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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most universally employed measurement of the impact of epidemics and pandemics is the excess of mortality due to influenza and pneumonia. Other criteria are absenteeism from school and work, and all three will show positive indications when epidemics are of substantial size. During the 1974-1975 influenza season in Houston, school and industrial absenteeism and the increase in influenza and pneumonia deaths, despite a newly devised statistical procedure, did not signal an epidemic. However, a system of community surveillance of febrile respiratory illness with cultures for influenza virus during late January and early February 1975 gave unmistakable evidence of an influenza epidemic, with more than 600 virus isolations and an estimated occurrence of 50,000 cases of the disease. It is believed that this type of study can explore facets of the epidemiology of the disease not hitherto adequately examined. From this surveillance, which will continue through the summer months, it is hoped to gain further knowledge of the occurrence of antigenic drift and shift, and of the details of the early origin and progress of epidemics. Current speculation is that there will be another world pandemic before 1980 caused by a derivative of A strains presently circulating; in 1985-1991, a pandemic is predicted to be caused by a virus antigenically related to the swine agent of 1918. The purity of vaccines has been increased in recent years through ultracentrifugation and high-efficiency filtration, so that dosages can be increased while severity of reactions is reduced. The current level of dosage of vaccine for adults is 1200 chick cell agglutinating units, almost double what it was a dozen years ago. Recently, vaccines have been prepared more rapidly by the use of viral recombinants that incorporate the surface antigens of newly emerged epidemic strains into the core of older strains that grow well in embryonated eggs. This practical device greatly reduces the lead time in the preparation of new vaccines. The main problem in immunization against influenza is the need to reimmunize every 1-3 years. This creates an enormous requirement for vaccine and therefore a problem of selection of recipients. Currently, it is recommended that aged persons and those with cardiovascular, pulmonary and other chronic illnesses should receive the vaccine. Pregnant women are not more susceptible than others to the disease, and they should receive vaccine only if they have some other indications for immunization. Schoolchildren probably are important in transmission of the disease, but at present there is no special recommendation to immunize them. Young children occasionally have severe febrile convulsions when immunized against influenza, and those with this history probably should not be immunized. Amantadine is useful as a prophylactic agent in A(H3N2) influenza infections, and several reports suggest therapeutic benefits as well. Its benefits probably have not been fully utilized...
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PMID:Influenza. 104 31

Surveillance of influenza virus infections was maintained on the medical and pediatric wards of a general hospital serving indigent patients of Harris County, Texas during the winter of 1987-88. Influenza A/Sichuan/2/87(H3N2) was the predominant virus during the community epidemic. Influenza A(H3N2) virus was isolated from six of 17 adult patients (35%) suspected to have nosocomial infections; two of these patients died of fulminating pneumonia. Another patient, admitted with alcoholism and hematemesis, developed pneumonia after a documented influenza infection, and the hospital stay was extended for two weeks. The paucity of virus positive community acquired infections on the medical wards suggested that the health care team was the probable source of the nosocomial infections. Community-acquired infections with influenza viruses were common on the pediatric service; however, most admissions were for acute conditions requiring brief hospital stays. Therefore, while nosocomial infections were unusual on the pediatric ward, they may have become evident after discharge. Recommendations for reducing the impact of nosocomial influenza virus infections include hospital-centred vaccination programs for both high risk patients and hospital personnel. Amantadine can be an important adjunctive therapy for reducing nosocomial spread during influenza A virus epidemics.
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PMID:Nosocomial influenza in a general hospital for indigent patients. 182 84

Virus replication is described, and the clinical trials and indications for amantadine, rimantadine, vidarabine, vidarabine phosphate, acyclovir, ribavirin, and other promising antiviral agents are reviewed. Amantadine and rimantadine are useful for the treatment and prophylaxis of viral influenza A infections. Vidarabine is a second-line agent and is effective for the treatment of herpes simplex encephalitis, neonatal herpes simplex types 1 and 2, and varicella-zoster infections. Vidarabine phosphate (also known as vidarabine monophosphate) has a similar spectrum of activity and can be administered in smaller volumes than vidarabine. Acyclovir has demonstrated clinical efficacy for chickenpox, shingles (herpes zoster), genital herpes, and other herpes simplex infections. Acyclovir is also useful for the suppression of herpes infections. Systemically administered ribavirin is indicated for the treatment of Lassa fever. Aerosol ribavirin is effective for the treatment of respiratory syncytial virus pneumonia in children and infants and influenza A infections in adults. Only acyclovir, amantadine, ribavirin, and vidarabine are used in clinical practice. Vidarabine phosphate and investigational agents such as rimantadine, ganciclovir (DHPG, BW B759U), phosphonoformate, and bromovinyl-deoxyuridine (BVDU) need further investigation.
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PMID:Recent advances in antiviral therapy. 354 44

The treatment of patients with community-acquired pneumonia can be expensive, particularly if care is hospital-based. Cost control begins with prevention. Current influenza vaccines are about 80 percent protective, but grossly underused. Amantadine and rimantadine are effective chemoprophylactic agents against influenza A, but also underused. Use of pneumococcal vaccine is controversial, but patients who are thought to be at increased risk should be immunized. Management decisions in patients with pneumonia that have major cost implications include the need for hospitalization and choice of diagnostic tests and therapy. The need for hospitalization has not been well studied. In general, young patients with atypical pneumonia are treated at home, whereas older patients with complicating illnesses are admitted to hospitals. Length of hospitalization has decreased in recent years. Diagnostic tests have traditionally emphasized chest roentgenography, Gram staining of the sputum, and sputum culture. Published data suggest that a Gram staining of the sputum can be useful. Sputum cultures are frequently confusing and should be discontinued. Intermittent positive pressure breathing treatments have no value, and chest physiotherapy is unnecessary for most patients.
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PMID:Community-acquired lower respiratory tract infections. Prevention and cost-control strategies. 401 88

Influenza is an epidemic respiratory illness caused by one of three viral subtypes: A, B, or C. Influenza A causes higher mortality than influenza B and C and is often responsible for pandemics and yearly epidemics of this common, infectious disease. Clinically, patients with influenza present with an abrupt onset of fever, malaise, headache, and a dry, hoarse cough. These symptoms usually last three to five days. Amantadine and rimantadine may be used to prevent and to treat influenza A infection, but not B or C. Ribavirin, however, may be effective treatment for severe influenza pneumonia caused by either A or B subtype, although it is not FDA approved for this application. Annual influenza vaccination should be administered between mid-October and mid-November to any person at increased risk for complications. Health-care workers, those in close contact with high-risk individuals, and personnel vital to community function should also be immunized.
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PMID:Influenza. More than mom and chicken soup. 884 75

Our rapidly expanding knowledge of the cause and pathogenesis of Community-acquired pneumonia (CAP) offers new opportunities to prevent this disease. Influenza vaccine is effective for the prevention of respiratory illness, including pneumonia, in the setting of influenza A and B infection. Pneumococcal vaccine is effective for preventing the most common form of bacterial CAP, but it is most effective when administered early in the course of chronic illnesses. Even with the widespread availability and proven efficacy of influenza and pneumococcal vaccines, their use has remained suboptimal. Rimantadine and Amantadine have also been used successfully for prevention of influenza A infection. Further improvement in strategies for the prevention of CAP lies in the development of new and improved vaccines, enhanced environmental control, and general education of physicians and the public, so that new approaches such as hospital-based immunization can be applied.
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PMID:Strategies for prevention of community-acquired pneumonia. 954 77

Influenza, respiratory syncytial, and parainfluenza viruses usually cause mild, self-limited illness in adults. However, elderly and immunocompromised persons are at increased risk for development of severe pneumonia. Clinical and radiographic features of epidemic viral pneumonias are often nonspecific. Newer and faster methods of viral culture and viral antigen detection have improved the capability for definitive diagnosis in recent years. Preventive measures for influenza virus pneumonia center on limiting exposure of high-risk patients to active cases of influenza, administering annual vaccinations, and providing chemoprophylaxis. Prophylaxis against RSV is effective in preventing complications. No effective vaccines have been developed against RSV or parainfluenza. Therapy for viral pneumonia is primarily supportive. Amantadine may be beneficial for influenza virus pneumonia, and ribavirin may be useful for RSV and parainfluenza virus disease. However, further definitive studies are necessary to determine their roles in these viral pneumonias.
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PMID:Viral pneumonias. Epidemic respiratory viruses. 1072 34

Influenza is a serious disease for the elderly. Influenza causes high fever in the elderly, similar as in healthy adults. Cough lasts longer, but frequency and degree of sore throat and coryza is lower in the elderly. Rapid diagnosis kits based on enzyme-linked immunoassay contribute to quick diagnosis, improving treatment of the elderly. Amantadine can mitigate various symptoms and hastens recovery. Other newly developed neuraminidase inhibitors are also hopeful for treatment. The poor prognosis of influenza in the elderly is associated with a high frequency of pneumonia complications. Decreased serum albumin level is a risk factor for post-influenza pneumonia. To reduce excess influenza death in the elderly, prophylaxis and management of the general health condition of elderly patients may be most important.
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PMID:[Clinical features of influenza in the aged]. 1122 12

Influenza infection is a serious problem in institutions for the elderly and those with increased risk factors because of the high pneumonia complication rate and a significant increase in mortality. An outbreak of influenza is mainly caused by contact from the staff to residents, therefore the health care of the staffs and prevention of influenza should be a high priority in institutions such as nursing homes. To prevent influenza epidemics, institutionalised elderly and high risk groups should be vaccinated more actively. The rapid test for diagnosis of influenza viral infection permits the timely administration of antiviral agents and infection control among institutionalised elderly and high risk groups. Amantadine and neuraminidase inhibitors could be used for treatment and prophylaxis of influenza among institutionalised elderly and high risk group patients.
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PMID:[Prevention and care management of influenza infection in institutions for the elderly and high risk groups]. 1122 25

Influenza vaccination is estimated to be 50-68% efficacious in preventing pneumonia, hospitalisation or death in nursing home residents. Large culture-proven outbreaks may occur despite high resident vaccination rates. There is, therefore, a significant role for concurrent administration of influenza vaccination and antiviral therapy. The use of antiviral treatment and chemoprophylaxis requires community reporting of viral isolates, and contingency plans for rapid case identification and application of antiviral therapy. Clinicians must react quickly to control a highly infectious seasonal pathogen that may strike as an explosive outbreak. This situation is unique in geriatric practice. Current antiviral treatment should be administered within 48 hours of symptom onset, and is more efficacious if administered within 12 hours. In the case of an explosive institutional outbreak, a 1-day delay in prophylaxis may allow infection of many residents with a potentially fatal illness. Influenza must be differentiated from other respiratory viruses or syndromes. Grouped rapid diagnostic tests can aid laboratory confirmation. Antiviral agents include the M(2) inhibitors, amantadine and rimantadine, active against influenza A, and the neuraminidase inhibitors, zanamivir and oseltamivir, active against influenza A and B. In our experience, influenza B illness is as severe as influenza A. All agents have similar efficacy as treatment and prophylaxis against sensitive strains. When M(2) inhibitors are used simultaneously within an enclosed space (i.e. household or nursing home) as both treatment and prophylaxis, resistant strains may emerge that limit prophylactic efficacy. When M(2) inhibitors are administered to suspected cases (residents or staff) in institutions, precautions against secretion are especially important to diminish the risk of transmission of resistant virus. Rimantadine has been shown to have significantly fewer CNS adverse events compared with amantadine. Amantadine and oseltamivir require dosage adjustment in those with renal impairment. Oseltamivir, rimantadine and amantadine are administered by mouth, while zanamivir is administered by oral inhalation in a lactose powder. The labelling advises caution in the use of zanamivir in those with underlying airway disease. Pooled analysis of studies in patients given zanamivir indicate that individuals over the age of 50 years (at high risk for complications) and those severely symptomatic at presentation, tend to benefit most from early treatment. Neuraminidase inhibitors also diminish the need for antibacterials to treat secondary complications. An institutional programme to control influenza should include vaccination, and contingency plans for clinical surveillance, specimen processing and the rapid application of antiviral treatment and prophylaxis.
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PMID:Influenza vaccination and antiviral therapy: is there a role for concurrent administration in the institutionalised elderly? 1257 97


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