Antigenic Drift of A/H3N2/Virus and Circulation of Influenza-Like Viruses During the 2014/2015 Influenza Season in Poland.

Morbidity rates of influenza could be greatly reduced due to vaccination. However, the virus is able to evolve through genetic mutations, which is why vaccines with updated composition are necessary every season. Their effectiveness depends on whether there is a good antigenic match between circulating viruses and vaccine strains. In Poland, the 2014/2015 influenza epidemic started in week 5 (January/February) of 2015 and continued until week 17 (April) of 2015. The influenza activity was moderate with the highest incidence of influence-like illness at week 10/2015 (March). During that season, antigenic drift of influenza virus A/H3N2/ occurred causing higher rates of A/H3N2/ infections. Among the 2416 tested specimens, 22.6 % of influenza cases were positive for A/H3N2/, while A/H1N1/pdm09 constituted 14.6 % cases. Influenza A viruses were detected in co-circulation with influenza B viruses; the latter amounted to 34.1 % of all influenza detections. Other detected causes of influenza-like illness consisted of respiratory syncytial virus (RSV), being predominant, and, sporadically, human coronavirus, parainfluenza 1-3, rhinovirus, and adenovirus. Despite low vaccine effectiveness of solely one component, A/H3N2/, the vaccine could mitigate or shorten the length of influenza infection and reduce the number of severe outcomes and mortality. Thus, vaccination against influenza remains the most effective way to prevent illness and possibly fatal outcomes.

Molecular Characteristics of Influenza Virus Type B Lineages Circulating in Poland.

From the time of the Hong Kong pandemic of 1968-1969, vaccines against influenza are trivalent, containing two subtypes of influenza type A: A/H1N1/ and A/H3N2/, and influenza type B. In 1980, circulation of the new Yamagata and Victoria lineages of influenza B virus was noted. Since both lineages have continued to circulate, the second lineage of influenza B was included into the trivalent vaccine as of the 2013/2014 epidemic season. In Poland, co-circulation of influenza type A and B has been registered over many seasons, although type A has predominated. According to the ACIP recommendations, quadrivalent vaccines against influenza are administered in some continents due to circulation of the B-Yamagata and B-Victoria lineages. Currently, only trivalent vaccines against influenza are available in Poland. The aim of the present research was to determine which of the two influenza type B lineages, or possibly both, would be isolated in Poland. The study was conducted with the use of RT-PCR. Generally, in the 2014/2015 epidemic season in Poland, circulation of type B virus was confirmed in 34 % of influenza cases. A total of 89 specimens of influenza B were tested, including co-infections of influenza B with influenza A subtypes: A/H1N1/pdm09 and A/H3N2/. The findings were that only lineage B-Yamagata circulates in the Polish population. Therefore, vaccines available on the Polish market do not require the introduction of a fourth component.

Viral Infections in Children in the 2014/2015 Epidemic Season in Poland.

In every epidemic season, viral infections affect the general population, including children, which is an underestimated issue. The present study demonstrates the results of examination of 802 clinical samples obtained from pediatric patients aged 0-14 years during the 2014/2015 epidemic season in Poland. The study was part of the virological surveillance systems - SENTINEL and NON-SENTINEL. A positive result for virological infection was obtained in 50.9 % of samples tested. The distribution of positive results by the age-groups was as follows: 38.2 % in 0-4 years old, 8.5 % in 5-9 years old, and 4.2 % in 10-14 years old children. Influenza viruses accounted for 48.0 % and influenza-like viruses for 52.0 % of all positive samples. Concerning the influenza virus, molecular biology-based techniques confirmed the infection caused by influenza type A in 63.3 % of samples, consisting of unsubtyped A virus detected in 65.3 % of cases of this sample group, subtype A/H1N1/pdm09 in 28.2 %, and subtype A/H3N2/ in 6.5 %. Genetic material of influenza B was detected in 36.7 % of samples. In a group of influenza-like viruses, the predominant virus was respiratory syncytial virus (RSV) in as many as 96.2 % of samples, followed by parainfluenza viruses: PIV3 - 1.4 % and PIV1 - 1.0 %. Attention should be paid to the coinfection of respiratory viruses. There were six possible coinfection combinations reported in Poland, with four of them related to children up to 14 years old.

Evaluation of the Activity of Influenza and Influenza-Like Viruses in the Epidemic Season 2013/2014.

Infections caused by respiratory viruses can have different clinical symptoms, while specific set of symptoms can be induced by different viruses. Despite usually mild course of disease, some viruses causing certain disease entity can result in serious complications. Therefore, quick and appropriate diagnostic is crucial for administering proper treatment. In the epidemic season 2013/2014, 2,497 specimens were tested. Infections caused by influenza viruses were confirmed in 9.8%, while infections caused by influenza-like viruses (ILI) in 13.2%. The co-domination of A/H1N1/pdm09 (29.4%) with A/H3N2/ (30.6%) was observed among circulating subtypes of influenza virus type A. Analysis of positive specimens categorized into 7 age groups indicated that most of morbidity to influenza was noted in the age intervals: 26-44 (22.9%) and 45-64 years old (21.6%). Considering infections caused by influenza-like viruses, the highest amount of positive cases was registered in the age group 0-4 years old (92.7%) with the highest ratio of RSV (87.9%) and PIV-3 (10.5%). Judging by the epidemiological and virological indicators, the 2013/14 influenza season was mild and only low virus activity was reported in Poland as well as in most European countries. Still, 9,000 hospitalizations and 17 deaths were registered in Poland during this epidemic season.

Incidence of Circulating Antibodies Against Hemagglutinin of Influenza Viruses in the Epidemic Season 2013/2014 in Poland.

The aim of this study was to determine the level of antibodies against hemagglutinin of influenza viruses in the sera of people in different age groups in the epidemic season 2013/2014 in Poland. The level of anti-hemagglutinin antibodies was determined by hemagglutination inhibition test (HAI). A total number of 1,050 randomly selected sera was tested in seven age groups. The level of antibodies against influenza viruses was very low, which indicates that the people have not been vaccinated against influenza in the epidemic season 2013/2014. The value of protection rate against influenza in the Polish population is very low. These results are worrying, because complications of influenza may be harmful to health and even life-threatening to persons who are not vaccinated. Furthermore, these results confirm the circulation of three antigenically different influenza virus strains, two subtypes of influenza A virus--A/California/7/2009/(H1N1)pdm09 and A/Victoria/361/2011(H3N2)--and B/Massachusetts/2/2012.