Improving the efficacy of influenza vaccination in older adults is a challenge. In this randomized clinical trial, a high-dose influenza vaccine was shown to be more effective than a standard-dose ...vaccine in the prevention of laboratory-confirmed influenza.
Between 1990 and 1999, seasonal influenza caused an average of 36,000 deaths and 226,000 hospitalizations per year in the United States.
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Adults 65 years of age or older are particularly vulnerable to complications associated with influenza and account for most seasonal influenza–related hospitalizations and deaths.
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Although vaccination currently represents the most effective intervention against influenza and associated complications,
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antibody response and protection elicited by the vaccine are lower among persons 65 years of age or older than among younger adults.
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Strategies to improve antibody responses to influenza vaccine in the older population, such as increasing the . . .
Currently, the United States has the largest number of reported coronavirus disease 2019 (COVID-19) cases and deaths globally. Using a geographically diverse surveillance network, we describe risk ...factors for severe outcomes among adults hospitalized with COVID-19.
We analyzed data from 2491 adults hospitalized with laboratory-confirmed COVID-19 between 1 March-2 May 2020, as identified through the Coronavirus Disease 2019-Associated Hospitalization Surveillance Network, which comprises 154 acute-care hospitals in 74 counties in 13 states. We used multivariable analyses to assess associations between age, sex, race and ethnicity, and underlying conditions with intensive care unit (ICU) admission and in-hospital mortality.
The data show that 92% of patients had ≥1 underlying condition; 32% required ICU admission; 19% required invasive mechanical ventilation; and 17% died. Independent factors associated with ICU admission included ages 50-64, 65-74, 75-84, and ≥85 years versus 18-39 years (adjusted risk ratios aRRs, 1.53, 1.65, 1.84, and 1.43, respectively); male sex (aRR, 1.34); obesity (aRR, 1.31); immunosuppression (aRR, 1.29); and diabetes (aRR, 1.13). Independent factors associated with in-hospital mortality included ages 50-64, 65-74, 75-84, and ≥ 85 years versus 18-39 years (aRRs, 3.11, 5.77, 7.67, and 10.98, respectively); male sex (aRR, 1.30); immunosuppression (aRR, 1.39); renal disease (aRR, 1.33); chronic lung disease (aRR 1.31); cardiovascular disease (aRR, 1.28); neurologic disorders (aRR, 1.25); and diabetes (aRR, 1.19).
In-hospital mortality increased markedly with increasing age. Aggressive implementation of prevention strategies, including social distancing and rigorous hand hygiene, may benefit the population as a whole, as well as those at highest risk for COVID-19-related complications.
Respiratory syncytial virus (RSV) is historically known for causing respiratory illness in young children, but the appreciation of its impact on older adults is growing. Studies have shown that ...hospitalization for respiratory illness due to RSV is complicated by cardiovascular events in 14% to 22% of adult patients, including worsening congestive heart failure, acute coronary syndrome, and arrhythmias. Additionally, underlying cardiovascular disease is associated with hospitalization in 45% to 63% of adults with confirmed RSV. In summary, patients with cardiopulmonary disease have higher rates of health care utilization for RSV-related illness and worse outcomes. Patients with cardiovascular disease likely represent an important target population for the rapidly developing field of RSV vaccines.
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Background. We performed a prospective study to determine the disease burden of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) in older adults in comparison with influenza virus. ...Methods. During 3 consecutive winters, we enrolled Davidson County (Nashville, TN) residents aged ≥50 years admitted to 1 of 4 hospitals with acute respiratory illness (ARI). Nasal/throat swabs were tested for influenza, RSV, and HMPV with reverse-transcriptase polymerase chain reaction. Hospitalization rates were calculated. Results. Of 1042 eligible patients, 508 consented to testing. Respiratory syncytial virus was detected in 31 participants (6.1%); HMPV was detected in 23 (4.5%) patients; and influenza was detected in 33 (6.5%) patients. Of those subjects aged ≥65 years, 78% received influenza vaccination. Compared with patients with confirmed influenza, patients with RSV were older and more immunocompromised; patients with HMPV were older, had more cardiovascular disease, were more likely to have received the influenza vaccination, and were less likely to report fever than those with influenza. Over 3 years, average annual rates of hospitalization were 15.01, 9.82, and 11.81 per 10 000 county residents due to RSV, HMPV, and influenza, respectively. Conclusions. In adults aged ≥50 years, hospitalization rates for RSV and HMPV were similar to those associated with influenza.
Viral respiratory disease in older adults has been increasingly recognized as a significant cause of hospitalizations and death. Unfortunately, the recognition and diagnosis of infection due to many ...viral respiratory pathogens in older adults can be elusive because of atypical clinical presentations and the insensitivity of current laboratory diagnostic tests in this population. For influenza diagnosis, rapid antigen tests followed by viral culture (if antigen test results are negative), can be useful in older adults as long as clinicians are mindful of test limitations. Although specific, rapid antigen tests are insensitive in this population. Erroneous negative results may lead to delays in timely administration of antiviral treatment and institution of appropriate isolation precautions. The increasing availability of new, rapid, and sensitive molecular diagnostics, such as polymerase chain reaction testing, should provide more accurate and timely diagnoses of viral respiratory infections in older adults in the near future.
On December 11, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 (BNT162b2) vaccine (Pfizer, Inc; Philadelphia, Pennsylvania), ...a lipid nanoparticle-formulated, nucleoside-modified mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). Vaccination with the Pfizer-BioNTech COVID-19 vaccine consists of 2 doses (30 μg, 0.3 mL each) administered intramuscularly, 3 weeks apart. On December 12, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation* for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19. To guide its deliberations regarding the vaccine, ACIP employed the Evidence to Recommendation (EtR) Framework,
using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The recommendation for the Pfizer-BioNTech COVID-19 vaccine should be implemented in conjunction with ACIP's interim recommendation for allocating initial supplies of COVID-19 vaccines (2). The ACIP recommendation for the use of the Pfizer-BioNTech COVID-19 vaccine under EUA is interim and will be updated as additional information becomes available.
Influenza in Older Adults Talbot, H Keipp
Infectious disease clinics of North America,
12/2017, Letnik:
31, Številka:
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Journal Article
Recenzirano
Annually, influenza viruses cause significant disease in older adults, varying with the virulence of the circulating strain, prior exposure to circulating strain, and influenza vaccine effectiveness. ...Older adults often present atypically (eg, without fever) and with complications of influenza infection such as chronic obstructive pulmonary disease and congestive heart failure exacerbations. Prevention methods include antiviral medications and vaccines. Current influenza vaccines have moderate effectiveness for the prevention of hospitalization, but newer more immunogenic vaccines designed for adults 65 years of age and older have been licensed.
Influenza may contribute to the burden of acute cardiovascular events during annual influenza epidemics.
To examine acute cardiovascular events and determine risk factors for acute heart failure ...(aHF) and acute ischemic heart disease (aIHD) in adults with a hospitalization associated with laboratory-confirmed influenza.
Cross-sectional study.
U.S. Influenza Hospitalization Surveillance Network during the 2010-to-2011 through 2017-to-2018 influenza seasons.
Adults hospitalized with laboratory-confirmed influenza and identified through influenza testing ordered by a practitioner.
Acute cardiovascular events were ascertained using discharge codes from the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification, and ICD, 10th Revision. Age, sex, race/ethnicity, tobacco use, chronic conditions, influenza vaccination, influenza antiviral medication, and influenza type or subtype were included as exposures in logistic regression models, and marginal adjusted risk ratios and 95% CIs were estimated to describe factors associated with aHF or aIHD.
Among 89 999 adults with laboratory-confirmed influenza, 80 261 had complete medical record abstractions and available ICD codes (median age, 69 years interquartile range, 54 to 81 years) and 11.7% had an acute cardiovascular event. The most common such events (non-mutually exclusive) were aHF (6.2%) and aIHD (5.7%). Older age, tobacco use, underlying cardiovascular disease, diabetes, and renal disease were significantly associated with higher risk for aHF and aIHD in adults hospitalized with laboratory-confirmed influenza.
Underdetection of cases was likely because influenza testing was based on practitioner orders. Acute cardiovascular events were identified by ICD discharge codes and may be subject to misclassification bias.
In this population-based study of adults hospitalized with influenza, almost 12% of patients had an acute cardiovascular event. Clinicians should ensure high rates of influenza vaccination, especially in those with underlying chronic conditions, to protect against acute cardiovascular events associated with influenza.
Centers for Disease Control and Prevention.
Abstract
Background
Influenza infection causes substantial morbidity and mortality. However, little is known about hospital readmissions after an influenza hospitalization. The aim of our study was ...to characterize frequency of hospital readmissions among patients hospitalized with laboratory-confirmed influenza.
Methods
We conducted a retrospective study using Tennessee Emerging Infections Program Influenza Surveillance data from 2006 to 2016 and the concurrent Tennessee Hospital Discharge Data System. We analyzed demographic characteristics and outcomes to better understand frequency and factors associated with hospital readmissions.
Results
Of the 2897 patients with a laboratory-confirmed influenza hospitalization, 409 (14%) and 1364 (47%) had at least 1 hospital readmission within 30 days and 1 year of the influenza hospitalization, respectively. Multiple readmissions occurred in 739 patients (54%). The readmission group was older, female predominant, and had more comorbidities than patients not hospitalized. Pneumonia, acute chronic obstructive pulmonary disease/asthma exacerbation, septicemia, acute respiratory failure, and acute renal failure were the most common causes for readmission at 30 days. Underlying cardiovascular disease, lung disease, kidney disease, diabetes, immunosuppression, and liver disease were associated with increased risk of readmission during the subsequent year.
Conclusions
After an admission with laboratory-confirmed influenza, there is a high likelihood of readmission within 30 days and 1 year adding to the morbidity of influenza.
Hospitalization due to influenza leads to high likelihood of readmission within 30 days. Cardiovascular, respiratory, and infectious etiologies were most common. Comorbidities may be important links to study in these readmissions.
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