Risk Of Influenza-like Illness Research Articles

Indoor environmental factors associated with influenza transmission in mainland China between February and April 2023

BackgroundThe relaxation of strict COVID-19 control measures has led to a considerable increase in the number of influenza cases in 2023. This worrisome situation has posed a greater burden on public health and healthcare systems. Understanding environmental drivers of influenza epidemics can provide valuable insights for developing effective interventions. MethodsWe conducted an online survey from April 13th to 14th, 2023 to investigate the incidence of influenza-like illness (ILI) and influenza A within the past two months. A total of 4916 valid questionnaires were collected in mainland China. The questionnaire explored the relationship between the spread of ILI/Influenza A and factors including personal attributes, living environment, indoor ventilation, and personal behaviours. ResultsOut of the 4916 respondents, 1583 reported having ILI in the past two months, and among them, 456 were infected with influenza A. The multivariate logistic regression analysis revealed significant associations with a lower likelihood of reporting ILI for the following variables: being female (Adjusted OR (aOR) = 0.834), having bedroom ventilation time exceeding 12 hours (aOR = 0.782), wearing masks in public places (aOR = 0.646), and using surgical masks (aOR = 1.417). Conversely, variables associated with an increased risk of ILI included larger household size (>4: aOR = 2.405), presence of odours in the bathroom (aOR = 1.163), commuting by bus (aOR = 1.265), longer indoor stay during weekdays (>18 h: aOR = 1.969), and a history of COVID-19 infection (aOR = 1.459). Furthermore, handwashing after toileting (aOR = 0.694) was associated with a lower reporting of influenza A. ConclusionsOur study innovatively examined the impact of personal and environmental factors on influenza transmission. These observational findings can provide a scientific guidance for preventive measures against influenza.

Respiratory viral infections before the COVID-19 in Portugal: A single center study

ObjectivesWe aimed to describe the respiratory viruses (RV) found in respiratory samples from patients admitted to Hospital de São Bernardo, Setúbal, Portugal, between October 2019 and March 2020, and to correlate these with clinical features. DesignThis retrospective study explored 948 fresh frozen naso/oropharyngeal swabs, tested by reverse transcription-polymerase chain reaction. ResultsRhinovirus/enterovirus, influenza, and respiratory syncytial virus (hRSV) were the most prevalent RV. Half of the patients fulfilled the acute respiratory infection (ARI) and/or influenza-like illness (ILI) criteria, with increasing age significantly reducing the risk of ARI and/or ILI. Hospital admission was more frequently observed in symptomatic patients, but the length of stay and mortality were significantly lower. Most (96.5 %) patients had a main respiratory diagnosis. In adults, the most prevalent was pneumonia, which particularly affected older patients, while in children, the most common was bronchiolitis. The number of hospital admissions was high. Sudden onset, shortness of breath, older age, and hRSV detection significantly increased the risk of hospital admission overall. In bronchiolitis, female gender significantly increased the risk of hospital admission, while older age significantly reduced this risk. Twenty patients died within the first month of sampling, and all were older adults. Older age and male gender significantly increased the risk of death. ConclusionsRespiratory viral infections can have a significant clinical impact, particularly in young infants with bronchiolitis and older adults with pneumonia. This study provides the first snapshot of the respiratory viral infections just before the outbreak of SARS-CoV-2 in Portugal, providing relevant clinical insights.

Spatial distribution and driving factors of the associations between temperature and influenza-like illness in the United States: a time-stratified case-crossover study

BackgroundSeveral previous studies investigated the associations between temperature and influenza in a single city or region without a national picture. The attributable risk of influenza due to temperature and the corresponding driving factors were unclear. This study aimed to evaluate the spatial distribution characteristics of attributable risk of Influenza-like illness (ILI) caused by adverse temperatures and explore the related driving factors in the United States.MethodsILI, meteorological factors, and PM2.5 of 48 states in the United States were collected during 2011–2019. The time-stratified case-crossover design with a distributed lag non-linear model was carried out to evaluate the association between temperature and ILI at the state level. The multivariate meta-analysis was performed to obtain the combined effects at the national level. The attributable fraction (AF) was calculated to assess the ILI burden ascribed to adverse temperatures. The ordinary least square model (OLS), spatial lag model (SLM), and spatial error model (SEM) were utilized to identify driving factors.ResultsA total of 7,716,115 ILI cases were included in this study. Overall, the temperature was negatively associated with ILI risk, and lower temperature gave rise to a higher risk of ILI. AF ascribed to adverse temperatures differed across states, from 49.44% (95% eCI: 36.47% ~ 58.68%) in Montana to 6.51% (95% eCI: -6.49% ~ 16.46%) in Wisconsin. At the national level, 29.08% (95% eCI: 27.60% ~ 30.24%) of ILI was attributable to cold. Per 10,000 dollars increase in per-capita income was associated with the increment in AF (OLS: β = -6.110, P = 0.021; SLM: β = -5.496, P = 0.022; SEM: β = -6.150, P = 0.022).ConclusionThe cold could enhance the risk of ILI and result in a considerable proportion of ILI disease burden. The ILI burden attributed to cold varied across states and was higher in those states with lower economic status. Targeted prevention programs should be considered to lower the burden of influenza.

Association between Temperature and Influenza Activity across Different Regions of China during 2010-2017.

Influenza causes a significant disease burden as an acute respiratory infection. Evidence suggests that meteorological factors can influence the spread of influenza; however, the association between these factors and influenza activity remains controversial. In this study, we investigated the impact of temperature on influenza across different regions of China based on the meteorological data and influenza data from 554 sentinel hospitals in 30 provinces and municipalities in China from 2010 to 2017. A distributed lag nonlinear model (DLNM) was used to analyze the exposure lag response of daily mean temperatures to the risk of influenza-like illness (ILI), influenza A (Flu A), and influenza B (Flu B). We found that in northern China, low temperatures increased the risk of ILI, Flu A, and Flu B, while in central and southern China, both low and high temperatures increased the risk of ILI and Flu A, and only low temperatures increased the risk of Flu B. This study suggests that temperature is closely associated with the influenza activity in China. Temperature should be integrated into the current public health surveillance system for highly accurate influenza warnings and the timely implementation of disease prevention and control measures.

Etiology, clinical characteristics, and risk factors associated with severe influenza-like illnesses in Mexican adults

ObjectiveThe aim of this study was to determine the risk factors associated with severe influenza-like illness (ILI) in Mexican adults that could be useful to clinicians when assessing patients with ILI. MethodsData from adult patients enrolled from 2010 through 2014 in ILI002 – a prospective hospital-based observational cohort study – were analyzed. Etiology and clinical characteristics were compared between cases of severe ILI (defined as hospitalization and/or death) and cases of non-severe ILI. ResultsOverall, 1428 (39.0%) out of a total 3664 cases of ILI were classified as severe. Adjusted analyses showed a higher risk of severe ILI associated with signs and symptoms related to lower tract infection, i.e. cough with sputum (odds ratio (OR) 2.037, 95% confidence interval (CI) 1.206–3.477; P = 0.008), dyspnea (OR 5.044, 95% CI 2.99–8.631; and shortness of breath (OR 5.24, 95% CI 3.0839.124; P < 0.001), and with increases in lactate dehydrogenase (OR 4.426, 95% CI 2.321–8.881; P < 0.001) and C-reactive protein (OR 3.618, 95% CI 2.5955.196; P < 0.001). Further, there was an increased risk of severe ILI with a longer time between symptom onset and inclusion (OR 1.108, 95% CI 1.049–1.172; P < 0.001) and with chronic steroid use (OR 14.324, 95% CI 8.059-26.216; P < 0.001). ConclusionsRespiratory viruses can cause severe ILI. The results of this study highlight the importance of evaluating data compatible with lower tract involvement and previous use of immunosuppressants at baseline, because patients meeting these conditions may develop severe illness.

Effects of ambient temperature on influenza-like illness: A multicity analysis in Shandong Province, China, 2014-2017.

The associations between ambient temperature and influenza-like illness (ILI) have been investigated in previous studies. However, they have inconsistent results. The purpose of this study was to estimate the effect of ambient temperature on ILI in Shandong Province, China. Weekly ILI surveillance and meteorological data over 2014-2017 of the Shandong Province were collected from the Shandong Center for Disease Control and Prevention and the China Meteorological Data Service Center, respectively. A distributed lag non-linear model was adopted to estimate the city-specific temperature-ILI relationships, which were used to pool the regional-level and provincial-level estimates through a multivariate meta-analysis. There were 911,743 ILI cases reported in the study area between 2014 and 2017. The risk of ILI increased with decreasing weekly ambient temperature at the provincial level, and the effect was statistically significant when the temperature was <-1.5°C (RR = 1.24, 95% CI: 1.00-1.54). We found that the relationship between temperature and ILI showed an L-shaped curve at the regional level, except for Southern Shandong (S-shaped). The risk of ILI was influenced by cold, with significant lags from 2.5 to 3 weeks, and no significant effect of heat on ILI was found. Our findings confirm that low temperatures significantly increased the risk of ILI in the study area. In addition, the cold effect of ambient temperature may cause more risk of ILI than the hot effect. The findings have significant implications for developing strategies to control ILI and respond to climate change.

Influence of air pollution on influenza-like illness in China: A nationwide time-series analysis.

Evidence concerning effects of air pollution on influenza-like illness (ILI) from multi-center is limited and little is known about how regional factors might modify this relationship. In this ecological study, ILI cases defined as outpatients with temperature ≥38°C, accompanied by cough or sore throat, were collected from National Influenza Surveillance Network in China. We adopted generalized additive model with quasi-Poisson to estimate province-specific association between air pollution and ILI in 30 Chinese provinces during 2015-2019, after adjusting for time trend and meteorological factors. We then pooled province-specific association by using random-effect meta-analysis. Potential effect modifications of season and regional characteristics were explored. A total of 26, 004, 853 ILI cases and 777, 223, 877 hospital outpatients were collected. In general, effects of air pollutants were acute. An inter-quartile range increase of PM2.5, SO2, PM10, NO2 and CO at lag0, and O3 at lag0-2 was associated with 3.08% (95% CI: 1.91%, 4.27%), 3.00% (1.86%, 4.16%), 6.46% (4.71%, 8.25%), 7.21% (5.73%, 8.71%), 4.37% (3.05%, 5.70%), and-9.26% (-11.32%,-7.14%) change of ILI at national level, respectively. Associations between air pollutants and ILI varied by season and regions, with higher effect estimates in cold season, eastern and central regions and provinces with more humid condition and larger population. This study indicated that most air pollutants increased the risk of ILI in China. Our findings might provide implications for the development of policies to protect public health from air pollution and influenza. National Natural Science Foundation of China and Chongqing Health Commission Program.

Short-term effects of ambient particulate matter (PM1, PM2.5 and PM10) on influenza-like illness in Guangzhou, China.

Particulate matter (PM) has been linked to respiratory infections in a growing body of evidence. Studies on the relationship between ILI (influenza-like illness) and PM1 (particulate matter with aerodynamic diameter ≤1μm) are, however, scarce. The purpose of this study was to investigate the effects of PM on ILI in Guangzhou, China. Daily ILI cases, air pollution records (PM1, PM2.5, PM10 and gaseous pollutants), and metrological data between 2014 and 2019 were gathered from Guangzhou, China. To estimate the risk of ILI linked with exposure to PM pollutants, a quasi-Poisson regression was used. Additionally, subgroup analyses stratified by gender, age and season were carried out. For each 10μg/m3 increase of PM1 and PM2.5 over the past two days (lag01), and PM10 over the past three days (lag02), the relative risks (RR) of ILI were 1.079 (95% confidence interval [CI]: 1.050, 1.109), 1.044 (95% CI: 1.027, 1.062) and 1.046 (95% CI: 1.032, 1.059), respectively. The estimated risks for men and women were substantially similar. The effects of PM pollutants between male and female were basically equivalent. People aged 15-24 years old were more susceptive to PM pollutants. It implies that PM1, PM2.5 and PM10 are all risk factors for ILI, the health impacts of PM pollutants vary by particle size. Reducing the concentration of PM1 needs to be considered when generating a strategy to prevent ILI.

Cumulative Effects of Particulate Matter Pollution and Meteorological Variables on the Risk of Influenza-Like Illness.

The cold season is usually accompanied by an increased incidence of respiratory infections and increased air pollution from combustion sources. As we are facing growing numbers of COVID-19 cases caused by the novel SARS-CoV-2 coronavirus, an understanding of the impact of air pollutants and meteorological variables on the incidence of respiratory infections is crucial. The incidence of influenza-like illness (ILI) can be used as a close proxy for the circulation of influenza viruses. Recently, SARS-CoV-2 has also been detected in patients with ILI. Using distributed lag nonlinear models, we analyzed the association between ILI, meteorological variables and particulate matter concentration in Bialystok, Poland, from 2013–2019. We found an exponential relationship between cumulative PM2.5 pollution and the incidence of ILI, which remained significant after adjusting for air temperatures and a long-term trend. Pollution had the greatest effect during the same week, but the risk of ILI was increased for the four following weeks. The risk of ILI was also increased by low air temperatures, low absolute humidity, and high wind speed. Altogether, our results show that all measures implemented to decrease PM2.5 concentrations would be beneficial to reduce the transmission of SARS-CoV-2 and other respiratory infections.

1715. Influenza-like Illness (ILI) Experience Among Healthcare Workers in Military Treatment Facilities: An Offshoot of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) Study

BackgroundHealthcare workers (HCWs) are at heightened risk of exposure to respiratory pathogens. There are limited published data on influenza-like illness (ILI) experience among HCWs, and the few available studies were hampered by incomplete vaccination histories. PAIVED, a multicenter, multiservice study assessing influenza vaccine effectiveness in the Department of Defense, provides a unique opportunity to describe ILI experience among vaccinated HCWs compared to vaccinated non-HCWs.MethodsPAIVED participants were randomized to receive either egg-based, cell-based, or recombinant-derived influenza vaccine then surveyed weekly for ILI. At enrollment, participants provided key demographic data including whether they were HCWs with direct patient contact. ILI was defined a priori as 1) having cough or sore throat plus 2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection.ResultsOf 4433 eligible participants enrolled during the 2019-20 influenza season, 1551 (35%) were HCWs. A higher percentage of HCWs experienced an ILI than non-HCWs (34% vs 26%, p< 0.001). Overall, HCWs were more likely to be female (42% vs 32%), age 25-34 years (39% vs 28%), active-duty military (81% vs 62%), non-smokers (88% vs 75%), and physically active (92% vs 85%). Self-reported race differed between HCWs and non-HCWs; a higher proportion of HCWs identified as White (63% vs 56%) or Asian (8% vs 5%). Similar demographic differences existed among HCWs and non-HCWs with ILI. HCWs were more likely to respond to at least 50% of weekly surveillance messages, irrespective of ILI status. HCWs with ILI had less severe lower respiratory symptoms (p< 0.001) and a shorter duration of illness (12.4±8.1 days vs 13.7±9.0, p=0.005) than non-HCWs. Pathogen data is pending.ConclusionHCWs in PAIVED were more likely to report ILI than their non-HCW counterparts yet tended to have lower illness severity, possibly reflecting a higher level of baseline health or enhanced awareness of early ILI symptoms. The important epidemiologic position HCWs occupy for ILI has been apparent in the COVID-19 pandemic. Exploring ways to mitigate ILI risk in HCWs beyond influenza vaccination is warranted.Disclaimer Disclosures All Authors: No reported disclosures

Factors associated with influenza-like illness in care homes in Cheshire and Merseyside during the 2017–2018 influenza season

ObjectivesThe aim of the study was to identify care home characteristics associated with reported care home influenza outbreaks and factors associated with increased transmission of influenza-like illness (ILI) in care homes in Cheshire and Merseyside during the 2017–2018 influenza season. Study designThis is a matched case-control study comparing characteristics between care homes with and without a declared influenza outbreak and a retrospective risk factor analysis of care home residents with ILI. MethodsRoutinely collected outbreak surveillance data on symptomatic residents and staff, antiviral prophylaxis and influenza vaccination history, which were reported to Public Health England, were extracted from health protection electronic records. Further care home characteristics were extracted from the Care Quality Commission (CQC) website. Care homes with declared influenza outbreaks were matched with care homes without outbreaks. Chi-squared tests and logistic regression were used to examine associations between care home factors and ILI. ResultsThere were no significant differences in characteristics between 77 care homes with declared influenza outbreaks and 77 matched care homes without outbreaks. Of 2,744 residents from the homes with a declared outbreak, 644 (24%) developed an ILI. The care home risk factors were having a low CQC score and activation of antiviral prophylaxis and the protective factors were having higher numbers of residents, specializing in dementia care and having the highest CQC score. Significantly more cases occurred in residential homes than in nursing homes, in homes with lower CQC scores and in homes where eligible residents were given antiviral prophylaxis. ConclusionsIn homes with declared outbreaks, certain characteristics including activation of antiviral prophylaxis were associated with an increased risk of ILI. Further research is needed, particularly focussing on temporality between provision of prophylactic antivirals and the onset of ILI.

Environmental complex exposure and the risk of influenza-like illness among housewives: A case study in Shanxi Province, China.

The association between environmental pollution and risk of influenza-like illness (ILI) among general population has been reported. However, the relationships between the individual pollutants and ILI risk are still under discussion. Our study aimed to explore the associations of the typical environmental polycyclic aromatic hydrocarbons (PAHs) and metal(loid)s with ILI risk among women population. We carried out a cross-sectional study and included a total of 396 housewives in Shanxi Province, China. The information on their general characteristics and ILI frequency was collected by questionnaire. We collected their hair samples and analyzed the concentrations of PAHs and various metal(loid)s. The results indicated that only acenaphthylene concentration of the nine detected PAH congeners in the hair was significantly associated with ILI risk with adjusted odds ratio (AOR) and 95% confidence interval (95% CI) of 0.58 (0.38 - 0.91). Among the concerned 4 toxic metal(loid)s and 15 rare earth elements, only the hair concentration of arsenic had a positive dose-response relationship with ILI risk. In addition, we found that there were negative dose-response associations of the three essential trace elements (i.e. chromium, cobalt, and nickel), and four essential alkaline earth elements (i.e. magnesium, calcium, strontium, barium) with ILI risk. It was concluded that the environmental exposure to certain compounds of housewives may contribute to their ILI development.

Impact of Doxycycline as Malaria Prophylaxis on Risk of Influenza-Like Illness among International Travelers.

.Travelers are often at risk for both influenza-like illness (ILI) and malaria. Doxycycline is active against pathogens causing ILI and is used for malaria prophylaxis. We evaluated the risk factors for ILI, and whether the choice of malaria prophylaxis was associated with ILI. TravMil is a prospective observational study enrolling subjects presenting to military travel clinics. Influenza-like illness was defined as subjective fever with either a sore throat or cough. Characteristics of trip and use of malaria prophylaxis were analyzed to determine association with development of ILI. Poisson regression models with robust error variance were used to estimate relative risk (RR) of ILI. A total of 3,227 trips were enrolled: 62.1% male, median age of 39 years (interquartile range [IQR] 27,59), median travel duration 19 days (IQR 12, 49); 32% traveled to Africa, 40% to Asia, and 27% to the Caribbean and Latin America. Military travel (46%) and vacation (40%) were most common reasons for travel. Among them, 20% took doxycycline, 50% other prophylaxis, and 30% took none; 8.7% developed ILI. Decreased RR of ILI was associated with doxycycline (RR 0.65 [0.43–0.99], P = 0.046) and military travel (RR 0.30 [0.21–0.43], P < 0.01). Increased risk of ILI was associated with female gender (RR 1.57 [1.24–1.98], P < 0.01), travel to Asia (RR 1.37 [1.08–1.75], P = 0.01), and cruises (RR 2.21 [1.73–2.83], P < 0.01). Use of doxycycline malaria prophylaxis is associated with a decreased risk of ILI. Possible reasons include anti-inflammatory or antimicrobial effects, or other unmeasured factors. With few strategies for decreasing ILI in travelers, these findings bear further investigation.

The short-term effects of air pollutants on influenza-like illness in Jinan, China

BackgroundThere is valid evidence that air pollution is associated with respiratory disease. However, few studies have quantified the short-term effects of six air pollutants on influenza-like illness (ILI). This study explores the potential relationship between air pollutants and ILI in Jinan, China.MethodsDaily data on the concentration of particulate matters < 2.5 μm (PM 2.5), particulate matters < 10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) and ILI counts from 2016 to 2017 were retrieved. The wavelet coherence analysis and generalized poisson additive regression model were employed to qualify the relationship between air pollutants and ILI risk. The effects of air pollutants on different age groups were investigated.ResultsA total of 81,459 ILI counts were collected, and the average concentrations of PM2.5, PM10, O3, CO, SO2 and NO2 were 67.8 μg/m3, 131.76 μg/ m3, 109.85 μg/ m3, 1133 μg/ m3, 33.06 μg/ m3 and 44.38 μg/ m3, respectively. A 10 μg/ m3 increase in concentration of PM2.5, PM10, CO at lag0 and SO2 at lag01, was positively associated with a 1.0137 (95% confidence interval (CI): 1.0083–1.0192), 1.0074 (95% CI: 1.0041–1.0107), 1.0288 (95% CI: 1.0127–1.0451), and 1.0008 (95% CI: 1.0003–1.0012) of the relative risk (RR) of ILI, respectively. While, O3 (lag5) was negatively associated with ILI (RR 0.9863; 95%CI: 0.9787–0.9939), and no significant association was observed with NO2, which can increase the incidence of ILI in the two-pollutant model. A short-term delayed impact of PM2.5, PM10, SO2 at lag02 and CO, O3 at lag05 was also observed. People aged 25–59, 5–14 and 0–4 were found to be significantly susceptible to PM2.5, PM10, CO; and all age groups were significantly susceptible to SO2; People aged ≥60 year, 5–14 and 0–4 were found to be significantly negative associations with O3.ConclusionAir pollutants, especially PM2.5, PM10, CO and SO2, can increase the risk of ILI in Jinan. The government should create regulatory policies to reduce the level of air pollutants and remind people to practice preventative and control measures to decrease the incidence of ILI on pollution days.

Factors associated with influenza-like-illness: a crowdsourced cohort study from 2012/13 to 2017/18

BackgroundInfluenza generates a significant societal impact on morbidity, mortality, and associated costs. The study objective was to identify factors associated with influenza-like-illness (ILI) episodes during seasonal influenza epidemics among the general population.MethodsA prospective study was conducted with the GrippeNet.fr crowdsourced cohort between 2012/13 and 2017/18. After having completed a yearly profile survey detailing socio-demographic, lifestyle and health characteristics, participants reported weekly data on symptoms. Factors associated with at least one ILI episode per influenza epidemic, using the European Centre for Disease Prevention and Control case definition, were analyzed through a conditional logistic regression model.ResultsFrom 2012/13 to 2017/18, 6992 individuals participated at least once, and 61% of them were women (n = 4258). From 11% (n = 469/4140 in 2013/14) to 29% (n = 866/2943 in 2012/13) of individuals experienced at least one ILI during an influenza epidemic. Factors associated with higher risk for ILI were: gender female (OR = 1.29, 95%CI [1.20; 1.40]), young age (< 5 years old: 3.12 [2.05; 4.68]); from 5 to 14 years old: 1.53 [1.17; 2.00]), respiratory allergies (1.27 [1.18; 1.37]), receiving a treatment for chronic disease (1.20 [1.09; 1.32]), being overweight (1.18 [1.08; 1.29]) or obese (1.28 [1.14; 1.44]), using public transport (1.17 [1.07; 1.29]) and having contact with pets (1.18 [1.09; 1.27]). Older age (≥ 75 years old: 0.70 [0.56; 0.87]) and being vaccinated against influenza (0.91 [0.84; 0.99]) were found to be protective factors for ILI.ConclusionsThis ILI risk factors analysis confirms and further completes the list of factors observed through traditional surveillance systems. It indicates that crowdsourced cohorts are effective to study ILI determinants at the population level. These findings could be used to adapt influenza prevention messages at the population level to reduce the spread of the disease.

Potential effect of germanium exposure on the risk of influenza-like illness in housewives in Shanxi Province, China

Few studies have examined the relationship between exposure to germanium (Ge) and the risk of influenza-like illness (ILI). Therefore, we investigated the association of Ge exposure and its interaction with single nucleotide polymorphisms (SNPs) related to Phase II metabolism on ILI risk among housewives in Shanxi Province, northern China. This cross-sectional study enrolled 373 housewives. Information on the housewives' characteristics and the frequency of ILI was collected by questionnaire. We analyzed the Ge concentrations in hair samples taken from near the scalp at the back of the head. Blood samples were used to identify SNPs related to Phase II metabolism. The results suggested that the hair Ge concentration was associated with ILI risk with an adjusted odds ratio and 95% confidence interval of 2.59 (1.61–4.19). A significant dose-response relationship was observed without or with adjusting for confounders. We did not observe any interaction effect between the hair Ge concentration and the SNPs on ILI risk. We found that high dietary consumption of meat and fried foods was positively correlated with the hair Ge concentration. Therefore, chronic Ge exposure may be a risk factor for an increased frequency of ILI in housewives.

Influenza syndromic surveillance and vaccine efficacy in the UK Armed Forces, 2017–2018

IntroductionThis paper describes the first ever analysis of health data to report influenza vaccine uptake and the effectiveness of the vaccine in preventing general practice presentations for influenza-like illness (ILI)...

964. Impact of Doxycycline as Malaria Prophylaxis on Risk of Influenza Like Illness Among International Travelers

BackgroundInternational travelers are often at risk for both influenza like illness (ILI) and malaria. Doxycycline is active against many pathogens causing ILI and is routinely used for malaria prophylaxis. We evaluated the incidence of and risk factors for ILI, and whether the choice of malaria prophylaxis was associated with ILI.MethodsTravMil is a prospective observational study enrolling subjects presenting to 6 military travel clinics. We analyzed pre- and post-travel surveys from travelers to regions outside of the continental United States, Western or Northern Europe, Canada, or New Zealand between July 2010 and August 2018. ILI was defined as subjective fever associated with either a sore throat or cough. Characteristics of trip and traveler and the use of malaria prophylaxis were analyzed to determine association with development of ILI. Poisson regression models with robust error variance were used to estimate relative risk of ILI.ResultsA total of 3,227 travelers were enrolled: 62.1% male, median age of 39 (IQR 27, 59), median travel duration 19 days (IQR 12, 49). 32% traveled to Africa, 40% to Asia, and 27% to the Caribbean, Mexico, and Central or South America. Military travel (46%) and vacation (40%) were most common reasons for travel. Twenty percent took doxycycline for malaria prophylaxis, 50% other prophylaxis (89% atovaquone–proguanil), and 30% took none. 8.7% developed ILI. Compared with those on no or other prophylaxis, doxycycline was associated with decreased risk of ILI [RR 0.65 (0.43–0.99), P = 0.046], as was military travel [RR 0.30 (0.21–0.43), P < 0.01]. Increased risk of ILI was associated with female gender [RR 1.57 (1.24–1.98), P < 0.01], travel to Asia [RR 1.37 (1.08–1.75), P = 0.01], cruises [RR 2.21 (1.73–2.83), P < 0.01], and longer duration of travel [RR 1.01 (1.00–1.01, P < 0.01].ConclusionThe use of doxycycline is associated with a decreased risk of ILI compared with taking no or other malaria prophylaxis. The reasons for this are unclear but may be related to anti-inflammatory effects, activity against bacterial respiratory pathogens, effects on disease transmission in closed populations (e.g., military deploying groups), or other unmeasured factors. With few proven strategies for decreasing ILI risk in travelers, these findings bear further investigation.Disclosures All authors: No reported disclosures.

188. A Novel Inpatient Antibiotic Stewardship Assistance Program (ASAP) Using Real-Time Electronic Health Record Data, Prediction Modeling and Epidemiologic Data to Provide Personalized Empiric Antibiotic Recommendations

BackgroundAntibiotic prescribing varies amongst clinicians, which can result in inappropriate or overuse. Inappropriate antibiotics can increase the risk of adverse drug events and multi-drug-resistant organisms (MDRO). Decreasing variability and increasing alignment with guideline-based therapy may improve antimicrobial stewardship and outcomes.MethodsWe developed a point of care stewardship tool embedded in the electronic health record (EHR) that provides empiric antibiotic recommendations for four syndromes, urinary tract infection (UTI), abdominal biliary infection (ABI), pneumonia, and cellulitis. We identified key variables that alter antibiotic selection or need for infectious disease (ID) consultation such as allergy history, immunosuppression and risk factors for MDRO, and mortality. We created algorithms of preferred empiric antibiotic choices based on national and hospital guidelines using these risk factors. We used a weighted incidence syndromic combined antibiogram (WISCA) prediction model to recommend ID consultation when likelihood of coverage was below a defined threshold. We also incorporated a home-grown epidemiologic tool that takes real-time data from outpatient clinics on incidence of influenza-like-illness (ILI) to recommend influenza PCR testing during periods of high ILI risk. Data on risk factors and WISCA variables including demographics, allergy history, ICD10 codes, vitals, laboratories, and microbiology results were extracted in real-time from the EHR and sent via URL into a web server which has an embedded Windows ASP.NET C# web site and an SQL server database. The web server was then embedded back into the EHR. This tool stores recommendations into the database for stewardship auditing.ResultsThirteen key and 20 WISCA variables are extracted from the EHR in real-time. There are eight distinct antibiotic recommendations for UTI and ABI, 12 for cellulitis, and 40 for pneumonia. An illustration of the ASAP tool is shown in Figure 1.ConclusionASAP is an HER-embedded platform that provides clinicians access to personalized antibiotic prescribing tied to best practices and optimal stewardship initiatives. Future work will look into the tool’s effect on variation in care, antibiotic prescribing, and outcomes.Figure 1:Disclosures All authors: No reported disclosures.

Influenza-Like Illness in Travelers to the Developing World.

Travelers to developing regions are at risk for development of influenza-like illness (ILI). Little is known of traveler and trip characteristics associated with the development of ILI. TravMil is a prospective observational study, enrolling subjects presenting to six military travel clinics or predeployment-screening sites. We analyzed pre- and post-travel surveys from travelers visiting regions outside of the continental United States, Western or Northern Europe, Canada, Australia, or New Zealand between January 2010 and March 2016. Influenza-like illness was defined as a self-reported fever associated with either sore throat or cough. Trip and traveler characteristics were analyzed to determine risk factors for the development of ILI. Two thousand nine hundred and thirty-two trips were recorded (55% male, median age 45 years, 69% white, 51% on vacation, median travel duration 17 days). The 2,337 trips included the number of self-reported influenza vaccinations in the preceding 5 years (median 5). Eleven percent of the trips were complicated by an ILI lasting a median of 5 days; 70% and 17% of these reported upper and lower respiratory tract infection, respectively, and 12% reported both. On multivariate analysis, increased risk of ILI was associated with female gender (odds ratio [OR]: 1.60 [confidence interval (CI): 1.25-2.05], P < 0.01), age (years) (OR: 1.01 [CI: 1.01-1.02], P < 0.01); and duration of travel (days) (OR: 1.01 [CI: 1.00-1.01], P < 0.01). Influenza-like illness is common in travelers, regardless of traveler characteristics, purpose of travel, destination, or season of year. Female gender, older age, and longer duration of travel were associated with an increased risk of ILI. Additional tools and strategies are needed to prevent ILI in international travelers.