Search Results (65)

Surveillance of swine influenza A virus (swIAV) traditionally focuses on respiratory matrices, yet emerging evidence suggests that fecal shedding and secondary environmental contamination may also contribute to viral dissemination. In this study, we collected and analyzed nasal, rectal, environmental, milk, and colostrum samples from naturally infected pigs in a commercial farm in Minas Gerais, Brazil. IAV RNA was detected in 25% of samples, including 42% from asymptomatic animals, with nasal swabs showing higher detection rates (30%) than rectal swabs (20%), though rectal Ct values were consistently higher, indicative of lower viral loads. We successfully isolated viable viruses from feces and effluent samples. Whole-genome sequencing revealed co-circulation of enzootic pH1N1 clade #2 (HA) and pN1 clade #4 (NA), alongside human-origin H3N2 sequences clustering within clade 3C.2a1b.2a.2a.1, and N2 segments related to pre-3C human lineages from 2001 to 2002. Phylogenetic and p-distance analyses support both recent reverse zoonosis and historical transmission events. Detection of complete HA/NA sequences from rectal swabs and treated effluent further emphasizes the surveillance value of non-respiratory matrices. The integration of respiratory and fecal/environmental sampling appears important to achieve more comprehensive IAV monitoring in swine herds and may have significant implications for One Health strategies in Brazil and beyond. Full article

The uptake of the COVID-19 and seasonal influenza (SI) vaccines have decreased in Europe and especially in Malta. The present study aimed to investigate the attitudes toward COVID-19 and SI vaccines and determine if individuals perceive that these vaccines are relevant to protect their health and identify reasons for their responses. A cross-sectional study using an anonymous questionnaire, informed by the Theory of Planned Behavior, addressing behavior beliefs and attitudes, and targeted at adult residents in Malta, was designed on Google Forms and disseminated using social media between January and March 2024. A total of 555 responses were received. The majority of respondents did not take/intend to take the COVID-19 (75%, n = 417) or SI (64.3%, n = 362) vaccines, with females being less likely to do so (p = 0.033). Perceived lack of safety (31.3%, n = 174) was the primary reason for rejecting the COVID-19 vaccine, and perceived lack of a threat from SI (26%, n = 144) was the reason for rejecting the SI vaccine. Those having chronic conditions were positively associated with uptake of both vaccines. In the post-pandemic era, these vaccines are not envisaged as having a major role in protecting one’s health. A high degree of skepticism especially toward the combined COVID-19 and SI vaccine in terms of safety, mostly in women, is still present. Full article

Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, we implemented a custom mobile application. We aimed to evaluate the implementation, adherence, benefits, and limitations of this study’s app. Methods: The app allowed secure data collection through questionnaires, disseminated serological results, and managed bidirectional communication. Access was double-pseudonymized and irreversibly anonymized six months after enrollment. Download frequency, login events, and questionnaire submissions between October 2021 and December 2022 were analyzed. Multivariable logistic regression identified factors associated with app adherence. Results: Of the 3979 participants with app access, 3622 (91%) used the app; out of these, 1016 (28%) were “adherent users” (≥12 submitted questionnaires). App adherence significantly increased with age. Among HCW, adherent users were more likely to be non-smokers (p < 0.001), working as administrators or nursing staff vs. physicians (p < 0.001), vaccinated against influenza (p < 0.001), and had not travelled abroad in the past year (p < 0.001). IBD patients exposed to SARS-CoV-2 (p = 0.0133) and those with adverse events following the second COVID-19 vaccination (p = 0.0171) were more likely adherent app users. Despite technical issues causing dropout or non-adherence, the app served as a secure solution for cohort management and longitudinal data collection. Discussion: App-based cohort management enabled continuous data acquisition and individualized care while providing flexibility and anonymity for the study team and participants. App usability, technical issues, and cohort characteristics need to be thoroughly considered prior to implementation to optimize usage and adherence in clinical research. Full article

Background: Influenza B usually causes mild illness in children. Severe and fatal cases can occur when complicated by secondary Staphylococcus aureus (S. aureus) pneumonia, including community-acquired methicillin-resistant Staphylococcus aureus (MRSA). We present a rare, rapidly progressive fatal case in an adolescent with no known medical history to highlight diagnostic and therapeutic pitfalls. Case Presentation: A 16-year-old boy with no known underlying conditions (unvaccinated for influenza) presented critically ill at “Sf. Ioan” Clinical Emergency Pediatric Hospital in Galați after one week of high fever and cough. He was in respiratory failure with septic shock, requiring immediate intubation and vasopressors. Chest X-ray (CXR) showed diffuse bilateral infiltrates (acute respiratory distress syndrome, ARDS). Initial laboratory tests revealed leukopenia, severe thrombocytopenia, disseminated intravascular coagulation (DIC), rhabdomyolysis, and acute kidney injury (AKI). Reverse transcription polymerase chain reaction (RT-PCR) confirmed influenza B, and blood cultures grew MRSA. Despite maximal intensive care, including mechanical ventilation, antibiotics (escalated for MRSA), antiviral therapy, and cytokine hemoadsorption therapy, the patient developed refractory multi-organ failure and died on hospital day 6. Autopsy revealed bilateral necrotizing pneumonia (NP) without radiographic cavitation, underscoring the diagnostic challenge. Discussion: The initial chest radiography showed diffuse bilateral pulmonary infiltrates, predominantly in the lower zones, with an ill-defined, patchy, and confluent appearance. Such appearance, in our case, was more suggestive of rapid progressive NP caused by MRSA rather than the typical pneumococcal one. This is one of the few reported cases of influenza B–MRSA coinfection with fulminant rhabdomyolysis and autopsy-confirmed necrosis. Our fulminant case illustrates the synergistic virulence of influenza and MRSA. Toxin-producing MRSA strains can cause NP and a “cytokine storm,” causing capillary leak, ARDS, shock, and DIC. Once multi-organ failure ensues, the prognosis is grim despite aggressive care. The absence of early radiographic necrosis and delayed anti-MRSA therapy (initiated after culture results) likely contributed to the poor outcome. Conclusions: Influenza B–MRSA co-infection, though rare, demands urgent empiric anti-MRSA therapy in severe influenza cases with leukopenia or shock, even without radiographic necrosis. This fatal outcome underscores the dual imperative of influenza vaccination and early, aggressive dual-pathogen targeting in high-risk presentations. Full article

Background: Health departments disseminate health education related to influenza to the public through various media in China. We examined knowledge, attitudes, and practices regarding influenza and the influenza vaccine (KAP-flu) over time among pregnant women (PW) compared to non-PW. Methods: A cross-sectional survey was conducted in Suzhou, China in 2013 and 2023. We included and interviewed PW seeking prenatal care and excluded PW there for non-routine visits. The comparison group was drawn from non-PW seeking physical examinations at the same facilities. Stratified cluster sampling was used to enroll participants from the various levels of prenatal-care facilities. Results: In 2013, we surveyed 1673 PW and 401 non-PW, and in 2023, we surveyed 2195 PW and 1171 non-PW. The proportion of PW who had ever heard of the influenza vaccine showed no significant change, at 56% in 2013 and 57% in 2023; by contrast, there was a significant increase among non-PW (55% to 78%). The proportion of pregnant participants who knew when to get vaccinated dropped from 14% to 12%, in contrast to the increase among non-PW (6% to 20%). The proportion of PW who believed that the influenza vaccine is effective dropped from 91% in 2013 to 76% in 2023, in contrast to the stable value among non-PW (84% to 82%). In 2023, pregnant participants exhibited lower levels of knowledge about both influenza disease and the influenza vaccine, along with less positive attitudes toward the effectiveness and safety of the vaccine. They also showed lower willingness to vaccinate and lower vaccination rates compared to non-pregnant participants. Concerning KAP-flu among PW, less than half recognized that influenza is different from a common cold; fewer than one in five understood the timing and frequency of vaccination or the policy prioritizing PW for influenza vaccination; vaccination coverage remained below 2% over time. Conclusions: PW had concerning gaps in knowledge and attitudes regarding influenza and the influenza vaccine compared to non-PW in Suzhou, China. Specific actions targeting PW, such as initiatives leveraging the maternal and child healthcare system, are warranted to reduce the gaps. Full article

Background: Workers in healthcare facilities can encourage and serve as role models for the general population regarding vaccination. The information source preferences of employees in healthcare facilities can play an important role in their decisions to receive COVID-19 and seasonal influenza vaccinations (SIVs). A study of specific channels of information and their impact on vaccine acceptance could provide valuable insights. Methods: A cross-sectional questionnaire-based survey was conducted during the first semester of 2021 among 2592 staff members in healthcare facilities (primary, secondary and tertiary). Results: Higher odds of seasonal influenza vaccination (SIV) acceptance were found among staff who were informed by the National Public Health Organization (NPHO) (adjusted Odds Ratio (aOR): 1.47, 95% confidence intervals (CI): 1.13–1.90), the Hellenic Ministry of Health (HMH) (aOR: 1.50, 95% CI: 1.16–1.94) and the Healthcare Facilities Infection Control Committees (ICC) (aOR: 1.35, 95% CI: 1.06–1.73). Professionals who were more willing to accept a COVID-19 vaccine were more likely to obtain information from television (aOR: 1.43, 95% CI: 1.08–1.92), the ICC (aOR: 1.36, 95% CI: 1.03–1.81), the NPHO (aOR: 1.71, 95% CI: 1.28–2.28) and the HMH (aOR: 1.68, 95% CI: 1.26–2.26). Social media presented no statistically significant association with either COVID-19 vaccine acceptance or SIV. Conclusions: Workers in healthcare facilities who received information from highly credible organizations were more likely to accept vaccines. Television was effective in disseminating COVID-19 vaccine campaigns. Full article

Highly pathogenic avian influenza (HPAI) H5 viruses have been found to have a substantial geographic distribution since they were first reported in Guangdong Province, China. The emergence of new genotypes threatens the poultry industry and human health worldwide. Here, we report five HPAI H5N1 variants isolated from Anser indicus in Yunnan Province, China. A phylogenetic analysis of the hemagglutinin (HA) gene showed that all isolates belong to the highly pathogenic H5 clade 2.3.4.4b and formed two distinct genetic clusters. Bayesian phylogenetic analysis also revealed that the viruses were initially disseminated from wild birds to Anser indicus, implying that infected birds most likely contributed to viral transmission in the region. Genomic sequence analysis revealed several amino acid substitutions, also implying that the infected birds contributed to the spread of the virus throughout the region. Substitutions in the HA glycoprotein increased the virus’s binding affinity to human α-2,6 sialic acid residues. Substitutions in the PB1, PA, and PB2 motifs increased viral polymerase activity and replication in hosts, whereas substitutions in the NP, M1, and NS motifs increased viral pathogenicity in chickens and mice. Full article

Highly Pathogenic Avian Influenza H5N1 (HPAI H5N1) was first detected in chickens in Scottland in 1959 and has since circulated globally, causing regular outbreaks among different animal species, as well as incidental infections in humans. In this scoping review, the epidemiology and impact of HPAI H5N1 among migratory birds, poultry, and cattle in the United States were analyzed, with a particular focus on outbreaks since January 2022. Following PRISMA guidelines, a total of 27 articles were identified for this review. Publicly available data and reports from the USDA and CDC were also evaluated and summarized. The identified articles primarily included epidemiological studies of detections in wild birds, mammals, and case reports on H5N1 and transmission dynamics among cattle, with a notable absence of poultry-focused reports. Wild birds, especially migratory species, have played an important role in virus dissemination. Studies among mammals, including seals, bears, and domestic cats, along with the emerging outbreak among cattle, highlight the virus’s ability to adapt to diverse hosts, with the possibility of mammal-to-mammal transmission. Despite the low number of human infections, the zoonotic risk of the disease and the possibility of a human outbreak remain significant. The complexity and risks associated with the virus, in comparison with the limited current scientific studies in the United States, demand further investigations to mitigate its impact on animals, ecosystems, and human health. Full article

Objective: The aim was to evaluate the pharmacokinetics and underlying mechanisms of peramivir, a clinically approved antiviral agent for severe influenza, subsequent to airway inhalation in rats, thereby surmounting the constraints associated with the sole currently available intravenous formulation. Methods: Pharmacokinetic and tissue distribution investigations of peramivir were carried out in rats following both intravenous and inhaled administration. In vitro cell models were verified to investigate peramivir’s transmembrane transport and cellular uptake across diverse cell systems. Results: In vivo, peramivir exhibited restricted permeability, predominantly localizing within the alveolar epithelial lining fluid and lung tissue after inhalation, accompanied by minimal systemic dissemination. In vitro, it manifested low permeability across cell models, with no participation of efflux transporters. Despite the low rate of A549 uptake, the underlying uptake transport mechanism was still revealed. Peramivir was verified as an OCTN2 substrate. A robust correlation was observed between the in vitro and in vivo findings. Conclusions: A preclinical pharmacokinetic platform applicable to inhaled medications was established. Inhalation of peramivir augments exposure at the target site while diminishing systemic exposure, presenting potential therapeutic benefits in terms of efficacy and safety and suggesting it as a favorable alternative administration pathway. Full article

Background: Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated inflammatory disorder of the central nervous system (CNS), typically characterized by the acute onset of multifocal demyelination. The pathogenesis of ADEM remains unclear, but it is believed to be triggered by an autoimmune response, often following viral infections or vaccinations. Case report: This case report describes a 3-year-old child who developed ADEM after receiving two concurrent influenza vaccines: one for seasonal influenza and one for the 2009 H1N1 pandemic. The patient presented with motor regression, mild pleocytosis in cerebrospinal fluid (CSF), and typical MRI findings of ADEM. Steroid pulse therapy resulted in rapid improvement, and the patient recovered fully without sequelae. Results: Although the influenza vaccine has been linked to ADEM in some studies, it remains uncertain whether the simultaneous administration of both vaccines contributed to the onset of ADEM. While influenza vaccines are considered safe and effective by health organizations such as the CDC, data suggest that the incidence of ADEM and other neurological complications is significantly higher after natural influenza infections compared to vaccination. This highlights the importance of vaccination in preventing severe outcomes. Conclusions: This case underscores the importance of monitoring and reporting adverse events following vaccination to refine our understanding of rare complications like ADEM. While simultaneous vaccine administration warrants further research, the benefits of vaccination in preventing severe complications from natural infections far outweigh the risks. Continued vigilance and improved surveillance systems are essential for maintaining public confidence in vaccination programs. Full article

Disease prediction using computer-based methods is now an established area of research. The importance of technological intervention is necessary for the better management of disease, as well as to optimize use of limited resources. Various AI-based methods for disease prediction have been documented in the literature. Validated AI-based systems support diagnoses and decision making by doctors/medical practitioners. The resource-efficient dissemination of the symptoms identified and the diagnoses undertaken is the requirement of the present-day scenario to support paperless, yet seamless, information sharing. The representation of symptoms using grammar provides a novel way for the resource-efficient encoding of disease diagnoses. Initially, symptoms are represented as strings, and, in terms of grammar, this is called a sentence. Moreover, the conversion of the generated string containing the symptoms and the diagnostic outcome to a QR code post encryption makes it portable. The code can be stored in a mobile application, in a secure manner, and can be scanned wherever required, universally. The patient can carry the medical condition and the diagnosis in the form of the QR code for medical consultations. This research work presents a case study based on two diseases, influenza and coronavirus, to highlight the proposed methodology. Both diseases have some common and overlapping symptoms. The proposed system can be implemented for any kind of disease detection, including clinical and diagnostic imaging. Full article

Background: Influenza poses a substantial health burden, especially among older adults in China. While vaccination is one of the most effective preventions, influenza vaccine uptake rates among Chinese older adults remain low. This study examines the individual and combined effects of behavioral interventions based on the Information–Motivation–Behavioral Skills (IMB) model and economic incentives in promoting influenza vaccine uptake among older adults living in China. Methods: The study will recruit 640 older adults living in eight communities that have not been covered by the free influenza vaccination policy. These eight communities (as clusters), stratified by urban and rural, will be randomized to four parallel arms, including a usual care arm, an IMB-based behavioral intervention arm, a conditional economic incentive arm, and a combined behavioral-economic arm. The interventions will start from the beginning of the flu season and last for about one month. Specifically, the IMB-based behavioral intervention encompasses health education brochures, healthcare provider-led lectures, interactive quizzes, and personalized consultations. The exact number of economic incentives is conditional on the timing of vaccination (a higher amount for early immunization) and the number of people within a household to be vaccinated at the same appointment (a higher amount for more people). The primary outcome is the influenza vaccination rate. Data will be gathered through vaccination records and questionnaires covering IMB-based vaccination cognitions. Mixed-effects models will be used to analyze the outcome of vaccination rate, reporting difference-in-differences estimates with 95% confidence intervals. Conclusions: The results of this study have the potential to inform influenza vaccination program scaleup among older adults who are not yet covered by the free influenza vaccination policy. Ethics and dissemination: Ethics approval has been granted by the ethics commission of Peking University Health Science Centre (IRB00001052-24090). Participants will be required to sign a written consent form. Findings will be reported in conferences and peer-reviewed publications in accordance with the recommendations of the Consolidated Standards of Reporting Trials. Registration number: This study was registered at the Chinese Clinical Trial Registry (ChiCTR2400090229). Full article

Background and Clinical Significance: Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a widely accepted supportive treatment for severe acute respiratory distress syndrome (ARDS) in intensive care units (ICUs). Although it has gained popularity, some of its aspects, including optimal anticoagulation management and the best means of monitoring hemostasis, remain unresolved. Thrombosis and bleeding are still important complications of ECMO. Case Presentation: A 44-year-old male patient, with no underlying conditions, was diagnosed with severe acute respiratory distress syndrome (ARDS) due to AH1N1 influenza. He presented severe hypoxemia despite the use of mechanical ventilation, neuromuscular blocking agent infusion and prone position. VV ECMO was used, and coagulation was stopped on ECLS day 6 due to severe pulmonary hemorrhage. The systemic hemostatic disorders found in this patient were difficult to differentiate from disseminated intravascular coagulation (DIC) or sepsis-induced coagulopathy (SIC), improved transiently after circuit exchange, and resolved only after discontinuation of ECMO. The patient was discharged fully conscious and cooperative, with no apparent neurological deficit. Conclusions: Systemic hemostatic abnormalities may precede oxygenator failure and mimic DIC or SIC. Timely oxygenator exchange may therefore be considered. However, it is a high-risk procedure, especially in fully ECLS-dependent patients. Full article

Social media plays a crucial role in health information dissemination, yet it also raises concerns about misinformation. This study examines the role of Spanish health centers in promoting influenza vaccination on social networks, particularly X (formerly Twitter), during the 2023–2024 campaign. An observational, retrospective study analyzed the activity of 832 Spanish health centers on X. Data collection focused on the existence of official accounts, follower engagement and the nature of messages posted. Metrics were obtained using X Analytics, and statistical analysis was performed using JAMOVI v2.4 software. Of the 832 centers, 607 had readable X accounts. Collective accounts were more prevalent (351) than individual ones (239). Collective accounts had significantly more followers and posts but showed less engagement compared to individual accounts. The most followed accounts belonged to public entities, like the Community of Madrid and private organizations, such as Sanitas. An analysis of the vaccination campaign revealed that most posts had a political focus with limited health information, resulting in minimal interaction with the public. As a conclusion, the study highlights the fragmented nature of health communication through social networks in Spain. Despite the higher visibility of collective accounts, their engagement with the public is low, often due to the political nature of posts. A unified national strategy is essential for enhancing public health communication, focusing on interactive and relevant content. Full article

Highly pathogenic avian influenza (HPAI) is a highly contagious viral disease that represents a significant threat to poultry production worldwide. Variants of the HPAI virus (HPAIV) H5A/Goose/GuangDong/1/96 (H5 Gs/GD/96) lineage have caused five intercontinental epizootic waves, with the most recent, clade 2.3.4.4b, reaching Argentina in February 2023. Initially detected in wild birds, the virus quickly spread to backyard and commercial poultry farms, leading to economic losses, including the loss of influenza-free status (IFS). By March/April 2023 the epidemic had peaked and vaccination was seriously considered. However, the success of strict stamping-out measures dissuaded the National Animal Health Authority (SENASA) from authorizing any vaccine. Suspected cases sharply declined by May, and the last detection in commercial poultry was reported in June. The effective control and potential eradication of HPAIV in Argentina were due to SENASA’s early detection and rapid response, supported by private companies, veterinarians, and other stakeholders. Stamping-out measures have been effective for virus elimination and reduced farm-to-farm transmission; however, as the virus of this clade may remain present in wild birds, the risk of reintroduction into poultry production is high. Therefore, maintaining continuous active surveillance will be crucial for promptly detecting any new HPAIV incursion and taking appropriate action to contain virus dissemination. Full article