Influenza in the COVID-19 Era

Solomon, Daniel A.; Sherman, Amy C; Kanjilal, Sanjat

doi:10.1001/jama.2020.14661

Cited by 111 publications

(112 citation statements)

References 9 publications

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“…In conclusion, symptoms associated with SARS-CoV-2 and other respiratory viral infections are frequently shared [8]. This poses potential challenges in patient management in case of a large co-circulation of all these viruses, as expected in the upcoming months in most northern countries.…”

Section: Plos Onementioning

confidence: 89%

“…As patients presenting with influenza-like illnesses (ILIs) could be infected by any RV, including SARS-CoV-2, this will raise an additional challenge for patients' diagnosis and isolation in an emergency department (ED). The looming threat of concurrent SARS-CoV-2 and other RV epidemics is an increasing concern for both physicians and health policies [8]. Being able to quickly identify and isolate patients who are highly suspected of having COVID-19 is indeed a cornerstone of preventing nosocomial transmission of this new and deadly infection in crowded EDs and other units.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics associated with COVID-19 or other respiratory viruses’ infections at a single-center emergency department

et al. 2020

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Background Rapid identification of patients with high suspicion of COVID-19 will become a challenge with the co-circulation of multiple respiratory viruses (RVs). We have identified clinical or biological characteristics to help distinguish SARS-CoV-2 from other RVs. Methods We used a prospective cohort including all consecutive patients admitted through the emergency department’s (ED) and presenting respiratory symptoms from November 2019 to April 2020. Patients were tested for RV using multiplex polymerase chain reaction (mPCR) and SARS-CoV-2 RT-PCR. Results 203/508 patients were positive for an RV during the non-SARS-CoV-2 epidemic period (November to February), and 268/596 patients were SARS-CoV-2 positive during the SARS-CoV-2 epidemic (March to April). Younger age, male gender, fever, absence of expectoration and absence of chronic lung disease were statistically associated with SARS-CoV-2 detection. Combining these variables allowed for the distinguishing of SARS-CoV-2 infections with 83, 65, 75 and 76% sensitivity, specificity, PPV and NPV, respectively. Conclusion Patients’ characteristics associated with a positive PCR are common between SARS-CoV-2 and other RVs, but a simple discrimination of strong SARS-CoV-2 suspicion with a limited set of clinical features seems possible. Such scoring could be useful but has to be prospectively evaluated and will not eliminate the need for rapid PCR assays.

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Section: Plos Onementioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Characteristics associated with COVID-19 or other respiratory viruses’ infections at a single-center emergency department

et al. 2020

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“…The ability to differentiate the diseases caused by these viruses is essential for patient management, infection control, as well as public health surveillance and response. These viruses can cause infections that present with very similar symptoms making clinical differentiation between them very difficult (1). Clinical microbiology and public health laboratories are likely to face pressure to offer parallel testing for these viruses, optimally using rapid assays with simultaneous detection of SARS-CoV-2, influenza A/B, and RSV.…”

Section: Downloaded Frommentioning

confidence: 99%

Multicenter Evaluation of the Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV Test

et al. 2021

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With the approach of respiratory virus season in the Northern Hemisphere, clinical microbiology and public health laboratories will need rapid diagnostic assays to distinguish SARS-CoV-2 from influenza and respiratory syncytial virus (RSV) infections for diagnosis and surveillance. In this study, the clinical performance of the Xpert® Xpress SARS-CoV-2/Flu/RSV test (Cepheid, Sunnyvale, CA, USA) for nasopharyngeal swab specimens was evaluated in four centers: Johns Hopkins Medical Microbiology Laboratory, Northwell Health Laboratories, NYC Public Health Laboratory, and Los Angeles County/University of Southern California (LAC+USC) Medical Center. A total of 319 nasopharyngeal swab specimens, positive for SARS-CoV-2 (n = 75), influenza A (n = 65), influenza B (n = 50), RSV (n = 38), or negative (n = 91) by the standard of care nucleic acid amplification tests at each site were tested using the Cepheid panel test. The overall positive percent agreement for the SARS-CoV-2 target was 98.7% (n= 74/75) and the negative agreement was 100% (n= 91) with all other analytes showing 100% total agreement (n= 153). Standard of care tests to which the Cepheid panel was compared included the Cepheid Xpert Xpress SARS-CoV-2, Cepheid Xpert Xpress Flu/RSV, the GenMark ePlex respiratory panel, the BioFire Respiratory panels 2.1 and v1.7, the DiaSorin Simplexa COVID-19 Direct, and the Hologic Panther Fusion SARS-CoV-2 assays. The Xpert Xpress SARS-CoV-2/Flu/RSV test showed high sensitivity and accuracy for all analytes included in the test. This test will provide a valuable clinical diagnostic and public health solution for detecting and differentiating SARS-CoV-2, influenza A and B, and RSV infections during the current respiratory virus season.

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“…Although slightly increasing in recent years, the percentage observed in our study is lower than the target coverage of 75% in those aged 65 years or older. These data are particularly worrisome because of the co-circulation of both influenza and SARS-CoV-2 viruses in the current northern hemisphere's fall/winter season, which will pose major challenges due to the major diagnostic and clinical difficulties in managing upper and lower respiratory tract symptoms [19]. Based on these concerns, the Italian Ministry of Health recommends extending the vaccination coverage to the whole population during the 2020/2021 flu season, and the vaccine will be offered free of charge also for subject between 60 and 64 years of age [20].…”

Section: Discussionmentioning

confidence: 99%

Missed Opportunities of Flu Vaccination in Italian Target Categories: Insights from the Online EPICOVID 19 Survey

et al. 2020

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We aimed to assess the reported rate of flu vaccination in the 2019/2020 season for respondents to the Italian nationwide online EPICOVID 19 survey. A national convenience sample of volunteers aged 18 or older was assessed between 13 April and 2 June 2020. Flu vaccine rates were calculated for all classes of age. The association between the independent variables and the flu vaccine was assessed by applying a multivariable binary logistic regression model. Of the 198,822 respondents, 41,818 (21.0%) reported having received a flu vaccination shot during the last influenza season. In particular, 15,009 (53.4%) subjects aged 65 years or older received a flu vaccination shot. Being 65 years aged or older (Adjusted Odds Ratios (aOR) 3.06, 95% Confidence Interval (CI) 2.92–3.20) and having a high education level (aOR 1.34. 95%CI 1.28–1.41) were independently associated to flu vaccination. Heart and lung diseases were the morbidities associated with the higher odds of being vaccinated (aOR 1.97 (95%CI 1.86–2.09) and aOR 1.92 (95%CI 1.84–2.01), respectively). Nursing home residents aged ≥ 65 years showed lower odds of being vaccinated (aOR 0.39 (95%CI 0.28–0.54)). Our data indicate the need for an urgent public heath effort to fill the gap of missed vaccination opportunities reported in the past flu seasons.

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Influenza in the COVID-19 Era

Cited by 111 publications

References 9 publications

Characteristics associated with COVID-19 or other respiratory viruses’ infections at a single-center emergency department

Characteristics associated with COVID-19 or other respiratory viruses’ infections at a single-center emergency department

Multicenter Evaluation of the Cepheid Xpert Xpress SARS-CoV-2/Flu/RSV Test

Missed Opportunities of Flu Vaccination in Italian Target Categories: Insights from the Online EPICOVID 19 Survey

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