Clinical symptoms cannot predict influenza infection during the 2013 influenza season in Bavaria, Germany

2015 ◽  
Vol 144 (5) ◽  
pp. 1045-1051 ◽  
Author(s):  
H. CAMPE ◽  
S. HEINZINGER ◽  
C. HARTBERGER ◽  
A. SING
Keyword(s):  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Influenza Season ◽  
Influenza Infection ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Case Definition ◽  
Influenza Surveillance ◽  
Case Definitions ◽  
Laboratory Confirmation

SUMMARYFor influenza surveillance and diagnosis typical clinical symptoms are traditionally used to discriminate influenza virus infections from infections by other pathogens. During the 2013 influenza season we performed a multiplex assay for 16 different viruses in 665 swabs from patients with acute respiratory infections (ARIs) to display the variety of different pathogens causing ARI and to test the diagnostic value of both the commonly used case definitions [ARI, and influenza like illness (ILI)] as well as the clinical judgement of physicians, respectively, to achieve a laboratory-confirmed influenza diagnosis. Fourteen different viruses were identified as causing ARI/ILI. Influenza diagnosis based on clinical signs overestimated the number of laboratory-confirmed influenza cases and misclassified cases. Furthermore, ILI case definition and physicians agreed in only 287/651 (44%) cases with laboratory confirmation. Influenza case management has to be supported by laboratory confirmation to allow evidence-based decisions. Epidemiological syndromic surveillance data should be supported by laboratory confirmation for reasonable interpretation.

scholarly journals Estimation of influenza activity in Vojvodina (Serbia) for five consecutive influenza seasons

2018 ◽  
Vol 75 (6) ◽  
pp. 589-597
Author(s):  
Mioljub Ristic ◽  
Mirjana Strbac ◽  
Snezana Medic ◽  
Vladimir Petrovic
Keyword(s):  
Influenza A ◽  
Influenza Season ◽  
Influenza Infection ◽  
Laboratory Data ◽  
Respiratory Illness ◽  
Case Definition ◽  
Influenza Surveillance ◽  
Influenza B ◽  
Case Definitions ◽  
Influenza A H1n1

Background/Aim. After pandemic 2009/10 influenza season, influenza A (H1N1)pdm09, A(H3N2) and B viruses have continued to circulate in the population. The aim of this study was to describe the epidemiological and virological characteristics of influenza and evaluate values of proposed case definitions of influenza like illness (ILI), severe acute respiratory illness (SARI) and acute respiratory distress syndrome (ARDS) for detecting laboratory-confirmed influenza cases in Vojvodina. Methods. We conducted a descriptive epidemiological study using surveillance reports and laboratory data from October 2010 to May 2015 (five surveillance seasons). Results. Out of 1,466 samples collected, 720 (49.1%) were laboratory confirmed as influenza. Influenza A infection was more frequently detected than influenza B infection. Using the case definition of ILI was a good predictor for influenza confirmation (p < 0.05) during 5 influenza seasons. The predominant age-range of patients with confirmed influenza A (42.2%) and B (43.0%) infections was 30 to 64, but the patients aged from 15 to 29 years were more likely to have influenza A (p = 0.0168). In the period from December to January, influenza A (17.8%) was more frequently registered than influenza B (7.6%). The highest number of deaths (19/38) and hospitalized patients (128/402) was registered during the last influenza season (2014/15). The immunosuppressed patients with confirmed influenza infection were more likely to have influenza B than influenza A (p = 0.0110). Conclusion. Our results indicate that influenza surveillance should be continued and expanded in order to fully assess the burden of the disease in given population.

scholarly journals Performance of influenza case definitions for influenza community surveillance: based on the French influenza surveillance network GROG, 2009-2014

2017 ◽  
Vol 22 (14) ◽  
Author(s):  
Jean-Sebastien Casalegno ◽  
Daniel Eibach ◽  
Martine Valette ◽  
Vincent Enouf ◽  
Isabelle Daviaud ◽  
...  
Keyword(s):  
Influenza Infection ◽  
Age Groups ◽  
Case Definition ◽  
World Health ◽  
Influenza Surveillance ◽  
Case Definitions ◽  
Surveillance Network ◽  
Increased Risk ◽  
Influenza Case ◽  
Health Organization

International case definitions recommended by the Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), and the World Health Organization (WHO) are commonly used for influenza surveillance. We evaluated clinical factors associated with the laboratory-confirmed diagnosis of influenza and the performance of these influenza case definitions by using a complete dataset of 14,994 patients with acute respiratory infection (ARI) from whom a specimen was collected between August 2009 and April 2014 by the Groupes Régionaux d’Observation de la Grippe (GROG), a French national influenza surveillance network. Cough and fever ≥ 39 °C most accurately predicted an influenza infection in all age groups. Several other symptoms were associated with an increased risk of influenza (headache, weakness, myalgia, coryza) or decreased risk (adenopathy, pharyngitis, shortness of breath, otitis/otalgia, bronchitis/ bronchiolitis), but not throughout all age groups. The WHO case definition for influenza-like illness (ILI) had the highest specificity with 21.4%, while the ECDC ILI case definition had the highest sensitivity with 96.1%. The diagnosis among children younger than 5 years remains challenging. The study compared the performance of clinical influenza definitions based on outpatient surveillance and will contribute to improving the comparability of data shared at international level.

scholarly journals Diagnostic Value of Clinical Features to Distinguish Enteric Fever From Other Febrile Illnesses in Bangladesh, Nepal, and Pakistan

2020 ◽  
Vol 71 (Supplement_3) ◽  
pp. S257-S265 ◽  
Author(s):  
Kristen Aiemjoy ◽  
Dipesh Tamrakar ◽  
Shampa Saha ◽  
Shiva R Naga ◽  
Alexander T Yu ◽  
...  
Keyword(s):  
Blood Culture ◽  
Clinical Features ◽  
Diagnostic Performance ◽  
Enteric Fever ◽  
Random Effect ◽  
Clinical Signs ◽  
Febrile Illness ◽  
Diagnostic Value ◽  
Case Definition ◽  
Mixed Effect

Abstract Background Enteric fever, a bacterial infection caused by Salmonella enterica serotypes Typhi and Paratyphi A, frequently presents as a nonlocalizing febrile illness that is difficult to distinguish from other infectious causes of fever. Blood culture is not widely available in endemic settings and, even when available, results can take up to 5 days. We evaluated the diagnostic performance of clinical features, including both reported symptoms and clinical signs, of enteric fever among patients participating in the Surveillance for Enteric Fever in Asia Project (SEAP), a 3-year surveillance study in Bangladesh, Nepal, and Pakistan. Methods Outpatients presenting with ≥3 consecutive days of reported fever and inpatients with clinically suspected enteric fever from all 6 SEAP study hospitals were eligible to participate. We evaluated the diagnostic performance of select clinical features against blood culture results among outpatients using mixed-effect regression models with a random effect for study site hospital. We also compared the clinical features of S. Typhi to S. Paratyphi A among both outpatients and inpatients. Results We enrolled 20 899 outpatients, of whom 2116 (10.1%) had positive blood cultures for S. Typhi and 297 (1.4%) had positive cultures for S. Paratyphi A. The sensitivity of absence of cough was the highest among all evaluated features, at 65.5% (95% confidence interval [CI], 55.0–74.7), followed by measured fever at presentation at 59.0% (95% CI, 51.6–65.9) and being unable to complete normal activities for 3 or more days at 51.0% (95% CI, 23.8–77.6). A combined case definition of 3 or more consecutive days of reported fever and 1 or more of the following (a) either the absence of cough, (b) fever at presentation, or (c) 3 or more consecutive days of being unable to conduct usual activity--yielded a sensitivity of 94.6% (95% CI, 93.4–95.5) and specificity of 13.6% (95% CI, 9.8–17.5). Conclusions Clinical features do not accurately distinguish blood culture–confirmed enteric fever from other febrile syndromes. Rapid, affordable, and accurate diagnostics are urgently needed, particularly in settings with limited or no blood culture capacity.

scholarly journals Performance of case definitions and clinical predictors for influenza surveillance among patients followed in a rural cohort in Senegal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mamadou Aliou Barry ◽  
Florent Arinal ◽  
Cheikh Talla ◽  
Boris Gildas Hedible ◽  
Fatoumata Diene Sarr ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Virus Infection ◽  
Sore Throat ◽  
Predictive Value ◽  
Influenza Infection ◽  
Clinical Signs ◽  
Influenza Virus Infection ◽  
Nasal Discharge ◽  
Age Group ◽  
Case Definitions

Abstract Background Influenza is a major cause of morbidity and mortality in Africa. However, a lack of epidemiological data remains for this pathology, and the performances of the influenza-like illness (ILI) case definitions used for sentinel surveillance have never been evaluated in Senegal. This study aimed to i) assess the performance of three different ILI case definitions, adopted by the WHO, USA-CDC (CDC) and European-CDC (ECDC) and ii) identify clinical factors associated with a positive diagnosis for Influenza in order to develop an algorithm fitted for the Senegalese context. Methods All 657 patients with a febrile pathological episode (FPE) between January 2013 and December 2016 were followed in a cohort study in two rural villages in Senegal, accounting for 1653 FPE observations with nasopharyngeal sampling and influenza virus screening by rRT-PCR. For each FPE, general characteristics and clinical signs presented by patients were collected. Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) for the three ILI case definitions were assessed using PCR result as the reference test. Associations between clinical signs and influenza infection were analyzed using logistic regression with generalized estimating equations. Sore throat, arthralgia or myalgia were missing for children under 5 years. Results WHO, CDC and ECDC case definitions had similar sensitivity (81.0%; 95%CI: 77.0–85.0) and NPV (91.0%; 95%CI: 89.0–93.1) while the WHO and CDC ILI case definitions had the highest specificity (52.0%; 95%CI: 49.1–54.5) and PPV (32.0%; 95%CI: 30.0–35.0). These performances varied by age groups. In children < 5 years, the significant predictors of influenza virus infection were cough and nasal discharge. In patients from 5 years, cough, nasal discharge, sore throat and asthenia grade 3 best predicted influenza infection. The addition of “nasal discharge” as a symptom to the WHO case definition decreased sensitivity but increased specificity, particularly in the pediatric population. Conclusion In summary, all three definitions studies (WHO, ECDC & CDC) have similar performance, even by age group. The revised WHO ILI definition could be chosen for surveillance purposes for its simplicity. Symptomatic predictors of influenza virus infection vary according the age group.

scholarly journals Epidemiology and Clinical Symptoms Related to Seasonal Coronavirus Identified in Patients with Acute Respiratory Infections Consulting in Primary Care over Six Influenza Seasons (2014–2020) in France

Viruses ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 630
Author(s):  
Shirley Masse ◽  
Lisandru Capai ◽  
Natacha Villechenaud ◽  
Thierry Blanchon ◽  
Rémi Charrel ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Features ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Epidemiological Data ◽  
Influenza Surveillance ◽  
Respiratory Pathogens ◽  
Detection Rates ◽  
Representative Samples

There is currently debate about human coronavirus (HCoV) seasonality and pathogenicity, as epidemiological data are scarce. Here, we provide epidemiological and clinical features of HCoV patients with acute respiratory infection (ARI) examined in primary care general practice. We also describe HCoV seasonality over six influenza surveillance seasons (week 40 to 15 of each season) from the period 2014/2015 to 2019/2020 in Corsica (France). A sample of patients of all ages presenting for consultation for influenza-like illness (ILI) or ARI was included by physicians of the French Sentinelles Network during this period. Nasopharyngeal samples were tested for the presence of 21 respiratory pathogens by real-time RT-PCR. Among the 1389 ILI/ARI patients, 105 were positive for at least one HCoV (7.5%). On an annual basis, HCoVs circulated from week 48 (November) to weeks 14–15 (May) and peaked in week 6 (February). Overall, among the HCoV-positive patients detected in this study, HCoV-OC43 was the most commonly detected virus, followed by HCoV-NL63, HCoV-HKU1, and HCoV-229E. The HCoV detection rates varied significantly with age (p = 0.00005), with the age group 0–14 years accounting for 28.6% (n = 30) of HCoV-positive patients. Fever and malaise were less frequent in HCoV patients than in influenza patients, while sore throat, dyspnoea, rhinorrhoea, and conjunctivitis were more associated with HCoV positivity. In conclusion, this study demonstrates that HCoV subtypes appear in ARI/ILI patients seen in general practice, with characteristic outbreak patterns primarily in winter. This study also identified symptoms associated with HCoVs in patients with ARI/ILI. Further studies with representative samples should be conducted to provide additional insights into the epidemiology and clinical features of HCoVs.

Clinical Predictors for Laboratory-Confirmed Influenza Infections: Exploring Case Definitions for Influenza-Like Illness

2015 ◽  
Vol 36 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Shital C. Shah ◽  
Dino P. Rumoro ◽  
Marilyn M. Hallock ◽  
Gordon M. Trenholme ◽  
Gillian S. Gibbs ◽  
...  
Keyword(s):  
Influenza A ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Signs ◽  
Case Definition ◽  
Chief Complaint ◽  
Nasopharyngeal Swab ◽  
Clinical Predictors ◽  
Case Definitions ◽  
Influenza Like Illness

OBJECTIVETo identify clinical signs and symptoms (ie, “terms”) that accurately predict laboratory-confirmed influenza cases and thereafter generate and evaluate various influenza-like illness (ILI) case definitions for detecting influenza. A secondary objective explored whether surveillance of data beyond the chief complaint improves the accuracy of predicting influenza.DESIGNRetrospective, cross-sectional study.SETTINGLarge urban academic medical center hospital.PARTICIPANTSA total of 1,581 emergency department (ED) patients who received a nasopharyngeal swab followed by rRT-PCR testing between August 30, 2009, and January 2, 2010, and between November 28, 2010, and March 26, 2011.METHODSAn electronic surveillance system (GUARDIAN) scanned the entire electronic medical record (EMR) and identified cases containing 29 clinical terms relevant to influenza. Analyses were conducted using logistic regressions, diagnostic odds ratio (DOR), sensitivity, and specificity.RESULTSThe best predictive model for identifying influenza for all ages consisted of cough (DOR=5.87), fever (DOR=4.49), rhinorrhea (DOR=1.98), and myalgias (DOR=1.44). The 3 best case definitions that included combinations of some or all of these 4 symptoms had comparable performance (ie, sensitivity=89%–92% and specificity=38%–44%). For children <5 years of age, the addition of rhinorrhea to the fever and cough case definition achieved a better balance between sensitivity (85%) and specificity (47%). For the fever and cough ILI case definition, using the entire EMR, GUARDIAN identified 37.1% more influenza cases than it did using only the chief complaint data.CONCLUSIONSA simplified case definition of fever and cough may be suitable for implementation for all ages, while inclusion of rhinorrhea may further improve influenza detection for the 0–4-year-old age group. Finally, ILI surveillance based on the entire EMR is recommended.Infect Control Hosp Epidemiol 2015;00(0): 1–8

scholarly journals What about the others: differential diagnosis of COVID-19 in a German emergency department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David Fistera ◽  
Annalena Härtl ◽  
Dirk Pabst ◽  
Randi Manegold ◽  
Carola Holzner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Health Care Systems ◽  
Clinical Signs ◽  
Vital Signs ◽  
Main Diagnosis ◽  
Clinical Trial Registry ◽  
Airway Infections

Abstract Background The ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging. Method We performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs. Results Among the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014). Conclusion For many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections. Trial registration: German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.

scholarly journals Performance of surveillance case definitions for respiratory syncytial virus infections through the sentinel influenza surveillance system, Portugal, 2010 to 2018

2019 ◽  
Vol 24 (45) ◽  
Author(s):  
Emma Sáez-López ◽  
Pedro Pechirra ◽  
Inês Costa ◽  
Paula Cristóvão ◽  
Patrícia Conde ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Characteristic Curve ◽  
Age Groups ◽  
Case Definition ◽  
Influenza Surveillance ◽  
Surveillance Systems ◽  
The European Union ◽  
Case Definitions ◽  
Rsv Infection ◽  
Syncytial Virus

Background Well-established influenza surveillance systems (ISS) can be used for respiratory syncytial virus (RSV) surveillance. In Portugal, RSV cases are detected through the ISS using the European Union (EU) influenza-like illness (ILI) case definition. Aim To investigate clinical predictors for RSV infection and how three case definitions (EU ILI, a modified EU acute respiratory infection, and one respiratory symptom) performed in detecting RSV infections in Portugal. Methods This observational retrospective study used epidemiological and laboratory surveillance data (October 2010–May 2018). Associations between clinical characteristics and RSV detection were analysed using logistic regression. Accuracy of case definitions was assessed through sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). A 0.05 significance level was accepted. Results The study involved 6,523 persons, including 190 (2.9%) RSV cases. Among 183 cases with age information, RSV infection was significantly more frequent among individuals < 5 years (n = 23; 12.6%) and ≥ 65 years (n = 45; 24.6%) compared with other age groups (p < 0.0001). Cough (odds ratio (OR): 2.4; 95% confidence interval (CI): 1.2–6.5) was the best RSV-infection predictor considering all age groups, while shortness of breath was particularly associated with RSV-positivity among ≤ 14 year olds (OR: 6.7; 95% CI: 2.6–17.4 for 0–4 year olds and OR: 6.7; 95% CI: 1.5–28.8 for 5–14 year olds). Systemic symptoms were significantly associated with RSV-negative and influenza-positive cases. None of the case definitions were suitable to detect RSV infections (AUC = 0.51). Conclusion To avoid underestimating the RSV disease burden, RSV surveillance within the Portuguese sentinel ISS would require a more sensitive case definition than ILI and, even a different case definition according to age.

scholarly journals Self-Swabbing for Virological Confirmation of Influenza-Like Illness Among an Internet-Based Cohort in the UK During the 2014-2015 Flu Season: Pilot Study (Preprint)

2017 ◽  
Author(s):  
Clare Wenham ◽  
Eleanor R Gray ◽  
Candice E Keane ◽  
Matthew Donati ◽  
Daniela Paolotti ◽  
...  
Keyword(s):  
Pilot Study ◽  
Influenza Infection ◽  
Routine Data ◽  
Influenza Surveillance ◽  
Influenza Like Illness ◽  
Time Estimates ◽  
Laboratory Confirmation ◽  
Community Transmission ◽  
The Uk ◽  
Study Participants

BACKGROUND Routine influenza surveillance, based on laboratory confirmation of viral infection, often fails to estimate the true burden of influenza-like illness (ILI) in the community because those with ILI often manage their own symptoms without visiting a health professional. Internet-based surveillance can complement this traditional surveillance by measuring symptoms and health behavior of a population with minimal time delay. Flusurvey, the UK’s largest crowd-sourced platform for surveillance of influenza, collects routine data on more than 6000 voluntary participants and offers real-time estimates of ILI circulation. However, one criticism of this method of surveillance is that it is only able to assess ILI, rather than virologically confirmed influenza. OBJECTIVE We designed a pilot study to see if it was feasible to ask individuals from the Flusurvey platform to perform a self-swabbing task and to assess whether they were able to collect samples with a suitable viral content to detect an influenza virus in the laboratory. METHODS Virological swabbing kits were sent to pilot study participants, who then monitored their ILI symptoms over the influenza season (2014-2015) through the Flusurvey platform. If they reported ILI, they were asked to undertake self-swabbing and return the swabs to a Public Health England laboratory for multiplex respiratory virus polymerase chain reaction testing. RESULTS A total of 700 swab kits were distributed at the start of the study; from these, 66 participants met the definition for ILI and were asked to return samples. In all, 51 samples were received in the laboratory, 18 of which tested positive for a viral cause of ILI (35%). CONCLUSIONS This demonstrated proof of concept that it is possible to apply self-swabbing for virological laboratory testing to an online cohort study. This pilot does not have significant numbers to validate whether Flusurvey surveillance accurately reflects influenza infection in the community, but highlights that the methodology is feasible. Self-swabbing could be expanded to larger online surveillance activities, such as during the initial stages of a pandemic, to understand community transmission or to better assess interseasonal activity.

scholarly journals An outbreak of pertussis among young Israeli soldiers

2003 ◽  
Vol 131 (3) ◽  
pp. 1049-1054 ◽  
Author(s):  
E. KLEMENT ◽  
L. ULIEL ◽  
I. ENGEL ◽  
T. HASIN ◽  
M. YAVZORI ◽  
...  
Keyword(s):  
Young Adults ◽  
Attack Rate ◽  
Respiratory Infections ◽  
Significant Proportion ◽  
Clinical Signs ◽  
Igg Antibodies ◽  
Serum Samples ◽  
Carriage Rate ◽  
Laboratory Confirmation ◽  
Israeli Soldiers

In winter 2001, an outbreak of pertussis involving an estimated 75 people occurred among soldiers serving in an infantry regiment of the Israeli Defense Forces (IDF). Nasopharyngeal swabs were obtained from patients and contacts for culture and PCR. Serum samples were obtained and assayed by ELISA for the presence of IgA, IgM and IgG antibodies to a lysate antigen of Bordetella pertussis. The calculated attack rate was 21% based on clinical signs alone (cough lasting 30 days or longer) and 9·5% based on clinical signs with laboratory confirmation (by PCR, IgA or IgM). A high carriage rate was observed; 20% of the asymptomatic and previously symptomatic subjects were PCR-positive for B. pertussis. These findings emphasize the importance of B. pertussis as a causative agent of epidemic respiratory infections in young adults and reveal the occurrence of a significant proportion of pertussis transient carriers during an outbreak of the disease.

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