Severe Acute Respiratory Infection Patients Research Articles

Use of proxy indicators for automated surveillance of severe acute respiratory infection, the Netherlands, 2017 to 2023: a proof-of-concept study.

BackgroundEffective pandemic preparedness requires robust severe acute respiratory infection (SARI) surveillance. However, identifying SARI patients based on symptoms is time-consuming. Using the number of reverse transcription (RT)-PCR tests or contact and droplet precaution labels as a proxy for SARI could accurately reflect the epidemiology of patients presenting with SARI.AimWe aimed to compare the number of RT-PCR tests, contact and droplet precaution labels and SARI-related International Classification of Disease (ICD)-10 codes and evaluate their use as surveillance indicators.MethodsPatients from all age groups hospitalised at Leiden University Medical Center between 1 January 2017 up to and including 30 April 2023 were eligible for inclusion. We used a clinical data collection tool to extract data from electronic medical records. For each surveillance indicator, we plotted the absolute count for each week, the incidence proportion per week and the correlation between the three surveillance indicators.ResultsWe included 117,404 hospital admissions. The three surveillance indicators generally followed a similar pattern before and during the COVID-19 pandemic. The correlation was highest between contact and droplet precaution labels and ICD-10 diagnostic codes (Pearson correlation coefficient: 0.84). There was a strong increase in the number of RT-PCR tests after the start of the COVID-19 pandemic.DiscussionAll three surveillance indicators have advantages and disadvantages. ICD-10 diagnostic codes are suitable but are subject to reporting delays. Contact and droplet precaution labels are a feasible option for automated SARI surveillance, since these reflect trends in SARI incidence and may be available real-time.

Epidemiological and etiological characteristics of 1266 patients with severe acute respiratory infection in central China, 2018–2020: a retrospective survey

Epidemiological and etiological characteristics of 1266 patients with severe acute respiratory infection in central China, 2018–2020: a retrospective survey

Factors associated with COVID-19 among hospitalized patients with severe acute respiratory infections in Serbia, 2022-2023: A test negative case-control study.

Severe acute respiratory infections (SARI) are estimated to be the cause of death in about 19% of all children younger than 5 years globally. The outbreak of coronaviral disease (COVID-19) caused by SARS-CoV-2, increased considerably the burden of SARI worldwide. We used data from a vaccine effectiveness study to identify the factors associated with SARS CoV-2 infection among hospitalized SARI patients. We recruited SARI patients at 3 hospitals in Serbia from 7 April 2022-1 May 2023. We collected demographic and clinical data from patients using a structured questionnaire, and all SARI patients were tested for SARS-CoV-2 by RT-PCR. We conducted an unmatched test negative case-control study. SARS-CoV-2 infected SARI patients were considered cases, while SARS CoV-2 negative SARI patients were controls. We conducted bivariate and multivariable logistic regression analysis in order to identify variables associated with SARS-CoV-2 infection. We included 110 SARI patients: 74 were cases and 36 controls. We identified 5 factors associated with SARS-CoV-2 positivity, age (OR = 1.04; 95% CI = 1.01-1.07), having received primary COVID-19 vaccine series (OR = 0.28; 95% CI = 0.09-0.88), current smoking (OR = 8.64; 95% CI = 2.43-30.72), previous SARS CoV-2 infection (OR = 3.48; 95% CI = 1.50-8.11) and number of days before seeking medical help (OR = 0.81; 95% CI = 0.64-1.02). In Serbia during a period of Omicron circulation, we found that older age, unvaccinated, hospitalized SARI patients, previously infected with SARS CoV-2 virus and those who smoked, were more likely to be SARS-CoV-2-positive; these patient populations should be prioritized for COVID vaccination.

Infective Versus Non-Infective Respiratory Illness Admissions: Comparative cost analysis in a tertiary hospital in Malaysia

Background: Severe Acute Respiratory Infection (SARI) that is mainly caused by the Influenza virus, poses a significant public health threat, demanding timely detection and preventive measures. This study assesses the financial implications of managing two distinct respiratory conditions: SARI and Acute Exacerbation of Bronchial Asthma (AEBA). Method: Data were collected for 100 patients, with 50 cases of SARI and 50 cases of AEBA, admitted to Hospital Canselor Tuanku Muhriz (HCTM) from July to December 2022. Cost analysis was conducted from a provider perspective, considering factors such as building, asset, emolument, overhead, utility, medication, consumables, and laboratory and imaging expenses. Results: The study revealed that the average total cost of treating SARI patients was RM 1,587.11 ($US334.80), significantly higher (30.7%) than AEBA patients at RM 1,214.41 ($US256.18).This was mainly due to the acute and severe nature of SARI, requiring more intensive medical interventions, potentially leading to complications and greater strain on healthcare resources. The study highlighted the economic challenges posed by SARI, provided valuable insights for resource allocation and public health planning. The study's limitations include retrospective data collection and potential underestimation of actual costs due to top-down costing methodology. Conclusion: SARI, especially in the elderly population, leads to substantial healthcare costs and economic impact. Effective preventive measures, such as vaccination, are crucial in reducing the burden of influenza-related illnesses. Health financing plays a vital role in addressing communicable diseases and ensuring the well-being of the population.

Vaccine effectiveness against influenza hospitalisation in adults during the 2022/2023 mixed season of influenza A(H1N1)pdm09, A(H3N2) and B circulation, Europe: VEBIS SARI VE hospital network.

We conducted a multicentre hospital-based test-negative case-control study to measure vaccine effectiveness (VE) against PCR-confirmed influenza in adult patients with severe acute respiratory infection (SARI) during the 2022/2023 influenza season in Europe. Among 5547 SARI patients ≥18 years, 2963 (53%) were vaccinated against influenza. Overall VE against influenza A(H1N1)pdm09 was 11% (95% CI: -23-36); 20% (95% CI: -4-39) against A(H3N2) and 56% (95% CI: 22-75) against B. During the 2022/2023 season, while VE against hospitalisation with influenza B was >55%, it was ≤20% for influenza A subtypes. While influenza vaccination should be a priority for future seasons, improved vaccines against influenza are needed.

Epidemic profile of common respiratory viruses in association SARS CoV-2 among SARI and ARI-two year study.

COVID-19/SARS CoV-2 continue to pose a threat to human health and placed millions of livelihoods at risk. Surveillance for the other circulating seasonal viruses during this pandemic is necessary to understand the manifestations of the CoV-2 pandemic and their incidence. A detailed study survey was performed on subjects with acute respiratory infections (ARI) and severe acute respiratory infection (SARI) in the King Institute of Preventive Medicine and Research, Chennai from April 2020 to March 2022. A total of 1480 patients presenting with either SARI (41.8%) or ARI (58.1%) were screened for SARS CoV-2 and other respiratory viruses. The SARS CoV-2 real-time PCR was carried out using ICMR-approved kits and other respiratory viruses were detected using the commercially available real-time kit. Out of the 620 SARI patients, 198 (31.9%) were positive for SARS CoV-2 RNA. Out of the 860 ARI patients, 352 (40.9%) were positive for SARS CoV-2 RNA. Among the 550 patients positive for SARS CoV-2, 7 (1.2%) were positive coexistent with other respiratory viruses. Among the 930 patients with negative SARS CoV-2, 222 (23.8%) were positive for other common respiratory viruses (p = 0.001). Influenza viruses (36.9%) predominated followed by RSV (31.9%) and Parainfluenza virus (13.5%). This study suggests that viral coinfections are significantly higher among SARS CoV-2 negative individuals (23.8 vs. 1.2%). It is possibly due to viral interference and the competitive advantage of SARS CoV-2 in modulating the host immunity. Continuous surveillance is necessary for understanding the viral co-infection mechanisms.

Epidemiology of influenza in Nigeria: A secondary analysis of the sentinel surveillance data in Nigeria from 2010 – 2020

BackgroundInfluenza is a leading cause of morbidity and mortality globally. Little is known of the true burden and epidemiology of influenza in Africa. Nigeria has a sentinel surveillance system for influenza virus (IFV). This study seeks to describe the epidemiological characteristics of influenza cases in Nigeria through secondary data analysis of the sentinel surveillance data from 2010 to 2020. MethodologyA retrospective secondary data analysis of data collected from patients with influenza-like illness (ILI) and severe acute respiratory infection (SARI) in the four Nigeria Influenza Sentinel Surveillance sites from January 2010 to December 2020. Data was cleaned and analyzed using Microsoft Excel and Epi info 7.2 for frequencies and proportions. The results of the analysis were summarized in tables and charts. ResultsA total of 13,828 suspected cases of influenza were recorded at the sentinel sites during the study period. About 10.3% (1421/13,828) of these tested positive for IFV of which 1243 (87.5%) were ILI patients, 175 (12.3%) SARI patients, and 3 (0.2%) novel H1N1 patients. Males accounted for 54.2% (770/1421) of the confirmed cases. The median age of confirmed cases was 3 years (range: <1month–97 years). Children 0–4 years accounted for 69.3% (985/1421) of all cases. The predominant subtypes were B lineage not determined (32.3%), A/H1N1 pdm09 (28.8%) and A/H3 (23.0%). There were periods of sustained transmission in most years with 2011 having the highest number of cases. Overall, there were more cases around January to March and August to November. Heart disease and chronic shortness of breath were the most common co-morbidities identified among confirmed cases. ConclusionInfluenza remains a significant cause of respiratory illness, especially among children aged less than 4 years. Influenza cases occur all year round with irregular seasonality in Nigeria. Children less than 4 years and those with co-morbidities should be prioritized for vaccination. Vaccine composition in the country should take cognizance of the prevailing strains which are type B (lineage not determined), A/H1N1 pdm09 and A/H3.

Impact of BioFire FilmArray Multiplex PCR in the Detection of Microbial Agents causing Severe Acute Respiratory Infection in the COVID-19 Era: A Cross-sectional Study from a Tertiary Care Hospital in Central India

Introduction: Many viral and bacterial respiratory tract infections can present with respiratory signs and progress to complicated pneumonia. In the recent Coronavirus Disease2019 (COVID-19) pandemic, it is crucial to test all Severe Acute Respiratory Infection (SARI) patients for other microbial infections in addition to COVID-19, enabling timely diagnosis and treatment to reduce morbidity and mortality. The automated system, BioFire FilmArray, utilises multiplex Polymerase Chain Reaction (PCR) to rapidly detect and identify multiple respiratory pathogens, including selected Antimicrobial Resistance (AMR) genes, within an hour. Aim: To detect bacterial and/or viral pathogens associated with hospitalised COVID-19-negative SARI patients using the BioFire FilmArray Pneumonia Panel (BFPP). Materials and Methods: This laboratory-based cross-sectional study was conducted at All India Institute of Medical Sciences (AIIMS), Nagpur, Maharashtra, India, from June 2020 to February 2021. Respiratory samples, such as sputum, tracheal aspirate, Endotracheal (ET) secretions, and Bronchoalveolar Lavage (BAL), were collected from COVID-19-negative hospitalised SARI cases. A total of 81 patients were included in the study. The samples were tested using the BFPP (multiplex PCR) system and processed using conventional culture techniques. Patient characteristics, clinical and laboratory investigation data, and findings of respiratory viral and bacterial agents, as well as antibiotic resistance genes detected by BioFire FilmArray, were recorded using paper case reports. The data were collected and analysed using Statistical Package for Social Sciences (SPSS) software. Results: Out of the 81 clinical samples processed, the BFPP detected 168 bacterial and 18 viral pathogens. Bacterial-viral codetection was observed in 13 (16%) samples. Atypical bacteria were detected in 3% of cases. Among the bacterial pathogens, the AMR gene for New Delhi Metallo-beta-lactamases (NDM) was detected in 42 (25.9%) cases, followed by CTX-M betalactamases, VIM, and the oxacillinase group of β-lactamases. Conclusion: The BFPP test is a valuable tool for the rapid detection of a wide range of pathogens, including associated AMR genes, with high sensitivity and specificity. This can greatly aid in treatment decisions.

Respiratory syncytial virus among hospitalized patients of severe acute respiratory infection in Bhutan: Cross-sectional study.

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections worldwide, particularly in young children. In Bhutan, respiratory disease continues to be among the top 10 diseases of morbidity for several years. This study aimed to estimate the prevalence of RSV among hospitalized patients with severe acute respiratory infection (SARI) in Bhutan. Respiratory specimens were collected from SARI patients of all ages in 2016 and 2018 following influenza surveillance guidelines. Specimens were tested for influenza and RSV, human metapneumovirus, adenovirus, and human parainfluenza virus types 1, 2, and 3 using real-time reverse-transcription polymerase chain reaction assay. Descriptive statistics were used to analyze the result in STATA 16.1. Of the 1339 SARI specimens tested, 34.8% were positive for at least one viral pathogen. RSV was detected in 18.5% of SARI cases, followed by influenza in 13.4% and other respiratory viruses in 3%. The median age of SARI cases was 3 (IQR: 0.8-21 years)years. RSV detection was higher among children aged 0-6 (Adj OR: 3.03; 95% CI: 1.7-5.39) and 7-23 months (Adj OR: 3.01; 95% CI: 1.77-5.12) compared with the children aged 5-15 years. RSV was also associated with breathing difficulty (Adj OR: 1.73; 95% CI: 1.17-2.56) and pre-existing lung disease, including asthma (Adj OR: 2.78; 95% CI: 0.99-7.8). Respiratory viruses were detected in a substantial proportion of SARI hospitalizations in Bhutan.

Comparison of the clinical features and outcomes of severe seasonal influenza and COVID-19 patients in Tunisia between 2021 and 2022.

We compared patients diagnosed at a SARI (severe acute respiratory infections) surveillance site with COVID-19 and those with seasonal influenza to investigate the clinical differences, common features, and outcomes. We conducted a descriptive, retrospective study in the Medical Intensive Care Unit (ICU) at Abderrahman Mami Hospital between September 2021 and April 2022. Demographic, clinical, and biological data as well as outcomes were recorded for all patients. Among 223 SARI patients, 83 were confirmed COVID-19, and 22 were influenza positive. The distribution according to gender was similar; but patients with influenza were younger than those suffering from COVID-19(mean age 60.36 SD 17.28 vs. 61.88 SD 17.91; P = 0.601). In terms of underlying chronic diseases, the frequency was 84.3% in the COVID-19 group and 72.7% in the influenza group. COVID-19 patients had a longer duration of hospitalization (mean [SD], 9.51 days [8.47 days] vs. 7.33 days [8.82 days]; P = 0.003), and a more frequent need for invasive ventilation (80 [97.4%] vs. 20 [92.3]). Case fatality was also higher among this group compared to the latter (39 [47%] vs. 6 [27.3%], P = 0.01). This exploratory study suggests higher severity of COVID-19 compared to seasonal influenza among SARI hospitalized patients even during the Omicron wave. Further research on higher sample sizes is required to confirm this conclusion.

Pan-India influenza-like illness (ILI) and Severe acute respiratory infection (SARI) surveillance: epidemiological, clinical and genomic analysis.

Over time, COVID-19 testing has significantly declined across the world. However, it is critical to monitor the virus through surveillance. In late 2020, WHO released interim guidance advising the use of the existing Global Influenza Surveillance and Response System (GISRS) for the integrated surveillance of influenza and SARS-CoV-2. In July 2021, we initiated a pan-India integrated surveillance for influenza and SARS-CoV-2 through the geographically representative network of Virus Research and Diagnostic Laboratories (VRDLs) across 26 hospital and laboratory sites and 70 community sites. A total of 34,260 cases of influenza-like illness (ILI) and Severe acute respiratory infection (SARI) were enrolled from 4 July 2021 to 31 October 2022. Influenza A(H3) and B/Victoria dominated during 2021 monsoon season while A(H1N1)pdm09 dominated during 2022 monsoon season. The SARS-CoV-2 "variants of concern" (VoC) Delta and Omicron predominated in 2021 and 2022, respectively. Increased proportion of SARI was seen in extremes of age: 90% cases in < 1 year; 68% in 1 to 5 years and 61% in ≥ 8 years age group. Approximately 40.7% of enrolled cases only partially fulfilled WHO ILI and SARI case definitions. Influenza- and SARS-CoV-2-infected comorbid patients had higher risks of hospitalization, ICU admission, and oxygen requirement. The results depicted the varying strains and transmission dynamics of influenza and SARS-CoV-2 viruses over time, thus emphasizing the need to continue and expand surveillance across countries for improved decision making. The study also describes important information related to clinical outcomes of ILI and SARI patients and highlights the need to review existing WHO ILI and SARI case definitions.

Antibiotic use among SARI patients according to the AWaRe classification before and during the COVID-19 pandemic in Bangladesh

Background: Irrational antibiotic use among hospitalized patients can lead to antibiotic resistance. For rational use, the WHO introduced the Access, Watch, and Reserve (AWaRe) classification of antibiotics. We explored antibiotic use according to the AWaRe classification among patients hospitalized with severe acute respiratory infection (SARI) between the prepandemic and COVID-19 pandemic periods in Bangladesh. Methods: From June 2017 to November 2022, we analyzed SARI inpatient data from the hospital-based influenza surveillance platform at 9 tertiary-level hospitals in Bangladesh. We defined June 2017–February 2020 as the prepandemic period and March 2020–November 2022 as the pandemic period. Physicians identified inpatients meeting the WHO SARI case definition and recorded patient demographics, clinical characteristics, and antibiotics received during hospitalization. We used descriptive statistics to summarize the data. Results: We enrolled 20,640 SARI patients (median age, 20 years; IQR, 1.6–50; 63% male); and among them, 18,197 (88%) received antibiotics (26% of those received &gt;1 different course of antibiotics). Compared to the prepandemic period, the proportion of antibiotic use among SARI patients was higher during the pandemic: 93% (9,887 of 10,655) versus 83% (8,310 of 9,985) (P &lt; .001). According to AWaRe classification, Access, Watch, and Reserve groups accounted for 32% (n = 2,623), 86% (n = 7,158), and 0.05% (n = 4), respectively, before the pandemic and 32% (n = 3,194), 90% (n = 8,850), and 0.08% (n = 8), respectively, during the pandemic (Fig.). The most common antibiotic prescribed for children aged &lt;5 years during the prepandemic was ceftriaxone (n = 1,940, 74%), followed by amikacin (n = 325, 13%) and flucloxacillin (n = 300, 12%); similarly, during the pandemic, most common antibiotic prescribed was ceftriaxone (n = 3,097, 79%), followed by amikacin (n = 723, 18%) and flucloxacillin (n = 348, 9%). The most common antibiotic prescribed for patients aged ≥5 years during the prepandemic period was ceftriaxone (n = 3,174, 54%), followed by amoxicillin-clavulanic acid (n = 1,304, 22%) and azithromycin (n = 1,038, 18%). During the pandemic, the most common antibiotic prescribed for patients aged ≥5 years was ceftriaxone (n = 3,793, 64%), followed by amoxicillin-clavulanic acid (n = 1,327, 22%) and clarithromycin (n = 797, 13%). Among children aged &lt;5 years, use of the Watch group of antibiotics during the prepandemic and pandemic periods was similar: 94% (n = 3,688) versus 95% (n = 2,347) (P = .099). However, among patients aged ≥5 years, the use of Watch antibiotics was higher during the pandemic compared to the prepandemic period: 87% (n = 5,163) versus 82% (n = 4,811) (P &lt; .001). Conclusions: Use of antibiotics in the Watch group was predominant among SARI patients both before and during the COVID-19 pandemic, and it increased among SARI patients aged ≥5 years during the pandemic period in Bangladesh. Promoting antibiotic stewardship programs for physicians, including in-service training on antibiotic use, could reduce irrational antibiotic use, which might contribute to mitigating antibiotic resistance in the country.Financial support: This study was funded by the CDC.Disclosures: None

Prevalence of Influenza Virus in Patients with Severe Acute Respiratory Infections (SARI)

BACKGROUND&#x0D; Influenza is viral fever with the main symptoms of the respiratory tract like cough, fever, breathlessness, nasal discharge, sore throat &amp; myalgia. Pandemic 2009 H1N1 influenza A was the virus that presented a significant public health threat on a global scale. This prospective study was undertaken to analyse the prevalence of the influenza virus in patients with a severe acute respiratory infection (SARI) and also to determine the demographic characteristics and seasonal variations.&#x0D; METHODS&#x0D; This was a hospital-based prospective study done in the Department of Microbiology, Silchar Medical College &amp; Hospital, Silchar for 1 year from June 2021 to May 2022. Respiratory specimens were tested for Influenza virus by one step real-time reverse transcription polymerase chain reaction (RT-PCR).&#x0D; RESULTS&#x0D; In real-time PCR, the influenza virus was detected in 6 out of 85 SARI patients (7%). Of 6 total positives, 4(67%) were influenza A and 2(33%) were influenza B. Among 4 influenza A positive cases, 3(75%) were influenza A (H1N1) pdm09 and 1(25%) was seasonal influenza A (H3N2). The highest percentage of positivity (50%) was detected in the age group of 15-29 years. The most common symptoms among the positive influenza cases were fever (100%), cough (88%), and breathlessness (56%). Other associated symptoms were sore throat (63%), nasal discharge (75%), and myalgia (75%).&#x0D; CONCLUSIONS&#x0D; This study clearly shows that influenza is an important cause of severe acute respiratory infection. It also suggests the need for continuous effective surveillance of influenza viruses to detect cases and control outbreaks. Early intervention and proper management of influenza virus cases are required to curb the disease burden.

Effectiveness of vero cell inactivated vaccine against severe acute respiratory infections (SARI) in Sibu, Malaysia: A retrospective test-negative design

ABSTRACT The effectiveness of the vero cell inactivated vaccine (CoronaVac®) against severe acute respiratory infection (‎SARI)‎ caused by SARS-CoV-2 in the real world was assessed. A matched test-negative case-control design was employed using the web-based national information system, as well as the hospitalization dataset in Sibu Hospital. Vaccine effectiveness was measured by conditional logistic regression with adjustment for gender, underlying comorbidity, smoking status, and education level. Between 15 March and 30 September 2021, 838 eligible SARI patients were identified from the hospitalization records. Vaccine effectiveness was 42.4% (95% confidence interval [CI]: −28.3 to 74.1) for partial vaccination (after receiving the first dose to 14 days after receiving the second dose), and 76.5% (95% CI: 45.6 to 89.8) for complete vaccination (at 15 days or more after receiving the second dose). This analysis indicated that two doses of CoronaVac® vaccine provided efficacious protection against SARI caused by SARS-CoV-2 in the short term. However, the duration of protection, and performance against new variants need to be studied continuously.

Surveillance of Severe Acute Respiratory Infection and Influenza Vaccine Effectiveness among Hospitalized Italian Adults, 2021/22 Season

Following an extremely low incidence of influenza during the first waves of the ongoing COVID-19 pandemic, the 2021/22 Northern Hemisphere winter season saw a resurgence of influenza virus circulation. The aim of this study was to describe epidemiology of severe acute respiratory infections (SARIs) among Italian adults and estimate the 2021/22 season influenza vaccine effectiveness. For this purpose, a test-negative case-control study was conducted in a geographically representative sample of Italian hospitals. Of 753 SARI patients analyzed, 2.5% (N = 19) tested positive for influenza, most of which belonged to the A(H3N2) subtype. Phylogenetic analysis showed that these belonged to the subclade 3C.2a1b.2a.2, which was antigenically different from the 2021/22 A(H3N2) vaccine component. Most (89.5%) cases were registered among non-vaccinated individuals, suggesting a protective effect of influenza vaccination. Due to a limited number of cases, vaccine effectiveness estimated through the Firth's penalized logistic regression was highly imprecise, being 83.4% (95% CI: 25.8-97.4%) and 83.1% (95% CI: 22.2-97.3%) against any influenza type A and A(H3N2), respectively. Exclusion of SARS-CoV-2-positive controls from the model did not significantly change the base-case estimates. Within the study limitations, influenza vaccination appeared to be effective against laboratory-confirmed SARI.

СРАВНИТЕЛЬНАЯ ОЦЕНКА РС-ВИРУСНОЙ ИНФЕКЦИИ И ГРИППА В РАЗЛИЧНЫХ ВОЗРАСТНЫХ ГРУППАХ БОЛЬНЫХ ОРВИ В 2013–2019 гг.

Human respiratory syncytial virus (hRSV or RSV) is the most common cause for the lower respiratory tract infections in infants. Despite the leading role and burden of RSV infection (RSVI), the contribution of this infection to the incidence among both young and older children, as well as in people over 18 y/o, remains largely unexplored. The purposes of the research were as follows: to assess the prevalence of RSVI in certain age groups of registered patients with acute respiratory viral infections (ARVI) (0 to 2 y/o, 3 to 6 y/o, 7 to 14 y/o, and 15 y/o and older) in Russia according to traditional laboratory surveillance data; determination of seasonality in the circulation of RSV; comparison of the frequency of diagnosing influenza and RSVI in patients of certain age groups; assessment of risk groups by age among hospitalized patients with severe acute respiratory infection (SARI) caused by RSV. Materials and methods of the research: as part of the traditional laboratory surveillance on influenza and ARVI/SARS, a retrospective analysis of all cases of RSVI confirmed by polymerase chain reaction (PCR) tests was carried out in Russia for the period from Oct. 1, 2013 till Sept. 30, 2019, among 121,773 registered patients in 8 cities of Russia (Izhevsk, Irkutsk, Kazan, Perm, Petropavlovsk, Rostov-on-Don, Saint Petersburg, and Khabarovsk). Authors used aggregated weekly data for age groups (as stated above) (Order of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being No. 373 dated Mar. 31, 2005). In addition, authors have analyzed and systematized the age data of 6,547 individual cards of hospitalized patients with SARI with PCR-confirmed RSVI in 5 cities of Russia (Kaliningrad, Saint Petersburg, Chita, Khabarovsk, and Vladivostok) that carry out the signaling surveillance on influenza and ARVI for the epidemiological seasons from 2013/2014 till 2018/2019 (starting the 40th week of the initial year till the 39th week of the final year). SARI was detected using the standard definition of a SARI case (body temperature 38 degrees Celsius and above lasting for at least 7 consecutive days according to the anamnesis or when seeking medical help, cough, shortness of breath, need for hospitalization) in accordance with the Guideline “Organization and conduct of a signaling clinical and laboratory epidemiological surveillance in Russia.” Thus, individual cards of all SARI patients included in the corresponding Signaling Surveillance (SS) database for the specified period were used. Results: according to the traditional laboratory surveillance, the risk group for RSVI is children aged 0 to 6 y/o. In addition, in children under 2 y/o, the frequency of detection of RSV at the peaks of the seasonal increase in the incidence was higher or comparable to the frequency of confirmation of the influenza etiology of the disease in certain epidemic seasons. According to SS, RSV-associated SARIs most often develop in children of 0 to 5 months old (32.1% of the examined patients with SARI in this age group). Conclusion: the registration of a seasonal increase in RSVI almost simultaneously with an epidemic increase in the incidence of influenza indicates an urgent need for differential diagnosis of influenza and RSVI in patients at risk, and especially in children under 6 y/o, in order to prescribe the therapy needed.

A comparative study of platelet to lymphocyte ratio as novel biomarker to predict severity and association with prognosis in COVID–19 patients

Background: Influenza-like illness (ILI) and severe acute respiratory infection (SARI) are the important manifestations in day today clinical practice in COVID era. A number of clinical investigations including haematological parameters are used for the risk stratification of the patients. This study was undertaken in order to find the applicability of platelet to lymphocyte ratio in risk stratification.Methods: A prospective study was undertaken in Victoria hospital and Bowring and Lady Curzon hospitals attached to BMCRI tertiary care hospitals in Bangalore for a period of one and half years. All the patients were subjected for clinical and haematological evaluation and appropriate ratios were calculated. A total of 266 patients were enrolled in the study, out of which 144 were COVID negative and 122 were COVID positive. The data was analyzed using appropriate statistical methods using statistical package for social sciences (SPSS) version 24.Results: The mean age of the COVID negative patients was 43.37 years and COVID positive patient was 49.08 years. Males outnumbered females. There was statistically significant difference in mean platelet to lymphocyte ratio between the COVID positive and negative cases (226.4 versus 399.38). The area under curve was 0.614 for the platelet to lymphocyte ratio (PLR) in patients with severe and non-severe ILI and SARI cases. Majority of the haematological parameters were significantly different in SARI patients who were COVID positive and negative.Conclusions: PLR can be used as an indicator for risk stratification in ILI and SARI patients.

Capacity and use of diagnostics and treatment for patients with severe acute respiratory infections in the pre-COVID-19 era in district and provincial hospitals in Viet Nam.

ObjectiveTo describe the burden of severe acute respiratory infection (SARI) and the infrastructure and current practices of SARI management in hospitals in Viet Nam.MethodsWe conducted a short observational study at critical care units (CCUs) in 32 district hospitals and 16 provincial hospitals in five provinces in Viet Nam from March to July 2019. We collected data on hospital equipment and medicines used in SARI management. At the patient level, data were collected for 14 consecutive days on all patients presenting to CCUs, including information on demographics, intervention and treatment within 24 hours of CCU admission and 7-day outcome.ResultsThere were significant differences between district and provincial hospitals in the availability of microbial culture, rapid influenza diagnostic tests, inflammatory markers and mechanical ventilation. Among 1722 eligible patients admitted to CCUs, there were 395 (22.9%) patients with SARI. The median age of SARI patients was 74 (interquartile range: 58–84) years; 49.1% were male. Although systemic antibiotics were available in all hospitals and were empirically given to 93.4% of patients, oseltamivir was available in 25% of hospitals, and only 0.5% of patients received empiric oseltamivir within 24 hours of admission. The 7-day mortality was 6.6% (26/395). Independent factors associated with 7-day mortality were septic shock and requiring respiratory support within 24 hours of admission.DiscussionSARI is a major burden on CCUs in Viet Nam. Barriers to delivering quality care include the limited availability of diagnostics and medication and non-protocolized management of SARI in CCUs.

Spotlight influenza: Extending influenza surveillance to detect non-influenza respiratory viruses of public health relevance: analysis of surveillance data, Belgium, 2015 to 2019.

BackgroundSeasonal influenza-like illness (ILI) affects millions of people yearly. Severe acute respiratory infections (SARI), mainly influenza, are a leading cause of hospitalisation and mortality. Increasing evidence indicates that non-influenza respiratory viruses (NIRV) also contribute to the burden of SARI. In Belgium, SARI surveillance by a network of sentinel hospitals has been ongoing since 2011.AimWe report the results of using in-house multiplex qPCR for the detection of a flexible panel of viruses in respiratory ILI and SARI samples and the estimated incidence rates of SARI associated with each virus.MethodsWe defined ILI as an illness with onset of fever and cough or dyspnoea. SARI was defined as an illness requiring hospitalisation with onset of fever and cough or dyspnoea within the previous 10 days. Samples were collected in four winter seasons and tested by multiplex qPCR for influenza virus and NIRV. Using catchment population estimates, we calculated incidence rates of SARI associated with each virus.ResultsOne third of the SARI cases were positive for NIRV, reaching 49.4% among children younger than 15 years. In children younger than 5 years, incidence rates of NIRV-associated SARI were twice that of influenza (103.5 vs 57.6/100,000 person-months); co-infections with several NIRV, respiratory syncytial viruses, human metapneumoviruses and picornaviruses contributed most (33.1, 13.6, 15.8 and 18.2/100,000 person-months, respectively).ConclusionEarly testing for NIRV could be beneficial to clinical management of SARI patients, especially in children younger than 5 years, for whom the burden of NIRV-associated disease exceeds that of influenza.

Epidemiological and virological surveillance of Severe Acute Respiratory Infections in the 2019/2020 season in Siena, Tuscany, Italy.

SummaryBackgroundInfluenza is a major public health issue. Indeed, in Italy there were 7.6 million symptomatic cases of influenza in the 2019/2020 influenza season (from October 2019 to April 2020). The aim of this study is to analyse the circulation of influenza A and B viruses in hospitalized adult and elderly patients with Severe Acute Respiratory Infections (SARI) at Le Scotte University Hospital in Siena.MethodsOropharyngeal swabs were taken from SARI patients, who also completed a questionnaire recording their underlying diseases and vaccination status. Total RNA was extracted from each respiratory swab by means of the QIAamp Viral RNA Mini kit, and RT-PCR was carried out. All statistical analyses were performed by means of GraphPad Prism 6 software and STATA.ResultsIn this study we collected 68 swabs. The average age of subjects was 79.4 years (C.I.: 76.6-82.3) and 52.9% were female. The subjects had fever (89.7%), fatigue (77%), headache (47%), cough (75%), sore throat (70.5%), and breathlessness (63.2%). We found that 20% of the 68 subjects were positive (13% for A H3N2 and 7% for A H1N1). Of the 68 subjects, 25% had received a seasonal influenza vaccine (91.6% trivalent and 8.4% quadrivalent).ConclusionsOur study is important in order to determine the timing and spread of influenza viruses and track changes in circulating influenza viruses, so as to inform seasonal influenza vaccine composition. Seasonal vaccination is considered the most effective way to prevent influenza and its complications.