Risk Of Influenza Infection Research Articles

Optimizing influenza vaccination among oncology patients through quality improvement cycles.

285 Background: Influenza poses significant risks to cancer patients, who are especially vulnerable due to immunosuppression caused by both their disease and treatment. (Cooksley et al., 2005) Sidney Kimmel Cancer Center – Jefferson Health (SKCC)’s Quality Improvement (QI) initiative aimed to increase influenza vaccination rates among adult cancer patients in our Center City clinic from October 2023 to March 2024. At baseline in the 2022-2023 flu season, 49% of our patients had a documented vaccination against influenza, leaving most of our patient population at increased risk for influenza infection. Methods: A series of four Plan-Do-Study-Act (PDSA) cycles were implemented over the course of the vaccination season. Cycle 1 collected baseline data on vaccination status via electronic health records (EHRs) and identified gaps in patient knowledge and vaccine hesitancy. Cycle 2 trained medical assistants (MAs) to engage in effective vaccination conversations, emphasizing the use of presumptive communication techniques and the reconciliation of immunization records in EHRs. Cycle 3 integrated patient education materials on vaccination in the clinical encounter. Cycle 4 scaled assessment protocols across teams. Results: Cumulatively, 68% (2,592/3,824) of unique oncology patients had a documented influenza vaccination by the completion of the season in March 2024. Integration of vaccine reconciliation into the MA workflow was the iteration that led to the biggest increase in vaccination rate among the PDSA cycles tested. We surpassed our initial aim for the season (59%) in this metric. Conclusions: The QI project at SKCC demonstrates that layered strategies involving both patients and care teams can improve vaccination rates among adult cancer patients. Integration of vaccine assessment into clinic workflows was an effective tactic. Future efforts will focus on replicating these successes with other vaccines. Rates of influenza vaccination by PDSA cycle. Cycle # Date Cycle Description Outcome Metric: Cumulative Vaccination Rate (%) 1 Oct 2023 Provider perception survey of vaccination knowledge 65 2 Nov 2023 Integration of vaccine reconciliation in MA workflow 69 3 Dec 2023 Integration of patient education materials to clinical encounter 70 4 Jan 2024 – Mar 2024 Scaling of updated workflows to entire clinic 68

Increased Risk of Influenza Infection During Cold Spells in China: National Time Series Study.

Studies have reported the adverse effects of cold events on influenza. However, the role of critical factors, such as characteristics of cold spells, and regional variations remain unresolved. We aimed to systematically evaluate the association between cold spells and influenza incidence in mainland China. This time series analysis used surveillance data of daily influenza from 325 sites in China in the 2014-2019 period. A total of 15 definitions of cold spells were adopted based on combinations of temperature thresholds and days of duration. A distributed lag linear model was used to estimate the short-term effects of cold spells on influenza incidence during the cool seasons (November to March), and we further explored the potential impact of cold spell characteristics (ie, intensity, duration, and timing during the season) on the estimated associations. Meta-regressions were used to evaluate the modification effect of city-level socioeconomic indicators. The overall effect of cold spells on influenza incidence increased with the temperature threshold used to define cold spells, whereas the added effects were generally small and not statistically significant. The relative risk of influenza-associated with cold spells was 3.35 (95% CI 2.89-3.88), and the estimated effects were stronger during the middle period of cool seasons. The health effects of cold spells varied geographically and residents in Jiangnan region were vulnerable groups (relative risk 7.36, 95% CI 5.44-9.95). The overall effects of cold spells were positively correlated with the urban population density, population size, gross domestic product per capita, and urbanization rate, indicating a sterner response to cold spells in metropolises. Cold spells create a substantial health burden on seasonal influenza in China. Findings on regional and socioeconomic differences in the health effects of cold spells on seasonal influenza may be useful in formulating region-specific public health policies to address the hazardous effects of cold spells.

Association between Statins Administration and Influenza Susceptibility: A Systematic Review and Meta-Analysis of Longitudinal Studies.

Previous studies reported that the association between statins use and influenza infection was contradictory. A systematic review and meta-analysis of longitudinal studies were performed to determine the association between statins use and influenza susceptibility. The literature search was conducted in PubMed, Embase, and Web of Science, from each database's inception to 21 May 2023. The fixed effect model and random effects model were used for data synthesis. In our study, a total of 1,472,239 statins users and 1,486,881 statins non-users from five articles were included. The pooled risk ratio (RR) of all included participants was 1.05 (95% CI: 1.03-1.07), and there were still significant differences after adjusting for vaccination status. Of note, RR values in statins users were 1.06 (95% CI: 1.03-1.08) in people aged ≥60 years old and 1.05 (95% CI: 1.03-1.07) in participant groups with a higher proportion of females. Administration of statins might be associated with an increased risk of influenza infection, especially among females and elderly people. For those people using statins, we should pay more attention to surveillance of their health conditions and take measures to prevent influenza infection.

Efficacy and safety of pediatric flu vaccination: a systematic review

Children are at a higher risk of influenza infection compared to the general population. The World Organization Health and recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics contemplate annual vaccination as the most effective way to prevent the disease. Therefore, the purpose of this review was to update information on efficacy and safety in the anti -shed vaccine in children and adolescents. A search in four electronic databases (Scopus, Cumulative Index to Nursing and Allied Health Literature, Medline / Pubmed, Google Scholar and Cochrane), as well as a manual search to identify original research published between 2012 and 2022. The guidelines of ANALYSIS (PRISMACR) as a preferred report element for systematic reviews. Seven original research articles were included where two issues of antigripal vaccination were identified in healthy children/adolescents and with pathologies. The efficacy (between approximately 30% and 80%) varied depending on the vaccine used and circulating subtypes. Most adverse reactions were mild intensity, and the most common local adverse event was pain in the injection site. We positively highlight the safety of pediatric flu vaccination in analyzed studies, on the contrary, with respect to the efficacy of flu vaccination, we observe a wide variability of results. There is a clear need to continue conducting efficacy and safety studies in the child.

Transient increased risk of influenza infection following RSV infection in South Africa: findings from the PHIRST study, South Africa, 2016–2018

BackgroundLarge-scale prevention of respiratory syncytial virus (RSV) infection may have ecological consequences for co-circulating pathogens, including influenza. We assessed if and for how long RSV infection alters the risk for subsequent influenza infection.MethodsWe analysed a prospective longitudinal cohort study conducted in South Africa between 2016 and 2018. For participating households, nasopharyngeal samples were taken twice weekly, irrespective of symptoms, across three respiratory virus seasons, and real-time polymerase chain reaction (PCR) was used to identify infection with RSV and/or influenza. We fitted an individual-level hidden Markov transmission model in order to estimate RSV and influenza infection rates and their interdependence.ResultsOf a total of 122,113 samples collected, 1265 (1.0%) were positive for influenza and 1002 (0.8%) positive for RSV, with 15 (0.01%) samples from 12 individuals positive for both influenza and RSV. We observed a 2.25-fold higher incidence of co-infection than expected if assuming infections were unrelated. We estimated that infection with influenza is 2.13 (95% CI 0.97–4.69) times more likely when already infected with, and for a week following, RSV infection, adjusted for age. This equates to 1.4% of influenza infections that may be attributable to RSV in this population. Due to the local seasonality (RSV season precedes the influenza season), we were unable to estimate changes in RSV infection risk following influenza infection.ConclusionsWe find no evidence to suggest that RSV was associated with a subsequent reduced risk of influenza infection. Instead, we observed an increased risk for influenza infection for a short period after infection. However, the impact on population-level transmission dynamics of this individual-level synergistic effect was not measurable in this setting.

Influenza Vaccine Administration and Effectiveness Among Children and Adults With Glomerular Disease

IntroductionInfluenza infections contribute to excess healthcare utilization, morbidity, and mortality in individuals with glomerular disease, however influenza vaccination may not yield protective immune responses in this high-risk patient population. The objective of the present study was to describe influenza vaccine administration from 2010 to 2019 and explore the effectiveness of influenza vaccination in patients with glomerular disease. MethodsWe conducted an observational cohort study using healthcare claims for seasonal influenza vaccination (exposure) and influenza and influenza-like illness (outcomes) from commercially insured children and adults <65 years of age with primary glomerular disease in the Merative MarketScan® Research Databases. Propensity score-weighted cox proportional hazards models and ratio-of-hazard ratios (RHR) analyses were used to compare influenza infection risk in years where seasonal influenza vaccines matched or mismatched circulating viral strains. ResultsThe mean proportion of individuals vaccinated per season was 23% (range 19-24%). In pooled analyses comparing matched vs. mismatched seasons, vaccination was minimally protective for both influenza (RHR 0.86, 95% CI 0.52-1.41) and influenza-like illness (RHR 0.86, 95% CI 0.59-1.24), though estimates were limited by sample size. ConclusionsRates of influenza vaccination are suboptimal among patients with glomerular disease. Protection from influenza after vaccination may be poor, leading to excess infection-related morbidity in this vulnerable population.

Caregivers' understanding of childhood influenza vaccination during the epidemic in China. A mixed-methods study.

Influenza vaccination uptake among young children has been poor in China, but it is unclear how it changed during the COVID-19. This study aimed to investigate the uptake status and reasons of childhood influenza vaccination during the pandemic in China. A mixed-methods study combining a questionnaire survey and semi-structured interviews was conducted in Anhui, Shaanxi, and Guangdong provinces between September and November 2021. 2081 caregivers completed the valid questionnaire. 38 caregivers participated in interviews, and data were analyzed thematically, using deductive and inductive coding. A total of 2081 caregivers completed the valid questionnaire, and 38 caregivers participated in interviews. Among the caregivers, a total of 1796 were in the age group for high-risk groups in the 2019-2020 flu season, and 46.10% reported that their children received influenza vaccination in the 2019-2020 flu season; 43.63% said that they vaccinated their children against influenza in the 2020-2021 flu season. Many caregivers indicated that the adoption of nonpharmacologic interventions (NPIs) during COVID-19 reduced the risk of influenza infection for children. Most caregivers consider the severity of influenza to be low, and some confused the common cold with influenza. Meanwhile, some caregivers lack confidence in the vaccine's effectiveness and importance. They thought that vaccines are not effective in preventing the constantly mutating virus. Despite clear perceptions about the severity of influenza and the effectiveness of the vaccine, we found that most caregivers did not receive any relevant medical information, and the communication about vaccines between caregivers and professional information sources, such as healthcare workers, is inadequate. Hence, caregivers have no scientific evidence to back up their perceptions. In terms of access to vaccination service, caregivers reported conflicts between time of vaccination service and their schedule, and the need for vaccine prices to be reduced. Targeted interventions are needed to address caregivers' lack of risk perception on influenza during COVID-19 and promote communication between caregivers and professional information sources. Extending vaccination service hours and increasing the number of vaccine clinics close to residential areas and expansion of financing sources for self-paid vaccination could facilitate the access to influenza vaccination service.

Sustained Increase in Very Low Influenza Vaccination Coverage in Residents and Healthcare Workers of Long-Term Care Facilities in Austria after Educational Interventions.

Residents of long-term care facilities (LTCFs) are particularly at risk for influenza infections. We aimed to improve influenza vaccination coverage among residents and healthcare workers (HCWs) in four LTCFs by implementing educational programs and enhanced vaccination services. We compared vaccination coverage before and after the interventions (2017/18 and 2018/19 seasons). Data on vaccination adherence were recorded during a four-year observational period (2019/20 to 2022/23 seasons). Following the interventions, vaccination coverage increased significantly from 5.8% (22/377) to 19.1% (71/371) in residents and from 1.3% (3/234) to 19.7% (46/233) in HCWs (p < 0.001). During the observational period (2019/20 to 2022/23 seasons), vaccination coverage remained high in residents but decreased in HCWs. Vaccination adherence was significantly higher in residents and HCWs in LTCF 1 compared to the other three LTCFs. Our study suggests that a bundle of educational interventions and enhanced vaccination services can be an effective method for improving influenza vaccination coverage in LTCFs in both residents and HCWs. However, vaccination rates are still well below the recommended targets and further efforts are needed to increase vaccine coverage in our LTCFs.

Host-targeted self-attenuated influenza virus as an effective nasal spray vaccine in aged population

Abstract The elderly are at high risk for influenza infection and its complication. However, current inactivated influenza vaccines are often modestly immunogenic and show low protective immunity in the elderly, due to immunosenescence. New approaches are urgently needed for developing effective vaccines against influenza for the elderly. In current study, we have constructed new recombinant influenza viruses, named host-targeted self-attenuated influenza viruses (SAIVs), which can express functional mammalian species-specific artificial microRNAs (amiRNAs). The expression of these amiRNAs can inhibit expression of some host factors critical for influenza replication, and therefore the resultant recombinant influenza viruses are replication restricted and attenuated in the host cells. One of these SAIVs, which can express an amiRNA that inhibits expression of the host cellular Cdc2-like kinase 1 (CLK1), was produced in embryonic chicken eggs and evaluated in an aged mouse model of influenza infection. It elicited robust antibody and T cell responses against influenza virus and demonstrated significantly protective efficacy against lethal infection with wild type influenza virus H1N1 PR8 after single dose of intranasal vaccination. Our research finding provided a proof of concept that the new host targeted self-attenuated influenza virus can be further used as an effective vaccine against influenza in aged population. Supported by a research grant from National Institute of Allergy and Infectious Diseases (AI133207).

Evaluating the Impact of Statin Use on Influenza Vaccine Effectiveness and Influenza Infection in Older Adults.

Older adults are recommended to receive influenza vaccination annually, and many use statins. Statins have immunomodulatory properties that might modify influenza vaccine effectiveness (VE) and alter influenza infection risk. Using the test-negative design and linked laboratory and health administrative databases in Ontario, Canada, we estimated VE against laboratory-confirmed influenza among community-dwelling statin users and nonusers aged ≥66 years during the 2010-2011 to 2018-2019 influenza seasons. We also estimated the odds ratio for influenza infection comparing statin users and nonusers by vaccination status. Among persons tested for influenza across the 9 seasons, 54 243 had continuous statin exposure before testing and 48 469 were deemed unexposed. The VE against laboratory-confirmed influenza was similar between statin users and nonusers (17% [95% confidence interval, 13%-20%] and 17% [13%-21%] respectively; test for interaction, P = .87). In both vaccinated and unvaccinated persons, statin users had higher odds of laboratory-confirmed influenza than nonusers (odds ratios for vaccinated and unvaccinated persons 1.15 [95% confidence interval, 1.10-1.21] and 1.15 [1.10-1.20], respectively). These findings were consistent by mean daily dose and statin type. VE did not differ between users and nonusers of other cardiovascular drugs, except for β-blockers. We did not observe that vaccinated and unvaccinated users of these drugs had increased odds of influenza, except for unvaccinated β-blocker users. Influenza VE did not differ between statin users and nonusers. Statin use was associated with increased odds of laboratory-confirmed influenza in vaccinated and unvaccinated persons, but these associations might be affected by residual confounding.

2202. Influenza Surveillance of Families in an Observational Household Study 2019-2021

Abstract Background Families with children may be at higher risk for influenza infection. Community transmission can suffer from underreporting as testing is often not performed. We studied the epidemiology of influenza in households with school-aged children using home-based sample collection. Methods We conducted a remote household study surveilling respiratory viruses from November 2019-June 2021, in King County, Washington (WA), USA. Households with school-aged children were enrolled, mailed home specimen collection kits, and asked to self-assess for weekly acute respiratory illness (ARI) using remote survey platforms. Participants with ARI symptoms were prompted to complete serial illness surveys and self-collect/parent collect mid-turbinate nasal swabs. Samples were sent to a University of Washington study laboratory for RT-PCR influenza testing. Influenza rates were compared to WA Department of Health (DOH) reporting. Results A total of 1861 ARI events were reported among 992 adults and 869 children in 470 households; 75 influenza cases were detected (36 influenza A and 39 influenza B). The study participant median age was 32 years (0-84), 10 years (1-49) for influenza A, and 11 years (3-49) for influenza B cases. Overall 13% of households had an influenza case, of which 13 (22%) reported &amp;gt;1 case. A total of 81% of participants reported receipt of one dose of the 2019-2020 influenza vaccine, including 91% of influenza A and 90% of influenza B cases, and 84% received the 2020-2021 influenza vaccine. Like WA DOH, we observed a wave of influenza B cases followed by influenza A in 2019-2020. During influenza season 2020-2021, WA DOH reported 9 positive influenza tests and none observed in our study. Commonly, influenza case-patients reported were fever, cough, rhinorrhea, and fatigue. GI symptoms were more common in children than adults. Of the cases, 92% of influenza A and 78% of influenza B occurred in children. Figure 1.Influenza A and B cases from 2019-2021Figure 2A.Reported Symptoms of Influenza A D0-Day of reported onset, D7-7 days after reported illness onset. No participants &amp;gt;49 years were positive for influenza. D0: 30 participants responded and of respondents, 13% &amp;lt;5 years, 47% 5-12 years, 3% 13-17 years, and 37% 18-49 years. D7: 31 participants responded and of respondents 13% &amp;lt;5 years, 48% 5-11 years, 3% 12-17 years, and 36% 18-49 years. Figure 2B.Reported Symptoms of Influenza B D0-Day of reported onset, D7-7 days after reported illness onset. No participants &amp;gt;49 years were positive for influenza. D0: 28 participants responded and of respondents, 4% &amp;lt;5 years, 57% 5-12 years, 14% 13-17 years, and 25% 18-49 years. D7: 28 participants responded and of respondents, 4% &amp;lt;5 years, 57% 5-11 years, 18% 12-17 years, and 21% 18-49 years. Conclusion Influenza illness in 2019-2020 was initially influenza B, and subsequently replaced by influenza A. Most cases were in children and adolescents, despite at least one dose of influenza vaccine. Symptoms were widely distributed and similar between influenza A and B. Influenza incidence in our cohort declined to zero with the rise of SARS-CoV-2 cases and widespread mitigation efforts. Disclosures Janet A. Englund, MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.

Evaluation of Adverse Reactions to Influenza Vaccination: A Prospective Cohort Study.

This study aimed to investigate the influence of sex, age, and quadrivalent vaccination history on adverse reactions (ARs) to influenza vaccines and the relationship between the occurrence of ARs and the risk of influenza infection. Study participants were employees of three hospitals in the Hyogo Prefecture, Japan, who received the influenza vaccine in 2019. Data were collected using questionnaires. The main factors were age, sex, and history of influenza vaccination as a control. The primary outcomes were the incidence of local and systemic ARs attributable to the vaccine and positive influenza cases among the participants during the influenza season. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Among the 1493 participants, 80% experienced either local or systemic ARs. ARs were less common among men than among women (OR: 0.28, 95% CI: 0.21–0.37) and less common among those aged ≥60 years (OR: 0.48, 95% CI: 0.26–0.89). ARs were significantly more likely to occur in those with a history of influenza vaccination (OR: 1.96, 95% CI: 1.15–3.33). Those who had ARs, notably localized ones, were significantly more likely to incur influenza infection. Individuals who report ARs to influenza vaccination should strictly adopt non-pharmaceutical preventive measures in the hospital, community settings, and at home.

The influence of air quality and meteorological variations on influenza A and B virus infections in a paediatric population in Singapore

IntroductionInfluenza is an important cause of paediatric illness across the globe. However, information about the relationships between air pollution, meteorological variability and paediatric influenza A and B infections in tropical settings is limited. MethodsWe analysed all daily reports of influenza A and B infections in children <5 years old obtained from the largest specialist women and children's hospital in Singapore. In separate negative binomial regression models, we assessed the dependence of paediatric influenza A and B infections on air quality and meteorological variability, using multivariable fractional polynomial modelling and adjusting for time-varying confounders. ResultsApproximately 80% of 7329 laboratory-confirmed reports were caused by influenza A. We observed positive associations between sulphur dioxide (SO2) exposure and the subsequent risk of infection with both influenza types. We observed evidence of a harvesting effect of SO2 on Influenza A but not Influenza B. Ambient temperature was associated with a decline in influenza A reports (Relative Risk at lag 5 [RRlag5]: 0.949, 95% CI: 0.916–0.983). Rainfall was positively associated with a subsequent increase in influenza A reports (RRlag3: 1.044, 95% CI: 1.017–1.071). Nitrogen dioxide (NO2) concentration was positively associated with influenza B reports (RRlag5: 1.015, 95% CI: 1.005–1.025). There was a non-linear association between CO and influenza B reports. Absolute humidity increased the ensuing risk of influenza B (RRlag5: 4.799, 95% CI: 2.277–10.118). Influenza A and B infections displayed dissimilar but predictable within-year seasonal patterns. ConclusionsWe observed different independent associations between air quality and meteorological variability with paediatric influenza A and B infections. Anticipated seasonal infection peaks and variations in air quality and meteorological parameters can inform the timing of community measures aimed at reducing influenza infection risk.

MO1043: Influenza Vaccine Awareness and Acceptance Among Individuals with Glomerulonephritis and Renal Vasculitis During the Corononavirus Disease 2019 Pandemic

BACKGROUND AND AIMSPatients with glomerulonephritis may have an increased risk of influenza infection and morbidity, but vaccine coverage remained low with little data on acceptance in glomerulonephritis. We aimed to assess influenza vaccine awareness among patients with glomerulonephritis and identify determinants of vaccine acceptance.METHODSingle-center cross-sectional study of patients with glomerulonephritis who completed a survey in the clinic or over the telephone between June and August 2021. Sociodemographic data, health literacy measured by HLS-EU-47 questionnaire, influenza and the coronavirus disease (COVID-19) vaccine awareness and determinants of vaccine acceptance according to the World Health Organization framework.RESULTSAmong 86 patients who completed the survey, influenza vaccine awareness was lower than COVID-19 vaccine awareness (75.6% versus 100%). After adjusting for the survey type, use of English language at home and at healthcare settings, higher income and professional or executive occupation were significantly associated with influenza vaccine awareness, while older age and lower education level were associated with reduced awareness. The healthcare provider was the most frequent information source and > 90% trusted that healthcare providers and the government considered the patients’ best interests and gave correct information. Only half thought their medical condition and medications would affect their vaccine decision while a quarter to half did not understand how the vaccine worked and thought there were better ways to protect against infection.CONCLUSIONHealthcare providers can actively identify and advocate influenza vaccines to the unaware and overcome potential barriers to reduce influenza infections and morbidity in glomerulonephritis.

Incidence of Influenza Virus Infection among Wroclaw's Healthcare Workers in Pre-COVID-19 2019-2020 Influenza Season Using Novel Flu SensDx Device.

Background: Healthcare workers (HCWs) are more exposed to influenza infection, and the influenza vaccination is recommended each year, to reduce the risk of influenza infection and prevent influenza transmission. This study is a cross-sectional study and the objectives were to determine the rate of influenza virus infection among HCWs in the 2019–2020 influenza season. Methods: Between January and March 2020, a survey was carried out in 2 hospitals and 15 primary health-care settings (PHCS) in Wroclaw (Poland). The novel point-of-care testing Flu SensDx device was used, which detects the M1 protein of the influenza virus using electrochemical impedance spectroscopy from biological material (throat/nasal swabs). Results: A total of 150 samples were collected. The majority of participating HCWs by profession were 83 physicians (55.3%) and half (51.3%) of the participating HCWs worked in PHCS. Influenza vaccination coverage was 61.3% in 2019–2020 and 46.0% in the 2018–2019 season for all participants. Of the participating HCWs, 44.0% were positive tested by the Flu SensDx device. There were no statistically significant differences among the positive tested HCWs, their influenza immunization history, and the presence of symptoms of influenza-like illness (p > 0.05). Conclusion: Although the results of the present study suggest that influenza vaccination does not reduce the frequency of influenza virus detection by Flu SensDx testing in the HCWs participants, larger studies are needed to estimate the incidence of influenza virus infection among HCWs to understand the underlying mechanism and fine-tune policies aimed at reducing nosocomial infections.

Spinal corticosteroid injections are not associated with increased influenza risk

BACKGROUND CONTEXTSpinal corticosteroid injections (CSI) are often used to treat radicular and axial pain arising from the spine. Systemic corticosteroids are well known to cause immunosuppression, and locally injected spinal CSI are known to have some systemic absorption. However, it is unknown whether spinal CSI increases the risk of systemic viral infections, such as influenza. PURPOSETo determine whether spinal CSI causes an increased risk for influenza infection and whether they reduce the protective effect of vaccination STUDY DESIGN/SETTINGA retrospective cohort study was performed at Kaiser Permanente Northern California, a large healthcare system with a diverse population. PATIENT SAMPLEAdults (n=60,880) who received a spinal CSI during influenza seasons from 2016 to 2019. A comparison was made with 121,760 case-matched individuals who did not receive a spinal CSI. OUTCOME MEASURESThe primary outcome was odds of influenza diagnosis following spinal CSI compared with case-matched controls. Secondary analysis examined odds of influenza diagnosis based on vaccination status, multiple same-day injections, and epidural versus non-epidural route of injection. METHODSThe electronic health record and associated research databases were analyzed to identify patients who received a spinal CSI during three consecutive flu seasons, 2016 through 2019. Injections were stratified into epidural versus non-epidural CSI and single injections versus multiple same-day injections. Additionally, the rate of influenza in vaccinated versus non-vaccinated individuals was examined. Inpatient flu diagnosis was used as a proxy for severe disease. After case matching was completed, odds ratios for flu diagnosis were calculated using a logistical regression model. RESULTSThe odds of flu diagnosis following spinal CSI were not increased compared with controls (OR 0.93 [0.87-1.01, 95% Wald CL]). For epidural CSI the OR was 0.91 (0.83-1.00, 95% Wald CL), and non-epidural it was 1.00 (0.89-1.13, 95% Wald CL). There were similar findings for multiple same-day injections and when looking at inpatient flu diagnosis. For vaccinated individuals, the OR for flu following spinal CSI was 0.86 (0.80-0.92, 95% Wald CL), which indicates a protective effect in these patients. CONCLUSIONSSpinal CSI did not increase the odds of subsequently receiving a diagnosis of influenza, regardless of vaccination status, location of injection, single versus multiple same-day injection, or co-morbidity. Vaccination had a protective effect against influenza, and this was not adversely affected by receiving spinal CSI during the flu season.

Influenza vaccination uptake and its determinants during the 2019-2020 and early 2020-2021 flu seasons among migrants in Shanghai, China: a cross-sectional survey

ABSTRACT Influenza vaccination coverage has generally been low in mainland China. However, few studies have attempted to measure influenza vaccination coverage among internal migrants in China who are at an increased risk of influenza infections. This study assessed influenza vaccination coverage and the factors associated with vaccination uptake among internal migrants in Shanghai, China. We conducted a cross-sectional online survey among a sample of migrants residing in Shanghai during November 1–20, 2020, to investigate vaccination uptake during the 2019–20 and early 2020–21 flu seasons (September to November 2020). Multivariable logistic regression was used to examine the factors associated with influenza vaccination uptake for the two flu seasons. About a quarter, 26.3%, and 24.4% of respondents reported receiving an influenza vaccination during the 2019–20 and early 2020–2021 flu seasons, respectively. Respondents who were divorced or widowed, had more household members (2 or ≥ 3), and considered themselves in good health were more likely to receive an influenza vaccine, regardless of the season. Respondents who perceived that they were highly susceptible to influenza and COVID-19 and those who reported ever consulting a medical professional about COVID-19 were more likely to have received a flu vaccination in the early 2020–21 flu season. The uptake of influenza vaccination among internal migrants in Shanghai was suboptimal. We found a range of factors linked to influenza vaccination uptake, pointing to the need for more in-depth evaluations on the underlying reasons driving the vaccination uptake among vulnerable populations in China, especially during the COVID-19 pandemic.

Acceptance Rate of Influenza Vaccination Among Patients with Type II Diabetes.

Background:It is well known that patients with diabetes are at increased risk of influenza infection and its serious complications. Our aim was to evaluate the attitude towards and prevalence of influenza vaccination among Saudi patients with diabetes.Methodology:Descriptive questionnaire-based cross-sectional survey of a sample of patients with diabetes attending a specialist diabetic centre in the Ministry of Health Hospital in Taif city in Saudi Arabia. We utilized a generalized logistic regression model analysis to evaluate the effect of background factors on influenza vaccine uptake.Results:The study included (n = 336) patients with diabetes. The prevalence of uptake of influenza vaccine was 43.5% (CI: 38.2% to 48.8%). Adjusted analysis of background effects revealed that uptake of influenza vaccine was improved with age, university education, and belief in the dangerousness of flu infection in patients with diabetes. Factors that deterred from the uptake of flu vaccines were longer in DM duration, getting health messages about flu vaccines, belief in vaccine effectiveness, health practitioner information, in addition to physician recommendation of the vaccine.Conclusion:The content of health messages about flu vaccine and the quality of practitioner-patient interaction requires considerable improvement and re-evaluation if the flu vaccine uptake rates among Saudi individuals with diabetes were to increase. Comprehensive therapeutic packages for patients with diabetes should include high quality education about influenza vaccine. Research into preventative measures among patients with diabetes should evaluate the effect of educational interventions using robust methodology.

The effect of standard-dose wintertime vitamin D supplementation on influenza infection in immunized nursing home elderly residents

AimTo investigate whether three-month oral vitamin D supplementation (800 IU in drops) reduces the risk of influenza infection in elderly nursing home residents vaccinated against influenza.MethodsThis cross-sectional observational study enrolled 97 participants (73.2% women) who received one dose of seasonal trivalent 2016-2017 influenza vaccine. The patients were randomized into an experimental group, which received vitamin D supplementation for three months starting on the day of vaccination, and a control group, which did not receive vitamin D supplementation. The primary outcome was the number of influenza infections laboratory-confirmed using a rapid point-of-care test based on nasal swabs collected during vitamin D supplementation. The secondary outcome was serum 25-hydroxyvitamin D level at the end of the study.ResultsThe mean age ±standard deviation was 78.5± 8.8 years. All participants had vitamin D deficiency at baseline. Twenty-three participants who developed signs of respiratory infections during the study were tested for influenza virus. Although the number of influenza-positive participants was lower in the group receiving vitamin D supplementation as compared with the control group (5 vs 12), this difference was not significant. Vitamin D supplementation failed to increase 25(OH)D levels after three months of supplementation.ConclusionElderly nursing home residents in Zagreb County have a significant vitamin D deficiency. The recommended national supplementation of 800 IU daily failed to lead to vitamin D sufficiency and did not reduce the risk of influenza infection among the vaccinated elderly.

Exploration of correlation of oral hygiene and condition with influenza infection.

Influenza viruses are known to be infected through epithelial cells of the upper respiratory tract. The oral cavity is in close anatomical proximity to the upper respiratory tract, and it is conceivable that the viruses could pass through the oral cavity and infect to the upper respiratory tract. Several researchers have suggested that colonization of certain pathogenic bacteria such as Staphylococcus aureus or Streptococcus pneumoniae might affect the risk of influenza viral disease, indicating that oral hygiene and/or condition might play an important role in respiratory viral infection. Therefore, the purpose of this study was to investigate whether an oral hygiene/condition might impact influenza infection. We conducted a retrospective observational study of Japanese citizens’ regional cohort (N = 2,904) consisting of National Health Insurance beneficiaries who underwent annual health/dental examination with data entries in the Kokuho database (KDB). Trained dentists checked the oral hygiene/condition, and saliva specimens were examined using the LION dental saliva multi-test (SMT) kit. Influenza infection was identified from the diagnosis recorded in the KDB. The correlations between influenza infection and oral hygiene, dryness of the mouth, or various salivary test results were examined by a multivariate analysis adjusting for confounding factors such as gender, age, recent smoking, alcohol drinking, BMI, HbA1c, RBC for influenza infection. The logistic regression model showed that age significantly correlated with influenza infection. In addition, oral hygiene status had a nearly significant impact on influenza infection (p = 0.061), whereby, the subjects with poor oral hygiene had a higher risk of influenza infection than those with good oral hygiene (odds ratio: 1.63, 95% confidence interval: 0.89–2.95). Further, the prevalence of influenza infection was lower in the subjects with saliva weakly acidic and/or containing higher protein level. The results of this study suggested that the maintenance of oral health conditions might be one of the pivotal factors for preventing and reducing influenza infection.