Epidemiology, Seasonality and Treatment of Hospitalized Adults and Adolescents with Influenza in Jingzhou, China, 2010-2012

Abstract

BackgroundAfter the 2009 influenza A (H1N1) pandemic, we conducted hospital-based severe acute respiratory infection (SARI) surveillance in one central Chinese city to assess disease burden attributable to influenza among adults and adolescents.MethodsWe defined an adult SARI case as a hospitalized patient aged ≥ 15 years with temperature ≥38.0°C and at least one of the following: cough, sore throat, tachypnea, difficulty breathing, abnormal breath sounds on auscultation, sputum production, hemoptysis, chest pain, or chest radiograph consistent with pneumonia. For each enrolled SARI case-patient, we completed a standardized case report form, and collected a nasopharyngeal swab within 24 hours of admission. Specimens were tested for influenza viruses by real-time reverse transcription polymerase chain reaction (rRT-PCR). We analyzed data from adult SARI cases in four hospitals in Jingzhou, China from April 2010 to April 2012.ResultsOf 1,790 adult SARI patients enrolled, 40% were aged ≥ 65 years old. The median duration of hospitalization was 9 days. Nearly all were prescribed antibiotics during their hospitalization, less than 1% were prescribed oseltamivir, and 28% were prescribed corticosteroids. Only 0.1% reported receiving influenza vaccination in the past year. Of 1,704 samples tested, 16% were positive for influenza. Influenza activity in all age groups showed winter-spring and summer peaks. Influenza-positive patients had a longer duration from illness onset to hospitalization and a shorter duration from hospital admission to discharge or death compared to influenza negative SARI patients.ConclusionsThere is substantial burden of influenza-associated SARI hospitalizations in Jingzhou, China, especially among older adults. More effective promotion of annual seasonal influenza vaccination and timely oseltamivir treatment among high risk groups may improve influenza prevention and control in China.

Mortality estimates among adult patients with severe acute respiratory infections from two sentinel hospitals in southern Arizona, United States, 2010–2014

“…The independent risk factors for mortality that were identified in this analysis, age ≥ 65 years and ICU admission, are consistent with those found in a limited number of studies reporting risk factors for mortality in all SARI patients [20,24]. Of 1790 adult and adolescent SARI patients in China, age ≥ 65 years was a significant risk factor for severe SARI outcomes (ICU admission or death) [21]. Among SARI patients aged ≥ 5 years in a South African population with high-HIV-prevalence, Cohen et al found that ICU admission was a significant risk factor in bivariate analysis while increasing age was an independent risk factor in multivariate analysis [20].…”

“…We can make some comparisons to other studies with the caveat that varying populations, years studied and enrollment methods may affect the findings. The proportion of influenza-positive SARI cases in our study was higher than reported in Kenya (10%) [26] and China (16%) [21], within range of eight African countries (5% in Tanzania to 26% in Madagascar) [19] and slightly lower than New Zealand (23%) [27]. In our surveillance system, the percent of SARI cases positive for an influenza virus varied by year from 5.6% to 20% and likely reflects the influenza activity of the dominant virus that year [11].…”

“…In a study of SARI patients ≥ 18 years in Bogotá, Colombia, Remolina et al reported higher in-hospital mortality of 15% [3]. One study of adult SARI patients in central China reported an overall mortality of 4% up to 30-days post discharge [21]. Again, the higher in-hospital mortality in our surveillance compared to other global SARI studies is not surprising given the 37% ICU admission and high median age of Arizona SARI patients.…”

Notifiable Respiratory Infectious Diseases in China: A Spatial–Temporal Epidemiology Analysis

“…All these component series have a certain characteristic or type of behavior [19][20][21]. Zt represents the monthly incidence of the diseases.…”

Evaluation of Patients Diagnosed With Severe Acute Respiratory Tract Infection: 2015-2016 Influenza Season

“…2009 pandemisinde yatarak izlenen hastaların çoğu, genç erişkinlerden oluşmaktayken (7); 2009 sonrası SARI tanısıyla takip edilen hastalar için ortanca yaşın 63 yıl olduğu (8) ve 65 yaş üstü hastaların influenza vakalarının %40-61'ini oluş-turduğu bildirilmiştir (8)(9)(10). Çalışmamızda izlenen hasta grubunda ortanca yaş 68 (20-95) yıldı ve olguların %55'i 65 yaş üstü hastalardan oluşmaktaydı.…”