Avian influenza: are you prepared?

This article aims to assist healthcare workers to prepare, both in their professional and personal life, for a possible influenza pandemic. It identifies the medical and non-medical interventions that may be required.     

Neuraminidase inhibitor susceptibility profile of human influenza viruses during the 2016–2017 influenza season in Mainland China

To understand the current situation of antiviral-resistance of influenza viruses to neuraminidase inhibitors (NAIs) in Mainland China, The antiviral-resistant surveillance data of the circulating influenza viruses in Mainland China during the 2016–2017 influenza season were analyzed.The total 3215 influenza viruses were studied to determine 50% inhibitory concentration (IC₅₀) for oseltamivir and zanamivir using a fluorescence-based assay.Approximately 0.3% (n = 10) of viruses showed either highly reduced inhibition (HRI) or reduced inhibition (RI) against at least one NAI. The most common neuraminidase (NA) amino acid substitution was H275Y in A (H1N1)pdm09 virus, which confers HRI by oseltamivir. Two A (H1N1)pdm09 viruses contained a new NA amino acid substitution respectively, S110F and D151E, which confers RI by oseltamivir or/and zanamivir. Two B/Victoria-lineage viruses harbored a new NA amino acid substitution respectively, H134Q and S246P, which confers RI by zanamivir. One B/Victoria-lineage virus contained dual amino acid substitution NA P124T and V422I, which confers HRI by zanamivir. One B/Yamagata-lineage virus was a reassortant virus that haemagglutinin (HA) from B/Yamagata-lineage virus and NA from B/Victoria-lineage virus, defined as B/Yamagata-lineage virus confers RI by oseltamivir, but as B/Victoria-lineage virus confers normal inhibition by oseltamivir. All new substitutions that have not been reported before, the correlation of these substitutions and observed changes in IC₅₀ should be further assessed.During the 2016–2017 influenza season in Mainland China the majority tested viruses were susceptible to oseltamivir and zanamivir. Hence, NAIs remain the recommended antiviral for treatment and prophylaxis of influenza virus infections.     

Acceptability of Intanza? 15 μg intradermal influenza vaccine in Belgium during the 2010–2011 influenza season

Introduction

Intradermal (ID) influenza vaccination induces an enhanced immune response in the elderly when compared with intramuscular (IM) vaccination. In 2009, an ID seasonal influenza vaccine (Intanza? [Sanofi Pasteur MSD, Lyon, France] 15 ??g) was approved for use in individuals aged ?? 60 years in Europe. This survey conducted in Belgium was the first in Europe to assess the acceptability of this vaccine in routine clinical practice by vaccinees and their general practitioners (GPs).

Methods

GPs willing to use both the ID and IM influenza vaccines were selected during the 2010?C2011 influenza season. Each GP recruited ?? 10 patients aged ?? 60 years who received the ID vaccine. Vaccinees and GPs completed questionnaires about their opinions on influenza vaccination and the acceptability of the ID influenza vaccine.

Results

In total, 105 GPs and 837 vaccinees completed questionnaires. A high proportion of vaccinees (40.3%) was aged ?? 75 years, and 95.5% had been vaccinated the previous year. The majority of vaccinees was very satisfied (70.0%) or satisfied (27.9%) with the ID vaccine. The main reasons for the high satisfaction rate were that the injection was not very painful, administration was quick, and the vaccinee felt confident about the micro-needle injection system. Most vaccinees (91.1%) who had previously received IM influenza vaccination preferred the ID vaccine, and 98.5% of vaccinees reported they would consider receiving the ID vaccine the following year. The majority of GPs was very satisfied (78.6%) or satisfied (18.4%) with the ID vaccine, and most GPs (87.6%) expressed a preference for the ID vaccine over IM influenza vaccine.

Conclusion

The ID influenza vaccine was well accepted by vaccinees and their GPs, who expressed a preference for the ID vaccine over conventional IM influenza vaccine. The availability of the ID influenza vaccine may help to improve uptake of seasonal influenza vaccination in the elderly.     

Avian influenza: a new pandemic threat?

In December 2003, the largest outbreak of highly pathogenic avian influenza H5N1 occurred among poultry in 8 Asian countries. A limited number of human H5N1 infections have been reported from Vietnam and Thailand, with a mortality rate approaching 70%. Deaths have occurred in otherwise healthy young individuals, which is reminiscent of the 1918 Spanish influenza pandemic. The main presenting features were fever, pneumonitis, lymphopenia, and diarrhea. Notably, sore throat, conjunctivitis, and coryza were absent. The H5N1 strains are resistant to amantadine and rimantadine but are susceptible to neuraminidase inhibitors, which can be used for treatment and prophylaxis. The widespread epidemic of avian influenza in domestic birds increases the likelihood for mutational events and genetic reassortment. The threat of a future pandemic from avian influenza is real. Adequate surveillance, development of vaccines, outbreak preparedness, and pandemic influenza planning are important. This article summarizes the current knowledge on avian influenza, including the virology, epidemiology, diagnosis, and management of this emerging disease.     

Avian influenza: a pandemic waiting in the wings?

Recent widespread outbreaks of avian influenza and, associated with these a growing number of human infections with a high mortality rate, have raised concerns that this might be the prelude to a severe pandemic of human influenza. As a background to these concerns the present article reviews influenza as a human disease, its origins and the involvement of other species, properties of the influenza viruses and the current status of influenza prevention and control.     

Pandemic influenza: are we prepared to face our obligations?

After decades of low personal risk for contracting lethal diseases, physicians are suddenly facing the possibility of a substantial increase in occupational risk during an influenza pandemic. If they are not confronted before the onset of an influenza pandemic, feelings of unease and fear or ignorance about physicians' professional obligations could profoundly hinder individual physicians in fulfilling their professional duties. Such feelings could therefore undermine institutional and societal preparations. In their review published in Critical Care, Anantham and coworkers outline the ethical framework that forms the basis of the professional obligations of physicians who respond to health care emergencies, such as an influenza pandemic.     

Does vaccinating ED health care workers against influenza reduce sickness absenteeism?

This study aims to investigate the association between influenza vaccination of health care workers (HCWs) and sickness absenteeism. A retrospective cohort study was conducted in an emergency department (ED) of an acute care hospital. All full-time HCWs except physicians (73 nurses and health care attendants) were included. Influenza vaccine was administered to HCWs on a voluntary basis commencing November 2004. Absenteeism due to influenza-like illness during the period from January to October 2005 was noted. The mean number of cumulative sick leave days per person was smaller (1.0 days against 1.75 days) in vaccine recipients than in vaccine nonrecipients although the difference was not statistically significant. A significantly larger proportion of subjects took sick leave because of influenza-like illness in the vaccine nonrecipient group (55% against 30.3%, P = .034). Conclusion: Influenza vaccination of HCWs in the ED setting is significantly associated with a fewer number of HCWs requiring sick leave.