Intensive Care Admissions and Associated Severity of Influenza B Versus A During Influenza B Vaccine–mismatched Seasons

Korem, Maya; Orenbuch‐Harroch, Efrat; Ben‐Chetrit, Eli; Israel, Sarah; Cohen, Matan J.; Sviri, Sigal; Levin, Phillip D.; Mandelboim, Michal; Wolf, Dana

doi:10.1093/cid/ciz053

Cited by 12 publications

(10 citation statements)

References 11 publications

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“…Pneumonia on infection presentation was very frequent, in line with more recent reports [9][10][11][12][13][14][15][16][17], revealing how an important proportion of patients showed a direct viral injury in lung parenchyma and/or bacterial co-infection. However, despite being a life-threatening condition, it was neither predictive of NIV use nor of IHD.…”

Section: Discussionsupporting

confidence: 84%

Influenza and respiratory syncytial virus infections in the oldest-old continent

Boattini

Almeida

Christaki

et al. 2020

Eur J Clin Microbiol Infect Dis

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SARS-CoV-2 dramatically revealed the sudden impact of respiratory viruses in our lives. Influenza and respiratory syncytial virus (RSV) infections are associated with high rates of morbidity, mortality, and an important burden on healthcare systems worldwide, especially in elderly patients. The aim of this study was to identify severity predictors in the oldest-old admitted with influenza and/or RSV infections. This is a multicenter, retrospective study of all oldest-old patients (≥ 85 years old) admitted for laboratory-confirmed influenza and/or RSV infection in three tertiary hospitals in Portugal, Italy, and Cyprus over two consecutive winter seasons. The outcomes included the following: pneumonia on infection presentation, use of non-invasive ventilation (NIV), and in-hospital death (IHD). The association with possible predictors, including clinical features and type of virus infection, was assessed using uni-and multivariable analyses. A total of 251 oldest-old patients were included in the study. Pneumonia was evident in 32.3% (n = 81). NIV was implemented in 8.8% (n = 22), and IHD occurred in 13.9% (n = 35). Multivariable analyses revealed that chronic obstructive pulmonary disease (COPD) or asthma was associated with pneumonia (OR 1.86; 95% CI 1.02-3.43; p = 0.045). COPD or asthma (OR 4.4; 95% CI 1.67-11.6; p = 0.003), RSV (OR 3.12; 95% CI 1.09-8.92; p = 0.023), and influenza B infections (OR 3.77; 95% CI 1.06-13.5; p = 0.041) were associated with NIV use, respectively, while chronic kidney disease was associated with IHD (OR 2.50; 95% CI 1.14-5.51; p = 0.023). Among the oldest-old, chronic organ failure, such as COPD or asthma, and CKD predicted pneumonia and IHD, respectively, beyond the importance of viral virulence itself. These findings could impact on public health policies, such as fostering influenza immunization campaigns, home-based care programs, and end-of-life care. Filling knowledge gaps is crucial to set priorities and advise on transition model of care that best fits the oldest-old.

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Section: Discussionsupporting

confidence: 84%

Influenza and respiratory syncytial virus infections in the oldest-old continent

Boattini

Almeida

Christaki

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…However, other previous studies suggested a similar course. Among patients with influenza who were admitted to medical ICU, influenza A was associated with increased rate of viral pneumonia, adult respiratory distress syndrome (ARDS), but mortality, LOS at ICU admission, and other clinical outcomes did not differ between influenza A-and influenza B-infected patients [8], similarly to our study. Among ambulatory adults with seasonal influenza, clinical features and outcomes (hospitalization, antibiotic prescription, pneumonia) of influenza A (H 3 N 2 strain) and influenza B were similar in a prospective study [7]; however, patients with influenza A sought medical attention earlier.…”

Section: Discussionsupporting

confidence: 80%

“…However, infection with influenza B is as severe as infection with influenza A with increased morbidity and mortality, especially for patients prone to suffer from influenza-related adverse events due to their medical conditions. This finding might correlate with mismatch vaccine year of the influenza B lineage as shown previously [8]. This could also explain why influenza B has represented more than two-thirds of the cases in our cohort, inversely related to their endemic attack rate.…”

Section: Discussionsupporting

confidence: 79%

Comparison of clinical outcomes of influenza A and B at the 2017–2018 influenza season: a cohort study

Avni

Babich

Nir

et al. 2020

Eur J Clin Microbiol Infect Dis

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Influenza has significant morbidity and mortality. Some experts consider infection with influenza B as milder than that with influenza A. The objective of this study is to evaluate the outcomes of hospitalized patients with laboratory-confirmed influenza A or B in 2017-2018 influenza season. All hospitalized patients between October 2017 and April 2018 with laboratoryconfirmed influenza A and B were included. The primary composite outcomes were pneumonia/myocarditis/encephalitis, mechanical ventilation, ICU admission, and 30-day mortality. Secondary outcomes were 30-/90-day mortality, length of hospital stay, and readmission rates. The study included 201 influenza A and 325 influenza B. For the primary composite outcome, no significant difference was demonstrated between influenza A and B. Rates of mortality were similar at 30 and 90 days. Influenza A had higher pneumonia rates and mechanical ventilation. On multivariate analysis, higher Charlson's score, hypoalbuminemia, and vasopressor use were associated with 30-day mortality, while infection with either influenza A or B was not. Influenza A was associated with higher pneumonia and mechanical ventilation rates. However, influenza B resulted with similar 30-day mortality rate as influenza A.

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“…Moreover, influenza B is a major contributor to the total morbidity and mortality from influenza, with attributable hospitalization rate similar to influenza A/H3N2 and greater than A/H1N1 [6], accounting for 15% of all influenzaattributable respiratory and circulatory-related death in the United States and 34% among paediatric patients [1,7]. In a recent study from Israel, similar rates of ICU admission and disease severity were found in patients hospitalized with either influenza A or B [8].…”

Section: Introductionmentioning

confidence: 92%

Quadrivalent versus trivalent influenza vaccine: clinical outcomes in two influenza seasons, historical cohort study

Shasha

Valinsky

Sikron

et al. 2020

Clinical Microbiology and Infection

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a b s t r a c tObjectives: The quadrivalent influenza vaccine (QIV) contains two influenza B antigens (one of each B lineage), while the trivalent vaccine (TIV) contains solely one. As a result, a mismatch between the circulating B lineage and the lineage in the TIV occurs frequently. We aimed to compare the frequency of clinically significant outcomes in a large cohort of vaccinees receiving either TIV or QIV. Methods: Historical cohort study of all inactivated influenza vaccinees (aged 3 years and older) in a Health Maintenance Organization insuring 1.2 million individuals, over two influenza seasons in which both vaccines were provided non-selectively. Primary outcome was hospital admissions during the influenza season. Multivariate analysis was performed using logistic regression to adjust for relevant covariates. Results: Our cohort included 150 518 and 168 296 vaccinees in the first (S1) and second season (S2), respectively. The two influenza seasons were characterized by high Influenza B activity. Of those vaccinated with QIV, 2074 of 49 726 (4.2%) and 6563 of 121 741 (5.4%) were hospitalized compared with 7378 of 100 792 (7.3%) and 3372 of 46 555 (7.2%) of those vaccinated with TIV (S1 and S2, respectively). After multivariate analysis adjusting for several covariates (gender, age, socioeconomic status, chronic morbidity, timing of vaccination), compared with TIV recipients, QIV vaccinees had lower odds for hospitalization (OR ¼ 0.92, 95% CI 0.87e0.98 and OR ¼ 0.89, 95% CI 0.85e0.93) or emergency department visit (OR ¼ 0.91, 95% CI 0.87e0.95 and OR ¼ 0.84, 95% CI 0.81e0.87) in S1 and S2, respectively (p < 0.001). Lower odds of mortality and influenza-like illness were also observed in S2 (OR ¼ 0.61, 95% CI 0.50e0.75 and OR ¼ 0.92, 95% CI 0.90e0.95, respectively). Conclusions: In seasons with relatively high influenza B activity, QIV appeared more protective than TIV in Israel. D. Shasha, Clin Microbiol Infect 2020;26:101

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Intensive Care Admissions and Associated Severity of Influenza B Versus A During Influenza B Vaccine–mismatched Seasons

Cited by 12 publications

References 11 publications

Influenza and respiratory syncytial virus infections in the oldest-old continent

Influenza and respiratory syncytial virus infections in the oldest-old continent

Comparison of clinical outcomes of influenza A and B at the 2017–2018 influenza season: a cohort study

Quadrivalent versus trivalent influenza vaccine: clinical outcomes in two influenza seasons, historical cohort study

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