Obesity Increases the Duration of Influenza A Virus Shedding in Adults

Maier, Hannah E.; López, Roger; Sánchez, Nery; Ng, Sophia; Gresh, Lionel; Ojeda, Sergio; Burger-Calderon, Raquel; Kuan, Guillermina; Harris, Eva; Balmaseda, Ángel; Gordon, Aubree

doi:10.1093/infdis/jiy370

Cited by 200 publications

(218 citation statements)

References 13 publications

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“…Also, obese patients shed influenza virus for longer periods of time compared with non-obese individuals. 21 In our cohort, although obesity was prevalent, it did not increase the risk of pneumonia or death, but was correlated with dyspnea and hypoxemia, which is consistent with ventilatory dysfunction and increased risk of mechanical ventilation and death. AKI occurred in 20 (17.5%) patients.…”

Section: Discussionsupporting

confidence: 80%

Influenza in patients with cancer after 2009 pandemic AH1N1: An 8‐year follow‐up study in Mexico

Ángeles‐Sistac

Martin-Onraët

Cornejo‐Juárez

et al. 2019

Influenza Resp Viruses

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Background Immunosupressed patients are at high risk of influenza‐related complications. Influenza AH1N1 has been hypothesized to induce worse outcomes in patients with malignancies, but after the A(H1N1)pdm09 few publications have analyzed the presentation and complications related to influenza afterward. Objectives We aimed to describe the characteristics, risk factors, and outcomes of influenza in an oncologic center after the 2009 pandemic and to compare our case distribution to the National community acquired influenza databases in Mexico and the United States. Methods We reviewed the cases of confirmed influenza in patients with cancer from an oncological center in Mexico from April 2009 to April 2017. Data on severity and influenza type, malignancy, comorbidities, and outcomes were recorded. We correlated data between the Centers for Disease Control and Prevention (CDC) in the United States and SISVEFLU (Influenza Surveillance Program) in Mexico. Results One hundred eighty‐eight patients were included; 75 (39.9%) had a solid neoplasm and 113 (60.1%) had hematologic malignancies. AH1N1 was the most frequent influenza type (54.2%). Patients with hematologic malignancies had more pneumonia (55% vs 25%, P < .001), needed more hospitalizations (75% vs 39% P < .001), had higher all‐cause mortality at 30 days (20% vs 9% P = .048) and influenza‐associated mortality (17% vs 7% P = .041). Thirty (16%) patients died within 30 days, and 24 (12.7%) were related to influenza. Influenza type was not associated with worse outcomes. Yearly occurrence of influenza reported by the CDC and SISVEFLU showed a significant correlation (ρ = 0.823, P = .006). Conclusions AH1N1 was the dominant serotype. Patients with hematologic malignancies had more severe influenza and presented worse outcomes. Annual SISVEFLU and CDC surveillance information showed a similar distribution of cases along time but influenza serotypes did not match for all seasons.

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Section: Discussionsupporting

confidence: 80%

Influenza in patients with cancer after 2009 pandemic AH1N1: An 8‐year follow‐up study in Mexico

Ángeles‐Sistac

Martin-Onraët

Cornejo‐Juárez

et al. 2019

Influenza Resp Viruses

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“…Three factors make obese subjects more contagious than leans: First, obese subjects with influenza shed the virus for a longer period of time (up to 104% longer) than lean subjects, potentially increasing the chance to spread the virus to others [22]. Secondly, the obese microenvironment favors the emergence of novel more virulent virus strains.…”

Section: Why Are Obese Patients Potentially More Contagious Than Leanmentioning

confidence: 99%

“…Incubation time for COVID-19 is considered 14 days, at most. Based on the concept of prolonged shedding of the virus in obese subjects [22], quarantine should be prolonged in obese with respect to lean subjects, presumably doubled. Until a specific vaccine is not available, the only actions that can be taken are isolation of positive patients and potentiation of positive immune modulation response.…”

Section: What Are the Lessons To Be Learned From Previous Influenza Vmentioning

confidence: 99%

Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic

2020

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Aims Analyze the relationship between obesity and influenza. Methods Basal hormone milieu, defective response of both innate and adaptive immune system and sedentariness are major determinants in the severity of influenza viral infection in obese patients. Being overweight not only increases the risk of infection and of complications for the single obese person, but a large prevalence of obese individuals within the population might increase the chance of appearance of more virulent viral strain, prolongs the virus shedding throughout the total population and eventually might increase overall mortality rate of an influenza pandemic. Results Waiting for the development of a vaccination against COVID-19, isolation of positive cases and social distancing are the primary interventions. Nonetheless, evidence from previous influenza pandemics suggests the following interventions aimed at improving immune response: (1) lose weight with a mild caloric restriction; (2) include AMPK activators and PPAR gamma activators in the drug treatment for obesity associated with diabetes; and (3) practice mild-to-moderate physical exercise. Conclusions Due to prolonged viral shedding, quarantine in obese subjects should likely be longer than normal weight individuals.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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“…The mechanisms relating to obesity to susceptibility are likely complex and multi-factorial, including increased inflammation and decreased wound healing in obese individuals. Additionally, obesity dampens some features of adaptive immunity that may delay viral clearance or increase susceptibility to initial infection [29][30][31].…”

Section: How Influenza Triggers Ardsmentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual’s contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix. Approximately 30–40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised. Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae . Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30–50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission. Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses. In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.

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Obesity Increases the Duration of Influenza A Virus Shedding in Adults

Cited by 200 publications

References 13 publications

Influenza in patients with cancer after 2009 pandemic AH1N1: An 8‐year follow‐up study in Mexico

Influenza in patients with cancer after 2009 pandemic AH1N1: An 8‐year follow‐up study in Mexico

Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic

Influenza virus-related critical illness: pathophysiology and epidemiology

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