https://scholars.lib.ntu.edu.tw/handle/123456789/508010
標題: | The impact of matching vaccine strains and post-sars public health efforts on reducing influenza-associated mortality among the elderly | 作者: | Chan T. CHUHSING KATE HSIAO Lee C. Chiang P. CHUAN-LIANG KAO Liu C. King C. |
公開日期: | 2010 | 卷: | 5 | 期: | 6 | 起(迄)頁: | e11317 | 來源出版物: | PLoS ONE | 摘要: | Public health administrators do not have effective models to predict excess influenza-associated mortality and monitor viral changes associated with it. This study evaluated the effect of matching/mismatching vaccine strains, type/subtype pattern changes in Taiwan's influenza viruses, and the impact of post-SARS (severe acute respiratory syndrome) public health efforts on excess influenza-associated mortalities among the elderly. A negative binomial model was developed to estimate Taiwan's monthly influenza-associated mortality among the elderly. We calculated three winter and annual excess influenzaassociated mortalities [pneumonia and influenza (P&I), respiratory and circulatory, and all-cause] from the 1999-2000 through the 2006-2007 influenza seasons. Obtaining influenza virus sequences from the months/years in which death from P&I was excessive, we investigated molecular variation in vaccine-mismatched influenza viruses by comparing hemagglutinin 1 (HA1) of the circulating and vaccine strains. We found that the higher the isolation rate of A (H3N2) and vaccine-mismatched influenza viruses, the greater the monthly P&I mortality. However, this significant positive association became negative for higher matching of A (H3N2) and public health efforts with post-SARS effect. Mean excess P&I mortality for winters was significantly higher before 2003 than after that year [mean ± S.D.: 1.44±1.35 vs. 0.35±1.13, p = 0.04]. Further analysis revealed that vaccine-matched circulating influenza A viruses were significantly associated with lower excess P&I mortality during post-SARS winters (i.e., 2005-2007) than during pre-SARS winters [0.03±0.06 vs. 1.57±1.27, p = 0.01]. Stratification of these vaccine-matching and post-SARS effect showed substantial trends toward lower elderly excess P&I mortalities in winters with either mismatching vaccines during the post-SARS period or matching vaccines during the pre-SARS period. Importantly, all three excess mortalities were at their highest in May, 2003, when inter-hospital nosocomial infections were peaking. Furthermore, vaccine-mismatched H3N2 viruses circulating in the years with high excess P&I mortality exhibited both a lower amino acid identity percentage of HA1 between vaccine and circulating strains and a higher numbers of variations at epitope B. Our model can help future decision makers to estimate excess P&I mortality effectively, select and test virus strains for antigenic variation, and evaluate public health strategy effectiveness. ? 2010. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/508010 | ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0011317 | SDG/關鍵字: | epitope; Influenza virus hemagglutinin; vaccine; aged; antigenic variation; article; cause of death; controlled study; hospital infection; human; influenza; Influenza virus A; Influenza virus A H3N2; mortality; pneumonia; public health; respiratory tract disease; risk reduction; seasonal variation; severe acute respiratory syndrome; trend study; virus isolation; virus strain; winter; Aged; Humans; Influenza Vaccines; Influenza, Human; Population Surveillance; Public Health Practice; Severe Acute Respiratory Syndrome; Influenza A virus; Orthomyxoviridae |
顯示於: | 醫學檢驗暨生物技術學系 |
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