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Outcomes of Patients With Hospital-Acquired Influenza
- Melissa Campbell, Amber James, Iyanna Fairweather, Jose Rivera-Vinas, Richard Kaslow, Marie-Louise Landry, David Peaper, Richard Martinello
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s340
- Print publication:
- October 2020
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Background: Hospital-acquired influenza (HA flu) lacks a consensus definition. However, it is known to be associated with increased inpatient morbidity and mortality. Objective: To describe the clinical course of HA flu in a cohort population. Methods: A retrospective cohort study was conducted at a tertiary-care adult and pediatric teaching hospital. Patients with HA flu during 3 seasons, 2016 through 2019, were identified from medical record information based on timing of the onset of signs and symptoms and positive virologic testing >72 hours after admission. Influenza infection was confirmed by multiplex respiratory PCR, influenza A/B PCR, or direct fluorescent antibody tests. Chart review was performed to abstract patient demographics and comorbidities, length of stay, testing, and timing to antiviral administration as well as diagnosis of pneumonia, coinfections, and 30-day mortality. Escalation of care during hospitalization was defined as a new requirement of supplemental oxygen, invasive or noninvasive ventilation, and transfer to an intensive care unit. Results: During the 3 flu seasons, 132 patients were identified with HA flu; 76 (58%) were women, 6 (4.6%) were aged <18 years, and 126 (95.4%) were adults. Annually, HA-flu patients accounted for 5%–7.8% of all patients hospitalized with laboratory-proven influenza. The median duration between hospitalization and positive flu test was 15 days, and the median length of stay after influenza diagnosis was 6 days. Antiviral treatment was received by 96% of the patients. In total, 41 patients (31%) showed radiographic evidence for pneumonia. Coinfection with either a viral or bacterial pathogen was identified in 25% of the cases. In addition, 26% of the patients experienced an escalation of care, and 20 patients (15%) were transferred to the intensive care unit after HA flu diagnosis. Furthermore, 4 deaths (3%) were attributed to influenza during their hospitalization. Conclusions: HA flu was a frequent cause for escalation in care and was associated with a mortality rate substantially higher than is typically seen in community-based populations with influenza. Coinfection was mostly related to bacteremia and pneumonia, yet not all pneumonias had an associated microbiological diagnosis other than influenza, and there was no significant association between coinfection and mortality. Future work should explore more precise definitions for HA flu as well as its complications.
Funding: None
Disclosures: None
Access, Education and Policy Awareness: Predictors of Influenza Vaccine Acceptance Among VHA Healthcare Workers
- Jennifer Lipkowitz Eaton, David C. Mohr, Kathleen M. McPhaul, Richard A. Kaslow, Richard A. Martinello
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 38 / Issue 8 / August 2017
- Published online by Cambridge University Press:
- 23 June 2017, pp. 970-975
- Print publication:
- August 2017
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OBJECTIVE
To identify predictors of influenza vaccine acceptance among VHA healthcare workers (HCWs), with emphasis on modifiable factors related to promotion campaigns.
DESIGNSurvey.
SETTINGNational single-payer healthcare system with 140 hospitals and 321,000 HCWs.
PARTICIPANTSNational voluntary sample of HCWs in the Veterans Health Administration (VHA) system.
METHODSWe invited a random sample of 5% of all VHA HCWs to participate. An 18-item intranet-based survey inquired about occupation, vaccination status, employer policy, and local campaign efforts.
RESULTSThe response rate was 17.4%. Of 2,502 initial respondents, 2,406 (96.2%) provided usable data. This sample includes respondents from all 140 VA hospitals. Self-reported influenza vaccination rates were highest among physicians (95.6%) and licensed independent providers (88.3%). Nonclinical staff (80.7%) reported vaccine uptake similar to other certified but nonlicensed providers (81.2%). The strongest predictor of vaccine acceptance among VHA HCWs was individual awareness of organizational policy. Vaccine acceptance was also higher among HCWs who reported more options for access to vaccination and among those in facilities with more education activities.
CONCLUSIONSInfluenza vaccine acceptance varied significantly by employee awareness of employer policy and on-site access to vaccine. Employer-sponsored activities to increase access continue to show positive returns across occupations. Local influenza campaign efforts to educate HCWs may have reached saturation in this target group. These results suggest that focused communications to increase HCW awareness and understanding of employer policy can drive further increase in influenza vaccination acceptance.
Infect Control Hosp Epidemiol 2017;38:970–975
Contributors
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- By Cecil S. Ash, Paul Barach, Ulrike Buehner, M. Ross Bullock, Leonardo Canale, Henry G. Chou, Jeffrey A. Claridge, John J. Como, Armagan Dagal, Martin Dauber, James S. Davis, Shalini Dhir, François Donati, Roman Dudaryk, Richard P. Dutton, Talmage D. Egan, Yashar Eshraghi, John R. Fisgus, Jeff Gadsden, Sugantha Ganapathy, Mark A. Gerhardt, Inderjit Gill, Joseph F. Golob, Glenn P. Gravlee, Marcello Guglielmi, Jana Hambley, Peter Hebbard, Elena J. Holak, Khadil Hosein, Ken Johnson, Matthew A. Joy, George W. Kanellakos, Olga Kaslow, Arthur M. Lam, Vanetta Levesque, Jessica Anne Lovich-Sapola, M. Jocelyn Loy, Peter F. Mahoney, Donn Marciniak, Maureen McCunn, Craig C. McFarland, Maroun J. Mhanna, Timothy Moore, Cynthia Nguyen, Maxim Novikov, E. Orestes O’Brien, Ketan P. Parekh, Claire L. Park, Michael J. A. Parr, Elie Rizkala, Steven Roth, Alistair Royse, Colin Royse, Kasia Petelenz Rubin, David Ryan, Claire Sandstrom, Carl I. Schulman, Rishad Shaikh, Ranjita Sharma, Jeffrey H. Silverstein, Peter Slinger, Charles E. Smith, Christopher Smith, Paul Soeding, Rakesh V. Sondekoppam, P. David Soran, Eldar Søreide, Elizabeth A. Steele, Kristian Strand, Dennis M. Super, Kutaiba Tabbaa, Nicholas T. Tarmey, Joshua M. Tobin, Kalpana Tyagaraj, Heather A. Vallier, Sandra Werner, Earl Willis Weyers, William C. Wilson, Shoji Yokobori, Charles J. Yowler
- Edited by Charles E. Smith
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- Book:
- Trauma Anesthesia
- Published online:
- 05 April 2015
- Print publication:
- 09 April 2015, pp vii-x
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Contributors
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- By Brendan Astley, Shawn Banks, Michael D. Bassett, John J. Como, Armagan Dagal, Christian Diez, Sylvia Y. Dolinski, Richard Dutton, Ashraf Fayad, Yvette Fouche, Megan Gatlin, Ralf E. Gebhard, Suneeta Gollapudy, Andreas Grabinsky, Thomas E. Grissom, Pertti Hakala, Olga Kaslow, Robert Kettler, Jeb Kucik, Jessica A. Lovich-Sapola, Scott Margraf, Joseph H. McIsaac, Richard McNeer, Nicholas Nedeff, Edgar J. Pierre, Ramesh Ramaiah, Sripad Rao, Sam Sharar, Deepak Sharma, Roger Shere-Wolfe, Robert Sikorski, Charles E. Smith, Michael J. Souter, Christopher Stephens, Brandon A. Van Noord, Albert J. Varon, Monica S. Vavilala, Michael Woo
- Edited by Albert J. Varon, Charles Smith
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- Book:
- Essentials of Trauma Anesthesia
- Published online:
- 05 July 2012
- Print publication:
- 07 June 2012, pp xi-xiv
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7 - Polymorphic chemokine receptor and ligand genes in HIV infection
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- By Jianming (James) Tang, Division of Geographic Medicine, Department of Medicine, School of Medicine, Richard A. Kaslow, Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham
- Edited by Richard Bellamy, Kintampo Health Research Centre, Ghana
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- Book:
- Susceptibility to Infectious Diseases
- Published online:
- 14 August 2009
- Print publication:
- 22 December 2003, pp 185-220
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Summary
Human immunogenetic studies beginning in 1996 have produced clear evidence that initial acquisition of HIV-1 infection can be effectively blocked by homozygosity for a 32-bp deletion (Δ32) in the open reading frame of the beta (C-C motif) chemokine receptor 5 (CCR5) and further inhibited by the Δ32 heterozygous genotype or by Δ32 in combination with another mutation that also introduces a premature stop codon in CCR5. Conversely, homozygosity for the CCR2-CCR5 HHE haplotype defined by several single-nucleotide polymorphisms (SNPs) appears to enhance HIV-1 acquisition. The two closely related CCR2-CCR5 haplotypes HHE and HHG*2 (=CCR5-Δ32) and probably others [e.g., HHF*2 (=CCR2-64I)] are also associated with varying rates of HIV-1 disease progression against certain ethnic backgrounds. Additional but less consistent associations with both HIV-1 infection and disease progression have been documented for SDF-1, RANTES (SCYA5), CX3CR1, and MIP-1α polymorphisms within the chemokine receptor and ligand system. Both chance association and population heterogeneity probably account for some of the inconsistencies. More recent recognition of CCR2-CCR5 haplotype-mediated effects on HIV-1 RNA concentration implies that CCR polymorphisms are important early determinants of the virus–host equilibrium. Evolving usage of chemokine receptors by HIV-1 may cloud the interpretation of newly acquired data and impede translation of this research into improvements in clinical care. The functional complexity of the chemokine system and its interactions with other host and viral factors calls for a comprehensive analytic approach to the elucidation of immunogenetic influences on HIV/AIDS and vigilance for effects of viral adaptation.