Impact of adenovirus (Ad) vaccine on clinical presentation and epidemiology of respiratory pathogens associated with upper respiratory infection (URI)

• Single-centre study (USA; 2008-2013): N=2,711 Air Force trainees presenting for clinical care for URI → prospective collection of demographic, clinical and PCR data from respiratory specimens (throat swab + nasal swab)

• Live oral Ad vaccine including serotypes 4 + 7: introduced Oct-Nov 2011

• 72% of data collected before vaccine introduction (pre-VI)

28% of data collected after vaccine introduction (post-VI)• Symptoms: P<0.01 for all comparisons, except for sore throat (not significant)

Young A. IDWeek 2014 abs. 131

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Data from oral presentation

Comparison

Impact of adenovirus (Ad) vaccine on clinical presentation and epidemiology of respiratory pathogens associated with upper respiratory infection (URI)

• Median duration of URI symptoms: Pre-VI: 3 days vs Post-VI: 6 days (P<0.01)

• Vital signs: P<0.01 for all comparisons

Young A. IDWeek 2014 abs. 131

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Data from oral presentation

Impact of adenovirus (Ad) vaccine on clinical presentation and epidemiology of respiratory pathogens associated with upper respiratory infection (URI)

• Frequency of pathogen detection:

Ad vaccine seems to be highly effective in reducing febrile URI and Ad-specific illness. Ad was detected less frequently, while other respira-tory pathogens, especially rhinovirus, were detected more frequently

Young A. IDWeek 2014 abs. 131

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Data from oral presentation

Prevalence of influenza among afebrile and vaccinated healthcare workers (HCWs)

• Single-centre study (Jan-Feb 2014; USA): Temporary sick policy for HCWs with respiratory symptoms (cough, sore throat, runny nose, congestion):

– HCWs with respiratory symtoms but no fever: influenza test:

• If +: refrain from work for 7 d or until symptom resolution (whichever longer)

• If -: continue work but wear mask until symptom resolution

– HCWs with fever: optional influenza test:

• If + or not tested: refrain from work for 7 d or until symptom resolution

• If -: return to work when afebrile for >24h without use of antipyretics; wear mask until symptom resolution

• 449 HCWs underwent influenza testing:

– Positive for any respiratory pathogen: 54% (N=243)

– Positive for influenza A: 7.6% (N=34)

• Influenza A H1N1: 7.3% (N=33; 1 coinfected with influenza B)

• Influenza A H3: 0.2% (N=1)

– Diagnosis of influenza A H1N1 by outside physicians: N=7

Ridgway JP. IDWeek 2014 abs. 532

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Data from oral presentation

Prevalence of influenza among afebrile and vaccinated healthcare workers (HCWs)

Nearly 50% of HCWs with influenza may be afebrile prior to diagnosis and may pose a risk of influenza transmission to pts and coworkers

Ridgway JP. IDWeek 2014 abs. 532

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Data from oral presentation

Frequency of fever among influenza-pos. HCWs, according to prior influenza vaccination history

• Multi-centre, phase IIIb-IV, double-blind RCT (USA, Canada; 2011-2013): N=31,989 adults aged ≥65 yr, randomised to:

– Standard-dose (SD) IIV3 (15 µg haemagglutinin/strain): N=15,998

– High-dose (HD) IIV3 (60 µg haemagglutinin/strain): N=15,991

Primary efficacy endpoint: Occurrence, ≥14 days after vaccination, of laboratory-confirmed influenza caused by any influenza viral (sub)types, in association with a protocol-defined influenza-like illness

Safety:

High dose (HD) vs standard dose (SD) trivalent inactivated influenza vaccine (IIV3) for older adults

Diazgranados C et al. N Engl J Med 2014;371:635-45

Diazgranados C. IDWeek 2014 abs. 1059

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High dose (HD) vs standard dose (SD) trivalent inactivated influenza vaccine (IIV3) for older adults

Expanded immunogeniticity (serum samples provided ±28 d after vaccination):

•Full immunogenicity subset (study yr 2: influenza season 2012-2013): IIV-HD: N=2,879 / IIV-SD: N=2,872: Haemagglutinin inhibition (HAI) assay using egg-propagated H3N2 antigen: GMT ratio=1.82 (95% CI: 1.71-1.94)•Substudy using case-cohort design: N=675 representative serum samples (123 who developed PCR/culture-confirmed H3N2 influenza illness; 552 from random subset of 10% of non-cases)

In adults ≥65 yr, IIV-HD may induce higher Ab responses and provide better protection against lab-confirmed influenza illness than IIV-SD

Diazgranados C et al. N Engl J Med 2014;371:635-45

Diazgranados C. IDWeek 2014 abs. 1059

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Data from poster

Expanded immunogenicity assay GMT ratio (95% CI)

HAI using MDCK cell-propagated H3N2 Ag 1.48 (1.26-1.73)

N2 Ab titres by ELLA 1.42 (1.23-1.65)

NT titres by assay using egg-propagated H3N2 Ag 1.53 (1.29-1.82)

NT titres by assay using cell-propagated H3N2 Ag 1.75 (1.43-2.15)Ab: antibody; ELLA: enzyme-linked lectin assay; GMT: geometric mean titre; H3N2 Ag: A/Victoria/361/2011 antigen; N2: anti-neuraminidase; NT: viral neutralisation

New criteria for ventilator-associated pneumonia (VAP) from NHSN definitions of ventilator-associated events (VAEs) 1McMullen K. IDWeek 2014 abs. 1233

2Magill SS. IDWeek 2014 abs. 1234

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reviewed by: Klompas M. N Engl J Med 2013;368:1472-5 CFU: colony-forming unit; LPF: low-power field; min.: minimum; pos.: positive

New criteria for ventilator-associated pneumonia (VAP) from NHSN definitions of ventilator-associated events (VAEs)

Traditional definition of VAP (tVAP) vs new definition of VAE: comparison:

Single-centre study (2011-2012; USA)1: N=1,832 pts ventilated for >2 days in 6 ICUs; total ventilator (vent) days: 14,904; median days/pt: 5 (range: 2-80)

•Surveillance using VAP definition: done manually through routine surveillance processes of trained infection prevention specialists (IPS)

•Surveillance using new VAE definition: done retrospectively through combination of automated and manual surveillance (IPS blinded to results of existing VAP surveillance)

•tVAP vs new probable/possible VAP definition: poor agreement (κ=0.05)

1McMullen K. IDWeek 2014 abs. 12332Magill SS. IDWeek 2014 abs. 1234

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New criteria for ventilator-associated pneumonia (VAP) from NHSN definitions of ventilator-associated events (VAEs)

Retrospective study (2012-2013; USA)2 in 9 ≠ types of adult ICUs:

±79% of VAEs: in pts on MV for ≥5 d or in hospital for ≥5 d at time of VAE onset

Compared with the tVAP definition, the new VAE definitions seem to result in higher event rates and different patient characteristics

1McMullen K. IDWeek 2014 abs. 12332Magill SS. IDWeek 2014 abs. 1234

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*P≤0.003 for comparison all VAEs with tVAP; MV: mechanical ventilation