Droplet precautions on-site (DroPS) during the influenza season 2018/2019: a possible alternative to single room isolation for respiratory viral infections

Background The guideline-driven and widely implemented single room isolation strategy for respiratory viral infections (RVI) such as influenza or respiratory syncytial virus (RSV) can lead to a shortage of available hospital beds. We discuss our experience with the introduction of droplet precautions on-site (DroPS) as a possible alternative. Methods During the 2018/19 influenza season we introduced DroPS on several wards of a single tertiary care center, while other wards maintained the traditional single room isolation strategy. On a daily basis, we evaluated patients for the development of respiratory symptoms and screened those with a clinical diagnosis of hospital-acquired respiratory viral infection (HARVI) for influenza/RSV by molecular rapid test. If negative, it was followed by a multiplex respiratory virus PCR. We report the concept of DroPS, the feasibility of the strategy and the rate of microbiologically confirmed HARVI with influenza or RSV infection on the DroPS wards compared to wards using the traditional single room isolation strategy. Results We evaluated all hospitalised patients at risk for a HARVI, 741 (72%) on the DroPS wards and 293 (28%) on the regular wards. The hospital-acquired infection rate with influenza or RSV was 2/741 (0.3%; 1× influenza A, 1× RSV) on the DroPS wards and 2/293 (0.7%; 2× influenza A) on the regular wards. Conclusions Droplet precautions on-site (DroPS) may be a simple and potentially resource-saving alternative to the standard single room isolation strategy for respiratory viral infections. Further studies in a larger clinical context are needed to document its safety.

A Lower Level of Post-Vaccinal Antibody Titer against Influenza Virus A H1N1 May Protect Patients with Autoimmune Rheumatic Diseases from Respiratory Viral Infections

Background and Objectives: The concentration of antibodies against virus influenza A H1N1 in the titer (≥1:32) positively correlates with resistance to flu in healthy persons. In elderly and immune-compromised patients, an influenza vaccine may be less immunogenic. Hypothesis: A lower post-vaccinal antibody titer (≥1:16) may be sero-protective against respiratory viral infections in patients with autoimmune rheumatic diseases. Materials and Methods: Fifty patients with autoimmune rheumatic diseases (Systemic Lupus Erythematosus—24; Rheumatoid Arthritis—15; and Sjögren’s Syndrome—11), who were at least 65 years old or whose relative disease duration (disease duration/age) was greater than 1/8, were examined. Thirty-four of them were vaccinated with a trivalent inactivated non-adjuvant influenza vaccine. The antibody concentration against influenza virus A H1N1 was measured using the standardized hemagglutination inhibition test and patients who got any respiratory viral infection were registered. To test the hypothesis, a correlative analysis was applied, followed by a binary logistic regression that included potential confounding variables, such as age, disease duration and therapy (personal/health-related conditions). Results: Vaccinated patients were significantly less affected by respiratory viral infections (21% vs. 75%). The lower titer considered (≥1:16) was significantly present more often among vaccinated patients (68% vs. 6%). The correlation between its presence/absence and that of respiratory viral infections was –0.34 (p < 0.05). The binary logistic regression evidenced the relevance of this correlation, confirming the hypothesis. Vaccination was associated with the 87.3% reduction in the likelihood of getting respiratory viral infections, whereas the lower antibody titer (≥1:16) was associated with the 77.6% reduction in the likelihood of getting respiratory viral infections. The vaccine was well tolerated by all patients and after vaccination no exacerbation of the underlying disease was observed. Conclusions: A lower antibody titer (≥1:16) against influenza virus A H1N1 could be protective against respiratory viral infections for certain autoimmune rheumatic diseases patients, which confirms the clinical effectiveness of influenza vaccination.

STATE OF IMMUNITY IN PRESCHOOLERS WITH ACUTE RESPIRATORY VIRAL INFECTIONS ASSOCIATED WITH ADENOID VEGETATIONS

Introduction. Acute respiratory infections are the most common infectious diseases worldwide among children of different age groups. Materials and methods. 59 children between the ages of 3 and 7 participated in the study. The first group included 22 patients with an acute respiratory viral infection, the second one consisted of 23 patients with acute respiratory viral infections associated with adenoid vegetation, and 14 apparently healthy children were included in the control group. Immunology research was conducted during the acute period of the disease. Statistical processing of received data was done with the standard statistical software EZR 1.41. Results. After the research, most of the patients with acute respiratory viral infections were identified an actual increase in CD3+, CD4+, CD8+, CD22+- cells and IgA, IgM in the blood serum. Simultaneously, in patients with acute respiratory viral infections associated with adenoid vegetation during the acute period, the increase in total lymphocytes was identified due to CD4+, CD8+, CD22+ cells and IgG. A comparative analysis of the study results of both groups of patients showed that children from the second group had a significantly higher level of CD3+- cells, while the CD22+- lymphocytes, IgA, IgM and IgG were significantly lower from the similar indicators of the first group. Conclusions. The acute period of the disease in children with acute respiratory viral infections, associated with adenoid vegetation, had an imbalance in both the cell and the immune system's humoral component

Epidemiological features of acute respiratory infections in dentists

Aim. To study the incidence of acute respiratory infections (ARI) in medical staff of dental clinics.Materials and Methods. We performed a descriptive, retrospective epidemiological study of ARI incidence by means of conducting an anonymous survey of 1,081 dentistry practitioners (358 in specialised dental clinics and 723 employees of polyclinics) in Kemerovo (2020). ARI included COVID-19, community-acquired pneumonia, and other common respiratory viral infections. The questionnaire included 12 questions about ARI, age, gender, working experience, and position.Results. The incidence of ARI in dentistry practitioners in specialised dental clinics was 2.6-fold higher as compared with those working in polyclinics [379.52 per 1,000 (95% CI = 327.10-434.11) and 146.19 per 1,000 (95% CI = 120.56-174.93), respectively, p = 0,00001], regardless of age. Prolonged and close contact with the patients along with an intensive use of aerosol-generating technologies were associated with a 2.3-fold times higher incidence of ARI in dental therapists in comparison with dental surgeons. Female dentists suffered from ARI 1.8-fold more frequently than males [410.91 per 1,000 (95% CI = 352,18-471,58) and 228.07 per 1,000 (95% CI = 127.40-358.36), p = 0,01] but most women worked as dental therapists that could confound such association. ARI incidence was not associated with age, work experience, and position (p = 0.22).Conclusion. Dentistry practitioners working in specialised clinics more frequently experienced ARI than those working in polyclinics. Dental therapists were at higher risk of ARI in comparison with dental surgeons, potentially due to the active use of aerosol generating technologies and prolonged close contact with the patients during treatment. Other factors were not among the major determinants of ARI incidence in dentistry practitioners.

Retrospective analysis of cerebral neurological complications against background of seasonal respiratory viral infections and new coronavirus infection Covid‑19

Based on the example of seasonal epidemics of respiratory viral infections, it is partially possible to model the outcomes of neurological complications from Covid‑19, taking into account the pathogenetic features of the virus effect on the vascular wall and nerve cells. The accumulated experience of doctors of various specialties makes it possible to prevent such life-threatening complications as ACVA, PATE, intoxication, and sepsis. From the first days of the disease, it is necessary to conduct dynamic monitoring of blood rheology, the level of systemic oxygenation, use anticoagulants in preventive doses in patients at the early stages of the disease, conduct therapy aimed at reducing the risk of cytokine storm development.

Cytokine status indicators in children with acute respiratory viral infections after treatment with intranasal interferon-based medicine

Objective: to study the dynamics of local and systemic cytokine production in children with different clinical forms of acute respiratory viral infections (ARVI), including COVID-19, and to assess the effectiveness of local interferon-based therapy.Patients and methods: The study included 180 patients aged from 1 month to 17 years with сonfirmed acute respiratory viral infections (ARVI), including COVID-19. Patients were divided into 2 groups (main and control) of 90 people each. In the main group patients received the intranasal interferon-based medicine Grippferon® in addition to the basic therapy, the control group patients received only basic therapy. The cytokine status was assessed by the content of IFN-α and -γ, IL-1β, IL-8, IL-4, IL-10, IL-17 in blood serum and in nasopharyngeal secretions by enzyme immunoassay kits ("Cytokine", St. Petersburg).Results: Statistically significant differences were revealed in the systemic and local content of individual cytokines in ARVI of different etiologies, depending on the level of damage to the respiratory tract. The use of the interferon-based medicine Grippferon® for intranasal use in children in the early stages of ARVI, including COVID-19, helps to decrease the high content of cytokines IL-1β and IL-8 in the nasopharynx by reducing the viral load. As a result, the duration of catarrhal disease symptoms and intoxication was also significantly reduced as well as the pathogen elimination time.

Respiratory viral infections including caused by coronaviruses in oncological and oncohematological patients

BACKGROUND: Patients with cancer are prone to developing infectious complications. They significantly aggravate the course of the underlying disease and worsen the quality of life of patients. The emergence of infections is largely promoted by immunosuppression associated with the use of cytostatic drugs, high-dose chemotherapy and hematopoietic stem cell transplantation in hematological cancer patients. Among infectious agents, respiratory viruses, especially influenza viruses, play an important role. The urgency of this problem has increased many times in connection with the development of the COVID-19 pandemic. AIM: To study the features of the course of respiratory infections, including coronavirus (seasonal and COVID-19), infections in cancer and oncohematological patients during hospitalization and in outpatient settings. MATERIALS AND METHODS: The study of the frequency and course of infectious complications in cohorts of patients with oncological diseases, who were under dispensary supervision in the polyclinic in Kirovsk, Leningrad region. Retrospective analysis of the frequency and characteristics of the course of coronavirus infection caused by HCoVs (OC43, 229E, NL63, HKU1) in patients treated at the clinics of the Russian research institute of Hematology and Transfusionology. Prospective study of the coronavirus COVID-19 of patients hospitalized at the Russian research institute of Hematology and Transfusionology and at the Kirov interdistrict hospital in Leningrad Region during the period of its conversion to specialized infection diseases hospital. RESULTS: Coronavirus infection caused by HCoVs (OC43, 229E, NL63, HKU1), occurs in hematological cancer patients more often in association with other respiratory viruses. In the cases of detection of the SARS-CoV-2 in hospitalized patients, they need to be transferred to specialized infectious hospitals. CONCLUSIONS: Respiratory viral infections are risk factors in cancer and oncohematological patients. Outpatient oncological and oncohematological patients require constant dispensary observation and special attention during the COVID-19 pandemic, outbreaks of influenza and other viral infections.