Shelly A. McNeil

Background: Human metapneumovirus (hMPV) significantly impacts young children, older adults, and those with preexisting conditions. This study examines frailty and clinical outcomes in middle-aged and older adults hospitalized due to hMPV infections. Methods: Data from the Canadian Immunization Research Network's Serious Outcomes Surveillance Network were analyzed. Included were adults aged ≥50 with lab-confirmed hMPV infection. Severe infection was marked by pneumonia, oxygen need, intensive care unit admission, mechanical ventilation, or death within 30 days. The Frailty Index (FI) categorized individuals as nonfrail (FI < 0.08), prefrail (FI ≥ 0.08, FI < 0.21), and frail (FI ≥ 0.21). Multivariate ridge regression identified factors linked to disease severity. Results: Among 212 patients (median age 76), 85.4% had severe disease and 61.3% were frail. Frail patients had higher rates of severe disease (80.8% vs. 63.4%), oxygen therapy need (80.8% vs. 63.4%), and longer hospital stays (median 8 vs. 4 days) than patients who were nonfrail. Any cardiac illness (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.02–3.09), congestive heart failure (OR, 1.91; 95% CI, 1.12–3.09), chronic obstructive pulmonary disease (OR, 1.93; 95% CI, 1.14–3.35), and frailty (OR, 1.99; 95% CI, 1.18–3.38) were significantly associated with increased odds of severe disease. Conclusions: Frailty, assessable with standardized tools, is associated with severe hMPV infections in middle-aged and older adults. Recognizing frailty in clinical management and as a vaccination criterion is necessary as hMPV vaccines become available. Clinical Trials Registration: NCT01517191 (ClinicalTrials.gov).

Background: Oseltamivir is recommended for the treatment of adults hospitalized with influenza, but adherence is often suboptimal. This may be due to doubts about the reliability of the evidence supporting its benefits, particularly when initiation is delayed. We aimed to assess the effectiveness of oseltamivir in reducing mortality in older adults hospitalized with influenza, with a focus on the timing of initiation. Methods: The CIRN-SOS Network gathered data on severe respiratory illnesses across 5 Canadian provinces during the influenza seasons 2012–2019. Individuals aged ≥65 years with confirmed influenza and available antiviral prescription data were included. We compared the 30-day survival rates of hospitalized patients based on oseltamivir prescription status. Kaplan-Meier estimated survival probability and inverse probability of treatment (IPT)–weighted Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. The analyses considered the time to antiviral initiation (>48 vs ≤48 hours). Results: Among the 8135 influenza patients studied, 2126 did not receive antiviral treatment, whereas 6009 were treated with oseltamivir. A total of 395 patients were hospitalized for >30 days. The overall mortality rate was 8.32 per 1000 person-days, with 53.9% of the deaths occurring within the first week. Oseltamivir recipients had a 18% lower risk of 30-day mortality (IPT-weighted HR, 0.82 [95% CI, .69–.98]). The benefit was significant for influenza A (IPT-weighted HR, 0.74 [95% CI, .61–.91]) but not for influenza B (IPT-weighted HR, 1.12 [95% CI, .81–1.56]). Oseltamivir remained effective even when initiated after 48 hours (IPT-weighted HR, 0.66 [95% CI, .49–.90]). Influenza vaccination did not mediate the effectiveness of oseltamivir in reducing mortality. Conclusions: Oseltamivir significantly reduces mortality risk in older adults hospitalized with influenza, even when administered after 48 hours, independent of vaccination status. Clinical Trials Registration. NCT01517191.

This qualitative, cross-sectional study aimed to understand the barriers and facilitators related to the adherence and completion of the recombinant zoster vaccine (RZV) two-dose series in Canada, as perceived by healthcare providers (HCPs) and patients. Data collection occurred via 60-minute concept elicitation interviews with 12 HCPs (4 physicians, 2 nurse practitioners, 6 pharmacists) who had prescribed and/or administered RZV in Canada, and 21 patients aged ≥50 years who had received ≥1 dose of RZV. Patients were categorized as adherent (received both doses within the recommended 2-to-6-month timeframe; n = 11) or non-adherent (received only one dose or second dose outside the recommended timeframe; n = 10). Interview transcripts were coded and analyzed using a two-part thematic analysis approach. HCP-identified barriers to RZV adherence included high out-of-pocket cost, inconsistent/lack of health plan coverage, inconvenient processes for accessing RZV, and patient forgetfulness. HCP-identified facilitators included desire for shingles protection, HCP encouragement, and reminders. Barriers to RZV adherence identified by patients included lack of HCP knowledge/experience with RZV, receiving unreliable/confusing information, having unpleasant/severe side effects following the first dose, high out-of-pocket cost, lack of insurance coverage, and forgetfulness. Patient-identified facilitators included self-motivation, financial support, convenient processes for obtaining RZV, and reminders. In conclusion, many factors can influence RZV series completion and adherence among adults in Canada, including cost, insurance coverage, HCP knowledge and encouragement, and reminders. Awareness of these factors may inform HCPs in helping patients overcome barriers and identify opportunities for future consideration, facilitating protection against herpes zoster.

Background: Respiratory syncytial virus (RSV) disease in older adults is undercharacterized. To help inform future immunization policies, this study aimed to describe the disease burden in Canadian adults aged ≥50 years hospitalized with RSV. Methods: Using administrative data and nasopharyngeal swabs collected from active surveillance among adults aged ≥50 years hospitalized with an acute respiratory illness (ARI) during the 2012–2013, 2013–2014, and 2014–2015 influenza seasons, RSV was identified using a respiratory virus multiplex polymerase chain reaction test to describe the associated disease burden, incidence, and healthcare costs. Results: Of 7797 patients tested, 371 (4.8%) were RSV positive (2.2% RSV-A and 2.6% RSV-B). RSV prevalence varied by season from 4.2% to 6.2%. Respiratory virus coinfection was observed in 11.6% (43/371) of RSV cases, with influenza A being the most common. RSV hospitalization rates varied between seasons and increased with age, from 8–12 per 100 000 population in adults aged 50–59 years to 174–487 per 100 000 in adults aged ≥80 years. The median age of RSV cases was 74.9 years, 63.7% were female, and 98.1% of cases had ≥1 comorbidity. Among RSV cases, the mean length of hospital stay was 10.6 days, 13.7% were admitted to the intensive care unit, 6.4% required mechanical ventilation, and 6.1% died. The mean cost per RSV case was $13 602 (Canadian dollars) but varied by age and Canadian province. Conclusions: This study adds to the growing literature on adult RSV burden by showing considerable morbidity, mortality, and healthcare costs in hospitalized adults aged ≥50 years with ARIs such as influenza.

The aim of this study was to evaluate an educational pamphlet that incorporates evidence-based pain mitigation strategies during adult vaccine injections and determine its effect on the knowledge, ... Objectifs: L'objectif de cette étude était d'évaluer une brochure éducative qui incorpore des stratégies d'atténuation de la douleur fondées sur des données probantes pendant les injections de vacc...

Inactivated influenza vaccines efficacy is variable and often poor. We conducted a phase 1 trial (NCT02188810), to assess the safety and immunogenicity of a novel nanoparticle Toll-like receptor 7/8 agonist adjuvant (Papaya Mosaic Virus) at different dose levels combined with trivalent influenza vaccine in healthy persons 18–50 years of age. Hemagglutination-inhibition assays, antibody to Influenza A virus nucleoprotein and peripheral blood mononuclear cells for measurement of interferon-gamma ELISPOT response to influenza antigens, Granzyme B and IFNγ:IL-10 ratio were measured. The most common adverse events were transient mild to severe injection site pain and no safety signals were observed. A dose-related adjuvant effect was observed. Geometric mean hemagglutination-inhibition titers increased at day 28 in most groups and waned over time, but fold-antibody responses were poor in all groups. Cell mediated immunity results were consistent with humoral responses. The Papaya Mosaic Virus adjuvant in doses of 30 to 240 µg combined with reduced influenza antigen content was safe with no signals up to 3 years after vaccination. A dose-related adjuvant effect was observed and immunogenicity results suggest that efficacy study should be conducted in influenza antigen-naïve participants.

Background: Compared to the standard two-tier testing algorithm (STTT) for Lyme disease serology using an enzyme immunoassay (EIA) followed by Western blot, data from the United States (US) suggests that a modified two-tiered testing (MTTT) algorithm employing two EIAs has improved sensitivity to detect early localized Borrelia burgdorferi infections, without compromising specificity. From 2011-2014, in the Canadian province of Nova Scotia where Lyme disease is hyperendemic, sera submitted for Lyme disease testing was subjected to a whole cell EIA, followed by C6 EIA and subsequently IgM and/or IgG immunoblots on sera with EIA positive or equivocal results. Here we evaluate the effectiveness of the MTTT algorithm compared to the STTT approach in a Nova Scotian population. Methods: Retrospective chart reviews were performed on patients testing positive with the whole cell and C6 EIAs (i.e. MTTT algorithm). Patients were classified as having Lyme disease if they had: a positive STTT result; a negative STTT result, but symptoms consistent with Lyme disease; or evidence of seroconversion on paired specimens. Results: Of the 10253 specimens tested for Lyme disease serology, 9806 (95.6%) were negative. Of 447 patients that tested positive, 271 charts were available for review, and 227 were classified as patients with Lyme disease. The MTTT algorithm detected 25% more early infections with a specificity of 99.56% (99.41-99.68%) compared to the STTT. Conclusions: This is the first Canadian data to show a MTTT has excellent specificity and improved sensitivity for detecting early B. burgdorferi infection compared to the STTT.