Posts filed under ‘Influenza’

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America.

Am J Respir Crit Care Med. October 1, 2019  V.200 N.7  e45-e67.

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al.

Background

This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.

Methods

A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.

Results

The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.

Conclusions

The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

 

Este documento proporciona pautas de práctica clínica basadas en evidencia sobre el manejo de pacientes adultos con NAC.

Métodos

Un panel multidisciplinario realizó revisiones sistemáticas pragmáticas de la investigación relevante y aplicó la metodología de calificación de recomendaciones, evaluación, desarrollo y evaluación para recomendaciones clínicas.

Resultados

El panel abordó 16 áreas específicas para recomendaciones que abarcan preguntas sobre pruebas de diagnóstico, determinación del sitio de atención, selección de terapia ATB empírica inicial y decisiones de manejo posteriores. Aunque algunas recomendaciones permanecen sin cambios con respecto a la guía de 2007, la disponibilidad de resultados de nuevos ensayos terapéuticos e investigaciones epidemiológicas condujo a recomendaciones revisadas para estrategias de tratamiento empírico y decisiones de manejo adicionales.

Conclusiones

El panel formuló y proporcionó la justificación de las recomendaciones sobre estrategias seleccionadas de diagnóstico y tratamiento para pacientes adultos con NAC.

FULL TEXT

https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST#_i6

PDF

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST

November 15, 2019 at 7:59 am

Diagnosis and Treatment of Adults with Community-acquired Pneumonia

Am J Respir Crit Care Med October 1, 2019 V.200 N.7 P.e45–e67

An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

FULL TEXT

https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST

PDF

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST

November 10, 2019 at 11:36 am

Age-associated changes in the impact of sex steroids on influenza vaccine responses in males and females 

npj Vaccines 2019 V.4 N.29

            

Vaccine-induced immunity declines with age, which may differ between males and females. Using human sera collected before and 21 days after receipt of the monovalent A/Cal/09 H1N1 vaccine, we evaluated cytokine and antibody responses in adult (18–45 years) and aged (65+ years) individuals. After vaccination, adult females developed greater IL-6 and antibody responses than either adult males or aged females, with female antibody responses being positively associated with concentrations of estradiol. To test whether protection against influenza virus challenge was greater in females than males, we primed and boosted adult (8–10 weeks) and aged (68–70 weeks) male and female mice with an inactivated A/Cal/09 H1N1 vaccine or no vaccine and challenged with a drift variant A/Cal/09 virus. As compared with unvaccinated mice, vaccinated adult, but not aged, mice experienced less morbidity and better pulmonary viral clearance following challenge, regardless of sex. Vaccinated adult female mice developed antibody responses that were of greater quantity and quality and more protective than vaccinated adult males. Sex differences in vaccine efficacy diminished with age in mice. To determine the role of sex steroids in vaccine-induced immune responses, adult mice were gonadectomized and hormones (estradiol in females and testosterone in males) were replaced in subsets of animals before vaccination. Vaccine-induced antibody responses were increased in females by estradiol and decreased in males by testosterone. The benefit of elevated estradiol on antibody responses and protection against influenza in females is diminished with age in both mice and humans.

FULL TEXT

https://www.nature.com/articles/s41541-019-0124-6

August 30, 2019 at 7:49 am

Efficacy and accuracy of qSOFA and SOFA scores as prognostic tools for community-acquired and healthcare-associated pneumonia

International Journal of Infectious Diseases July 2019 V.84 P.89-96

Nobuhiro Asai, Hiroki Watanabe, Arufumi Shiota, Hideo Kato, Daisuke Sakanashi, Mao Hagihara, Yusuke Koizumi, Yuka Yamagishi, Hiroyuki Suematsu, Hiroshige Mikamo

Highlights

  • The Japanese Respiratory Society recently updated the prognostic guidelines for pneumonia in 2017.
  • The new guidelines recommend that pneumonia severity be evaluated using the sequential organ failure assessment (SOFA) and the quick SOFA (qSOFA) scoring systems in a therapeutic strategy flowchart.
  • The combination of qSOFA and SOFA score could be an independent prognostic factor for 30-day mortality among patients with community-onset pneumonia.

Background

The Japanese Respiratory Society recently updated its prognostic guidelines for pneumonia, recommending that pneumonia severity be evaluated using the sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) scoring systems in a therapeutic strategy flowchart. However, the efficacy and accuracy of these tools are still unknown.

Methods

All patients with community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) who were admitted to the study institution between 2014 and 2017 were enrolled in this study. Pneumonia severity on admission was evaluated by A-DROP, CURB-65, PSI, I-ROAD, qSOFA, and SOFA scoring systems. Prognostic factors for 30-day mortality were also analyzed.

Results

This study included 406 patients, 257 male (63%) and 149 female (37%). The median age was 79 years (range 19–103 years). The 30-day and in-hospital mortality rates were both 5%. With respect to the diagnostic value of the predictive assessments for 30-day mortality, the area under the receiver operating characteristic curve (AUROC) value for the SOFA score was 0.769 for CAP patients and 0.774 for HCAP patients. Further, the AUROC values for the SOFA score in CAP and HCAP patients with a qSOFA score ≥2 were 0.829 and 0.784, respectively, for 30-day mortality.

Conclusions

qSOFA and SOFA scores were able to correctly evaluate the severity of CAP and HCAP.

FULL TEXT

https://www.ijidonline.com/article/S1201-9712(19)30190-0/fulltext

PDF

https://www.ijidonline.com/article/S1201-9712(19)30190-0/pdf

June 30, 2019 at 9:25 pm

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.

Clinical Infectious Diseases March 5, 2019 V.68 N.6 P.e1-e47.   

Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.

Uyeki TM1, Bernstein HH2, Bradley JS3,4, Englund JA5, File TM6, Fry AM1, Gravenstein S7, Hayden FG8, Harper SA9, Hirshon JM10, Ison MG11, Johnston BL12, Knight SL13, McGeer A14, Riley LE15, Wolfe CR16, Alexander PE17,18, Pavia AT19.

Abstract

These clinical practice guidelines are an update of the guidelines published by the Infectious Diseases Society of America (IDSA) in 2009, prior to the 2009 H1N1 influenza pandemic. This document addresses new information regarding diagnostic testing, treatment and chemoprophylaxis with antiviral medications, and issues related to institutional outbreak management for seasonal influenza. It is intended for use by primary care clinicians, obstetricians, emergency medicine providers, hospitalists, laboratorians, and infectious disease specialists, as well as other clinicians managing patients with suspected or laboratory-confirmed influenza. The guidelines consider the care of children and adults, including special populations such as pregnant and postpartum women and immunocompromised patients.

Published by Oxford University Press for the Infectious Diseases Society of America 2018.

FULL TEXT

https://academic.oup.com/cid/article/68/6/e1/5251935

PDF (CLIC en PDF)

May 1, 2019 at 6:23 pm

Cost-effectiveness analysis of quadrivalent seasonal influenza vaccines in England.

BMC Med. September 8, 2017 V.15 N.1 P.166.

Thorrington D1, van Leeuwen E2,3, Ramsay M4, Pebody R2, Baguelin M2,5.

Author information

1 Respiratory Diseases Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK. dominic.thorrington@phe.gov.uk

2 Respiratory Diseases Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.

3 Imperial College Faculty of Medicine, London, SW7 2AZ, UK.

4 Immunisation, Hepatitis & Blood Safety Department, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.

5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.

Abstract

BACKGROUND:

As part of the national seasonal influenza vaccination programme in England and Wales, children receive a quadrivalent vaccine offering protection against two influenza A strains and two influenza B strains. Healthy children receive a quadrivalent live attenuated influenza vaccine (QLAIV), whilst children with contraindications receive the quadrivalent inactivated influenza vaccine (QIIV). Individuals aged younger than 65 years in the clinical risk populations and elderly individuals aged 65+ years receive either a trivalent inactivated influenza vaccine (TIIV) offering protection from two A strains and one B strain or the QIIV at the choice of their general practitioner. The cost-effectiveness of quadrivalent vaccine programmes is an open question. The original analysis that supported the paediatric programme only considered a trivalent live attenuated vaccine (LAIV). The cost-effectiveness of the QIIV to other patients has not been established. We sought to estimate the cost-effectiveness of these programmes, establishing a maximum incremental total cost per dose of quadrivalent vaccines over trivalent vaccines.

METHODS:

We used the same mathematical model as the analysis that recommended the introduction of the paediatric influenza vaccination programme. The incremental cost of the quadrivalent vaccine is the additional cost over that of the existing trivalent vaccine currently in use.

RESULTS:

Introducing quadrivalent vaccines can be cost-effective for all targeted groups. However, the cost-effectiveness of the programme is dependent on the choice of target cohort and the cost of the vaccines: the paediatric programme is cost-effective with an increased cost of £6.36 per dose, though an extension to clinical risk individuals younger than 65 years old and further to all elderly individuals means the maximum incremental cost is £1.84 and £0.20 per dose respectively.

CONCLUSIONS:

Quadrivalent influenza vaccines will bring substantial health benefits, as they are cost-effective in particular target groups.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590113/pdf/12916_2017_Article_932.pdf

April 13, 2019 at 12:58 pm

A review of the value of quadrivalent influenza vaccines and their potential contribution to influenza control.

Hum Vaccin Immunother. July 3, 2017 V.13 N.7 P.1640-1652.

Ray R1, Dos Santos G2, Buck PO3, Claeys C1, Matias G1, Innis BL3, Bekkat-Berkani R1.

Author information

1 a GSK , Wavre , Belgium.

2 b Business & Decision Life Sciences , Brussels , Belgium (on behalf of GSK).

3 c GSK , Philadelphia , PA , USA.

Abstract

The contribution of influenza B to the seasonal influenza burden varies from year-to-year. Although 2 antigenically distinct influenza B virus lineages have co-circulated since 2001, trivalent influenza vaccines (TIVs) contain antigens from only one influenza B virus. B-mismatch or co-circulation of both B lineages results in increased morbidity and mortality attributable to the B lineage absent from the vaccine. Quadrivalent vaccines (QIVs) contain both influenza B lineages. We reviewed currently licensed QIVs and their value by focusing on the preventable disease burden. Modeling studies support that QIVs are expected to prevent more influenza cases, hospitalisations and deaths than TIVs, although estimates of the case numbers prevented vary according to local specificities. The value of QIVs is demonstrated by their capacity to broaden the immune response and reduce the likelihood of a B-mismatched season. Some health authorities have preferentially recommended QIVs over TIVs in their influenza prevention programmes.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512791/pdf/khvi-13-07-1313375.pdf

 

April 13, 2019 at 12:57 pm

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