Pandemic influenza and secondary bacterial infections: do we need antibiotic stockpiles?
PHE ePoster Library. Chiavenna C. Apr 9, 2019; 257528; 15456
Chiara Chiavenna
Chiara Chiavenna
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Abstract
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Abstract Measures of the impact of influenza on S.pneumoniae infections, both in the seasonal and pandemic setting, are needed to predict the burden of secondary bacterial infections in future pandemics. The magnitude of the interaction between these two pathogens has been difficult to quantify because a combined viral-bacterial testing is rarely performed, and surveillance data suffer from confounding problems common to all ecological studies. We propose a novel multivariate model for age-stratified disease incidence, incorporating contact patterns and estimating disease transmission within and across groups.We use surveillance data from England over the years 2009 to 2017, where influenza infections are identified through the virological testing of samples taken from influenza-like-illness (ILI) patients, and invasive pneumococcal disease (IPD) cases are routinely reported by the microbiology laboratories. Mean IPD counts are decomposed into an endemic component describing some seasonal background, an auto-regressive component mimicking pneumococcal transmission and an influenza-driven component.The contribution of influenza on IPD is estimated to be larger during the 2009 pandemic compared to seasonal flu. The effect varies greatly across subgroups, being highest in school-age children and adults (19.63% and 5.86% respectively). However the role of influenza is reduced when counts of other viral infections, such as RSV and rhinovirus, are added to the model, or when the seasonal background is described by temperature and rainfall information.In conclusion, the method proposed usefully allows the decomposition of the IPD incidence in the various contributions..
Results:
show that an influenza pandemic with comparable severity to the 2009 H1N1 could have a modest impact in the general population but more significant on school-age children and young adults. Nonetheless, the 2009 H1N1 was a particularly mild pandemic and stockpiling of antibiotics could be a conservative choice. Funding PHE-funded PhD scholarship
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