Pneumococcal Colonization and Pneumococcal Disease in Children with Influenza Clinical, laboratory and epidemiological features

Miron, Victor Daniel; Drăgănescu, Anca; Săndulescu, Oana; Visan, Constanta Angelica; Merisescu, Maria Madalina; Streinu-Cercel, Adrian; Pițigoi, Daniela; Rafilă, Alexandru; Dorobăţ, O; Jugulete, Gheorghiță; Cercel, Adrian Streinu; Stoicescu, Silvia Maria; Luminos, Monica

doi:10.37358/rc.18.10.6618

Cited by 7 publications

(7 citation statements)

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“…Clinical characteristics of influenza did not differ significantly between elderly patients with influenza A and B in our study. This is in line with previous research from our institute in children 14 and from France in all age groups, showing that clinical characteristics are mostly indistinguishable between viral types and subtypes 15 . Among the SARI criteria, fever and odynophagia associated higher odds of testing positive for influenza in our study; this is consistent with the data reported by Falsey et al, which showed that the combination of fever with cough or odynophagia exhibited the best balance of sensitivity and specificity for diagnosing influenza 16 .…”

Section: Discussionsupporting

confidence: 93%

Surveillance of medically‐attended influenza in elderly patients from Romania—data from three consecutive influenza seasons (2015/16, 2016/17, and 2017/18)

Pițigoi

Streinu‐Cercel

Ivanciuc³

et al. 2020

Influenza Resp Viruses

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Background Influenza is an acute infection affecting all age groups; however, elderly patients are at an increased risk. We aim to describe the clinical characteristics and the circulation of influenza virus types in elderly patients admitted for severe acute respiratory infection (SARI) to a tertiary care hospital in Bucharest, Romania, part of the I‐MOVE+ hospital network. Methods We conducted an active surveillance study at the National Institute for Infectious Diseases “Prof. Dr Matei Balș,” Bucharest, Romania, during three consecutive influenza seasons: 2015/16, 2016/17, and 2017/18. All patients aged 65 and older admitted to our hospital for SARI were tested for influenza by PCR. Results A total of 349 eligible patients were tested during the study period, and 149 (42.7%) were confirmed with influenza. Most patients, 321 (92.5%) presented at least one underlying condition at the time of hospital admission, the most frequent being cardiovascular disease, 270 (78.3%). The main influenza viral subtype circulating in 2015/16 was A(H1N1)pdm09, followed by A(H3N2) in 2016/17 and B influenza in 2017/18. Case fatality was highest in the 2015/16 season (3.7%), 0% in 2016/17, and 1.0% in 2017/18. Vaccination coverage in elderly patients with SARI from our study population was 22 (6.3%) over the three seasons. Conclusions Our study has highlighted a high burden of comorbidities in elderly patients presenting with SARI during winter season in Romania. The influenza vaccine coverage rate needs to be substantially increased in the elderly population, through targeted interventions.

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Section: Discussionsupporting

confidence: 93%

Surveillance of medically‐attended influenza in elderly patients from Romania—data from three consecutive influenza seasons (2015/16, 2016/17, and 2017/18)

Pițigoi

Streinu‐Cercel

Ivanciuc³

et al. 2020

Influenza Resp Viruses

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“…A similar biphasic predominance was observed during the previous 2016–2017 season among hospitalized patients from the same region, although by contrast, only B/Victoria-lineage and A/H3 viruses were identified [7]. Also, unlike previous seasons at our hospital [7, 14], influenza A viruses were detected in ILI admissions throughout the 2017–2018 season and, unusually, all four subtyped viruses (A/H1, A/H3, and both B lineage viruses) were identified in meaningful numbers.…”

Section: Discussionsupporting

confidence: 64%

“…Influenza hospitalizations of young, otherwise healthy children have been frequently reported in previous seasons at the same hospital [7] and at other public healthcare facilities in Romania [5]. Young children have a higher risk of developing severe influenza illness as well as other complications (e.g., bacterial superinfections [14]), which emphasizes the importance of vaccination for this age group [1]. Individuals with chronic illnesses also account for a large proportion of influenza hospitalizations in Romania.…”

Section: Discussionmentioning

confidence: 99%

The 2017–2018 influenza season in Bucharest, Romania: epidemiology and characteristics of hospital admissions for influenza-like illness

et al. 2019

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BackgroundSeasonal influenza causes a considerable burden to healthcare services every year. To better measure the impact of severe influenza cases in Romania, we analyzed active surveillance data collected during the 2017–2018 season from patients admitted for influenza-like illness (ILI) at a tertiary care hospital in Bucharest.MethodsPatients admitted for acute ILI were included if they were resident in the Bucharest-Ilfov region, had been hospitalized for at least 24 h, and had onset of symptoms within 7 days before admission. Patient demographics, healthcare use, vaccination status, and outcome data were collected by questionnaire or by searching clinical records. Respiratory swabs were also obtained from each patient to confirm influenza A (A/H1 and A/H3 subtypes) or influenza B (Yamagata and Victoria lineages) infection by real-time reverse-transcription polymerase chain reaction assay.ResultsThe study included 502 patients, many (45.2%) of whom were aged < 5 years. Overall, 108 patients (21.5%) had one or more comorbidities. Seventeen adults aged 18–64 years (3.4%) had been vaccinated against influenza. Patients were hospitalized for a median of 5 days and most (90.4%) were prescribed antiviral treatment. More than one-half of the patients (n = 259, 51.6%) were positive for influenza. Most influenza cases were caused by B viruses (172/259, 66.4%), which were mostly of the B/Yamagata lineage (85 of 94 characterized, 90.4%). Most of the subtyped A viruses were A/H1 (59/74, 79.7%). A/H1 viruses were frequently detected in influenza-positive admissions throughout the 2017–2018 season, whereas the predominant B/Yamagata viruses were detected around the middle of the season, with a peak in cases at week 7 of 2018. Eleven patients were admitted to an intensive care unit; of these, one patient with confirmed B/Yamagata infection died.ConclusionsThese results show that seasonal influenza results in considerable hospitalization in Bucharest-Ilfov, Romania and suggest vaccine coverage should be extended, especially to the youngest age groups. The data from this study should help inform and optimize national influenza healthcare policies.

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“…In our population, we have seen a predominance of pediatric patients among cases of LCI. While this may reflect to a certain extent a real increased circulation of influenza viruses among young children, who are known to be a risk group for influenza, this may also be driven at least in part by an increased addressability of pediatric patients with ILI to tertiary care rather than primary care services in our country, as previously discussed [19,20]. Furthermore, a potential propensity towards managing fever and administering antiviral treatment in children in the hospital rather than as outpatients cannot be ruled out, and this is probably reflected in the rather short 5 days median length of hospitalization in infants and toddlers.…”

Section: Plos Onementioning

confidence: 87%

Clinical and molecular epidemiology of influenza viruses from Romanian patients hospitalized during the 2019/20 season

et al. 2021

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Two main mechanisms contribute to the continuous evolution of influenza viruses: accumulation of mutations in the hemagglutinin and neuraminidase genes (antigenic drift) and genetic re-assortments (antigenic shift). Epidemiological surveillance is important in identifying new genetic variants of influenza viruses with potentially increased pathogenicity and transmissibility. In order to characterize the 2019/20 influenza epidemic in Romania, 1042 respiratory samples were collected from consecutive patients hospitalized with acute respiratory infections in the National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, Bucharest Romania and tested for influenza A virus, influenza B virus and respiratory syncytial virus (RSV) by real-time PCR. Out of them, 516 cases were positive for influenza, with relatively equal distribution of influenza A and B. Two patients had influenza A and B co-infection and 8 patients had influenza-RSV co-infection. The most severe cases, requiring supplemental oxygen administration or intensive care, and the most deaths were reported in patients aged 65 years and over. Subtyping showed the predominance of A(H3N2) compared to A(H1N1)pdm09 pdm09 (60.4% and 39.6% of all subtyped influenza A isolates, respectively), and the circulation of Victoria B lineage only. Influenza B started to circulate first (week 47/2019), with influenza A appearing slightly later (week 50/2019), followed by continued co-circulation of A and B viruses throughout the season. Sixty-eight samples, selected to cover the entire influenza season and all circulating viral types, were analysed by next generation sequencing (NGS). All A(H1N1)pdm09 sequences identified during this season in Romania were clustered in the 6b1.A clade (sub-clades: 6b1.A.183P -5a and 6b1.A.187A). For most A(H1N1)pdm09 sequences, the dominant epitope was Sb (pepitope = 0.25), reducing the vaccine efficacy by approximately 60%. According to phylogenetic analysis, influenza A(H3N2) strains circulating in this season belonged predominantly to clade 3C.3A, with only few sequences in clade 3C.2A1b. These 3C.2A1b sequences, two of which belonged to vaccinated patients, harbored mutations in antigenic sites leading to potential reduction of vaccine efficacy. Phylogenetic analysis of influenza B, lineage Victoria, sequences showed that the circulating strains belonged to clade V1A3. As compared to the other viral types, fewer mutations were observed in B/Victoria strains, with limited impact on vaccine efficiency based on estimations.

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Pneumococcal Colonization and Pneumococcal Disease in Children with Influenza Clinical, laboratory and epidemiological features

Cited by 7 publications

References 0 publications

Surveillance of medically‐attended influenza in elderly patients from Romania—data from three consecutive influenza seasons (2015/16, 2016/17, and 2017/18)

Surveillance of medically‐attended influenza in elderly patients from Romania—data from three consecutive influenza seasons (2015/16, 2016/17, and 2017/18)

The 2017–2018 influenza season in Bucharest, Romania: epidemiology and characteristics of hospital admissions for influenza-like illness

Clinical and molecular epidemiology of influenza viruses from Romanian patients hospitalized during the 2019/20 season

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