Contribution of influenza to acute exacerbations of chronic obstructive pulmonary disease in Kashmir, India, 2010–2012

Koul, Parvaiz A; Khan, Umar Hafiz; Asad, Romana; Yousuf, Rubaya; Broor, Shobha; Lal, Renu B.; Dawood, Fatimah S.

doi:10.1111/irv.12291

Cited by 12 publications

(14 citation statements)

References 13 publications

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“…As against the rest of the country with more tropical climate, the valley of Kashmir bound by the Himalayas has a temperate geography with respiratory tract illnesses predominating during the winter months, much like the northern hemispherical seasonality of respiratory viral illnesses seen in Northern America and Western Europe. We have earlier documented pandemic and seasonal influenza viruses as a cause of respiratory illness in Kashmir,3 , 4 that constitute the majority of hospital visits during the winter months, either as acute respiratory infections or as infective exacerbations of underlying chronic lung diseases like COPD 9. Sheri-Kashmir Institute of Medical Sciences (SKIMS) is a 820-bed facility in the summer capital, Srinagar, and constitutes the main tertiary referral centre for respiratory cases for the area.…”

Section: Methodsmentioning

confidence: 99%

The 2015 Outbreak of Severe Influenza in Kashmir, North India: Emergence of a New Clade of A/H1n1 Influenza Virus

et al. 2018

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Introduction: Following the initial outbreak of A/H1N1pdm09, periodic resurgences of the virus, with variable morbidity and mortality, have been reported from various parts of India including the temperate Kashmir region of northern India. An outbreak of A/H1N1 was reported in early 2015 across India with a high morbidity and mortality. We studied patients during the outbreak in Kashmir.Methods: Patients (n=1780, age 1 month to 90 years, median 35 years) presenting with acute respiratory illness to a tertiary care hospital in Srinagar, Kashmir from October 2014 to April 2015 were recruited. After clinical data recording, combined throat and nasal swabs were collected in viral transport medium and tested by real-time RT-PCR for influenza viruses. All influenza A positive samples were further subtyped using primers and probes for A/H1N1pdm09 and A/H3 whereas influenza B samples were further subtyped into B/Yamagata and B/Victoria lineages. Virus isolation, hemagglutination inhibition testing, sequencing and phylogenetic analysis was carried out using standard procedures. Testing for H275Y mutation was done to determine sensitivity to oseltamivir. All patients received symptomatic therapy and influenza positive patients were administered oseltamivir.Results: Of the 1780 patients, 540 (30%) required hospitalization and 533 tested positive for influenza [influenza A=517(A/H1N1pdm09=437, A/H3N2=78 with co-infection of both in 2 cases); influenza B=16 (B/Yamgata=15)]. About 14% (n=254) had been vaccinated against influenza, having received the NH 2014-15 vaccine, 27 (11.3%) of these testing positive for influenza. Sixteen patients, including 4 pregnant females, died due to multi-organ failure. HA sequencing depicted that 2015 isolates belonged to Clade 6B.1. No H275Y mutation was reported from A/H1N1 positives.Conclusion: Resurgent outbreak of A/H1N1pdm09, with emergence of clade 6B.1, in 2014-15 resulted in high rate of hospitalizations, morbidity and mortality. Periodic resurgences and appearance of mutants emphasize continued surveillance so as to identify newer mutations with potential for outbreaks and severe outcomes.

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Section: Methodsmentioning

confidence: 99%

The 2015 Outbreak of Severe Influenza in Kashmir, North India: Emergence of a New Clade of A/H1n1 Influenza Virus

et al. 2018

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“…Kashmir has a temperate geography in contrast with the generally more tropical climate in the rest of the country, and we have earlier reported a temperate seasonality of influenza virus circulation[56] which contributes to the exacerbations of COPD in 8% cases. [4] Demographic and clinical parameters were recorded in each case. Twin nasopharyngeal/oropharyngeal swabs were collected from the patients as described earlier.…”

Section: Methodsmentioning

confidence: 99%

“…Twin nasopharyngeal/oropharyngeal swabs were collected from the patients as described earlier. [4] Tested for respiratory viruses including respiratory syncytial virus (RSV) A and B, parainfluenza (PIV) 1, 2, 3,[7] and 4,[8] human metapneumovirus (hMPV) A and B,[9] influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses,[10] adenovirus 2 and 4,[11] rhinovirus,[10] and bocavirus,[12] were performed by in-house standardized duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using previously published primers and probes. The details of the enrollment and testing for influenza among these patients have been reported elsewhere.…”

Section: Methodsmentioning

confidence: 99%

“…We have recently reported that influenza A and B viruses are associated with about 8% of COPD exacerbations. [4] Data regarding the contribution of other respiratory viruses in the causation of exacerbations of COPD are scant, especially from the developing countries. We herewith report our results of testing of patients for other respiratory viruses in patients with COPD exacerbation.…”

Section: Introductionmentioning

confidence: 99%

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Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease

et al. 2017

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Objective:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) cause significant morbidity, mortality, and an inexorable decline of lung function. Data from developed countries have shown viruses to be important causes of AECOPD, but data from developing countries like India are scant. We set out to determine the contribution of viruses in the causation of hospitalized patients with AECOPD.Methods:Twin nasopharyngeal/oropharyngeal swabs collected from 233 patients admitted with an acute AECOPD and tested for respiratory viruses including respiratory syncytial virus A and B, parainfluenza were (PIV) 1, 2, 3, and 4, human metapneumovirus (hMPV) A and B, influenza A and B, enterovirus, corona NL65, OC43, and 229E viruses, adenovirus 2 and 4, rhinovirus, and bocavirus, by duplex real time reverse-transcription polymerase chain reaction (qRT-PCR) using CDC approved primers and probes. Samples positive for influenza A were subtyped for A/H1N1pdm09 and A/H3N2 whereas influenza B samples were subtyped into B/Yamagata and B/Victoria subtypes, using primers and probes recommended by CDC, USA.Results:Respiratory viruses were detected in 46 (19.7%) cases, influenza A/H3N2 and rhinoviruses being the most common viruses detected. More than one virus was isolated in four cases consisting of hMPV-B + adeno-2 + Inf-B; rhino + H3N2, PIV-1 + rhino; and PIV-1+ hMPV-B in one case each. Ancillary supportive therapeutic measures included bronchodilators, antibiotics, steroids, and ventilation (noninvasive in 42 and invasive in 4). Antiviral therapy was instituted in influenza-positive patients. Three patients with A/H3N2 infection died during hospitalization.Conclusions:We conclude that respiratory viruses are important contributors to AECOPD in India. Our data calls for prompt investigation during an exacerbation for viruses to obviate inappropriate antibiotic use and institute antiviral therapy in viral disease amenable to antiviral therapy. Appropriate preventive strategies like influenza vaccination also need to be employed routinely.

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“…Although there is evidence that viral infections lead to exacerbations of chronic airway diseases such as COPD [10,11], vaccination has not been proven to reduce mortality [12]. On the other hand, a systematic review that summarized the immunogenicity, safety, efficacy, and effectiveness of influenza vaccination in patients with COPD found that six of seven studies indicated long-term benefits such as decreased number of exacerbations, reduced number of hospitalizations, and decreased rates of all-cause and respiratory mortality [13].…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Influenza Vaccination Rates among Patients with Chronic Obstructive Pulmonary Disease in Rize, Turkey

et al. 2018

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OBJECTIVES: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major components of COPD-related socioeconomic burden. Upper or lower respiratory tract infections, usually caused by respiratory viruses or bacteria, are common causes of AECOPD. Vaccination aganist influenza virus and Streptoccus pneumoniae, the most prevalent agents, is recommended by COPD guidelines. The aims of this study were to determine the factors affecting vaccination among patients with COPD and to assess the effect of vaccination status on AECOPD. MATERIALS AND METHODS:Patients with COPD were recruited from the outpatient clinic of a tertiary hospital between December 2014 and January 2015. Demographic data, vaccination status, and COPD-related hospital admissions triggered by tracheobronchial infections were evaluated. RESULTS:In total, 108 patients were enrolled; 102 (94%) subjects were male, and 6 (6%) subjects were female; the mean age was 65.6 years. The number of patients who had received pneumococcal and influenza vaccinations were 8 (0.07%) and 36 (33.3%), respectively. There was no significant correlation between the level of education and vaccination status. No significant difference was found between two groups in terms of exacerbation frequency, hospitalization rates, mMRC scores, and COPD stages. CONCLUSION:More efforts by both physicians and patients are needed to reach the ideal rates of vaccination for COPD.

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Contribution of influenza to acute exacerbations of chronic obstructive pulmonary disease in Kashmir, India, 2010–2012

Cited by 12 publications

References 13 publications

The 2015 Outbreak of Severe Influenza in Kashmir, North India: Emergence of a New Clade of A/H1n1 Influenza Virus

The 2015 Outbreak of Severe Influenza in Kashmir, North India: Emergence of a New Clade of A/H1n1 Influenza Virus

Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease

Factors Affecting Influenza Vaccination Rates among Patients with Chronic Obstructive Pulmonary Disease in Rize, Turkey

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