Severe Acute Respiratory Illness Patients Research Articles

Clinical Profile and Outcome of Severe Acute Respiratory Illness (SARI) in Children Amidst the COVID-19 Pandemic.

Beginning in December 2019, COVID-19 rapidly emerged as a global pandemic. Though its severity in children was reported to be less than that in adults, data on its epidemiology in relation to severe acute respiratory illness (SARI) caused by other microbes needed to be generated. This study compares theclinical profile and outcome of children hospitalized with COVID-19-positive and negative SARI. This is a prospective observational analytical study involving children 1 month to 18 years old, hospitalized with COVID-19-positive and negative SARI during the pandemic. All eligible patients were enrolled after obtaining informed parental consent. Their clinical manifestations, investigations, and outcomes were documented on a predesigned case record form. A nasopharyngeal swab sample for COVID-19 reverse transcription polymerase chain reaction was sent, and results were noted. From May 2020 to July 2021, 267 children were hospitalized with a diagnosis of SARI. Out of these, 146 (54.7%) were boys and 78.7% were under five years of age. Other presentations included fever and cough, breathlessness, nausea, vomiting, diarrhea, rash, seizures, and altered sensorium. Twenty-eight patients (10.5%) tested positive for COVID-19. COVID-19 patients were similar in terms of demographic characteristics and presenting symptoms to non-COVID-19 patients but had a lower absolute lymphocyte count (p = 0.019) and higher serum alanine transaminase levels (p = 0.013). Acute respiratory distress syndrome (OR, 4.3; 95% CI, 1.8-10.0),shock (OR, 3.9; 95% CI, 1.9-7.9), and need for intensive care unit admission (OR, 9.9; 95% CI, 6.9-14) were more common in COVID-19 SARI patients. Death occurred in 18% of COVID-19 and 9% of non-COVID-19 patients (p = 0.07). SARI nonsurvivors had significantly lower blood pH and platelet counts than survivors. Comparison of COVID-19-positive and negative SARI patients showed subtle differences between the two groups, with COVID-19-positive children having an increased severity of illness. Also, laboratory evidence of multiorgan dysfunction at admission was associated with higher mortality.

Incidence of influenza virus-associated Severe Acute Respiratory Infections in three districts in 2018 at Gharbia governorate, Egypt.

Influenza remains a contributor to substantial global morbidity and mortality. There is very limited data on disease burden in Egypt. The purpose of this study was to estimate the incidence of influenza-associated Severe Acute Respiratory Illness (SARI) in three districts in Gharbia governorate in 2018. This study Followed the World Health Organization (WHO) manual for estimating disease burden associated with seasonal influenza. The hospital admission database was screened for SARI patients in three districts at Gharbia governorate in 2018. A hospital admission survey (HAS) was used to define the catchment population. The incidence rate estimation was computed as the number of influenza-positive SARI cases per 100,000 population. A total of 180 SARI cases were identified in the catchment area. The median age was 23 years [IQR: 2-53], and 45% were males. Out of the total SARI cases, 33.3% influenza was confirmed by the laboratory test of RP-PCR. Influenza A(H3N2) virus predominated representing 55.0% of patients, thanA(H1N1) 26.7% and Flu-B virus 18.3%. Influenza prevailed in winter and spring; no deaths from influenza were reported. The annual incidence of influenza-associated SARIs found higher in <2 years (282 /100,000) and ≥65 years patients (215/100,000) at significant level p<0.001. The WHO Manual for estimating disease burden associated with seasonal influenza was successfully operationalized in the three districts of Gharbia governorate. It can be used in other districts. A considerable burden was associated with influenza viruses requiring hospitalization, especially among the older adult group.

Effect of COVID-19 pandemic on influenza; observation of a tertiary level virology laboratory.

The lockdown enforced amid the COVID-19 pandemic has affected the occurrence and trends of various respiratory virus infections, with a particular focus on influenza. Our study seeks to analyze the repercussions of the COVID-19 pandemic on the positivity of the influenza virus throughout a 4-year span, encompassing both the pre-COVID-19 era (2018 and 2019) and the COVID-19 period (2020 and 2021). Data collected from patients clinically diagnosed with Influenza-like Illness and Severe Acute Respiratory Illness (SARI) from January 2018 to December 2021 for influenza virus detection were acquired and analyzed through multiplex RT-qPCR. The statistical analysis was conducted using SPSS (Statistical Package for Social Sciences) Version 21.0 Software. A total of 4464 samples were tested over 4years (2018-2021), with 3201 samples from the pre-COVID era and 1263 samples from the COVID era. Influenza A positivity dropped from 17.7 to 9.57% and Influenza B positivity decreased from 3.74 to 2.61%. Subtyping revealed changes in prevalence for both viruses. Seasonal variations showed more pronounced peaks in the pre-COVID-19 era with reduced activity during lockdown. Influenza A saw a resurgence in August 2021. Throughout the COVID-19 pandemic (2020-2021) SARI cases did not decrease. The positivity rate for Influenza A slightly rose to 7.79% from 4.23% in the COVID period (2020-2021). This increase correlates with heightened hospitalization rates during the pandemic, sparking concerns of potential coinfection with coronavirus and Influenza A. The notable drop in influenza cases in 2020-2021 is likely due to stringent precautions, lockdowns, drug repurposing, and prioritized testing, indicating no reduction in influenza transmission. Increased influenza positivity in SARI patients during COVID-19 highlights a heightened risk of coinfection. Emphasizing solely on COVID-19 may lead to underreporting of other respiratory pathogens, including influenza viruses.

Epidemiology of Human Seasonal Coronaviruses Among People With Mild and Severe Acute Respiratory Illness in Blantyre, Malawi, 2011-2017.

The aim of this study was to characterize the epidemiology of human seasonal coronaviruses (HCoVs) in southern Malawi. We tested for HCoVs 229E, OC43, NL63, and HKU1 using real-time polymerase chain reaction (PCR) on upper respiratory specimens from asymptomatic controls and individuals of all ages recruited through severe acute respiratory illness (SARI) surveillance at Queen Elizabeth Central Hospital, Blantyre, and a prospective influenza-like illness (ILI) observational study between 2011 and 2017. We modeled the probability of having a positive PCR for each HCoV using negative binomial models, and calculated pathogen-attributable fractions (PAFs). Overall, 8.8% (539/6107) of specimens were positive for ≥1 HCoV. OC43 was the most frequently detected HCoV (3.1% [191/6107]). NL63 was more frequently detected in ILI patients (adjusted incidence rate ratio [aIRR], 9.60 [95% confidence interval {CI}, 3.25-28.30]), while 229E (aIRR, 8.99 [95% CI, 1.81-44.70]) was more frequent in SARI patients than asymptomatic controls. In adults, 229E and OC43 were associated with SARI (PAF, 86.5% and 89.4%, respectively), while NL63 was associated with ILI (PAF, 85.1%). The prevalence of HCoVs was similar between children with SARI and controls. All HCoVs had bimodal peaks but distinct seasonality. OC43 was the most prevalent HCoV in acute respiratory illness of all ages. Individual HCoVs had distinct seasonality that differed from temperate settings.

Prevalence and Characteristics of Influenza Cases From 2017 to 2019 at a Tertiary Care Teaching Hospital in Karnataka.

Introduction Influenza virus is a significant human pathogen causing severe acute respiratory illness (SARI) associated with significant mortality worldwide. The H1N1 Influenza virus that caused a pandemic in 2009 continued to cause periodic epidemics worldwide, with new variants posing significant public health problems. The present study was carried out to determine the prevalence and characteristics of influenza at a tertiary care teaching hospital. Methods From 2017 to 2019, respiratory samples from suspected cases of influenza belonging to category C received at the microbiology laboratory were transported to Manipal Centre for Virus Research, Manipal,in the cold chain for testing of influenza virus by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) as per CDC guidelines. The microbiological reports were collected and evaluated. The details of patients positive for influenza were analyzed for demographic and clinical characteristics. Results During the study period, 172 samples from SARI patients were tested, out of which 44 patients were positive for the influenza virus, accounting for a prevalence of 25.58%; 84% (n=37) of the cases were infected with H1N1 influenza virus, and the other 11.36% (n=5) and 4.54% (n=2) cases yielded H1N2 and H1N3 influenza virus, respectively. Among 44 patients, 56.81% (n=25) were females and 43.18% (n=19) were males. Most of the patients, 65.9% (n=29), were between 40 and 60 years old. The predominant presenting symptoms were fever in 81.81% (n=36) patients, breathlessness in 56.8% (n=25) patients, and cough in 54.54% (n=24) patients. Twelve (27.27%) patients had acute severe respiratory distress syndrome (ARDS). A significant mortality rate of 22.72% (n=10) was noted in the study. Conclusion A significant prevalence of influenza was noted in the study at 25.58%. Along with the H1N1 Influenza virus, the new strains detected in our region were H1N2 and H1N3 influenza viruses. Regular surveillance is important in the early detection of cases, for timely management, to reduce mortality, and to take measures to prevent the spread of this important infectious disease.

Effect of Systemic Illness and Comorbidities in the Prognosis of Severe Acute Respiratory Illness Patients: An Observational Study

Background: Globally critically ill COVID-19 (Coronavirus disease-19) patients have stretched critical care services. This study was undertaken to find factors implicated in mortality amongst COVID positive and negative patients presenting with severe acute respiratory illness (SARI) and factors having the probability of indicating COVID positivity.&#x0D; Methods: The demographic parameters, comorbid illness, clinical parameters and laboratory values of 327 patients were retrospectively analyzed to find the risk factors for mortality in COVID positive and negative patients and factors predicting COVID positivity amongst SARI patients.&#x0D; Results: 58% of SARI patients tested positive by RTPCR. Most common comorbidities were diabetes and hypertension, 35.2% and 33% respectively. Duration of swelling and low haemoglobin were significantly associated with mortality in COVID positive group (p=0.01, 0.005). Acidosis and tachycardia (p=0.003, 0.034) were associated with mortality amongst COVID negative. Creatinine, Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) were higher in non-survivors of both groups (p&lt;0.001). Age, history of contact or from containment zone, cough, pain abdomen and P/F ratio were significant predictors of COVID positivity (1.020(1.006–1.035); 3.889(1.316–11.495); 2.908(1.182–7.152); 2.147(1.149–4.012); 0.997(0.994-1.000) respectively) by multivariable regression analysis.&#x0D; Conclusion: A long duration of swelling and low haemoglobin (&lt;12 g%) were responsible for COVID positive mortality while pain abdomen, raised levels of AST, tachycardia and acidosis were associated with mortality in COVID negative. Deranged creatinine, higher SOFA and qSOFA were associated with mortality in both groups. Age, contact history, residence in containment zone, cough, pain abdomen and poor P/F ratio are predictive factors for COVID positivity.

Clinicoepidemiological Profile and Diagnosis of Severe Acute Respiratory Syndrome Coronavirus-2 and Influenza Viruses in Patients with Severe Acute Respiratory Illness by Real-time Reverse Transcription Polymerase Chain Reaction: A Cross-sectional Study

Introduction: Severe Acute Respiratory Illness (SARI) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) and influenza viruses represent a significant global public health concern. The disease spectrum ranges from mild to life-threatening conditions. Surveillance of hospitalised SARI patients is an essential public health tool used to identify cause of the disease, track changes in circulating viruses and serve as an alert mechanism for potential pandemic viruses. Aim: To determine the rate of SARS-CoV-2 and influenza virus positivity among SARI cases and to investigate the epidemiological and clinical characteristics of the patients. Materials and Methods: A cross-sectional study was conducted on 400 SARI patients admitted to Guru Nanak Dev Hospital, Amritsar, Punjab, India between February 2021 and June 2022. The clinical, demographic, and epidemiological data, as well as co-morbidities of all patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARSCoV-2, Influenza A, Influenza A (H3N2), Influenza A (H1N1) pdm09-pandemic 2009, and Influenza B using real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 23.0 for Windows. Results: Out of the 400 SARI patients, 117 (29.25%) tested positive for SARS-CoV-2, 14 (3.5%) for Influenza A, 7 (1.75%) for Influenza A (H1N1) pdm09, and 4 (1%) for Influenza A (H3N2). The majority of cases in both SARS-CoV-2 and influenza were in the 41-60 years age group (47.86% and 57.14%, respectively). Males were predominantly infected in SARS-CoV-2 positive patients (62/117, 52.99%), while females were more infected in influenza positive cases (9/14, 64.28%). The most common presenting symptoms were fever, cough, dyspnoea, and sore throat in both cases. Hypertension, diabetes mellitus, Chronic Obstructive Pulmonary Disease (COPD), and coronary artery disease were the most common co-morbidities observed. Conclusion: Evaluation of clinical and epidemiological profiles of SARI patients can aid in better understanding and management of outbreaks. Close monitoring and quarantine measures will be necessary to prevent extensive transmission within the community

Clinical profile, etiology, outcome and new-onset diabetes: A SARI case series

Introduction: The world is currently facing the SARS-CoV-2 pandemic with evolving 2nd wave. The COVID-19 patients present most commonly with Severe Acute Respiratory Illness (SARI) in an emergency room with acute onset fever, cough, and breathlessness. However, not all SARI cases as per definition are due to COVID-19 infection, which is well proven in this case series of 113 cases of SARI. This is just the opposite of the other SARI series done in the pre-COVID-19 era. Also, no previous SARI case series data has shown significant association with Diabetes Mellitus, including new-onset diabetes thus figuring out the major Pathophysiological association of COVID-19 with glucose metabolism and has a bearing on the pathogenesis, treatment, and outcome of COVID-19 infection and perpetuity of pandemic of this magnitude. Here we raise concern for the first time about the growing association of an infectious pandemic with the lifestyle disorders which are non-communicable diseases but carry with them the potential of fertile soil for rapidly spreading epidemics. Aim and objective: To find out the etiology, clinical profile, treatment outcome, and mortality rate in different sub-groups of SARI cases in a tertiary care hospital and the incidence of new-onset Diabetes Mellitus in them and to investigate theoretically the hypothesis that maintaining normal glucose metabolism could prevent progression of a mild Flu-like illness (FLI) to a severe form of Severe Acute Respiratory Illness (SARI) and consequent complications such as Cytokine Storm Syndrome and Multi-Organ failure. Design: Retrospective, single-center case series of 113 SARI patients at a tertiary care hospital in Agra India between 1 March- 30 October 2020. Main outcome: The demographics, clinical, pathological, imaging, and treatment outcome data were collected. The SARI cases analyzed were defined as “Severe acute respiratory infections (SARIs) an acute respiratory illness of recent onset (within seven days) manifested by fever (≥ 38 °C), cough and shortness of breath or difficulty in breathing requiring hospitalization and were sub-classified according to the primary etiology producing SARI in them. The findings were compiled and compared. Conclusion: Of the 113 patients of SARI – 32.7% were associated with Diabetes, with 9.74% new-onset Diabetes and 26% previously known Diabetes. This was mainly due to SARS-CoV-2 (24 Diabetics out of 52 COVID-19 cases- 46.1%). The Average hospitalization stay of SARI cases was 10 days with a maximum in SARS-CoV-2 and a minimum stay of 5.22 days in Bacterial Pneumonia and 5.66 days in Koch’s Lungs. The death rate was maximum (4 out of 26) 15.3%. Hospitalized TB/Koch’s Lung patients who presented as SARI and 3.8% in Bacterial Pneumonia, 2.43% in SARS-CoV-2, and &lt; 1% in Sepsis. Those SARI cases who were euglycemic at the time of initial presentation recovered early and carried a good prognosis with less mortality as compared to those who were hyperglycemic on presentation. Also, those FLI cases who maintained euglycemia or did not have any other risk factor which predisposes them to stress (Diabetes, Prolonged fasting, Obesity, major organ disorder, Psychological disorder, and Cancer) did not progress to SARI as the endogenous steroid secretion and sympathetic activation did not occur, the intracellular pH levels remained in the alkaline range. 10.18% of cases developed new-onset diabetes (a total of 11 cases) out of which 10 were in COVID-19. Thus 19.2% incidence of new-onset diabetes in SARS-CoV-2 and a prevalence of 26.9% in SARS-CoV-2, making total diabetes 46.1% in SARS-CoV-2, and out of all SARI cases, 26% of patients developed pulmonary fibrosis with consequent long-term complications. In COVID-19 patients, it was seen only in diabetics SARS CoV-2 male patients, thus no death in non-diabetic females in COVID-19 in this case series.

Sentinel surveillance for influenza A viruses in Lahore District Pakistan in flu season 2015\u20132016

BackgroundInfluenza A virus (IAV) remains an important global public health threat with limited epidemiological information available from low-and-middle-income countries. The major objective of this study was to describe the proportions, temporal and spatial distribution, and demographic and clinical characteristics of IAV positive patients with influenza like illness (ILI) and severe acute respiratory illness (SARI) in Lahore, Pakistan.MethodsProspective surveillance was established in a sentinel hospital from October 2015 to May 2016. All eligible outpatients and inpatients with ILI or SARI were enrolled in the study. Nasal and/or throat swabs were collected along with clinico-epidemiological data. Samples were tested by real-time RT-PCR (rRT-PCR) to identify IAV and subtype. The descriptive analysis of data was done in R software.ResultsOut of 311 enrolled patients, 284 (91.3%) were ILI and 27 (8.7%) were SARI cases. A distinct peak of ILI and SARI activity was observed in February. Fifty individuals (16%) were positive for IAV with peak positivity observed in December. Of 50 IAV, 15 were seasonal H3N2, 14 were H1N1pdm09 and 21 were unable to be typed. The majority of IAV positive cases (98%) presented with current or history of fever, 88% reported cough and 82% reported sore throat. The most common comorbidities in IAV positive cases were hepatitis C (4%), obesity (4%) and tuberculosis (6%). The highest incidence of patients reporting to the hospital was seen three days post symptoms onset (66/311) with 14 of these (14/66) positive for IAV.ConclusionDistinct trends of ILI, SARI and IAV positive cases were observed which can be used to inform public health interventions (vaccinations, hand and respiratory hygiene) at appropriate times among high-risk groups. We suggest sampling from both ILI and SARI patients in routine surveillance as recommended by WHO.

Epidemiological, Clinical and Virological Profiles of Influenza Infection in the Democratic Republic of the Congo, from 2009 to 2018

Background: To better understand the epidemiological characteristic of influenza infection, the Democratic Republic of Congo set up the sentinel influenza surveillance system in 2007 with eleven health facilities. Oral and nasopharyngeal specimens were sampled from outpatients with influenza-like illness (ILI) and inpatients with severe acute respiratory illness (SARI) using case definitions. Those specimens were shipped to the Influenza National Laboratory for testing with the real-time reverse-transcription polymerase chain reaction. This study aimed to describe ILI and SARI patients’ epidemiological, clinical, and virological profiles. Material and Method: We conducted a cross-sectional study based on a documentary review of suspected notified influenza cases from January 2009 to December 2018. As variables, we exploited sex, age, symptoms, sentinel site of provenance, patient category, viral type and subtype identified, and period of health facility visit. Results: Of 18,461 notified cases, 1795 (9.7%) were positive for the Influenza virus, among them; 53.1% of patients under five years old; 68% of type A virus, 31.5% of type B; 21% of SARI positive vs. 79% for ILI positive cases. The majority of cases occurred during the rainy season. Conclusion: The results of this study contribute to a better understanding of the influenza infection in the Democratic Republic of Congo.

Study of hypokalemia and correlation with severity of disease in patients with COVID-19 positive severe acute respiratory illness and COVID-19 negative severe acute respiratory illness

Background: Although the coronavirus disease-2019 (COVID-19) pandemic is creating a major global health crisis, the risk factors for mortality and the detailed clinical course of disease has not yet established. Clinical spectrum of the disease varies from mild symptoms to ARDS. The main objective of this study was to determine hypokalemia and correlation of severity of disease with hypokalemia in patients with COVID-19 positive SARI (severe acute respiratory illness) and COVID-19 negative SARI patients.Methods: The study was a cross-sectional study conducted on 265 SARI patients who were admitted in hospitals attached to BMCRI from April 2019 to December 2019. History was taken, general and systemic examination was done. Patients were categorized and selected patients with moderate and severe illness. RT-PCR for COVID-19 patients done using throat and nasal swab. Potassium levels were estimated and correlated with severity of illness in patients with COVID-19 positive and COVID-19 negative status.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. Patients categorized into moderate and severe SARI. Mean age of subjects with COVD-19 positive (severe) was higher, 58.70±15.598 followed by COVID-19 positive (moderate), 55.13±14.480. About 30% (N=90) belonged to severe SARI group, Chi square test showed statistical significant association with respect to age. In this study there was no statistically significant hypokalemia found between COVID-19 positive SARI patients (N=20, 14.81%) and COVID-19 negative SARI patients (N=17, 13.07%). However hypokalemia COVID-19 positive SARI patients 14.81% (N=20) and COVID-19 negative SARI patients 13.07% (N=17). And also there is no statistically significant hypokalemia between SARI severe and SARI moderate cases.Conclusions: However in this study there is no statistically significant hypokalemia found between COVID-19 positive SARI patients and COVID-19 negative SARI patients. And also there is not statistically significant hypokalemia between SARI severe and SARI moderate cases. Hypokalemia is found in both in both COVID-19 positive SARI patients and COVID-19 negative SARI patients and relatively more in COVID-19 positive patients. Hypokalemia is one of the treatable condition and early detection and treatment reduces mortality.

Comparison of neutrophil-lymphocyte ratio among severe acute respiratory illness COVID-19 positive and negative patients and to correlate with disease severity

Background: COVID-19, a pandemic caused by SARS-CoV-2, has caused a wide impact globally. Clinical spectrum of COVID-19 ranges widely including asymptomatic infection, mild upper respiratory tract infection, severe pneumonia, ARDS, MODS and even death. Neutrophil-lymphocyte (NL) ratio is an indicator of systemic inflammatory response. Many previous studies have shown NL ratio to be good prognostic marker for COVID-19 pneumonia.Methods: A study was conducted on 265 SARI (severe acute respiratory illness) patients who were admitted in hospitals attached to BMCRI between May 2020 and September 2020. History was taken, general and systemic examination was done. Patients were categorized into moderate and severe illness. RT-PCR for all patients was done using throat and nasal swab. Total WBC counts and differential counts were estimated. NL ratio was correlated with pneumonia severity and compared between COVID-19 positive and negative SARI.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. The patients were further sub-categorised into moderate and severe SARI. Mean age for COVID-19 positive severe SARI was higher than the moderate SARI. Males were majority of the subjects. Out of 265, 99 patients (37.4%) had diabetes. Out of this, 34 (42%) were COVID-19 positive (severe) followed by 28 (51.9%) COVID-19 positive (moderate). Mean NL ratio was higher in COVID-19 positive (severe) subjects 15.95±10.31 followed by COVID-19 positive (moderate) subjects 8.99±6.22. There was significant difference with respect to NL ratio between COVID-19 positive and negative subjects. NL ratio levels were high in subjects having diabetes in COVID-19 positive severe sub group and COVID-19 positive severe hypertension sub group as compared to other sub groups.Conclusions: NL ratio was higher in patients with COVID-19 positive SARI as compared to COVID-19 negative SARI. There was significant correlation between increase in NL ratio and disease severity of COVID-19 positive pneumonia. We found that increase in NL ratio was associated with co-morbidities like diabetes mellitus and hypertension.

Clinical outcomes of patients attending a flu clinic at a tertiary health-care facility in india during the covid-19 pandemic

Purpose: In response to ongoing coronavirus disease (COVID)-19 pandemic, flu clinics were set by most of the hospitals all over India to screen patients for the disease. The study aimed to find out treatment outcome of patients attending a flu clinic at a tertiary health-care facility. Methods: It is an observational study, cross-sectional in design. The study used data routinely collected at the flu clinic of a selected tertiary health-care facility of a selected state of India. Data collected between March 22, 2020, and May 31, 2020 were used for the study. Results: Among 3873 study participants, 364 (9.4%) required admission in COVID-19 isolation ward for testing, while 1536 (39.6%) were referred for further management and the rest being symptomatically managed or home quarantined. In multivariate multinomial logistic regression analysis, females, lockdown phases, symptomatic, severe acute respiratory illness patients, those with contact history with a COVID-19 case, chronic comorbidities, and health worker had significantly higher odds of being admitted in COVID-19 isolation ward compared to others. Those who belonged to the age group of 16–30 years had significantly lower odds of admission. On the other hand, age, sex, lockdown phases, native district COVID-19 risk category, symptom status, chronic comorbidity, contact history, travel history. and profession were significant predictors of referral for further management. Conclusion: Half of the study participants were home quarantined or symptomatically managed. Age, sex, symptom status, contact history, travel history, chronic comorbidity, and profession were significant predictors for their treatment outcome.

MO391RISK FACTORS OF ACUTE KIDNEY INJURY IN SEVERE ACUTE RESPIRATORY ILLNESS DURING CORONAVIRUS DISEASE 2019 PANDEMIC

Background and AimsAcute Kidney Injury (AKI) is associated with poor outcome in severe acute respiratory illness (SARI) during Coronavirus Disease 2019 (COVID 19) pandemic. This study aim at detetction of risk factors for AKI among patients admitted for SARI at our Center for COVID 19 screening.MethodRestrospective study by reviewing admission notes from March 2020 until December 2020 at our district center. Patient aged more than 18 year old who admitted for SARI as defined by World Health Organisation and AKI as defined by Kidney Disease Improving Global Outcome (KDIGO) guideline were included. Chronic kidney disease and End stage Renal Failure as defined by KDIGO were excluded.ResultsA total 230 ( 56%) patients out of 410 patients with SARI had AKI during hospitalisation. The mean age was 72 years old (SD 13.8), 130 (56.5%) were male and 100 ( 43.5%) were female. SARI patients with AKI took mean 5 days ( SD 0.9) to be admitted at our center from the first day of illness. The mean body mass index (BMI) was 27.2 kg/m2 . The mean arterial pressure was 52.1 ( SD 3.7) mmhg upon admission. The mean neutrophils lymphocytes ratio ( NLR ) was 22.4 (SD 2.4). The independant Risk factors for AKI in SARI are Male gender ( OR 0.95; 95% CI 0.35-2.6), smoking ( OR 0.72 ;95% CI 0.23- 2.3), ischaemic heart disease (OR 0.48; 95% CI 0.06-3.8), diabetes mellitus ( OR 1.15; 95% CI 0.39-3.38) and hypertension ( OR 1.58; 95% CI 0.58-4.25).ConclusionNon modifiable risk factors for AKI in SARI include male gender and advance age. The modifiable risk factors for AKI in SARI are over weight, smoking, ischemic heart disease, diabetes mellitus and hypertension. NLR play a role in predicting AKI among SARI patients. Delay hospitalisation and hypoperfusion predispose to AKI in SARI. Early recognition of risk factors is crucial in preventing deterioration of kidney function in SARI patients during the inital screening for COVID 19 infection.

Implementing an Influenza Vaccine Effectiveness Study in a Hospital Context in Portugal: The EVA Hospital Project.

The project 'Integrated Monitoring of Vaccines in Europe' aimed to measure seasonal influenza vaccine effectiveness against hospitalised adults, aged 65 years and over, with influenza. We describe the protocol implementation in Portugal. We implemented a test-negative design, targeting community-dwelling patients aged 65 years old and over hospitalised with severe acute respiratory illness. Patients were reverse transverse-polymerase chain reaction tested for influenza. Cases were those positive for influenza while others were controls. Most variables were collected using hospital medical records. Selection bias was evaluated by comparison with the laboratory influenza test requests database according to demographic characteristics. Crude, season-adjusted influenza vaccine effectiveness was estimated as = 1 - odds ratio, and 95% confidence intervals wereobtained by conditional logistical regression, matched with the disease onset month. The recruitment rate was 37.8%. Most participants (n = 368) were female (55.8%) and aged 80 years old and over (55.8%). This was similar to values for potentially eligible severe acute respiratory illness patients (80 years old and over: 56.8%, female: 56.2%). The proportion of missing values was below 2.5% for 20 variables and above 5% (maximum 11.6%) for six variables. Influenza vaccine effectiveness estimates were 62.1% against AH1pdm09 (95% confidence intervals: -28.1 to 88.8), 14.9% against A(H3N2) (95% confidence intervals: -69.6 to 57.3), 43.6% against B/Yam (95% confidence intervals: -66.2 to 80.8). Given the non-existence of a coded admission database in either participating hospital the selection of severe acute respiratory illness due to clinical features was the feasible one. These results are only valid for the older adult population residing in the catchment area of the two participating hospitals who were admitted to a public hospital with severe influenza or SARI symptoms. Despite the low participation rate, we observed comparable characteristics of participants and eligible severe acute respiratory illness patients. Data quality was high, and influenza vaccine effectiveness results were in accordance with the results of meta-analyses and European season-specific estimates. The final sample size was low, which inhibited obtaining estimates with good precision.

Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression

Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression

Virus detections among patients with severe acute respiratory illness, Northern Vietnam.

Severe acute respiratory illness (SARI) is a major cause of death and morbidity in low- and middle-income countries, however, the etiologic agents are often undetermined due to the lack of molecular diagnostics in hospitals and clinics. To examine evidence for select viral infections among patients with SARI in northern Vietnam, we studied 348 nasopharyngeal samples from military and civilian patients admitted to 4 hospitals in the greater Hanoi area from 2017–2019. Initial screening for human respiratory viral pathogens was performed in Hanoi, Vietnam at the National Institute of Hygiene and Epidemiology (NIHE) or the Military Institute of Preventative Medicine (MIPM), and an aliquot was shipped to Duke-NUS Medical School in Singapore for validation. Patient demographics were recorded and used to epidemiologically describe the infections. Among military and civilian cases of SARI, 184 (52.9%) tested positive for one or more respiratory viruses. Influenza A virus was the most prevalent virus detected (64.7%), followed by influenza B virus (29.3%), enterovirus (3.8%), adenovirus (1.1%), and coronavirus (1.1%). Risk factor analyses demonstrated an increased risk of influenza A virus detection among military hospital patients (adjusted OR, 2.0; 95% CI, 1.2–3.2), and an increased risk of influenza B virus detection among patients enrolled in year 2017 (adjusted OR, 7.9; 95% CI, 2.7–22.9). As influenza A and B viruses were commonly associated with SARI and are treatable, SARI patients entering these hospitals would benefit if the hospitals were able to adapt onsite molecular diagnostics.

Severe acute respiratory illness surveillance for coronavirus disease 2019, India, 2020.

Background & objectives:Sentinel surveillance among severe acute respiratory illness (SARI) patients can help identify the spread and extent of transmission of coronavirus disease 2019 (COVID-19). SARI surveillance was initiated in the early phase of the COVID-19 outbreak in India. We describe here the positivity for COVID-19 among SARI patients and their characteristics.Methods:SARI patients admitted at 41 sentinel sites from February 15, 2020 onwards were tested for COVID-19 by real-time reverse transcription-polymerase chain reaction, targeting E and RdRp genes of SARS-CoV-2. Data were extracted from Virus Research and Diagnostic Laboratory Network for analysis.Results:A total of 104 (1.8%) of the 5,911 SARI patients tested were positive for COVID-19. These cases were reported from 52 districts in 20 States/Union Territories. The COVID-19 positivity was higher among males and patients aged above 50 years. In all, 40 (39.2%) COVID-19 cases did not report any history of contact with a known case or international travel.Interpretation & conclusions:COVID-19 containment activities need to be targeted in districts reporting COVID-19 cases among SARI patients. Intensifying sentinel surveillance for COVID-19 among SARI patients may be an efficient tool to effectively use resources towards containment and mitigation efforts.

Epidemiological determinants of COVID-19 infection and mortality: A study among patients presenting with severe acute respiratory illness during the pandemic in Bihar, India.

The study was designed to explore epidemiological characteristics, determinants of COVID-19 infection development and mortality of patients presenting with severe acute respiratory illness (SARI) to a tertiary care health facility of Bihar. This was an observational record-based study, longitudinal in design. Data of 281 SARI patients who have attended All India Institute of Medical Sciences, Patna, Bihar, India during 25th April 2020, till 12th July 2020 (16 weeks) were used for the study. Out of 281 study participants, 95 (33.8%) were detected to have COVID-19 and 42 (14.9%) died. Among COVID-positive study subject's death rate was 28.4%. In the multivariable logistic regression analysis; increasing age (adjusted odds ratio [AOR] = 1.02 [1.00-1.03]), gender (males) (AOR = 2.51 [1.27-4.96]), presenting symptom (cough) (AOR = 2.88 [1.46-5.70]), co-morbidity (hypothyroidism) (AOR = 4.59 [1.45-14.56]) and delay between symptom onset and admission (>2 days) (AOR = 2.46 [1.19-5.07]) were significant predictors of COVID-19 infection among study participants adjusted with other co-morbidities (diabetes and hypertension). Similarly, place of residence (outside Patna district) (AOR = 2.38 [1.03-5.50]), co-morbidity (diabetes) (AOR = 3.08 [1.12-8.50]), intensive care unit (ICU) requirement at admission (yes) (AOR = 9.47 [3.98-22.52]) and COVID status (positive) (AOR = 6.33 [2.68-14.96]) were significant predictors of death among the study participants whereas place of residence (outside Patna district) (AOR = 4.04 [1.33-12.28]) and ICU requirement at admission (yes) (AOR = 7.22 [2.54-20.52]) were attributes affecting death of COVID-positive study participants. Risk of COVID-19 infection among the study participants was high. Age, gender and co-morbidities increased the risk of infection. COVID-19 infection negatively impacted the treatment outcome of the study participants. Age, co-morbidity and ICU requirement were the other attributes affecting mortality.

Laboratory based Influenza sentinel surveillance in Pakistan At NIC, Islamabad 2007-2017

Abstract Background A country-wide lab-based surveillance system for ILI and Severe Acute Respiratory Illness (SARI) with weekly sampling and reporting was established in 2008.This system was necessary for early detection of emerging novel influenza subtypes and timely response for influenza prevention and control. Objectives To assess the trends of Influenza-like-Illness(ILI) and to monitor the predominant circulating strains of influenza viruses through Lab based sentinel surveillance. Methods A cross-sectional study was conducted based on ten years (2007-2017) influenza surveillance data obtained from National Influenza Central Laboratory Pakistan (NICLP) from January to March 2018.Study was done from the data records and samples of suspected ILI patients and SARI patients received from all seven sentinel sites. An ILI case was defined as sudden onset of fever of ≥ 38 C° and cough, with onset within last 10 days, while patients with sudden onset of fever (&amp;gt;38 °C), cough/sore throat requiring hospital admission within 7 days were termed as SARI. Samples were tested at NICLP for confirmation of virus, typing and subtyping by RT-PCR. Results A total of 15885 samples were analyzed during ten years period, out of which 3475(21.9%) were found positive for influenza virus. Among positive samples 26(0.75%) were Influenza-A (H1N1), 550(38%) were A/H3N1,550(15.9%) were A/H3N1,1587(45.7%) were A/H1N1 pdm09and 1312(37.8%) were influenza B. Males were predominant(54%).Influenza Maximum cases were reported from age group 01-&amp;gt;12 years(66%).Virus circulation was detected throughout the year along with few cases of seasonal A/H1N1 virus during late winter(January February) and spring(March). Influenza A/H3N2 virus circulation was mainly observed during summer months (August-October). Conclusions The findings of this study emphasize the need for continuous and comprehensive influenza surveillance to predict seasonal trends for vaccine development and to further fortify pandemic preparedness. Key messages The need for continuous and comprehensive influenza surveillance. Public health importance by pandemic preparedness.