Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-23 (of 23 Records) |
Query Trace: Suntarattiwong P [original query] |
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Influenza virus circulation and vaccine effectiveness during June 2021–May 2023 in Thailand
Prasert K , Praphasiri P , Nakphook S , Ditsungnoen D , Sapchookul P , Sornwong K , Naosri S , Akkapaiboon Okada P , Suntarattiwong P , Chotpitayasunondh T , Montgomery MP , Davis WW , Pittayawonganon C . Vaccine X 2024 19 Thai Ministry of Public Health recommends influenza vaccination for certain risk groups. We evaluated 2023 Southern Hemisphere influenza vaccine effectiveness against medically attended influenza using surveillance data from nine Thai hospitals and a test-negative design. During June 2022–May 2023, influenza vaccine provided moderate protection against seeking care for influenza illness (adjusted vaccine effectiveness 51%; 95% confidence interval 28–67). Understanding vaccine effectiveness can help guide future antigen selection and support clinicians to make a strong influenza vaccine recommendation to patients. © 2024 The Author(s) |
Burden of respiratory syncytial virus-associated acute respiratory infections during pregnancy
Kenmoe S , Chu HY , Dawood FS , Milucky J , Kittikraisak W , Matthewson H , Kulkarni D , Suntarattiwong P , Frivold C , Mohanty S , Havers F , Li Y , Nair H . J Infect Dis 2023 INTRODUCTION: With the licensure of maternal RSV vaccines in Europe and USA, data are needed to better characterize the burden of respiratory syncytial virus (RSV)-associated acute respiratory infections (ARI) in pregnancy. This study aims to determine among pregnant individuals the proportion of ARI testing positive for RSV and RSV incidence rate, RSV-associated hospitalizations, deaths, and perinatal outcomes. METHODS: We conducted a systematic review following PRISMA 2020 guidelines using five databases (Medline, Embase, Global Health, Web of Science and Global Index Medicus) and included additional unpublished data. Pregnant individuals with respiratory infections who had respiratory samples tested for RSV were included. We used a random-effects meta-analysis to generate overall proportions and rate estimates across studies. RESULTS: Eleven studies with pregnant individuals recruited between 2010 and 2022 were identified, most of which recruited pregnant individuals in community, inpatient and outpatient settings. Among 8126 pregnant individuals, the proportion with respiratory infections that tested positive for RSV ranged from 0.9% to 10.7%, with a meta-estimate of 3.4% (95% CI: 1.9; 54). The pooled incidence rate of RSV infection episodes among pregnant individuals was 26.0 (15.8; 36.2) per 1000 person-years. RSV hospitalization rates reported in two studies were 2.4 and 3.0 per 1000 person-years. Of five studies that ascertained RSV-associated deaths among 4708 pregnant individuals, no deaths were reported. Three studies comparing RSV-positive and RSV-negative pregnant individuals found no difference in odds of miscarriage, stillbirth, low birth weight, and small for gestational age. RSV-positive pregnant individuals had higher odds of preterm delivery (odds ratio 3.6 [1.3; 10.3]). CONCLUSION: Data on RSV-associated hospitalization incidence rates are limited but available estimates are lower than those reported in older adults and young children. As countries debate whether to include RSV vaccines in maternal vaccination programs, which are primarily intended to protect infants, this information could be useful in shaping vaccine policy decisions. |
Knowledge, attitude/perception, and practice related to seasonal influenza vaccination among caregivers of young Thai children: A cross-sectional study
Thanee C , Kittikraisak W , Sinthuwattanawibool C , Roekworachai K , Klinklom A , Kornsitthikul K , Jirasakpisarn S , Srirompotong U , Chittaganpitch M , Dawood FS , Suntarattiwong P , Mott JA , Chotpitayasunondh T . PLoS One 2021 16 (6) e0253561 BACKGROUND: Seasonal influenza vaccination uptake among young children in Thailand is low despite national recommendation for vaccination. We implemented a knowledge, attitude/perception, and practice survey to understand determinants of influenza vaccination in children aged six months to two years. METHODS: Using a cross-sectional design, we interviewed caregivers of 700 children in seven hospitals using a structured questionnaire to collect information on caregivers' and children's demographic characteristics, and caregivers' knowledge of influenza illness and national vaccine recommendation, attitude/perception toward influenza vaccine, and information sources. We verified children's influenza vaccination status against medical records (vaccinated vs. unvaccinated). Logistic regression was used to examine factors independently associated with children receiving influenza vaccination in the 2018 season using the dataset restricted to only children's parents. Variables associated with vaccination at p-value ≤0.20 were included in subsequent multivariable logistic models. Significant independent determinants of children's influenza vaccination and collinearity of covariates were assessed. The final model was constructed using a stepwise backward elimination approach with variables significant at p-value <0.05 retained in the model. RESULTS: During August 2018-February 2019, 700 children's caregivers completed the questionnaire; 61 (9%) were caregivers of vaccinated children. Caregivers of the vaccinated children were statistically more likely to have higher education (61% vs. 38%; p-value<0.01) and to know of influenza illness (93% vs. 76%; p-value = 0.03) than those of the unvaccinated group. Factors associated with children receiving influenza vaccination were identifying healthcare providers as a primary source of information about influenza illness for parents (adjusted odds ratio [aOR], 2.8; 95% confidence interval [CI], 1.3-6.0), parents' strongly agreeing with the national recommendation for influenza vaccination in young children (aOR, 2.9; 95% CI, 1.5-5.9), using health insurance provided by the government or parent's employer for children's doctor visits (aOR, 2.6; 95% CI, 1.1-6.6), and the children's history of receiving influenza vaccination in the 2017 season or earlier (aOR, 3.2; 95% CI, 1.4-7.8). CONCLUSION: The majority of caregivers of children in this study had knowledge of influenza illness and influenza vaccine. Caregivers reported various sources of information regarding influenza illness and the vaccine, but healthcare providers remained the most trusted source. Children's history of influenza vaccination in prior season(s) was the strongest determinant of children being vaccinated for influenza in the current season. |
What do pregnant women think about influenza disease and vaccination practices in selected countries
Arriola CS , Suntarattiwong P , Dawood FS , Soto G , Das P , Hunt DR , Sinthuwattanawibool C , Kurhe K , Thompson MG , Wesley MG , Saha S , Hombroek D , Brummer T , Kittikraisak W , Kaoiean S , Neyra J , Romero C , Patel A , Bhargav S , Khedikar V , Garg S , Mott JA , Gonzales O , Cabrera S , Florian R , Parvekar S , Tomyabatra K , Prakash A , Tinoco YO . Hum Vaccin Immunother 2021 17 (7) 1-9 Introduction: We evaluated knowledge, attitudes, and practices (KAP) related to influenza and influenza vaccination among pregnant women in three selected countries. Methods: During 2017, pregnant women seeking antenatal care at hospitals at participating sites were enrolled. We described characteristics and responses to KAP questions. We also evaluated predictors associated with influenza vaccination during pregnancy at sites with substantial influenza vaccine uptake by multivariable logistic regression. Results: Overall, 4,648 pregnant women completed the survey. There were substantial differences among the three survey populations; only 8% of the women in Nagpur had heard of influenza, compared to 90% in Lima and 96% in Bangkok (p-value<0.01). Despite significant differences in sociodemographic characteristics in the three populations, most participants across sites who were aware of influenza prior to study enrollment believe they and their infants are at risk of influenza and related complications and believe influenza vaccination is safe and effective. Half of women in Lima had verified receipt of influenza vaccine compared to <5% in Bangkok and Nagpur (p < .05). For further analysis conducted among women in Lima only, household income above the poverty line (aOR: 1.38; 95%CI: 1.01, 1.88), having 8+ antenatal visits, compared to 0-4 (aOR: 2.41; 95%CI: 1.39, 2.87, respectively), having 0 children, compared to 2+ (aOR: 1.96; 95%CIs: 1.23, 3.12), and vaccination recommended by a health-care provider (aOR: 8.25; 95%CI: 6.11, 11.14) were strongly associated with receipt of influenza vaccine during pregnancy. Conclusions: Our findings identify opportunities for targeted interventions to improve influenza vaccine uptake among pregnant women in these settings. |
The feasibility and performance of participant-collected mid-turbinate nasal swabs for detection of influenza virus, respiratory syncytial virus, and human metapneumovirus infections among pregnant women
Suntarattiwong P , Mott JA , Mohanty S , Sinthuwattanawibool C , Srisantiroj N , Patamasingh Na Ayudhaya O , Klungthong C , Fernandez S , Kim L , Hunt D , Hombroek D , Brummer T , Chotpitayasunondh T , Dawood FS , Kittikraisak W . J Infect Dis 2021 224 (5) 831-838 BACKGROUND: We assessed performance of participant-collected mid-turbinate nasal swabs compared to study staff-collected mid-turbinate nasal swabs for the detection of respiratory viruses among pregnant women in Bangkok, Thailand. METHODS: We enrolled pregnant women aged ≥18 years and followed them throughout the 2018 influenza season. Women with acute respiratory illness (ARI) self-collected mid-turbinate nasal swabs at homes for influenza viruses, RSV, and hMPV real-time RT-PCR testing while the study nurse collected a second mid-turbinate nasal swab during home visits. Paired specimens were processed and tested on the same day. RESULTS: The majority (109, 60%) of 182 participants were 20-30 years old. All 200 paired swabs had optimal specimen quality. The median time from symptom onsets to participant-collected swabs was two days and to staff-collected swabs was also two days. The median time difference between the two swabs was two hours. Compared to staff-collected swabs, the participant-collected swabs were 93% sensitive and 99% specific for influenza virus detection, 94% sensitive and 99% specific for RSV detection, and 100% sensitive and 100% specific for hMPV detection. CONCLUSIONS: Participant-collected mid-turbinate nasal swabs were a valid alternative approach for laboratory confirmation of influenza-, RSV-, and hMPV-associated illnesses among pregnant women in a community setting. |
Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries: a multisite prospective longitudinal cohort study
Dawood FS , Kittikraisak W , Patel A , Rentz Hunt D , Suntarattiwong P , Wesley MG , Thompson MG , Soto G , Mundhada S , Arriola CS , Azziz-Baumgartner E , Brummer T , Cabrera S , Chang HH , Deshmukh M , Ellison D , Florian R , Gonzales O , Kurhe K , Kaoiean S , Rawangban B , Lindstrom S , Llajaruna E , Mott JA , Saha S , Prakash A , Mohanty S , Sinthuwattanawibool C , Tinoco Y . Lancet Infect Dis 2020 21 (1) 97-106 BACKGROUND: Influenza vaccination during pregnancy prevents influenza among women and their infants but remains underused among pregnant women. We aimed to quantify the risk of antenatal influenza and examine its association with perinatal outcomes. METHODS: We did a prospective cohort study in pregnant women in India, Peru, and Thailand. Before the 2017 and 2018 influenza seasons, we enrolled pregnant women aged 18 years or older with expected delivery dates 8 weeks or more after the season started. We contacted women twice weekly until the end of pregnancy to identify illnesses with symptoms of myalgia, cough, runny nose or nasal congestion, sore throat, or difficulty breathing and collected mid-turbinate nasal swabs from symptomatic women for influenza real-time RT-PCR testing. We assessed the association of antenatal influenza with preterm birth, late pregnancy loss (≥13 weeks gestation), small for gestational age (SGA), and birthweight of term singleton infants using Cox proportional hazards models or generalised linear models to adjust for potential confounders. FINDINGS: Between March 13, 2017, and Aug 3, 2018, we enrolled 11 277 women with a median age of 26 years (IQR 23-31) and gestational age of 19 weeks (14-24). 1474 (13%) received influenza vaccines. 310 participants (3%) had influenza (270 [87%] influenza A and 40 [13%] influenza B). Influenza incidences weighted by the population of women of childbearing age in each study country were 88·7 per 10 000 pregnant woman-months (95% CI 68·6 to 114·8) during the 2017 season and 69·6 per 10 000 pregnant woman-months (53·8 to 90·2) during the 2018 season. Antenatal influenza was not associated with preterm birth (adjusted hazard ratio [aHR] 1·4, 95% CI 0·9 to 2·0; p=0·096) or having an SGA infant (adjusted relative risk 1·0, 95% CI 0·8 to 1·3, p=0·97), but was associated with late pregnancy loss (aHR 10·7, 95% CI 4·3 to 27·0; p<0·0001) and reduction in mean birthweight of term, singleton infants (-55·3 g, 95% CI -109·3 to -1·4; p=0·0445). INTERPRETATION: Women had a 0·7-0·9% risk of influenza per month of pregnancy during the influenza season, and antenatal influenza was associated with increased risk for some adverse pregnancy outcomes. These findings support the added value of antenatal influenza vaccination to improve perinatal outcomes. FUNDING: US Centers for Disease Control and Prevention. TRANSLATIONS: For the Thai, Hindi, Marathi and Spanish translations of the abstract see Supplementary Materials section. |
Influenza-associated medical visits prevented by influenza vaccination in young children in Thailand, 2012-2014
Rolfes MA , Olsen SJ , Kittikraisak W , Suntarattiwong P , Klungthong C , Ellison D , Mott JA , Chotpitayasunondh T . J Pediatric Infect Dis Soc 2020 10 (3) 349-351 Despite recommendations, few children aged 6-35 months in Thailand receive seasonal influenza vaccination. Using previously estimated incidence and vaccine effectiveness data from the period 2012-2014, we estimate that up to 121 000 medical visits could be prevented each year with 50% coverage and expanded recommendations to children aged <5 years. |
Influenza virus seroincidence in a cohort of healthy and high-risk children enrolled in infancy, Bangkok, Thailand
Rungrojcharoenkit K , Kittikraisak W , Ditsungnoen D , Olsen SJ , Suntarattiwong P , Chotpitayasunondh T , Klungthong C , Yoon IK , Dawood FS , Fernandez S , Macareo L , Lindblade KA . Int J Infect Dis 2019 89 21-26 BACKGROUND: We measured seroconversion to influenza viruses and incidence of symptomatic influenza virus infection in a cohort of children in Bangkok, Thailand. METHODS: Children aged </=6 months were followed for two years for acute respiratory illness and had serum specimens taken at 6-month intervals and tested by hemagglutination inhibition (HI) assay. Seroconversion was defined as a >4-fold rise in the HI titers between time points with a titer of >40 in the second specimen. Respiratory swabs were tested by rRT-PCR for influenza. Data were analyzed using generalized linear models. RESULTS: Of 350 children, 266 (76%, 147 were healthy and 119 high-risk) had >/=2 serum specimens collected before influenza vaccination. During the 2-year follow-up, 266 children contributed 370 person-years of observation, excluding post-vaccination periods. We identified 32 ARI cases with rRT-PCR-confirmed influenza virus infection (7 infections/100 person-years, 95% confidence interval [CI], 4-11). There were 126 episodes of influenza virus infection, resulting in a seroconversion rate of 35 infections/100 person-years (95% CI, 30-42). Rates in healthy and high-risk children did not differ. CONCLUSIONS: Influenza virus infection is common during the first two years of life among Thai children. A large proportion of infections may not be detected using the ARI case definition. |
Predictors for influenza vaccination among Thai pregnant woman: The role of physicians in increasing vaccine uptake
Kaoiean S , Kittikraisak W , Suntarattiwong P , Ditsungnoen D , Phadungkiatwatana P , Srisantiroj N , Asavapiriyanont S , Chotpitayasunondh T , Dawood FS , Lindblade KA . Influenza Other Respir Viruses 2019 13 (6) 582-592 BACKGROUND: Physician recommendation and attitudes and beliefs of pregnant women toward influenza and vaccination may influence vaccine uptake during pregnancy. We examined how physician recommendation and health beliefs of pregnant women may jointly affect influenza vaccination during pregnancy. METHODS: Thai pregnant women aged >/=18 years and >13 gestational weeks attending antenatal care (ANC) clinics, and ANC physicians were recruited during May-August 2015. Women and physicians, linked using unique identifiers, provided data on demographic, health and work history, knowledge, attitudes, and beliefs toward influenza and vaccination, based on Health Belief Model constructs. Physicians also provided data on their practices in recommending influenza vaccination during pregnancy. Prevalence ratios for the association between knowledge, attitudes and beliefs of pregnant women, physician recommendation and documented receipt of vaccination within 30 days of the visit were calculated. RESULTS: Among 610 women, the median age was 27 years; 266 (44%) and 344 (56%) were in the second and third trimesters, respectively. Twenty-one (3%) had pre-existing conditions. Of 60 physicians with the median years of practice of 5; 17 (28%) reported frequently/usually/always recommending influenza vaccine to their pregnant patients, while 43 (72%) reported never/rarely/sometimes recommending the vaccine. Controlling for the pregnant women's knowledge and beliefs, pregnant women whose physician recommended influenza vaccination were 2.3 times (95% confidence interval 1.4-3.8) more likely to get vaccinated. CONCLUSIONS: In this study, physician recommendation was the only significant factor associated with influenza vaccine uptake among Thai pregnant women. Understanding physicians' motivation/barrier to recommending influenza vaccination to pregnant women may increase coverage. |
Comparison of incidence and cost of influenza between healthy and high-risk children <60 months old in Thailand, 2011-2015
Kittikraisak W , Suntarattiwong P , Kanjanapattanakul W , Ditsungnoen D , Klungthong C , Lindblade KA , Fernandez S , Dawood FS , Chotpitayasunondh T , Olsen SJ . PLoS One 2018 13 (5) e0197207 INTRODUCTION: Thailand recommends influenza vaccination for children aged 6 months to <36 months, but investment in vaccine purchase is limited. To inform policy decision with respect to influenza disease burden and associated cost in young children and to support the continued inclusion of children as the recommended group for influenza vaccination, we conducted a prospective cohort study of children in Bangkok hospital to estimate and compare influenza incidence and cost between healthy and high-risk children. METHODS: Caregivers of healthy children and children with medical conditions ('high-risk') aged <36 months were called weekly for two years to identify acute respiratory illness (ARI) episodes and collect illness-associated costs. Children with ARI were tested for influenza viruses by polymerase chain reaction. Illnesses were categorized as mild or severe depending on whether children were hospitalized. Population-averaged Poisson models were used to compare influenza incidence by risk group. Quantile regression was used to examine differences in the median illness expenses. RESULTS: During August 2011-September 2015, 659 healthy and 490 high-risk children were enrolled; median age was 10 months. Incidence of mild influenza-associated ARI was higher among healthy than high-risk children (incidence rate ratio [IRR]: 1.67; 95% confidence interval [CI]: 1.13-2.48). Incidence of severe influenza-associated ARI did not differ (IRR: 0.40; 95% CI: 0.11-1.38). The median cost per mild influenza-associated ARI episode was $22 among healthy and $25 among high-risk children (3-4% of monthly household income; difference in medians: -$1; 95% CI for difference in medians: -$9 to $6). The median cost per severe influenza-associated ARI episode was $232 among healthy and $318 among high-risk children (26-40% and 36-54% of monthly household income, respectively; difference in medians: 110; 95% CI for difference in medians: -$352 to $571). CONCLUSIONS: Compared to high-risk children, healthy children had higher incidence of mild influenza-associated ARI but not severe influenza-associated ARI. Costs of severe influenza-associated ARI were substantial. These findings support the benefit of annual influenza vaccination in reducing the burden of influenza and associated cost in young children. |
Tolerability of trivalent inactivated influenza vaccine among pregnant women, 2015
Asavapiriyanont S , Kittikraisak W , Suntarattiwong P , Ditsungnoen D , Kaoiean S , Phadungkiatwatana P , Srisantiroj N , Chotpitayasunondh T , Dawood FS , Lindblade KA . BMC Pregnancy Childbirth 2018 18 (1) 110 BACKGROUND: Thailand recommends influenza vaccination among pregnant women. We conducted a cohort study to determine if the prevalence of adverse events following immunization (AEFIs) with influenza vaccine among Thai pregnant women was similar to that often cited among healthy adults. METHODS: Women who were >/=17 gestational weeks and >/=18 years of age were recruited. Demographic and health history data were collected using structured questionnaires. Women were provided with symptom diary, ruler to measure local reaction(s), and thermometer to measure body temperature. AEFIs were defined as any new symptom/abnormality occurring within four weeks after vaccination. The diaries were abstracted for frequency, duration, and level of discomfort/inconvenience of the AEFIs. Serious adverse events (SAEs) and the likelihood of AEFIs being associated with vaccination were determined using standard definitions. RESULTS: Among 305 women enrolled between July-November 2015, median age was 29 years. Of these, 223 (73%) were in their third trimester, 271 (89%) had completed secondary school or higher, and 20 (7%) reported >/=1 pre-existing conditions. AEFIs were reported in 134 women (44%; 95% confidence interval [CI] 38-50%). Soreness at the injection site (74, 24%; CI 19-29%), general weakness (50, 16%; CI 12-21%), muscle ache (49, 16%; CI 12-21%), and headache (45, 15%; CI 1-19%) were most common. Of those with AEFIs, 120 (89%) reported symptom/abnormality occurred on day 0 or day 1 following vaccination. Ten women (7%) reported the AEFIs affected daily activities. The AEFIs generally spontaneously resolved within 24 h of onset. There were two vaccine-unrelated SAEs. Of 294 women with complete follow-up, 279 (95%) had term deliveries, 12 (4%) had preterm deliveries, and 3 (1%) had miscarriage or stillbirth. CONCLUSION: In our cohort, AEFIs with influenza vaccine occurred with similar frequency to those reported among healthy adults in other studies, and were generally mild and self-limited. No influenza vaccine-associated SAEs were identified. |
Cost-effectiveness of inactivated seasonal influenza vaccination in a cohort of Thai children ≤60 months of age
Kittikraisak W , Suntarattiwong P , Ditsungnoen D , Pallas SE , Abimbola TO , Klungthong C , Fernandez S , Srisarang S , Chotpitayasunondh T , Dawood FS , Olsen SJ , Lindblade KA . PLoS One 2017 12 (8) e0183391 BACKGROUND: Vaccination is the best measure to prevent influenza. We conducted a cost-effectiveness evaluation of trivalent inactivated seasonal influenza vaccination, compared to no vaccination, in children ≤60 months of age participating in a prospective cohort study in Bangkok, Thailand. METHODS: A static decision tree model was constructed to simulate the population of children in the cohort. Proportions of children with laboratory-confirmed influenza were derived from children followed weekly. The societal perspective and one-year analytic horizon were used for each influenza season; the model was repeated for three influenza seasons (2012-2014). Direct and indirect costs associated with influenza illness were collected and summed. Cost of the trivalent inactivated seasonal influenza vaccine (IIV3) including promotion, administration, and supervision cost was added for children who were vaccinated. Quality-adjusted life years (QALY), derived from literature, were used to quantify health outcomes. The incremental cost-effectiveness ratio (ICER) was calculated as the difference in the expected total costs between the vaccinated and unvaccinated groups divided by the difference in QALYs for both groups. RESULTS: Compared to no vaccination, IIV3 vaccination among children ≤60 months in our cohort was not cost-effective in the introductory year (2012 season; 24,450 USD/QALY gained), highly cost-effective in the 2013 season (554 USD/QALY gained), and cost-effective in the 2014 season (16,200 USD/QALY gained). CONCLUSION: The cost-effectiveness of IIV3 vaccination among children participating in the cohort study varied by influenza season, with vaccine cost and proportion of high-risk children demonstrating the greatest influence in sensitivity analyses. Vaccinating children against influenza can be economically favorable depending on the maturity of the program, influenza vaccine performance, and target population. |
Standardized interpretation of chest radiographs in cases of pediatric pneumonia from the PERCH Study
Fancourt N , Deloria Knoll M , Barger-Kamate B , de Campo J , de Campo M , Diallo M , Ebruke BE , Feikin DR , Gleeson F , Gong W , Hammitt LL , Izadnegahdar R , Kruatrachue A , Madhi SA , Manduku V , Matin FB , Mahomed N , Moore DP , Mwenechanya M , Nahar K , Oluwalana C , Ominde MS , Prosperi C , Sande J , Suntarattiwong P , O'Brien KL . Clin Infect Dis 2017 64 S253-s261 Background.: Chest radiographs (CXRs) are a valuable diagnostic tool in epidemiologic studies of pneumonia. The World Health Organization (WHO) methodology for the interpretation of pediatric CXRs has not been evaluated beyond its intended application as an endpoint measure for bacterial vaccine trials. Methods.: The Pneumonia Etiology Research for Child Health (PERCH) study enrolled children aged 1-59 months hospitalized with WHO-defined severe and very severe pneumonia from 7 low- and middle-income countries. An interpretation process categorized each CXR into 1 of 5 conclusions: consolidation, other infiltrate, both consolidation and other infiltrate, normal, or uninterpretable. Two members of a 14-person reading panel, who had undertaken training and standardization in CXR interpretation, interpreted each CXR. Two members of an arbitration panel provided additional independent reviews of CXRs with discordant interpretations at the primary reading, blinded to previous reports. Further discordance was resolved with consensus discussion. Results.: A total of 4172 CXRs were obtained from 4232 cases. Observed agreement for detecting consolidation (with or without other infiltrate) between primary readers was 78% (kappa = 0.50) and between arbitrators was 84% (kappa = 0.61); agreement for primary readers and arbitrators across 5 conclusion categories was 43.5% (kappa = 0.25) and 48.5% (kappa = 0.32), respectively. Disagreement was most frequent between conclusions of other infiltrate and normal for both the reading panel and the arbitration panel (32% and 30% of discordant CXRs, respectively). Conclusions.: Agreement was similar to that of previous evaluations using the WHO methodology for detecting consolidation, but poor for other infiltrates despite attempts at a rigorous standardization process. |
The Happy Teen programme: a holistic outpatient clinic-based approach to prepare HIV-infected youth for the transition from paediatric to adult medical care services in Thailand
Lolekha R , Boon-Yasidhi V , Na-Nakorn Y , Manaboriboon B , Vandepitte WP , Martin M , Tarugsa J , Nuchanard W , Leowsrisook P , Lapphra K , Suntarattiwong P , Thaineua V , Chokephaibulkit K . J Int AIDS Soc 2017 20 81-90 INTRODUCTION: We developed an 18-month Happy Teen 2 (HT2) programme comprised of a one-day workshop, two half-day sessions, and three individual sessions to prepare HIV-infected youth for the transition from paediatric to adult HIV care services. We describe the programme and evaluate the change in youth's knowledge scores. METHODS: We implemented the HT2 programme among HIV-infected Thai youth aged 14-22 years who were aware of their HIV status and receiving care at two hospitals in Bangkok (Siriraj Hospital, Queen Sirikit National Institute of Child Health [QSNICH]). Staff interviewed youth using a standardized questionnaire to assess HIV and health-related knowledge at baseline and at 12 and 18 months while they participated in the programme. We examined factors associated with a composite knowledge score ≥95% at month 18 using logistic regression. RESULTS: During March 2014-July 2016, 192 of 245 (78%) eligible youth were interviewed at baseline. Of these, 161 (84%) returned for interviews at 12 and 18 months. Among the 161 youth, the median age was 17 years, 74 (46%) were female, and 99% were receiving antiretroviral treatment. The median composite score was 45% at baseline and increased to 82% at 12 months and 95% at 18 months (P < 0.001). The range of median knowledge scores for antiretroviral management, HIV monitoring, HIV services, and family planning significantly increased from baseline (range 0-75%) to (range 67-100%) at 12 months and to 100% at 18 months (P < 0.001). Almost all youth were able to describe education and career goals at 12 and 18 months compared to 75% at baseline. In multivariable analysis, a composite knowledge score at 18 months >95% was associated with education level >high school (aOR: 2.15, 95%CI, 1.03-4.48) and receipt care at QSNICH (aOR: 2.43, 95%CI, 1.18-4.98). Youth whose mother and father had died were less likely to have score ≥95% (aOR: 0.22, 95%CI, 0.07-0.67) than those with living parents. CONCLUSIONS: Knowledge useful for a successful transition from paediatric to adult HIV care increased among youth participating in the HT2 programme. Youth follow-up will continue to assess the impact of improved knowledge on outcomes following the transition to adult care services. |
Effectiveness of the 2013 and 2014 Southern hemisphere influenza vaccines against laboratory-confirmed influenza in young children using a test-negative design, Bangkok, Thailand
Kittikraisak W , Suntarattiwong P , Ditsungnoen D , Klungthong C , Fernandez S , Yoon IK , Lindblade K , Dawood FS , Olsen SJ , Chotpitayasunondh T . Pediatr Infect Dis J 2016 35 (10) e318-25 BACKGROUND: The Thai Advisory Committee on Immunization Practices recommends annual influenza vaccination for children six months through two years of age, although older children may be vaccinated on request. We evaluated effectiveness of the 2013 and 2014 inactivated influenza vaccines to reduce medically-attended laboratory-confirmed influenza illness among Thai children aged 7-60 months. METHODS: From September 2013-May 2015, children with influenza-like illness (ILI) were screened with a rapid influenza diagnostic test. Enrolled children had nasal and throat swabs tested for influenza viruses using polymerase chain reaction (PCR). Cases and controls were subjects testing positive and negative, respectively, for influenza viruses by PCR. Vaccination status was ascertained from vaccination cards. Vaccine effectiveness (VE) was calculated as 100%*(1-odds ratio of vaccination among cases versus controls). RESULTS: Of 1,377 children enrolled, cases (n=490) and controls (n=887) were similar in demographic characteristics. Cases were less likely to receive influenza vaccine than controls in 2013 (6% vs. 14%; p=0.02), but not in 2014 (6% vs. 7%; p=0.57). Among cases, 126 (26%) were positive for influenza A(H1N1)pdm09 virus, 239 (49%) for influenza A(H3N2) and 124 (25%) for influenza B. One specimen was positive for both influenza A(H3N2) and B viruses. VE for full vaccination against all viruses was 64% (95% confidence interval [CI], 21%, 84%) in 2013 and 26% (95% CI, -47%, 63%) in 2014. CONCLUSIONS: Influenza vaccination was low among Thai children in our study, and VE varied by year, highlighting the need for annual monitoring of VE to better understand vaccine program effectiveness. |
Influenza vaccination coverage and effectiveness in young children in Thailand, 2011-2013
Kittikraisak W , Suntarattiwong P , Levy J , Fernandez S , Dawood FS , Olsen SJ , Chotpitayasunondh T . Influenza Other Respir Viruses 2015 9 (2) 85-93 BACKGROUND: Since 2009, Thailand has recommended influenza vaccine for children aged 6 months through 2 years, but no estimates of influenza vaccine coverage or effectiveness are available for this target group. METHODS: During August 2011-May 2013, high-risk and healthy children aged ≤36 months were enrolled in a 2-year prospective cohort study. Parents were contacted weekly about acute respiratory illness (ARI) in their child. Ill children had combined nasal and throat swabs tested for influenza viruses by real-time reverse transcription-polymerase chain reaction. Influenza vaccination status was verified with vaccination cards. The Cox proportional hazards approach was used to estimate hazard ratios. Vaccine effectiveness (VE) was estimated as 100% x (1-hazard ratio). RESULTS: During 2011-2013, 968 children were enrolled (median age, 10.3 months); 948 (97.9%) had a vaccination record and were included. Of these, 394 (41.6%) had ≥1 medical conditions. Vaccination coverage for the 2011-2012 and 2012-2013 seasons was 29.3% (93/317) and 30.0% (197/656), respectively. In 2011-2012, there were 213 ARI episodes, of which 10 (4.6%) were influenza positive (2.3 per 1000 vaccinated and 3.8 per 1000 unvaccinated child-weeks). The VE was 55% (95% confidence interval [CI], -72, 88). In 2012-2013, there were 846 ARIs, of which 52 (6.2%) were influenza positive (1.8 per 1000 vaccinated and 4.5 per 1000 unvaccinated child-weeks). The VE was 64% (CI, 13%, 85%). CONCLUSION: Influenza vaccination coverage among young children in Thailand was low, although vaccination was moderately effective. Continued efforts are needed to increase influenza vaccination coverage and evaluate VE among young children in Thailand. |
Modes of transmission of influenza B virus in households
Cowling BJ , Ip DK , Fang VJ , Suntarattiwong P , Olsen SJ , Levy J , Uyeki TM , Leung GM , Peiris JS , Chotpitayasunondh T , Nishiura H , Simmerman JM . PLoS One 2014 9 (9) e108850 INTRODUCTION: While influenza A and B viruses can be transmitted via respiratory droplets, the importance of small droplet nuclei "aerosols" in transmission is controversial. METHODS AND FINDINGS: In Hong Kong and Bangkok, in 2008-11, subjects were recruited from outpatient clinics if they had recent onset of acute respiratory illness and none of their household contacts were ill. Following a positive rapid influenza diagnostic test result, subjects were randomly allocated to one of three household-based interventions: hand hygiene, hand hygiene plus face masks, and a control group. Index cases plus their household contacts were followed for 7-10 days to identify secondary infections by reverse transcription polymerase chain reaction (RT-PCR) testing of respiratory specimens. Index cases with RT-PCR-confirmed influenza B were included in the present analyses. We used a mathematical model to make inferences on the modes of transmission, facilitated by apparent differences in clinical presentation of secondary infections resulting from aerosol transmission. We estimated that approximately 37% and 26% of influenza B virus transmission was via the aerosol mode in households in Hong Kong and Bangkok, respectively. In the fitted model, influenza B virus infections were associated with a 56%-72% risk of fever plus cough if infected via aerosol route, and a 23%-31% risk of fever plus cough if infected via the other two modes of transmission. CONCLUSIONS: Aerosol transmission may be an important mode of spread of influenza B virus. The point estimates of aerosol transmission were slightly lower for influenza B virus compared to previously published estimates for influenza A virus in both Hong Kong and Bangkok. Caution should be taken in interpreting these findings because of the multiple assumptions inherent in the model, including that there is limited biological evidence to date supporting a difference in the clinical features of influenza B virus infection by different modes. |
Increased hand washing reduces influenza virus surface contamination in Bangkok households, 2009-2010
Levy JW , Suntarattiwong P , Simmerman JM , Jarman RG , Johnson K , Olsen SJ , Chotpitayasunondh T . Influenza Other Respir Viruses 2014 8 (1) 13-6 Within a hand-washing clinical trial, we evaluated factors associated with fomite contamination in households with an influenza-infected child. Influenza virus RNA contamination was higher in households with low absolute humidity and in control households, suggesting that hand washing reduces surface contamination. |
Challenges with new rapid influenza diagnostic tests
Olsen SJ , Kittikraisak W , Fernandez S , Suntarattiwong P , Chotpitayasunondh T . Pediatr Infect Dis J 2014 33 (1) 117-8 Rapid influenza diagnostic tests (RIDTs) are often used at point-of-care due to their ease of use and rapidly available results. Most tests are lateral flow immunoassays that detect chromatographic changes if an influenza antigen is present in the respiratory specimen. These tests have high specificity (therefore, a positive is almost certainly a true positive) but low sensitivity (therefore, will often miss true cases).1,2 A newer immunofluorescence assay, Sofia A+B FIA (Quidel, San Diego, CA), demonstrated increased sensitivity but maintained high specificity.3 However, on December 3, 2012, Quidel issued a voluntary recall of certain lots of Sofia A+B because of false positive results.4 | In August 2011, we began a prospective cohort study of children aged ≤36 months at Queen Sirikit National Institute of Child Health, the largest pediatric referral hospital in Thailand. Children (equal numbers of high risk and healthy) are followed for 2 years and parents contacted weekly to inquire about whether their child had acute respiratory illness. Ill children came to the hospital and had a combined nasal and throat swab collected and tested for influenza viruses by realtime reverse transcription polymerase chain reaction (rRT-PCR).5 In addition, a separate nasal swab was taken and tested using 1 of 2 RIDTs made by Quidel (QuickVue A+B during August 2011 to January 20, 2013; Sofia A+B during January 21, 2013 to May 2013). | Of the 1152 specimens tested with QuickVue A+B, 59 (5.1%) were positive by rRT-PCR. Compared with rRT-PCR, Quick-Vue A+B had a sensitivity of 55.9% (33/59; 95% confidence interval (CI): 42.4–68.8%) and a specificity of 99.4% (1086/1093; 95% CI: 98.7–99.7%). Seven (0.6%) were false positive on QuickVue A+B. Of the 370 specimens tested with Sofia A+B, 12 (3.2%) were positive by rRT-PCR. Compared with rRT-PCR, Sofia had a sensitivity of 100% (12/12; 95% CI: 73.5–100.0%) and a specificity of 61.2% (219/358; 95% CI: 55.9–66.3%). One-hundred thirty nine (38.8%) were false positive on Sofia. Of the 139 false positives, 123 (88.5%) were influenza B and 16 were influenza A. There was no difference in the time between illness onset and specimen collection date between true and false positives (median days = 2; P = 0.96), nor was there a difference between the prevalence of influenza during the 2 periods (5.1% vs. 3.2%, P = 0.1). Two lots of the Sofia assay were used and both had poor specificity (data not shown). |
The serial intervals of seasonal and pandemic influenza viruses in households in Bangkok, Thailand
Levy JW , Cowling BJ , Simmerman JM , Olsen SJ , Fang VJ , Suntarattiwong P , Jarman RG , Klick B , Chotipitayasunondh T . Am J Epidemiol 2013 177 (12) 1443-51 The serial interval (SI) of human influenza virus infections is often described by a single distribution. Understanding sources of variation in the SI could provide valuable information for understanding influenza transmission dynamics. Using data from a randomized household study of nonpharmaceutical interventions to prevent influenza transmission in Bangkok, Thailand, over 34 months between 2008 and 2011, we estimated the influence of influenza virus type/subtype and other characteristics of 251 pediatric index cases and their 315 infected household contacts on estimates of household SI. The mean SI for all households was 3.3 days. Relative to influenza A(H1N1)pdm09 (3.1 days), the SI for influenza B (3.7 days) was 22% longer (95% confidence interval: 4, 43), or about half a day. The SIs for influenza viruses A(H1N1) and A(H3N2) were similar to that for A(H1N1)pdm09. SIs were shortest for older index cases (age 11-14 years) and for younger infected household contacts (age ≤15 years). Greater time spent in proximity to the index child was associated with shorter SIs. Differences in the SI might reflect differences in incubation period, viral shedding, contact, or susceptibility. These findings could improve parameterization of mathematical models to better predict the impact of epidemic or pandemic influenza mitigation strategies. |
Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand
Simmerman JM , Suntarattiwong P , Levy J , Jarman RG , Kaewchana S , Gibbons RV , Cowling BJ , Sanasuttipun W , Maloney SA , Uyeki TM , Kamimoto L , Chotipitayasunondh T . Influenza Other Respir Viruses 2011 5 (4) 256-67 BACKGROUND: Evidence is needed on the effectiveness of non-pharmaceutical interventions (NPIs) to reduce influenza transmission. METHODOLOGY: We studied NPIs in households with a febrile, influenza-positive child. Households were randomized to control, hand washing (HW), or hand washing plus paper surgical face masks (HW + FM) arms. Study nurses conducted home visits within 24 hours of enrollment and on days 3, 7, and 21. Respiratory swabs and serum were collected from all household members and tested for influenza by RT-PCR or serology. PRINCIPAL FINDINGS: Between April 2008 and August 2009, 991 (16.5%) of 5995 pediatric influenza-like illness patients tested influenza positive. Four hundred and forty-two index children with 1147 household members were enrolled, and 221 (50.0%) were aged <6 years. Three hundred and ninety-seven (89.8%) households reported that the index patient slept in the parents' bedroom. The secondary attack rate was 21.5%, and 56/345 (16.3%; 95% CI 12.4-20.2%) secondary cases were asymptomatic. Hand-washing subjects reported 4.7 washing episodes/day, compared to 4.9 times/day in the HW + FM arm and 3.9 times/day in controls (P = 0.001). The odds ratios (ORs) for secondary influenza infection were not significantly different in the HW arm (OR = 1.20; 95% CI 0.76-1.88; P-0.442), or the HW + FM arm (OR = 1.16; 95% CI .0.74-1.82; P = 0.525). CONCLUSIONS: Influenza transmission was not reduced by interventions to promote hand washing and face mask use. This may be attributable to transmission that occurred before the intervention, poor facemask compliance, little difference in hand-washing frequency between study groups, and shared sleeping arrangements. A prospective study design and a careful analysis of sociocultural factors could improve future NPI studies. |
Influenza virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission
Simmerman JM , Suntarattiwong P , Levy J , Gibbons RV , Cruz C , Shaman J , Jarman RG , Chotpitayasunondh T . Clin Infect Dis 2010 51 (9) 1053-61 BACKGROUND: Rational infection control guidance requires an improved understanding of influenza transmission. We studied households with an influenza-infected child to measure the prevalence of influenza contamination, the effect of hand washing, and associations with humidity and temperature. METHODOLOGY: We identified children with influenza and randomly assigned their households to hand washing and control arms. Six common household surfaces and the fingertips of the index patient and symptomatic family members were swabbed. Specimens were tested by real-time reverse-transcription polymerase chain reaction (rRT-PCR), and specimens with positive results were placed on cell culture. A handheld psychrometer measured meteorological data. RESULTS: Sixteen (17.8%) of 90 households had influenza A-positive surfaces by rRT-PCR, but no viruses could be cultured. The fingertips of 15 (16.6%) of the index patients had results positive for influenza A, and 1 virus was cultured. Index patients with seasonal influenza infections shed more virus than did patients with pandemic influenza infection. Control households had a higher prevalence of surface contamination (11 [24.4%] of 45) than did hand washing households (5 [11.1%] of 45); prevalence risk difference (PRD), 13.3%; [95% confidence interval {CI}, -2.2% to 28.9%]; P = .09). Households in which the age of the index patient was ≤8 years had a significantly higher prevalence of contamination (PRD ,19.1%; 95% CI, 5.3% -32.9%; P = .02). Within the strata of households with secondary infections, an effect of lower absolute humidity is suggested (P = .07). CONCLUSIONS: We documented influenza virus RNA contamination on household surfaces and on the fingertips of ill children. Homes with younger children were more likely than homes of older children to have contaminated surfaces. Lower absolute humidity favors surface contamination in households with multiple infections. Increased hand washing can reduce influenza contamination in the home. |
Clinical performance of a rapid influenza test and comparison of nasal versus throat swabs to detect 2009 pandemic influenza A (H1N1) infection in Thai children
Suntarattiwong P , Jarman RG , Levy J , Baggett HC , Gibbons RV , Chotpitayasunondh T , Simmerman JM . Pediatr Infect Dis J 2009 29 (4) 366-7 We identified febrile pediatric outpatients seeking care for influenza like illness in Bangkok. Two nasal and 1 throat swab were tested using the QuickVue A+B rapid influenza kit and reverse transcription-polymerase chain reaction. Among 142 pandemic influenza A (H1N1)-positive patients, the QuickVue test identified 89 positive tests for a sensitivity of 62.7% (95% confidence interval [CI]: 54.7-70.6). Specificity was 99.2% (95% CI: 98-100). In the 0 to 2 years age group, sensitivity was 76.7% (95% CI: 61.5-91.8). Throat and nasal swabs are equally useful diagnostic specimens for reverse transcription-polymerase chain reaction diagnosis. |
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