Influenza Complications Research Articles

Knowledge and Attitudes of Women toward the Influenza Vaccination during Pregnancy in Amman, Jordan

Objectives: The study aimed to assess the level of knowledge and attitudes of Jordanian women regarding influenza and its vaccine during pregnancy.
 Methods: A cross-sectional study was conducted on 384 Jordanian women who had had a full-term delivery during the last 12 months. Data were collected with an interviewer-administrated questionnaire at five governmental comprehensive healthcare centers in Amman governorate.
 Results: Most participants had moderate knowledge (78.1%) (average score of 6.08 ± 1.38 out of 10). Women were either positive (51.0%) or neutral (47.9%) towards the influenza vaccination during pregnancy (average score of 52.43 ± 6.29 out of 75). Further, the vaccination rate during the women’s latest pregnancy was 2.1%. A significant positive relationship was found between the knowledge and attitudes of participants (p=0.001).
 Conclusion: The vaccination rate was low among women during pregnancy. The study’s results suggest that a greater awareness of the flu vaccine would help build positive attitudes towards its uptake during pregnancy. In this sense, antenatal care healthcare providers, such as gynecologists and midwives, should communicate strong health education messages about the flu vaccine as a preventative measure against influenza complications during pregnancy.

Efficacy of the Adjuvanted Influenza Vaccine Compared With the High-Dose for Older People.

Reported cases of influenza are increasing among those 65 years of age and older. Older people may be less likely to get sick from influenza, but they are at an increased risk for influenza complications, hospitalizations, and deaths. Influenza infections and complications have become even more of a concern for this population recently because of the impact of COVID-19. Evidence exists of waning immunity in older people because of immunosenescence. Enhanced vaccines were manufactured to help boost the immune response more than what is seen with standard influenza vaccines in older people. There are currently two enhanced vaccines specifically approved for persons 65 years of age and older: the adjuvanted quadrivalent influenza vaccine (aQIV) and the high-dose quadrivalent influenza vaccine (HD-QIV). Based on current data, enhanced vaccines may be of more benefit for those 65 years of age and older. This is reflected in the most recent recommendations from the Advisory Committee on Immunization Practices (ACIP) for people 65 years of age and older, which advise to not delay vaccination and receive either a high-dose or adjuvanted influenza vaccine. There is currently no preference given over any enhanced vaccine in this age group. Influenza vaccinations have been found to reduce the risk of hospitalization from influenza complications, such as cardiovascular complications like strokes and myocardial infarction, in those 65 years of age and older, specifically those with co-existing cardiovascular disease. Immunizations are the primary prevention strategy, and we should ensure proper vaccine administration to provide maximal efficacy and reduce the chances of influenza complications.

Influenza in Liver and Kidney Transplant Recipients: Incidence and Outcomes.

Influenza is a common respiratory tract infection in solid organ transplant (SOT) recipients. We aimed to investigate the incidence, risk factors, and complications of influenza in a large cohort of kidney and liver transplant recipients over 10 consecutive seasons. We conducted a retrospective study, including 378 liver and 683 kidney transplant recipients who were transplanted from January 1, 2010, to October 1, 2019. The data on influenza were retrieved from MiBa, which is a nationwide database that contains all of the microbiology results in Denmark. Clinical data were retrieved from patient records. Incidence rates and cumulative incidences were calculated, and risk factors were investigated using time-updated Cox proportional hazards models. The cumulative incidence of influenza in the first 5 years posttransplantation was 6.3% (95% CI: 4.7 to 7.9%). Of the 84 influenza positive recipients, 63.1% had influenza A, 65.5% were treated with oseltamivir, 65.5% were hospitalized, and 16.7% developed pneumonia. There were no significant differences in outcomes when comparing patients with influenza A and B. We found no significant effect of same-season influenza vaccination, sex, age, or comorbidities on the risk of acquiring influenza. The incidence of influenza in kidney and liver recipients is high, and 65.5% of infected transplant recipients required hospitalization. We were not able to confirm a reduction in influenza incidence or in the risk of complications associated with vaccination. IMPORTANCE Influenza is a common respiratory virus in solid organ transplant recipients that may have severe complications, including pneumonia and hospitalization. This study investigates the incidence, risk factors, and complications of influenza in a Danish cohort of kidney and liver transplant recipients over 10 consecutive influenza seasons. The study shows a high incidence of influenza and a high frequency of both pneumonia and hospitalization. This emphasizes the importance of continuous focus on influenza in this vulnerable group. During the COVID-19 pandemic, the incidence of influenza has been low due to COVID-related restrictions, and immunity may have waned. However, as most countries have now opened up, the incidence of influenza is expected to be high this season.

Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies

AimsIn order to better define the need for influenza vaccination in people with diabetes (DM), we collected all available evidence on the effect of DM as a risk factor for complications of both seasonal and pandemic influenza, and on the specific effectiveness of vaccines in patients with DM. Data synthesisTwo distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and Embase databases were performed, one for each metanalysis, collecting all observational studies and randomized clinical trials performed on humans up to May 31st, 2022. We retrieved 34 observational studies comparing risk for influenza complications in people with or without diabetes, and 13 observational studies assessing vaccine effectiveness on preventing such complications. Mortality for influenza and hospitalization for influenza and pneumonia resulted significantly higher in individuals with versus without DM, both when unadjusted and adjusted data are analyzed. In diabetic individuals vaccinated for influenza overall hospitalization, hospitalization for influenza or pneumonia and overall mortality are significantly lower in comparison with not vaccinated DM subjects, both when unadjusted and adjusted data were analyzed. ConclusionThis systematic review and meta-analysis shows that: 1) influenza is associated with more severe complications in diabetic versus not diabetic individuals and 2) influenza vaccination is effective in preventing clinically relevant outcomes in adults with DM with a NNT (number needed to treat) of 60, 319, and 250 for all-cause hospitalization, specific hospitalization, and all-cause mortality, respectively. The identification of diabetic patients as the target of vaccination campaigns for influenza appears to be justified by available clinical evidence.

Impact of the COVID-19 Pandemic on Influenza Vaccination and Associated Factors among Pregnant Women: A Cross-Sectional Study in Korea.

Pregnant women are vulnerable to developing influenza complications. Influenza vaccination during pregnancy is crucial to avoid infection. The COVID-19 pandemic might exacerbate fear and anxiety in pregnant women. The purpose of this study was to evaluate the effect of the COVID-19 pandemic on influenza vaccination and determine the factors associated with influenza vaccine acceptance among pregnant women in Korea. We conducted a cross-sectional study using an online survey in Korea. A survey questionnaire was distributed among pregnant or postpartum women within 1 year after delivery. Multivariate logistic regression analysis was performed to identify the factors associated with influenza vaccination among pregnant women. A total of 351 women were included in this study. Of them, 51.0% and 20.2% were vaccinated against influenza and COVID-19 during pregnancy, respectively. The majority of participants who had a history of influenza vaccination reported that the COVID-19 pandemic did not affect (52.3%, n = 171) or increased the importance (38.5%, n = 126) of their acceptance of the influenza vaccine. Factors associated with influenza vaccine acceptance were knowledge of influenza vaccine (OR 1.21; 95% CI 1.09, 1.35), trust in healthcare providers (OR 2.57; 95% CI 1.43, 4.65), and COVID-19 vaccination during pregnancy (OR 6.11, 95% CI 2.86, 13.01). Participants were more likely to accept the influenza vaccine when they received a COVID-19 vaccine during pregnancy, but the rate of influenza vaccination was not affected by the COVID-19 pandemic. This study showed that the COVID-19 pandemic did not influence influenza vaccine uptake in the majority of pregnant women in Korea. The results emphasize the necessity of appropriate education for pregnant women to enhance awareness of vaccination.

The impact of influenza vaccination on cardiovascular diseases.

The link between influenza and medical complications is well stablished and plays a role in the high mortality rates of this disease. Available scientific evidence suggests that influenza vaccination might reduce the risk of cardiovascular events. This setting for cardiovascular prevention beyond immunoprotection has been studied in several clinical trials. Most of them include populations with coronary artery disease. However, differences in clinical design, population included, and vaccination strategies might explain divergent results and should be interpreted with caution. The present article summarizes available literature in a manner that aids physicians in a better interpretation and encourages the implementation of influenza vaccination in cardiovascular prevention programmes.

Platelet Abnormalities in Children with Laboratory-Confirmed Influenza

The role of platelets in the immune response against influenza has been raised, and a diagnostic or prognostic value of platelet parameter abnormalities, including platelet count (PLT), or mean platelet volume (MPV), has been suggested. The study aimed to analyze the prognostic value of platelet parameters in children hospitalized due to laboratory-confirmed influenza. We retrospectively verified the platelet parameters (PLT, MPV, MPV/PLT, and PLT/lymphocyte ratio regarding the influenza complications (acute otitis media, pneumonia, and lower respiratory tract infection-LRTI), and the clinical course (antibiotic treatment, tertiary care transfer, and death). An abnormal PLT was observed in 84 out of 489 laboratory-confirmed cases (17.2%, 44 thrombocytopaenia cases, and 40 thrombocytoses). Patients' age correlated negatively with PLT (rho = -0.46) and positively with MPV/PLT (rho = 0.44), while MPV was not age-dependent. The abnormal PLT correlated with increased odds of complications (OR = 1.67), including LRTI (OR = 1.89). Thrombocytosis was related to increased odds of LRTI (OR = 3.64), and radiologically/ultrasound-confirmed pneumonia (OR = 2.15), mostly in children aged under 1 year (OR = 4.22 and OR = 3.79, respectively). Thrombocytopaenia was related to antibiotic use (OR = 2.41) and longer hospital stays (OR = 3.03). A lowered MPV predicted a tertiary care transfer (AUC = 0.77), while MPV/PLT was the most versatile parameter in predicting LRTI (AUC = 0.7 in <1 yo), pneumonia (AUC = 0.68 in <1 yo), and antibiotic treatment (AUC = 0.66 in 1-2 yo and AUC = 0.6 in 2-5 yo). Platelet parameters, including PLT count abnormalities and MPV/PLT ratio, are related to the increased odds of complications and a more severe disease course, and may add important data in assessing pediatric influenza patients, but should be interpreted cautiously due to age-related specificities.

Therapeutic Targeting of Inflammation and Virus Simultaneously Ameliorates Influenza Pneumonia and Protects from Morbidity and Mortality.

Influenza pneumonia is a severe complication caused by inflammation of the lungs following infection with seasonal and pandemic strains of influenza A virus (IAV), that can result in lung pathology, respiratory failure, and death. There is currently no treatment for severe disease and pneumonia caused by IAV. Antivirals are available but are only effective if treatment is initiated within 48 h of onset of symptoms. Influenza complications and mortality are often associated with high viral load and an excessive lung inflammatory cytokine response. Therefore, we simultaneously targeted the virus and inflammation. We used the antiviral oseltamivir and the anti-inflammatory drug etanercept to dampen TNF signaling after the onset of clinical signs to treat pneumonia in a mouse model of respiratory IAV infection. The combined treatment down-regulated the inflammatory cytokines TNF, IL-1β, IL-6, and IL-12p40, and the chemokines CCL2, CCL5, and CXCL10. Consequently, combined treatment with oseltamivir and a signal transducer and activator of transcription 3 (STAT3) inhibitor effectively reduced clinical disease and lung pathology. Combined treatment using etanercept or STAT3 inhibitor and oseltamivir dampened an overlapping set of cytokines. Thus, combined therapy targeting a specific cytokine or cytokine signaling pathway and an antiviral drug provide an effective treatment strategy for ameliorating IAV pneumonia. This approach might apply to treating pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Early and Increased Influenza Activity Among Children - Tennessee, 2022-23 Influenza Season.

Influenza seasons typically begin in October and peak between December and February (1); however, the 2022-23 influenza season in Tennessee began in late September and was characterized by high pediatric hospitalization rates during November. This report describes a field investigation conducted in Tennessee during November 2022, following reports of increasing influenza hospitalizations. Data from surveillance networks, patient surveys, and whole genome sequencing of influenza virus specimens were analyzed to assess influenza activity and secondary illness risk. Influenza activity increased earlier than usual among all age groups, and rates of influenza-associated hospitalization among children were high in November, reaching 12.6 per 100,000 in children aged <5 years, comparable to peak levels typically seen in high-severity seasons. Circulating influenza viruses were genetically similar to vaccine components. Among persons who received testing for influenza at outpatient clinics, children were twice as likely to receive a positive influenza test result as were adults. Among household contacts exposed to someone with influenza, children were more than twice as likely to become ill compared with adults. As the influenza season continues, it is important for all persons, especially those at higher risk for severe disease, to protect themselves from influenza. To prevent influenza and severe influenza complications, all persons aged ≥6 months should get vaccinated, avoid contact with ill persons, and take influenza antivirals if recommended and prescribed.

Association Between Influenza Vaccination During Pregnancy and Infant Influenza Vaccination.

To examine the association between influenza vaccination during pregnancy and infant influenza vaccination. We conducted a retrospective analysis of individuals aged 15-49 years who were continually privately insured from August 2017 to May 2019 and had singleton live births between September 2017 and February 2018 and their infants. Influenza vaccination coverage was assessed for pregnant people during the 2017-2018 influenza season and for their infants during the 2018-2019 season using the 2017-2019 MarketScan data. Multivariate log-binomial regressions were conducted to examine the association between influenza vaccination during pregnancy and infant influenza vaccination. Of the 34,919 pregnant people in this analysis, 14,168 (40.6%) received influenza vaccination during pregnancy. Of the infants born to people vaccinated during pregnancy, 90.0% received at least one dose of influenza vaccine during the 2018-2019 season and 75.5% received at least two doses. Of the infants born to those not vaccinated during pregnancy, 66.3% received at least one dose of influenza vaccine and 51.8% received at least two doses. At-least-one-dose coverage was 35.7% higher (adjusted risk ratio [aRR] 1.34, 95% CI 1.33-1.36) and at-least-two-dose coverage was 45.8% higher (aRR 1.43, 95% CI 1.41-1.46) for infants born to people who received influenza vaccination during pregnancy compared with infants born to people who did not. Our results show a positive and statistically significant relationship between influenza vaccination during pregnancy and infant influenza vaccination status in their first season eligible for vaccination. Interventions to increase influenza vaccination coverage among pregnant people may also increase infant influenza vaccination coverage, offering greater protection against serious complications of influenza in both vulnerable populations.

Successful Treatment of Complicated Influenza A(H3N2) Virus Infection and Rhabdomyolysis with Compassionate Use of IV Zanamivir

In 2019, EMA licensed intravenous (IV) zanamivir for severe influenza virus infection in children over 6 months as well as adults. Prior to that, it was possible via a compassionate use program. We present successful compassionate use of IV zanamivir in a 14-year-old female with severe influenza A(H3N2) and multi-organ failure, who had failed oral oseltamivir. Her illness was complicated by acute respiratory distress syndrome and rhabdomyolysis requiring extracorporeal membrane oxygenation and hemofiltration. Considering the broad safety margins with neuraminidase inhibitors, an adult dose of 600 mg IV BID was administered in this 60 kg patient. Influenza virus was cleared rapidly and undetectable on day 13. Creatine kinase (CK) values were dropping from 38,000 to 500 within nine days. Given the recent licensure of IV zanamivir, multi-center prospective observational studies in pediatric Intensive Care Unit patients would be beneficial to guide the most appropriate use of IV zanamivir in this vulnerable age group.

Influenza vaccine coverage in 6months-64 years-old patients affected by chronic diseases: A retrospective cohort study in Italy

ABSTRACT At the beginning of each flu season, the Italian Ministry of Health defines the categories at higher risk of influenza complications, for which vaccination is actively and freely offered. The vaccine coverage (VC) of the influenza vaccine in subjects from 6 months to 64 years of age suffering from diseases that increase the risk of complications from influenza during the 2020–2021 season was evaluated. Our study wants to evaluate the VCs of the influenza vaccine in these subjects during the 2020/2021 season in Apulia. The digital archives relative to the Apulian population were used. A retrospective cohort study design was performed. 484,636 Apulian residents aged between 6 months and 64 years suffered from at least one chronic disease; 139,222 of 484,636 subjects received the influenza vaccine (VC: 28.7%) from October 2020 to January 2021. Considering the single comorbidities, the greatest values are found for pathologies for which major surgical interventions are planned and chronic renal failure/adrenal insufficiency patients, while the worst for chronic liver diseases and pathologies for which major surgical interventions are planned. In any case, it would seem that better VC is achieved in subjects with more than one chronic condition. Influenza vaccination must be promoted as a central public health measure, also because by reducing the burden on hospitals, it can greatly benefit the management of COVID-19 patients. Greater efforts by public health institutions must be implemented in order to achieve better VC in the target categories, including chronic patients.

Neurološke komplikacije teškog oblika Influenze A kod dece

Introduction: Neurological complications of Influenza infection in pediatric population vary in incidence and severity. The central nervous system is most often affected by encephalitis and encephalopathy. Acute necrotizing encephalopathy (ANE) is the most serious complication. The aim of this case study was to present a variety of severe cases of neuro-influenza in pediatric patients. Methods: The study presents five children who were hospitalized in the pediatric intensive-care unit due to neurological complications of Influenza A infection during the winter season of 2022/2023. The identification of the causative agent was carried out by the reversetranscription-polymerase chain reaction or by the detection of viral antigens in the samples of nasopharyngeal swabs. Results: Four out of five presented patients were male. The average age at admission was 6 years (min. 7 months, max. 11 years). All patients had an acute disturbance of consciousness at admission and four of them had seizures. Neurological complications of Influenza A infection presented as acute encephalitis, posterior reversible encephalopathy syndrome, acute disseminated encephalomyelitis, encephalopathy, and ANE. Neurological signs appeared approximately four days after the first symptoms. There were no lethal outcomes. Younger patients had more severe brain damage and took longer to recover. None of the children had been vaccinated against the flu. Conclusions: Children presenting with acute neurological deterioration during influenza season should be evaluated for influenza-associated central nervous system complications even if the respiratory involvement is mild or there are no respiratory signs at all. Magnetic resonance imaging is the most important tool for early diagnosis.

Эффективность нового режима дозирования препарата Виферон® в терапии гриппа и других ОРВИ у детей разного возраста с нарушениями в состоянии здоровья

Purpose. To study the efficacy and safety of a new dosing regimen of Viferon®, rectal suppositories, in the treatment of influenza and other acute respiratory viral infections (ARVI) in children from 1 month of age. up to 18 years of age with deviations in the state of health (related to II–IV health groups). Patients and methods. Conducted a double-blind placebo-controlled study involving 260 children aged 1 month up to 18 years of health groups II–IV, patients with influenza and other acute respiratory viral infections, who were randomized into 2 groups: 129 people group 1 received Viferon®, rectal suppositories, 131 people group 2 – placebo according to one of the three treatment regimens in accordance with the age of the children. All patients received standard therapy: antipyretics, anticongestants, mucolytics, if necessary, antihistamines and antibacterials. Clinical and laboratory observation was carried out within 10 days of therapy and then 1, 3 and 6 months after the start of treatment. Statistical processing was carried out using the statistical software Statistica 13.0. Null hypotheses were rejected at p &lt; 0.05. Results. The inclusion of the drug Viferon®, rectal suppositories, in the complex therapy of influenza and other acute respiratory viral infections in children of II–IV health groups, compared with Placebo, significantly reduces the period of improvement by 2.82 days (p = 0.0001, Tukey's test), by 2.85 days of recovery (p = 0.0001, Tukey's test), contributes to a 3.5-fold decrease in the proportion of patients with complications (p &lt; 0.001), and also allows a significant reduction in the number of episodes of influenza and other acute respiratory viral infections during the follow-up period after 1, 3 and 6 months after therapy. Conclusion. Complex therapy of influenza and other acute respiratory viral infections in children with functional and morphofunctional deviations in health status (II–IV health groups) using the drug Viferon®, rectal suppositories, according to a modified scheme using higher doses and with a longer duration of therapy, can reduce the onset improvement and overall recovery of patients, reduce the number of complications of influenza and other acute respiratory viral infections, reduce the number of recurrent episodes of the disease during the follow-up period 1, 3 and 6 months after treatment. Key words: Viferon®, children, immunity, interferon, influenza, acute respiratory viral infections

Joint Prevalence of Influenza Preventive Behaviors Among Adults-United States, 2020.

The Centers for Disease Control and Prevention recognizes routine vaccination, sufficient sleep, and adequate physical activity as behavioral approaches to reduce the incidence of influenza. We aimed to determine the joint national prevalence of these health behaviors among U.S. adults, which has not been reported. We used the 2020 National Health Interview Survey to assess prevalence of receiving influenza vaccination in the past 12 months, obtaining sufficient sleep, and achieving adequate physical activity among U.S. adults (n = 30,312). We calculated the joint prevalence overall and by sociodemographic and health-related variables. The overall joint prevalence was 8.5% (95% CI, 8.0-9.0). Prevalence was lower among older persons (vs younger); Hispanic and non-Hispanic Black persons (vs non-Hispanic White); current and former smokers (vs never smokers); postpartum women (vs neither pregnant nor postpartum); and those with a history of coronary heart disease, hypertension, stroke, diabetes, and chronic obstructive pulmonary disease (vs not having those respective condition). In addition to recommending annual vaccination, primary care providers might encourage sufficient sleep and adequate physical activity-especially among patients who have increased risk for influenza complications and are less likely to achieve these behaviors.

Coverage of influenza vaccination of patients with diabetes and determination of barriers for implementation of vaccination

People with diabetes (PWD) are considered to be at high risk of developing severe influenza complications that can lead to hospitalization and sometimes death. It is because of the high risk of developing severe complications that WHO recommends seasonal influenza vaccination (SIV) for PWD.&#x0D; The purpose of the work is to establish the level of coverage of vaccination in PWD and to identify barriers to vaccination in this group in order to overcome obstacles.&#x0D; We analyzed data on the coverage of SIV in PWD and studied the problems of low adherence to vaccination in PWD. We used content analysis, bibliosemantic, analytical, generalizing analyses. An insufficient level of vaccination coverage of PWD has been established. Barriers to vaccination in PWD have been identified. Barriers can be: age, health status, allergic reactions and chronic diseases of people, lower level of education, gender and their employment in economic activities. At the same time, gaps in the knowledge of health care provider, insufficient involvement of endocrinologists and diabetologists in informing PWD about vaccination, a limited number of imported vaccines, and low physical and economic accessibility of vaccines negatively affect the coverage of SIV. A significant factor influencing the level of vaccination coverage of people is their vaccination hesitation. Pharmacists should actively participate in the vaccination campaign by raising public awareness and providing advice to PWD who regularly visit pharmacies. To increase the vaccination coverage of PWD, it is necessary to introduce training programs for doctors and pharmacists to attract them to influenza vaccination companies. Simultaneously conduct educational campaigns and education of PWD. It is advisable to organize a free flu vaccination in medical and diagnostic diabetic hospital (institutions) to increase the physical and economic accessibility of vaccination for PWD. A large number of studies showing the cost-effectiveness of SIV in PWD should be a significant factor for health authorities to improve measures to increase the level of coverage of SIV in patients in this risk group.

Burden of Severe Illness Associated With Laboratory-Confirmed Influenza in Adults Aged 50-64 Years, 2010-2011 to 2016-2017.

Understanding the burden of influenza is necessary to optimize recommendations for influenza vaccination. We describe the epidemiology of severe influenza in 50- to 64-year-old residents of metropolitan Toronto and Peel region, Canada, over 7 influenza seasons. Prospective population-based surveillance for hospitalization associated with laboratory-confirmed influenza was conducted from September 2010 to August 2017. Conditions increasing risk of influenza complications were as defined by Canada's National Advisory Committee on Immunization. Age-specific prevalence of medical conditions was estimated using Ontario health administrative data. Population rates were estimated using Statistics Canada data. Over 7 seasons, 1228 hospitalizations occurred in patients aged 50-64 years: 40% due to A(H3N2), 30% A(H1N1), and 22% influenza B. The average annual hospitalization rate was 15.6, 20.9, and 33.2 per 100 000 in patients aged 50-54, 55-59, and 60-64 years, respectively; average annual mortality was 0.9/100 000. Overall, 33% of patients had received current season influenza vaccine; 963 (86%) had ≥1 underlying condition increasing influenza complication risk. The most common underlying medical conditions were chronic lung disease (38%) and diabetes mellitus (31%); 25% of patients were immunocompromised. The average annual hospitalization rate was 6.1/100 000 in those without and 41/100 000 in those with any underlying condition, and highest in those with renal disease or immunocompromise (138 and 281 per 100 000, respectively). The case fatality rate in hospitalized patients was 4.4%; median length of stay was 4 days (interquartile range, 2-8 days). The burden of severe influenza in 50- to 64-year-olds remains significant despite our universal publicly funded vaccination program. These data may assist in improving estimates of the cost-effectiveness of new strategies to reduce this burden.

Thromboembolic Events in Patients with Influenza: A Scoping Review.

Influenza is an acute respiratory infection that usually causes a short-term and self-limiting illness. However, in high-risk populations, this can lead to several complications, with an increase in mortality. Aside from the well-known extrapulmonary complications, several studies have investigated the relationship between influenza and acute cardio and cerebrovascular events. Reviews of the thromboembolic complications associated with influenza are lacking. the study aims to conduct a scoping review to analyze the epidemiological and clinical characteristics of patients suffering from influenza and thromboembolic complications. A computerized search of historical published cases using PubMed and the terms "influenza" or "flu" and "thrombosis", "embolism", "thromboembolism", "stroke", or "infarct" for the last twenty-five years was conducted. Only articles reporting detailed data on patients with thromboembolic complications of laboratory-confirmed influenza were considered eligible for inclusion in the scoping review. Fifty-eight cases with laboratory documented influenza A or B and a related intravascular thrombosis were retrieved. Their characteristics were analyzed along with those of a patient who motivated our search. The localizations of thromboembolic events were pulmonary embolism 21/58 (36.2%), DVT 12/58 (20.6%), DVT and pulmonary embolism 3/58 (5.1%), acute ischemic stroke 11/58 (18.9%), arterial thrombosis 4/58 (6.8%), and acute myocardial infarction 5/58 (8.6%). Our findings are important in clarifying which thromboembolic complications are more frequent in adults and children with influenza. Symptoms of pulmonary embolism and influenza can be very similar, so a careful clinical evaluation is required for proper patient management, possible instrumental deepening, and appropriate pharmacological interventions, especially for patients with respiratory failure.

Symptoms and Complications of Influenza a in the Elderly Upon arrival at the Hospital

Symptoms and Complications of Influenza a in the Elderly Upon arrival at the Hospital

Reducing Hospital Capacity Needs for Seasonal Respiratory Infections: The Case of Switching to High-Dose Influenza Vaccine for Dutch Older Adults

ObjectivesInfluenza is responsible for considerable health and economic burden every year. Especially older adults are vulnerable for influenza infection and its complications due to immunosenescence and often-underlying medical conditions. Recently, the innovative quadrivalent high-dose influenza vaccine (QIV-HD) has become available in Europe. Through its enhanced immunogenicity, QIV-HD offers improved protection for older adults against respiratory as well as cardiovascular complications. We estimated the potential impact—specifically in terms of hospital admissions and related costs—of a hypothetical past switch from QIV-Standard dose (SD) to QIV-HD in The Netherlands. MethodsEstimates of hospitalizations for the older adults vaccinated with QIV-SD were derived from the seasons 2010/2011-2017/2018. Subsequently, the number of respiratory infections and cardiovascular complications of influenza were estimated for the year 2019/2020 for both QIV-SD and QIV-HD. To calculate the overall corresponding savings, costs for hospital complications, derived from literature, were used. ResultsWhen QIV-HD would have been used instead of QIV-SD during the season 2019/2020, an additional 220 hospitalizations would have been averted among older adults of 60 years and older in the Netherlands. This corresponds to savings of €1 219 779 (uncertainty interval: 1 089 813-1 348 549), of which 69% is attributable to cardiovascular-related hospitalizations. ConclusionsWe demonstrate that a relevant improvement in influenza vaccination among older adults in The Netherlands can be achieved by switching from the current QIV-SD to QIV-HD. Not only comes a switch from QIV-SD to QIV-HD with a significant reduction in pressure on hospital capacity but also with notable cost savings.