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U.S. flu activity steady in late January
Overall influenza-like illness (ILI) activity underwent a small increase in the United States during week 16 of the 2015-2016 flu season, but Puerto Rico took a significant turn for the worse as activity there rose to the highest possible level, the Centers for Disease Control and Prevention reported Feb. 5.
Puerto Rico, which had been at level 8 on the CDC’s 1-10 scale of flu activity for the previous 3 weeks, jumped up to level 10 for the week ending Jan. 30, 2016. Meanwhile, the main measure for national flu activity, the proportion of outpatient visits for ILI, was 2.2% for the second week in a row, just above the national baseline of 2.1%, the CDC said.
The state with the highest level of flu activity (level 7) for the week was Connecticut, with Arkansas the only other state in the “moderate” range at level 6. States in the “low” range were Florida, Hawaii, Illinois, Maryland, Nevada, New Jersey, and Pennsylvania at level 4 and Georgia, Idaho, Louisiana, Massachusetts, Mississippi, New Mexico, and Virginia at level 3. All told, there were 22 states with activity above level 1, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were two influenza-associated pediatric deaths reported during week 16, although one death actually occurred during the week ending Jan. 16. There have been nine flu-associated pediatric deaths reported so far during the 2015-2016 season.
The hospitalization rate for the season so far is 2.6/100,000 population, up from 2.1/100,000 last week. Adults aged 65 years and older had the highest rate at 8.5/100,000, with children aged 0-4 years next at 3.8/100,000.
Overall influenza-like illness (ILI) activity underwent a small increase in the United States during week 16 of the 2015-2016 flu season, but Puerto Rico took a significant turn for the worse as activity there rose to the highest possible level, the Centers for Disease Control and Prevention reported Feb. 5.
Puerto Rico, which had been at level 8 on the CDC’s 1-10 scale of flu activity for the previous 3 weeks, jumped up to level 10 for the week ending Jan. 30, 2016. Meanwhile, the main measure for national flu activity, the proportion of outpatient visits for ILI, was 2.2% for the second week in a row, just above the national baseline of 2.1%, the CDC said.
The state with the highest level of flu activity (level 7) for the week was Connecticut, with Arkansas the only other state in the “moderate” range at level 6. States in the “low” range were Florida, Hawaii, Illinois, Maryland, Nevada, New Jersey, and Pennsylvania at level 4 and Georgia, Idaho, Louisiana, Massachusetts, Mississippi, New Mexico, and Virginia at level 3. All told, there were 22 states with activity above level 1, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were two influenza-associated pediatric deaths reported during week 16, although one death actually occurred during the week ending Jan. 16. There have been nine flu-associated pediatric deaths reported so far during the 2015-2016 season.
The hospitalization rate for the season so far is 2.6/100,000 population, up from 2.1/100,000 last week. Adults aged 65 years and older had the highest rate at 8.5/100,000, with children aged 0-4 years next at 3.8/100,000.
Overall influenza-like illness (ILI) activity underwent a small increase in the United States during week 16 of the 2015-2016 flu season, but Puerto Rico took a significant turn for the worse as activity there rose to the highest possible level, the Centers for Disease Control and Prevention reported Feb. 5.
Puerto Rico, which had been at level 8 on the CDC’s 1-10 scale of flu activity for the previous 3 weeks, jumped up to level 10 for the week ending Jan. 30, 2016. Meanwhile, the main measure for national flu activity, the proportion of outpatient visits for ILI, was 2.2% for the second week in a row, just above the national baseline of 2.1%, the CDC said.
The state with the highest level of flu activity (level 7) for the week was Connecticut, with Arkansas the only other state in the “moderate” range at level 6. States in the “low” range were Florida, Hawaii, Illinois, Maryland, Nevada, New Jersey, and Pennsylvania at level 4 and Georgia, Idaho, Louisiana, Massachusetts, Mississippi, New Mexico, and Virginia at level 3. All told, there were 22 states with activity above level 1, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were two influenza-associated pediatric deaths reported during week 16, although one death actually occurred during the week ending Jan. 16. There have been nine flu-associated pediatric deaths reported so far during the 2015-2016 season.
The hospitalization rate for the season so far is 2.6/100,000 population, up from 2.1/100,000 last week. Adults aged 65 years and older had the highest rate at 8.5/100,000, with children aged 0-4 years next at 3.8/100,000.
Majority of children aged 6-23 months are not vaccinated for flu
Less than half of children aged 6-23 months are vaccinated for influenza in the United States, according to an analysis of data obtained via the 2003-2013 National Immunization Survey.
The researchers analyzed providers’ reports of influenza vaccinations, received as one or two doses by children aged 6-23 months. The age group studied is at highest risk of influenza-related complications and was the first group of children for which the Advisory Committee on Immunization Practices recommended influenza vaccination, regardless of an individual’s medical condition.
A child’s age was defined by his or her age on Nov. 1 of each influenza season under study. Two full calendar years of data files were combined to enable analysis of full influenza seasons, which cover parts of 2 consecutive calendar years. The percentages of children requiring two doses to be considered fully vaccinated were based on the dosage recommendations for each flu season.
Overall, flu vaccination coverage increased, reaching 45% in the 2011-2012 flu season, up from 5% during the 2002-2003 flu season. Within each racial/ethnic group examined, influenza vaccination coverage also grew; however, lower percentages of non-Hispanic black children and Hispanic children were vaccinated than of non-Hispanic white children during all 10 of the flu seasons studied. Coverage ranged from 24% in Mississippi to 72% in Massachusetts.
“Despite the increase, the majority of children 6-23 months in the United States were not fully vaccinated against influenza,” said Tammy A. Santibanez, Ph.D., of the Centers for Disease Control and Prevention, and her colleagues.
Among other findings consistent throughout each flu season examined was that full influenza vaccination coverage was higher among children requiring only one dose of a flu vaccine, compared with those requiring two doses of a flu vaccine.
“Prevention of influenza among infants and young children is a public health priority because of their high risk for influenza-related complications,” wrote Dr. Santibanez and her colleagues. “Appropriate implementation of evidence-based strategies is needed to increase the percentage of children who are fully vaccinated.”
Read the study in Pediatrics (doi: 10.1542/peds.2015.3280).
Less than half of children aged 6-23 months are vaccinated for influenza in the United States, according to an analysis of data obtained via the 2003-2013 National Immunization Survey.
The researchers analyzed providers’ reports of influenza vaccinations, received as one or two doses by children aged 6-23 months. The age group studied is at highest risk of influenza-related complications and was the first group of children for which the Advisory Committee on Immunization Practices recommended influenza vaccination, regardless of an individual’s medical condition.
A child’s age was defined by his or her age on Nov. 1 of each influenza season under study. Two full calendar years of data files were combined to enable analysis of full influenza seasons, which cover parts of 2 consecutive calendar years. The percentages of children requiring two doses to be considered fully vaccinated were based on the dosage recommendations for each flu season.
Overall, flu vaccination coverage increased, reaching 45% in the 2011-2012 flu season, up from 5% during the 2002-2003 flu season. Within each racial/ethnic group examined, influenza vaccination coverage also grew; however, lower percentages of non-Hispanic black children and Hispanic children were vaccinated than of non-Hispanic white children during all 10 of the flu seasons studied. Coverage ranged from 24% in Mississippi to 72% in Massachusetts.
“Despite the increase, the majority of children 6-23 months in the United States were not fully vaccinated against influenza,” said Tammy A. Santibanez, Ph.D., of the Centers for Disease Control and Prevention, and her colleagues.
Among other findings consistent throughout each flu season examined was that full influenza vaccination coverage was higher among children requiring only one dose of a flu vaccine, compared with those requiring two doses of a flu vaccine.
“Prevention of influenza among infants and young children is a public health priority because of their high risk for influenza-related complications,” wrote Dr. Santibanez and her colleagues. “Appropriate implementation of evidence-based strategies is needed to increase the percentage of children who are fully vaccinated.”
Read the study in Pediatrics (doi: 10.1542/peds.2015.3280).
Less than half of children aged 6-23 months are vaccinated for influenza in the United States, according to an analysis of data obtained via the 2003-2013 National Immunization Survey.
The researchers analyzed providers’ reports of influenza vaccinations, received as one or two doses by children aged 6-23 months. The age group studied is at highest risk of influenza-related complications and was the first group of children for which the Advisory Committee on Immunization Practices recommended influenza vaccination, regardless of an individual’s medical condition.
A child’s age was defined by his or her age on Nov. 1 of each influenza season under study. Two full calendar years of data files were combined to enable analysis of full influenza seasons, which cover parts of 2 consecutive calendar years. The percentages of children requiring two doses to be considered fully vaccinated were based on the dosage recommendations for each flu season.
Overall, flu vaccination coverage increased, reaching 45% in the 2011-2012 flu season, up from 5% during the 2002-2003 flu season. Within each racial/ethnic group examined, influenza vaccination coverage also grew; however, lower percentages of non-Hispanic black children and Hispanic children were vaccinated than of non-Hispanic white children during all 10 of the flu seasons studied. Coverage ranged from 24% in Mississippi to 72% in Massachusetts.
“Despite the increase, the majority of children 6-23 months in the United States were not fully vaccinated against influenza,” said Tammy A. Santibanez, Ph.D., of the Centers for Disease Control and Prevention, and her colleagues.
Among other findings consistent throughout each flu season examined was that full influenza vaccination coverage was higher among children requiring only one dose of a flu vaccine, compared with those requiring two doses of a flu vaccine.
“Prevention of influenza among infants and young children is a public health priority because of their high risk for influenza-related complications,” wrote Dr. Santibanez and her colleagues. “Appropriate implementation of evidence-based strategies is needed to increase the percentage of children who are fully vaccinated.”
Read the study in Pediatrics (doi: 10.1542/peds.2015.3280).
FROM PEDIATRICS
U.S. flu activity continues slow increase
The proportion of U.S. outpatient visits for influenza-like illness (ILI) crept up from 2.1% to 2.2% for the week ending Jan. 23 – week 15 of the 2015-2016 flu season, the Centers for Disease Control and Prevention reported.
That increase put the proportion of visits involving ILI back above the national baseline level of 2.1% for the first time since the week ending Jan. 2, when it reached a season-high 2.8%, the CDC said.
Puerto Rico was the nation’s influenza hotspot at level 8 on the CDC’s 1-10 scale of ILI activity, but the states with the most activity were Connecticut, Maryland, and South Carolina, which were categorized in the “moderate” range at level 6. Connecticut was up from level 2 the week before; the other two states were unchanged.
There were five states in the “low” range: Arizona, New Jersey, and Oklahoma at level 5 and Illinois and Virginia at level 4. Arizona (down from level 7) and Oklahoma (up from level 3) were the biggest movers in this group from the previous week. There were 12 states at level 3 and four states at level 2, putting the total at 24 states at level 2 or higher, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were no pediatric deaths reported in week 15, keeping the total for the season at seven, the CDC said, which is well below the number of deaths reported by week 15 in each of the last three flu seasons.
The ILI hospitalization rate for the season so far is 2.1 per 100,000 population, with 575 laboratory-confirmed, influenza-associated hospitalizations reported between Oct. 1, 2015, and Jan. 23, 2016. The highest hospitalization rates are among adults aged 65 years and older (7.0 per 100,000 population) and children aged 0-4 years (3.4 per 100,000), the CDC reported.
The proportion of U.S. outpatient visits for influenza-like illness (ILI) crept up from 2.1% to 2.2% for the week ending Jan. 23 – week 15 of the 2015-2016 flu season, the Centers for Disease Control and Prevention reported.
That increase put the proportion of visits involving ILI back above the national baseline level of 2.1% for the first time since the week ending Jan. 2, when it reached a season-high 2.8%, the CDC said.
Puerto Rico was the nation’s influenza hotspot at level 8 on the CDC’s 1-10 scale of ILI activity, but the states with the most activity were Connecticut, Maryland, and South Carolina, which were categorized in the “moderate” range at level 6. Connecticut was up from level 2 the week before; the other two states were unchanged.
There were five states in the “low” range: Arizona, New Jersey, and Oklahoma at level 5 and Illinois and Virginia at level 4. Arizona (down from level 7) and Oklahoma (up from level 3) were the biggest movers in this group from the previous week. There were 12 states at level 3 and four states at level 2, putting the total at 24 states at level 2 or higher, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were no pediatric deaths reported in week 15, keeping the total for the season at seven, the CDC said, which is well below the number of deaths reported by week 15 in each of the last three flu seasons.
The ILI hospitalization rate for the season so far is 2.1 per 100,000 population, with 575 laboratory-confirmed, influenza-associated hospitalizations reported between Oct. 1, 2015, and Jan. 23, 2016. The highest hospitalization rates are among adults aged 65 years and older (7.0 per 100,000 population) and children aged 0-4 years (3.4 per 100,000), the CDC reported.
The proportion of U.S. outpatient visits for influenza-like illness (ILI) crept up from 2.1% to 2.2% for the week ending Jan. 23 – week 15 of the 2015-2016 flu season, the Centers for Disease Control and Prevention reported.
That increase put the proportion of visits involving ILI back above the national baseline level of 2.1% for the first time since the week ending Jan. 2, when it reached a season-high 2.8%, the CDC said.
Puerto Rico was the nation’s influenza hotspot at level 8 on the CDC’s 1-10 scale of ILI activity, but the states with the most activity were Connecticut, Maryland, and South Carolina, which were categorized in the “moderate” range at level 6. Connecticut was up from level 2 the week before; the other two states were unchanged.
There were five states in the “low” range: Arizona, New Jersey, and Oklahoma at level 5 and Illinois and Virginia at level 4. Arizona (down from level 7) and Oklahoma (up from level 3) were the biggest movers in this group from the previous week. There were 12 states at level 3 and four states at level 2, putting the total at 24 states at level 2 or higher, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were no pediatric deaths reported in week 15, keeping the total for the season at seven, the CDC said, which is well below the number of deaths reported by week 15 in each of the last three flu seasons.
The ILI hospitalization rate for the season so far is 2.1 per 100,000 population, with 575 laboratory-confirmed, influenza-associated hospitalizations reported between Oct. 1, 2015, and Jan. 23, 2016. The highest hospitalization rates are among adults aged 65 years and older (7.0 per 100,000 population) and children aged 0-4 years (3.4 per 100,000), the CDC reported.
U.S. flu activity picks up slightly
There were no states in the “high” range of influenza-like illness (ILI) activity during week 14 of the 2015-2016 flu season, but there were more states with elevated levels, compared with the previous week, the Centers for Disease Control and Prevention reported.
Arizona had the highest activity (level 7) for the week ending Jan. 16, with Maryland and South Carolina (level 6) the only other states in the “moderate” range of ILI activity. There were 21 states at level 2 or higher, up from 18 the week before, but still below the peak of 24 that was seen 2 weeks ago. The overall proportion of outpatient visits for ILI was 2.1% for week 14, which was up from 2% for week 13 but was right at the national baseline, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were no influenza-related pediatric deaths reported for week 14, so the number of total deaths remains at seven for the season, which is well below the week-14 totals for each of the previous three seasons. There have been 494 laboratory-confirmed influenza-associated hospitalizations reported in the 13 states of the CDC’s Influenza Hospitalization Surveillance Network through week 14, for an overall hospitalization rate of 1.8/100,000 population, the CDC said.
Among all hospitalizations, 65.4% were associated with influenza A, 28.7% with influenza B, 3.2% with influenza A and B coinfection, and 2.6% had no virus type information, the CDC report noted.
There were no states in the “high” range of influenza-like illness (ILI) activity during week 14 of the 2015-2016 flu season, but there were more states with elevated levels, compared with the previous week, the Centers for Disease Control and Prevention reported.
Arizona had the highest activity (level 7) for the week ending Jan. 16, with Maryland and South Carolina (level 6) the only other states in the “moderate” range of ILI activity. There were 21 states at level 2 or higher, up from 18 the week before, but still below the peak of 24 that was seen 2 weeks ago. The overall proportion of outpatient visits for ILI was 2.1% for week 14, which was up from 2% for week 13 but was right at the national baseline, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were no influenza-related pediatric deaths reported for week 14, so the number of total deaths remains at seven for the season, which is well below the week-14 totals for each of the previous three seasons. There have been 494 laboratory-confirmed influenza-associated hospitalizations reported in the 13 states of the CDC’s Influenza Hospitalization Surveillance Network through week 14, for an overall hospitalization rate of 1.8/100,000 population, the CDC said.
Among all hospitalizations, 65.4% were associated with influenza A, 28.7% with influenza B, 3.2% with influenza A and B coinfection, and 2.6% had no virus type information, the CDC report noted.
There were no states in the “high” range of influenza-like illness (ILI) activity during week 14 of the 2015-2016 flu season, but there were more states with elevated levels, compared with the previous week, the Centers for Disease Control and Prevention reported.
Arizona had the highest activity (level 7) for the week ending Jan. 16, with Maryland and South Carolina (level 6) the only other states in the “moderate” range of ILI activity. There were 21 states at level 2 or higher, up from 18 the week before, but still below the peak of 24 that was seen 2 weeks ago. The overall proportion of outpatient visits for ILI was 2.1% for week 14, which was up from 2% for week 13 but was right at the national baseline, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
There were no influenza-related pediatric deaths reported for week 14, so the number of total deaths remains at seven for the season, which is well below the week-14 totals for each of the previous three seasons. There have been 494 laboratory-confirmed influenza-associated hospitalizations reported in the 13 states of the CDC’s Influenza Hospitalization Surveillance Network through week 14, for an overall hospitalization rate of 1.8/100,000 population, the CDC said.
Among all hospitalizations, 65.4% were associated with influenza A, 28.7% with influenza B, 3.2% with influenza A and B coinfection, and 2.6% had no virus type information, the CDC report noted.
Gene signatures aid diagnosis of acute respiratory infection etiology
Pathogen-specific host gene expression patterns accurately discriminated most noninfectious from infectious illnesses, and bacterial from viral causes of acute respiratory infection (ARI) in an observational study conducted in acute care settings.
The findings could have important implications for combating inappropriate antibiotic use and emerging antibiotic resistance, Dr. Ephraim L. Tsalik of the department of medicine at Duke University, Durham, N.C., and his colleagues reported online Jan. 20 in Science Translational Medicine.
The investigators analyzed peripheral whole-blood gene expression from 273 subjects with community-onset viral ARI (115 subjects), bacterial ARI (70 subjects), or noninfectious illness (88 subjects) who were seen in an emergency department, and from 44 healthy control subjects. Classifiers for bacterial ARI, viral ARI, and noninfectious causes of illness were developed, and were 87% accurate overall (Sci Transl Med. 2016;8[322]:322ra11. doi/ 10.1126/scitranslmed.aad6873).
“Bacterial ARI was identified in 83% of patients and excluded in 94% without bacterial infection. Viral ARI was identified in 90% and excluded in 92% of cases. Using the noninfectious illness classifier, infection was excluded in 86% of cases,” they wrote.
The classifiers were more accurate than procalcitonin – a widely used biomarker with some specificity for bacterial infection (86% vs. 78% accuracy in 238 available samples), and three published classifiers of bacterial vs. viral infection, and were validated in five publicly available data sets, they noted.
The gene signature patterns identified in the course of this study mark an important step toward development of a rapid blood test that could be used in clinics to guide appropriate treatment for ARIs, the investigators said.
Precision treatment of viruses
More precise ways to distinguish infections could reduce unnecessary antibiotic use and lead to more precise treatment of viruses, senior author Dr. Geoffrey S. Ginsburg, director of Duke’s Center for Applied Genomics & Precision Medicine, said in a press statement.
“Right now, we can give patients [oseltamivir] Tamiflu to help them recover from an influenza infection, but for most viral infections, the treatment is fluids and rest until it resolves. In the next 5-10 years, we will likely see new antiviral medications for common bugs like respiratory syncytial virus and even rhinovirus, and guiding treatment choices will be even more important,” he added.
Senior author Dr. Christopher W. Woods, also of Duke University, further explained in an interview that the findings are particularly exciting because “there isn’t much out there that accomplishes what we’ve done. So just about any level of accuracy is an improvement.” Further, he said the test is “a tool to aid in diagnosis, used in conjunction with the patient’s symptoms, examination, and other testing. So an imperfect test is okay, because it does not stand alone.”
Next steps include putting the assay on a testing platform that can be used at the point of care, and validating the findings in all populations, including infants, the elderly, and across ethnic groups, he said.
“The work is ongoing, and we expect to have results available within the course of an outpatient visit in the near future,” Dr. Woods, also a professor of medicine and global health, added, noting that efforts also are underway to “expand the repertoire of this approach to many different types of viral and bacterial infections and also to fungal infections, and to address the challenges of critically ill patients in intensive care units.”
This study was supported by the U.S. Defense Advanced Research Projects Agency, the National Institutes of Health, the Agency for Healthcare Research and Quality, the U.S. Department of Veterans Affairs Office of Research and Development, and an in-kind contribution from bioMérieux. The authors reported having no relevant competing interests.
Pathogen-specific host gene expression patterns accurately discriminated most noninfectious from infectious illnesses, and bacterial from viral causes of acute respiratory infection (ARI) in an observational study conducted in acute care settings.
The findings could have important implications for combating inappropriate antibiotic use and emerging antibiotic resistance, Dr. Ephraim L. Tsalik of the department of medicine at Duke University, Durham, N.C., and his colleagues reported online Jan. 20 in Science Translational Medicine.
The investigators analyzed peripheral whole-blood gene expression from 273 subjects with community-onset viral ARI (115 subjects), bacterial ARI (70 subjects), or noninfectious illness (88 subjects) who were seen in an emergency department, and from 44 healthy control subjects. Classifiers for bacterial ARI, viral ARI, and noninfectious causes of illness were developed, and were 87% accurate overall (Sci Transl Med. 2016;8[322]:322ra11. doi/ 10.1126/scitranslmed.aad6873).
“Bacterial ARI was identified in 83% of patients and excluded in 94% without bacterial infection. Viral ARI was identified in 90% and excluded in 92% of cases. Using the noninfectious illness classifier, infection was excluded in 86% of cases,” they wrote.
The classifiers were more accurate than procalcitonin – a widely used biomarker with some specificity for bacterial infection (86% vs. 78% accuracy in 238 available samples), and three published classifiers of bacterial vs. viral infection, and were validated in five publicly available data sets, they noted.
The gene signature patterns identified in the course of this study mark an important step toward development of a rapid blood test that could be used in clinics to guide appropriate treatment for ARIs, the investigators said.
Precision treatment of viruses
More precise ways to distinguish infections could reduce unnecessary antibiotic use and lead to more precise treatment of viruses, senior author Dr. Geoffrey S. Ginsburg, director of Duke’s Center for Applied Genomics & Precision Medicine, said in a press statement.
“Right now, we can give patients [oseltamivir] Tamiflu to help them recover from an influenza infection, but for most viral infections, the treatment is fluids and rest until it resolves. In the next 5-10 years, we will likely see new antiviral medications for common bugs like respiratory syncytial virus and even rhinovirus, and guiding treatment choices will be even more important,” he added.
Senior author Dr. Christopher W. Woods, also of Duke University, further explained in an interview that the findings are particularly exciting because “there isn’t much out there that accomplishes what we’ve done. So just about any level of accuracy is an improvement.” Further, he said the test is “a tool to aid in diagnosis, used in conjunction with the patient’s symptoms, examination, and other testing. So an imperfect test is okay, because it does not stand alone.”
Next steps include putting the assay on a testing platform that can be used at the point of care, and validating the findings in all populations, including infants, the elderly, and across ethnic groups, he said.
“The work is ongoing, and we expect to have results available within the course of an outpatient visit in the near future,” Dr. Woods, also a professor of medicine and global health, added, noting that efforts also are underway to “expand the repertoire of this approach to many different types of viral and bacterial infections and also to fungal infections, and to address the challenges of critically ill patients in intensive care units.”
This study was supported by the U.S. Defense Advanced Research Projects Agency, the National Institutes of Health, the Agency for Healthcare Research and Quality, the U.S. Department of Veterans Affairs Office of Research and Development, and an in-kind contribution from bioMérieux. The authors reported having no relevant competing interests.
Pathogen-specific host gene expression patterns accurately discriminated most noninfectious from infectious illnesses, and bacterial from viral causes of acute respiratory infection (ARI) in an observational study conducted in acute care settings.
The findings could have important implications for combating inappropriate antibiotic use and emerging antibiotic resistance, Dr. Ephraim L. Tsalik of the department of medicine at Duke University, Durham, N.C., and his colleagues reported online Jan. 20 in Science Translational Medicine.
The investigators analyzed peripheral whole-blood gene expression from 273 subjects with community-onset viral ARI (115 subjects), bacterial ARI (70 subjects), or noninfectious illness (88 subjects) who were seen in an emergency department, and from 44 healthy control subjects. Classifiers for bacterial ARI, viral ARI, and noninfectious causes of illness were developed, and were 87% accurate overall (Sci Transl Med. 2016;8[322]:322ra11. doi/ 10.1126/scitranslmed.aad6873).
“Bacterial ARI was identified in 83% of patients and excluded in 94% without bacterial infection. Viral ARI was identified in 90% and excluded in 92% of cases. Using the noninfectious illness classifier, infection was excluded in 86% of cases,” they wrote.
The classifiers were more accurate than procalcitonin – a widely used biomarker with some specificity for bacterial infection (86% vs. 78% accuracy in 238 available samples), and three published classifiers of bacterial vs. viral infection, and were validated in five publicly available data sets, they noted.
The gene signature patterns identified in the course of this study mark an important step toward development of a rapid blood test that could be used in clinics to guide appropriate treatment for ARIs, the investigators said.
Precision treatment of viruses
More precise ways to distinguish infections could reduce unnecessary antibiotic use and lead to more precise treatment of viruses, senior author Dr. Geoffrey S. Ginsburg, director of Duke’s Center for Applied Genomics & Precision Medicine, said in a press statement.
“Right now, we can give patients [oseltamivir] Tamiflu to help them recover from an influenza infection, but for most viral infections, the treatment is fluids and rest until it resolves. In the next 5-10 years, we will likely see new antiviral medications for common bugs like respiratory syncytial virus and even rhinovirus, and guiding treatment choices will be even more important,” he added.
Senior author Dr. Christopher W. Woods, also of Duke University, further explained in an interview that the findings are particularly exciting because “there isn’t much out there that accomplishes what we’ve done. So just about any level of accuracy is an improvement.” Further, he said the test is “a tool to aid in diagnosis, used in conjunction with the patient’s symptoms, examination, and other testing. So an imperfect test is okay, because it does not stand alone.”
Next steps include putting the assay on a testing platform that can be used at the point of care, and validating the findings in all populations, including infants, the elderly, and across ethnic groups, he said.
“The work is ongoing, and we expect to have results available within the course of an outpatient visit in the near future,” Dr. Woods, also a professor of medicine and global health, added, noting that efforts also are underway to “expand the repertoire of this approach to many different types of viral and bacterial infections and also to fungal infections, and to address the challenges of critically ill patients in intensive care units.”
This study was supported by the U.S. Defense Advanced Research Projects Agency, the National Institutes of Health, the Agency for Healthcare Research and Quality, the U.S. Department of Veterans Affairs Office of Research and Development, and an in-kind contribution from bioMérieux. The authors reported having no relevant competing interests.
FROM SCIENCE TRANSLATIONAL MEDICINE
Key clinical point: Pathogen-specific host gene expression patterns accurately discriminated most noninfectious from infectious illnesses, and bacterial from viral causes of acute respiratory infection (ARI) in an observational study.
Major finding: Classifiers for bacterial ARI, viral ARI, and noninfectious causes of illness were 87% accurate overall.
Data source: An observational cohort study involving 273 patients and 44 controls.
Disclosures: This study was supported by the U.S. Defense Advanced Research Projects Agency, the National Institutes of Health, the Agency for Healthcare Research and Quality, the U.S. Department of Veterans Affairs Office of Research and Development, and an in-kind contribution from bioMérieux. The authors reported having no relevant competing interests..
New year brings reduced flu activity
Influenza-like illness (ILI) activity was down during the first full week in January – a not-so-unlucky week 13 of the 2015-2016 flu season, the Centers for Disease Control and Prevention reported.
South Carolina was at level 8, making it the only state in the “high” range of activity for the week ending Jan. 9. Puerto Rico was also at level 8, but there was no state in the “moderate” range and only seven states in the “low” range: Arizona and Maryland at level 5 and Connecticut, Illinois, Pennsylvania, Texas, and Virginia at level 4. There were 18 states at level 2 or higher, compared with 24 the previous week, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
The proportion of outpatient visits for ILI was 2% for week 13, which was down from 2.8% in week 12 and below the national baseline of 2.1%, the CDC said. ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.
One ILI-related pediatric death was reported during week 13, although it actually occurred in December. So far, there have been seven pediatric deaths reported during the 2015-2016 flu season, the CDC report noted.
Since Oct. 1, 2015, there have been 423 laboratory-confirmed influenza-associated hospitalizations reported in the 13 states – including California, New York, and Ohio – of the CDC’s Influenza Hospitalization Surveillance Network, for an overall hospitalization rate of 1.5 per 100,000 population. That rate, however, is “likely to be an underestimate as influenza-related hospitalizations can be missed, either because testing is not performed, or because cases may be attributed to other causes of pneumonia or other common influenza-related complications,” the CDC said.
Influenza-like illness (ILI) activity was down during the first full week in January – a not-so-unlucky week 13 of the 2015-2016 flu season, the Centers for Disease Control and Prevention reported.
South Carolina was at level 8, making it the only state in the “high” range of activity for the week ending Jan. 9. Puerto Rico was also at level 8, but there was no state in the “moderate” range and only seven states in the “low” range: Arizona and Maryland at level 5 and Connecticut, Illinois, Pennsylvania, Texas, and Virginia at level 4. There were 18 states at level 2 or higher, compared with 24 the previous week, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
The proportion of outpatient visits for ILI was 2% for week 13, which was down from 2.8% in week 12 and below the national baseline of 2.1%, the CDC said. ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.
One ILI-related pediatric death was reported during week 13, although it actually occurred in December. So far, there have been seven pediatric deaths reported during the 2015-2016 flu season, the CDC report noted.
Since Oct. 1, 2015, there have been 423 laboratory-confirmed influenza-associated hospitalizations reported in the 13 states – including California, New York, and Ohio – of the CDC’s Influenza Hospitalization Surveillance Network, for an overall hospitalization rate of 1.5 per 100,000 population. That rate, however, is “likely to be an underestimate as influenza-related hospitalizations can be missed, either because testing is not performed, or because cases may be attributed to other causes of pneumonia or other common influenza-related complications,” the CDC said.
Influenza-like illness (ILI) activity was down during the first full week in January – a not-so-unlucky week 13 of the 2015-2016 flu season, the Centers for Disease Control and Prevention reported.
South Carolina was at level 8, making it the only state in the “high” range of activity for the week ending Jan. 9. Puerto Rico was also at level 8, but there was no state in the “moderate” range and only seven states in the “low” range: Arizona and Maryland at level 5 and Connecticut, Illinois, Pennsylvania, Texas, and Virginia at level 4. There were 18 states at level 2 or higher, compared with 24 the previous week, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
The proportion of outpatient visits for ILI was 2% for week 13, which was down from 2.8% in week 12 and below the national baseline of 2.1%, the CDC said. ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.
One ILI-related pediatric death was reported during week 13, although it actually occurred in December. So far, there have been seven pediatric deaths reported during the 2015-2016 flu season, the CDC report noted.
Since Oct. 1, 2015, there have been 423 laboratory-confirmed influenza-associated hospitalizations reported in the 13 states – including California, New York, and Ohio – of the CDC’s Influenza Hospitalization Surveillance Network, for an overall hospitalization rate of 1.5 per 100,000 population. That rate, however, is “likely to be an underestimate as influenza-related hospitalizations can be missed, either because testing is not performed, or because cases may be attributed to other causes of pneumonia or other common influenza-related complications,” the CDC said.
Flu activity high in New Jersey, South Carolina
Week 12 of the 2015-2016 U.S. flu season saw two states in the “high” range of the influenza-like illness (ILI) activity scale, the Centers for Disease Control and Prevention reported.
New Jersey was at level 10 on the CDC’s 1-10 scale for the week ending Jan. 2, 2016, and South Carolina was at level 9. The next-most-active state, Texas, was at level 7, putting it in the “moderate” range along with Maryland, which was at level 6, the CDC said.
States in the “low” range were Arizona, Oklahoma, Pennsylvania, and Virginia at level 5 and California, Colorado, and Georgia at level 4. Altogether, there were 24 states at level 2 or higher, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
Puerto Rico also moved up to level 10 for the week ending Jan. 2 and, in a case of geographic concentration, New York City was at level 6 even though New York State was still at level 1.
The proportion of outpatient visits for ILI nationally was 2.8% at the end of week 12, which is above the national baseline of 2.1%. For comparison, at this point in the 2014-2015 flu season, the proportion of visits for ILI was about 6%, and in 2013-2014 it was around 4.5%.
There were two flu-related pediatric deaths reported during the week, bringing the total to six for the 2015-2016 season. One death was associated with an influenza A (H3) virus and the other was associated with
an influenza A (H1N1)pdm09 virus. Looking again at previous years, there had been single weeks with at least six pediatric deaths by week 12 in each of the last three seasons, the CDC report showed.
Week 12 of the 2015-2016 U.S. flu season saw two states in the “high” range of the influenza-like illness (ILI) activity scale, the Centers for Disease Control and Prevention reported.
New Jersey was at level 10 on the CDC’s 1-10 scale for the week ending Jan. 2, 2016, and South Carolina was at level 9. The next-most-active state, Texas, was at level 7, putting it in the “moderate” range along with Maryland, which was at level 6, the CDC said.
States in the “low” range were Arizona, Oklahoma, Pennsylvania, and Virginia at level 5 and California, Colorado, and Georgia at level 4. Altogether, there were 24 states at level 2 or higher, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
Puerto Rico also moved up to level 10 for the week ending Jan. 2 and, in a case of geographic concentration, New York City was at level 6 even though New York State was still at level 1.
The proportion of outpatient visits for ILI nationally was 2.8% at the end of week 12, which is above the national baseline of 2.1%. For comparison, at this point in the 2014-2015 flu season, the proportion of visits for ILI was about 6%, and in 2013-2014 it was around 4.5%.
There were two flu-related pediatric deaths reported during the week, bringing the total to six for the 2015-2016 season. One death was associated with an influenza A (H3) virus and the other was associated with
an influenza A (H1N1)pdm09 virus. Looking again at previous years, there had been single weeks with at least six pediatric deaths by week 12 in each of the last three seasons, the CDC report showed.
Week 12 of the 2015-2016 U.S. flu season saw two states in the “high” range of the influenza-like illness (ILI) activity scale, the Centers for Disease Control and Prevention reported.
New Jersey was at level 10 on the CDC’s 1-10 scale for the week ending Jan. 2, 2016, and South Carolina was at level 9. The next-most-active state, Texas, was at level 7, putting it in the “moderate” range along with Maryland, which was at level 6, the CDC said.
States in the “low” range were Arizona, Oklahoma, Pennsylvania, and Virginia at level 5 and California, Colorado, and Georgia at level 4. Altogether, there were 24 states at level 2 or higher, according to data from the CDC’s Outpatient Influenza-like Illness Surveillance Network.
Puerto Rico also moved up to level 10 for the week ending Jan. 2 and, in a case of geographic concentration, New York City was at level 6 even though New York State was still at level 1.
The proportion of outpatient visits for ILI nationally was 2.8% at the end of week 12, which is above the national baseline of 2.1%. For comparison, at this point in the 2014-2015 flu season, the proportion of visits for ILI was about 6%, and in 2013-2014 it was around 4.5%.
There were two flu-related pediatric deaths reported during the week, bringing the total to six for the 2015-2016 season. One death was associated with an influenza A (H3) virus and the other was associated with
an influenza A (H1N1)pdm09 virus. Looking again at previous years, there had been single weeks with at least six pediatric deaths by week 12 in each of the last three seasons, the CDC report showed.
Infectious disease in elderly a significant burden for EDs
More U.S. adults over the age of 65 visited an emergency department because of an infectious disease than for myocardial infarction and congestive heart failure combined, according to a new study.
Based on a nationwide ED sample, adults over 65 visited the ED just over 3.1 million times in 2012 due to infectious diseases (ID), more than three times the estimated amount for myocardial infarction and congestive heart failure. The most common diagnoses were lower respiratory infections (26.2%), urinary tract infections (25.3%), and septicemia (18.9%).
Of the 3.1 million cases brought to the ED, nearly 1.8 million cases were hospitalized, with septicemia the most common cause for hospitalization, accounting for 32.2% of ID-related hospitalizations, followed by lower respiratory infections. Septicemia was also the most common cause of mortality, accounting for 74.7% of the nearly 124,000 deaths.
“These observations underscore the importance of integrated strategies aimed at reducing ID-related morbidity and health care use of elderly adults as a national priority for research, health policy, and community action,” Dr. Tadahiro Goto of the University of Fukui (Japan) Hospital and his associates concluded.
Find the full study in the Journal of the American Geriatrics Society (2015 Dec 23. doi: 101111/jgs.13836).
More U.S. adults over the age of 65 visited an emergency department because of an infectious disease than for myocardial infarction and congestive heart failure combined, according to a new study.
Based on a nationwide ED sample, adults over 65 visited the ED just over 3.1 million times in 2012 due to infectious diseases (ID), more than three times the estimated amount for myocardial infarction and congestive heart failure. The most common diagnoses were lower respiratory infections (26.2%), urinary tract infections (25.3%), and septicemia (18.9%).
Of the 3.1 million cases brought to the ED, nearly 1.8 million cases were hospitalized, with septicemia the most common cause for hospitalization, accounting for 32.2% of ID-related hospitalizations, followed by lower respiratory infections. Septicemia was also the most common cause of mortality, accounting for 74.7% of the nearly 124,000 deaths.
“These observations underscore the importance of integrated strategies aimed at reducing ID-related morbidity and health care use of elderly adults as a national priority for research, health policy, and community action,” Dr. Tadahiro Goto of the University of Fukui (Japan) Hospital and his associates concluded.
Find the full study in the Journal of the American Geriatrics Society (2015 Dec 23. doi: 101111/jgs.13836).
More U.S. adults over the age of 65 visited an emergency department because of an infectious disease than for myocardial infarction and congestive heart failure combined, according to a new study.
Based on a nationwide ED sample, adults over 65 visited the ED just over 3.1 million times in 2012 due to infectious diseases (ID), more than three times the estimated amount for myocardial infarction and congestive heart failure. The most common diagnoses were lower respiratory infections (26.2%), urinary tract infections (25.3%), and septicemia (18.9%).
Of the 3.1 million cases brought to the ED, nearly 1.8 million cases were hospitalized, with septicemia the most common cause for hospitalization, accounting for 32.2% of ID-related hospitalizations, followed by lower respiratory infections. Septicemia was also the most common cause of mortality, accounting for 74.7% of the nearly 124,000 deaths.
“These observations underscore the importance of integrated strategies aimed at reducing ID-related morbidity and health care use of elderly adults as a national priority for research, health policy, and community action,” Dr. Tadahiro Goto of the University of Fukui (Japan) Hospital and his associates concluded.
Find the full study in the Journal of the American Geriatrics Society (2015 Dec 23. doi: 101111/jgs.13836).
FROM JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
LAIV, IIV almost equally effective against influenza
When vaccinating children against influenza, inactivated and live attenuated influenza vaccines show little significant difference in effectiveness against nearly all strains of the virus, according to a new study in Pediatrics.
However, the study – which examined the effectiveness of IIV and LAIV across four consecutive influenza seasons between 2010 and 2014 – cautions that the 2013-2014 season’s A/(H1N1)pdm09 showed an uncharacteristically large gap in effectiveness favoring IIV, a discrepancy likely due to a problem with a vaccine component in LAIV. (Pediatrics. 2016;137(2):e20153279)
“We found that lower LAIV effectiveness in 2013-2014 was specific to the A/(H1N1)pdm09 vaccine component and was consistent with a previously unexamined effect during the 2010-2011 influenza season,” Jessie R. Chung of the influenza division at the Centers for Disease Control and Prevention and associates wrote, adding that the impetus for the study was the lack of available data “from observational studies after the 2009 pandemic on relative effectiveness of LAIV and IIV in children and adolescents.”
Ms. Chung* and coinvestigators enrolled children aged 2-17 years from clinics and hospitals in Michigan, New York, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin during the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 influenza seasons. Children brought in with symptoms of acute respiratory illness – cough, fever, or feverishness – had nasal and throat swabs collected to test for presence and type of influenza.
In total, 7,718 subjects were evaluated across the four influenza seasons, but after excluding subjects for various reasons – unknown vaccine type, indeterminate vaccine status, and inconclusive reverse transcription polymerase chain reaction results, among others – 6,819 subjects were included for vaccine effectiveness analysis, of which 2,703 were ultimately matched age appropriately and placed into IIV and LAIV cohorts for comparison. The IIV cohort consisted of 2,066 individuals (76.4%), while the LAIV cohort had 637 (23.6%).
During the 2010-2011 season, 66 of the 477 IIV subjects contracted influenza, versus 21 of 116 who received LAIV (14% vs. 18%, respectively). In the 2011-2012 season, 51 of the 499 IIV subjects (10%) contracted influenza, compared with 12 of the 152 LAIV subjects (8%). In the 2012-2013 season, 198 of the 622 IIV subjects (32%) contracted influenza, versus 61 of the 205 LAIV subjects (30%). But, in the 2013-2014 season, 36 of the 468 IIV subjects (8%) contracted influenza, versus 34 of the 164 LAIV subjects (21%).
After adjustment for age and season, the odds ratio for the 2013-2014 season was significantly higher than those of the other seasons across the entire age spectrum of 2-17 years: 2.88, compared with 1.49 (2010-2011), 0.67 (2011-2012), and 0.92 (2012-2013).
When comparing influenza type/subtype, adjusted odds ratio was 5.53 for those with A/(H1N1)pdm09 in the 2010-2011 season, compared with 2.65 for those with the same in the 2013-2014 season. Those with A/H3N2 did not show as significant a difference across seasons (2010-2013), nor did those with influenza type B (2010-2011, 2012-2013).
“We found no statistically significant difference in LAIV effectiveness compared with IIV against medically attended, laboratory-confirmed influenza illness due to A/H3N2 or B viruses,” Ms. Chung and colleagues concluded. “We found significantly higher odds of influenza A/(H1N1)pdm09 among participants vaccinated with LAIV, compared with IIV, [but] reasons for lower effectiveness of LAIV against the A/(H1N1)pdm09 virus, compared with IIV are not fully understood.”
The investigators added that “the finding appears to be specific to the A/(H1N1)pdm09 vaccine component; we did not detect any statistically significant differences in effectiveness for the other components.” Three previous randomized controlled trials indicated that trivalent LAIV was just as effective, if not more so, than IIV, making the findings of this study surprising and “unexpected,” the authors noted.
This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Ms. Chung and associates reported no relevant financial disclosures.
*A previous version of this story misstated Jessie Chung’s academic title. Ms. Chung holds a Master’s in public health.
Influenza vaccination has been recommended for everyone for the past few years. Acceptance of this recommendation has been variable, and vaccine failures do not help the cause of convincing our patients to accept vaccination. In the paper by Chung et al. from the CDC and other coinvestigators who are prominent in influenza research, we learn that the live attenuated intranasally administered flu vaccine was significantly inferior to the killed injection administered flu vaccine for one of the type A flu strains. As a consequence, more kids vaccinated with the live attenuated vaccine got the flu. So parents who claim “the flu shot does not work” were partially correct more often since the 2009 flu season, if their child got the intranasal flu vaccine. However, neither the intranasal nor the injectable flu vaccine have an exceptionally high efficacy because the calculations by the authors for the study described and by citation of prior studies we are reminded that vaccine efficacy varies by strain and yearly by the season between 45% and 71%. We need to have better flu vaccines.
 |
Dr. Michael E. Pichichero |
At Legacy Pediatrics, where I am in part-time private practice, we have seen increasing requests for the intranasal flu vaccine each year because parents and kids who can voice their wishes don’t want the shot. Our nurses like it, too, because the crying, wailing, and fighting to hold the kid down is avoided. There had been some reports before 2009 that the intranasal flu vaccine was more effective than the shot. But those of us who have been around long enough practicing medicine have learned about the pendulum of data and opinion sometimes swings back and forth. The article by Chung et al. reminds us once again of this reality.
Dr. Michael E. Pichichero is at the University of Rochester (N.Y.) Medical Center. He has received investigator-initiated grants from Sanofi Pasteur to study novel pneumococcal protein vaccines over the past 3 years and currently but has received no funding from Sanofi regarding injectable influenza vaccine. He also has conducted research with study coauthor Dr. John J. Treanor that was supported by MedImmune, who makes the intranasal flu vaccine.
Influenza vaccination has been recommended for everyone for the past few years. Acceptance of this recommendation has been variable, and vaccine failures do not help the cause of convincing our patients to accept vaccination. In the paper by Chung et al. from the CDC and other coinvestigators who are prominent in influenza research, we learn that the live attenuated intranasally administered flu vaccine was significantly inferior to the killed injection administered flu vaccine for one of the type A flu strains. As a consequence, more kids vaccinated with the live attenuated vaccine got the flu. So parents who claim “the flu shot does not work” were partially correct more often since the 2009 flu season, if their child got the intranasal flu vaccine. However, neither the intranasal nor the injectable flu vaccine have an exceptionally high efficacy because the calculations by the authors for the study described and by citation of prior studies we are reminded that vaccine efficacy varies by strain and yearly by the season between 45% and 71%. We need to have better flu vaccines.
|
Dr. Michael E. Pichichero |
At Legacy Pediatrics, where I am in part-time private practice, we have seen increasing requests for the intranasal flu vaccine each year because parents and kids who can voice their wishes don’t want the shot. Our nurses like it, too, because the crying, wailing, and fighting to hold the kid down is avoided. There had been some reports before 2009 that the intranasal flu vaccine was more effective than the shot. But those of us who have been around long enough practicing medicine have learned about the pendulum of data and opinion sometimes swings back and forth. The article by Chung et al. reminds us once again of this reality.
Dr. Michael E. Pichichero is at the University of Rochester (N.Y.) Medical Center. He has received investigator-initiated grants from Sanofi Pasteur to study novel pneumococcal protein vaccines over the past 3 years and currently but has received no funding from Sanofi regarding injectable influenza vaccine. He also has conducted research with study coauthor Dr. John J. Treanor that was supported by MedImmune, who makes the intranasal flu vaccine.
Influenza vaccination has been recommended for everyone for the past few years. Acceptance of this recommendation has been variable, and vaccine failures do not help the cause of convincing our patients to accept vaccination. In the paper by Chung et al. from the CDC and other coinvestigators who are prominent in influenza research, we learn that the live attenuated intranasally administered flu vaccine was significantly inferior to the killed injection administered flu vaccine for one of the type A flu strains. As a consequence, more kids vaccinated with the live attenuated vaccine got the flu. So parents who claim “the flu shot does not work” were partially correct more often since the 2009 flu season, if their child got the intranasal flu vaccine. However, neither the intranasal nor the injectable flu vaccine have an exceptionally high efficacy because the calculations by the authors for the study described and by citation of prior studies we are reminded that vaccine efficacy varies by strain and yearly by the season between 45% and 71%. We need to have better flu vaccines.
|
Dr. Michael E. Pichichero |
At Legacy Pediatrics, where I am in part-time private practice, we have seen increasing requests for the intranasal flu vaccine each year because parents and kids who can voice their wishes don’t want the shot. Our nurses like it, too, because the crying, wailing, and fighting to hold the kid down is avoided. There had been some reports before 2009 that the intranasal flu vaccine was more effective than the shot. But those of us who have been around long enough practicing medicine have learned about the pendulum of data and opinion sometimes swings back and forth. The article by Chung et al. reminds us once again of this reality.
Dr. Michael E. Pichichero is at the University of Rochester (N.Y.) Medical Center. He has received investigator-initiated grants from Sanofi Pasteur to study novel pneumococcal protein vaccines over the past 3 years and currently but has received no funding from Sanofi regarding injectable influenza vaccine. He also has conducted research with study coauthor Dr. John J. Treanor that was supported by MedImmune, who makes the intranasal flu vaccine.
When vaccinating children against influenza, inactivated and live attenuated influenza vaccines show little significant difference in effectiveness against nearly all strains of the virus, according to a new study in Pediatrics.
However, the study – which examined the effectiveness of IIV and LAIV across four consecutive influenza seasons between 2010 and 2014 – cautions that the 2013-2014 season’s A/(H1N1)pdm09 showed an uncharacteristically large gap in effectiveness favoring IIV, a discrepancy likely due to a problem with a vaccine component in LAIV. (Pediatrics. 2016;137(2):e20153279)
“We found that lower LAIV effectiveness in 2013-2014 was specific to the A/(H1N1)pdm09 vaccine component and was consistent with a previously unexamined effect during the 2010-2011 influenza season,” Jessie R. Chung of the influenza division at the Centers for Disease Control and Prevention and associates wrote, adding that the impetus for the study was the lack of available data “from observational studies after the 2009 pandemic on relative effectiveness of LAIV and IIV in children and adolescents.”
Ms. Chung* and coinvestigators enrolled children aged 2-17 years from clinics and hospitals in Michigan, New York, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin during the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 influenza seasons. Children brought in with symptoms of acute respiratory illness – cough, fever, or feverishness – had nasal and throat swabs collected to test for presence and type of influenza.
In total, 7,718 subjects were evaluated across the four influenza seasons, but after excluding subjects for various reasons – unknown vaccine type, indeterminate vaccine status, and inconclusive reverse transcription polymerase chain reaction results, among others – 6,819 subjects were included for vaccine effectiveness analysis, of which 2,703 were ultimately matched age appropriately and placed into IIV and LAIV cohorts for comparison. The IIV cohort consisted of 2,066 individuals (76.4%), while the LAIV cohort had 637 (23.6%).
During the 2010-2011 season, 66 of the 477 IIV subjects contracted influenza, versus 21 of 116 who received LAIV (14% vs. 18%, respectively). In the 2011-2012 season, 51 of the 499 IIV subjects (10%) contracted influenza, compared with 12 of the 152 LAIV subjects (8%). In the 2012-2013 season, 198 of the 622 IIV subjects (32%) contracted influenza, versus 61 of the 205 LAIV subjects (30%). But, in the 2013-2014 season, 36 of the 468 IIV subjects (8%) contracted influenza, versus 34 of the 164 LAIV subjects (21%).
After adjustment for age and season, the odds ratio for the 2013-2014 season was significantly higher than those of the other seasons across the entire age spectrum of 2-17 years: 2.88, compared with 1.49 (2010-2011), 0.67 (2011-2012), and 0.92 (2012-2013).
When comparing influenza type/subtype, adjusted odds ratio was 5.53 for those with A/(H1N1)pdm09 in the 2010-2011 season, compared with 2.65 for those with the same in the 2013-2014 season. Those with A/H3N2 did not show as significant a difference across seasons (2010-2013), nor did those with influenza type B (2010-2011, 2012-2013).
“We found no statistically significant difference in LAIV effectiveness compared with IIV against medically attended, laboratory-confirmed influenza illness due to A/H3N2 or B viruses,” Ms. Chung and colleagues concluded. “We found significantly higher odds of influenza A/(H1N1)pdm09 among participants vaccinated with LAIV, compared with IIV, [but] reasons for lower effectiveness of LAIV against the A/(H1N1)pdm09 virus, compared with IIV are not fully understood.”
The investigators added that “the finding appears to be specific to the A/(H1N1)pdm09 vaccine component; we did not detect any statistically significant differences in effectiveness for the other components.” Three previous randomized controlled trials indicated that trivalent LAIV was just as effective, if not more so, than IIV, making the findings of this study surprising and “unexpected,” the authors noted.
This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Ms. Chung and associates reported no relevant financial disclosures.
*A previous version of this story misstated Jessie Chung’s academic title. Ms. Chung holds a Master’s in public health.
When vaccinating children against influenza, inactivated and live attenuated influenza vaccines show little significant difference in effectiveness against nearly all strains of the virus, according to a new study in Pediatrics.
However, the study – which examined the effectiveness of IIV and LAIV across four consecutive influenza seasons between 2010 and 2014 – cautions that the 2013-2014 season’s A/(H1N1)pdm09 showed an uncharacteristically large gap in effectiveness favoring IIV, a discrepancy likely due to a problem with a vaccine component in LAIV. (Pediatrics. 2016;137(2):e20153279)
“We found that lower LAIV effectiveness in 2013-2014 was specific to the A/(H1N1)pdm09 vaccine component and was consistent with a previously unexamined effect during the 2010-2011 influenza season,” Jessie R. Chung of the influenza division at the Centers for Disease Control and Prevention and associates wrote, adding that the impetus for the study was the lack of available data “from observational studies after the 2009 pandemic on relative effectiveness of LAIV and IIV in children and adolescents.”
Ms. Chung* and coinvestigators enrolled children aged 2-17 years from clinics and hospitals in Michigan, New York, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin during the 2010-2011, 2011-2012, 2012-2013, and 2013-2014 influenza seasons. Children brought in with symptoms of acute respiratory illness – cough, fever, or feverishness – had nasal and throat swabs collected to test for presence and type of influenza.
In total, 7,718 subjects were evaluated across the four influenza seasons, but after excluding subjects for various reasons – unknown vaccine type, indeterminate vaccine status, and inconclusive reverse transcription polymerase chain reaction results, among others – 6,819 subjects were included for vaccine effectiveness analysis, of which 2,703 were ultimately matched age appropriately and placed into IIV and LAIV cohorts for comparison. The IIV cohort consisted of 2,066 individuals (76.4%), while the LAIV cohort had 637 (23.6%).
During the 2010-2011 season, 66 of the 477 IIV subjects contracted influenza, versus 21 of 116 who received LAIV (14% vs. 18%, respectively). In the 2011-2012 season, 51 of the 499 IIV subjects (10%) contracted influenza, compared with 12 of the 152 LAIV subjects (8%). In the 2012-2013 season, 198 of the 622 IIV subjects (32%) contracted influenza, versus 61 of the 205 LAIV subjects (30%). But, in the 2013-2014 season, 36 of the 468 IIV subjects (8%) contracted influenza, versus 34 of the 164 LAIV subjects (21%).
After adjustment for age and season, the odds ratio for the 2013-2014 season was significantly higher than those of the other seasons across the entire age spectrum of 2-17 years: 2.88, compared with 1.49 (2010-2011), 0.67 (2011-2012), and 0.92 (2012-2013).
When comparing influenza type/subtype, adjusted odds ratio was 5.53 for those with A/(H1N1)pdm09 in the 2010-2011 season, compared with 2.65 for those with the same in the 2013-2014 season. Those with A/H3N2 did not show as significant a difference across seasons (2010-2013), nor did those with influenza type B (2010-2011, 2012-2013).
“We found no statistically significant difference in LAIV effectiveness compared with IIV against medically attended, laboratory-confirmed influenza illness due to A/H3N2 or B viruses,” Ms. Chung and colleagues concluded. “We found significantly higher odds of influenza A/(H1N1)pdm09 among participants vaccinated with LAIV, compared with IIV, [but] reasons for lower effectiveness of LAIV against the A/(H1N1)pdm09 virus, compared with IIV are not fully understood.”
The investigators added that “the finding appears to be specific to the A/(H1N1)pdm09 vaccine component; we did not detect any statistically significant differences in effectiveness for the other components.” Three previous randomized controlled trials indicated that trivalent LAIV was just as effective, if not more so, than IIV, making the findings of this study surprising and “unexpected,” the authors noted.
This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Ms. Chung and associates reported no relevant financial disclosures.
*A previous version of this story misstated Jessie Chung’s academic title. Ms. Chung holds a Master’s in public health.
FROM PEDIATRICS
Key clinical point: Inactivated influenza vaccine was significantly more effective against at least one strain of influenza than live attenuated influenza vaccine in 2013-2014.
Major finding: While no significant differences were seen in influenza rates between the IIV and LAIV cohorts for three consecutive seasons (2010-2013), the A/(H1N1)pdm09 strain of 2013-2014 affected subjects with LAIV at a significantly higher rate than did those with IIV.
Data source: Prospective cohort study of 2,703 children aged 2-17 years vaccinated between 2010 and 2014 with either IIV or LAIV.
Disclosures: This study was supported by the CDC through cooperative agreements with a variety of universities and foundations, and funded by the National Institutes of Health. Dr. Chung and his associates reported no relevant financial disclosures.
U.S. influenza cases rise above baseline level
For the first time this flu season, the proportion of outpatient visits for influenza-like illness (ILI) was higher than the national baseline level of 2.1%, the Centers for Disease Control and Prevention reported.
According to data from the U.S. Outpatient Influenza-like Illness Surveillance Network, for the week ending Dec. 19 (week 10 of the 2015-2016 season), 2.2% of outpatient visits nationwide involved ILI, the CDC said.
South Carolina remained the only state in the “high” range of activity. New Jersey went up to level 7 – the high end of the “moderate” range – to remain the second most affected state, and Texas jumped from level 2 last week to level 6 this week to move into “moderate” territory. Alabama and Georgia both moved up to “low” status for the first time with ILI activity at level 5, and Virginia stayed at level 4 – the only other state in the “low” range, according to the CDC.
A total of 17 states were at level 2 or higher during week 10, up from 15 states the week before. Arizona, Illinois, Louisiana, Mississippi, and Pennsylvania were at level 3, and Colorado, Hawaii, Minnesota, New Mexico, and Utah were at level 2, data from the Outpatient Influenza-like Illness Surveillance Network revealed.
One influenza-related pediatric death was reported during week 10, bringing the total for the season to four.
For the first time this flu season, the proportion of outpatient visits for influenza-like illness (ILI) was higher than the national baseline level of 2.1%, the Centers for Disease Control and Prevention reported.
According to data from the U.S. Outpatient Influenza-like Illness Surveillance Network, for the week ending Dec. 19 (week 10 of the 2015-2016 season), 2.2% of outpatient visits nationwide involved ILI, the CDC said.
South Carolina remained the only state in the “high” range of activity. New Jersey went up to level 7 – the high end of the “moderate” range – to remain the second most affected state, and Texas jumped from level 2 last week to level 6 this week to move into “moderate” territory. Alabama and Georgia both moved up to “low” status for the first time with ILI activity at level 5, and Virginia stayed at level 4 – the only other state in the “low” range, according to the CDC.
A total of 17 states were at level 2 or higher during week 10, up from 15 states the week before. Arizona, Illinois, Louisiana, Mississippi, and Pennsylvania were at level 3, and Colorado, Hawaii, Minnesota, New Mexico, and Utah were at level 2, data from the Outpatient Influenza-like Illness Surveillance Network revealed.
One influenza-related pediatric death was reported during week 10, bringing the total for the season to four.
For the first time this flu season, the proportion of outpatient visits for influenza-like illness (ILI) was higher than the national baseline level of 2.1%, the Centers for Disease Control and Prevention reported.
According to data from the U.S. Outpatient Influenza-like Illness Surveillance Network, for the week ending Dec. 19 (week 10 of the 2015-2016 season), 2.2% of outpatient visits nationwide involved ILI, the CDC said.
South Carolina remained the only state in the “high” range of activity. New Jersey went up to level 7 – the high end of the “moderate” range – to remain the second most affected state, and Texas jumped from level 2 last week to level 6 this week to move into “moderate” territory. Alabama and Georgia both moved up to “low” status for the first time with ILI activity at level 5, and Virginia stayed at level 4 – the only other state in the “low” range, according to the CDC.
A total of 17 states were at level 2 or higher during week 10, up from 15 states the week before. Arizona, Illinois, Louisiana, Mississippi, and Pennsylvania were at level 3, and Colorado, Hawaii, Minnesota, New Mexico, and Utah were at level 2, data from the Outpatient Influenza-like Illness Surveillance Network revealed.
One influenza-related pediatric death was reported during week 10, bringing the total for the season to four.
