Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days
Background The duration of viral shedding is an important determinant of infectivity and transmissibility and provides vital information for effective infection prevention and control. However, few studies have evaluated viral shedding in patients admitted to hospital with 2009 H1N1 influenza and tr...
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| Veröffentlicht in: | Influenza and other respiratory viruses 2013-09, Vol.7 (5), p.833-837 |
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| container_title | Influenza and other respiratory viruses |
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| creator | Ryoo, Seung M. Kim, Won Y. Sohn, Chang H. Seo, Dong W. Oh, Bum J. Lee, Jae H. Lee, Yoon S. Lim, Kyoung S. |
| description | Background
The duration of viral shedding is an important determinant of infectivity and transmissibility and provides vital information for effective infection prevention and control. However, few studies have evaluated viral shedding in patients admitted to hospital with 2009 H1N1 influenza and treated with oseltamivir.
Objective
To determine the incidence of prolonged 2009 H1N1 influenza viral shedding in patients treated for 5 days with oseltamivir and to identify factors that promote prolonged viral shedding.
Methods
This was a prospective, observational cohort study of 173 patients infected with 2009 H1N1 influenza (confirmed by RT‐PCR) who were admitted to isolation rooms in the emergency department of our hospital between August 25, 2009 and December 31, 2009. All of the patients were treated according to institutional protocols and received routine follow‐up RT‐PCR testing after 5 days of oseltamivir therapy. Prolonged viral shedding was defined as a positive follow‐up RT‐PCR result.
Result
Of the 173 patients in our cohort, 88 (50·8%) showed persistent viral shedding after oseltamivir treatment. Viral shedding was significantly prolonged if antiviral therapy was started ≥2 days after symptom onset (OR 2·74, 95% CI 1·29–5·82), if there were major comorbidities (OR 3·07, 95% CI 1·29–7·32), and/or if respiratory symptoms were still present on the day 5 of antiviral treatment (OR 4·13, 95% CI 2·10–8·11).
Conclusions
The presence of major comorbidities, a delay in initiating antiviral treatment, and continuing respiratory symptoms after 5 days of antiviral treatment are associated with prolonged shedding of the 2009 H1N1 influenza virus. |
| doi_str_mv | 10.1111/irv.12065 |
| format | Article |
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The duration of viral shedding is an important determinant of infectivity and transmissibility and provides vital information for effective infection prevention and control. However, few studies have evaluated viral shedding in patients admitted to hospital with 2009 H1N1 influenza and treated with oseltamivir.
Objective
To determine the incidence of prolonged 2009 H1N1 influenza viral shedding in patients treated for 5 days with oseltamivir and to identify factors that promote prolonged viral shedding.
Methods
This was a prospective, observational cohort study of 173 patients infected with 2009 H1N1 influenza (confirmed by RT‐PCR) who were admitted to isolation rooms in the emergency department of our hospital between August 25, 2009 and December 31, 2009. All of the patients were treated according to institutional protocols and received routine follow‐up RT‐PCR testing after 5 days of oseltamivir therapy. Prolonged viral shedding was defined as a positive follow‐up RT‐PCR result.
Result
Of the 173 patients in our cohort, 88 (50·8%) showed persistent viral shedding after oseltamivir treatment. Viral shedding was significantly prolonged if antiviral therapy was started ≥2 days after symptom onset (OR 2·74, 95% CI 1·29–5·82), if there were major comorbidities (OR 3·07, 95% CI 1·29–7·32), and/or if respiratory symptoms were still present on the day 5 of antiviral treatment (OR 4·13, 95% CI 2·10–8·11).
Conclusions
The presence of major comorbidities, a delay in initiating antiviral treatment, and continuing respiratory symptoms after 5 days of antiviral treatment are associated with prolonged shedding of the 2009 H1N1 influenza virus.</description><identifier>ISSN: 1750-2640</identifier><identifier>EISSN: 1750-2659</identifier><identifier>DOI: 10.1111/irv.12065</identifier><identifier>PMID: 23279949</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Adult ; Antiviral agents ; Antiviral Agents - therapeutic use ; Antiviral drugs ; Chronic illnesses ; Diabetes ; Emergency medical care ; Emergency medical services ; Female ; H1N1 subtype ; Hospitals ; Humans ; Hypertension ; Identification methods ; Immunization ; Infectivity ; Influenza ; influenza A virus ; Influenza A Virus, H1N1 Subtype - drug effects ; Influenza A Virus, H1N1 Subtype - genetics ; Influenza A Virus, H1N1 Subtype - isolation & purification ; Influenza A Virus, H1N1 Subtype - physiology ; Influenza virus ; Influenza, Human - drug therapy ; Influenza, Human - epidemiology ; Influenza, Human - virology ; Laboratories ; Lung diseases ; Male ; Middle Aged ; Observational studies ; Original ; Oseltamivir ; Oseltamivir - therapeutic use ; Pandemics ; Patients ; Prospective Studies ; Republic of Korea - epidemiology ; Respiratory diseases ; RT‐PCR ; Swine flu ; Variables ; viral shedding ; Virus Shedding - drug effects ; Viruses ; Young Adult</subject><ispartof>Influenza and other respiratory viruses, 2013-09, Vol.7 (5), p.833-837</ispartof><rights>2012 John Wiley & Sons Ltd</rights><rights>2012 Blackwell Publishing Ltd.</rights><rights>Copyright John Wiley & Sons, Inc. Sep 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4765-17e6ee0be27af74ab167e6381aba426675a6e98160b735f4e8ea9dfb97654f6d3</citedby><cites>FETCH-LOGICAL-c4765-17e6ee0be27af74ab167e6381aba426675a6e98160b735f4e8ea9dfb97654f6d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781218/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781218/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,1411,11541,27901,27902,45550,45551,46027,46451,53766,53768</link.rule.ids><linktorsrc>$$Uhttps://onlinelibrary.wiley.com/doi/abs/10.1111%2Firv.12065$$EView_record_in_Wiley-Blackwell$$FView_record_in_$$GWiley-Blackwell</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23279949$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ryoo, Seung M.</creatorcontrib><creatorcontrib>Kim, Won Y.</creatorcontrib><creatorcontrib>Sohn, Chang H.</creatorcontrib><creatorcontrib>Seo, Dong W.</creatorcontrib><creatorcontrib>Oh, Bum J.</creatorcontrib><creatorcontrib>Lee, Jae H.</creatorcontrib><creatorcontrib>Lee, Yoon S.</creatorcontrib><creatorcontrib>Lim, Kyoung S.</creatorcontrib><title>Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days</title><title>Influenza and other respiratory viruses</title><addtitle>Influenza Other Respir Viruses</addtitle><description>Background
The duration of viral shedding is an important determinant of infectivity and transmissibility and provides vital information for effective infection prevention and control. However, few studies have evaluated viral shedding in patients admitted to hospital with 2009 H1N1 influenza and treated with oseltamivir.
Objective
To determine the incidence of prolonged 2009 H1N1 influenza viral shedding in patients treated for 5 days with oseltamivir and to identify factors that promote prolonged viral shedding.
Methods
This was a prospective, observational cohort study of 173 patients infected with 2009 H1N1 influenza (confirmed by RT‐PCR) who were admitted to isolation rooms in the emergency department of our hospital between August 25, 2009 and December 31, 2009. All of the patients were treated according to institutional protocols and received routine follow‐up RT‐PCR testing after 5 days of oseltamivir therapy. Prolonged viral shedding was defined as a positive follow‐up RT‐PCR result.
Result
Of the 173 patients in our cohort, 88 (50·8%) showed persistent viral shedding after oseltamivir treatment. Viral shedding was significantly prolonged if antiviral therapy was started ≥2 days after symptom onset (OR 2·74, 95% CI 1·29–5·82), if there were major comorbidities (OR 3·07, 95% CI 1·29–7·32), and/or if respiratory symptoms were still present on the day 5 of antiviral treatment (OR 4·13, 95% CI 2·10–8·11).
Conclusions
The presence of major comorbidities, a delay in initiating antiviral treatment, and continuing respiratory symptoms after 5 days of antiviral treatment are associated with prolonged shedding of the 2009 H1N1 influenza virus.</description><subject>Adult</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Antiviral drugs</subject><subject>Chronic illnesses</subject><subject>Diabetes</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Female</subject><subject>H1N1 subtype</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Identification methods</subject><subject>Immunization</subject><subject>Infectivity</subject><subject>Influenza</subject><subject>influenza A virus</subject><subject>Influenza A Virus, H1N1 Subtype - drug effects</subject><subject>Influenza A Virus, H1N1 Subtype - genetics</subject><subject>Influenza A Virus, H1N1 Subtype - isolation & purification</subject><subject>Influenza A Virus, H1N1 Subtype - physiology</subject><subject>Influenza virus</subject><subject>Influenza, Human - drug therapy</subject><subject>Influenza, Human - epidemiology</subject><subject>Influenza, Human - virology</subject><subject>Laboratories</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Original</subject><subject>Oseltamivir</subject><subject>Oseltamivir - therapeutic use</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Republic of Korea - epidemiology</subject><subject>Respiratory diseases</subject><subject>RT‐PCR</subject><subject>Swine flu</subject><subject>Variables</subject><subject>viral shedding</subject><subject>Virus Shedding - drug effects</subject><subject>Viruses</subject><subject>Young Adult</subject><issn>1750-2640</issn><issn>1750-2659</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkt1qFDEUgAdRbK1e-AIS8Ka92DbJ5GdyI5RibaEoiHobMjMnuykzyZpktqz3vofP4pOZdeqigmBuknPy5eMkOVX1nOBTUsaZi5tTQrHgD6pDIjleUMHVw_2a4YPqSUq3GHPRcPa4OqA1lUoxdVh9vTRdDjGhdQxjyM4vUV7BLhqCX0KP0gr6fpcOdt4xvofRdej4irwlJ4hirJDzdpjAfzFo4-KUSly47MDnhHIEk4vozuUVCgmGbEZXMGRDRPz7t95s09PqkTVDgmf381H18fL1h4urxc27N9cX5zeLjknBF0SCAMAtUGmsZKYlomTqhpjWMCqE5EaAaojAray5ZdCAUb1tVTnMrOjro-rV7F1P7Qh9VwqMZtDr6EYTtzoYp__c8W6ll2GjuWwIJU0RHN8LYvg8Qcp6dKmDYTAewpQ0YTXDtCFY_AdKJcZSCFXQl3-ht2GKvryEpkVHBVUNLtTJTHUxpBTB7usmWO_6QJc-0D_7oLAvfr_onvz18QU4m4E7N8D23yZ9_f7TrPwBvL6-Nw</recordid><startdate>201309</startdate><enddate>201309</enddate><creator>Ryoo, Seung M.</creator><creator>Kim, Won Y.</creator><creator>Sohn, Chang H.</creator><creator>Seo, Dong W.</creator><creator>Oh, Bum J.</creator><creator>Lee, Jae H.</creator><creator>Lee, Yoon S.</creator><creator>Lim, Kyoung S.</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>7U2</scope><scope>5PM</scope></search><sort><creationdate>201309</creationdate><title>Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days</title><author>Ryoo, Seung M. ; Kim, Won Y. ; Sohn, Chang H. ; Seo, Dong W. ; Oh, Bum J. ; Lee, Jae H. ; Lee, Yoon S. ; Lim, Kyoung S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4765-17e6ee0be27af74ab167e6381aba426675a6e98160b735f4e8ea9dfb97654f6d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Antiviral drugs</topic><topic>Chronic illnesses</topic><topic>Diabetes</topic><topic>Emergency medical care</topic><topic>Emergency medical services</topic><topic>Female</topic><topic>H1N1 subtype</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Identification methods</topic><topic>Immunization</topic><topic>Infectivity</topic><topic>Influenza</topic><topic>influenza A virus</topic><topic>Influenza A Virus, H1N1 Subtype - drug effects</topic><topic>Influenza A Virus, H1N1 Subtype - genetics</topic><topic>Influenza A Virus, H1N1 Subtype - isolation & purification</topic><topic>Influenza A Virus, H1N1 Subtype - physiology</topic><topic>Influenza virus</topic><topic>Influenza, Human - drug therapy</topic><topic>Influenza, Human - epidemiology</topic><topic>Influenza, Human - virology</topic><topic>Laboratories</topic><topic>Lung diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Original</topic><topic>Oseltamivir</topic><topic>Oseltamivir - therapeutic use</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Republic of Korea - epidemiology</topic><topic>Respiratory diseases</topic><topic>RT‐PCR</topic><topic>Swine flu</topic><topic>Variables</topic><topic>viral shedding</topic><topic>Virus Shedding - drug effects</topic><topic>Viruses</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ryoo, Seung M.</creatorcontrib><creatorcontrib>Kim, Won Y.</creatorcontrib><creatorcontrib>Sohn, Chang H.</creatorcontrib><creatorcontrib>Seo, Dong W.</creatorcontrib><creatorcontrib>Oh, Bum J.</creatorcontrib><creatorcontrib>Lee, Jae H.</creatorcontrib><creatorcontrib>Lee, Yoon S.</creatorcontrib><creatorcontrib>Lim, Kyoung S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Safety Science and Risk</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Influenza and other respiratory viruses</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Ryoo, Seung M.</au><au>Kim, Won Y.</au><au>Sohn, Chang H.</au><au>Seo, Dong W.</au><au>Oh, Bum J.</au><au>Lee, Jae H.</au><au>Lee, Yoon S.</au><au>Lim, Kyoung S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days</atitle><jtitle>Influenza and other respiratory viruses</jtitle><addtitle>Influenza Other Respir Viruses</addtitle><date>2013-09</date><risdate>2013</risdate><volume>7</volume><issue>5</issue><spage>833</spage><epage>837</epage><pages>833-837</pages><issn>1750-2640</issn><eissn>1750-2659</eissn><abstract>Background
The duration of viral shedding is an important determinant of infectivity and transmissibility and provides vital information for effective infection prevention and control. However, few studies have evaluated viral shedding in patients admitted to hospital with 2009 H1N1 influenza and treated with oseltamivir.
Objective
To determine the incidence of prolonged 2009 H1N1 influenza viral shedding in patients treated for 5 days with oseltamivir and to identify factors that promote prolonged viral shedding.
Methods
This was a prospective, observational cohort study of 173 patients infected with 2009 H1N1 influenza (confirmed by RT‐PCR) who were admitted to isolation rooms in the emergency department of our hospital between August 25, 2009 and December 31, 2009. All of the patients were treated according to institutional protocols and received routine follow‐up RT‐PCR testing after 5 days of oseltamivir therapy. Prolonged viral shedding was defined as a positive follow‐up RT‐PCR result.
Result
Of the 173 patients in our cohort, 88 (50·8%) showed persistent viral shedding after oseltamivir treatment. Viral shedding was significantly prolonged if antiviral therapy was started ≥2 days after symptom onset (OR 2·74, 95% CI 1·29–5·82), if there were major comorbidities (OR 3·07, 95% CI 1·29–7·32), and/or if respiratory symptoms were still present on the day 5 of antiviral treatment (OR 4·13, 95% CI 2·10–8·11).
Conclusions
The presence of major comorbidities, a delay in initiating antiviral treatment, and continuing respiratory symptoms after 5 days of antiviral treatment are associated with prolonged shedding of the 2009 H1N1 influenza virus.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>23279949</pmid><doi>10.1111/irv.12065</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Antiviral agents Antiviral Agents - therapeutic use Antiviral drugs Chronic illnesses Diabetes Emergency medical care Emergency medical services Female H1N1 subtype Hospitals Humans Hypertension Identification methods Immunization Infectivity Influenza influenza A virus Influenza A Virus, H1N1 Subtype - drug effects Influenza A Virus, H1N1 Subtype - genetics Influenza A Virus, H1N1 Subtype - isolation & purification Influenza A Virus, H1N1 Subtype - physiology Influenza virus Influenza, Human - drug therapy Influenza, Human - epidemiology Influenza, Human - virology Laboratories Lung diseases Male Middle Aged Observational studies Original Oseltamivir Oseltamivir - therapeutic use Pandemics Patients Prospective Studies Republic of Korea - epidemiology Respiratory diseases RT‐PCR Swine flu Variables viral shedding Virus Shedding - drug effects Viruses Young Adult |
| title | Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days |
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