Influenza in obese travellers: increased risk and complications, decreased vaccine effectiveness.
Obesity
influenza
traveller
Journal
Journal of travel medicine
ISSN: 1708-8305
Titre abrégé: J Travel Med
Pays: England
ID NLM: 9434456
Informations de publication
Date de publication:
10 May 2019
10 May 2019
Historique:
received:
04
02
2019
revised:
11
03
2019
accepted:
13
03
2019
pubmed:
30
3
2019
medline:
16
7
2020
entrez:
30
3
2019
Statut:
ppublish
Résumé
Obesity is a worldwide epidemic and was empirically shown to increase the risk of developing severe influenza virus infection. As international travel becomes more common and obesity is now prevalent even in low- and middle-income countries, travellers may have an increased risk of contracting influenza virus especially during peak influenza season. An analysis of the literature, centred on publications from 2014-19, was performed, with an emphasis on human epidemiological data, human studies ex vivo and studies in mouse models of obesity. Our search efforts focused on influenza disease severity, pathogenesis, evolutionary dynamics and measures of infection control in the obese and overweight host. Obesity is associated with an increased risk of infection, as well as a greater chance for hospitalization and severe complications. Studies in mouse models of obesity have uncovered that obese hosts suffer increased viral spread, delayed viral clearance and heightened damage to the respiratory epithelium. Innate and adaptive immune responses are delayed, thus increasing morbidity and mortality. Further, infection control measures, including vaccination and antivirals, prove less effective in obese hosts. Finally, the obese microenvironment allows for increased duration and amount of viral shedding and potentially increases the chance for emergence of virulent minor variants in the viral population. Together, obese hosts are at high risk of influenza infection, as well as severe sequelae following infection. Obese travellers should be aware of influenza activity in the regions visited, as well as take protective measures prior to travel. Vaccination is highly recommended for all travellers, but especially highly susceptible obese travellers.
Sections du résumé
BACKGROUND
BACKGROUND
Obesity is a worldwide epidemic and was empirically shown to increase the risk of developing severe influenza virus infection. As international travel becomes more common and obesity is now prevalent even in low- and middle-income countries, travellers may have an increased risk of contracting influenza virus especially during peak influenza season.
METHODS
METHODS
An analysis of the literature, centred on publications from 2014-19, was performed, with an emphasis on human epidemiological data, human studies ex vivo and studies in mouse models of obesity. Our search efforts focused on influenza disease severity, pathogenesis, evolutionary dynamics and measures of infection control in the obese and overweight host.
RESULTS
RESULTS
Obesity is associated with an increased risk of infection, as well as a greater chance for hospitalization and severe complications. Studies in mouse models of obesity have uncovered that obese hosts suffer increased viral spread, delayed viral clearance and heightened damage to the respiratory epithelium. Innate and adaptive immune responses are delayed, thus increasing morbidity and mortality. Further, infection control measures, including vaccination and antivirals, prove less effective in obese hosts. Finally, the obese microenvironment allows for increased duration and amount of viral shedding and potentially increases the chance for emergence of virulent minor variants in the viral population. Together, obese hosts are at high risk of influenza infection, as well as severe sequelae following infection.
CONCLUSION
CONCLUSIONS
Obese travellers should be aware of influenza activity in the regions visited, as well as take protective measures prior to travel. Vaccination is highly recommended for all travellers, but especially highly susceptible obese travellers.
Identifiants
pubmed: 30924873
pii: 5423056
doi: 10.1093/jtm/taz020
pmc: PMC6509472
pii:
doi:
Substances chimiques
Antiviral Agents
0
Influenza Vaccines
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© International Society of Travel Medicine 2019. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
Références
J Am Diet Assoc. 1999 Mar;99(3):294-9
pubmed: 10076580
FASEB J. 2001 Aug;15(10):1846-8
pubmed: 11481250
J Biol Chem. 2003 Nov 21;278(47):46654-60
pubmed: 13129912
N Engl J Med. 2004 Mar 18;350(12):1236-47
pubmed: 15028828
Circulation. 2004 Sep 21;110(12):1564-71
pubmed: 15364812
Metabolism. 2005 Nov;54(11):1546-51
pubmed: 16253647
J Immunol. 2006 Nov 1;177(9):5997-6006
pubmed: 17056524
J Infect Dis. 2007 Mar 1;195(5):675-9
pubmed: 17262708
J Nutr. 2007 May;137(5):1236-43
pubmed: 17449587
Annu Rev Pathol. 2008;3:499-522
pubmed: 18039138
Immunology. 2009 Feb;126(2):268-79
pubmed: 18754811
Euro Surveill. 2009 Aug 20;14(33):null
pubmed: 19712643
Blood. 2009 Oct 29;114(18):3803-12
pubmed: 19721009
Euro Surveill. 2009 Dec 10;14(49):null
pubmed: 20003906
Jpn J Infect Dis. 2010 Jan;63(1):67-71
pubmed: 20093768
Intern Med. 2010;49(5):427-30
pubmed: 20190477
J Nutr. 2010 Sep;140(9):1691-7
pubmed: 20592105
Nat Rev Immunol. 2011 Feb;11(2):85-97
pubmed: 21252989
PLoS Med. 2011 Jul;8(7):e1001053
pubmed: 21750667
Antimicrob Agents Chemother. 2011 Dec;55(12):5640-5
pubmed: 21930881
Surgery. 2012 Jan;151(1):107-12
pubmed: 21982524
Int J Obes (Lond). 2012 Aug;36(8):1072-7
pubmed: 22024641
J Infect Dis. 2012 Jan 15;205(2):252-61
pubmed: 22147799
J Infect Dis. 2012 Jan 15;205(2):244-51
pubmed: 22147801
Immunol Res. 2012 Jun;52(3):182-99
pubmed: 22160809
Euro Surveill. 2012 Jan 26;17(4):null
pubmed: 22297139
J Infect. 2012 Nov;65(5):423-30
pubmed: 22820034
Nutrition. 2013 Jan;29(1):207-12
pubmed: 22951153
Immunity. 2012 Sep 21;37(3):574-87
pubmed: 22981538
J Infect Dis. 2013 Apr 15;207(8):1270-80
pubmed: 23325916
Int J Obes (Lond). 2013 Nov;37(11):1510-3
pubmed: 23439322
Obesity (Silver Spring). 2013 Nov;21(11):2377-86
pubmed: 23512822
Travel Med Infect Dis. 2013 Mar-Apr;11(2):110-8
pubmed: 23523241
BMC Med. 2013 Jun 25;11:153
pubmed: 23800265
Pediatr Obes. 2014 Oct;9(5):381-90
pubmed: 23852831
J Infect Dis. 2013 Oct 15;208(8):1305-14
pubmed: 23863950
Am J Epidemiol. 2013 Nov 1;178(9):1478-87
pubmed: 24008912
Clin Nutr. 2014 Oct;33(5):922-6
pubmed: 24182768
Clin Respir J. 2014 Oct;8(4):410-6
pubmed: 24308324
Vet Microbiol. 2014 Jan 10;168(1):208-13
pubmed: 24315038
Antimicrob Agents Chemother. 2014;58(3):1615-21
pubmed: 24366750
Hum Vaccin Immunother. 2014;10(5):1181-6
pubmed: 24614530
PLoS One. 2014 Mar 18;9(3):e92450
pubmed: 24642966
Cochrane Database Syst Rev. 2014 Apr 10;(4):CD008965
pubmed: 24718923
J Antimicrob Chemother. 2014 Sep;69(9):2458-69
pubmed: 24840623
Diabetes Metab Syndr. 2014 Oct-Dec;8(4):197-204
pubmed: 25301008
Diabetes Metab Syndr. 2015 Oct-Dec;9(4):280-6
pubmed: 25470639
PLoS One. 2015 Mar 18;10(3):e0120918
pubmed: 25785862
J Immunol. 2015 May 15;194(10):4846-59
pubmed: 25862817
Vaccine. 2015 Jun 26;33(29):3306-13
pubmed: 26044491
Nature. 2015 Jul 9;523(7559):217-20
pubmed: 26053121
Lancet Infect Dis. 2016 Feb;16(2):252-8
pubmed: 26654122
Pediatr Infect Dis J. 2016 Apr;35(4):440-5
pubmed: 26658380
J Virol. 2015 Dec 30;90(6):2838-48
pubmed: 26719259
Adv Nutr. 2016 Jan 15;7(1):66-75
pubmed: 26773015
Br J Clin Pharmacol. 2016 Jun;81(6):1103-12
pubmed: 26810861
Respir Res. 2016 Mar 08;17:24
pubmed: 26956558
Infect Dis (Lond). 2016 Nov-Dec;48(11-12):813-22
pubmed: 27385315
MBio. 2016 Aug 02;7(4):
pubmed: 27486196
Front Immunol. 2016 Aug 02;7:289
pubmed: 27531997
Acta Virol. 2016;60(3):298-306
pubmed: 27640440
Prev Vet Med. 2016 Nov 1;134:211-215
pubmed: 27726887
J Travel Med. 2017 Jan 11;24(1):
pubmed: 28077609
Vaccine. 2017 Feb 7;35(6):856-864
pubmed: 28081970
Influenza Other Respir Viruses. 2017 May;11(3):240-246
pubmed: 28146320
Influenza Other Respir Viruses. 2017 May;11(3):254-262
pubmed: 28207989
Travel Med Infect Dis. 2017 Mar - Apr;16:3-10
pubmed: 28351605
J Immunol. 2017 Jun 15;198(12):4738-4752
pubmed: 28500069
Int J Obes (Lond). 2017 Sep;41(9):1324-1330
pubmed: 28584297
BMJ Open Diabetes Res Care. 2017 May 8;5(1):e000379
pubmed: 28761653
Vaccine. 2017 Sep 12;35(38):5095-5101
pubmed: 28807608
Curr Diab Rep. 2017 Aug 15;17(10):87
pubmed: 28812211
Trends Immunol. 2018 Jan;39(1):70-79
pubmed: 28867526
J Med Virol. 2018 Feb;90(2):212-218
pubmed: 28892181
MBio. 2017 Sep 19;8(5):
pubmed: 28928207
J Travel Med. 2017 Sep 1;24(6):
pubmed: 29088479
Proc Natl Acad Sci U S A. 2018 Jan 30;115(5):1081-1086
pubmed: 29348203
PLoS Negl Trop Dis. 2018 Mar 29;12(3):e0006247
pubmed: 29596427
J Infect Dis. 2018 Sep 22;218(9):1378-1382
pubmed: 30085119
J Virol. 2019 Jan 4;93(2):null
pubmed: 30381485
J Infect Public Health. 2018 Nov 13;:null
pubmed: 30446255
J Infect Dis. 2019 Apr 19;219(10):1652-1661
pubmed: 30535161
J Infect Dis. 2019 Apr 19;219(10):1525-1535
pubmed: 30551178
J Travel Med. 2019 Jan 1;26(1):null
pubmed: 30590731