model. Adjusted odds ratio for mortality with hypoxia was 2.36 (95% CI: 1.42–3.92).ConclusionAlmost one-third of cases hospitalized with severe CAP had hypoxia, which increased chances of mortality. Besides known danger signs, certain newer clinical signs such as pallor and wheezing as well as PEP+OI were associated with hypoxic CAP. Therefore, objective assessment of oxygen saturation must be done by pulse oximetry in all cases of CAP at the time of diagnosis.

Surveillance of bacterial pneumonia and other invasive bacterial diseases among under-five children in India, 2016–2018

Background: Bacterial pneumonia and other invasive bacterial diseases (IBDs) are leading causes of morbidity and mortality in under-five children globally. Common etiological agents include Streptococcus pneumoniae, Haemophilus influenzae type b (Hib) and Neisseria meningitidis. Vaccination against Hib is already covered in the national immunization program (NIP) in India and a phased introduction of Pneumococcal Conjugate Vaccine (PCV-13) was started in 2017. Towards understanding the trends in common etiologies of bacterial pneumonia/IBDs and serotype distribution of S. Pneumoniae in pre and post-vaccination scenario, a hospital based surveillance network was established in 2016. Preliminary findings from the surveillance network are herein reported. Methods & Materials: Children aged 1–59 months admitted to six pediatric hospitals with suspected pneumonia, meningitis and sepsis were enrolled between 2016 and 2018. At the hospital site, blood, cerebrospinal fluid (CSF), and other normally sterile body fluids samples were collected and processed following conventional microbiological procedures. CSF was additionally screened by latex-agglutination (Wellcogen). PCR, serotyping (Quellung reaction) and antimicrobial susceptibility testing of pneumococcal isolates at the network's reference laboratory. Results: A total of 2008 blood, 730 CSF and 81 other samples were collected from 2297 enrolled children. In CSF, S. pneumoniae (35.1%), N. meningitidis (21.6%) and Hib (16.2%) were the major etiology. Staphylococcus aureus (32.9%) was the commonest blood isolate and S. pneumoniae was identified from 26 blood samples (9.3%). Overall, S. pneumoniae was the major pathogen among children <2 years of age (61.9%). Among the 24 pneumococcal isolates, 12 different serotypes were detected and the commonest were 14 (20.8%), 19F (16.7%), 6B (8.3%), 1 (8.3%), 10A (8.3%), 9V (8.3%) and 5 (8.3%). Seventy five percent of identified serotypes were covered by PCV-13. Antibiotic resistance was highest to co-trimoxazole (100%) followed by erythromycin (54.2%). Conclusion: Study documented S. pneumoniae as the major cause of bacterial pneumonia and IBDs in India among under-five children. With over two-thirds of pneumococcal serotypes covered by the current PCV-13, continued surveillance will document trends in pneumococcal disease burden and serotype distribution. Data thus generated will aid in assessing the effectiveness of PCV-13 in India and inform the program managers for decision making regarding sustenance of PCV and reconjugation.

Antimicrobial susceptibility testing and antibiotic consumption results from 16 hospitals in Viet Nam: The VINARES project 2012-2013.

To establish a hospital-based surveillance network with national coverage for antimicrobial resistance (AMR) and antibiotic consumption in Viet Nam. A 16-hospital network (Viet Nam Resistance: VINARES) was established and consisted of national and provincial-level hospitals across the country. Antimicrobial susceptibility testing results from routine clinical diagnostic specimens and antibiotic consumption data in Defined Daily Dose per 1000 bed days (DDD/1000 patient-days) were prospectively collected and analysed between October 2012 and September 2013. Data from a total of 24 732 de-duplicated clinical isolates were reported. The most common bacteria were: Escherichia coli (4437 isolates, 18%), Klebsiella spp. (3290 isolates, 13%) and Acinetobacter spp. (2895 isolates, 12%). The hospital average antibiotic consumption was 918 DDD/1000 patient-days. Third-generation cephalosporins were the most frequently used antibiotic class (223 DDD/1000 patient-days, 24%), followed by fluoroquinolones (151 DDD/1000 patient-days, 16%) and second-generation cephalosporins (112 DDD/1000 patient-days, 12%). Proportions of antibiotic resistance were high: 1098/1580 (69%) Staphylococcus aureus isolates were methicillin-resistant (MRSA); 115/344 isolates (33%) and 90/358 (25%) Streptococcus pneumoniae had reduced susceptibility to penicillin and ceftriaxone, respectively. A total of 180/2977 (6%) E. coli and 242/1526 (16%) Klebsiella pneumoniae were resistant to imipenem, respectively; 602/1826 (33%) Pseudomonas aeruginosa were resistant to ceftazidime and 578/1765 (33%) to imipenem. Of Acinetobacter spp. 1495/2138 (70%) were resistant to carbapenems and 2/333 (1%) to colistin. These data are valuable in providing a baseline for AMR among common bacterial pathogens in Vietnamese hospitals and to assess the impact of interventions.

Vigilância da influenza: avanços e desafios para o Brasil

Vigilância da influenza: avanços e desafios para o Brasil

Global Influenza Hospital-based Surveillance Network (GIHSN): results of surveillance of influenza and other respiratory viruses in hospitalised patients in Brazil, 2015

BackgroundInfluenza-like illness occurs annually worldwide, with peak timing and severity varying seasonally, resulting in significant annual mortality.ObjectivesThere were three objectives: (1) to describe the epidemiological and clinical features of hospitalised...

Profile and trends of rotavirus gastroenteritis in under-five children in India (2012-2014): Preliminary report of the Indian national rotavirus surveillance network

To estimate the burden of rotavirus-associated gastroenteritis in India. Hospital based surveillance network was established, with clinical evaluation and laboratory testing for rotavirus among children aged below 5 years hospitalized with acute gastroenteritis. Between September 2012 and December 2014, stool samples from 10207 children were tested and rotavirus was detected in 39.6% of cases. Infections were more commonly seen among younger children (<2 years). Detection rates were higher during cooler months of September February. Among rotavirus infected children, 64.0% had severe or very severe disease. G1P[8] was the predominant rotavirus genotype (62.7%) observed during the surveillance period. Surveillance data highlights the high rotavirus disease burden and emphasizes the need for close monitoring to reduce morbidity and mortality associated with rotavirus gastroenteritis in India.

Hospital-based surveillance for radiological pneumonia in children under 5 years of age in Uttar Pradesh and Bihar

Abstract Background and rationale Pneumonia is responsible for about 1.4 million deaths in children under five years of age, mostly in developing countries, including India. In India, Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI) are the common bacterial etiologic agents of pneumonia, and often cause abnormal chest radiology. Vaccine against HI has already been introduced in India. Pneumococcal conjugate vaccine (PCV) roll out will begin in 2017–2018 in a phased manner using Gavi funding. Objectives (1) To estimate the annual incidence of radiological pneumonia in children between 2 and 59 months of age, in prespecified districts. (2) To document the clinical and demographic characteristics of cases of WHO-defined community-acquired pneumonia (CAP) with lower chest in-drawing (LCI) and severe CAP, by establishment of hospital-based surveillance network. Study design In a prospective design, surveillance for WHO-defined radiological pneumonia in patients hospitalized for CAP is being done in two districts each of Uttar Pradesh and Bihar. For this, a pneumonia surveillance network of public and private hospitals has been established. Data are abstracted from hospital records. One copy of routine chest X-ray is also collected, digitalized, and archived electronically. An independent panel of radiologists interprets the X-rays. Five milliliters of urine of a subset of cases is being stored at −20 °C for future antigen testing. In Phase I, procedures were standardized, hospital network established, and recruitments initiated from Lucknow district. This was expanded in Phase II to include Etawah district, Uttar Pradesh and Patna and Darbhanga districts of Bihar. Progress A pneumonia surveillance network was established, having 120 health facilities in Lucknow, 60 in Patna, 64 in Darbhanga and 17 in Etawah. From 1st January 2015 to 30th April 2016, 745 CAP cases were enrolled in Lucknow. From 1st January to 30th April 2016 Patna recruited 229, Darbhanga 321 and Etawah 80 cases. Chest X-rays of all cases have been archived for interpretation by the panel of radiologists. Implications Baseline incidence of radiological pneumonia in Uttar Pradesh and Bihar will be estimated and follow-up data will enable assessment of the impact of PCV introduction.

A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel

Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n = 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008–2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011–2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0–23 months (60–61%) than in toddlers aged 24–59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.

Canadian vaccine research networks: Vaccine safety resources for Canada.

The Public Health Agency of Canada / Canadian Institutes of Health Research Influenza Research Network (PCIRN), established in 2009 to undertake evaluative research to inform public health decision making in Canada, is now being replaced by the Canadian Immunization Research Network (CIRN), which will retain the mandate of PCIRN but expand it to all vaccines including influenza vaccine. CIRN is organized as a network of networks focusing on undertaking research in the areas of vaccine safety, adverse events following immunization (AEFIs), vaccine hesitancy, vaccine effectiveness, and vaccine coverage. CIRN's networks include: a clinical trial network; a laboratory network; a modelling and economics network; a network of social science and humanities researchers; a vaccine safety surveillance network; a hospital-based surveillance network; a clinic network to evaluate serious AEFIs; and a network that links vaccine research capacity in provincial health agencies and departments. PCIRN has contributed to Canada's vaccine safety surveillance system and has facilitated the translation of safety research into policy. Vaccine safety surveillance and research will remain a focus of the newly formed Canadian Immunization Research Network.

Etiology of acute diarrhea due to enteropathogenic bacteria in Beijing, China

Acute diarrhea is of great concern due to considerable morbidity and mortality worldwide. The causative bacteria leading to acute diarrhea in general population remains unclear in China. This study was conducted to determine the etiology of acute diarrhea using a sentinel hospital-based surveillance network in Beijing. Active surveillance was implemented from April 2010 to December 2011 on two random days per week by enrolling every tenth diarrheal patients admitted to seventeen intestinal clinics. Shigella spp., Vibrio spp, Salmonella spp., diarrheagenic Escherichia coli and other genera of bacteria, were investigated from 4803 outpatients with acute diarrhea by microbiological methods. The pathogenic bacteria recovered out from fecal samples of 968 (20.2%) patients had the following profile: Shigella spp. (5.9%) was the most prevalent pathogen, Vibrio parahaemolyticus (5.2%), Salmonella spp. (3.9%) and enteropathogenic E. coli (EPEC) (0.9%) had from the second to fourth highest prevalence, respectively. Of the 55 co-infections detected, V. parahaemolyticus was the most common pathogen from 28 cases (50.9%), with the main combination of V. parahaemolyticus and Salmonella. The highest proportion of all causative bacteria was found in adults aged 20-39 year and in summer as well as early autumn. The clinical symptoms associated with specific bacterial infection, such as fever, abdominal pain, tenesmus, nausea, vomiting, and watery and bloody stool, were observed frequently in diarrheal patients. Shigella spp., V. parahaemolyticus, Salmonella spp., and EPEC are important enteropathogenic bacteria causing acute diarrhea in Beijing. To execute reasonable interventions, the comprehensive and continuous surveillance is needed to identify the prevalence of different enteropathogeic bacteria.

Collaborative Hospital-Based Surveillance Network of Drug-Induced Pancreatitis: A Feasibility Study in Italy

Collaborative Hospital-Based Surveillance Network of Drug-Induced Pancreatitis: A Feasibility Study in Italy

Hospital-based active surveillance of childhood pertussis in Austria from 1996 to 2003: Estimates of incidence and vaccine effectiveness of whole-cell and acellular vaccine

Background This study was undertaken to analyse the epidemiology of pertussis disease among hospitalised children during the transition period from whole-cell to acellular pertussis vaccine in order to compare the respective estimates of vaccine effectiveness. Methods Surveillance was conducted between 1 January 1996 and 31 December 2003. The data originated from a voluntary hospital-based surveillance network including all 44 nationwide paediatric departments. Results The mean annual hospitalisation incidence for children decreased over time, from 27.9 per 100 000 population in 1996 to 6.8 cases per 100 000 population in 2003. The mean age of reported hospitalised pertussis cases was 4.7 years (±5.5 S.D.), increasing from 4.06 years (±4.6 S.D.) in 1996 to 5.5 years (±8.6 S.D.) in 2003. Estimated vaccine effectiveness (after three vaccine doses) was 79% for the whole-cell versus 92% for the acellular pertussis vaccine. A significantly higher proportion (19%) of fully immunised children among hospitalised patients was observed for the years where only acellular pertussis vaccine was used compared to whole-cell vaccine era (2%) which was, however, mainly due to children above 2 years of age. Conclusions Our results imply that despite high vaccination coverage rate, pertussis is still a considerable cause of hospital admissions in children in Austria where it remains to be shown that the novel vaccination strategy of additional booster doses in adolescents and adults will control disease in the long term.