Epidemiology of influenza-associated hospitalization in adults, Toronto, 2007/8

Abstract

The purpose of this investigation was to identify when diagnostic testing and empirical antiviral therapy should be considered for adult patients requiring hospitalization during influenza seasons. During the 2007/8 influenza season, six acute care hospitals in the Greater Toronto Area participated in active surveillance for laboratory-confirmed influenza requiring hospitalization. Nasopharyngeal (NP) swabs were obtained from patients presenting with acute respiratory or cardiac illness, or with febrile illness without clear non-respiratory etiology. Predictors of influenza were analyzed by multivariable logistic regression analysis and likelihoods of influenza infection in various patient groups were calculated. Two hundred and eighty of 3,917 patients were found to have influenza. Thirty-five percent of patients with influenza presented with a triage temperature ≥38.0°C, 80% had respiratory symptoms in the emergency department, and 76% were ≥65 years old. Multivariable analysis revealed a triage temperature ≥38.0°C (odds ratio [OR] 3.1; 95% confidence interval [CI] 2.3–4.1), the presence of respiratory symptoms (OR 1.7; 95% CI 1.2–2.4), admission diagnosis of respiratory infection (OR 1.8; 95% CI 1.3–2.4), admission diagnosis of exacerbation of chronic obstructive pulmonary disease (COPD)/asthma or respiratory failure (OR 2.3; 95% CI 1.6–3.4), and admission in peak influenza weeks (OR 4.2; 95% CI 3.1–5.7) as independent predictors of influenza. The likelihood of influenza exceeded 15% in patients with respiratory infection or exacerbation of COPD/asthma if the triage temperature was ≥38.0°C or if they were admitted in the peak weeks during the influenza season. During influenza season, diagnostic testing and empiric antiviral therapy should be considered in patients requiring hospitalization if respiratory infection or exacerbation of COPD/asthma are suspected and if either the triage temperature is ≥38.0°C or admission is during the weeks of peak influenza activity.

Clinical features, treatments and outcomes of influenza A (H1N1) 2009 among the hospitalized patients in the clinic for infectious diseases in Novi Sad

“…This is consistent with other studies on 2009 pandemic influenza which found greater affinity of the novel A (H1N1) virus for the younger population [21][22][23][24][25][26][27] . The majority of the patients (79.3%) were between the age of 10 and 50 years.…”

Influenza-Induced Priming and Leak of Human Lung Microvascular Endothelium upon Exposure to Staphylococcus aureus

“…While many studies invoke bacterial overgrowth, epidemiological data suggest almost all patients receive antibiotics (13,43) and many lung cultures at autopsy are negative (11). The fact that superinfection is associated with worse outcomes despite universal prescription of antibiotics (13) suggests that superinfection-related disease might be related to an aberrant host response (44), in addition to a role for immunosuppression by the virus.…”

Respiratory illnesses in Canadian health care workers: a pilot study of influenza vaccine and oseltamivir prophylaxis during the 2007/2008 influenza season

“…Two participants, both in the prophylaxis group and in health care workers, dropped out before starting antiviral prophylaxis and are not included in the remaining analyses. Demographic characteristics of participants are 15 Of the 42 participants who started oseltamivir prophylaxis, 4 (10%) discontinued before 13 weeks owing to adverse effect, including: nausea (week 1), nausea and malaise (week 3), sleep disturbances (week 4) and headache (week 11). Thirty-nine of 42 participants (95%) reported taking six or seven capsules per week for the first 8 weeks; by week 12, 34 (81%) reported continuing to miss no more than one capsule per week.…”