Michelande Ridore

Epidemiologic, clinical, and virologic characteristics of human rhinovirus infection among otherwise healthy children and adults: Rhinovirus among adults and children

Abstract Background human rhinovirus (HRV) is a major cause of influenza-like illness (ILI) in adults and children. Differences in disease severity by HRV species have been described among hospitalized patients with underlying illness. Less is known about the clinical and virologic characteristics of HRV infection among otherwise healthy populations, particularly adults. Objectives to characterize molecular epidemiology of HRV and association between HRV species and clinical presentation and viral shedding. Study design observational, prospective, facility-based study of ILI was conducted from February 2010 to April 2012. Collection of nasopharyngeal specimens, patient symptoms, and clinical information occurred on days 0, 3, 7, and 28. Patients recorded symptom severity daily for the first 7 days of illness in a symptom diary. HRV was identified by RT-PCR and genotyped for species determination. Cases who were co-infected with other viral respiratory pathogens were excluded from the analysis. We evaluated the associations between HRV species, clinical severity, and patterns of viral shedding. Results eighty-four HRV cases were identified and their isolates genotyped. Of these, 62 (74%) were >18 years. Fifty-four were HRV-A, 11HRV-B, and 19HRV-C. HRV-C infection was more common among children than adults (59% vs. 10%, P <0.001). Among adults, HRV-A was associated with higher severity of upper respiratory symptoms compared to HRV-B (P =0.02), but no such association was found in children. In addition, adults shed HRV-A significantly longer than HRV-C (P trend=0.01). Conclusions among otherwise healthy adults with HRV infection, we observed species-specific differences in respiratory symptom severity and duration of viral shedding.

Vaccine-associated reduction in symptom severity among patients with influenza A/H3N2 disease.

BACKGROUND The moderate level of protection conferred by influenza vaccines is well-known, but the vaccines ability to attenuate symptom severity among vaccinated individuals (i.e., vaccine failures) has not been established. METHODS We enrolled otherwise healthy adults who presented with influenza-like illness (ILI) at five US military hospitals between 2009 and 2014. Influenza was diagnosed and subtyped by PCR. Individual and composite severity scores were compared between those who had vs. had not received the seasonal influenza vaccine >14 days prior to enrollment. RESULTS A total of 155 cases of influenza (A/H1N1, n=69; A/H3N2, n=66; A/untyped, n=3; B, n=17) were identified, of whom 111 (72%; A/H1N1, n=44; A/H3N2, n=52; A/untyped, n=3; B, n=12) had been vaccinated. Women were significantly less likely to be vaccinated than men (49% vs. 89%; p<0.01). In multivariate analysis, vaccinated individuals were significantly less likely to report a fever >101°F (OR 0.24; 95% CI [0.10, 0.62]) and more likely to report myalgias (OR 3.31; 95% CI [1.22, 8.97]) than vaccinated individuals. Among patients with A/H3N2 infection, upper respiratory and total symptom severity scores were significantly lower for vaccinated patients during the first 2 days of illness, and differences in total symptom severity persisted over 7 days (p<0.05 for all comparisons). Differences across additional symptom categories (lower respiratory and systemic) were also observed throughout 7 days of illness in bivariate analyses. Differences in symptom severity were not observed between vaccinated and unvaccinated participants with A/H1N1 infection. CONCLUSIONS Among patients with A/H3N2 infection, receipt of seasonal influenza vaccine was associated with reduced symptom severity. Patient-centered discussion about the benefits of influenza vaccination should be expanded to include the possibility that the vaccine could attenuate symptoms.

Neuraminidase inhibitor therapy in a military population

BACKGROUND Although neuraminidase inhibitors (NI) are the mainstay of treatment for influenza infection, prescribing practice for these agents is not well described. Additionally, benefit is contested. OBJECTIVES We examined provider prescriptions of NI during the 2009 pandemic and post-pandemic periods. We also evaluated the effectiveness of NI in reducing severity of influenza infection. STUDY DESIGN Data on NI prescription and severity of influenza infection were compiled in healthy pediatric and adult beneficiaries enrolled in a prospective study of influenza like illness conducted at five military medical centers over five years. Subjects underwent nasal swabs to determine viral etiology of their infection. Demographic, medication and severity data were collected. Subjects with positive influenza were included. RESULTS Two hundred sixty three subjects were influenza positive [38% [H1N1] pdm09, 38.4% H3N2, and 20.5% B); 23.9% were treated with NI. NI were initiated within 48h in 63% of treated subjects. Although NI use increased over the five years of the study, early use declined. Most measures for severity of illness were not significantly reduced with NI; adults treated within 48h had only a modest reduction in duration and severity of some of their symptoms. CONCLUSIONS NI use in our population is increasing, but early use is not. NI use resulted in no reduction in complications of illness. Resolution of symptoms and reduction in severity of some symptoms were slightly better in adults who were treated early. These modest benefits do not support routine treatment with NI in otherwise healthy individuals with influenza.

Comparative Evaluation of Diatherix Target Enriched Multiplex Polymerase Chain Reaction and BioFire FilmArray in the Detection of Viral and Bacterial Respiratory Pathogens

238. Comparative Evaluation of Diatherix Target Enriched Multiplex Polymerase Chain Reaction and BioFire FilmArray in the Detection of Viral and Bacterial Respiratory Pathogens Wei-Ju Chen, PhD; John Arnold, MD; Mary Fairchok, MD; Erin Hansen, BS; Leslie Malone, MS, MB(ASCP)CM; Elena Grigorenko, PhD; Donald Stalons, PhD, D (ABMM), MPH; Jacqueline Owens Milzman, MS; Michelande Ridore, MS; Christian Coles, PhD; Timothy Burgess, MD; Eugene Millar, PhD; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Naval Medical Center San Diego, San Diego, California; Madigan Army Medical Center, Tacoma, Washington; Naval Health Research Center, San Diego, California; Diatherix Laboratories, LLC, Huntsville, Alabama; Children’s National Medical Center, Washington, District of Columbia

Epidemiologic, Clinical, and Virologic Characteristics of Respiratory Syncytial Virus Infection among Otherwise Healthy Adults

www.PosterPresentations.com Epidemiologic, clinical, and virologic characteristics of Respiratory Syncytial Virus infection among otherwise healthy adults Anjali Kunz, MD3, Levi Strube, MD3, Christina Schofield, MD3, Tahaniyat N. Lalani MD4,9, Patrick J. Danaher MD5, Michael Rajnik MD6, Leslie Malone MS MB(ASCP)CM8, Elena Grigorenko PhD8, Donald Stalons PhD8, Deepika Mor MS2,9, Michelande Ridore, MS2,9, Wei-Ju Chen, PhD2,9, John C. Arnold MD1, Eugene Millar, PhD2,9, Mary P. Fairchok, MD2,3,9

Etiology Unknown: Are Less Recognized Respiratory Pathogens Associated With a Milder Course of Illness?

1Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD; 2 Naval Medical Center San Diego CA; 3 Madigan Army Medical Center, Fort Lewis WA; 4 Naval Medical Center Portsmouth VA; 5 San Antonio Military Health System, San Antonio TX; 6 Walter Reed National Military Medical Center, Washington DC; 7 Naval Health Research Center, San Diego CA; 8 Diatherix Laboratories, Inc., Huntsville AL; 9 Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda MD

11412013-2014 Resurgence of 2009 Influenza A (H1N1) Infection among Adults: Has the Epidemiology and Clinical Severity of Disease Changed?

Adults: Has the Epidemiology and Clinical Severity of Disease Changed? John Arnold, MD; Wei-Ju Chen, PhD; Mary Fairchok, MD; Christina Schofield, MD FACP; Tahaniyat Lalani, MBBS, MHS; Patrick Danaher, MD; Michael Rajnik, MD; Erin Mcdonough, BS; Deepika Mor, MS; Michelande Ridore, BA; Timothy Burgess, MD, MPH; Eugene Millar, PhD; Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD; Infectious Disease Clinical Research Program, Tacoma, WA; Madigan Army Medical Center, Tacoma, WA; Naval Medical Center Portsmouth, Portsmouth, VA; San Antonio Military Medical Center, Fort Sam Houston, TX; Walter Reed National Military Medical Center, Bethesda, MD; Naval Health Research Center, San Diego, CA; Infectious Disease Clinical Research Program, Rockville, MD