flu
Effect of influenza A virus infection on natural and adaptive cellular immunity.

Skoner DP, Whiteside TL, Wilson JW, Doyle WJ, Herberman RB, Fireman P.

Department of Pediatrics, School of Medicine, University of Pittsburgh, Pennsylvania 15260, USA.

Influenza A virus (FLU) is an important pathogen in humans. Although many features of the antiviral immune response have been elucidated in murine and human models of disease, little is known about the role of NK cells, which provide natural, innate immunity. The effects of experimental intranasal FLU (H1N1) inoculation on NK cells and other immune parameters were studied in 18 healthy, adult volunteers during the acute and convalescent phases of infection. Peripheral blood mononuclear cells (PBMNC) were assayed at baseline and on Postinoculation Days 1, 3, 4, 6, 7, 23, and 44. FLU infection and pathophysiologic upper airway responses were documented in all subjects, and there was no mortality. During both the acute (Days 1-3) and the convalescent (Days 23 and 44) stages of the FLU infection, significant increases in NK activity and decreases in the number of activated NK cells were observed. Reductions in the absolute number of T lymphocytes and in PBMNC proliferation to FLU virus antigen and mitogen were also observed. The current investigation extended those findings to include reductions in the number of CD4+ and CD8+ T lymphocytes and increases in the number of activated T lymphocytes. These results document that FLU infection was accompanied by enhancement of natural immunity and, as expected, suppression of most of the other measured parameters of cellular immunity. The normal response to FLU infection in humans may involve sequential modulation of the different components of the cellular immune system.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8635289&dopt=Abstract flu, flu medicine, tamiflu



flu
[Clinical evaluation of an immunochromatography test for rapid diagnosis of influenza]

[Article in Japanese]

Yamazaki M, Mitamura K, Kimura K, Komiyama O, Nirasawa M, Yamamoto K, Ichikawa M, Someya K, Nakano T, Hashimoto Y, Hagiwara N, Maezawa T, Watanabe S, Shimizu H, Sugaya N.

Department of Pediatrics, Hadano Red Cross Hospital.

We evaluated a rapid diagnostic kit that detects influenza type A and B viral antigens by immunochromatography, Quick Vue Influenza Test (Quidel Corp., San Diego, CA, USA), with 425 specimens collected from patients with influenza-like symptoms at three hospitals between January and March 2001. The specimens included 184 nasal aspirates, 140 nasal swabs, and 101 throat swabs. The test correctly identified 179 of the 204 culture positive specimens and 203 of the 221 culture negative specimens; the sensitivity and specificity compared with the culture were 87.7% and 91.9%, respectively. The sensitivity of the test was 92.6% (112/121) for nasal aspirates, 83.7% (41/49) for nasal swabs, and 76.5% (26/34) for throat swabs, which is similar to the results for conventional rapid enzyme immunoassay kits for influenza virus infection. The sensitivity and specificity of the QuickVue Influenza Test were equivalent to those of Flu OIA (BioStar, Inc., Boulder, CO, USA), with the agreement of 84.2%. Although the QuickVue Influenza Test does not differentiate between influenza A and B viruses, the easy-to-use kit detects both types in the physician's office, allowing physicians to make a decision on prescription of neuraminidase inhibitor therapy during the initial visit.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11806139&dopt=Abstract flu, flu medicine, tamiflu



flu
[Study of a disease outbreak in a home for the aged]

[Article in Spanish]

Gomez de Caso JA, Franco Yague JA, Castillo Izquierdo JM, Ruiz Cosin C.

Equipo de Atencion Primaria de Riaza y Servicio Territorial de Sanidad y Bienestar Social de Segovia.

OBJECTIVE: To describe an epidemic outbreak in an elderly persons' home. DESIGN: A descriptive, longitudinal study. SETTING: Elderly persons' home in the Riaza Health District, Segovia. PATIENTS AND PARTICIPANTS: 90 elderly people resident at this geriatric centre. MEASUREMENTS AND MAIN RESULTS: Between January 18 and 25, 1995, there was an epidemic outbreak. Some cases had digestive symptoms: diarrhoea and vomiting, but without a temperature. Other cases had respiratory symptoms with temperature, cough, expectoration, breathing difficulty and myalgia. 25 elderly people were affected: 68% suffering the respiratory symptoms; and 32%, the digestive ones. Three people were admitted to hospital and one died. The presence of Rotavirus was found in the faeces of patients with digestive symptoms. The study-period had the highest incidence of flu in this Health District. 20% of the elderly people were not vaccinated for flu. CONCLUSIONS: Elderly persons' homes are an environment which favours the spread of germs which can cause epidemic situations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8664433&dopt=Abstract flu, flu medicine, tamiflu



flu
Rapid diagnosis of influenza type A infection: comparison of shell-vial culture, directigen flu-A and enzyme-linked immunosorbent assay.

Marcante R, Chiumento F, Palu G, Cavedon G.

Laboratorio Analisi chimico-cliniche e microbiologia, Ospedale Civile, Universita di Padova.

Two direct antigen detection methods (Directigen FLU A, Becton-Dickinson, Cokeysville, Md. and Influenza A virus ELISA Antigen detection kit, Alpha Biotech, Milano) were compared with isolation by shell-vial cultures for rapid diagnosis of influenza type A virus infection. The three methods were performed using a reference viral suspension consisting of a clinical isolate of influenza type A virus as well as 41 nasopharyngeal aspirates collected from patients with influenza symptoms. Influenza type A virus was recovered from 14 specimens by shell-vials. Ten specimens were positive by Directigen FLU A and 7 by ELISA antigen detection kit. When performed on clinical samples the sensitivity of Directigen FLU A and ELISA was 64.2% and 42.8%, respectively. The limit of sensitivity of the shell-vials, performed on a virus stock suspension titrated by haemagglutinin activity, was 0.06-0.03 HA units/ml at 24 hours or 72 hours after inoculation. Directigen FLU A and ELISA detected as positive a virus stock suspension containing 0.25 HA units/ml and 1 HA units/ml, respectively.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8722310&dopt=Abstract flu, flu medicine, tamiflu



flu
Physician performance of preventive care for women.

Gill JM.

BACKGROUND: The purpose of this study was to examine whether academic primary care physicians recommended appropriate preventive care to their female patients, whether recommendations differed for different types of physicians, and how often these recommendations led to completion of the preventive service. METHODS: A retrospective chart review was conducted in the family medicine and internal medicine outpatient practices at the Medical Center of Delaware (MCD). A total of 324 women ages 40 and over were selected from the patient panels of nine faculty and 14 residents. Physician recommendation of PAP smears, mammograms, breast exams, and influenza immunizations were measured against the guidelines of the U.S. Preventive Service Task Force. Specifically examined was whether rates of recommendation differed by specialty, gender and faculty/resident status of the physician. Also measured was completion of each preventive service and whether rates of completion differed from rates of physician recommendation. RESULTS: Physicians recommended appropriate PAPs in 72 percent of patients, mammograms in 83 percent of patients, breast exams in 46 percent of patients and influenza immunizations in 30 percent of patients. Family physicians were more likely to recommend PAP smears (odds ratio 5.53, 95 percent confidence interval 2.26-12.98), but not more likely to recommend other services; female physicians were more likely to recommend breast exams (odds ratio 3.48, 95 percent confidence interval 2.05-5.89), but not other services. There were no significant differences between faculty and residents. Preventive services were completed in 48 percent of patients for PAPs, 68 percent for mammograms, 42 percent for breast exams, and 27 percent for flu shots. CONCLUSIONS: In academic primary care practices at MCD, physicians perform well in recommending PAPs and mammograms, but not in recommending breast exams or influenza immunizations. There were few differences in performance among different types of physicians. Because many women did not follow through with their physicians' recommendations for preventive care, physician performance is more accurately measured according to their recommendations rather than completion of services. Efforts to improve preventive care in women should differ depending on whether the problem lies in physician performance or patient behavior.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8764518&dopt=Abstract flu, flu medicine, tamiflu



flu
Implementation of a flu immunization program for homebound elders: a graduate student practicum.

Hughes DL, Tartasky D.

Approximately 80% to 90% of all influenza-associated deaths in the United States occur in people aged 65 years and older. Costs associated with influenza-related hospitalizations have been estimated to range from $750 million to 1 billion during recent epidemics. In spite of these statistics, few programs target elders, who are particularly at risk for influenza. This article describes the development of a graduate student practicum in which an influenza immunization program for homebound elders was implemented. The Health Belief Model was used as the theoretical framework for this intervention. As a result of this program, 88 people received immunizations in the home environment. The need for this type of program is underscored in Health People 2000, which specifically addresses the need to increase vaccine use for those 65 and older.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8924121&dopt=Abstract flu, flu medicine, tamiflu