Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN).

BACKGROUND: The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions. METHODS: We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level. RESULTS: The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P = .01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2. CONCLUSIONS: Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs.

Age Differences in Comorbidities, Presenting Symptoms, and Outcomes of Influenza Illness Requiring Hospitalization: A Worldwide Perspective From the Global Influenza Hospital Surveillance Network.

Background: The Global Influenza Hospital Surveillance Network (GIHSN) was established in 2012 to conduct coordinated worldwide influenza surveillance. In this study, we describe underlying comorbidities, symptoms, and outcomes in patients hospitalized with influenza. Methods: Between November 2018 and October 2019, GIHSN included 19 sites in 18 countries using a standardized surveillance protocol. Influenza infection was laboratory-confirmed with reverse-transcription polymerase chain reaction. A multivariate logistic regression model was utilized to analyze the extent to which various risk factors predict severe outcomes. Results: Of 16 022 enrolled patients, 21.9% had laboratory-confirmed influenza; 49.2% of influenza cases were A/H1N1pdm09. Fever and cough were the most common symptoms, although they decreased with age (P < .001). Shortness of breath was uncommon among those <50 years but increased with age (P < .001). Middle and older age and history of underlying diabetes or chronic obstructive pulmonary disease were associated with increased odds of death and intensive care unit (ICU) admission, and male sex and influenza vaccination were associated with lower odds. The ICU admissions and mortality occurred across the age spectrum. Conclusions: Both virus and host factors contributed to influenza burden. We identified age differences in comorbidities, presenting symptoms, and adverse clinical outcomes among those hospitalized with influenza and benefit from influenza vaccination in protecting against adverse clinical outcomes. The GIHSN provides an ongoing platform for global understanding of hospitalized influenza illness.

[Surveillance, prevention, and control of influenza virus in Peru]. / Vigilancia, prevención y control del virus de la influenza en Perú.

The importance of surveilling the circulation of the influenza virus and timely vaccination of different populations in Peru was analyzed in three sessions by a group of clinical experts from different specialties. The Peruvian national influenza surveillance system has many selected establishments that have become currently ineffective in terms of a timely report. Most of the samples come from Lima. The viral distribution is inadequately analyzed. The northern and jungle areas of the country have weather and season conditions different to those in Lima and on the southern highlands. This lack of coordination is accentuated by the opportunity of arrival of the influenza vaccine in the country. The Ministry of Health uses a trivalent vaccine but the possibility of a tetravalent vaccine with the two type-B lineages must be analyzed from a cost-benefit standpoint. The appropriateness of vaccinating two times a year, regionally, should be assessed.

La importancia de la vigilancia de la circulación del virus de influenza y la vacunación oportuna a las diferentes poblaciones del Perú, fue analizada en tres sesiones por un grupo de clínicos expertos de diferentes especialidades. En Perú, en los últimos años, el sistema nacional de vigilancia de influenza tiene muchos establecimientos seleccionados que son ineficaces en la notificación oportuna. La mayoría de las muestras provienen de Lima. La distribución viral es inadecuadamente analizada. El norte y la selva tienen estaciones climáticas diferentes a Lima y la sierra sur. Esta descoordinación se acentúa con la oportunidad de la llegada de la vacuna de influenza al país. El Ministerio de Salud utiliza una vacuna trivalente pero la posibilidad de una vacuna tetravalente con los dos linajes de tipo B, debe ser analizada desde el punto de vista de costo-beneficio. Se debería evaluar la pertinencia de vacunar en dos momentos anuales, regionalmente.

Vigilancia, prevención y control del virus de la influenza en Perú / Surveillance, prevention, and control of influenza virus in Peru

RESUMEN La importancia de la vigilancia de la circulación del virus de influenza y la vacunación oportuna a las diferentes poblaciones del Perú, fue analizada en tres sesiones por un grupo de clínicos expertos de diferentes especialidades. En Perú, en los últimos años, el sistema nacional de vigilancia de influenza tiene muchos establecimientos seleccionados que son ineficaces en la notificación oportuna. La mayoría de las muestras provienen de Lima. La distribución viral es inadecuadamente analizada. El norte y la selva tienen estaciones climáticas diferentes a Lima y la sierra sur. Esta descoordinación se acentúa con la oportunidad de la llegada de la vacuna de influenza al país. El Ministerio de Salud utiliza una vacuna trivalente pero la posibilidad de una vacuna tetravalente con los dos linajes de tipo B, debe ser analizada desde el punto de vista de costo-beneficio. Se debería evaluar la pertinencia de vacunar en dos momentos anuales, regionalmente.

ABSTRACT The importance of surveilling the circulation of the influenza virus and timely vaccination of different populations in Peru was analyzed in three sessions by a group of clinical experts from different specialties. The Peruvian national influenza surveillance system has many selected establishments that have become currently ineffective in terms of a timely report. Most of the samples come from Lima. The viral distribution is inadequately analyzed. The northern and jungle areas of the country have weather and season conditions different to those in Lima and on the southern highlands. This lack of coordination is accentuated by the opportunity of arrival of the influenza vaccine in the country. The Ministry of Health uses a trivalent vaccine but the possibility of a tetravalent vaccine with the two type-B lineages must be analyzed from a cost-benefit standpoint. The appropriateness of vaccinating two times a year, regionally, should be assessed.

Capacity-building efforts by the AFHSC-GEIS program.

Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.

Changes in the viral distribution pattern after the appearance of the novel influenza A H1N1 (pH1N1) virus in influenza-like illness patients in Peru.

BACKGROUND: We describe the temporal variation in viral agents detected in influenza like illness (ILI) patients before and after the appearance of the ongoing pandemic influenza A (H1N1) (pH1N1) in Peru between 4-January and 13-July 2009. METHODS: At the health centers, one oropharyngeal swab was obtained for viral isolation. From epidemiological week (EW) 1 to 18, at the US Naval Medical Research Center Detachment (NMRCD) in Lima, the specimens were inoculated into four cell lines for virus isolation. In addition, from EW 19 to 28, the specimens were also analyzed by real time-polymerase-chain-reaction (rRT-PCR). RESULTS: We enrolled 2,872 patients: 1,422 cases before the appearance of the pH1N1 virus, and 1,450 during the pandemic. Non-pH1N1 influenza A virus was the predominant viral strain circulating in Peru through (EW) 18, representing 57.8% of the confirmed cases; however, this predominance shifted to pH1N1 (51.5%) from EW 19-28. During this study period, most of pH1N1 cases were diagnosed in the capital city (Lima) followed by other cities including Cusco and Trujillo. In contrast, novel influenza cases were essentially absent in the tropical rain forest (jungle) cities during our study period. The city of Iquitos (Jungle) had the highest number of influenza B cases and only one pH1N1 case. CONCLUSIONS: The viral distribution in Peru changed upon the introduction of the pH1N1 virus compared to previous months. Although influenza A viruses continue to be the predominant viral pathogen, the pH1N1 virus predominated over the other influenza A viruses.

Molecular characterization of adenovirus circulating in Central and South America during the 2006-2008 period.

BACKGROUND: Human Adenoviruses are recognized pathogens, causing a broad spectrum of diseases. Serotype identification is critical for epidemiological surveillance, detection of new strains and understanding of HAdvs pathogenesis. Little data is available about HAdvs subtypes in Latin America. METHODS: In this study, we have molecularly characterized 213 adenoviruses collected from ILI presenting patients, during 2006-08, in Central and South America. RESULTS: Our results indicate that 161(76%) adenoviruses belong to subgroup C, 45 (21%) to subgroup B and 7 (3%) to subtype E4.

Epidemiological and molecular characteristics of HIV-1 infection among female commercial sex workers, men who have sex with men and people living with AIDS in Paraguay.

An HIV seroprevalence and molecular study was conducted among 935 subjects: 723 female commercial sex workers, 92 men who have sex with men and 120 HIV-positive volunteers. The reported injection drug use rates were 0.7% in female commercial sex workers and 3% in men who have sex with men. Sexually transmitted infections were reported in 265 (37%) of the female commercial sex workers and 38 (41%) of the men who have sex with men. A total of 20 (2.8%) female commercial sex workers and 12 (13%) men who have sex with men became HIV infected during the study period. A history of sexually transmitted infection increased the risk of subsequent HIV infection twofold (adjusted odds ratio of 2.5) among the female commercial sex workers, while cocaine use had an adjusted odds ratios of 6.61 among men who have sex with men. From 130 samples, and based on heteroduplex mobility assaying for the env gene, with sequencing of part of pol and/or full genomes, subtype B was the predominant subtype identified (66%); followed by subtype F (22%) and subtype C (4%). Recombinant CRF12-BF strains were identified in 6% and CRF17_BF was identified in 2%.

Epidemiological and molecular characteristics of HIV-1 infection among female commercial sex workers, men who have sex with men and people living with AIDS in Paraguay / Características epidemiológicas e moleculares da infecção por HIV-1 entre as mulheres que trabalham no comércio do sexo, entre homens que mantém relações sexuais com homens e nas pessoas convivendo com AIDS no Paraguai

An HIV seroprevalence and molecular study was conducted among 935 subjects: 723 female commercial sex workers, 92 men who have sex with men and 120 HIV-positive volunteers. The reported injection drug use rates were 0.7 percent in female commercial sex workers and 3 percent in men who have sex with men. Sexually transmitted infections were reported in 265 (37 percent) of the female commercial sex workers and 38 (41 percent) of the men who have sex with men. A total of 20 (2.8 percent) female commercial sex workers and 12 (13 percent) men who have sex with men became HIV infected during the study period. A history of sexually transmitted infection increased the risk of subsequent HIV infection twofold (adjusted odds ratio of 2.5) among the female commercial sex workers, while cocaine use had an adjusted odds ratios of 6.61 among men who have sex with men. From 130 samples, and based on heteroduplex mobility assaying for the env gene, with sequencing of part of pol and/or full genomes, subtype B was the predominant subtype identified (66 percent); followed by subtype F (22 percent) and subtype C (4 percent). Recombinant CRF12-BF strains were identified in 6 percent and CRF17_BF was identified in 2 percent.

Um estudo de soroprevalência e de avaliação molecular do HIV foi realizado com 935 indivíduos: 723 mulheres que trabalhavam no comércio do sexo, 92 homens que mantinham relações sexuais com outros homens e com 120 voluntários HIV-positivos. O relato de uso de drogas injetáveis foi de 0,7 por cento nas mulheres que trabalhavam no comércio do sexo e de 3 por cento nos homens que mantinham relações sexuais com outros homens. Infecções sexualmente transmitidas foram relatadas por 265 (37 por cento) das mulheres que trabalhavam no comércio do sexo e em 38 (41 por cento) dos homens que mantinham relações sexuais com homens. Um total de 20 (2,8 por cento) mulheres que trabalhavam no comércio do sexo e 12 (13 por cento) homens que mantinham relações sexuais com homens se infectou com HIV durante o período do estudo. História prévia de infecção sexualmente transmitida aumentou em duas vezes o risco de infecção subseqüente por HIV (odds ratio ajustado de 2,5) entre as mulheres que trabalhavam no comércio do sexo, enquanto cocaína apresentou odds ratio ajustado de 6,61 entre os homens que mantinham relações sexuais com outros homens. De 130 amostras, com base no ensaio da mobilidade heteroduplex para o gene env, com sequenciamento de parte do pol e/ou genomas completos, o subtipo B foi o subtipo mais identificado (66 por cento); seguido pelo subtipo F (22 por cento) e subtipo C (4 por cento). Cepas recombinantes CRF12-BF foram identificadas em 6 por cento e CRF17_BF foi identificada em 2 por cento.

Manifestaciones clínicas, epidemiológicas y serotipos en un brote de dengue clásico en el departamento de Lambayeque. Enero-junio 2001 / Clinical, epidemiological manifestations and serotipos in an outbreak of classic dengue in Lambayeque's department. January - June, 2001

Objetivo: Describir las manifestaciones clínicas, epidemiológicas y serotipos del dengue en un brote en el departamento de Lambayeque entre enero y junio del 2001. Materiales y métodos: Se realizó un estudio descriptivo transversal de reporte de casos. Los datos se obtuvieron de la ficha epidemiológica de investigación de Dengue de la Dirección de Salud Lambayeque en los casos de dengue confirmado. Resultados: Se confirmó dengue en 68 pacientes con igual distribución por sexo. Las manifestaciones clínicas más frecuentes fueron: fiebre (97,1 por ciento), cefalea (91.2 por ciento), dolor óseo (80,9 por ciento) y dolor retroobitario (80,9 por ciento). La manifestación hemorrágica más frecuente fue petequias. La prueba de lazo sólo se presentó en 2 casos (4,4 por ciento). El distrito más afectado fue Olmos con 28 casos (41.2 por ciento). 22 (32,4 por ciento) casos fueron considerados como probables importados, de los cuales el destino de viaje con mayor frecuencia fue Bagua (18,2 por ciento); y 46 como probables casos autóctonos (67.6 por ciento). Se aisló el virus en 6 casos, en 4 de ellos se identificó el serotipo DEN 1, y en 2 el DEN 2. Conclusiones: Las manifestaciones clínicas son compatibles con otras epidemias reportadas en las Américas. Los virus circulantes fueron identificados como DEN 1 y DEN 2. Se demostró por primera vez la presencia de casos autóctonos en el departamento de Lambayeque. El distrito más afectado fue Olmos ubicándose en el escenario epidemiológico III-A. La circulación simultánea de dos serotipos de dengue aumenta el riesgo de dengue hemorrágico.

Piomisitis Tropical: características clínico - epidemiológicas de 90 casos en una área amazónica. Hospital de Apoyo Banda de Shilcayo, San Martín, 1999-2001 / Tropical Piomisitis: characteristics clinical - epidemiological of 90 cases in an Amazonian area. Hospital of Support Band of Shilcayo, St Martin, 1999 - 2001

El objetivo del estudio fue identificar las características clínico-epidemiológicas, el tratamiento y la evolución de 90 casos con el diagnóstico de piomiositis tropical (PT). Se revisaron las historias clínicas de los pacientes atendidos en el Hospital de Apoyo Banda de Shilcayo, San Martín, entre enero de 1999 y junio del 2001, identificándose 90 casos de PT. Los pacientes tuvieron de 2 a 40 años, 57 fueron varones y 33 mujeres. La sintomatología más común fue fiebre, mialgia y signos inflamatorios en los sitios de lesión. Generalmente había una sola lesión, siendo la ubicación más frecuente los miembros inferiores y la pelvis. La desnutrición y la lesión, siendo la ubicación más frecuente los miembros inferiores y la pelvis. La desnutrición y la anemia estuvieron presentes en más de la mitad de los menores de 10 años. El diagnóstico se basó en los hallazgos clínicos y ecográficos. Los antimicrobianos más utilizados fueron oxacilina, clindamicina, aminoglucósidos y dicloxacilina. Dieciséis pacientes presentaron complicaciones (neumonía, sepsis, shock séptico, etc). La letalidad fue 2.2 por ciento.

[Epidemic dermatits by Paederus irritans in Piura, Perú at 1999, related to El Niño phenomenon]. / Dermatite epidêmica por Paederus irritans em Piura, Perú, 1999, relacionada ao fenômeno El Niño.

The phenomen El Niño that affected Peru at 1998, made possible the growth of copious vegetation in traditionally dry places. On this way, Paederus irritans, dipterous of the order Coleoptera that produces dermatitis when croushed on the skin, found substract that allowed the natural growth of its population. The coming of occasional rains on the months of February to April 1999, attacked the habitat of this insect, that looked for urban areas, exposing seriously the general population of Piura on north Perú to the contact. During February and May 1,451 cases of dermatitis caused by Paederus irritans, called latigazo because of its linear and eritematous characteristic lesions on the skin, were notified at Piura. The more affected body areas were head (56.6%) and neck (30.9%), but there were also cases of conjunctivitis and genital injuries, because of hands contamination.

Dermatite epidêmica por Paederus irritans em Piura, Perú, 1999, relacionada ao fenômeno El Niño / Epidemic dermatits by Paederus irritans in Piura, Peru at 1999, related to El Niño phenomenon

The phenomen El Niño that affected Peru at 1998, made possible the growth of copious vegetation in traditionally dry places. On this way, Paederus irritans, dipterous of the order Coleoptera that produces dermatitis when croushed on the skin, found substract that allowed the natural growth of its population. The coming of occasional rains on the months of February to April 1999, attacked the habitat of this insect, that looked for urban areas, exposing seriously the general population of Piura on north Perú to the contact. During February and May 1,451 cases of dermatitis caused by Paederus irritans, called latigazo because of its linear and eritematous characteristic lesions on the skin, were notified at Piura. The more affected body areas were head (56.6) and neck (30.9), but there were also cases of conjunctivitis and genital injuries, because of hands contamination.

Seroprevalencia de leptospirosis en humanos y reservorios en la localidad de Koribeni. La Convención, Cusco / Seroprevalence of leptospirosis in humans and reservoirs in the locality of Koribeni. The convention, Cusco

Del 5 al 16 de julio de 1998 personal del Ministerio de Salud (MINSA) viajó a la comunidad de Koribeni (Echerate - Cusco) a fin de determinar la seroprevalencia de infección por leptospira en humanos y animales (domésticos y silvestres). Conocer la magnitud del problema, los posibles reservorios y los serovares predominantes. Se tomaron muestras de animales domésticos, peridomésticos y se capturaron ratas y marsupiales. Las muestras se procesaron en el INS mediante aglutinación macroscópica (tamizaje) y aglutinación microscópica (MAT). Para los cultivos se usó el medio Fletcher. De 164 muestras humanas, 41 (25 por ciento) presentaron anticuerpos contra Leptospira interrogans. El serovar prevalente fue Autumnalis (31 por ciento) seguido de Djasiman (11 por ciento), Botaviae (9.25 por ciento) y otros (48.75 por ciento). En 33 muestras de sangre canina, 12 (36.4 por ciento) fueron positivas, el serovar prevalente fue Autumnalis (27.8 por ciento) seguido de Australis (16.6 por ciento) Poma (16.2 por ciento) y otros (39.4 por ciento). Los cultivos (33) fueron negativos (suero y órganos correspondientes a 18 animales entre ratas, cuyes y marsupiales). El género Autumnalis fue prevalente en humanos y canes lo que presupone que puedan ser éstos los reservorios que brinden la infección a los humanos. Llamó la atención la ausencia del serovar canícola en los sueros estudiados. La leptospirosis ha sido considerada dentro de la vigilancia del síndrome icterohemorrágico que el MINSA ha iniciado en Cusco, Huánuco y Ayacucho.