The burden of laboratory-confirmed influenza infection in Lebanon between 2008 and 2016: a single tertiary care center experience

Assaf-Casals, Aia; Saleh, Zeina M.; Khafaja, Sarah; Fayad, Danielle; Ezzeddine, Hady; Saleh, Marwa; Chamseddine, Sarah; Sayegh, Rouba; Sharara, Sima L.; Chmaisse, Ahmad; Kanj, Souha S.; Kanafani, Zeina A.; Hanna-Wakim, Rima; Araj, George F.; Mahfouz, Rami; Saito, Reiko; Sano, Hiroshi; Zaraket, Hassan; Dbaibo, Ghassan

doi:10.1186/s12879-020-05013-7

Cited by 8 publications

(8 citation statements)

References 76 publications

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“…The proportion of hospitalized severe influenza cases admitted to the ICU was 16.6% (17.8% for influenza A cases and 15.9% for influenza B cases), figures close to the 15.4% (23% for influenza A cases and 12.7% for influenza B cases) obtained by Stahl et al 39 in Germany in the same influenza season, and the 13.4% for influenza A cases and 17.8% for influenza B cases obtained by Assaf-Casals et al 24 in Lebanon during 2008–2016. Other authors studying severe patients have found higher figures 29 , but the differences in criteria for hospitalization might, at least in part, explain the differences.…”

Section: Discussionsupporting

confidence: 82%

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Behavior of hospitalized severe influenza cases according to the outcome variable in Catalonia, Spain, during the 2017–2018 season

Soldevila

Acosta

Martı́nez

et al. 2021

Sci Rep

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Influenza is an important cause of severe illness and death among patients with underlying medical conditions and in the elderly. The aim of this study was to investigate factors associated with ICU admission and death in patients hospitalized with severe laboratory-confirmed influenza during the 2017–2018 season in Catalonia. An observational epidemiological case-to-case study was carried out. Reported cases of severe laboratory-confirmed influenza requiring hospitalization in 2017–2018 influenza season were included. Mixed-effects regression analysis was used to estimate the factors associated with ICU admission and death. A total of 1306 cases of hospitalized severe influenza cases were included, of whom 175 (13.4%) died and 217 (16.6%) were ICU admitted. Age 65–74 years and ≥ 75 years and having ≥ 2 comorbidities were positively associated with death (aOR 3.19; 95%CI 1.19–8.50, aOR 6.95, 95%CI 2.76–1.80 and aOR 1.99; 95%CI 1.12–3.52, respectively). Neuraminidase inhibitor treatment and pneumonia were negatively associated with death. The 65–74 years and ≥ 75 years age groups were negatively associated with ICU admission (aOR 0.41; 95%CI 0.23–0.74 and aOR 0.30; 95%CI 0.17–0.53, respectively). A factor positively associated with ICU admission was neuraminidase inhibitor treatment. Our results support the need to investigate the worst outcomes of hospitalized severe cases, distinguishing between death and ICU admission.

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Section: Discussionsupporting

confidence: 82%

“…The risk of death increased in the 65–74 years and ≥ 75 years age groups, coinciding with the findings of most studies reviewed 12 , 17 – 23 , although some authors found no differences in mortality according to age 24 .…”

Section: Discussionsupporting

confidence: 77%

Behavior of hospitalized severe influenza cases according to the outcome variable in Catalonia, Spain, during the 2017–2018 season

Soldevila

Acosta

Martı́nez

et al. 2021

Sci Rep

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“…In-person schooling in Lebanon was stopped on March 18, 2020 and remained remote for the duration of the period. This, along with other physical distancing measures and the general adherence of the public to masks and hand hygiene measures, that occurred aggressively and early in our setting, likely resulted in sudden drops of communicable disease, particularly influenza in spite of having the post-COVID-19 period coincide with the typical influenza season in Lebanon [ 21 ]. This is further supported by the association of a significant drop in overall ED visits after closure of in-person educational institutions including schools and universities.…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 lockdown measures on ED visits in Lebanon

Mahmassani

Tamim

Makki

et al. 2021

The American Journal of Emergency Medicine

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Introduction As the COVID-19 pandemic spread globally, emergency departments (ED) around the world began to report significant drops in volumes and changes in disease patterns. During the early COVID-19 period, Lebanon followed an aggressive containment approach to halt the spread of the disease. Objective This study aims to examine the impact of the different national containment measures and the early COVID-19 outbreak in Lebanon on ED visit volume and disease spectrum in a single center ED in Lebanon. Methods This study is a secondary analysis of ED visit administrative data, comparing ED visits during the three months period prior to the first identified COVID-19 case in Lebanon with the first 3 months post-COVID-19. A time series analysis of ED visit trends in relation to the major lockdown measures was conducted. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS, version 27) and STATA version 15 (StataCorp LLC., College Station,TX). Statistical significance was set at 0.05. Results The daily ED visit volume significantly decreased in response to the closure of educational institutions (19.96% per day, p -value = 0.04) and the declaration of public mobilization state with border closure (97.11% per day, p -value <0.0001). ED visits decreased by 47.2% post-COVID-19. The drop was highest amongst pediatric patients (66.64%). Patients who presented post-COVID-19, compared to pre-COVID-19 were older (40.39 ± 24.96 vs 33.71 ± 24.83, p -value <0.0001), had higher hospital admission rates (28.8% vs. 22.1%, p-value <0.0001), higher critical care admission rates (5.6% vs. 3.5%, p-value <0.001), and double mortality rate (0.4% vs 0.2%, p-value = 0.006). While visits for most diseases dropped, the odds of presenting to the ED post-COVID19 were higher for bacterial infections and non-communicable disease and lower for injuries and communicable diseases. Conclusion ED visits dropped significantly during the COVID-19 containment period. Understanding the trends of changes in disease entities is important for ED staffing purposes during the pandemic and the varying containment efforts. While stringent lockdown measures were associated with drops in ED visits, understanding the reason behind these drops, specifically whether behavioral or related to true drops in disease prevalence, needs further exploration.

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“…To our knowledge, this study is the first in Lebanon to explore vaccination rates and attitudes towards influenza vaccination among university students in three influenza seasons, using interventional awareness and descriptive surveys. In Lebanon, which has a burden of laboratory-confirmed influenza of about 14% and mortality of 3.8% [ 17 ], and with crises severely impacting the once top-tier healthcare system [ 18 ], an investigation of influenza vaccination status is important. In 2022, a meta-analysis of global influenza vaccination recommended more studies on this topic from the Eastern Mediterranean region [ 19 ], indicating that a profound understanding of influenza vaccination uptake and attitudes from our area is critical.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Influenza Vaccination Uptake and Attitudes among Lebanese University Students: The Impact of Vaccination Promotional Programs and COVID-19 Pandemic

Mourad

Halat

et al. 2023

Vaccines

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Vaccination is the most effective preventative strategy against influenza, yet university students’ influenza vaccination uptake remains low. This study aimed firstly to determine the percentage of university students who were vaccinated for the 2015–2016 influenza season and to identify reasons for non-vaccination, and secondly to examine the impact of external factors (on-campus/online influenza awareness campaigns and COVID-19 pandemic) on their influenza vaccination uptake and attitudes for the 2017–2018 and 2021–2022 influenza seasons. A descriptive study was conducted over three phases for three influenza seasons at a Lebanese university in the Bekaa Region. Based on data collected in 2015–2016, promotional activities were developed and implemented for the other influenza seasons. This study was conducted using an anonymous, self-administered questionnaire by students. The majority of the respondents in the three studies did not receive the influenza vaccine (89.2% in the 2015–2016 study, 87.3% in the 2017–2018 study, and 84.7% in the 2021–2022 study). Among the unvaccinated respondents, the main reason for non-vaccination was that they thought that they did not need it. The primary reason for vaccination among those who were vaccinated was that they believed they were at risk of catching influenza in a 2017–2018 study and due to the COVID-19 pandemic in the 2021–2022 study. As for attitudes towards influenza vaccination post-COVID-19, significant differences were shown among the vaccinated and unvaccinated respondents. The vaccination rates among university students remained low despite of the awareness campaigns and COVID-19 pandemic.

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The burden of laboratory-confirmed influenza infection in Lebanon between 2008 and 2016: a single tertiary care center experience

Cited by 8 publications

References 76 publications

Behavior of hospitalized severe influenza cases according to the outcome variable in Catalonia, Spain, during the 2017–2018 season

Behavior of hospitalized severe influenza cases according to the outcome variable in Catalonia, Spain, during the 2017–2018 season

The impact of COVID-19 lockdown measures on ED visits in Lebanon

Factors Affecting Influenza Vaccination Uptake and Attitudes among Lebanese University Students: The Impact of Vaccination Promotional Programs and COVID-19 Pandemic

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