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1.
MMWR Morb Mortal Wkly Rep ; 69(2): 40-43, 2020 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945035

RESUMEN

Multiple genetically distinct influenza B/Victoria lineage viruses have cocirculated in the United States recently, circulating sporadically during the 2018-19 season and more frequently early during the 2019-20 season (1). The beginning of the 2019-20 influenza season in Louisiana was unusually early and intense, with infections primarily caused by influenza B/Victoria lineage viruses. One large pediatric health care facility in New Orleans (facility A) reported 1,268 laboratory-confirmed influenza B virus infections, including 23 hospitalizations from July 31 to November 21, 2019, a time when influenza activity is typically low. During this period, Louisiana also reported one pediatric death associated with influenza B virus infection. An investigation of the influenza B virus infections in Louisiana, including medical and vaccine record abstraction on 198 patients, primarily from facility A, with sporadic cases from other facilities in the state, found that none of the patients had received 2019-20 seasonal influenza vaccine, in part because influenza activity began before influenza vaccination typically occurs. Among 83 influenza B viruses sequenced from 198 patients in Louisiana, 81 (98%) belonged to the recently emerged B/Victoria V1A.3 genetic subclade. Nationally, to date, B/Victoria viruses are the most commonly reported influenza viruses among persons aged <25 years (2). Of the 198 patients in the investigation, 95% were aged <18 years. Although most illnesses were uncomplicated, the number of hospitalizations, clinical complications, and the reported pediatric death in Louisiana serve as a reminder that, even though influenza B viruses are less common than influenza A viruses in most seasons, influenza B virus infection can be severe in children. All persons aged ≥6 months should receive an annual influenza vaccination if they have not already received it (3). Antiviral treatment of influenza is recommended as soon as possible for all hospitalized patients and for outpatients at high risk for influenza complications (including children aged <2 years and persons with underlying medical conditions) (4).


Asunto(s)
Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Gripe Humana/virología , Adolescente , Adulto , Niño , Preescolar , Humanos , Lactante , Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Louisiana/epidemiología , Estaciones del Año , Adulto Joven
2.
BMC Infect Dis ; 19(1): 990, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752738

RESUMEN

BACKGROUND: Since 1985, two antigenically distinct lineages of influenza B viruses (Victoria-like and Yamagata-like) have circulated globally. Trivalent seasonal influenza vaccines contain two circulating influenza A strains but a single B strain and thus provide limited immunity against circulating B strains of the lineage not included in the vaccine. In this study, we describe the characteristics of influenza B viruses that caused respiratory illness in the population in Italy over 13 consecutive seasons of virological surveillance, and the match between the predominant influenza B lineage and the vaccine B lineage, in each season. METHODS: From 2004 to 2017, 26,886 laboratory-confirmed influenza cases were registered in Italy, of which 18.7% were type B. Among them, the lineage of 2465 strains (49%) was retrieved or characterized in this study by a real-time RT-PCR assay and/or sequencing of the hemagglutinin (HA) gene. RESULTS: Co-circulation of both B lineages was observed each season, although in different proportions every year. Overall, viruses of B/Victoria and B/Yamagata lineages caused 53.3 and 46.7% of influenza B infections, respectively. A higher proportion of infections with both lineages was detected in children, and there was a declining frequency of B/Victoria detections with age. A mismatch between the vaccine and the predominant influenza B lineage occurred in eight out of thirteen influenza seasons under study. Considering the seasons when B accounted for > 20% of all laboratory-confirmed influenza cases, a mismatch was observed in four out of six seasons. Phylogenetic analysis of the HA1 domain confirmed the co-circulation of both lineages and revealed a mixed circulation of distinct evolutionary viral variants, with different levels of match to the vaccine strains. CONCLUSIONS: This study contributes to the understanding of the circulation of influenza B viruses in Italy. We found a continuous co-circulation of both B lineages in the period 2004-2017, and determined that children were particularly vulnerable to Victoria-lineage influenza B virus infections. An influenza B lineage mismatch with the trivalent vaccine occurred in about two-thirds of cases.


Asunto(s)
Virus de la Influenza B/aislamiento & purificación , Gripe Humana/virología , Monitoreo Epidemiológico , Humanos , Virus de la Influenza B/clasificación , Virus de la Influenza B/genética , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Italia/epidemiología , Filogenia , Estudios Retrospectivos , Estaciones del Año
3.
BMC Infect Dis ; 19(1): 967, 2019 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-31718578

RESUMEN

BACKGROUND: Seasonal influenza causes a considerable burden to healthcare services every year. To better measure the impact of severe influenza cases in Romania, we analyzed active surveillance data collected during the 2017-2018 season from patients admitted for influenza-like illness (ILI) at a tertiary care hospital in Bucharest. METHODS: Patients admitted for acute ILI were included if they were resident in the Bucharest-Ilfov region, had been hospitalized for at least 24 h, and had onset of symptoms within 7 days before admission. Patient demographics, healthcare use, vaccination status, and outcome data were collected by questionnaire or by searching clinical records. Respiratory swabs were also obtained from each patient to confirm influenza A (A/H1 and A/H3 subtypes) or influenza B (Yamagata and Victoria lineages) infection by real-time reverse-transcription polymerase chain reaction assay. RESULTS: The study included 502 patients, many (45.2%) of whom were aged < 5 years. Overall, 108 patients (21.5%) had one or more comorbidities. Seventeen adults aged 18-64 years (3.4%) had been vaccinated against influenza. Patients were hospitalized for a median of 5 days and most (90.4%) were prescribed antiviral treatment. More than one-half of the patients (n = 259, 51.6%) were positive for influenza. Most influenza cases were caused by B viruses (172/259, 66.4%), which were mostly of the B/Yamagata lineage (85 of 94 characterized, 90.4%). Most of the subtyped A viruses were A/H1 (59/74, 79.7%). A/H1 viruses were frequently detected in influenza-positive admissions throughout the 2017-2018 season, whereas the predominant B/Yamagata viruses were detected around the middle of the season, with a peak in cases at week 7 of 2018. Eleven patients were admitted to an intensive care unit; of these, one patient with confirmed B/Yamagata infection died. CONCLUSIONS: These results show that seasonal influenza results in considerable hospitalization in Bucharest-Ilfov, Romania and suggest vaccine coverage should be extended, especially to the youngest age groups. The data from this study should help inform and optimize national influenza healthcare policies.


Asunto(s)
Hospitalización/estadística & datos numéricos , Gripe Humana/diagnóstico , Adolescente , Adulto , Anciano , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/diagnóstico , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Virus de la Influenza B/genética , Virus de la Influenza B/aislamiento & purificación , Vacunas contra la Influenza/inmunología , Gripe Humana/complicaciones , Gripe Humana/epidemiología , Influenzavirus A/genética , Influenzavirus A/aislamiento & purificación , Masculino , Persona de Mediana Edad , Rumanía/epidemiología , Estaciones del Año , Adulto Joven
4.
MMWR Morb Mortal Wkly Rep ; 68(40): 880-884, 2019 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-31600182

RESUMEN

During May 19-September 28, 2019,* low levels of influenza activity were reported in the United States, with cocirculation of influenza A and influenza B viruses. In the Southern Hemisphere seasonal influenza viruses circulated widely, with influenza A(H3) predominating in many regions; however, influenza A(H1N1)pdm09 and influenza B viruses were predominant in some countries. In late September, the World Health Organization (WHO) recommended components for the 2020 Southern Hemisphere influenza vaccine and included an update to the A(H3N2) and B/Victoria-lineage components. Annual influenza vaccination is the best means for preventing influenza illness and its complications, and vaccination before influenza activity increases is optimal. Health care providers should recommend vaccination for all persons aged ≥6 months who do not have contraindications to vaccination (1).


Asunto(s)
Salud Global/estadística & datos numéricos , Vacunas contra la Influenza/química , Gripe Humana/epidemiología , Vigilancia de la Población , Farmacorresistencia Viral , Humanos , Subtipo H1N1 del Virus de la Influenza A/efectos de los fármacos , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/efectos de los fármacos , Subtipo H3N2 del Virus de la Influenza A/genética , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/efectos de los fármacos , Virus de la Influenza B/genética , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/virología , Estaciones del Año , Estados Unidos/epidemiología
5.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 904-910, 2019 Aug 10.
Artículo en Chino | MEDLINE | ID: mdl-31484252

RESUMEN

Objective: To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017. Methods: Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens. Results: A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001). Conclusions: In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.


Asunto(s)
Bacterias/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Gripe Humana/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Nasofaringe , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Virosis/diagnóstico , Virus/aislamiento & purificación , Enfermedad Aguda , Adulto , Bacterias/genética , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , China/epidemiología , Coinfección/diagnóstico , Enterovirus/genética , Enterovirus/aislamiento & purificación , Monitoreo Epidemiológico , Humanos , Incidencia , Virus de la Influenza A/genética , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/genética , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Gripe Humana/virología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Mycoplasma pneumoniae , Nasofaringe/microbiología , Nasofaringe/virología , Vigilancia de la Población , Infecciones del Sistema Respiratorio/diagnóstico , Rhinovirus/genética , Rhinovirus/aislamiento & purificación , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Virosis/epidemiología , Virosis/virología , Virus/genética
6.
BMC Public Health ; 19(1): 1089, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31409397

RESUMEN

BACKGROUND: Monitoring seasonal influenza epidemics is the corner stone to epidemiological surveillance of acute respiratory virus infections worldwide. This work aims to compare two sentinel surveillance systems within the Daily Acute Respiratory Infection Information System of Catalonia (PIDIRAC), the primary care ILI and Influenza confirmed samples from primary care (PIDIRAC-ILI and PIDIRAC-FLU) and the severe hospitalized laboratory confirmed influenza system (SHLCI), in regard to how they behave in the forecasting of epidemic onset and severity allowing for healthcare preparedness. METHODS: Epidemiological study carried out during seven influenza seasons (2010-2017) in Catalonia, with data from influenza sentinel surveillance of primary care physicians reporting ILI along with laboratory confirmation of influenza from systematic sampling of ILI cases and 12 hospitals that provided data on severe hospitalized cases with laboratory-confirmed influenza (SHLCI-FLU). Epidemic thresholds for ILI and SHLCI-FLU (overall) as well as influenza A (SHLCI-FLUA) and influenza B (SHLCI-FLUB) incidence rates were assessed by the Moving Epidemics Method. RESULTS: Epidemic thresholds for primary care sentinel surveillance influenza-like illness (PIDIRAC-ILI) incidence rates ranged from 83.65 to 503.92 per 100.000 h. Paired incidence rate curves for SHLCI -FLU / PIDIRAC-ILI and SHLCI-FLUA/ PIDIRAC-FLUA showed best correlation index' (0.805 and 0.724 respectively). Assessing delay in reaching epidemic level, PIDIRAC-ILI source forecasts an average of 1.6 weeks before the rest of sources paired. Differences are higher when SHLCI cases are paired to PIDIRAC-ILI and PIDIRAC-FLUB although statistical significance was observed only for SHLCI-FLU/PIDIRAC-ILI (p-value Wilcoxon test = 0.039). CONCLUSIONS: The combined ILI and confirmed influenza from primary care along with the severe hospitalized laboratory confirmed influenza data from PIDIRAC sentinel surveillance system provides timely and accurate syndromic and virological surveillance of influenza from the community level to hospitalization of severe cases.


Asunto(s)
Epidemias , Hospitalización/estadística & datos numéricos , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Atención Primaria de Salud , Vigilancia de Guardia , Humanos , Gripe Humana/diagnóstico , Gripe Humana/terapia , Laboratorios de Hospital , Reproducibilidad de los Resultados , Estaciones del Año , Índice de Severidad de la Enfermedad , España/epidemiología
7.
Nat Commun ; 10(1): 3422, 2019 07 31.
Artículo en Inglés | MEDLINE | ID: mdl-31366921

RESUMEN

Severe influenza infection has no effective treatment available. One of the key barriers to developing host-directed therapy is a lack of reliable prognostic factors needed to guide such therapy. Here, we use a network analysis approach to identify host factors associated with severe influenza and fatal outcome. In influenza patients with moderate-to-severe diseases, we uncover a complex landscape of immunological pathways, with the main changes occurring in pathways related to circulating neutrophils. Patients with severe disease display excessive neutrophil extracellular traps formation, neutrophil-inflammation and delayed apoptosis, all of which have been associated with fatal outcome in animal models. Excessive neutrophil activation correlates with worsening oxygenation impairment and predicted fatal outcome (AUROC 0.817-0.898). These findings provide new evidence that neutrophil-dominated host response is associated with poor outcomes. Measuring neutrophil-related changes may improve risk stratification and patient selection, a critical first step in developing host-directed immune therapy.


Asunto(s)
Trampas Extracelulares/inmunología , Gripe Humana/inmunología , Gripe Humana/patología , Activación Neutrófila/inmunología , Neutrófilos/inmunología , Ciclo Celular/inmunología , Femenino , Expresión Génica/genética , Humanos , Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/inmunología , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/inmunología , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/mortalidad , Pulmón/inmunología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Respiración Artificial , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/patología , Insuficiencia Respiratoria/virología
8.
Adv Exp Med Biol ; 1222: 63-68, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31352577

RESUMEN

The SENTINEL influenza surveillance system is an important tool for monitoring influenza in Poland. Data from this system are necessary to determine the dynamics of seasonal infections and to announce the epidemic by the country level. For the 2017/18 epidemic season, the dominance of influenza type B was recorded and the highest percentage of infections was recorded in the age group 45-64 years. Among the subtypes of influenza type A, A/H1N1/pdm09 was the predominated subtype. Most cases were reported in the age group of 26-44 and 0-4 years. The influenza virus frequently undergoes modifications. Therefore, it is necessary to constantly monitor the emerging strains around the world.


Asunto(s)
Epidemias , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Vigilancia de Guardia , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Subtipo H1N1 del Virus de la Influenza A/genética , Virus de la Influenza B/genética , Persona de Mediana Edad , Polonia/epidemiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Estaciones del Año , Adulto Joven
9.
Virol J ; 16(1): 91, 2019 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-31324259

RESUMEN

BACKGROUND: Influenza A and B viruses mainly cause respiratory infectious disease. Till now, few tests are able to simultaneously detect both, especially in primary medical establishments. METHODS: This study was designed to compare the performance of two different one-step-combined test strips for the detection of influenza A and B: one strip with fluorescent microspheres for tracers (FMT); and the other strip with colored microspheres for tracers (CMT). To test the strips, cultures of influenza A, B, and other pathogenic viruses were used, in addition to 1085 clinical specimens from symptomatic patients with respiratory infections. Real-time RT-PCR was also considered as a reference method used to detect the different results of FMT and CTM. RESULTS: Detection thresholds for influenza A and B cultures using serial dilutions revealed that the sensitivity of FMT was higher than that of CMT (both P < 0.05). With the culture mixtures of Coxsackie virus (A16), enteric cytopathic human orphan virus (ECHO type30), enterovirus (EV71), rotavirus (LLR strain), and enteric adenovirus (AdV 41), specificity assessment demonstrated that there was no cross reaction during the usage of the two test strips as shown by the results which were negative. In the detection of influenza A in 1085 clinical specimens, the total coincidence rate was 96.7%, the positive coincidence rate was 97.1%, and the negative coincidence rate was 96.7%. In the case of influenza B detection, the total coincidence rate was 99.1%, the positive coincidence rate was 92.6%, and the negative coincidence rate was 98.5%. In addition, with influenza A or B real-time RT-PCR detection method, the results showed that, for influenza A, 26 of the 33 specimens that negative with CMT but positive with FMT, showed positive results, and none of the 3 specimens that positive with CMT but negative with FMT showed a positive result; For influenza B, 12 of the 15 specimens that negative with CMT but positive with FMT, showed positive results, and none of the 5 specimens that positive with CMT but negative with FMT showed a positive result. CONCLUSIONS: FMT performed better than CMT in the combined detection of influenza A and B viruses.


Asunto(s)
Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Microesferas , Tiras Reactivas/normas , Infecciones del Sistema Respiratorio/virología , Color , Fluorescencia , Humanos , Gripe Humana/diagnóstico , Gripe Humana/virología
10.
Int J Infect Dis ; 87: 67-74, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31357058

RESUMEN

BACKGROUND: We describe the relative proportions and epidemiological features of influenza B/Victoria and B/Yamagata, using data from nationwide surveillance systems. METHODS: We collected respiratory samples from outpatients with influenza-like illness (ILI) and intensive care unit (ICU)-admitted patients with complications (pulmonary or neurological complications, myocarditis/pericarditis or invasive bacterial infection) for virus isolation and lineage typing. Demographics, epidemiological features, and vaccination history from ICU-admitted patients with complications were analyzed. RESULTS: From July 2013-June 2017, 21% of 11517 influenza isolates were influenza B. B/Victoria was the predominant circulating strain in 2013-2014, accounted for 56% of all influenza B positive samples and B/Yamagata was predominant in 2014-2017 (82%, 69%, and 85%, respectively). Among all typed viruses, the proportion of B/Yamagata was higher among specimens from ICU-admitted patients with complications (77%, 154/199) than from ILI outpatients (66%, 276/418, p<0.005). Compared to B/Victoria, B/Yamagata infected ICU-admitted patients with complications were older, median age (71 vs. 59 years, p<0.05), had longer durations of hospitalization (15 vs. 7.5 days, p<0.05) and ICU stays (8.5 vs. 5.5 days, p<0.05). CONCLUSIONS: Two lineages of influenza B viruses co-circulate annually in Taiwan. Among ICU-admitted patients with complications, B/Yamagata causes more severe illness than B/Victoria.


Asunto(s)
Virus de la Influenza B/aislamiento & purificación , Gripe Humana/virología , Adolescente , Adulto , Anciano , Niño , Preescolar , Cuidados Críticos , Femenino , Hospitalización , Humanos , Lactante , Virus de la Influenza B/clasificación , Virus de la Influenza B/genética , Gripe Humana/complicaciones , Gripe Humana/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Taiwán/epidemiología , Factores de Tiempo , Adulto Joven
11.
BMC Infect Dis ; 19(1): 668, 2019 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-31357951

RESUMEN

BACKGROUND: A severe seasonal influenza epidemic was observed during 2017-2018 in China, prompting questions on clinical characteristics and outcomes of severe cases with influenza. METHODS: We retrospectively collected clinical data and outcomes of laboratory-confirmed hospitalized patients (severe to critical) during Jan-2011 to Feb-2018 from five hospitals, followed by a systematic analysis of cases from 2017 to 2018 (n = 289) and all previous epidemics during 2011-2017 (n = 169). RESULTS: In-hospital fatality was over 5-folds higher during the 2017-2018 (p < 0.01) in which 19 patients died (6.6%), whereas only 2 mortalities (1.2%) were observed during 2011-2017. Of the 289 hospitalized in 2017-2018, 153 were confirmed with influenza B virus, 110 with A/H1N1pdm09, and 26 A/H3N2, whereas A/H1N1pdm09 was the predominant cause of hospitalization in previous seasons combined (45%). Fatal cases in 2017-2018 were exclusively associated with either influenza B or A/H1N1pdm09. Our results show that a significant lower proportion of patients aged 14 or greater were treated with oseltamivir, during the 2017-2018 epidemic, and exhibited higher levels of clinical severity. CONCLUSIONS: In-hospital fatality rate might be significantly higher in the 2017-2018 season in China. A sufficient supply of oseltamivir and antiviral therapy within 48 h from onset could reduce fatality rates.


Asunto(s)
Antivirales/uso terapéutico , Epidemias , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Oseltamivir/uso terapéutico , Adolescente , Adulto , China/epidemiología , Femenino , Hospitalización , Humanos , Gripe Humana/mortalidad , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
12.
Infect Dis Health ; 24(3): 147-151, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31160245

RESUMEN

BACKGROUND: Influenza-like illness is often caused by respiratory viral infections, and is a frequent cause of presentation to hospital. Rapid diagnostics for respiratory viruses, with turnaround times of less than sixty minutes, are increasingly available. Early physician knowledge of positive respiratory virus tests has previously been shown to impact patient care in a paediatric population but hasn't been evaluated in adults. METHODS: Rapid testing for the respiratory viruses Influenza A, Influenza B and respiratory syncytial virus (RSV) was introduced in our institution in 2018. This reduced turnaround time for tests from more than 24 h, to 1-10 h depending on time of day. A retrospective cohort study was performed on patients presenting with influenza-like illness, in whom a nasopharyngeal swab for respiratory viruses was requested. Data was collected before and after the introduction of the rapid assay. Outcomes included antibiotic use (less or more than 24 h) and length of hospital stay (less or more than 24 h). RESULTS: In all patients who tested positive for a respiratory virus, there was an association between rapid testing and less antibiotic use. This was largely driven by paediatric cases; there was no change in prescribing for adult patients. There was no impact on timing of patient discharge. CONCLUSIONS: Rapid testing for respiratory viruses has a potentially useful role in antimicrobial stewardship. It is unclear why earlier knowledge of positive viral test didn't lead to less antibiotics in adults. This study showed no impact of rapid testing on time to patient discharge.


Asunto(s)
Antibacterianos/uso terapéutico , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Tiempo de Internación , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Infecciones del Sistema Respiratorio/diagnóstico , Adulto , Programas de Optimización del Uso de los Antimicrobianos , Niño , Estudios de Cohortes , Humanos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/virología , Estudios Retrospectivos , Centros de Atención Terciaria , Factores de Tiempo
13.
Wien Klin Wochenschr ; 131(15-16): 362-368, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31214922

RESUMEN

PURPOSE: The clinical presentation, complications and mortality in molecularly confirmed influenza A and B infections were analyzed. METHODS: This retrospective observational single-centre study included all influenza positive patients older than 18 years who were hospitalized and treated at the flu isolation ward during 2017/2018. The diagnosis was based on point-of-care tests with the AlereTM. RESULTS: Of the 396 patients tested positive for influenza, 24.2% had influenza A and 75.8% influenza B. Influenza A patients were younger (median age 67.5 years vs. 77 years, p < 0.001), were more often smokers (27.7% vs. 16.8%, p = 0.021), had chronic pulmonary diseases more frequently (39.6% vs. 26.3%, p = 0.013), presented with a higher body temperature (38.6 °C vs. 38.3 °C, p = 0.004), leucocyte count (8 G/L vs. 6.8 G/L, p = 0.002), C­reactive protein (CRP) level (41 mg/l vs. 23 mg/l, p < 0.001) and had dyspnea more often (41.7% vs. 28%, p = 0.012). Influenza B patients had an underlying chronic kidney disease in 37% vs. 18.8% (p < 0.001) and presented with vomiting on admission more frequently (21.7% vs. 11.5%, p = 0.027). Influenza A patients were admitted for 8 days vs. 7 days (p = 0.023). There were no differences in the rate of complications; however, 22 (5.6%) patients died during the hospital stay. The in-hospital mortality was higher in influenza A patients (8.3% vs 4.7%, p = 0.172). CONCLUSION: Some differences were found between influenza A and B virus infections but symptoms were overlapping, which necessitates polymerase chain reaction point-of-care testing for accurate diagnosis. Influenza A was a more severe disease than influenza B during the period 2017/2018.


Asunto(s)
Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana , Pruebas en el Punto de Atención , Reacción en Cadena de la Polimerasa/métodos , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Gripe Humana/diagnóstico , Masculino , Estudios Retrospectivos , Factores de Riesgo
14.
MMWR Morb Mortal Wkly Rep ; 68(24): 544-551, 2019 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-31220057

RESUMEN

Influenza activity* in the United States during the 2018-19 season (September 30, 2018-May 18, 2019) was of moderate severity (1). Nationally, influenza-like illness (ILI)† activity began increasing in November, peaked during mid-February, and returned to below baseline in mid-April; the season lasted 21 weeks,§ making it the longest season in 10 years. Illness attributed to influenza A viruses predominated, with very little influenza B activity. Two waves of influenza A were notable during this extended season: influenza A(H1N1)pdm09 viruses from October 2018 to mid-February 2019 and influenza A(H3N2) viruses from February through May 2019. Compared with the 2017-18 influenza season, rates of hospitalization this season were lower for adults, but were similar for children. Although influenza activity is currently below surveillance baselines, testing for seasonal influenza viruses and monitoring for novel influenza A virus infections should continue year-round. Receiving a seasonal influenza vaccine each year remains the best way to protect against seasonal influenza and its potentially severe consequences.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Vigilancia de la Población , Adolescente , Adulto , Anciano , Antivirales/farmacología , Niño , Mortalidad del Niño , Preescolar , Costo de Enfermedad , Farmacorresistencia Viral , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Subtipo H1N1 del Virus de la Influenza A/efectos de los fármacos , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H3N2 del Virus de la Influenza A/efectos de los fármacos , Subtipo H3N2 del Virus de la Influenza A/genética , Virus de la Influenza B/efectos de los fármacos , Virus de la Influenza B/genética , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/química , Gripe Humana/mortalidad , Gripe Humana/prevención & control , Gripe Humana/virología , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Neumonía/mortalidad , Estaciones del Año , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , Adulto Joven
15.
Artículo en Inglés | MEDLINE | ID: mdl-31203585

RESUMEN

As part of its role in the World Health Organization's (WHO) Global Influenza Surveillance and Response System (GISRS), the WHO Collaborating Centre for Reference and Research on Influenza in Melbourne received a record total of 5866 human influenza positive samples during 2017. Viruses were analysed for their antigenic, genetic and antiviral susceptibility properties and were propagated in qualified cells and hens' eggs for use as potential seasonal influenza vaccine virus candidates. In 2017, influenza A(H3) viruses predominated over influenza A(H1)pdm09 and B viruses, accounting for a total of 54% of all viruses analysed. The majority of A(H1)pdm09, A(H3) and influenza B viruses analysed at the Centre were found to be antigenically similar to the respective WHO recommended vaccine strains for the Southern Hemisphere in 2017. However, phylogenetic analysis indicated that the majority of circulating A(H3) viruses had undergone genetic drift relative to the WHO recommended vaccine strain for 2017. Of 3733 samples tested for susceptibility to the neuraminidase inhibitors oseltamivir and zanamivir, only two A(H1)pdm09 viruses and one A(H3) virus showed highly reduced inhibition by oseltamivir, while just one A(H1)pdm09 virus showed highly reduced inhibition by zanamivir.


Asunto(s)
Antígenos Virales/inmunología , Antivirales/farmacología , Virus de la Influenza A/inmunología , Virus de la Influenza B/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/virología , Animales , Australia/epidemiología , Pollos , Perros , Farmacorresistencia Viral , Huevos , Femenino , Humanos , Virus de la Influenza A/efectos de los fármacos , Virus de la Influenza A/genética , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/efectos de los fármacos , Virus de la Influenza B/genética , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/tratamiento farmacológico , Gripe Humana/prevención & control , Células de Riñón Canino Madin Darby , Neuraminidasa/antagonistas & inhibidores , Oseltamivir/farmacología , Filogenia , Organización Mundial de la Salud , Zanamivir/farmacología
16.
J Coll Physicians Surg Pak ; 29(5): 459-462, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31036119

RESUMEN

OBJECTIVE: To determine the frequency of infections caused by Influenza viruses, i.e. Influenza A (H1N1) pdm09, Influenza A (H3N2) and Influenza B in patients presenting with respiratory tract infections, i.e. influenza-like illness (ILI) and severe acute respiratory illness (SARI). STUDY DESIGN: Descriptive, cross-sectional study. PLACE AND DURATION OF STUDY: Department of Virology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from October 2017 to February 2018. METHODOLOGY: A total of 624 samples from patients with respiratory tract infections (both ILI and SARI) were included in the study. Specimens collected from the patients included nasal swabs and throat swabs, which were transported in viral transport medium (VTM) to Virology Department, AFIP. Multiplex PCR was done for Influenza A (H1N1) pdm09, Influenza A (H3N2) and Influenza B. RESULTS: A total of 200 (32%) samples were found to be positive for Influenza viruses. Out of total 624 samples analysed, 220 (35.3%) were from females and 404 (64.7%) from males. Among these, 510 (81.7%) presented with ILI and 114 (18.3%) with SARI. Among positive samples, 120 (19.2%) samples were positive for H1N1, 61 (9.8%) for H3N2 and 19 (3%) were positive for Influenza B. Highest number of positive cases occurred in the month of January, i.e. 148 (74%) cases. Only 3 (2.5%) patients out of 120 infected with H1N1 were in age group-I (0-5 years). While in age group-II (6-30 years), age group-III (31-60 years), and age group-IV (>60 years); 39 (32.5%), 63 (52.5%) and 15 (12.5%) patients were infected by H1N1, respectively. Maximum patients with H3N2 infection were in age group-III; 30 (49.2%) of the total 61. Commonest Influenza subtype in age group-IV was H3N2 found in 20 (32.8%) patients, followed by H1N1 in 15 (12.5%) patients. CONCLUSION: The dominant subtype in our set-up, during winter of 2017-2018, was Influenza A (H1N1) pdm09. Highest numbers of positive cases were recorded in the month of January. People with ILI and SARI should be tested for Influenza viruses to avoid unnecessary use of antibiotics.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H3N2 del Virus de la Influenza A/genética , Virus de la Influenza B/genética , Gripe Humana/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Infecciones del Sistema Respiratorio/diagnóstico , Síndrome Respiratorio Agudo Grave/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Subtipo H3N2 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Estaciones del Año , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/virología , Adulto Joven
17.
Anal Bioanal Chem ; 411(16): 3591-3602, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31079175

RESUMEN

We present a detailed study on visual detection of influenza viruses by duplex recombinase polymerase amplification (RPA) with lateral flow dipsticks (LFDs). The LFD consisted of two test lines and a control line, on which anti-fluorescein isothiocyanate antibodies, anti-digoxigenin antibodies, and biotinylated bovine serum albumin were immobilized, respectively. The performance of the LFD was evaluated with dual-labeled DNA amplicons. The results indicate that the detection of DNA amplicons by LFDs is specific and sensitive, with detection limits of 5.80 fmol for fluorescein isothiocyanate-labeled amplicons and 8.39 fmol for digoxigenin-labeled amplicons. We next developed a duplex RPA-LFD assay for simultaneous detection of influenza A virus and influenza B virus, and then optimized the parameters, including the reaction temperature, reaction time, and concentrations of primers and probes. Assessment of the specificity and sensitivity indicated that this assay is sensitive and specific for simultaneous detection of influenza viruses, with detection limits of 50 copies per reaction for influenza B virus and 500 copies per reaction for influenza A virus, without cross-reactivity with other pathogens. Compared with real-time PCR as a reference method to detect influenza viruses in clinical samples, the clinical sensitivity of the duplex RPA-LFD assay was 78.57% for influenza A virus and 87.50% for influenza B virus, with 100% specificity. In conclusion, the duplex RPA-LFD assay is a rapid, cost-effective, and sensitive method for the identification of influenza viruses.


Asunto(s)
Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Técnicas de Amplificación de Ácido Nucleico/métodos , Recombinasas/química , Electroforesis en Gel de Agar , Humanos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Sensibilidad y Especificidad
18.
Artículo en Inglés | MEDLINE | ID: mdl-31005703

RESUMEN

Options for hydrophobic-interaction chromatography (HIC) for purification of cell culture-derived influenza A and B virus have been assessed using a 96-well plate format using a semi-high-throughput approach. Follow-up experiments at preparative scale were used to characterize dynamic binding capacity, viral hemagglutinin protein (HA protein) recovery, and the influence of influenza virus (IV) strains on yield and contamination levels. Virus recoveries of up to 96% with a residual DNA level of about 1.3% were achieved. To achieve DNA contamination levels required for manufacturing of influenza vaccines for human use, a purification train comprising clarification, inactivation, concentration, column-based anion-exchange chromatography (AEC), and HIC was used in a final set-up. AEC using strong quaternary ammonium ligands was applied as an orthogonal method for DNA depletion by adsorption. Subsequently, HIC (with polypropylene glycol as functional group) was used to reversibly bind virus particles for capture and to remove residual contaminating DNA and proteins (flow-through). This two-step chromatographic process, which requires neither a buffer exchange step nor nuclease treatment had a total virus particle yield for IV A/PR/8/34 (H1N1) of 92%. The protein and the DNA contamination level could be reduced to 42% and at least 1.0%, respectively. With 17.2 µg total protein and 2.0 ng DNA per monovalent dose, this purity level complies with the limits of the European Pharmacopeia for cell culture-derived human vaccines. Overall, the presented downstream process represents a valuable alternative to existing virus purification schemes. Furthermore, it utilizes only off-the-shelf materials and is a simple as well as an economic process for production of cell culture-derived viruses and viral vectors.


Asunto(s)
Cromatografía Liquida/métodos , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Hemaglutininas Virales/análisis , Hemaglutininas Virales/aislamiento & purificación , Ensayos Analíticos de Alto Rendimiento/métodos , Interacciones Hidrofóbicas e Hidrofílicas , Vacunas contra la Influenza , Cloruro de Sodio/química , Cultivo de Virus
19.
Diagn Microbiol Infect Dis ; 94(4): 342-343, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30971360

RESUMEN

The Alere-i™ Influenza A&B (Abbott), a nicking endonuclease amplification reaction test, has recently been improved in order to deliver results in a few minutes. Our field observation highlights two problems with this new version: improper interpretation of a test as valid despite improper reagent hydration and falsely influenza B positive results. We advise users of the new system to check reagent hydration prior to reporting a result and to systematically confirm positive influenza B results.


Asunto(s)
Virus de la Influenza B/aislamiento & purificación , Gripe Humana/diagnóstico , Técnicas de Diagnóstico Molecular/normas , Juego de Reactivos para Diagnóstico/normas , Adulto , Reacciones Falso Positivas , Francia , Humanos , Virus de la Influenza B/genética , Masculino , Técnicas de Amplificación de Ácido Nucleico/normas , Sistemas de Atención de Punto/normas , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
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