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The controversy over H5N1 transmissibility research: An opportunity to define a practical response to a global threat.

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The controversy over H5N1 transmissibility research: An opportunity to define a practical response to a global threat.

Hum Vaccin Immunother. 2013 Feb 7;9(5)

Authors: Fedson DS, Opal SM

Abstract
Since December 2011, influenza virologists and biosecurity experts have been engaged in a controversial debate over research on the transmissibility of H5N1 influenza viruses. Influenza virologists disagreed with the NSABB's recommendation not to publish experimental details of their findings, whereas biosecurity experts wanted the details to be withheld and future research restricted. The virologists initially declared a voluntary moratorium on their work, but later the NSABB allowed their articles to be published, and soon transmissibility research will resume. Throughout the debate, both sides have had understandable views, but both have overlooked the more important question of whether anything could be done if one of these experimentally derived viruses or a naturally occurring and highly virulent influenza virus should emerge and cause a global pandemic. This is a crucial question, because during the 2009 H1N1 influenza pandemic, more than 90% of the world's people had no access to timely supplies of affordable vaccines and antiviral agents. Observational studies suggest that inpatient statin treatment reduces mortality in patients with laboratory-confirmed seasonal influenza. Other immunomodulatory agents (glitazones, fibrates and AMPK agonists) improve survival in mice infected with influenza viruses. These agents are produced as inexpensive generics in developing countries. If they were shown to be effective, they could be used immediately to treat patients in any country with a basic health care system. For this reason alone, influenza virologists and biosecurity experts need to join with public health officials to develop an agenda for laboratory and clinical research on these agents. This is the only approach that could yield practical measures for a global response to the next influenza pandemic.

PMID: 23391967 [PubMed - as supplied by publisher]

The Occurrence and Impact of Bacterial Organisms Complicating Critical Care Illness Associated with Influenza A(H1N1) infection.

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The Occurrence and Impact of Bacterial Organisms Complicating Critical Care Illness Associated with Influenza A(H1N1) infection.

Chest. 2013 Feb 7;

Authors: Muscedere J, Ofner M, Kumar A, Long J, Lamontagne F, Cook D, McGeer A, Chant C, Marshall J, Jouvet P, Fowler R

Abstract
ABSTRACT PURPOSE: Although secondary infections are recognized as a cause of morbidity and mortality in seasonal influenza, their frequency, characteristics and associated clinical outcomes in Influenza A (H1N1)-related critical illness are unknown. METHODS: In a prospective cohort of adult patients admitted to Canadian Intensive Care Units (ICUs) with H1N1 infection, the frequency and associated clinical outcomes of prevalent (culture taken within 72 hours of ICU admission) and ICU-acquired (culture taken after 72 hours from ICU admission) positive bacterial cultures were determined. RESULTS: Among 681 patients the mean age was 47.9 years (standard deviation [SD] 15.1), APACHE II was 21.0 (9.9) and 573 (84.0%) were invasively mechanical ventilated (MV). Positive cultures were obtained in 259 (38.0 %): 77 (29.7%) prevalent; 115 (44.4%) ICU-acquired; 40 (15.4%) had both; culture date was unavailable in 27 (10.4%). The most common bacterial organisms isolated were coagulase negative staphylococci, Staphylococcus aureus, Pseudomonas sp. and Streptococcus pneumoniae. Antibiotics were prescribed in 661 (97.1%) with 3.8 (1.9) prescriptions per patient. Patients with any positive culture had longer days of MV [mean(SD); 15.2 (10.7) vs. 10.7 (9.0), p< 0.0001], ICU stay [median(IQR);18.2 (12.5) vs. 10.8 (9.0) days, p< 0.0001], hospitalization [median(IQR); 30.7 (20.7) vs. 19.2 (17.4) days, p< 0.0001] and a trend towards increased hospital mortality (25.1% vs. 19.9%, p = 0.15). Patients with ICU-acquired positive cultures had worse outcomes compared to those with positive prevalent cultures or who were culture negative. CONCLUSION: Culture-based evidence of secondary infections commonly complicates Influenza A(H1N1)-related critical illness and is associated with worse clinical outcomes despite nearly ubiquitous antibiotic administration.

PMID: 23392627 [PubMed - as supplied by publisher]

Comparison of Immune Response by Virus Infection and Vaccination to 2009 Pandemic Influenza A/H1N1 in Children.

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Comparison of Immune Response by Virus Infection and Vaccination to 2009 Pandemic Influenza A/H1N1 in Children.

J Korean Med Sci. 2013 Feb;28(2):274-9

Authors: Kang EK, Lim JS, Lee JA, Kim DH

Abstract
We aimed to compare the immune response induced by natural infection with 2009 pandemic influenza A/H1N1 (pH1N1) virus and by monovalent pH1N1 vaccination in children and adolescents. This cross-sectional clinical study was conducted at 3 hospitals in Korea from February to May 2010. A total of 266 healthy subjects aged from 6 months to 18 yr were tested for the presence of the antibody against pH1N1 using hemagglutination inhibition (HI) test. Information about pH1N1 vaccination and laboratory-confirmed pH1N1 infection history was obtained. The overall rate of HI titers of ≥ 1:40 against pH1N1 was 38.7%, and the geometric mean titer (GMT) was 20.5. Immunogenicity of pH1N1 vaccination only was reflected by a 41.1% of seroprotection rate and a GMT of 22.5. Immunogenicity of natural infection only was reflected by a 61.0% of seroprotection rate and a GMT of 40.0. GMT was significantly higher in the subjects of natural infection group than in the subjects of pH1N1 vaccination group (P < 0.001). The immune responses induced by natural pH1N1 infection exceed those induced by pH1N1 vaccinations.

PMID: 23399558 [PubMed - in process]

Clinical Research During a Public Health Emergency: A Systematic Review of Severe Pandemic Influenza Management.

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Clinical Research During a Public Health Emergency: A Systematic Review of Severe Pandemic Influenza Management.

Crit Care Med. 2013 Feb 8;

Authors: Ortiz JR, Rudd KE, Clark DV, Jacob ST, West TE

Abstract
OBJECTIVE:: Rigorous evaluation of clinical interventions in the setting of a public health emergency is necessary to identify best practices, to develop clinical management guidelines, and to inform resource allocation. The 2009 influenza A (H1N1) pandemic necessitated care of critically ill patients around the world. To inform the WHO Public Health Research Agenda for Influenza, we conducted a systematic review to identify clinical interventions other than antiviral therapies that would benefit severely ill 2009 H1N1 influenza patients (adults and children) in both high- and low-resource settings. DATA SOURCES:: PubMed, EMBASE, Cochrane Central Register of Clinical Trials, and Cochrane Database of Systematic Reviews; hand search of abstracts from six professional society annual conferences and bibliographies of clinical review articles; and personal communication with leaders in the field. STUDY SELECTION:: English language; human studies; citations added to databases from January 1, 2009 (Cochrane databases) or March 15, 2009 (PubMed and EMBASE) through January 31, 2012; randomized controlled trials, prospective cohort studies, or systematic reviews/meta-analyses of non-antiviral clinical interventions in hospitalized 2009 influenza A (H1N1) patients. DATA EXTRACTION:: The search identified 2,452 articles. Thirty-six potentially relevant articles were read. Seven articles met criteria. All were observational studies. DATA SYNTHESIS:: One study found benefit of convalescent plasma infusion, three studies found no benefit of corticosteroids, and three studies had mixed results on the benefit of extracorporeal lung support. No study was applicable to health care delivery in low-resource settings. CONCLUSIONS:: There is a paucity of high quality clinical research to inform clinical care of severe H1N1 influenza, and we found no beneficial interventions appropriate for low-resource settings. This may be due to the logistical difficulties of conducting clinical research in response to a public health emergency. Our investigation underscores the need for the development of outbreak-ready research capacity in both high and low-resource settings.

PMID: 23399939 [PubMed - as supplied by publisher]

The Cognitive Mediation Model: Factors Influencing Public Knowledge of the H1N1 Pandemic and Intention to Take Precautionary Behaviors.

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The Cognitive Mediation Model: Factors Influencing Public Knowledge of the H1N1 Pandemic and Intention to Take Precautionary Behaviors.

J Health Commun. 2013 Feb 12;

Authors: Ho SS, Peh X, Soh VW

Abstract
This study uses the cognitive mediation model as the theoretical framework to examine the influence of motivations, communication, and news elaboration on public knowledge of the H1N1 pandemic and the intention to take precautionary behaviors in Singapore. Using a nationally representative random digit dialing telephone survey of 1,055 adult Singaporeans, the authors' results show that the cognitive mediation model can be applied to health contexts, in which motivations (surveillance gratification, guidance, and need for cognition) were positively associated with news attention, elaboration, and interpersonal communication. News attention, elaboration, and interpersonal communication in turn positively influence public knowledge about the H1N1 influenza. In addition, results show that the motivations have significant indirect effects on behavioral intentions, as partially mediated by communication (media attention and interpersonal communication), elaboration, and knowledge. The authors conclude that the cognitive mediation model can be extended to behavioral outcomes, above and beyond knowledge. Implications for theory and practice for health communication were discussed.

PMID: 23402299 [PubMed - as supplied by publisher]

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