Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

Behavioral patterns in health over 18 years through multiple correspondence analysis, Argentina, 2013

Submitted by Repositório Arca ([email protected]) on 2019-12-23T14:17:50Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) maria_romina.pdf: 2078593 bytes, checksum: 13291a6a97ea60f6981039b2d782f7f9 (MD5)Approved for entry into archive by Ana Maria Souza dos Santos ([email protected]) on 2020-02-27T17:26:31Z (GMT) No. of bitstreams: 2 maria_romina.pdf: 2078593 bytes, checksum: 13291a6a97ea60f6981039b2d782f7f9 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2020-02-27T17:26:31Z (GMT). No. of bitstreams: 2 maria_romina.pdf: 2078593 bytes, checksum: 13291a6a97ea60f6981039b2d782f7f9 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2015Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Introducción: la transición demográfica y epidemiológica ha condicionado modificaciones en las tendencias de morbimortalidad, en todo el mundo, con aumento de la prevalencia de enfermedades crónicas. El presente estudio pretende caracterizar patrones de comportamiento en salud, considerando variables relacionadas a factores de riesgo para dolencias crónicas, a partir de la 3° Encuesta Nacional de Factores de Riesgo 2013, en Argentina. Materiales y Métodos: se realizó un análisis descriptivo bivariado, comparando frecuencias según categorías, mediante el test de Chi Cuadrado, considerando significativo un valor de p<0.05. Posteriormente se aplicó Análisis de Correspondencia Múltiple (ACM) y Cluster. Las variables activas fueron: consumo regular de riesgo de alcohol (CRRA), hábito de fumar, consumo regular de frutas y verduras (CRFV) y actividad física (AF). Resultados: 69.5% de la inercia estuvo explicada en dos dimensiones. Se definieron 3 patrones de comportamiento. Un primer patrón, agrupando CRRA, fumar actualmente y no consumo de frutas y verduras, relacionados con personas jóvenes (menores de 50 años) de sexo masculino, con nivel de instrucción intermedio; este patrón estuvo bien representado en la primera dimensión, con una contribución del 35.7%. Un segundo patrón caracterizado por conductas positivas (consumo de alcohol sin riesgo, práctica de actividad física, ex fumadores); en el análisis de Cluster la conformación de este perfil se completó con el CRFV. Dicho perfil coincidió con personas del sexo masculino, de entre 50 a 64 años, instrucción superior, ocupados laboralmente y divorciados, y tuvo mejor representación en la segunda dimensión, con una contribución de 31.2%. Un patrón agrupó categorías sin consumo de alcohol ni tabaco, y sedentarismo, y se correspondió con mujeres ancianas, viudas o casadas, laboralmente inactivas; con una contribución del 49.7% en la segunda dimensión. Discusión: La definición de perfiles o patrones de comportamiento, relacionados con elecciones en salud como así también con el contexto de vida de las personas, resulta útil a la hora de definir estrategias de prevención y control de factores de riesgo para ENT.Introduction: the demographic and epidemiological transition has conditioned changes in the trends of morbidity and mortality worldwide with increasing prevalence of chronic diseases. The present study aims to characterize health behavior patterns, considering variables related to risk factors for chronic diseases, from the 3rd National Survey of Risk Factors 2013 in Argentina. Materials and Methods: Bivariate descriptive analysis was performed, comparing frequencies by category, using the Chi Square test, (p <0.05). Multiple Correspondence Analysis (MCA) and Cluster was applied. The active variables were: regular risk alcohol consumption (RRAC), smoking, regular consumption of fruits and vegetables (RCFV) and physical activity (PA). Results: 69.5% of the inertia was explained in two dimensions. Three behavioral profiles were defined. A first profile, grouping RRAC, currently smoking status and no consumption of fruits and vegetables, involving young male people, with intermediate instruction level; this pattern was well represented in the first dimension, contributing 35.7%. A second profile characterized by positive behaviors (drinking alcohol without risk consumption, physical activity, ex-smokers); by the Cluster analysis, this profile was completed with the CRFV. This profile coincided with male, aged 50-64 years, with superior instruction, with stable employment occupation and divorced; it had better representation in the second dimension, with a contribution of 31.2%. A third profile grouped categories without alcohol and tobacco consumption, sedentary lifestyle, and corresponded to elderly women, widowed or married and retirees; with a contribution of 49.7% in the second dimension. Discussion: The definition of profiles or patterns of behavior related to health is useful for defining prevention strategies for control risk factors for chronic diseases

Mortality, Severe Acute Respiratory Infection, and Influenza-Like Illness Associated with Influenza A(H1N1)pdm09 in Argentina, 2009

<div><h3>Introduction</h3><p>While there is much information about the burden of influenza A(H1N1)pdm09 in North America, little data exist on its burden in South America.</p> <h3>Methods</h3><p>During April to December 2009, we actively searched for persons with severe acute respiratory infection and influenza-like illness (ILI) in three sentinel cities. A proportion of case-patients provided swabs for influenza testing. We estimated the number of case-patients that would have tested positive for influenza by multiplying the number of untested case-patients by the proportion who tested positive. We estimated rates by dividing the estimated number of case-patients by the census population after adjusting for the proportion of case-patients with missing illness onset information and ILI case-patients who visited physicians multiple times for one illness event.</p> <h3>Results</h3><p>We estimated that the influenza A(H1N1)pdm09 mortality rate per 100,000 person-years (py) ranged from 1.5 among persons aged 5–44 years to 5.6 among persons aged ≥65 years. A(H1N1)pdm09 hospitalization rates per 100,000 py ranged between 26.9 among children aged <5 years to 41.8 among persons aged ≥65 years. Influenza A(H1N1)pdm09 ILI rates per 100 py ranged between 1.6 among children aged <5 to 17.1 among persons aged 45–64 years. While 9 (53%) of 17 influenza A(H1N1)pdm09 decedents with available data had obesity and 7 (17%) of 40 had diabetes, less than 4% of surviving influenza A(H1N1)pdm09 case-patients had these pre-existing conditions (p≤0.001).</p> <h3>Conclusion</h3><p>Influenza A(H1N1)pdm09 caused a similar burden of disease in Argentina as in other countries. Such disease burden suggests the potential value of timely influenza vaccinations.</p> </div

Rates of influenza A(H1N1)pdm09-associated mortality among influenza-like illness (ILI) cases at three sentinel cities in Argentina, according to age group. April–December, 2009.

a<p>Estimated by multiplying the <u>week-specific</u> number of decedents identified (row 1) by the <u>week-specific</u> proportion testing positive for 2009 H1N1 (row 2) and its 95% confidence interval.</p>b<p>Corrected for the proportion of case-patients missing date of illness onset (epidemiologic week) information (i.e. 2 of 39 among persons aged 45–64 years and 2 of 27 among persons aged ≥65 years).</p

Rates of influenza A(H1N1)pdm09-associated severe acute respiratory case-patients at three sentinel cities in Argentina, according to age group May–December, 2009.

a<p>Estimated by multiplying the <u>week-specific</u> number of decedents identified (row 1) by the <u>week-specific</u> proportion testing positive for 2009 H1N1 (row 2) and its 95% confidence interval.</p>b<p>Corrected for the proportion of case-patients missing date of illness onset (epidemiologic week) information (i.e. 1 of 271 among children aged <5 years, 7 of 748 among persons aged 5–44, 6 of 350 among persons aged 45–64 years, and 1 of 253 among persons aged ≥65 years).</p

Distribution of influenza A(H1N1)pdm09-associated case-patients in three cities in Argentina by epidemiologic week, May–December 2009.

<p>Distribution of influenza A(H1N1)pdm09-associated case-patients in three cities in Argentina by epidemiologic week, May–December 2009.</p

Description of case-patients with available risk factor data identified during active case-finding in 2009 and during three consecutive health utilization surveys in 2010, three cities in Argentina.

<p>2009 H1N1 denotes influenza A (H1N1)pdm09, SARI denotes severe acute respiratory illness, and ILI denotes influenza-like illness.</p>a<p>among cases with available age, pregnancy, obesity, chronic obstructive pulmonary disease, or asthma status data.</p>b<p>The age of case-patients is significantly associated with decedent, SARI, or ILI case-status in linear regression (p≤0.001).</p>c<p>The sex of case-patients is significantly associated with decedent, SARI, or ILI case-status in Fisher Exact testing (p = 0.01).</p>d<p>The characteristic is significantly associated with decedent, SARI, or ILI case-status in Fisher Exact testing (p<0.001).</p

Rates of influenza A(H1N1)pdm09-associated influenza-like illness case-patients at three sentinel cities in Argentina, according to age group April–December, 2009.

a<p>Estimated by multiplying the week-specific number of ILI cases identified (row 1) by the proportion testing positive for 2009 H1N1 (row 3) and its 95% confidence interval by the proportion of ILI cases among ILI physician visits (row 4) while adjusting for the proportion of cases-patients missing data on their epidemiologic week of illness.</p>b<p>Corrected for the proportion of case-patients missing date of illness onset (epidemiologic week) information (i.e. 95 of 2,365 among children aged <5 years, 688 of 16,204 among persons aged 5–44, 101 of 2725 among persons aged 45–64 years, and 63 of 1180 among persons aged ≥65 years).</p