Unadjusted associations of DENV illness severity and JEV antibody status.

*<p>Non-hospitalized infections incorporate both non-hospitalized DF and asymptomatic seroconversions.</p>**<p>Non-DHF infections incorporate both non-hospitalized and hospitalized DF and asymptomatic seroconversions.</p>†<p>P-values were calculated using the Mantel-Haenzel chi-square statistic.</p

Factors associated with JEV seropositivity among those experiencing dengue (DENV) infection.

*<p>Refers to first-detected DENV infections in the cohort that occurred during the active surveillance period each year (June 1 – November 1) and had neutralizing antibody data available.</p>**<p>Statistical tests considered the association between variables of interest and the presence or absence of JEV NAbs in the pre-infection sample. p-values were obtained using the Pearson chi-square test for categorical variables, with α = 0.05 as the level of significance. ‘Missing’ categories were not included in statistical comparisons.</p

Duration of DENV illness (days) by JEV NAb status.

*<p>Duration of illness was calculated as the number of days elapsed from first day of febrile illness to the last day that a child reported any fever, muscle or joint pain, headache, nauseas, vomiting, diarrhea, or any signs of bleeding or hemorrhage.</p>**<p>P-values were calculated using 2-way analysis of variance testing (ANOVA), with α = 0.05 as the level of significance.</p

Cohort characteristics associated with symptomatic DENV illness.

*<p>Refers to first-detected DENV infections in the cohort that occurred during the active surveillance period each year (June 1–November 1) and had neutralizing antibody data available</p>**<p>Statistical tests considered the association between variables of interest and the occurrence of symptomatic versus asymptomatic infection. p-values were obtained using the Pearson chi-square test for categorical variables, with α = 0.05 as the level of significance. ‘Missing’ categories were not included in statistical comparisons.</p

Clinical severity of dengue infections by strata of preexisting DENV and JEV immunity.

<p>The proportions of dengue (DENV) infections resulting in symptomatic illness (1a), hospitalized illness (1b), and dengue hemorrhagic fever (1c) are shown. Data are stratified by preexisting DENV immunity (naïve [DENV -], monotypic [DENV 1+], multitypic older and younger than 10 years of age [DENV >1+]) and preexisting Japanese encephalitis virus (JEV) neutralizing antibodies (NAbs) (positive [+] or negative [-]). The JEV NAb positive groups are indicated by hash lines for each stratum of DENV immunity. Odds ratios (ORs) estimate the odds of being experiencing the disease severity of interest (dengue hemorrhagic fever [DHF], hospitalized illness [Hosp], or symptomatic illness [Sx]) in the presence of JEV NAbs over the odds of experiencing the disease severity of interest in the absence of JEV NAbs. Values in parentheses indicate the 95% confidence intervals for the ORs. Error bars indicate the 95% confidence intervals for proportions.</p

Clinical and laboratory predictors of influenza infection among individuals with influenza-like illness presenting to an urban Thai hospital over a five-year period

<div><p>Early diagnosis of influenza infection maximizes the effectiveness of antiviral medicines. Here, we assess the ability for clinical characteristics and rapid influenza tests to predict PCR-confirmed influenza infection in a sentinel, cross-sectional study for influenza-like illness (ILI) in Thailand. Participants meeting criteria for acute ILI (fever > 38°C and cough or sore throat) were recruited from inpatient and outpatient departments in Bangkok, Thailand, from 2009–2014. The primary endpoint for the study was the occurrence of virologically-confirmed influenza infection (based upon detection of viral RNA by RT-PCR) among individuals presenting for care with ILI. Nasal and throat swabs were tested by rapid influenza test (QuickVue) and by RT-PCR. Vaccine effectiveness (VE) was calculated using the case test-negative method. Classification and Regression Tree (CART) analysis was used to predict influenza RT-PCR positivity based upon symptoms reported. We enrolled 4572 individuals with ILI; 32.7% had detectable influenza RNA by RT-PCR. Influenza cases were attributable to influenza B (38.6%), A(H1N1)pdm09 (35.1%), and A(H3N2) (26.3%) viruses. VE was highest against influenza A(H1N1)pdm09 virus and among adults. The most important symptoms for predicting influenza PCR-positivity among patients with ILI were cough, runny nose, chills, and body aches. The accuracy of the CART predictive model was 72.8%, with an NPV of 78.1% and a PPV of 59.7%. During epidemic periods, PPV improved to 68.5%. The PPV of the QuickVue assay relative to RT-PCR was 93.0% overall, with peak performance during epidemic periods and in the absence of oseltamivir treatment. Clinical criteria demonstrated poor predictive capability outside of epidemic periods while rapid tests were reasonably accurate and may provide an acceptable alternative to RT-PCR testing in resource-limited areas.</p></div

Receiver operating characteristic (ROC) curves for (Fig 3A) CART analysis and (Fig 3B) QuickVue, compared to RT-PCR for identifying influenza infection among individuals with ILI.

<p>Receiver operating characteristic (ROC) curves for (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0193050#pone.0193050.g003" target="_blank">Fig 3A</a>) CART analysis and (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0193050#pone.0193050.g003" target="_blank">Fig 3B</a>) QuickVue, compared to RT-PCR for identifying influenza infection among individuals with ILI.</p

Predictors of clinical severity and receipt of antimicrobial medications among those with PCR-confirmed influenza infection.

<p>Predictors of clinical severity and receipt of antimicrobial medications among those with PCR-confirmed influenza infection.</p

Temporal distribution of ILI cases testing positive for influenza infection (RED) and negative for influenza infection (BLUE).

<p>Solid circles indicate months identified as experiencing influenza outbreaks (defined as months wherein > = 25% of ILI specimens tested positive for influenza infection by RT-PCR).</p

CART analysis to predict influenza RT-PCR positivity on the basis of clinical symptoms.

<p>CART analysis to predict influenza RT-PCR positivity on the basis of clinical symptoms.</p