RESUMO
BACKGROUND: The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. METHODS: We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded. RESULTS: We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78-.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS. CONCLUSIONS: When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.
Assuntos
Antivirais/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/tratamento farmacológico , Influenza Humana/epidemiologia , Tempo de Internação , Neuraminidase/antagonistas & inibidores , Pandemias , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Inibidores Enzimáticos/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Influenza disease burden varies by age and this has important public health implications. We compared the proportional distribution of different influenza virus types within age strata using surveillance data from twenty-nine countries during 1999-2014 (N=358,796 influenza cases). METHODS: For each virus, we calculated a Relative Illness Ratio (defined as the ratio of the percentage of cases in an age group to the percentage of the country population in the same age group) for young children (0-4 years), older children (5-17 years), young adults (18-39 years), older adults (40-64 years), and the elderly (65+ years). We used random-effects meta-analysis models to obtain summary relative illness ratios (sRIRs), and conducted meta-regression and sub-group analyses to explore causes of between-estimates heterogeneity. RESULTS: The influenza virus with highest sRIR was A(H1N1) for young children, B for older children, A(H1N1)pdm2009 for adults, and (A(H3N2) for the elderly. As expected, considering the diverse nature of the national surveillance datasets included in our analysis, between-estimates heterogeneity was high (I2>90%) for most sRIRs. The variations of countries' geographic, demographic and economic characteristics and the proportion of outpatients among reported influenza cases explained only part of the heterogeneity, suggesting that multiple factors were at play. CONCLUSIONS: These results highlight the importance of presenting burden of disease estimates by age group and virus (sub)type.
Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Influenza Humana/virologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Influenza Humana/diagnóstico , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
It is important to characterize the clinical and epidemiological pattern of the influenza A (H1N1) pdm09 virus and compare it with influenza A (H3N2) virus, as surveyed in just a few studies, in order to contribute to the implementation and strengthening of influenza control and prevention strategies. The aims in this study were to describe influenza clinical and epidemiological characteristics in hospitalized patients, caused by influenza A (H1N1)pdm09 and influenza A (H3N2) viruses during 2013, in Santa Fe, Argentina. A retrospective study was conducted over 2013 among hospitalized patients with laboratory-confirmed influenza diagnosis. In contrast to patients with influenza A (H3N2) (20.5%), a higher proportion of hospitalizations associated with influenza H1N1pdm were reported among adults aged 35-65 years (42.8%). Of all patients, 73.6% had an underlying medical condition. Hospitalized patients with H1N1pdm were subject to 2.6 (95%CI, 1.0-6.8) times higher risk of severity, than those hospitalized with influenza A (H3N2). This results demonstrate the impact in the post-pandemic era of H1N1pdm virus, with increased risk of severe disease, in relation to H3N2 virus, both viruses co-circulating during 2013.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Vírus da Influenza A Subtipo H3N2 , Influenza Humana/epidemiologia , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Vírus da Influenza A Subtipo H3N2/genética , Vírus da Influenza A Subtipo H3N2/imunologia , Vírus da Influenza A Subtipo H3N2/isolamento & purificação , Influenza Humana/diagnóstico , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
Human rhinoviruses (HRVs) were historically considered upper airway pathogens. However, they have recently been proven to cause infections in the lower respiratory tract, resulting in hospitalization of children with pneumonia, bronchiolitis, and chronic pulmonary obstruction. In this report, HRV frequency and seasonality are described together with patient clinical-epidemiological aspects. From a total of 452 surveyed samples, the HRV nucleic acids was detected in 172 (38.1%) and found in every month of the study year. 60% of inpatients with acute respiratory infection (ARI) associated with HRV were under 6 months of age and 31% had a clinical history, being preterm birth and recurrent wheezing the prevailing conditions. The most frequent discharge diagnoses were pneumonia (35.2%), bronchiolitis (32.4%), and bronchitis (12.4%). Fifteen point nine percent of patients required admission into intensive care units. The results obtained in this study demonstrated the association between HRV and children hospitalizations caused by ARI.
Assuntos
Hospitalização , Infecções por Picornaviridae/epidemiologia , Infecções Respiratórias/epidemiologia , Rhinovirus/isolamento & purificação , Adolescente , Fatores Etários , Argentina/epidemiologia , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Infecções por Picornaviridae/patologia , Infecções por Picornaviridae/virologia , Prevalência , Infecções Respiratórias/patologia , Infecções Respiratórias/virologia , Estudos Retrospectivos , Fatores de Risco , Estações do AnoRESUMO
BACKGROUND: Influenza viruses have a relevant public health impact. OBJECTIVE: To describe the activity of influenza and assess the morbidity and mortality impact during 2005 to 2010 in Santa Fe, Argentina. METHODS: Epidemiological and virological indicators were calculated based on sentinel surveillance. Mortality data from patients over and under the age of 65 were analyzed using the integrated autoregressive moving average model and an excess of mortality attributable to influenza was determined. RESULTS: The viral circulation effect on morbidity was measured through the evolution in the proportion of influenza-like illness (ILI) patients. Peak incidence was observed between weeks 23 and 33. An excess of deaths was identified in 2007 among patients over 65 and among those under 65 in 2009, which was related with influenza A(H3N2) and A(H1N1)pandemic virus circulation respectively, associated with a higher proportion of virus recovery and a higher ILI percentage. CONCLUSIONS: The sentinel surveillance of influenza is a simple and efficient methodology that identifies influenza trends. Our study showed that the virus has caused a rise of mortality in patients > 65 in epidemic periods associated with the H3N2 subtype and in patients < 65 in the pandemic period with the circulation ofA(HIN1)pandemic virus.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Vírus da Influenza A Subtipo H3N2 , Influenza Humana/mortalidade , Vigilância de Evento Sentinela , Idoso , Argentina/epidemiologia , Humanos , Incidência , Influenza Humana/virologia , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION: Pertussis, a vaccine-preventable respiratory disease, remains a public health problem. OBJECTIVE: The goal of this study is to describe epidemiological and clinical patterns of B. pertussis-caused respiratory infection over the period 2006-2010 in Santa Fe, Argentina. METHODS: Inpatients and outpatients < 14 years of age, meeting pertussis case definition criteria were included. Household family contacts of confirmed cases with compatible symptoms were also surveyed. RESULTS: 1074 patients were evaluated, 102 (9.49%) were confirmed through PCR. The proportion of confirmed cases was: in 2006, 35.5%; 2007, 21.2%; 2008, 4.9%. In 2009 and 2010 no cases were detected. 94.2% of hospitalized patients and 42.8% of outpatients were less than six months of age. Of all patients, 67.6% required hospitalization as they had a moderate to severe illness. The length of stay for these patients was over six days. 27.5% had pre-existing medical conditions, the most frequent being prematurity and malnutrition. The outcome was severe in 23.1% of cases, all of whom hadn't started the vaccination schedule. Severe pulmonary hypertension was present in five patients. Fatality rate was 4.9%. CONCLUSIONS: Pertussis mainly affected children < 6 months, non-vaccinated or with less than 3 doses. The bacterium was also detected among adults and teenagers.
Assuntos
Coqueluche/epidemiologia , Adolescente , Adulto , Argentina/epidemiologia , Criança , Pré-Escolar , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Humanos , Lactente , Fatores de Risco , Estações do Ano , Índice de Gravidade de Doença , Coqueluche/diagnóstico , Adulto JovemRESUMO
BACKGROUND: Parotitis is an acute viral disease characterized by swelling and pain in one or both salivary glands, submaxillary or submental, fever, headache, muscle ache and/or fatigue. AIM: To investigate the occurrence of influenza virus infection in parotitis cases in a population of Santa Fe during 2017 and analyze clinical and epidemiological characteristics of the cases. METHODS: We studied patients with diagnosis of mumps without age restriction, who came for examination from week 26 to the network of clinicians forming the Sentinel Influenza Unit in Santa Fe. RESULTS: Between epidemiological weeks 26 and 44, 22 clinical parotitis cases we enrolled. The influenza virus was detected in 68.2%, influenza A (H3N2) 93%, and influenza B, 7%. The clinical signs of cases were mild, with an average swelling development of 5 days and no complications. 74% presented with influenza-like illness in tandem with parotitis. CONCLUSIONS: This study provides evidence that a proportion of children presenting with parotitis had influenza A(H3N2) virus infection. It is necessary to implement systematic surveillance of parotitis associated with influenza and differential diagnosis even in the absence of respiratory symptoms.
Assuntos
Influenza Humana/virologia , Parotidite/epidemiologia , Parotidite/virologia , Adolescente , Adulto , Argentina/epidemiologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Estações do Ano , Adulto JovemRESUMO
We describe the epidemiological characteristics, pattern of circulation, and geographical distribution of influenza B viruses and its lineages using data from the Global Influenza B Study. We included over 1.8 million influenza cases occurred in thirty-one countries during 2000-2018. We calculated the proportion of cases caused by influenza B and its lineages; determined the timing of influenza A and B epidemics; compared the age distribution of B/Victoria and B/Yamagata cases; and evaluated the frequency of lineage-level mismatch for the trivalent vaccine. The median proportion of influenza cases caused by influenza B virus was 23.4%, with a tendency (borderline statistical significance, p = 0.060) to be higher in tropical vs. temperate countries. Influenza B was the dominant virus type in about one every seven seasons. In temperate countries, influenza B epidemics occurred on average three weeks later than influenza A epidemics; no consistent pattern emerged in the tropics. The two B lineages caused a comparable proportion of influenza B cases globally, however the B/Yamagata was more frequent in temperate countries, and the B/Victoria in the tropics (p = 0.048). B/Yamagata patients were significantly older than B/Victoria patients in almost all countries. A lineage-level vaccine mismatch was observed in over 40% of seasons in temperate countries and in 30% of seasons in the tropics. The type B virus caused a substantial proportion of influenza infections globally in the 21st century, and its two virus lineages differed in terms of age and geographical distribution of patients. These findings will help inform health policy decisions aiming to reduce disease burden associated with seasonal influenza.
Assuntos
Vírus da Influenza B/patogenicidade , Influenza Humana/epidemiologia , Epidemias/história , Epidemias/estatística & dados numéricos , Monitoramento Epidemiológico , Feminino , História do Século XXI , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A/imunologia , Vírus da Influenza B/imunologia , Vírus da Influenza B/metabolismo , Vacinas contra Influenza/imunologia , Influenza Humana/história , Masculino , Vigilância da População/métodos , Estações do AnoRESUMO
En el contexto de la pandemia de COVID-19, a partir de 2020, la Unidad Centinela de Enfermedades Tipo Influenza (UC-ETI) (Santa Fe, Argentina) integró la vigilancia clínica y por laboratorio de SARS-CoV-2 y rinovirus (HRV) a la habitual vigilancia de influenza y otros virus respiratorios (OVR). El objetivo de este estudio transversal y retrospectivo fue describir las características clínico-epidemiológicas de casos de ETI de la ciudad de Santa Fe, con diagnóstico de HRV confirmado durante 2020-2021, en el marco de la UC-ETI. Del total de 600 casos de ETI cuyas muestras fueron analizadas, más del 50,0% fueron mujeres; y la mayor proporción se concentró en el grupo de 15 a 39 años (40,2%). El 33,7% registró al menos una comorbilidad o factor de riesgo, siendo la hipertensión arterial, asma, diabetes, obesidad y EPOC las más frecuentes. Además de fiebre y tos, los signos/síntomas predominantes fueron odinofagia, mialgia y cefalea. El porcentaje de positividad fue de 41,3% en 2020, 27,8% en 2021 y 35,5% en 2020-2021. De las muestras positivas del bienio (213), 59,0% fue SARS-CoV-2, 40,0% HRV y 1,0% OVR. La mayor proporción de diagnósticos positivos de SARS-CoV-2 se concentró en pacientes de 15 años y más, y la de HRV en menores de 15. Los periodos en los que predominó la circulación de HRV no lo hizo la de SARS-CoV-2, y viceversa. El aporte a la carga real de las infecciones virales respiratorias y su impacto en la salud pública destaca la importancia de sostener la vigilancia de HRV
In the context of the COVID-19 pandemic, in 2020, the influenza-like illness Sentinel Unit (ILI-SU) (Santa Fe, Argentina), integrated clinical and laboratory surveillance of SARS-CoV-2 and Rhinovirus (HRV) to the usual surveillance of Influenza and other respiratory viruses (ORV). The objective of this cross-sectional and retrospective study was to describe the clinical-epidemiological characteristics of ILI cases of Santa Fe city, who had a confirmed HRV diagnosis during 2020-2021, by the ILI-SU. Of a total of 600 ILI cases whose samples were analyzed, more than 50.0% were women; and the highest proportion was concentrated in the group between 15 and 39 years of age (40.2%). 33.7% of the cases registered at least one comorbidity or risk factor, among which arterial hypertension, asthma, diabetes, obesity and COPD were the most frequent. In addition to fever and cough, the predominant signs/symptoms were sore throat, myalgia and headache. The percentage of positivity was 41.3% in 2020, 27.8% in 2021, and 35.5% in 2020-2021. Of the biennium positive samples (213), 59.0% were SARS-CoV-2, 40.0% HRV, and 1.0% ORV. The highest proportion of SARS-CoV-2 positive diagnoses were concentrated in patients 15 years of age and older, while the highest proportion of HRV positive diagnoses were concentrated in patients under 15 years of age. The periods in which the circulation of HRV predominated did not predominated SARS-CoV-2, and vice versa. The contribution to the real burden of respiratory viral infections and its impact on public health, highlight the importance of sustaining HRV surveillance
Assuntos
Humanos , Masculino , Feminino , Rhinovirus/imunologia , Síndrome Respiratória Aguda Grave/epidemiologia , COVID-19/epidemiologiaRESUMO
Introducción: La bronquiolitis constituye una de las principales causas de Infecciones Respiratorias Agudas Bajas en Pediatría, y es responsable de una proporción significativa de hospitalizaciones en lactantes, fundamentalmente, en menores de 1 año. Su diagnóstico es clínico, caracterizado por síntomas y signos de amplio grado de gravedad. Objetivo: Describir las características clínico-etiológicas de casos de bronquiolitis en menores de 1 año, internados en un hospital de niños de la ciudad de Santa Fe, durante un periodo de un año. Materiales y Métodos: Estudio observacional, transversal. Se analizaron datos demográficos, clínicos y de laboratorio de fichas médicas de vigilancia epidemiológica. Las técnicas diagnósticas usadas según el agente viral fueron RT-PCR en tiempo real, PCR-punto final e Inmunofluorescencia Indirecta. Resultados: Sobre un total de 108 casos, 90,7% tuvo de 1 a 6 meses de edad. La mediana de internación fue de 5 días, y el nacimiento prematuro fue la condición médica previa más frecuente. Un 78,7% (85) tuvo diagnóstico viral positivo, siendo Rinovirus (hRV) y Virus Sincicial Respiratorio (VSR) los agentes más prevalentes, tanto en infección única como en coinfección. El tiempo de oxigenoterapia fue mayor en los pacientes más graves (p<0,001). El 32,4% (35) recibió alguna medicación que fue, en mayor frecuencia, antibiótico. Se encontró asociación positiva y significativa entre la edad menor de 3 meses y una hospitalización mayor a 5 días (OR=2,5; IC: 1,1-5,8; p=0,02); y entre un diagnóstico VSR positivo y un cuadro grave (OR: 7,7; IC: 1,95-39,6; p<0,001). Conclusión: Las características y condiciones médicas consideradas por la literatura como factores de riesgo para el padecimiento y la gravedad de una IRAB, fueron halladas con mayor frecuencia en la población de estudio. El hRV y el VRS fueron los agentes de mayor rescate viral, encontrándose una asociación positiva entre la infección por VSR y la gravedad del cuadro.
Introduction: Bronchiolitis is one of the main causes of Acute Lower Respiratory Infections in pediatrics, and is responsible for a significant proportion of hospitalizations in infants, mainly in children under 1 year of age. Its diagnosis is clinical. The disease is characterized by a wide variety and degree of signs and symptoms. Objective: To describe the clinical-etiological characteristics of cases of bronchiolitis in children under 1 year of age, admitted to a children's hospital in the city of Santa Fe, over a period of one year. Materials and Methods: This was an observational and cross-sectional study. Demographic, clinical and laboratory data from epidemiological surveillance medical records were analyzed. The diagnostic techniques used, based on the viral agent, were real-time RT-PCR, end-point PCR and Indirect Immunofluorescence. Results: Out of a total of 108 cases, 90.7% were between 1 and 6 months old. The median hospital stay was 5 days, and premature birth was the most common prior medical condition. 78.7% (85) had a positive viral diagnosis, with Rhinovirus (hRV) and Respiratory Syncytial Virus (RSV) being the most prevalent agents, both in single infection and coinfection. Oxygen therapy time was longer in the most seriously ill patients (p<0.001). 32.4% (35) received some medication, which was, most frequently, antibiotics. A positive and significant association was found between age less than 3 months and hospitalization longer than 5 days (OR=2.5; CI: 1.1-5.8; p=0.02); and between a positive RSV diagnosis and a severe condition (OR: 7.7; CI: 1.95-39.6; p<0.001). Conclusions: The characteristics and medical conditions considered by the literature as risk factors for the morbidity and severity of a lower respiratory tract infection were found more frequently in the study population. hRV and RSV were the most commonly-detected viral agents. We found a positive association between RSV infection and the severity of the condition.
RESUMO
INTRODUCTION: The increased availability of influenza surveillance data in recent years justifies an actual and more complete overview of influenza epidemiology in Latin America. We compared the influenza surveillance systems and assessed the epidemiology of influenza A and B, including the spatio-temporal patterns of influenza epidemics, in ten countries and sub-national regions in Latin America. METHODS: We aggregated the data by year and country and characteristics of eighty-two years were analysed. We calculated the median proportion of laboratory-confirmed influenza cases caused by each virus strain, and compared the timing and amplitude of the primary and secondary peaks between countries. RESULTS: 37,087 influenza cases were reported during 2004-2012. Influenza A and B accounted for a median of 79% and, respectively, 21% of cases in a year. The percentage of influenza A cases that were subtyped was 82.5%; for influenza B, 15.6% of cases were characterized. Influenza A and B were dominant in seventy-five (91%) and seven (9%) years, respectively. In half (51%) of the influenza A years, influenza A(H3N2) was dominant, followed by influenza A(H1N1)pdm2009 (41%) and pre-pandemic A(H1N1) (8%). The primary peak of influenza activity was in June-September in temperate climate countries, with little or no secondary peak. Tropical climate countries had smaller primary peaks taking place in different months and frequently detectable secondary peaks. CONCLUSIONS: We found that good influenza surveillance data exists in Latin America, although improvements can still be made (e.g. a better characterization of influenza B specimens); that influenza B plays a considerable role in the seasonal influenza burden; and that there is substantial heterogeneity of spatio-temporal patterns of influenza epidemics. To improve the effectiveness of influenza control measures in Latin America, tropical climate countries may need to develop innovative prevention strategies specifically tailored to the spatio-temporal patterns of influenza in this region.
Assuntos
Vírus da Influenza A , Vírus da Influenza B , Influenza Humana/epidemiologia , Humanos , Influenza Humana/virologia , América Latina , Vigilância da População , Estações do Ano , Clima TropicalRESUMO
BACKGROUND: A large proportion of acute respiratory tract infections (ARTI) remain without etiologic diagnosis, reason why new pathogens are investigated continuously. Human bocavirus (HBoV) was discovered in 2005, as a new member of Parvoviridae family and proposed to cause ARTI. AIM: To know the prevalence of HBoV among pediatric populations hospitalized for ARTI in two provinces of Argentina: Santa Fe and Tucuman; and to describe epidemiological and clinical aspects associated to its detection. MATERIALS AND METHODS: We studied nasopharyn-geal aspirates of patients younger than 5 years old that were hospitalized during 2013 due ARTI. HBoV DNA was assayed using PCR described by Allander et al. Traditional virnses were studied by immunofluorescence. Personal, clinical and epidemiological data were collected in a standardized form. RESULTS: The HBoV was detected in 7% of the samples and was prevalent in spring and summer and in children younger of 2 years old. Other respiratory viruses were detected in 22% of HBoV positive samples. DISCUSSION: We detected HBoV in these two provinces of Argentina. Further studies should be performed to determine if it's a recent infection or prolonged viral shedding.
Assuntos
Bocavirus Humano/isolamento & purificação , Infecções por Parvoviridae/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Distribuição por Idade , Fatores Etários , Argentina/epidemiologia , Pré-Escolar , Infecções Comunitárias Adquiridas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estações do Ano , Distribuição por Sexo , Fatores de TempoRESUMO
INTRODUCTION: Determining the optimal time to vaccinate is important for influenza vaccination programmes. Here, we assessed the temporal characteristics of influenza epidemics in the Northern and Southern hemispheres and in the tropics, and discuss their implications for vaccination programmes. METHODS: This was a retrospective analysis of surveillance data between 2000 and 2014 from the Global Influenza B Study database. The seasonal peak of influenza was defined as the week with the most reported cases (overall, A, and B) in the season. The duration of seasonal activity was assessed using the maximum proportion of influenza cases during three consecutive months and the minimum number of months with ≥80% of cases in the season. We also assessed whether co-circulation of A and B virus types affected the duration of influenza epidemics. RESULTS: 212 influenza seasons and 571,907 cases were included from 30 countries. In tropical countries, the seasonal influenza activity lasted longer and the peaks of influenza A and B coincided less frequently than in temperate countries. Temporal characteristics of influenza epidemics were heterogeneous in the tropics, with distinct seasonal epidemics observed only in some countries. Seasons with co-circulation of influenza A and B were longer than influenza A seasons, especially in the tropics. DISCUSSION: Our findings show that influenza seasonality is less well defined in the tropics than in temperate regions. This has important implications for vaccination programmes in these countries. High-quality influenza surveillance systems are needed in the tropics to enable decisions about when to vaccinate.
Assuntos
Vírus da Influenza A/imunologia , Vírus da Influenza B/imunologia , Influenza Humana/prevenção & controle , Vacinação , Humanos , Influenza Humana/epidemiologia , Estudos Retrospectivos , Estações do Ano , Clima TropicalRESUMO
BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta-analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) 'pandemic influenza'. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64-1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44-1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71-1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55-0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54-0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support.
Assuntos
Antivirais/uso terapêutico , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/tratamento farmacológico , Neuraminidase/antagonistas & inibidores , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/enzimologia , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Literature on influenza focuses on influenza A, despite influenza B having a large public health impact. The Global Influenza B Study aims to collect information on global epidemiology and burden of disease of influenza B since 2000. METHODS: Twenty-six countries in the Southern (n = 5) and Northern (n = 7) hemispheres and intertropical belt (n = 14) provided virological and epidemiological data. We calculated the proportion of influenza cases due to type B and Victoria and Yamagata lineages in each country and season; tested the correlation between proportion of influenza B and maximum weekly influenza-like illness (ILI) rate during the same season; determined the frequency of vaccine mismatches; and described the age distribution of cases by virus type. RESULTS: The database included 935 673 influenza cases (2000-2013). Overall median proportion of influenza B was 22·6%, with no statistically significant differences across seasons. During seasons where influenza B was dominant or co-circulated (>20% of total detections), Victoria and Yamagata lineages predominated during 64% and 36% of seasons, respectively, and a vaccine mismatch was observed in ≈25% of seasons. Proportion of influenza B was inversely correlated with maximum ILI rate in the same season in the Northern and (with borderline significance) Southern hemispheres. Patients infected with influenza B were usually younger (5-17 years) than patients infected with influenza A. CONCLUSION: Influenza B is a common disease with some epidemiological differences from influenza A. This should be considered when optimizing control/prevention strategies in different regions and reducing the global burden of disease due to influenza.
Assuntos
Saúde Global , Vírus da Influenza B , Influenza Humana/epidemiologia , Influenza Humana/virologia , Vigilância da População , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Surtos de Doenças/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Vírus da Influenza A , Vírus da Influenza B/genética , Vacinas contra Influenza , Masculino , Pessoa de Meia-Idade , Estações do Ano , Adulto JovemRESUMO
Resumen Introducción: La parotiditis es una enfermedad vírica aguda caracterizada por tumefacción y dolor en una o ambas glándulas salivales, submaxilar o submentoniana, fiebre, dolor de cabeza, dolor muscular y/o fatiga. Objetivos Investigar la ocurrencia de infección por el virus influenza en casos de parotiditis en una población de Santa Fe, durante 2017 y analizar las características clínicas y epidemiológicas de los casos. Materiales y Métodos: Se estudiaron pacientes con diagnóstico de parotiditis, que acudieron a la consulta desde la semana 26 en la red de médicos que forman la Unidad Centinela de Influenza en Santa Fe. Resultados: Entre las semanas epidemiológicas 26 y 44, se incluyeron 22 casos de parotiditis clínica. El virus influenza se detectó en 68,2%, influenza A (H3N2) 93% e influenza B 7%. Los síntomas clínicos de los casos fueron leves, con una tumefacción de cinco días y sin complicaciones. El 74% presentó una enfermedad tipo influenza en conjunto con la parotiditis. Conclusiones: Este estudio evidencia que niños que presentaban parotiditis tenían una infección por el virus de la influenza A (H3N2). Es necesario implementar una vigilancia sistemática de las parotiditis asociadas con influenza y el diagnóstico diferencial, incluso en ausencia de síntomas respiratorios.
Background: Parotitis is an acute viral disease characterized by swelling and pain in one or both salivary glands, submaxillary or submental, fever, headache, muscle ache and/or fatigue. Aim: To investigate the occurrence of influenza virus infection in parotitis cases in a population of Santa Fe during 2017 and analyze clinical and epidemiological characteristics of the cases. Methods: We studied patients with diagnosis of mumps without age restriction, who came for examination from week 26 to the network of clinicians forming the Sentinel Influenza Unit in Santa Fe. Results: Between epidemiological weeks 26 and 44, 22 clinical parotitis cases we enrolled. The influenza virus was detected in 68.2%, influenza A (H3N2) 93%, and influenza B, 7%. The clinical signs of cases were mild, with an average swelling development of 5 days and no complications. 74% presented with influenza-like illness in tandem with parotitis. Conclusions: This study provides evidence that a proportion of children presenting with parotitis had influenza A(H3N2) virus infection. It is necessary to implement systematic surveillance of parotitis associated with influenza and differential diagnosis even in the absence of respiratory symptoms.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Parotidite/epidemiologia , Parotidite/virologia , Influenza Humana/virologia , Argentina/epidemiologia , Estações do Ano , Diagnóstico DiferencialRESUMO
BACKGROUND: Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. METHODS: We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. FINDINGS: We included data for 29,234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70-0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41-0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37-0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio [HR 1·23] [95% CI 1·18-1·28]; p<0·0001 for the increasing HR with each day's delay). INTERPRETATION: We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection. FUNDING: F Hoffmann-La Roche.
Assuntos
Antivirais/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/tratamento farmacológico , Neuraminidase/antagonistas & inibidores , Oseltamivir/uso terapêutico , Pandemias , Zanamivir/uso terapêutico , Adolescente , Adulto , Criança , Feminino , Hospitalização , Humanos , Influenza Humana/mortalidade , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: During 2009 occurred the emergence and global spread of a novel influenza A (H1N1) virus. We describe the clinical and epidemiologic features of hospitalized patients who survived and patients who died because of pandemic 2009 influenza A (H1N1) infection reported in Santa Fe, Argentina, from May to July 2009. METHODS: Using medical charts, we collected data on 242 patients who were hospitalized with confirmed laboratory results (defined as positive by specific PCR for pandemic 2009 influenza A H1N1). RESULTS: During the study period, there were 242 cases of hospitalization or death. Of the 242, 46% were admitted to an intensive care unit (ICU) and 33·5% died. The mean age was 27·8 years for surviving and 39·6 for those who died. Twenty-eight percent of hospitalizations involved persons under the age of 15 years; 33% of the patients were between the age of 15 and 44 years; and only 3·3% were 65 years of age or older. Sixty-seven percent had an underlying medical conditions, including diabetes, obesity, heart and lung diseases, and pregnancy. Of the 242 patients, 68% had findings consistent with pneumonia. Treatment with oseltamivir was administered to 227 (93·8%) patients from which 38 received oseltamivir within 48 hours after the onset of symptoms. CONCLUSIONS: The pandemic strain caused severe illness, including pneumonia and acute respiratory distress syndrome, and resulted in ICU admissions in 46% of patients and death in 33·5%. The mean age of hospitalized infected cases was lower than is common with seasonal influenza. Underlying medical conditions were common in the 67% the evaluated patients. Patients who died had a higher prevalence of comorbidities (86·4%) than those who survived (57%), suggesting that the presence of chronic illness may increase the likelihood of death. However, the severe illness was also identified among young, healthy persons.
Assuntos
Hospitalização/estatística & dados numéricos , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/tratamento farmacológico , Influenza Humana/mortalidade , Influenza Humana/virologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: We estimated rates of influenza-associated deaths and hospitalizations in Argentina, a country that recommends annual influenza vaccination for persons at high risk of complications from influenza illness. METHODS: We identified hospitalized persons and deaths in persons diagnosed with pneumonia and influenza (P&I, ICD-10 codes J10-J18) and respiratory and circulatory illness (R&C, codes I00-I99 and J00-J99). We defined the influenza season as the months when the proportion of samples that tested positive for influenza exceeded the annual median. We used hospitalizations and deaths during the influenza off-season to estimate, using linear regression, the number of excess deaths that occurred during the influenza season. To explore whether excess mortality varied by sex and whether people were age <65 or ≥ 65 years, we used Poisson regression of the influenza-associated rates. RESULTS: During 2002-2009, 2411 P&I and 8527 R&C mean excess deaths occurred annually from May to October. If all of these excess deaths were associated with influenza, the influenza-associated mortality rate was 6/100,000 person-years (95% CI 4-8/100,000 person-years for P&I and 21/100,000 person-years (95% CI 12-31/100,000 person-years) for R&C. During 2005-2008, we identified an average of 7868 P&I excess hospitalizations and 22,994 R&C hospitalizations per year, resulting in an influenza-associated hospitalization rate of 2/10,000 person-years (95% CI 1-3/10,000 person-years) for P&I and 6/10,000 person-years (95% CI 3-8/10,000 person-years) for R&C. CONCLUSION: Our findings suggest that annual rates of influenza-associated hospitalizations and death in Argentina were substantial and similar to neighboring Brazil.
Assuntos
Hospitalização/estatística & dados numéricos , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Feminino , Humanos , Incidência , Influenza Humana/terapia , MasculinoRESUMO
INTRODUCTION: While there is much information about the burden of influenza A(H1N1)pdm09 in North America, little data exist on its burden in South America. METHODS: During April to December 2009, we actively searched for persons with severe acute respiratory infection and influenza-like illness (ILI) in three sentinel cities. A proportion of case-patients provided swabs for influenza testing. We estimated the number of case-patients that would have tested positive for influenza by multiplying the number of untested case-patients by the proportion who tested positive. We estimated rates by dividing the estimated number of case-patients by the census population after adjusting for the proportion of case-patients with missing illness onset information and ILI case-patients who visited physicians multiple times for one illness event. RESULTS: We estimated that the influenza A(H1N1)pdm09 mortality rate per 100,000 person-years (py) ranged from 1.5 among persons aged 5-44 years to 5.6 among persons aged ≥ 65 years. A(H1N1)pdm09 hospitalization rates per 100,000 py ranged between 26.9 among children aged <5 years to 41.8 among persons aged ≥ 65 years. Influenza A(H1N1)pdm09 ILI rates per 100 py ranged between 1.6 among children aged <5 to 17.1 among persons aged 45-64 years. While 9 (53%) of 17 influenza A(H1N1)pdm09 decedents with available data had obesity and 7 (17%) of 40 had diabetes, less than 4% of surviving influenza A(H1N1)pdm09 case-patients had these pre-existing conditions (p ≤ 0.001). CONCLUSION: Influenza A(H1N1)pdm09 caused a similar burden of disease in Argentina as in other countries. Such disease burden suggests the potential value of timely influenza vaccinations.