Melissa K Andrew1,2, Janet E McElhaney3, Allison A McGeer4, Todd F Hatchette1,2, Jason Leblanc2,5, Duncan Webster6, William Bowie7, Andre Poirier8, Michaela K Nichols2, Shelly A McNeil1,2. 1. Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada. 2. Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada. 3. Health Sciences North Research Institute, Sudbury, Ontario, Canada. 4. Mount Sinai Hospital, Toronto, Ontario, Canada. 5. Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada. 6. Saint John Regional Hospital, Dalhousie University, Saint John, New Brunswick, Canada. 7. Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada. 8. Centre Intégré Universitaire de santé et services sociaux, Quebec, Quebec, Canada.
Abstract
OBJECTIVE: Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults. DESIGN: Prospective cohort study. SETTING: The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults. METHODS: Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index. RESULTS: Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58-82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6-52.6) for younger adults versus 44.6% (95% CI, 43.6-45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7-65.6) of younger adults versus 57.1% (95% CI, 55.9-58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions. CONCLUSIONS: A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.
OBJECTIVE: Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults. DESIGN: Prospective cohort study. SETTING: The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults. METHODS: Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index. RESULTS: Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58-82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6-52.6) for younger adults versus 44.6% (95% CI, 43.6-45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7-65.6) of younger adults versus 57.1% (95% CI, 55.9-58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions. CONCLUSIONS: A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.
Authors: Christopher N Osuafor; Catriona Davidson; Alistair J Mackett; Marie Goujon; Lelane Van Der Poel; Vince Taylor; Jacobus Preller; Robert J B Goudie; Victoria L Keevil Journal: Geriatrics (Basel) Date: 2021-02-01
Authors: Sarah Damanti; Marta Cilla; Maria Cilona; Aldo Fici; Aurora Merolla; Giacomo Pacioni; Rebecca De Lorenzo; Sabina Martinenghi; Giordano Vitali; Cristiano Magnaghi; Anna Fumagalli; Mario Gennaro Mazza; Francesco Benedetti; Moreno Tresoldi; Patrizia Rovere Querini Journal: Front Med (Lausanne) Date: 2022-07-14
Authors: Koos Korsten; Niels Adriaenssens; Samuel Coenen; Chris C Butler; Theo J M Verheij; Louis J Bont; Joanne G Wildenbeest Journal: J Infect Dis Date: 2022-08-12 Impact factor: 7.759
Authors: Mary K Foley; Samuel D Searle; Ali Toloue; Ryan Booth; Alec Falkenham; Darryl Falzarano; Salvatore Rubino; Magen E Francis; Mara McNeil; Christopher Richardson; Jason LeBlanc; Sharon Oldford; Volker Gerdts; Melissa K Andrew; Shelly A McNeil; Barry Clarke; Kenneth Rockwood; David J Kelvin; Alyson A Kelvin Journal: EClinicalMedicine Date: 2021-06-27