Infections & Antimicrobial
For the first time in 27 years, influenza B viruses have predominated in the United States
'Mixed bag' flu season has been particularly tough on children. "Flu is going to be a much bigger killer in the United States than this coronavirus and people aren't doing everything that they possibly can to diminish the spread!"
For the first time in 27 years, influenza B viruses have predominated in the United States, accounting for more than 56% of samples tested in public health laboratories as of Jan. 18, according to CDC data. Influenza B viruses are more common in children than adults, which potentially explains some incongruities in U.S surveillance data, according to Lynnette Brammer, MPH, who leads the CDC’s domestic influenza surveillance team. CDC data showed that the percentage of outpatient visits for influenza-like illness increased from 4.7% to 5% for the week ending Jan. 18, after declining sharply for 2 weeks in a row. CDC estimates showed a cumulative rate of influenza-related hospitalization of 24.1 per 100,000 people, not out of line with previous seasons. The rate of deaths attributed to pneumonia or influenza declined slightly in the week ending Jan. 18, from 7.1% to 6.7%, remaining below the epidemic threshold. Brammer called the season a “mixed bag.” “Influenza B — particularly the B Victoria [viruses] that are out there — don't tend to impact the elderly very much. Aaron E. Glatt
But they do impact kids, particularly school-age kids,” Brammer told Healio. “Our influenza-like illness graph looks like it was a bad season — it's pretty high at the peak. But if you look at the hospitalizations and the pneumonia and influenza mortality, that's not very remarkable, and that's because the people that tend to get hospitalized and die from influenza in the largest numbers are the elderly.” Brammer suggested the uncommon predominance of influenza B viruses may be explained by the lack of circulating B viruses in previous seasons, particularly of the B/Victoria lineage, which have accounted for almost all influenza B specimens tested this season. “The Victorias have been changing, and I think it got to the point to where there wasn't a lot of population immunity to them,” Brammer said.
The CDC reported an additional 15 pediatric influenza deaths for the week ending Jan. 18, raising the seasonal total to 54. There were 143 influenza-related pediatric deaths in the U.S. last season. Bernhard L. “Bud” Wiedermann, MD, MA, attending physician in infectious diseases at Children’s National Hospital in Washington, D.C., and professor of pediatrics at The George Washington University School of Medicine & Health Sciences, said his hospital was “clearly still in the midst of a very busy flu Bernhard L. “Bud” Wiedermann
season.” He wondered if there would be a second peak attributed to influenza A. “We will need to continue to be prepared as best we can, knowing that any season can contain surprises,” he told Healio. Overall, the CDC estimated that 15 million to 21 million influenza-related illnesses and 7 million to 10 million influenza-related medical visits occurred as of Jan. 18. In addition, it estimated there were 140,000 to 250,000 influenza-related hospitalizations and 8,200 to 20,000 influenza-related deaths. “The critical message has to still be vaccinate, vaccinate, vaccinate,” Infectious Diseases Society of America spokesperson Aaron E. Glatt, MD, professor of medicine at Mount Sinai’s Icahn School of Medicine and chair of medicine at Mount Sinai South Nassau in Oceanside, New York, told Healio. “When you get vaccinated, you're not only helping yourself, you're also preventing everybody else around you from getting sick — and it's not too late to get vaccinated.” Brammer said the CDC would have preliminary estimates of the effectiveness of the 2019-2020 influenza vaccine in the coming weeks. “Flu is going to be a much bigger killer in the United States than this coronavirus and people aren't doing everything that they possibly can to diminish the spread,” Glatt said.
References:
CDC. Weekly U.S. Influenza Surveillance Report. https://www.cdc.gov/flu/weekly/index.htm/. Accessed January 27, 2020.
CDC. 2019-2020 U.S. Flu Season: Preliminary Burden Estimates. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm. Accessed January 27, 2020.
Does Herpes 6 Infection Have a Role in Bell’s Palsy Among Children and Adolescents?
Bell’s palsy is a peripheral paralysis of the seventh cranial nerve, whose etiology is unknown. Using polymerase chain reaction technology, it is possible to sample accessible body fluids and identify possible viral factors. The purpose of this research is to investigate its connection to the herpes virus family by testing for the presence of the virus in the saliva and tear fluid of Bell’s palsy patients.
Methods: Saliva and tears were collected from 42 children and adolescents suffering from idiopathic facial nerve paralysis. Polymerase chain reaction was used to test for the presence of the viruses Epstein-Barr virus, cytomegalovirus, herpes simplex virus 1 and 2, varicella zoster virus and human herpes virus 6 (HHV-6). Samples were also taken from a control group without paralysis. A second specimen was taken from patients who tested positive for HHV-6 several months after their recovery.
Results: Of the 42 patients in the study group, 71% (30 patients) tested positive for HHV-6, compared with only 37% of the control group (P = 0.001). The prevalence of the other 5 viruses tested was low—herpes simplex virus 1: 9.5%, Epstein-Barr virus: 9.5%, cytomegalovirus: 4.8%, varicella zoster virus: 2.3% and herpes simplex virus 2: 0%. Twenty-four of the 30 patients who were HHV-6-positive during their illness were reexamined following recovery. Only 13 patients (54.2%) excreted the virus after recovery from the paralysis.
Conclusions: Herpes 6 virus appears to play some role in the etiology of facial nerve paralysis. The virus was detected in the saliva of children during acute illness and decreased with resolution. Our research opens new insights linking HHV-6 to the etiology of Bell’s palsy in children.
(Genizi, J, et al. The Pediatr Infect Dis J2019;38: 481-83. DOI: 10.1097/INF.0000000000002278)
Placebo vs Amoxicillin for Non-severe Fast-Breathing Pneumonia in Children Aged 2 to 59 Months
A Double-blind, Randomized Clinical Noninferiority Trial
Question: Are antibiotics necessary for the treatment of non-severe fast-breathing pneumonia in children?
Findings: In this double-blind, randomized clinical noninferiority trial that included 1126 HIV-uninfected children aged 2 to 59 months in a malaria-endemic region of Malawi, Africa, placebo treatment of non-severe fast-breathing pneumonia was significantly inferior to 3 days of amoxicillin treatment with respect to treatment failure at day 4. Fast-breathing pneumonia resolved by day 4 in 93% of children without the use of the antibiotic.
Meaning: Without amoxicillin treatment, 7% of Malawian children with non-severe fast-breathing pneumonia failed treatment by day 4, and treating 33 children with amoxicillin was necessary for 1 child to benefit.
Comment: These results should motivate the World Health Organization to update their recommendation for the use of amoxicillin for all cases of non-severe fast-breathing pneumonia in resource-constrained settings
(Compiled by Dr Piyush Gupta, To read free full text, go to https://jamanetwork.com/journals/jamapediatrics/fullarticle/2714280)
Parenteral Antibiotic Therapy Duration in Young Infants With Bacteremic Urinary Tract Infections
OBJECTIVES: To determine the association between parenteral antibiotic duration and outcomes in infants ≤60 days old with bacteremic urinary tract infection (UTI).
METHODS: This multicenter retrospective cohort study included infants ≤60 days old who had concomitant growth of a pathogen in blood and urine cultures at 11 children’s hospitals between 2011 and 2016. Short-course parenteral antibiotic duration was defined as ≤7 days, and long-course parenteral antibiotic duration was defined as >7 days. Propensity scores, calculated using patient characteristics, were used to determine the likelihood of receiving long-course parenteral antibiotics. We conducted inverse probability weighting to achieve covariate balance and applied marginal structural models to the weighted population to examine the association between parenteral antibiotic duration and outcomes (30-day UTI recurrence, 30-day all-cause reutilization, and length of stay).
RESULTS: Among 115 infants with bacteremic UTI, 58 (50%) infants received short-course parenteral antibiotics. Infants who received long-course parenteral antibiotics were more likely to be ill appearing and have growth of a non–Escherichia coli organism. There was no difference in adjusted 30-day UTI recurrence between the long- and short-course groups (adjusted risk difference: 3%; 95% confidence interval: −5.8 to 12.7) or 30-day all-cause reutilization (risk difference: 3%; 95% confidence interval: −14.5 to 20.6).
CONCLUSIONS: Young infants with bacteremic UTI who received ≤7 days of parenteral antibiotics did not have more frequent recurrent UTIs or hospital reutilization compared with infants who received long-course therapy. Short-course parenteral therapy with early conversion to oral antibiotics may be considered in this population.
(Desai S, et al. Pediatrics. 2019;144(3):e20183844. doi:10.1542/peds.2018-3844)