Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya3220110.17116/terarkh201789162-71Research ArticlePharmacoepidemiological study of the course of influenza and other acute respiratory viral infections in risk groupsBulgakovaV A-PoromovA A-GrekovaA I-PshenichnayaN Yu-SelkovaE P-LvovN I-LenevaI A-ShestakovaI V-MaleevV V-15012017891627110042020Copyright © 2017, Consilium Medicum2017Aim. To identify risk factors (RFs) for the development of bacterial complications and the prolonged course of influenza and other acute respiratory viral infections (ARVIs) among inpatients treated in Russian healthcare facilities in the post-pandemic period; to determine the clinical presentation of the disease (flu-like syndrome) in risk-group people and to evaluate the efficacy of antiviral therapy with arbidol (umifenovir). Materials and methods. The investigators retrospectively analyzed randomly selected medical records of inpatients with influenza and other ARVI in 88 hospitals from 50 regions of the Russian Federation: those of 3532 and 1755 patients in the 2010-2011 and 2014-2015 seasons, respectively, by applying parametric and nonparametric statistical methods. Results. The built database of patients with influenza-like syndrome contained data from the histories of 2072 men and 2537 women, of whom there were 317 (12.49%) pregnant women; gender evidence was not given in the medical records for 678 patients. 382 (7.2%) were vaccinated against influenza. 1528 (28.9%) people were admitted to hospital with various complications. Information on laboratory tests was available in 1691 (31.98%) patients; of these, 1291 (76.4%) were detected to have influenza and other respiratory viruses. Influenza viruses were found in 1026 (60.7%) examinees; influenza A viruses in 712 (42.1%) people while pandemic strain of swine influenza A/H1N1 and A/H3N2 viruses was detected in 487 (28.8%) and 107 (6.3%) patients, respectively; influenza A subtype was indicated in 118 (7%) persons with laboratory-confirmed influenza virus. Influenza B viruses were found in 314 (18.6%) examinees. Other types of respiratory viruses were detected in 265 (15.7%) patients. The body mass index exceeded 30 kg/m2 in 227 (4.3%) patients. Single-factor analysis of variance revealed factors influencing the course of flu-like syndrome and identified risk groups: children younger than 2 years old and adults over 65, pregnant women, and people with chronic somatic diseases and obesity. The high-risk groups exhibited a more severe course of flu-like syndrome than did the patients outside the risk groups. The incidence of complications was higher, especially in the under 2-year-year-old children and in patients with endocrine, metabolic, or respiratory diseases, with a large proportion of complications being pneumonia. The efficacy of antiviral therapy was higher in the elderly, patients with chronic diseases, and pregnant women than in patients not at risk. In patients treated with umifenovir (provided that it was administered in the first 48 hours after disease onset), the duration of fever and frequency of complications proved to be lower than those in patients who did not receive antiviral therapy. Conclusion. The FRs for influenza and ARVI complications are patient’s age (children under 3 years of age and adults older than 65 years), the presence of chronic somatic diseases, and pregnancy. Patients with endocrine, eating, metabolic (including obesity), circulatory, and respiratory disorders are at high risk for influenza and ARVI complications. Umifenovir therapy substantially reduces the duration of fever and risk of complications, especially in patients with laboratory-confirmed influenza infectioninfluenzaacute respiratory viral infectionscomplicationspneumoniarisk groupschronic somatic diseasesobesityantiviral therapyumifenovirarbidolгриппострые респираторные вирусные инфекцииосложненияпневмониягруппы рискахронические соматические заболеванияожирениепротивовирусная терапияумифеновирарбидол[Grohskopf LA, Sokolow LZ, Broder KR, Olsen SJ, Karron RA, Jernigan DB, Bresee JS. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep. 2016;65(No. RR-5):1-54. doi:10.15585/mmwr.rr6505a1][World Health Organization. Seasonal influenza factsheet no. 211. 2014. Accessed 9 October 2016. Available at: http://www.who.int/mediacentre/factsheets/fs211/en/][Center for Disease Control and Prevention. People at High Risk of Developing Flu-Related Complications. 2016. Accessed 9 October 2016. Available at: http://www.cdc.gov/flu/about/disease/high_risk.htm][Dawood FS, Iuliano AD, Reed C, et al. Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study. Lancet Infect Dis. 2012;12(9):687-695. doi:10.1016/S1473-3099(12)70121-4][Hui DS, Hayden FG. Editorial commentary: Host and viral factors in emergent influenza virus infections. Clin Infect Dis. 2014;58(8):1104-1106. doi:10.1093/cid/ciu054][Fiore AE, Fry A, Shay D, Gubareva L, Bresee JS, Uyeki TM; Centers for Disease Control and Prevention (CDC). Antiviral agents for the treatment and chemoprophylaxis of influenza — recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(1):1-24.][World Health Organization. Strategic Advisory Group of Experts (SAGE) on Immunization. Report for the SAGE meeting of April 2016. Accessed 9 October 2016. Available at: http://www.who.int/wer/2016/wer9121.pdf?ua=1][Вакцинопрофилактика — краеугольный камень в контроле над гриппом. Ссылка активна на 9.11.2016. Доступно по: http://www.influenza.spb.ru/institute_for_population/gripp_prof/][Centers for Disease Control and Prevention (CDC). Estimates of deaths associated with seasonal influenza - United States, 1976-2007. MMWR Morb Mortal Wkly Rep. 2010;59:1057-1062.][Simonsen L. The global impact of influenza on morbidity and mortality. Vaccine. 1999;23(suppl):3-10.][Лещенко И.В., Кривоногов А.В. Особенности течения пневмонии при пандемическом гриппе А/Н1N1/09. Пульмонология. 2011;(6):62-68. doi:10.18093/0869-0189-2011-0-6-62-68][Здравоохранение в России. 2015: Стат.сб./Росстат. М., 2015. 174 с. ISBN 978-5-89476-413-9.][Семенов Б.Ф. Концепция отложенной смерти при гриппе и тактика вакцинопрофилактики инфарктов, инсультов и летальных исходов при этой инфекции. Русский медицинский журнал. 2003;11(22):1266-1267.][Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza Vaccination and Reduction in Hospitalizations for Cardiac Disease and Stroke among the Elderly. N Engl J Med. 2003;348(14):1322-1332. doi:10.1056/NEJMoa02502][Прикладная фармакоэпидемиология: учебник. Под ред. В.И. Петрова. М.: ГЭОТАР-Медиа, 2008. 384 с. ISBN 978-5-9704-0632-8][Berger ML, Dreyer N, Anderson F, Towse A, Sedrakyan A, Normand SL. Prospective observational studies to assess comparative effectiveness: the ISPOR good research practices task force report. Value Health. 2012;15(2):217-230. doi:10.1016/j.jval.2011.12.010][Малеев В.В., Селькова Е.П., Простяков И.В., Осипова E.A. Фармакоэпидемиологическое исследование течения гриппа и других ОРВИ в сезоне 2010/11 гг. Инфекционные болезни. 2012;10(3):15-23.][Bulgakova V, Uchaikin V, Shamsheva O et al. Pharmacologic and Epidemiologic Study of the Course of Influenza and Other Acute Respiratory Viral Infections in Postpandemic Season in Children Younger than 18 years. J Pediatr Infect Dis. 2016;10(03):068-075. doi:10.1055/s-0036-1571306][Leneva IA, Burtseva EI, Yatsyshina SB, Fedyakina IT, Kirillova ES, Selkova EP, Osipova E, Maleev VV. Virus susceptibility and clinical effectiveness of anti-influenza drugs during the 2010-2011 influenza season in Russia. Int J Infect Dis. 2016;43:77-84. doi:10.1016/j.ijid.2016.01.001][Reiczigel J. Confidence intervals for the binomial parameter: some new considerations. Stat Med. 2003;22(4):611-621. doi:10.1002/sim.1320][von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-808. doi:10.1136/bmj.39335.541782.AD][Cocoros NM, Lash TL, DeMaria A, Klompas M. Obesity as a risk factor for severe influenza-like illness. Influenza Other Respi Viruses. 2014;8(1):25-32. doi:10.1111/irv.12156][Brooks MJ, Burtseva EI, Ellery PJ, et al. Antiviral activity of arbidol, a broad-spectrum drug for use against respiratory viruses, varies according to test conditions. J Med Virol. 2012;84(1):170-181. doi:10.1002/jmv.22234][Shi L, Xiong H, He J, et al. Antiviral activity of arbidol against influenza A virus, respiratory syncytial virus, rhinovirus, coxsackie virus and adenovirus in vitro and in vivo. Arch Virol. 2007;152(8):1447-1455. doi:10.1007/s00705-007-0974-5][Pécheur E-I, Borisevich V, Halfmann P, et al. The Synthetic Antiviral Drug Arbidol Inhibits Globally Prevalent Pathogenic Viruses. J Virol. 2016;90(6):3086-3092. doi:10.1128/JVI.02077-15][Ferguson NM, Cummings DAT, Fraser C, Cajka JC, Cooley PC, Burke DS. Strategies for mitigating an influenza pandemic. Nature. 2006;442(7101):448-452. doi:10.1038/nature04795][Longini IM, Halloran ME, Nizam A, Yang Y. Containing pandemic influenza with antiviral agents. Am J Epidemiol. 2004;159(7):623-633. Accessed November 7, 2016.][Kumar A, Singh S. Editorial: Influenza Virus Vaccines and Immunotherapies. Frontiers in Immunology. 2015;6:599. doi:10.3389/fimmu.2015.00599]