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Please cite this paper as: Wong et al. (2012) Cigarette smoking as a risk factor for influenza-associated mortality: evidence from an elderly cohort. Influenza and Other Respiratory Viruses 7(4), 531-539. Background The effects of individual lifestyle factors on the mortality risk after influenza infection have not been explored. Objectives In this study, we assessed the modifying effects of cigarette smoking on mortality risks associated with influenza in a cohort of Hong Kong elders with a follow-up period of 1998-2009. Methods We used the Cox proportional hazards model with time-dependent covariates of weekly proportions of specimens positive for influenza (termed as influenza virus activity), to calculate the hazard ratio of mortality associated with a 10% increase in influenza virus activity for never, ex- and current smokers. Other individual lifestyle and socioeconomic factors as well as seasonal confounders were also added into the models. Results The overall hazard ratio associated with influenza was 1·028 (95% confidence interval, 1·006, 1·051) for all natural cause mortality and 1·035 (1·003, 1·068) for cardiovascular and respiratory mortality. We found that influenza-associated hazard ratio was greater in current and ex-smokers than in never smokers for mortality of all natural causes, cardiovascular and respiratory diseases. Conclusions The findings suggest that smoking might increase influenza-associated mortality risks among elders. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Pepin et al. (2012) Multiannual patterns of influenza A transmission in Chinese live bird market systems. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2012.00354.x. Background Avian influenza viruses (AIV) cause huge economic losses in poultry industries and pose a substantial threat to human health. However, predicting AIV epizootics and emergence in humans is confounded by insufficient empirical data on the ecology and dynamics of AIV in poultry systems. To address this gap, we quantified incidence patterns for 13 hemagglutinin subtypes of AIV using 6 years of surveillance data that were collected from ten different species of poultry and three different types of poultry holdings (contexts) - retail, wholesale, or farms. Methods We collected 42 646 samples in Shantou, China between 2000 and 2006. We screened samples for hemagglutinin subtypes 1-13 of AIV and Avian Paramyxovirus-type-1 (APMV-1) using monospecific antisera in hemagglutination inhibition tests. We analyzed the data to determine seasonality patterns, subtype-host, and subtype-subtype interactions as well as subtype bias in incidence in different contexts. Results H3, H6, H9, and APMV-1 were the most prevalent. No significant seasonality was found when all subtypes were considered together. For most AIV subtypes and APMV-1, there was subtype specificity for host, context, and coinfection partner. H5 showed the most generalized host usage pattern, followed by H9 and H6. Conclusion Subtype-specific patterns because of host, context, and other subtypes suggest that risk assessments that exclude these details are likely inaccurate. Surveillance should include longitudinal sampling of multiple host species in multiple contexts. Quantitative models of control strategies must consider multiple subtypes, hosts, and source contexts to assess the effectiveness of interventions. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Yang et al. (2011) Seroprevalence of pandemic (H1N1) 2009 influenza and effectiveness of 2010/2011 influenza vaccine during 2010/2011 season in Beijing, China. Influenza and Other Respiratory Viruses 6(6), 381-388. Background In the post-pandemic period, pandemic (H1N1) 2009 virus was expected to circulate seasonally and was introduced into trivalent influenza vaccine during 2010/2011 season in the Northern Hemisphere. Objectives The aim of this study was to examine the evolution of herd immunity against pandemic (H1N1) 2009 virus in Beijing, China, during 2010/2011 season and effectiveness of the 2010/2011 trivalent vaccine. Methods Two serological surveys were conducted before and after 2010/2011 season in Beijing. A case-control study was used to investigate vaccine effectiveness against influenza-like illness (ILI) and lower respiratory tract infection (LRI). Results A total of 4509 and 4543 subjects participated in the pre- and post-season surveys, respectively. The standardized seroprevalence of pandemic (H1N1) 2009 influenza increased from 22·1% pre-season to 24·3% post-season ( P < 0·001). Significant elevation in seroprevalence appeared in the ≥60 years age-group ( P < 0·001), but not in others. The 2010/2011 trivalent vaccine contributed to the higher post-seasonal seroprevalence in unvaccinated individuals ( P = 0·024), but not in those vaccinated with monovalent pandemic vaccine ( P = 0·205), as well as in those without prior immunity versus those with immunity. The adjusted effectiveness of the 2010/2011 trivalent vaccine was 79% protection against ILI (95% CI, 61-89%) and 95% against LRI (95% CI: 59-99%). Conclusions A slight increase in herd immunity against pandemic (H1N1) 2009 influenza was observed in Beijing, China, during the 2010/2011 season. Prior vaccination and immunity had a suppressive impact on immune response toward this novel influenza virus, elicited by 2010/2011 trivalent vaccine. This trivalent vaccine conferred good protection against ILI and LRI. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Mak et al. (2012) The impact of pandemic influenza A (H1N1) 2009 on the circulation of respiratory viruses 2009-2011. Influenza and Other Respiratory Viruses 6(3), e6-e10. Surveillance of respiratory viruses has been conducted for many years at the public health laboratory in Hong Kong. With the occurrence of pandemic influenza A (H1N1) 2009, we observed a change in the seasonality of influenza activity with a seemingly corresponding change in the activity of respiratory syncytial virus, parainfluenza virus, and adenovirus during 2009-2011. This phenomenon could most likely be explained by virus interference. [ABSTRACT FROM AUTHOR]

Please cite this paper as: MacIntyre et al. (2011) A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2010.00198.x. We compared the efficacy of medical masks, N95 respirators (fit tested and non fit tested), in health care workers (HCWs). A cluster randomized clinical trial (RCT) of 1441 HCWs in 15 Beijing hospitals was performed during the 2008/2009 winter. Participants wore masks or respirators during the entire work shift for 4 weeks. Outcomes included clinical respiratory illness (CRI), influenza-like illness (ILI), laboratory-confirmed respiratory virus infection and influenza. A convenience no-mask/respirator group of 481 health workers from nine hospitals was compared. The rates of CRI (3·9% versus 6·7%), ILI (0·3% versus 0·6%), laboratory-confirmed respiratory virus (1·4% versus 2·6%) and influenza (0·3% versus 1%) infection were consistently lower for the N95 group compared to medical masks. By intention-to-treat analysis, when P values were adjusted for clustering, non-fit-tested N95 respirators were significantly more protective than medical masks against CRI, but no other outcomes were significant. The rates of all outcomes were higher in the convenience no-mask group compared to the intervention arms. There was no significant difference in outcomes between the N95 arms with and without fit testing. Rates of fit test failure were low. In a post hoc analysis adjusted for potential confounders, N95 masks and hospital level were significant, but medical masks, vaccination, handwashing and high-risk procedures were not. Rates of infection in the medical mask group were double that in the N95 group. A benefit of respirators is suggested but would need to be confirmed by a larger trial, as this study may have been underpowered. The finding on fit testing is specific to the type of respirator used in the study and cannot be generalized to other respirators. Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN: ACTRN12609000257268 (). [ABSTRACT FROM AUTHOR]

Please cite this paper as: Wang et al. (2010) Emergency surveillance of influenza during 2009 in the Chinese city of Qingdao. Influenza and Other Respiratory Viruses 5(1), 53-59. In April, 2009, a new influenza pandemic caused by a swine-origin H1N1 subtype influenza virus was imminent. We thereby carried out an emergency surveillance study in a Chinese city of Qingdao. Pharyngeal swab samples were collected from four targeted groups and tested by reverse-transcription polymerase chain reaction. Each laboratory-confirmed pandemic H1N1 case or cluster was investigated, and the hemagglutinin genes of some of the viruses were sequenced and analyzed. A total of 140 pandemic H1N1 cases including 92 from 7 clusters were identified in the four targeted groups. None of them developed into severe infections. Meanwhile, 103 cases of seasonal influenza (98 H3N2 and 5 H1N1) and 10 clusters of seasonal H3N2 influenza were also identified. Among them, 38 pandemic H1N1 and two seasonal H3N2 influenza cases were air travellers, suggesting that air travel facilitates the spread of pandemic and seasonal influenza even in the northern hemisphere summer. In addition, it was found that pandemic H1N1 and seasonal H3N2 influenza viruses co-circulated in two clusters. No significant mutations were found in the hemagglutinin gene sequences of pandemic H1N1 viruses, but the seasonal H3N2 influenza viruses have become genetically distinguishable from those circulating in 2007-2008. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Huai et al. (2010) A primary school outbreak of pandemic 2009 influenza A (H1N1) in China. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2010.00150.x. Background We investigated the first known outbreak of pandemic 2009 influenza A (H1N1) at a primary school in China. Objectives To describe epidemiologic findings, identify risk factors associated with 2009 H1N1 illness, and inform national policy including school outbreak control and surveillance strategies. Methods We conducted retrospective case finding by reviewing the school’s absentee log and retrieving medical records. Enhanced surveillance was implemented by requiring physicians to report any influenza-like illness (ILI) cases to public health authorities. A case–control study was conducted to detect potential risk factors for 2009 H1N1 illness. A questionnaire was administered to 50 confirmed cases and 197 age-, gender-, and location-matched controls randomly selected from student and population registries. Results The attack rate was 4% (50/1314), and children from all grades were affected. When compared with controls, confirmed cases were more likely to have been exposed to persons with respiratory illness either in the home or classroom within 7 days of symptom onset (OR, 4·5, 95% CI: 1·9–10·7). No cases reported travel or contact with persons who had traveled outside of the country. Conclusions Findings in this outbreak investigation, including risk of illness associated with contacting persons with respiratory illness, are consistent with those reported by others for seasonal influenza and 2009 H1N1 outbreaks in school. The outbreak confirmed that community-level transmission of 2009 H1N1 virus was occurring in China and helped lead to changes in the national pandemic policy from containment to mitigation. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Belshe et al. (2010). Efficacy of live attenuated influenza vaccine in children 6 months to 17 years of age. Influenza and Other Respiratory Viruses 4(3), 141–145. Background It has been suggested that live attenuated influenza vaccine (LAIV) may be less effective in older individuals because of prior wild-type influenza infections. LAIV is currently approved in the United States, South Korea and Hong Kong for individuals 2–49 years of age. Objective To examine data from previously published pediatric studies to determine the efficacy of LAIV in various age groups. Methods Four studies in which the subject age range exceeded 36 months were identified: one 2-year study comparing LAIV with placebo and three 1-year studies comparing LAIV with trivalent inactivated influenza vaccine (TIV). Efficacy against any strain regardless of antigenic similarity to vaccine was analyzed by age; age groups were based on the study design and sample size. A logistic regression model was used to assess whether age, as a continuous variable, was an effect modifier on LAIV efficacy. Results The efficacy of LAIV did not vary with age in children aged 15–84 months compared with placebo or in children aged 6 months to 17 years compared with TIV. Conclusions The available data from prospective, randomized studies in children does not support the concept that prior repeated exposure to influenza, either through wild-type infection or vaccination with live, attenuated or inactivated vaccines, reduces the efficacy of LAIV compared with placebo or TIV. The decreased immunologic responses to LAIV reported in older individuals or those with pre-existing immunity do not appear to translate into reduced protection from influenza in children. [ABSTRACT FROM AUTHOR]