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Background Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. Methods and findings We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: 'influenza' AND 'cost' OR 'economic.' The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. Conclusions The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs., Author(s): Radhika Gharpure 1,*, Anna N. Chard 1, Maria Cabrera Escobar 2, Weigong Zhou 1, Molly M. Valleau 1, Tat S. Yau 1, Joseph S. Bresee 2, Eduardo Azziz-Baumgartner 1, [...]

Transplant recipients are among the groups for whom the updated recommendations for 2020–2021 influenza vaccination should generally be considered essential, notably in the face of the COVID-19 pandemic.

Objective To assess the stability of improvements in global respiratory virus surveillance in countries supported by the United States Centers for Disease Control and Prevention (CDC) after reductions in CDC funding and with the stress of the coronavirus disease 2019 (COVID-19) pandemic. Methods We assessed whether national influenza surveillance systems of CDC-funded countries: (i) continued to analyse as many specimens between 2013 and 2021; (ii) participated in activities of the World Health Organization's (WHO) Global Influenza Surveillance and Response System; (iii) tested enough specimens to detect rare events or signals of unusual activity; and (iv) demonstrated stability before and during the COVID-19 pandemic. We used CDC budget records and data from the WHO Global Influenza Surveillance and Response System. Findings While CDC reduced per-country influenza funding by about 75% over 10 years, the number of specimens tested annually remained stable (mean 2261). Reporting varied substantially by country and transmission zone. Countries funded by CDC accounted for 71% (range 61-75%) of specimens included in WHO consultations on the composition of influenza virus vaccines. In 2019, only eight of the 17 transmission zones sent enough specimens to WHO collaborating centres before the vaccine composition meeting to reliably identify antigenic variants. Conclusion Great progress has been made in the global understanding of influenza trends and seasonality. To optimize surveillance to identify atypical influenza viruses, and to integrate molecular testing, sequencing and reporting of severe acute respiratory syndrome coronavirus 2 into existing systems, funding must continue to support these efforts. Objectif Evaluer la stabilite des ameliorations en matiere de surveillance mondiale des virus respiratoires dans les pays soutenus par les Centers for Disease Control and Prevention (CDC) des Etats-Unis d'Amerique, apres les baisses de financement des CDC et avec le stress cause par la pandemie de maladie a coronavirus 2019 (COVID-19). Methodes Nous avons examine les mecanismes nationaux de surveillance de la grippe dans les pays finances par les CDC pour determiner: (i) s'ils continuaient a analyser le meme nombre d'echantillons entre 2013 et 2021; (ii) s'ils participaient a des activites du Systeme mondial de surveillance de la grippe et de riposte mis en place par l'Organisation mondiale de la Sante (OMS); (iii) s'ils testaient suffisamment d'echantillons pour detecter des evenements rares ou des signes d'activite inhabituelle; et enfin, (iv) s'ils faisaient preuve de stabilite avant et pendant la pandemie de maladie a coronavirus 2019 (COVID-19). Nous avons utilise les documents budgetaires des CDC, ainsi que les donnees du Systeme mondial OMS de surveillance de la grippe et de riposte. Resultats Bien que les CDC aient reduit d'environ 75% leur financement aux differents pays pour etudier la grippe au cours de la decennie ecoulee, le nombre d'echantillons testes chaque annee est reste stable (2261 en moyenne). Les signalements variaient fortement en fonction du pays et de la zone de transmission. Les pays finances par les CDC representaient 71% (plage comprise entre 61% et 75%) des echantillons inclus dans les consultations de l'OMS sur la composition des vaccins contre les virus grippaux. En 2019, seulement huit des 17 zones de transmission ont envoye suffisamment d'echantillons aux centres collaborant avec l'OMS pour identifier avec certitude les variants antigeniques avant la reunion sur la composition des vaccins. Conclusion Des progres considerables ont ete realises en matiere de comprehension des tendances et du caractere saisonnier de la grippe. Neanmoins, le financement doit se poursuivre afin d'ameliorer la surveillance et, par consequent, d'identifier les virus grippaux atypiques, mais aussi d'integrer les tests moleculaires, le sequencage et le signalement du coronavirus 2 du syndrome respiratoire aigu severe dans les systemes existants. Objetivo Valorar la estabilidad de las mejoras en la vigilancia mundial de los virus respiratorios en los paises que reciben apoyo de los Centros para el Control y la Prevencion de Enfermedades (CDC) de los Estados Unidos despues de las reducciones en la financiacion de los CDC y ante la situacion de estres por la pandemia de la enfermedad por coronavirus de 2019 (COVID-19). Metodos Se analizo si los sistemas nacionales de vigilancia de la influenza de los paises que reciben fondos de los CDC: i) seguian analizando la misma cantidad de muestras entre 2013 y 2021; ii) participaban en las actividades del Sistema Mundial de Vigilancia y Respuesta a la Gripe de la Organizacion Mundial de la Salud (OMS); iii) analizaban suficientes muestras para detectar acontecimientos raros o senales de actividad inusual; y iv) demostraban estabilidad antes y durante la pandemia de la enfermedad por coronavirus de 2019 (COVID-19). Se utilizaron los registros de presupuesto de los CDC y los datos del Sistema Mundial de Vigilancia y Respuesta a la Gripe de la OMS. Resultados Aunque los CDC redujeron los fondos destinados a la gripe por pais en casi un 75 % a lo largo de 10 anos, el numero de muestras analizadas al ano se mantuvo estable (media de 2261). Los informes variaron de manera sustancial segun el pais y la zona de transmision. Los paises que recibieron financiacion de los CDC representaron el 71 % (rango entre el 61 y el 75 %) de las muestras incluidas en las consultas de la OMS sobre la composicion de las vacunas antigripales. En 2019, solo ocho de las 17 zonas de transmision enviaron suficientes muestras a los centros colaboradores de la OMS antes de la reunion sobre la composicion de la vacuna para identificar de una manera fiable las variantes antigenicas. Conclusion Se ha logrado un gran progreso en la comprension global de las tendencias y la estacionalidad de la gripe. Para optimizar la vigilancia con el fin de identificar los virus atipicos de la gripe e integrar las pruebas moleculares, la secuenciacion y la notificacion del coronavirus del sindrome respiratorio agudo grave de tipo 2 en los sistemas existentes, la financiacion debe seguir apoyando estos esfuerzos. [phrase omitted], Introduction Global surveillance of influenza guides prevention and control decisions and monitors pandemic threats. Investment in global capacity-building for influenza surveillance was prompted by concerns about the pandemic potential of [...]

Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory specimens that recurs over extended time intervals might indicate viral RNA persistence, continued viral replication, reinfection, or sample [...]

Pregnancy is associated with increased risk for severe illness and complications associated with influenza infection. Insufficient knowledge about the risk for influenza among pregnant women and their health care providers in China is an important barrier to increasing influenza vaccination coverage and treating influenza and its complications among pregnant women. Improved influenza incidence estimates might promote wider vaccine acceptance and higher vaccination coverage. In Suzhou, active population-based surveillance during October 2018–September 2023 estimated that the annual rate of hospitalization for acute respiratory or febrile illness (ARFI) among women who were pregnant or <2 weeks postpartum was 11.1 per 1,000 live births; the annual rate of laboratoryconfirmed influenza-associated ARFI (influenza ARFI) hospitalization in this group was 2.1 per 1,000 live births. A majority of hospitalized pregnant or early postpartum patients with ARFI (82.6%; 2,588 of 3,133) or influenza ARFI (85.5%; 423 of 495) were admitted to obstetrics wards rather than respiratory medicine wards. Only one (0.03%) pregnant or postpartum ARFI patient had received influenza vaccination, and 31.3% of pregnant or postpartum women hospitalized for influenza ARFI received antiviral treatment; the lowest percentage of hospitalized women with influenza ARFI who received antiviral treatment was among women admitted to obstetrics and gynecology wards (29.6% and 23.1%, respectively), compared with 54.1% of those admitted to a respiratory medicine ward. These findings highlight the risk for influenza and its associated complications among pregnant and postpartum women, the low rates of influenza vaccination among pregnant women, and of antiviral treatment of women with ARFI admitted to obstetrics and gynecology wards. Increasing awareness of the prevalence of influenza ARFI among pregnant women, the use of empiric antiviral treatment for ARFI, and the infection control in obstetrics wards during influenza seasons might help reduce influenza-associated morbidity among pregnant and postpartum women. [ABSTRACT FROM AUTHOR]

Annual circulation of influenza viruses causes substantial disease and death worldwide, disproportionately affecting young children and older adults (2,2). Globally, influenza causes [approximately equal to] 9.4 million hospitalizations each year [...]

Background: There is limited information about how on-line screening tools developed by integrated systems facilitated management of COVID-like illness patients. Methods: Using the Kaiser Permanente Northwest (KPNW) Electronic Health Record, we identified adult plan members who accessed online COVID-19 screening e-visits and enumerated their subsequent medical encounters, tests for SARS-CoV-2, and test outcomes. Results: Between May 2020 and December 2021, members completed 55,139 e-visits, with disproportionate representation among females (65% vs. 53% in the overall membership) and members aged <45 years (61% vs. 39%). Thirty percent of patients (16,953) were managed entirely through e-visits and 70% received subsequent in-person care. The percent of SARS-CoV-2 positive individuals was highest among the 1055 individuals triaged to inpatient care (17.9%), compared to 9.5% among those escalated to additional ambulatory care. Conclusions: The e-visit on-line screening tool helped KPNW assist thousands of patients with COVID-19 symptoms, avoid unnecessary in-person patient encounters, and preserved KPNW infection control and pandemic surge capacity. [ABSTRACT FROM AUTHOR]

Background: Global influenza‐associated acute respiratory infections contribute to 3–5 million severe illnesses requiring hospitalization annually, with 90% of hospitalizations occurring among children < 5 years in developing countries. In Bangladesh, the inadequate availability of nationally representative, robust estimates of influenza‐associated hospitalizations limits allocation of resources for prevention and control measures. Methods: This study used data from the hospital‐based influenza surveillance (HBIS) system in Bangladesh from 2010 to 2019 and healthcare utilization surveys to determine hospital utilization patterns in the catchment area. We estimated annual influenza‐associated hospitalization numbers and rates for all age groups in Bangladesh using WHO methods, adjusted for a 6‐day‐a‐week enrollment schedule, selective testing of specimens from children under five, and healthcare‐seeking behavior, based on the proportion of symptomatic community participants seeking healthcare within the past week. We then estimated national hospitalization rates by multiplying age‐specific hospitalization rates with the corresponding annual national census population. Results: Annual influenza‐associated hospitalization rates per 100,000 population for all ages ranged from 31 (95% CI: 27–36) in 2011 to 139 (95% CI: 130–149) in 2019. Children < 5 years old had the highest rates of influenza‐associated hospitalization, ranging from 114 (95% CI: 90–138) in 2011 to 529 (95% CI: 481–578) in 2019, followed by adults aged ≥ 65 years with rates ranging from 46 (95% CI: 34–57) in 2012 to 252 (95% CI: 213–292) in 2019. The national hospitalization estimates for all ages during 2010–2019 ranged from 47,891 to 236,380 per year. Conclusions: The impact of influenza‐associated hospitalizations in Bangladesh may be considerable, particularly for young children and older adults. Targeted interventions, such as influenza vaccination for these age groups, should be prioritized and evaluated. [ABSTRACT FROM AUTHOR]

Highly pathogenic avian influenza A(H5N1) virus causes outbreaks in poultry and sporadic infections in humans globally (2,2). H5N1 virus is endemic to poultry in several countries in Southeast Asia, including [...]

Information about the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among hospitalized pregnant women is available (1), but information about incidence among pregnant women in the community [...]

Background: Limited data exists regarding risk factors for adverse outcomes in older adults hospitalized with Community-Acquired Pneumonia (CAP) in low- and middle-income countries such as India. This multisite study aimed to assess outcomes and associated risk factors among adults aged ≥60 years hospitalized with pneumonia. Methods: Between December 2018 and March 2020, we enrolled ≥60-year-old adults admitted within 48 hours for CAP treatment across 16 public and private facilities in four sites. Clinical data and nasal/oropharyngeal specimens were collected by trained nurses and tested for influenza, respiratory syncytial virus (RSV), and other respiratory viruses (ORV) using the qPCR. Participants were evaluated regularly until discharge, as well as on the 7th and 30th days post-discharge. Outcomes included ICU admission and in-hospital or 30-day post-discharge mortality. A hierarchical framework for multivariable logistic regression and Cox proportional hazard models identified risk factors (e.g., demographics, clinical features, etiologic agents) associated with critical care or death. Findings: Of 1,090 CAP patients, the median age was 69 years; 38.4% were female. Influenza viruses were detected in 12.3%, RSV in 2.2%, and ORV in 6.3% of participants. Critical care was required for 39.4%, with 9.9% in-hospital mortality and 5% 30-day post-discharge mortality. Only 41% of influenza CAP patients received antiviral treatment. Admission factors independently associated with ICU admission included respiratory rate >30/min, blood urea nitrogen>19mg/dl, altered sensorium, anemia, oxygen saturation <90%, prior cardiovascular diseases, chronic respiratory diseases, and private hospital admission. Diabetes, anemia, low oxygen saturation at admission, ICU admission, and mechanical ventilation were associated with 30-day mortality. Conclusion: High ICU admission and 30-day mortality rates were observed among older adults with pneumonia, with a significant proportion linked to influenza and RSV infections. Comprehensive guidelines for CAP prevention and management in older adults are needed, especially with the co-circulation of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

In April 2017, the Institute of Epidemiology Disease Control and Research (IEDCR) in Bangladesh noted an 89% increase in severe acute respiratory infections (SARI) compared with April 2016 through the [...]