January 16, 2025

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Influenza

Antiviral Medications for Treatment of Nonsevere Influenza: A Systematic Review and Network Meta-Analysis
To compare effects of antiviral drugs for treating nonsevere influenza MEDLINE, Embase, CENTRAL, CINAHL, Global Health, Epistemonikos, and ClinicalTrials.gov were searched from database inception to September 20, 2023. The selected randomized clinical trials comparing direct-acting influenza antiviral drugs to placebo, standard care, or another antiviral drug for treating people with nonsevere influenza. Mortality, admission to hospital, admission to the intensive care unit, duration of hospitalization, time to alleviation of symptoms, emergence of resistance, and adverse events were the main outcomes. Overall, 73 trials with 34 332 participants were included. Compared with standard care or placebo, all antiviral drugs had little or no effect on mortality for low-risk patients and high-risk patients (all high certainty). All antiviral drugs (no data for peramivir and amantadine) had little or no effect on hospital admission for low-risk patients (high certainty). For hospital admission in high-risk patients, oseltamivir (risk difference [RD], −0.4%; 95% CI, −1.0 to 0.4; high certainty) had little or no effect and baloxavir may have reduced risk (RD, −1.6%; 95% CI, −2.0 to 0.4; low certainty); all other drugs may have had little or uncertain effect. For time to alleviation of symptoms, baloxavir probably reduced symptom duration (mean difference [MD], −1.02 days; 95% CI, −1.41 to −0.63; moderate certainty); oseltamivir probably had no important effect (MD, −0.75 days; 95% CI, −0.93 to −0.57; moderate certainty). For adverse events related to treatment, baloxavir (RD, −3.2%; 95% CI, −5.2 to −0.6; high certainty) had few or no adverse events; oseltamivir (RD, 2.8%; 95% CI, 1.2 to 4.8; moderate certainty) probably increased adverse events. In summary:Baloxavir likely reduces time to alleviation of symptoms by 1.02 days, does not increase adverse events related to treatment, but it may be associated with the emergence of resistance in approximately 10% of those treated. Oseltamivir was found to have little or no effect on mortality and admission to hospital, likely has no important effect on time to alleviation of symptoms, and likely increases risk of adverse events related to treatment.

COVID: The Late Phase/PASC/Long COVID

Symptom Evolution in Individuals with Ongoing Symptomatic COVID-19 and Post COVID-19 Syndrome After SARS-CoV-2 Vaccination versus Influenza Vaccination
COVID-19 symptoms may persist beyond acute SARS-CoV-2 infection, as ongoing symptomatic COVID-19 [OSC] (symptom duration 4-12 weeks) and post-COVID syndrome [PCS] (symptom duration ≥12 weeks). Using data from the ZOE COVID Symptom Study app, two comparative analyses were carried out, both in prospectively-reporting individuals with OSC/PCS: A) symptoms in individuals receiving first vaccination against SARS-CoV-2, compared with unvaccinated individuals, matched for age, sex, BMI and week of test (n=1679 in each group); B) symptoms in individuals receiving vaccination against influenza, compared with unvaccinated individuals, matched for age, sex, BMI, week of test and number of SARS-CoV-2 vaccinations (n=692 in each group). In both analyses, vaccination date (or equivalent time from start of symptoms in the unvaccinated group) was considered as the index time, and symptom evolution was measured by comparing symptoms during the second week before and second week after vaccination. After first vaccination against SARS-CoV-2, many symptoms in individuals with OSC/PCS improved more rapidly than natural history resolution, including the commonly reported symptoms of fatigue (p<0.0001, β=--0.9 [95% CI: -1.86; -0.67]) and myalgia (p<0.001, β=-0.3 [95% CI: -0.50; -0.12]). No symptom worsened after vaccination. In contrast, there was no improvement in OSC/PCS symptoms beyond natural history resolution after vaccination against influenza.
Neurological Post-COVID Syndrome is Associated with Substantial Impairment of Verbal Short-term and Working Memory
Investigators performed in-depth neuropsychological assessment of PCS patients referred to the Neurologic PCS clinic compared to patients without sequelae after COVID-19 (non-PCS) and healthy controls (HC) to decipher the most prevalent cognitive deficits. included n = 60 PCS patients with neurologic symptoms, n = 15 non-PCS patients and n = 15 healthy controls. Detailed neuropsychological test battery followed, including assessments of general orientation, motor and cognitive fatigue, screening of depressive and anxiety symptoms, information processing speed, concentration, visuomotor processing speed, attention, verbal short-term and working memory, cognitive flexibility, semantic and phonematic word fluency, as well as verbal and visual memory functions. Authors present the data in a number of figures and document substantial impairment of verbal short-term and working memory.