Picornavirus, the most common respiratory virus causing infection among patients of all ages hospitalized with acute respiratory illness.

We evaluated the prevalence of respiratory virus infection (RVI) in 403 illnesses of 364 persons hospitalized over a 2-year period with acute respiratory conditions using virus-specific reverse transcription-PCR (RT-PCR) assays in addition to cell culture and serology. RVIs were identified in >75% of children under 5 years of age and 25 to 37% of adults. The molecular assays doubled the number of infections identified; picornaviruses were the most frequent in patients of all ages, followed by respiratory syncytial virus and influenza viruses.

Direct and indirect effectiveness of influenza vaccination delivered to children at school preceding an epidemic caused by 3 new influenza virus variants.

Background: Influenza is an uncontrolled epidemic disease that is vaccine preventable. New recommendations for universal immunization present a challenge to the implementation of vaccine delivery. This field trial examines the effectiveness of school-based clinics for vaccine delivery before an epidemic caused by 3 new influenza virus variants not contained in the vaccine.

Improving influenza immunization in pregnant women and healthcare workers.

Objective: To evaluate the effect of several strategies to increase influenza immunization in a multispecialty clinic.

Study Design: Retrospective electronic database analysis of influenza vaccinations in a 6-year period at Kelsey-Seybold Clinic in Houston, Texas.

Methods: We evaluated immunization rates in pregnant women and healthcare workers during 6 influenza seasons (2003-2004 to 2008-2009) after implementing the following strategies for pregnant women: assessing baseline immunization rates for obstetric providers, followed by direct encouragement and behavior modeling; implementing standing orders for influenza vaccination in pregnancy; and offering vaccination training to obstetricians and nurses.

Universal influenza vaccination and live attenuated influenza vaccination of children.

Influenza is an uncontrolled epidemic disease that is vaccine preventable. Each winter the peak of medically attended acute respiratory illness coincides with the peak of influenza virus activity. The anatomy of an urban influenza epidemic is presented highlighting the role of children in the spread of influenza.

Modifying clinical practices to manage influenza in children effectively.

Children less than 5 years of age are at increased risk of morbidity from influenza infection compared with older children and adults aged 18-54 years. Although much of the disease burden can be prevented by annual vaccination, the misperception that influenza does not result in serious illness in children, including schoolchildren, contributes to ongoing low vaccination rates. In conjunction with community surveillance of influenza activity, rapid diagnostic tests can help identify influenza patients who may benefit from initiation of antiviral therapy.

Safety of the intranasal, trivalent, live attenuated influenza vaccine (LAIV) in children with intermittent wheezing in an open-label field trial.

Background: Safety of the intranasal, trivalent, live attenuated influenza vaccine (LAIV) in children with asthma is unknown. A previous report showed an "asthma signal" in children aged 18-35 months.

Methods: Healthy children aged 1.

Trivalent live attenuated intranasal influenza vaccine administered during the 2003-2004 influenza type A (H3N2) outbreak provided immediate, direct, and indirect protection in children.

Objective: Live attenuated influenza vaccine may protect against wild-type influenza illness shortly after vaccine administration by innate immunity. The 2003-2004 influenza A (H3N2) outbreak arrived early, and the circulating strain was antigenically distinct from the vaccine strain. The objective of this study was to determine the effectiveness of influenza vaccines for healthy school-aged children when administered during the influenza outbreak.

Efficacy of trivalent, cold-adapted, influenza virus vaccine against influenza A (Fujian), a drift variant, during 2003-2004.

In the 2003-2004 influenza season, the predominant circulating influenza A (H3N2) virus in the United States was similar antigenically to A/Fujian/411/2002 (H3N2), a drift variant of A/Panama/2007/99 (H3N2), the vaccine strain. That year, a field study of trivalent live-attenuated influenza vaccine (LAIV-T) was conducted in Temple-Belton, Texas, as part of a larger community-based, non-randomized, open-label study in three communities that began in August 1998 [Gaglani MJ, Piedra PA, Herschler GB, Griffith ME, Kozinetz CA, Riggs MW, et al. Direct effectiveness of the trivalent, cold-adapted, influenza virus vaccine (CAIV-T) against the 2000-2001 influenza A (H1N1) and B epidemic in healthy children.

Asthma, influenza, and vaccination.

Exacerbations of asthma in children are usually triggered by virus infections. Many different respiratory viruses are associated with these exacerbations, but influenza viruses are frequently associated with those requiring hospitalization and are the only ones for which specific treatment and prophylaxis are available. Current studies have shown that influenza vaccines are safe for patients with asthma.

Herd protection against influenza.

Mortality and hospitalization rates due to influenza have risen despite increasing vaccine coverage for the most vulnerable population; however, those most vulnerable to complications and death are the least likely to respond to the vaccine. New strategies for influenza control are needed and indirect effectiveness (herd protection) has been demonstrated for several currently used vaccines - rubella, H. influenzae type b, pneumococcus varicella and hepatitis A.

Medically attended pediatric influenza during the resurgence of the Victoria lineage of influenza B virus.

Objectives: During the 2002-2003 season, a new variant of influenza B co-circulated with influenza A viruses. This study examines the characteristics and outcomes of children with influenza A and B virus infection vs. other acute respiratory illnesses.

A response to strategy #2: streamlining the regulatory process.

Regulatory burden has contributed to the decline in the production of vaccines in the United States. Production of influenza virus vaccine is perilously limited at a critical period when vulnerable populations are increasing and the threat of a pandemic is looming. Regulatory bodies must work with manufacturers to facilitate implementation of new production practices, to ensure steady expansion of the supply of safe and effective vaccines.

Live attenuated influenza vaccine, trivalent, is safe in healthy children 18 months to 4 years, 5 to 9 years, and 10 to 18 years of age in a community-based, nonrandomized, open-label trial.

Objective: Influenza-associated deaths in healthy children that were reported during the 2003-2004 influenza season heightened the public awareness of the seriousness of influenza in children. In 1996-1998, a pivotal phase III trial was conducted in children who were 15 to 71 months of age. Live attenuated influenza vaccine, trivalent (LAIV-T), was shown to be safe and efficacious.

A personnel time-motion study of intranasal influenza vaccination in healthy children.

Vaccinating millions of Americans depends, in part, on short vaccination times. During two intranasal influenza vaccine trials, times for six vaccination steps were recorded for 497 children. The total of mean times for the steps was 115 s, almost half spent explaining the vaccine and intranasal delivery.

Safety of influenza vaccination during pregnancy.

Objective: The purpose of this study was to evaluate the safety of influenza vaccine that is administered in the second or third trimester of gestation.

Study Design: A retrospective electronic database search of 5 influenza seasons (July 1, 1998, to June 30, 2003) was performed at a large multispecialty clinic in Houston, Texas. Immunization rates were calculated, and outcomes of pregnancy were compared between a cohort of healthy women who received influenza vaccine and a control group of healthy unvaccinated women who were matched by age, month of delivery, and type of medical insurance.