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Seasonal flu holding strong in New Jersey
The 2015-2016 seasonal influenza virus has gotten hold of New Jersey and just won’t let go, according to the latest data from the Centers for Disease Control and Prevention.
For the week ending April 23, 2016, influenza-like illness (ILI) activity in the United States remained at level 10 on the CDC’s 1-10 scale for the 11th consecutive week, even as the country’s overall proportion of outpatient visits for ILI dropped to 2.0%, which is below the national baseline of 2.1%, the CDC reported.
Two other states – Arizona and Arkansas – joined New Jersey in bucking the trend of decreasing ILI activity, as both moved up to level 7 and the high end of the “moderate” range. Arizona had been at level 5 the week before, while Arkansas was at level 4. No other state was above level 5 for the most recent week, and 27 states were at level 1, data from the CDC’s Influenza-like Illness Surveillance Network (ILINet) show.
Four flu-related pediatric deaths were reported during the week ending April 23, only one of which occurred that week. The total number of pediatric deaths rose to 60 for the 2015-2016 season, with 27 states and Puerto Rico reporting deaths so far, the CDC noted.
The CDC also reported a cumulative influenza-associated hospitalization rate for the season of 29.8 such hospitalizations per 100,000 population. This data was based on 8,239 laboratory-confirmed influenza-associated hospitalizations reported between October 1, 2015 and April 23, 2016. The highest rate of hospitalization was among adults aged 65 years or older (79.6 per 100,000 population), followed by adults aged 50-64 (43.1 per 100,000 population) and children aged 0-4 years (40.5 per 100,000 population). Among all hospitalizations, 6,254 (75.9%) were associated with influenza A, 1,905 (23.1%) with influenza B, 41 (0.5%) with influenza A and B co-infection, and 39 (0.5%) had no virus type information.
The 2015-2016 seasonal influenza virus has gotten hold of New Jersey and just won’t let go, according to the latest data from the Centers for Disease Control and Prevention.
For the week ending April 23, 2016, influenza-like illness (ILI) activity in the United States remained at level 10 on the CDC’s 1-10 scale for the 11th consecutive week, even as the country’s overall proportion of outpatient visits for ILI dropped to 2.0%, which is below the national baseline of 2.1%, the CDC reported.
Two other states – Arizona and Arkansas – joined New Jersey in bucking the trend of decreasing ILI activity, as both moved up to level 7 and the high end of the “moderate” range. Arizona had been at level 5 the week before, while Arkansas was at level 4. No other state was above level 5 for the most recent week, and 27 states were at level 1, data from the CDC’s Influenza-like Illness Surveillance Network (ILINet) show.
Four flu-related pediatric deaths were reported during the week ending April 23, only one of which occurred that week. The total number of pediatric deaths rose to 60 for the 2015-2016 season, with 27 states and Puerto Rico reporting deaths so far, the CDC noted.
The CDC also reported a cumulative influenza-associated hospitalization rate for the season of 29.8 such hospitalizations per 100,000 population. This data was based on 8,239 laboratory-confirmed influenza-associated hospitalizations reported between October 1, 2015 and April 23, 2016. The highest rate of hospitalization was among adults aged 65 years or older (79.6 per 100,000 population), followed by adults aged 50-64 (43.1 per 100,000 population) and children aged 0-4 years (40.5 per 100,000 population). Among all hospitalizations, 6,254 (75.9%) were associated with influenza A, 1,905 (23.1%) with influenza B, 41 (0.5%) with influenza A and B co-infection, and 39 (0.5%) had no virus type information.
The 2015-2016 seasonal influenza virus has gotten hold of New Jersey and just won’t let go, according to the latest data from the Centers for Disease Control and Prevention.
For the week ending April 23, 2016, influenza-like illness (ILI) activity in the United States remained at level 10 on the CDC’s 1-10 scale for the 11th consecutive week, even as the country’s overall proportion of outpatient visits for ILI dropped to 2.0%, which is below the national baseline of 2.1%, the CDC reported.
Two other states – Arizona and Arkansas – joined New Jersey in bucking the trend of decreasing ILI activity, as both moved up to level 7 and the high end of the “moderate” range. Arizona had been at level 5 the week before, while Arkansas was at level 4. No other state was above level 5 for the most recent week, and 27 states were at level 1, data from the CDC’s Influenza-like Illness Surveillance Network (ILINet) show.
Four flu-related pediatric deaths were reported during the week ending April 23, only one of which occurred that week. The total number of pediatric deaths rose to 60 for the 2015-2016 season, with 27 states and Puerto Rico reporting deaths so far, the CDC noted.
The CDC also reported a cumulative influenza-associated hospitalization rate for the season of 29.8 such hospitalizations per 100,000 population. This data was based on 8,239 laboratory-confirmed influenza-associated hospitalizations reported between October 1, 2015 and April 23, 2016. The highest rate of hospitalization was among adults aged 65 years or older (79.6 per 100,000 population), followed by adults aged 50-64 (43.1 per 100,000 population) and children aged 0-4 years (40.5 per 100,000 population). Among all hospitalizations, 6,254 (75.9%) were associated with influenza A, 1,905 (23.1%) with influenza B, 41 (0.5%) with influenza A and B co-infection, and 39 (0.5%) had no virus type information.
Neuraminidase inhibition titer a better predictor of influenza protection
Neuraminidase inhibition (NAI) titer is a better predictor of protection against influenza infection than hemagglutination inhibition (HAI) titer, according to new research, which could have implications for future flu vaccine development.
Investigators at the National Institute of Allergy and Infectious Diseases (NIAID) and the University of Pennsylvania, Philadelphia, performed a healthy volunteer challenge study with a wild-type 2009 A(H1N1)pdm influenza A challenge virus at the NIH Clinical Center in Bethesda, Md., to evaluate two groups of participants with HAI titers of greater than 1:40 and less than 1:40. The primary objective was to determine whether participants with HAI titers of greater than 1:40 were less likely to develop mild to moderate influenza disease after intranasal inoculation
In a multiple regression analysis, researchers evaluated the independent effects of both HAI and NAI titers on four diseases severity measures. In all measures – duration of shedding (HAI: P = .164; NAI: P less than .001), duration of symptoms (HAI: P = .497; NAI: P = .011), number of symptoms (HAI: P = .533; NAI: P less than .001), and symptom severity score (HAI: P = .906; NAI: P less than .001) – increasing NAI titers showed a statistically significant independent effect of decreasing severity, while HAI titers showed no significant independent effect on any of the disease severity measures examined.
When grouped by baseline NAI titers, those participants with high titers (greater than or equal to 1:40) had only minimal increases in NAI after challenge, but unlike HAI titer, every cohort with a low NAI titer had a rise in NAI titer after challenge, regardless of the outcome.
“These data further suggest that NAI titer may play a more significant role as a correlate of protection than previously thought and that the role of neuraminidase immunity should be considered when studying influenza susceptibility after vaccination and as a critical target in future influenza vaccine platforms,” Dr. Jeffery K. Taubenberger of the NIAID and his coauthors concluded.
This study was the first time the current “gold standard” for evaluating influenza vaccines – a protective HAI titer of greater than 1:40 – has been evaluated in a well-controlled healthy volunteer challenge since the cutoff was established, and the first time NAI titer has been identified in a controlled trial to be an independent predictor of a reduction in all aspects of influenza. The authors declared no conflicts of interest.
Read the full study in mBio (doi: 10.1128/mBio.00417-16).
Neuraminidase inhibition (NAI) titer is a better predictor of protection against influenza infection than hemagglutination inhibition (HAI) titer, according to new research, which could have implications for future flu vaccine development.
Investigators at the National Institute of Allergy and Infectious Diseases (NIAID) and the University of Pennsylvania, Philadelphia, performed a healthy volunteer challenge study with a wild-type 2009 A(H1N1)pdm influenza A challenge virus at the NIH Clinical Center in Bethesda, Md., to evaluate two groups of participants with HAI titers of greater than 1:40 and less than 1:40. The primary objective was to determine whether participants with HAI titers of greater than 1:40 were less likely to develop mild to moderate influenza disease after intranasal inoculation
In a multiple regression analysis, researchers evaluated the independent effects of both HAI and NAI titers on four diseases severity measures. In all measures – duration of shedding (HAI: P = .164; NAI: P less than .001), duration of symptoms (HAI: P = .497; NAI: P = .011), number of symptoms (HAI: P = .533; NAI: P less than .001), and symptom severity score (HAI: P = .906; NAI: P less than .001) – increasing NAI titers showed a statistically significant independent effect of decreasing severity, while HAI titers showed no significant independent effect on any of the disease severity measures examined.
When grouped by baseline NAI titers, those participants with high titers (greater than or equal to 1:40) had only minimal increases in NAI after challenge, but unlike HAI titer, every cohort with a low NAI titer had a rise in NAI titer after challenge, regardless of the outcome.
“These data further suggest that NAI titer may play a more significant role as a correlate of protection than previously thought and that the role of neuraminidase immunity should be considered when studying influenza susceptibility after vaccination and as a critical target in future influenza vaccine platforms,” Dr. Jeffery K. Taubenberger of the NIAID and his coauthors concluded.
This study was the first time the current “gold standard” for evaluating influenza vaccines – a protective HAI titer of greater than 1:40 – has been evaluated in a well-controlled healthy volunteer challenge since the cutoff was established, and the first time NAI titer has been identified in a controlled trial to be an independent predictor of a reduction in all aspects of influenza. The authors declared no conflicts of interest.
Read the full study in mBio (doi: 10.1128/mBio.00417-16).
Neuraminidase inhibition (NAI) titer is a better predictor of protection against influenza infection than hemagglutination inhibition (HAI) titer, according to new research, which could have implications for future flu vaccine development.
Investigators at the National Institute of Allergy and Infectious Diseases (NIAID) and the University of Pennsylvania, Philadelphia, performed a healthy volunteer challenge study with a wild-type 2009 A(H1N1)pdm influenza A challenge virus at the NIH Clinical Center in Bethesda, Md., to evaluate two groups of participants with HAI titers of greater than 1:40 and less than 1:40. The primary objective was to determine whether participants with HAI titers of greater than 1:40 were less likely to develop mild to moderate influenza disease after intranasal inoculation
In a multiple regression analysis, researchers evaluated the independent effects of both HAI and NAI titers on four diseases severity measures. In all measures – duration of shedding (HAI: P = .164; NAI: P less than .001), duration of symptoms (HAI: P = .497; NAI: P = .011), number of symptoms (HAI: P = .533; NAI: P less than .001), and symptom severity score (HAI: P = .906; NAI: P less than .001) – increasing NAI titers showed a statistically significant independent effect of decreasing severity, while HAI titers showed no significant independent effect on any of the disease severity measures examined.
When grouped by baseline NAI titers, those participants with high titers (greater than or equal to 1:40) had only minimal increases in NAI after challenge, but unlike HAI titer, every cohort with a low NAI titer had a rise in NAI titer after challenge, regardless of the outcome.
“These data further suggest that NAI titer may play a more significant role as a correlate of protection than previously thought and that the role of neuraminidase immunity should be considered when studying influenza susceptibility after vaccination and as a critical target in future influenza vaccine platforms,” Dr. Jeffery K. Taubenberger of the NIAID and his coauthors concluded.
This study was the first time the current “gold standard” for evaluating influenza vaccines – a protective HAI titer of greater than 1:40 – has been evaluated in a well-controlled healthy volunteer challenge since the cutoff was established, and the first time NAI titer has been identified in a controlled trial to be an independent predictor of a reduction in all aspects of influenza. The authors declared no conflicts of interest.
Read the full study in mBio (doi: 10.1128/mBio.00417-16).
FROM MBIO
U.S. flu activity down again, except in New Jersey
Overall activity of influenza-like illness (ILI) in the United States continued to fall, but New Jersey took a turn for the worse during the week ending April 9, 2016, according to the Centers for Disease Control and Prevention.
New Jersey’s ILI activity level went from 8 the previous week to 10 on the CDC’s 1-10 scale. For the week ending April 9, it was the only U.S. state in the “high” range, with Hawaii the next highest at level 6 – the only state in the “moderate” range, the CDC reported.
Nationwide, the proportion of outpatient visits for ILI was 2.1%, which is at the national baseline of 2.1% and down from 2.5% the week before. That number has now dropped for 4 consecutive weeks since hitting a season high of 3.7% for the week ending March 12. The CDC also reported a cumulative rate of 26.6 influenza-associated hospitalizations per 100,000 population.
Ten flu-related pediatric deaths were reported during the week, of which only one occurred during the week. A total of 50 flu-related pediatric deaths have been reported during the 2015-2016 season, the CDC said. The overall proportion of deaths attributed to pneumonia and influenza was below the system-specific threshold in the National Center for Health Statistics Mortality Surveillance System, but above the system-specific threshold in the 122 Cities Mortality Reporting System.
Overall activity of influenza-like illness (ILI) in the United States continued to fall, but New Jersey took a turn for the worse during the week ending April 9, 2016, according to the Centers for Disease Control and Prevention.
New Jersey’s ILI activity level went from 8 the previous week to 10 on the CDC’s 1-10 scale. For the week ending April 9, it was the only U.S. state in the “high” range, with Hawaii the next highest at level 6 – the only state in the “moderate” range, the CDC reported.
Nationwide, the proportion of outpatient visits for ILI was 2.1%, which is at the national baseline of 2.1% and down from 2.5% the week before. That number has now dropped for 4 consecutive weeks since hitting a season high of 3.7% for the week ending March 12. The CDC also reported a cumulative rate of 26.6 influenza-associated hospitalizations per 100,000 population.
Ten flu-related pediatric deaths were reported during the week, of which only one occurred during the week. A total of 50 flu-related pediatric deaths have been reported during the 2015-2016 season, the CDC said. The overall proportion of deaths attributed to pneumonia and influenza was below the system-specific threshold in the National Center for Health Statistics Mortality Surveillance System, but above the system-specific threshold in the 122 Cities Mortality Reporting System.
Overall activity of influenza-like illness (ILI) in the United States continued to fall, but New Jersey took a turn for the worse during the week ending April 9, 2016, according to the Centers for Disease Control and Prevention.
New Jersey’s ILI activity level went from 8 the previous week to 10 on the CDC’s 1-10 scale. For the week ending April 9, it was the only U.S. state in the “high” range, with Hawaii the next highest at level 6 – the only state in the “moderate” range, the CDC reported.
Nationwide, the proportion of outpatient visits for ILI was 2.1%, which is at the national baseline of 2.1% and down from 2.5% the week before. That number has now dropped for 4 consecutive weeks since hitting a season high of 3.7% for the week ending March 12. The CDC also reported a cumulative rate of 26.6 influenza-associated hospitalizations per 100,000 population.
Ten flu-related pediatric deaths were reported during the week, of which only one occurred during the week. A total of 50 flu-related pediatric deaths have been reported during the 2015-2016 season, the CDC said. The overall proportion of deaths attributed to pneumonia and influenza was below the system-specific threshold in the National Center for Health Statistics Mortality Surveillance System, but above the system-specific threshold in the 122 Cities Mortality Reporting System.
ED bedside flu test accurate across flu seasons
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
FROM DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
Key clinical point: A rapid bedside diagnostic test for influenza was accurate across four consecutive flu seasons in a pediatric ED.
Major finding: The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19.
Data source: A prospective analysis of the sensitivity and specificity of one rapid bedside diagnostic test in 764 children seen over a 4-year period.
Disclosures: Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
ED bedside flu test accurate across flu seasons
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
A rapid bedside diagnostic test for influenza showed consistent sensitivity and specificity across four consecutive flu seasons in a single pediatric ED in France, according to a report in Diagnostic Microbiology and Infectious Disease.
During flu seasons, it is difficult to distinguish young children who have the flu from those who have serious bacterial infections because clinical symptoms alone cannot differentiate the two conditions and fever may be the only symptom during the onset of a bacterial infection. Rapid influenza diagnostic tests purport to help ED clinicians estimate the probability of influenza at the bedside, which in turn can reduce the need for further diagnostic testing, length of ED stay, inappropriate use of antibiotics, and the costs of care, said Dr. E. Avril of the pediatric ED, University Hospital in Nantes, France, and associates.
To assess the diagnostic value of one rapid influenza diagnostic test used in this setting every winter, the investigators studied 764 patients younger than age 5 years who were admitted to the ED during four consecutive flu seasons with fever of no known origin. The prevalence of influenza varied widely during the study period, from a low of 30% to a high of 62%.
The rapid diagnostic test performed comparably well across the four flu seasons, with only a modest decrease in sensitivity and specificity during the 2010 H1N1 flu pandemic. The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19. These results are similar to those of two previous small-scale studies that found sensitivities of 69%-85% and specificities of 83%-98%, Dr. Avril and associates said (Diag Microbiol Infect Dis. 2016 doi:10.1016/j.diagmicrobio.2016.03.015).
These findings “support the rational use of rapid influenza diagnostic tests in clinical practice for young children presenting with fever without a source during flu season,” the investigators said.
Dr. Avril and associates added that they assessed only one rapid diagnostic test for influenza (QuickVue) – the only one available in their ED because of cost – but that there are 22 such tests commercially available. Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
FROM DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
Key clinical point: A rapid bedside diagnostic test for influenza was accurate across four consecutive flu seasons in a pediatric ED.
Major finding: The bedside test had an overall sensitivity of 0.82, a specificity of 0.98, a positive likelihood ratio of 37.8, and a negative likelihood ratio of 0.19.
Data source: A prospective analysis of the sensitivity and specificity of one rapid bedside diagnostic test in 764 children seen over a 4-year period.
Disclosures: Nantes University Hospital supported the study. Dr. Avril and associates reported having no relevant disclosures.
U.S. flu activity continues to drop, but still widespread
A third straight week of reduced influenza-like illness (ILI) left the U.S. with no states at the highest level of ILI activity for the first time since early February, according to the Centers for Disease Control and Prevention.
The states with the highest activity for the week ending April 2, 2016, were New Jersey and New Mexico, and both were at level 8 on the CDC’s 1-10 scale, putting them on the low end of the “high” range. States in the “moderate” range were Georgia and North Carolina at level 7 and Alabama, Alaska, Arkansas, Missouri, and Virginia at level 6, according to a report from the CDC’s Influenza-like Illness Surveillance Network (ILINet).
The proportion of outpatient visits for ILI was 2.4% for the week, down from 2.9% the week before but still above the national baseline of 2.1%, the CDC said. The CDC also reported a cumulative rate of 24.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population for the 2015-16 flu season.
There were seven flu-related pediatric deaths reported – all of them occurring during earlier weeks. So far, 40 flu-related pediatric deaths have been reported during the 2015-2016 season, with California having the highest number (9). The CDC said 7.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza. This percentage was above the epidemic threshold of 7.1% for week 13 of the flu season.
A third straight week of reduced influenza-like illness (ILI) left the U.S. with no states at the highest level of ILI activity for the first time since early February, according to the Centers for Disease Control and Prevention.
The states with the highest activity for the week ending April 2, 2016, were New Jersey and New Mexico, and both were at level 8 on the CDC’s 1-10 scale, putting them on the low end of the “high” range. States in the “moderate” range were Georgia and North Carolina at level 7 and Alabama, Alaska, Arkansas, Missouri, and Virginia at level 6, according to a report from the CDC’s Influenza-like Illness Surveillance Network (ILINet).
The proportion of outpatient visits for ILI was 2.4% for the week, down from 2.9% the week before but still above the national baseline of 2.1%, the CDC said. The CDC also reported a cumulative rate of 24.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population for the 2015-16 flu season.
There were seven flu-related pediatric deaths reported – all of them occurring during earlier weeks. So far, 40 flu-related pediatric deaths have been reported during the 2015-2016 season, with California having the highest number (9). The CDC said 7.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza. This percentage was above the epidemic threshold of 7.1% for week 13 of the flu season.
A third straight week of reduced influenza-like illness (ILI) left the U.S. with no states at the highest level of ILI activity for the first time since early February, according to the Centers for Disease Control and Prevention.
The states with the highest activity for the week ending April 2, 2016, were New Jersey and New Mexico, and both were at level 8 on the CDC’s 1-10 scale, putting them on the low end of the “high” range. States in the “moderate” range were Georgia and North Carolina at level 7 and Alabama, Alaska, Arkansas, Missouri, and Virginia at level 6, according to a report from the CDC’s Influenza-like Illness Surveillance Network (ILINet).
The proportion of outpatient visits for ILI was 2.4% for the week, down from 2.9% the week before but still above the national baseline of 2.1%, the CDC said. The CDC also reported a cumulative rate of 24.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population for the 2015-16 flu season.
There were seven flu-related pediatric deaths reported – all of them occurring during earlier weeks. So far, 40 flu-related pediatric deaths have been reported during the 2015-2016 season, with California having the highest number (9). The CDC said 7.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza. This percentage was above the epidemic threshold of 7.1% for week 13 of the flu season.
U.S. flu activity continues downward trend
Influenza-like illness (ILI) activity in the United States continued to drop during the week ending March 26, 2016, with only one state still at the highest level, according to the Centers for Disease Control and Prevention.
That one state was New Jersey, which was at level 10 on the CDC’s 1-10 scale of ILI activity. One state at level 10 was down from three states the week before and seven states 2 weeks earlier. Also down for a second consecutive week was the proportion of outpatient visits for ILI, which was 2.9% for the most recent week, compared with 3.2% the previous week and a season high of 3.7% for the week ending March 12, the CDC’s Influenza-like Illness Surveillance Network (ILINet) reported.
The only other state in the “high” range for the week ending March 26 was New Mexico at level 8. States in the “moderate” range were Alabama, Arizona, Georgia, and Pennsylvania at level 7 and Kentucky, North Carolina, and Virginia at level 6, according to data from ILINet.
Three flu-related pediatric deaths were reported to CDC during the week, but two occurred the previous week and one occurred in February. That brings the total of flu-related pediatric deaths to 33 for the 2015-2016 influenza season, the CDC said. However, 7.7% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza. This percentage was above the epidemic threshold of 7.2%.
The CDC also reported a cumulative rate for the season of 21.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population. The highest rate of hospitalization was among adults aged 65 years or older (54.5 per 100,000 population), followed by adults aged 50-64 (31.4 per 100,000 population) and children aged 0-4 years (29.3 per 100,000 population).
Influenza-like illness (ILI) activity in the United States continued to drop during the week ending March 26, 2016, with only one state still at the highest level, according to the Centers for Disease Control and Prevention.
That one state was New Jersey, which was at level 10 on the CDC’s 1-10 scale of ILI activity. One state at level 10 was down from three states the week before and seven states 2 weeks earlier. Also down for a second consecutive week was the proportion of outpatient visits for ILI, which was 2.9% for the most recent week, compared with 3.2% the previous week and a season high of 3.7% for the week ending March 12, the CDC’s Influenza-like Illness Surveillance Network (ILINet) reported.
The only other state in the “high” range for the week ending March 26 was New Mexico at level 8. States in the “moderate” range were Alabama, Arizona, Georgia, and Pennsylvania at level 7 and Kentucky, North Carolina, and Virginia at level 6, according to data from ILINet.
Three flu-related pediatric deaths were reported to CDC during the week, but two occurred the previous week and one occurred in February. That brings the total of flu-related pediatric deaths to 33 for the 2015-2016 influenza season, the CDC said. However, 7.7% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza. This percentage was above the epidemic threshold of 7.2%.
The CDC also reported a cumulative rate for the season of 21.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population. The highest rate of hospitalization was among adults aged 65 years or older (54.5 per 100,000 population), followed by adults aged 50-64 (31.4 per 100,000 population) and children aged 0-4 years (29.3 per 100,000 population).
Influenza-like illness (ILI) activity in the United States continued to drop during the week ending March 26, 2016, with only one state still at the highest level, according to the Centers for Disease Control and Prevention.
That one state was New Jersey, which was at level 10 on the CDC’s 1-10 scale of ILI activity. One state at level 10 was down from three states the week before and seven states 2 weeks earlier. Also down for a second consecutive week was the proportion of outpatient visits for ILI, which was 2.9% for the most recent week, compared with 3.2% the previous week and a season high of 3.7% for the week ending March 12, the CDC’s Influenza-like Illness Surveillance Network (ILINet) reported.
The only other state in the “high” range for the week ending March 26 was New Mexico at level 8. States in the “moderate” range were Alabama, Arizona, Georgia, and Pennsylvania at level 7 and Kentucky, North Carolina, and Virginia at level 6, according to data from ILINet.
Three flu-related pediatric deaths were reported to CDC during the week, but two occurred the previous week and one occurred in February. That brings the total of flu-related pediatric deaths to 33 for the 2015-2016 influenza season, the CDC said. However, 7.7% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza. This percentage was above the epidemic threshold of 7.2%.
The CDC also reported a cumulative rate for the season of 21.4 laboratory-confirmed influenza-associated hospitalizations per 100,000 population. The highest rate of hospitalization was among adults aged 65 years or older (54.5 per 100,000 population), followed by adults aged 50-64 (31.4 per 100,000 population) and children aged 0-4 years (29.3 per 100,000 population).
U.S. flu activity may be waning
The 2015-2016 U.S. flu season may have reached its peak. The proportion of outpatient visits for influenza-like illness (ILI) dropped to 3.2% for the week ending March 19, according to the Centers for Disease Control and Prevention.
The drop came after 9 consecutive weeks without a decrease, as the proportion of outpatient visits for ILI topped out at 3.7%, the CDC reported. The national baseline is 2.1%.
For the week ending March 19, three states – Kentucky, New Jersey, and New Mexico – were at level 10 on the CDC’s 1-10 scale of ILI activity, compared with seven the week before. Other states in the “high” range for the week were North Carolina at level 9 and Alabama, New York, and Virginia at level 8, according to data from the CDC’s Influenza-like Illness Surveillance Network (ILINet).
The CDC also reported a cumulative rate of 18.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population for the 2015-2016 flu season.
Two flu-related pediatric deaths were reported during the most recent week, one of which occurred during the week ending March 5. That brings the total to 30 reported for the 2015-2016 season. For the three previous flu seasons, the pediatric death totals were 148 (2014-2015), 111 (2013-2014), and 171 (2012-2013), according to the CDC report.
The 2015-2016 U.S. flu season may have reached its peak. The proportion of outpatient visits for influenza-like illness (ILI) dropped to 3.2% for the week ending March 19, according to the Centers for Disease Control and Prevention.
The drop came after 9 consecutive weeks without a decrease, as the proportion of outpatient visits for ILI topped out at 3.7%, the CDC reported. The national baseline is 2.1%.
For the week ending March 19, three states – Kentucky, New Jersey, and New Mexico – were at level 10 on the CDC’s 1-10 scale of ILI activity, compared with seven the week before. Other states in the “high” range for the week were North Carolina at level 9 and Alabama, New York, and Virginia at level 8, according to data from the CDC’s Influenza-like Illness Surveillance Network (ILINet).
The CDC also reported a cumulative rate of 18.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population for the 2015-2016 flu season.
Two flu-related pediatric deaths were reported during the most recent week, one of which occurred during the week ending March 5. That brings the total to 30 reported for the 2015-2016 season. For the three previous flu seasons, the pediatric death totals were 148 (2014-2015), 111 (2013-2014), and 171 (2012-2013), according to the CDC report.
The 2015-2016 U.S. flu season may have reached its peak. The proportion of outpatient visits for influenza-like illness (ILI) dropped to 3.2% for the week ending March 19, according to the Centers for Disease Control and Prevention.
The drop came after 9 consecutive weeks without a decrease, as the proportion of outpatient visits for ILI topped out at 3.7%, the CDC reported. The national baseline is 2.1%.
For the week ending March 19, three states – Kentucky, New Jersey, and New Mexico – were at level 10 on the CDC’s 1-10 scale of ILI activity, compared with seven the week before. Other states in the “high” range for the week were North Carolina at level 9 and Alabama, New York, and Virginia at level 8, according to data from the CDC’s Influenza-like Illness Surveillance Network (ILINet).
The CDC also reported a cumulative rate of 18.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population for the 2015-2016 flu season.
Two flu-related pediatric deaths were reported during the most recent week, one of which occurred during the week ending March 5. That brings the total to 30 reported for the 2015-2016 season. For the three previous flu seasons, the pediatric death totals were 148 (2014-2015), 111 (2013-2014), and 171 (2012-2013), according to the CDC report.
U.S. flu activity: Another week, another increase
Influenza-like illness (ILI) activity in the U.S. showed no signs of slowing down during the week ending March 12, 2016, as the number of states at the highest level increased to seven, compared with four the previous week, according to the Centers for Disease Control and Prevention.
The seven states at level 10 on the CDC’s 1-10 scale of ILI activity were Alabama, Arizona, Arkansas, Indiana, Kentucky, New Jersey, and North Carolina. Other states in the “high” range for the week were Mississippi, New Mexico, and Virginia at level 9 and Georgia, Hawaii, Illinois, and Oregon at level 8, the CDC’s Influenza-like Illness Surveillance Network (ILINet) reported.
The proportion of outpatient visits for ILI was 3.7% for the week, up from 3.5% the previous week and another new high for the season. The national baseline is 2.1%. The geographic spread of influenza in 40 states and Puerto Rico was reported as widespread, the CDC said.
There were eight flu-related pediatric deaths reported to the CDC, of which only one occurred during the week ending March 12. For the season so far, a total of 28 flu-related pediatric deaths have been reported in 14 states and Puerto Rico.
Since Oct. 1, 2015, 4,006 laboratory-confirmed flu-associated hospitalizations have been reported to the CDC’s Influenza Hospitalization Surveillance Network, which covers more than 70 counties in a group of 10 Emerging Infections Program states plus four additional states. The overall hospitalization rate for the season is 14.5 per 100,000 population, with the highest rate occurring in adults aged 65 years and older (37.2 per 100,000), followed by adults aged 50-64 (21.3) and children aged 0-4 years (20.9), the CDC report noted.
Influenza-like illness (ILI) activity in the U.S. showed no signs of slowing down during the week ending March 12, 2016, as the number of states at the highest level increased to seven, compared with four the previous week, according to the Centers for Disease Control and Prevention.
The seven states at level 10 on the CDC’s 1-10 scale of ILI activity were Alabama, Arizona, Arkansas, Indiana, Kentucky, New Jersey, and North Carolina. Other states in the “high” range for the week were Mississippi, New Mexico, and Virginia at level 9 and Georgia, Hawaii, Illinois, and Oregon at level 8, the CDC’s Influenza-like Illness Surveillance Network (ILINet) reported.
The proportion of outpatient visits for ILI was 3.7% for the week, up from 3.5% the previous week and another new high for the season. The national baseline is 2.1%. The geographic spread of influenza in 40 states and Puerto Rico was reported as widespread, the CDC said.
There were eight flu-related pediatric deaths reported to the CDC, of which only one occurred during the week ending March 12. For the season so far, a total of 28 flu-related pediatric deaths have been reported in 14 states and Puerto Rico.
Since Oct. 1, 2015, 4,006 laboratory-confirmed flu-associated hospitalizations have been reported to the CDC’s Influenza Hospitalization Surveillance Network, which covers more than 70 counties in a group of 10 Emerging Infections Program states plus four additional states. The overall hospitalization rate for the season is 14.5 per 100,000 population, with the highest rate occurring in adults aged 65 years and older (37.2 per 100,000), followed by adults aged 50-64 (21.3) and children aged 0-4 years (20.9), the CDC report noted.
Influenza-like illness (ILI) activity in the U.S. showed no signs of slowing down during the week ending March 12, 2016, as the number of states at the highest level increased to seven, compared with four the previous week, according to the Centers for Disease Control and Prevention.
The seven states at level 10 on the CDC’s 1-10 scale of ILI activity were Alabama, Arizona, Arkansas, Indiana, Kentucky, New Jersey, and North Carolina. Other states in the “high” range for the week were Mississippi, New Mexico, and Virginia at level 9 and Georgia, Hawaii, Illinois, and Oregon at level 8, the CDC’s Influenza-like Illness Surveillance Network (ILINet) reported.
The proportion of outpatient visits for ILI was 3.7% for the week, up from 3.5% the previous week and another new high for the season. The national baseline is 2.1%. The geographic spread of influenza in 40 states and Puerto Rico was reported as widespread, the CDC said.
There were eight flu-related pediatric deaths reported to the CDC, of which only one occurred during the week ending March 12. For the season so far, a total of 28 flu-related pediatric deaths have been reported in 14 states and Puerto Rico.
Since Oct. 1, 2015, 4,006 laboratory-confirmed flu-associated hospitalizations have been reported to the CDC’s Influenza Hospitalization Surveillance Network, which covers more than 70 counties in a group of 10 Emerging Infections Program states plus four additional states. The overall hospitalization rate for the season is 14.5 per 100,000 population, with the highest rate occurring in adults aged 65 years and older (37.2 per 100,000), followed by adults aged 50-64 (21.3) and children aged 0-4 years (20.9), the CDC report noted.
Flu vaccination found safe in surgical patients
Immunizing surgical patients against seasonal influenza before they are discharged from the hospital appears safe and is a sound strategy for expanding vaccine coverage, especially among people at high risk, according to a report published online March 14 in Annals of Internal Medicine.
All health care contacts, including hospitalizations, are considered excellent opportunities for influenza vaccination, and current recommendations advise that eligible inpatients receive the immunization before discharge. However, surgical patients don’t often get the flu vaccine before they leave the hospital, likely because of concerns that potential adverse effects like fever and myalgia could be falsely attributed to surgical complications. This would lead to unnecessary patient evaluations and could interfere with postsurgical care, said Sara Y. Tartof, Ph.D., and her associates in the department of research and evaluation, Kaiser Permanente Southern California, Pasadena.
“Although this concern is understandable, few clinical data support it,” they noted.
“To provide clinical evidence that would either substantiate or refute” these concerns about perioperative flu vaccination, the investigators analyzed data in the electronic health records for 81,647 surgeries. All the study participants were deemed eligible for flu vaccination. They were socioeconomically and ethnically diverse, ranged in age from 6 months to 106 years, and underwent surgery at 14 hospitals during three consecutive flu seasons. Operations included general, cardiac, eye, dermatologic, ENT, neurologic, ob.gyn., oral/maxillofacial, orthopedic, plastic, podiatric, urologic, and vascular procedures.
Patients received a flu vaccine in 6,420 hospital stays for surgery – only 15% of 42,777 eligible hospitalizations – usually on the day of discharge. (The remaining 38,870 patients either had been vaccinated before hospital admission or were vaccinated more than a week after discharge and were not included in further analyses.)
Compared with eligible patients who didn’t receive a flu vaccine during hospitalization for surgery, those who did showed no increased risk for subsequent inpatient visits, ED visits, or clinical work-ups for infection. Patients who received the flu vaccine before discharge showed a minimally increased risk for outpatient visits during the week following hospitalization, but this was considered unlikely “to translate into substantial clinical impact,” especially when balanced against the benefit of immunization, Dr. Tartof and her associates said (Ann Intern Med. 2016 Mar 14. doi: 10.7326/M15-1667).
Giving the flu vaccine during a surgical hospitalization “is an opportunity to protect a high-risk population,” because surgery patients tend to be of an age, and to have comorbid conditions, that raise their risk for flu complications. In addition, previous research has reported that 39%-46% of adults hospitalized for influenza-related disease in a given year had been hospitalized during the preceding autumn, indicating that recent hospitalization also raises the risk for flu complications, the investigators said.
“Our data support the rationale for increasing vaccination rates among surgical inpatients,” they said.
This study was funded by the U.S. Centers for Disease Control and Prevention through the Vaccine Safety Datalink program. Dr. Tartof reported receiving grants from Merck outside of this work; two of her associates reported receiving grants from Novartis and GlaxoSmithKline outside of this work.
Immunizing surgical patients against seasonal influenza before they are discharged from the hospital appears safe and is a sound strategy for expanding vaccine coverage, especially among people at high risk, according to a report published online March 14 in Annals of Internal Medicine.
All health care contacts, including hospitalizations, are considered excellent opportunities for influenza vaccination, and current recommendations advise that eligible inpatients receive the immunization before discharge. However, surgical patients don’t often get the flu vaccine before they leave the hospital, likely because of concerns that potential adverse effects like fever and myalgia could be falsely attributed to surgical complications. This would lead to unnecessary patient evaluations and could interfere with postsurgical care, said Sara Y. Tartof, Ph.D., and her associates in the department of research and evaluation, Kaiser Permanente Southern California, Pasadena.
“Although this concern is understandable, few clinical data support it,” they noted.
“To provide clinical evidence that would either substantiate or refute” these concerns about perioperative flu vaccination, the investigators analyzed data in the electronic health records for 81,647 surgeries. All the study participants were deemed eligible for flu vaccination. They were socioeconomically and ethnically diverse, ranged in age from 6 months to 106 years, and underwent surgery at 14 hospitals during three consecutive flu seasons. Operations included general, cardiac, eye, dermatologic, ENT, neurologic, ob.gyn., oral/maxillofacial, orthopedic, plastic, podiatric, urologic, and vascular procedures.
Patients received a flu vaccine in 6,420 hospital stays for surgery – only 15% of 42,777 eligible hospitalizations – usually on the day of discharge. (The remaining 38,870 patients either had been vaccinated before hospital admission or were vaccinated more than a week after discharge and were not included in further analyses.)
Compared with eligible patients who didn’t receive a flu vaccine during hospitalization for surgery, those who did showed no increased risk for subsequent inpatient visits, ED visits, or clinical work-ups for infection. Patients who received the flu vaccine before discharge showed a minimally increased risk for outpatient visits during the week following hospitalization, but this was considered unlikely “to translate into substantial clinical impact,” especially when balanced against the benefit of immunization, Dr. Tartof and her associates said (Ann Intern Med. 2016 Mar 14. doi: 10.7326/M15-1667).
Giving the flu vaccine during a surgical hospitalization “is an opportunity to protect a high-risk population,” because surgery patients tend to be of an age, and to have comorbid conditions, that raise their risk for flu complications. In addition, previous research has reported that 39%-46% of adults hospitalized for influenza-related disease in a given year had been hospitalized during the preceding autumn, indicating that recent hospitalization also raises the risk for flu complications, the investigators said.
“Our data support the rationale for increasing vaccination rates among surgical inpatients,” they said.
This study was funded by the U.S. Centers for Disease Control and Prevention through the Vaccine Safety Datalink program. Dr. Tartof reported receiving grants from Merck outside of this work; two of her associates reported receiving grants from Novartis and GlaxoSmithKline outside of this work.
Immunizing surgical patients against seasonal influenza before they are discharged from the hospital appears safe and is a sound strategy for expanding vaccine coverage, especially among people at high risk, according to a report published online March 14 in Annals of Internal Medicine.
All health care contacts, including hospitalizations, are considered excellent opportunities for influenza vaccination, and current recommendations advise that eligible inpatients receive the immunization before discharge. However, surgical patients don’t often get the flu vaccine before they leave the hospital, likely because of concerns that potential adverse effects like fever and myalgia could be falsely attributed to surgical complications. This would lead to unnecessary patient evaluations and could interfere with postsurgical care, said Sara Y. Tartof, Ph.D., and her associates in the department of research and evaluation, Kaiser Permanente Southern California, Pasadena.
“Although this concern is understandable, few clinical data support it,” they noted.
“To provide clinical evidence that would either substantiate or refute” these concerns about perioperative flu vaccination, the investigators analyzed data in the electronic health records for 81,647 surgeries. All the study participants were deemed eligible for flu vaccination. They were socioeconomically and ethnically diverse, ranged in age from 6 months to 106 years, and underwent surgery at 14 hospitals during three consecutive flu seasons. Operations included general, cardiac, eye, dermatologic, ENT, neurologic, ob.gyn., oral/maxillofacial, orthopedic, plastic, podiatric, urologic, and vascular procedures.
Patients received a flu vaccine in 6,420 hospital stays for surgery – only 15% of 42,777 eligible hospitalizations – usually on the day of discharge. (The remaining 38,870 patients either had been vaccinated before hospital admission or were vaccinated more than a week after discharge and were not included in further analyses.)
Compared with eligible patients who didn’t receive a flu vaccine during hospitalization for surgery, those who did showed no increased risk for subsequent inpatient visits, ED visits, or clinical work-ups for infection. Patients who received the flu vaccine before discharge showed a minimally increased risk for outpatient visits during the week following hospitalization, but this was considered unlikely “to translate into substantial clinical impact,” especially when balanced against the benefit of immunization, Dr. Tartof and her associates said (Ann Intern Med. 2016 Mar 14. doi: 10.7326/M15-1667).
Giving the flu vaccine during a surgical hospitalization “is an opportunity to protect a high-risk population,” because surgery patients tend to be of an age, and to have comorbid conditions, that raise their risk for flu complications. In addition, previous research has reported that 39%-46% of adults hospitalized for influenza-related disease in a given year had been hospitalized during the preceding autumn, indicating that recent hospitalization also raises the risk for flu complications, the investigators said.
“Our data support the rationale for increasing vaccination rates among surgical inpatients,” they said.
This study was funded by the U.S. Centers for Disease Control and Prevention through the Vaccine Safety Datalink program. Dr. Tartof reported receiving grants from Merck outside of this work; two of her associates reported receiving grants from Novartis and GlaxoSmithKline outside of this work.
FROM ANNALS OF INTERNAL MEDICINE
Key clinical point: Immunizing surgical patients against seasonal influenza before they leave the hospital appears safe.
Major finding: Patients received a flu vaccine in only 6,420 hospital stays for surgery, comprising only 15% of the patient hospitalizations that were eligible.
Data source: A retrospective cohort study involving 81,647 surgeries at 14 California hospitals during three consecutive flu seasons.
Disclosures: This study was funded by the U.S. Centers for Disease Control and Prevention through the Vaccine Safety Datalink program. Dr. Tartof reported receiving grants from Merck outside of this work; two of her associates reported receiving grants from Novartis and GlaxoSmithKline outside of this work.
