Inflammatory bowel disease (IBD) is a long-standing disease that often requires long-term use of immunosuppressive agents including immunomodulators (such as azathioprine, 6-mercaptopurine and methotrexate) and tumor necrosis factor-alpha inhibitors (such as infliximab and adalimumab). Introduction of immunosuppressive therapies, however, involves the risk of host susceptibility to opportunistic infections in this patient population. Therefore, adequate immunization for vaccine-preventable infectious diseases is currently recommended for all patients with IBD and is emerging as an important target for quality improvements in IBD care. However, ongoing issues regarding underuse of immunization, safety and efficacy of vaccines in patients with IBD remain. For quality improvements in IBD care, all physicians should follow the recent immunization guidelines proposed by professional IBD societies. Additionally, there are ongoing needs for intensive educational programs regarding a role of immunization in long-term care of IBD and up-to-date immunization guidelines. Immunization status should be checked at the time of diagnosis of IBD and timely vaccination before initiation of immunosuppressive therapies can be a practical solution for maximizing the efficacy of vaccination at this point. Inactivated vaccines can be used safely irrespective of immunization status of patients, while attenuated vaccines are contraindicated in patients on immunosuppressive therapies. This article reviews an ideal strategy for vaccinating patients with IBD based on the currently recommended immunization guidelines.
Antibodies, Monoclonal/therapeutic use ; Humans ; Immunosuppressive Agents/therapeutic use ; Inflammatory Bowel Diseases/diagnosis/drug therapy/*immunology ; Influenza Vaccines/immunology ; Influenza, Human/prevention & control ; Pneumonia/prevention & control ; *Vaccination ; Vaccines, Synthetic/immunology

BACKGROUNDNovel influenza A viruses of avian-origin may be the precursors of pandemic strains. This descriptive study aims to introduce a novel avian-origin influenza A (H10N8) virus which can infect humans and cause severe diseases.

METHODSCollecting clinical data of three cases of human infection with a novel reassortment avian influenza A (H10N8) virus in Nanchang, Jiangxi Province, China.

RESULTSThree cases of human infection with a new reassortment avian influenza A(H10N8) virus were described, of which two were fatal cases, and one was severe case. These cases presented with severe pneumonia that progressed to acute respiratory distress syndrome (ARDS) and intractable respiratory failure.

CONCLUSIONThis novel reassortment avian influenza A (H10N8) virus in China resulted in fatal human infections, and should be added to concerns in clinical practice.

Aged ; Antiviral Agents ; therapeutic use ; Female ; Fluoroquinolones ; therapeutic use ; Humans ; Imipenem ; therapeutic use ; Influenza A Virus, H10N8 Subtype ; drug effects ; pathogenicity ; Influenza, Human ; complications ; diagnosis ; drug therapy ; Male ; Middle Aged ; Oseltamivir ; therapeutic use

OBJECTIVETo understand the clinical and epidemiological aspects of avian influenza A (H7N9) virus infection in children.

METHODThe clinical data of the first confirmed pediatric case of avian influenza A(H7N9) virus infection were collected, and the epidemiological information, presenting symptoms, laboratory investigation, management and outcome were analyzed. The data of the pediatric cases were also compared with those of the adults cases.

RESULTThe case reported in this paper was a previously healthy 3.6-year-old boy residing in rural area of Shanghai. He had onset of fever and mild rhinorrhea on 31 March 2013 and he was afebrile and well since April 3. Influenza A (H7N9) virus was detected in his nasopharyngeal sample collected on 1 April through national Influenza-like Illness surveillance using real-time reverse transcriptase PCR and virus culture.His family raised domestic poultry with no apparent disease and there was no virological evidence of H7N9 infection. Monitoring and testing of 16 contacts had not found any secondary infection.

CONCLUSIONThe clinical course of H7N9 avian influenza virus infection in children was relatively mild as compared to adult cases. The source of infection and detail of exposure for children have not been known yet. Continued surveillance studies of mild and severe respiratory disease and subclinical infection are essential to further characterize the epidemiology and clinical spectrum of this emerging H7N9 virus infection in children.

Animals ; Child, Preschool ; China ; epidemiology ; Communicable Diseases, Emerging ; Humans ; Influenza A Virus, H7N9 Subtype ; genetics ; isolation & purification ; Influenza in Birds ; Influenza, Human ; diagnosis ; drug therapy ; virology ; Male ; Oseltamivir ; therapeutic use ; Poultry ; Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction

influenza virus can infect humans and cause disease. The clinical presentation of human infection is usually mild, but the infection caused by A(H5N1) avian influenza virus occurring initially in Hongkong in 1997 or the A(H7N9) virus isolated first at the beginning of this year in China is severe and characterized by high mortality. The mortality rate of adolescents and children caused by H5N1 avian influenza is lower than that of adults and the younger the child the lower the mortality rate. A few pediatric H7N9 avian influenza cases recovered soon after treatment. A child was determined to be a H7N9 avian influenza virus carrier. These findings suggested that the pediatric H7N9 avian influenza infection was mild. It is very important to start anti-virus treatment with oseltamivir as early as possible in cases of avian influenza infection is considered. Combined therapy, including respiratory and circulatory support and inhibiting immunological reaction, is emphasized in the treatment of severe cases.
Animals ; Birds ; virology ; China ; epidemiology ; Disease Outbreaks ; Humans ; Influenza A Virus, H5N1 Subtype ; Influenza in Birds ; virology ; Influenza, Human ; diagnosis ; drug therapy ; epidemiology ; virology ; Time Factors

OBJECTIVETo assess the effect and safety of Jinhua Qinggan Granule (JHG) in treating influenza patients of wind-heat affecting Fei syndrome (WHAFS).

METHODSTotally 136 influenza patients of WHAFS were randomized by stratification into 3 groups, the high dose JHG group (44 cases, 10 g each time), the low dose JHG group (45 cases, 5 g JHG + 5 g placebo each time), and the placebo control group (47 cases, 10 g placebo each time). All medication was administered three times daily for 5 days. The fever disappearance time, the fever disappearance rate, efficacy of TCM syndrome, the disappearance rate of main symptoms and physical signs of flu, the negative rate of virus nucleic acid in the pharyngeal secretion, and safety indicators were assessed.

RESULTSThe median fever disappearance time was 32.8 h (95% CI: 22.5-41.0 h) in the high dose JHG group, 26.0 h (95% CI: 14.5-36.5 h) in the low dose JHG group, 39.5 h (95% CI: 29.0-46.0 h) in the placebo control group. There was statistical difference in the median fever disappearance time between the low dose JHG group and the placebo control group (P = 0.011). Three days after treatment, the markedly effective rate of TCM symptoms in the low dose JHG group was 66.7%, higher than that of the placebo control group (38.3%), and its effective rate was superior to that of the high dose JHG group (P = 0.043). Five days after treatment, the recovery rate of the low dose JHG group (42.2%) was higher than that of the high dose JHG group (25.0%, P = 0.026) and that of the placebo control group (14.9%, P = 0.002). The markedly effective rate of the low dose JHG group (86.7%) was higher than that of the placebo control group (55.3%, P = 0.001). Similar effects were obtained in the low dose JHG group and the high dose JHG group, but slightly poor in partial indicators of the high dose JHG group. There was no statistical difference in adverse reaction among these three groups (P > 0.05).

CONCLUSIONSJHG was effective and safe in treating influenza patients of WHAFS. Routinely low dose was the optimal dosage of JHG.

Adult ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Influenza, Human ; diagnosis ; drug therapy ; Male ; Medicine, Chinese Traditional ; Phytotherapy ; Young Adult

Aged, 80 and over ; Animals ; Antiviral Agents ; therapeutic use ; Humans ; Influenza, Human ; diagnosis ; drug therapy ; virology ; Male

In 2009, pandemic influenza A (H1N1) virus (H1N1 09) started to spread quickly in many countries. It causes respiratory infection with signs and symptoms of common infectious agents. Thus, clinicians sometimes may miss the H1N1 patient. Clinical laboratory tests are important for the diagnosis of the H1N1 infection. There are several tests available, however, the rapid test and direct fluorescence antigen test are unable to rule out the influenza virus infection and viral culture test is time consuming. Therefore, nucleic acid amplification techniques based on reverse transcription polymerase chain reaction assays are regarded as a specific diagnosis to confirm the influenza virus infection. Although the nucleic acid-based techniques are highly sensitive and specific, the high mutation rate of the influenza RNA-dependent RNA polymerase could limit the utility of the techniques. In addition, their use depends on the availability, cost and throughput of the diagnostic techniques. To overcome these drawbacks, evaluation and development of the techniques should be continued. This review provides an overview of various techniques for specific diagnosis of influenza infection.
Disease Outbreaks/prevention & control ; Drug Resistance, Viral ; Fluorescent Antibody Technique, Direct/methods ; Humans ; Influenza A Virus, H1N1 Subtype/drug effects/*genetics ; Influenza, Human/*diagnosis/drug therapy ; Polymerase Chain Reaction/methods ; Sensitivity and Specificity ; Time Factors

The majority of Korean patients with pandemic influenza A (H1N1) during the 2009 epidemic were under 20 yr of age. The limited data on the clinical characteristics of these children led us to conduct a case note-based investigation of children admitted to 6 university hospitals with 2009 H1N1 influenza. A total of 804 children was enrolled. The median age was 5 yr; 63.8% were males; and 22.4% had at least one chronic underlying disease. Ninety-five of the patients (11.8%) were critically ill and they suffered more from shortness of breath, dyspnea and lymphopenia than the other patients. Among all the patients, 98.8% were treated with antivirals and 73% received treatment within 48 hr of illness onset. All the enrolled patients are alive and appear to have had good outcomes, probably due to the early intervention and antiviral treatment. This study deals with hospitalized children whose diagnoses of influenza A (H1N1) were confirmed, and therefore provides important new information about the clinical patterns of children with influenza A (H1N1) in Korea.
Adolescent ; Antiviral Agents/therapeutic use ; Child ; Child, Hospitalized ; Child, Preschool ; Critical Illness ; Dyspnea/etiology ; Female ; Humans ; Infant ; Infant, Newborn ; Influenza A Virus, H1N1 Subtype/genetics/*isolation & purification ; Influenza, Human/*diagnosis/drug therapy/epidemiology ; Lymphopenia/etiology ; Male ; Oseltamivir/therapeutic use ; Pandemics ; Republic of Korea/epidemiology ; Retrospective Studies

Leukocytoclastic vasculitis (LCV) usually presents palpable purpura characterized by inflammation of vessel walls and fragmentation of nuclei. Various conditions can cause LCV, and it can be induced by influenza A virus infection. We report a 2-yr-old Korean girl who presented palpable purpuric and hemorrhagic lesions with fever. She was diagnosed as LCV by skin biopsy, and influenza A virus was isolated from nasopharyngeal swab. She was treated with oseltamivir (Tamiflu(R)) and prednisolone with dramatic effect of vasculitis and fever.
Anti-Inflammatory Agents/therapeutic use ; Antiviral Agents/therapeutic use ; Child, Preschool ; Female ; Fever/etiology ; Humans ; Influenza A virus/*genetics/isolation & purification ; Influenza, Human/*complications/drug therapy/virology ; Nasopharynx/virology ; Oseltamivir/therapeutic use ; Prednisolone/therapeutic use ; Reverse Transcriptase Polymerase Chain Reaction ; Skin/pathology ; Vasculitis, Leukocytoclastic, Cutaneous/*diagnosis/drug therapy/etiology

Plastic bronchitis is an uncommon disorder characterized by the formation of bronchial casts. It is associated with congenital heart disease or pulmonary disease. In children with underlying conditions such as allergy or asthma, influenza can cause severe plastic bronchitis resulting in respiratory failure. A review of the literature showed nine cases of plastic bronchitis with H1N1 including this case. We report a case of a child with recurrent plastic bronchitis with eosinophilic cast associated with influenza B infection, who had recovered from plastic bronchitis associated with an influenza A (H1N1) virus infection 5 months previously. To the best of our knowledge, this is the first case of recurrent plastic bronchitis related to influenza viral infection. If patients with influenza virus infection manifest acute respiratory distress with total lung atelectasis, clinicians should consider plastic bronchitis and early bronchoscopy should be intervened. In addition, management for underlying disease may prevent from recurrence of plastic bronchitis.
Administration, Inhalation ; Adrenal Cortex Hormones/therapeutic use ; Antiviral Agents/therapeutic use ; Bronchitis/complications/*diagnosis/drug therapy ; Bronchoscopy ; Child ; DNA, Viral/analysis ; Dyspnea/etiology ; Humans ; Hypersensitivity/pathology ; Influenza A Virus, H1N1 Subtype/*genetics/isolation & purification ; Influenza B virus/genetics/isolation & purification ; Influenza, Human/complications/*diagnosis/drug therapy ; Male ; Oseltamivir/therapeutic use ; Pulmonary Atelectasis/drug therapy/radiography ; Real-Time Polymerase Chain Reaction ; Tachypnea/etiology ; Tomography, X-Ray Computed