Retrospective study of the use of an influenza disease two-tiered classification system to characterize clinical severity in US children

Hsiao, Amber; Buck, Philip O.; Yee, Arnold; Hansen, John; Lewis, Edwin; Aukes, Laurie; Yanni, Emad; Bekkat-Berkani, Rafik; Schuind, Anne; Klein, Nicola P.

doi:10.1080/21645515.2019.1706412

Cited by 3 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…where fever, sore throat, and cough equal 1 on days they were reported and 0 on days they were not (Figure 1B). Fever was weighted more heavily as a proxy for increased clinical severity [26–28]. We also defined an alternative score, S ANY , that accounted for any sign or symptom assessed in the diaries.…”

Section: Methodsmentioning

confidence: 99%

“…We also defined an alternative score, S ANY , that accounted for any sign or symptom assessed in the diaries. In this score, shortness of breath and wheezing were more heavily weighted, in addition to fever, to include greater lower respiratory tract involvement as a proxy for severity (Figure 1C) [26, 27, 29]. A value of 3 was assigned if at least one of fever, shortness of breath, or wheezing were reported; this value did not increase if more than one was reported.…”

Section: Methodsmentioning

confidence: 99%

“…We translated these diaries into a quantitative score, SILI, that measured the sum of influenza-like-illness (ILI) signs or symptoms reported on each day as SILI = 3 (fever) + sore throat + cough, where fever, sore throat, and cough equal 1 on days they were reported and 0 on days they were not (Figure 1B). Fever was weighted more heavily as a proxy for increased clinical severity [26][27][28]. We also defined an alternative score, SANY, that accounted for any sign or symptom assessed in the diaries.…”

Section: Symptom Scoresmentioning

confidence: 99%

See 2 more Smart Citations

Influenza virus shedding and symptoms: Dynamics and implications from a multi-season household transmission study

Morris,

Nguyen,

Grijalva

et al. 2024

Preprint

View full text Add to dashboard Cite

Isolation of symptomatic infectious persons can reduce influenza transmission. However, virus shedding that occurs without symptoms will be unaffected by such measures. Identifying effective isolation strategies for influenza requires understanding the interplay between individual virus shedding and symptom presentation. From 2017–2020, we conducted a case-ascertained household transmission study using influenza real-time reverse transcription quantitative PCR (RT-qPCR) testing of nasal swabs and daily symptom diary reporting for up to 7 days after enrollment (≤14 days after index onset). We assumed real-time RT-qPCR cycle threshold (Ct) values were indicators of quantitative virus shedding and used symptom diaries to create a score that tracked influenza-like-illness (ILI) symptoms (fever, cough, or sore throat). We fit phenomenological nonlinear mixed-effects models stratified by age and vaccination status and estimated two quantities influencing isolation effectiveness: shedding before symptom onset and shedding that might occur once isolation ends. We considered different isolation end points (including 24 hours after fever resolution or 4 days after symptom onset) and assumptions about the infectiousness of Ct shedding trajectories. Of the 116 household contacts with ≥2 positive tests for longitudinal analyses, 105 (91%) experienced ≥1 ILI symptom. On average, children <5 years experienced greater peak shedding, longer durations of shedding, and elevated ILI symptom scores compared with other age groups. Most individuals (63/105) shed <10% of their total shed virus before symptom onset, and shedding after isolation varied substantially across individuals, isolation end points, and infectiousness assumptions. Our results can inform strategies to reduce transmission from symptomatic individuals infected with influenza.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Symptom Scoresmentioning

confidence: 99%

See 1 more Smart Citation

Influenza virus shedding and symptoms: Dynamics and implications from a multi-season household transmission study

Morris,

Nguyen,

Grijalva

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The residual CSF samples from patients in IANE group and in non-IANE group were used for detection of inflammatory cytokines. The criteria for severe influenza in this study were based on the Expert Consensus on Childhood Influenza Diagnosis and Treatment of China (2020 edition) as there is no generally accepted definition for moderate-to-severe influenza to date ( 7 ). Notably, to rule out autoimmune encephalitis, residual plasma samples from the seven patients with IANE were used to test for Abs associated with autoimmune encephalitis.…”

Section: Methodsmentioning

confidence: 99%

Cytokine Storm Related to CD4⁺ T Cells in Influenza Virus-Associated Acute Necrotizing Encephalopathy

Wang,

Wang

et al. 2024

Immune Netw

View full text Add to dashboard Cite

Acute necrotizing encephalopathy (ANE) is a rare but deadly complication with an unclear pathogenesis. We aimed to elucidate the immune characteristics of H1N1 influenza virus-associated ANE (IANE) and provide a potential therapeutic approach for IANE. Seven pediatric cases from a concentrated outbreak of H1N1 influenza were included in this study. The patients’ CD4 + T cells from peripheral blood decreased sharply in number but highly expressed Eomesodermin (Eomes), CD69 and PD-1, companied with extremely high levels of IL-6, IL-8 in the cerebrospinal fluid and plasma. Patient 2, who showed high fever and seizures and was admitted to the hospital very early in the disease course, received intravenous tocilizumab and subsequently showed a reduction in temperature and a stable conscious state 24 h later. In conclusion, a proinflammatory cytokine storm associated with activated CD4 + T cells may cause severe brain pathology in IANE. Tocilizumab may be helpful in treating IANE.

show abstract

Influenza virus shedding and symptoms: Dynamics and implications from a multiseason household transmission study

Morris,

Nguyen,

Grijalva

et al. 2024

PNAS Nexus

View full text Add to dashboard Cite

Isolation of symptomatic infectious persons can reduce influenza transmission. However, virus shedding that occurs without symptoms will be unaffected by such measures. Identifying effective isolation strategies for influenza requires understanding the interplay between individual virus shedding and symptom presentation. From 2017–2020, we conducted a case-ascertained household transmission study using influenza real-time reverse transcription quantitative PCR (RT-qPCR) testing of nasal swabs and daily symptom diary reporting for up to 7 days after enrollment (≤14 days after index onset). We assumed real-time RT-qPCR cycle threshold (Ct) values were indicators of quantitative virus shedding and used symptom diaries to create a score that tracked influenza-like-illness (ILI) symptoms (fever, cough, or sore throat). We fit phenomenological nonlinear mixed-effects models stratified by age and vaccination status and estimated two quantities influencing isolation effectiveness: shedding before symptom onset and shedding that might occur once isolation ends. We considered different isolation end points (including 24 hours after fever resolution or 5 days after symptom onset) and assumptions about the infectiousness of Ct shedding trajectories. Of the 116 household contacts with ≥2 positive tests for longitudinal analyses, 105 (91%) experienced ≥1 ILI symptom. On average, children <5 years experienced greater peak shedding, longer durations of shedding, and elevated ILI symptom scores compared with other age groups. Most individuals (63/105) shed <10% of their total shed virus before symptom onset, and shedding after isolation varied substantially across individuals, isolation end points, and infectiousness assumptions. Our results can inform strategies to reduce transmission from symptomatic individuals infected with influenza.

show abstract

Retrospective study of the use of an influenza disease two-tiered classification system to characterize clinical severity in US children

Abstract: Retrospective study of the use of an influenza disease two-tiered classification system to characterize clinical severity in US children, Human Vaccines & Immunotherapeutics,

Cited by 3 publications

References 18 publications

Influenza virus shedding and symptoms: Dynamics and implications from a multi-season household transmission study

Influenza virus shedding and symptoms: Dynamics and implications from a multi-season household transmission study

Cytokine Storm Related to CD4⁺ T Cells in Influenza Virus-Associated Acute Necrotizing Encephalopathy

Influenza virus shedding and symptoms: Dynamics and implications from a multiseason household transmission study

Contact Info

Product

Resources

About

Retrospective study of the use of an influenza disease two-tiered classification system to characterize clinical severity in US children

Abstract: Retrospective study of the use of an influenza disease two-tiered classification system to characterize clinical severity in US children, Human Vaccines & Immunotherapeutics,

Cited by 3 publications

References 18 publications

Influenza virus shedding and symptoms: Dynamics and implications from a multi-season household transmission study

Influenza virus shedding and symptoms: Dynamics and implications from a multi-season household transmission study

Cytokine Storm Related to CD4+ T Cells in Influenza Virus-Associated Acute Necrotizing Encephalopathy

Influenza virus shedding and symptoms: Dynamics and implications from a multiseason household transmission study

Contact Info

Product

Resources

About

Cytokine Storm Related to CD4⁺ T Cells in Influenza Virus-Associated Acute Necrotizing Encephalopathy