Diagnostic Accuracy of the Quidel Sofia Rapid Influenza Fluorescent Immunoassay in Patients with Influenza-like Illness: A Systematic Review and Meta-analysis

( Jonghoo Lee ),( Jae-uk Song ),( Yee Hyung Kim ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.3

Background: Although the Quidel Sofia rapid influenza fluorescent immunoassay (FIA) is widely used to identify influenza A and B, the diagnostic accuracy of this test remains unclear. Thus, the objective of this study was to determine the diagnostic performance of this test compared to reverse transcriptase-polymerase chain reaction. Methods: A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary receiver-operating characteristic curve (HSROC) of this test for identifying influenza A and B were determined using meta-analysis. A sensitivity subgroup analysis was performed to identify potential sources of heterogeneity within selected studies. Results: We identified 17 studies involving 8,334 patients. Pooled sensitivity, specificity, and DOR of the Quidel Sofia rapid influenza FIA for identifying influenza A were 0.78 (95% confidence interval [CI], 0.71-0.83), 0.99 (95% CI, 0.98-0.99), and 251.26 (95% CI, 139.39-452.89), respectively. Pooled sensitivity, specificity, and DOR of this test for identifying influenza B were 0.72 (95% CI, 0.60-0.82), 0.98 (95% CI, 0.96-0.99), and 140.20 (95% CI, 55.92-351.54), respectively. The area under the HSROC for this test for identifying influenza A was similar to that for identifying influenza B. Age was considered a probable source of heterogeneity. Conclusion: Pooled sensitivities of the Quidel Sofia rapid influenza FIA for identifying influenza A and B did not quite meet the target level (≥80%). Thus, caution is needed when interpreting data of this study due to substantial between-study heterogeneity.

임신부의 인플루엔자 백신 접종률 및 관련요인

김미정,이광수,김아름,정문현,박신구,이병익,이진수,이승연,손동욱,박지현 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.6

Background:During seasonal influenza epidemics and previous pandemics, pregnant women have been at increased risk for complications related to influenza infection. Although influenza vaccination has been widely recommended to pregnant women and immunocompromised hosts, the vaccination rate is presumed to be low in pregnant women. This study was aimed to evaluate the vaccination rate and factors associated with Influenza vaccination among pregnant women, who are at high risk for developing complications from the influenza. Materials and Methods:This study was carried out by telephone survey from April, 2007 to August, 2007. Women who were in their second trimester of pregnancy or above,- during October, 2006 and February, 2007, the recommended vaccination period, and had given birth at Inha University Hospital were selected as the study population. Immunization status, general understanding, and factors associated with vaccination were evaluated. Results:Among a total of 506 eligible pregnant women, 227 (44.8%) responded to the questionnaires. The influenza vaccination rate among the pregnant women was only 4% (9/227). Major reasons for not receiving vaccination were first, not awaring the necessity of immunization during pregnancy (48.5%, 110/227) and second, misunderstanding that it is prohibited during pregnancy (36.1%, 82/227). The major factors that influenced the compliance of vaccination were correct understanding and doctor's recommendation on the influenza immunization during pregnancy. Conclusions:The influenza vaccine coverage on pregnant women was very low and the awareness of influenza vaccination during pregnancy in general was inaccurate. Shift in perception is required and this can be achieved by educating the pregnant women on the safety and efficacy of vaccination. In addition, doctors' active encouragement to vaccination is highly recommended. Background:During seasonal influenza epidemics and previous pandemics, pregnant women have been at increased risk for complications related to influenza infection. Although influenza vaccination has been widely recommended to pregnant women and immunocompromised hosts, the vaccination rate is presumed to be low in pregnant women. This study was aimed to evaluate the vaccination rate and factors associated with Influenza vaccination among pregnant women, who are at high risk for developing complications from the influenza. Materials and Methods:This study was carried out by telephone survey from April, 2007 to August, 2007. Women who were in their second trimester of pregnancy or above,- during October, 2006 and February, 2007, the recommended vaccination period, and had given birth at Inha University Hospital were selected as the study population. Immunization status, general understanding, and factors associated with vaccination were evaluated. Results:Among a total of 506 eligible pregnant women, 227 (44.8%) responded to the questionnaires. The influenza vaccination rate among the pregnant women was only 4% (9/227). Major reasons for not receiving vaccination were first, not awaring the necessity of immunization during pregnancy (48.5%, 110/227) and second, misunderstanding that it is prohibited during pregnancy (36.1%, 82/227). The major factors that influenced the compliance of vaccination were correct understanding and doctor's recommendation on the influenza immunization during pregnancy. Conclusions:The influenza vaccine coverage on pregnant women was very low and the awareness of influenza vaccination during pregnancy in general was inaccurate. Shift in perception is required and this can be achieved by educating the pregnant women on the safety and efficacy of vaccination. In addition, doctors' active encouragement to vaccination is highly recommended.

2017-2018, 2018-2019 절기 제주 지역 소아 인플루엔자의 역학적 특성

김윤주 ( Yoon-joo Kim ),최영준 ( Young June Choe ),최재홍 ( Jae Hong Choi ) 대한소아감염학회 2020 Pediatric Infection and Vaccine Vol.27 No.3

목적: 제주 지역에서 2017-2018 절기와 2018-2019 절기에 소아 연령에서 인플루엔자의 역학에 대해 알아보고자 하였다. 이에 더하여 국내 인플루엔자 표본감시체계와 비교하여 그 대표성을 확인해보고자 하였다. 방법: 2017-2018, 2018-2019 각각의 절기에 제주대학교 병원에 방문하여 인플루엔자 검사를 시행 받은 13세 미만의 소아를 대상으로 하였다. 의무기록을 통하여 대상 환자들의 인구학적 자료, 인플루엔자 검사 결과를 후향적으로 분석하였다. 결과: 총 5,219명의 인플루엔자 의사환자가 연구 대상자로 포함되었다. 전체적으로 연구 대상자의 평균 나이는 2.85±2.79세였고, 두 절기 모두 인플루엔자 의사환자는 1세 연령 그룹이 가장 많았다. 인플루엔자 감염이 확인된 소아는 총 902 (17.3%)명이었다. 2017-2018 절기에는 인플루엔자 A형의 양성률은 10.4% (236/2,279), 인플루엔자 B형의 양성률은 9.1% (208/2,279)이었다. 2018-2019 절기에는 인플루엔자 A형의 양성률은 10.3% (303/2,940), 인플루엔자 B형의 양성률은 5.3% (155/2,940)이었다. 인플루엔자 환자의 평균 연령은 2017-2018 절기에는 4.09세, 2018-2019 절기에는 5.05세로 통계적으로 유의한 차이를 보였다 (P<0.05). 인플루엔자의 주별 분포는 국내 임상감시시스템의 인플루엔자 의사환자와 유사한 형태로 나타났다. 결론: 제주 지역에서 2017-2018 절기와 2018-2019 절기 사이에 인플루엔자 유행 양상과 연령 분포의 뚜렷한 차이를 보였다. 국내 다른 지역과의 역학적 특성과 비교하여 제주 지역 고유의 인플루엔자 역학에 대한 지속적인 연구가 필요하다. Purpose: In Korea, seasonal influenza is an important respiratory illness afflicting children every year. We aimed to investigate the childhood epidemiology in Jeju during the 2017-2018 and 2018-2019 seasons. Methods: Children aged <13 years, who were tested for influenza at the Jeju National University Hospital during the 2017-2018 and 2018-2019 influenza seasons, were included. Demographics and the influenza test results were retrospectively reviewed from their medical records. Results: This study included 5,219 cases of influenza-like illness (ILI) (2017-2018: n=2,279; 2018-2019: n=2,940). The mean age of the eligible children was 2.85±2.79 years, and the most common age among ILI patients in each season was 1 year group. There were 902 (17.3%, 902/5,219) confirmed influenza cases during the 2 seasons. The rate of influenza confirmed by rapid influenza diagnostic test or polymerase chain reaction among ILI patients in the 2017-2018 and 2018-2019 seasons was 10.4% (236/2,279) and 10.3% (303/2,940) for influenza A, and 9.1% (208/2,279) and 5.3% (155/2,940) for influenza B, respectively. The mean age of influenza-confirmed cases was 4.09 years and 5.05 years in the 2017-2018 and 2018-2019 seasons, respectively (P<0.05). Weekly distribution of influenza was similar to that of ILI in the clinical sentinel surveillance system in both seasons. Conclusion: The difference in the influenza epidemic trend and age-group distribution between the 2017-2018 and 2018-2019 seasons was distinct in Jeju. Steady epidemiological studies on influenza in Jeju are needed for comparison with other regions of Korea.

인플루엔자 감염과 합병증 발생의 임상양상 및 위험인자 분석

오욱현,이숙희,장태창,김균무,서영우,고승현 대한응급의학회 2022 대한응급의학회지 Vol.33 No.3

Objective: Influenza is an acute, respiratory viral disease, and may lead to complications such as pneumonia, which presents with significant morbidity and mortality. Previous studies did not have sufficient data regarding the risk factors and complications of the H1N1 flu caused by the influenza A virus subtype H1N1 during the 2009 pandemic in Korea. Therefore, this study was conducted to analyze the characteristics and risk factors of complicated influenza. Methods: Data were collected from influenza patients who visited a local emergency center in Daegu from January 2017 to December 2019. The study population was divided into three groups: influenza, influenza pneumonia, and influenza with a bacterial infection. The patients’ sex, age, influenza type, comorbidities, vital signs, symptoms, laboratory findings, and clinical outcomes were investigated for the risk analysis of complicated influenza. Results: The total number of patients was 574, of which 393 (68.5%) had influenza only, 135 (23.5%) had influenza pneumonia, and 46 (8%) had influenza with a bacterial infection. The odds ratio of complicated influenza was found using multivariate logistic regression analysis; for influenza pneumonia, it was 2.94 for patients aged over 65-years, 3.47 for those with an elevated procalcitonin level, 2.24 for cough, 6.41 for dyspnea, and 3.11 for renal disease. For influenza with bacterial infection, the odds ratio was 2.31 for males, 2.68 for over 80-year-olds, 3.75 for elevated procalcitonin levels, 7.61 for dyspnea, and 3.65 for nursing home residents. Conclusion: The risk factors of complicated influenza were advanced age, elevated procalcitonin level, dyspnea, renal disease, and residing in a nursing home.

인플루엔자 유행시 국가방역 관리 능력 향상을 위한 기초연구

김지희,김우주,이주연,나병국,박종원,신구철,김선숙,김진아,고연아,박순희,김도근,임윤구 국립보건연구원 1999 국립보건원보 Vol.36 No.-

노인복지관 이용 노인의 독감 예방접종 여부에 따른 독감의사질병 발생

김옥선(Og Son Kim),오진환(Jin Hwan Oh) 다문화건강학회 2021 다문화건강학회지 Vol.11 No.2

Purpose: The purpose of this study was to identify influenza vaccination and influenza-like-illness incidence rates caused by influenza vaccination in the elderly using the senior citizen welfare center. Methods: The subjects of the study were 65-year-old 250 people who used the senior citizen welfare center located in Seoul and Gyeonggi-do, Korea. The survey was conducted from May 1 to May 17, 2019, and 242 data were analyzed. The data were analyzed by descriptive statistics, test, Fisher s exact test and independent t-test using the SPSS WIN 18.0 program. Results: Influenza vaccination rate was 93.4%, and influenza-like-illness incidence rate was 5.4%. Cold suspected respiratory infection was 36.8%, and 92.3% of people with influenza-like-illness were treated in hospital. Also, the average duration of symptoms was 13.08±9.55 days. The effect of influenza vaccination was significantly higher in the group who received the vaccination(p=.036) and the group who did not develop the influenza-like-illness(p=.016). The difference in the incidence of influenza-like-illness was not statistically significant, depending on whether the influenza was immunized. Conclusion: Considering the severity of symptoms and secondary problems due to respiratory infections in the elderly, different strategies should be implemented to prevent and treat influenza and influenza-like-illness.

Comparative analyses of influenza virus receptor distribution in the human and mouse brains

Kim, M.,Yu, J.E.,Lee, J.H.,Chang, B.J.,Song, C.S.,Lee, B.,Paik, D.J.,Nahm, S.S. Elsevier Science Publisher 2013 Journal of chemical neuroanatomy Vol.52 No.-

Accumulating evidence suggests a potential link between influenza A virus infection and the occurrence of influenza-associated neurological disorders. As influenza infection is mediated by specific receptors on the host cell surface, it is important to understand the distribution patterns of influenza receptors in target organs. We carried out comprehensive experiments to localize influenza receptors in the brains of two different mouse strains and the human brain for comparison using lectin histochemistry. We further compared the brain regions in which influenza receptors were expressed and the regions in which experimental influenza infection was observed. Our results show that the expression patterns for influenza receptors in mouse and human brains are different. In the mouse brain, human influenza virus receptors (HuIV-R) were expressed in part of brainstem and cerebellar white matter while avian influenza virus receptors (AIV-R) were expressed in the cerebellar Purkinje neurons. In contrast, in the human brain, many neurons and glia in widespread regions, including the cerebral cortex, hippocampus, brainstem, and cerebellum, express both AIV-R and HuIV-R. Importantly, vascular endothelial cells, choroid plexus epithelial cells and ependymal cells in both mouse and human brains express high levels of HuIV-R and AIV-R. The regional reciprocity was not observed when comparing regions with influenza receptor expression and the regions of influenza infection within the mouse brain. Our results demonstrate a differential influenza receptor expression pattern in mouse and human brains, and a disparity between influenza receptor distribution and regions with actual influenza infection.

Estimating Influenza-associated Mortality in Korea: The 2009-2016 Seasons

Kwan Hong,Sangho Sohn,천병철 대한예방의학회 2019 예방의학회지 Vol.52 No.5

Objectives: Estimating influenza-associated mortality is important since seasonal influenza affects persons of all ages, causing severe illness or death. This study aimed to estimate influenza-associated mortality, considering both periodic changes and age-specific mortality by influenza subtypes. Methods: Using the Microdata Integrated Service from Statistics Korea, we collected weekly mortality data including cause of death. Laboratory surveillance data of respiratory viruses from 2009 to 2016 were obtained from the Korea Centers for Disease Control and Prevention. After adjusting for the annual age-specific population size, we used a negative binomial regression model by age group and influenza subtype. Results: Overall, 1 859 890 deaths were observed and the average rate of influenza virus positivity was 14.7% (standard deviation [SD], 5.8), with the following subtype distribution: A(H1N1), 5.0% (SD, 5.8); A(H3N2), 4.4% (SD, 3.4); and B, 5.3% (SD, 3.7). As a result, among individuals under 65 years old, 6774 (0.51%) all-cause deaths, 2521 (3.05%) respiratory or circulatory deaths, and 1048 (18.23%) influenza or pneumonia deaths were estimated. Among those 65 years of age or older, 30 414 (2.27%) all-cause deaths, 16 411 (3.42%) respiratory or circulatory deaths, and 4906 (6.87%) influenza or pneumonia deaths were estimated. Influenza A(H3N2) virus was the major contributor to influenza-associated all-cause and respiratory or circulatory deaths in both age groups. However, influenza A(H1N1) virus–associated influenza or pneumonia deaths were more common in those under 65 years old. Conclusions: Influenza-associated mortality was substantial during this period, especially in the elderly. By subtype, influenza A(H3N2) virus made the largest contribution to influenza-associated mortality.

대유행 인플루엔자(H1N1 2009) 진료와 대응에 관한 감염내과 전문의들의 견해

김백남 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

Background: The 2009 pandemic influenza (H1N1 2009) virus spread rapidly to the community after being introduced in Korea since late April, 2009. According to the health authority’s revised management guideline, most of major private and public hospitals are required to take part in the medical care of pandemic influenza patients since 21 August, 2009. This questionnaire survey was conducted to identify Infectious Disease physicians’ perspectives on issues related to the management of the 2009 pandemic influenza in Korea. Materials and Mthods: A 13-item questionnaire was e-mailed to 118 physicians who were board certified in Infectious Disease in November 2009. Respondents were asked about their opinion on diagnosis and treatment of influenza, and response to the pandemic influenza (H1N1 2009). Results: The response rate was 69.5%. Of the respondents, 51.2% believed that they could make a diagnosis of influenza on clinical grounds. Most indicated that a laboratory testing is needed for the management of the pandemic and seasonal influenza (80.5% and 82.7%, respectively). Regarding the use of rapid influenza antigen test, 70.7% reported that it might be beneficial in the care of pandemic influenza patients when results are properly interpreted, and 82.9% claimed that its use during influenza seasons could reduce unnecessary antibiotic usage. These opinions were significantly higher among those who had seen more than 100 pandemic influenza patients (P=0.008 and 0.03, respectively). Evaluation using an 11-point numeric rating scale showed that respondents only moderately supported the policies and guidelines of the public health authority (mean score±standard deviation, 5.4±1.99). In view of confronting and solving the pandemic influenza (H1N1 2009), the contribution of mass media and doctors’ representative organization on public health was rated as 3.5±1.89 and 3.7±1.83, respectively. The validity of media reports on the pandemic influenza was assessed as 3.3±1.71. Conclusions: Most respondents acknowledged the need for laboratory diagnosis in the case management of suspected influenza infection. They regarded overall reactions of both governmental and non-governmental sectors in Korea to the pandemic influenza (H1N1 2009) as relatively unsatisfactory or modest at best. The results of this study showed that improvement is necessary in responses to this pandemic influenza and future seasonal influenza.

2010년에서 2015년까지 소아에서 발생한 계절성 인플루엔자와 관련된 신경학적 합병증

윤희정(Hui Jeong Yun),남명수(Myoung Soo Nam),김용욱(Yong Wook Kim),김경심(Kyoung Sim Kim),조형민(Hyung Min Cho),김 령(Young Kim),김은영(Eun Young Kim) 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.2

목적: 소아에서의 인플루엔자 신경계 합병증은 다양하며, 드물게 심각한 후유증을 남기는 것으로 보고되고 있으나, 이에 대한 장기간 및 대규모 연구가 부족한 실정이다. 저자들은 인플루엔자 바이러스 감염과 관련된 신경학적 합병증의 발생 빈도를 조사하고, 신경학적 합병증 발생과 관련된 인자를 찾아, 진단과 치료에 도움이 되는 자료를 얻고자 하였다. 방법: 2010년 10월부터 2016년 5월까지 6년간 계절성 인플루엔자로 광주기독병원 소아청소년과에 입원한 만 18세 이하의 환자를 대상으로 후향적으로 의무기록을 분석하였다. 결과: 1. 인플루엔자 감염으로 입원한 940명의 소아 중 96명 (10.2%)에서 신경학적 합병증이 동반되었다. 열성경련이 81명(8.6%) 으로 대부분을 차지하였고, 기타 경련 12명(1.3%), 뇌염, 길랭-바레 증후군, 무균성 뇌수막염이 1명씩(0.1%) 포함되었다. 뇌염 1례를 제외 하고는 양호한 경과를 보였다. 2. A형 인플루엔자에서 B형 인플루엔자보다 신경학적 합병증 발생률이 더 의미 있게 높았다(11.9% vs. 7.0%, P =0.036). 3. A형 인플루엔자는 2월에, B형 인플루엔자는 3, 4월에 분리되는 경향을 보이며, 월별 신경학적 합병증 발생률도 인플루엔자 유행 시기를 반영하였다. 4. 인플루엔자와 관련된 신경학적 합병 증 발생의 위험 인자로는 신경계 기저질환, 어린 나이가 관련되었다. 5. 신경학적 합병증의 대부분을 차지했던 열성경련에서 인플루엔자 A형과 B형으로 나누어 임상적 특징을 비교했을 때, 두 군 간에 의미 있는 차이는 없었다. 결론: 인플루엔자 감염에 의한 신경학적 합병증은 대부분이 열성경련으로 예후가 양호하다. 그러나 뇌증/뇌염의 경우 드물게 발생하지만 심각한 후유증을 남길 수도 있기에, 신속한 진단과 치료가 필요하다. 또한, 뇌전증, 발달 지연 및 선천성 뇌 기형 등을 가진 소아들에서 신 경학적 합병증 발생의 위험이 증가하므로, 이들에게 적극적인 인플루엔자 예방접종을 독려해야 한다. Purpose: Influenza-associated neurologic complications in children are diverse. But there has been little long-term and large-scale research about neurologic complications of seasonal influenza. This study aimed to identify the incidence, characteristics, and risk factors for neurologic complications in children hospitalized with influenza. Methods: Retrospective analysis was conducted on the clinical data of 940 children hospitalized with confirmed influenza infection from Oct, 2010 to May, 2016 in Kwangju Christian Hospital. Results: A total of 940 children with influenza were hospitalized, of whom 96 (10.2%) had neurologic complications:81 children presented febrile seizures (8.6%) and some included 12 other seizures (1.3%),1 encephalitis (0.1%), 1 Guillain-Barré syndrome (0.1%), 1 aseptic meningitis (0.1%). They had good prognosis except the encephalitis child. The incidence of neurologic complications was significantly higher in influenza A than in influenza B (11.9% vs. 7.0%, P=0.036). The incidence of influenza A was highest in February, while that of influenza B was highest in March and April. The monthly distribution of neurological complications reflected the influenza incidence. The risk factors for influenza-associated neurologic complications were underlying neurologic disease and young age. No significant clinical differences were observed between influenza A and B in febrile seizure. Conclusion: Febrile seizures are the most common neurologic complication with good prognosis. Although encephalitis/encephalopathy is rare, it can be severe with sequelae, so prompt diagnosis and treatment should be initiated. And influenza vaccine should be encouraged to children with underlying neurologic disease.